Recent advances in TV technology has made it possible to utilize the closed-circuit television system as an information transmission medium in the clinical, educational and research fields of otolaryngology. The characteristic features of CCTV with an immediate and permanent documentation by the video cassette taperecorder is summarized here with respect to its simultaneity, recordability, reproducibility, instantaneity, and repeatability. The significance of introduction of CCTV into endoscopy, microsurgery, communication betweena surgeon and pathologist in surgery, clinical lecture, histological presentation to students, and presentation at medical conferences is discussed.
There have been various surgical procedures for the treatment of Meniere's disease with a wide range of variation in the reported success rates which are the subject of much controversy. The present paper is a review of the treatment for Meniere's disease by labyrinthectomy, endolymphatic shunt operation, and section of the eighth nerve. Labyrinthectomy is performed in order to control vertigo. The effects are predictable, but residual hearing is sacrificed. A certain number of patients continue to experience unsteadiness postoperatively. Efficacy of partial labyrinthine destruction by ultrasound or cryosurgery is uncertain. Many patients develop permanent hearing loss and/or facial palsy without benefit from surgery. Recently, control of vertigo with preservation of hearing has been of major concern in surgery. Vestibular neurectomy has been found to be effective in the control of vertigo. Hearing should theoretically not be affected in this procedure, but is often lost postoperatively. A majority of inner ear specimens obtained from patients with Meniere's disease showed distention of the endolymphatic space. Perisacular fibrosis and loss of the epithelial layer are the common features while bilateral involvement has been seen in one-third of the cases. Epidural shunt operation is the most rational, safest procedure available and the chosen treatment to perform in the early stage, before the endolymphatic sac becomes fibrotic and hearing deteriorates. It is the safest procedure available, and can relieve the symptoms of vertigo with preservation of residual hearing.
The depressed pneumatization of the mastoid which is a common occurrence in chronic middle ear infections, has not been explained plausibly in respect to its etiology, i. e. whether the poorly pneumatized mastoid induces chronic infection of the middle ear or it is an essential outcome of middle ear infection. The authors studied the effect of middle ear infection in the early stage of life upon the development of pneumatization of the mastoid using pigs, whose mastoid is comparable to that of man. The present study indicated that infections of the middle ear in the early stage of life depress the normal development of pneumatization of the mastoid bone in pigs.
In the field of otolaryngology, diseases of the paranasal sinuses, especially cystic lesions are the most frequent causes of exophthalmos. In order to diagnose the cause of unilateral exophthalmos, it is important to differentiate cystic lesions of the paranasal sinuses from other diseases such as neoplasms (orbital tumors, tumors of the paranasal sinuses, pituitary tumors) which produce unilateral exophthalmos. In these patients, past history, inspective, palpative and ophthalmological examinations are very useful for topographical diagnosis, but further examination such as x-ray examination, CT scanning, or echogram should be performed for the differential diagnosis. The mucocele of the anterior sinuses can be easily diagnosed, while those of the posterior sinuses (especially sphenoidal sinuses) cannot be done easily. Some of those patients with sphenoidal mucocele may not be diagnosed definitely even after these examinations. However the route of approach to the lesion must be decided with this limited information. In this paper, some essential points in the diagnosis of cystic lesions of the paranasal sinuses are described.
A total of 26 patients showing a sore throat, fever, pseudomembrane on the tonsils and/or epipharynx and lymph node swellings in the posterior cervical chains have been examined with the suspicion of having infectious mononeucleosis. The results of the examination revealed 6 cases of infectious mononucleosis with an elevation of Epstein-Barr virus titer, 6 of suspected infectious mononucleosis with either a decrease of EB virus titer or the titer unexamined, 11 inconclusive cases, 2 cases of acute bacterial tonsillitis and a case of an infectious mononucleosis like disease with an elevation of adeno virus titer. This study indicates that a combination of symptoms of acute tonsillitis, pseudomembrane and swelling of the posterior cervical lymph nodes is highly suggestive of infectious mononucleosis.
A review of 122 chronic cases of otitis media with effusion in children in an attempt to study the predisposing factors to the disease revealed the following: 1) the incidence of the disease is much greater during winter time than in other seasons, 2) 155 ears or 64% of the series showed a history of acute otitis media within one year prior to the initial visit with hearing impairment, 3) of the 155 ears 81 ears or 52% had received paracentesis, which suggests that the failure in the practice of paracentesis cannot be blamed for as the major cause of the disease, 4) 106 children or 87% had prolonged upper respiratory infections within one year prior to the onset of hearing defect, 5) nasal symptoms e. g. nasal obstruction, nasal discharge and snoring were seen in 50 to 60% of the series, 6) 74 children (61%) developed the disease during or right after a swimming course at the pool where chlorine is used as disinfectant, which may be one of the causes of the acute rhinitis, nasopharyngitis or salpingitis and subsequent otitis media with effusion. Based on the above findings and 1. above most cases are bilateral, 2. the incidence is centered at a specific age group, 3. its clinical picture suggesting an abortive infection, 4. antibiotic treatment is usually ineffective, 5. frequent occurrence of spontaneous healing, 6. most cases heal or have a fixed disease at a certain age; it is inferred that otits media with effusion may be a result of abortive infection in children of certain age group with temporary local immune dysfunction against infections.
The nature of the tinnitus in Meniere's disease was investigated quantitatively by the tinnitus balance test using the pure tone audiometer before and after the glycerol administration (glycerol loading-tinnitus balance test). The definite cases of Meniere's disease showed several types of change in tinnitus after the glycerol administration. They were as follows:(1) Some cases showed decreased loudness of the tinnitus without any change in the frequency of the tinnitus and in the pure tone threshold. (2) Some cases showed decreased loudness of the tinnitus associated with decreased pure tone threshold of that frequency. (3) Some cases showed decreased loudness of the tinnitus associated with the change in the frequency which did not accompany the change in the pure tone threshold. (4) Some cases showed change in the frequency of the tinnitus without any change in the loudness of the tinnitus and in the pure tone threshold. Some cases of the fluctuating hearing loss showed change in the loudness and the frequency of the tinnitus after the glycerol administration. However, the glycerol loading showed no effects on the sensorineural hearing loss of unknown origin which had no significant change in the pure tone threshold fora long time. The glycerol loading-tinnitus balance test can differentiate the tinnitus which is associated with the endolymphatic hydrops from the tinnitus in the other types of sensorineural hearing loss, and therefore is useful as a routine tinnitus test.
Nasal calculus is one of the calculi to be treated in the field of otorhinolaryngology, but its incidence is comparatively low. We have recently treated a patient with nasal calculus considered to have existed for seven years, and succeeded in analyzing the components of the calculus. The patient was a woman aged 57. She had been treated for sinusitis, with the chief complaints of a stuffy nose and nasal discharge, for about seven years. At her first visit to our department, a brown to dark brown coloured hard mass was noted in the right nasal cavity. Nasal calculus was suspected after taking X-rays, and easy removal followed. The calculus was of irregular shape (21×18×8mm) and weighed 1.33g. When the calculus was cut into two parts through the center, the cross section showed a plant-like core of the size of half a grain of rice at the place considered to be the center of the calculus, surrounded by layers. Infrared absorbance assay, X-ray analysis and X-ray microanalyzer methods revealed that the main component of the calculus was calcium phosphate, and that there were sodium, sulfur and magnesium as the minor components in trace amounts. This calcium phosphate is the same component as that in bones. From this, the nasal calculus was considered to beendogenic.