Direct injury to the facial nerve is frequently a cause of facial paralysis after operation to the middle ear. The surgeon in such cases is often unaware that he had traumatized the nerve. This complication could be avoided by identifying the location of the nerve during operation. Damages to the cochlea or vestibule may develop, although rare, as a complication of surgery to the middle ear, but the true cause of such complications remains unknown and no absolute method is available for prevention of such complication. The paralysis of the facial nerve however, can be prevented totally by a meticulous operation. In many cases the author used the posterior tympanoplasty technique and found that this was a superior method in avoiding facial nerve complications. The author has operated on 432 cases during the past 4 and a half years and encountered 5 cases of temporary facial paresis, all of whom recovered within 48 hours. The author described the course of the facial nerve in the middle ear in the 432 cases.
Many otolaryngological operations that had been performed under local anesthesia previously are now conducted under endotracheal anesthesia. But other types of anesthesia may be beneficial in decreasing the amount of blood loss during operations. 1. Ketamine anesthesia has been used in operations for chronic sinusitis and fracture of the nasal bone. Although the amount of bleeding is usually greater than other methods this is an excellent method in children because ketamine can be administered intramuscularly. 2. Epontal anesthesia was used for correction of fractures of the nasal bone and for myringomy. Admission of patients is usually not necessary as the patients awake quickly from this anesthesia. 3. NLA has been applied for laryngomicrosurgery and sinusectomy. One can obtain a better exposure in laryngomicrosurgery as compared with endotracheal anesthesia. This method has also been proved to be effective in sinusectomy. 4. Acupuncture was tried for sinusectomy, tonsillectomy and for extraction of teeth. The overall effectiveness has been 64%.
Magnified vertebral angiography on Stenvers projection was carried out in 13 ears (8 cases) and it proved to be an excellent method to visualize the anterior inferior cerebellar artery. The internal auditory artery was visualized in two ears, the anterior inferior cerebellar artery was seen originating the basilar artery in 12 ears, and posterior inferior cerebellar artery in one ear to form.the vascular loop. The vascular loop was recognized in 12 ears. A space occupying lesion around the internal auditory canal is readily diagnosed by recognizing distortions of the vascular loop.
Studies of ASL-O titer and serum protein fractions in patients with frequent infection of the tonsil suggested that some of these patients have more or less disturbance in immunological performance. An increase in α2-globulin in adults is often a sign of focal infection, and focal infection survey is recommendatory in such cases.