The author reviewed the otological findings in 226 cases of sudden sensori-neural hearing impairment encountered over a ten-year period at Jichi Medical School Hospital. No definite cause of deafness was detectable in 202 (89%) out of the 226 cases. However, four (1.8%) were diagnosed later as acoustic neurinoma, one (0.4%) metastasized liver carcinoma in the temporal bone, nine (4.0%) initial attack of Meniere's disease, three (1.3%) mumps deafness, five (2.2%) Williams' disease (endolymphatic hydrops without vertigo), two (0.9%) perilymphatic fistula, respectively. The etiology, incidence, treatment and prognosis of each disease are briefly discussed.
Acoustic neurinoma is a brain tumor which starts with symptoms of the 8th cranial nerve such as tinnitus, hearing loss and dizziness. It is a disease we otorhinolaryngologists encounter occasionally in our daily clinical practice. Making early diagnosis of this disease is important for the otorhinolaryngologists. History taking, nose-ear-throat examinations, hearing test, examination of equilibrium function, neurootological examination, plain X-ray, multiple tomography and CT scan are considered important as essential examinations in case acoustic neurinoma is suspected. Where, however, positive findings are few, time is wasted while suspicion of the tumor cannot completely be dispeled in some cases. Recently, we encountered a case in which the examinations mentioned above failed to reveal any postive findings. So, we employed the magnetic resonance imaging (MRI), of whic clinical application was recently made possible and were able to make diagnosis of this disease. This paper is a report of our study of MRI in comparison with various other examinations.
Three hundred and six children (380 ears) with acute otitis media (AOM) who were treated in the outpatient department of Sado General Hospital during the one-year period between April 1, 1986, and March 31, 1987 were analyzed. Sixtythree children (79 ears), or 21% of all patients, and treatment for over 14 days. The highest incidence was from 0 to 4 years of age. Boys were more susceptible to acute otitis media than girls. The male-female ratio of AOM was 1.15: 1. Otitis media with effusion occurred in thirty-five ears (9% of all cases) and 16 of them (5% of all cases) required ventilation tube insertion. Sixtytwo percent of the cases which required treatment of over 14 days had a past history of AOM, and 83% of them had sufferd from sinusitis. Otorrea and swelling of the ear drum were more often seen in the prolonged cases. Haemophilus influenzae was isolated at a high rate (30%) from the middle ear effusion of the prolonged cases.
Nasal provocation test was evaluated by three characteristic symptoms, perennial sneezing, nasal obstruction and watery discharge. In addition, we studied a method for quantitatively evaluating the response of the nasal mucous membrane to provocation using antigen disk, while nasal respiratory resistance was continuously measured by a rhinograph. The response curve in the nasal respiratory resistance with provocation test was classified by the patterns into six types. Also, we obtained three parameters as analysis of the response curve. (1) Ta: This represents the duration for the beginning rise of nasal respiratory resistance in response to the provocation test, reflecting the degree of the sensitivity of the nasal mucous membrane. (2) ΔRrs·N: This parameter is an inclination in rise when nasal respiratory resistance is increasing in the provocation test, and this can be calculated by the tan θ. (3) Rrs·N: This is the value of the stable nasal respiratory resistanse within the initial one minute of the measurement. In this paper, we examined the effect of autonomic nerve and antiallergic drugs in the allergic nasal mucosa by using Rhinograph. The results were as follows, (1) The α-adrenergic stimulant reduced reactivity and sensitivity of the allergic nasal mucosa remarkably. (2) The β2-adrenargic stimulant induced nasal obstruction. (3) The cholino-reseptor antagonist produced no change in three parameters. (4) All of antiallergic drugs were reduced reactivity and sensitivity of the allergic nasal mucosa remarkably, in addition further more topical steroids reduced nasal obstruction remarkably.