In this study, dynamic behavior of the basilar membrane and cochlear fluid caused by the vibration of the stapes was analyzed using a three-dimensional finite element model of the human cochlea. Numerical results and the measurement results were compared, and the validity of the model was verified. In addition, an influence of perilymphatic fistula on the vibration of the basilar membrane was analyzed. The leakage of the lymph from a perforation opened near the round window did not have the great influence on the vibration of the basilar membrane. In contrast, the amplitude of the basilar membrane decreased when the lymph flowed out through the perforation near the oval window. This result suggests that oval window perilymphatic fistula causes an increase of hearing threshold from the viewpoint of dynamics.
Gentian violet (Pyoktanin) is known to have a potent antibacterial activity against Gram-positive bacteria including methicillin-resistantStaphylococcus aureus (MRSA). From November 2000 to August 2006, we have treated 91 patients for intractable ear infected with MRSA by topical treatment with gentian violet. There were 99 infected ears: 44 chronic otitis media, 11 otitis media with effusion treated with tympanostomy tube, 10 repetitive suppurative otitis media, 10 otitis externa, 8 postoperative discharging mastoid cavity for cholesteatoma, 6 cholesteatoma, 4 eosinophilic otitis media, 3 acute otitis media, 3 myringitis. The pathogens detected in those ears during the treatment period were as follows: MRSA in 92 ears, MRSA andP. aeruginosa7 ears. Topical treatment with gentian violet was performed 7.5 times on average. In the 92 ears (92.9%), topical treatment was performed 5.4 times on average. Noteworthily, 23 ears required only one treatment and 16 ears required twice, and this fact was suggesting that frequent treatments were not necessary to control the pathogens sensitive to gentian violet. This high cure rate (92/99) of the ear infected with MRSA also suggested that this treatment was especially effective for the treatment of MRSA infected ears.
We investigated health-related quality of life (HRQOL) in patients with Bell's palsy. HRQOL questionnaire, SF-36 Japanese version 2, was filled out by 32 patients with Bell's palsy at 3 weeks or later after the onset. The QOL scores were analysed twice in 15 patients within 7 days and about a month after the onset. No significant relation was observed between age and any of 8 subscales, however significant decrease was noted in 4 of 8 subscales in women, which were Role Physical (p=0.022), Bodily Pain (p=0.039), Mental Health (p=0.039), and Social Functioning (p=0.004). Patients with moderate and severe paralysis (score 8-32 on Yanagihara grading scale) tended to have lower scores in General Health (p=0.085), compared to the patients with mild paresis (score 34-40 on Yanagihara grading scale). Social Functioning significantly lowered about a month after the onset in comparison to those within 7 days from the onset (p=0.029). In conclusion, HRQOL in Bell's palsy patients obtained by using SF-36 was promising, and especially Social Functioning (SF) was thought to be the most effective subscale for evaluation of QOL in Bell's palsy.
An 11-year-old boy with the right ear discharge showed a soft tissue density with extensive destruction of the middle cranial fossa bone on CT. At the first operation, cholesteatoma was found attached to the middle fossa dura causing cerebrospinal fluid leakage. The operation was completed after removal of most of the cholesteatoma matrix except for the dura area. At the second operation, however, there was no cholesteatoma in the middle cranial fossa and the bone defect was closed. We speculated that the rest of cholesteatoma was evacuated to the mastoid cavity because of reduction of volume at the first operation, and the regeneration of periosteum and bone occurred.