It is said that high frequency hearing loss is often found in commercial airline pilots. The cause was considered to be the radio communication sound of the Air Traffic Control. The pilots monitor the communication sound through a single earphone on one ear. Some reports have said captains tend to have hearing loss of the left ear, because they monitor the sound with the left ear. Co-pilots and flight engineers have problems with the right ear for the same reason. The noise the pilots are exposed to is radio communication sound and cockpit noise of the aircraft. Flight engineers are further exposed to the noise on the airport apron during the exterior inspection. In this study, cockpit noise, cabin noise and exterior noise were analysed. The results were that none of them cause hearing loss at a high rate. The special quality of the headset which the pilots use was also analysed. The sound pressure greatly changed according to the contact of the ear canal and the ear tip. At the condition of the opening is exist (between the ear canal and the ear tip) the sound pressure of the low frequencies tend to be low. The occurence and progress of hearing loss was thought to depend on the way the radio communication equipment was used. Using audiograms recorded at periodic medical examinations in 1989 by certain airline, the hearing level and the frequency of hearing loss of right and left ears were analysed. 1937 pilots were classified by type of occupation (captain, co-pilot or flight engineer), age and flight time. The examination of the difference of the average of right and left ears' hearing level, difference of the frequency of c5dip, showed no statistically significant difference between right and left ears. Further the correlation of hearing level at 4, 000 Hz versus age, hearing level of 4, 000Hz versus flight time, hearing level of 4, 000Hz of the right ear versus the left ear were investigated. As the results showed the correlation of the hearing level versus age to be greater than versus flight time, the influence of aging is suggested. The correlation of the hearing level of right ear versus that of left ear was largest. The hearing of the right and left ears seemed to change similarly. Therefore the sound of radio communication cannot possively be the main cause of the hearing loss such as the difference of the individual tolerance to noise are more plausible. 1, 452 pilots, 388 cabin attendants and 1, 175 members of the general public were compared in age bracket groups for the hearing level and loss of high frequency hearing. In the same age groups, the hearing level and the rate of hearing loss of pilots and cabin attendants were almost same degree, but comparison with general pubic, showed the rate of hearing loss of the general public to be larger than that of pilots and cabin attendants. Furthermore, when the rate of high frequency hearing loss was compared between different types of pilot, the difference was not statistically significant. The hearing levels of pilots recorded in 1984 and 1989 were compared. The hearing level had not fallen during these five years. It was therefore shown that being a commercial airline pilot causes loss of hearing not so frequently.
In the patients with adhesive otitis media, the mucosa of the inferior turbinate was transplanted to the site on the medial wall of the middle ear where the mucosa was missing to prevent recurrent adhesion. Histomorphological investigation was made using light and transmission electron microscopies of the mucosa of the inferior turbinate to be transplanted, normal promotory mucosa, the middle ear promontory mucosa of the non-adhered region in the cases of adhesive otitis media and the middle ear mucosa to which the mucosa of the inferior turbinate was transplanted. The postoperative courses of 10 cases undergone staged operations were favorable, showing no recurrence of adhesion in any of them. We could not decide whether the transplanted mucosa of the inferior turbinate took as middle ear mucosa in all cases. However, it was considered that this staged operative method by which the mucosa of the inferior turbinate is transplanted is useful for preventing recurrence of adhesion by securing the middle ear cavity. Many of the epithelia of the middle ear mucosa to which the mucosa of the inferior turbinate was transplanted were cuboidal epithelia with less goblet cells, showing a difference from the pseudostratified epithelium peculiar to the mucosal epithelium of the inferior turbinate. In the lamina propria, no clear zone and nasal glanduler tissue which is characteristic in the mucosa of the inferior turbinate was observed in the middle ear promontory mucosa to which the mucosa of the inferior turbinate was transplant-ed. However, the middle ear mucosa closely resembling the mucosa of the inferior turbinate was observed in 1 case. In this case, no nasal glandular tissue was observed, But, it suggested that the mucosa of the inferior turbinate transplanted takes as middle ear mucosa and keep a part of the charactaristic of the mucosa of the inferior turbinate.
On the basis of the results of a clinical study on 61 patients (67 lesions) with postoperative mucocele in the frontal, ethmoidal and sphenoidal sinuses and who were treated during the 10-year period from 1980 through 1989, the authors emphasize the following points. 1. Paranasal operation in young patients (teenagers) is likely to cause postoperative mucocele due to postoperative changes in the surgical wound. In most postoperative mucocele cases, the mucocele develops 15-24 years after the initial operation. 2. In about 1/3 of mucocele cases, the middle meatus is normal or shows only slight changes, such as mild edema. Although the incidence of adhesion of the middle meatus is high, the incidence of polyposis, etc., which suggests severe sinusitis, is low. 3. There is no relation between the development of mucocele and deviation of the nasal septum. 4. Some mucocele are polycystic, and thus it is important to check the mucocele by preoperative CT scanning. 5. Mucocele of the frontal and anterior ethmoidal sinuses have many clinical symptoms compared with mucocele of the posterior paranasal sinus. 6. Cure of ethmoidal and sphenoidal mucocele can be achieved by sufficient opening of the mucocele wall by the endonasal approach. Also, some cases of frontal sinus mucocele can be treated by sufficient opening of the naso-frontal duct by the endonasal approach under endoscopic observation.
Two cases of the high cervicals cord dysfunction were presented and the respiratory management after tracheostomy was studied. The fisrt case was a 48-year-old male suffering from the cervical cord tumor at C2-4. After laminectomy, he had dyspnea and was tracheostomized. A tracheal T-shaped tube with speech bulb was placed in his stoma. The respiratory rehabilitation was performed on and his stoma was closed. The five years later he could not walk and the tumor was removed. After the operation he had dyspnea. Tracheostomy was performed. But he required respiratory assistanse at night and fatigue. A special devise was made in order to connect tracheal T-shaped tube with respirator, so that he could speak with a speech bulb on T-shaped tube while he did not have dyspnea. The second case was a 20-year-old T21 trisomy female with atlanto-axial subluxation in whose trachea a intubation stenosis was found. A tracheal T-shaped tube was placed after her tracheostomy. She could speak whenenever she wanted with the help of speech bulb. The respiratory rehabilitation was performed on, but the result was poor mainly because of her mental retardation.
One hundred and eight thyroid malignancies were treated from July, 1978 to December, 1985 in our clinic. In comparison with 98 detectable malignancies, occult tumors were 3 cases, and latent tumors were 7 cases ; each five and one of them were detected in the midst of operation for cancer of the larynx or hypopharynx, respectively. The detectable malignancies were pathologically papillary carcinoma in 82 cases (83.7%), follicular carcinoma in 9 cases (9.2%), medullary carcinoma in 3 cases, undifferentiated carcinoma in 2 cases and malignant lymphoma in 2 cases. Operative modalities were lobectomy with isthmectomy in 51 cases (54.3%), subtotal thyroidectomy in 16 cases, total thyroidectomy in 18 cases and others. In 12 died cases (8: detectable, 4: undetecta ble), two cases of undifferentiated carcinoma, one case of medullary carcinoma and 2 cases of papillary carcinoma were died from lung and/or bone metastases. Other 7 cases were died from either local uncontrol, or another advanced malignancy. Three of five laryngectomized patients without distant metastasis were alive more than 8 years. It is suggested that aggressive operation like total laryngectomy or tracheal ring resection may be effective in the treatment of local advanced thyroid malignancies.
A 14-year-old girl who was diagnosed as having psychogenic vertigo is reported. Psychological and personality tests revealed that this case was intropunitive and socially unstable. The psychological cause of this case was thought to be a tease in the school life. The psychological treatment by the team of otolaryngologists and counsellors was effective in this case. This treatment was thought to be the recommendable one to not only the case of psychogenic vertigo, but also another cases caused by psychological factors.
The cases of esophageal foreign bodies treated at the Department of Otolaryngology Yamaguchi University during the last 12 years from 1976 to 1987 were collected and statistically surveyed. The results were as follows; 1. Esophageal foreign bodies were seen in 97 cases (male: 49, female: 48). The incidence was 0.25% of the number of outpatients who newly visited the Department. 2. Forty cases (41.2%) of the whole 97 cases were children under 5 years of age, which was the age groups highest in occurrence. The highest kind of foreign body was coins, which was seen in 28 cases (28.9%) of the whole 97 cases. 3. Foreign bodies in 46 cases (48.4%) of 95cases were located at the first narrowing of theesophagus. 4. The motive for aspiration was while eating in 47 cases (54.7%) of 86 cases. Initial symptom was swallowing pain in 32 cases (34.4%) of 93 cases. 5. Of hte 94 cases, 62 cases (66.0%) were treated under general anesthesia, and 32 cases (34.0%) were treated under local anesthesia. 6. Direct esophagoscopy was performed in 89 cases (91.8%) of whole 97 cases. 7. The complication of foreign bodies in esophagus was periesophageal abscess in 5 cases.
A series of 6255 patients treated at ENT section of night emergency clinic center in Sapporo City from June 1989 to May 1990 were reviewed. Among these, acute otitis media was most common (2870 patints, 45.8%) followed by the foreign body (742 patients, 12.2%) and then epistaxis (583 patients, 9.6%). The author focused on the clinical aspects of acute otitis media and reviewed the results.
In consideration of the size of oval window, the new type of hydroxyapatite ossicular prosthesis T-type (Apaceram®-T) whose shaft was 1.3mm instead of the original shaft of 0.8mm in diameter was designed in order to increase its stability. The new shaft became larger than original one 1.6 times in diameter, and 2.6 times in area. We reported the new type of Apaceram®-T and its clinical application of 15 ears. The new type of Apaceram®-T is considered to be useful for reconstruction of the ossicular chain, judging from adaptation, stability, and postoperative hearing gain.