A case of middle-ear cavernous lymphangioma with facial palsy.

OBJECTIVE: Only a few benign tumours of the middle ear have been reported to lead to the development of facial palsy. Here, we describe a patient with middle-ear cavernous lymphangioma and facial palsy. STUDY DESIGN: Single case study. PATIENT: A 61-year-old man presented with left-sided hearing impairment and incomplete left facial palsy. A tumour was confirmed to be occupying the epi- to mesotympanum and to be joined to the facial nerve. The tumour was removed along with facial nerve tissue, which was resected at its horizontal portion, and the remaining facial nerve was fixed by end-to-end anastomosis. Complete facial paralysis occurred after the operation, but the patient's House-Brackmann grade gradually improved to grade III. Post-operative histopathological examination revealed infiltration of the lymphangioma into the facial nerve tissue, together with mild neural atrophy of the facial nerve. CONCLUSION: These findings suggested that tumour invasion was the cause of facial palsy in this patient.

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children.

OBJECTIVES: Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS: From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS: Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS: DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

[Evaluation of canal wall down tympanoplasty with canal reconstruction for draining ear with middle ear cholesteatoma].

OBJECTIVES: We studied the postoperative stability of canal wall down tympanoplasty with canal reconstruction for middle ear cholesteatoma with preoperative otorrhea. SUBJECTS AND METHODS: 155 ears with middle ear cholesteatoma treated with canal wall down tympanoplasty with canal reconstruction were evaluated retrospectively. A comparison was made between the group of 80 ears which showed otorrhea, preoperatively, and the group of 75 without preoperative otorrhea. Problems observed in the tympanic membrane or reconstructed external auditory canal were evaluated both at the postoperative initial stage and more than 1 year after surgery. Postoperative hearing prognosis was also studied. RESULTS: 1) In the postoperative initial stage, local infection and necrosis of materials for canal reconstruction were significantly more likely to be observed in ears with preoperative otorrhea. 2) In ears with postoperative local infection, necrosis of materials for canal reconstruction occurred more frequently, and the period until drying of the reconstructed external auditory canal was significantly extended. 3) No significant difference was seen in postoperative status of the tympanic membrane and reconstructed ear canal at least 1 year after surgery. 4) The presence of preoperative otorrhea had no influence on hearing prognosis. CONCLUSIONS: When canal wall down tympanoplasty with canal reconstruction is used for ears with preoperative otorrhea, careful attention should be paid to local treatment at the postoperative initial stage. However, no significant problem occurred in the outcome of preoperative ear draining at least 1 year after surgery.

Examination of three-dimensional movements in human embryos using computer imaging technology.

This paper describes the use of computer imaging technology to study in three dimensions the dynamics of differentiations in human embryos. Three-dimensional computer reconstruction technology was used to build a series of models of the brain/face and the ear region from fixed, serially sectioned embryos at representative stages. When certain principles are followed each model can be equated to one frame on a motion picture film. The dynamics of differentiation are then revealed as changes in size, shape and position (growth movements) of multiple structures as they build the definitive arrangement.

Clinical analysis of malignant lymphomas of tonsils.

Data of 38 patients with primary tonsil lymphoma, treated during the past 14 years was analysed. All cases were non-Hodgkin lymphomas. There were 11 patients with Stage 1, 14 with Stage II, 8 with Stage III, and 4 with Stage IV tonsillar lymphomas. The applied chemotherapies were CHOP or MACOP-B regimen. The overall 5-year survival rate was 64.4%. Further analysis of the intermediate grade group showed that 5-year survival rates were 72.7%) for patients younger than 60 years old, in contrast to 35.0% for patients aged 60 or older (p 0.0049). Five-year survival rates were 100%) for Stage I, 32.4% for Stage II, 55.6% for Stage III, and 100%) for Stage IV patients (p = 0.0878). In patients with Stage II tonsillar lymphomas, 5-year survival rates were below 100% for CHOP regimen, 100% for MACOP-B regimen, 66.7% for radiation alone, and 0% for radiation followed by chemotherapy (p = 0.1966). In patients with Stage III tonsillar lymphomas, 5-year survival rates were below 100% for MACOP-B regimen, and 0% for initial radiation followed by chemotherapy (p = 0.2568). The factors influencing survival were age, stage, and treatment modality. For Stage I patients without bulky mass, radiation therapy is sufficient. For Stage II patients or Stage I patients with a bulky mass, CHOP regimen (followed by radiation) is the choice of treatment. For Stage III or IV patients,, MACOP-B regimen is promising.

Increased soluble CD23 molecules in serum/saliva and correlation with the stage of sialoectasis in patients with primary Sjögren's syndrome.

OBJECTIVE: We examined the soluble CD23 (sCD23) molecules in sera and saliva from patients with Sjögren's syndrome. METHODS: The determination of sCD23 and other soluble molecules were made by the enzyme-linked immunosorbent assay. RESULTS: The amounts of sCD23 in the sera/saliva were significantly increased in the patients compared to the controls and the levels were significantly correlated with sialoectasis. CONCLUSION: The findings suggest that increased sCD23 molecules in saliva from patients with Sjögren's syndrome may reflect active sialoectasis.

Three-dimensional development of the facial nerve path through the ear region in human embryos.

The goal was to determine how the facial nerve path forms normally through the ear region. Five three-dimensional computer reconstructions and eight wax plate-graphic, two-dimensional reconstructions were made from a group of 47 serially sectioned human embryos that were in the blastemal period of ear development, when most of the definitive arrangement is established. The size, shape, and positional changes of the facial nerve relative to the external ear and notochord were studied in both lateral and frontal views. The vertical (dorsoventral) position of the external ear region remains constant but shifts caudally. After formation, the geniculate ganglion assumes a position that gradually becomes rostrodorsal to the external ear. Facial nerve branches form and grow into regions expanding peripherally. The superficial petrosal branch appears to hold the ganglion in position as the horizontal segment of the facial nerve forms when the external ear shifts caudally. Possible growth movements explaining abnormal nerve paths are discussed.

Neurotransmitter effects on inhibitory burst neurons in the cat.

The present experiment was designed to determine which neurotransmitter influences the burst pattern in the firing of the inhibitory burst neurons (IBN) during vestibular nystagmus. Cats were anesthetized with ether and mounted in a stereotaxic apparatus on a turntable, implanted stimulation electrodes, removed occipital bone and aspirated the vermal part of cerebellum. After the operation ether was discontinued. The recordings took place with the cats in an alert condition created by upper cervical cord transsection, artificial respiration and local anesthesia by infiltrating 0.5% lidocaine into the semilunar ganglions every two hours. We also employed iontophoretic application of the various drugs: GABA, muscimol, glycine, serotonin (5-HT) and bicuculline through seven-barrelled glass micropipettes. GABA or muscimol did not influence nystagmus rhythm, but both chemicals caused strong suppression of burst activities in IBN. Since this inhibitory effect of GABA was suppressed by the simultaneous application of bicuculline, IBNs appear to be controlled by GABAA receptor. Glycine and 5-HT did not change the firing pattern of IBN. Application of bicuculline itself caused an increase of tonic discharges of IBN. These findings suggest that IBN receive inhibitory impulses from the higher GABAergic neurons.

Neuro-otological study of positional vertigo caused by head injury.

A neuro-otological examination was given to 22 patients with paroxysmal positional vertigo within 1 week of head injury. In all cases, reverse rotatory positional nystagmus accompanied by a vertiginous sensation was observed in the positional nystagmus test. No relationship between the affected side and the direction of eye movement in the head-hanging position was found in the positional nystagmus test. From the prognosis and the nystagmus findings, the cause of the vertigo was thought to be partial damage to the inner ear. The clinical course was generally favorable, but recovery was slower in the 11 cases with neuro-otologically demonstrated central nervous system disorders than in the other 11 cases.

Scanning electron microscopic studies of the membranous labyrinth after transtympanic infusion of local anesthetics (lidocain).

Scanning electron microscopic observation of the transtympanic infusion of 10% xylocain revealed twisting and disorders of outer hairs especially from the 2nd and 3rd rows of the basal to the 2nd turn of the organ of Corti, and adhesion and fusion of the sensory hairs of the crista ampullaris and otolith organ 1 and 4 days after injection. Four percent xylocain however demonstrated very minor alteration of the sensory hairs and no missing sensory hairs were detected from any cases. The authors hypothesized from electron microscopic observation that adhesion and fusion of vestibular sensory hairs or twisting and disorders of the sensory hairs of the organ of Corti might act to intercept harmful circulation of exclusion of abnormal excitement of hair cells and the innovation of electrical discharge of sensory hairs due not only to the pharmacological effects of xylocain but also to osmotic pressure.