Clinical observations using laryngostrobovideography were conducted to clarify the dynamic movement of air tract fluid in lubricating the larynx during phonation. In patients with normal wave motions of the vocal fold mucous membrane during phonation, the following phenomenon was noted: During phonation, rotating columns of air tract fluid formed bilaterally on the upper surface of the vocal folds. Consequently, it was demonstrated that dynamic movement of fluid in the air tract was closely correlated to the vocal fold vibration, especially in the wave motions of the vocal fold mucous membranes.

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A 37 year old man, suffering from Lermoyez syndrome, maintained a diary of his vestibular and cochlear symptoms for a year and four months. During this time, he had received caloric tests five times, and audiometry 34 times. As a result, he found that after attacks of vertigo, his hearing ability recovered immediately. This was confirmed by audiometry. However, even during periods without vertigo, the caloric response of the suffering ear was decreased. Of the 17 cases of Lermoyez syndrome reported in Japan, males outnumber females, and the peak age range was for those patients in their thirties. We speculate that the rupture site of the membranous labyrinth is important in the etiology of this syndrome.

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This report reviews ventilation tube (VT) therapy performed in 238 ears of 147 patients with otitis media with effusion (OME) at Fukuoka Children's Hospital between April, 1984 and July, 1986. Follow up for at least one year was made for post operative problems such as otorrhea, spontaneous extrusion, recurrence of OME after removal or extrusion of the VT, and long-term perforation of the tympanic membrane. Otorrhea was observed in 26 ears (10.3%), and spontaneous extrusions were found in 70 ears (29.4%). Recurrence of OME occurred in 21.8% of all the ears. The reccurrence rate was significantly lower in the ears which retained the VT more than 12 months. A perforation lasting for one year or more was not found in ears with spontaneous extrusion of the VT, but was observed in 8 of the 148 ears followed over 12 months after removal of the VT. From these data, we conclude that a VT designed to prevent spontaneous extrusion should be retained for more than one year, but because of the risk of long-term perforation, feel that VT therapy should be considered carefully.

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A case of Castleman's lymphoma occurring in the neck was reported in a 52 year old male. The tumor was located in the left submandibular portion, and was very difficult to distinguish from the submandibular gland during the preoperative examination. The well-encapsulated tumor pressed on the submandibular gland, and was removed easily. The principal microscopic characteristics were extensive vascular proliferation with hyalinization and prominent follicle centers.

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This is an analysis of 44 cases of bronchial foreign bodies treated in our clinic between 1976 and 1985. We classified the bodies as either man-made objects or beans. A tendency was found that the man-made objects, rather than the beans, fell into the right bronchus: 78% of the man-made objects, 56% of the beans. Peanuts were dislodged from the bronchii of 21 of our patients (48%), most of whom were under 2 years of age. Most patients were placed under general anaesthesia and a center action-type forceps and ventilation bronchoscope were used to remove the foreign bodies.

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Thirteen patients (12 previously treated, 1 previously untreated) with squamous cell carcinoma of the head and neck were each given 1.0g or 1.5g of FT-207 suppositories a day. Ten of the 13 patients, who were treated as such for at least 28 days, were evaluated for clinical effects. Side effects for any of the patients were studied. An overall response rate of 40% was obtained. There was 1 complete response, 3 partial responses, 1 no change, and 5 progressive diseases. Fifty per cent regression of tumor size among all the patients was seen after an average administration of 30.6g. Side effects were observed in 69.2% of all the cases. Three patients discontinued the administration, due to appetite loss, nausea and vomiting, diarrhea, and stomatitis. FT-207 suppositories appear effective in treating head and neck carcinoma patients who have previously been treated with other anticancerants or radiation.

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It is very difficult to find records in the bibliography of reports discussing the invasive region of nerve sheath tumors and cervical nerve fibers, in and around neck tumors, because of technical reasons. Recently, we have adopted new discriminative staining methods: luxol fast blue periodic acid Schiff-hematoxylin, modified hematoxylin-eosin, modified Masson- Goldner, etc. to demonstrate the spread of a tumor in the peripheral nerves, and the conditions of nerve fibers remaining in or around, the tumor, in three patients with so-called schwannomas. The outline of staining methods and treatments of nerve sheath tumors are mentioned and discussed in this paper.

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Many studies have been performed on cases with chronic Ménière's disease who have had recurrent previous attacks. The purpose of the present study was to investigate the vestibular and cochlear manifestations of incipient Ménière's disease. None of the patients in this study had had a single attack until the current hospitalization, thereafter, they had recurring episodes of vertigo and hearing loss. The following results were obtained: 1. Meniere's disease is most often seen in the fifth decade of life. However, in my investigation, 91% of the 34 cases occurred before 48 years of age, and the most incidental age at onset was at 35 years of age. 2. At onset and at the second attack, a marked fluctuation in the lower frequencies was noted when compared with the third attack. 3. The vertigo score was 3.1 at the second attack, 2.4 at the third attack, and 2.2 at the fourth attack. The interval between the third and fourth attack was longer than the previous attack intervals.

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Two rare cases of melanosis in the middle ear mucosa were studied via histochemistry and ultramicroscopy. Case 1: Male, 36 years old. When the patient came in for a tympanoplasty for chronic otitis media, pigmentation in the middle ear mucosa was noticed. The pigmentation was identified as melanin granules by histochemical methods: Fontana-Masson, decolorization, and Berlin blue. Melanocytes in the subepithelial layer were identified by transmission electron microscopy. Case 2: Male, 53 years old. Diagnosed as having nervus of Ota. When he underwent radical operation of the middle ear for cholesteatomatous otitis media, pigmentation in the middle ear mucosa was observed. Melanocytes with mature melanosomes were identified by electron microscopy.

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The effectiveness of traditional Chinese herb drugs (Kampoyaku) has been well documented in many clinical studies and many new articles and presentations appear each year. This summarizes the presentations given from 1987 to 1988. Among the various chronic diseases of otolaryngology, kampoyaku show remarkable effectiveness in treating global sensation of the hypopharynx and exudative otitis media. It should be emphasized many types of otolaryngological diseases in which Western medicines show no effect, are very effectively treated by kampoyaku.

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The tendency to bleed after administration of broad spectrum antibiotics, particularly those of the cephalosporin group, has attracted attention in recent years. The predominant opinions are that this is due to two mechanisms, namely, thrombocytopenia, and impaired prothrombin synthesis from Vitamin K deficiency attributable to a decrease in the population of intestinal flora. This patient was a 58 year old male with hypopharyngeal squamous cell carcinoma (rT1N⁰M⁰) who had undergone resection of the hypopharyngeal portion with reconstruction using a pectoralis major myocutaneous flap. A drain retained in the anterior chest wall was removed after confirming the absence of abnormality on the 8th day after the operation, and thereafter the clinical course was uneventful. However, on the 14th day, a hematoma formed in the anterior chest wall, below the axilla. Within several days, the hemoglobin levels fell from 10.2g/dl to 6.5 g/dl and the white blood cell count increased from 7500/mm² to 16200/mm², resulting in the necessitation of blood transfusions. These numbers, coupled with results showing platelet counts of 709, 000/mm², prothrombin time of 26.2sec (15%), A-PT time of 76.0sec, fibrinogen levels of 588mg/dl and normal FDP, suggested that Vitamin K₂ deficiency due to the antibiotics, rather than DIC was responsible. Intravenous administration of Vitamin K₂ was immediately started. After several days, the hematoma ceased to grow, and the results of the hemostatic test returned to normal. The patient's general condition improved by the 28th day after the operation, and an operation to remove the hematoma was perfomed. The patient's recovery progressed favorably, and he was discharged.

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Seventeen children with acute suppurative otitis media were treated with Cefteram pivoxil, and the following results were obtained: 1. The efficacy rates against acute suppurative otitis media as judged by the doctors in charge and by a unified criteria were both 94.1%. 2. The bacteriological elimination rate was 93.8%. As for the bacteriological response against each isolated organism, the elimination rate was 95.7%. 3. The disappearance rates of aural discharge on the third day and the 7th day after initiation of treatment were 86.7% and 85.7%, respectively. 4. One other child, not included above, with acute exacerbation of chronic suppurative otitis media, was also treated with Cefteram pivoxil. The clinical effect for this case was fair. 5. There were no side effects in any of the patients.

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To evaluate the clinical efficacy, safety, and utility of T-3262 (tosufloxacin tosilate, a new pyridonecarboxylic acid derivative) in treating suppurative otitis media, a comparative, double- blind study was carried out using ofloxacin (OFLX) as control drug. Patients over 16 years old with suppurative otitis media were orally administered T-3262 (450 mg/day) or OFLX (600 mg day) for 7 days. 1. Committee evaluation of the clinical efficacy gave efficacy rates of 63.7% for the T-3262 group and 59.8% for the OFLX group. There was no significant difference between these efficacy rates. 2. On day 7 after initiation of treatment, the overall improvement rate was 54.9% and 49.0% in the T-3262 and OFLX groups, respectively. There was no significant difference between these groups. 3. The bacteriological effect (eradication rate) of the T-3262 and OFLX groups, as judged by committee were 67.0% and 72.6%, respectively. No significant difference was noted in two groups. 4. Side effects were observed in 3 (2.8%) of 106 cases in the T-3262 group and 4 (3.8%) of 104 cases in OFLX group. There was no significant difference between two groups. 5. The attending physicians rated 68.6% of the T-3262 group and 73.5% of the OFLX group as “satisfactory, ” or “markedly satisfactory.” There was no significant difference between these two groups. These results indicate that T-3262, as well as OFLX, are useful drugs for the treatment of suppurative otitis media.

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To objectively evaluate the clinical efficacy and safety of Ceftazidime (CAZ) in treating suppurative otitis media, a standard protocol was designed and carried out in a multi-center clinical study. CAZ was examined for its sensitivity distribution against different clinical strains and its transfer into mucosal tissues of middle ear and otorrhea. 1. The MIC₈₀ of CAZ was 6.25 μg/ml for 49 strains of gram-positive bacteria (34 of them were strains of _{S. aureus}) and 3.13 μ g/ml for 22 strains of gram-negative bacteria (8 of them were _{P. aeruginosa}). These strains were all isolated from patients with suppurative otitis media. CAZ had stronger antibacterial activity than the three other antibiotics used for comparison (cefpiramide, cefotiam, and cefazolin). 2. The peak concentrations of CAZ (1 g, i. v.) was 33.8μg/g in the mucosal tissue of the middle ear and 27.9μg/ml in otorrhea, at 30 minutes and 60 minutes after administration, respectively. 3. Clinical evaluation of CAZ was made in 68 patients Clinical effectiveness was made in 63, clinical usefulness in 64. Safety was evaluated in all 68 patients. The dose of CAZ was 1g, twice daily, for most of the patients (59, 86.8%), and the duration of the administration was longer than 5 days, but not exceeding 7 days for 36 patients (52.9%). 4. The clinical efficacy rate assessed by the Efficacy Assessment Committee was rated at 76.2% (48/63), while the doctors in charge rated CAZ to have an efficacy of 74.6% (47/63). The percentage of “Excellent” cases was 57.1% in the assessment by the Committee. The efficacy rates (“Excellent” plus “Good”) in the committee assessment were 100% against acute suppurative otitis media (8 cases), 76.1% against acute exacerbation of chronic suppurative otitis media (46 cases), and 55.6% against chronic suppur- ative otitis media (9 cases). 5. The bacterial elimination rate was 86.0% in the assessment for each case (57 cases) and 87.0% in the assessment for each clinical strain (69 strains). The elimination rate for each species, excluding P. putida (2 strains), and X. maltophilia (1 strain), ranged from 82.4% to 100%. 6. Clinically adverse events were observed in 2 of the 68 patients; one case of rash and induction of an asthmatic attack in the other. Laboratory findings showed a decrease in white blood cell count in 1 case. None of these adverse events or abnormal laboratory findings were judged to be serious. In conclusion, CAZ is considered to be very useful in the treatment of suppurative otitis media.

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To objectively evaluate the clinical efficacy and safety of Ceftazidime (CAZ) in treating paranasal sinusitis, a standard protocol was designed and carried out in a multi-center clinical study. CAZ was examined for its sensitivity distribution against different clinical isolates, and its transfer into the tissue membranes of the maxillary antrum. The results are as follows: 1. The MIC₈₀, of CAZ was 1.56μg/ml for 23 strains of Gram-positive bacteria and 0.39μg/ml for 9 strains of Gram-negative bacteria. These strains were all isolated from patients with paranasal sinusitis. Among all the antibiotics tested (cefpiramide, cefotiam, cefazolin, and ceftazidime), CAZ showed the most potent antibacterial activity against Gram-negative bacteria. 2. The mean tissue concentration in the membranes of the maxillary antrum were 31-32μg/g for the interval 30 to 90 minutes after intravenous administration of 1g CAZ. Although the tissue levels gradually declined with the passage of time, the concentration was still 8.6μg/g at 180 minutes after administration. The ratio of tissue level to serum level of CAZ tended to increase with the passage of time. 3. A total of 43 patients received CAZ for clinical evaluation. Clinical effectiveness was evaluated in 39 cases, clinical usefulness in 40 and safety in all 43 cases. The majority of the patients were given a dose of 1 g, twice daily (28 patients, 65.1%) for longer than 5 days, but not exceeding 7 days (21 patients, 48.8%). 4. Both the Efficacy Assessment Committee and the doctors in charge evaluated the efficacy rate (“Excellent” and “Good”) of CAZ to be 74.4% (29/ 39). However, the percentage of “Excellent” cases was higher in the committee evaluation (53.8%). In the assessment by the Committee, the efficacy rate for each type of disease was 86.4% (22 cases) in acute paranasal sinusitis, 69.2% (13 cases) in acute exacerbation of chronic paranasal sinusitis and 25.0% (4 cases) in chronic paranasal sinusitis. 5. When the bacteriological effects were evaluated by case, bacteria were eliminated in all the cases, except for one case with polymicrobial infection (23 cases were assessed). When the evaluation was done by strain (25 strains were assessed), bacteria were eliminated, except for one strain of _{S. intermedius}. The bacterial elimination rates in the above assessments were 95.7% and 96.0%, respectively. 6. Clinically adverse events were observed in 3 cases out of 43 (One each of eruption, loose stool, and palpitation). As for abnormal laboratory findings, one case of increased platelet counts and one case of elevated GPT levels were noted. None of the above adverse events or abnormal laboratory findings were considered to be serious. From the above results, CAZ is considered to be highly useful drug in the treatment of paranasal sinusitis.

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One hundred and two patients at several institutions with peripheral and central vertigo or dizziness were orally administered Dilazep hydrochloride to analyze its clinical efficacy. The evaluation by the attending otolaryngologists show improvement rates as high as 85.3% against subjective symptoms of vertigo or dizziness, 70.0% on objective findings, and 82.7% in total. Scoring assessment also showed high rates of improvement with 89.2% for subjective symptoms, 81.3% for objective findings, and 89.2% in total. The rate of improvement was higher in patients with peripheral vertigo and dizziness than in patients with central vertigo and dizziness. It was similarly higher for subjective symptoms than for objective symptoms. It was also observed that the rate of improvement becomes higher in proportion to the duration of the administration. Safety analysis showed side effects in four of the 106 cases (3.8%), the side effects were temporary and none were serious.

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Beclomethasone dipropionate inhalers (BDI), were used to treat nine cases of non-specific granulomas of the larynx. Although the standard treatment for this condition is surgical removal, the recurrence of these granulomas is very frequent. BDI was examined as an alternative therapy for this ailment. BDI was administered by oral spray in two, 50 microgram per puff doses, four times daily a total daily dose of 400 micrograms for two to six months. In this trial, symptoms and findings improved markedly over the course of six months in seven cases. In three cases, granulomas disappeared within three months. No side effects were noted. We believe that proper post-operative treatment, i. e., a long term resting of the voice, is a very important factor in the cure of this disease, but may be impractical. In these cases, BDI is a very useful therapeutic adjunct for the treatment of non-specific granulomas of the larynx.

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