In 1981, Panje reported the voice button technique as a simple method for vocal rehabilitation following laryngectomy. The present paper describes our experience with the voice button applied to a 74-year-old male. The surgical proceduce was simple and the patient learned to speak very easily, although, there were two minor problems. One problem was caused by the too large tracheostoma (8mm×25mm). This was solved by a surgical correction. The other problem was brought about by an excessive resistance at the outlet of the button. The aerodynamic resistance measured 157 to 343 dyne. sec/cm5. This was managed by enlarging the slits at the outlet.

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Three cases with sensorineural deafness due to acute acoustic trauma caused by a firecracker explosion showed mainly a profound flat type audiogram with permanent hearing loss. SISI tests were not always positive and AP responses showed low output potentials at high stimulus levels. On the other hand, the cases with sudden deafness due to rock drills showed a profound flat type audiogram similar to those damaged by firecracker, however, the AP responses showed a high output potential at higher stimulus levels. These differential results seem to arise from the difference of sound pressure level. Namely, a more severe damage of sensory hair cells is caused by the noise of firecracker because it has a more intensive sound pressure than that of a rock drill. In experimental cases with a high AP output potential, disarrangement of the hair cell cilia was seen. Consequently, it is speculated that a minimal decoupling of hair cell cilia from the tectrial membrane is coupled by a intensive stimulus, thus AP output potential become steeper, causing recruitment.

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One hundred and thirty six children with bilateral hearing loss of unknown etiology were followed up for a period of 6 months to 9 years. These children were classified into 2 groups; 20 cases of idiopathic bilateral sensorineural hearing loss and 116 non-progressive cases. The conclusions obtained by comparative study on the 2 groups were as follows: 1. Progression was observed in 30% of sensorineural hearing loss of unknown etiology. Almost 50% of these progressive cases, correspondingly to 15% of all cases, belonged to the idiopathic bilateral sensorineural hearing loss (IBSH) group. 2. The age of IBSH cases, on the first visit to our clinic, ranged from 4 to 11 years old, mostly 8 year-olds or younger. 3. Progression was observed at age 4 through 14, and mostly at age 7 and 8.4 The dominant shape of audiogams of IBSH cases, was of a gradually sloping type, in which a saucer type audiogram appeared more frequently. 5. No difference was found between the 2 groups of IBSH and others in regards to genetic factors. 6. No essential difference was found between the juvenile type of IBSH and other sensorineural hearing loss group of unknown etiology without rapid progression.

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Intravenous 10% Glycerol administration improved hearing of MENIERE'S disease in 14 ears of 11 cases. Pronounced recoveries (over 30 dB) were observed in 2 of 14 ears, recoveries over 10 dB were observed in 4 ears, thus 43% of the ears showed arecovery. Five cases, 45% of eleven patients, showed subjectiue improvement of vertigo. We conclude that administration of 10% Glycerol is suitable in these types of cases; 1) when hearing is fluctuating, 2) if the glycerol test is positive, even if there is no fluctuating hearing, 3) when the hearing loss is not severe. The duration of improved hearing was 6 months on the average. In these cases with improved hearing, repeated treatments every 3 to 6 months is necessary. No side effect was experienced following 10% Glycerol administration.

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Laryngeal papilloma, most frequently treated by surgical resection, is freqently liable to recur. In light of recent reports of successful treatment with interferon, juvenile laryngeal papilloma was treated with a combination of surgical resection and local interferon injection. This treatment produced favourable prognostic results and suggests that even a local injection can demonstrate the effect, though systemic administration is the usual method of interferon treatment.

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A case of relapsing polychondritis is reported. The primary locus of this case was the tracheal cartilage and we had to perform emergency tracheotomy. Steroid therapy was initiated but the symptom was progressive. The etiology of this disease is thought to be related to a immunological reaction. With fluorescein conjugated serum from the patient, we exhibited more fluorescence around the prechondritium than with control serum.

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Two patients with wheat flour coryza who worked in a bakery were examined in the allergic out-patient department at our infirmary. They suffered from typical allergic rhinitis coinciding with employment in an atmosphere filled with wheat flour grain. Intracutaneous reaction tests with extracts of wheat flour were performed with positive results. Prausnitz-Ktistner reaction examination of wheat flour were tried in these two patients and anti-wheat flour reagin antibody were demontrated. In one of them, we discovered the antibody for glutenine which is a protein present in wheat flour. No increase of serum Ig-E level could be found in these two patients. We diagnosed the patients as having wheat flour coryza and recommended that they change their trade. They were treated conservatively without specific hyposensitization therapy.

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Twelve cases of inner ear syphilis, 38 to 60 years old,(8 congenital and 4 acquired) were studied emphasizing the results of the otoneurological examination. The 12 cases consisted of 4 males and 8 females. No gaze nystagmus was found in any case, but positional nystagmus was evident in 10 of the 12 cases with electronystagmography with eyes covered in darkness. All cases showed C. P. or D. P. in caloric testing, above all 4 ears revealed absent responses. The Romberg Test was positive in 2 cases, and the Mann Test was positive in 7 cases. The average of the hearing threshold level at 500, 1000 and 2000 Hz was 65.3 dB. in congenital and 32.8 dB. in acquired syphilis. With regard to SRT, 65.3 dB. in congenital and 27.7 dB. in acquired. About SDS, 50.6% in the former and 83.5% in the latter. The Ogata-Method, Rapid Plasma Reagin (RPR) Test and TPHA were performed as serologic test for syphilis. Four cases were positive in Ogata-Method, 9 cases were positive in the RPR Test and all cases were positive in the TPHA. The authors emphasize the importance of performing serologic test for patient with severe sensorineural hearing loss and bilaterally diminished caloric responses.

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Misdirection of the stapedial muscle after recovery of facial palsy and concomitant contraction of the muscle with facial spasms were studied to determine the effect of the muscle contraction on sound transmission. Fifteen ears revealed hearing loss between 5 and 15 dB at low frequencies; 4 patients showed a 20 to 35 dB loss. Contraction of the stapedial muscle seems to have a significant effect on hearing loss.

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Causal factors of wide shape tympanogram were investigated using a Madsen ZO-72 impedancemeter. Although a wide shape may be recognized in each type (A, AD, As, and C), only wide A and wide AD type were analyzed in this study. Wide A type, whose relative pressure gradient is below 0.15, was found in patients with middle ear effusion and posttympanoplasty, and in normal infants. Soft, hypermobile external auditory meatus with a relatively hypomobile eardrum due either to thickening or effusion, along with a large equivalent volume of the external ear canal, may contribute to form a wide A tympanogram. On the other hand, eardrums of the patients with wide AD tympanogram were partially hypermobile due to an atrophic scar, where we found adhesion of the tympanic membrane around the incudostapedial joint.

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A 18 years old man with unilateral inner ear impairment caused by intraventricular injection of gentamicin is reported. The patient had been complaining of tinnitus and hearing impairment in his left ear only two days after gentamicin-injection. Total dose was 10 mg. Ataxic was noted on ambulation. His average hearing loss was about 60 dB and the audiogram was a flat form. Recruitment phenomenon was also confirmed. Equi-librium function tests revealed left vestibular dysfunction. It was concluded that the inner ear impairment was caused by the intraventricular injection of gentamicin, since the inner ear impairment had appeared so early in this case.

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