The authors studied the changes in the clincal manifestations of nasal diseases through cohort study of school children. Examination consisted of intranasal examination using the fiberoptic telescope, nasal provocation tests, skin tests and psychological tests. There is a recent trend that the prevalence of both chronic sinusitis and nasal allergics are on the decrease even in polluted areas. The frequency of purulent chronic sinusitis at the out-patient clinic is also on the decrease. The pathology of nasal allergy which was more severe in the polluted areas shows a tendency toward moderation probably due to improvement in nutrition, sanitation and living conditions. For teatment of chronic sinusitis radical sinusectomy is less frequently used than conservative surgery or medical treatment is.
Electrogustometry has been widely used for examination of taste disturbance due to facial nerve paralysis or chronic otitis media. Another method of gustometry using taste substances, which has also been in frequent practice, has its drawbacks such as the inability to determine the localization of the disturbance and to attain quantitative evaluation. The filter paper disc method may be able to overcome these drawbacks. A total of 122 cases including those with chronic otitis media, facial palsy and glossitis were examined by both the filter paper disc method and electrogustometry, and the results from each measurement were then compared to assess the quality of the filter paper disc method. The results: 1. Results of the two tests conformed best at the areas innervated by the chorda tympani nerve, followed by the area innervated by the glossopharyngeal nerve and then the area by the greater petrosal nerve. 2. A discrepancy in the results was seen in not a few cases. 3. The two results matched relatively well in such cases as facial nerve paralysis and chronic otitis media. This means that the filter paper disc method has satisfactory quantitative reoponse as in electrogustometry. 4. There was a marked elevation of threshold in patients over 45 years old both in the filter paper disc method and electrogus ometry.
Hearing acuity of 103 tank crews of the Self Defence Forces in the Fuji Educational Division were measured by pure tone audiometry and Békésy audiometry fixed frequency tracing at 4000 Hz. The crews were asked by questionnaire if they had any otologic symptoms, eg. tinnitus, stuffy feeling, autophonia, and hearing difficulty. All examinees were male and their age distribution was between 19 to 49 years. All of them have been exposed to tank-machine noise at the level of 80-95 dBSPL (C), and bombardment sounds 500 times a year at the peak level of 150 dBSPL (C) since they enlisted at 18 years of age. Stuffy feeing was reported by 8.2%, of them, autophonia by 8.2%, continuous tinnitus by 38.5% and 44.9% complained of being hard of hearing c5 dip of more than 30 dB was seen in 26 subjects and a sharp decline of more than 40 dB at 8000 Hz appeared in 17 ears of 12 subjects. A combination of c5 dip in one ear and sharp decline on the other was seen in 2 subjects. After subtracting the level of the aging component of hearing loss, the percentage of occurrence of hearing loss at 4000 Hz became extremely high when their employment period exceeded five years. In spite of their marked hearing loss at 4000 Hz, the fluctuation in continuous traceing in Békésy audiometry narrowed only in a few examinees.
In recent years, a sudden hearing loss showing a temporal severe decrement in hearing during the early stage after the onset of the disease without any reference to the treatments, has attracted the attention of otologists. This hearing loss is evidently different from usual cases of sudden hearing impairments, including sudden deafness, which shows a severe loss at the time of onset and no deterioraton in hearing during any time of the course. The authors report clinical features of this characteristic sudden hearing loss in this article. Case 1 is a 21-year-old student who was treated with the administration of steroid, case 2 a 54-year-old housewife with intravenous injection of low molecular dextran L solution, and case 3 a 51-year-old official with administration of vitamine and vasodilator alone. The appearance of hearing loss at the time of onset was sudden and the hearing threshold at the time of admission ranged from 40 dB to 60 dB in each case. The threshold began to deteriorate on the 3 rd to 5 th day after the onset. The threshold at that time ranged from 70 dB to more than 85 dB and was unmeasurable at low frequency. This severe hearing loss began to improve within the 9 th to 12 th day and returned to normal within the 14 th to 20 th day after the initial onset of hearing loss. From the symptoms of the 3 cases mentioned above, the clinical features of this characteristic sudden hearing loss are summarized as follows. The hearing loss at the time of onset is not always severe. The decrement in hearing is most severe at low frequencies. Recovery of hearing is not always complete. The tinnitus and fullness of ear are quite common, but vertigo is not. The decrement in hearing develops without any reference to the administration of steroids, even in cases in which a viral infection is suspected. The sudden hearing loss reported here is a specific and unusual ear disease that requires further study.
An observation of children with otitis media with effusion revealed the following: The highest incidence of OME was at age 5-6 with the incidence gradually decreasing as age increased. There was another elevation of incidence at age 10, where the disease of tympanic membrane tended to aggravate. These two peaks of high incidence were found to coincide with the ages of acute development in the mastoid pneumatization. The authors suggest that the development of OME is related to the development of mastoid pneumatization.
The authors report rwo cases of rhinogenic retrobulbar neuritis with disturbed visual acuity which were successfully treated by sinus operations. Although there are various theories as to the etiology and definition of the disease these two cases appeared to have been caused by invasion of paranasal diseases into the optic nerve. Better prognosis can be obtained by a prompt operation under an early, confirmative diagnosis. The most important prerequisite for prevention of visual disturbance was thought to be a careful operation of the primary diseae in the paranasal sinuses.
The authors report a simple and effective pack for the defect of the hard palate created by the resection of a maxillary malignancy to be used when a patient can not undergo reconstructive procedure. In many such instances, a simple gauze had been used to pack the defect. The use of a vinyl sheet to wrap the gauze before local application improved various inconveniences created by the simple gauze packing: It gives less discomfort to the patient, less frequent changing by doctors is necessary and a good and secure seal of the defect is attained for effective mastication and ingestion.