Hirosato Miyake

Klippel-Feil Syndrome with Conductive Deafness and Histological Findings of Removed Stapes

The Klippel-Feil syndrome is usually associated with sensorineural hearing impairment, but rarely is it associated with conductive or mixed deafness. A 22-year-old female presented with fusion of the cervical vertebrae, torticollis, scoliosis, pterygium colli, the Sprengel deformity with an omovertebral bone, concavity of the thorax and conductive hearing impairment of the right ear. Tympanotomy disclosed an atrophic long process of incus and a fixation of the stapes footplate, and stapedectomy was performed with immediate postoperative improvement of hearing. However, she developed a sudden hearing loss with dizziness soon after she had physical exercise on the 15th postoperative day, and revision surgery revealed a perilymph fistula of the oval window. Histological investigations of the removed stapes showed no specific osseous changes but hyperostosis of the posterior edge of the footplate. The literature is reviewed and the etiology of the conductive deafness and the perilymph fistula is discussed.

Clinical Efficacy of Oxatomide on Japanese Cedar Pollinosis. Results of Kanagawa Multicenter Study for 3 Years.

Atsushi Shinkawa, Hirosato Miyake and Makoto Sakai (Tokai University), Isamu Takeyama (St. Marianna University School of Medicine), Tetsuya Shitara (Kitazato University), Hirokuni Otsuka and Yasuo Hattori (Nippon Medical School, Dai-ni Hospital), Yoichi Ishizuka (Teikyo University School of Medicine, Mizonokuchi Hospital), Tetsuaki Kubota (Showa University School of Medicine, Fujigaoka Hospital), Hiroyuki Zusho (Kanto Rosai Hospital)

Giant Air Cell of the Petrous Apex: A Possible Cause of Facial Hypalgesia:

A giant air cell of the left petrous apex was found in a 23-year-old man with ipsilateral facial hypalgesia. The size of the giant air cell depicted on computed tomography was 1.5 × 2.0 × 2.0 cm. A coronal T1-weighted magnetic resonance image showed that the trigeminal nerve was compressed superomedially by a large signal void area that was probably a result of excessive pneumatization of the petrous apex. It is suggested that the facial hypalgesia was caused by the compression by the giant air cell of the petrous apex on the trigeminal nerve.

Tomographic Diagnosis of Gholesteatoma of the Middle Ear

Tomographic study coupled with information obtained from otoscopic observation of the ear drum, middle ear and audiometry provide otologists with a complete picture of cholesteatomatous involvement of the temporal bone. Tomographic studies were performed in our clinic preoperatively using a Hitachi Polytome. The ear was sectioned at consecutive levels 2.5mm apart with 4 cuts for lateral projection and 5 for frontal. Diagnosis of cholesteatoma was made when there were tomographic findings of widening over 3mm of spur interval (distance between the lateral aspect of the head of malleus and the lateral attic wall), destruction of the anterior tympanic spine and an excessively blurred attic.In the retrospective review of tomograms of the surgically treated patients, we found changes compatible with cholesteatoma in 89% of 46 patients with surgically confirmed cholesteatoma. Tomographically we were able to determine the size and extent of cholesteatoma as well as the involvement of the ossicles, dural plate, facial canal, lateral sinus and lateral semicircular canal. Forty-six cases of cholesteatoma were classified according to the site and the extent of cholesteatoma into three types: the attic type (13 ears), the tympanic type (15) and the advanced type (18).Thus the usefullness and accuracy of preoperative tomographic examinations in cholesteatoma cases have been well demonstrated.