The author reviewed the literature concerning psychosomatic medicine and diseases in the realm of otolaryngology and discussed psychosomatic aspect of vertigo, functional deafness, tinnitus aurium, chronic sinusitis, nasal allergy, discomfort in the throat (lump in throat), functional dysphonia and stammering. As the diesases in the realm of otolaryngology are closely related with the important perceptive or vital organs patients with these diseases have a prominent tendency to manifest various symptoms of psychosomatic nature. The author also comments on the clinical approach, diagnosis, and treatment of these patients with psychosomatic diseases and particularly on the time and method of discontinuance of treatment in these patients.
A total of 58 cases of cancer of the maxillary sinus have been treated during the past five years at the Department of Otorhinolaryngology, The Jikei University School of Medicine. Our method of treatment consisted of a combined use of intra-arterial infusion of anti-cancer agents and irradiation or surgical treatment combined with the above treatment. Of the 58 cases, 28 cases have been treated by the combined use of intra-arterial infusion and Lineac irradiation and 11 cases survive at present. The remaining 30 cases have been treated by surgical treatment combined with the above treatment and 17 cases survive at present. The authors concluded that most of the tumors cofined to the sinus cavity can be treated successfully by the intra-arterial infusion of Bleomycin (15 mg, 2 times a week to a total dose of 300 mg) and 6, 000 rads of Lineac irradiation and also that cancers extending beyond the walls of the sinus can be best treated by the radical operation performed after treatment by 150 mg. of Bleomycin and 3, 000 rads of Lineac irradiation.
Chordoma is a benign tumor which rarely occurs in the nose and paranasal sinuses. The authors report a case of chordoma that originated in the right maxillary bone with subsequent extension to the hard palate, nasal septum and finally to the left maxillary sinus, ethmoid sinus and the orbit during a 17-year course of repeated recurrence. In the early stage the tumor showed moderate anisocytosis without atypical cells however, in the late stage the neuclei showed a tendency toward pleomorphic and hyperchromatic changes without malignant characteristics. Repeated surgical resections of the tumor were encountered by subsequent recurrence. 5 FU and Bleomycin were totally ineffective for the lesion. The authors conclude that a complete removal of the tumor including the normal surrounding tissues in the early stage would be the rule of treatment of the tumor since this type of tumor could change into sarcoma in the extended course of the lesion.
Many cancer patients suffer from intractable pain in their late stage because of extensive local cancer infiltration. These patients may be helped greatly either by medication of various analgesics or by nerve block. The analgesics include antipyretic analgesics, anti-inflammatory analgesics, combined analgesics and narcotics. In some cases other drugs such as sedatives, tranquilizers, anti-convulsive and hormonal agents may help to alleviate the cancer pains. The authors described 2 cases of cancer of the epipharynx in whom pain was successfully controlled, one by antidepressants used together with various analgesics and the other case by use of steroids, and also a third case in whom severe pain associated with cancer of the external auditory canal had been significantly eased by administration of a large dose of pentazine. Successful control of the severe pain caused by a widely infiltrated cancer can only be accomplished by unstinted effort of the doctor in finding the most appropriate agent for each patient based on a good patient-doctor relation.