Recently, there seems an increasing criticism against the use of intact canal wall technique for cholesteatoma cases due to a high incidence of recurrent diseases. In order to study possible causes and effective preventive measures of recurrent cholesteatomas the author has reviewed 426 revision cases operated on during the past 9 years, 121 of which were with cholesteatoma, and 37'staged tympanoplasty. cases, 17 of which were with recurrent cholesteatoma. The conclusions drawn were 1. Combined approach tympanoplasty should be performed by a well trained and skilled otologic surgeon. 2. Although one stage combined approach tympanoplasty may be possible for cases where non-infected cholesteatoma is restricted in the attic, staged tympanoplasty should be used for extensive, infected, or child cholesteatomas. 3. Combined approach tympanoplasty should be avoided in cases where cholesteatoma has extended into the tympanic sinus. 4. In combined approach tympanoplasty the posterior bony wall should not be too thinned because it may be absorbed later. 5. The defected lateral wall of the attic should be reconstructed with cartilage and a silastic sheet should be used to prevent adhesions of the tympanic membrane. Gelfoam should not be used in the middle ear in large amount. 6. Combined approach tympanoplasty should not be used for cases with eustachian tube dysfunction.
A 42-year-old male who had two facial fistulas in the right cheek complained of recurrent attacks of pain on mastication and bilateral hearing loss. He had been treated under the diagnosis of osteomyelitis of temporomandibular joint on the right side and chronic otitis media on both side at many hospitals including five university hospitals for the past 17 years. When we examined him first with indirect nasopharyngoscopy at the out-patient clinic of the Jikei University hospital on September 9th in 1977, we found a chopstick made of plastic material bridged. between both sides of the posterior portion of Rosenmullers fossa through the soft tissue of infra-temporal region The foreign body was successfuly removed by palatoepipharyngotomy, followed with an uneventful post-operative course.
Among various causes of CSF rhinorrhea trauma has been considered to be the most frequent and many such reports are available since the first report made as early as the 6th Century. CSF rhinorrhea of non-traumatic origin is rare. The first such report was made in 1899 by Thompson. The authors report an idiopathic CSF rhinorrhea case which was associated with empty sella syndrome and a cystic mass in the sphenoid sinus, the surface of which was characterized by engorged. blood vessels. The mass in the sphenoid sinus was resected by intranasal exposure of the sphenoid sinus and the cavity was obliterated with a muscle graft. Histopathological examination revealed the cyst as meningoencephalocele and the patient has been free from the symptoms for two years.
On several occasions, we have reported pathologies of so-called dental sinusitis and chronic sinusitis. It has been known that unstable pathology of so-called dental sinusitis is quite different from that of chronic sinusitis. Such evidence has been presented from our observations. The so-called dental sinusitis develops easily by infection of the sinus through a decayed tooth and in such cases management of the dental disease is very important. Furthermore such patients respond favorably to antibiotics and other anti-inflammatory agents. The radical operation has to be performed only in cases who failed to respond to conservative treatments. In order to make an accurate diagnosis of dental sinusitis rhinologists are required to have a broad knowledge of odontology.
Objective audiometry was performed on 10 patients with mental retardation by means of Brainstem Evoked Responce (=BSR). It is often important, for the evaluation or training of mentally retarded children, whether they are suffering from hearing loss or not In mental retardation, it is very difficult to perform subjective audiometry, and so is necessary to utilize pure objective audiometry. But it is not always easy to estimate general subjective threshold of hearing loss only by BSR. And then, combined with the other ERA series (i.e., EcochG, FFR, MLR, SVR, etc.), impedance audiometry, and possible audiometries or hearing evaluation, one can estimate the state of hearing loss more accurately. However, when the features of mental retardation are known, BSR appears to be one. of the most useful methods to estimate the hearing in mentally retarded children.