An earpick can be a cause not only for a perforation of the tympanic membrane but also for injuries of the ossicular chain, in a rare case, involving the inner ear. The authors report two cases of ossicular injuries caused by an earpick ; in one case the stapes was fractured and in the other disruption of the incudostapedial joint and dislocation of the stapes footplate incurred associated with vestibular symptoms. The disrupted chain was reconstructed by interpositioning a Y-shaped homogeneous cartilage (septal cartilage) between the long process of the incus and the footplate resulting in an improvement of hearing in both cases. The authors reviewed 19 such cases appearing, during the past 10 years, in Japanese literature.
Intravenous administration of lidocaine chloride has been shown to have some beneficial effects in the treatment of tinnitus. The authors noticed during the treatment that the treatment results were much better when electrococholeography had been taken during the treatment. The authors surmised that the pulse tone of the electrocochleography to which the patients had been exposed during the intravenous injection of lidocaine chloride enhanced the treatment results. The authors presented 28 such cases and discussed the probable mechanism.
To date, Castleman's lymphoma has been known to occur as a benign tumor of the medistinum, However, we recently encountered a case of Castleman's lymphoma occurring in the neck of a 42-year-old female patient. Dynamic CT showed a high density, which decreased rapidly. From the facts that the enhancement image was uniformly dense and the high density did not last long, the tumor would not be a malignant tumor nor hemangioma. Our diagnosis was a hypervascular solid mass. The tumor was excised from the patient's neck. The surface of the tumor was rich in blood vessels and was readily bleeding. Histologically, a diagnosis of giant lymphoid hamartoma (Castleman's lymphoma) was made. The postoperative course was good, and no relapse has occurred to date. One characteristic of this case was marked proliferation of the blood vessels. This result indicates that dynamic CT is highly useful for the differential diagnosis of neck tumors.
Cis-diaminedichloroplatinum (cisplatin) has become known as an important addition to the anti-cancer chemotherapeutic drugs toward not only genito-urinary carcinomas but also head and neck cancers. But, cisplatin therapy may be accompanied by various toxicities toward hematopoietic, audiological, gastrointestinal, neurological and renal organs. To overcome these problems we studied the effects of combination chemotherapy of cisplatin and its potent antidote, sodium thiosulfate (STS), in patients with head and neck cancers. Cisplatin and STS were administered via two different routes, the superficial temporal artery and intravenous drip infusion (two route infusion chemotherapy). The anti-tumor response rate was 50%, whereas better response was observed in the patients treated with peplomycin combined with cisplatin. Furthermore, the two route infusion chemotherapy reduced side effects on the kidney, liver and bone marrow. For prevention of nausea and vomiting from cisplatin intravenous administration of droperidol in a dose of 0.5-0.7mg and a suppository, domperidon 60mg, were useful.
Sudden deafness is defined as an idiopathic hearing impairment of acute onset. Many workors have discussed possible etiologies but the true cause is still unknown. Clinical data from 101 patients with sudden deafness who had visited our clinic within 30 days of the onset of the disease were studied. 1) The highest incidence was seen in patients in their fifth decade. 2) More patients visited the year after year. 3) The prognosis was best in the patients in their third decade, and in patients showing horizontal type of hearing loss. 4) The prognosis was better in patients who sought medial aid soon after the onset of the disease. 5) CP negative cases had better prognosis. 6) Further study is needed to conclude that LV therapy is effective for the treatment of sudden deafness.