This review gives an outline of stimulaled oto-acoustic emissions (OAEs) which are echoic oscillations from the inner ear and deals with its clinical application as a cochlear function test. In pseudothresholds of OAE (OAE thresholds) of the subjects with normal hearing, a large difference was recognized among individuals. The intersubject difference was small as the interaural difference of OAE threshold. The interaural differences were large in the unilateral inner ear anomaly and mumps deafness but they were less than 5 dB in the cases of unilateral functional deafness. There is a positive correlation between the interaural differences of psycho-acoustic threshold and of the OAE threshold in 109 cases of unilateral sudden deafness. An elongation of the OAE duration more than 6 ms was seen in 34% of the ears of normal subjects, whereas it was seen in all ears of tinnitus without hearing loss and of c5 dip deafness. The OAE threshold is useful as an indicator not only to know the presence of inner ear impairments but also to evaluate the grade of impairments, especially in children. It is also instrumental to differenciate a cochlear mechanical tinnitus from other sensori-neural tinnitus. The cochlear function test by means of the OAE will be generalized in the near future.
The histamine release from the leukocytes of Sugi Pollinosis patients is inhibited by histamine itself. We examined whether the histamine-induced inhibition of histamine release was brought about by the stimulation of H1 or H2 receptors. 2-methylhistarhine as the H1 agonist and 4-methylhistamine as the H2 agonist were used. The results are as follows. 1. The percent inhibition of the histamine release due to antigen stimulation by histamine was 69.2±20.5%(mean±SD), and by H1 agonist was 28.0±20.1%, by H2 agonist was 56.1±22.4%, 2. This inhibition was significantly higher in the antigen-induced release than in the natural release. 3. The inhibition effects of H1 agonist against per histamine was 39.2±25.5% and of H2 agonist was 80.4±19.0%. 4. The feedback mechamism of histamine release is almost found upon the stimulation of the H2 receptors, but only in a little part is found upon the stimulation of the H1 receptors.
The results of pitch match test with a synthesizer (DANAC 100) were reported in this study. The pitch match test was perfomed in 60 tinnitus ears and the discrimination of five kinds of test tones produced from the synthesizer was examined in 6 normal hearing subjects. The short-term reproducibility of the results of pitch match test with the synthesizer was also studied in 10 tinnitus ears. The results were as follows: 1) Seventy-five percent of tinnitus was simulated with sine waves. 2) The incidence of tinnitus simulated with sine waves was high in high-pitched tinnitus. In contrast, the pitch of tinnitus simulated with clipped sine wave and square wave was existed only in low frequency. 3) There was no clear relationship between the onomatopoetic expression of tinnitus and the test tones of the synthesizer. 4) Most of the tinnitus simulated with pure tones of the pure tone audiometer were simulated with sine waves of the synthesizer, and the tinnitus simulated with band noise and white noise of the pure tone audiometer were simulated with test tones other than sine waves of the synthesizer. When the pitch evaluated from 0.1 octave step test with the synthesizer was compared with that in 1.0 octave step test with the pure tone audiometer, an aberration to the higher or lower frequencies was found evenly in any frequency area. However, the degree of their aberration was mostly less than one octave. 5) A consistency of the pitch evaluated from 0.1 octave step test between contralateral and ipsilateral evaluations was found in only 17.3% of the subjects. Other tinnitus showed an aberration of the pitch to the higher or lower frequencies evenly in any frequency area, and the degree of their aberration was more than 0.1 octave. In 86.5% of the subjects, there was no difference of test tones of the synthesizer using for the simulation between contralateral and ipsilateral evaluations. Most of these tinnitus were simulated with sine waves. A consistency of test tones of the synthesizer using for the simulation between contralateral and ipsilateral evaluations was poor in the tinnitus simulated with test tones other than sine waves, and a large aberration of the pitch was also found in these tinnitus. 6) When the discrimination of five kinds of test tones of the synthesizer was examined in 6 normal hearing subjects, it was difficult to discriminate four kinds of test tones except pulse waves in high frequency. Also a big difference of discrimination rate was found in high frequency when an order of presenting two test tones was reversed. 7) As far as the short-term reproducibility of the results of pitch match test with the synthesizer was concerned, only 50% of tinnitus showed the excellent reproducibility of the pitch and the test tones using for the simulation, and they were simulated with sine waves.
Three types of very thin fiber optical system for otolaryngologists were made and used to visualize inside of the Wharton's duct, the maxilla and ethmoid sinuses, and the bronchioles. The one of 0.75 mm diameter was possible to be inserted into the 18 gauge needle. The one of 1.2 mm had a flushing channel and a balloon at the tip. That of 2.0 mm also had a flushing channel and could be angulated 90 degrees. Although thequality of the picture and handling ability was not yet satisfactory, these endoscopes were found to be useful because of their small size and flexibility. Further improvement of the quality of the picture and handling ability will make it possible to apply widly for daily practice.
The radioallergosorbent test (RAST) is one of useful method in detecting specific IgE antibodies in serum. It is an objective, in vitro test with the advantage of low risk. It was widely used as a routine check in the allergic patients now. In order to prove the existance of the specific IgE antibody in nasal tissue, 8 cases of nasal polyp and 6 cases of nasal mucosa were checked with tissue RAST (t-RAST) in our studies. The result of t-RAST was discussed and compared with nasal smear, skin test and serum RAST. In cases of polyps, t-RAST showed the same or somewhat higher level than the serum RAST. In 2 cases of nasal polyp which were negative in serum RAST, we proved positive results in t-RAST of polyp. T-RAST and serum RAST revealed the same score in 5 cases of nasal mucosa with allergic rhinitis. Conclusively, tissue RAST is one of the useful methods in diagnosis of nasal allergy.
Three patients with submandibular gland carcinoma were treated in our department from 1984 to 1986. All of them chiefly complained of a tumor in the submandibular region. In 2 cases, metastases to the neck lymph nodes were seen preoperatively. Surgical treatment was done for all cases. Two patients with the metastases to the neck lymph nodes received radical neck dissection and post-operative irradiation. The primary and the neck lesion were well controlled in all cases, but distant metastases (bone and lung) occurred. One case with solitary lung metastasis was cured by lobectomy of the lung, but the other 2 cases were not controlled with chemotherapy (CDDP, ADM, Ex, etc.). It is suggested that we must be careful with distant metastases especially to the bones and lungs, in the treatment of submandibular gland carcinoma.
Twenty-one cases (22 eyes) with visual disturbance caused by the cysts of ethmoid and sphenoid sinuses were treated in our clinic from July 1975 to January 1988. The average age of the patient (12 males and 9 females) was 44.1 years old. Eighteen cases underwent surgical treatment of the paranasal sinuses. Pain in the eye was complained in 4 cases, swelling of the eyelid was noted in 4 cases, exophthalmos was found in 2 cases and no case complained of double vision. The examination of visual field of the flicker fusion threshold was done in 17 eyes, 4 eyes that indicated the CFF (critical flicker frequency) of 26 Hz in the minimum had good recovery but 3 of 13 eyes that indicated low frequency under 25 Hz did not recover. It is suggested that the cases outside low CFF under 25 Hz, without significant change of the fundus and no severe infection (mucocele or pyocele) and short period from onset of visual disturbance has good prognosis of visual acuity.
A case of cervical malignant lymphoma accompanied by Lennert's lesion in a 55-year-old man is reported. Histology revealed a malignant lymphoma composed of diffuse and nodular proliferation of medium-sized tumor cells, accompanied by clusters of epithelioid histiocytes (so-called Lennert's lesion). But its clinical entity is still a controversial, difficult to classify.
A case of neurothekeoma of the right nasal vestibule is reported. The patient was 52-yearold female. She was seen to our clinic on July 12th, 1984, complaining of about eight months duration. There was a painless mass of the right nasal vestibule with a red color at the right nasal vestibule. The diameter of the mass was 10 mm×7 mm. Since the biopsy from the surface of the mass could not give a definite pathological diagnosis, a relatively wide resection of right nasal vestibule including the mass was performed on August 21 st, 1984. The defect of right nasal vestibule was reconstructed with a free skin flap taken from the right breast. The pathological diagnosis of the resected mass was neurothekeoma. The lightmicroscopic findings of this specimen was in keeping with the reports of Gallager and Helwig (1980) and Gartmann (1983). The postoperative recovery was uneventful and there was neither local recurrence nor distant metastasis until the present time (February, 1988). According to Gallager and Helwig, neurothekeoma is a benign cutaneous tumor of neural origin and tends to occur in the central area of the face, arms and shoulders, with a predominance in females. We found no report of neuroth-ekeoma similar to this case in Japanese literature.
A 26-year-old female and a 56-year-old male who suffered from middle ear cholesteatoma which extended into the inner ear are reported. The vestibule, the semicircular canals and even the cochlea were destroyed by cholesteatoma. They had complete facial palsy and total deafness in the diseased ear. The hearing loss showed no change, but facial palsy improved after the treatments.
The clinical data from 111 patients with sudden deafness who had visited in our clinic from 1982 to 1987 were selected in our study. The number of patients tended to increase in recent years. In these patients, the highest incidense was in fifth decade. There is no difference in sex distinction and side of ear. The patients were divided into 4 groups. The first group was treated with traditional drugs with steroid, Vitamine B12 and ATP. The second group was treated with Lasix (Furosemide). The third group was treated with Prostaglandin E1 (PGE1). The fourth group was treated with Acyclovir (ACV). The rate of efficacy in the traditional method group was 41.7%, in Lasix-ATP method group was 55.3%, in PGE1 method group was 44.0%, inACV method group was 57.1%, but there were no significant difference in the rate of efficacy in these 4 groups. The Lasix-ATP therapy was effective for the cases of so-called scaling out, long time of the onset and old patients. The ACV therapy was effective for the cases of so-called scaling out, early time of the onset and young patients. It is suggested that sudden deafness was probably caused by viral infection in the case of so-called scaling out and young patients.
A 36-year-old male presented with squamous cell carcinoma in the left ethmoid sinus. His chief complaints were left exophtalmos and left nasal bleeding, but he had no complaints of intracranial and spinal disease, We unexpectedly found intracranialand spinal diseases by the use of Magnetic Resonance Imaging (MRI) examination. MRI is useful for head and neck image diagnosis and this examination may lead to distinguish silent diseases.
A case of foreign body in the maxillary sinus (a disposable cigarette pipe made of plastcs) is reported. This foreign body was found accidentally during the operation of chronic sinusitis. The patient was a 32-year-old man. He had been suffered from chronic sinusitis complaining of a nasal obstruction with a frontal headache for 12 years. About five years ago, the 6 th tooth of his right maxilla was extracted because of the caries. Some time after this extraction, he stuck the disposable cigarette pipe into a space of extracted tooth involuntarily. When this accident occurred, he was getting drunk and therefore he misunderstood that the cigarette pipe was misswallowed. This cigarette pipe could be introduced into the right maxillary sinus through the oromaxillary fistula which was madeby the extraction of the 6 th tooth. This foreign body had not been found until the operation. The maincause of this could be that the presumable symptoms of the foreign body introduction was masked by the preceding severe chronic sinusitis. And also the other causes were no occurrence of acute excerbation of sinusitis and the difficulty in the detection of this foreign body by X-ray because of its radiotranslucency. We found no similar report of foreign body in the maxillary sinus in the literature.
In recent years, local thermotherapy (41-43°C) has been conducted for the treatment of cancer. An increasing number of investigators in Japan and abroad have found this therapy to be effective also for allergic rhinitis and rhinitis associated with viral infections. Nasal thermotherapy uses Rhinotherm, an apparatus which aerosolizes distilled water at about 43°C. We recently introduced and tested this apparatus in our facility. Intranasal inhalation was conducted for 15min. once a week in 10 patients with perennial allergic rhinitis and 5 healthy volunteers without allergic rhinitis. The two groups were subjected to nasal airway resistance determination, nasal smear test and nasal provocation test before and after thermotherapy. Data obtained from the two groups were compared. Rhinotherm was used in the rhinitis patients and volunteers after ensuring in a pre-study in a 27-year old healthy female volunteer that the intranasal temperature increases up to 41 to 43°C.
Oto-acoustic emission (OAE) is thought to be originated from the active sound transduction mechanism in the cochlea. The clinical application of OAE is desired because it must reflect cochleal function, and is recorded easily and noninvasively. Effective and simplified stimulus condition is needed to be selected. For this purpose, stimulated OAEs evoked by click sounds and short tone bursts were compared The OAEs evoked by click and tone bursts were recorded from 50 normal hearing ears with type A tympanogram. The frequency of tone burst was varied according to the resonance frequency of the examining ear-probe system. The frequency of OAE evoked by click corresponded with that by tone burst and the pseudothresholds were statistically not differ each other. These facts suggested that click stimulus is essentially identical to the tone burst stimulus. The amplitudes, durations and the endpoint times of OAE were statistically significantly larger in tone bursts evoked OAE than in click sound evoked ones (p<0.01). These facts indicated the tone burst evoked OAE were more easily detectable from the noise level than those evoked by click sounds.
Fifteen cases (eleven males, four females) of acute epiglottitis were reported in this study, All cases were adults with the age ranged from 21 years old to 57 years old. The incidence of various clinical symptoms were as follows; 100% in sore throat, 73.3% in dysphagia, 33.3% in dyspnea, 26.7% in pyrexia and 13.3% in hoarseness. The lateral view of X-ray photograph of the larynx showed the marked swelling of the epiglottis only in 3 cases out of 15. The aerobic cultures from pharynx, epiglottis and blood did not show any growth of Haemophilus influenzae in all cases which was considered to be the causative bacteria of acute epiglottitis. Fourteen cases recovered by the intravenous administration of large amount of antibiotics, but one case needed emergency tracheotomy. All cases recovered without eventful complications. Acute epiglottitis had been considered as an emergency disease in the childhood because of the high incidence of severe dyspnea with the rapid progression. However, this study showed that acute epiglottitis could be the emergency disease even in adults, but not only in children. The swelling of the epiglottis should be checked by indirect laryngoscopy or laryngofiberscopy and the X-ray films of the larynx is only the supplemental tool for the diagnosis of acute epiglottitis.
We reviewed the patients who were seen in the emergency clinics of our department during 1985. The results obtained in this study were as follows: 1. About 70% of the patients were children. 2. About 60% of the patients were seen in weekends and national holidays, and about 55% of the patients were seen during 6:00 p.m.-0:00 a.m. 3. The most frequent emergency disease was otitis media acuta (46.3%), followed by foreign body (16.6%) and nasal bleeding (8.0%). 4. About 95% of the patients were the subjects who did not need to be hospitalized. 5. About 70% of the patients brought by ambulance were the subjects who did not need to be hospitalized.
We compared serum lipids of vertebro-basiller insufficiency (VBI) group (68) with those in Menier's disease group (106) that we had examined during the 4 years from January 1984-December 1987. In our study the serum lipids values in VBI group showed a tendency to be higher than those in Mènier's disease group, particularly in esterized cholestrlol (p<0.01), β-lipoprotein (p<0.01) and in Triglycerid (p<0.05). On the contrary HDL cholestelol showed higher values in Ménier' disease group than in VBI group (p<0.01). We presume that ateroscrelosis is advanced in VBI group with hyperlipocemia etc.
Peripheral blood lymphocytes (PBL) on T lymphocyte subsets in 20 patients with head and neck malignant tumors and in 20 healthy controls were determined in Fluorescence Activated Cell Sorter (FACS) using fluorescein isothiocyanate-conjugated monoclonal antibodies (anti-Leu 2 a, and-Leu 3 a) and phycoerythrinconjgated monoclonal antibobies (anti-Leu 8, anti-Leu 15). The results obtained were as follow: 1. Leu 3 a+Leu 8-cells in patients were significantly increased than healty controls. 2. Leu 2 a+Leu 15+ cells showed no differance between patients and healthy controls. 3. Leu 3 a+ Leu 8-/Leu 2 a+Leu 15+ratio was significantly increased in patients than in healty controls.
Thirty-one cases of blowout fracture were treated at Dokkyo University Hospital between 1980 and 1987. Twenty-one cases were male and ten cases were female. They aged from 4 years to 65 years (average, 23.7 years). Causes of fracture were blows in 21 cases falling down in 6 cases and dropping in 4 cases. Chief complaints and major symptoms were diplopia, disturbance of eye movements and enophthalmos. Occipito-frontal polytomography and computed tomography in addition to sinus-x-ray examinations by Caldwell's view and Waters' view were recommended for the diagnosis. Ophthalmological evaluation included visual acuity, eye movements, traction test and Hess chart test. Twenty-four cases were treated surgically and seven cases were treated coservatively. Among the surgically treated cases, diplopia and disturbance of eye movements were improved in a ratio of 70.8%, 83.3%, respectively. We could not determine the relations of the operation time to the improvement in diplopia and eye movements. But, if the symptoms remained without a tendency to improve after the swelling had disappeared, surgical treatment should be considered positively.
In order to investigate the family history of patients with cedar pollinosis, a questionnaire study was done in patients who called on our out patients department from January 1986 to April 1987. It showed that: 1) The average age of onset was younger than that in the previous study which was done in our department 7 years ago 2) The average age of onset in patients with positive family history was younger than that of the patients without family history. Although cedar pollinosis has been considered recessive heredity, our study suggested that many other factors may be involved.
We report a case of parotid sialolithiasis. A male, aged 41, complained of swelling of the left preauricular region and pain of the same area during taking foods and openning the mouth. On the diagnosis of sialolithiasis of the left parotid gland with the decrease of secretory function of saliva caused by chronic parotitis, he underwent left total parotidectomy after the conservative treatment. A sialolith, small in size, with rough surface was removed from the Stenon's duct. He recovered satisfactorily without facial palsy and other problems. The literature was reviewed and diagnostic, therapeutic methods for sialolithiasis were discussed.
The tonsillar provocation test is one of the diagnostic examinations for tonsillar diseases. Especially it is useful examination for diagnosis of tonsillitis caused by focal infection (tonsillitis chronica focalis). This time, we performed the ultlasonic provocation test in the cases of chronic tonsillitis without focal infection (tonsillitis chronica simplex). The provocation tests were performed in 56 tonsillectomy cases in our clinic during the last five years. Statistical evaluation of the test revealed the following results. 1) Positive results of provocation test were 60.7%. 2) Leucocytes and body temprature showed to be comparative high in the cases of positive provocation test. And they were positive indication for tonsillectomy. 3) In the improved cases after tonsillectomy, leukocytes revealed significant increase during provocation test. It was revealed that the tonsillar provocation test with the ultrasonic method is useful indication for tonsillectomy in the cases of tonsillitis chronica simplex.
A rare case of Ramsay-Hunt syndrome associated with paralysis of the left recurrent nerve was reported. The patient was a 47-years-old male who complained of husky voice. Physical examination revealed left facial palsy, herpetic vesicles of the left auricule, and left vocal cord paralysis. However, the patient did not complain of vertigo and dizziness. The pure tone audiometry indicated the normal hearing of both ears. The presence of herpetic lesion was seen in the areas of the vagal nerve and facial nerve