Persistent disturbance of the physiological respiratory function of the nasal cavity is a major factor in the pathogenesis of chronic sinusitis, the causes for this in particular being adenoids in early childhood or deviation of the nasal septum which makes itself distinct around the age of 10. About 1, 000 patients with chronic sinusitis who came to our university hospital over a three-year period (1973-1975) were radiologically examined (12 tomograms at intervals of 5 mm along the antero-posterior diameter and plane x-rays from three different angles were taken for each patient) in order to carry out a diagnosis of lesions in the paranasal cavity and also obtain measurements of the nasal cavity. For morphological assessment of the nasal cavity, it was divided into its soft and hard parts consisting of soft tissue and bones and cartilages, respectively, and each of these parts was measured at three different sites along the antero-posterior diameter of the nasal cavity. In addition, color photographs of the nasal cavity were taken and the airflow through it checked (by anterior and combined methods) to investigate the relationship between the variation with time of the airflow through the cavity and its structure, and also between lesions in the paranasal sinus and its structure. The following conclusions were reached: 1. Adenoids apparently give rise to sinusitis in infants by exerting a simple but unfavorable effect on the width of the nasal cavity and hence the airflow through it. 2. There is a tendency in children aged 5 to 10 for nasal cavity lesions to predominantly occur on the convex side of septal deviation (narrower side of the nasal cavity). 3. It is presumed that septal deviation in adults is a major factor in subnormality of the nasal cavity structure, followed by deviation of the bony structure and then by chronic transformation of soft tissue. 4. In cases of septal deviation of a moderate or lesser degree, swelling or hypertrophy of the interior turbinate is seen more frequently on the concave side rather than the convex side of the nasal cavity, with a tendency at the same time for paranasal lesions to predominantly occur on the concave side. 5. Severe septal deviation with curvature of the upper septum is associated with narrowing of the nasal cavity on its convex side, i.e., stenosis or obliteration of the middle nasal meatus as well as a predominance of paranasal lesions on the convex side. Finally, there also were some cases in which pathological mucosa of the. paranasal cavity returned to a normal condition in about three months after reconstruction of the nasal cavity (with paranasal mucosa conserved).
Although aerotitis is a disorder of the middle ear precipitated by rapid barometric changes, it is rarely seen in modern air passengers despite the tremendous increase in air travel because of the smooth and automatic control of changes in pressurization in large passenger planes. However, among airplane personnel it still occurs in a fairly high incidence and is a hazard to which those whose occupation involves flying are exposed. The author has compiled a list of 403 cases of aerotitis media among commercial airplane personnel in our country during a recent 3-year-period and has analysed the data concerning any difference in incidence between cockpit and cabin crews, tendencies to onset, predisposing factors, and has reviewed in detail the flight patterns and pressure changes in the interi Qr of the planes, in orderto pinpoint someol the factors that may be responsible tor the reiativeiy nign inclaence. The literature on this subject is reviewed and the main points and problems in the therapy of this disorder are discussed.
Since the discovery of penicillin by Alexander Fleming in 1929 and the subsequent advent of other powerful antibiotics, otogenic intracranial complications which had been regarded with dread have been drastically decreased, even to the point that almost no attention is being given to its possible occurrence. However, when intracranial complications do occur, the prognosis is grave and such complications are associated with a relatively high mortality. Moreover, the rapid progress and reliance on antibiotic therapy and the abuse of the various antibiotic agents have wrought changes in the pathologic progress of the disease, masking the classical symptoms and signs in not a few instances and leading to misdiagnosis or a delay in arriving at the true diagnosis, not only by internists but also by otorhinologists. On the other hand, less attention is being given to chronic infections of the middle ear because of the decreased incidence and trend toward milder cases but the incidence of cholesteatomas of the middle ear has not decreased. In relation to their site, growth, and resultant bone destruction, intracranial complications, once acute infections set in, are always a potential hazard and their presence should not be overlooked. Four recent cases of otogenic intracranial complications, 2 with thrombosinusitis and 2 postoperative intracranial complications (3 associated with cholesteatomas) are reported and a statistical review of intracranial complications of otogenic origin in Japan for the past 15 years from 1961, particularly in relation to the presense of cholesteatomas of the middle ear, is given.
Disseminated intravascular coagulation is not at all uncommon and can occur in patients in all specialties. Tracheostomies were performed in 2 cases with suspected DIC. In the first case DIC was not suspected beforehand and much difficulty was encountered in controlling the excessive bleeding. In the second case, based on our previous experience, adequate precautions were taken beforehand and the operation was successfully completed without difficulty. These two cases are reported in detail and the problems encountered in such patients are discussed.
A case of a solitary extramedullary plasmacytoma of the nasal cavity is reported. A man, aged 35, complained of epistaxis and nasal discharge for three months. Bence-Jones protein in the urine was absent. There was no evidence of bone involvement on repeated x-ray examinations. Preoperatively, telecobalt irradiation was performed. The tumor was completely removed by an approach employing a combined route through the maxillary sinus and endonasally. Histologically, the tumor proved to be a plasmacytoma. A year after the operation the patient has no recurrence or any evidence of generalized manifestation. Forty-five cases of plasmacytomas of the head and neck in the Japanese literature are reviewed.
Nasopharyngeal stenosis in a 7-year-old boy was encountered, probably due to a previous tonsillectomy and at the age of 5 as nasal obstruction was first noticed about three weeks after the operation. A local mucosal flap was utilized to correct and repair the obstructed portion. Methods employed for the surgical correction of this disorder since the first attempt about 1946 with opening of the cavity and insertion of various tube prostheses and subsequent modifications, leading to the present procedure with use of a mucosal flap, first described by Hamacher in 1957, are reviewed. Although usually acquired, as rare cases of congenital nasopharyngeal stenosis have been reported, an embryologic speculation on the development of this disorder is also attempted.
In continuance with our series of investigations on the influence of environmental and other factors on the incidence of inflammatory disorder of the nose and paranasal sinuses, the results of our latest rhinologic survey among indigenous inhabitants of Mexico are presented. Our previous investigations since 1952, especially our long-term observations of rural and urban children in Japan disclosed wide differences in the incidence and severity of inflammatory disorders of the nose and paranasal sinuses, which were closely related to differences in the nutritional state, availability of hygienic facilities, climatic environments and economic standards. Similar surveys have been carried out by us in various parts of the world among different races living in quite different climatic environments. The present investigation was undertaken in relatively pure Mayan descendents living in Mexico. The primitive mode of life of the Mayan tribe where this survey was conducted was in sharp contrast to the high level of civilization of their forebears. The results of the survey revealed similar rates of incidence of rhinosinusitis as among those living in developed countries (France, United States), but chronic or acute inflammation or hypertrophic changes of the palatine tonsils, adenoidal tissue, lateral pharyngeal walls and lymph follicles were rare and no chronic inflammation of the middle ear was found. We naturally presume that the absence of atmospheric pollution, the low risk of outside infection and the relatively balanced diet, rich in animal proteins, of the natives in the village have contributed to the low incidence of inflammatory disorders of the nose, ear and throat.
In 1928 Seiffert (Berlin) described an effective method of controlling nasal bleeding by ligation of the maxillary artery. A trans-antral approach was used to open the pterygopalatine fossa and expose the maxillary artery. During a 4-year-period from 1970, this method was employed by us successfully in 25 cases, 26 sides, to control nasal bleeding with only one failure. The surgical techniques, indications, results, advantages and disadvantages of this method are discussed and the literature is reviewed. Histopathological examination of resected specimens of the ligated maxillary artery from 1 1 clinical cases and from 10 randomly selected cadavers was also performed. In the clinical cases, those with mild to moderate nasal bleeding showed only thickening of the intima of the artery, whereas in severe cases of nasal bleeding marked disruptions of the tunica elastica of the intima and calcification and hyaline degeneration of the medial coat were found. In the specimens from cadavers, arteriosclerotic changes consistent with age, such as disruptions of the tunica elastica and calcification of the intima and media were seen.
Otorhinolaryngologists and bronchoesophagologists often encounter patients whose chief complaint is hoarseness. Although hoarsseness is complained chiefly in only about 2.6 per cent of all cases of lung cancer, its possible association with lung cancer should be kept is mind and such cases should be carefully examined, as illustrated by the following case. The patient, a 57-year-old man, complaining chiefly of hoarseness, was found to have progressive paralysis of the left and then right vocal cords. Chest films disclosed abnormal shadows in the right upper and middle lobes. Subsequent bronchoscopic examinations, chest angiograms and bronchograms established the diagnosis of primary lung cancer, stage III, which was treated with anti-tumor drugs but the patient expired 5 months later. Autopsy revealed wide-spread metastatic involvement, to regional lymphnodes and distant organs. The clinical course and pathological findings are described in detail and the hoarseness was probably due to metastasis to the peribronchial and cervical lymphnodes with cancerous invasion into the peripheral nerve tissue.
Plastic surgery for microtia requires 3 to 4 operations before it is completed and when combined with the surgical creation or reconstruction of the external auditory canal, additional operations are needed. The purpose of this paper is to describe a 2 or 3 stage method for creation of the external auditory canal and tympanoplasty simultaneously for microtia. The long-term results (3 years to 5 years after operation) of 18 cases are reported.
Accidentally swallowed clasp dentures that are impacted in the esophagus are frequently difficult to remove with the use of a esophagoscope and forceps. The removal of such objects has been facilitated with the use of a vinyl tubing slit down one side with one or two more slits about 5 cm. long at the distal end. The caliber of the tube should be less than the inside diameter of the endoscope to allow easy insertion and about 1.5 to 2.0 times the length of the endoscope. When the impacted denture is freed from the esophageal wall and grasped with forceps, the vinyl tubing is inserted through the endoscope, opening the slit along the side of the tubing to accomodate the arm of the forceps. The tubing is then pushed down further until the slit end opens and entirely covers the denture. The denture enclosed in the vinyl tubing and the endoscope are then removed together.