Society Transactions ORL 39: 342-348 (1977)
Nederlandse Keel-Neus-Oorheelkundige Vereniging 145ste Vergadering te Utrecht, 28 en 29 oktober 1977
Dutch Oto-Rhino-Laryngological Society 145th Meeting, Utrecht, October 28 and 29, 1977 President
G. de Wit
Secretary
-
J. van der Borden
Some Physical Aspects of the Vestibular System A. Clemens University of Utrecht, Utrecht To get insight in the transfer of the saccular statolith system up to and including the primary afferents, the response on sinusoidal changing movements is studied. The direction al sensitivity of the hair cell affects this response. To avoid these spatial aspects, the stimulus has to be rectilinear in the macular plane, locally where the hair cells of the measured single unit are. A tilt table does not give a rectilinear stimulus and even a parallel swing cannot satisfy this condition. We used a cabin on a rail. The cabin was connected with springs on both sides; by this the stimulation was rectilinear and sinusoidal with a frequency adjustable between 0.04 and 3 Hz. One of the ways the overall transfer function can be interpreted is a combination of a slow (heavily damped) mechanical system and a proportional differenti ating processing in the remaining system before the primary afferents. This gives a ‘speeding up’ resulting in a total system with fast-reacting properties. The frog does not have a flat macular plane and the striola is not a straight line. These properties imply for the ensemble of primary afferents to possess information about magnitude and direction of the stimulating force as a time function. Reference Galle, H. and Clemens, A.: The sacculus of Rana esculenta; thesis, Utrecht University (1976).
Alternating Nystagmus W.J.A.C. Rademakers ENT Department, University of Amsterdam, Amsterdam
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Alternating nystagmus is a very rare condition. About 90 patients with this phenome non are reported in the literature. Only in 12 of these patients is the nystagmus of congeni-
Society Transactions
343
tal origin; in most cases a disorder in the central nervous system is the cause of the acquired type of alternating nystagmus and thus it is important to detect these cases. The literature gives only little information. As the characteristics of alternating nystagmus that are described in the literature are widely variable, our criterion for the diagnosis is ‘recording of a nystagmus changing its direction without any external influence’. In that way, alternating nystagmus was diagnosed in 20 patients; 15 patients fulfilled the criteria for the diagnosis ‘congenital nystagmus’ too. The following conclusions are made from the data of our 20 patients: (I) . The characteristics of alternating nystagmus as described in the literature are also found in our study. (II) . Concerning the differentiation between congenital and acquired alternating nystagmus: (A) The characteristics of the alternating nystagmus itself ate of very little help. (ft) Other nystagmographical findings are important for differentiation: (1) the find ings in cases with a congenital type of alternating nystagmus correspond exactly with the features of congenital nystagmus without spontaneous alternating; (2) the findings in cases with the acquired type of alternating nystagmus are clearly distinguished by: (a) a pure jerk form when recordings are made of the patient with the eyes open; (b) the absence of a nystagmus like the Bruns’ nystagmus; (c) the saccadic pattern of the curve at the pendulum swing test which is obviously different from the pattern found at the pendulum swing test in congenital nystagmus; (d) the optokinetic nystagmus is disturbed but inversion is never found; (e) the caloric responses are closely connected with the underlying disorder. (C) The other symptoms in alternating nystagmus are also of consequence: (1) Absence of complaints suggests congenital alternating nystagmus; (2) normal hearing or conductive hearing loss suggests a congenital alternating nystagmus; perceptive hearing loss at one or both ears suggests an acquired alternating nystagmus; (3) other neurological pathology than the nystagmus obviously supports the diagnosis ‘acquired alternating nystagmus’; (4) Radio pathology is usually found only in patients with acquired alternating nystagmus; in patients with congenital alternating nystagmus no radiopathology is found in relation to their nystagmus. Final conclusion: alternating nystagmus of congenital origin can be distinguished from acquired alternating nystagmus; not the widely varying characteristics of the alternating nystagmus itself but the other nystagmographical findings and other symptoms are of decisive value for the differentiation. Reference Rademakers, W.J.A.C.: Nystagmus alternans; thesis, Univeisity of Amsterdam (1977).
Clinical evidence points towards the fact that, in therapeutic laryngotracheal intuba tion (1, 2), impregnation of a silicone rubber tube with dimethylpolysiloxane oil leads to improved results (3). Laboratory experiments, performed with a ‘pin-on disc’ type tribometer (4), show that this is probably due to a friction-reducing effect of the silicone oil.
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Friction Measurements with Silicone Rubber Impregnated with Silicone Oil A. W.J. de Gee, R.N.P. Berkovits; C.F. Bos, and C. Kruithof TNO Delft, University of Rotterdam, Rotterdam
Society Transactions
344
References 1 2 3 4
Berkovits, R.N.P.: Therapeutische laryngo-tracheale intubatie; thesis, Erasmus Universi ty, Rotterdam (1971). Bos, C.E.; Berkovits, R.N.P., and Struben, W.H.: Wider application of prolonged naso tracheal intubation. J. Lar. Otol. 87: 263-280 (1973). Berkovits, R.N.P.: Personal communication (1977). Vaessen, G.H.G. and de Gee, A. W.J.: Interface of water vapour on the wear of lightly loaded contacts. Wear 18: 325-332 (1971).
At first a definition is given on the use of the word implantation. It is in common use to speak about (homoio-)transplantation. The material used was the patients’ own bone or cartilage for reconstruction of the bony meatal wall. For reconstruction of the middle ear system, tissue of human cadavers was used. As homoiotransplant material was used the fibrous meatal wall, the eardrum, the malleus, the incus and the stapes or parts of these tissues. As possibilities we see: (1) the reconstruction of radical cavities (the most important one in our view); (2) when, during an ear operation, an almost total destruction of the ossicular chain is seen, a reconstruction can be done at the same time; (3) the reconstruction of the eardrum when a total perforation is present; (4) the reconstruction of atresia ears. The results of the last 4 years at the Utrecht University Hospital are presented in table I. From the left to the right the columns represent: type of implant material used, total number of cases, radical cavities, conservative radical cavities (with an amount of mucous epithelium in the middle ear cavity), a dry ear found during operation, obstruction of mucous epithelium in the form of cholesterol granuloma in cysts, the number of cases with cholesteatoma, found during operation. The results summarize the anatomical situation of the drum postoperatively. + indicates intact drum; ± indicates microperforation and dry ear, and - indicates failure (wet ear, cholesteatoma, and so on). The posterior meatal wall is the next column with + for intact bony wall, covered with epithelium, - indicates partial extrusion of the wall, or a partially bare bony wall with a dry ear, and - indicates failure (sequestration, running ear, cholesteatoma, which makes a new radical cavity necessary, and so on). In the functional results we give the percentage which have a loss of less than 35 dB hearing loss for the frequencies 500, 1,000 and 2,000 Hz. Restriction: In this review of our cases it is not shown (though it was evident) that the initial difficulties caused failures that would possibly not have occurred if the most adequate postoperative care had been practised. The regularly changing of the sponges, beginning on the 4th postoperative day is absolutely necessary for the achieving of good results. Too much bleeding during the operation also caused failures. Conclusion: With the increment of the results we think we are on the right track with this type of surgery, but we suppose that there should be certain limitations in the indica tions for this type of surgery.
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Experiences in Microsurgery of the Middle Ear with the Help of Homograft Implants at the University Hospital of Utrecht, over Almost 4 Years A.J. Boezeman ENT Department, University of Utrecht, Utrecht
Society Transactions
345
Table / Type of implant
n
Rad. Cons. Dry rad.
Obstr. Wet
Choi. Results anatomy drum
function < 35 dB bony at 500, wall 1.000 and 2.000 Hz %
Bony wall + cuff, drum, malleus incus, stapes
41
27
14
31
6
3
8
24 + 9* 62
23 + 7± 92
Cuff, drum, malleus, incus, stapes
26
0
2
16
3
5
14
16 + 5± 5-
3-
+ 27 -6 6 7
+ 27 -7 0 3
Cuff, drum, malleus and incus
6
0
0
5
0
1
3
4+ 1± 1-
Cuff, drum and malleus
5
1
0
5
0
0
1
2+ 1± 1-
1-
+ 40 -2 0 20
7+ 2± 2-
1-
+ 46 -2 7 27
Cuff and drum
Drum
11
1
1
0
0
0
7
1
2
0
1
0
2
0
1+
+ 17 -8 3
+ 100
Flight Behavior of Birds in Weightlessness W.J. Oosterveld, A.J. Greven, A. Graybiel and J.L. Kupper MAMRL, Pensacola, Fla.
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
The flight behavior of pigeons was studied in the weightless phase of parabolic flight aboard a Boeing 707 of NASA. This plane provides zero g-periods of up to 30 sec. Experi ments were conducted on pigeons with different handicaps. The behaviour of the birds was observed by means of a movie camera. This behaviour was analysed later on in slow motion. Normal pigeons flew around in weightlessness avoiding collisions with the wall of the plane. Extensive head movements were seen. This can be explained by the assumption that the birds were ‘hunting for gravity’. When the claws were strapped and bound to the body either spread or together - the pigeons did not make any flying movement. Covering the eyes in these birds did not change this behaviour. So the information from the legs seems to
Society Transactions
346
be important in the initiation of flying movements. Pigeons with their eyes covered showed the ‘tumble phenomenon’, this means that they made somersaults backwards. This tumbling backwards is a reverse reaction on the illusion of tumbling forwards. Birds with both labyrinths destroyed made aimless flying movements, likely due to lack of vestibular in formation. Covering their eyes did not make any difference. Flying without labyrinthine function is not possible. Unilateral labyrinthless pigeons showed rotation around the length axis of the body in a direction towards the destroyed labyrinth. When the eyes were covered these movements increased in speed. The explanation of this phenomenon can be that there is a reverse reaction on a sensation caused by asymmetrical decrease of information, as the pigeons were already adapted to the condition that only one labyrinth provided information to the central nervous system.
Bell the CAT L. Feenstra ENT Department, Free University, Amsterdam More and more it becomes evident that the combined approach tympanoplasty (CAT) is not always a safe and satisfactory procedure. Nor is the radical mastoidectomy Bondy type the ideal solution for every cholesteatoma because of the resulting cavity. After a suggestion of Austin (1) we started 20 months ago the bone obliteration method which begins with a radical mastoidectomy Bondy type. The resulting cavity is obliterated with a Palva flap at the meatal side and with bone paste (2) at the cavity side. So far the results have been very satisfactory. References 1 2
Austin, D.F.: Personal communication. Feenstra, L. and Uges, D.: Archs Otolar. (to be published).
Middle Ear Implantation: an Immunologically Privileged Way of Tolerance Induction in Otologic Tissue Grafting? J.E. Veldman and IV. Kuijpers ENT Departments, University of Utrecht and Nijmegen
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Serious hearing impairment as a consequence of chronic middle ear disease is still very common. During the past decade preserved allogenous tympanic membranes and tympanoossicular blocs have been employed to establish an optimal anatomical and physiological reconstruction of the sound-conducting mechanism. The success rate obtained with de vitalized implants can partly be attributed to the destruction of the autolytic enzymes by the preservation procedure (1). A very remarkable finding in this kind of tympanoplasty is the fact that no clear evidence of graft rejection has been reported in the literature. The lack of any reported immunological reaction in the implant has been suggested to be due to the middle ear being a privileged site or to a decrease or even total abolition of the antigens by the used preservatives (2). In those instances, where implantation fails it has been attributed to factors as an inadequate surgical procedure, secondary infection or recurrent disease, but not to an active immunological interference.
Society Transactions
347
The presence of antigenicity of these preserved grafts could be simply demonstrated in rabbits and rats by histological analyses of the draining lymph nodes, when implanted ectopically in a suitable vascularized bed such as exists in a subcutaneous pocket. Although any of the preservatives (alcohol 70%, formaldehyde, Cialit®) might have changed the tissues antigenicity, it definitely did not abolish it: both plasma cell and cellular immunity reactions are present in these nodes (3, 4). Experimentally it could be demonstrated that both an afferent and efferent limb of the immune response is intact in the middle ear complex. How is the nature of the exemption enjoyed by these otologic tissue grafts from immunological rejection then explained (5, 6)? (1) A lack of antigenicity is not the case. (2) Experimental evidence about an adequate ly functioning afferent and efferent immune loop does not make the hypothesis of the existence of a special privilege conferred upon the graft by virtue of the middle ear itself very solid. (3) ‘Adaptation’ of the graft within the recipient, the covering by an epithelial layer on the outside of the eardrum and with mucosal lining at the middle ear side, as has also been suggested in keratoplasty can hardly be an explanation for non-immunological interference of the host. (4) The only remaining explanation seems to be the occurrence of changes in the host which render it unable to respond to the donor histocompatibility antigens or, if sensitized, to reject them. According to this reasoning, the middle ear should be considered as an immunologically privileged site for tolerance induction in tympano ossicular implantation. This concept is discussed. References 1 2 3 4
5 6
Kuijpers, W. and Broek, P. van den: Biological considerations for the use of homograft tympanic membranes and ossicles. Acta oto-lar. 80: 283 (1975). Marquet, J.; Schepens, R., and Kuijpers, W.: Experience with tympanic transplants. Archs Otolar. 97: 58 (1973). Veldman, J.E.: Histophysiology and electron microscopy of the immune response; PhD thesis, Groningen (1970). Veldman, J.E. and Kuijpers, W.: Analysis of the immune response of lymph nodes to fresh and preserved homologous tympano-ossicular implants. The antigenicity of the tympano-ossicular bloc (manuscript in preparation). Veldman, J.E.; Kuijpers, W., and Overbosch, H.C.: Middle ear implantation: its place in the immunohistophysiology of lymphoid tissue. Clin. Otolar. (in press, 1978). Veldman, J.E. and Kuijpers, W.: The middle ear: an immunologically privileged site for tolerance induction in otologic tissue grafting? Proc. 3rd Int. Congr. of Immunology; in workshop: Deletion models of tolerance (Australian Academy of Science, in press, Sydney 1977).
Schwannoma of the Pharynx J.G. Van Hoorn ENT Specialist, Hoogeveen
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A patient is presented who showed, after removal of the tonsillae because of recurrent tonsillitis, a smooth tumor in the left parapharyngeal space. This was transorally removed. Pathologic diagnosis: schwannoma or neurilemoma. The attention is drawn to the fact that a tumor is suspected to be a neurilemoma if it is smooth with a rubberish sensation at palpation.
Society Transactions
348
On the neck an operation from outside is to be preferred, because a very big tumor can always be removed that way and perorally only small tumors can be operated. References Hiades, C.E.; Hock, H., and Gelman, H.: Neurilemoma of the pharynx. Laryngoscope 82: 430 (1972). Iwamura, S.; Suginra, S., and Nomura, J.: Schwannoma of the nasal cavity. Archs Otolar. 96: 176 (1972). Das Gupta, T.K.; Brafield, R.D.; Strong, S. \V., and Hajdu, S.I.: Benign solitary schwannomas (neurilemomas). Cancer 24: 355 (1969).
Detection and Guidance of Children with Hearing Impairment P. Schierbeek GGD Audiological Centre, Amsterdam An inquiry into the age at which the pupils of 11 schools for hard of hearing children were admitted shows that only V3 of them were admitted before the age of 4; half of the pupils have not been placed before the age of 6 years has been reached. The age of admittance in the period 1971-1977 has not become lower as compared to the period 1964-1970. Children with severe hearing losses (more than 50 dB FI in the best ear) were admitted earlier than those with a moderate loss. The inquiry will be extended to and completed for all schools for hard of hearing children (20) and institutes for the deaf (5) in the country. The expectation seems justified that the execution of the Ewing screening on a nation wide scale will advance the detection of hearing-impaired children. Measures leading to an exact diagnosis, home training and parent guidance must, however, immediately be taken after a severe hearing loss has become probable as a result of the screening tests. Only if this occurs without delay a proper guidance of hearing-impaired children will be the result. Up to the present the detection and guidance of children, probably to be admitted to a school for the hard of hearing, is neither speedy nor efficacious.
Prednisone in Idiopathic Facial Paralysis (Bell’s Palsy) P.P. Devriese ENT Department, University of Amsterdam, Amsterdam
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
ORL 39: 257-271 (1977).
Nederlandse Keel-Neus-Oorheelkundige Vereniging 145ste Vergadering te Utrecht, 28 en 29 oktober 1977
Dutch Oto-Rhino-Laryngological Society 145th Meeting, Utrecht, October 28 and 29, 1977 President
G. de Wit
Secretary
-
J. van der Borden
Some Physical Aspects of the Vestibular System A. Clemens University of Utrecht, Utrecht To get insight in the transfer of the saccular statolith system up to and including the primary afferents, the response on sinusoidal changing movements is studied. The direction al sensitivity of the hair cell affects this response. To avoid these spatial aspects, the stimulus has to be rectilinear in the macular plane, locally where the hair cells of the measured single unit are. A tilt table does not give a rectilinear stimulus and even a parallel swing cannot satisfy this condition. We used a cabin on a rail. The cabin was connected with springs on both sides; by this the stimulation was rectilinear and sinusoidal with a frequency adjustable between 0.04 and 3 Hz. One of the ways the overall transfer function can be interpreted is a combination of a slow (heavily damped) mechanical system and a proportional differenti ating processing in the remaining system before the primary afferents. This gives a ‘speeding up’ resulting in a total system with fast-reacting properties. The frog does not have a flat macular plane and the striola is not a straight line. These properties imply for the ensemble of primary afferents to possess information about magnitude and direction of the stimulating force as a time function. Reference Galle, H. and Clemens, A.: The sacculus of Rana esculenta; thesis, Utrecht University (1976).
Alternating Nystagmus W.J.A.C. Rademakers ENT Department, University of Amsterdam, Amsterdam
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Alternating nystagmus is a very rare condition. About 90 patients with this phenome non are reported in the literature. Only in 12 of these patients is the nystagmus of congeni-
Society Transactions
343
tal origin; in most cases a disorder in the central nervous system is the cause of the acquired type of alternating nystagmus and thus it is important to detect these cases. The literature gives only little information. As the characteristics of alternating nystagmus that are described in the literature are widely variable, our criterion for the diagnosis is ‘recording of a nystagmus changing its direction without any external influence’. In that way, alternating nystagmus was diagnosed in 20 patients; 15 patients fulfilled the criteria for the diagnosis ‘congenital nystagmus’ too. The following conclusions are made from the data of our 20 patients: (I) . The characteristics of alternating nystagmus as described in the literature are also found in our study. (II) . Concerning the differentiation between congenital and acquired alternating nystagmus: (A) The characteristics of the alternating nystagmus itself ate of very little help. (ft) Other nystagmographical findings are important for differentiation: (1) the find ings in cases with a congenital type of alternating nystagmus correspond exactly with the features of congenital nystagmus without spontaneous alternating; (2) the findings in cases with the acquired type of alternating nystagmus are clearly distinguished by: (a) a pure jerk form when recordings are made of the patient with the eyes open; (b) the absence of a nystagmus like the Bruns’ nystagmus; (c) the saccadic pattern of the curve at the pendulum swing test which is obviously different from the pattern found at the pendulum swing test in congenital nystagmus; (d) the optokinetic nystagmus is disturbed but inversion is never found; (e) the caloric responses are closely connected with the underlying disorder. (C) The other symptoms in alternating nystagmus are also of consequence: (1) Absence of complaints suggests congenital alternating nystagmus; (2) normal hearing or conductive hearing loss suggests a congenital alternating nystagmus; perceptive hearing loss at one or both ears suggests an acquired alternating nystagmus; (3) other neurological pathology than the nystagmus obviously supports the diagnosis ‘acquired alternating nystagmus’; (4) Radio pathology is usually found only in patients with acquired alternating nystagmus; in patients with congenital alternating nystagmus no radiopathology is found in relation to their nystagmus. Final conclusion: alternating nystagmus of congenital origin can be distinguished from acquired alternating nystagmus; not the widely varying characteristics of the alternating nystagmus itself but the other nystagmographical findings and other symptoms are of decisive value for the differentiation. Reference Rademakers, W.J.A.C.: Nystagmus alternans; thesis, Univeisity of Amsterdam (1977).
Clinical evidence points towards the fact that, in therapeutic laryngotracheal intuba tion (1, 2), impregnation of a silicone rubber tube with dimethylpolysiloxane oil leads to improved results (3). Laboratory experiments, performed with a ‘pin-on disc’ type tribometer (4), show that this is probably due to a friction-reducing effect of the silicone oil.
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Friction Measurements with Silicone Rubber Impregnated with Silicone Oil A. W.J. de Gee, R.N.P. Berkovits; C.F. Bos, and C. Kruithof TNO Delft, University of Rotterdam, Rotterdam
Society Transactions
344
References 1 2 3 4
Berkovits, R.N.P.: Therapeutische laryngo-tracheale intubatie; thesis, Erasmus Universi ty, Rotterdam (1971). Bos, C.E.; Berkovits, R.N.P., and Struben, W.H.: Wider application of prolonged naso tracheal intubation. J. Lar. Otol. 87: 263-280 (1973). Berkovits, R.N.P.: Personal communication (1977). Vaessen, G.H.G. and de Gee, A. W.J.: Interface of water vapour on the wear of lightly loaded contacts. Wear 18: 325-332 (1971).
At first a definition is given on the use of the word implantation. It is in common use to speak about (homoio-)transplantation. The material used was the patients’ own bone or cartilage for reconstruction of the bony meatal wall. For reconstruction of the middle ear system, tissue of human cadavers was used. As homoiotransplant material was used the fibrous meatal wall, the eardrum, the malleus, the incus and the stapes or parts of these tissues. As possibilities we see: (1) the reconstruction of radical cavities (the most important one in our view); (2) when, during an ear operation, an almost total destruction of the ossicular chain is seen, a reconstruction can be done at the same time; (3) the reconstruction of the eardrum when a total perforation is present; (4) the reconstruction of atresia ears. The results of the last 4 years at the Utrecht University Hospital are presented in table I. From the left to the right the columns represent: type of implant material used, total number of cases, radical cavities, conservative radical cavities (with an amount of mucous epithelium in the middle ear cavity), a dry ear found during operation, obstruction of mucous epithelium in the form of cholesterol granuloma in cysts, the number of cases with cholesteatoma, found during operation. The results summarize the anatomical situation of the drum postoperatively. + indicates intact drum; ± indicates microperforation and dry ear, and - indicates failure (wet ear, cholesteatoma, and so on). The posterior meatal wall is the next column with + for intact bony wall, covered with epithelium, - indicates partial extrusion of the wall, or a partially bare bony wall with a dry ear, and - indicates failure (sequestration, running ear, cholesteatoma, which makes a new radical cavity necessary, and so on). In the functional results we give the percentage which have a loss of less than 35 dB hearing loss for the frequencies 500, 1,000 and 2,000 Hz. Restriction: In this review of our cases it is not shown (though it was evident) that the initial difficulties caused failures that would possibly not have occurred if the most adequate postoperative care had been practised. The regularly changing of the sponges, beginning on the 4th postoperative day is absolutely necessary for the achieving of good results. Too much bleeding during the operation also caused failures. Conclusion: With the increment of the results we think we are on the right track with this type of surgery, but we suppose that there should be certain limitations in the indica tions for this type of surgery.
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Experiences in Microsurgery of the Middle Ear with the Help of Homograft Implants at the University Hospital of Utrecht, over Almost 4 Years A.J. Boezeman ENT Department, University of Utrecht, Utrecht
Society Transactions
345
Table / Type of implant
n
Rad. Cons. Dry rad.
Obstr. Wet
Choi. Results anatomy drum
function < 35 dB bony at 500, wall 1.000 and 2.000 Hz %
Bony wall + cuff, drum, malleus incus, stapes
41
27
14
31
6
3
8
24 + 9* 62
23 + 7± 92
Cuff, drum, malleus, incus, stapes
26
0
2
16
3
5
14
16 + 5± 5-
3-
+ 27 -6 6 7
+ 27 -7 0 3
Cuff, drum, malleus and incus
6
0
0
5
0
1
3
4+ 1± 1-
Cuff, drum and malleus
5
1
0
5
0
0
1
2+ 1± 1-
1-
+ 40 -2 0 20
7+ 2± 2-
1-
+ 46 -2 7 27
Cuff and drum
Drum
11
1
1
0
0
0
7
1
2
0
1
0
2
0
1+
+ 17 -8 3
+ 100
Flight Behavior of Birds in Weightlessness W.J. Oosterveld, A.J. Greven, A. Graybiel and J.L. Kupper MAMRL, Pensacola, Fla.
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
The flight behavior of pigeons was studied in the weightless phase of parabolic flight aboard a Boeing 707 of NASA. This plane provides zero g-periods of up to 30 sec. Experi ments were conducted on pigeons with different handicaps. The behaviour of the birds was observed by means of a movie camera. This behaviour was analysed later on in slow motion. Normal pigeons flew around in weightlessness avoiding collisions with the wall of the plane. Extensive head movements were seen. This can be explained by the assumption that the birds were ‘hunting for gravity’. When the claws were strapped and bound to the body either spread or together - the pigeons did not make any flying movement. Covering the eyes in these birds did not change this behaviour. So the information from the legs seems to
Society Transactions
346
be important in the initiation of flying movements. Pigeons with their eyes covered showed the ‘tumble phenomenon’, this means that they made somersaults backwards. This tumbling backwards is a reverse reaction on the illusion of tumbling forwards. Birds with both labyrinths destroyed made aimless flying movements, likely due to lack of vestibular in formation. Covering their eyes did not make any difference. Flying without labyrinthine function is not possible. Unilateral labyrinthless pigeons showed rotation around the length axis of the body in a direction towards the destroyed labyrinth. When the eyes were covered these movements increased in speed. The explanation of this phenomenon can be that there is a reverse reaction on a sensation caused by asymmetrical decrease of information, as the pigeons were already adapted to the condition that only one labyrinth provided information to the central nervous system.
Bell the CAT L. Feenstra ENT Department, Free University, Amsterdam More and more it becomes evident that the combined approach tympanoplasty (CAT) is not always a safe and satisfactory procedure. Nor is the radical mastoidectomy Bondy type the ideal solution for every cholesteatoma because of the resulting cavity. After a suggestion of Austin (1) we started 20 months ago the bone obliteration method which begins with a radical mastoidectomy Bondy type. The resulting cavity is obliterated with a Palva flap at the meatal side and with bone paste (2) at the cavity side. So far the results have been very satisfactory. References 1 2
Austin, D.F.: Personal communication. Feenstra, L. and Uges, D.: Archs Otolar. (to be published).
Middle Ear Implantation: an Immunologically Privileged Way of Tolerance Induction in Otologic Tissue Grafting? J.E. Veldman and IV. Kuijpers ENT Departments, University of Utrecht and Nijmegen
Downloaded by: Nagoya University 133.6.82.173 - 1/11/2019 4:05:40 PM
Serious hearing impairment as a consequence of chronic middle ear disease is still very common. During the past decade preserved allogenous tympanic membranes and tympanoossicular blocs have been employed to establish an optimal anatomical and physiological reconstruction of the sound-conducting mechanism. The success rate obtained with de vitalized implants can partly be attributed to the destruction of the autolytic enzymes by the preservation procedure (1). A very remarkable finding in this kind of tympanoplasty is the fact that no clear evidence of graft rejection has been reported in the literature. The lack of any reported immunological reaction in the implant has been suggested to be due to the middle ear being a privileged site or to a decrease or even total abolition of the antigens by the used preservatives (2). In those instances, where implantation fails it has been attributed to factors as an inadequate surgical procedure, secondary infection or recurrent disease, but not to an active immunological interference.
Society Transactions
347
The presence of antigenicity of these preserved grafts could be simply demonstrated in rabbits and rats by histological analyses of the draining lymph nodes, when implanted ectopically in a suitable vascularized bed such as exists in a subcutaneous pocket. Although any of the preservatives (alcohol 70%, formaldehyde, Cialit®) might have changed the tissues antigenicity, it definitely did not abolish it: both plasma cell and cellular immunity reactions are present in these nodes (3, 4). Experimentally it could be demonstrated that both an afferent and efferent limb of the immune response is intact in the middle ear complex. How is the nature of the exemption enjoyed by these otologic tissue grafts from immunological rejection then explained (5, 6)? (1) A lack of antigenicity is not the case. (2) Experimental evidence about an adequate ly functioning afferent and efferent immune loop does not make the hypothesis of the existence of a special privilege conferred upon the graft by virtue of the middle ear itself very solid. (3) ‘Adaptation’ of the graft within the recipient, the covering by an epithelial layer on the outside of the eardrum and with mucosal lining at the middle ear side, as has also been suggested in keratoplasty can hardly be an explanation for non-immunological interference of the host. (4) The only remaining explanation seems to be the occurrence of changes in the host which render it unable to respond to the donor histocompatibility antigens or, if sensitized, to reject them. According to this reasoning, the middle ear should be considered as an immunologically privileged site for tolerance induction in tympano ossicular implantation. This concept is discussed. References 1 2 3 4
5 6
Kuijpers, W. and Broek, P. van den: Biological considerations for the use of homograft tympanic membranes and ossicles. Acta oto-lar. 80: 283 (1975). Marquet, J.; Schepens, R., and Kuijpers, W.: Experience with tympanic transplants. Archs Otolar. 97: 58 (1973). Veldman, J.E.: Histophysiology and electron microscopy of the immune response; PhD thesis, Groningen (1970). Veldman, J.E. and Kuijpers, W.: Analysis of the immune response of lymph nodes to fresh and preserved homologous tympano-ossicular implants. The antigenicity of the tympano-ossicular bloc (manuscript in preparation). Veldman, J.E.; Kuijpers, W., and Overbosch, H.C.: Middle ear implantation: its place in the immunohistophysiology of lymphoid tissue. Clin. Otolar. (in press, 1978). Veldman, J.E. and Kuijpers, W.: The middle ear: an immunologically privileged site for tolerance induction in otologic tissue grafting? Proc. 3rd Int. Congr. of Immunology; in workshop: Deletion models of tolerance (Australian Academy of Science, in press, Sydney 1977).
Schwannoma of the Pharynx J.G. Van Hoorn ENT Specialist, Hoogeveen
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A patient is presented who showed, after removal of the tonsillae because of recurrent tonsillitis, a smooth tumor in the left parapharyngeal space. This was transorally removed. Pathologic diagnosis: schwannoma or neurilemoma. The attention is drawn to the fact that a tumor is suspected to be a neurilemoma if it is smooth with a rubberish sensation at palpation.
Society Transactions
348
On the neck an operation from outside is to be preferred, because a very big tumor can always be removed that way and perorally only small tumors can be operated. References Hiades, C.E.; Hock, H., and Gelman, H.: Neurilemoma of the pharynx. Laryngoscope 82: 430 (1972). Iwamura, S.; Suginra, S., and Nomura, J.: Schwannoma of the nasal cavity. Archs Otolar. 96: 176 (1972). Das Gupta, T.K.; Brafield, R.D.; Strong, S. \V., and Hajdu, S.I.: Benign solitary schwannomas (neurilemomas). Cancer 24: 355 (1969).
Detection and Guidance of Children with Hearing Impairment P. Schierbeek GGD Audiological Centre, Amsterdam An inquiry into the age at which the pupils of 11 schools for hard of hearing children were admitted shows that only V3 of them were admitted before the age of 4; half of the pupils have not been placed before the age of 6 years has been reached. The age of admittance in the period 1971-1977 has not become lower as compared to the period 1964-1970. Children with severe hearing losses (more than 50 dB FI in the best ear) were admitted earlier than those with a moderate loss. The inquiry will be extended to and completed for all schools for hard of hearing children (20) and institutes for the deaf (5) in the country. The expectation seems justified that the execution of the Ewing screening on a nation wide scale will advance the detection of hearing-impaired children. Measures leading to an exact diagnosis, home training and parent guidance must, however, immediately be taken after a severe hearing loss has become probable as a result of the screening tests. Only if this occurs without delay a proper guidance of hearing-impaired children will be the result. Up to the present the detection and guidance of children, probably to be admitted to a school for the hard of hearing, is neither speedy nor efficacious.
Prednisone in Idiopathic Facial Paralysis (Bell’s Palsy) P.P. Devriese ENT Department, University of Amsterdam, Amsterdam
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ORL 39: 257-271 (1977).
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