Practica Oto-Rhino-Laryngologica

Peripheral Facial Nerve Palsy

Comments on the Poor Outcome

Haruo Saito

1985 Volume 78 Issue 12 Pages 2715-2724
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2715

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Patients with peripheral facial palsy caused by Bell's palsy, Hunt's syndrome, trauma, tumor and otitis media were followed for a minimum of 6 months. Of the total group of 159 cases, complete recovery was achieved in 105 (66.0%) and incomplete recovery in 54 (34.0%). Patients with pathologic synkinesis and/or with incomplete return of function were judged to have had incomplete recovery. Of the 54 incompletely recovered patients, 46 (85.2%) had pathological synkinesis, indicating more severe nerve damage than the third degree of Sunderland. The severity of the palsy at the first visit was closely related to the outcome. Patients with Bell's palsy, which was complete at the initial examinations had a lower recovery rate than those with mild or slight palsy (p<0.005). Of the 24 surgically treated patients, 18 (75.0%) had poor results. Surgically treated patients had a lower rate of recovery than conservatively treated patients (p<0.005). The poor outcome was correetly prognosed in 89.2% of the patients with the results of tear tests, salivary flow tests, salivary pH tests, impedance audiometry tests and the NET. The results of the steroid treated incomplete recovery group were compared with those of the surgically treated incomplete recovery group. No statistically significant difference was noted between the two groups. It was possible that the decompression operations were done after irreversible pathological changes had occurred in the facial nerves. It is noteworthy that in 50% of patients with malignant tumors the severity of the palsy fluctuated.

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Conductive Deafness with Normal Ear Drum

Fibrous Change of Long Process of the Incus

[in Japanese]

1985 Volume 78 Issue 12 Pages 2726-2727
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2726

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Transitory, Counterolling and Pure-Rotatory Positioning Nystagmus Caused by Cerebellar Vermis Lesion

Eiji Sakata, Kyoko Ohtsu, Hiromichi Shimura, Shigeru Sakai, Kunio Taka ...

1985 Volume 78 Issue 12 Pages 2729-2736
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2729

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Positioning nystagmus with a latent period, accompanied by severe vertigo along with nystagmus, with subsequent fatiguability has been reported in patients with partial lesions of the inner ear, especially otolith lesions. We agree with this opinion and have constantly emphasized the significance of this phenomenon in clinical diagnosis.
Since we started to use CT-scanning this type of nystagmus has been noted in 20 patients, all of whom had cerebellar vermis lesions. Attention should be focused on this association. A simple coincidence could not be excluded if such a combination were seen in only 1 or 2 patients, but its occurrence in as many as 20 patients suggests a causal role of cerebellar vermis lesions. The explanation may be incomplete inhibition of the vestibulo-oculomotor system by the cerebellar flocculo-nodular lobe or vestibulocerebellum.

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Use of Micro-Sliced Homograft Cartilage Plates in Staged Tympanoplasty

Etsuo Yamamoto, Yasushi Naito, Yoshinobu Hirono

1985 Volume 78 Issue 12 Pages 2737-2744
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2737

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Our experiences in the use of micro-sliced homograft cartilage plates in staged tympanoplasty are described. In the first stage operation, a cartilage plate is used instead of a silicone plate as sheeting material. The cartilage plate is placed on the tympanic sulcus anteriorly and the eminence of the facial nerve canal posteriorly in order to secure an aerated tympanic cavity. The aerated tympanic space can be satisfactorily obtained in the second stage operation. The cartilage plate is also used in the second stage operation to prevent retraction of the tympanic membrane and hold the columella material.

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Traumatic Facial Paralysis

A Retrospective Study of 16 Cases

Taizo Takeda, Haruo Saito, Akira Kodama

1985 Volume 78 Issue 12 Pages 2745-2754
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2745

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Of 16 patients with traumatic facial paralysis and fresh longitudinal fracture, 13 recovered well without surgery, and three required total decompression of the facial nerve. In these three patients there were fragments of fractured bone and in one case there was discontinuity of the facial nerve. Even in cases of delayed facial paralysis, the facial nerve should be explored surgically if nerve degeneration is imminent.

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Hyperacusis in Bell's Palsy

Yasushi Matsumoto, Hiroshi Fujita, Kôshirô Nakamura, Naoak ...

1985 Volume 78 Issue 12 Pages 2755-2762
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2755

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It has been generally accepted that stapedial muscle dysfunction is the cause of hyperacusis in Bell's palsy. However, the acoustically evoked stapedial reflex (AR) revealed by the tympanometric test is not always negative in patients with hyperacusis. The AR was negative in 64.7% of our 278 patients with Bell's palsy of recent onset, while only 19.1% complained of hyperacusis. In order to explain this discrepancy, the auditory tests, Bekesy audiometry, ABLB, SISI test and ABR, were carried out in 13 selected patients. No evidence of retrocochlear disturbance was found.
Although the underlying pathophysiological mechanism of hyperacusis has remained uncertain, we could not exclude the possibility of a false negative AR measured by conventional tympanometry or the contribution of tensor tympani muscle function when hyperacusis and AR results are contradictory.

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Assay of DP-Specific IgG Antibody Using ELISA

Tadao Enomoto, Mitsuo Yoshiuchi, Daisuke Iwahashi, Hiroshi Nakanishi, ...

1985 Volume 78 Issue 12 Pages 2763-2770
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2763

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It is well known that allergen-specific IgE antibodies play an important role in nasal allergy, but the role of specific IgG antibodies is also important. Specific IgG antibody is determined by radioimmunoassay and various other methods. Different antisera are used in different institutions, and the results vary somewhat from one institution to another.
The DP (Dermatophagoides pteronyssinus)-specific IgG assay kit put on the market by Shionogi Co., Ltd. uses the ELISA (enzyme-linked immunosorbent assay) system, antigen recognizing specific antibody IgE and monoclonal anti-IgG antibody. This kit is a promising diagnostic agent which minimizes variations in data among institutions. We used it to test.
Patients with nasal allergy who showed positive skin reactions to house dust (HD). One hundred and twenty-one patients showed a variety of RAST scores, and 17 patients were being hyposensitized with HD.
The titer of specific IgG antibody to DP was higher in the younger patients (under the age of 19 years) and lower in patients aged 20 years or older and increased with increasing DP IgE RAST scores.
The significance of the titer of DP-specific IgG antibody is discussed.

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A Case of Abnormal Dental Eruption in the Nasal Cavity

Keiko Nishikawa, Masutoshi Nishikawa, Akiko Nishio, Kimio Ishiguro, Hi ...

1985 Volume 78 Issue 12 Pages 2771-2773
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2771

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A 16-year-old boy showed an abnormal dental eruption on the floor of the right nasal cavity. The abnormal tooth was removed by maxillotomy, as it was impossible to remove the tooth via the nostril. The pathological specimen showed normal tooth organization.

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Bleeding from a Giant Cerebellar A-V Malformation induced by Peritonsillar Abscess: A Case Report

Yasuo Mizuta, Akira Takada, Wataru Ohshima, Hideo Nishimura, Masayoshi ...

1985 Volume 78 Issue 12 Pages 2775-2781
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2775

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A rare case of bleeding from a giant cerebellar arterio venous malformation induced by the stress of peritonsillar abscess is reported.
A 31-year-old male, 2 days after the incision and drainage of a left peritonsillar abscess, complaind of staggering gait, nausea and vomitting, followed by left ear tinnitus. These clinical features indicated a probable intracranial complication, but otoneurological examination, CT scan and brain-angiogram revealed a giant cerebellar A-V malformation and a bleeding mass.
Thus, the heavy stress of peritonsillitis and peritonsillar abscess may induce dramatic sequelae.

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Four Cases of Elongated Styloid Process: Patients with Abnormal Feeling in the Throat

Yoshihiro Tsuruta, Takeo Sato, Hiroshi Miyahara, Kunitoshi Yoshino, Ka ...

1985 Volume 78 Issue 12 Pages 2783-2791
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2783

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Four patients whose chief complaint was sensation of a foreign body in the throat were found to have elongated styloid processes.
The patients were a 41-year-old male, a 1-year-old female, a 45-year-old female and a 46-year-old male. In the first patient, a submucosal projection in the tonsil bed was noted after bilateral tonsillectomy. The elongated styloid process was removed by a transoral approach. In the other three patients no abnormality was seen in the pharynx, but a bony submucosal projection was palpated behind the tonsil: therefore a diagnosis was made of elongated styloid process.
The incidence of laryngo-pharyngeal neurosis is increasing, and it should be kept in mind that an elongated styloid process is not rare one. It does not always cause an abnormal appearance in the pharynx. Xeroradiography seems to be better than roentgenography in the diagnosis of this abnormality.

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Five Cases of Functioning Thyroid Nodule

Masaki Ohmura, Kiyotaka Taguchi, Michiyuki Kita, Akihiko Fujita, Kazuo ...

1985 Volume 78 Issue 12 Pages 2793-2798
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2793

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Two cases of non-toxic autonomously functioning thyroid nodule and three cases of toxic autonomously functioning thyroid nodule (Plummer's disease) are reported.
In all five patients the preoperative diagnosis was autonomously functioning thyroid nodules on the basis of thyroid scintigraphy with T₃ suppression. All patients had partial or total lobectomies on the involved side.
Hyperthyroidism in three cases was controlled preoperatively by anti-thyroid medication. Postoperative follow-up for one to five years has shown a favourable course and no recurrence in all five patients.

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Malignant Melanoma Developing in the Mucosa of the Head and Neck Region; A Report of 30 Cases

Shun-ichi Sakai, Mahito Itoh, Yukikazu Hyo, Jun-ichi Yoshida, Ryoji Sa ...

1985 Volume 78 Issue 12 Pages 2799-2812
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2799

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1. Malignant melanomas developing in the mucosa of the head and neck region of 30 patients were distributed as follows: 20 in the nasal cavity, 1 in a maxillary sinus, 6 in the hard palate, 1 in the epipharynx, 1 in a tonsil and 1 in the conjunctival mucosa. Of these cases, 25 were primary and 5 were secondary.
2. Histopathological diagnosis of malignant melanoma was difficult when melanin pigment was not found under the light microscope. In 8 cases (27%), the melanoma was amelanotic and diagnosed first by electron microscope.
3. The clinical course varied greatly. Some patients expired very soon, while others survived an unexpectedly long time. In some cases there were late recurrences and in some cases spontaneously healing. The survival rate among the 25 primary cases was 16% after 5 years and 11% after 10 years.
4. The author's treatment policy was preoperative irradiation (5, 000rad), radical operation with elective neck dissection on both sides and immunotherapy with Nocardia-CWS for a few years. If the case was inoperable, the policy was as much irradiation as possible combined with cryosurgery and immunotherapy.

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A Case Report of Thymic Cyst

Tetsuo Hoshino, Haruhiko Ishida, Takashi Fukazawa, Satomi Taniguchi

1985 Volume 78 Issue 12 Pages 2813-2822
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2813

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A case of cervical thymic cyst is presented, and the literature is reviewed.
A 29 year-old-female was found to have a right branchial cleft cyst on CT-scan and aspiration biopsy. At operation, a cyst 2×4×2cm, below the sternocleid mastoid muscle was excised.
The histological diagnosis was cervical thymic cyst.

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Pathological Changes in the Cochlea of Heritable Hyperlipidemic (WHHL) Rabbits

Sohji Takashima

1985 Volume 78 Issue 12 Pages 2823-2839
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2823

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Effects of long-term hyperlipidemia on the hearing organ have not been studied experimentally in detail, because animals with this condition could not be reliably produced for long periods. Using Watanabe heritable hyperlipidemic (WHHL) rabbits, with serum cholesterol and triglycerides about ten times those of normal rabbits from birth, without special fatty feed, we examined the hearing physiologically by the auditory brain stem response (ABR) with air- and bone-conduction and morphologically by light microscopy and transmission electron microscopy.
The following results were obtained.
1. The bone-conducted ABR threshold of WHHL rabbits (17±8dB (mean±S. D.)) was higher than that of the controls (0±2dB (mean±S. D.)). Morphologically, pathological changes were observed in the outer hair cells and stria vascularis of the WHHL rabbits.
Therefore, WHHL rabbits have sensorineural hearing loss caused by the inner ear damage.
2. The degree of inner ear damage in the WHHL rabbits was severer than that in guinea pigs with alimentary hyperlipidemia reported to date.
3. The transmission electron microscopic changes in the cochlea of WHHL rabbits agreed in many points with those of other disease-model animals promoting hearing impairment, reported to date (spontaneously hypertensive rats, spontaneously diabetic mice (KK mice), non-obese diabetic mice).
These results show that inner ear damage due to hyperlipidemia is definite.

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Changes of Nasal Resistance in Nasal Allergy Assessed by Nasal Provocation

Influence of Serous Nasal Discharge

Kensei Naito, Toshio Senoh, Yukimoto Horibe, Keizo Koyama, Tadao Nishi ...

1985 Volume 78 Issue 12 Pages 2841-2848
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2841

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In 17 cases of nasal allergy (8 cases untreated, 9 cases receiving specific hyposensitization) nasal resistance was measured by rhinomanometry (16 cases by the anterior method, one case by the oscillation method).
Nasal resistance was measured before, at the end of and 60 min. after nasal provocation. During provocation resistance was also determined before and after nose, blowing if the patient complained of nasal obstruction.
Serous nasal secretion due to provocation was found to be an important factor in the increased resistance and a sensation of nasal obstruction based on reactive swelling of the turbinates. In unilateral provocation (10 cases), serous nasal discharge and increased nasal resistance appeared on the opposite side. In bilateral provocation (6 cases), a significant increase in nasal resistance was recognized on the narrower side.

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Biochemical Study of Nasal and Paranasal Mucosa

Hirofumi Matsuyama

1985 Volume 78 Issue 12 Pages 2849-2873
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2849

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Glycoprotein profiles were studied in tissues of maxillary mucosa, nasal polyp, nasal papilloma and maxillary cancer by affinity chromatography on lectin conjugated agarose and SDS-polyacrylamide gel electrophoresis. Sialyltransferase activities were measured in maxillary sinus mucosa, nasal polyps of chronic sinusitis, retained fluid in the maxillary sinus, inferior turbinates and nasal secretions of patients with chronic sinusitis or nasal allergy, and their sialic acid content was determined by the thiobarbituric acid method of Aminoff. These data were correlated with the histopathological characteristics of the mucosa. The distribution of the glycoconjugates in the maxillary mucosa was determined with the use of lectin (Con A, WGA, RCA and PNA) conjugated with FITC.
(1) Glycoprotein profiles of nasal polyps were similar to those of maxillary sinus mucosa in receptors for Con A, WGA, RCA and PNA.
(2) Low molecular weight (below 15, 000 daltons) components were detected in receptors for Con A, WGA and RCA in nasal papillomas.
(3) PNA receptors of molecular weight about 65, 000 were numerous in nasal polyps and maxillary sinus mucosa, scarce in nasal papillomas and not detectable in maxillary cancer.
(4) Sialyltransferase activity was somewhat higher in the polypous group than in the fibrous group of maxillary sinus mucosa.
(5) Sialyltranferase activity in the soluble fraction was markedly higher in the tissue of maxillary sinus mucosa and nasal polyp than in the other tissues.
(6) The quantity of sialic acid in the soluble fraction was higher in nasal secretions and retained fluid in the maxillary sinus of patients with chronic sinusitis than in the nasal secretions of patients with nasal allergy.

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Tumor Associated Antigens Isolated from Maxillary Cancer Cells

Susumu Yamauchi, Shigeaki Saitoh, Nobuyuki Komatsu, Hirosato Miyake

1985 Volume 78 Issue 12 Pages 2875-2882
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2875

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Oncofetal proteins and oncoplacental proteins (CEA, AFP and HCG) have been demonstrated in the tissues and/or sera of patients with various cancers, and these tumor markers have been used in the immunological diagnosis or monitoring of cancer.
New tumor markers or techniques for early diagnosis by RIA or EIA test are needed, since most of the tumor markers have also been detected in patients with no malignancy and in normal controls.
The initial purpose of this study was to prepare specific antibodies to maxillary cancer. The results indicate that this preparation may be useful in the early diagnosis and management of maxillary cancer.
A new technique was devised for the isolation and characterization of maxillary cancer associated antigens (MCAA).
Frozen sections of MC 10μm thick were applied directly to ampholine PAG-plates for isoelectric focusing. Saline extracts of tumor tissue and sera were treated in the same manner.
Specific components at around pH 6.1 were determined on the ampholine PAG-plate and collected by chromatofocusing.
AntiMCAA rabbit serum was obtained by immunization, and antiMCAA IgG serum was purified by protein A sepharose CL-4B.
AntiMCAA IgG serum was shown to be specific by double immunodiffusion.
MC sections were exposed to antiMCAA IgG serum, and specific fluorescence for MCAA was demonstrated on the surface of cancer cells by the method of indirect immunofluorescence, while control sections of membranes from three patients with chronic paranasal sinusitis were definitively negative.

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Experimental Assessment of Combined Treatment with Steroid and Methylcobalamin

Hiroshi Fujita, Shingo Murakami, Yasushi Matsumoto, Naoaki Yanagihara

1985 Volume 78 Issue 12 Pages 2883-2890
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2883

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Compression of the extratemporal facial nerve of guinea pigs induces facial nerve paralysis reversible in two or three weeks. This animal model is very useful in the assessment of drugs conventionally used in the treatment of facial palsy.
In the first group of guinea pigs, 20mg/kg of methylprednisolone acetate was injected intramuscularly immediately after the compression and then once a week. In the second group, 1000μg/kg of methylcobalamin was injected intramuscularly immediately after the compression and every 48 hours. In the third group, both 20mg/kg of methylprednisolone acetate and 1000μg/kg of methylcobalamin were injected in the same schedule. In the control group, the same volume of physiological saline was injected as in the second group.
The facial paralysis and its recovery were assessed by evoked electromyograms of the orbicularis oculi muscle, and by blink reflexes elicited by air puffs. In selected animals, nerve specimens obtained from the compressed site were stained by toluidine blue and examined by light microscope.
1) Injection of either steroid hormone or methylcobalamin accelerated the repair of the facial nerve.
2) Steroid hormone was very effective in selected cases, while methylcobalamin was moderately effective in all cases.
3) The earliest recovery of the palsy, confirmed by the blink reflex, evoked electromyogram and histological findings, were found in the animals injected with both steroid hormone and methylcobalamin.

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Study of Tissue Concentration of Clindamycin-2-Phosphate and Its Clinical Usefulness

Hisashi Yokoi, Keiko Murahashi, Noriyuki Yanagita, Koichi Deguchi

1985 Volume 78 Issue 12 Pages 2891-2896
Published: December 01, 1985
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.78.2891

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The concentration of clindamycin-2-phosphate (CLDM-P) in blood, maxillary sinus mucosa and middle-ear mucosa following intravenous drip infusion for 30 minutes were determined in surgical patients in the otorhinolaryngology department. The clinical usefulness of CLDM-P was assessed in five cases of peritonsillar abscess. CLDM-P showed a peak blood concentration of 9.654±3.770ug/ml at the end of infusion, with a half-life of 4.43 hours.
Concentrations of CLDM-P in maxillary sinus mucosa and middle-ear mucosa averaged 9.312±2.476ug/g and 3.63±1.756ug/g respectively.
Anaerobes were isolated in all five cases of peritonsillar abscess. Aerobes were also detected in three cases. In treating these five cases, CLDM-P proved excellent in four and good in one. No adverse reaction was noted in any of the five.
The blood and tissue concentrations, minimal inhibitory concentrations and clinical effectiveness, indicate that CLDM-P is a very useful antibiotic for otorhinolaryngological infections.

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