Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 87, Issue 1
Displaying 1-21 of 21 articles from this issue
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  • Gas Exchange in the Middle Ear
    Iwao HONJO
    1994 Volume 87 Issue 1 Pages 1-5
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.1
    JOURNAL FREE ACCESS
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    Gas exchange in the middle ear, as well as ventilation through the eustachian tube, has been thought to be important in the physiology and pathophysiology of the middle ear. From the clinical point of view, it should be determined whether the impairment of gas exchange is related to the development or prolongation of middle ear diseases. We found that normally developed mastoid air cells contribute greatly to gas exchange in the middle ear. Experiments in cats also revealed that tubal dysfunction alone does not necessarily cause either profound negative middle ear pressure or middle ear effusion. Thus, middle ear gas exchange, in cooperation with ventilation through the eustachian tube, is considered to keep the middle ear in a physiological condition, whereas in pathological conditions of the middle ear, such as otitis media with effusion, abnormal gas exchange appears to cause negative middle ear pressure due to absorption of oxygen in the middle ear cavity; in this process, cells either in the mucous membrane or in the effusion of the middle ear may consume oxygen in the middle ear cavity. In refractory otitis media, in which both poor mastoid pneumatization and intractable tubal dysfunction are generally observed, ventilation and pressure equalization of the middle ear are very difficult. Further investigation of gas exchange should be conducted in ears with both sclerotic mastoids and tubal dysfunction.
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  • Bony Tympanic Diaphragm and Anterior Tympanotomy in Cholesteatoma
    [in Japanese]
    1994 Volume 87 Issue 1 Pages 6-7
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.6
    JOURNAL FREE ACCESS
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  • Early Diagnosis of C erebello-Pontine Angle Tumors by Directional Hearing Test
    Tsunemasa SATOH, Naohisa IIZUKA, Katsuhiro SHIMODA, Shinobu NOHARA, Ta ...
    1994 Volume 87 Issue 1 Pages 9-22
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.9
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    The authors report 22 patients with cerebello-pontine angle lesions: 15 with acoustic tumors and 7 with menigiomas, epidermoids or trigeminal neurinomas. Nearly all showed close to normal or only slightly impaired hearing threshold levels on their audiograms.
    All patients received the full battery of directional hearing tests, speech audiometry, acoustic reflex threshold, and decay test, ENG and caloric test, and ABR test. Finally, they received CT scanning or MRI tests, and cerebello-pontine angle lesions were confirmed.
    Twenty patients (91%) had very positive findings, especially increased thresholds of interaural time discrimination in the directional hearing tests. This test has good sensitivity for retrocochlear lesions; it is very simple and needs only a few minutes to perform. The authors conclude that this test provides the most useful information in the early diagnosis of cerebello-pontine angle tumors, as a screening test.
    We present a flow-chart of the battery of tests in which the directional hearing test is performed in the early stage of test procedures.
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  • Convergence Nystagmus in Two Patients with Infarction of the Thalamus
    Mitsuya SUZUKI, Masahiro MIZUNO, Masaaki YAMANE
    1994 Volume 87 Issue 1 Pages 23-31
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.23
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    Convergence nystagmus, which is a main finding in Sylvian aqueduct syndrome is not common. We examined two patients of convergence nystagmus associated with infarction of the thalamus. The patients, aged 21 and 64-years, visited our clinic because of sudden dizziness. There was no cochlear sign in either case. Neurotological examinations, including electronystagmography (ENG), were carried out. Both patients had up-beat nystagmus, convergence nystagmus and abnormal vertical eye movements; however, no upward gaze palsy was observed. One patient showed a normal response to caloric testing, but the other showed rt-canal paresis (41%). On computerized tomography (CT scan), no lesion could be identified in the midbrain or thalamus of either patient. However, in one patient, T2-weighted MRI revealed a high signal region and Ti-weighted MRI demonstrated a low signal region in the lt-medial part of the thalamus. In the second patient, T2-weighted MRI revealed multiple bilateral lacunar high signal lesions in the thalamus, the putamen and in the region of the deep white matter. The etiology of abnormal vertical eye movements and convergence nystagmus is discussed with emphasis on the neurotological examinations and MRI.
    Convergence nystagmus may be associated with lesions of the posterior commisure and nucleus in the medial part of the thalamus, and abnormal vertical eye movements may be attributed to a lesion in the tract from ri-MLF to the posterior commisure.
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  • The Influence of Prolonged Bed Rest on the Vestibular System and the Autonomic Nervous System
    -A Preliminary Report-
    Tetsuya TAHARA, Toru SEKITANI, Hiroshi YAMASHITA, Yoichi OGATA
    1994 Volume 87 Issue 1 Pages 33-38
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.33
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    Prolonged bed rest often induces disturbed balance. However, there are few reports on this pathophysiological condition. Schellong's test, otolithic functional test and spontaneous, gaze, and positional nystagmus tests were performed to evaluate the influence of prolonged bed rest on the vestibular system and the autonomic nervous system in orthopedic patients without direct injury to the vestibular system.
    Systolic and diastolic blood pressure and heart rate were serially measured every 2 minutes in the supine position for 10 minutes and in the standing position for 10 minutes. We used a tilt chair apparatus which was electrically driven as far as 30 degrees at a speed of 1 degree per second. Eye movement was observed using a nystagmograph and recorded by a CCD-camera in front of the eyes. Spontaneous, gaze, and positional nystagmus were tested using the nystagmograph.
    Schellong's test was positive in 75% of the patients. Prolonged bed rest evoked abnormal findings on the otolithic functional test and nystagmus tests.
    It was suggested that prolonged bed rest induced autonomic nervous dysfunction and vestibular dysfunction.
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  • Electrocochleography of the C ontralateral Ear in Patients with Unilateral Meniere's Disease
    Yoshiyuki KITAOKU, Kazuhiko NARIO, Ikuo KITANO, Takashi MATSUNAGA, Kaz ...
    1994 Volume 87 Issue 1 Pages 39-44
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.39
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    It is well known that some patients with unilateral Meniere's disease subsequently develop bilateral involvement. Since electrocochleography (ECochG) is useful in assessing endolymphatic hydrops, extratympanic ECochG was performed on both ears of 44 patients with unilateral Meniere's disease from 1985 to 1992. We investigated the relationship between ECochG findings and the hearing level. The negative summating potential (SP)/action potential (AP) ratio of normal control subjects in response to 80 dBnHL clicks was 0.231±0.063 (n=40), so a negative SP/AP ratio of more than 0.36 (=mean±1.96SD) was regarded as a positive ECochG response.
    In 32 involved ears and 6 contralateral ears, the ECochG response was positive. The negative SP/AP ratio of the involved ears was larger than that of the contralateral ears in all cases. The negative SP/AP ratio showed a significant difference between the involved ears and the contralateral ears as well as between the involved ears and the ears of control subjects, but not between the contralateral ears and the control ears. The hearing level of the involved ears with a positive ECochG response was worse than that of the ears with normal ECochG findings. The hearing level of the involved ears was better when the contralateral ear was positive on ECochG than when it was not. The time from the first episode to the performance of ECochG was shorter when the contralateral ear was positive on ECochG than when it was not, but the difference was not significant. The largest negative SP/AP ratio in the contralateral ears was 0.48, which was not as large as that in the involved ears. It seems likely that patients with a positive ECochG response in the contralateral ear will develop bilateral Meniere's disease, but we have not yet confirmed this clinically.
    In conclusion, the contralateral ear may show a positive ECochG response even in the early stage of unilateral Meniere's disease.
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  • Transtympanic Electrocochleography in Meniere's Disease
    Masutoshi NISHIKAWA, Keiko NISHIKAWA
    1994 Volume 87 Issue 1 Pages 45-49
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.45
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    Transtympanic electrocochleography was performed in 51 patients with Meniere's disease. Both ears, (i. e., the ear affected by Meniere's disease and the contralateral ear) were examined. The SP-AP ratio of the ear with Meniere's disease (mean 0.40) was significantly higher than that of the contralateral ear (mean 0.27) (p<0.01). However, in six patients (14%) the SP-AP ratio of the contralateral ear was over 0.40. Therefore, the ear contralateral to the ear affected by Meniere's disease should not be classified as normal.
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  • A Clinical Study of Ear Trauma
    Masaya UCHIDA, Akiko NISHIYAMA, Ryou KAWATA, Masataka MURAKAMI, Fumika ...
    1994 Volume 87 Issue 1 Pages 51-59
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.51
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    We conducted retrospective study of 181 traumatic perforations of the eardrum and 174 traumas of the external canal that had occurred between January 1987 and December 1992.
    1) Almost all traumas of the external canal were due to direct injury during earwax removal.
    2) In patients under ten years of age, almost all ear traumas were due to direct injury during earwax removal. In patients over ten and under twenty years of age, numerous traumatic perforations of the eardrum were due to indirect injury from slapping or striking.
    3) Traumatic perforations of the eardrum doused spontaneously within 26.5 days on average.
    4) Spontaneous healing was sometimes delayed by infection.
    5) The period needed for closure of perforation did not differ in Grades I b, I c, II and III.
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  • Neurofibromatosis of External Auditory Meatus with Conductive Deafness
    Isamu ITO, Mitsuyoshi OHKI, Akihiro IKUI, Minoru IKEDA, Hiroshi TOMITA
    1994 Volume 87 Issue 1 Pages 61-65
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.61
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    We treated a 61-year-old male with neurofibroma of the external auditory meatus and conductive deafness. Numerous cafe au lait spots were scattered over his body since birth, and a small growth had appeared on the neck about 15 years earlier. He had noted a tumor in his left external auditory meatus and hearing impairment for about four months. The tumor coused pressure on the external auditory meatus leading to erosion and malodorous otorrhea. The tumor was removed because of the diagnosis of “von Recklinghausen's disease”. His hearing returned to normal after the operation. The histopathological diagnosis was neurofibromatosis.
    Neurofibromatosis type I is usually a cosmetic problem but seldom causes any functional disorder. This was one of the rare cases in which it caused auditory dysfunction, and surgical treatment was indicated.
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  • Treatment of Mandibular Fractures
    Hideo SHIGEMI, Yuichi KURONO, Noritake WATANABE, Goro MOGI
    1994 Volume 87 Issue 1 Pages 67-71
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.67
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    Twelve patients with mandibular fractures were treated with open reduction. Four patients with condylar fracture were treated by excision of the fractured segments which disturbed jaw movement. Patients without the condylar fracture were treated by transosseous wire and/or miniplate fixation. Intermaxillary fixation with an arch bar was also employed to obtain better postoperative occlusion in 8 patients with multiple fractures. However, for monofractures, the wire and miniplate fixation provides firm interosseous fixation and stable occlusion, so intermaxillary fixation with an arch bar is not necessary. In all 12 patients, good postoperative occlusion was acquired within 3 months after surgery.
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  • Parotid Sialolithiasis in a Child
    Yoshikatsu NAKAMURA, Shigeo SAEAI, Tomoo SUZUKI, Hideo MIYATA, Shigeno ...
    1994 Volume 87 Issue 1 Pages 73-77
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.73
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    The incidence of sialolithiasis in the parotid gland is usually lower than in the submandibular salivary gland. Parotid sialolithiasis was found in a 10-year-old child who visited our clinic with a complaint of repeated swelling of the left parotid gland. A salivary stone was noted on soft X-ray radiography, CT, Echo and sialography. The stone was treated with extracorporeal shock wave lithotripsy (ESWL). The patient has been of inflammation of the left parotid gland for 18 months.
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  • A Case of Pharyngeal Syphilis
    Tadahiko SAIKI, Yoshio OKAZAKI, Nobuhiro INOUE, Yoshito MIYAMOTO
    1994 Volume 87 Issue 1 Pages 79-86
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.79
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    The authors report a case of second-stage pharyngeal syphilis with condylomata lata. A 20-year-old female was admitted to the Department of Internal Medicine for the treatment of acute hepatitis type B. A few days prior to admission, she noticed increasing throat pain. At her first visit to the ENT clinic, the soft palate and bilateral pharyngeal tonsils showed severe erosion with a white-gray coating. In addition, some papules were found around the anus. Serological tests revealed high RPR and TPHA titers. After administration of benzyl penicillin, notable improvement was achieved.
    The number of reports concerning pharyngeal syphilis has been increasing lately. We should consider this disease when diagnosing a patient with erosive throat with a white-gray coating.
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  • Large Hemangioma of the Larynx; A Case Report
    Kazuki HAYAKAWA, Keisuke MIZUTA, Bunya KUZE, Takahiro YAMADA, Hideo MI ...
    1994 Volume 87 Issue 1 Pages 87-92
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.87
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    A large laryngeal hemangioma was found in a 45-year-old male complaining of abnormal sensation in the larynx. The tumor had a wide pedicle from the left arytenoid and the aryepiglottic fold, and was about 30mm in diameter. From laryngoscopic findings and CT scan, hypervascularity of the tumor was suggested. The tumor was resected by YAG laser under laryngomicroscope. Histological examination revealed cavernous hemangioma. The hemangioma has not reccurred for 6 months following surgery.
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  • CDDP Treatment for Nasopharyngeal Cancer with Chronic Renal Failure and Dialyzer
    Katsuhiko TETSUKA, Nagahiro SO, Yoriko ITO, Keiko KOBAYASHI, Shinjiro ...
    1994 Volume 87 Issue 1 Pages 93-97
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.93
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    Since one of the major side effects of CDDP (cisdiamminedichloroplatinum) is renal toxicity, the administration of CDDP to patient with renal failure is greatly restricted. In this case, we used CDDP with radiation for nasopharyngeal cancer in a patient with chronic renal failure under hemodialysis. We measured the concentrations of protein-binding and non-binding CDDP in serum. The side effect of bone marrow depression appeared while non-binding CDDP was low, but protein-binding CDDP was high. It is thought to be important to measure both types of CDDP in serum to monitor the side effects of CDDP in patients with renal failure.
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  • Safety of Carotid Ligation; Assessment preceding or during Surgery
    Akiko NISHIYAMA, Susumu MARUYAMA, Kaori HIGUCHI, Yuko SAITO, Takashi S ...
    1994 Volume 87 Issue 1 Pages 99-108
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.99
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    Treating patients with head and neck tumor occasionally requires permanent occlusion of the internal carotid artery (ICA). To assess whether a patient will tolerate this occlusion, we studied stump pressure, EEG and angiogram under direct clipping of the common carotid artery during surgery for severely invasive hypopharyngeal carcinoma. In other cases, we tried balloon test occlusion and measured cerebral blood flow (CBF) with positron emission tomography (PET) using C15O2. This direct clipping test can be performed with the usual surgical instruments and provides significant information on carotid ligation. However, we recognized that the information was not sufficient for a clear assessment even if the stump pressure and EEG were within the normal range. Balloon occlusion test and PET were performed in two cases. The first case showed temporary hemiplegia after a slight decrease in stump pressure, while the second case did not show any change despite a severe decrease in stump pressure. The second case showed an increase of CBF on PET. Stump pressure does not necessarily reflect changes in CBF, and PET should be used for more reliable assessment.
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  • Nonfunctioning Parathyroid Cysts; Report of Four Cases
    Osamu TANAKA, Takashi MATSUNAGA, Hiroshi MIYAHARA, Hitomi TAKAHASHI, Y ...
    1994 Volume 87 Issue 1 Pages 109-113
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.109
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    Four nonfunctioning parathyroid cyst are reported in this article. In the Japanese literature only 78 cases have been reported.
    Three women and one man, aged 41 to 79 years, presented with an asymptomatic neck mass thought to originate from the parathyroid gland. The lesions ranged in size from 37 to 77 mm in length. All were located on the left side of the neck. None of the patients had symptoms of hyperparathyroidism. In all cases, water-clear fluid was aspirated from the neck mass. The level of parathyroid hormone in the cyst fluid was greatly elevated. In 3 patients the cyst was excised; one patient was followed conservatively after aspiration.
    It is emphasized that needle aspiration of water-clear fluid high in parathyroid hormone is diagnostic and may be curative in some cases.
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  • Phonatory Function Following Thyroplasty (Type I) in Patients with Unilateral Vocal Cord Paralysis
    Shigenobu IWATA, Akihiko TAKASU, Kenji TAKEUCHI, Hitoshi TODA, Mikiko ...
    1994 Volume 87 Issue 1 Pages 115-121
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.115
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    Thyroplasty (Type I) was performed in 34 patients with unilateral vocal cord paralysis. Before and after operation, voice analysis and aerodynamic phonatory tests were performed. The thyroplasty was always done under local anesthesia with modified NLA, so that intra operative adjustments could produce optimal phonation and ensure satisfaction for both the patient and the operator. The patient was requested to phonate and sing to see the effect on the voice quality by medialization of the vocal cord through a window in the throid cartilage.
    A silicon plug, which had a ditch to fit the cut edge of the window, was inserted through the window, Our data indicate that thyroplasty is very effective in improving the voice in patients with a median or paramedian position of the paralyzed cord, but produces a limited improvement of phonatory function in patients with intermediate positions of the paralyzed vocal cord who have less than 3 seconds of maximum sustained phonation.
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  • Depth of Imprint on the Tectorial Membrane
    -Studies Using by 3 Dimensional Measurement System-
    Isuzu KAWABATA, Masato YAGI, Ryuichiro TAMOCHI
    1994 Volume 87 Issue 1 Pages 123-129
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.123
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    This study estimated the depth of imprint on the tectorial membrane using a new three dimensional measurement system. The tectorial membrane covers the surface of the organ of Corti. The tips of the sensory cell hairs are firmly embedded in the undersurface of the tectorial membrane. Scanning electron microscopic findings show the existence of small holes (hair imprint) made by tips of sensory hairs.
    Since the sensory cells of the organ of Corti are believed to be stimulated by bending the sensory hair, it is interesting to determine the depth of imprint. The three dimensional measuring system used in the present studies, was recently developed and can measure the surface structure of a material. The principles of the system are described.
    According to this system, the depth of imprint varies but average values are from 0.02 to 0.03 um. The bird's-eye view of the imprints obtained by this system are also shown. The findings are briefly discussed.
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  • Bacteriological Effect of NFLX in Suppurative Otitis Media
    Yasuyuki ISHIKAWA
    1994 Volume 87 Issue 1 Pages 131-139
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.131
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    The occurrence of drug-resistant bacteria such as MRSA is one of the major problems in the treatment of infectious diseases. The author evaluated the clinical and bacteriological effects of Norfloxacin (NFLX) in 23 patients with acute suppurative otitis media (AOM) or acute exacerbations of chronic suppurative otitis media (COM) from October 1986 to February 1987. A similar investigation was performed from October 1992 to February 1993, in 33 patients with AOM or COM, to determine whether NFLX-resistant bacteria have increased during the past 6 years. The clinical efficacy of NFLX was also examined in these patients and compared to that in the former study.
    The frequencies of NFLX-sensitive bacteria in the former period were 95.5% for gram positive bacteria and 83.3% for gram negative ones. In the latter period the figures were 94.4% and 100%, respectively; i. e., no significant difference between the two periods.
    The clinical efficacy rate for suppurative otitis media in the former study was 72.0% and in the latter 80.0%. The difference was not significant.
    It appears that the antibacterial activity of NFLX has remained unchanged during the past 6 years.
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  • Effect of CPDX-PR on Pediatric Infections
    Katsuhiko TAMAKI, Toyohiko SAKAI, Kiyotaka MURATA, Fumihiko OHTA, Hisa ...
    1994 Volume 87 Issue 1 Pages 141-149
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.141
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    We investigated the clinical and bacteriological effects of Cefpodoxime proxetil (CPDX-PR) in pediatric infections in 118 boys and 111 girls aged one month to 14 years and 7 months. The diagnosis was acute otitis media in 89, acute tonsillitis in 81, acute pharyngolaryngitis in 34, paranasal sinusitis in 22, and other infections in 3. The daily dose of CPDX-PR was usually 9 mg/kg, but some adjustments were made depending on the effect. In 165 patients the causative organisms were cultured: H. influenzae was the most common, followed by S. aureus and S. pneumoniae. Gram-positive bacteria were detected in 54.2%, Gram-negative bacteria in 45.3%, and fungi in 0.5%. The incidence of Gramnegative infection is higher in children than in adults. The efficacy rate was 91.3%. Side effects were noted in 4 patients but they were mild. Rapid hematological effects on WBC counts, ESR, and differential counts were observed with the administration of CPDX-PR.
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  • Qualifying Processes of Otolaryngologist in the United States
    [in Japanese]
    1994 Volume 87 Issue 1 Pages 150-151
    Published: January 01, 1994
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.87.150
    JOURNAL FREE ACCESS
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