Practica oto-rhino-laryngologica. Suppl.

Clinical Significance of AC/DC% in the Vocal Function Tests

Kazutomo Kitajima

1993 Volume 1993 Issue Supplement66 Pages 1-12
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_1

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The rate of AC component to DC component of the expiratory flow rate during sustained phonation (AC/DC%) was studied to determine whether it can reflect the stiffness of the vocal folds.
In normal subjects, AC/DC% increased with intensity of phonation, which could be explained by changes in stiffness of the vocal folds.
AC/DC% reflected the stiffness of the vocal folds in pathological larynges.
AC/DC% was more sensitive to pathological changes in the vocal folds than was mean flow rate.
AC/DC% reflected some aspect of laryngeal efficiency.

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Laryngeal Function Following Subtotal Laryngectomy

Kazutomo Kitajima

1993 Volume 1993 Issue Supplement66 Pages 13-24
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_13

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Five patients with supraglottic laryngeal cancer were treated surgically using Biller's technique of 3/4 laryngectomy and five patients with transglottal cancer were treated using Pearson's technique of near-total laryngectomy. Recovery of swallowing and phonatory functions following these surgeries were compared with those following vertical partial laryngectomy.
3/4 laryngectomy: The time required for recovery of swallowing was longer than that following partial laryngectomy. Phonatory functions were satisfactory. Supraglottic cancer with a possibility of downward invasion was considered to be safely treated with this procedure.
Near-total laryngectomy: Transglottal cancer was considered to be safely treated with this technique. Although permanent tracheostomy was necessary, phonatory functions were satisfactory.
These two laryngectomy techniques could extend the limits of partial laryngectomy and thus reduce the number of total laryngectomies.
The oncological safety of near-total laryngectomy is expected to be comparable to that of total laryngectomy.3/4 laryngectomy can be safely applied in selected cases.

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Long-Term Follow-Up of the Mastoid Cavity Obliteration for the Chronic Middle Ear Diseases

Yoshiro Yazawa, Masaaki Kitahara

1993 Volume 1993 Issue Supplement66 Pages 25-33
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_25

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Mastoid cavity obliteration using the Palva flap procedure was performed on 51 cases of chronic middle ear disease between 1978 and 1981. These cases included 30 cases of chronic otitis media (COM) and 21 cases of cholesteatoma. In 36 of the 51 (70.6%), the Palva flap procedure was combined with Feldmann's osteoplastic technique to reconstruct the posterior canal wall. In the remaining 15 cases, the Palva flap procedure was perfomed after the canal wall down (CWD) procedure. During the follow-up period of 11 to 14 years,13 of the 51 cases (25.5%) required revision surgery due to subsequent cavity problems. The pathological conditions which necessitated surgery in these 13 cases were cholesteatoma (7 cases), infection (3 cases), ossicular interruption (2 cases) and cyst formation (1 case). The Palva flap procedure combined with Feldmann's osteoplastic technique required a high incidence of revision surgery (11 of 36 cases; 30.6%) compared with the Palva flap procedure with CWD (2 of 15 cases: 13.3%). Noteworthy is the frequent appearance of cholesteatoma after Feldmann's technique (6 of 11 revision cases). The principle problem with this procedure was due to a minute gap that tends to remain between the posterior canal and the re-positioned bone. The canal skin gradually and silently intrudes into the cavity through this gap as the Palva flap atrophies, creating a new cholesteatoma; this condition was seen in revision surgery 95.7 months (52-132 months) after the initial surgery for 3 cases in which the original condition was COM.

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Clinical Features of Facial Paralysis in Children

Yoshiro Yazawa, Masaaki Kitahara

1993 Volume 1993 Issue Supplement66 Pages 34-42
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_34

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Clinical studies were performed on 121 cases of facial paralysis (FP) in children under 15 years old who were treated at our department between October 1978 and March 1993. The percentage of children's FP (121 cases) was only 11.9% of all 1,012 cases of FP. Children's FP consisted of Bell's palsy (62.0%), Hunt syndrome (16.5%), congenital type (13.2%), traumatic type (6.6%) and otogenic type (1.7%). Bell's palsy was most frequent in children 2 or 3 years old and the incidence of Hunt syndrome increased in children over 6 or 7 years old. Bell's palsy in children was most frequent in July and Hunt syndrome in August. Two special complications in Bell's palsy were MCLS (Kawasaki disease) in a 5month-old girl and mycoplasma pneumonia in a 3-year-and-10-month-old boy. There were 5 special types of FP including 1 case of bilateral simultaneous FP,2 cases of alternating FP and 2 cases of recurrent FP. In Bell's palsy, significant changes in antibody titer of herpes simplex virus (HSV) was 15.2% while that of varicella zoster virus (VZV) was only 3%. In Hunt syndrome, changes were 0% in HSV and 40% in VZV. The recovery rate in Bell's palysy was 94.1% and that in Hunt syndrome was 75.0% in children. These figures were better than those in adult cases.

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Hemifacial Spasm; EMG-Histogram Evaluation

Haruo Saito

1993 Volume 1993 Issue Supplement66 Pages 43-55
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_43

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This study investigated a new method of evaluating the severity of hemifacial spasm (HFS) with an aid of an EMG-Histogram. A point at issue in HFS is the irregularity of attacks. To determine the most effective and appropriate time to test, EMG-telemetries were performed on 5 patients whose HFS were severe enough to involve the platysma. This examination revealed that 97% of the spastic attack information could be documented in a 20 min recording.
Based on these findings, EMG-Histograms were made with an EMG-recording system (Medelec ATA6) and a X-Y plotter (YHP 3000/33). The Medelec is equipped to calculate across a set of EMG voltage changes. This paper showed the followings: 1. Participation of the trigeminal nerve to proprioceptor of the facial muscles.2. Exaggeration (positive-feedback) of the HFS by tonal perception of the spasm, and light stimulation.3. Diagnosis of functional spasm by reduction of the EMG-Histogram.4. Evaluation of medical and surgical treatment.
EMG-Histogram is a useful method of evaluating the severity of HFS and the efficacy of therapy.

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Changes of Plasma Antidiuretic Hormone and Plasma Osmolality in Glycerol Test

Taizo Takeda, Akinobu Kakigi, Haruo Saito

1993 Volume 1993 Issue Supplement66 Pages 56-59
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_56

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Changes in plasma antidiuretic hormone (ADH) and plasma osmolality were studied before and after the glycerol test in 25 patients including 21 cases of Meniere's disease. Plasma osmolality rose an average of 12 mOsm/kg (4.1%) 3 hours after glycerol intake, and plasma ADH was also elevated by 3.7 pg/ml, on average. There was no correlation between glycerol test results and plasma ADH values. However, there were no positive results on glycerol tests when the plasma ADH level was greater than 5.0 pg/ml.
Recently, considerable evidence has accumulated indicating that ADH plays a great role in endolymph formation, which leads to the assumption that an over-secretion of ADH results in an increase of endolymphatic hydrops. Thus, it seems unlikely that hydrops can be sufficiently decompressed by a glycerol-induced osmotic dehydration in cases with a high level of plasma ADH.

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Intramastoid Drainage Surgery for Meniere's Disease

Masaaki Kitahara, Yoshiro Yazawa, Akira Kodama, Hisao Izukura, Takayo ...

1993 Volume 1993 Issue Supplement66 Pages 60-67
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_60

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Endolymphatic sac surgery is one of the widely accepted techniques used to treat Meniere's disease. Our Modified intramastoid drainage procedure-Kitahara sac surgery-employs the following principles; 1) intramastoid opening of the lateral wall of the sac, including the rugous portion,2) fixation of the lateral wall of the sac and inserting gelfilm,3) combining other treatments with surgery. After detailed description of our technique, we discussed the results and indications for surgical treatment of Meniere's disease, based on our twenty five years of experience.

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Sound-Proof Pressure Chamber

Masaaki Kitahara, Akira Kodama, Hiroshi Ozawa, Shuzo Inoue

1993 Volume 1993 Issue Supplement66 Pages 68-74
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_68

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Although the effect of atmospheric pressure on hearing and/or equilibrium has been studied, many questions remain unanswered. The major reason is thought to be in the specifications of the pressure chamber. Most pressure chambers used previously were capable of generating either overpressure or underpressure. Further, since the chambers were usually not designed for otological examinations, ventilation with fresh air produced noise above 60 dB within the chamber. For neurotological research, we constructed a sound-proof pressure chamber in which pressure could be varied between 1,000 mmH2O and 1,000 mm H₂O at a maximum speed of 100 mm H₂O/sec. The noise in the chamber could be kept below 30-35 dB while pressure was maintained at the same level.

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Effect of Ambient Pressure on Hearing of Normal Subject

Masaaki Kitahara, Hiroshi Ozawa, Akira Kodama, Hisao Izukura, Shuzo In ...

1993 Volume 1993 Issue Supplement66 Pages 75-80
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_75

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Hearing altered during or immediately after changing in ambient pressure, has not yet actually been examined but just presumed. In this study, the way in which alterating the ambient pressure on hearing in normal subjects was examined using our sound-proof pressure chamber. Twenty six healthy subjects were included in this study. The subjects were placed in the sound-proof pressure chamber in a supine position and instructed not to perform active equilibration of the middle ear pressure. The pressure was changed± 500 mmH₂O at 33 mmH₂O/sec. Results were as follows: 1) Hearing levels by both air and bone conduction deteriorated.2) At low frequency tones, the threshold of bone conduction increased more than that of air conduction. At high frequency tones, the threshold of both bone and air conduction were only slightly changed.3) The grade of deterioration was greater in cases where the chamber pressure was increased (descent) than that in cases where the chamber pressure was decreased (ascent). The major part of deterioration in bone conduction was considered functional and due to an increase in both the stiffness and damping of the sound transmission mechanism.

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Mechanism of Hearing Disturbance due to Alteration of Atmospheric Pressure

Masaaki Kitahara, Hiroshi Ozawa, Hisao Izukura, Shuzo Inoue, Kaoru Uch ...

1993 Volume 1993 Issue Supplement66 Pages 81-86
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_81

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The mechanism of deterioration in bone conduction due to changes in atmospheric pressure was examined in 20 normal subjects using a sound-proof pressure chamber. The subjects wore special ear plugs with which the external auditory canal was connected to a pressure gauge and and a small pump placed outside the chamber. Subjects were in structed not to swallow to avoid active opening of the Eustachian tube. The chamber pressure was decreased (or increased) to± 500 mmH₂O at a speed of 30 mmH₂O/sec. Then pressure in the external auditory canal was decreased (or increased) gradually after the chamber pressure had reached ±500 mmH₂O. However, the level of bone conduction did not recover the level before decrease (or increase) in the chamber pressure. These findings suggest that at a least minor part of the deterioration in bone conduction after changes in the chamber pressure was caused by displacement of the round window membrane.

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Test for Pressure Control Capacity of Eustachian Tube

Masaaki Kitahara, Akira Kodama, Hiroshi Ozawa, Hisao Izukura

1993 Volume 1993 Issue Supplement66 Pages 87-90
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_87

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Considering that the Eustachian tube controls middle ear pressure to maintain the optimum hearing level, the equilibration capacity of the Eustachian tube was tested by measuring hearing levels in a sound-proof pressure chamber. As an index of equilibration capacity for static pressure differences across the ear drum, we counted the number of swallows required to recover normal hearing after the chamber pressure reached ± 200 mmH₂O. In normal subjects, less than approximately 8 swallows were necessary except in a few cases. As indices of equilibration capacity for dynamic pressure differences across the ear drum, the worst level of hearing and the time required to recover normal hearing from the beginning of the alteration in the chamber pressure to ± 700 mmH₂O were recorded. In normal subjects, the average worst level of hearing was 7.7-12.5 dB and hearing levels recovered within approximately 60 seconds except for a few cases.

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Pressure Test for the Diagnosis of Eustachian Tube Function Using a Sound-Proof Pressure Chamber

Masaaki Kitahara, Akira Kodama, Hiroshi Ozawa, Hisao Izukura

1993 Volume 1993 Issue Supplement66 Pages 91-96
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_91

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Using a newly designed sound-proof pressure chamber, we tested Eustachian tube function in seven patients with suspected tubal dysfunction.
Patients lay in a supine position in the pressure chamber. Bekesy air conduction audiometry was performed at 1,000 Hz under the following pressure conditions: 1)200 mmH₂O below atmospheric pressure,2) 200 mmH₂O above atmospheric pressure,3)700 mmH₂O below atmospheric pressure, and 4) 700 mmH₂O above atmospheric pressure. The rate of pressure change was a constant 33 mmH₂O/sec for all four conditions. In conditions 1) and 2), the patient was instructed not to swallow until the pressure change was complete; when the target pressure had been reached, the patient was asked to swallow once every 15 seconds. We then counted the number of swallows required for the patient's hearing to return to the baseline level. In conditions 3) and 4), the patient was told to swallow as frequently as possible both before and after completion of the pressure change; measurements were made of the maximum hearing level and of the time needed before the patient's hearing returned to its original level.
Although six of the seven patients showed normal results in catheter insufflation tests performed during their previous visit and tympanograms taken just prior to our pressure test, longer than normal times were required to recover their hearing. Interestingly, one of these six reported a disappearance of ear stuffiness following the test. We concluded that this pressure test is useful not only for the diagnosis of Eustachian tube function but also as a possible therapy for aiding adaptation to changing environmental pressure.

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Pressure Test in Normal Subjects

Masaaki Kitahara, Akira Kodama, Hiroshi Ozawa, Hisao Izukura

1993 Volume 1993 Issue Supplement66 Pages 97-100
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_97

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Changes in hearing after pressure test have not been evaluated in normal subjects. In this study, changes in hearing after under and over pressure tests were examined using 20normal subjects. In the underpressure test, the subjects were placed in a supine position in the sound-proof pressure chamber. The pressure was first decreased to - 500 mmH₂O and after 5 minutes to- 700 mmH₂O. The pressure was maintained at this level for another 5minutes and then increased to 0 mmH₂O. This procedure was carried out 3 times in succession. While the chamber pressure was below 0 mmH₂O, the subjects were instructed to avoid active equilibration of the middle ear pressure. When the chamber pressure was raised to 0 mmH₂O, they were instructed to equilibrate the middle ear pressure and if necessary Politzerization or catheterization of the Eustachian tube was performed. In the overpressure test, the pressure was first increased to 500 mmH₂O and then 700 mmH₂O. In both the negative and positive pressure tests,10 dB gains (or loss) at either 250,500,1,000 Hz were observed in few cases.

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Underpressure Test for the Diagnosis of Meniere's Disease

Masaaki Kitahara, Hisao Izukura, Hiroshi Ozawa, Akira Kodama

1993 Volume 1993 Issue Supplement66 Pages 101-106
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_101

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During the last 15 years, a pressure chamber capable of generating negative air pressure has been employed to treat Meniere's patients. In this study, we investigated whether a underpressure chamber can be used in the diagnosis of Meniere's disease. Included in this study were 43 patients (45 ears) with neurotological diseases. The subjects were placed in a spine position in a sound-proof pressure chamber. The pressure was first decreased to - 500 mmH₂O and after 5 minutes to - 700 mmH₂O. The pressure was maintained at this level for another 5 minutes and then increased to 0 mmH₂O. This pro- cedure was carried out 3 times in succession. While the chamber pressure was below 0 mmH₂O, the subjects were instructed to avoid active equilibration of the middle ear pressure. When the chamber pressure was increased to 0 mmH₂O, they were instructed to equilibrate the middle ear pressure and if necessary Politzerization or catheterization of the Eustachian tube was performed. As a result, hearing was improved after this procedure only in patients with Meniere's disease and/or cochlear Meniere's disease in which endolymphatic hydrops was suspected.

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Effect of Chamber Pressure on Hearing in Patients with Meniere's Disease

Masaaki Kitahara, Akira Kodama, Hisao Izukura, Hiroshi Ozawa, Makoto H ...

1993 Volume 1993 Issue Supplement66 Pages 107-109
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_107

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It is well known that reduced chamber pressure improves hearing in patients with Meniere's disease. In this study, whether or not hearing levels in patients with Meniere's disease are lowered at exposure to overpressure by using 46 patients with neurotological diseases including Meniere's disease. As a result, it was confirmed that hearing in patients with Meniere's disease was improved after exposure to overpressure as well as underpressure. The mechanism of hearing improvement is discussed.

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Equilibrium in Inner and Middle Ear Pressure

Masaaki Kitahara, Mikio Suzuki, Akira Kodama

1993 Volume 1993 Issue Supplement66 Pages 110-113
Published: October 05, 1993
Released on J-STAGE: November 27, 2012

DOIhttps://doi.org/10.5631/jibirinsuppl1986.1993.Supplement66_110

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Global balance of the inner and middle ear pressure is controlled by the cerebrospinal fluid inside and atmospheric pressure outside. The cochlear- vestibular aqueducts and the Eustachian tube which allow unidirectional passage, provide fine control of the inner and middle ear pressure.

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