For the purpose of clarifying the clinical features of perilymphatic fistula, we investigated the clinical symptoms, tests results and therapeutic results in 24 recent patients with perilymphatic fistula. The inducing factors of perilymphatic fistula, such as blowing the nose, landing in an airplane or diving were found in about half of the patients, while, the other patients had no inducing factors. Hearing loss was the most common symptom, which occurred suddenly in most patients. There was no characteristic tinnitus of the perilymphatic fistula. Pop sound and tinnitus expressed as a stream were observed in only 10% of the patients. Audiogram showed profound deafness in many patients and the configuration of audiogram varied from patient to patient. Positional nystagmus was observed in 33.3% of the patients. Fistula sign was also observed in 50% of the patients. Perilymphatic fistula was commonly found in the round window. Hearing was improved in 5 patients (20.8%) postoperatively. Tinnitus was improved in 7 out of 22 patients (31.8%), and blocked sensation in the ear was improved in 5 out of 14 patients (35.7%). Vertigo or disequilibrium was diminished in 18 out of 21 patients (85.8%). From these results, we contemplated the diagnostic and therapeutic problems in perilymphatic fistula.
Infralabyrinthine vestibular neurectomy was performed in two patients with serious Meniere's disease. Postoperatively, they returned to walk with full relief of vertigo within 3 weeks and their tinnitus decreased more than half of the preoperative level. The hearing was preserved within 10dB loss in one case. Follow up at 8 months has shown no new problems. This procedure offers several distinct advantages: extracranial-the risks of intracranial surgery are avoided and the exposure enough laterally in the internal auditory canal allows for easy separation of cochlear and vestibular nerves.
The case was a 60-year-old male, who had an early cerebellopontine-angle tumor in the better hearing ear (left ear). His chief complaint was hearing loss with sudden onset at the contralateral ear (right ear). The bilateral sensorineural hearing loss-worse in the right-was documented by audiograms. ABR revealed the prolongation of I-III IPL in the better hearing ear and MRI showed a left cerebellopontine-angle tumor of 1cm diameter in size. However he complained of no symptom in the left ear. Our final decision was to follow up this patient without any surgical treatment. In two years after his initial visit to our out-patient clinic, he noticed no symptom at the left side.
When the central auditory pathway is suddenly disturbed, acute hearing loss may occur. Depending upon the extension of the lesion, hearing loss appears not only unilaterally but also bilaterally. A case who suffered from acute bilateral hearing loss and rotatory vertigo was studied neurootologically. At first from her history the patient had treated as sudden deafness. The findings of nystagmus test, OKP, ETtest, speech discrimination, and ABR, however, indicated the brain stem pathology. In addition, MRI revealed a small image of infarction in the right dorsal part of the mid-pons. We suspect that the anatomical features including vascular network may cause this poor neurological symptoms with out the 8th nerve signs. Prednisolon, Low molecule dextran, Prostagrandin E1, Vitamin B12, Vinpocetine and Bifemelane HCl were given to the patient. After the treatment, the hearing loss, speech discrimination, caloric response, OKP AND ET were improved remarkably.
Age-related changes in maximum amplitude and pseudothreshold of evoked otoacoustic emission (e-OAE) were investigated. The subject consisted of 52 normal hearing ears from 41 persons with the age between 6 years old and 73 years old. The e-OAE was elicited by tone-bursts with 6 frequencies between 500Hz and 4 kHz. The results obtained were as follows; 1) Any meaningful age-related change was not found in maximum amplitude of e-OAE. 2) The e-OAE pseudothreshold was elevated along the age increased. 3) It is suggested that the function of cochlear micromechanics deteriorates along the age increases even in normal hearing ears.
Our previous paper suggested that secondary immune response in the endolymphatic sac (ES) suppressed caloric response (CR) in the Hartley guinea pigs. In this paper, we analysed the relation between individual course of caloric response and histopathological findings. According to the course of individual CR, we classified it into two groups, the reversible group (n=21) and the nonreversible group (n=9). The reversible group was subdivided into two types, the mild suppressive (MS) type (n=12) and the severe suppressive (SS) type (n=9). Secondary immune response of the ES, seen in most of the animals of the non reversible group and the SS-reversible group, significantly suppressed caloric response within the 1st week after secondary challenge. Vacuolization of the sensory cells of the lateral crista was seen only in the nonreversible group. However there was nocorrelation between the course of CR and the terminal histological findings of endolymphatic hydrops and cellular infiltration of the ES. These results suggest that the course of caloric response following secondary immune response of the ES is greatly dependant on the extent of immune injury to the sensory cells of the lateral crista
7lpatients with bilateral chronic otitis media with effusion (C.O.M.E.) who had continuous middle ear effusion more than 6 months., were treated unilatrally by insertion of a long-term ventilation tube. Final cure-ratio and residual complications of each side was compared every 12months.for 4 years, untill the tubes were spontaneously extruded. Final cure-ratio (87.3%) of tube-inserted side was better than that (67.3%) of non-tube side. There was minimum difference between two sides on residual complications. From those results, it is concluded that if the cases are reasonablly selected, Tympanostomy-Tube could be one of the beneficical procedures for treatment of C.O.M.E.
The bacterial floras of the nasal cavity and adenoid were studied in 80 children. Among them 40 children were the cases of secretory otitis media (SOM) and the other 40 children were the cases of acute otitis media (AOM). Histological study of adenoid was also performed in SOM cases. In AOM cases, swab samples were obtained from the nasopharynx through the nasal cavity. In SOM cases, they were operated by adenoidectomy and insertion of ventilation tube and bacterial studies of adenoid were done directly. In the SOM group, Haemophilus influenzae was isolated in 24 cases (60.0%) and streptococcus pneumoniae was isolated in 11 cases (27.5%). Usually Haemophilus influenzae was found in the cases of acute inflammatory disease of epipharynx, but this result showed that the isolation rate of H. influenzae was significantly higher in the case of SOM which was the chronic inflammatory disease than in the case of AOM (p<0.05). This findings suggest that adenoid mass may play a role as chronic inflammatory focus which is caused by the frequent acute inflammatory stimulation. On the other hand, histological study of the adenoid with SOM showed the hypertrophy of secondary lymphoid follicle and the changes of epithelium from ciliary epithelium tosquamous epithelium. This results also showed that the adenoid mass was exposed to frequent acute inflammation. As the result, it is concluded that adenoid play an important role in the etiology of SOM. We consider the adenoid as bacterial flora, so SOM cases have to be operated not only by insertion of ventilation tube but also by adenoidectomy.
Frequently encountered are cases of perforated ear drum, for whom there is no opportunity of myringoplasty or operation to repair the perforation, owing to work or school. A new method of myringoplasty by intrameatal approach without skin incision and using a homograft of temporal fascia in an outpatient should thus be made available. The results of such myringoplasty in 15 ear cases, ranging in age from 21 to 75 years are presented in the following. The advantages of this treatment are summarized as follows; 1) The operation can be done in an outpatient clinic. 2) The surgical procedure is restricted to only the intrameatal region since obtaining the patients own temporal fascia is not necessary. 3) Local anesthesia of the drum is sufficient for the operation. 4) The patient may drink, eat, and return to work or school immediately following after surgery. 5) The operation can be conducted on patients having general complications since general anesthesia is not required. However, the success rate of closure of the perforation was 67 per cent in this study. The reasons why the transplanted fascia was not “self” so to speak are considered. Attempts are being made to improve this rate such as by treatment of a homograft and application of fibronectin extracted from the patient's own serum to promote adherence of the graft.
A 17-year-old male with a complaint of right hearing loss was presented. In this case, right ossicular anomaly was suspected by a close otological examination, and probe tympanotomy was performed. There was no major anomalies on malleus and incus, but the crural arch of the stapes made ectopic connection with facial nerve canal. The footplate of the stapes was in correct position and mobile. Behind the incus, a cystic cholesteatoma revealed, which was detached from ear drum and external auditory canal. So it was diagnosed as congenital cholesteatoma. The literature was reviewed, and embryological problems were discussed.
A bacteriological study was carried out in 101 preoperative patients with chronicotitis media who underwent tympanoplasty from 1988 to 1991. The most frequent species were Staphylococcus aureus (27.6%), followed by Staphylococcus epidermidis (19.5%), and Pseudomonas aeruginosa (16.1%). Mycotic infections were recognized in 13.8%. The most susceptible antibiotics to Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa by MIC 80 were imipenam, ampicillin/ cloxacillin, sulbactam/cefoperazone and ofloxacin. Oral use of new quinolone suchas ofloxacin seemed to be the best choice for the critical stage of draining ears before surgery from the results of the present study.
Preoperative audiograms of 96 ears with congenital ossicular anomaly and 80 ears with otosclerosis were analized. The ossicular anomalies were classified into 6 groups by operative findings from aspect of sound conduction mechanism. The air-bone gaps were significantly larger in the ears with ossicular disconnection, compared to the ears without it. The bone conduction thresholds were compared in the ears with ossicular anomary, between with and without stapes fixation. The former showed significantly higher threshold at 500Hz and 1000Hz. The bone conduction thresholds were also compared between fragile and rigid fixation, in the ears with otosclerosis. The latter also showed significantly higher threshold at 500Hz and 1000Hz. The influence of abnormality of ossicular chain on the bone conduction threshold seemed to yield mainly at 500Hz and 1000Hz.
Superstructures of the stapes were monopedal in two cases, and were bipedal in the other two. At the cut end of the footplate, underdeveloped cartilage were observed in three cases, and exposed matured cartilage without connective tissue was observed in the other case. The stapes were fixed by either developing or matured cartilage in 4 cases with congenital stapes fixation.
It is assumed that no relapsing hearing loss occurs in sudden deafness. The author has reported 4 cases of relapsing hearing loss first diagnosed as sudden deafness. An arachnoid cyst in cerebellar pontine angle was found in one case. A medially situated high jugular bulb was confirmed in one case. Immunological disorder was found in one case. No distinct cause was determined in one case. To exclude various clear-cut causes, investigation and follow-up (time and course) should be performed in patients with sudden deafness.
A high jugular bulb in the middle ear is an anomaly well known but rarely documented in the literature. We experienced a case of high jugular bulb which occurred in the right ear of a 50-year-old male. The patient presented with right otorrhea from his childhood. Under the diagnosis of infected attic retraction pocket, the ear of the patient was explored. Surgery revealed a jugular bulb protruding into the posteroinferior portion of the middle ear cavity. Such a case had been reported only three times in the Japanese literature.