Mitsunobu Shibusawa

Sonotubometric Measurement of the Eustachian Tube Function by Means of Band Noise

The Eustachian tube is well known as an organ serving the ventilation and drainage of the tympanic cavity and mastoid. Ventilation is carried out by the opening and closing of the Eustachian tube accompanying swallowing movements. Until now there has been no instrument to quantify these motor activities of the tube necessary for its function as a ventilator. The author developed a generally applicable sonotubometer Model WIO-01 with the help of Siemens Hearing Institute K.K. for automatic measurement of the aforesaid tubal function with the use of 7 kHz full-octave band noise. In a sonotubometric trial with 32 adult female subjects, the duration of patency of the Eustachian tube was 288.5 +/- 1.38.5 ms, and the amplitude eliciting response was 16.4 +/- 8.3 dB. The positive response rate was 89.1%. In 89 children aged 4-12 years, a positive response was detected in 117 ears (61.9%). The mean duration of patency was 337.7 +/- 154.4 ms, and the amplitude 16.3 +/- 7.2 dB. It is physiological to have tubal opening and closing during natural swallowing. It is therefore important to understand the tubal function when dealing with tympanoplasty and diseases caused by tubal dysfunction.

Globus sensation caused by abnormal muscular contraction.

Abnormal muscular contraction in the upper neck or pharynx was associated with a globus sensation in two patients. One patient was a 24-year-old male and the other was a 52-year-old female. EMG showed abnormal rhythmic contractions of the geniohyoid muscle in the former case and the cricopharyngeus muscle in the latter. The characteristics of the muscle contractions were similar to those of palatal myoclonus.

Hyperbaric therapy of otitis media in children.

Secretory otitis media occurs most frequently in infancy. Since the Eustachian tube functions differently in children and adults, it is considered unlikely that secretory otitis media in the two age groups is due to the same cause. Since the infantile Eustachian tube is a kind of pressure open type, we preffered high-pressure therapy in the treatment of secretory otitis media in children.We used high-pressure therapy for 111 children aged 3 to 12 years 188 ears) with secretory otitis media. As a result, 129 ears(68.6%)showed improved average hearing levels within 10 dB in the low, medium, and high tone ranges. No patient experienced earache or other trouble when exposed to high-pressures. In the highpressure therapy, air escapes through the Eustachian tube when the middle ear pressure is regulated. In this case, the fluid can be excreted together with the air. Since the partial pressure of oxgen rises with the pressure, it is estimated that the highpressure therapy favorably affects ciliary movement and restores the mucous menbranes in the tympanic cavity and the Eustachian tube.

MANOMETRIC STUDIES ON THE FREE JEJUNAL SEGMENT TRANSPLANTED AFTER HYPOPHARYNGOLARYNGOESOPHAGECTOMY

咽頭喉頭食道摘出術後遊離空腸移植による再建を行った7例を対象とし, 移植空腸および残存食道運動につき検討した. 静止圧では上部食道括約機構に相当する昇圧帯が認められず, 移植空腸部分は大気圧に近い値を示した. 空腸の空腹期自律運動は検査時間の27%にみられ, そのうち48%は肛門側への伝播を示す規則性のある連続性収縮波であった. この出現時間は術後経過期間とともに低下する傾向を示し, また食事中の連続性収縮波はまれで, 本来の空腸運動周期に類似していた. 移植空腸の静止期, 自律運動期にかかわらず嚥下による移植空腸内の伝達性陽性波は観察されなかったが, 残存食道の運動はほぼ正常のパターンを示した.