Purpose of the present study is to learn the recent trends in surgery of chronic otitis media, particularly of cholesteatoma, in various areas of the world by sending questionnaires to otologic surgeons in the US, Europe and Japan. This study which was confined to those cases operated on during the year of 1977 revealed that: 1. Frequency of mastoidectomy in non-cholesteatoma while it was over 60% in Japan. 2. The homograft tympanic membrane is used more frequently in Europe than in the US. 3. Frequency of radical mastoidectomy for cholesteatoma cases was 11% in Europe, 18% in the US and 21% in Japan. 4. The frequency of modified radical mastoidectomy for cholesteatoma cases was 26% in the US, 23% in Europe and 15% in Japan. 5. The frequency of tympanoplasty.without mastoidectomy for cholesteatoma cases was 13% in the US and Europe while it was 6% in Japan. 6. Frequency of tympanoplasty with mastoidectomy for cholesteatoma cases was 43% in the US, 53% in Europe and 58% in Japan. 7. In the US and Japan the frequency of tympanoplasty with removal (without reconstruction) of the posterior canal wall was about 45% to 50% of all tympanoplaty cases for cholesteatoma while it was 29% in Europe. 8. Reconstruction after removal of posterior canal wall in tympanoplasty for cholesteatoma was more frequent in Europe than in the US or in Japan. 9. In intact canal wall technique for cholesteatoma, it is a recent trend in the US and Europe that a greater number of tympanoplasty are performed as staged operation.
The authors summarized the results of obliterations of the frontal sinus with autogenous bone, homogenous bone, Kiel bone and self-prepared deproteinized heterogenous bone, which had been performed during the past 20 years and discuss the possible causes of failures. Autogenous bone was used in 50 (62 sides), homogenous bone in 36 (49 sides), Kiel bone in 30 (30 sides) and self-prepared heterogenous bone in 19 cases (26 sides). Recurrence occurred in 4 cases (4 sides) of autogenous bone, two of which were considered due to technical failure, in 3 cases of homogenous bone, in 4 cases (4 sides) of Kiel bone and none with self-prepared heterogenous bone. Among the above four materials, the authors consider self-prepared deproteinized heterogenous bone as the most convenient for this technique as it is easy to obtain and less expensive than the others. Failures in the operation may be attributable to 1. failure in total removal of the mucous membrane in the sinus, 2. inadequate treatment of the fistulas, 3. delay in removal of the obliteration material in the early stage of infection if developed, 4. obstruction of the nasofrontal duct, 5. infection of contralateral sinus in the presence of communicating holes, 6. presence of foreign objects in the sinus.
The author examined sound spectrograms of 5 vowels preand postoperatively in 2 cases of laryngeal polyp, 2 cases of laryngeal cyst and a case of laryngeal nodule. Observations which were made mainly on the localization of formant, sound intensity and changes in spectrogram showed a tendency of gradual to normal pattern after surgery and also an increase in intensity associated with noticeable objective improvement in volume. Sonagrams of normal subjects and distribution patterns of 5 vowels-reported by Umeda and Ohta used as the normal standard for the present study.
From the anatomical relations between the posterior ethmoid cells and the optic nerve, it is conceivable that diseases in the posterior ethmoid cells could possibly involve the optic nerve. The authors report 4 cases of postoperative mucocele nd pyocelye the posterior ethmoid sinus with little or no subjective symptoms meanwhile, who developed visual disturbance more than 20 years after the initial permaxillary sinusectomy. The visual disturbance improved markedly after intranasal ethmoidal sinusectomies. The authors discuss the usefulness of microsurgical technique in surgery of such cases.
The authors report a case of basal cell carcinoma of the face occurring in a 57-year-old female who survived for 13 years by a combined treatment of surgery and irradiation, and discuss pathological characteristics of the tumor.