第81回日本耳鼻咽喉科学会総会学術講演会パネルディスカッション耳鼻咽喉科日常診療の将来 耳鼻咽喉科日常診療二処置における視診とその問題点
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1. The problems of visual examination in ENT practice.<BR>The otolaryngological region consists mainly of deep narrow slits, canals, and cavities, though it is reached from outside of the body. On the other hand, the visual acuity of the surgeon for near vision becomes increasingly poorer with age. According to Ishihara, observation with the naked eye at distances less than 50cm, becomes fairly difficult for Japanese with normal vision. This means there is a need of somesort of magnification for observation in ENT practice for the majority of otolaryngologists.<BR>2. Present status of inspection in ENT local treatment.<BR>(1) Ear: For detailed observation and local treatment of the ear drum and middle ear, 6 to 16 times magnification is necessary. This problem is being solved by the introduction of binocular microscope, endoscope or monocular aural microscope. According to a recent survey, the coefficient of utlization of the binocular microscope is 53.8% in university doctors, and 12.5% in office practitioners in Japan.<BR>(2) Nose: The introduction of flexible fiberscopes enabled detailed observation of otherwise inaccessible structures. This is most helpful for local treatment as well as diagnosis in these regions. The utlization of this instrument still seems to be low in office practice.<BR>(3) Nasopharynx: Flexible or rigid type endoscopes can be effectively employed for observation and local treatment.<BR>(4) Larynx and hypopharynx: Observation of these areas has been made easier by the introduction of the pernasal flexible fiberscope and peroral rigid type endoscope. The utilization of laryngeal endoscopes for practice was 72.3% in university hospitals and 35.1% in office practice.<BR>(5) Therapeutic endoscopes: It is considered that development of therapeutic endoscopes will make it possible to enlarge the limits of ENT local treatment in biopsy, removal of pathological tissue, administration of therapeutic agents to target cavities,. and injection. However, these instruments still leave room for further improvement.<BR>3. Conclusion<BR>The present status and problems of inspective measures with regard to ENT local treatment is surveyed. For safe, reliable and easy local treatment promoting the advancement of medicine, the introduction of magnification, and endoscope is considered to be indispensable to improving present status of ENT local treatment. However, further effort is necessary to match these measures to every type of current ENT practice, and more improvement of inspection methods is advisable.
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