In 90 patients with chronic sinusitis and septum deviation undergoing endonasal surgery (ethmoidectomy and sphenoidectomy with enlargement of middle meatus), submucous resection or submucous lower conchotomy, the airway resistance through nose (abbreviated as TAR hereinafter) was measured before and after sugery to determine the effect of intranasal structure on TAR. TAR was measured by 3 Hz oscillation method using TUC 5000 Rhinograph (Chest Co., Ltd). Results showed that the ratio of change (difference in TAR before and after operation/preoperative value) showed the greatest reduction for the concave side nasal cavity in septum deviation after lower conchotomy, followed by the convex side after lower conchotomy, the convex side after submucous resection and the concave side after endonasal surgery in this decreasing order. The ratio rather elevated in the concave side nasal cavity in septum deviation after submucous resection. From these results, it was found that the most important factor responsible for an increase in TAR is narrowing of the common nasal meatus due to hypertrophy of the lower turbinate, and the next most important one is septum deviation. In addition, 60 patients having the same disease as those described above were divided into three groups according to age as the group of young age generation under 20 years (abbreviated as the young age group hereinafter), the group of middle age generation of 21 to 40 years (abbreviated as the middle age group hereinafter) and the group of the old age generation over 41 years (abbreviated as old age group), and in each of these groups TAR was measured before and after application of adrenalin. The greatest decrease in the ratio of change (difference in TAR before and after application of adrenalin/value before application of adrenalin) before and after application of adrenalin was recorded for the concave side nasal cavity in septum deviation in the middle age group, followed by the convex side in the middle age group, the concave side in the highage group, the convex side in the low age group, the concave side in the low age group and the convex side in the high age group. Among these changes, the difference observed between the concave side and the convex side in the middle age group was greater as compared to other values. From these results it is considered that in the middle age group the swelling of the lower turbinate is irreversible and in this group conchotomy has great significance.
We made experimental animal model of perilymphatic fistula and observed it histopathologically. Perilymphatic fistula was produced by the injection of artificial perilymph into the subarachnoid space of posterior fossa. Rupture of the round window was confirmed by direct observation of the round window membrane under a surgical microscope during the injection. The animals were either vitally fixed immediately after injection or kept alive for 1 to 3 months before fixation. For histopathological study, the conventional celloidin embedding method was used for serial sectioning. Various types and degrees of changes in the membrana labyrinth were observed. In immediate observation, ten cochleas showed hydrops, seven showed collapse, and 21 of 38 cochleas showed no change. Changes in the vestibular apparatus varied, with collapse of the membranous vestibular labyrihth as the main change. Delayed observation revealed 17 normal cochleas and four collapses and one marked hydrops out of 22 ears. Of these 22, ten ears showed normal vestibular apparatus, ten collapse, and two saccule hydrops. The marked cochlear hydrops was produced by blöcking the longitudinal flow of endolymph. Loss of the outer hair cells was observed in six of 22 cochleas. Marked compression of the örgan of Corti was seen in both immediate and delayed obsevations.
Rhinomanometry is important in the diagnosis of nasal obstruction since it verifies the patient's complaint and provides information regarding the degree and site of obstruction. The nasal mirror, an old device for measuring nasal flow, is also useful, but objective evaluation of the results is difficult. In this study, we designed and tested a liquid cristal rhinoairflowmeter (LCR), which is a modification of the Glatzel nasal mirror, It is also very handy and can be equipped with an instant colour photo system for recording and analyzing the expiratory images on the LCR. The LCR (8×15×0.4 cm) was constructed of four layers, namely, a polyester film layer, a microcapsule layer including liquid crystals, a black layer and a heat-insulating layer. LCR is capable of exhibiting five different colors between 27 and 31°C. As with the nasal mirror, the LCR is held immediately beneath the nose while the patient breathes quietly. The expiratory airflow produces an oval area of changing colors and expiratory patterns of varying colours. The area of the expiratory image on the LCR correlated well (r=0.735) with the nasal conductance determined with a rhinomanometer (RION SR-11). These results confirm that the LCR is convenient and useful for diagnosis of nasal obstruction.
From a practical point of view, the imagings of head and neck tumor with both magnetic resonance imaging (MRI) and X-ray CT were examined in the same cases. Four cases were selected for this study. They were a brachiogenic carcinoma and a carotid body tumor of the neck, an inverted papilloma in the maxillary sinus and a malignant lymphoma of the nasopharynx. Five points for diagnosis such as, 1) conspicuousness, 2) interal structure, 3) regional extent, 4) marginal figure of a tumor and 5) relationship to vessels were inspected. The result indicated that MRI is the imaging modality of choice for investigation of the conspicuosness, regional extent of a lesion and the relationship to vessels and superior to those from CT but CT is superior to MRI in order to determine the marginal edge and its internal structure, especially in the case with cystic tumor.
Frontal sinus infection can spread to the intracrainial space so fast as the crinical situation becomes far advanced before a complication is recognized. A 17-year-old boy with an epidural empyema which developed from frontal sinusitis is reported. There had been severe headaches and fever. He was admitted of a local hospital and treated by antibiotics.CTscan revealed that he had an intracranial abscess. He was referred to our hospital for cranial surgery. Frontal craniotomy was carried out to confirm an epidural abscess. Smears and cultures of fluid aspirated from the abscess were negative. A radical ethmoid, maxillary and frontal sinus surgery was carried out ten days after the cranial surgery. We investigated the bone wall carefully, but didn't recognized any bone defect. The patient made a complete recovery four weeks after admission. Reports in recent ten years were surveyed, and compared to published series in Japan. 23 cases were reported, the number of rhinogenic intracranial complication seems to be not declining. The death rate was 8.7%. The spread of CTscan and the progress of antibiotic therapy have reduced this figure considerably. Many cases of epidural, subdural or brain abscesses developed from frontal sinusitis following upper respiratory infections (URI).
A case of 33-year-old male with peculiar shaped bone formation in the bilateral maxillary sinuses is presented. He visited the hospital because of a persistent uncomfortable sensation in the left cheek. As the diffuse shadow and abnormal calcification in the bilateral maxillary sinuses were found in X-ray examination of CT etc., he underwent the exploratory operation to the bilateral maxillary sinuses. In the left maxillary sinus, there was bone tissue like an imperfect septum which divided the sinus into the anterior one and the posterior one, and a confeteo-shaped bone was on it. A cup-like bone tissue was found in the right maxillary sinus. Both of these bone tissues had no continuity to each sinus wall. The histopathological examination revealed the following; these bone tissues consisted of the spongy bone covered by compact bone layer. The bilateral maxillary sinus mucosa showed striking chronic inflammatory changes. The tiny bone trabeculae in the early stages of bone development were found in the deep layer of the lamina propria in each maxillary sinus mucosa. The fi ndings of histopathology and the discontinuity to the sinus wall, suggested that these bone tissues were developed from the isolated bone fragments which originated inside the maxillary sinus mucosa.
During ENG with eyes closed, we have routinely pressed the eyelashes. This procedure inhibited blinking, facilitating determination of the presence or absence of nystagmus and, in some patients, induced nystagmus. Occasionally, the direction of nystagmus was changed. Pressing the eyelashes not only eliminated interference such as blinks, facilitating determination of the presence or absence of nystagmus but also contributed to the development of nystagmus. We propose that this simple procedure should be added to routine ENG.