Operation of the stapes is one of the most important in tympanoplasty. There are many methods for this operation and the present author has included myringostapediopexy, malleostapediopexy and incudostapediopexy. Mobilization and stapediovestibular osteotomy are included in its narrow sense. Recently, colmellisation with polyethylene tubing, arthroprosthesis, arthrosynthese, and stapes interposition with veingraft have been reported, and the chief object of these methods are for the treatment of otosclerosis. Otosclerosis is quite rare in our country as compared to Europe and U.S.A., but this operation of the stapes will probably open a new field for the treatment of not only otosclerosis but also for destructed stapes in chronic otitis media, vestibular obstruction, and after-effects of radical operation of the middle ear.
The author reported 10 cases of the intracranial complication of otitis media who were observed in the Clinic of Oto-rhino-laryngology in Hirosaki University Hospital during the two year period from 1958 to 1959. They were 1 otogenous meningitis, 5 otogenous sinus phlebitis and 4 otogenous brain abscess. Discussing these cases from several viewpoints especially the symptom manifestation, bacteriology, treatment, morbidity, mortality and statistics, the author summarized as the conclusion of this report in the following description: In the antibiotic era, the following remarks were reported as the main alterations that was seen in the clinical picture of the intracranial complication of otitis media. (1) Decrement of the cases of the otitis media, Particularly its severe form. (2) Decrease in the morbidity and mortality of the intracranial complication of otitis media due to the application of Sulfonamides or Antibiotics, especially Penicillin. (3) Poor symptom manifestation perhaps due to the masking effect of these new therapeutic agents. But now, considering the literature and the author's own cases who were reported in this paper, the author noticed that the second alteration was beginning in their clinical picture in the most recent days, and concluded that this facts are important in the field of the diagnosis and treatment of otitis media and its complication. They are:(1) Increasing difficulty in the diagnosis of this disease, due to the masking of the symptoms that is carried by the inadequate usage of many antibiotics. (2) Tendency to the increment of these diseases in the most recent days. (3) Marked diminution of the effect of the Penicillin. (4) Alteration of the etiological microbes and its sensitivity (or resistance) to several antibiotics.
In the tympanoplasty of chronic otitis media, we have been our idea saving the mastoid cells as possible as we can, except a granulation or cholesteatoma exist. We left the mastoid cells by observation in the operation-microscope, nevertheless we saw the unfavourable progress occasionaly. And so, in order to demonstrate this cause, we compared a histopathological observation of mastoid with postoperative course. Clinical states of 70 cases: A) 35 cases were favourable, B) 23 cases were Prolonged the recoverry by a granulation and exsudation in the surface of mastoid wound, C) 6 cases were prolonged the recovery and reperforation of drum membrane after leaving hospital, D) 6 cases had the reperforation during a hospitalization period by the excessive exsudation in the tympanic cavity and the surface of the mastoid wound, or a formation of excessive granulation. Histo-pathological states: a) 36 cases indicated the old granulation tissue or hyper-cornification: fibrocyt and fibroblast, or a excessive cornification was seen principally, b) 5 cases indicated a new granulation tissue or acut inflammatory change: neutrophil leukocyt, lymohocyt, plasma cells, exsudation, bleeding and many blood capillar was seen principally, c) 5 cases indicated allergic change: hydrops, eosinophil leukocyt mast cells and plasma cells was seen many, d) 3 cases indicated many duct and a cystic formation with an infiltration of cells, e) 5 cases indicated an appearance of the cholesterin crystall and giant cells, f) 16 cases indicated the mixed type of a and b, a and c, or b and c, we compared a clinical states with a histopathological states. As a result of this, we knew that the most C and D which progress was unfavourable showed c, d and e type of histopathological condition and A type which progress was favourable did not showed d and c and then the most A was a type of histopathological condition.
There are about 1, 000 cases of diphtheria every year in Tokyo with about 10 fatal cases. It goes without saying that early and adequate treatment by the first doctor is most important in order to obtain satisfactory results. Since erythromycin is the only antibiotic which is highly effective, this antibiotic should be used whenever the above conditions are suspected. The cardiac changes are most remarkable at the period when the local findings have improved and this is one point which must be kept in mind. Since laryngotracheobronchitis in influenza infection usually shows characteristic crust formation, one can hardly overlook this condition, but one must remember that tracheotomy should be carried out at once. Intercricothyreotomy should give satisfactory results.