Since domestic air lines commenced their service in Japan, the department Otorhynolaryngogy, the Jikei University School of Medicine has been participating to the health controls of flight crews of the 'domestic air lines and students of the Aviation Academy. Highly developed airplanes, vastly increased number of flight crews and serial domestic air accidents prompted us to establish the details of medical standards in accepting new crews and students. The Otorhynolaryngological standards have been set to prevent individual health hazards in long duties, to eliminate the accidents due to human errors and to save resultant losses of the air line companies. The standards were prescribed based mainly on the experience and date in our dapartment, which were accumulated previously, in conjunction with the Japanese domestic flight rules and the medical standards of Air France and F. A. A.
Since 1955, tympanoplsty was a procedure of choice for sequela of the previously operated otitis media. His Clinic now accumulated 122 such cases and the details of the cases were discussed, 1. Chief complaints prior to the reoperation; a) otorhea and hearing hardness (30-55 d B) 60% b) hearing hardness only (30-85 d B) 40% 2. Procedures performed at the initial operations a) radical operation 39 cases b) semiradical operation 46 cases c) tympanoplaty 37 cases 3. Characteristic reoperative findings a) remaining inflammation type (granulation, cyste, etc.) b) choleatoma forming type (infection, cholesteatoma arrising from the skin graft, etc.) c) reacting type to transplanted materials (skin graft, fascia, bone, columella, etc.) d) adhesive-hypertrophic type (habitus, drugs, etc.) e) combined type (combined type of a to d) 4. Efficacy of the reoperation; There were some cases, in which hearing hardness was not improved and the diseased foci were not eliminated at the initial operation. Such cases would be benifitied quite often by the tympanoplaty. Therefore, the author concludes, the tympanoplasty should be considered when reoperation is require.
Long term serial radiological examinations were conducted on the healing process following radical operations for chronic frontal sinusitis. The Author acknowledged the following four facts: 1) When operations were performed bilaterally for chronic frontal sinusitis, the heavily involved side obliterated and healed earlier than the contralateral side. 2) In case a frontal sinus was not evenly diseased, the heavily involved area obliterated and healed quicker than the less diseased area. 3) The older the lesion was, the easier it healed. 4) Stimuli applied for a certain postoperative period enhanced the obliteration and the healing. Above mentioned facts should be kept in mind in making therapeutic plan and in selecting plombage materials. The author presented representative cases with pertinent discussion.
Twelve cases of the combined hearing hardness associated with tinnitus were treated by intravenous injections of Vitamedin. An ampoule a day was repeated for ten consecutive days as a set of the treatments. During and 2 weeks pre and postinjection periods, no other drugs were administered. Its results for tinnitus were (++) 2 in cases, (+) 3, (±) 2, (-) 5 and thus 58.3% of the patients with tinnitus were benefited. On the other hand, no symptomatic improvement was demonstrated for the hearing hardness. From the results, the author stated, the intravenous use of Vitamedin should be considered for the stubborn tinnitus.
A 63 year old male had repeated episodes of marked submandibular swelling. Antibiotics failed to alter his course of the disease. A biopsy was inconclusive. The diagnosis was not established until bone marrow aspiration was performed, which showed acute myeloid leukemia. The patient responded temporarily with regression of the swelling to anti-leukemic agents but succumbed four months after the diagnosis was made. In autopsy, the submandibular swelling was of inflammatory nature. The healing of the inflammatory swelling was hindered by the underlying leukemia and thus the diagnosis was initially made difficult. The authors emphasize that hematologic disorders should be ruled out whenever a persistent inflammation is encountered.
For patients with chronic nasal occlusion, who are unable to receive the drug treatmene because of drug allergy, etc., the following methods can be tried effectively; 1) Nasal occlusion subsides with moderate pressure applied by thumb and index finge on the lower third of lateral margins of both nasal bones adjacent frontal processu of maxillae toward a center of the skull. 2) Frontal headache disappears with simultaneously applied pressure to frontal and oc cipital areas by both hands. 3) Duration of pressure is limited to 10-30 seconds. Longer application is useless. 4) The effect is ipsilateral, namely-the pressure to the right side relieves the righ sided occlusion and the pressure to left for the left nasal occlusion. 5) Excessive pressure causes nasal pain. 6) The effects last for 15 minutes to 3 hours. 7) Uncomplicated nasal diseases respond more readily to these methods and so does till acute. 8) Eighty seven percent of 162 cases treated responded favourably.