Hiromichi Ishigami

Topical Ofloxacin for chronic suppurative otitis media and acute exacerbation of chronic otitis media: Optimum duration of treatment

Objective To assess the optimum duration of topical ofloxacin therapy for chronic otitis media and to compare the response between patients with chronic suppurative otitis media (CSOM) and acute exacerbation of chronic otitis media (AE). Study Design Prospective observational study. Setting Five university hospitals and 30 affiliated institutions. Patients A total of 294 patients who presented to the participating institutions with CSOM were enrolled. Among them, 268 patients were evaluable for safety and 237 were evaluable for efficacy (64 with CSOM and 173 with AE. Intervention Ofloxacin otic solution was administered for as long as 4 weeks. Main Outcome Measures Clinical and bacteriologic assessment was done weekly during the treatment period. The clinical response was assessed on the basis of the symptom scores. Results There were no differences between CSOM and AE patients with respect to sex, age, and severity. The most common bacterial isolate from middle ear discharge was Staphylococcus aureus. The clinical response rates in patients with CSOM and AE were 39.1% and 61.3% after 2 weeks of treatment and 57.8% and 75.1% after 4 weeks, respectively, and the bacterial eradication rate was 91.0% at 2 weeks and 94.6% at 4 weeks. Detection of new fungal infection did not increase as the duration of therapy was prolonged. No serious adverse events were reported. Conclusions The duration of treatment was shorter and the clinical response was higher in AE patients than in CSOM patients. The standard topical ofloxacin regimen for chronic otitis media should consist of a 2-week course from the aspect of bacteriologic efficacy, although patients showing insufficient symptomatic improvement after 2 weeks may benefit from another 1 or 2 weeks of therapy. Administration of this drug for as long as 4 weeks can increase the clinical efficacy without causing safety problems.

Critical bandwidth determined by masking in the presence of two narrow-band noises.

In this experiment, the critical band (CB)-widths were measured using two narrow-band noises (NBNs) with steep cut-off slopes as a masker, varying their spectral level and center-frequency. The following results were obtained: (i) The CB-widths at all center-frequencies were narrower than the classical CB-widths estimated by Zwicker et al [J Acoust Soc Am 29:548-557 (1957)], and decreased continuously toward the lower frequency at the center-frequencies below 500 Hz, though Zwickers data were constant in the same range. These results barely coincided with the frequency dependence of the equivalent rectangular bandwidth (ERB) which was estimated from the shape of the auditory filter measured directly. (ii) Level dependence of masking noise in CB was constant beyond 20 dB of the masked threshold. This depends on the use of NBN as a masker. (iii) The CB was influenced by distortion products and off-frequency listening. Accordingly, the bandwidths might differ with the experimental method.

TUMOR OF GLOMUS JUGULARE REPORT OF A CASE

A typical case of glomus jugulare tumor was presented. This 42‐year‐old man suffering from a left‐sided Impaired hearing progressive over a Ave year period was found to have a small hemorrhagic polypoid tumor in the left external auditory canal. After repeated surgical treatments the tumor removed was light and electron microscopically diagnosed as glomus jugulare tumor which corresponded to the 13th case in this country. The Implication that this tumor may constitute a distinctive group of tumor among the neuroendocrine tumors from other sites was discussed from the facts of the presence of a large number of rather small argyrophilic granules of secretory type in the cytoplasm of tumor cells including the present case and of the appearance of increasing cases with functioning glomus jugulare tumor secreting catecholamine in the recent medical literature.

A Study of 4 Cases of Cervical Subacute Necrotizing Lymphadenitis.

This report documents 4 cases of subacute necrotizing lymphadenitis which were confirmed by cervical lymphonodus biopsy. The patients included 3 females and 1 male, and the age of these patients at the first diagnosis ranged from 14 to 37 years old. With respect to symptoms, cervical lymphadenopathy with fever and tenderness was observed in all cases, pharyngalgia was observed in 3 cases, pharyngeal flare lasting 7-14 days was observed in 3 cases, definite tonsillitis was observed in 1 case, and papuloerythema was observed in 1 case. With respect to the examination findings, leukopenia was observed in all cases, the CRP was positive in 3 cases, an increase in LDH was observed in 2 cases, an increase in GOT and GPT was observed in 2 cases, 2 cases were positive for reumatoid factor (RF), all of the patients were negative for antinuclear antibody, and the presence of EBV antibody indicated previous infection. The tuberculin reaction was positive in 3 cases, but not intensely positive, and negative in 1 case. The period of fever lasted from 10 days to 6 weeks. In 3 cases, administration of an antibiotic drug and a non-steroidal antiphlogistic analgesic drug were curative. The remaining case required steroidal treatment.

Relationship between Psychophysical Tuning Curves and Critical Bandwidths

In Experiment I, band noises were used as signals and pure tones were used as maskers. The conventional psychophysical tuning curves (PTCs) present the following characteristics depending on the signal level; slopes of the PTC are steeper than those of the auditory nerve fibers frequency threshold curve (FTC). This result from the large effect of the combination tones and, especially, of the off-frequency listening. Bandwidths of PTC do not depend on both signal levels and duration, but they are narrower than the equivalent rectangular bandwidth (ERB) of auditory filters. Masked thresholds at tips of PTC are affected by the temporal integration of signal sound at signal levels of 10- and 20-dB SL, but are not affected at 30-dB SL. This implies a close relation between PTCs and critical bandwidths (CB-widths). In Experiment II, pure tones were used as signals and band noise were used as maskers. The low- and high-frequency slopes were steeper in Experiment I. The flat parts of the masked threshold at the tips of curves become broader as the signal duration increased. No such flattening was found at a 30-dB signal level, irrespective of signal duration. The results of Experiment II coincide with the prediction derived from the excitation-pattern model. Masked thresholds at the tip of PTC were the same as in Experiment I. The conventional PTC represents the psychological frequency selectivity, and its 3-dB bandwidth corresponds to the CB-width. However, the quantitative properties depend greatly upon the bandwidths of the band noises used as signals or maskers.

Psychophysical tuning curve and critical band determined by masking in the presence of FM sounds.

Frequency modulation (FM) sounds were used as simultaneous maskers to estimate the psychophysical tuning curve (PTC). Maskers (800 ms duration) were FM sounds sweeping upward (1.2-->2.8 kHz) in Experiment I and downward (2.8-->1.2 kHz) in Experiment II. The signal was a pure tone of 2 kHz and the signal levels were 15-, 20-, 30-, and 35-dB SL. Masked PTCs were obtained as a function of masker frequency. The results were as follows: (i) When an upward-sweeping FM sound is used for high signal level, the slope of the PTC is shallower on the low frequency side and steeper on the high frequency side, and the 10-dB bandwidth of PTC coincides with that of the restricted PTC. (ii) When a downward-sweeping FM sound is used for the high signal level, the above relation for the PTC slope is reversed, and the 10-dB bandwidth for PTC coincides with that of unrestricted PTC. (iii) PTCs determined by masking in the presence of FM sounds apparently restrict the subject to listening to off-frequency, and it is shown that the bandwidth of PTC properly reflects the critical band. (iv) The properties of these PTCs can be easily explained by a neural network model of lateral inhibition, so we can accept a hypothesis that the hierarchical processing mechanism is incorporated within the inferior colliculus for parallel signal processing. (v) We conclude that the frequency resolution and the critical band filtering are, therefore, realized in a psychophysically relevant way in the auditory midbrain level.

A Case of Blood-Transfusion-Associated Graft-Versus-Host Disease Following Total Laryngectomy

We present a rare case of post-trasfusion Graft Versus Host Disease (GVHD) that developed in a patient treated for laryngeal cancer. A 65-year-old man with laryngeal cancer (T2N1Mo) underwent total laryngectomy with right radical neck dissection after 30 Gy irradiation and chemotherapy with CBDCA and 5-FU. Blood loss volume during surgery was 890 ml and he was transfused with 3 U of packed red blood cells. On the fifth day after blood transfusion, high fever (39.0°C) developed. On the 7th day, erythema appeared over the whole body. Thereafter, liver dysfunction and pancytopenia developed. The patient died of heart failure on the 34th day. Prevention of transfusion-associated GVHD is very important because the mortality rate is more than 90%. Therefore, should be treated products with gamma radiation before transfusion or autologous blood should be used as a safety precaution.

Surgical Results for Middle Ear Cholesteatoma in 392 New Cases

We evaluated surgical results for middle ear cholesteatoma in new cases treated between 1983 and 1992. Hearing improved in 131 of 211 (62%) ears treated by single stage tympanoplasty and 22 of 48 (45.8%) ears treated by two-stage tympanoplasty. Better results were shown after single stage tympanoplasty. These results were associated with pathological deficits of the stapes. In the two-stage tympanoplasty group, supperstructural defects of the stapes were observed in 21 ears and footplate defects of the stapes in 7 ears. The closed method was performed in 84.5% of all cases ; Residual cholesteatoma was found in 3.0% during single stage tympanoplasty and 6.3% during two-stage tympanoplasty. The incidence of recurrent cholesteatoma was 8.5% after single stage tympanoplasty and 14.6% after two-stage tympanoplasty. Since two-stage tympanoplasty was used in children and advanced cases, surgical results may have been poorer.

Surgery for Chronic Ear Disease in Children

This paper describes a retrospective study of 44 children (50 ears) whose first ear operation was performed during the past four years.The most common disease was acquired cholesteatoma (27 cases), followed by 15 ears with simple chronic infection and 6 with cholesterol granulomas.On the basis of the analysis of cholesteatomas, the authors emphasize that cholesteatomas in children under the age of six years are more progressive and destructive, so early diagnosis and early operation are essential.The operative procedures for each disease and the postoperative results are discussed briefly.

Statistical Analysis of Inpatient at Aichi Medical University

The authors analysed statistically 2, 514 inpatients treated from 1978 to 1983 in this department. Diseases of the ear predominated as did operations on the ear: tympanoplasty, auriculoplasty for microtia, decompression to the facial nerve for Ramsay Hunts syndrome, Bells palsy and traumatic facial palsy.