Lidocaine HCl is used in the treatment of tinnitus, but its site of action is still unknown. We report our findings on the sequential monitoring of electrocochleographs during administration of lidocaine HCl in 129 patients. Measurements were recorded on a PDP-11 microcomputer. By 1024 samplings at 5 microsecond intervals, we were able to obtain sufficient resolution on the time axis. The average electrocochleograph, following either 300or 600 sweeps, was recorded on floppy diskettes. The time required to process this information was approximately 30 seconds for an average of 300 measurements. We were therefore able to record data at exactly one minute interval by the real time clock. Following attachment of the electrodes, measurements were recorded for ten minutes. 60 to 100mg of lidocaine HCl was then given intravenously within 30 seconds. Electrocochleographs were recorded for 20to 30 minutes following drug administration. The 129 patients studied were made up of 73 males and 56 females with an average age of 45 years (range: 16 to 72 years). Changes in AP latency were studied from the electrocochleographs. In 48 cases (37%), there was no change, however, in 36 patients (28%), there was a prolongation of AP latency. A shortening is observed in 9 cases (7%). Other 36 cases (28%) were unknown, because accurate measurement of AP latency failed due to the included noise. Our conclusions are as follows: (1) There was a wide variation in the effect of lidocaine on AP latency, showing a prolongation in some, a shortening in others and no effect on the others. (2) It was not possible to clarify the relationship between the effect upon latency time, efficacy in treating tinnitus and clinical diagnosis of this disease state. (3) In the cases where a shortening of latency occurred, the change was slight and it was not clear from the time course whether this effect was truly due to administration of lidocaine HCl. (4) In the cases where a shortening of latency occurred, however, the effect was rapid and evident showing a correlation with the tissue concentration. This effect appeared two to five minutes following administration of lidocaine HCl and correlated almost exactly with the symptomatic relief of tinnitus and its effect upon hearing. (5) At the same time, SP latency was also prolongated and the peak values of SP and AP were decreased. (6) From the effect on SP, it is evident that lidocaine affects the organ of Corti directly. However, regarding the effect on AP, since it follows the effect on SP, it is not possible to determine whether or not this is a direct effect of lidocaine on the cochlear nerve. It is believed that the effect on N2 is not a direct effect of lidocaine HCl. From the above findings, we can conclude that lidocaine HC1 has a direct electrophysiological effect upon the cochlea. The time course of this effect correlates directly with the disappearance of tinnitus and it is believed that the inhibition of tinnitus is cochlear-mediated.
The stapedial footplate including its joint with the oval window in 43 ears (29 cases) was studied histopathologically after being embedded in celloidine and cut into serial sections of 20 to 30 micron thick. The thickness of the cartilage around the footplate was found to reduce with the increase in age without totally disappearing in any advanced age group. The stapedial footplate was found to be supported by the annular ligament, which is more like an extension of the periosteum rather than a joint. Such anatomical features simulate the ones between the vomer and the septal cartilage in the nose. No footplate with otosclerotic changes was found in the present series.
In patients with nasal allergy, an isotonic sodium chloride solution, an α-adrenergic receptor stimulator, a β2-adrenergic receptor stimulator and a cholinergic receptor blocker were sprayed at the affected site of the nasal mucosa. Both before and after the spraying, changes in the respiratory resistance of the nose as induced by the nasal mucosal antigen were recorded continuously by the rhinograph. Thus, the effects of these drugs on the hyperresponsiveness of the nasal mucosa responsible for the onset of nasal allergy were grasped objectively and assessed quantitatively. As the results, involvement of the autonomic nerve in the allergic nasal mucosa could be brought to light to some extent, and a clue was obtained for the physiological study clinically on the onset mechanism of nasal allergy. Measurements were made as follows: Firstly, the respiratory resistance of the nose was measured for the right, left and both nasal cavities using the rhinograph. Then, the antigen disks were attached to the medial and anterior spots of the inferior nasal conchae, and the respiratory resistance of the nose for both sides was measured promptly for 8 minutes and the nasal mucosal induced response curves or the rhinograms were recorded. This was done with each drug, spraying it into both nasal cavities, twice for each side. Fifteen minutes later, the measurements before spraying were repeated. Evaluation was made on three parameters of the patient: The air passage through nasal cavities Rrs·N immediately before induced nasal resistance; the reactivity ΔRrs·EN due to swelling of the nasal mucosa; and the sensitivity Ta of the nasal mucosa. The results were that the nasal mucosa was found not to react to the isotonic sodium chloride solution and that the non-reactive drug produced the same wave shape how often the test was repeated. This had demonstrated the reproducibility of the present test method. The α-adrenergic receptor stimulator by its stimulation evaluated the hyperresponsiveness threshold of the nasal mucosa. The β2-adrenergic receptor stimulator by its stimulation reduced the air passage through nasal cavities. While it was not involved in the hyperresponsiveness of the nasal mucosa. Because of its blocking, the cholinergic receptor blocker did not react on the hyperresponsiveness of the nasal mucosa nor did it exert any influence on nasal obstruction.
Eustachian tube function in 28 ears (19children, 9 adults) with otitis media with effusion (OME) were examined on the convalescent stage. They were free from middle ear effusion for several months after myringostomas were closed. Following results were obtained. 1. The excretory function was most improved and the positive pressure (200 mmH2O) equalizing function followed. 2. Tubal passage was normal in all the cases. 3. The negative pressure (-200 mmH2O) equalizing function of the tube showed only a little improvement. These results indicate that impairment of the negative pressure equalizing function is important as one of etiological factors in OME.
Fifteen ears of 12 children with otitis media with effusion were studied by myringotomy. Their tubal functions were examined after the procedure. Without aspiration of mucus in the tympanic cavity, 3 of 6 ears showed no mucus 2 hours after myringotomy. Two days after the procedure all of the nine ears became dry. Ciliary clearance of their tubes were not good and equilibration of negative pressure were totaly disturbed. We concluded that the reduction of negative middle ear pressure by myringotomy restores no ciliary function but the muscular one to clear the middle ear effusion through the tube.
The etiology of otitis media with effusion has been proposed to include tubal dysfunction, inflammation and allergy. Allergy as a cause of otitis media with effusion has frequently been described. The authors used Disodium cromogiicate (Intal) for treatment of otitis media with effusion with the following results: The patients with otitis media with effusion were divided into two groups. The group 1 was those with nasal allgery and group 2 was those without. 1. Improvements in the sensation of fullness in the ear and hearing were greater in group 1. 2. Improvement in the disease of the eardrum was greater in group 1. 3. Improvement in the results of tympanogram was greater in group 1. The improvement in hearing in group 1 was statistically greater than that in group 2. 4. Overall improvement rate was 87% in group 1 and 29% in group 2. (p<0.01).
The measures that have been taken before acoustic tumor surgery for a member of the Jehovah's Witness faith are reported. In this case, fortunately, no transfusion of blood was required. At the present time, the situation regarding the treatment of the members of this faith in Japan is different from that in the United States, and there is no other choice than for each institution to set its own basic policies. However, surgery that will definitely require transfusion will not be able to be performed unless some legislation equivalent to the American system permitting life-saving treatment is established in Japan.
There is a recent tendency that pathology of chronic sinusitis is more complicated because of the frequent and concomitant involvements of the nose and sinuses by allergic diseases. Passive attitude of rhinologists toward surgical treatments may have contributed to the increased number of cases with advanced sinus diseases. We have encountered a severe bleeding from the internal carotid artery during intranasal sinusectomy in a case with advanced sinus diseases with bone involvements. This was due to been a rupture of the internal carotid artery. The authors describe the cause of the bleeding and topographical anatomy of the posterior sinus group in relation to the internal carotid artery.
Fuji computed Radiography (FOR) which is one of the digital radiography was applied for diseases of oto-rhino-laryngology. The features of FCR were as follows: 1. less radiation exposure. 2. enable quantitave treatment. 3. able to obtain wide latitude photo. 4. with edge effect, able to show an outline clearly. 5. easy substruction. 6. the data can be preserved or transported. From our experience FCR was useful in observation of the soft tissues and changes in the inside the respiratory tract.
A compact mobile ORL treatment unit (system) that has many kinds of functions for diagnosis and treatment of ORL is indroduced. This unit was systematically made from several kinds of conventional medical instruments that widely sold in Japan. It is low-priced compared with the conventional units. It may be very convenient in the use in emergency department, outpatient, intensive care areas and in the patients room.