Many problems on recurrent laryngeal nerve paralysis have been studied and discussed. There are at present, however, many questions awaiting solution in the causes and methods for seeking the cause of the paralysis. In this paper, the following two points were re-examined and discussed on the basis of our clinical experience during the past two years. 1) Recurrent laryngeal nerve paralysis which is easily curable comprises several types. Paralysis of inflammatory origin may be one of these types, but inflammation does not find general acceptance as a cause of recurrent nerve paralysis. Incomplete paralysis (paresis) is not always easily curable but complete paralysis is often cured by conservative treatment. Paralysis caused by intratracheal intubation is considered to be cured easily. 2) Recurrent nerve paralysis caused by malignant tumors present important problems. In this paper the relationship between esophageal carcinoma at the second area of narrowing of the esophagus and recurrent nerve paralysis of the right side examined by tomography, Ga-67 citrate scanning, esophagography and angiography is reported.
The lymphocytes are divided into subpopulations according to their origin and function. B cells are precursor cells of antibody producing cells. T cells are the lymphocytes which are originally derived from haematopoietic organ as B cells but have differentiated and acquired their own properties in the thymus. Most of the antigens alone do not stimulate B cells to differentiate into antibody producing cells. They require the factor produced by T cells (helper T cell) at the some time. The proliferation and differentiation of B cells are controlled by another kind of T cells (suppressor T cell) Thus adequate antibody production is controlled and facilitated by these two types of T cells. Dysfunction of suppressor T cells may allow excess production of reagin or autoantibody, and this may lead to the appearance of allergic or autoimmune diseases. Transplanted allogenic cells, tumor cells, and virus infected cells are eliminated mainly by T cells (effector or killer T cell) and sometimes by antibodies in collaboration with complement or the cells having receptor f or Fc portion of IgG antibody (K cell). Target cell killing by K cells is called “antibody dependent cell mediated cytotoxicity (ADCC) ”. Most so called cellular immunities are mediated by the lymphokines: effector molecules produced by activated lymphocytes. Macrophage chematactic factor (MCF), migration inhibitory factor (MIF) and other lymphokines cause accumwnlation of macrophages and inflammation in the area where lymphocytes react with antigen and establish a “delayed type hypersensitivity reaction”. Macrophage activating factor (MAF) increases the activity of macrophages and leads to the killing of phagotized bacteria such as salmonella, tuberculosis, listeria, and leplosis. Immune response is characterized as a specific reaction with antigens. The lymphocytes are only the cells which have antigen specificity. Therefore they play the central role in immune responses.
The audiograms obtained by the practicing clinician and those taken in the departments of otorhinolaryngology of large medical institutions or research centers often show considerable discrepencies in the results. Even tests of the hearing function of the same individual at separate reliable departments of university hospitals may show dissimilar audiograms. Thus the reliability and objective value of such hearing tests have come to be questioned and debated. As examination of the hearing acuity relies upon the subjective response of the individual being tested and as the results are greatly influenced by variable physiologic factors, some difference in the results cannot be avoided. It is however worthwhile to consider and discuss the various factors that might produce discrepencies in the audiogram in order to pinpoint some of the causes that could be corrected and the precautionary measures that must be taken to obtain as nearly as possible a reliable and accurate audiogram. Periodic testing and calibration of the audiometer, gentle handling and correct application of the receiver, the effect of background noise, and the use of interrupted tones are obviously important. Introduction of attenuation in steps of 5 db/sec is best, and initial audiograms of patients at both extremes of age are not reliable. Because of variation in hearing acuity during different periods of the day, tests should preferably be repeated at the same time of day as previously. Audiograms taken in surroundings where the background noise level is high or when TTS due to noise is suspected are worthless. As audiometry is an examination of the sense of hearing, the results should not be interpretated simply as in other objective tests or else considerable errors might be introduced. The above points have been found important for accurate operation and interpretation of audiometric examinations and are stressed in the present paper.
A 36- year-old man with Recklinghausen's disease had impaired hearing of the right ear for over 20 years but otherwise had been free of any other symptoms. Four months prior to his initial visit to our hospital, he noted gradual progressive hearing loss of the left ear. A diagnosis of tumors of the auditory nerves on both sides was made on neuro-otologic examination and the final diagnosis of bilateral acoustic neuromas associated with Recklinghausen's disease was confirmed by skin biopsies, and at operation and autopsy. The results of auditory and x-ray examinations were as follows: Complete deafness of the right ear. Pure hearing loss of the left ear with poor speech discrimination, no recruitment phenomenon and transient elevation of hearing threshhold were indicative of typical retrolabyrinthine deafness. No fixation, positional or positioning nystagmus. No reaction to caloric test of the right ear but the left side was normal. CP on the right. Decreased response to the rotatory test on both sides. No difference between the right and left sides. X-ray examinations with Stenver's and Town's methods and tomograms of the inner ear revealed destruction of the right petrous portion of the temporal bone and enlargement of the internal auditory canal.
The study of nasal resistance to air flow is important for understanding nasal function. Many methods have been used to measure the nasal pressure-flow rate relationship and nasal resistance. However, a standard measurement technique and a standard expression for nasal rsistance have not been agreed upon and a comparison between the findings of various investigators is difficult. A new method for measuring nasal resistance was used here. The experiments were performed on twenty-six volunteers from the medical school. Evaluation of the nasal passage was first made by the passive anterior method using the 3Hz forced oscillation technique, followed by measurements of nasal resistance by the direct method (measurement of transnasal pressure drop and flow rate). The two methods give values of comparable magnitude. There was a fairly close correlation between the two. The method recommended in this paper has the advantage of simplicity, wide range of applicability, reasonable accuracy and sensitivity.
In a review. of our operated cases of chronic otitis rriedia performed by the same operator during the past 7 years, the records of 324 ears that were operated on for the first time were selected for analysis of the pre-and intraoperative clinical findings, especially concerning the benignity of central perf o mation in this disease. The results disclosed that central perforation of the tympanic membranne is not always a benign site of perforation.
A new type of glass suction tip was designed to overcome or eliminate some of the main disadvantages of commonly used metallic suction tips. Preliminary trials with this suction tip have demonstrated its advantages for the aspiration of nasal secretions as follows: 1) The nasal mucosa is not traumatized and therefore the patient is completely free of any pain on aspiration. 2) The transparent walls allow visualization of the nature of the aspirated content and immediate description and explanation to the patient is possible. 3) Ploetz's method can be easily performed with this suction tip, and the use of Politzer's bulb is unnecessary. 4) It is most suitable for use in infants and children. 5) Suction can be easily performed by anyone. We are sure that the use of this new type of suction tip will prove beneficial to clinicians in their daily examination and care of ENT patients.