In the past decade interest in the pathogenesis of otitis media with effusion (OME) has been renewed along with striking advances in immunology and widespread use of electron microscopy. The clinical aspect of OME seems unlike that of middle ear infection. However, recent immunologic and microbiologic studies have found evidence that the main causative agent of OME is bacterial infection. Many morphologic studies have proved that the mucosa lining the tympanic cavity is a respiratory type, suggesting that the accumulation of effusion can be attributed to the enhanced secretory activity and dysfunction of mucociliary clearance of the mucosa of the tympanic cavity and eustachian tube as well. Secretory IgA is the main immunoglobulin component in certain external secretions. This immunoglobulin is produced locally in the mucous membrane and secreted to the lumen upon antigenic stimuli. This mechanism is called a local immunologic defense system. The results of several immunochemical and immunobiological studies have demonstrated the presence of a local immune defense system in the middle ear. Although it is hard to make a definite classification of middle ear effusions, an acceptable proposal came from the Second International Symposium on Recent Advances in Otitis Media with Effusion (Columbus, Ohio, 1979). Any single laboratory criterion could not differentiate an effusion from one belonging to another category. Nevertheless, mucoid, purulent, and even serous effusions each has secretory IgA. It is generally accepted that mucoid effusions come mainly from secretion, while serous effusions come mainly from serum transudation. Thus, middle ear effusion is a mixture of secretion and serum transudation. On the basis of clinical observations it has been shown that allergy is one of the major causes in the production of middle ear effusion. However, cytologic studies and IgE studies on middle ear effusions failed to find evidence that supports an atopic allergic etiology of this entity. The demonstration of T lymphocytes and elevated C3 proactivator in middle ear effusions suggests that types III and IV allergic reactions injure the middle ear mucosa, resulting in the formation of middle ear effusion. However, it is still not proven.
Fractures of the orbita may involve the suprior ridge or the thin bony plate of the socket as in the case with so-called blow-out fractures. The authors describe five cases with fractures of the orbita, the damage of each of which being quite different. The common sites of the fractures, however, were the lower ridge and the inferior wall of the orbita, while in some cases, they were seen extending into the ethmoid plate of the orbita. All the cases have been corrected through antral approach, which affords various advantages such as easy correction of the medial wall and simultaneous treatment of the damages to the sinuses. Since the paranasal sinuses are involved more or less in many cases with orbital fractures, rhinological approach seems essential for the surgical correction in the sense that the damages to the sinuses ought to be corrected mimulatenously in the same procedure.
A case of cancer of the ethmoidal sinus associated with osteoma of the same site and cancer of the colon is reported. The patient, a 61-year-old female, developed nasal obstruction and proptosis in April 1976 and later visual disturbance. A biopsy of the tumor revealed undifferentiated carcinoma. An extensive surgical resection and postoperative irradiation failed to control the tumor, which extended gradually and finally invaded into the opposite ethmoidal sinus and the patient succumbed three years after the surgery.