The number of elderly patients with chronic otitis media is on the increase because of the increasing percentage of elderly persons in the population. This paper is based on 24 tympanoplasties performed on elderly patients over 60 years of age. The clinical history, pathology and results of the operation were studied in order to find out whether chronic otitis media in this age range had some specific characteristics and whether tympanoplasty as a surgical procedure was applicable to aged patients. There were no special inflammatory reactions in the ears of this age range. The postoperative hearing results as a whole were poor. However, in some cases good hearing gain approaching socially serviceable hearing or nearly this level was obtained, and in other cases a dry ear which facilitates the use of a hearing aid and prevents infection of the ear, was attained. Therefore, tympanoplasty procedure to obtain a dry ear is of particular importance in elderly patients. It is concluded that although tympanoplasty, as a rule, can be applicable to elderly persons, if the patient is senile and physically older than his chronological age, tympanoplasty is not advisable.
Restoration of vision by surgery in cases with sphenoidal sinus cyst is discussed. In cases 1 and 2, extranasal pansinectomy was performed within 15 days after the onset of visual disturbance and a complete recovery of visual function followed. But in case 3, transseptal approach to the sphenoidal pyocele performed 21 months after the onset of the symptom, and only a transient recovery of visulal function was observed. Furthermore postoperative re-exacerbation of visual disturbance did not improve by a revision through the extranasal approach. These clinical observations suggested that it was very important to perform extranasal pansinectomy at an early stage for cases with visual disturbance caused by a sphenoidal sinus cyst.
Two cases of acoustic neurinoma presenting initial symptoms as sudden deafness are reported from the view point of audiological examination. Both cases presented perceptive deafness only, and did not present any other neurological symptoms. Retrospective study showed that speech audiometry and ABR test had indicated latent retrocochlear disturbance, particularly at the occasion of the attack of sudden deafness.
Although causes of hiccups are unknown, several folk remedies such as breathholding, sudden fright, drinking cold water, sneezing and traction on the tongue are effective in some cases. But intractable hiccups based on organic diseases render resistance to various treatments. In some cases, the general condition of the patients aggravated because of continuing hiccups. We describe phrenic nerve block and herb medicines which we usually use for intractable hiccups. Herb medicines in particular, were most effective for intractable hiccups. Up to now all 12 cases of intractable hiccups disappeared by the adminstration of herb medicines. The herb medicine used was Kippichikuzyoto with Shitei or Gosyuyuta with Shitei which was prescribed on the basis of traditional Chinese medicinal practices. In this paper we report three such cases.
A case of a metal foreign body in the ethmoid sinus is reported. The patient was a 43-year-old man. While he was operating a machine for cutting scraps, the machine broke and a piece of scrap pierced his face through the right inferior palpebra. The patient visited the department of ophthalmology because of visual disturbance. Adduction of the eyeball was disturbed and diminution of visual acuity (0.01) was observed. The fundus could not be examined. X-ray examination revealed a metal foreign body in his right ethmoid sinus. In order to remove the foreign body, the ethmoid sinus was opened extranasally under local anaesthesia. After removing the foreign body successfully by the authors, the medial straight muscle was adducted by an ophthalmologist. Afer the surgery, eyeball movement improved. However, visual acuity did not improve because of hemorrhaging in the retina and the vitreous body andof a macular hiatus. Clinical characteristics of this case are discussed mainly concerning the site, ophthalmologic signs and kind of foreign body. The length of time before the removal is also discussed with reference to the previous literature over the past 21 years. In this case, CT examination was not helpful to determine the site of the foreign body because the metal body caused a strong dispersion of X-ray.