Electrically induced stapedial reflex on Meniere's disease has been studied in 48 ears and compared to that of normal subjects. Reflex pattern was the same as those of normal subjects in respect of their occurence rate, value of reflex thresholds, input-output function and reflex wave form. According to these results, we thought that the inner ear was not included in the reflex pathway, even though the electric current may spread to the inner ear. However, since the pathological change of cochlear nerve has been reported in rare cases of Meniere's disease, we could not exclude the influence of the current spread to the cochlear nerve. Accordingly, when we apply this reflex in the investigation of Meniere's disease, we should consider this possibility.
Chondroblastoma of the temporal bone is a very rare bone tumor. Twenty-nine cases have been reported in the literature. Recently, we experienced a case of a 45-year-old female with chondroblastoma arising from the left temporal bone. We found the tumor by roentogenologic examination and made a diagnosis of chondroblastoma by it's histopathological findings. It is necessary for diagnosis to distinguish chondroblastoma from other diseases (cholesteatoma, giant cell tumor, aneurysmal bone cyst, chondrosarcoma and hyperparathyroidism). It is easy for a typical case to make a diagnosis by histopathological findings. Surgical treatment is effective for chondroblastoma. However, an extended operation is not necessary. Radiotherapy is also effective, but may cause postradiational sarcoma. Cryosurgery and bone grafting after resection are recommendable. It is very difficult for chondroblastoma of temporal bone to be removed completely, therefore a long term follow-up is necessary.
A retrospective review was made of the medical records of 17 patients, who had branchial cyst, sinus or fistula, and who had been admitted to Kanazawa University Hospital during the 11-years from October, 1977 to 1988. Clinical information was obtained from clinic and office records. The following results were obtained: 1) The sex distribution was 8 males and 9 females, and age distribution was between 6 and 72 years old. 2) Three sinuses were found to be open at the anterior border of the sternocleidmastoid muscle, and 13 sinuses had no evidence of a tract. 3) A branchial pit which connected with an internal opening at the posterior tonsillar pillar was found. 4) Type I or Type II (Bailey's classification) had a higher incidence of branchial cyst. 5) Pathologically, 16 cysts were lined by stratified squamous epithelium but only one was lined by both stratified squamous and non-ciliated epithelium.
We report a case of post-traumatic cholesteatoma of the external auditory canal (EAC). A 27-year-old man visited our clinic with the complaints of right otalgia and otorrhea. His EAC was stenotic and CT scan revealed a fracture of EAC due to the traffic accident in which he had been involved 7 years prior to the visit to our clinic. The surgery revealed the presence of cholesteatoma behind the stenotic area which extended to the tympanic cavity. The postoperative course was uneventful and there is no sign of recurrence in a 6 month follow-up study. Post-traumatic cholesteatoma is uncommon, especially when the obstruction of EAC is incomplete. The most possible explanation for the generation mechanism of cholesteatoma in the present case is the disturbance of the epithelial migration secondary to the post-traumatic deformity in EAC.
The olfactory epithelium of a patient with olfactory disturbance, which was assumed to be caused by Tegafur, was examined with H. E. and immunohistochemical staining. The patient was a 48-year-old male who received 600 mg/day of Tegafur for 4 years until the visit to our clinic. A specimen was obtained from the patient using by Nakano's biopsy forceps type 4 without anesthesia. PAP method was used by immunohistochemical staining. H.E. staining revealed that the epithelium was thin and atrophic. Various-sized nuclei were arranged irregularly in the epithelium. Immunohistochemically, neuron-specific enolase immunoreactivity was not found in the epithelium. On the other hand, all cells throughout the epithelium reacted strongly to anti-cytokeratin antiserum. Glia-specific S-100 protein immunoreactivity was found in nerve bundles and Bowmans glands in the lamina propria. These results showed that functional receptor cell was not present in the epithelium and olfactory neuroepithelium was completely replaced with squamous epithelium. Moreover, it was assumed that clinical olfactory disturbance caused by Tegafur occured by the degeneration of olfactory epithelium. The mechanism of the degeneration of olfactory epithelium was suspected that Tegaful blocked the division of olfactory receptor cells which turned over in normal circumstance. The findings of olfactory epithelium indicate that the prognosis of this olfactory disturbance is poor.
We applied ventilation T-tubes for the treatment of perichondritis of the auricle. T-tube (designed by Goode for the treatment of eustachian tube insufficiency) was inserted under the perichondrium, and allowed for drainage of the pus and the exudate under the perichondrium. T-tube has little tissue irritation, and causes no deformity of the auricle. We treated five cases of perichondritis of the auricle by this method and all cases healed successfully.
Fibrin tissue adhesive (Tisseel-kit) was applied in 31 cases of submucous resection and 23 cases of conchotomy. Clinical efficacy was evaluated in five categories, with the following results: 1) Fixation effects in submucous resection were recognized in 26 of 31 cases. 2) Hemostatic effects in conchotomy were recognized in 20 of 23 cases. 3) Tamponade-reducing effects were recognized in 26 of a total of 33 cases. 4) Early removal of tamponade was possible in 15 of a total of 33 cases. 5) Healing was promoted in 20 of a total of 33 cases. These results indicated that fibrin tissue adhesive was useful in submucous resection and conchotomy, and promoted postoperative healing.