Archives of oto-rhino-laryngology最新文献

A CT study was made of the eustachian tube in normal subjects as a control group and patients with chronic pathological inflammation of the middle ear. CT made it possible to perform contiguous scans at homologous depths of 1.5 mm, showing the whole interior of the tube in clear detail: the protympanum, the bony and cartilaginous portions, and the nasopharyngeal orifice. In most of the cases of pathological middle ear inflammations, the eustachian tube lumen was seen to be constricted and obstructed with isodense matter. Our present results also show the importance of extending CT investigations beyond the tympanic cavity and the mastoid to the eustachian tube in order to have more clinical data on its condition.

The concentrations of prostaglandins (PGs) were measured by a radioimmunoassay in human middle ear effusions (MEEs) obtained from patients with otitis media with effusions. Each sample of MEE was divided into two groups: serous effusions and mucoid ones. The main PG in both the serous and mucoid effusions was TXB2 (375 and 857 pg/ml, respectively), followed by PGE2 (173 and 459 pg/ml, respectively). Smaller quantities of PGD2 (35 and 64 pg/ml, respectively), PGF2 alpha (139 and 183 pg/ml, respectively), and 6ketoPGF1 alpha (129 and 201 pg/ml, respectively) were also found in the MEEs. The amounts of each PG in the mucoid effusions were 2 or 3 times higher than those found in the serous effusions, while protein concentrations and the profile of these PGs in the MEEs were almost the same in the mucoid and serous groups. These results suggest that PGs may play an important role as a mediator of the inflammatory responses in the pathogenesis of MEEs.

An immunohistochemical technique with decalcified frozen sections was used to study aminoglycoside ototoxicity. Decalcified guinea pig cochleas were cut with a fine blade parallel to the plane of the modiolus to facilitate the penetration of inclusion material and the manipulation of frozen sections. Light microscopy was carried out and additional frozen sections were employed for an immuno-electron microscopic study. Twenty-four hours after a single transtympanic injection of 10 mg gentamicin, there was a definite distribution of the drug in only type I hair cells of the ampullae as well as in both inner and outer hair cells along the length of the cochlea. In those animals treated intraperitoneally with 200 mg/kg amikacin for 8 days, the drug was located in the outer hair cells of the cochlea, with a tendency to decrease from base to apex and in the inner hair cells towards the apex.

Severe unilateral cases of Menière's disease can be successfully treated with ototoxic antibiotics. Among them gentamicin sulfate gives the safest results. With the aid of a small syringe this antibiotic is introduced into the external auditory canal 5 times/day. From there it reaches the middle ear through a ventilating tube by using a Politzer bag. Gentamicin then penetrates the round and oval windows, where it influences inner ear function. Of 92 patients treated during the past 20 years, more than 90% have had no further attacks after therapy.

The results and the sequelae are reported from a series of consecutive 400 translabyrinthine removals of acoustic neuromas comprising almost all such tumors in Denmark during a 12-year period from 1976 to 1988. There were two intrameatal, 137 median-sized, 112 large and 149 advanced tumors, the latter having a diameter exceeding 40 mm. The mortality rate in the overall series was 2%. The incidence of cerebrospinal fluid leak occurred in 11%, and persisted for more than 2 weeks in 4%. Facial nerve function was completely normal in 67% of the patients, while only 5% required a nerve anastomosis.

The results of laryngeal cancer surgery were assessed in a group of 832 patients treated in four major ENT centers in Poland. Five-year survival rates were as follows: stage I, 86%; stage II, 71%; stage III, 54%; and stage IV, 42%. In experienced hands and for properly selected cases, cure rates after partial (conservation) laryngeal surgery were similar to those after total laryngectomy. For early stages (I and II), the survival after partial surgery was better than that found after radiotherapy.

An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.

Lymphokine-activated killer cells (LAK) are able to kill natural killer (NK)-resistant fresh bioptic tumor cells. We have tried to increase the antitumor activity of peripheral blood lymphocytes by the simultaneous stimulation with interleukin-2 and autologous tumor extract (TE). The influence of LAK cells and LAK cells stimulated with TE was compared in the subrenal capsule assay in nude mice. Experiments were performed with eight head and neck tumors following their surgical extirpation. The tumors were first grown in the renal capsule space while lymphocytes were being stimulated in vitro. Following this, the lymphocytes were injected into the growing tumors. The autologous TE-stimulated LAK cells were more effective in treating tumors than were the LAK cells. Tumors regressed in some cases so treated, a finding which was never observed with LAK cells alone.

To clarify the effect of the temporary decline in cerebellar function on the vestibulo-ocular reflex (VOR) and gaze functions, we examined 12 normal adults under passive rotations before and after they drank alcohol at dosages of 0.43 and 0.65 g/kg. Whereas spatial gaze fixation was maintained accurately with 0.65 g/kg administration (0.06% blood alcohol level), gaze fixation on a head-fixed target and smooth pursuit were impaired by the higher dosage of 0.43 g/kg (0.03% blood alcohol). The magnitude of the alteration in the VOR gain after drinking was correlated significantly with the VOR gain before drinking: while small values were enhanced by drinking, large values were suppressed. The present study indicates that the VOR in the dark is regulated by the balance between the amplifying and suppressing forces controlled by the cerebellum.

Conventional brain scanning uses polar tracers which do not penetrate the normal blood-brain barrier. Radiolabeled amines like 123-iodoamphetamine (IMP) cross the barrier to inhibit serotonin and norepinephrine in synaptosomes. Studies of cerebral perfusion and function seem to be successful with such labeling. We advance the hypothesis for an increased IMP uptake in the stimulated primary auditory cortex. The method of single photon emission computed tomography (SPECT) is described. We have also been able to demonstrate marking of the primary auditory cortex by an increased amphetamine input in 6 out of 15 cases during stimulation by white noise.