Eiichi Ishiyama

NEURO-OTOLOGICAL STUDY OF POSITIONAL VERTIGO CAUSED BY HEAD INJURY

A neuro-otological examination was given to 22 patients with paroxysmal positional vertigo within 1 week of head injury. In all cases, reverse rotatory positional nystagmus accompanied by a vertiginous sensation was observed in the positional nystagmus test. No relationship between the affected side and the direction of eye movement in the head-hanging position was found in the positional nystagmus test. From the prognosis and the nystagmus findings, the cause of the vertigo was thought to be partial damage to the inner ear. The clinical course was generally favorable, but recovery was slower in the 11 cases with neuro-otologically demonstrated central nervous system disorders than in the other 11 cases.

Scanning electron microscopic studies of the membranous labyrinth after transtympanic infusion of local anesthetics (lidocain).

Scanning electron microscopic observation of the transtympanic infusion of 10% xylocain revealed twisting and disorders of outer hairs especially from the 2nd and 3rd rows of the basal to the 2nd turn of the organ of Corti, and adhesion and fusion of the sensory hairs of the crista ampullaris and otolith organ 1 and 4 days after injection. Four percent xylocain however demonstrated very minor alteration of the sensory hairs and no missing sensory hairs were detected from any cases. The authors hypothesized from electron microscopic observation that adhesion and fusion of vestibular sensory hairs or twisting and disorders of the sensory hairs of the organ of Corti might act to intercept harmful circulation of exclusion of abnormal excitement of hair cells and the innovation of electrical discharge of sensory hairs due not only to the pharmacological effects of xylocain but also to osmotic pressure.

Dysgeusia Due to an Orthodontic Wire: A Case Report*

A 14-year-old female developed gustatory disorder due to an orthodontic wire having pierced the right trigonal retromolar. The patients complaints included traction pain on the right lower jaw, numbness on the right front half of the tongue and hypogeusia with the exception of sweet tastes. Possible causes of dysgeusia in this case were: (i) direct mechanical compression of a gustatory nerve by the orthodontic wire; and (ii) disturbance of blood supply to a gustatory nerve by edema that developed in nerve tissues around the wire. The patients retention of a normal threshold for the recognition of sweet tastes is not fully understood.

MRSA Infections in Private ENT Clinics.

An increased number of cases of methicillin resistant staphylococcus aureus (MRSA) infection has been reported in hospitalized patients in university hospitals. It is estimated that approximately 16-20% of patients in the otolaryngological departments of such hospitals suffer from MRSA infections. However, accurate statistics of MRSA in outpatients in the private clinics of ENT practitioners have not been compiled.The authors attempted to determine the incidence of MRSA infections in outpatients treated in these clinics, using the same OPA staphylococcus agar and epidemiological markers such as phage typing patterns, coagulase type, enterotoxin and toxic shock syndrome toxin-1.We found 2% of the MRSA in both private ENT clinics.The epidemiological data suggest that MRSA was not of epidemic type.

SCANNING ELECTRON MICROSCOPIC STUDY OF THE MIDDLE EAR MUCOSA AFTER TRANSTYMPANIC INFUSION OF FLUIDS WITH DIFFERENT OSMOTIC PRESSURE

This study focused on the morphological alteration of the mucous membrane of the middle ear after transtympanic infusion of fluids with different osmotic pressure. Our results suggested that fluids with high osmotic pressure will seriously damage the mucous membrane of the middle ear regardless of whether or not the fluids have ototoxicity. On the other hand, fluids with low osmotic pressure were found to demonstrate minor changes on the mucous membrane. The authors have confirmed through this study that Beriplast-P A (894 mOsm) and B (228 mOsm), fibrinogen-based tissue sealants, may be safely used in the middle ear with minimum injury to the mucous membrane.

Indication of Cryosurgery on Tonsillar Diseases

The present studies are concerned with the reconfirmation of cryo-effects on the tonsil, such as advantages of cryosurgery on habitual tonsillitis, on expansive growth of tonsillar haemangioma and papilloma, and on malignant lymphoma. The present results revealed that post-operative healing of the wounds was satisfactory with minimum scar formation. Recurrence of habituere tonsillitis within three years after cryosurgery was 17%. Cryosensitivity was extremely high on patients with haemangioma and papilloma, even in cases of malignant lymphoma.

Long-Term Investigation of Habitual Tonsillitis in Children

The authors were in close contact with children who had indications for tonsillectomy and investigated them in both acute tonsillitis and intermittent periods of tonsil inflammation. The results obtained were as follows: Repeated attacks of acute tonsillitis clearly decreased in number. No secondary diseases due to tonsillitis were observed. When repeated attacks of acute tonsillitis occurred, the symptoms were not as serious as previously.

ABNORMAL SENSATIONS OF THE PHARYNGO-LARYNX

By use of a chart questionnaire, abnormal sensations of the pharyngo-larynx (ASPL) were analyzed between May 1-October 30, 1984 and followed up uintil 1 year after the first consultation date. Two hundred ninety-one patients from the total were found to suffer from ASPL, the ratio of ASPL to all out-patients being 1.47%. The ratio of sex distinction was 6.2 (males): 10 (females). A significant number of ASPL cases occured between the ages of 30-59 years old. ASPL patients were divided into the following categories: (1) causes originating from the ENT field, (2) internal medicine origin, (3) psychological internal medicine, (4) malignant origin and (5) unknown origin. The authors also conducted an investigation of the relationship between iron deficiency and abnormal sensations of the pharyngo-larynx. ASPL in females aged between 30 to 40 years indicated a significant relation to anemia of latent iron deficiency. The authors also investigated from the psychological internal medicine view and the results revealed sticky sensations of the pharyngo-larynx and autonomic imbalances with position reaction to psychosomatic and neurotic symptoms.