The following article is a summary of the more important recommendations contained in a recent article published in the Trans. Am. Acad. Opthalmol. and Otolaryngol. The article also is published as a “Guide for the Classification and Evaluation of Hearing Handicap”, prepared under the direction of the Committee on Conservation of Hearing. Copies of this Guide may be obtained by writing to Dr. Hallowell Davis. Central Institute for the Deaf, 818 South Euclid Ave., St. Louis, Mo., 63110, U. S. A.
Hearing impairment may be caused by habitual exposure to loud noise in some industrial situations and it may also be caused by sudden accidents. In such situations the otologist may be called upon to estimate the “percent impairment of hearing” in order to establish the proper payment of workmen's compensation or insurance. The following rules and procedures have been recommended by the Committee on Conservation of hearing and are now quite widely accepted.

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On the relationship between the autonomic nervous system and the inner ear, a considerable amount of researches with electrophysiological and histological techniques have been reported. But, there has been found no definite correlation between the sympaticomimetic and parasympaticomimetic drugs and those effects. The author presumed that the autonomic reactivity might be different in each experimented animal. As for the inner ear itself, the effects of autonomic nervous system acts on it so irregularily that the further investigations on this problem seemed to be necessary.
Taking into consideration the well known fact that the stimulation of the hypothalamus anterior and hypothalamus posterior increases temporarily the excitability of the parasympathetic and sympathetic centers, the author tried to cause some autonomic unbalance in the inner ear. In this study, the influences of electrostimulation of the hypothalamus and the reticular formation upon the cerebral and cochlear micro blood circulation were observed and the changes in the cochlear microphonics from the bilateral ears by the stimulation were also observed. Cats were immobilized with decamethonium bromide (C-10), and no anesthesia was used.
Blood pressure of femoral artery was recorded by means of a straingauge and penwriting-osci llograph.
The microcirculations in the temporal and frontal lobes and in the inner ear were recorded continuously by impedance plethysmographies, each of which had a pair of electrodes (0.1mm insulated steel wires, 1.5mm apart from each other). This method is based on the principle that the changes of blood volume in a given part cause the changes of electrical impedance in the same portion (Literature 84, 118).
To cause electrical stimulation, bipolar stainless steel electrodes, 0.7mm in diameter were implanted stereotaxically in the anterior hypothalamus, the posterior hypothalamus, and the reticular formation.
As the indicator of excitability in the hypothalamus, the pupille reflex, the nictitate membrane reflex and the changes of blood pressure were tested, and in view of those results the adequate parameter of stimulation on the animal was decided to be approximately of 3-5 voltage, 0.3 msec pulse duration, 60-80 pulses/sec during 5-10 secs at the hypothalamus, and approximately of 3-5 volts, 0.03 msec pulse duration, 300 pulses/sec during 5-10 secs at the reticular formation (Table 1).
1) The changes of contraction rate in the nictitate membrane, of heart contraction rate and of femoral blood pressure resulting from various parameters of electric stimulation are shown in Fig. 2a, 2b and 2c. The electrostimulation of hypothalamus posterior caused an irregular and fluctuating excitability of the sympathetic center repeatedly.
2) The changes of temporal blood flow resulting from hypothalamic stimulation were compared with the results from 10% CO2 inhalation. The changes of the latter were more conspicuous than the former (Fig. 1).
3) The effects of electrostimulation of the reticular formation, the hypothalamus anterior, and the hypothalamus posterior on the blood flow in the temporal and the frontal lobes are shown in Fig. 3, 4 and 5. The stimulation of the hypothalamus anterior (parasympathetic area) was followed by no demonstrable change in the frontal and temporal blood circulation nor in the blood pressure (Fig. 3). After the stimulation of the hypothalamus posterior (sympathetic area), the blood pressure rose several times 50-80 mmHg higher than usual during about 10 minutes before it became normalized. The blood flow in the frontal lobe was more stable than in the temporal lobe, but both of them corresponded to the change of blood pressure (Fig. 3, 4, 5).
4) The changes of cerebral blood flow in the frontal and the temporal lobes after a 10 γ noradrenaline intravenous injection were similar in the pattern of blood pressure to those of the hypothalamic stimulation (Fig. 4, 7).

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Caloric tests were made upon 335 patients of Ménièe's disease to evaluate the labyrinthine disorder according to Hallpike's method. The magnitude of the reactions was mainly taken as the nystagmic duration. The measurement had been performed under the dim and silent room not using any glasses and ENG.
The results obtained were as follows:
1) Over 10% of the sum of the total nystagmic duration had a much significance in the decision of canal paresis (CP) or directional preponderance (DP).
2) The direction of caloric nystagmus in DP cases was not favour always toward the uneffected side.
3) Positional nystagmus in the CP cases had a tendency to have the direction toward the opposite side in evoking nystagmus, while in DP cases and combined type cases (CP plus DP) toward the same side direction to DP side.
4) The degree of DP, which was contained within CP cases, was also shown in co-ordinates comparing these two components. In this way the location of the lesion in the vestibule could be demonstrated schematically in each clinical course.

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The authors reported here on two rare cases of angioleiomyoma and leiomyosarcoma occurring in the nasal cavity.
Case 1: A woman of forty-nine years old had complained of the pain in the left cheek for six years. A mass about 1.8×1.2×1.3cm large was seen on the left nasal vestibulium. The tumor was removed operatively and no recurrence was seen after the operation.
Histological examination revealed that the tumor was angioleiomyoma.
Case 2: A woman of fifty-three years old had complained of progressive nasal obstruction for six months. A tumor filled the right nasal cavity and the epipharynx at the time of admission to the hospital. It was exstirpated, and after that it proved to be leiomyosarcoma histologically. Radiation therapy was tried and the course after the treatment was even and neither recurrence nor metastasis was seen one year after the operation.

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There are many kinds of benign tumors occurring in the nasal and paranasal cavities, but adenoma (adenoma simplex) is rarer than is expected. The author reported here on a case of a woman, fifty-five years of age, who was suffering from dull pain of the right cheek, nasal obstruction and nasal discharge mixed with blood three years after the maxillary sinectomy.
Histological examination revealed adenoma simplex, and the patient had the Denker's operation and Ra.-irradiation. She has had no evidence of recurrence for five years after the treatment.

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Papilloma developing in the nasal cavity and the accessory nasal cavity was found and reported for the first time by Dr. Billoth (1855). In Japan, Dr. Akamatsu (1908) was the first scholar who made a report on it.
This particular disease has been a target of intense interest among the scholars because of the histopathological nature of the epithelium of tumor, and the circumstances, yet unclarified, of the development of a tumor having a cornified epithelium at the place which ought to have a columnar epithelium.
The author reported on a rare case of papilloma of the right maxillary sinus, which was found in a man aged 20. The diagnosis was confirmed by histo-pathological examinations of the exstirpated tissue.
This disease is grown in the sinus and remains there, without invading other organs-adjacent to the maxillary sinus.
In Japan, only 3 cases of this kind, including the present one, have so far been reported. This fact indicates that it is an occurrence extremely rare in this country.

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A 14 years old boy who had suffered from nasal obstruction was by chance noticed as a case of silent type acatalasemia, in process of conchotomy. Investigation into his family tree revealed that his parents were in cousinhood, one of his two brothers had acatalasemia, and his father had hypocatalasemia (Table 3).
Hereditary dispositions were strongly suspicious in these cases.
Although the healing process after the operation was normal, the author considered it necessary to apply some antibiotics.
Two cases of the silent type acatalasemia from a family tree is reported here because of the rarity of the type.

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The authors applied “Lysozym”, a sort of Mucopolysaccharase, to tonsillectomy, in which 50 mg of this drug was injected mixed with a local anesthetic. The efficacy was evaluated by the postoperative findings of the side to which Lysozym was applied, compared with those of the opposite side to which it was not done.
1) The redness of the Lysozym-applied side was slighter than that of the opposite side.
2) Postoperative edema was observed only on the opposite side.
3) Postoperative pain was more intense in 7 cases on the Lysozym-applied side, and in 17 cases on the opposite side.
4) White membrane was observed on the wound at the time of leaving hospital in 13 cases. Among them it was thicker on the Lysozym-applied side in 12 cases.
5) Out of the 25 cases which complained of the pain at swallowing when they left hospital, 18 cases complained of more intense pain on the opposite side. In general, postoperative redness, edema and pain were slighter on the Lysozymapplied side than on the opposite side, and the efficacy of Lysozym was 70 percent.

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The authors referred to the status and treatment of patients who consulted the authors' clinic about the complaint of paresthesia on their throat. The etiology of the paresthesia is plural. A certain local organic diseases, and the unbalance of autonomic nerve which comes from the abnormal inner secretion and metabolism caused by psychogenic factors result in the paresthesia. The most frequent disease among organic ones is the inflammation of the naso-pharyngo-laryngeal area, and this can be treated with a liniment, a nebulizer, some antibiotics, and operation. The secondly frequent disease is a group of tumors such as laryngeal polyp, epiglottic cyst, keratosis, carcinoma. The third is the partial paresis of the larynx, which can be treated with a nebulizer, ATP, Vitamin B₁, B₁₂, antibioitcs, etc. As other causal diseases of the paresthesia, the abnormality of epiglottis, anemia, hypertension, parasites have been noted in literature. So otorhinolaryngological examination, X-ray examination, endoscopy, examinations of blood pressure, blood, parasites, heart and lungs, and of the function of autonomic nerve are needed for the diagnosis of the patients who complain of the paresthesia of their throat. Diagnosis as “neurosis” is made in case any organic disease does not exist or in case the paresthesia does not disappear after the suitable treatment of the organic disease. The paresthesia must be treated in three ways o local treatment, psychotropic medicine and psychotherapy.

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The patient, a 75 years old house wife, was suddenly attacked by profuse discharge of mucoid salivation, difficulty in swallowing, hoarseness, cough and shortness of breath, soon after she had gone out in the cold weather.
Local examination revealed as light hyperemia and swelling in the right side of the epiglottis. Hyperemia and swelling were also observed in the area of the cartilago arytaenoidea, and they were more remarkable on the right side. Both vocal cords showed a slight hyperemia, and the movement of the right side vocal cord was limited, staying in the adduction position. Ankylosis of the crico-arytaenoid joint was observed. Neither abscess nor suppuration was seen.
In her career, she had had lumbago and the pain in the left thigh of 8 months duration about 4 years before. She had suffered from the left intercostal pain for two years and was diagnosed as having rheumatic pain.
The patient was treated with nebulization of corticosteroids, injection and administration of antibiotics, antirheumatic drugs, antihistamic drugs, vitamine B₁ condroitin sulfate, and was cured of those symptomes in two months.

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The author reported here on three cases of tuberculosis of oral cavity, pharynx and larynx, which were very similar to malignant tumors clinically.
Case 1. A farmer's wife, forty-two years old, whose complaints were nasal bleeding and tumor on the mucous membrane of the left cheek. She had suffered from toothache for one year and had an extraction of that tooth twice. We suspected it to be tuberculosis of gingiva.
Case 2. A woman, thirty-one years old, who complained of swelling on the right submandibular region. She had some treatment for syphilitic pharyngitis, because the serologic test for syphilis was positive. First of all we suspected it to be sarcoma of pharynx, and she was treated with ⁶⁰Co-irradiation and extirpation of the tumor. Afterwards, it proved to be the tuberculosis of the pharynx by histological re-examination.
Case 3. A farmer's wife, forty-seven years old, whose complaint was hoarseness. Two years before she had suffered from cold and her voice became hoarse after that. The authors found that there was tumorous swelling on the right vocal cord. It was suspected to be a malignant tumor and irradiated with 60Co. Afterwards the histological examination revealed it to be tuberculosis.
The authors stress that in diagnosis of any disease tuberculosis must be always kept in mind.

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