Protein composition of the otoconia of the guinea pig was analyzed using SDS polyacrylamide gelelectrophoresis (SDS-PAGE). Adult albino guinea pigs were CO2-anesthetized and decapitated. Thetemporal bone was separated, and the otoconial membrane of the utricle and the saccule was collected in Eagle's minimum essential medium under a dissection microscope. The gelatin layer of the otoconialmembrane was solubilized by thermolysin digestion to isolate the otoconia, which was then dissolved inhydrochloric acid and analyzed with SDS-PAGE under a reduced condition. The analysis revealed that 58 kDa and 65 kDa proteins were present as major components in this tissue. After N-glycanase treatment, the 58kDa band moved to the position of 50 kDa, which indicated that the 58kDa protein had N-linkedcarbohydrate. In the discussion, we mention the possible role of organic material of the otoconia such asglycoproteins in the formation of the otoconial crystals.
Although it is widely believed that the occurrence of secretory otitis media is closely related to theprevious history of acute otitis media, this could not be proved in a questionnaire survey performed duringan otological screening for 3-year-old children: The ratio of the ears with positive history of acute otitismedia was as low as28%(Toshima et al 1992) In order to clarify whether this is due to the difficulty in diagnosis of acute otitis media in young childrenor no actual correlation between the two conditions, a study was conducted to reveal the incidence ofundetected acute otitis media. In a consecutive series of 97children under 3 years of age who visited thepediatric department of Tohoku Rosai Hospital for high fever persisting for more than 3days, tympanometry and microscopic examination of the tympanic membrane were performed by otolaryngologists, irrespective of aural symptoms or diagnosis. It was found that 54 out of97children (56%, 77ears) had acute otitis media. The highest incidence (69%) was found in infants under 1 year old, followedby children in the third year of life (58%), and the second year of life (41%). Under two years of age79%of the cases with acute otitis media lacked aural symptoms, therefore their family was not aware of thepresence of the disease. These results show that acute otitis media could not be excluded especially under two years of age eventhough the occurrence of the disease was not reported. This study also suggested that the cooperationbetween otolaryngologists and pediatricians is mandatory in order to diagnose acute otitis media correctlyin infants and young children.
Tympanometric tests for preschool children aged 4 to 5 years were performed in an isolated island, Izuhara-Machi in Tsushima Island and a city, Nagasaki-Shi, in June and December. Test results ofIzuhara-Machi were compared with those of Nagasaki-Shi. Incidence of type C1, type C2 and type Bdecreased in Izuhara-Machi and increased in Nagasaki-Shi from June to December in each year. Incidence of otitis media with effusion in Nagasaki-Shi was significantly higher than in Izuhara-Machi.Several children with otitis media with effusion showed spontaneous improvement of abnormal tympanograms (type C2 or type B totype A) both in Izuhara-Machi and Nagasaki-Shi. From the results of tests, it was decided that re-examination should be done for children with type C2 and type B, but not with type C1.
We studied bacteria speicies isolated from the tympanic cavity and the mastoid antrum during surgeryin patients with chronic otitis media. The most frequent bacterial species in the tympanic cavities was S.aureus (22%), followed by S. epidermidis (20%), Corynebacterium (13%), and P. aeruginosa (11%). S.epidermidis (29%) was the most common organism in the mastoid antrum. In only12 (20%) of61earsexamined, bacteria were detected in both the tympanic and mastoid cavities. The ears in which S.epidermidis or P. aeruginosa was detected in the tympanic cavities tended to have a different bacteria in themastoid antrum.
Thirty-two patient (36 ears) received stapes surgery from 1989 to 1991. Ten ears, receivedstapedectomy with a autograft cartilage strut, consisted of otosclerosis (6 ears), otosclerosis reoperation (3 ears) and ossicular displacement by injury (1 ear). Twenty-six ears, received stapedotomy with a T eflon piston wire, were all otosclerosis. The postoperative hearing results were evaluated one year afterthe surgery. The air-conduction hearing gains (Mean±S. D.) of speech frequencies were 23.9±13.4 dBin stapedectomy using a cartilage strut and 28.4±9.4 dB in stapedotomy using a Teflon piston wire. Bothhearing results were not significantly different (unpaired two way t-test). The cartilage strut is recommended in place of the Teflon piston wire when the incus is lost or when anappropriate piston wire is not available.
A44-year-old woman with bilateral chronic otitis media underwent left tympanoplasty for improvementof the left hearing acuity. During removal of peristapedial granulation tissue, the footplate of the stapeswas dislocated accidentally and a perilymphatic fistula was encountered. The oval window was closedwith a piece of temporalis fascia and fibrin glue. Ossicular chain was reconstructed with a ceramicprosthesis (T-type) and a perforation was grafted with temporalis fascia and lyophilized homograft dura.The patient complained of vertigo postoperatively. Hearing has been improved to 34 dB by 6 months afterdischarge from hospital.
Operative findings and surgical resuslts were studied in 34 children (36 ears) with middle ear cholesteatoma, including 24 ears with the attic type, 7 with the adhesive type and 5 with the posterior superiorquadrant type. The open method was performed in47%(17ears) of the ears and the closed method in 53%(19ears). The planned staged tympanoplasty was completed in only 2 ears. Cholesteatoma recurredmore frequently in the closed method group than in the open method group (42% vs. 11%). Otherpostoperative complications (such as erosion of the mastoid cavity, otorrhea, perforation of the ear drum) occurred more often in the open method group than the closed method group. However, a postoperativeretraction pocket formed, causing recurrent cholesteatoma after several years in a patient in the closedmethod group. The rate of postoperative hearing improvement was 60% in both groups. Recent surgicalmethods in the literature are also discussed.
The aeration routes in 9 cases of localized cholesteatoma were evaluated by preoperativecomputed tomography and surgical findings. In 4 out of 5cases of attic type cholesteatoma, cholesteatomawas localized at the Prussak's space, and the tympanic isthmus was found to be patent.However, the anterior attic bony plate and associated mucosal folds completely separated the atticfrom the supratubal recess. In the remaining case the mastoid tip was aerated through a perforationof the matrix membrane of cholesteatoma. In 3 out of 4 cases of adhesive type cholesteatoma, cholesteatoma located within the vestibular window portion. Although both the anterior and theposterior tympanic isthmus were closed, an aeration route between the supratubal recess and theattic was found in all of these cases. A case with blocked anterior route showed a patency solelyof the posterior tympanic isthmus. These cases. suggest that cholesteatoma can develop without complete blockage of so calledtympanic diaphragm. The significance of the anterior route as well as tympanic isthmus in the mastoidaeration was clarified.
We have experienced 3 cases of post-operative mastoid cyst (48, 30 and 23-year-old females). Thehistochemical and immunohistochemical features in mastoid cyst were not different from those of 3 cases ofcholesterine granuloma. Therefore, both post-operative mastoid cyst and cholesterine granuloma may beattributed to common pathophysiological factors. The isolation of mastoid cells caused by post-operativeblockage of the epitympanum and aditus with granulation tissues may produce post-operative mastoid cyst.
Three cases of glomus jugulare tumor receiving radiotherapy are reported. All cases were female.Concerning the neurological symptoms, two of the three cases presented cranial nerves palsy except the VIIIth nerve, while the other one featured only the VIII th nerve disorder. On audiograms, one case presenteda conductive hearing loss, one case a mixed hearing loss and the other one a profound deafness. The causeof diversity of symptoms was discussed from the anatomical perspective. MRI was found to be useful for diagnosis and deriving on informations of the tumor invaded area. Radiotherapy is expected to provide a good prognosis in the treatment.
Malignant lymphoma in the middle ear is extremely rare, and only six cases have been reportedin the literature. The purpose of this report is to describe a case of primary malignant lymphoma ofthe middle ear. The histological findings were consistent with malignant lymphoma of plemorphictype. The immunologic function studies showed EMA (-), LCA (+), UCHL -1 (+), L26 (-), and itwas classified as T cell type lymphoma. CT and MRI of the skull showed a mass in the left mastoidcavity with extension to the posterior cranial fossa and destruction of the wall of the externalauditory canal. The 67Ga scintigraphy suggested a malignant process of the left middle ear. This isthe first reported case of T cell type malignant lymphoma of the middle ear.
In order to establish the diagnostic criteria of so-called low tone sensorineural hearing loss, weinvestigated the relationship between prognosis of hearing loss and various clinical factors in 76 cases ofunilateral sensorineural hearing loss which satisfied the following 4 conditions such as (1) no known etiologywas found, (2) the hearing loss appeared rapidly and the initial hearing test was conducted within 2 week safter the onset of hearing loss, (3) the averaged hearing level was more than 30 dB between 125Hz and 500Hz, and (4) no vertigo or dizziness was noticed. All subjects were classified into 4 groups based upon prognosis of hearing loss as follows; a) complete recovery with a single attack of hearing loss (CRS). b) no recovery with a single attack of hearing loss (NRS). c) complete recovery with recurrent attacks of hearing loss (CRR). d) no recovery with recurrent attacks of hearing loss (NRR).The results obtained were as follows; 1) The single attack of hearing loss was found in57cases out of76 (75.0%) and recurrent attacks in 19 cases (25.0%). 2) CRS was found in 50 cases (65.8%), NRS in 7 cases (9.2%), CRR in 10 cases (13.2%) and NRR in 9 cases (11.8%). 3) When the relationship between prognosis of hearing loss and the age at the onset of hearing loss wasanalyzed, the mean age at the onset of hearing loss in NRS was higher than others. 4) When the relationship between prognosis of hearing loss and the time lag between the onset of hearingloss and first visit was analyzed, the mean time lag in CRS was shorter than others. 5) When the relationship between prognosis of hearing loss and the averaged pure-tone audiogram ofaffected ears at initial test was analyzed, the hearing level in NRS was higher than others in allfrequency areas. 6) When the relationship between prognosis of hearing loss and the time course of hearing level in earlystage after the onset of hearing loss was analyzed, a rapid recovery was found in most cases of CRS, however the recurrent attacks of hearing loss within relatively short term was noticed in some cases of CRR and NRR, which suggested the different pathophysiology of hearing loss in individual groups. 7) When the relationship between prognosis of hearing loss and the hearing level at high frequency areawas analyzed, the incidence in CRS and CRR decreased and that in NRS increased in the cases with more than 20dB of averaged hearing level between 2kHz and 8kHz compared with those of less than 20dB. 8) Based upon these results, it was concluded that prognosis of hearing loss in so-called low tonesensorineural hearing loss could be influenced by various clinical factors and it was also suggested thatthe results obtained in this study could give us useful informations to establish the clinical diagnosticcriteria of so-called low tone sensorineural hearing loss in the future.
Eighty-six patients with sudden deafness treated from January1989to December1991in Dokkyo University School of Medicine were reviewed retrospectively. The age, audiogram pattern, presenceof dizziness and the duration time to hearing fixation were analyzed. The complications, such asdiabetes mellitus, hyperlipidemia and hypertension were found in 31patients and no complication in55patients. There were8patients with diabetes mellitus, 8patients with hyperlipidemia and21patients with hypertension. Among them, 5 patients had two or more complications. The prognosisof the patients with complications was worse, and dizziness was more frequently found than theothers. The patients with diabetes mellitus showed a tendency to have a high tone deafness and allof them had a sensorineural hearing loss in the other side.
Recently, many types of the low power laser have been developed and used in the treatment of variousdiseases. An attempt to use the laser beam for pain relief instead of an acupuncture needle has beenintroduced by Plog in1973. We have been using the low power laser (Ga-Al-As diode laser produced by Japan Morita Company) for the treatment of tinnitus. In this study, we reported the methods and results of our'treatment. SinceApril 1991 until June 1992, 37cases (44 ears) have received more than one course of the treatment. Onecourse consisted of ten times of laser irradiation. Laser beams were irradiated on three meridian points (TE 21or SI 19, TE 17 and Liv 2) once a week and a6-minute irradiation was performed on each point.A patient was asked to fill in the questionnaire in order to get a subjective evaluation of the effect for thetreatment. For objective evaluation, the pitch match and loudness balance tests were performed in 28 cases with unilateral tinnitus and contralateral normal hearing level. According to the data of thequestionnaire, the subjective effective rate was 73%. At the end of one course treatment, the pitch oftinnitus became lower in almost all cases. The pitch of tinnitus was usually modified after two or fourtimes of irradiation and became stable after six or seven times of irradiation. There was a good relationshipbetween the objective and subjective evaluation. The changes of the tinnitus pitch have a relativelygood relationship with the subjective evaluation of the treatment effect. We discussed the possibility thatthe changes of the tinnitus pitch might become one of the indices of the treatment effect.
The hearing impairments elicited by screening hearing test were examined for the presence of evokedotoacoustic emissions (e-OAE) to investigate the relationship of e-OAE to hearing test. The threshold ofscreening hearing test coincided with pure tone audiometry threshold in 236 ears (88.7%) at 1kHz and 212ears (79.7%) at 4kHz. The incidence of false positive was 41.3% at 1kHz and 20.2% at 4kHz, falsenegative was 5% at 1kHz and 21.4% at 4kHz. In comparison with e-OAE to screening hearing test, the correlation between e-OAE and pure toneaudiometric threshold (1kHz tone-burst OAE to 1kHz pure tone, 2kHz tone-burst OAE to 4kHz pure tone) was predominant. The rate of correlation was 91.7% at lkHz-OAE and 88.2% at 2kHz-OAE, falsepositive was29.4% at 1kHz-OAE and 5.5% at 2kHz-OAE. However, there were some problem for e-OAEin screening test. The rate of false negative at 2kHz-OAE was not satisfied and in about 30% of cases, thee-OAE was not measured for the noise.
A 39 year-old-female with a chief complaint of hearing impairment was found to have van Buchem'sdisease which is a rare malformation of the bone, characterized by abnormal subperiosteal bone hyperplasia. The disease can be differentiated from marble bone disease and other hypertrophic bone diseases byradiographical findings. This present case, the third reported case in Japan, was described with special references to otorhinolaryngologicalfindings together with a review of the literature.
A rare case of meningioma located within the right internal auditory canal was reported. A 51-year-old female patient was complaining of a hearing loss and fullness of the right ear of 8 months'duration. The preoperative diagnosis of intracanalicular acoustic neuroma was made based upon the results ofotoneurological examinations including ABR, CT and MRI, and the tumor removal was conducted throughthe middle cranial fossa approach. However, the postoperative diagnosis was meningotheliomatousmeningioma by the histopathological examination. The differential diagnosis between intracanalicular acoustic neuroma and intracanalicular meningiomawas discussed.
For evaluation of facial nerve function, Yanagihara's 40 points grading system (Yanagihara's system) has widely been used in Japan, while House and Brackmann's facial nerve grading system (House andBrackmann's system) has been generally used in the United States and Europe. In order to investigate the relationship of the results of facial nerve function test between these twosystems, we conducted a total of68evaluations of postoperative facial nerve function simultaneously usingthese two systems in36cases of surgically proven unilateral acoustic neuroma, and the results werecompared. The results obtained were as follows; 1) Although the method of evaluation of the motor function of the eyes and mouth apparently differsbetween these two systems, a highly positive correlation was found between facial nerve functionregarding the movements of eye and mouth evaluation. 2) There was a highly positive correlation between total points in Yanagihara's system and the evaluationgrade in House and Brackmann's system. 3) Some of long-lasting cases without hypoglossal-facial anastomosis were evaluated to be in grade III orgrade IV in House and Brackmann's system because of the presence of secondary defects although theyshowed the relatively excellent postoperative recovery in more than 30 points in Yanagihara's system.However, in the cases with hypoglossal-facial anastomosis, the presence of secondary defects did notapparently affect on the relationship between the results obtained by these two systems because of therelatively poor recovery of postoperative facial nerve function. 4) Based upon these results, it was concluded that the facial nerve function evaluated by these twosystems can be speculated from each other although there is a discrepancy between them in some caseswith secondary defects.
In order to investigate whether the long-term prognosis of postoperative facial nerve function might bepredicted by the precise analysis of facial nerve function in early stage after acoustic neuroma surgery, weconducted the sequential evaluation of facial nerve function as frequently as possible up to60postoperativedays in11cases of unilateral acoustic neuroma (AN). The operation was conducted through the extendedmiddle cranial fossa approach, and the facial nerve function was evaluated by the modified Yanagihara'sgrading system (40points Japanese grading system). Based upon the lowest facial score within5daysafter the operation, all subjects were classified into 4 groups such as Group A (below10points), Group B (over10points, below20points), Group C (over20points, below30points) and Group D (over30points), and the postoperative facial nerve function up to60postoperative days was analyzed in the individual group. The results obtained were as follows; 1) Three cases in Group A showed a low facial score immediately after the operation and did not showany improvement of the facial score during the follow-up period. 2) One case in Group B showed a deterioration of the facial score from10days after the operation anddid not show any improvement during the follow-up period. 3) Three cases in Group C showed a temporary deterioration of the facial score10to20days after theoperation, however, the facial nerve function improved markedly by the end of the follow-up period. 4) Four.cases in Group D showed a high facial score immediately after the operation and no facial palsywas observed thenafter. 5) Based upon these results, it was concluded that the precise analysis of facial nerve function in earlystage after tumor removal enables us to differentiate the cases with excellent long-term prognosis fromothers, and the precise analysis is very useful in predicting the long-term prognosis of postoperativefacial nerve function in AN natients.
The histological features of the facial nerve removed in patients with facial palsy after removal ofacoustic neurinoma, and the relationship of histological findings with the clinical data were investigated inorder to clarify the pathology of facial palsy and the indications for hypoglossal-facial nerve anastomosis.Facial nerve specimens were obtained near the stylomastoid foramen during hypoglossal-facial nerveanastomosis from9patients. The interval between the tumor removal and the anastomosis ranged from 3 weeks to V23 months in 7 patients who were followed up for 10 months or more after anastomosis. Theintervals in the other 2 patients who were followed up for less than 10 months after anastomosis were 3 weeks and48months. The nerve specimens were examined by light and electron microscopy, and thefindings obtained were compared with the clinical data prior to tumor removal and the improvement offacial palsy after anastomosis. Facial nerve specimens obtained from patients with facial palsy prior totumor removal showed a smaller diameter of the endoneurial space than those obtained from patientswithout prior palsy. As the interval between tumor removal and anastomosis increased, the density ofregenerating myelinated and unmyelinated nerve fibers became greater. However, the diameter of theregenerating myelinated nerve fibers was smaller than that of normal nerve fibers. Because theelectromyographic findings and the facial palsy scores prior to anastomosis indicated the severe dysfunctionin all of the patients, the regenerating nerve fibers histologically observed in this study were regarded asessentially nonfunctional. Facial nerve palsy improved after the anastomosis in seven patients, except fortwo who were followed up for a short period of time postoperatively, regardless of the difference ofhistological findings of the facial nerves. Accordingly, the following conclusion was drawn from thisresult. Anastomosis is recommended even in the patients who show a poor recovery of facial palsy thatmight be due to the facial nerve atrophy or proliferation of collagen fibers, when the interval between tumorremoval and surgical anastomosis is shorter than at least 23 months.
Evoked otoacoustic emission (EOAE), auditory brainstem response (ABR) and electrochochleography (Ecoch G) were recorded in3patients with acoustic neurinoma. In all cases EOAE was detectable, despiteof the hearing threshold exceeded 60dB HL, where the occurrence of EOAE usually fall to zero except forcases with fluctuant hearing loss cases i. e. sudden deafness and Meniere's disease. But, ABR was notdetected in any case. EcochG also revealed that the cochlear nerve was damaged in all cases. Theseresults lead us to the assumption that outer hair cells may be preserved in cases of acoustic neurinoma, evenwith severe hearing loss.