Practica Oto-Rhino-Laryngologica

Preservation of Hearing in Surgery for Acoustic Neuroma

Jin Kanzaki

1988 Volume 81 Issue 2 Pages 153-161
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.153

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One hundred thirty-four patients with acoustic neuromas were operated on via the middle cranial fossa approach (MCF) or extended MCF by a team of otologists and neurosurgeons. Surgery to preserve hearing (MCF or MCF combined with a transtentorial approach) was performed in 17 (13%) patients with preoperative hearing levels of 50dB or less and tumors less than 2.0cm in diameter. Hearing could be preserved in 8 (47%) of these patients. In contrast, in 17 other patients with hearing levels of 51dB or over, hearing could be preserved in only one patient.
The indications for hearing preservation, surgical approaches, intraoperative monitoring, and significance of hearing preservation in acoustic neuroma surgery are discussed.

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Laser Surgery of Infantile Subglottic Stenosis

[in Japanese], [in Japanese], [in Japanese]

1988 Volume 81 Issue 2 Pages 162-163
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.162

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Visual Suppression Test in Spinocerebellar Degenerations

Masahiro Mizuno, Masaaki Yamane, Ryuichi Osanai

1988 Volume 81 Issue 2 Pages 165-171
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.165

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Visual suppression of caloric nystagmus was studied in 86 consecutive patients with spinocerebellar degenerations.
In 16 of the 86 cases caloric nystagmus was normally suppressed by visual fixation, while in 41 it was not suppressed and in 19 it was even enhanced by visual fixation. In 10, the influence of visual fixation on caloric nystagmus could not be evaluated because of absence of caloric nystagmus or disturbance of the quick phase of nystagmus.
Patients with hereditory and/or chronic illness had a higher incidence and severer degree of disturbance of visual suppression of caloric nystagmus. The correlation between the duration of illness and the extent of visual suppression was confirmed statistically. There was no correlation, however, between the age of onset and the extent of visual suppression.

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Clinical Study on Congenital Nystagmus

-Statistical Analysis-

Hiroshi Nakazawa, Eiji Sakata, Naoko Ito, Kouki Nakaigawa, Kyoko Ohtsu

1988 Volume 81 Issue 2 Pages 173-179
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.173

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There have been many case reports on so-called congenital nystagmus, but only a few papers have deal with the statistics and pathophysiology. May be that is the reason that some patients with congenital nystagmus are simply diagnosed as having a visual defect, and some have been sent to a school for the blind.
Recently, our department has done precise neurootological examinations on 2, 400 subjects. Congenital nystagmus was found in 84 of them (3.5%); 45 had the jerking type, 19 the pendular jerking type, 11 the pendular type and 9 the latent type of nystagmus. The male/female ratio was 2:1.
The congenital nystagmus in these 84 cases is analyzed statistically.

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Inner Ear Symptoms Following Head Injury: Two Cases

Motohisa Ikeda, Jiro Muto, Masaki Tajima, Takashi Yoshino

1988 Volume 81 Issue 2 Pages 181-191
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.181

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Neurotological examinations were performed repeatedly on patients with head injury due to traffic accidents. Their symptoms were disequilibrium, tinnitus, hearing loss and bleeding from the ear. A 55-year-old man had been suffering from these symptoms for three months. At operation a fracture of the left promontrium was discovered. The fracture line was covered by two pieces of fascia of the temporal muscle. A 12-year-old boy recovered from his ear symptoms within three weeks, so he was not operated on. Both patients are now asymptomatic.

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Dysfunction of Chorda Tympani after Middle Ear Surgery

Zenya Ito, Ryo Yuasa, Shigeru Saijo, Sachiko Tomioka, Masaru Toshima, ...

1988 Volume 81 Issue 2 Pages 193-200
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.193

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The function of the chorda tympani in 76 patients treated by tympanoplasty at Tohoku Rosai Hospital was evaluated by electrogustometry (EGM) and salivary flowmetry of the submandibular gland.
1) Nineteen patients, in whom the chorda tympani was touched traumatically or sectioned during ear surgery, complained of dysgeusia postoperatively. EGM revealed a moderately elevated threshold (12.6±14.0dB) in the cases touched traumatically, but a very high threshold (29.2±9.6dB) when the chorda tympani had been sectioned. There was a greater variety of EGM elevations in the patients with trauma only than in those whose nerves were sectioned.
2) Recovery of EGM thresholds within one month after surgery was rare in the touched cases, and did not occur in the sectioned cases.
3) Salivary flow from the submandibular gland was measured in 13 patients pre- and postoperatively. One patient, whose chorda tympani was neither touched nor cut during surgery, showed no diminution of the salivary flow rate. Four of the nine patients whose chorda tympani was touched, showed slight diminution and the remaining five showed severe diminution of the salivary flow rate immediately after surgery. Of the three patients whose chorda tympani was cut, one showed moderate diminution and the other two severe diminution of the salivary flow rate.
4) We found a good correlation between the EGM threshold and the salivary flow rate in each patient.
5) Two of the 14 patients operated on bilaterally developed xerostomia.

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Electroneuronography for Prognostic Evaluation of Facial Paralysis

Tomoyoshi Yoza, Kunihiko Nagahara

1988 Volume 81 Issue 2 Pages 201-209
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.201

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Eighty three consecutive patients with either Bell's palsy or Ramsey Hnut syndrome were first conservatively treated for two weeks with intravenous administration of steroid and intermittent inhalation of carbogen (95% oxygen and 5% carbon dioxide). When the amplitude on the electroneuronogram (ENoG) on the affected side decreased to less than 10% of that on the contralateral healthy side, decompression surgery of the tympanic and mastoid portions of the facial nerve was conducted up to the level of the geniculate ganglion. Ninety-seven percent of the patients recovered completely without surgery when the ENoG amplitude exceeded 10%. Sixty-five percent of the patients with the ENoG amplitude less than 10% recovered completely when the operation was performed, usually within three weeks from the onset. Decompression surgery improved the cure rate by 37%. No significant low tone hearing loss was noted after surgery.

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Results of Surgery for Congenital Aural Atresia and Stenosis

Toru Minatogawa, Takeo Kumoi, Yoshihiko Nishimur, [in Japanese], [in J ...

1988 Volume 81 Issue 2 Pages 211-219
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.211

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We analyzed the results of surgery in 16 cases of congenital aural atresia or stenosis and correlated the degree of malformation of the auricles and the ossicles. Of the 5 types of skin grafting of the external ear canal simple skin grafting was the least successful (6 out of 11).
Tympanoplasty was done in all cases except one in which the tympanum was hypoplastic. Allograft tympanic membranes with attached malleus were used in 6 ears with good graft takes. Follow up tests of hearing acuity more than 6 months after operation were possible in 13 ears. Of the 7 ears in which temporal fascia had been used, the hearing was good in only 2 ears and had diminished in 5. In the 6 ears in which allograft tympanic membranes had been used, hearing remained unchanged in one ear and had gradually increased in 5 ears.

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CO₂ Laser Surgery for Nasal Allergy

Koichi Tomoda, Sumio Ohnishi, Kenji Machiki

1988 Volume 81 Issue 2 Pages 221-227
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.221

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We applied CO₂ laser to treat perennial nasal allergy caused by house dust. Among 30 patients treated, 24 showed a more than 50% reduction of symptoms after 5 laser treatments over a 4-month period. Sneezing and nasal discharge were greatly decreased but not nasal obstruction. Microcirculation of the nasal mucosa was measured by a tissue spectrum analyzer. The level of IHb as a marker of hemoglobin was significantly lower (p<0.05) in the allergic mucosa (49.5±10.6) than in the normal (64.8±12.3). It increased significantly just after the laser vaporization, then gradually decreased to the normal level. But in the non-effective group, it went down to the pre-treatment level. Histologic findings in the treated mucosa were squamous epithelization, neovascularization and fibrosis of subepithelial layer. There were no side effects in any of the treated patients.
Allergic reactions might be inhibited by structural changes of the nasal mucosa, especially in the superficial layer of the subepithelium where allergic reactions may take place. This treatment is easy, safe and suitable for children and pregnant women, since there are no side effects.

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Lipoma in the Deep Lobe of the Parotid Gland; A Case Report

Toru Nakajima, Yasuo Uesugi, Seiji Nagata, Yuzo Yamamoto, Kazuo Makimo ...

1988 Volume 81 Issue 2 Pages 229-233
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.229

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60-year-old male had a tumor which originated in the deep lobe of the parotid gland and extended to the parapharyngeal space. CT-sialography revealed tumor extension to the parapharyngeal space with clear imaging. The CT number of this tumor was lower (-104 to -128) than that of lipoma tissue (-80 to -90).
Ga-scintigraphy showed RI accumulation, probably because of the sialography performed 35 days before scintigraphy.
Under general anesthesia, the patient was operated on. The tumor was a parotid tumor with a dumbell-like shape.

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Two Cases of Epidermoid Cyst of the Floor of the Mouth

Keiko Yamabe, Yasushi Nishikawa, Masayuki Honda, Akira Hohki

1988 Volume 81 Issue 2 Pages 235-240
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.235

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Cystic diseases such as dermoid cyst, epidermoid cyst, ranula and thyroglossal cyst are often found in the floor of the mouth. We report two cases of large epidermoid cyst which developed in adults. Magnetic resonance imaging (MRI) clearly demonstrated the location and cystic features of the tumor in the second case, which was not diagnosed by other examinations. We concluded that MRI is of great benefit in the diagnosis of lesions of the head and neck.

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Magnetic Resonance Imaging (MRI) of Head and Neck Tumors

Yasushi Naito, Yoshihiro Watanabe, Yasuyuki Tasaka, Kazuhiko Shyoji, I ...

1988 Volume 81 Issue 2 Pages 241-248
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.241

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MR images of parotid tumors, lingual and oropharyngeal carcinoma, nasopharyngeal carcinomas and skull base tumors were obtained, and the clinical significance of MRI for their treatment was evaluated. In all of these regions, MRI provided much information that could not be obtained by conventional CT, and contributed to treatment planning and the evaluation of treatment efficacy. MRI is now becomming an indispensable method for assessing head and neck tumors.

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Reconstruction with Microvascular Tissue Transfer after Ablation of Head and Neck Cancer

Kazuya Kinoshita, Takaaki Kawaguchi, Kiyonori Kuki, [in Japanese], [in ...

1988 Volume 81 Issue 2 Pages 249-255
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.249

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Microvascular tissue transfer is recommended by plastic surgeons for defects following radical ablation of head and neck tumors. After experimenting with microvascular anastomosis of the femoral vessels of guinea pigs, we performed reconstruction of head and neck defects following radical surgery for six oral and hypopharynx cancer with three free jejunums, three forearm flaps and one free latissimus dorsi myocutaneous flap.
Radial forearm flaps are very suitable for intraoral reconstruction because of their pliability, thin, hairless skin and long vessel pedicles. Even in patients who had had high doses of irradiation or several cervical operations, the forearm flaps were useful and successful.
Free jejunum transfer was very effective for hypopharyngeal cancer, since wide resection of the cervical esophagus and hypopharynx was possible. Two of our three patients had no complication after the operation. One patient had a small fistula at the pharyngo jejuno junction, but it healed spontaneously within two weeks. The average time from the operation to the beginning of oral feeding was ten days in our three patients.
We consider that microvascular tissue transfer is preferable and useful following surgery for head and neck cancer.

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Experimental Research on the Permeability of the Blood-Cochlea Barrier to Furosemide

Masaki Ohmura

1988 Volume 81 Issue 2 Pages 257-271
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.257

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To clarify the characteristics and the control of the blood-cochlea barrier, we measured EP (the endocochlear potential) and the furosemide concentration in the perilymph of guinea pigs. It was recognised that: 1) glycerol increased the toxicity of furosemide against the EP in adults, 2) the toxicity of furosemide against EP was stronger in neonates than in adults, 3) glycerol did not increase furosemide toxicity against EP in neonates, 4) acute hypertension also increased the ototoxicity of furosemide, 5) glycerol increased furosemide concentration in the perilymph.
These findings suggest that glycerol facilitates the permeability of blood-cochlea barrier to furosemide. Therefore, it is assumed that glycerol and acute hypertension can facilitate the access of some drugs used to treat inner ear diseases.

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α-Adrenoceptors in Nasal Blood Vessels

Keiichi Ichimura, Ming-jeng Chow, Atsuro Seki

1988 Volume 81 Issue 2 Pages 273-289
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.273

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The presence, location and function of the α-adrenoceptors in the blood vessels of the nasal mucosa were evaluated by observing the in vitro vasoactivity to agonists and/or antagonists of the receptors involved. Human nasal mucosa was obtained during turbinectomy from patients with severe nasal allergy or hypertrophic rhinitis, and canine septal mucosa was taken after sacrificing dogs with pentobarbital. Bioassay using an in vitro tension detecting device and radioisotope study quantifying tritium-noradrenaline released from nerve terminals showed existence of prejunctional α-2 adrenoceptors, which posess autoinhibitory effect on noradrenaline release from sympathetic nerve endings. This effect was calcium dependent.
In contrast to the ease with which confirmatory evidence for the existence of two subgroups of a-adrenoceptors was obtained in vivo, it has been relatively difficult to demonstrate postjunctional α-2 receptors in vitro so far. This may reflect the fact that α-2 receptors are present in larger numbers in the very small resistance vessels which are not available for in vitro studies with usual vessel specimens. However, they are easily available in the nasal mucosa. The response of the postjunctional α-adrenoceptors of either human or canine mucosa to α-2 agonists (clonidine, B-HT 920) was less in magnitude and slower in speed than that to the α-1 agonist methoxamine. It was obvious especially in the former specimen. Stimulation of both α-1 and α-2 receptors by noradrenaline also mediated vasoconstriction, which was independent of extracellular calcium influx. Phenoxybenzamine, an irreversible antagonist with α-1 selectivity, depressed but did not abolish noradrenaline-induced contractions. The remaining response was not affected by another α-1 specific antagonist prazosin, but was markedly attenuated by the α-2 antagonist yohimbine. These results suggest that human and canine nasal vessels contain both α-1 and α-2 adrenoceptors.

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Clinical Effect of Surgam® on Inflammation of Post Radical Operation for Chronic Sinusitis

Hitoshi Ogino, Yoshito Ohya, Toru Matsunaga, [in Japanese], [in Japane ...

1988 Volume 81 Issue 2 Pages 291-296
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.291

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The effect of Surgam in 32 patients treated with radical surgery for bilateral chronic sinusitis on postoperative inflammation was evaluated.
1. Swelling began to improve on the third postoperative day and continued to be slighter in the treated group than in the control group.
2. In cases in which the body temperature was 37.5°C or higher, the treated group showed a significantly more favorable response (p<C0.05) on the third postoperative day.
3. Patients' impressions and general improvement ratings were significantly higher in the treated group than in the control group.
4. The effectiveness of Surgam tablets on postoperative inflammation was confirmed in 24 of 32 patients (75.0%).
5. No side effect was noted in any patient.
These findings suggest that Surgam is a very useful drug for postoperative inflammation.

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Effect of Dosulepin Hydrochloride, an Antidepressant, on Abnormal Sensation in the Throat

Mikikazu Yamagiwa, Yasuo Sakakura, Masahiko Kubo, Teruhiko Harada, Kim ...

1988 Volume 81 Issue 2 Pages 297-307
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.297

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Depressive state is frequent in patients with abnormal sensation in the throat (AST). It is still not certain, however, that depression can cause AST. In some cases, prolonged AST may cause a depressive state.
We assumed that anti-depressants would be effective for patients with AST caused by depression or those with AST combined with a depressive or an apprehensive state, and administered an anti-depressant, Prothiaden 25® (1-2 Cap/day), for two weeks to 64 patients with AST. Five patients were excluded, in one whom side effects were so severe that the medication had to be suspended and 4 who dropped out before the evaluation. The therapeutic effects of the medication were evaluated in the remaining 59 patients (27 males and 32 females) at the end of the first week and of the second week of administration and one week after the termination of treatment. It was considered to be effective when the AST improved subjectively by 50% or more. Among the 59 patients, the medication was effective in 42% in one week, in 56% in two weeks and in 54% in three weeks (one week after the termination of treatment). These efficacy rates are rather low in comparison with those we obtained previously with a minor tranquilizer and/or an anti-inflammatory agent. It was obvious that this anti-depressant was more effective in 19 patients with depressive state than in 40 non-depressed patients. The efficacy rates were 47% in one week, 63% in two weeks and 68% in three weeks in the former, and 40%, 53% and 48%, respectively, in the latter.
We conclude that anti-depressants are of value in the therapy of patients with AST who are suspected of being depressed.

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Fiberscopy of Larynx, Bronchus and Esophagus

[in Japanese]

1988 Volume 81 Issue 2 Pages 308-309
Published: February 01, 1988
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.81.308

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