Chronic sinusitis is frequently associated with chronic bronchial disease in children as well as in adults. However, it is not easy to find out the entity of this syndrome even with the close cooperation of an otolaryngologist, a pediatrician and a chest specialist because such patients are suffering from lesions extending broadly along the upper and lower respiratory tracts. In some cases, the lesions are spread widely over the middle ear, eustachian tube and Waldyer tonsillar ring. This report deals chiefly with the clinical observations of such adult patients having chronic sinusitis or chronic bronchial diseases. In an attempt to evaluate the relationshiip between the diseases, we have analysed the case histories of 25 patients who had bronchiectasis combined with chronic suppurative sinusitis, of 25 patients with bronchienctasis and of 60 patients who underwent sinusectomy for chronic suppurative sinusitis that lasted at least 2 years.
In an attempt to study the normal fluctuation of hearing threshold, the author tested hearing acuity of normal subjects every other hour within one day or at the same hour every second week. The results were as follows; 1. In the every other hour test within a day, normal ears showed 19 dB fluctuation of the threshold at maximum. The fluctuation was greater in low and high frequencies, while it was lesser in the middle frequency range. 2. In about two thirds of the subjects tested there was a tendency for the threshold to elevate at about 1 to 3 p. m. and also at 6 to 8 p. m., which appeared to be related to meals. 3. The Fourier analysis of the results revealed a relative cycle of 2.33 3.50 and 4.67 hours. 4. The fluctuation within a day was greater than that of every second week. 5. Using a JIS standard audiometer and receivers the author found it difficult to determine the real threshold in a subject, for normal ears often showed -10 dB value in 3000 to 6000 Hz. range.
Clinically, rhinorrhea presents itself as one of the main symptoms of diseases of the paranasal sinuses and is an important clue in establishing diagnosis and in deciding on the treatment. Although rhinorrhea has long been studied from various viewpoints, there are very few papers describing the results of rheological studies on it including its detailed physical characteristics. We have performed a rheological study on 30 specimens of rhinorrhea utilizing cone-plate viscometer, which has been reported to be the most accurate method to detemine physical properties of non-newtonian fluid such as rhinorrhea. The results were as follows: 1) Rhinorrhea is non-newtonian fluid with apparent viscosity depending on shear rate. It gave thixotropy phenomenon and had pseudo-plastic and structural viscosity. Its viscosity curve and fluidity curve formed a hysteresis loop. 2) When comparing our date of rhinorrea with those of sputum reported by Akagami, shear stress, which corresponds to shear rate of each specimen, was higher for rhinorrhea than for sputum. 3) Rhinorrhea was found to have a mean value of about 53 dyn/cm2 by Cone's Ascending Order as studied in 30 specimens in this study.
There are many reports concerning the effects of irritation to the nasal mucosa on the lower respiratory tract. In our previous study, the effects of irritation by a nasal applicator to the middle nasal meatus and inferior nasal meatus in the nasal cavity upon the lower respiratory tract were observed by measuring the pulmonary resistance. The study on the right nasal cavity preceded that on the left nasal cavity. It was concluded that the pulmonary resistance slightly decreased upon nasal irritation. In the present study, the effects on lung compliance were studied in the same cases as those in the previous study. The measurement was performed by an apparatus equipped with the polygraph RM-45 produced by the Nihon Koden Co., Ltd. and a transducer of MFP-IT respiratory flowmeter. The effects of irritation to the left and the right nasal cavities were compared, while the patients were asked to breathe by mouth. It was found that there were definite changes in lung compliance. The lung compliance increased in both lungs in 3 cases. It decreased in both lungs in 5 cases. It sometimes decreased or increased by the stimulation in the left or the right nasal cavity in 2 cases. In general, the lung compliance tended to increase to some degree upon nasal muosal irritation.
The general procedure for the differential diagnosis of olfactory disturbances has been topics of some interest, but it is far from clear. The present study was intended to measure the discriminative capacity of kinds of odors (DKO) of several persons, and to get the possible suggestion of affected sites in those with various kinds of olfactory disturbances. Material: This olfactory test was carried out with “T &T OIfactometer”, which consisted of 5 kinds of standard odors, such as β-phenyl ethyl alcohol, cyclopentenolone, isovaleric acid, γ-undecalactone and scatol, each in 10n times diluted solution into Nujol, on persons without any olfactory disturbances and patients with different types of olfactory disturbances shown as follows: 1) Respiratory olfactory disturbances, 2) olfactory mucosa-olfactory disturbances, 3) olfactory disturbances caused by nasal and paranasal disease, and 4) intra cranial olfactory disturbances followed by intracranial disorders such as head injury, brain tumors or craniotomy. Method: First, the examined person was determined his detection threshold of each odor. One of odors which had more concentration by one step (10 times) than first examined was shown to the patient, and he was requested to find out the same odor among other 5 odors which contained the tested odor. This trial was performed on 5 odors, and correct answeres among the 5 odors were recorded by the score from O to 5. Respiratory olfactory disturbance and olfactory mucosa-olfactory disturbance were induced experimentally in normal persons. In the former, a rubber thumbstall was inserted into common nasal meatus to obliterate olfactory rima, and in the latter, 2 mililiters of mucosa anesthetising agent was poured into nasal cavities. Results: In the group without olfactory disturbance, there were no errors in 5 odors by all persons, and no fall of DKO was observed in them. In the group of olfactory disturbances induced experimentally (both respiratory and of olfactory mucosa), in case of moderate disturbance, fall of DKO was observed slightly, and in case of severe disturbance, fall of DKO was observed markedly. In the group of olfactory disturbance caused by nasal and paranasal diseases, there observed slight fall of DKO with moderate disease, and marked fall in advanced conditions. In the group of intracranial olfactory disturbance, marked decrease of DKO was observed independently of severity of the lesion. In case within moderate olfactory disturbances, it might be concluded that DKO less than 2 suggested intracranial disturbance etiologically. In case of advanced olfactory disturbances, however, such differential diagnosis cannot be drawn out by our present examination.
Eight cases of advanced cancer associated with severe pain were given hydrocortison 1000 mg per day or dexamethasone 25 to 40 mg per day for one or two weeks. The pain was alleviated in all patients and no analgesics were needed, furthermore, the patients were benefited by mental exaltation, increased appetite and improvement in systemic conditions. Although no complications such as gastrointestinal bleeding or infections were encountered, there was a decrease in serum potassium, which had to be replaced parentenally.
A statistical study on patients With vertigo who visited Kyoto Red Cross Hospital during the past five years revealed that such patients occupied 8% of all the out-patients visting the department of otolaryngology and that the average number of such patients was 350 a year. About 60% of such patients were referred from other departments including neuromedicine and neurosurgery, the latter two sending about one half of all the patients referred. The number of cases with Meniere's disease appeared to decrease during the years while the number of patients with vertigo of peripheral causes increased. Patients with chronic otitis media were counted about 60 per year, consisting of 37% of all the patients with vertigo of peripheral causes, and 17% of all the patients with vertigo. The high incidence of peripheral vertigo cases may reflect an increasing number of various ear surgeries.
Disturbance in occular movements may be caused by a variety of diseases and such cases are often referred to rhinologists by ophthalmologists or internists. The author reports five such cases operated intranasally, four of whom were cured and one alleviated. Primary cyst of the sphenoid sinus, osteomyelitis of the maxillary bone, postoperative maxillary sinus cysts and multiple myeloma with sphenoid bone involvement were the causes of the occular symtoms. The author discusses a variety of causative lesions and effects of intranasal surgical treatment in such cases.
The authors report a 67-year-old male with cancer of the right kidney that metastasized to the lip and the scalp. The patient survived for one year after the metastases. Autopsy revealed metastatic lesions in both lungs, right femur and left kidney. It is understood that metastasis of cancer of the visceral organs to the skin and lip is extremely rare, and this seems to be the first to appear in Japanese literature.
The author reports his experience in which a round foreign body, a plastic material, impacted in the external ear canal of a 19-year-old female, was removed with the use of a quick setting epoxy resin adhesive. This method was much easier than by the use of forceps and caused no pain.