Some patients with adenoid vegetation may manifest. changes in the level of immunoglobulins such as increased immunoglobulin D or decreased γ-globulin. The present study indicated that adenoidectomy for such subjects with naso-sinusitis helped to correct the abnormal values in immunoglobulins. It seems that recurrent infections of the nose and paranasal sinuses and the middle ear stimulate the adenoid tissue to produce IgD, causing an increased value of IgD in the circulating blood. Recurrent infections of the upper respiratory tract particularly of the nose and sinuses should be recognized clinically as a disease which may create immunological disturbances.
A 39-year-old woman was admitted to the Dept. of Otolaryngology of Keio Univ. Hosp. with complaints of slight dysphagia of two years' duration. Physical examinations revealed no remarkable findings. Chest X-ray studies showed an abnormal shadow in the right anterior mediastinum, and deviation of the trachea and esophagus to the left. The brachiocephalic artery was also deviated to the right on the aortogram. A curved skin incision in the neck and anterior chest wall with median sternotomy was employed to remove the cyst locating mostly in the anterior mediastinum and partly in the neck. Meticulous care was taken not to damage the recurrent laryngeal nerve. The postoperative course was uneventful, but paralysis of the right recurrent laryngeal nerve was noticed two months postoperatively, which might be due to cicatrical contraction in the mediastinal areolar tissues. Pathological diagnosis was simple cyst but failed to demonstrate its origin.
Since the initial report on postoperative maxillary sinus cyst by Kubo in 1927 numerous papers have been reported on the pathogenesis of the disease. The authors analyzed 137 cases of postoperative maxillary sinus cyst that were treated at the Department of Otolaryngology, Kitazato University Hospital and classified the disease into nine types according to the site of location of the cyst in the maxillary sinus. They are supero-medial, infero-medial, central, medial, superior, infero-lateral, lateral, supero-lateral and polycystic types. In 60 percent of the cases the cysts were found to be located in the medial aspect of the maxillary sinus. The authors reviewed the literature and discuss the etiology of the disease on the basis of their findings in the series.
Myringotomy requires analgesia of the tympanic membrane, this is particularly true in children. Comeau et al revived the method of iontophoretic anesthesia by making a new apparatus. Accoridng to their paper, numerous painless myringotomies were performed in patients ranging in age from 2 1/2 years to adulthood without any major complications. Included in the present study were thirty-nine patients with serous otitis media (42 ears) and eleven patients with Meniere's disease (14 ears). The former group consisted of twenty-four males (27 ears, 4-78 years old) and fifteen females (15 ears, 4-65 years old). The latter group consisted of two males (2 ears, 29-54 years old) and nine females (12 ears, 31-72 years old). An iontophoretic applicator (Medical System Ltd. U. S. A.) was used for anesthesia of the tympanic membrane in these patients. The effectiveness of analgesia of the tympanic membrane by iontophoresis was judged by the degree of pain during myringotomy and ventilatory tube insertion in the group of serous otitis media, and by rubbing the tympanic membrane with the tip of the probe in patients with Meniere's disease. In all cases, tube insertion or tympanic membrane stimulation was performed without pain. The author considers that inotophoretic anesthesia of the tympanic membrane with lidocaine is a painless and safe method for myringotomy and ventilatory tube insertion.