Application of the combined surgery, radiotherapy, and regional chemotherapy has made it possible to treat carcinomas of the nose and the paranasal sinuses without leaving any awkward defect in the face, and yet preserving the normal function. Thus, total resection of the maxilla has not been required even in advanced cases, since August, 1965. Besides, by this therapy the rate of local recurrences has been reduced and consequently, five year survival rate has been improved to more than 50 per cent.
At the sametime, however, the incidences of visual disturbances or bone necrosis increased gradually in the subsequent course. Before June, 1968, the patients were iufused with 5-Fluorouracil (5-FU) alone as a radiosensitizer. In this group, mean-total dosage of irradiation was 6000 rads. The incidences of complications were high in cases which were irradiated more than 7000 rads and infused more than 10 times. Since July, 1968, we added Bromodeoxyuridine (BUdR) to 5-FU. In the latter group, the average total dosage of irradiation and infusion decreased to 3000 rads and less than 10 times respectively, nevertheless, the rate of local recurrences also decreased and cosequently the number of patients who rehabilitated increased.

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The purpose of this subject is to demonstrate how allergic methods of diagnosis and treatment are incorporated into our otolaryngologic practice. The keystone to proper management of nasal allergy is identifying the causes. This calls for the use of the methods of etiologic diagnosis such as allergic history, cytologic examination, skin test and provocation test.
The cytologic examination of nasal secretions is essential in every case of rhinorrhea in order to determine the presence of allergy. As a quick method of staining nasal smears, I have introduced the one-minute technic using Hansel stain which is now available in Japan. A predominance of eosinophils in nasal smear is diagnostic of nasal allergy. Skin testing for allergy survey is a great aid in the evaluation and managment of nasal allergy. Scratch and intradermal tests are routine in our practice. For the purpose of detecting causative allergens, I have usually used extracts of inhalants such as house dust, pollens, molds and animal danders. Scratch test is technically easier to perform and many allergens may by examined at one time, while intradermal test is more useful for determining the starting point of hyposensitization.
The routine performance of the provocation test is a valuable help in ascertaining the actual allergen. Instead of using the traditional nasal or sniff test, I have performed the provocation test by placing the diagnostic allergen disk (supplied by Torii and Co., Tokyo) on the anterior end of the inferior turbinate. Specific hyposensitization therapy is the best indication when the offending allergen is ascertained. In our practice this therapy is confined to treatment of house dust, pollen and mold allergies.
When the offending allergen is not ascertained, nonspecific treatment is indicated. Since the appearance of effectiveness of both specific and nonspecific therapies is gradual, the symptomatic treatments with drugs such as antihistamines, minor tranquilizers and steroids are indicated. Steroids, however, should be used when the patient is not responding to other forms of treatment. Because of adverse effects, local use is desirable.
When the patients are properly indicated, surgical treatments such as conchotomy, polypectomy and septal operation are of benefit to relieve nasal obstruction. In our practice the local treatment for nasopharyngitis coexisting with nasal allergy in almost all the patients is the routine procedure of the management of nasal allergy. The tip on the management of nasal allergy is to design a good combination of the method of treatments according to etiologic factors and symptoms.

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An observation of cerumen by micropolariscope revealed cholesterol crystals in 66% of normal individuals. Therefore, in the diagnosis of cholesteatoma caused by otitis media, pus existing in the tympanic cavity which contains no cerumen should be tested for cholesterol crystals.

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In order to obtain some informations on the pathogenesis of Meniere's disease, the hypotonic solution (Aqua distillata) of 1.0 or 2.0 was injected into the scala tympani or scala vestibuli at the basal turn of guinea pigs and changes of cochlear microphonics were recorded at the basal turn and third turn simultaneously with the differential electrodes technique.
1. When the hypotonic solution was injected into either scala tympani or scala vestibuli at the basal turn, cochlear microphonics was affected only at the basal turn and there was no visible effect on cochlear microphonics at the third turn. This result seems to support the radial flow theory of the inner ear fluids.
2. As for the modification patterns of cochlear microphonics at the basal turn, there was a qualitative difference between the injection into the scala tympani and the injection into the scala vestibuli. When the hypotonic solution was injected into the scala tympani, cochlear microphonics, following a rapid decrease and recovery, showed a slow decrease and recovery. On the other hand by the injection into the scala vestibuli, cochlear microphonics showed only a slow decrease without recovery. From these results, it is presumed that the basilar membrane is easily permeable compared with the Reissner's membrane and then the production and absorption of perilymph are more active in the scala tympani than in the scala vestibuli.
3. The effects of the hypotonic solution on cochlear microphonics are quantitatively identical with the effects of the hypertonic solution injected into the perilymphatic spaces in spite of the inference that the hydrops of the cochlear duct should be induced by the injection of the hypotonic solution and the collapse of the cochlear duct by the hypertonic solution.
From the results obtained, it is presumed that changes of cochlear microphonics were caused by some direct osmotic effect of the hypertonic or hypotonic solution on the Corti's organ.

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The experiments which are reported here add new data through a study of the electrical response of regenerating canine laryngeal nerves. Evaluation was carried out by stimulating recurrent nerves surgically sutured after dissection. Action potentials elicited from laryngeal muscles innervated by regenerating recurrent nerves were studied at intervals up to 45 weeks following the primary suture. These data permit determining the correlation between electrophysiological findings and histological data obtained from some nerve specimens.
In summary, the items presented are: (1) During the early stage of regeneration process, fibrillation potentials of relatively low voltage were demonstrated.(2) In more advanced stages, electromyographic analysis showed mixed patterns of normal and abnormal interference patterns. However, no evoked potential was demonstrated.(3) After 24 weeks, electromyographic analysis showed a normal interference pattern. Evoked potentials revealed prolonged latency and a characteristic pattern.(4) After 45 weeks, evoked potentials revealed normal latency and relatively simple, diphasic or triphasic defletions. However, the amplitude of the evoked potentials was of low voltage.(5) Histologically, the regenerated nerve fibers were less in number and there was considerable development of fibrous tissue.(6) Even in cases of complete recovery on the electromyographic findings, vocal cord motion often differed from the normal behavior.

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Seit 1963 bis 1965 wurden 50 Fälle des Kehlkopfpolypen in der Hals-, Nasen-Ohrenklinik der Universität Kagoshima behandelt. Unter diesen 50 Fällen waren 41 Männer and 9 Frauen. In der Gruppe der Männer gab es 34 Raucher, in der Gruppe der Frauen 2. Also ist die Gesamtzahl der Raucher 36. Die Polypen, die histologisch die auffallende Tendenz der Fibrose zeigten, wurden nur in der Gruppe der Raucher festgestellt. Die durch das Rauchen verursachte chronische Entzündung der Stimmbänder scheint die Fibrose des Polypen zu fördern, in manchen Fällen sogar zu verursachen. Wenn auch das Rauchen nicht die einzige Ursache des Polypen ist, so wird die Entstehung desselben durch das Rauchen sehr beeinfluBt.

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Five cases of benign tumors arising from the septal mucosa were reported. These include benign salivary-gland-type mixed tumor and pyogenic granuloma. All but one arose from the Little's area. Reviews of the references concerning benign tumors of the nasal septum were done. Possible traumatic origin of pyogenic granuloma was discussed. Similar process to that of vocal nodules was suggested. Resection of the tumors including perichondrium and septal mucosa was suggested as the best choice of surgical methods.

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The authors reported a case of facial paralysis associated with hypertension. The patient was 12 years old female who presented with a right facial nerve paralysis and complained disturbance of vision. Her blood pressure was 216/138 mmHg. A pediatrist diagnosed her as hypertension associated with nephritis. Ophthalmologic diagnosis was neuroretinopathia angiospastica. The findings were spasm of the retinal artery, papilloedema and bleeding in the retina. She was admitted to our clinic for investigation of facial nerve paralysis. According to our investigation the facial nerve of this patient was affected at the level of the infrachordal part of the facial canal. We assumed that the pressure induced by bleeding in the facial canal pressed the nerve and the paralysis occurred. The bleeding was suspected as a similar phenomenon to bleeding in the retina.

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[in Japanese]

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The paper presents some aspects in logopedics and phoniatrics which appears to be of the greatest clinical interest for otolaryngologists in the recent few years. The description is based upon 504 publications contributed by members of the Japan Society of Logopedics and Phoniatrics.
1. Delayed development of speech. Whenever one sees a child with speech delayed, he should keep, at least, the following possible causes in his mind: mental retardation, hearing impairment, motor disturbances of the speech organs such as cerebral palsy, brain injuries which may cause developmental aphasia, emotional disturbances, general weakness, and unfavorable speech environment.
2. Cleft palate speech. Many clinicians agree that the age appropriate to the first surgery is from one to two years after the birth because of better speech results in cases operated in this period than cases first operated after two years of age. Surgery at the age less than one year seems to be a subject to further discussion. For cases which have received surgery, various functional tests of nasopharyngeal competency have been proposed: auditory judgement of nasality, inspection, blowing tests, examination of nasal leakage of foods, X-ray investigation, aerodynamic tests, acoustical tests, electromyography, and so on.
3. Voice tests. In order to evaluate the vocal function objectively, the Committee for Clinical Examination of Voice Disorders has proposed several test items for clinical use: maximum phonation time, phonation quotient (vital capacity/maximum phonation time), classification of hoarse voice, vocal range, and speech level. Typical findings in these tests for various voice disorders are presented.

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A peripheral vasodilator (Duvadilan) and tranquilizer (Trancopal) were administered orally to 37 cases of inner ear diseases including perceptive deafness, Meniere's disease, tinnitus, sudden deafness and Bell's palsy. The treatment appeared to be effective in 14 cases (38%), particulary in acute peripheral circulatory disturbances. On the other hand, it was effective only in 4 of 21 cases of perceptive deafness and tinnitus.

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