Round window electrodes were permanently implanted in 15 rabbits. They were exposed to 2KHz pure tones for two hours everyday and each intensitiy level of the pure tones was at 80, 85, 90, 95 and 100dB SPL. Changes of compound action potential (AP) were determined following repeated sound exposures. And the thresholds of the acoustic reflex were measured in normal rabbits. The criterion used for the measurement of the acoustic reflex was a change in the amplitude of the cochlear microphonic generated by a 2KHz eliciting tone. The following results were obtained: 1) A group of 80dB exposure showed no AP changes. Thresholds of the AP increased systemically throughout the 100dB sound exposure. Variabil ity in individual sound damage susceptibility was found at 90dB exposure. 2) Noise induced temporary threshold shift (NITTS) was an integral part of the noise induced permanent threshould shift (NIPTS) process. Hazardous exposure showed a large NITTS. But the large NITTS did not always produce a dangerous effect. 3) N₁ latency was prolonged and N₁ amplitude was deminished immediately after sound exposure. But N₁ latency recovered more quickly than N₁ amplitude. 4) Input-output functions for the AP during exposure period resemb led the loudness recruitment functions, and AP amplitudes obtained frequently exceeded pre-exposure values. 5) The mean acoustic reflex threshold at 2KHz was 74.8dB SPL. Round window electrodes were permanently implanted in 15 rabbits. They were exposed to 2KHz pure tones for two hours everyday and each intensitiy level of the pure tones was at 80, 85, 90, 95 and 100dB SPL. Changes of compound action potential (AP) were determined following repeated sound exposures. And the thresholds of the acoustic reflex were measured in normal rabbits. The criterion used for the measurement of the acoustic reflex was a change in the amplitude of the cochlear microphonic generated by a 2KHz eliciting tone. The following results were obtained: 1) A group of 80dB exposure showed no AP changes. Thresholds of the AP increased systemically throughout the 100dB sound exposure. Variabil ity in individual sound damage susceptibility was found at 90dB exposure. 2) Noise induced temporary threshold shift (NITTS) was an integral part of the noise induced permanent threshould shift (NIPTS) process. Hazardous exposure showed a large NITTS. But the large NITTS did not always produce a dangerous effect. 3) N1 latency was prolonged and N1 amplitude was deminished immediately after sound exposure. But N1 latency recovered more quickly than N1 amplitude. 4) Input-output functions for the AP during exposure period resembled the loudness recruitment functions, and AP amplitudes obtained frequently exceeded pre-exposure values. 5) The mean acoustic reflex threshold at 2KHz was 74.8dB SPL.

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Using chronic electrodes placed on the round window membrane, changes of the cochlear microphonics (CM) and acoustic middle ear muscle reflex (AR) were measured following application of repeated sound in rabbits. The sound was 2KHz pure tone and the intensity ranged between 80 and 100dB SPL. The results were as follows; 1) The decrease in CM amplitude following sound exposure was variant. 2) The amplitude of CM was constant following 80dB sound exposure and decreased after 85dB sound exposure. The degree of this decrease changed proportionally with the sound intensity exposed. 3) AR was attenuated by prolonged sound exposure. This attenuation tended to become larger when the sound intensity exposed was stronger. 4) The amplitude of CM in rabbits which AR were attenuated with anesthesia decreased more than those in awake rabbits following sound exposure. 5) Recovery of CM amplitude has a relationship with that of AR attenuation. It is suggested that AR protects the cochlea from repeated and prolonged sound exposure.

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It is well known that the patients with Vogt-Koyanagi-Harada's disease have hearing disorders frequently. This pathogenesis, however, remains obscure. In oder to elucidate the pathological situation of the cochlea in patients with Vogt-Koyanagi-Harada's disease, the pure tone audiometry, short increment sensitivity index (SISI) test, electrocochleography and glycer ol test were performed. And it was concluded as follows: 1. In all cases, bilateral fluctuating hearing impairment was observed and recruitment phenomenon was positive. 2. Most cases were characterized by an increase in the dominantly negative SP and in the ratio of AP to negative SP. 3. The hearing impairment in some cases was improved by intravenous injection of glycerol. 4. In some cases, vestibular symptoms such as rotatory vertigo and horizontal nystagmus were observed, and these symptoms were fluctant. 5. From the above findings, it was concluded that the pathophysiology of the cochlea in patients with Vogt-Koyanagi-Harada's disease is the endolymphatic hydrops and similar to those of Meniere's disease.

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One hundred and forty children with Down's syndrome were studied otologically and audiologically. In the selected group (41 children who had any oto-rhino-laryngological symp toms), 34 children (83%) suffered from otitis media with effusion (OME). In screening group (99 children who had such no symptoms), 53 children (56%) suffered from OME (4 children could not be tested). This high incidence of OME in Down's syndrome may relate to stenotic external ear canals which are often found in Downs' patient. The natural healing of OME that is thought to occur in ordinary cases does not occur in Down's syndrome. Conservative treatment of OME in Downs' children tends to be unsuccessful, the best therapy is surgical, but complication such as heart disease should be considered. However, the incidence of sensorineural hearing loss is relatively high in Down's syndrome and many parents do not recognize the hearing impairment of the child. Effective otological screening of Downs' children is indicated.

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A case with tympanosclerosis underwent transcanal tympanoplasty. The elevation of the fibrous annulus from the posterior inferior bony sulcus was hard, but the venous wall of the jugular bulb arising from the hypotympanum was separated safely from the eardrum. Curetting of granulation tissue around the stapes ended in profuse bleeding, which was controlled by pressure. Polytomography, high resolution CT, and cerebral angiography showed the jugular bulb projecting into the middle ear, and also a diverticulum extended upwardly behind the internal auditory canal. The case reports of 33 high bulbs were discussed and summarized.

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An 18-year-old boy visited our clinic with pulsating tinnitus in his left ear. No obvious abnormality was found by pure tone audiometry, X-ray examination or routine blood test. Otoscope examination of the left ear revealed a high-pitched pulsating objective tinnitus, similar to the wind blowing a wire. CT scan revealed a tumor originating from a pineal lesion with enlarged cerebral ventricles. Immediatley after admission, a convulsive attack occurred with loss of consciousness. Drainage to the cerebral ventricle was successful, resulting in disappearance of the tinnitus. It was concluded that the tinnitus was caused by a stenotic or obstructive noise in the vascular system due to the intracranial tumor and/or increased intra cranial pressure.

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During the past twelve years, twenty-one patients with nasal vestibular cyst were observed at the Yokohama City University Hospital and Tokyo Senbai Hospital. Of these, one case of bilateral nasal vestibular cysts was reported. The patient was a 41-year-old male diagnosed by physical and X-ray examinations. The removed cysts were diagnosed as nasal vestibular cysts on both sides. Klestadt's theory that the cyst arises from the embryonic cleft in the facial region is supported by the histological and clinical findings in this study.

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From July 1983 to June 1985, there were 669 allergic rhinitis patients in Cathay General Hospital, Taipei, Taiwan, R. O. C. They were diagnosed by the symptoms of sneezing, watery rhinorrhea, nasal obstruction, and itching of nose, as well as immunological examinations such as total eosinophil count in nasal secretion and peripheral blood, and serum IgE level. Two hundred fifty patients received desensitization therapy for more than 6 months, during which time 129 patients' (51.6%) symptoms completely disappeard and 84 patients (33.6%) reported improvement of symptoms. The rate of effective treatment was 85.2%. Sixty-four patients received Histaglobin injection, in 22 patients (34.4%) symptoms completely disappeared, and in 19 patients (29.7%) symptoms improved. The rate of effective treatment was 64.1%. Thirty patients received disodium cromoglycate (Intal) intranasal spray. They were symptomless after 4 weeks. The current skin tests are the scratch test, the prick test and the intradermal test. In view of the tendency of patients to be younger nowadays and the convenience of use, we use the blood lancet for the skin prick test. It is less costly and does not cause too much pain for the patients, especially for children.

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Comparative study on the clinical and immunological efficacy of oral and subcutaneous hyposensitization was investigated for Sugi pollinosis. Thirty adult patients with allergy to Sugi pollen were randomly assigned to two treatment groups: 15 of them by daily oral application of the crude freeze-dried Sugi pollen extracts, the remaining 15 by subcutaneous injection on a weekly basis until the maximum dose. Treatment started about 12 months before Sugi pollen season with the schedules for perennial hyposensitization in both groups. The two groups were well matched for usual severity of nasal symptoms. According to daily symptom score, assesment of the therapy effect was similar for both groups. However, nasal reactivity to Sugi pollen and eosinophils in nasal smear decreased more in the orally treated group than in the injection therapy group. The levels of serum Sugi-specific IgE antibody and histamine liberation from basophils appreciable decreased and also the increase of serum Sugi-specific IgG antibody was significantly seen in the orally treated group. No obvious side effect attributable to oral hyposensitization therapy was observed.

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A 51-year-old male consulted our clinic complaining of hoarseness. The typical cutaneous sign (split papule) was observed as well as pharyngo-laryngitis. The serological test was immediately tried, and secondary syphilis was diagonsed. The patient was treated with penicillin G for 4 weeks and the symptoms disappeared. Recently syphilis has increased. Otolaryngotists should have a knowledge of this disease.

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The case of a 52 year old female with pyogenic osteomyelitis of the cervical spine was reported. The patient visited our clinic complaining sore throat and pharyngeal mass. The mass occurred from the posterior pharyngeal wall with pedicle. Initially it was suspected that the tumor derived from the pharyngeal mucosa. However, it was diagnosed as pyogenic osteomyelitis of the cervical spine by various clinical examinations, including imaging figures. It is emphasized that the diagnosis should be made only after taking into consideration all aspects of the case.

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A female patient, 38 years old, suffered from foreign body sensation on the throat. A tumorous growth was found on the mesopharynx. A biopsy of the growth was histologically diagnosed to be an amyloid tumor. The case has been followed for more than 6 months, without any aggressive treatment. The size of the tumor has not increased. The amyloidosis in the head and neck are few, and the localized pharyngeal amyloidosis is especially rare. The thirty definite cases of amyloidosis of the head and neck, which have appeared in literature, have been discussed on their frequency, sex and age distributions, localized area and symptoms, and treatment.

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One hundred and fifteen children's larynges (66 males and 49 females), obtained from autopsy cases, were examined with measurement of the following portion: the length of the membraneous portion of the vocal fold, the length of the vocal fold, the glottic length from the anterior to the posterior commissure, the height of ventral thyroid cartilage, the height of ventral and dorsal cricoid cartilage. The age ranged from fetus to sixteen years. All measured value of the larynges were significantly correlative to age. In infants who died within 3 months, the value had the significant correlation to the gestational age. No sex difference was found among the cases. Relationships between the measured values of the larynx and the height, weight, crown-rump length, head circumference and chest circumference had the signifi cant correlation. In all cases, both the height and the crown-rump length showed the highest correlation with the measured values of the larynx. But in infants who died within 3 months, the weight and chest circumference were the most correlative factors. Basal metabolism related significantly to the laryngeal size. But it was considered that the children's larynges were at a disadvantage in the respiration as compared with adult's.

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Thirty-seven cases with laryngeal anomalies were observed at our department for tne past five years. There were 20 cases with laryngomalacia, 13 with recurrent nerve paralysis, 5 with subglottic stenosis, and one with laryngeal web. Symptoms include stridor, hoarseness, and dyspnea. Some cases had other anomalies, such as cardiac, or central nervous system. Two patients died of such complications. The prognoses were good in the vast majority of the cases. No active therapy was necessary, except in two cases, in whose subglottic stenosis were aggravated, and tracheostomy needed. Diagnoses were mainly made by laryngoscopy. For inspection of the subglottic space, X-ray pictures were used. Recently, energy subtraction computed radiography has been used for this inspection. With this technique, the spinal shadow is excluded, and the condition of the airway can be clearly observed. A representative case, in which this type of radiograph was useful, is reported.

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Seventy-four cases of vocal cord nodules in children were reported. Most of the patients were boys and age distribution at the time of onset, was between 1 and 11 years. Because the incidence of vocal abuse was high (74%), the cause of vocal nodules was thought to be related to vocal abuse. Vocal nodules or hoarseness in 29 cases was improved by conservative therapy including voice therapy. Vocal nodules disappeared in most boys after puberty, but the improvement in girls was not as good. Consequently, it is emphasized that conservative therapy was preferred in boys, but surgical treatment was indicated in some of the girls' cases.

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Many cases of cricoarytenoid arthritis associated with collagen disease have been reported in western countries, while such cases are rare in Japan. A case of cricoarytenoid arthritis caused by rheumatoid arthritis has been reported. The case is a 40 year-old woman with a history of rheumatoid arthritis. Despite steroid therapy, her condition aggravated gradually for 10 years. After 10 years she complained of sore throat, hoarseness and increasing inspiratory dyspnea. Fiberscopic examination revealed swelling on the arytenoid. The left vocal cord was fixed at the paramedian position, and the movement of the right vocal cord was slightly disturbed. Subglottic edema was observed. Immediately after admission, a tracheostomy was performed for relief of dyspnea. Systemic antibiotic and steroid therapy was initiated. The steroid was injected to the subglottic edema. With this therapy, the vocal cord movement was normalized, and the hoarseness and dyspnea disappeared within 7 days.

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Twenty-two cases of vocal cord paralysis caused by endotracheal intubation were treated at our clinic during the past 15 years. Paralysis frequently occurred in patients over 40 years old, and the left vocal cord was more frequently affected than the right. In most cases the time of anesthesia was more than 3 hours, and spontaneous recovery took place within 3 months. The recovery period was longer in patients over 40 years old than in patients under 40 years. To prevent this paralysis, it is necessary to avoid the inadequate endotracheal tube and overextention of the neck, and to monitor the pressure of the endotracheal tube cuff.

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A case of Werner's syndrome with hoarseness was reported. The patient was a 35 year-old male whose parents were cousins. The patient had undergone an operation on his bilateral cataracta at the age of 21, but his left eye was eventually removed at age 28 due to glaucoma. He was short with gray hair, scleroderma-like skin and hoarse-voiced. He was diagnosed to have mild diabetes mellitus and hypergonadotrophic hypogonadism. His vocal cords were found to be yellow and atrophic, with deep sulci. His voice was very breathy on auditory impression. His maximam phonation time was 6 45, his usual spoken pitch was 300 Hz and speech range was d→a. Intracordal silicon injections followed by general administration of androgen and voice training resulted in a considerable improvement.

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Intensity, fundamental frequency of voice and air flow rate during phonation were simulta-neously measured in normal subjects (24 young men, 27 young women, 24 old men and 40 old women, with mean ages of 32, 30, 78 and 76 years, respectively). The subjects were required to hold a mouth piece and sustain the vowel/a/at a comfortable, soft and loud level. Greater air flow rate generally showed higher intensity of voice in young persons. In older groups, individual cases generated different volumes of air flow. However, their voices showed similar intensity at comfortable and soft levels. Mean intensity of the voice in the older groups took higher magnitude as compared with that of young groups. However, it was of the same magnitude in young adults at a loud level. Those with louder voices also tended to have higher fundamental frequencies in both young and older groups. Comparing older women with young women, the average fundamental frequency in the older women was lower than that in the younger women. Consideration of senescent change of phonatory ability is thought to be important in vocal examination of older people.

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Four hundred and thirty-six cases with phoniatric disorders were examined at our special clinic during January 1983 to December 1985. They were analyzed statistically, and the following results were obtained: 1) The main diseases were vocal cord nodules, recurrent nerve palsy, vocal cord polyp and polypoid vocal cord. The cases with vocal cord nodules showed a significant difference between both sexes. It is supposed that this difference had a relation to vocal abuse. 2) The causes of the recurrent nerve palsy were made clear in 3/4 of the cases. The operative procedure was the most frequent cause, and disease in the chest followed. Malignant tumors have increased, compared to past reports. 3) The conservative therapy was performed in a majority of cases. The laryngeal leukoplakia in some cases was biopsized with LMS repeatedly and was finally diagnosed as a cancer. Cases with such precancerous condi-tions must be observed for a longer period.

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Seven female adults with vocal cord nodules were examined and treated by vocal hygiene on admission for 2 weeks. The results were as follows; Laryngoscopic observations revealed that the vocal cord nodules either disappeared or reduced in size in 6 cases (85.7%). The vocal cord nodules originated by vocal abuse and some trigger episode such as shouting, cheering, or acute exacerbation of sinusitis and upper respiratory inflammation. Vocal hygiene was effective in the cases which had some trigger. In the cases with neck and shoulder stiffness or hard glottal attack at phonation, vocal cord nodules recur in some patients after discharge.

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This patient suffered from a brain tumor. Brain surgery was performed, but her voice became hoarse due to paralysis of her left recurrent laryngeal nerve. We performed phonosurgery, arytenoid rotation operation (Isshiki), but improvement of the hoarseness was transient. We trained her voice with the pushing method. Gradually her hoarseness and maximum phonation time (MPT) improved. 1. Both phonosurgery and voice training were performed, and satisfactory results were obtained. 2. We introduced the treatment plan to improve hoarseness caused by unilateral recurrent laryngeal nerve paralysis. We also described the general outline of phonosurgery. We emphasized the importance of voice training to be performed along with phonosurgery. 3. We studied the use of computer acoustic analysis as a means of objectively evaluating improvement on voice hoarseness by various treatment methods.

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During the past 18 years, 46 cases of a foreign body (artificial teeth) in the esophagus were treated at our clinic. Males surpassed females 5.6 times. Older persons suffered from this more frequently than younger persons. Recently the frequency on the younger persons has increased due to the change in social life. Most frequently, the foreign bodies were located in the first stricture of the esophagus. The vast majority of cases visited our hospital within 24 hours after misswallowing. The metal hook of the artificial teeth can be easily found with x-ray examination. However, this hook is an obstacle to removal of the foreign body. We must be cautious during removal procedure.

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To investigate human tumor heterogeneity in the effect of therapeutic agents, two maxillary sinus cancer cell lines of keratinizing squamouse cell carcinoma from same patient, namely, OKK-Y2-P from a maxillary sinus and OKK-Y2-LN from a neck lymph node metastasis, occurred after chemotherapy and radiation therapy, were established. An in vitro assey, which evaluates the effect of drugs (CDDP, VCR, PLM, ACM, CPM) on labeled precursor H³-thymidine after 24 hours of in vitro treatment, was applied to these two human maxillary sinus cancer cell lines. Comparing the sensitivities of these two cell lines to agents, the results of two cell lines were showed different, and to explain the difference, the two subclones, OKK-Y2-CLA, OKK-Y2-CLB, from OKK-Y2-P were examined in the sensitivities to agents. These two subclones were revealed the results, which were detected in OKK-Y2-LN, similarly. These results predict the hypothesis that the primary tumor has already many subclones, which have different sensitivity to agents, and some subclones, something like resistant to agents, make metastasis or recurrence.

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Two cases of non-healing granuloma of the nose were treated at our clinic. Case 1; 31 year old male. The biopsized specimen from the nasal cavity showed marked necrosis and polymorphic cellular infiltration. Polymorphic reticulosis was suspected. Case 2; 49 year old female. The histological findings of the nasal mucosa revealed severe massive necrosis, but in certain foci the monotonous histiocytic proliferation was prominent. The malignant histiocytosis was indicated. Both cases were treated by radiation, but it was ineffective. In case 1, the necrosis spread rapidly to the face and neck, and the patient died 7 months after the onset of the disease. In case 2, metastasis to the liver was suspected, and the patient died after 4 months. The clinical courses of two cases were remarkably fulminant. We propose to name such cases “the fulminant type of the non-healing granuloma of the nose”. It was unique that the granuloma was far less sensitive to the radiation. This was due to the prominent necrosis and hypoxia of the tissue. It is recommended that the hypoxic cell radiosensitizer and hyperthermic therapy with radiation should be indicated in fulminant cases.

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A continuous cell strain (NPC-TY861) was established from nasopharyngeal carcinoma patients with undifferentiated squamous cell carcinoma. NPC-TY861 grew like a monolayer of epithelioid cells. The average doubling time of this cell line was 18 hrs. The modal chromosome number was 65, with a range of 48 to 70. Immunofluorescence method, NPC-TY861 line were found to be positive for EBNA, VCA and cytokeratin. From these results, this cell line was productive of EBV, in the supernatant of the culture. After the heteroinoculation of this cell line to a BALB/c nude mice, a tumor formed subcutaneously and was histologically similar to a primary tumor in structure.

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The antibodies to Epstein-Barr virus (EBV)-related antigens were examined in sera from 52 untreated patients with nasopharyngeal carcinoma (NPC), 10 long-term survival NPC, 32 other head and neck carcinoma, 30 normal healthy, and 12 patients with neck tumor unknown origin. The sera were titrated for IgG, IgA antibodies to viral capsid antigen (VCA), for IgG, IgA antibodies to early antigen (EA). The positive rate was 63% and the geometric mean titer (GMT) of anti VCA-IgG antibody were remarkably higher in NPC (1: 1195). In pathological difference, the positive rate (VCA-IgG; 72%) and GMT (VCA-IgG; 1: 1332) were significantly higher in the non-keratinizing or undifferentiated carcinoma cases. In untreated patients the titers of and VCA-IgG and VCA-IgA increased with stage, especially the patients with advanced neck tumor showed the high GMT (VCA-IgG; 1: 1860, VCA-IgA; 1: 170, EA-IgG; 1: 571, EA-IgA; 1: 123). Titers of and VCA-IgG, IgA, EA-IgG, IgA positively correlated each other in NPC patients. No relation of all titers in untreated patients to their prognosis were determined. But GMT of these four kinds of antibodies in the tumor bearing NPC patients were significantly higher than the non-bearing patients. It was emphasized that the EBV serological test is useful in the differentiation of the NPC from the occult neck tumor.

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Antibody-secreting hybridoma was generated by fusion of mouse myeloma cells with mouse spleen cells immunized with nasopharyngeal carcinoma (NPC) cell line (NPC 204). Only the monoclonal antibody 5-9 reacted to NPC cells in vitro, and in vivo accumurated to the NPC 204 tumor site, implanted into mice subcutaneously. This monoclonal antibody against NPC cells was conjugated to liposomes containing adriamycin (ADM). And the specificity and antitumor effects of the conjugates were examined in vitro, using NPC 204 cells as the target tumor. The antibody conjugated liposomes were selectively bound to NPC 204 cells. The studies on the cytotoxicity with NPC 204 cells in vitro was clarified that the antibodyconjugated liposomes containing ADM exerted the selective effects on NPC 204 cells in the inhibition assay of the incorporation of ³H-thymidine.

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Carcinomatous neuropathy associated with neoplasm has been well known since Denny-Brown reported two cases in 1948, but carcinomatous neuropathy associated with squamous cell carcinoma is rare. The neuropathy associated with nasopharyngeal carcinoma has never been reported. This is the case of a 35 year old female whose recurrent nesopharyngeal carcinoma was treated. After admission, she complained of progressive limb weakness, and after ten days she was completly paralysed, and complained of dyspnea due to weakness of the respiratory muscles. Direct invasion of the spinal cord was not detected by radiological examination. Radiation induced neuropathy was considered unlikely because of the acute and violent clinical course. Cerebrospinal fluid test showed protein-cell dissociation and elevated IgG. From these findings, it was considered that some immunological disorders may be related to the pathogenesis. It is suggested that this disorder might be caused by remote influence of the nasopharyngeal carcinoma or by an immunological dificiency.

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During the past fifteen years, 56 cases of mesopharyngeal carcinoma (MPC) were treated at our clinic. According to the UICC (1978) TNM classification, stage I had 2 cases, II 11 cases, III 14 cases, and IV 29 cases. The vast majority of the cases were advanced. The calculated three year survival rate was 55.5% among total cases, however, according to the stage classification, those of stage I and II was 75.2% and III and IV was 43.7%.

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The mortality of pharyngeal cancer in Japan was statistically examined. The study was based on mortality registration in Japan for the past ten years. The findings are as follows: 1) The mortality of pharyngeal cancer, compared to head and neck cancer, and cancer in general was extremely low. 2) The age adjusted mortality rate per 100,000 people was 0.166 in men and 0.062 in women in nasopharyngeal cancer; 0.110 for men, and 0.023 for women in mesopharyngeal cancer; and 0.181 and 0.065 for men and women, respectively in hypopharyngeal cancer. 3) Pharyngeal cancer tended to increase with age. The rate of hypopharyngeal cancer was particularly higher. 4) The sex ratio for pharyngeal cancer mortality was as follows: Nasopharyngeal cancer: 2.6, Mesopharyngeal cancer: 4.5, Hypopharyngeal cancer: 2.8, Unspecified pharyngeal cancer: 3.5. For each type of pharyngeal cancer, mortality rates were higher for men than women. 5) The highest incidences of nasopharyngeal cancer were observed in cases in their sixties. However, for both mesopharyngeal and hypopharyngeal cancer the highest incidences were found in still older age groups.

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Eighty-four cases of hypopharyngeal cancer were treated at our clinic from 1978 to 1985. Thirty three of the patients died, and eleven cases were autopsied postmortem. The clinical stage classification was as follows, stage I, 1; II, 0; III, 1; and IV, 9 cases. Nine cases had lymph node metastases and eight had organ metastases. On the other hand, the tumor remained at the primary site in 9 cases. In order to improve the survival rates, earlier diagnosis and earlier treatment are much preferred.

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Registered 404 autopsy cases of malignant tumors in the hypopharynx were collected from the Annual Records of the Pathological Autopsy Cases in Japan (1977 to 1984). These cases represented 0.2% of all malignant tumors. The sex ratio was 2.86. The median age was in the 70's in both sexes. The autopsy cases per 100,000 population of male and both sexes were higher in the Kanto and Kyushu districts than other districts. Histomorphologically 385 cases (95.3%) were squamous cell carcinomas, while 2 cases (0.5%) were adenocarcinomas, and 3 cases (0.7%) belonged to sarcomas (the remaining 14 cases (3.5%) were unknown). Metastasis into the lymph nodes was 47.7% in the carcinoma cases. The most frequent site of metastasis was the cervical lymph node, and the pneumonal-hilus-, mediastinal-, paraaortic lymph nodes followed in frequency. Distant metastasis was observed in 57.7% of cases. This incidence is higher than the clinical observation. Organs to which the tumor metastasized frequently were lung, bone, and liver.

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One hundred five cases of early laryngeal carcinoma were treated with radiation at our clinic during the past 13 years. The five-year survival rate was 95% for stage I cases and 72% for stage II. Five year disease-free rate of the cases treated with 60Co-γ ray was 88%, those with 10 MV-X ray was 62%. The significant difference could be detected. There was no correlation between the prognosis and the field size of radiation. Thirty-three patients relapsed after radiation therapy. Twenty-nine cases (88%) of failure appeared within 3 years. Among the unsuccessful cases, 8 were treated with radiation again, and 2 cases (25%) were cured. Partial laryngectomies were performed for 6 cases, and 2 cases (33%) were cured. Ten cases (67%) of the 15 total laryngectomized cases were recovered. Total laryngectomy is the best choice when a patient relapses.

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A 59-year-old male suffered from hoarseness for more than seven months and complained of a sore throat for two months. Bilateral vocal and false cords were swollen and biopsied by laryngo-microsurgery. Histologically it was diagnosed as adenosquamous carcinoma. Because radiation therapy was ineffective, a total laryngectomy was performed. In the literature, only seven cases of adenosquamous carcinoma of the larynx are reported. The incidence of metastasis and recurrence of this specific carcinoma is higher than those of the squamous cell carcinoma. Therefore, it is emphasized that careful follow-up is necessary.

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Factors influencing the prognosis of the head and neck carcinomas, especially factors of the host immunity and the immunotherapy were studied, on 180 cases with advanced stage III and IV head and neck squamous cell carcinomas. Following 9 prognostic factors were examined by multivariate analysis: sex, age, host immunity, original site, stage, histological classification, radiation and operation, chemotherapy and immunotherapy. The factors which influenced most strongly the prognosis were the stage and the original site, and the factors which influenced slightly were the sex and the host immunity. Even the host immunity influenced the prognosis slightly, its suppressive status made the prognosis poorer. Concerning immunotherapy, the longer administration of the non-specific immunotherapeutic agent made the prognosis better during the two years after initial treatment, comparing its shorter or no administration. But this effectiveness of immunotherapy diminished after three years. It was supposed that the immunity was intimately related to the condition of the head and neck carcinoma patients, but the non-specific immunotherapeutic agents which are admitted presently are limited in effectiveness. So it is expected that the more effective immunothrapeutic agents is developed on the near future.

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We cooperated from March 1, 1984 to February 28, 1985 with other 12 otolaryngologic departments in the northern, central, southern, and eastern parts of Taiwan in order to study statistically the present status of pediatric otorhinolaryngologic diseases in Taiwan. There were 70, 337 pediatric otorhinolaryngologic patients (0-15 years of age) as our study. Several conclusions have been drawn from our survey:(1) The incidence of various otorhinolaryngologic diseases was not similar in 4 parts of Taiwan; but, such differences tended to minimize at times, if it was considered in terms of diseased organs.(2) The monthly or seasonal incidence in the 4 parts of Taiwan was different; but, it was rather remarkable in certain otorhinolaryngologic diseases.(3) The seasonal incidence was particularly higher in northern and southern parts of Taiwan. It was higher in spring and summer in the former, and autumn and winter in the latter. In summer, the incidence was almost the same in all parts of Taiwan.(4) There was no regular order of seasonal incidence either in any otorhinolaryngologic diseases or in all parts of Taiwan.(5) The influences of the temperature, humidity and atmospheric pressure on the incidence were very complicated. As far as all the pediatric otorhinolaryngologic diseases of Taiwan were concerned, low humidity and moderate atmospheric pressure would promote the incidence.

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Ofloxacin (OFLX) was administered to 32 patients with otolaryngological inflammatory diseases and its clinical efficacy was studied at our clinic. Cases were grouped as follows: 15 with chronic purulent otitis media, 3 with acute sinusitis, 11 with chronic sinusitis, and 3 with chronic tonsillitis. Satisfactory efficacy was noted in 84.4% of the cases. Efficacy was most noticeable in the cases, with chronic otitis media (93.3%). One case each of vertigo, palpitation, and constipation developed as side effects. In our evaluation, Ofloxacin is a useful drug in treating infectious otolaryngological diseases.

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The present status of the treatment with Chinese traditional herb drugs was reviewed. This therapy has been emaciated in Japan for the occidental medicine. However recently, the effects of these drugs are re-evaluated, because of the circuference, that the cases with the chronic diseases, are increasing. The many literature on this theses were reviewed. And the effective rate, which these herb drugs were adapted to the vertigo, allergic rhinitis, sinusitis and the global sensation of the hypopharynx, was inspected. Each report apraises the excellent effect of the herb drugs. The Chinese traditional medicine looks important the general condition of the patient. It is considered that this is very reasonable as the therapeutic procedure.

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