Finger plethysmography and R-R interval measurement on ECG were performed on patients with peripheral vertigo to assess autonomic nervous function. Involved in this study were 175 persons who were seen at the Jikei University Hospital and its Kashiwa Branch Hospital with the presenting symptom of vertigo, of whom 102 had both tests, 73 had the ECG test only and 8 Meniere's disease patinets underwent the ECG test before and after endolymphatic sac operation (Portman's method). No statistically significant difference was observed between normal persons and patients with peripheral vertigo in the coefficient of variation calculated for 100 plethysmographic waves (CVPTG). In respect to the value of the coefficiet of variation of R-R interval on ECG for 100 cardiac cycles (CV R-R) significant differences from normal were noted for Meniere's disease (p<0.01), vestibular disorder (p<0.05), vertigo of autonomic nervous origin (p<0.05) and pshycological vertigo (p<0.01); CV values found were high only for pshycological vertigo and low for any other varieties. CVR-R values for Meniere's disease patients undergoing endolymphatic sac operation showed an upward tendency toward approaching the normal postoperatively with a significant difference noted between before and 6 months after operation (p<0.01). The CVR-R test has the advantages of easy to perform and permitting simultaneous assessment of the functional integrity of the sympathetic and parasympathetic nervous systems, while the usefulness of finger pleth smography for this particular purpose remains to be verified by further studies.
Measurement of the swallowing pressure using an intraluminal manometer is very useful for understanding the swallowing mechanism. However, if a catheter-probe method is employed for measuring the swallowing pressure, the probe itself moves, causing a discrepancy in the time peristaltic contraction wave relationship. This makes interpretation of the data relating to the swallowing pressure difficult. To solve this problem, we also recorded, under visualization by lateral x-rays, the electromyograph and the intraluminal pressure and studied the mechanism of generation of the swallowing pressure, mainly on the basis of analysis of the movement of the pressure sensor. The results were as follows. (1) The resting pressure peaked at the 6th cervidcal vertebra with a value of 44± 19mmHg, and the width of the positive resting pressure zone was 32± 6mm. (2) The movement of the sensor at the time of swallowing resembled the lifting movement of the larynx, showing a trapezoidal pattern. (3) The maximum positive pressure in the pharynx was biphasic, but it was not generated before the sensor reached the highest posision. It was generated as a pharyngeal contraction wave when the posterior end of a swallowed bolus (barium) passe the pharynx after the sensor had reached the highest position. (4) The negative pressure in the upper esophageal sphincter (UES) was generated immediately before the anterior end of the bolus passed the sensor. This negative pressure is generated due to the anatomical structure of the pharynx, including the UES, a state of suction in caused by passage of a swallowed bolus. (5) EMG of the geniohyoid was usable as an indicator of the initiation of swallowing. However, the time from initiation of geniohyoid contraction to the maximum positive pressure was not constant. Therefore, the cricopharyngeus should also be included in future studies on the second phase of swallowing and the physiology of the UES.
One hundred twenty-seven records of patients who received exploratory tympanotomy for suspected perilymph fistula (PLF) were reviewed. Surgical selection was based on history of onset, including such factors as trauma, barometric pressure change, or CFS pressure change. Patients with spontaneous onset of hearing los were also studied if either a sudden loss or fluctuating loss with progressive deterioration occurred, or if severe hearing loss was not respond to conservative therapies within two weeks from onset. All operations, except one in a child (9 years old) were done under local anesthesia. In nearly all patients, both the oval and round windows were grafted, whether PLF was confirmed or not. PLFs were identified in 62 patients (confirmed group), and not identified in 65 patients (uncertain group). To determine how often we failed to find fistulas during explor atory tympanotomy in patients who actually had PLF, background data such as age, sex, history of onset, preoperative audiograms, duration from onset to operation, and hearing outcome after PLF closure were compared between the two groups. Numerous similarities in these parame ters were seen in the two groups, and the author concluded that a considerable number of patients with PLF might be missed at exploration, prob ably due to intermittence of PLF or low CSF pressure at the time of surgery.
The mechanism of pars flaccida type cholesteatoma, which we have considered, is as follows. Chronic inflammation in the attic is maintained due to a disturbance of ventilation which is induced by obstruction of the tympanic isthmus. As a result, the pars flaccida of tympanic membrane retracts, and the epithelium of the pars flaccida invaginates toward the mastoid cavity, accompanied by repeated infection and accumulation of debris in the retraction pocket. However, there are some surgical cases of cholesteatoma which do not fit this theory. When the pars flaccida is retracted and the epithelium is localized in the attic (acquired cholesteatoma), another cholesteatoma (congenital cholesteatoma) is located just behind the acquired cholesteatoma. These cholesteatomas are independent. It seems that congenital cholesteatoma, which is located in the aditus, block aeration (ventilation) of the attic, causing the pars flaccida to retract. If retraction of the pars flaccida is accompanied by acute infection, both cholesteatomas become continuous and may be classified as an acquired cholesteatoma. Recently, we experienced three cases of such cholesteatoma which may contribute to elucidation of the pathogenesis of cholesteatoma.
The evoked otoacoustic emission (e-OAE) against the stimulus sounds at 500 Hz was investigated in 72 ears. The subjects consisted of 57 ears with normal hearing and 15 ears with cochlear deafness. The stimulus sounds were tonebursts with 2 ms rise/fall time and 6 ms total duration. The responses 30 ms after the stimulus onset were averaged 500 times with the band pass between 200 Hz and 1 kHz. The results obtained were as follows; 1) The clear e-OAEs were obtained in 70 ears out of 72 (97.2%) and the e-OAE pseudothreshold was able to be analyzed in 64 ears (88.9%). 2) The frequency of e-OAE almost corresponded to the stimulus frequency in either normal hearing ears or cochlear deafness. 3) In normal hearing ears, the e-OAE pseudothreshold was distributed between-15 dB (nHL) and 30 dB and the mean e-OAE pseudothreshold was 7.2 dB. The intersubject variance of e-OAE pseudothreshold was relatively large, while the interaural difference of e-OAE pseudothreshold was within 5 dB in 90.0% of the subjects. 4) In cochlear deafness, the e-OAE pseudothreshold was distributed between 35 dB and 55 dB and the mean e-OAE pseudothreshold was 42.9 dB which was remarkably higher than that in normal hearing ears. 5) A positive correlation was found between e-OAE pseudothreshold elicited by 500 Hz tonebursts and pure-tone hearing level at 500 Hz. 6) When the configuration of emission cochleogram between 500 Hz and 4 kHz and that of pure-tone audiogram were compared in impaired side of cochlear deafness, an excellent correspondence was found between them considering the fact that the e-OAE pseudothreshold is elevated at high frequencies even in normal hearing ears. Based upon these results, it was concluded that the recording of e-OAE elicited by 500 Hz tonebursts enabled us to analyze the function of cochlear micromechanics of a wider frequency range.
A case of pemphigus vulgalis with mucosal lesions in the upper respiratory tract is reported. A 63-year-old female complained of oral pain, sore throat and hoarseness. The clinical examination revealed multiple white coatings and bleeding erosions on her oral and pharyngo-laryngealmucosae, and erosions on her nasal mucosa. The skin lesions (bullae and erosions) appeared for the period of 22 days after admission. The histopathologicalexamination revealed the intraepithelial bulla formation with acantholysis and direct immunofluorescent staining demonstraed intercellular deposition of IgG and C3. The circulating anti-intercellular substance antibody in her serum was not detected. The diagnosis of pemphigus vulgalis was established and she was treated with prednisolone. We reviewed 34 reported cases of pemphigus vulgalis with initial lesions in the oral mucosa. Eight patients were male and 26 were female. Most of patients had the buccal mucosal lesion.
With the objective of developing a material for use in the study of the complicated structure of the nasal cavity and as a teaching device, hemilateral nasal cavity replica models faithfully reproducing the human's nasal cavity were prepared. Resin was injected into a hemilateral nasal cavity of adult cadavers to make nasal molds, and these molds were used to prepare silicone models of the nasal cavity. The key point of preparation of this nasal cavity model were (1) selection of an appropriate cadaver, (2) selection of model materials and (3) the method of injetion of the material. Selection was made of cadavers fixed for as short a period as possible and showing as good maintenance of the nasal cavity mucosa as possible. In selecting materials, in order to reproduce the fine structure of the nasal cavity as clearly as possible, attention was focused on materials known to show good fluidity, little shrinkage and good elasticity upon solidification. Based on these characteristics, we selected a resin as the mold material and a silicone resin as the replica model. The selected materials were injected into a hemilateral nasal cavity under a constant positive pressure to achieve replication of the fine structure, and vibration was applied using a lab strirrer (Vortex mixer) to prevent defects due to bubble. Three nasal cavity models were prepared by the above approach replicated the nasal cavity faithfully without any large defects due to bubbles, etc. At P=1.0 cmH2O, the nasal resistance of each model was within the human normal range of the nasal resistance.
An improved surgical procedure for polypoid vocal cord is reported. The procedure is as follows: 1. A mucosal incision is made on the lateral part of the superior surface of the vocal cord. 2. The Reinke's space is separated from the vocal ligament with the forceps until the inferior border of the polypoid tissue is recognized. 3. The removal of the contents attached to the epithelium is initiated from the inferior part with sucking and pinching technique. With this procedure we could sufficiently remove the content of the polypoid tissue without injuring the epithelium and the vocal ligament. Recovery of the acoustic impression of the voice and the phonatory function was rapid.