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Two hundred and twenty-nine patients were studied in an attempt to determine the main causative factors behind their having a residual foreign body in the esophagus. Strictures were present in 13%. Fifty-two percent of the patients with stricture had been hospitalized more than once for treatment of foreign body impaction; this was the case in only 8.5% of the rest of the patients (p less than 0.001). More than half of the patients aged 15 years or younger had a foreign body in the hypopharynx. This location was extremely uncommon in adults (p less than 0.001). The hypothesis of spasm distal to an esophageal foreign body as the cause for obstruction in patients without esophageal stricture was supported by the following findings: spontaneous disimpaction occurred in more than one-third of the patients and became more frequent as time progressed; 63% of 16 patients given spasmolytic drugs experienced spontaneous disimpaction of the foreign body; half of the patients had the foreign body in the proximal esophagus distal to the narrower passage of the upper esophageal sphincter; foreign body impaction in the esophagus turned out to be a once-only event in 86% of the patients; and 21% of the patients had a disorder of the central nervous system and had been hospitalized significantly more often because of food impaction than the other patients. The findings indicate that adults with a history of impaction of foodstuff lacking sharp bones and who do not have stricture suffer food impaction because of spasm of the esophageal smooth muscle, and can be treated accordingly.

A retrospective evaluation was performed in 112 patients treated during a 10-year period as inpatients with the diagnosis idiopathic sudden hearing loss. Excluding all patients in whom later other diagnoses were established, like Ménière’s disease, collagenoses, mumps etc., 101 patients remained. 80 of them had been treated consistently according to a protocol as having idiopathic sudden hearing loss. These patients had all 5-day treatment with low molecular weight dextran and nicotinic acid and vitamin B during 1 month. 68% did completely recover or were markedly improved ( > 30 dB), another 19% were fairly improved (10–30 dB). Statistical analysis showed that all retrocochlear signs or nystagmus made the prognosis less favorable. To wake up with the hearing loss was more favorable than a daytime debut. A midfrequency loss had always a good prognosis. Because no untreated controls were included in the study, it was not possible to evaluate the specific effect of the treatment. The results obtained from this study have changed the treatment policy in our clinic.

A transient pontine lesion was demonstrated in a young adult male who had a complete acute peripheral facial nerve palsy due probably to multiple sclerosis. In the acute stage of the palsy, T2-weighted magnetic resonance imaging (MRI) revealed a high signal intensity in the ipsilateral pons in the region of the nucleus and pontine part of the facial nerve. The patient recovered completely 5 weeks after the onset of the palsy, and at this stage, the lesion in the brainstem was no longer demonstrable on MRI. The onset and course of the disease resembled the idiopathic form of facial palsy (Bell’s palsy): the present findings along with recent MRI and topodiagnostic studies may indicate that in some cases of Bell’s palsy the primary lesion is located centrally. By improved MRI techniques and intravenous contrast agents it may be possible to visualize and follow the disease process and ascertain more of the pathogenesis of Bell’s palsy.

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