Michiya Matsumura

The efficacy of Burow's solution as an ear preparation for the treatment of chronic ear infections.

Objective To determine the efficacy of Burows solution as an otologic preparation for the treatment of chronic ear infection. Study Design Two studies were included: 1) a prospective clinical study and 2) a laboratory study on antibacterial and antifungal effects. Setting A private otology practice and a laboratory study. Patients Fifty-eight patients with refractory otorrhea. Intervention Diagnosis by otoscopy, audiometry, and bacteriology. Methods Burows solution was mixed in solutions with four organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Candida albicans, and Aspergillus. Soon after Burows solution was mixed in the solutions with organisms, and 5, 10, and 20 minutes thereafter, the mixtures were cultured on agars. The numbers of the bacterial or fungal colonies were counted to evaluate the effect of Burows solution. Main Outcome Measures Changes in the clinical findings of the ears, the symptom of otorrhea, and side effects were assessed. Results Thirty-five (70%) of the 50 ears assessed were “cured” and 10 (20%) ears assessed were “improved.” No significant side effect was observed. Regarding the laboratory study, the four organisms disappeared within 20 minutes after Burows solution was mixed. Conclusion Burows solution was considered to be an effective otologic preparation.

Effects of spontaneous otoacoustic emissions on distortion product otoacoustic emission

OBJECTIVE It has been reported that spontaneous otoacoustic emission (SOAE) can prolong the responses or increase the echo power of transiently evoked otoacoustic emission (TEOAE), yet the effects of SOAE on distortion product otoacoustic emission (DPOAE) have been studied less thoroughly. As most of the previous studies have not paid attention to the patients age, sex and hearing level, they have not reflected possible effects of those factors. We studied the effects of SOAE specifically on DPOAE in the following subjects. SUBJECTS AND METHODS The subjects were all females ranging in age from 19 to 24 (average: 21.4) and the 78 ears had a hearing threshold under 15 dB for 1.2, and 4 kHz on pure-tone hearing test. IL088 (Otodynamics) was used for measurement of SOAE and IL092 (Otodynamics) for DPOAE. SOAEs were measured by time-averaging over 100 of the responses, of which those showing a clear peak 3 dB above the noise floor and being reproducible were considered as SOAE-positive. In all the ears. DPOAE responses were measured at L1 = L2 = 70 dB, and in 42 ears also at L1 = L2 = 60 dB and L1/L2 = 60/50 dB. The subjected ears were grouped into two by the presence or the absence of SOAE, and DPOAE amplitudes of 1, 2, and 4 kHz were compared. respectively. RESULTS Of the total, 39 ears were SOAE-positive and 39 SOAE-negative. Statistically no significant difference was observed in the average hearing level between the SOAE-positive and SOAE-negative groups. The hearing levels did not significantly differ in the frequencies of 1, 2. and 4 kHz, respectively, indicating that influence of the hearing level on DPOAE could be excludable. DPOAE amplitudes at L1 = L2 = 70 dB in the frequencies of 1, 2, and 4 kHz were higher in the SOAE-positive group than in the SOAE-negative group. And DPOAE amplitudes were also higher in SOAE-positive group at L1 = L2 = 60 dB and L1/L2 = 60/50 dB in the frequency of 1.2, and 4 kHz, but significant differences were observed only in the frequencies of 4 kHz. By grouping the ears by the number of SOAE. we revealed the tendency that the larger the number of SOAE, the higher the DPOAE amplitudes. CONCLUSIONS We evidenced that SOAE has significant effects on DPOAE responses. In clinical application of DPOAE measurement, therefore, the effects should be seriously taken into account.

Preserved otoacoustic emission in a child with a profound unilateral sensorineural hearing loss

We report a case of profound unilateral sensorineural hearing loss with good response of otoacoustic emission. The patient was a 5-year-old boy. who was diagnosed to have unilateral hearing impairment on pure tone audiometry at the first visit. The affected ear showed the absence of auditory brainstem response; however, its transiently evoked otoacoutic emission and distortion product otoacoustic emission were considered to be normal. These findings indicated that the outer hair cell of cochlea was not impaired and that the impairment should be localized between inner hair cells, primary afferent fiber or its synapses, spiral ganglion of the cochlea and acoustic fiber, or at a combination of these areas. That is, evaluation of otoacoustic emission was useful in determining the region of impairment in sensorineural hearing loss. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.

Optimal stimulus level conditions for measurements of distortion product otoacoustic emissions

OBJECTIVE Distortion product otoacoustic emission (DPOAE) is a tool for an objective examination of the cochlea function. While the clinical application of DPOEA test is in progress, the measurements vary depending on the stimulus conditions. We aimed to determine the most appropriate stimulus level in the clinical application of DPOAE test. METHODS Ninety-seven normal hearing ears and 80 hearing-impaired ears (total 177) were subjected to this study. Two levels of stimulations (L1 and L2) were applied as follows: L1 = L2 = 70 dB; L1 = L2 = 60 dB and L1 = 60/L2 = 50 dB, and DP level was measured at each stimulation, and compared with hearing level. RESULTS DP level was highest at L1 = L2 = 70 dB. Normal hearing ears and hearing-impaired ears were well differentiated at L1 = L2 = 60 dB. CONCLUSION In clinical application of DPOAE test, DP levels should be measured at the stimulus level most appropriate for the purposes.

Parotidectomy by U-shaped SkinIncision for small Benign Tumors

Parotidectomy by U-shaped Skin Incision for small Benign Tumors Objectives: The facelift incision has been used as a more cosmetically favorable alternative to the traditional cervicofacial, S-shaped incision for parotidectomy. However, the facelift incision has the disadvantage of requiring a long skin incision and wide skin-flap elevation. As an alternative, we analyzed the application and safety of a more limited U-shaped skin incision for parotidectomy. Methods: A U-shaped incision, consisting of pre- and postauricular incisions and a curved incision around the earlobe, was applied in 28 female patients. Their tumors were located in the superficial region of the parotid gland except one patient with a deep lobe tumor. Maximum diameter of the tumor was <3 cm. As a control, 18 patients with a S-shaped incision, who had superficial tumors <3 cm in diameter, were selected. Operative time and postoperative complications were retrospectively compared between the two incision approaches. Results: No significant difference in operative time was observed between U-shaped incision and S-shaped incision. The frequencies of temporary facial paralysis and salivary fistula were comparable between the two surgical methods. Conclusion: The U-shaped incision approach is feasible for parotidectomy in patients with small (<3 cm) benign tumors located in the superficial region of the parotid gland.

Therapy for otitis-prone children in Tenshi hospital

With the recent emergence and increases of multiple-drugs-resistant Streptococcus pneumoniae, we have been seeing an increasing number of infants with intractable recurrent otitis media which is resistant to the general conservative out-patient treatments such as oral administration of medicines or tympanotomy. In this study, we investigated the inflammation-causing bacteria in the infants with otitis media which were treated in our hospital from January to December in 1997, and in six serious cases among them, we measured IgG subclass and specific IgG2 antibody to S. pneumoniae to examine them. As a result, S. pneumoniae was found to be the cause in 45% of the cases of initial development of otitis media, and in 88% of them the S. pneumoniae was penicillin-resistant. The level of specific IgG2 antibody to S. pneumoniae was low in all the cases, whereas IgG2 subclass was deficient only in one out of the six cases; from these findings, the selectively low level of immune status was thought to be the cause of the recurrences of otitis media. In two cases, clinical condition was markedly improved by immunoglobulin substitute therapy, which demonstrates that immunoglobulin is effective for the intractable recurrent otitis media in infants.