In this new tympanometric system, air pressure in the external meatus is kept constant at either -200daPa or 0 daPa. The frequency of the probe tone is swept from 220Hz to 2000Hz in 4 seconds. During this frequency sweep, sound pressure in dB and phase angle in degrees in the external meatus are sampled and transferred to a microcomputor, which computes the differences in the sound pressure and in the phase angle between -200daPa and 0daPa pressures, and displays these results as a frequency-sound pressure curve and a frequency-phase angle curve. Four parameters in these curves are selected by discriminant analysis to provide diagnostic criteria: the minimum value and the 0-cross frequency of the frequency-sound pressure curve and the maximum value and its frequency of the frequency-phase angle curve.
Normal parameters were determined in 50 normal ears. The author evaluated 40 patients with ossicular disorders. The diagnosis was correct, in 10 out of 12 cases of ossicular discontinuity and in 5 out of 6 cases of malleus and/or incus fixation. In only 12 out of 22 ears with stapes fixation, the diagnosis was correct.
In summary, this system is more useful than conventional 220Hz tympanometry in the clinical diagnosis of ossicular disorders, producing a collection of curves and patterns that are distinct different for ossicular discontinuity and ossicular fixation.

View full abstract

Magnetic resonance imaging (MRI) was performed in 21 patients with clinical and histologic diagnoses of acoustic tumor with 0.15 Tesla and 0.5 Tesla whole body image scanner (Hitachi G-10, G-50). Eleven patients were evaluated by MRI before and after an intravenous injection of 0.1mmol/kg of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA). Contrast enhancement was seen in all cases. The degree of enhancement was greater with T-1 weighed images such as saturation-recovery (500/20-30) and inversion-recovery (2000/500/20) than with T-2 weighed images such as spin-echo (2000/20-60) sequences. The differentiation of tumor parenchyma from the cystic portion is easier with Gd-DTPA enhancement. After enhancement there was a reduction of measured T-1 value in all measured cases while no significant change was seen in T-2 value. No short time side effects were encountered and no significant change was seen in blood urea, creatinine, electrolytes, liver function tests, blood coagulation or urinalysis after injection of Gd-DTPA. Although much more work will be required to evaluate this contrast agent, Gd-DTPA is a promising MRI contrast enhancer for the clinical assessment of acoustic tumor.

View full abstract

Statistical studies of sudden deafness during the past eight years show that;
1) the patients are getting older,
2) the prognosis is worse if vertigo is present,
3) the prognosis is better when hearingloss is less than 70dB.
4) the number of patients with hypertension, diabetes, and renal disease is increasing.

View full abstract

A 52-year-old woman with Neuro-Behçet syndrome had fluctuating sensory hear-ing loss and gait disturbance. The patient had had recurrent painful ulcerations in the oral and genital regions over the past 34 years and frequent headaches and high fever due to encephalomeningitis for the past two years.
In addition, she had had hearing impairment and tinnitus for two years on the right and for one year on the left. These symptoms had become progressively worse. The pure tone audiogram revealed a sensorineural hearing loss which averaged 50 dB bilaterally. Speech audiometory and Békésy's audiometory suggested some type of inner ear deafness. The results of ABR recording, eye tracking test and optokinetic nystagmus test suggested the possibility of a central lesion in the right brain-stem. The patient was considered to have lesions in both inner ears and the right brain-stem.

View full abstract

A case of mixed-type hearing impairment due to Paget's disease of bone found in a Japanese woman was reported. A 29 year-old-female, who had had bilateral hearing impairment since her childhood, visited us because of aggravation of hearing loss. The right eardrum was intact, but the handle of the malleus looked thin. The left eardrum showed a dry perforation which presumably resulted from previous surgery at the age of 16. Audiometry revealed mixed-type hearing impairment of about 85dB on the average with reduced bone conduction of about 35dB in both ears.
In both ears surgery revealed interruption of the ossicular chains due to absorption of the ossicles. All the ossicles were thin, and there was complete loss of the stapes including its footplate. The horizontal portion of the bony facial canal was thick, causing narrowing of the vestibular window. In contrast, the bone was thin over the cochlear wall around the vestibular and cochlear windows. The bony trabecullae of the mastoid air cells were also unusually thin. However, reconstruction of the ossicular chain in the right ear resulted in moderate improvement of hearing in the lower frequencies, which was not sufficient to allow her to dispense with hearing aids.
Although Paget's disease has been very rare in Japan, the number of reported cases has increased recently. This is the second report in the Japanese otolaryngological literature which describes hearing impairment associated with Paget's disease of the bone. The authors point out that Paget's disease should be included in the differential diagnosis of hearing impairment even in Japan.

View full abstract

Otitis media with effusion (OME) in children is a disease which usually subsides spontaneously, but in some cases it becomes refractory.
In this study, we followed patients aged 8 to 29 years, when the incidence of OME is low, to find the factors which prevent recovery. Our follow-up shows that in 47% of those cases which proved to be refractory in spite of the insertion of ventilation tubes, the passive opening pressure of the Eustachian tube was higher than normal, and the tubal ventilatory function was greatly disturbed. In these patients with refractory OME, extreme retraction of the eardrums and poor aeration of the mastoids were found, suggesting the existence of some organic abnormalities of the Eustachian tube.

View full abstract

The effect of pressure on eustachian tube patency was examined in two clinical studies by sonotubometric techniques under normal atmospheric conditions and in a hyperbaric chamber. In the former experiment, 42 eustachian tubes were examined at various ambient pressures, and in the latter 30 eustachian tubes were tested under conditions of negative or positive middle ear pressure.
To evaluate the active opening function of the eustachian tube, its duration of patency and the sound pressure change during deglutition were analyzed, while the increased pressure level in the nasal cavity with Valsalva's maneuver passively forcing the eustachian tube to open was also recorded for the passive opening function of the eustachian tube.
Ambient pressure had no significant effects on eustachian tube patency, but patency was relatively reduced after exposure to hyperbaric pressure.
Reduced patency was noted when negative middle ear pressure was as little as -100--200mmH₂O. For example, there was good tube patency when the mid-dle ear pressure was -100 to +100 mmH2₂O, with 93.6% of the tubes opening dur-ing deglution, and the positive rate was reduced to 83.3% as the middle ear pressure decreased to -100- -200mmH₂O. No significant changes of eustachian tube patency were detected when the middle ear pressure was positive.

View full abstract

A rise of the IAP level to over 100μg/ml in the nasal secretions and 500μg/ml in the serum was observed in patients with maxillary cancer or chronic sinusitis. IAP elevation was present in all 11 patients with maxillary cancer. On the other hand, few normal subjects or patients with allergic rhinitis showed such on increase. Determination of the IAP level in the nasal secretions and in the serum appears to be of use in assessing immunosuppressive activity in patients with diseases of the nose or sisuses.

View full abstract

A 67-year-old male with an intermittently painful adherent mass in the left parotid region was examined at our department. Ga scintigraphy revealed a hot area at the site. Since left parotid gland cancer was highly suspected, left total parotidectomy was performed.
Histopathological findings, however, suggested chronic sclerosing adenitis (Küttner's disease) of the parotid gland. About 6 months after surgery, the same clinical findings were observed on the right side. This mass was treated with anti-biotics and antiinflammatory drugs because of the high possibility of Küttner's disease. The mass gradually decreased in size and disappeared completely after 9 months of treatment.
The etiology and treatment of Küttner's disease are discussed.

View full abstract

Case 1 was a 41-year-old female with retropharyngeal abscess secondary to tuberculosis of the cervical lymph nodes. Administration of tuberculostatics and needle drainage gradually reduced the symptoms, and swelling in the retropharyngeal wall nearly disappeared after about 5 months. After treatment with the tuberculostatic agents for about 1 1/2 years, the patient has been under observation without recurrence.
Case 2 was a 47-year-old male with primary retropharyngeal abscess following acute inflammation of the upper respiratory tract. Examination revealed diabetes. The patient improved rapidly following antibiotic administration, intraoral incision and drainage of the abscess, and control of the diabetes. He was discharged 18 days after admission.
Case 3 was a 62-year-old female with retropharyngeal abscess 4 days after injury of the pharynx caused by a fish bone. She had diabetes treated with insulin. Following the administration of antibiotics in addition to insulin, the patient improved rapidly and was discharged 10 days after admission.
Though various tuberculostatics and antibiotics are available today, retropharyngeal abscess still occurs sometimes. Adequate attention must be paid to the diagnosis and treatment.

View full abstract

Recurrent sore throats are common in patients with abnormal sensation in the throat, perhaps because abnormal sensation is caused mainly by local inflammatory changes.
In order to test this hypothesis, the authors evaluated clinically the inflammatory changes of the palatine tonsils, posterior oropharyngeal wall, lateral pharyngeal band and lingual tonsils in 208 patients (85 males and 123 females, 17 to 84 years of age) with abnormal sensation in the throat (AST group) and compared them with 350 patients (167 males and 183 females, 14 to 85 years of age) who had never complained of abnormal sensation (control group).
1. AST group had a significantly higher incidence of recurring sore throat.
2. Tonsillitis, hyperemic palatine tonsils, hyperemic posterior oropharyngeal wall and hyperemic lateral pharyngeal band were found somewhat or significantly more often in the AST group.
3. Hypertrophy of the palatine and lingual tonsils was not significantly different in the two groups.
These results indicate that chemical stimulation by unknown substances produced in inflamed tissues may be more important in eliciting the abnormal sensations in the throat than mechanical stimulation by hypertrophic organs.

View full abstract

Injury of the recurrent laryngeal nerve is one of the most important complications in thyroid surgery. CT images in 54 cases of surgically treated thyroid tumors revealed a close relationship between recurrent laryngeal nerve paralysis and the extent of the thyroid tumor into the tracheoesophageal groove in the CT image.
When the tumor extends into the tracheoesophageal groove at the level of 0.5 and/or 1.0cm below the cricoid cartilage in CT images, the incidence of either preoperative or postoperative recurrent laryngeal nerve paralysis is very high (17 of 19 cases; 90%). When the fat tissue or normal thyroid tissue exists in the tracheoesophageal groove at the same levels in CT images, no recurrent laryngeal nerve paralysis occurred in any of the 35 cases.
These results point to the importance of the preoperative evaluation of CT images at the above mentioned levels in patients with thyroid tumor to determine the risk of injury of the recurrent laryngeal nerve.

View full abstract

In two cases of multiple system atrophy —Shy-Drager syndrome and olivopontocerebellar atrophy— sonorous respiratory sounds accompanied by hyperpnea were observed during sleep. Fiberscopic and sound-analytic examinations revealed that the sound source was the inspiratory vibration of the vocal folds. The limitation of the vocal fold abduction seemed to result in this abnormal vibration.
The possibility of atrophy of the posterior cricoarytenoid muscle is discussed.

View full abstract

The cupula and the subcupular space were studied by scanning electron microscope (SEM) in ginea pigs, pigeons and chicks. Some ampullae were fractured by a styren lesion for observation of the relationship between the sensory hairs and the cupula. Electronmicroscopy revealed that the side of the cupula consists of a tubular structure. There were a number of small holes in the top and the bottom of the Cupula. On the surface of the crista were observed many small granules secreted by the supporting cells. Many sensory hair bundles traversed the subcupular space and were in contact with the cupular base.
In a physiological study, the cupula of the Rana catesbiana was stimulated either by direct pressure or by mechanical endolymphatic flow. Action potentials from the posterior ampullary nerve were recorded before and after removal of the cupula and the subcupular substance. After cupular removal no action potential was evoked. When the cupula was replaced in the crista, the maximum frequency of the action potential in response to both direct pressure and mechanical endolymphatic flow recovered. However, the time course of the response was shorter than that prior to cupular removal.
The cupula and the subcupular space were analyzed histochemically by light and electron microscopy. The ampulla of the chick was stained by periodic acid-Schiff (PAS), diastase-PAS, alcian blue-hyaluronidase, AB (pH2.5), AB (pH1.0), HID and AB-sialidase. The cupula and the intracellular microglomerus of the supporting cells contained mainly sialoglycoprotein (sialomucin). The cupula and the subcupular space were studied by both secondary electron (SE) image and backscattered electron (BSE) image. Ruthenium red (RR) staining was used for SEM observation of BSE image. The cupula and the granules of the crista surface contained mainly acid glyconjugate. Thus, the cupula and the gelatinous substance in the subcupular space contained mainly sialoglycoprotein.

View full abstract

We implanted single channel cochlear electrodes to the round-window niche of guinea pigs to examine whether or not the second formant (F₂) information could be transmitted to the auditory system. The response of the auditory nerve was examined by recording the compound action potentials (CAP) which were evoked by electrical pulses applied to the cochlea through the round-window membrane.
The results showed that it is difficult to transmit F₂ information by using the dif-ference of stimulus intensity because the dynamic range of CAP induced by stimulus current is too small. On the transmission of the second formant information for single channel cochlear implants, we proposed that the second pulse corresponding to the F₂ was inserted between pitch pulses with the time difference which was inversely proportional to the F₂ frequencies.
It seems that further investigations must be carried out of the ability to discriminate speech sound.

View full abstract

The therapeutic effect of flunisolide given with a nebulizer was compared with that of the drug given as a metered-dose spray. Flunisolide nebulizer was given at least 3 times a week (each dose contained 100μg of flunisolide) and metered-dose flunisolide spray twice a day (morning and evening, each dose contained 100-200μg of flunisolide), both for 2 weeks. The metered dose spray was superior to the nebulizer in improving clinical symptoms, but the differences were significant only in the onset of sneezing and nasal secretion. There was no significant difference in the percent efficacy between the nebulizer (68.7%) and metered-dose spray (72.0%) in patients treated for 8 days or more. The patients treated with nebulizer had normal clinical laboratory values and serum cortisol level and experienced no adverse reactions. The results suggest that flunisolide is effective against nasal diseases other than allergic rhinitis which respond to corticosteroid aerosol.

View full abstract

Thirty-three patients were treated with Zyderm collagen implant for the correction of depressed scars (traumatic or surgically-induced scars and viral pockmarks) and age-related wrinkles. Zyderm was very effective in treating wrinkles, depressed scars with dimpling, and superficial linear scars. The effect was variable in surgicallyinduced scars and rather poor in viral pockmarks. Zyderm is considered to be safe and effective adjunct therapy for soft tissue augmentation.

View full abstract