Hiroyuki Zusho

DIAGNOSIS OF OLFACTORY DISTURBANCE

The methods of examination for dysosmia were reported. One thousand four hundred cases of dysosmia were treated in the last 5 years by the following examinations: 1) Olfactory acuity (detected and recognized) threshold test using T & T olfactometer. 2) Blast injection method using an applicator permeated with Alinamin solution. 3) Intravenous olfaction test using Alinamin solution. 4) Endoscopic observation of olfactory mucosa using an endoscope. The parts of lesions were diagnosed and various treatments were selected based on the results of these examinations. Nose drops of adrenocortical hormone were mainly used, while medications of peripheral vasodilator or medications for reducing of the mucosa were used in some cases. Many cases were effectively improved by the nose drops of adrenocortical hormone in Japanese patients. More than 70% of total cases were improved by these treatments.

Measurements of internal auditory meatus by polytomography. 1. Normal subjects

Polytomography permits clear visualisation of the internal auditory meatus (IAM), the normal range of measurements of which is important for radiograph interpretation. Previous reports indicate wide variation in vertical diameter and in the length of the posterior canal wall although in any one individual there is usually little variation between the two sides. We studied the relationship of both the vertical diameter and the length of the posterior walls of the IAM to the growth of the skull and pneumatisation of the temporal bone in 300 patients with no evidence of a lesion of the VIII nerve. No statistically significant correlation was observed between these factors.

When to remove the ventilation tube--judgement using T-tube on the time to remove the tube.

As is generally known, inserting a ventilation tube for secretory otitis media is an excellent therapeutic method. However, the tube used in such therapy must be of a type which does not cause infections or easily become dislodged. Recently, tubes meeting such demands have been under development and various types (GOOD, 1973; ELICHAR et al., 1983) of tubes are available on the market. If, however, a tube that satisfies such a demand and can remain in place over a long period of time is developed, one will find it difficult to judge when to remove the tube. At present, regrettable as it is, there is no unified opinion as to the period the tube should remain in place. Therefore, we studied how to judge the time for removal of the tube using the T-tube (GOOD, 1973).

A Clinical Study of Noise-Induced Deafness

当院は労災病院という特殊性から騒音性難聴の補償に関連した症例の診療が日常業務となっている。 これらの症例のなかには機能性難聴, 特に難聴を誇大に訴える, いわゆる誇大難聴の症例が時にみられる。 今回われわれは, 最近5年5ヵ月間に騒音性難聴の労災認定のために当科を受診した341症例のなかから誇大難聴と考えられた症例を抽出し, 検討した。 その結果, これらの症例の診断には, 診察中の態度や会話聴取の状態, 聴力検査士からの情報, 聴検の反復, 自記オージオメトリー, ABRなどの検査結果を有効に活用し, 総合的に診断する姿勢が重要であると考えられた。 補償における誇大難聴症例には, 難聴を誇張するに至った背景に心理的, 社会的な要因が存在する。 したがってこれらの症例に対しては, 詐聴者ではなく, 心因性難聴と同様にあくまでも難聴を訴える患者として対応するべきであると考えられた。

A Case of Acute Myelocytic Leukemia with Some Otological Symptoms.

A case of a 19 year-old male with acute myelocytic leukemia (AML) is reported. The patient visited us because of left facial nerve palsy and acute otitis media on both sides. He was diagnosed as AML on the basis of blood and bone marrow examinations. These symptoms subsided after chemotherapy. Two months later, however, the patients left facial nerve palsy recurred and a granular mass was observed in his right external ear canal. At that time, results of a blood examination were normal. This mass was excised for histopathological examination, and the presense of leukemic cells was proven. This patient underwent chemotherapy again, in addition to radiotherapy but died because of general deterioration of his condition.In this case, histopathological examination was instructive.

Perceptive Deafness and Presbycusis

「感音難聴と加齢」, とりわけすでに難聴になった人, すなわち, 騒音性難聴症例がその騒音職場を難脱した後どの様な聴力変化を示すのか, 追跡調査にて検討し, 以下の結果をえた。1) 騒音職場就業中の騒音性難聴進行の経過は一般的に騒音下作業に就いた比較的早期に, すなわち5-15年の間に比較的急激に悪化し, その後はほとんど変化しないか, あるいは極めて緩徐に悪化する。 この緩徐な悪化とは生理的加齢変化とほぼ一致した。 また, 高音域においては曝露音が高い場合は, その後増悪する例が多い。2) 騒音職場離職後10年間以上の追跡調査を行った結果, 250Hz-2kHzは, 加齢変化とほぼ同等の傾きで聴力は悪化している。 しかし, 4kHz, 8kHzでは, 離職時にすでに聴力がかなり悪いためか, 加齢変化に比較して悪化は緩徐であった。3) 騒音職場離職後の5年間以上の追跡調査を行った結果, 前項の10年間の追跡調査結果とほぼ同様の結果がえられた。 しかし, 中低音域においては加齢変化より著しく悪化した症例が認められた。以上の結果を下に騒音性難聴と加齢についてその内耳の病態について考察した。

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)

MRI in Cerebellopontine Angle Tumors.

We report 12 cases of tumors the cerebellopontine angle demonstrated by magnetic resonance imaging (MRI). T1-, T2-, and T2*-weighted imaging and gadoliniumdiethylenetriamine pentaacetic acid (Gd-DTPA) contrast medium radiography were carried out with a superconducting-type MR apparatus with a static magnetic field of 1.5 tesula. The tumor images were demonstrated by signals of lower intensity than those of the white matter of the brain in T1-weighted images, and by slightly higher-intensity signals in T2-and T2*-weighted images, but were very strongly depicted with Gd-DTPA. It was sometimes possible to identify the nerve from which the tumor developed, depending on the direction of the MRI, but it was necessary to select the imaging conditions carefully in order to avoid false negatives. We know of past cases of such tumors that have been treated as sudden deafness or other conditions.