Radiographic observations of deglutitory function were made in subjects complaining of abnormal sensation of the throat in order to evaluate possible changes. Two hundred patients with the above complaints and 63 normal subjects were examined by 15-second serial radiography with a 30 cc barium swallow. Results were, 1) The dilated type and spastic type which are considered pathological were seen in 23% of the patients. 2) In patients with abnormal sensation, the esophageal passage time and evacuation time were all prone to protraction, and barium retention was frequently seen. 3) Patterns of esophageal passage time curves displayed by these subjects may be classified into 4 distinct types ; normal, slow, static and mixed. And it would be appropriate to add a dilated type to these 4 types. 4) As for evacuation of esophageal contents, achalasia-like findings were noted in only 3% of the patients whereas findings suggestive of transient, mild dysfunction of the cardia were frequent. 5) The esophageal function seems to be closely affected either by gastric tonicity or acidity but there was no evidence that its impairment is related to aging or to general autonomic nerve imbalance. Pharmacodynamic tests revealed that cholinergic drugs tend to affect the lower segment of the esophagus whilst adrenergics are liable to affect the upper portion. 6) 43% of the patients showed radiographic evidence of abnormality in phase 2 of swallowing, where, except for 4 cases of true cricopharyngeal dysphagia, the abnormality was no more than a slight hypertonicity of the adit possibly reflecting prolonged passage of contents in the lower esophageal segment. The findings obtained suggest involvement of the higher center in the development of esophageal hypertonia. 7) The authors discussed the clinical implication of the protracted passage of contents in the lower esophageal segment in approximately a half of subjects with abnormal sensation of the throat.
A morphologic study of the distribution of the autonomic nerve fibers in mucosa of the maxillary sinus was undertaken, particularly with respect to changes in the nerve fibers in accordance with the various types of morbid processes in the sinus mucosa. Pathology in the maxillary sinus were divided into two groups on the basis of their severity, mild or harsh, as determined by x-ray mucous membrane function test. There were 10 cases in each group, and mucosal specimens for study were obtained from four sites, the medial, lateral and superior walls and the floor, of the sinus. The distribution of and changes in peripheral nerve fibers, in relation to his, topathologic findings regarding the mucosa as well as clinical findings and past histories of the patients, were studied. The ages of the patients from whom the mucosal specimens were obtained ranged from 17 to 45. Results: 1) The distribution of nerve fibers to the sinus mucosa was sparse, definitely less than to the nasal mucosa. 2) Direct distribution of nerve fibers to the epithelial cells of the sinus mucosa was not observed. 3) Numerous fine nerve fibers running parallel to and near the capillaries in the upper part of the tunica propria were observed. 4) There was meager distribution of nerve fibers to mucosal glands and they were rarely observed around or leading directly to glandular alveoli except in one paticular parts. When they were present, the nerve fibers usually coursed through the connective tissue between the glandular alveoli. 5) Distribution of fine nerve fibers to edematous areas of the mucous membrane was rarely observed. In view of the demonstrably poor or defective staining of nerve fibers in such areas, it is possible that the presence of edema, which is a primary change in the early stage of a disease, compromises neural control of the integrity of the membrane, especially when the edematous change persists for long periods. 6) Cellular infiltration was associated with defective staining of nerve fibers in many specimens, but this finding was not consistent as many areas of severe cellular infiltration showed no signs of insufficiently stained nerve fibers. 7) Nerve bundles were obseved coursing through the tunica propria in fibrotic areas of the mucosa, but few or no fine nerve fibers were obseved in fibrotic tissue. 8) There were no fine nerve fibers along or near revasculized vessels in granular tissue. Conclusion: In view of sparse autonomic innervation in mucous membrane of the maxillary sinus, thickening or swelling of mucosa due to inflammatory lesions might easily lead to disruption of neural maintenance of mucosal integrity. Furthermore, observation of poor or defective staining of nerve fibers under such conditions could indicate adverse effects on functions of blood vessels and glands innervated by these nerves which would lead to impairment of mucosal function. This, together whith various other adverse factors, could be considered as a contributing factor in development chronic paranasal sinusitis.