The aspiration is classified into three types based on its X-ray investigation. The first type of aspiration occurs during the beginning of deglutition because of the insufficient elevation of the larynx. This type is named the aspiration in the ascending stage of the larynx. The second type occurs after the end of deglutition, since the whole amount of food does not pass through the upper junction of the esophagus. This type is called the aspiration in the descending stage of the larynx. The third type occurs in both stages.
The cricopharyngeal myotomy has usually been employed for aspiration in the descending stage of the larynx; however, the satisfactory effect has not always been obtained only by this surgery, and no surgical technique for aspiration in the ascending stage of the larynx has been established.
The authors deviced two new surgical techniques for each type of aspiration. One of them is “thyrohyoidpexia”. This technique is indicated to the aspiration in the ascending stage of the larynx during deglutition. Its surgical fundamental is to set the epiglottis in the retroflexed position by suture of the thyroid cartilage to the hyoid bone. The upper third of the thyroid cartilage may occasionally be removed. Since the level of the hyoid bone is apt to descend and the tip of the epiglottis is located to the upright position after this surgery, the retrotraction technique of the tongue, the division of both inferior thyroid veins and the sternothyroid myotomy are recommended simultaneously to be done.
Another technique is “lateral thyrolaminectomy” which is indicated to the aspiration in the descending stage of the larynx. The principle of this technique is to diminish the piriform sinus on the diseased side and make the food pass through the piriform sinus on the healthy side by removal of the lateral thyroid ala. Lateral thyrolaminectomy combined with cricopharyngeal myotomy is most effective for aspiration in the descending stage of the larynx.

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Introduction
A survey, by questioning, of dates of occurrence of attack in multitudes of patients with MÉNIÈRE's disease revealed that there were days on which vertiginous attack occurred in none of the patients, while, on the other hand, there also were those days on which 4 to 8 patients developed an attack (Figs. 1 and 4).
The reason for such a concentration of attack on particular days may possibly be explained: (1) as a mere chance phenomenon,(2) by life custom related to holidays or days of the week or (3) by some meteorological factors.
The objective of the present study was to test the validity of these hypotheses.
Material and Methods
From a series of patients with MÉNIÈRE's disease who were seen at the Neuro-otologic Clinic of Hamanomachi Hospital with a vertiginous attack of recent onset or its recurrence, those who could clearly define the date and time of the day of occurrence of attack and who provided objective evidence of attack (i. e. nystagmus) in pertinent tests done immediately after the attack were chosen for the study. In each patient the date of occurrence of each attack was recorded. The study covered a 5-year period from July 1, 1974 to June 30, 1979 (1826 days), during which time a total of 1654 attacks were recorded.
Rejection of the chance phenomenon theory and the day-of-the-week theory
A study of the monthly distribution of attacks that occurred during the 5-year period showed that the attack was of particularly frequent occurrence from January through April while relatively less frequent from May through December. This distinct seasonal variation suggests that the occurrence of the attack is not fortuitous but subject to some factors.
Next, the hypothesis that life custom related to holidays and ordinary days plays a role in the occurrence of attack of MÉNIÈRE's disease was examined for its legitimacy. A study of the distribution of entire attacks in holidays and nonholidays revealed that there was no striking difference between holidays and nonholidays in the frequency of occurrence of attack, indicating that factors relating to holidays and nonholidays have no bearing upon the attack.
Influence of atmospheric phenomena
Another hypothesis that changes in meteorological conditions are concerned with the occurrence of attack of MÉNIÈRE's disease was also tested for its validity.
Those days on which 4 or more patients developed an attack (during a period from July 1974 through June 1978) or 5 or more patients did so (from July 1978 through June 1979)* were arbitrarily taken as days of frequent occurrence of attack (*the condition was set more rigorous because the frequency of attack during this last year was much higher than in the preceding 4 years). There were 33 days of frequent occurrence of attack during the 5-year period studied (Fig. 5).
An investigation of the distribution of atmospheric pressure disclosed that the distribution pattern of atmospheric pressure prevailing on these 33 days was one of the following 4 types: (1) winter monsoon pattern (5 days),(2) migratory high pattern (19 days),(3) pattern of migratory high passing northerly latitude (7 days) and (9) western edge of pacific high (2 days).
In winter the winter monsoon pattern and migratory high pattern were prevalent, while in spring the migratory high pattern and the pattern of migratory high passing northerly latitude were predominant. Most of days of frequent occurrence of attack occurred in these two seasons. In summer, on the other hand, the western edge of pacific high pattern was prevalent and there were a few days of frequent occurrence of attack. There were no days of frequent occurrence of attack in autumn.

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Six patients with cranial polyneuropathies due to invasion of nasopharyngeal malignant tumors were reported.
The first patient showed Pseudo-GRADENIGO's syndrome with involvement of left V th and VI th nerve by invasion of anaplastic carcinoma of the nasopharynx.
The second and third patients with nasopharyngeal carcinoma showed Collet-Sicard's syndrome due to left cranial neuropathies of IX, X, XI, XII.
In the 4 th case, the combined syndromes composed from Pseudo-Gradenigo's syndrome and Collet-Sicard's syndrome were observed.
In the 5 th case, who had very curious symptoms of cranial nerves, V, VI, VII in both sides and IX in right side, it was revealed that such neuropathy depended on the cerebrovascular diseases from the findings of autopsy.
The 6 th patient with malignant mesenchymal tumor of nasopharynx suffered in the superior orbital fissure syndrome with involvement of left cranial nerves II, III, IV, V, VI.
On the clinical results of these cases, the relationship between the cranial neuropathy and nasopharyngeal malignancy were discussed in view of neuroanatomy.

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The stepping test (Fukuda, 1943) faithfully reflects the existing status of the vestibulospinal reflex and is one of the most reliable vestibular function tests. To our knowledge, however, no attempts have ever been made to investigate the results of the test in individuals having disordered lower extremities.
During the past 1 year we experienced 8 cases of vertigo with claudication due to a disorder of lower extrimities. In an attempt to make an otologic check-up of the vertigo the stepping test, along with nystagmus and past pointing tests, was performed repeatedly on these patients. The results indicated that the time course of the results of these tests was virtually the same in these patients as in patients with vertigo in general.
Otologic conditions in these 8 cases were MÉNIÈRE's disease in 7 and sudden deafness in 1. Defects of lower extremities were a shortening of one extremity in 4 cases, i. e., amputaton of one extremity with the use of a prosthesis in 2 cases and a shortening of the lower leg resulting from its fracture and of one extremity due to long-standing gonarthritis in one case ach.
In 3 caes limping was due to pain arising from gonarthritis, fracture of the 5 th toe or sprain of the ankle.
The remaining one case was of a slight degree of hemiplegia as a sequela to stroke.
In all these cases the angle of rotation in the stepping test became widened when inner ear manifestations were present and reduced to 0° as the disease of the inner ear subsided even in the presence of claudication.
These observations permit us to conclude that the angle of rotation in the stepping test is an indication of abnormality of vestibulospinal reflex and also that a disorder of the lower extremity is unlikely to cause the test to convert to positive.

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A 22 year old male with extremely large left middle ear cholesteatoma was reported. He consulted our clinic because of the swelling of left zygomatic arch portion, in which the soft subcutaneous mass (4×6cm) was palpable. Roentogenogram revealed two large sinuses, one in the mastoid and the other in the temporal fossa, which should be due to the destruction of the temporal bone by cholesteatoma. It was expected that the dura was widely exposed to the sinus in the mastoid.
The matrix membrane of the sinus in the temporal fossa was removed. The sinus was completely filled with healthy granulation three months later. The matrix membrane of the sinus in the mastoid was remained. The sinus was widely opened to the external auditory meatus and also to the retroauricular portion. The matrix membrane has become dry and appeared to be normal skin.

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A 33-year-old woman doctor developed swelling of right cervical lymph nodes on September 19, 1979 following common cold. The swelling was associated with slight pain and fever. She was first examined on Septemer 26. Immediate diagnosis was not available. She was put under careful observations and repeated laboratory tests were made. The swelling of the lymph nodes gradually increased in size and number, involving an inguinal node. She also developed erythema on the elbows and knees. Laboratory tests revealed an increase in BSR, leucocytopenia, an increase in GOT, GPT and LDH values, and an increase in antibody titer for EB virus and simple herpes virus.
On October 19, biopsy of a cervical node was made. The result showed that the lesion was necrotizing lymphadenitis. Steroid was dramatically effective.

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The responses of auditory neurons in the inferior colliculus of the rabbit were obtained in response to mixed tone, which consisted of 3 tones. The 1st group; f₁ was 300Hz, f₂ was 1000Hz and f₃ was 2300Hz. The 2nd group; f₄ was 800Hz, f₅ was 1100Hz and f₆ was 2400Hz. The responses to pure tone stimulus and mixed tone stimulus were compared. The results showed that temporal distribution of spike discharges of the inferior colliculus neuron to mixed tone stimulus were different from simple summation of pure tone responses. The changes of the response pattern (PST histgram) were obtained in some specific neurons and the simple changes of spike rate were observed in some neurons. Accoding to the results we concluded that the change of the response could be based on the neural mechanism of the auditory system in the brainstem and were different from the audiotory adaptation and/or two-tone suppuression mechanism.

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The middle and inferior pharyngeal constrictor muscles which are composed of the hyopharyngeal, thyropharyngeal and the cricopharyngeal muscle directly act and convey the bolus from the pharynx to the cervical esophagus. These muscles spread over the midposterior of the thyroid and cricoid cartilage like belts, and act like peristaltic movement of the visceral smooth muscle.
Histochemical and physiological studies were done used the canine cricopharyngeal muscle just after sacrifice.
Histochemical study;
The fresh muscle were frozen and sectioned by cryostat The specimens were then stained by myofibrillar adenosine triphosphatase, phosphorylase, reduced nicotinamide adenine dinucleotid dehydrogenase and succinic dehydrogense. The cricopharyngeal muscle was occupied mainly by the type I fiber, whose occupational ratio was 57%. The type I fiber was recognized at the ratio of 12% in the hyopharyngeal, 20% in the thyropharyngeal, and 16% in the cervical esophageal muscle.
Mechanogram:
The muscle specimen was diluted by the modified Krebs solution aerated by 95% O₂. The cricopharyngeal muscle was then electrically stimmulated by 0.5 msec duration rectangular impulse. Time to reach peak tension in single twitch was 380 msec in the cricopharyngeal muscle and 70 msec in the brachial muscle. The cricopharyngeal muscle was easily fused by 10Hz stimmulation, and formed the complete tetanus. The hypoharyngeal and thyropharyngeal muscle didn't show K⁺-induced contracture, but the cricopharyngeal muscle partially show this contracture while 118 mMol KCI solution was diluted.
Manometric study in man:
A recording catheter with four openings of diaphragmatic transducers 1.5cm apart was swallowed through the nose until the lower esophagus and the recording on swallowing 2ml of water was done with the catheter withdrawn. The sequences of study were done aiming to the pressure change, first, on swallowing at the level of the nasopharynx, oropharynx, hypopharynx and upper most of the esophagus, and secondarily, of dynamic propelling force to convey the bolus ahead in the esophagus. It was an interesting result that there was a physiological low pressure zone around the vallecula of the pharynx. This result reflects the phenomenon that patient complaining of mild dysphagia remains the rest of barium at the vallecula on esophagography. Force to withdow the ball from the esophagus was stronger in male than in female, and at the level of the cricopharyngeal muscle, strain gauge showed the force of 700g in male and 400g in female.

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Frequency analysis of surface electromyograms (power spectrum) performed on facial muscles namely M. frontalis, M. orbicularis oculi and M. orbicularis oris. The range of the analysis was 0 to 1.0kHz. The results are as follows:
I. Relaxed, all muscles showed no effective components depend on frequency.
II. Activated, the components depend on frequency registered in the 80 to 500Hz range, while the main components registered about 150 to 200Hz. It suggests that facial muscles have more tonic components than phasic components.
III. The paralytic muscle of facial nerve paralysis showed no effective components during muscle contraction.

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The running course of the collagenous and elastic fibers in the lamina propria of canine vocal fold was investigated. Observations were made in thin spread specimens under a light and a scanning electron microscope. The results of the present observations were related to the already reported histological findings of the vocal fold tissue and the general histological properties of these fibers. The directionality of the elastic properties of both fibers of the lamina propria was considered to be orthotropy. And the degree of orthotropy of the elastic fibers was assumed to be weaker than that of the collagenous fibers. Consequently, for the lamina propria as a whole, it is reasonable to assume the directionality of the elastic properties to be “orthotropy”.

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This antigenic substance extracted from the urine of allergic patients by SOEDA is a kind of polypeptide consisting of 19 aminoacid. This agent is readily soluble in water and has not allergic provoking property.
The most striking finding may be that anaphylactic shock and Arthus's phenomenon are suppressed in the pretreated guinea pig and rabbit. The liberation of chemical mediators including mast cells occurs from abnormal lymphocytes.
We have treated many cases of nasal allergy with this agent for ten years since 1965. We were very interested in that there were some cases of a complete conversion of skin test to negative after treatment of this drug and this drug was clinically effective in these cases.
We have reported 9 cases which were conversion of house-dust, ragweed and candida skin test to negative with the same density in 3-36 months after intramuscular administration of this drug for 10-40 days.

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The antigenic substance extracted by SOEDA (1965) from the urin of allergic diseases is a kind of polypeptide consisting of 19 amino acid. It is non toxic and has no allergyprovoking property. This agent has the peculiar effect of inhibiting anaphylactic shock as well as the Arthus's phenomenon in animal experiments.
Fluctuations of pre-and post-treatment thresholds of intracutaneous allergen reactions and those of serum IgE were studied in 97 nasal allergy patients treated by MSantigen.
1) This drug was effective in 80 patients (82.5%).
2) Intracutaneous thresholds increased in 31 (38.8%) of the patients who were responsive to this drug, showing a distinct correlation with the effectiveness of the drug.
3) In the patients whose pre-treatment serum IgE values were high and responsive to this drug, the post-treatment mean serum IgE was “0.86”, if the pre-treatment serum IgE was “1”.

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Clinical effecacy of Combipenix®(ampicillin-dicloxacillin combination product) on acute excavation of chronic otitis media was studied in 47 patients, especially in the cases caused by mixed infection.
The age range was 20 to 75 years, and 28 were male.
Middle ear discharge was also examined bacteriologically and there were 18 cases in which more than two kinds of pathogen had been proved.
Mixed infections with gram-positive bacteria were 7 cases, with gram-positive and gram-negative bacteria were 7 cases and with gram-negative bacteria were 4 cases.
Clinical effects of these 18 cases treated with Combipenix® were as follows; excellent effect was 27.8%, good was27.8% and total was 55.6%.
Synergistic effects ofCombipenix® were shown in some organisms lisolated from these patients.
No adverse side effect was observed except one case with eruption, however, this case could not bedefined clearly whether symptom attributed to the drug.
It is considered that Combipenix® is effective in therapy for chronic suppurative otitis media caused by mixed infections other than pseudomonad.

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