We report 10 postlingually deafened adults in whom the electrophysical criteria for cochlear implant were fulfilled, except that they showed the following unfavorable middle ear lesions: otitis media with effusion, chronic perforative otitis media, cholesteatoma and previous radical ear operation. Staged operations for cochlear implant were performed in 8 cases, and 2 patients who had undergone radical ear operation had a single-stage operation. As a first step, one of the following was performed in each patient as surgically indicated: myringoplasty with or without mastoidectomy, mastoidectomy with reconstruction of the posterior wall of the external canal, mastoidectomy with the insertion of a ventilation tube, radical mastoidectomy or surgical cleansing of the radical cavity. From 6 months to 2.5 years after the first operation, the actual cochlear implant was performed in the second or third stage. There was no major complication as a result of electrode insertion into the cochlea and the results of speech perception in these cases were not different from those in patients with normal middle ears. In our experience, it was considered that the staged operations would enable successful cochlear implants in selected patients with pathological middle ear lesions even if they had previously been diagnosed as contraindicated for this procedure. In a case with radical ear cavity a single-stage operation could be performed when there was no cavity problem.
A total of 124 normal school children in three classes (aged 8 to 9) were examined for beta-hemolytic streptococci for 29 months from August 1977 to December 1979 by means of serial monthly throat cultures. No significant difference between the carrier rate of boys and that of girls was observed. Although no monthly variation of carrier rates appeared in class II, marked temporal increases of carrier rates appeared from June 1978 (in Class I) and from August 1978 (in class III) to August 1979. These periodical variations of carrier rates observed in this investigation do not coincide with the low-in-summer and high-in-winter seasonal variation which has generally been observed by many other investigators. The average values of carrier rates throughout the period of this investigation were 30.9, 29.7, and 24.5% in classes 1, II, and III, respectively. The carrier rate of group A streptococci by month and by class showed some positive correlation with the carrier rate of total beta-hemolytic streptococci. Ttype 4 and T-untypable strains were not identified up to a certain period; then each strain appeared at a given time during the course of our investigation in one class, spread to all three classes, and continued to be isolated until the end of this investigation. The origin of these types of strains could not be identified in this study. Of the children, 36 (29.0%) never became streptococcal carriers during the period of examination and 88 (71.0%) became streptococcal carriers at least one time during the 29 examinations; among these positive carriers, 29 children (23.0%) showed positive results in more than 50% of the examinations.
In order to obtain evidence that viral infection may be involved in chronic otitis media with effusion, an attempt was made to detect secretory IgA antibodies to respiratory viruses in the effusions. The enzyme-linked immunosorbent assay used with purified viral antigens was employed for detecting antibodies in this study. Secretory IgA antibodies against adenoviruses, respiratory syncytial, and parainfluenza type 2 viruses were demonstrated in 31 of 128 effusions (27 of 114 ears with chronic otitis media with effusions and 4 of 14 ears with blue eardrum conditions). The specificity of antibody activity to each virus was confirmed by an absorption test.
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