In the present study, using radioisotope we observed functionally the changes in submucosal microvascular permeability of the middle ear and response to histamine after occlusion of the eustachian tube in rabbits with experimentally induced otitis media with effusion. Results obtained were compared with results of histopathological study performed simultaneously. As experimental animals 22 adult rabbits were used. Thirteen of these animals were subjected to functional study by use of radioisotope and 9 animals to histopathological study. Otitis media with effusion was induced by pretreating the animals with an insertion of laminalia prepared in wedge form into the pharyngeal orifice of the eustachian tube to occlude it. At 1, 7 and 14 days after the treatment animals were subjected to experiments. The animals with untreated eustachian tube served as the controls. Prior to experiments, a hole as large as possible was made in the tympanic membrane and the middle ear cavity was perfused via the external auditory canal. Also tritium water was administered through intravenous injection and transference of this tritium water into the middle ear cavity was measured by the radioactivity of the middle ear perfusate. From the results obtained, microvascular permeability of submucosa of the middle ear cavity was determined at various periods after establishment of otitis media. Moreover, histamine was added to the fluid for perfusion to determine whether vascular permeability is increased by histamine or not. Radioactivity levels were measured using a scintillation counter. The vascular permeability as measured at 1, 7 and 14 days after occlusion of the eustachian tube increased in function with time. A histopathological study of otitis media with effusion induced by the same procedure indicated a remarkable increase in permeability such as edematous hypertropy of the submucosal tissue of the middle ear. The intensity of the response (increase in vascular permeability) of the mucosa of the middle ear to histamine decreased gradually after occulusion of the eustachian tube, while the effect of the histamine tended to have a long duration. In this tendency no dose-respond relation was seen. From these findings it was demonstrated that the mucosal membrane of the middle ear induced of otitis media with effusion shows a remarkable increase in vascular permeability which persists at least until 14 days after treatment. Moreover it was indicated that histamine increase vascular permeability of not only submucosal micro blood vessels of the mucosa of the normal middle ear cavity but also these in already established otitis media with effusion, suggesting its involvement in the persistence of this disease. Similar to histamine, the vascular permeating factors present in the fluid of the middle ear easily enter into the mucosa through inflammed tissue to further increase microvascular permeability, making chronic inflammation and irreversible. The remarkable proliferation and organization tendency of the connective tissue as revealed by the histopathological observation made at 7 and 10 weeks after treatment of the eustachian tube reflect the above described process. Therefore, in otitis media with effusion which persists for a prolong time and in which the mucosa of the middle ear consistently exposed to the retained fluid containing various factors such as the vascular permeability increasing factor, it is difficult to find a cure of otitis media with conservative treatment such as administration of drugs. We confirmed it is again important under these conditions to employ surgical treatment such as removal of retained fluid as early as possible, namely myringotomy and transtympanic insertion of a drainage tube.
The purpose of this study is to investigate the influence of intense sound on static body balance. Thirty-three subjects and thirty subjects with auditory or vestibular disorders were examined in Romberg's posture on forceplate (gravicorder, Anima Co.). 500 Hz: 87, 107, 127 dB SPL pure tones were applied to each ears for 5 seconds from head phone and the body sways of center of gravity to the lateral directions for 10 seconds were summated 10 times by signal processor (NEC-sanei, 7 T-07 A). The response pattern of normal subjects was classified into 3 types: type A (no remarkable body sway, 52%); type B (symmetrical body sway, 42%); type C (asymmetrical body sway, 6%). These results suggest that abnormal response pattern is the significant asymmetry or inversion of body sway in proportion to increasing of sound levels. As for auditory findings, no specific correlations were observed between the response pattern of body sway and hearing impairment of subjects. One case of sudden deafness and two cases of perilymphatic fistula showed distinct abnormal responses, but no nystagmus was observed when the same stimuli were applied in each case. Two cases of Meniere's disease showed inversion of body sway in proportion to increasing of sound levels. Parker and Reschke (1972) monitored perilymph pressure changes and stapes displacement related to acoustical stimulation in guinea pigs. They noted that intense sound made nonlinear stapes displacement and perilymph pressure change. This mechanism suggests the fact that on-off effect of 500 Hz acoustical stimulation may play analogous effects those of static pressure applied to the external auditory canal. And it may play part of the mechanisms of acoustical vestibular stimulation. It is concluded that this method may provide a new information about the certain pathological change of the vestibulue.
One hundred and three rats of Wistar strain were used in this study. Sixty-nine rats were received infrasound of 0-125 Hz at 85 dB (allpass) for two years and thirty-four animals were offered as controls. The animals exposed in infrasound were periodically sacrificed at two months' interval up to the termination of two years' exposure. The cochleas were examined by means of a scanning electron microscope. The hair cells of the organ of Corti showed an absolutely normal histology in the animals exposed in infrasound of one year's duration. However, the loss of outer hair cells was always noted sporadically in the cochlea of the animals exposed in infrasound of 1.5 years' duration. The animals in infrasound of 2 years' exposure showed a decreased number of the outer hair cells in the organ of Corti of the upper turns, especially apical turn. The pattern of the hair cell loss in the organ of Corti of experimented animals was almost similar to that of controlled animals. Accordingly, the authors considered that the loss of the hair cells in the organ of Corti was due to age-related changes in both experimented and controlled animals.
The authors report a case of a 2-year-old boy with otitis media with effusion, who developed facial paralysis after acute mastoiditis and acute sinusitis. The treatment included mastoidectomy, tube insertion, adenoidectomy and irrigation of the affected maxillary sinus. The facial paralysis began to improve a week after the mastidectomy. The authors pointed that treatment of the paranasal sinuses is also important for a successful management of otitis media with effusion associating complications.
The post-operative cysts of the posterior ethmoidal sinus or the sphenoidal sinus show lower incidence than that of the cysts in the maxillary sinus and the frontal sinus. However, the postoperative cysts of the posterior parananal sinuses often cause visual disturbance as their principal symptom. We have experienced 19 cases of postoperative posterior parananal sinus cysts with visual disturbance during 1980-1987. The clinical symptoms, X-ray findings, surgical findings, surgical technique, prognosis of visual disturbance and mechanism of development of disease are discussed.
It has often been reported that epistaxis from the posterior part of the nasal cavity is attributable to the sphenopalatine artery in most cases. However, the descending artery may also be one of its causes. In particular, it is postulated that the major palatine artery which is running within the major palatine foramen is the responsible vessel. In cranial preparations of 21 cadavers the course and histology of major palatine artery were studied. The major palatine artery bends anteriorly in a sharp angle at 5 to 10 mm above the site where it passes through the palatine bone. At this site the artery is nearest to the mucosa. Like the maxillary artery, the major palatine artery is a muscular type artery. However, the outer membrane becomes thinner at the peripheral side. At that peripheral area there may by bone defect. Therefore, it is estimated that the blood vessel may break relatively easily due to exogenous factors.
Tonsillar calculus is a relatively rare disease. A 49-year-old man visited us with chief complaints of pharyngitis, and redness and swelling of the unilateral soft palate. Incision of Ciari's position produced no discharge of pus, and administration of antibiotios and antiinflammatory agents was ineffective. From these findings, under the suspicion of malignant tumor of the tonsil close examination was carried out. Facial lateral X-ray film revealed a stone in the tonsil. The size of the stone was 10 × 11 × 12mm.
Since paranasal sinuses are anatomically adjoining to the orbit, various sinusal diseases are apt to cause ophthalmic pymptoms. We experienced two cases of orbital cellulitis which appeared to be originated from paranasal sinusitis. The first patient was a 28-year-old man who had progressive exophthalmos and disturbance of ocular movements with reduction in visual acuity. For these disturbances emergency operation was considered necessary. Palpebral vertebra was incised to remove pus, and drainage was carried out. The second patient was a 57-year-old man. Although his ocular symptoms and roentgenographic findings were mild in nature, it was considered desirable to examine the paranasal sinuses grossly and extranasal frontonasal sinustomy was carried out.
We recently encountered a patient with Osier's disease and a patient with systemic lupus erythematosus (SLE) who showed nasal bleeding. The patient with Osler's disease was a 63-year-old female, who exhibited three signs of Osler's disease, i. e., hereditary predisposition, telangiectasia in the cutaneous mucosa and a hemorrhagic tendency. This patient received conservative treatment and surgical correction of the nasal septum. The nasal mucosa of this patient was histologically examined. Light microscopy revealed hyperplasia and dilatation of capillary vessels. By electron microscopy, thinning of endothelial cells, and stratification, hypertrophy and disruption of the basement membrane were observed. The patient with SLE was a 45-year-old female, who showed hematologic abnormalities (hemolytic anemia and thrombocytopenia), immunologic abnormalities (presence of LE cells and a biological false positive to the syphilis test) and antinuclear antibodies. This patient received transfusion and steroid therapy. She later received steroids, immunosuppressing agents and plasma exchange therapy, resulting in an increase in erythrocytes and platelets.
Experiments using the excised canine larynges and clinical observations were conducted to clarify the dynamic movement of the air tract fluid on the glottis to lubricate the larynx during phonation. It was thought that the dynamic movement of the air tract fluid for lubricating of the larynx during phonation was correlated with the vocal fold vibration, especially with the wave motion of the mucous membrane of the vocal fold and dynamic movement of the air tract fluid on the glottis might be one of parameters to evaluate the flexibility of the mucous membrane of the vocal fold.
Effect of hyperbaric exposure on the normal ears was studied in 33 healthy volunteers. High pressure was applied to the subjects for 35 minutes under 2 ATA (atmospheres absolute) condition in hyperbaric chamber. To evaluate the effect on the auditory physiological function, function, pure tone audiometry and tympanometry were performed. The results were as follows; 1) There were no barotrauma cases under hyperbaric condition. 2) No specific changes were found in pure tone audiometry. 3) Increased compliance of tympanic membrane was observed just after the high pressure exposure. 4) Increased compliance of tympanic membrane was almost recoverd 24 hours after the hyperbaric exposure.
A case of auricular cancer is reported. The pationt is a 56-year-old female who has suffered from earache for one year and a half. Biopsy of the auricle revealed adenoid cystic carcinoma. Total auricular resection containing the tragus was performed, preserving external bone canal. The surgical defect was repaired with full thickness skin graft and split thickness skin graft. Right ear scalpture (made of dental rubber) served as a model of a prosthesis. This ear model was sent to Sato Giken (Kyoto) to make a auricular prosthesis. Silicone rubber prosthesis is attached to the defect using adhesive made of silicone. Silicone prosthesis showed a superior cosmetic result. Silicone rubber has excellent property in texture, color and softness.