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87 巻, 2 号
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―診断と治療―坂井 真1994 年 87 巻 2 号 p. 153-161
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーIn 116 ears of 106 patients with ossicular abnormalities with intact tympanic membranes, the preoperative diagnosis, differential diagnosis, operative findings and postoperative results were analyzed. The ossicular abnormalities in this study included 44 ears with otosclerosis, 48 with congenital anomalies and 22 with traumatic ossicular disruption.
For the preoperative diagnosis, history taking and stapedial reflex tests were thought to be more reliable and useful diagnostic tools than tympanograms and radiological imaging.
In congenital anomalies of the ossicular chain, surgeons should pay attention to auricular and facial anomalies even those of minimal degree, because there might be a close relationship between the ossicular anomaly and an auricular or facial anomaly.
In traumatic ossicular disruption, history taking is indispensable and may disclose a history of minor head trauma such as falling down stairs in childhood.
Reconstruction of the ossicular chain is most often successful for otosclerosis, and for traumatic disruption, but is not always satisfactory for congenital anomalies. Ossicular anomalies may be associated with other anatomical abnormalities such as facial nerve dehiscence, perilymph gusher etc. in exploratory tympanotomy. If so, the surgical results will not be satisfactory.
In obtaining informed consent, all surgeons should be aware of these unexpected situations, and complete information regarding the surgical complications and the operative results should be given to the patient and his or her family.抄録全体を表示PDF形式でダウンロード (5477K) -
柳田 則之, 曽根 三千彦, 中田 誠一, 中島 務1994 年 87 巻 2 号 p. 162-163
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1767K) -
結縁 晃治, 中田 道広, 増田 游, 竹久 亨1994 年 87 巻 2 号 p. 165-170
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーA man, suffering from hypertension, was affected by dizziness and nausea. These symptoms disappeared in a week under medical treatment.
Six or seven years later, the patient again had severe vertigo, nausea and vomiting again. After this attack, he complained of continuous dizziness. Infarction of the inferior left cerebellar hemisphere was detected by MRI, but no abnormal image was found in the medial part of the cerebellum.
We recognized no neurological signs caused by dysfunction in the cerebellar hemisphere, intension tremor, dyssynergy, etc., but severe disequilibrium was confirmed by Romberg's test, Mann's test and in the squatting position.
In the sitting position, the patient did not exhibit gaze nystagmus, but through Frenzel's glasses we recognized downbeat nystagmus in the right and left eye position. In the supine position with his head hanging down, the patient showed spontaneous downbeat nystagmus. This nystagmus increased with gazing, decreased without gazing and included high frequency pendular-saccadic movements. Caloric nystagmus was well developed in both ears, and visual suppression was also good. A horizontal eye tracking test (ETT) showed smooth eye movements and optokinetic nystagmus (OKN) was well developed.
These otoneurologic findings indicated that 1) there was no difference between right and left eye vestibular functions, 2) his brain stem function was not damaged, 3) neurological lesions were present in the medial part of the cerebellum, flocculus, nodules and vermis. These findings disagreed with those of MRI imaging, suggesting that the medical imaging has its limitations in demonstrating lesions of the central nervous system.
This case showed us that diagnosis of disequilibrium should be based not only on results of medical imaging, but also on otoneurological findings.抄録全体を表示PDF形式でダウンロード (1807K) -
金丸 眞一, 福島 英行, 中村 一, 木村 裕毅, 玉木 久信1994 年 87 巻 2 号 p. 171-176
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーThe severe type of idiopathic sudden sensorineural hearing loss (ISSHL) was treated with genetic recombination interferon alpha-2a (alpha-IFN) (3 million IU/day for 10 days) plus cortico-steroid, and the results were significantly better than those obtained by conventional treatment with cortico-steroid, vitamins, and vasodilators. Assays for 2'-5' oligoadenylate synthetase (2-5 AS), one of the indices of circulating anti-viral activity were performed patients before and on the third day of IFN therapy, and the levels were found to correlate well with the degree of their hearing improvement. These results suggest that viral infections may be related to the etiology of the severe type of ISSHL and that alpha-Interferon is useful in its treatment.抄録全体を表示PDF形式でダウンロード (645K) -
―人工内耳改良の手がかりとして―大森 孝一, 児嶋 久剛, 庄司 和彦, 塩見 洋作, 本庄 巖1994 年 87 巻 2 号 p. 177-183
発行日: 1994/02/01
公開日: 2011/08/10
ジャーナル フリーThe ability to recognize consonants, especially voiceless plosives, is inadequate in patients with multi-channel cochlear implants. In order to establish a key for the recognition of voiceless plosives [p] [t] [k], we examined the consonant-vowel syllables [pa] [ta] [ka] and processed various syllables by computer; 1) the parts of a consonant signal were differentiated; 2) the connection of consonants and vowels in other syllables was determined; 3) the synthesis of the vowel [a] was studied in 10 repetitions of the first waveform. These processed syllables were examined by four doctors and one speech therapist.
For the recognition of voiceless plosives, a signal of at least 1 msec for the voiced onset of the consonant and a spectral information, especially at high frequencies, in regard to the vowels are important factors. The recognition of a short voice onset and emphasis of high frequency power are essential for the improvement of speech perception in cochlear implant.抄録全体を表示PDF形式でダウンロード (693K) -
伊藤 壽一, 高木 明, 本庄 巖, 高橋 晴雄, 川野 通夫1994 年 87 巻 2 号 p. 185-192
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーSince 1987 we have performed multichannel cochlear implants in 34 patients with severe hearing impairment. Although we have had little experience with the surgical procedure and postoperative complications, postoperative speech recognition was satisfactory. However, some patients complain about their hearing in a noisy environment or while listening to TV and music. The present cochlear implant system needs further improvement.抄録全体を表示PDF形式でダウンロード (780K) -
―内リンパ水腫関連疾患を中心に―竹田 泰三, 柿木 章伸, 齋藤 春雄1994 年 87 巻 2 号 p. 193-197
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーWe reported previously that a high level of plasma antidiuretic hormone (ADH) was frequently observed in patients with endolymphatic hydrops. However, the reason for this elevation in plasma ADH level remains unclear. The secretion of ADH is known to be controlled mainly by plasma osmolality. We investigated the correlation between the plasma ADH level and plasma osmolality in 106 patients with and in 59 without endolymphatic hydrops. The mean plasma ADH level was 6.8±4.1pg/ml in the patients with endolymphatic hydrops, significantly higher than the 3.2±2.0pg/ml level in those without endolymphatic hydrops (t-test, p<0.001); but there was no significant difference in plasma osmolality between the two groups, in both of which it was in the normal range. Thus, the markedly elevated plasma ADH level found in patients with endolymphatic hydrops seems to be independent of plasma osmolality.抄録全体を表示PDF形式でダウンロード (603K) -
宇野 芳史, 斎藤 龍介, 前田 学, 金谷 真1994 年 87 巻 2 号 p. 199-206
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーHearing was tested in 49 ears with intact stapes superstructure 1-12 months after ossicular reconstruction and tympanoplasty. Audiograms were recorded not only at speech frequenices but at all seven frequencies from 125 to 8000Hz. Thirty bone autografts (preserved ossicles and mastoid cortical bone), 17 cartilage autografts and 2 hydroxyapatite ossicular prostheses (Apaceram-P) were used as columellae.
1. Overall success rates according to the criteria of Clinical Otology Japan (1987) were 82.9% at 6 months and 83.9% at 12 months after surgery.
2. Postoperative hearing gains were obtained at all frequencies except 8000Hz, and hearing improvement was greater at low and middle frequencies.
3. Hearing improvement was greatest 6 months after surgery, and it declined gradually until 12 months after surgery at both low and high frequencies.
4. The evaluation of postoperative hearing after modified type III tympanoplasty, which includes ossiculoplasty, should be done about 12 months after surgery.抄録全体を表示PDF形式でダウンロード (954K) -
高木 明, 本庄 巖, 藤田 明彦, 中村 一, 伊藤 壽一1994 年 87 巻 2 号 p. 207-213
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーThe results of tympanoplasty using allogenic auditory ossicle (incus) were studied in 30 ears 6 or more months after surgery. The allogenic auditory ossicles were supplied by Pfrimmer-Viggo Gmbh & Co in individual sterile packs and used for columellae in type III or IV tympanoplasty. Hearing success was defined as a postoperative pure tone threshold of <40dB or a 15dB improvement of hearing level or an air-bone gap of <20dB. The overall success rate was 73% (22 cases). Mean preoperative and postoperative pure tone air-bone gap was 35.0dB and 19.4dB, respectively. The postoperative pure tone air-bone gap was reduced to 20dB or less in 18 patients (60%). In 2 patients (6%) extrusion occurred, one with adhesive otitis media and one with recurrence of cholesteatoma.
The allogenic auditory ossicle (incus) is considered to be an effective alternative prosthetic material for ossicular chain reconstruction.抄録全体を表示PDF形式でダウンロード (2092K) -
北原 糺, 阪上 阪上, 肥塚 泉, 土井 勝美, 松永 亨, 浅井 英世1994 年 87 巻 2 号 p. 215-219
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーPre-operative ENG was carried out in 23 patients with cholesteatoma. The relationship between ENG findings and dizziness or middle ear disease was investigated. Those with nystagmus directed to the affected ear complained of significantly more dizziness than did the others. Cholesteatoma and/or granulation around the stapes was seen significantly more frequently in the former than in the latter patients. Patients with canal paresis (CP) in the affected ear had dizziness and pathologic findings around the stapes significantly more often than did CP-negative patients. These results suggest that pre-operative ENG can provide some information about lesions in the middle ear and inflammation of the inner ear.抄録全体を表示PDF形式でダウンロード (654K) -
―外鼻エピテーゼについて―雨皿 亮, 臼井 秀治, 高津 暢尚, 稲垣 政志, 清水 猛史, 西井 さつき, 間島 雄一, 坂倉 康夫1994 年 87 巻 2 号 p. 221-226
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーThree Patients, all male, with squamous cell carcinoma of the external nose were treated: primary cancer of the nasal vestibule, direct invasion from cancer of a lacrimal gland, and distant metastasis from lung cancer. They all underwent total rhinotomy. The first died of renal failure before treatment was completed. For the other two, facial prosthesis were made from silicon color-matched to the facial skin. Facial prosthesis is considered to be advantageous in that the operated wound can be observed carefully and frequently so as to discover recurrence at an early stage. As facial prosthesis can be provided quickly after surgery and is suitable for follow-up of the operated area.抄録全体を表示PDF形式でダウンロード (4439K) -
西川 益利, 西川 恵子1994 年 87 巻 2 号 p. 227-229
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーMagnetic resonance imaging (MRI) was useful in diagnosing primary ethmoid mucocele, which appeared as a high signal intensity with a distinct border in T2-weighted images and a low signal intensity region in T1-weighted images. The mucocele was treated by intranasal ethmoidectomy.抄録全体を表示PDF形式でダウンロード (1951K) -
田原 哲也, 緒方 洋一1994 年 87 巻 2 号 p. 231-236
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーPseudotumor is a term used to describe a space-occupying inflammatory lesion which mimics a true neoplastic process in its clinical presentation. We report a case of plasma cell granuloma of the right maxillary sinus that presented with swelling of the cheek. It is difficult to differentiate this rare lesion from a malignant tumor by imaging procedures. We diagnosed plasma cell granuloma postoperatively. Histological examination showed infiltration of plasma cells in the fibrous stroma. In these plasma cells there were no atypical features.抄録全体を表示PDF形式でダウンロード (3706K) -
―アンケート調査結果―長山 郁生, 木村 恭之, 瀧口 哲也, 三輪 高喜, 古川 仭1994 年 87 巻 2 号 p. 237-242
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーSince April 1990 we have used endoscopic sinus surgery (ESS) in the treatment of the chronic sinusitis in 54 patients aged 9 to 70 years. Follow-up information was sought by questionnaires mailed to all 54 patients. Thirty patients replied, and the charts of 14 others were reviwed. Ten patients were lost to follow-up. Of the 44 patients, 36 (82%) had resolution of their symptom, and 8 patients (18%) were unchanged. Of the unchanged patients 5 were young and 3 had previously undergone Caldwell-Luc surgery. The only operative complication was a lamina papyracea perforation in 1 patient, whose postoperative course, however, was uneventful. CT scan played an important role in demonstrating the state and extension of sinusitis and the paranasal anatomy. In most of the patients, the infection was in the anterior ethmoid sinuses. These results confirmed the concept of anterior ethmoid-middle meatus complex. We conclude that endoscopic sinus surgery is effective in the treatment of chronic sinusitis.抄録全体を表示PDF形式でダウンロード (2479K) -
石田 達也, 大津 信也, 嶋田 高明, 佐野 壽昭, 馬淵 厚至, 岡田 修治1994 年 87 巻 2 号 p. 243-251
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーA 2-year-old female with chief complaints of sneezing and mouth breathing was the 55th case of papillary hypertrophy of the palatine tonsil (PHPT) to be reported in Japan. She had no past history of frequent tonsillitis and no family history of PHPT. Polysomnographic examination showed that the maximum amplitude of mesopharyngeal pressure was 127 cmH2O and the minimum level of oxygen saturation was 52%. The diagnosis was severe upper airway obstruction (UAO), so adenotonsillectomy was performed. Postoperative improvement was definitive. Histological examination revealed chronic proliferative tonsillitis plus papillary structures and slight thickness of the surface epithelium.
The reports of 55 patients with PHPT published in Japan are reviewed. Clinical symptoms are described in 50 cases. Of the 26 children (under 13 years of age) 10 had a positive family history of recurrent tonsillitis, while the family history was negative in 22 of the 24 older patients. UAO was described in 10 (63%) of the 16 children without a family history. There was no past history of recurrent tonsillitis in 5 patients (56% of the children with UAO with no family history). The results of our investigation suggest that PHPT can also be caused by the mechanical stimulation due to the negative pressure induced by UAO, although the etiology of PHPT has been thought to be mainly inflammatory stimulus or congenital anomaly.
UAO in PHPT patients was relieved by tonsillectomy, although the adult type of UAO is usually not improved by tonsillectomoy alone. Thus, the etiology may be different between UAO in patients with PHPT and in those with the so-called adult type of UAO.抄録全体を表示PDF形式でダウンロード (3913K) -
平野 滋, 北村 薄之, 宮田 耕志, 金子 賢一, 安里 亮1994 年 87 巻 2 号 p. 253-257
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーTwenty one patients with extracranial neurinomas of the head and neck were treated at Tenri hospital from 1970 to 1992. The origin was the vagus nerve in 5 patients, cervical nerves in 4, the sympathetic trunk in 2, etc. The most common symptom was a mass in the neck. Only 3 patients had pre-operative palsy of the nerve of origin. MRI was especialy useful for the diagnosis. The tumors showed low intensity on T1 weighed images and high intensity on T2 weighed images and peripheral hyperintense rim with central low intensity on enhanced T1 images. Intracapsular removal of the tumor was performed in 8 patients who had post-operative nerve palsy: 5 of them recovered from the palsy. Only one patient had a recurrence after intracapusular resection. It was concluded that intracapusular removal is useful.抄録全体を表示PDF形式でダウンロード (1689K) -
―系統的な原因精査の重要性―古川 政樹, 古川 まどか, 大石 公直, 松田 秀樹, 陰里 ゆうみ1994 年 87 巻 2 号 p. 259-264
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーA 53-year-old female was referred to our clinic in January, 1993, because of hoarseness for 10 days. The left vocal cord was fixed in the paramedian position. Ultrasonography of the neck revealed a hypoechoic mass (12×12×11mm) in the left lobe of the thyroid gland. The mass was not palpable and was not seen in a CT scan of the neck. Fine needle aspiration cytology under ultrasonographic guidance showed a class V papillary adenocarcinoma. Subtotal thyroidectomy and left radical neck dissection were performed. The postoperative course has been uneventful, but the vocal cord paralysis was not improved.
It is emphasized that a thorough examination is essential to determine the cause of vocal cord paralysis rapidly.抄録全体を表示PDF形式でダウンロード (3595K) -
佐藤 英治1994 年 87 巻 2 号 p. 265-275
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーCochlear changes were studied in three different age groups of Sprague-Dawley rats: 1 month, 6 months, 24 months. Morphological changes in the cochlea were investigated by scanning electron and light microscopy, and auditory brainstem responses (ABR) were recorded.
At 24 months the threshold of ABR was significantly higher than at 1 and 6 months. Hair cell and ganglion cell loss increased with aging.
At 1 and 6 months of age hair cell loss was very slight. At 24 months it had increased, especially in the apex and basal turn. Hair cell loss was most severe in the outer hair cells of the third row, followed by those in the second row and the first row and least severe in the inner hair cells.
At 24 months inner hair cell loss was scattered and averaged 3.3%. Outer hair cell loss was greatest in the third row at 24 months (average, 21.3%).
The population of spiral ganglion cells was decreased at 24 months throughout the ganglia, with the greatest loss in the basal turn.
No significant correlation was found between age and the number of nerve fibers in the habenula perforata.
The pattern of cochlear changes with aging in Sprague-Dawley rats was similar to the human pattern.抄録全体を表示PDF形式でダウンロード (6622K) -
浅井 美洋, 梅村 和夫, 石崎 久義, 森田 浩史, 宮下 弘, 武林 悟, 船井 恒嘉, 荻野 哲史, 天野 肇, 野末 道彦1994 年 87 巻 2 号 p. 277-282
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーThe clinical effect of Celeport® was evaluated in 55 patients (mean age: 67 years), complaining of chronic dizziness or imbalance. Subjective symptoms, objective findings, subjective disability in activities of daily living and quality of life were recorded. The doctors in charge reported some improvement in 76.4% of the patients and noted that Celeport® reduced dizziness in 79.6%. Subjective disability in activities of daily living was significantly improved (p<0.01). Quality of life, especially a feeling of satisfaction with family life was also significantly improved by Celeport® administration (p<0.05). In conclusion, Celeport® was an effective treatment for patients complaining of chronic dizziness or imbalance.抄録全体を表示PDF形式でダウンロード (727K) -
池田 勝久, 小林 俊光, 高坂 知節1994 年 87 巻 2 号 p. 283-287
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーThe clinical effectiveness of the antifungal drug ‘fluconazole’ was evaluated in 13 patients with fungal infections of the external anditory canal and middle ear. Fluconazole was dissolved in physiological saline to make up 0.2% and was used as ear drops twice a day. The therapeutic effect was very good in 61% (8/13), moderate in 31% (4/13) and slight in 8% (1/13). No adverse effect was noted. Fluconazole in ear drops is a useful agent in the treatment of otomycosis.抄録全体を表示PDF形式でダウンロード (546K) -
古賀 慶次郎1994 年 87 巻 2 号 p. 288-289
発行日: 1994/02/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (306K)
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