It has been reported by many investigators that there is a correlation between the degree of the ossicular malformation and the auricular deformity in cases with the atresia or the narrow external meatus. This correlation, however, has not established in the middle ear malformation with the normal external meatus. The purpose of this paper is to study this correlation. The subjects are 60 ears (49 patients) of the middle ear malformation with the normal external meatus. Their occicular findings are confirmed operatively. Ossicular anomalies were classified into two groups according to the retrospectively estimated numbers of the maldeveloped foci.One is monofocal type with only one maldeveloped process, and the other is multifocal type with more than two maldeveloped processes.As the result, the monofocal type was more frequently observed than the multifocal type in cases with the normal auricule, the jaw and the face or in unilaterally affected cases. In contrast, the multifocal type was more frequently observed in cases with some anomalies of the auricle, the jaw and the face or in bilaterally affected cases. This difference has been proved to be significant by the Chi-square test.It is concluded that checking of the items above mentioned is important in middle ear malformations with the normal external meatus, because the multifocal type is more frequently observed in cases with some anomalies of the auricle, the jaw and the face or in bilaterally affected cases, and because surgical correction is also more difficult in these multifocal type anomalies.
The development of digital radiography (DR) has made it possible to analyze the contour of the laryngeal soft tissue structures in more detail than the conventional screen-film method.The authors first used the DR system for time subtraction of the larynx during inspiration and phonation.The images are acquired by means of frontal tomography of the larynx using the imaging plate during inspiration and phonation separately, and stored into the memory of the DR system. The thickness of the slices is 5.0 mm. Time subtraction between the mask image during inspiration and the live image during phonation is performed using digital processing on CRT. Superimposing the two images at the upper trachea and the thyroid cartilage of the same depth, makes it possible to measure movement of the vocal cord and false vocal cord quantitatively in three dimensions. The authors named this time subtraction as motion subtraction of the larynx.This motion subtraction image can be obtained by on-line digital processing without complicated development technique, but has so high spatial resolution. This image processing seems to be useful in functional radiographic analysis of laryngeal diseases.
The diagnosis of the ossicular condition, fixation or interruption , is often not achieved by the tympanometry, because the overlap of the distribution of the static compliance (SC) is so great with the normal group in these two groups. Therefore, it has been said that SC , by itself, has little diagnostic value for differentiating the ossicular lesion .The overlap of the distribution of SC, however, was much smaller between the group with ossicular fixation and the one with ossicular discontinuity. So , apart from deviation from the normal range of SC, the limiting value of SC for discriminating the two groups was determined in ears with conductive hearing loss. The subjects were fifty-one ears with ossicular fixation and seventeen ears with ossicular discontinuity, in which ossicular lesions were surgically confirmed.All ears showed intact tympanic membrane.The limiting value of SC was 0.9cc. The internal check using this discriminant value showed high ratio of discrimination, i.e. 94.1% in the fixation group and 64.7% in the discontinuity one were diagnosed correctly. Therefore the author proposed this value as the new criteria to differentiate type As ("s" means sclerosis) tympanogram from type Ad ("d" means discontinuity) one. In addition, the comparison of SC with the normal side in twenty-five unilaterally affected ears showed smaller SC in 75% of the fixation group and larger SC in 92.3% of the discontinuity one than the normal side.Thus, it can be said that SC have useful value in separating ossicular fixation from ossicular discontinuity, if one compares ears with both the intact tympanic membrane and conductive hearing loss.
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