The epithelium of mucous membrane of the maxillary sinus obtained during maxillary sinusectomies in chronic sinusitis has been studied by means of transmission electron microscopy.
The findings of this study were compared with the results of X-ray mucosal function test performed preoperatively in respective cases.
The normal epithelium of the antral mucosa is consisted of the ciliated cells, basal cells and non-ciliated cells. The ciliated cell is the major component of the epithelium and other cells are distributed in a certain frequency in the normal mucosa or in mildly pathological mucosa.
The structure of each cell and the distribution were found to be distorted in moderate or severe cases with chronic sinusitis. A decrease in the number of ciliated cells and increases in goblet cells and non-ciliated cells are characteristic findings in pathological mucosa, while transition type cells from ciliated cells to non-ciliated cells, cells with secretion granules and undifferentiated non-ciliated cells are also found in pathological mucous membrane.
Morphological changes of the cilia have been found even in mild cases of chronic sinusitis. They included wavy pattern of the peripheral sheath, homogeneous structure of the fibers and severance or distortion of the cilia.
In moderate or severe cases of chronic sinusitis, on the contrary, normal regular pattern of the cilia was rarely seen.
The changes of the organelle were observed in moderate or severe cases of chronic sinusitis. Destruction of crista structure in mitochondria was the most prominent finding in moderate cases of sinusitis while well developed Golgi body and secretion granules within the ciliated cells are found in severe cases of chronic sinusitis.
The goblet cells are scattered among the ciliary cells and they have the typical goblet shape in normal or mildly affected mucosa.
In these cells, secretion granules migrated in the upper part of the neucleus, while organelle and cytoplasma were pressed aside showing an increased electron opacity.
In moderate and severe cases of chronic sinusitis the goblet cells showed a different shape, where secretion granules were scattered in the whole cytoplasma, Golgi body and endoplasmic reticulum were well developed.
The secretion granules were seen being discharged from the free surfaces. These morphological changes appeared to suggest the cells were in the stage of production of secretion granules: or in hyperactive stage of the secretion cycle.
Electron microscopic findings of the mucous membrane epithelium of the maxillary sinus with different patterns of the X-ray mucosal function test can be summarized as follows:
In functionally normal mucous membrane the ciliated cells and cilia are arranged regularly interrupted by varying numbers of goblet cells. In mild cases of chronic sinusitis, although distribution of the ciliated cells are not disturbed the major changes included homogenous fibers, wavy pattern of the peripheral sheath, and vacuolization of hypobasal hyaline zone.
In moderate cases of chronic sinusitis normal distribution of the cells are basically distorted.
Although the morphological changes of cells in general were not conspicuous, a certain group of goblet cells showed active discharge of secretion granules and, in some part, the ciliated cells were replaced either by goblet cells or by non-ciliated cells.
The cilia are less densely distributed and some of them are destroyed in the halfway.
Destruction of crista structure and swelling of the mitochondria are present and the intercellular spaces are separated.
These changes appeared to indicate degenerative change of the epithelium per se.
In severe cases of chronic sinusitis, the antral mucosal epithelium is consisted of pathological ciliated cells on which cilia are distributed less densely.

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This is a report on a 54-year-old male who noticed a swelling in the right side of the neck one months prior to admission. Palpation of the tumor readily caused coughing spells. Surgical procedure to the tumor revealed a band arising at the center of the tumor extended into the intrathoracic cavity.
The size of the removed tumor was measured 8×5×3cm. Pathological examination showed neurilemmoma, a combination of histological features of Antoni A and B types.
The patient developed paralysis of the right vocal cord postoperatively but otherwise patient developed paralysis of the right vocal cord postoperatively but otherwise uneventful.

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Five cases of chronic otitis externa which had been misdiagnosed as chronic otitis media because of redness of the tympanic membrane and creamy pus in the external auditory meatus were reported. The differential diagnosis from chronic otitis media was possible as a meticulous cleansing of the meatus revealed the aural discharge was not the product of the middle ear.
Another problem was how to control this type of otitis externa. Two cases of them could be treated successfully by thorough daily cleansing of the meatus. However, the remaining three cases with fungus infection required hyposensitization therapy with fungus extract, which was very effective in the treatment of eczematoid dermatitis of the ear canal.

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In order to clarify transition of the clinical picture of chronic sinusitis intranasal findings at the first consultation were recorded periodically at Nagoya City University Hospital from 1959 to 1972 and the following results were obtained.
1. The percentage of cases with chronic paranasal sinusitis among all the outpatients decreased slightly since 1968. But no change was observed in the absolute number of such patients.
2. Clinical findings and X-ray examinations showed the disease become somewhat milder in nature since 1966.
3. It appeares that the incidence of purulent type of this disease decreased since 1962 as seen from the fact that the frequency of purulent discharge showed an evident decline among these patients.
4. The incidence of polyp formation in the middle nasal meatus tended to decrease slightly since 1962 but it still is found in about 20% of the patients.

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A case of sphenoid sinus mucocele developed in a 34-year-old male is reported. The initial symptoms of the patient included visual disturbance of the left eye and headache that started about four months prior to admission. The final diagnosis of the mucocele was confirmed by laminagraphy of the sphenoid bone and a puncture of the sinus.
The patient was operated on through the transnasal approach and the left vision imporved from 20 cm. finger counting to 1.2 (1.2x + 0.25) postoperatively.
A search of pertinent literature revealed 20 cases of sphenoid mucocele so far reported in Japanese literature and these cases are discussed in reference with 63 other cases reported by Nugent.

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The authors report the findings of scanning and transmission electron microscopic observations of the nasal mucous membrane in five cases with chronic sinusitis and a case with allergic rhinitis.
In severe cases with chronic sinusitis it appeared that the ciliary movement was considerably restricted due to attachments of thick mucus droplets. Infection of the mucous membrane appeared to have caused erosion and destruction of the epithelium.
These changes seemed to induce elongation of the peripheral sheath, which in turn facilitate adhesions between the cilia. In even severe cases, basal membrane was exposed.
In allergic rhinitis, the number of goblet cells was seen to have increased as compared with the cases of chronic sinusitis.
The authors found no evidence as to the origin of the goblet cells or whether they come from ciliary cells or not.

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