The author performed clinical and histopathological studies of the olfactory region particularly in chronic sinusitis. A total of 93 cases (50 males and 43 females) ranging in age from 12 to 70 years, who visited the department of otorhinolaryngology at Jikei University School of Medicine from May 1966 to June 1969 were examined. Of the 93 cases, 34 complained of anosmia, 27 of hyposmia and the remaining 32 had no olfactory complaints. The examination included rhinoscopic examination, measurement of the dimensions of the olfactory region, olfactory test, antral mucosal function test, contrast study of the olfactory region and operative findings. The shape of the olfactory region was classified into 8 types based on the results of contrast studies of the region. Using 12 cadavers, measurements and contrast studies of the olfactory region and contrast studies of the maxillary sinus were performed in an attempt to relate the pathologies of the olfactory region and the maxillary sinus. Large specimens containing the entire paranasal sinus, base of the skull, and the nasal septum were taken from the cadavers and serial sections of the paranasal sinuses in the frontal plane were prepared. The specimens were studied with particular interest in the relation between the results of contrast study and pathology of the olfactory region as well as between pathology of the olfactory region and that of paranasal sinuses. Results of the above studies could be summarized as follows: 1. The shape of olfactory region was classified into 8 different types from the results of contrast study of the region. Of 184 olfactory regions in 92 cases, 71 were classified as Type I, 21 as Type II, 18 as Type III, 3 as Type IV, 9 as Type V, 16 as Type VI, 8 as Type VII, 38 as Type VIII. 2. The filling defect of the olfactory region is not necessarily due to the presence of local inflammation. Narrowing of the region or contact of the opposing structures mainly due to well developed medial wall of the ethmoid sinus often caused filling defect of the area in the absence of local inflammation. 3. Olfactory sense appeared more severely affected by the disease of the ethmoid sinus than any other sinuses. Results of the contrast study of the olfactory region were not necessarily parallel with the pathology of the other paranasal sinuses. 4. Nasal mucous membrane at the olfactory region appears yellowish in color because it is particularly thin in the area and the yellow septal bone can be seen through it. The author concluded that reconstructive surgery of the olfactory region will benefit patients with distrubance of olfactory sense regardless of the presence of chronic sinusitis.
In recent years, Dr. Takahashi has emphasized an increasing incidence of instable pathology of maxillary sinusitis. The number of patients with fixed chronic inflammation of paranasal sinusitis is on the decrease, while the number of patients having instable lesions is increasing. We have also observed and reported on this tendency but it is often difficult to establish a diagnosis of instable pathology of chronic sinusitis. The author performed the following clinical and histopathologic studies in patients with chronic sinusitis. a) Radiographic examination (X-ray mucous membrane function test) using contrast media. b) Endoscopic examination of the maxillary ostium. c) Histopathologic observation of the mucosa of maxillary sinus. d) Histologic observation of maxillary ostium including its wall and surrounding structure from specimens removed from cadavers. Endoscopic findings of the maxillary orifice were classified into 5 types. 1) Normal type: Maxillary ostium opens well without abnormalities of the mucosa. 2) Slightly swollen type: Slight edema and hyperemia around the maxillary ostium. 3) Moderatery swollen type: Maxillary ostium is barely open and there is uneven mucosal surface due to edematous and polypous change. 4) Severely swollen type: Maxillary ostium is completery obstructed by polypous mucosa. 5) Overhung type: Maxillary ostium is completely obstructed by polypoid mucosa. The interrelationship of radiographic, histopathologic and endoscopic findings was discussed. The type of maxillary ostium can be figured by routine rhinologic examinations. Radiographic findings suggestive of normal or instable pathology of maxillary sinusitis, slight swelling of mucosa and clear moljodol image of maxillary ostium are suggestive of normal type of maxillary ostium, while moderate or severe pathology of maxillary sinusitis, swelling of antral mucosa and obscure image are suggestive of abnormal type. Radiographic findings were compaired at different period during the course of the disease. History, physical examinations, course of condition and response to treatment are studied. A significantly different course was noticed between the normal and abnormal types of maxillary ostium. The patients with normal type of maxillary ostium showed easy improvement and aggravation. It is presumed that normal maxillary ostium helps improvement of the sinus inflammation, however, inflammation in the nasal cavity easily invades the maxillary sinus. The abnormal type showed an unchanged (fixed sinusitis) or slightly changed course. In contrast, the abnormal type protect against invasion of inflammation into the maxillary sinus, but drainage of the contents and improvement of inflammation in maxillary sinus are disturbed. The specimens from moderate and severe maxillary sinusitis revealed intence infiltration of lymphocytes, leucocytes, plasma cells and fibrosis. Edematous change of the mucosa was observed in the instable stage of maxillary sinusitis. The above observation suggests that severe pathology rather than instable changes would, proceed to fixed maxillary sinusitis. The maxillary ostium was divided into 3 parts based on histologic findings; 1) Nasal cavity side, 2) Middle part, 3) Sinus side. Mucous and serous glands and cavernous blood spaces are abundant in the nasal cavity side as in the inferior nasal turbinate, less abundant in the sinus side and scarce in the middle part. It is generally accepted that humidification, thermostatic control and filtering of air are the main functions of the nasal cavity and paranasal sinuses. On the basis of the above observation, it is probable that the inspired air which is insufficienty heated and humidified in the nasal cavity becomes adequate temperature and humidity between both orifices of maxillary ostium.
The first case of muco-cutaneous lymphnode syndrome was reported by Kawasaki in 1962. This is a new disease entity affecting children, which manifests exfoliation of the skin similar to that seen in cases with scarlet fever. As its symptoms develop mainly in the mouth, pharynx and tongue, the patients often seek medical aid of otolaryngologists. Although bacterial, virus and Rickettsia infections, drug hypersensitivity, or allergy are listed as possible causative factors, its true etiology has not been definitery elucidated. The major pathology of the disease lies in the changes of the blood vessels. While no definite treatment is available, most cases heal spontaneously. Abrupt death has been reported in 1.3% of the cases.
Results of an experimental study on so-called respiratory hyposmia are reported. Using subjects with normal intranasal findings, a rubber tube was inserted into each nasal passage so as to the end of the tube reach the nasopharynx, with which inspired air was prevented from reaching directly the olfactory region of the nasal fossa. The subject who, in normal state, were able to detect the smell of Alinamin at a dilution of 105 times showed an elevation of threshold as to detect the smell at 103 dilution after placement of the tubes. In the other group with hyposmic subjects whose intranasal findings showed obstruction of the olfactory region due to swollen middle turbinates, the local treatment with adrenaline solution caused reduction in threshold for olfactory sense 10 to 102 dilution of Alinamin. Results of present study indicated that a complete anosmia does not occur even in the subjects with nasal obstruction whose olfactory regions appear obstructed completely by rhinoscopic examination. The average decrease in olfactory sense in these subjects was estimated as about 40%.
Histaglobin was administrated to 13 cases of nasal allergy. In all the cases, blood tests, cytological test of the nasal discharge and provocative test of the nasal mucosa were performed. Our treatment schedule consisted of 1 vial of Histaglobin injected subcutaneously once a week, for 3 weeks, which was counted a one course. One or two courses of treatment were given. Of the 13 cases, the results in 3 cases were indefinite, but 10 cases showed an improvement in the symptoms and intranasal findings, and favorable effects were observed. Of the improved 10 cases however, relapse occurred in 3 cases, and provocative tests of the nasal mucosa revealed that the antigen was house-dust in 1 case, hogweed (Ambrosia artemisiaefolia) pollen in 1 case and of unknown origin in the rest. It is generally believed that the combined use of Histaglobin and ACTH may weaken the effect of the former. But in our 2 effective cases administration of ACTH with a nebulizer did not inhibit the effect of Histaglobin presumably because of its topical application. Moreover, there was another case where the combined use of another anti-allergic agent produced favorable effect. It was observed that the therapeutic effect of Histaglobin began to appear after injecting 2 to 3 vials of the drug.