In nine cats (14 ears), active ventilatory functions were deprived by transecting tensor veli palatini muscles and excising hamulus with administration of 50 mg hydrocortisone on the day of the operations, which was for the purpose of preventing inflammatory effect of the surgical intervention on middle ears and eustachian tubes. From two to six weeks' observation, OME occurred in only one ear (7.1%) and high negative pressure in only two ears (14.3%). Eight ears showed low negative pressure within-200 mmH2O, three ears ambient pressure. Two of these showed transient positive pressure in their courses. We concluded that tubal ventilatory dysfunction is not the primary cause of OME but rather a secondary one.
Eighteen guinea pigs received infrasound (1, 10, 20 Hz) at 120-163 dB SPL for one hour. The animals did not show any nystagmus and/or disturbance of balance during infrasound exposure. They were sacrificed fourteen days after the exposure. The temporal bones were examined light microscopically. Pathological findings were loss and degeneration of outer hair cells and globus formation on the under surface of the tectorial membrane in the apical turn of the cochlea. These morphological changes were noted in the ears exposed by 20 Hz at 163 dB SPL. The stria vascularis and the spiral ligament were normal in all ears examined. There were no atrophy of the spiral and vestibular ganglion cells and of the cochlear and vestibular nerves in all experimented animals. The saccule, the utricule and semicircular canals were normal in sectioned specimens. As frequency and intensity of the sound increased the number of ears with pathologies increased. It is concluded from the present light microscopic observation that one hour exposure of the infrasound below 140 dB SPL does not induce any morphological changes in the ear of the guinea pig.
This report deals with psychological analysis of seventy-five cases of vertigo who showed inconsistent results in equilibrium function test. These cases were treated at the vertigo clinic and the psychosomatic clinic in the department of otorlinolaryngology of The Jikei University School of Medicine. Their characteristic profile were divided into five types, that is, type A, B, C, D and E, according to the rosults in Yatabe-Guilford test (YG test). The effects of psychogenic factors upon the onset of vertigo were investigated. The results of YG test were compared with those of other patients with vertigo. In cases of type A, they were not tended to be affected by physical disorders and had a tendency to have vertigo inconsistent with the result of equilibrium test. The type B showed a marked tendency to have such vertigo affected by psychogenic factor. The type C was hardest of the five types to be influenced by both physical disorder and psychogenic factor. The type D was easy to be affected by physical disorder and psychogenic factor. Among the five types the E type had most marked tendency to have vertigo inconsisitent with equilibrium function test affected by psychological factors.
A follow-up study was made on 296 cases with vertigo in this report. After the extended periods (7-10 years) following the first consultation, vertigo disappeared in 52% of the patients and improved in 25%, while tinnitus and hearing loss disappeared in no more than 21 and 17% of the patients. The prognosis of vertigo was not significantly different in age of the patients. The rate of disappearance of vertigo was the highest (at 59%) in the group with peripheral disturbance, followed by the groups with central disturbance (47%) and non-vestibular disturbance (40%). As for vertigenous disease, the rate of disappearance of vertigo stood at 100% for vestibular neuronitis, 63% for Meniere's disease, 54% for sudden deafness, 50% for positional vertigo of benign paroxysmal type, and 37% for cerebrovascular disturbance.
We report a patient with acute epiglottitis who developed cyanosis and respiratory arrest immediately after admission, and underwent emergency surgery in his hospital room. In addition, 22 patients with acute epiglottitis treated at our department during the past 2 years are reviewed. The patient was a 35-year-old male. At the initial examination, marked redness and swelling were observed in the lingual and laryngeal surfaces of the epiglottis. He suddenly developed severe dyspnea and cyanosis in his hospital room. Since endotracheal intubation failed, emergency tracheostomy was immediately performed in that room. He stopped breathing and lost consciousness during local anesthesia but recovered consciousness immediately after the tracheostomy. The interval between the appearance of odynophagia and cessation of breathing was 5 hours. He was treated by intravenous administration of hydrocortisone (500 mg). Antibiotics, CTM, CFS, and DKB, were administered intravenously and intramuscularly. Redness and swelling of the epiglottis subsided 4 days after the tracheostomy, and the patient was discharged after 1 month. Twenty two patients with acute epiglottitis were treated at our department between February, 1984 and February, 1986. The mean age of the patients was 37.8 years, and tne number of males was greater than that of females. Symptoms appeared during the period between September and November in more than half the patients. At the initial examination, no abnormality was detected in the middle pharynx in 16 patients. Seven patients had abscess type lesions and the remaining 15 had edematous type lesions.
The result of rhinomanometry in 285 objects in physical examination is evaluated. We measured nasal resistance with the anterior method of rhinomanometry, observed the shape of their nasal cavities and asked the examinee the level of subjective nasal obstruction. We obtained the nasal resistance in every object in a limited time. In many of them, the measured nasal resistance was different from that we had estimated from the shape of the nasal cavity. This suggests that it is difficult to estimate the actual nasal resistance by routine intranasal examination from the nostril. The rhinomanometry was useful to examine the shape of nasal cavity objectively in physical examination. Our study indicated that a subject would complain of subjective nasal obstruction even when the measured nasal resistance was low when there was a greater difference in the values of nasal resistance between the two nasal cavities.
Of facial bone fractures we, otorhinolaryngologists, encounter in our daily practice, the most frequent one is nasal bone fracture. It takes up 82.9% at the Kanto Rosai (Workmen's Accident) Hospital. We made a statistical observation on the cases who were admitted to hospital for reduction during the past 15 years. Computed tomography was taken in most cases. 1) The number of male patients was about 4 times that of female patients. The incidence as high in those in their teens and 20s; when the two combined, it stood at 72%. 2) As the cause of nasal bone fracture, sports were mentioned the most. Of the sports, ball games including beseball ranked high. In recent years, cases due to sports and fighting tends to increase in number, while those due to workmen's accidents and traffic accidents tends to decrease. 3) The days from injury to the initial hospital visit was within 1 week with the second day cf injury as the peak or 72% of the cases. As for the days up to surgical operation, about 60% of the cases underwent operation for reduction within 2 weeks. 4) Operation was done under general anesthesia in 90% of the cases. The simple reduction was done in 90% of the cases. Lateral ostectomy of the nasal bone was performed for old fracture and deviated nasal dosum cases. 5) The nasal cavity was filled with gauze in most cases, and fixation with buttons was done in 31% of the cases. Denver nasal splint kit was used as plaster fixation. 6) It was clear that CT, as image diagnosis, is more useful than roentgenography of the nasal bone. It is advisable to perform CT in 2 directions, that is, one axial and the other coronal.
Rhinogenous intracranial complications are considered as rare owing to the development of antibiotics. However, the number of reports on these complications has recently tended to increase because of their early detection by advanced diagnostic techniques, such as CT-scan. The authors report here the experience of a case in whom a brain abscess complicated to acute frontal sinusitis after a course of antibiotic treatment and frontal sinusotomy. Further, rhinogenous intracranial complications appeared in Japanese literature were reviewed for incidence by primary lesions, etiology, details of complications and mortality rates. The primary lesion was located in the frontal or the ethmoidal sinus in many cases. These complications were classified by etiology into spontaneous, postoperative and post-traumatic, and the mortality rate was higher in spontaneous cases than in postoperative and post-traumatic ones. As complications, meningitis and brain and subdural abscesses were noted in many cases. There is a report that the incidence of subdural abscess has tended to increase in recent years.
A Bacteriological study was carried out on middle ear discharge in 140 cases of chronic supprative otitis media. One hundred and seventy-two strains (81.4%) of pathogenic bacteria were isolated from 140 cases with chronic supprative otitis media. The most frequent organism found solitary was Staphylococcus aureus (27.9% of 172 strains) and the second was Staphylococcus epidermidis (14.5%) followed by Pseudomonas aeruginosa (9.9%), Pseudomnas maltophilia (7.6%), Candida tropicalis (5.8%), and Corynebacterium (4.7%). Anaerobic bacteria were isolated from 2.9% out of 172 strains. The frequency with mixed infection was 42 cases (33.3%) out of 126 cases. Especially, Staphylococcus aureus, Pseudomonas aeruginosa and Pseudomonas maltophilia were considered to be important pathogenic bacteria of chronic supprative otitis media.