The residue of tectorial membrane insertion of cochlear inner sensory cell hairs of the guinea pig was studied under a scanning electron microscope. Imprints were found on the under surface of the lateral portion of Hensen's stripe. The relative position of these imprints corresponded to the location and the size of the inner hair cells. Such imprints were noted only in the 1st and 2nd half turns of the cochlea. Thus, an actual physical contact between the tectorial membrane and the inner sensory cell hairs may exist in this animal. The pertinent literature is briefly reviewed.
It is known that radiation therapy of the head and neck causes otitis media with effusion. Otitis media with effusion was induced in guinea pigs by cobalt-60 irradiation. Twenty guinea pigs with intact drum and normal Preyer reflex were used. We conducted, two experiments as follows: 1) The animals were irradiated with doses of 2, 000 rad, 4, 000 rad, and 6, 000 rad. They were sacrificed seven days after the irradiation. 2) The animals were irradiated with doses of 4, 000 rad and sacrificed one day, three days, seven days, and fourteen days after the irradiation. Vascular permeability of the middle ear mucosa was observed by Majno's vascular labelling technique. Pathological change of the middle ear was examined under the light microscope. Vascular permeability increased in three days after 4, 000 rad irradiation and small vessels were labelled with carbon particles. Seven days after irradiation, carbon labelling of small vessels was more extensive and extravascular blackening was present in the adjacent tissues. Edematous change of the middle ear mucosa and metaplasia of the epithelial cells were also observed. New bone formation of the tympanic bulla was increased by repeated irradiations.
Two cases with mumps deafness of sudden onset are reported. Case 1: A man aged 25 was referred to the ENT clinic of the National Defense Medical College by an otolaryngologist because the patient complained of hearing impairment and tinnitus of the left ear and vertiginous attacks in the course of mumps. The audiogram showed a left profound hearing loss. Caloric tests of vestibular function indicated the presence of a left vestibular paralysis. A diagnosis of profound sensori-neural deafness and vestibular paralysis by mumps infection was made. Steroid hormone therapy was applied for approximately 2 weeks. However, no recovery has been noted. Case 2: A woman aged 43 presented at the ENT clinic with complaints of hearing impairment, tinnitus of the left ear and dizziness. They have been noted since she had suffered from mumps. The audiogram showed a left profound hearing loss. Caloric tests revealed an absent responsiveness of the affected ear. A diagnosis was made of profound sensori-neural deafness and vestibular paralysis due to mumps. Hearing and caloric impairments did not return to normal by administration of high doses of vitamin B complex.
Pharyngopathy, or discomfort in the throat, is a symptom rather than a disease. It requires clinical evaluation as it may be a manifestation of malignancy in the upper esophagus or hypopharynx. Pharyngopathy has often been regarded as a psychosomatic disease, which requires examination of the patient's psychological background as well as a thorough search for organic disease. Of 144 cases of pharyngopathy seen in the past three years, 3% were malignant tumors, 74% inflammation, 34% deformity of the cervical vertebrae, 14% esophageal disease and 5% neurosis. In spite of the high incidence of inflammatory changes observed in the pharynx, it was not possible to relate these changes to the cause of discomfort in the throat in many patients. The author's impression obtained from repeated interviews and CMI studies is that psychosomatic factors are frequently involved in the symptoms of discomfort in the throat.
A total of 109 cases of laryngeal cancer were treated at the Jikei University Hospital during the six years from 1976 to 1982. They included 72 cases of glottic cancer, 30 of supraglottic cancer and seven of subglottic cancer, with metastasis rates of 11.1%, 40% and 14.3% respectively. Overall survival rates were 74.5% in three years and 70% in five years. The survival rate of 88.8% in two years in glottic cancer did not decline with further years. In the subglottic cancer it was 50% in three years and 35% in five years. Of the supraglottic cancers with the lowest survival rates, in epiglottic cancer it was 25%, while in cancer of the false cord it was 75%. A high incidence of cervical metastasis was seen in epiglottic cancer, whereas local recurrence was found most frequently in cancer of the false cord. The different behaviors of the various supraglottic cancers indicate that different approaches should applied according to the individual case.
Although radiotherapy has proven of great therapeutic value in the treatment of malignant tumors, it should also be borne in mind that radiation has a serious potential risk of giving rise to a secondary malignancy. We recently experienced 2 cases each of carcinoma and sarcoma arising in the irradiated areas long after radiation therapy for malignant tumors. In these 4 cases, 2 males and 2 females, the primary neoplastic diseases were squamous cell carcinoma, epidermoid carcinoma, carcinoma of unknown pathology and malignant lymphoma, and the secondary tumors were epidermoid carcinoma, squamous cell carcinoma, osteosarcoma and chondrosarcoma, respectively. The sites of occurrence of these malignancies were invariably in the maxillary region; the mean latent period was 15 years, aside from an infantile case with a latent period of 5 years. In view of the primary diseases being malignant tumors the following criteria were set up for the diagnosis of radiation-induced malignancies:(1) the site of occurrence is within the confines of a previously irradiated area, (2) the latent period is prolonged and (3) the malignancy occurs as a double tumor. Therapy was primarily by operation. The prognosis was exceedingly ominous, the average survival time being 22 months. This was probably and mainly because of rapidity of tumor growth. Thus, the secondary tumors had already spread back to inward by the time they were first discovered. This should be kept in mind during a long-term follow-up of patients receiving radiotherapy for malignancy.
Visual disturbances occurring as a complication of intranasal ethmosphenoidectomy are often the consequences of injury to the optic canal or optic nerve at the posterior wall of the ethmoid sinus or superior wall of the sphenoid sinus. The authors presented a case where severe visual disturbance occurred on the following day of intranasal ethmoidectomy without injury to the optic canal. The visual disturbance was successfully treated by decompression of the optic nerve. The authors discussed that mechanism of such delayed visual disturbance might be a result of an interrupted blood supply within the optic canal due to surgical intervention around the optic canal, and presented a treatment method for such rare complications.
Although the author reported a one-hand ligation method previously two disadvantages were noted later; firstly it required complicated manipulation, and secondly the thread would be prone to severing because of frequent tangling. The new method presented here using two hands is simple quick and secure, and can be used as easily as the conventional methods.