The dimensions of the supratubal recess, epitympanum and mastoid peumatization were measured on 182 semiaxial computed tomograms of 123 cases. The measurement was done by using Image Command 5098 at one slice (1.5mm) lower level than at the level of geniculate ganglion. The temporal bones were classified into six types; simple otitis media type, attic retraction type with or without cholesteatoma, tensa adhesive type with or without cholesteatoma, and normal type. The dimensions of the supratubal recess and epitympanum were significantly correlated with that of mastoid pneumatization. The dimensions of the epitympanum in simple otitis media type and tensa adhesive type were significantly larger than those of the other types. The supratubal recess in normal type was significantly larger than that of other types. Significant difference was not recognized between the supratubal recess of tensa adhesive type with cholesteatoma and without cholesteatoma. But the supratubal recess of attic retraction type with cholesteatoma was significantly smaller than that without cholesteatoma. It was suggested that the dimension of the supratubal recess should be one of the important pathogenetic factors of attic cholesteatoma.
Observation of the porus acustics internus was possible only in cadaver and the dried temporal bone. We successfully observed this area in a living body by means of the surfacereconstructionthree dimensional images. The diameter of the porus measured by this method was similar to that obtained by the conventional method. Surface reconstruction-three dimensional images are dynamic and stereoscopic, and it allows us very useful and accurate observation for the surface of the temporal bone.
For the purpose of predicting prognosis after extrusion of the ventilation tube (VT), discriminant analysis was done on 78 ears with secretory otitis media (SOM) treated by insertion of VT. 78 ears were divided into two groups (good prognosis, poor prognosis) based on the clinical course after the extrusion of VT. Discriminant function was obtained by studying five following variables; age at which SOM was diagnosed, age at which a VT was inserted, age at which a VT was extruded, middle ear air volume measured by tympanometry 6 months after the insertion of VT and duration of ventilation by VT. In the study using a single variable, the lowest probability of misclassification was 0.281, which was obtained by using the middle ear air volume as the variable. This indicates that the middle ear air volume is the most useful prognostic indicator among the five variables. In the study of model with two variables, the lowest probability of misclassification was 0.248, which was obtained by the combination of the middle ear air volume and duration of ventilation. The results of this study suggest that the predication of prognosis of SOM is theoretically possible with 75% accurracy by using the discriminant function.
Hearing results of 188 ears after tympanoplasty during last 4 years were evaluated. According to the classification of Clinical Otology Japan, the hearing results of tympanoplasty was successful in 90% of type I tympanoplasty, 71% of type III tympanoplasty, 56% of type IV tympanoplasty, and 79% on the average. We suggested that, the case in which the post-operative hearing level became deterioruted, should be excluded from the successful group in this classification.
Tympanometric screening and a queationnaire survey were performed at an elementary school in Sendai City from 1984 to 1990. The children were examined when they were in the first, third and fifth grades and a total of 4202 test results were obtained. The percentage of abnormal tympanometric findings of the first graders was found higher than that of children in any other grades. There was no apparent annual increase in the ratio of aonormal tympanograms. Four hundred and thirty-eight children underwent all three tests performed when they were in the first, third and fifth grades, and were subjected to longitudinal analysis. It is concluded that the children with abnormal tympanometric findings on more than one examination tend to be diagnosed and frequeutly treated with insertion of ventilation tubes during their preschool years. This study also suggested the importance of tympanometric screening for preschool chuildren.
The relationship between secretory otitis media (SOM) and hypertrophy of adenoid is generally believed to exist, but it has not clearly been demonstrated. On the other hand, we already showed that the suppression of the growth of pneumatization was closely related to the persistent state of otic inflammation like SOM in the early stages of growth. According to our pneumatization theory, 433 children who had SOM at the age 3 to 15 years were classified by the degree of pneumatization on x-ray films, and 276 children who had a large mastoid air cell system were treated only with conservative treatment. After this treatment, 229 cases of this group were in good condition but the other 47 cases were changed to the operative treatment because of the difficulty of treatment by conservative treatment. In these two groups, the degree of the hypertrophy of adenoid was compared on x-ray films and the rate of hypertrophied cases was significantly higher in the 47 cases than in the 229 cases (p<0.05). Children in both groups were suffuring from primary SOM because of their good pneumatization, and in these primary cases the hypertrophied adenoid was a large factor on controlling the disease.
Three cases of van der Hoeve syndrome were reported. Two cases showed a conductive or mixed deafness which resembled to those of otosclerosis. The operative findings revealed the pathophysiology of deafness to be fixation of the stapedial footplate in one case and the combination of fixation of the footplate and fibrous change of the crura in another case. The third case showed profound mixed deafness. The pathophysiology of this case was considered to be similar to that of cochlear otosclerosis by the findings of high resolution CT scan. The diagnostic and therapeutic problems of this syndrome were discussed with a review of literature.
Case No.1. A 44- year-old male presented with left otalgia of three day's duration. His left ear was plugged with layers of keratin and polyp. Under local anesthesia, the polyp and keratin debris were removed without skin incision. No further treatment was needed. Considering the clinical feature and the histopathologic findings, a diagnosis of keratosis obturans was made. Case No.2. A 61-year-old male had intermittent otorrhea and otalgia for several months in the left ear. The diagnosis of otitis externa was made by an otolaryngologist, and topical medications were applied. Some white patches of keratin coat and ulceration were found in the antero - inferior canal wall. Mastoid X-ray study was reported as normal. A diagnosis of external auditory canal cholesteatoma was made. Surgical operation by a post-auricular incision was performed. After removal of the circumscribed cholesteatoma, the bony margin was curetted enough until the sound bone tissue appeared. Then the defect in the antero-inferior osseous canal was repaired with autograft auricular cartilage and fascia temporalis. Postoperatively, his hearing was preserved and there was no evidence of recurrence one year after the surgery.
A case of chronic granulomatous disease (CGD) in an 11-year-old boy suffering from right otalgia is reported. Based on the diagnosis of acute otitismedia, myringotomy was performed and antibiotics were given. However, the patient developed right facial palsy and an intermittent fever. Since X - ray examination and CT scan showed a diffuse shadow in the right mastoid, simple mastoidectomy was performed and it revealed the mastoid cavity filled with granuloma and the temporal bone so much destroyed as to expose the facial nerve. Despite of the removal of granuloma, fever persisted and CT scan showed advanced destrucion of the temporal bone. The patient was reoperated on, and regenerated granuloma was removed and the posterior canal wall of the external meatus was excised. After this second operation, the patient improved remarkably in his general condition, and there was no recurrence of the symptoms. This experience suggested that surgical intervention is indicated for mastoiditis in patients with CGD, especially when facial palsy is accompanied. And in such cases, the “open method” seems to be preferable for prevention of possible regeneration of granuloma.
A 11- yea-old girl complained of bilateral hearing loss, and otologic examinations and mastoid X-ray films revealed space occupying lesions involving bilateral temporal bone and right external auditory canal. CT scans demonstrated “punched-out” radiolucent defects without sclerotic margins. T 1-weighted MR imaging demonstrated an intermediate signal intensity area. This was of intermediate to high intensity on T 2-weighted image. The patient received mastoidectomy, and the histologic diagnosis of the mastoid tissue was eosinophilic granuloma. After the surgery, irradiation and chemotherapy were performed. The literature was reviewed, and radiological diagnosis of the disease were described.
A 29 years male with a chief complaint of a hearing loss presented with the external auditory meatus blocked by a painless mass. The mass was removed by the middle cranial fossa approach, and the pathological diagnosis was chondroblastoma with low grade malignancy. Two years later, the tumor recurred in the base of middle cranial fossa, which was also removed by the same approach. The diagnostic and therapeutic problems of this rare tumor were discussed.
The hearing recovery in 32 patients with sudden deafness of 80 dB or more at the first visit to our department, was investigated from two standpoints of view: the presence or absence of dizziness and/or vertigo, and the presence or absence of nystagmus. The hearing recovery was evaluated by the average hearing levels at low frequencies (0.125-0.5 kHz), middle frequencies (0.5-2.0 kHz), high frequencies (2.0-8.0 kHz) and five frequencies (0.25-4.0 kHz). In the cases with dizziness and/or vertigo, the hearing recovery was poor at all frequency areas. And the tendency that the higher the frequencies, the poorer the prognosis of hearing loss was observed. In the two groups with and without nystagmus on ENG examination, there were no significant differences in the hearing recovery. The various time of ENG test after the onset was considered as one of the cause of this result.
The effect of long-term supplemental administration of Saireito on hearing was investigated in 10 cases of a steroid-responsive sensorineural hearing loss. Saireito (3.0-9.0 g/day) was administered orally for more than 2 years and it was examined whether the dose of prednisolone might be reduced without any significant deterioration of hearing. By the supplemental administration of Saireito for more than 2 years, the dose of prednisolone was reduced in 8 out of 10 (80.0%) cases. In these 8 cases, the mean dose of 5.5mg/day of prednisolone was reduced without any significant deterioration of hearing. When theresults obtained in this study were compared with our previous data, it was suggested that the longer the term of supplemental administration of Saireito, the larger the reduction of dose of prednisolone without any significant deterioration of hearing. It was concluded that the long-term supplemental administration of Saireito is very useful in order to reduce the large dose of prednisolone without any significant deterioration of hearing in a steroid-responsive sensorineural hearing loss.
There are nearly 2500 female professional divers in the bays of Ise, and they are called as “ama”. They can dive to a depth of 10 meters to get seaweed, earshells and various kinds of sea urchin. An experienced female diver, aged 41 years, noted bilateral hearing loss, right tinnitus and dizziness following a dive. Right exploratory tympanotomy revealed a leakage from the oval window area. The fistula was sealed with temporal fascia. Her hearing was improved to the level before injury.
A 33-year-old male was seen with the chief complains of vertigo, right hearing loss and tinnitus. A pure tone audiogram showed a sensorineural hearing loss of 65 dB. A vestibular function test showed decreased function of labyrinth in both sides. A glycerol test was positive in the right ear. CT of the right temporal bone showed a medial high jugular bulb (MHJB) protruding into the medial petrous bone. We assumed that the MHJB may lead to compression of the endolymphatic sac and to increased hydrops and Meniere-like symptoms. There has been no recurrence of vertigo after treatment with isosorbide.
In 19 cases we have investigated the relationship between the examiner's evaluation (according to Yanagihara's 40-point scaling system) and the patients' subjective evaluation or satisfaction (full score: 100 points) with their facial function after hypoglossal-facial nerve anastomosis. No correlation was found between them. However, we have found a statistically significant negative correlation between their subjective evaluations and the scores estimated by Self-Rating Questionnaire for Depression (SRQ-D). Although statistically no significant correlations were found between the patients' subjective evaluations and the scores of Cornell Medical Index Test (CMI), we have speculated that the patients' subjective evaluation or satisfaction after hypoglossal-facial nerve anastomosis is much more related to their psychosomatic factors than the actual facial movements.