Various kinds of diseases, such as malignant tumors, benign tumors, cholesteatoma, and chronic inflammation, arise in the external ear canal, but there have been few statistical reports of external ear canal diseases. It often takes a long time to diagnose malignant tumors. We analyzed 61 cases in which patients were examined because of suspicion of a tumor at Osaka University Hospital between April 2008 and March 2015. The diseases were as follows: malignant tumor (23), benign tumor (15), chronic inflammation (granulation) (13), nevus (4), verruca(2), and other diseases (4). Otorrhea and bone erosion on CT were statistically higher in malignant tumors than benign diseases. Among the 61 cases, patients underwent surgery in 34. We compared preoperative diagnosis derived from FNA or incisional biopsy with postoperative diagnosis. In one case, postoperative diagnosis was different from preoperative diagnosis of FNA. Thus, incisional biopsy before surgery is recommended to determine the treatment.

Bacteriological investigation was performed in 716 children suffering from severe acute otitis media, classified according to the criteria in the 2013 Clinical Practice Guideline for the diagnosis and management of acute otitis media in children in Japan, between January 2011 and December 2014. This investigation on the relationship between age and drug-resistant bacteria revealed that drug-resistant Streptococcus pneumoniae (DRSP) was de- tected more frequently in children aged less than 3 years old than in children aged 3 or older; however, no difference was observed between these of age, but Ampicillin (ABPC)-resistant Haemophilus influenzae was equally detected in the two groups. Investigation on the relationship between the children attending at a day nursery and those who were not revealed that among children aged less than 3 years old both DRSP and ABPC-resistant H. influenzae were detected significantly more frequently in children attending a day nursery than in those who did not.

Pediatric patients younger than 3 years of age and attending a group nursery, diagnosed as having severe acute otitis media may require a selection of antimicrobial agents based on a higher risk of infection with drug resistant bacteria, and they should be carefully follow-up.

It was indicated that eosinophilic otitis media and otitis media with ANCA-associated vasculitis (OMAAV) caused refractory otitis media respectively. We herein report a case of OMAAV with perforative peritonitis initially diagnosed as definite eosinophilic otitis media.

A 41-year-old female with maturity-onset bronchial asthma suffered from bilateral refractory otitis media, diagnosed as definite eosinophilic otitis media. On her following up, she complained of fever, numbness and pain of limbs. Severe eosinophila was revealed from peripheral blood examination, she then hospitalized due to probable EGPA. On the 7th hospitalization day, she developed perforative peritonitis and emergency surgery was operated. According to the pathological findgings in her removed small intestine, she was diagnosed as definite EGPA finally.

In the past findings, there were some cases that firstly diagnosed as eosinophilic otitis media, then emerged EGPA. What is important is to observe cases of eosinophilic otitis media carefully, even if they are definite cases, some cases may develop EGPA.

We reported on 24 patients (29 ears) who underwent stapes surgery for otosclerosis (18 ears) or congenital ossicular malformations (11 ears). We evaluated the difference in the improvement depending on surgical procedure and etiology. There were less severe complications in stapedotomy or stapedotomy-M than stapedectomy postoperatively. Surgical procedure did not influence on the postoperative hearing improvement. There was no difference in the fixation places of a wire on the hearing results. Postoperative air-bone gap of otosclerosis was smaller than that of congenital ossicular malformation. In congenital stapes fixation, there may be other causes of hearing loss rather than fixation of the ossicles.

To measure the eustachian tube (ET) function in patients with patulous eustachian tube (PET), there are mainly sonotubometry and tubo-tympano aerodynamic method (TTAG) by using the ET function meter. Several papers have reported that patulous type is characterized by the extension of the duration of ET opening after swallowing (ski-slope wave pattern, plateau pattern) and the decrease of the sound pressure load applied to the nostril on sonotubometry and the synchronized change of external auditory pressure with nasal respiration on TTAG. However, these ET function tests do not reflect a distinctive feature that ear symptoms of PET change by the body posture. The ear symptoms of PET can generally be relieved, at least temporarily, by placing the head down into a dependent position or lying supine for some time. Therefore, we devised the postural change ET function test using a sonotubometry due to diagnosis of the PET.

In this study, the postural change ET function test was examined using a sonotubometry in 42 ears of 21 healthy volunteers without aural symptoms of PET and 60 ears of 40 patients with PET. A rise of external au- ditory canal sound pressure more than 5dB by the postural change ET function test was considered to be a positive finding of PET from the result of healthy volunteers. The positive rate of certain cases and suspected cases of PET was 48% (15/31) and 24% (7/29), respectively. This study suggested that the postural change ET function test is an useful new method for diagnosis of PET.

Double oblique images of the temporal bone CT that enabled us to show cross section images approximating the surgical field of view under microscope were made.

The images were made based on the direction of the visual axis under microscope. In order to visualize the direction of microscopic visual axis, a fine piano wire was placed in 11 cadaver temporal bones before corn- beam CT scanning. The piano wire was set parallel to the visual axis of the microscopic surgical view. The obliquity of the piano wire was measured in two different visual axis, one along the visual axis in view of tympanic membrane through the external ear canal, and the other via the posterior tympanotomy opening.

The reference line for obliquity measurement was set to the axis of the bony external ear canal that was defined as the line connecting the tip of malleus and the middle point of the external ear canal.

Based on the results obtained from the obliquity measurements of the piano wire, the double oblique images were made perpendicular to the piano wire.

The double oblique images were made using MPR (Multi-Planar Reconstruction) add appropriate obliquity to the horizontal base line of both axial and coronal planes depending on the obliquity of the external ear canal. The double oblique images can be fused together to form a surgical view by giving appropriate rotation or mak- ing mirror-reversed images, and can be helpful in understanding the anatomical structures and their spatial relationship.

The double oblique images provide intuitive recognition of the surgical structures and enable measurement of the anatomical relationships that are difficult to obtain from routine CT images using axial and/or coronal projections.

Temporal bone fractures occur in patients with head trauma, and the clinical features varies with the type and severity of fracture.

We studied 55 patients (59 ears) who visited our hospital and were confirmed to have a temporal bone fracture by computerized tomography between August 2003 and March 2014. We evaluated the cause of the injury, type of fracture, head injury, hearing loss, injury to the ossicles, presence of traumatic tympanic membrane perforation, hemotympanum, vertigo, cerebrospinal fluid otorrhea and facial nerve palsy. Falling was the most common cause of injury. Head injuries were more common in mixed-type fractures than in longitudinal or transverse type fractures alone. Conductive hearing loss due only to hemotympanum improved, but most cases with injury to the ossicles or tympanic membrane perforation did not improve. The incidence of traumatic facial nerve palsy was 23.7%. Immediate-onset paralysis was usually due to mixed-type fracture, whereas late-onset paralysis was usually caused by longitudinal fracture. The cure rate for facial nerve palsy was 100% for late-onset paralysis and 0% for immediate-onset paralysis. Early surgical treatment was not needed for cases of late-onset paralysis, but for immediate-onset cases we should consider surgery as soon as possible.

Purpose

We explored the ototoxic effects of formic acid (molecular weight 46 Da) at different osmotic pressures.

Materials and Methods

The osmotic pressures tested were 120, 300, and 430 mOsm. The acidities of these solutions were adjusted to pH 4. 0 by addition of small amounts of boric acid. Ototoxicity was evaluated in guinea pigs by measuring eights nerve compound action potentials (CAPs). Clicks and tone bursts at 4 and 8 kHz served as stimuli. After baseline CAP data were obtained, the middle ears were filled with formic acid (pH 4. 0) and CAPs relative to baseline were measured 30 min or 24 h later. To prevent infection of the middle ear cavity, all animals received 30 mg/kg body weight erythromycin via injection. To control pain, all animals were intraperitoneally injected with 30 mg/kg body weight pentobarbital sodium, and also received topical injections of 1% (w/v) xylocaine solution.

Results

At 24 h, the formic acid solution with the lowest osmotic pressure (120 mOsm) had minimal adverse effects on the CAPs, but the other solutions significantly reduced the CAPs.

Conclusions

Formic acid solutions (pH 4) of three different osmolarities (120, 300, and 430 mOsm) were evaluated in terms of ototoxicity. The solution of lowest osmolarity was not associated with any ototoxicity whereas the other two solutions caused significant ototoxicity. Thus, the extent of ototoxicity increased when the osmolarity rose.

Nontuberculous mycobacterial otitis media is rare and difficult to diagnose. We herein reported a case of 74-year-old man who presented with intractable left-sided chronic otitis media caused by nontuberculous mycobacteria. The patient exhibited a perforation of the left tympanic membrane, mucoid discharge, and some granulation tissue. A culture smear was positive for acid-fast bacilli, but Mycobacterium tuberculosis was not identified. Because of the patient’s mixed hearing loss and vertigo, he received antibiotic therapy for nontuberculous mycobacteria. After 1 month of appropriate antibiotic therapy, his vertigo resolved. After 3 months of treatment, the perforation of his left tympanic membrane had healed. He continued treatment for 1 year and was well without signs of reinfection at the time of this report.

I reported, first, summaries of database-items of 1,008 patients with Meniere’s disease in past 8 years and 5 months, second, relations between hearing losses and durations of disease, and, third, therapeutic results of aerobic exercise (1 hour or longer, everyday) and countermeasures for stress. Ages of 30s~50s took 64.8% of ages of disease onset. While dominant causatives in men were wholly pressure of business and/or stress at working place, those in women were family discord or troubles, pressure of business, stress at working place, care of aged family, living with children or parents, and disease or death of family. Hearing loss progressed almost in direct proportion to the logarithm of duration after onset; all-tone loss amounted to 55. 4% among 4~8 years after onset; bilateral lesions evidently began to increase when the duration exceeded 8 years. Left ears were involved 1.4 times more frequently (significantly higher, p<0.005) than right ears.

Vertigo disappeared soon after practicing aerobic exercises. Hearing levels after therapy were compared with those at the beginning in 319 patients, who were followed up longer than 3 months and 6 months, respectively, in cases of low-tone loss and in cases of both high-tone and all-tone loss. The percentage of normal hearing significantly (p<0. 00001, χ² study) increased after therapy in 319 patients. It was concluded from the present study, first, that Meniere’s disease is evidently caused by worsening of homeostasis in the inner ear by stress, and, second, that practicing consistent aerobic exercise and measures for stress at early stages can cure the disease and prevent its progression.

It is important to explain prognostication to the patient who had a medical examination in the early stage of facial nerve palsy. In this retrospective study, we investigated the possibility of prognosis prediction of facial nerve palsy using both integrated electromyography (integrated EMG) and electroneurography (ENoG) for 98 patients visiting within 3 days after onset. All patients underwent both integrated EMG and ENoG within 3 days after onset and 2 weeks later.

In the results, within 3 days after the onset, there were patients in whom ENoG values were under the normal range, who were hard to recover. The integrated EMG values were divided into two groups at 55% considering the cutoff value provided from a ROC curve, and the ENoG values were also devided at 25%. 58 % of patients with both the integrated EMG values of 25% or less and ENoG values of 55% or less in the orbicularis oculi muscle did not recover, and 70% of patients in orbicularis oris muscle did not. Ninety seven % of patients with both the integrated EMG values over 25% and ENoG values over 55% in the orbicularis oculi muscle re- covered, and 86% of patients in orbicularis oris muscle recovered.

In the results of two weeks after the onset, patients with both the integrated EMG values of 25% or less and ENoG values of 25% or less in the orbicularis oculi muscle showed positive predictive values of 69% and negative predictive values of 94% (sensitivity: 0. 83, specificity: 0. 88). Patients with those in the orbicularis oris muscle showed positive predictive values of 83% and negative predictive values of 93% (sensitivity: 0. 79, specificity: 0. 95).

In conclusion, the combination of results of integrated electromyography with those of ENoG provides the accurate and useful information predicting the prognosis and recovery rate of patients visiting within 3 days after facial nerve palsy onset.