Tetsuo Kozawa

Serum Antibody Levels to the Borrelia Spirochete in Japanese Patients with Bell's Palsy

The disease entity of Lyme borreliosis (Lyme disease) was first described in 1976 in the United States (1). A similar or identical disease had already been described in Europe at the beginning of the 20th century but the aetiological agent had not been identified (2). Lyme borreliosis is a multisystemic tick-borne disease caused by the spirochete Borrelia burgdorferi. It affects mainly the skin, joints, heart and nervous system. Peripheral facial palsy is one of the most common neurological complications of the disease (3-4). In European patients with isolated acute idiopathic peripheral facial palsy (Bells palsy), elevated serum antibody titers against the Borrelia spirochete occur in 10 to 20% of the population (5-6). In Japan, individual cases with the skin manifestation of Lyme borreliosis have been described (7). To our knowledge, however, there is no report on the possible relationship between acute peripheral facial palsy and infection by the Borrelia spirochete in this country. The aim of the pre...

Surgical treatment of synkinesis.

Synkinesis is the most troublesome and common sequela seen in the recovery course of facial nerve palsy. However, no appropriate treatment has been developed so far. We used selective neurectomy on two patients with synkinesis and obtained good results; this technique has often been utilized for hemifacial spasm.

A Case of Allergic Otitis Media

A 44-year-old man with a history of nasal allergy and drug eruption was complaining of persistent bilateral hearing loss, otorrhea and dizziness. He had previously undergone middle ear surgery twice on his right ear and 5 times on his left ear over the past 2 years. The characteristic findings were abundant eosinophils in the thick, glue-like otorrhea, high serum IgE levels to house dust, and bilateral paranasal sinusitis of an allergic origin. He had previously undergone surgery twice for bilateral sinusitis and three times for recurrent chronic otitis media. Histologic examinations of the middle ear granulation tissues revealed an enormous infiltration of eosinophils, suggesting that there was allergic inflammation. Desensitization to house dust allergens together with the general and topical administration of steroids were effective in controlling the disease. However, the patient still suffered from intermittent otorrhea from both ears. The allergic otitis media was believed to be caused by a type 1 allergy to house dust in this case.

Incidence of Sudden Hearing Loss in the Contralateral Ear in Patients with Previously Impaired Hearing.

Eight cases of acute onset hearing loss in the contralateral ears of severely hearing-impaired and profoundly deaf subjects were reported. The preceding hearing losses were sudden deafness in 5, mumps in 1, post acoustic neuroma surgery in 1, and unknown in 1. The recent hearing losses were acute low-tone sensory hearing loss in 3, later attack of bilateral non-simultaneous sudden deafness in 4, and accidental incidence of sudden deafness in the hearing ear in 1. Low-tone hearing loss was supposed to be caused by consensual delayed endolymphatic hydrops. Prognosis of the low-tone hearing loss was fairly good with the exception of one case with recurrence one year later. However, outcome for bilateral sudden deafness was poor; only 1 of 4 improved. Hearing of the patient with accidental loss improved.

Clinical Value of a Battery Electrodiagnostic Test

For the last 20 years we have used the standardized electrodiagnostic tests to assess grade of nerve injury and prognosis of facial palsy. The tests involve (1) conventional nerve excitability test, (2) strength-duration curve testing at the orbicularis oris, orbicularis oculi, and frontalis muscle and (3) evoked compound muscle action potential of the orbicularis oris and oculi muscle. The test battery was applied to more than 2000 patients with conditions including Bell’s palsy, Hunt’s syndrome, traumatic facial palsy, facial palsy due to otitis media, and other intratemporal facial palsies. Reliability, advantages, and disadvantages of each test are described. We emphasize the importance of a battery test for evaluation of prognosis of facial palsy due to different etiologies.

Motor Innervation Pattern of the Orbicularis Oris Muscle in Guinea Pig

Using evoked electromyography, Nishimura and Yanagihara [2] found that the orbicularis oris muscle in the vicinity of the midline was innervated by bilateral facial nerves. Figure la shows the evoked electromyograms (EMG) of the orbicularis oris muscle in a normal adult.

INFLUENCE OF TONSILLAR HYPERTROPHY TO SCHOOL-LIFE OF CHILDREN

The authors examined degree of facial tonsillar hypertrophy for 7190 pupils of elementary schools in nine different areas in Japan. The frequency of the third degree of tonsillar hypertrophy, based on Mackenzies criteria, decreased gradually from 6.9% of the first-year pupils to 2.9% of the sixth-year pupils with a mean of 4.8%. We also studied the relation between the degree of tonsillar hypertrophy of each pupil and the reply to the questionnaire from his or her teacher regarding various aspects of his or her school-life. The third degree of tonsillar hypertrophy of each pupil and the reply to the questionnaire from his or her teacher regarding various aspects of his or her school-life. The third degree of tonsillar hypertrophy seemed to affect school-life of pupils. For example, the frequency of pupils whose speech can be clearly recognized, was less in pupils with the third degree of tonsillar hypertrophy than in pupils without any tonsillar hypertrophy. Pupils of higher grades with the third degree of tonsillar hypertrophy were classified into two groups. One was the pupils whose school-life was not altered by tonsillar hypertrophy. The other was the pupils who were often absent from school due to chronic or acute tonsillar inflammation.