Yoshio Honda

Studies on mucocoeles of the ethmoid and sphenoid sinuses: Analysis of 47 cases

Forty-seven mucocoeles of the ethmoid and/or sphenoid sinuses (33 males, 14 females) were operated on during the 10-years period from 1980 through 1989. Thirty-seven cases were post-operative mucocoele, while the remaining 10 were so-called primary mucocoeles. None of the cases had a history of facial trauma. In the majority of post-operative cases, the mucocoele develops 15-24 years after initial surgery. Paranasal sinus surgery in young patients (teenagers) may lead to a mucocoele due to post-operative scarring in the surgical wound. The principal symptoms include globe displacement, double vision, headache, deep orbital pain, a mass in the supero-medial quadrant of the orbit, visual disturbance, etc. Sufficient opening of the mucocoele wall by the endonasal approach is recommended for surgical treatment of ethmoidal and sphenoidal mucocoeles.

Bone resorption in cholesteatoma: Epithelial-mesenchymal cell interaction and collagenase production†

Clinical evidence has shown that chronic otitis media with cholestentoma causes greater bone resorption than otitis media without cholesteatoma. What is the role of the epithelium and its products on the morbidity of cholesteatoma? We have studied the mechanism of collagenase production in cultures of rat epidermal cells and skin fibroblast‐like cells under various conditions. The epithelial cells significantly induced mesenchymal cells to produce collagenase. We conclude that interaction between epithelial cells and fibroblast‐like cells enhances production of collagenase. This enhancement of proteolytic activity may be crucial in the series of molecular events resulting in bone resorption associated with cholesteatoma.

Effect of Middle Ear Infection on Pneumatization and Growth of the Mastoid Process: An Experimental Study in Pigs

The intention of this experiment was to investigate whether anatomical variations of the temporal bone such as low middle fossa dura, anterior position of the sigmoid sinus or small mastoid process, which are often seen at surgery in cholesteatoma patients, are caused by inflammation in early childhood. In 7 pigs, 1.5 ml paraffin liquid were instilled into the left tympanic cavity 2 or 7 days after birth in order to produce inflammation of the middle ear and tubal dysfunction. After six and a half months the length and area of the mastoid process were significantly smaller on the left instilled side than on the right, normal side. In all cases there was remarkable hypocellularity and increased thickness of the cortical bone strongly supporting the environmental theory of pneumatization that inflammation suppresses the pneumatization process and growth of the mastoid process.

Effect of middle ear infection upon the pneumatization of the mastoid: An experimental study in pigs

The suppression of the temporal bones pneumatized cavities is commonly observed in chronic middle ear inflammatory disease, but this fact has not been explained in respect to its etiology, i.e., whether the poorly pneumatized cavity induces chronic middle ear infection or middle ear inflammatory condition suppresses the pneumatization of cellulae.

Eustachian tube function and mastoid pneumatization.

We investigated the relationship between the Eustachian tubes ventilatory function and the pneumatization of mastoid air cells. In 65 adults (66 ears) with chronic otitis media (COM), ventilatory Eustachian tubal function was evaluated by the inflation-deflation test, while the area of mastoid air cells was measured by the rectangular method on X-ray film. Group I represents good function in both the inflation and deflation tests. Group II represents good function in the inflation test but poor function in the deflation test. Group III represents a poorly functioning Eustachian tube in both tests. The opening pressure in Group III was statistically higher than in Group I and Group II. The area of mastoid air cells in Group I was statistically larger than in Group III. There was no correlation between opening pressure and area of mastoid air cells in COM. Postoperative failure of the tympanic membrane was frequently found in Group III. We discuss the tubal function and pneumatization of mastoid air cells.

Effect of Middle Ear Infection on Pneumatization and Growth of the Mastoid Process

The intention of this experiment was to investigate whether anatomical variations of the temporal bone such as low middle fossa dura, anterior position of the sigmoid sinus or small mastoid process, which are often seen at surgery in cholesteatoma patients, are caused by inflammation in early childhood. In 7 pigs, 1.5 ml paraffin liquid were instilled into the left tympanic cavity 2 or 7 days after birth in order to produce inflammation of the middle ear and tubal dysfunction. After six and a half months the length and area of the mastoid process were significantly smaller on the left instilled side than on the right, normal side. In all cases there was remarkable hypocellularity and increased thickness of the cortical bone strongly supporting the environmental theory of pneumatization that inflammation suppresses the pneumatization process and growth of the mastoid process.

Technique for Endoscopic Endonasal Sinus Surgery

Endoscopy enables us to avoid complications and achieve complete surgery of the ethmoid sinus, nasofrontal duct, and fontanelle under clear observation. By connecting a CCD camera, a surgeon can carry out an operation while watching the image on a TV monitor. Rigid 0° and 70° endoscopes are used. The 0° endoscope is selected for the ethmoid portion of the operation, and the 70° endoscope is used for treatment of the nasofrontal duct and the fontanelle. Use of various forceps has made it possible to treat the nasofrontal duct and the fontanelle and to establish a wide communication. In practice, intranasal procedures are conducted close to the anatomical location of the ground lamella (gl) in the ethmoid sinus. We discussed our technique for endoscopic endonasal sinus surgery for pansinusitis.

A study in children on the inhibited pneumatization of the mastoid in otitis media with effusion.

We investigated the development of mastoid air cells in cases of otitis media with effusion (OME) contracted during the fastgrowth period of childhood. It was considered that, if a comparative study of these cases against subjects in normal health was conducted on what types of effects of chronic inflammation of the middle ear in a child has on the development of the mastoid air cells from the time of onset until adulthood, it might reveal a major clue to the causal relationship between chronic inflammatory conditions of the middle ear and inhibited pneumatization of the temporal bone.

Homografts of the Tympanic Membrane With Malleus; Histological Study In Cat

The present experiments on cats were performed to explore the process of survival and take of transplanted homografts of tympanic membrane with malleus, the homografts being respectively preserved in 4% and 0.5% formalin (pH 7.0) solutions, and to explore the reaction of middle ear mucosa of the recipient. The present study also included gross and histopathological examinations of the eardrum and observation of fibers of the lamina propria of the transplanted tympanic membrane by means of polarizing microscopy and of vascularization by intravascular India ink injection. The experiments conducted using a total of 96 cats yielded results leading to the following conclusions. 1) After six months the transplanted tympanic membrane showed nearly normal histologic features, with a fibrous layer between the lining epithelial and thin mucosal layers. The middle ear mucosa also became thinner and was covered with ciliated epithelium at this stage. 2) As regards vascular distribution, most vessels entered from the peripheral regions to become distributed all over the eardrum with mutual anastomoses. 3) Fibrous tissues of the lamina propria of the pars tensa of the transplanted eardrum remained intact over the six month period. 4) The transplanted malleus was neither destroyed not absorbed, and proved to survive well with active vascularization. 5) The microscopic changes observed in the middle ear mucous membrane of the recipient showed non-specific reactions to Gelfoam. The grafts were not subjected to immunological rejection. Homograft thus offer the best grafting material, but seemed to show poor resistance to infection.

The clinical significance of the tympanic isthmus related to the development of cholesteatoma.

The epitympanum is separated from the mesotympanum by the ossicles, tendons and tympanic mucosal folds except at two narrow openings, the anterior and posterior tympanic isthmuses. Using large numbers of fresh cadaver temporal bone specimens, anatomical boundaries of the tympanic isthmus were defined and pathological variations were investigated in relation to the development of aural cholesteatoma. A total of 170 temporal bone specimens were examined under the operating microscope. Five of these were found to have middle ear diseases, most of which were cholesteatoma or a preliminary state of cholesteatoma, with their tympanic isthmuses obstructed or narrowed. Pneumatization of the mastoid was inhibited in all of the pathological specimens. From the results of temporal bone dissection supplemented by analysis of surgical findings in cholesteatoma, we have divided acquired cholesteatoma into two types: the pars flaccida-type cholesteatoma (attic retraction-type) and the pars tensa type. The close relationship between the development of cholesteatoma and occlusion of the tympanic isthmus is examined herein.