The tympanic folds may be considered as diaphragms in the tympanum. These folds consist of about 15 different folds and are distributed in certain anatomical locations. Their developments can be explained embryologically. The clinically important strictures are anterior and posterior tympanic isthmuses Prussak's space and anterior and posterior pouches of von Tröltsch, while the relation between the folds and posterior superior quadrant may play some important role in the production of cholesteatoma in the attic. The purpose of this paper is to study the role of the folds in the development of various middle ear diseases particularly of cholesteatoma.
The authors report two recent cases of tuberculosis of the tonsil. One is a very rare primary case of tuberculosis of the tonsil and the other is a secondary lesion from the tuberculosis of the lung. Although the incidence of tuberculosis of the tonsil has greatly decreased, the otolaryngologist still may encounter the disease nowadays. A review of Japanese literature revealed that 1) 19 cases of tuberculosis of the tonsil were reported during the past 18 years, 2) a tendency is observed in which more cases are affected by the hematogenous route during recrudescence of remittent lung tuberculosis and 3) histopathological examination is essential for confirmation of the disease.
Endonasal sinusectomy is one of the most useful operations for treatment of chronic sinusitis. However, severe complications may be associated with this procedure during operation. That is, injury to the roof of the ethmoid sinus, which is the base of the skull itself. The possible complications due to the injury will be CSF rhinorrhea or intracranial infections. A previous study by the author about the incidence of such complications revealed that injury to the base of the skull occurred in 0.15% and acute meningitis in 0.01% in a total of 450, 000 operations. In the present study a close observation of 17 (34 sides) skull spea'mens by the operating microscope revealed five major dangerous areas in the roof of the ethmoid sinus where anatomical structures present unusal vulnerability to injury during operation because of bony dehiscence or defects. The five dangerous areas are 1) the medial cranial wall of the ethmoid sinus, 2) the area about the anterior ethomoid nerve foramen, 3) the site of origin of the middle turbinate bone 4) the antero-lateral aspect of the ethmoid roof and 5) the area about the posterior ethmoid nerve foramen. The author found frequent bony dehiscences in the above sites where the submucous connective tissue is in direct contact with the dura mater and also unusual structure of intimate adhesions between the bony roof and connective tissue of the dura mater. Any injury to the bony roof of the ethmoid sinus in such areas would inevitably cause injury to the dura mater and would be followed by CSF rhinorrhea or intracranial infections. The author stressed that utmost care should be used in operation of the above 5 sites.
BCG therapy was performed in 34 cases with head and neck malignancies including 20 cases with nose and paranasal cancer, 9 case with laryngeal or hypopharyngeal cancer, 3 cases with sarcoma and 2 other cases with cancer. In 19 cases the BCG vaccine was given intradermally by the tine technique, in 6 cases by intra-tumor injection and in 18 cases by local application of many tiny pieces of gelfoam-soaked BCG. The BCG vaccine was given 0.1-40mg at time for 1 to 4 times, 20mg for 1 to 2 times or 40-160mg for 2 to 8 times. The most frequent side-effect of BCG therapy was fever of 2-3 days duration, which was observed in 13 out of the 34 cases. Three cases showed dysfunction of the liver and another 2 cases complained of itching all over the body. Those cases that showed positive cell immunity after the administration of BCG vaccine and, at the same time, survived more than one year without extension or recurrence of the tumor or with reduction of the tumor are considered markedly effective. The results were markedly effective in 7 out of 17 cases with intradermal application, one out of 6 cases with intra-tumor injection and in 11 out of 18 cases with local application. The authors conclude that the adequate method of administrati on is intradermal technique for prevention of recurrence, intra-tumor injection for local recurrence and local application for prevention of recurrence after removal of maxillary cancer.
A study of x-rays of the skull in 1431 ear, nose and throat patients revealed that in 386 cases (26.9%) the styloid process was greater than 20 mm in length. Of the 286 subjects, 204 persons (52.8%) complained of at least one symptom or unusual sensation of the throat. The various complaints were analyzed and classified in regard to possible effect upon the glossopharyngeal nerve, carotid artery, sympathetic nerves, eustachian tube and other surrounding tissues. Postoperative changes in subjective symptoms in five patients in whom the elongated styloid process was resected surgically are reported in connection with unusual sensation in the throat
Obliteration of the post-radical mastoidectomy cavity with muscle flap has been performed in cases, with persistent drainage and sensorineural hearing defect. The procedure is done through a postauricular incision by obtaining a superiorly based large muscle.flap including the temporal and sternocleid mastoid muscles. The mastoid cavity and middle ear are thoroughly exenterated by drilling, and then the ossicles are removed except the stapes. The external canal skin is elevated and reflected. The mastoid cavity, middle ear and the external canal are filled with the muscle flap. At the same time, the orifice of the eustachian tube is obstructed. The reflected canal skin is now put back in place and sutured primarily, leaving a drain in the postauricular incision. The operation wound usually becomes dry in about two weeks. The authors performed 10 such operations resulting in healing up to 5 years in 9 cases. One case developed cholesteatoma. The important procedure in this technique seems to be to obstruct the orifice of the eustachian tube completely and to preserve and replace the canal skin over the muscle flap.