Primary cancer of the sphenoid sinus is very rare. The authors report on a 53-year-old female, who manifested anosmia and pain around the left eye and was found, by a lateral rhinotomy, to have a tumor occupying the sphenoid sinus and both ethmoid sinuses. Pathological examination showed undifferentiated carcinoma. A search of Japanese literature revealed only 7 cases of primary sphenoid cancer. Primary cancer of the sphenoid sinus is found in the fifties and manifest few nasal symptoms but headache and paralysis of the ocular muscles are common. Abducens is frequently involved in the early stage because the nerve travels very close to the sphenoid sinus. Of the 7 cases appearing in the literature 6 were epidermoid carcinoma and one was adenocarcinoma. Prognosis is poor and all of the cases died within 2 years from the initial examinations.
Intravenous and nasal olfactory tests were performed on 107 cases with disturbance of olfactory sense using Alinamin (Thiamin propyl sulfid). Of 83 cases with peripheral disturbance, 56 cases were hyposmic and the remaining 28 were anosmic. Of 24 cases with central disturbance, 6 were hyposmic and 18 were anosmic. Complete loss of olfactory sense in which no responce was obtained even by the intravenous test was seen in 10 out of 83 cases of peripheral disturbance (12%), and in 14 of 24 cases with central disturbance (58%). Olfactory test in cases with chronic sinusitis showed positive or negative results depending upon the degree of pathological changes of the olfactory mucosa. Loss of olfactory sense due to morphological changes of the intranasal structures is presumed to be rare.
Damping pendular rotation test (PRT) was performed in fifty-five central lesions, in which the diagnosis was confirmed surgically or by neurological examinations, and the results of PRT were compared with those of optokinetic pattern test (OKP-test) and eye tracking test (ETT). Postoperatively patients with acoustic neuromas, which were mostly operated through suboccipital approach or by combined method (both translabyrinthine and suboccipital method), showed dysrhythmia, narrow writing (petite ecriture), and/or pathological habituation or markedly reduced responses. These findings could be regarded as central in origin, because they were found after the surgical procedures in cerebellopontine angle space. (Fig. 1) Dysrhythmia was also found after injection of diphenidol, which is reported to inhibit neuronal activity in vestibular nucleus. (Fig. 4) Dysrhythmia, which is thought to be a manifestation of the disturbance of the rhythm of the quick phase of nystagmus, was mostly seen in brainstem lesions (Fig. 5, 8), but not in cerebral and cerebellar lesions. (Fig. 7, 9) On the other hand, reduced response, ipsilateral or bilateral, was seen in cerebellar and brainstem lesions in which either contralateral or both labyrinth were normal. (Fig. 9) The possibility of correct diagnosis in central lesions was suggested with PRT in combination with OKN or OKP-test and ETT, though the final diagnosis should be made with a battery of audiological and vestibular tests including neurological and neurosurgical examinations. (Table 1) Dysrythmia or narrow writing could be seen in normal persons over 50 years old, in which these findings might probably be due to vascular changes in the brain with aging, and in younger persons under 10 years old in which nystagmus rhythm seems to be still immature, and also in some with Meniere's disease, but rarely in vestibular neuronitis.
A case of trauma to the larynx and hyoid bone in a 44-year-old male who made an unsucessful attempt to commit suicide by hanging himself is reported. The patient complained of pain in the pharynx particularly in swallowing. Bloody sputum was seen for two days after the injury. Hoarseness and aspiration of liquids persisted for one month. Examination one month after the injury revealed the marks of hanging in a part of the neck, edematously swollen right arythenoid region, swelling and redness of the right false cord, scars on the laryngeal aspect of the epiglottis and bony protrusions in the posterior wall of the hypopharynx which were proved to be the fractured conua of the thyroid cartilage. Right conu of the hyoid bone was also fractured. Conservative treatment alleviated the above symptoms in three months.
A case of psychosomatic disorder characterized by vertigo is reported. The patient was a 23-year-old male who has been treated at various institutions under the diagnosis of Meniere's disease but without avail. The authors suspected psychosomatic disorder in this patient and psychotherapy, particularly Morita's therapy was adopted, which produced favorable result. The authors also comment on psychotherapy for treatment of psychosomatic disorders.
The incidence of rhabdomyosarcoma is considered to be rare in the ear, nose and throat, but the pathological diagnosis of the tumor is not easy and some of rhabdomyosarcoma cases might have been misdiagnosed as carcinoma. Rhabdomyosarcoma appearing in the nasal cavity may be mistaken as an inflammatory polyp because of the similar appearance and the correct diagnosis may be delayed. Treatment often fails even by a combination of operation and irradiation therapy. The authors report on 4 cases of rhabdomyosarcoma occuring in the field of otolaryngology with a discussion of the pathological findings and a review of the literature.