A study of the residual changes of Osteomylitis of maxilla in infant in respect to alteration in the external appearance of the face, dentition, vision and intranasal and roentgenographic fi ndings was made in 29 cases, 1 to 20 years after the original lesion had healed. 1) External alterations of the face were observed in over a half of the cases, with the largest number showing healed scars of incisions or fistulas. 2) Loss of deciduous teeth was noted, mostly canines and next lateral incisors. Loss of teeth was closely related to whether or not operation had been performed. There was irregularity in the arrangement but no loss of permanent teeth. 3) Ophthalmologic complications consisted of optic nerve atrophy in 1, strabismus convergeus in 2, strabismus divergens in 1 and weak vision in 3 cases. 4) In Roentgenographic examination, acute inflammation does not affect the growth of the sinus, but when the immature maxillary sinus is afflicted with chronic inflammation or subjected to radical operation, pnuamatization is strongly suppressed temporarily or the cavity is obliterated In the cases of obliterated sinuses, 6 showed regeneration with advance in years. 5) Intranasal findings or subjective symptoms that could be referred to the disease in infancy were not found. 6) It is evident from the results that the two sequelae of any clinical importance are disfi gurement of face and malocclusion of teeth. Operation, however, should not be indiscriminately condemned. Surgical treatment should be given early, whenever necessary, after appropriate antibiotic therapy, taking care not to injure the orbital wall nor remove any normal teeth and avoid incisions on the face.
It is generally accepted that the upper respiratory and digestive tracts in human are farmore susceptible to infection as compared to the ones in the other mammals. The purpose of this study is to investigate into anatomical and histological differences ofthe upper airway mucous membrane between human and other mammals. Materials used were mucosal and submucosal tissues from five cats, four dogs, five rats, five rabbits, two cows, two goats, three pigs, three monkeys, and ixteen men. Both macroscopic and microscopic preparations were studied into the details in an attemptto understand the pecific structure for each species. Among other findings, the specific was that the distribution of submucous glands in the upper respiratory tract was much more abundant in herbivora than in carnivora. It was noticed that submucosal pathology was likely to be in parallel with phylogeny of the animals. The extent of lymphoid tissue proliferation and of round cell infiltration seen in the submucous tissue of respiratory tract was found to be more extensive among more developed mammals. It was inferred that human upper airway tract is less resistive to pathogenic organisms than those of under developed mammals and that the advanced inflammation process observed in submucous tissue of the human upper respiratory tract was the results of protective process of less resistive structures.
The non-acoustic part of the inner ear, the vestibular ganglion with its nerve and the vestibular nucleus are included in the vestibular system, which serve as sensory organs for static and kinetic stimuli, such as, gravity, linear and angular accelerations. The vestibular inputs ascend into the oculomotor system and descend into the spinal cord. They go into the cerebellum and the autonomic system, too. These functional connections act under the control of the central regulating system and the vestibular efferents, which are summarized in Fig. I. Pathological changes in those functional pathways may cause vertigo or dizziness subjectively and disturbance of equilibrium objectively in the case, though the subjective sensation and objective findings may vary on depending with the anatomy, the etiology and the onset of the disease. Anatomy of the disease which could cause vertigo or dizziness are shown in Fig. 2. It will be necessary for the purpose of differential diagnosis of vertigenous diseases that neurotological examinations of the functions of the vestibular system, the oculomotor system, the automomic system and the spinal cord must be carried completely and thoroughly. It would be required, however, too much time and burden both a patient and a examiner heavily, when all sorts of those examination are applied in every patient non-systematically. The results of recent progress on vestibular research have made us know how to select and how to simplify the examinations without missdiagnosis of diseases. Those routine examinations will be presented in this paper. The site of anatomy, of which function is detected by every test is shown in Fig. 3. The author would expect that those routine examinations are useful in out-patient clinic and are utilized by every E. N. T. practitioner.
Evalution of vestibular functions is of absolute requiste for determination of the site of involvement in patients whose chief complaints includes vertigo or unsteadieness. This report is to present a simple and effective method of vestibular function tests for daily clinical purposes. Three major methods of vestibular function test that comprised postural reflex test (Mann's test) deviation test (gait, stepping test) and oculomotor function test were explained and their interpretations were proposed. The deviation test and the oculomotor function test are the fundamental test with which 76% of all the involved may be detected. When the oculmotor function test is combined to the above two, 86% of the abnormalities may be diagnosed. We feel that combination practice of various vestibular function tests should be useful in locating the site of involvement in almost all the cases encountered in daily clinic.
The author discussed various features of electronystagmographic study and summarized that electronystagmography: 1. produces permanent objective records in regard to various nystagmus occurring at acertain time. 2. enables to obtain records even while the eyes are closed and also in the darkness. 3. enables to record provoked nystagmus by, for instance, temperature, vision, rotation, pressure and others, which often contribute greatly in locating the site of involvement. 4. makes quantitative analysis of the nystagmus possible by recording the amplidude, frequency and speed of nystagmus.
As the differential diagnosis between central and peripheral vertigo is of prime importancefor correct evaluation of the pathology in patients whose chief complaints include vertigo or un-steadieness, the author reports on the outline of the differential diagnosis. The diagnosis of acoustic neurinoma, of cerebellopontine angle tumor or of other organic changes may be made through a careful evaluation of the vestibular function tests. Three cases with vestibular involvement and three other cases with similar symtoms of central origin were presented to explain the interpretation of vestibular function test for differential diagnosis. The author commented on history takings, audiometry, diviation tests, positional nystagmus, positioning nystagmus, caloric test and neurological tests all of which were indespensable for the differential diagnosis between vertigo of central and peripheral origin.
The author pointed a trend in which diagnosis of Meniere's disease too oftenly and improperly applied, before a careful evaluation was being made for other conditions than Menierere's disease, to those patients whose chief complaint was characterized by vertigenous attack. It was proposed the diagnosis of Meniere's disease could only be adequately made when following conditions were combinedly confirmed; 1. vertigenous attack was repetitive, 2. the attack was associated with other auditory symptoms such as impaired hearing, tinnitus, filling sensation, 3. sensorineural hearing loss was confirmed, 4. no other causuative disease could be considerable and 5. no cranial nerve involved except the eigth nerve. The author described that following points should be checked carefully when dealing with patients with vertigo: whether or not 1) vertigo is associated with auditory symtoms, 2) vertigenous attack is repetitive, 3) inner ear symptoms is accompanied, 4) any spontaneous nystagmus that may due to central nervous origin is present.
Current therapies of Vertigo were presented on the basis of litteratures which had been published for recent 10 years and of the author's self experience in his neurotological clinic. It is the most important that the original disease which caused vertigo or dizziness, must be treated in the patient. Conservative treatment is also necessary, however, for the patient, who is suffering from a severe attack of vertigo, nausea and vomiting in acute stage. The patient needs absolute rest and adequate medications of drug for vertigo, antiemetica, sedativa and so on. It is indispensable to differenciate, whether, the origin of the disease is peripheral or central, because some of the later may have worse prognosis for the patient's life, for example, some of vertebro-basilar artery insufficiency, brain hemorrhage and etc. The neurotological examination should be carried to identify the origin of vertigo during attack, if it does not disturb the patient's condition. Several medications, stellate ganglion block, surgical treatment or ultrasonic treatment for vertigenous patients are also recommended in adequte cases.
Montease which comprised 10 mg. of protease in a capsule was used three doses a day for a period of one month for 22 patients with chronic sinusitis. This drug was found not to be effective for suppression of the infection in the sinuses however, showed a potent effect upon suppression of local edema and of swelling. The thick and sticky nasal discharge was often seen to change its character into serous discharge. An improvement of the pathology was confirmed by radiological examination on antral mucosal function. An effective result was obtained in 40% of the cases. A combined treatment with Montease and antibiotics would further enhance the efficacy in treatment of the disease. No untoward side effect was observed in any cases tested.
Cepharanthin has often been proposed to be an effective agent for exudative otitis, though the period of administration seem to be prolonged in most of the cases. The author tested a large dose (20 mg.) intravenous administration of the drug for patients with exudative otits. The results obtained in 42 cases that tested during a 7 months period were found to be satisfactory the author proposed.