Two main symptoms of Ménière's disease are recurrent vertiginous attacks and fluctuated hearing impairments. For its diagnosis, it is necessary to confirm the presence of inner ear dysfunction and to exclude other peripheral and central diseases. By useing several functional examinations, spontaneous nystagmus, body deviation in stepping, positive pseudofistular sign, directional preponderance in a turning test, both auditory and vestibular recruitment phenomena, negative SP in an electrocochleogram, fluctuating low tone deafness and positive glycerol test may be disclosed, which would indicate presence of endolymphatic hydrops. In this paper, various kinds of therapeutic method, which should be used selectively depending on the different stages of Ménière's disease, such as acute, subacute and chronic stage, were explained. A total of 425 cases with Ménière's disease seen at Kitasato University Hospital, who had been treated mainly by the conservative method, showed a cure rate of 60%. The authors introduced a method by which to evaluate the efficacy of a treatment method by the prolongation of the intervals between the attacks.
Thirty-four guinea pigs received infrasound (1, 10, 20 Hz) at 120-163 dB SPL for one hour. The animals showed no nystagmus and disturbance of balance during infrasound exposure. They were sacrificed fourteen days after the exposure. The cochleas were examined by means of a scanning electron microscope. Pathological findings were hair cell damage and globus formation of the tectorial membrane in the apical turn of the cochlea. These morphological changes were observed in the ears exposed by 20 Hz at 163 dB SPL. No pathological changes were found in the tympanic membrane and the middle ear. As frequency and intensity of the sound increased the number of ears with pathologies increased. Globus formation was observed mainly at the marginal zone and the middle zone of the tectorial membrane. The authors consider that globus is a partial swelling of the marginal nets or an altered substance protruded from the inside of membrane tissue. The attachment of the sensory hairs to the undersurface of the tectorial membrane is disturbed by the globus formation. It is concluded from the present experiment that one hour exposure of the infrasound below 133 dB SPL does not induce any morphological changes in the guinea pig cochlea.
Twenty-three cases of pleomorphic adenoma were treated at our department in the past six years. Thirteen cases of pleomorphic adenoma originated from the parotid gland, three from the palate, two from the lips, one each from the nasal cavity, larynx, external auditory meatus, pharynx and right neck. Pleomorphic adenomas of the parotid gland and palate are found relatively frequently, but cases in the nasal cavity, larynx and external auditory meatus are rare. Only two cases of pleomorphic adenoma of the lips were found in otolaryngological literatures in Japan, though oral surgeons find more cases in the oral cavities than we otolaryngologists do. There were 10 males and 13 females indicating no distinct sex difference. Age distribution was from 18 to 62 with an average being 39. Pathologically, pleomorphic adenomas usually have smooth surface, clear border with no adhesions, hard elasticity and a capsule.
Diagnosis of tuberculous otitis media can be established when tubercle bacilli are detected in otorrhea or when characteristic pathlogical findings are obtained by a histopathological examination. However, none of our five cases was considered having tuberculous otitis media at the beginning. They included the case where tubercle bacilli were identified in bacteria detected from otorrhea during treatment, or where diagnosis of tuberculous otitis media was made by a histopathologic examination after operation or where diagnosis of nospecific otitis media was made by the histopathologic examination after operation despite tubercle bacilli having been detected from otorrhea several times. Examinations to detect tubercle bacilli from otorrhea and histopathologic examinations are difficult to perform because of the amount of samples collected being very small. Where a case in which otorrhea does not stop has been encountered, however, it is important to perform those examinations repeatedly while keeping tuberculous otitis media in mind.
Tympanoplasty was performed using apatite ceramic artificial ossicles in 36 cases (27 cases with cholesteatoma and 9 without). Type 3 tympanoplasty using apatite ceramic ossicle was performed in 34 cases and type 4 in 2 cases. Staged operations were performed in child cases with cholesteatoma. In cholesteatoma cases the opened cavity was obliterated by inserting pieces of tragal cartilage, homograft septal cartilage or porous apatite ceramics into the attic and antrum mastoideum, after taking down the posterior wall and bridge, leaving the canal skin intact. Postoperative hearing level was within 30 dB in 89.0% of the non-cholesteatoma cases, while it was within 40 dB in 57.6% of the cholesteatoma cases. Upon applying the apatite ceramics, it is important to prevent extrusion of the artificial ossicle by inserting a cartilage between the graft and the ossicle.
The authors report that cancer of the lung constitue a larger part as the cause of left recurrent nerve paralysis of unknown etiology, which is greater in incidence than the ones caused by cancer of the thyroid gland. Cancer often involves the hilar lymph nodes either by infiltration or metastases, which is often elusive in radiological examination. A careful and contineous observation is needed for paralysis of the recurrent nerve on the left side.
Pectoralis major myocutaneous flap is one of the useful material for the head and neck reconstructive sugery. Deltopectoral skin flap is also frequently used for the same purposes. When the pectoralis major myocutaneous flap is used, the deltopectoral skin flap should not be sacrificed. When the pectoralis major myocutaneous flap is used, the surgical method to preserve the deltopectoral flap is described in this paper. Surgical procedure is as follows: a skin incision is carried as a usual manner to make the superior and lateral margin of deltopectoral flap and the inferior skin incision is carried down to the skin paddle of pectoralis major myocutaneous flap. After the pectoralis major myocutaneous flap is made, deltopectoral flap is replaced and the wound is closed primarily. We performed this method in 6 patients with head and neck cancer, obtaining good results in all cases.
This study was undertaken to see the usefulness of columella materials and the methods of ossicular reconstruction in modified type IV tympanoplasty. We devised a columella composed of autogenous bone and temporalis fascia. The remaining auditory ossicles or cortex of the temporal bone sculptured suitably was employed as columella material. Temporalis fascia was trimmed to a round sheet, 0.4 cm in diameter and glued to a bone piece with ARON ALPHA. This columella was set on the oval window fossa or foot plate of the stapes, which neither fall down nor slip off readily because of its stability, even by washing the wound. This technique was performed in 7 cases of cholesteatoma and in 5 cases of chronic suppurative otitis media. There were no operative failure cases such as perforation of the tympanic membrane or displacement of the columella. Postoperative hearing improved to within 40 dB in 4 of the 12 cases (33%).