The relationship between the outer hair cell damage and the amplitude of negative EP after administration of furosemide was studied in two groups of guinea pigs; one group was given kanamycin, the other was exposed to intense sound. The findings were as follows: negative EP was not seen in the guinea pigs which outer hair cells were damaged with intense sounds as the same as the kanamycin administrated guinea pigs. When different portions in the cochlea were damaged with varied freqency intense sound, negative EP hardly appeard at turns with extensive outer hair cell loss. Negative EP had almost normally appeared at turns with litte hair cell loss. It was concluded that there was a siginificant correlation between the number of surviving outer hair cells and the value of negative EP after administration of furosemide.

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The authors reported the results of an experiment which used an infrasound generator with a loudspeaker attached. Method: Hearing threshold, body sway, respiration, pulse, blood pressure ECG, ENG and GSR were evaluated with three different stimulations: whole body exposure, exposure by head phone and whole body exposure with ear plug. Results: 1) The hearing threshold showed no significant difference between whole body exposure and exposure by head phone, while it was significantly raised with whole body exposure with ear plug. 2) Body sway was more prominent with stimulation at 15 Hz than at 10 Hz and individual valiabilty was more marked at 15 Hz. 3) Respiration, pulse, blood pressure, ECG, ENG and GSR showed no remarkable change. 4) No nystagmus was seen any at exposure.

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Cholesterol crystals in middle ear lesions were investigated by means of a scanning electron microscope and a polarized light microscope. Their shape and size were variable depending upon the surrounding substances. In the middle ear fluid, the crystals showed large birefringent quadrate or rectangular structures. They were found to be formed of a considerable number of small and long rectangular crystals under both the scanning electron microscope and the polarized microscope. In the granuloma, the crystals appeared smaller and thinner as cellular components increased in the granulation tissues. Cholesterol crystals may possibly be dissolved by a phagocytosis of granulation tissue cells such as foreign body giant cells and foam cells. The crystals may be deformed more or less in the healing process of the granuloma.

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Peripheral blood and nasal eosinophils from normal individuals and nasal allergy patients were observed under scanning electron microscopy, without any purification procedure. This study was performed using the modified method previously described. Free eosinophils, neutrophils and other cells fixed with glutaraldehyde were placed on a cover glass and stained to identify each cell population. A scanning electron microscope was focused on an identified cell. A great number of eosinophils showed spherical or spheroidal shape, rich villous processus on their surface, and had 9-10μm diameters. Morphologically specific characteristics of the eosinophil surface, compared with neutrophils, could not be determined by this study. We were also unable to distinguish peripheral blood eosinophils from those in nasal secretion. This method could be widely applied to observe morphological changes of the free cell surface under certain condition.

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Twenty five cases with Minamata disease were investigated otologically and audiologically. The following results were obtained: Pure tone audiometries of the patients showed that their hearing thresholds showed gradually high frequency losses. The average pure tone thresholds at 500, 1000, 2000 and 4000 Hz, showed very slight losses, compared with threshold measured ten years ago. The thresholds of the stapedial reflex were approximately 95 dB at 250, 500, 1000 and 2000 Hz. In all cases, the latency and the amplitude of the auditory brain stem responses were within the normal range. The above results indicate that the hearing impairment due to chronic organic mercury poisoning was slight in the acoustic nerve passway. These audiological findings suggest that the hearing impairment in those cases may be caused by aging rather than by Minamata disease.

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The author treated an acoustic tumor case which mimicked MÉENIÈRE's disease in its early stages. She was treated with the presumptive diagnosis of MÉENIÈRE's disease. This resulted in improvement of both subjective smptoms (vertigo and hearing loss)and objective signs (disappearance of nystagmus and deviation of labyrinthine origin, a lowering of audiometric threshold value with maximum 35dB). The patient was a 54-year-old female who had tinnitus in her right ear since March 1981. In April 1982 she suddenly developed vertigo when she was informed on the telephone that her parents' house was on fire. Subsequently she began to complain of a hearing loss in the right ear, nuchal pain, a sensation of numbness in the mouth and dysgeusia involving the right half of the tongue. She was first seen by us on July 22, 1982. There was a gross hearing loss (threshold 55dB in the low frequency range) and leftward spontaneous nystagmus. Rightward deviation was noted on the past-pointing test and stepping test. The sense of taste was lost on the right half of the tongue, but facial paralysis was absent. Hypesthesia of the right half of the upper lip was present. There was no dysdiadochokinesis. Under suspicion of a disease of the central nervous system, a CT scan was made. No abnormality was revealed. A decision was made to give her treatment for MÉENIÈRE's disease. The treatment consisted of oral betamethasone and rest. With this therapeutic regimen, the nystagmus and deviation of the labyrinthine origin disappeared. Her hearing returned to almost normal with a maximum gain of 35 dB; however her right ear still showed no response to the caloric test. Stenvers test and tomography of the internal auditory meatus yielded findings suggesting enlargement of the orifice of the right internal auditory meatus. TTS (temporary threshold shift)was noted on Békésy audiometry. These facts led us to suspect the presence of an acoustic tumor. The patient was referred to the Department of Neurosurgery of our hospital. By contrast enhancement CT, she was found to have a mass at the cerebello-pontine angle. A ping-pong ball-sized tumor was totally removed surgically. Histological diagnosis was schwannoma. To the best of our knowledge, a total of 13 cases of brain tumors have been reported in the literature in which there was abatement of MÉENIÈRE's disease-like symptoms,(i. e. improvement of hearing loss and remission of vestibular symptoms). Of these tumors, the most frequent was acoustic neurinoma and the rest included angioblastoma, astrocytoma, glioblastoma and malignat pailloma. Their site of occurrence was always the cerebello-pontine angle. Why does such a remission of MÉENIÈRE-like symptoms occur during the course of a brain tumor? The author surmises that brain tumors, during a certain limited period of their growth, give rise to conditions that predispose the inner ear of the host to MÉENIÈRE's disease. Individual thus becomes ready to develop an attack of MÉENIÈRE's disease as precipitated by stress. When the tumor has outgrown a certain size, the inner ear disorder becomes irreversible and central nervous system symptoms corrsponding to a tumor of the cerebello-pontine angle come to the fore. A brain tumor causing MÉENIÈRE's symptom is probably due to disturbance of the blood supply to the inner ear by compression.

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Hearing screening with new “Crib-O-gram Type G₂A” device (COG) was carried out in 55 newborns. The results obtained in this study are summarized as follows: 1. The decision of “PASS” and “REFER” must be carefully made in the low birth weight subjects (less than 2500g), because of the weight limitation for COG device. 2. The test can be completed within 3 hours for most subjects. 3. The test failed in 10 of the 55 subjects. These failures were due mostly to the uncomfortable condition of the subjects. 4. The test succeeded in 45 of the 55 subjects. Forty of the 45 subjects were assessed to be “PASS” and 5 to be “REFER”. All subjects showing “REFER” were found to be “FALSE POSITIVE” from the re-test with COG and/or subsequent auditory brainstem response. 5. The scoring registered on COG ranged from 44 to 48 in the subjects assessed as “REFER”, and over 80 in about half of the subjects assessed as “PASS”. No correlation was observed between the time required for a test and the scoring distribution. From the ruslts above, the hearing screening with COG in newborns seems to be very useful.

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Thirty one white guinea pigs were exposed to sound(white noise, 100dB. SPL. or 4kHz. pure tone 115dB. SPL., 2 hours)and infrasound vibration(Frequency 10Hz., amplitude 5mm., 4 or 6 hours), independently or simultaneously to study the influence of infrasound vibration upon the cochlea. After the exposure, amplitude and latency time of the AP of the electrocochleogram was studied by inserting a needle electrode into the cochlea under intraperitonel anesthesia. The electrocochleogram was obtained by averaging response to 256 clicks at a rate of 8 per second. The results showed that the amplitude of the AP significantly decreased when guinea pigs were exposed to both 4kHz. pure tone and infrasound vibration(P≤0.05). The latency time of the AP was slightly prolonged when they were exposed to the sound and infrasound vibration simultaneously. These results imply that the exposure to sound and infrasound vibration have an effect upon the physiological function of the cochlea of the guinea pig.

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Three cases of head and neck tumors with neurofibromatosis (von RECKLINGHAUSEN'S disease) are reported. Case 1 is that of a 34 year-old woman who first visited our clinic in November 1981 for evaluation of a mass in the right preauricular region. She underwent total resection of the mass with preservation of the facial nerve. Microscopically, the excised specimen showed neurofibroma. Case 2, a 76 year-old man, and case 3, a 52 year-old man, both suffered neurofibromatosis, and primary squamous cell carcinoma of the unilateral true vocal cord. In both cases, vertical hemilaryngectomy was carried out following pre-operative radiation therapy. Cases of neurofibroma of the head and neck in association with neurofibromatosis is comparatively rare, and in association with cancer of the true vocal cord is very rare.

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Although sensorineural deafness is one of well-known manifestation of congenital and late acquired syphilis, its occurrence in early acquired syphilis is considerd rare. We report an unusual case of bilaterl sudden deafness which is probably due to early acquired syphilitic meningitis. A case-36 years old male visited our clinic on 9th May 1980 with the complaints of bilateral deafness and tinnitus of sudden onset which occured after severe headache of a week's duration. A battery of the audiometric examinations revealed profound sensorineural hearing loss of bilateral ears, poor discrimination and positive recruitment. Békésy audiometry showed Jerger type I bilaterally. In electrocochleography, CM was abolished but recruitment type AP and low negative SP were detected. Both ears were C. P. in caloric test. STS, TPHA and FTA-ABS were positive. We could confirm that STS and TPHA were negative from 1966 to February 1980, and thereby he was diagnosed as early acquired syphilis. Cerebrospinal fluid examination showed pleocytosis but normal protein content and normal pressure. STS and TPHA of CSF were negative. The patient was treated by administrations of high dose Penicillin and steroids for four weeks but his hearing acuity was not restored. Attention shoud be called for the fact that early acquired syphilis is one of the important etiology of sudden deafness.

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Twenty six patients with pharyngolaryngitis were received DL-8280 orally in daily dose of 300-600mg during 2-14 days. Clinical efficacy of this drug in the patients was divided into the following four groups; excellent 7, good 13, fair 5 and poor 1. The effectiveness rate including both excellent and good ones was 76.9%. Six S. aureus and 4 E. cloacae of these subjects were detected. DL-8280's MIC to these bacteria was showed a value of 0.05-0.39μg/ml and this was superior predominance than those of NFLX, PPA, NA, ABPC and CEX. The serum level of DL-8280 was 3.16μg/ml on 2 hours after single oral administration in dose of 200mg. The tissue concentration of DL-8280 in faucial tonsil were similar to the serum level. No side effects were observed.

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The tissue concentration of DL-8280 in the paranasal sinus mucosa after single oral administration of the drug in a dose of 200mg was determined in 5 patients who had undertaken Caldwell-Luc anatomy. In all patients, the tissue concentration of the drug in the sinus mucosa was higher than that of serum showing a value of 2.35μg at about 120 minutes after administration. DL-8280 was orally administered to 16 patients with paranasal sinusitis in daily doses of 300mg-600mg for 7-14 days. The clinical effects were excellent in one case, good in 8 and fair in 7. Effectiveness rate of DL-8280 was 70.0% in acute paranasal sinusitis and 33.3% in chronic paranasal sinusitis. No side effects were observed.

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For the purpose of comparing the clinical effectiveness, side effect and utility of DL-8280, a new synthetic antimicrobial agent, and amoxicillin (APMC) in acute lacunar tonsillitis, DL-8280 and AMPC were administered orally for 7 days at the daily dose of 200mg t. i. d. and 250mg t. i. d., respectively, by double-blind method and the following results were obtained. 1) DL-8280 and AMPC were administered to 129 patients and 110 patients of DL-8280 group and 111 patients of AMPC group were examined for clinical efficacy. One hundred and twenty-six (126) patients were evaluated for safety in both groups. 2) The clinical effectiveness was judged by the criteria of attending doctors and that of the committee. The effectiveness rate, judged by doctors, of DL-8280 group and AMPC group were 93.6% and 94.6%, respectively. On the other hand, the effectiveness rate, judged by the committee, of DL-8280 group and AMPC group was 70.9% and 74.8%, respectively. No significant difference was noticed in both groups. 3) The bacteria were isolated from 85 % of patients examined for clinical efficacy. The distribution rate of β-Streptococcus, S. aureus and H. influenzae was 36.1%, 24.7% and 15.0% of all strains, respectively. As the bacteriological effectiveness, the eradication rate was 97.8% in DL-8280 group and 98.9% in AMPC group and no significant difference was noticed. 4) With regard to side effects, gastrointestinal disturbance and hypersensitivity were observed and the former was major. The rate of appearance was 4.8% in DL-8280 group and 4.0% in AMPC group and there was no significant difference between two groups. 5) No significant difference was noted between two groups in utility of the drug. From these results, it was concluded that DL-8280 was as useful as AMPC for the treatment of acute lacunar tonsillitis.

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