In order to search for an ideal surgical treatment of middle ear cholesteatoma the following studies have been carried out, 1) Study on pathology of postoperative cholesteatoma: In my series of 1044 tympanoplasties with preservation of the posterior canal wall, postoperative cholesteatoma was seen in 20% of preoperative cholesteatoma cases and in 2.2% of non-cholesteatoma cases. The incidence of postoperative attic retraction cholesteatoma was greater in cases with perforation of the posterosuperior quadrant without cholesteatoma than in attic cholesteatoma cases. In many postoperative attic retraction cases. the tympanic membrane was adherent with the horizontal segment of the facial canal and cholesteatoma rested lateral to the ear drum. As granulation was the main pathological feature in the tympanum, it was inferred that absence of the lateral attic wall and malfunction of the eustachian tube were the major contributing factors for the development of postoperative attic retraction. The incidence of postoperative cholesteatoma decreased dramatically after corrective measures were taken for the above causes. 2) Examination of cholesteatoma which was found in planned staged tympanoplasties revealed that most of them were of residual nature, while some were considered to be implanted cholesteatoma. 3) Morphological and anatomical studies of the tympanic folds in temporal bone specimens in connection with the clinical findings indicated that attic cholesteatoma is prone to occur in poorly pneumatized temporal bones and its development appears to be related to obstruction of the tympanic isthmus, which might also be a cause of glue ear in children. Retraction of the postero-superior quadrant of the tympanic membrane, which may be a complication of glue ear seems associated with malfunction of the eustachian tube, proliferation of granulation in the middle ear and adhesions of the tympanic membrane to the promontory. 4) The three major factors in the pathogenesis of cholesteatoma are considered to be malfunction of the eustachian tube, granulation proliferation and negative pressure in the middle ear. By creating the three conditions in experimental animals we could produce cholesteatoma in the middle ear, which would offer a sound basis for the migration theory. 5) On the basis of our study it is concluded that prevention of postoperative recurrence of cholesteatoma can be attained by: 1. practice of staged tympanoplasty; 2. use of intact canal wall tympanoplasty; 3. utilization of silastic sheets in the tympanum; 4. reconstruction of the lateral wall of the attic; and 5. adoption of lateral grafting rather than medial grafting. 6) Survey on the status of middle ear surgery for cholesteatoma has been performed on an international basis.
Basic and clinical investigations with Cephacetrile (CEC), a new semisysthetic Cephalosporin derivative, were performed with results which may lead to the following conculsions, 1) Invitro antibacterial activity: The minimum inhibitory concentration (MIC) was tested by an agar plate dilution method. CEC revealed an excellent, broad spectrum antibacterial activity against 27 standard strains of various bacteria. CEC had the same antibacterial spectrum like those of other Cephalosporin antibiotics. The MIC of CEC against 80 strains of Staphylococcus aureus isolated from otorrhea was observed particularly at 0.78 μg/ml. Other strains of E.coli, Proteus mirabilis, Klebsiella pneumoniae were also examined for their sensivity to CEC, as well as other antibiotics. The MIC against 60 strains of Pseudomonas aeruginosa was > 100 μg/ml of CEC. 2) Blood concentration: The blood concentration of CEC in healthy adults who were given 500mg by intramuscular injection reached a peak level of 11.2 μg/ml on the average 30 minutes after injection. Even after 6 hours, clinically effective serum concentration of 3 μg/ml was still demonstrable. 3) Tissue concentration: CEC activity was demonstrable at the concentration of 1.3 to 1.5 μg/g in tissues of the human palatine tonsil, pharyngeal tonsil and maxillary mucous membrane after one hour of intramuscular injection of 500mg. At the same time, the serum concentration of CEC was 9 to 13 μg/ml. 4) Results of Clinical treatment: CEC was injected intramuscularly to 20 cases of infections in the otorhinolaryngologic field, and the results were excellent in 14 cases, good in 4 cases and fair in 2 cases. When the cases in which it was excellent and good were considered together, the ratio of effectiveness was 90 per cent. 5) Side effects: No side effect was observed in these 20 cases. The comparative examinations of hepatic function, serum electrolytes and auditory acuity before and after treatment showed no significant disturbance.
Eighteen cases of hemangioma of the nose and paranasal sinuses which were encountered at the Jikei University Hospital were reviewed in relation to their pathological charactristics ; capillary, cavernous, and hypertrophic or juvenile. Correct diagnosis could be obtained at the initial examination in all cases by a history of nasal obsruction and epistaxis, and rhinologic examination that showed a smooth, nodular, reddish bulging of the mucous membrane. Local biopsy might have caused severe hemorrhage. X-rays, particularly laminagraphy, were useful in determation of the extent of growth and their blood supply.
A case of sudden deafness with tinnitus and vertigo is reported. A 26-year-old male was admitted to our hospital three days after the onset and treated with various agents such as steroid, vasodilators vitamin B complex, metabolic improvement drugs, oxygen inhalation, and stellate ganglion block. The patient showed complete recovery in hearing within ten days.
The recent remarkable advances in operation for chronic otitis media have been made possible mainly by developments of operating microscope and operative instruments. Many tympanoplasties nowadays are performed with preservation of the posterior canal wall, however, there still are cases where we have to remove the posterior bony wall for complete removal of the middle ear pathology. We also encounter, from time to time, cases in which the posterior bony wall is absent due to a previous surgery. The authors present in this paper a new method of reconstruction of the posterior canal wall with the combined use of tragal cartilage, and muscle and periosteal flap.