Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 85, Issue 5
Displaying 1-23 of 23 articles from this issue
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  • Recent Advances in the Clinical Application of Otoacoustic Emissions
    Tomonori Takasaka, Kenji Ohyama
    1992 Volume 85 Issue 5 Pages 673-681
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.673
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    Clinical applications of otoacoustic emissions (OAEs) have long been studied since the discovery of this surprising phenomenon by D. T. Kemp in 1978. Although there are at least 4 classes of OAEs, i. e., transiently evoked OAE (EOAE), spontaneous OAE, synchronously evoked OAE and distortion product OAE (DPOAE), most researchers have attempted to evaluate EOAE as a possible measure of cochlear pathology. However, the results only indicate that the EOAE does not provide much information about the fine distribution of cochlear lesions. On the other hand, the measurement of the DPOAE has recently become available as another possible indicator of cochlear function, and has great advantages over EOAE measurement. The results of DPOAE measurement in sensorineural hearing-impaired patients clearly indicate that the DPOAE has excellent frequency specificity. In most cases, the DP-audiogram, a plot of DPOAE level against stimulus frequency, exactly reflects the longitudinally distributed integrity of the cochlear partition. This method may become the most powerful non-invasive tool for the evaluation of cochlear function.
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  • Pollinosis
    [in Japanese]
    1992 Volume 85 Issue 5 Pages 682-683
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.682
    JOURNAL FREE ACCESS
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  • Evaluation of Electric Promontory Stimulation Test for Cerebellopontine Angle Tumors
    Akiko Tamaki, Takayuki Shiraishi, Masako Okusa, Takeshi Kubo, Toru Mat ...
    1992 Volume 85 Issue 5 Pages 685-690
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.685
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    Transtympanic electric promontory stimulation (EPS) was first performed by House & Brackmann for the purpose of differentiating between sensory and neural type deafness. There are few reports dealing with EPS in neural deafness. This paper focuses on the accuracy of EPS, with the use of a promontory stimulator (Nucleus Co.), in patients with neural deafess. EPS was used to test 18 ears of 17 patients aged 23 to 63 years (mean 46.0 years). The diagnoses were acoustic neuroma (14 patients) and other cerebellopontine (CP) angle tumors (3 patients). A positive response to EPS was noted in 2 of the acoustic neuroma patients (22%), before surgery and hearing with good speech discrimination was preserved in these patients. A positive response was found in 2 of 2 CP angle tumor patients (100%) before the operation. Of the 7 patients tested with EPS after surgery, all showed a negative response. These results suggest that pressure on the acoustic nerve by the tumors was most closely correlated with the response to EPS.
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  • Acoustic Tumor Simulating Meniere's Disease
    A Case Report
    Chiaki Koida, Shuichi Igarashi, Tetsuya Kitamura, Hiroyuki Sasaki, Yui ...
    1992 Volume 85 Issue 5 Pages 691-697
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.691
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    A 53-year-old woman complained of recurrent attacks of vertigo with right-sided hearing loss and tinnitus. She was found to have a mild sensorineural hearing loss, right-sided vestibular weakness, and dominant negative SP on electrocochleography, but X-ray by the Stenvers method showed no enlargement of the right internal acoustic meatus. The initial diagnosis was Meniere's disease. After being symptom-free for three years and eight months, dizziness recurred and an acoustic tumor was discovered on a CT scan. The tumor was completely removed by the posterior fossa approach. The tumor originated from the superior vestibular nerve. Compression of the labyrinthine artery by the tumor was thought to have caused secondary endolymphatic hydrops in the initial stage.
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  • Clinical Assessment of Direction Changing Positional Nystagmus
    Satoshi Iwasaki, Yasuo Mori, Shuji Ocho, Shinri Kinaga, Michihiko Nozu ...
    1992 Volume 85 Issue 5 Pages 699-705
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.699
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    The beating geotropic type of direction changing positional nystagmus was observed in one patient and the beating apogeotropic type in three.
    None of the patients had any abnormal neurological signs or symptoms. We ruled out the central disorders with CT, MRI or angiography, so direction changing positional nystagmus could be considered to be caused by a peripheral vestibular disturbance.
    We suggest that peripheral positional nystagmus has three differential features: 1) brief episodes of vertigo, 2) in the early stage the nystagmus is more horizontal, but in the late stage there are both torsional and horizontal components, 3) fatigability.
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  • Ossifying Fibroma of the Temporal Bone
    Keiko Murahashi, Yoshinobu Nomura, Hideto Niwa
    1992 Volume 85 Issue 5 Pages 707-712
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.707
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    A 17-year-old male with partial hearing loss and otorrhea was diagnosed as having ossifying fibroma from the findings of plain skull roentogenograms, CT scan, bone scintigrapy (99mTc), selective carotid angiography, and biopsy. The tumor was removed by curettage, and the hearing improved by tympanoplasty.
    Ossifying fibroma is a rare fibro-osseous tumor, usually found in the maxilla or mandible. It is seldom seen in the temporal bone; only 5 such cases have been reported. The clinical, radiological, and pathological characteristics of the disease are discussed with some reference to the literature.
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  • Erythromycin Treatment for Otitis Media with Effusion in Children
    Yukiko Iino, Koichi Sugita, Jun-ichi Ishitoya, Atsuhito Nakai, Koichi ...
    1992 Volume 85 Issue 5 Pages 713-720
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.713
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    Twenty five children with chronic otitis media with effusion received low-dose and long-term erythromycin treatment (EM treatment), and the clinical and bacteriological effects were studied. After the EM treatment, resolution of middle ear effusion (MEE) was observed in 18 of the 25 patients. Within the 3-month follow-up period after EM treatment, 13 of the 18 patients were completely effusion-free, while recurrence of MEE was observed in 5 cases. The final rate of resolution, therefore, was 52%. EM treatment was not effective for younger children, especially for those under 2 years of age.
    Patients with accompanying chronic sinusitis tended to become effusion-free after EM treatment along with reduction of their nasal symptoms. Persistence of nasopharyngeal pathogens during the EM treatment was demonstrated, indicating that the resolution of MEE by the treatment did not depend on antimicrobial effects but on some antiinflammatory effects. The present results show that EM treatment can increase the resolution of MEE in children with OME.
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  • Hemifacial Spasm
    -Operative and Ultrastructural Findings-
    Yasushi Matsumo, Jack L. Pulec, Kanehisa Kohno, Sadanori Takeda, Shiro ...
    1992 Volume 85 Issue 5 Pages 721-728
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.721
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    Eight patients with idiopathic hemifacial spasm (HFS) were treated by surgery. Five of them (1985-1986) were treated with a total facial nerve decompression through a transmastoid and middle fossa approach combined with retrolabyrinthine microvascular decompression (MVD). A small amount of facial nerve tissue was taken from various portions in the temporal bone for electronmicroscopic evaluation in these cases. The other three patients (1990-1991) were treated by MVD through a suboccipital approach. One patient needed revision surgery, the other seven had an excellent clinical course without any complications. A definite vascular compression of the facial nerve at the root entry zone was identified in six patient. The ultrastructural findings suggested that the histological changes in the nerve tissue itself were not so severe as in Bell's palsy which needs decompression surgery. We concluded that MVD surgery by an experienced surgeon is the best treatment for HFS provided we can exclude secondary HFS.
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  • Papilloma Virus DNA in a Patient with the Nasal Inverting Papilloma
    Rinya Sugita, Tohru Ogiwara, Kazuhisa Ishi
    1992 Volume 85 Issue 5 Pages 729-735
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.729
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    HPV-6-type DNA was detected in a 57-year-old man with inverted nasosinus papilloma. This patient was negative for HPV-6, 11, 16, 18, 31, 33 and 35-type probes covered by in situ hybridization (Vira type® method). However, dot blot hybridization (Vira PapTM method) showed subsequently HPV-positive results, and Southern blot hybridization was positive for HPV-6-type DNA.
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  • Combined Intracranial and Facial Approach to Ethmoid Sinus Carcinoma
    A Report of Two Cases
    Akihito Watanabe, Osamu Oshima, Kunihiko Nohira, Masaru Shirato
    1992 Volume 85 Issue 5 Pages 737-745
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.737
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    Two patients with ethmoid sinus carcinoma were treated with a combined intracranial and facial approach.
    Case 1: A 39-year-old man complained of right nasal obstruction and headache for three months. CT scan and MR imaging of his face revealed a mass arising within the right ethmoid sinus and, involving the right nasal cavity, the right medial orbit and the anterior cranial base. Intranasal biopsy of the mass showed a moderately differentiated squamous cell carcinoma. He received FAR treatment, a combination of vitamin A, 5FU and radiation, preoperatively.
    Operation was performed by a team (otolaryngologist, plastic surgeon and neurosurgeon). With a combined intracranial and facial approach, the tumor was resected with the bilateral anterior cranial fossa floor, adjacent dura mater and right medial orbital wall. The anterior skull base and the nasal cavity defects were reconstructed with a calvarial bone flap and a free forearm flap.
    Ten days after surgery, a second operation was performed bacause of local infection and meningitis. The necrotic galeo-periosteal flap and the temporal fascia were replaced with a frontal muscle flap and lyophilized dura, respectively.
    After the patient recovered from meningitis, he was treated with radiation and chemotherapy (5FU and CDDP). He died of local recurrence 7 months later.
    Case 2: A 68-year-old man had a 2-year history of right nasal obstruction. CT scan and MR imaging of his face revealed a mass arising within the right ethmoid sinus, involving the right nasal cavity, the right medial orbit and the anterior cranial base. Intranasal biopsy showed well-differentiated squamous cell carcinoma. Radiation therapy was given to the patient preoperatively.
    After extirpation of the tumor involving with right orbital content and the anterior skull base, the defect was reconstructed with a free abdominis flap only. Postoperatively he was treated with chemotherapy (5FU and CDDP).
    This patient has been followed up for 1 year and shows no evidence of recurrence of the disease.
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  • Maxillary Cysts
    A Report of Four Cases
    Masaaki Kashiwamura, Keiji Iizuka, Hisashi Mikuni, Yoshihiro Dousaka
    1992 Volume 85 Issue 5 Pages 747-753
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.747
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    There are several kinds of maxillary cysts, but it is sometimes difficult to differetiate among them, because there is no useful clinical classification of maxillary cyst.
    Recently we treated four patients with maxillary cysts. In the first we used fatty tissue for filling the dead space in the maxillary bone after extirpating the cyst.
    The results were very good. We propose a new classification of maxillary cysts on the basis of our operative results.
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  • Branchiogenic Cyst within a Parotid Gland
    A Case Report
    Takeshi Akisada, Yozo Orita, Hidekazu Yamamoto, Kuniko Akisada
    1992 Volume 85 Issue 5 Pages 755-759
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.755
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    A 71-year-old male complained of painless swelling in the left parotid region. It was elastic hard to palpation, non-tender, mobile, and measured 2.5×3.0cm. Facial nerve function was normal. The preoperative diagnosis was mixed tumor, and the mass was removed surgically, with care not to injure the facial nerve. On gross examination, the lesion was cystic with a small lumen containing yellow serous fluid. The histologic examination revealed a Branchiogenic cyst. The postoperative course was uncomplicated, and there has been no recurrence to the present time.
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  • Pilomatrixoma Arising from Parotid Region in Two Children
    Toshiaki Yamanaka, Masako Yokota, Katsuya Akioka, Yoshihiro Tsuruta, O ...
    1992 Volume 85 Issue 5 Pages 761-765
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.761
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    Pilomatrixomas (calcifying epithelioma) are calcifying benign tumors originated from hair matrix cells.
    Two young female patients had tumors of the parotid area.
    It is difficult to diagnose these cases as pilomatrixoma before operation because the clinical features of pilomatrixoma are similar to those of parotid tumors.
    These lesions, which contained calcifications and were unrelated to the parotid gland, were revealed not by soft X-ray photography but by echography and parotid sialographic CT.
    Histopathological findings showed basophilic cells and shadow cells with calcification without mitoses.
    There have been no reports of recurrence or metastasis after operation.
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  • Tonsillolith
    A Case Report
    Hideyuki Kataoka, Kiyoshi Kubota, Seiji Kishimoto
    1992 Volume 85 Issue 5 Pages 767-772
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.767
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    A case of tonsillolith was reported with a literature review.
    A 70-year-old-female was referred to us because tonsillar malignancy was suspected. She has a 1-year history of tonsillitis. A large, yellowish, white and rough stone was found at biopsy. It measured 2.3×1.6×1.3cm and weighted 4.5g. The stone was composed mostly of calcium phosphate.
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  • Foreign Body in Tonsil (Radon Seed)
    A Case Report
    Setsuko Morinaka
    1992 Volume 85 Issue 5 Pages 773-776
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.773
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    A 31-year-old female was treated for tonsillitis with bilateral radon seeds in 1967. The inflamation of the tonsils was improved by the treatment, but a few years later tonsillitis recurred on both sides. The initial consultation was on May 2, 1991 and amygdales plongeantes was found. X-ray examination proved that a radon seed had stayed within the right tonsil. Laboratory examinations were within the normal range except for eosinophilia, which is often observed in patients with asthma or allergic rhinitis. When the tonsillectomy was done on June 11, 1991, a part of the buried radon seed was found near the center of the back of the right tonsil and it was possible to remove the radon seed completely.
    This is a rare case of a radon seed buried in the right tonsil for 24 years.
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  • Abortive Malignant Hyperthermia
    A Report of Three Cases
    Tachio Ono
    1992 Volume 85 Issue 5 Pages 777-782
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.777
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    Three patients had an abortive type of malignant hyperthermia (MH) caused by general anesthesia: a 28-year-old male whose planned tonsillectomy was abandoned, a 43-year-old male whose tympanoplasty was performed and a 41-year-old male whose microlaryngosurgery was also performed. All three were given SCC and intubated. MH was suspected from the port-wine-colored urine and muscle pain. They were diagnosed as having abortive type MH because there was no high fever and they recovered after intravenous infusions.
    We consider that the abortive type without a high fever is more frequent than the fulminant type and that the cause of both types of MH is at least destructive muscle disturbance caused by general anesthesia. So we propose a new nomenclature “post-anesthtic myopathy (PAM)” which is divided into two types, a fulminant type, so-called “malignant hyperthermia”, and a mild type.
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  • How Does Tizanidine Effect Tinnitus?
    Hiroya Kitano, Mikio Suzuki, Masaaki Kitahara
    1992 Volume 85 Issue 5 Pages 783-788
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.783
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    Tizanidine hydrochloride is a newly developed muscle relaxant which has proved effective in the treatment of tinnitus, but whose effects on the cochlear nervous system remain poorly understood. The present study attempts to clarify this question through an investigation of tizanidine's effects on the auditory brainstem response (ABR) in guinea pigs.
    A prolongation of the interpeak latencies between waves I-III was observed following the injection of tizanidine. Statistically significant differences between the tizanidine group and a control group were especially evident 3 to 15 minutes following injection. Decreases in the amplitude of wave III were also seen, with statistically significant differences between the tizanidine group and control group being particularly evident 10 to 15 minutes after injection.
    The experiment indicates that tizanidine acts principally upon the central areas of the cochlear nervous system. Comparison of these results with those of other researchers' studies on lidocaine shows that tizanidine's effects on the ABR bear a basic resemblance to those of lidocaine. Hence this agent, like lidocaine, may act to suppress tinnitus principally at the synapses of the central cochlear nervous system.
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  • Vestibulo-C ollic Reflex Induced by External Ear Canal Irrigation
    -Comparison of Normal Volunteers and Patients of Spino-Cerebellar Degeneration-
    Ryuichi Osanai
    1992 Volume 85 Issue 5 Pages 789-803
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.789
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    The three parameters (yawing: Y, sliding: S, and rolling or “wipering”: W) of calorically induced head movements (vestibulo-collic reflex, VCR) were measured by a method using three rotary photosensors.
    The subjects were 38 normal volunteers and 373 neurological patients, including 63 with spino-cerebellar degeneration (SCD). To elicit VCR, the external auditory canal was irrigated with 2 ml of 20°C water within 20 seconds.
    [RESULTS]
    1. The VCR parameters moved to the side of cold water irrigation in normal volunteers, patients with SCD and patients with other neurological diseases.
    2. In normal volunteers, Y and W showed a statistically significant positive relationship with the maximum slow phase velocity of caloric nystagmus (SPVmax). Bilateral Y, left S and bilateral W showed a weak but statistically significant positive relationship with SPVmax, except in SCD patients, who showed no relationship between VCR parameters and SPVmax.
    3. Both normal volunteers and SCD patients showed almost the same time course of VCR parameters, but the duration of caloric nystagmus in SCD patients was significantly shorter (rt: 153±21 sec, lt: 170±41 sec) than in normal volunteers (rt: 181±38 sec, lt: 188±35 sec). Several patients with SCD showed absent or diminished caloric nystagmus although they showed virtually normal VCR.
    4. These results suggest that the vestibulo-ocular system and the VCR system are damaged in different ways in the central nervous system of patients with SCD.
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  • Epidermal Growth Factor in Salivary Glands
    -Epidermal Growth Factor and its Receptor in Human Salivary Glands-
    Motoko Ino, Koichi Ushiro, Chiyonori Ino, Toshio Yamashita, Tadami Kum ...
    1992 Volume 85 Issue 5 Pages 805-814
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.805
    JOURNAL FREE ACCESS
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    Epidermal growth factor (EGF) stimulates the growth and differentiation of normal and tumor tissues after binding to its receptor (EGFR). To study the correlation between histological malignancy of salivary gland tumors and expression of EGFR or EGF, we investigated immunohistochemical expressions of EGFR and EGF in normal salivary glands and salivary gland tumors (n=136).
    In normal salivary glands (parotid, submaxillary, sublingual and minor salivary glands), EGFR and EGF were detected in ductal segments of intercalated, striated, and excretory ducts, but not in acinar cells. In salivary gland tumors, EGFR and EGF were positive in luminal tumor cells and squamous metaplastic cells in pleomorphic adenoma, tumor cells in adenolymphoma, epidermoid tumor cells in mucoepidermoid tumor, luminal tumor cells of tubular pattern in adenoid cystic carcinoma, and all tumor cells in adenocarcinoma and epidermoid carcinoma. But they were negative in acinic cell tumor, mucous tumor cells in mucoepidermoid tumor, tumor cells of cribriform pattern and outer tumor cells of tubular pattern in adenoid cystic carcinoma.
    EGFR and EGF are positive in duct-like arrangement cells of pleomorphic adenoma and adenolymphoma, which are considered to be well differentiated. On the other hand EGFR and EGF positive cells the arrangement of which is not similar to duct structures like adenocarcinoma or epidermoid carcinoma are thought to have more potential for growth. The EGFR positive rate is 100% in adenocarcinoma and epidermoid carcinoma which have a poor prognosis. The synchronous expression of EGFR and EGF may play some biological role in tumor proliferation by an autocrine mechanism.
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  • Application of S-CMC to Otitis Media with Effusion
    Yukiko Ito, Jun Shinogi, Kunio Shoji, Tsuyoshi Taniguchi, Chieko Tanig ...
    1992 Volume 85 Issue 5 Pages 815-819
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.815
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    A drug which reduces the need of surgery is required in the treatment of otitis media with effusion (OME) in children. We investigated the clinical efficacy of s-carboxymethylcysteine (S-CMC) without surgery on OME in children. S-CMC in a dose of 30mg/kg/day was administered for 2 weeks to 44 children (61 ears) under ten years of age with OME. The efficacy was evaluated at the end of treatment.
    1) In the 61 ears treated, responses were excellent in 3 (4.9%), good in 14 (23.0%), moderately good in 13 (21.3%), fair in 28 (45.9%), and poor in 3 (4.9%).
    2) An adverse reaction was noted in only one of the 44 patients (2.3%).
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  • Azelastine Hydrochloride Treatment of Allergic Rhinitis
    -Multi-Hospital Clinical Study in Nara Prefecture-
    Yoshiyuki Kitaoku, Takashi Matsunaga, Hiroshi Miyahara, [in Japanese], ...
    1992 Volume 85 Issue 5 Pages 821-835
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.821
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    The effects of azelastine were investigated in 23 patients with perennial and 57 with seasonal allergic rhinitis seen in our institutions between October 1986 and April 1988. The antigen in seasonal allergic rhinitis was identified as Japanese cedar pollen in 45 patients and cock's footgrass in 12.
    1. In the rating general improvement of the response was classified as moderate or better in 47.8% of those with perennial rhinitis and as slight or better in 82.6%. The corresponding values for seasonal rhinitis were 57.9% and 84.2%. The combined ratings were 55.0% and 83.8%, respectively.
    2. Treatment reduced the following symptoms: sneezing, nasal secretions, nasal obstruction, disturbances in daily living, and volume of secretion.
    3. Japanese cedar pollinosis was treated in 25 patients in 1987 and in 20 in 1988. The general improvement ratings were 40.0% and 68.0% in 1987 and 75.0% and 95.0% in 1988. Considering that in 1988 the Japanese cedar pollen count was four times that in 1987 the difference in the general improvement rating between the two years may be due more to the duration of treatment than to the pollen count.
    4. Drowsiness as an adverse reaction was noted in 4 of the 80 patients, and treatment was discontinued in one.
    5. In general utility the drug's usefulness was rated as moderate or better in 47.8% of the perennial rhinitis patients and as slight or better in 78.3%. The corresponding values for the seasonal rhinitis patients were 57.9% and 84.2%, respectively. The general utility ratings for both types combined were 55.0% and 82.5%.
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  • Statistical Review of ENT Emergency Patients
    Atsushi Yuta, Taro Maeda, Jun Shinogi, Shinya Kawaguchi
    1992 Volume 85 Issue 5 Pages 837-843
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.837
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    A statistical review was made of the 2914 emergency patients observed at the Maeda ENT Hospital between January 1, 1988 and December 31, 1990.
    1. The patients showed a wide age range, but 55.9% were children under ten years of age.
    2. 66.4% of the patients were seen on weekends and national holidays.
    3. 71.4% of the patients were seen in or near our city, but about 10% were seen in areas requiring more than 1 hour of travel by car.
    4. The most frequent emergency disease was acute otitis media (51.5%), followed by acute upper respiratory inflammation (13.2%), foreign body (12.0%), nasal bleeding (7.6%) and injury (5.6%).
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  • Sudden Deafness
    [in Japanese]
    1992 Volume 85 Issue 5 Pages 844-845
    Published: May 01, 1992
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.85.844
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