Tympanoplasty has been exercised these thirteen years and recently various techniques of this operation have been devised. In this report, the author reviewed those techniques and stated his opinions on them.
There are many problems of tympanoplasty. The perforation of the newly constructed ear drum is usually seen in 10-25% of all cases, and he recognized two types of perforation, the earlier and the later.
The mastoid cavity is usually covered with the grafted skin and sometimes the skin becomes erosive and some granulation tissue is seen in the cavity. He got the results that erosion and granulation were seen in less than 5% of 423 cases. The earlier changes in the mastoid cavity are caused by the inflammated mastoid bone, the ill mucous membrane, the survived cholesteatoma-matrix, and by the inflammation brought about by operation or the disorder of grafted skin. The later changes caused by local allergic reaction, mechanical or chemical irritation, bacterial or mycotic infection, and chronic irritation from the r rest of the mucous membrane.
Hearing-loss of high frequency tone is sometimes observed after operation. It may not only be ascribed to postoperative labyrinthitis, but also to the condition of the newly constructed ear drum.
In the cases having the normal ossicle chain, considerable improvement of hearing-loss is expected, but sometimes it is not in the cases which have columella effect, as is theoretically reasoned.
In the cases in which the ossicle chain is destroyed, we should reconstruct the chain. We have two ways of reconstructing the ossicle chain: one is to use the rest of it and the other some material. When we use the former, we must pay much attention to the ossicle connection lest it should be dislocated. As stapes surgery has progressed of late, the chain has come to be reconstructed with good results, using polyethylene tube, teflon, stainless steel wire.
To reconstruct the new ear drum, some tissue which has low metabolization must be selected.
There are three possible causes of postoperative cholesteatoma.
1) In the case in which the cholesteatoma-matrix remains.
2) In the case in which the epidermis is buried.
3) In the case in which cholesteatoma grows in the grafted skin.
We must take much care in treating cholesteatoma in consideration of these possibilities.
For the transplantable tissue, vein, fascia, periostium, peritoneum, pericardium, cornea are used. The author recommends the double-layer transplantation with skin and fascia. The mastoid cavity should be filled up with muscle, fat, connective tissue, bone, bone marrow, plastics, or the like. Recently osteoplasty, the method of filling the cavity with bone, is exercised, although a long time observation is needed to ascertain its curability.
To improve healing loss by operation, we should make more effort and discussions.

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There are many studies made about the effect of irradiation upon the organism, and the causal relationship between the irradiation dose as the action dose and the reaction of the organism to irradiation is the most important and basic problem. The author explained this relationship on the basis of the fundamental forms of dose-effect curve.
According to the conditions of irradiation, some proper unit is selected to express the action dose, but it should express the effective action dose which causes the reaction or express the radiation energy given to the tissue.
Some specific phenomena will be selected to express the grade of reaction, according to the aim of irradiation.
The form of relationship between the action and reaction doses is affected by the kind of organism and the type of reaction selected, and it is shown sometimes by the straight proportion curve and sometimes by the more complicated curve.
The radiation effect is affected by many factors, that is, the time from the irradiation to the observation of the reaction, the kind of organism, the circumstance of the organism, the method of irradiation. Therefore the author emphasized that we should estimate the reaction with rigid conditions, otherwise we could not properly evaluate the obtained dose effect curve.

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The author reported the results of the auditory fatigue test for the students who had been working for the instructive purpose in noise circumstances.
He tested the 280 ears of the boys, 15-18 years old, who had been working about three and a half hours a day in the noise of 60-100 db.
The catheterization test, the air and bone conduction test, the blocked bone conduction test and the simplified auditory fatigue test newly deviced by the author were employed.
In the auditory fatigue test, the stimulating tone (2 kc, 90 db) was given for 2 minutes to cause auditory fatigue whose recovery course was examined with the test tones of 2 kc and 3 kc respectively.
The number of boys who showed abnormal auditory fatigue through the test tone of 2 kc increased in accordance with the length of working time: 5.3% of the boys who had been working since 3 months before, 20.9% of those who had been working for 9 months, and 27.1% of those who had been working for 1-3 years. The number of the boys who showed abnormal auditory fatigue through the test tone of 3 kc increased in the same way 5.3%, 16.3% and 27.1% respectively.
It was concluded that when the youth of 15 -18 years worked in the noise of 60-100 db for 3.5 hours a day, the number of the boy who showed abnormal auditory fatigue increased by more than 10% after 10 month working and increased by more than 21% after 1-3 year working.

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Many kinds of treatment for vertigo have been reported, but complete cure of it is still difficult. We tried Theraptique which is known as the stimulant of respiratory centre, on the patients with vertigo, and recorded the changes of positional nystagmus with ENG.
Remarkable effect was observed in 6 out of 15 patients, comparative effect in other 6 and no effect at all in the rest.
We considered that the inhibitbry action of this drug upon nystagmus or dizziness was caused not only by the increases of blood flow in labyrinth but also by the central inhibition of nystagmus and some influence of autonomic nervous system.

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In two cases of chronic sinusitis, a thumb-sized concretion was noticed in the maxillary sinus.
The clinical feature and course of these cases were reported.
The main symptoms of the first case were muco-purulent nasal discharge and nasal obstruction, and of the second case nasal obstruction and tenderness on the buccal region.
X-ray examinations of these cases revealed a well-defined shadow in the affected maxillary sinus.
In each case the concretion was removed with a procedure of maxillotomy and the postoperative course was uneventful.
The chemical examination of these concretions revealed that one of these was mainly composed of calcium carbonate, and phosphorus, and the other of calcium carbonate and seconderycalcium phosphate.

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The authors reported a comparatively rare case of papillary cystadenoma lymphomatosum of the parotid gland (Warthin's tumor). The male patient, 72 years of age, had had a tumor in the right hypoauricular region since 3 years before and it enlarged gradually. The tumor was egg-sized, soft and not adherent to the skin. No facial palsy and no swelling of lymph nodes on the neck was recognized. Sialographical findings were normal.
By operation the tumor was easily removed. which had developed from the deeper lobe of the parotid gland and was encapsulated. The postoperative couse was uneventful.
Microscopically the tumor was consisted of the lymphoid tissue which had germinal centers, and its capsule was constructed of two or three layers and well-difined from the lymphoid tissue by the basal membrane.
Afterwords the author discussed, referring to the literature, the problem of its frequen-cy, site, histogenesis, treatment and prognosis.

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TTFD (thiamine tetrahydrofurfuryl disulfide) was applied to 21 cases of recurrent laryngeal nerve paralysis, 19 cases of so-called muscular paralysis of the larynx, 6 cases of phonasthenia, 21 cases of “abnormal sensation” of the larynx and 1 case of hysteric aphonia. Satisfactory results were obtained in 23 of 32 cases who were followed up.
An additional experiment was performed in order to discuss the effect of TTFD and TPD upon the vocal muscle in the rabbit. The vocal muscle (thyroarytenoid muscle) usually presents electrical activity in the expiratory phase of respiration at rest. Intravenous or intraarterial injection of TTFD or TPD caused marked increase in the expiratory electrical activity of the vocal muscle. This finding appears to have some relation to the clinical effect of TTFD, though the pharmacological mechanism of the effect of TTFD or TPD upon the vocal muscle is remained obscure

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Intralaryngeal injection of Betamethasone disodium phosphate (Rinderon) was done to control inflammatory processes of the larynx in nine cases with vocal cord nodule, acute or chronic laryngitis, or traumatic lesions of the larynx.
The effect of this treatment was evaluated photographically as well as symptomatically or by mirror examinations.
In seven out of nine cases, satisfactory effect was obtained in a short period of the treatment.

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The hearing of advanced age was discussed on its various spheres: the pure tone audiogram, the speech audiogram, its changes after the lapse of three or four years, and the relationship between hearing and general senile changes.
1: Audiometric tests were done about 123 patients of age greater than 50, who complained of their tinnitus or hearing impairment, and as the control 131 persons of the same age living in a certain area of Fukuoka City were examined (Fig. 1 and 2).
Pure tone audiograms were divided into 6 types according to the classification by Kawata (Fig. 3), and the number of patients of each type were compared with that of the control group of the same type in 5th, 6th and 7th decades respectively.
In all the decades, the respective number of patients of both A (normal) and C (abrupt) types were smaller than that of the control groups of the same types. And concerning B (horizontal) and D (descendent) types the contrary relationship was observed. Generally speaking, those belonging to A and C types decreased, and those belonging to B and D types increased with the advancement of age, in both groups (Fig. 4-6).
2. 39 out of 69 patients of age greater than 60 complained of tinnitus. This percentage was similar to that of the report by Kirikae (1957).
3. Speech audiograms were divided into 5 types according to the classification by Tateishi (Fig. 7).
III Type was most frequently observed and I Type was observed as often as V Type (Fig. 8). The most of the patients who were examined soon after they noticed their hearing impairment turned to belong to I Type, and those who had noticed their hearing impairment long before they were examined proved to be involved either in III or V Type.
4. Audiometric tests were done again about 28 patients after three or four years. The changes of hearing loss in these tests were classified into three groups as follows:
Group 1. The changes of hearing loss were observed only in the range of high frequency. That is to say, A Type changed to C Type, or hearing loss in the range of high frequency of C Type advanced (Fig. 13 and 14).
Group 2. The changes of hearing loss were remarkable in the range of low frequency. Hearing loss in the range of low frequency of C Type advanced, that is, C Type turned to D Type, or the delivity of D Type decreased,
Group 3. The changes of hearing loss were observed in all the range of frequency (Fig. 17 and 18).
About 40% of this series belonged to Group 1, about 40% belonged to Group 2 and about 20% belonged to Group 3. The patients belonging to Group 2 were not conscious of their hearing impairment in the first examination but conscious of it in the second (Fig. 15 and 16).
In speech audiograms, I Type changed to either III or V Type. Figs 19 -21 show the changes in audiograms of several patients. The change from I Type to III or VType indicates the quantitative and qualitative change of hearing.
Consequently the author concluded that the changes of hearing in advanced age must be estimated not only in quantity but also in quality.
5. In order to investigate the relationship between hearing and general senile change, audiometric test and calculation of senile change index were done about 113 persons of age greater than 40 who entered hospital for medical examination.
Senile change index was calculated by the external appearance of hair, eye, teeth, skin, etc., and by the function of mind, eye, heart, liver, kidney, etc. The audiograms were classified by age (Fig. 22), and by senile change index (Fig. 23) respectively. It was thought rather reasonable to classify hearing loss paying regard not only to age but also to the senile changes of other parts of the body.
The author divided presbycusis into three types: physiological, general and local presbycuses taking into consideration both age and senile change index.

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