Being interested in the intranasal and paranasal benign tumors, authors accumulated 108 ossifying fibromas in Japan and these cases were investigated from clinical and histopathological aspects. Clinically, their sex, age, location, chief complaint, cause, period prior to the consultation and the gross finding of the tumors were studied. Histopathologically, ossifying mechanism was studied. The tumors were classified into the differentiated and undifferentiated forms according to the interstitial findings. From these studies, ossifying fibromas were divided into 7 groups. Most of the tumors were known to occur in the maxillary sinus. And majority of the tumors arising from the maxillary sinus were of the differentiated forms. Like previously believed, prognosis of such tumors were benign. Contrary to these, the tumors originated in ethmoid and frontal sinuses were often of the undifferentiated forms with destructive propensity of the skull base. Furthermore, these tumors from emthoid or frontal sinus occasionally invaded intracranially leading to grove clinical course. Interestingly enough, the undifferentiated form often recurred and its prognosis was not always benign. The tumors should be ca refully differentiated from sarcomas in diagnosis.
Sixty-six patients, who had X-ray proven bilateral maxillary sinusitis, were selected for this study. The patients were divided into three groups and were treated differently. Group 1: Ananase only, 6 tablets (120mg) a day or 9 tablets (180mg) a day Group 2: Ananase 6 tablets a day plus Antibiotics Lincocin 1500mg a day Group 3: nasal irrigation only as a control
A case of bilateral compound paranasal sinusitis caused by Aspergillus was encountered recently. The case was reported here along with results of animal reactions tested by the same fungi. The patient was 44 years old female with chief complaint of foul rhinorrhea. In the past, she had measle at age 5, and alopecia areata from 40 to 43 which was treated by infrared and ultraviolet rays and anterior pituitary hormones. Once she reportedly had maxillary sinusitis due to persistent dental carries which she suffered for two years. General examination was negative. The nasal examination at that time revealed a small polyp in the middle meatus and profuse purulent discharge. Aspiration of the maxillary sinus yielded purely purulent material with grain sized dark brown nodules in it. A plain X-ray film taken at that time showed the right paranasal sinuses being diffusely involved. Diagnosis of bilateral compound paranasal sinusitis was made and surgery of maxillary and ethmoid sinuses were performed by endonasal approach. Pathologic changes noted at the time of the operation were papillary thickening of the mucosa, proliferation of granulation tissue and presence of the dark brown nodules either being attached to the mucosa or being suspended in the pus. The osseous walls were also thinned out or absent at places. Histologic examinations made on the removed tissues revealed the atrophied squamous epithelia. Aspergillary fungus balls were demonstrated being heavily stained by eosin and silver metanamine adjacent to the epithelia. Surrounding the fungus balls, noted were plasma cell infiltrations in edematous tissue indicating chronic inflammatory reactions and localized granulation formations. Animal experiments were conducted on grown rabbits weighing over 3500 gm, using Asp. fumigatus cultured on the Sabouraud's Agar media. The rabbits were divided into two groups, Group A and B. And directly into the right maxillary sinus, liquid suspending 5×106/0.1ml fungi was instilled in Group A and small fungus balls in Group B. After the instillations, frontal sections of the maxillary sinuses were made at certain intervals for the histologic examinations. In both groups, no systemic pathological change was brought by the instillations with the exception of the kidney which showed acute necrotic processes in some rabbits. Locally, however, acute and chronic aspergillary inflammations were recognized in Group B rabbits. The rabbits in Group A showed no significant local change.
During the period between April, 1966 and July, 1966, hearing tests were carried out on 24, 150 grammer school children (12, 314 boys and 11, 839 girls, their ages varing 6 to 11) living in Yokosuka City. Children with hearing hardness were selected by screening tests, first by well trained health teaches who performed the tests using 1000 and 4000c.p.s., 20db sounds in quiet room (noise less than 50 phon). Three hundred and fifty three children (1.42% of the entire children, 202 boys and 141 girls), who were thus picked up were subjected to further hearing tests done by physicians in the sound proof laboratory. Finally, 257 children (1.06% of the population, 166 boys and 91 girls) were selected for ditail hearing tests and their past histories were reviewed. The results obtained were as follows: a) Causes of the hearing hardness (348 ears of 257 children) Ear canal diseases due to stenosis, adenoids and paranasal sinusitis 98 ears (28%) Otitis media and its sequela 80 ears (23%) Neurogenic hearing hardness with unknown cause 170 ears (Among these, mumps, were presumably responsible in 19 ears and familial in 8 ears) b) Distribution of hearing loss by decibel checked by 4 type of speach range on 348 ears is shown on Fig. 1. The hearing loss was observed most often at 30db. The mean was 30.57±1.42 (=0.05). Forty-nine ears (0.11) showed hearing loss over 50db. c) After series of these examinations, 36 children were sent to the special class for the impaired hearing.
For the atresia auris congenita with microtia we attempted an operation as follows; the switch-back of the remnant auricle was performed according to Tanzer's method, a hole was made in the mastoid to constract the external auditory canal, and then split skin graft was used as a tympanoplasty after examining the ossicular chain. The purpose of this procedure is to prevent the newly formed canal from its stricture due to granulation, bone proliferation, cicatricial stenosis, etc. Newly formed canal should be in the mastoid surrounded by bony walls, so it must be situated backward from its normal position. Trimming, however, of this switch-back is always available to any case in order to produce normal position. Applying this technique to a few cases successfully, we reported these in this paper.