Isao Takimoto

Effect of Flunarizine on Experimentally Induced Facial Nerve Injury

The effect of flunarizine, a calcium antagonist, on experimentally induced facial nerve injury in guinea pigs was studied electron microscopically. In flunarizine-untreated animals, intra-axonal accumulation of cell organelles and degradation of myelin sheaths were observed. In flunarizine-treated animals, these changes were not observed, but a knob-like protrusion of myelin sheaths and a structure resembling the myelin sheath in Schwann cell cytoplasm was occasionally observed.

A case of polyradiculitis with hearing loss: analysis of auditory brain stem response.

A case of acute polyradiculoneuritis accompanied by rare complications of the VII, VIII and IX cranial nerve disorder was described. There was an elevation of the rubella virus antibody titer, which suggested the case had been infected before. Thirty-eight year-old woman complained of bilateral tinnitus and was proven audiometrically to have sensori-neural hearing loss. Electroacoustical examination disclosed that all the waves were suppressed and that wave I and V were barely detected, while wave II, III and IV were absent. The neurological and audiological disorders were successfully treated with corticosteroid, and the patient had neither sequelae nor recurrence.

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.

Histological Changes in the Inner Ear of Senile Mice

Age-related changes in the inner ear were investigated histopathologically in senile mice. Histological changes with age were first observed after 12 months of age. In mice, loss of outer hair cells was greater than that of inner hair cells. The characteristics of aging observed in the inner ear included a diminishing number of cells in Cortis organ, stria vascularis and spiral ganglions as well as a decrease in supporting cells. However, we could not classify the age-related changes into sensory, neural, strial and/or cochlear conductive presbycusis.

Case of Perforation of the Tympanic Membrane with Inner Ear Impediment

We report four case of the perforation of the tympanic membrane with inner ear impediment caused by direct trauma of earpick, which were suspected perilymph fistula. Two patients showed improvement by conservation therapy. In the other two, perilymph fistula was observed and repaired. After the operation, hearing in one patient returned to normal except the high register but the other showed little improvement. From the present findings, immediate operation should be considered for patients whose hearing dose not improve, or these in whom number of perilymph fistula dose not decrease.

Roentgenologically Observation of Tube Intubation

Tube intubation was performed in 105 ears with refractory infantile exudative otitis media and the process was observed roentgenologically. Most patients with adenoid vegetation underwent adenoidectomy and there was no difference in the process of otitis media with respect to the size of the adenoid. The healing rate was higher in patients with no shadow in the paranasal sinus than in those with shadow. Mastoid cells were observed by Schuller plain x-ray and the healing rate was high in the patients whose development of cells was good or in whom no shadow was found upon tube intubation. The patients whose condition of mastoid cells had improved showed a higher healing rate than those whose condition was unchanged or had worsend. A correlation was observed between the healing rate and the condition of mastoid cells.

Technique of middle ear surgery in relation to inner ear damage.

To reduce the incidence of inner ear damage related to surgery on the middle ear, the author investigated drug-ototoxicity following middle ear infusion and acoustic trauma due to the cutting burr and chisel.1) Chlorhexidine, a disinfectant, affected the conductive systems in the inner ear, such as perilymph and endolymph, and vascular stria.Aminoglycosides affected the organ of Corti directly.2) To prevent damage to the inner ear fluid or organ of Corti, the author recommends the use of diluted disinfectant or washing out soon after infusion rather than the application of steroid hormones which failed to reduce experimental drug-induced inner ear damage.3) Acoustic trauma caused by the cutting burr in contact with the incus was noted, but damage when contact with the middle ear wall was rare. Changes in the organ of Corti started on the second and third turn and then extended to the basal turn.4) Suction near the round window had no effect on inner ear.5) Clinically, the influence of burr drilling on tinnitus, bone conduction and vertigo was less severe. But we must avoid prolonged use of the burr with strong pressure.6) Manipulation of the stapes or its surroundings and of the perilabyrinthine cells seemed to affect the ear relatively often.7) The author prefers not to preserve cholesteatoma matrix over the labyrinthine fistula but to remove it to prevent cholesteatoma invasion into the labyrinth.

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.