Yasuyuki Ishikawa

Bacteriological Effect of NFLX in Suppurative Otitis Media.

The occurrence of drug-resistant bacteria such as MRSA is one of the major problems in the treatment of infectious diseases. The author evaluated the clinical and bacteriological effects of Norfloxacin (NFLX) in 23 patients with acute suppurative otitis media (AOM) or acute exacerbations of chronic suppurative otitis media (COM) from October 1986 to February 1987. A similar investigation was performed from October 1992 to February 1993, in 33 patients with AOM or COM, to determine whether NFLX-resistant bacteria have increased during the past 6 years. The clinical efficacy of NFLX was also examined in these patients and compared to that in the former study.The frequencies of NFLX-sensitive bacteria in the former period were 95.5% for gram positive bacteria and 83.3% for gram negative ones. In the latter period the figures were 94.4% and 100%, respectively; i. e., no significant difference between the two periods.The clinical efficacy rate for suppurative otitis media in the former study was 72.0% and in the latter 80.0%. The difference was not significant.It appears that the antibacterial activity of NFLX has remained unchanged during the past 6 years.

Myringotomy in Patients with Otitis Media with Effusion.

Myringotomy is commonly performed in the treatment of otitis media with effusion (OME). However, it has been reported that the effect of myringotomy is limited and that OME recurs frequently after this procedure.In this investigation, the recurrence rate of OME 6 months after myringotomy and factors which affect the recurrence were examined in 94 patients with OME, aged 6 to 83 years. Forty-six patients had paranasal sinusitis, and 9 had allergic rhinitis. Nasal mucociliary function was examined with the saccharin test, described in a previous report.The recurrence rate of OME was 68.1%, similar to that in previous reports. Patients with mucoid effusions had more frequent recurrences than did those with serous effusions (p<0.01). The recurrence rate was significantly higher in children than in adults (p<0.05). Patients with OME for more than 3 months (p<0.001) or bilateral OME (p<0.001) had higher recurrence rates than did those with OME for less than 3 months or those with unilateral OME. OME recurred more frequently in patients with paranasal sinusitis (p<0.001) or allergic rhinitis (p<0.05) than in those without these nasal diseases. The incidence of markedly prolonged saccharin time (over 30 minutes) was significantly higher (p<0.001) in the recurrent group than in the cured group.

Sonotubometry in Cleft Palate Patients in Relation to Movement of the Lateral Pharyngeal Wall and Soft Palate.

Eustachian tube (ET) function was examined by sonotubometry in 59 patients, aged 7 to 62 years, with cleft palate and A type tympanograms. Active ET opening function was determined to be good if 2 or more out of 4 saliva swallowings were positive by sonotubometry. The movements of the lateral pharyngeal wall and soft palate were also observed through a flexible fiberscope and graded as “good”, “moderate” or “poor”.There were significant relationships between ET function as tested by sonotubometry and the movement of the lateral pharyngeal wall or soft palate. The levator veli palatini muscle was reported to be the main muscle involved in the movements of the lateral pharyngeal wall and soft palate. Therefore, it was assumed that good function of the levator veli palatini muscle is necessary for the active opening of the eustachian tube.

Pharyngeal Flap Surgery and Nasal Airway Resistance.

Pharyngeal flap operations are commonly performed in the treatment of velopharyngeal insufficiency in patients with cleft palate or congenital velopharyngeal insufficiency (CVPI). It has been reported that nasal obstruction following this procedure usually disappears in 4 to 6 months.As previously reported, the difference between nasal resistance determined by the activeposterior method (Pp) and that determined by the active-anterior method (Pa) is thought to reflect the resistance of the nasopharynx or the pharyngeal flap.In the present study, we measured nasal airway resistance by both the active-posterior and the active-anterior methods before and after surgery periodically in 13 patients with cleft palate or CVPI, aged 5 to 24 years. The control group consisted of 57 patients with cleft palate without pharyngeal flap surgery, aged 4 to 36 years.The normal range of (Pp-Pa) was determined to be +0.2Pa/cm3/sec to -0.2Pa/cm3/sec because the value of (Pp-Pa) fell into this range in 55 out of 57 control subjects. The value of (Pp-Pa) returned to the normal range 6-7 months after flap surgery in 11 patients. However, it still remained abnormal 9 months following the procedure in 2 patients with stenosis of the lateral porus. Thus, if the flap operation is performed correctly, breathing through the nose is thought to normalize 6-7 months after the pharyngeal flap operation.

Otitis media with effusion. Saccharin test in evaluation of nasal mucociliary function.

The etiology of otitis media with effusion (OME) is still unknown. However, an inflammatory reaction to a bacterial infection originating in the nasopharynx is thought to be one of the main factors responsible for OME, and impaired mucociliary clearance of the nose and nasopharynx may increase the chance of infection through the Eustachian tube.Nasal mucociliary function was examined with the saccharin test in 115 noses of 61 patients with OME aged 8 to 92 years. Myringotomies were performed in almost all cases and aspirated middle ear effusions were classified into serous, mucoid and purulent types.1) Prolonged saccharin times (over 11 minutes) were noted in 84.3% of 61 patients with OME.2) The patients were divided into two proups; 35 patients had OME and chronic sinusitis (group A) and 26 patients had OME without sinusitis (group B). Prolonged saccharin times were found in 86.4% in group A and 81.6% in group B—not a statistically significant difference.3) Greatly prolonged saccharin times (over 30 minutes) were found in 45.5% in group A and 14.3% in group B—a significant difference. Thus, mucociliary function in the nose was thought to be impaired more severely in group A than group B.4) Bilateral OME and mucoid type effusion were found more frequently in group A than group B.5) The main cause of impaired nasal mucociliary function in group A was thought to be chronic inflammation of the nasal mucosa. On the other hand, acute upper respiratory infection preceding the development of OME was assumed to cause impaired nasal mucociliary clearance in group B.However, in group B, impaired nasal mucociliary function may be congenital in some cases without inflammatory findings by anterior rhinoscopy or episodes of acute upper respiratory infection

Middle Ear Diseases in Patients with Submucous Cleft Palate.

The association between middle ear disease and abnormal pathway of the levator veli palatini muscle was investigated by otological and endoscopic examination in patients with submucous clef palate (SMCP).The characteristics of middle ear diseases of SMCP patients were similar to those of cleft palate patients, suggesting that the morphology and function of the eustachian tube system are similar in those two types of cleft palate.In SMCP patients after palatoplasty, middle ear disease was less common in patients with levator muscle sling formation than in those without muscle sling formation. The abnormal pathway of the levator muscle was thought to have some effect on the middle ear. Some patients without muscle sling formation, however, had no middle ear disease, suggesting that other anatomical anomalies of the eustachian tube system also play an important role in the high incidence of middle ear disease in cleft palate patients.

Nasal Mucociliary Clearance in Patients with Chronic Middle Ear Infection.

Mucociliary function plays an important role in the defense mechanism of the upper respiratory tract including the middle ear and paranasal sinuses. It has been reported that impaired nasal mucociliary clearance of the nose and nasopharynx may increase the chance of infection through the Eustachian tube.Nasal mucociliary function was assessed by the saccharin test in 163 patients with OME, otitis media purulenta chronica, otitis media cholesteatomatica, or adhesive otitis media to determine whether it plays any role in the development of chronic middle ear infection. The control group included 67 normal subjects with no history of nasal disease who were assessed as having no nasal disease by rhinoscopic examination.Significant prolongation of saccharin time was noted in the patients regardless of age or nasal condition. Impaired nasal mucociliary clearance was thought to be due to inflammation of the nasal mucosa or a predisposition to nasal mucociliary dysfunction.

Middle ear diseases in patients with congenital velopharyngeal insufficiency.

To clarify the incidence of middle ear disease in patients with congenital velopharyngeal insufficiency (CVPI), we observed the shape of the velopharynx by a videofluorography and the movement of the lateral pharyngeal wall and soft palate with a flexible fxberscope. The findings of otoscopy, audiometry, and tympanometry were also recorded.Otitis media with effusion was the most common findings. The shape of the velopharynx had no relation to the incidence of middle ear disease. On the other hand, middle ear diseases were uncommon in CVPI patients with a good mobility of the lateral pharyngeal wall and soft palate. It was thought that the mobility of the velopharyngeal muscles, such as a levator veli palatini, might have some effect on conditions in the middle ear.

Pharyngeal flap operation and nasal breathing.

The clinical effectiveness of the pharyngeal flap operation for cleft palate has been widely documented. For the success of this operation, the lateral velopharyngeal apertures must be closed by mesial movement of the lateral pharyngeal wall during phonation, but they must be large enough for normal nasal breathing.To determine the minimum size of the lateral velopharyngeal apertures needed for normal nasal breathing, we measured their size with small balls. Nasal airway resistance was determined by both active-anterior and active-posterior methods. It was assumed that the pharyngeal flap had raised the resistance and disturbed nasal breathing when the difference in resistance between the two measurements was large.The minimum size of the two lateral velopharyngeal apertures needed for normal nasal breathing was found to be 6-7mm.

Nasal diseases in patients with congenital velopharyngeal insufficiency.

Several investigators have reported a high incidence of middle ear diseases in patients with congenital velopharyngeal insufficiency (CVPI). However, little is known about nasal diseases in these patients. In the present study, we examined the incidence of intranasal deformities and nasal sinusitis. Nasal airway resistance was determined by the active-anterior method. A history of allergic disease and eosinophils in nasal secretions were sought for in the patients with nasall sinusitis. The incidence of chronic middle ear diseases was also correlated with that of nasal sinusitis.1) A high incidence (55.9%) of nasal sinusitis was noted in patients with CVPI under 15 years of age.2) The incidence of intranasal deformities, such as deviation of the nasal septum and hypertrophy of the inferior turbinate, was low in patients under 15 years of age.3) Few patients had abnormaly high nasal airway resistance.4) Allergy was thought to contribute little to the development of nasal sinusitis in these patients.5) Chronic middle ear diseases in these patients showed a close correlation with the presence of nasal sinusitis.