[in Japanese]

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Adhesive otitis media is generally thought to be a sequelae of otitis media with effusion. However, past studies on experimental otitis media in animals found no evidence to support this hypothesis. I created an animal model with long-standing dysfunction of the eustachian tube, but adhesive otitis media was induced in few animals.
Recently O-kubo reported that gas metabolism in the middle ear cavity plays an important role in ventilation of middle ear cavity, so we considered that impaired gas metabolism in the middle ear cavity and eustachian tube dysfunction might be involved in the pathogenesis of adhesive otitis media.
We used Mongolian gerbils. A small opening was made into the bulla. Through the opening, the tympanic orifice of the eustachian tube was electrocauterized in order to block the tube, and the mucous membrane of the middle ear cavity was curetted in order to damage the membrane. Animals were sacrificed 12-16 weeks after the surgical treatment. We used 37 animals. The tympanic membrane was adherent to the promontory wall in four ears. Granulation was formed in the middle ear cavity, and retracted tympanic membrane was adherent to the promontory wall through granulation in seven ears. This study supports the hypothesis that the damage to the mucous membrane of the middle ear cavity as well as dysfunction or occlusion of the eustachian tube plays an important role in the pathogenesis of adhesive otitis media. This model is good for understanding the pathogenesis of adhesive otitis media,

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Cochlear implantation is considered the only means of improving audiologic performance in deaf patients and was performed successfully at many facilities. However, adequate speech perception could not be restored for some patients despite a favorable prognosis being made preoperatively. This is because it is difficult to make an accurate prognosis of patients' speech perception after implantation. We investigated the speech perception in patients who had received cochlear implants and discussed the involvement of various factors relating with improvement of speech perception. Multivariate regression analysis was used to analyze these factors and preoperatively predict improvement in the perception after cochlear implantation. We used data of 63 patients three obtained to six months after implantation using Fukuda video speech audiometry. The ten factors considered to affect patients'speech perception included age at the time of implantation, sex, side of the implantation, cause of hearing loss, period of hearing loss, period of deafness, number of electrodes inserted, lip-reading ability, data of promontory stimulating testing and data from character testing. Among them, only the period of hearing loss and period of deafness showed significant correlation with improvement in patients' speech perception. The number of electrodes inserted, lip reading ability and data from the character test showed no clear correlation with speech perception, but, these factors had an interesting relationship with speech perception. Factors of the promontory stimulating test had no correlation with speech perception. Multivariate regression analysis of these factors showed that prognostic diagnosis of patients' speech perception after cochlear implantation is difficult.

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Canalolithiasis is potentially a primary mechanism of benign paroxysmal positional vertigo (BPPV) of lateral canal type. The authors designed a canalith repositioning procedure (CRP) for this type of BPPV. CRP was perfomed in 13 cases. The vertigenous symptom was alleviated in 76.9%, and the nystagmus disappeared or decreased in 84.6% of the total patients. The overall efficacy rate was 84.6%. CRP should be first attempted in cases of lateral canal type BPPV.

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The purpose of this study is to evaluate lower airway hyperresponsiveness in chronic sinusitis patients with nasal polyps before and after nasal surgery (nasal polypectomy and endonasal sinus surgery), and to assess the effect of inhalation of methacholine through nose on the hyperresponsiveness of the lower airway.
The subjects were 14 males and 8 females. The age of the subjects ranged between 25 and 67 years, with an average age of 48 years.
A methacholine test through nose was performed with Astograph. The lower respiratory tract hyperresponsiveness was determined based on the respiratory resistance through the mouth, flow-volume curve and expiratory spirogram during the maximum forced vital capacity maneuver before and after methacholine inhalation through the nose. Data were obtained from 22 patients and the measurements were carried out in the follow-up period, before and after nasal surgery repeatedly.
Results :
1) The forced expiratory volume in one second percent (FEV_1.0%) was suitable for assessing the level of lower respiratory tract hyperresponsiveness in these cases.
2) In the methacholine-positive group (testing positive for methacholine before nasal surgery), the lower respiratory tract hyperresponsiveness increased significantly 12 months after surgery.
3) In the methacholine-positive group, the lower respiratory tract hyperresponsiveness decreased most 18 months after surgery.
4) In the methacholine-negative group (testing negative for methacholine before nasal surgery), a marked decrease in FEV_1.0% was demonstrated by methacholine inhalation 12 months after surgery.
As a result, the period necessary for treatment after nasal surgery was considered to be approximately 18 months.

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A case of fibro-inflammatory pseudotumor is reported. Fibro-inflammatory pseudotumor of the maxillary sinus is a rare lesion. The patient was a 68-year-old woman with the chief complaint of nasal obstruction, and CT showed resorption of the maxillary bone. She underwent partial resection of the right maxilla, and there has been no recurrence both clinically and radiologically for 3 years. The pseudotumor is not a genuine tumor but may be clinically misdiagnosed as a more serious condition, particularly a malignant tumor.

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Transtympanic electrocochleograms were evaluated in 24 patients. Action potential (AP), summating potential (SP), SP/AP ratio and SP polarity wererecorded with a needle electrode at positions both near the round window niche and near the stapes.
AP amplitudes recorded near the round window niche tended to be higher than those recorded near the stapes. The SP/AP ratio was stable at both positions. Positive SPs were recorded in 11 patients only near the round window niche.
SP polarities were influenced by the position at which electrodes were inserted.

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Uvulopalatopharyngoplasty (UPPP) is one of surgical treatment for obstructive sleep apnea syndrome.
We mesured nasal respiratory resistance and oral respiratory resistance before and after UPPP to estimate the physiological meaning of the surgical therapy. Twelve patients who were diagnosed as having obstructive sleep apnea by all-night sleep test were chosen in this study.
Nasal respiratory resistance and oral respiratory resistance were measured in sitting and supine position before and after surgery using a Microrhinograph and an MRI.
Nasal and oral respiratory resistance decreased after UPPP.
Upper respiratory resistance also deceased after UPPP performed postoperatively in supine position.
Therefore, UPPP is thought to improve oral respi-ratory airflow as well.
The effect of UPPP is achieved by eliminating the obstruction at the soft palate, especially in spine position.

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Sarcoidosis is a chronic systemic disease of unknown etiology characterized by non-caseating granulomatous inflammation of various organs. Nasal sarcoidosis commonly affects the mucosa of the septum and the inferior turbinates. These patients may nasal discharge, crusting, obstruction, epistaxis or anosmia. Sarcoidosis of the mucous membrane of sinus is comparatively rare. We report an unusual case of nasal sarcoidosis involving the maxillary sinus causing nasal obstruction and discuss its management.

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[in Japanese]

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