Olfactory detection and recognition thresholds were assessed in 30 children with normal olfactory sensitivity and in 95 primary school children as part of their health checkup. The conclusions of these olfactory tests are as follows: 1. The olfactometry was done using a simple table which listed word describing the standard odors. This was the best method for testing children with poor sensory experience and poor expression of language. We discovered that we could obtain more accurate responses using this method. 2. We were able to test the olfactory acuity of the primary school children at the health checkup without a deodorizing apparatus. Of the 95 subjects, 5 with chronic sinusitis or allergic rhinitis demonstrated hyposmia. 3. Sex differences in olfactory sensitivity were not found.

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A 60-year old man was successfully treated by total glossectomy without laryngectomy for squamous cell carcinoma on the bilateral margins of the tongue. A latissmus dorsi myocutaneous flap was used to reconstruct the oral cavity. Cricopharyngeal myotomy, Thyrohyoidpexia and anterior traction for the hyoid bone minimized aspiration into the respiratory tract and provided satisfactory swallowing. A 30 frame per second cineflorographic analysis seemed to indicate that pronounced pharyngeal peristaltic action carried the bolus through the hypopharynx into the esophagus. This compensatory mechanism would seem to be important for swallowing after undergoing a glossectomy.

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Eighteen patients with low tone perceptive deafness without vertigo, treated in our clinic during the last 7 years, were clinically studied. The audiometric criteria of the diagnosis were as follows: The total hearing level of the lower three frequencies was greater than100 dB and the higher three frequencies were less than 60dB, or the difference between the higher and lower sets of frequencies was more than 50dB. Patients were divided up into two groups; 10 cases of the non-recurrent type, and 8 cases of the recurrent type-the type considered to be Cochlear Meniere's disease. There were no definite differences in age, sex, subjective symptoms or the hearing level distribution between the two groups. The non-recurrent group demonstrated complete recovery in 4 cases, partial recovery in one case and no change in 4 cases. The condition of the tenth case could not be followed, and remained unknown. The recurrent group demonstrated complete recovery at various intervals between attacks, except in one case. This case developed into typical Meniere's disease. The relationship between low tone perceptive deafness and cochlear Meniere's disease in discussed.

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A case of primary giant paranasal mucocele in the right sphenoidal sinus was reported. A 75-year old man had complained of visual disturbance of the right eye, temporalgia, and bilateral nasal obstruction. We expended six months in diagnosis, and another three months before operating. The wall of the mucocele was resected as much as possible via a transnasal approach, and drainage was routed into the nasal cavity, The patient's visual disturbance did not improve over the three years following the operation, thus highlighting the importance of immediate diagnosis and treatment.

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Diving, in particular, scuba diving, has become a very popular sport among the general public. As the number of amateur divers increase in number, so too have the number of accidents and disorders. Many of these accidents would be preventable if an otologist had examined these divers beforehand, and had instructed them with basic precautions. In this paper, we present some points of clinical importance for otological examination of divers.

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A 55-year old woman suffering from mandibular swelling, dull mandibular pain, gingival swelling with normal surface, lockjaw, hoarseness, dysphagia, headache and marasmus was admitted to our hospital. All laboratory tests, except for anemia, were within normal limits. Physical examination showed that the hoarseness and dysphagia were the results of polyneuropathy (IX, X, XI, Horner syndrome), but the cause was unknown. A biopsy from the mandible revealed a squamous cell carcinoma arising centrally within the jaw. Orthopantomography, CT scan, MRI, ⁶⁷Ga scintillography and bone scintillography of the mandible showed that the polyneuropathy was caused by the invasion of the cancer from the mandible to the skull base, near the jugular foramen, and that the disease was at the T₄ stage. Radiotherapy and chemotherapy improved her condition, but she died of pneumonia. An autopsy was not performed. When encountering a case of mandibular swelling with normal surface, one must suspect central carcinoma arising in the mandible. Definite diagnosis must be established by means of biopsy.

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Two rare cases of small cell carcinoma of the hypopharynx in a 78-year old man and an 81-year old man are presented. Small cell carcinomas account for only 1.4% (2/148) of all hypopharyngeal cancers in patients treated between 1978 and 1986. The most common site of small cell carcinomas is the lung, but the tumors may also rarely occur in extrapulmonary sites. Small cell carcinomas of the larynx in the head and neck are not as rare, with 66 cases reported in the literature. However, small cell carcinoma of the hypopharynx is extremely rare, with only 4 cases reported in the literature. Our cases are the fifth and sixth reported in the world medical literature. Patients with these tumors should be treated with a combination of systematic chemotherapy and radiotherapy. The literature on this neoplasm is reviewed.

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A 55-year old man visited our clinic with a chief complaint of trismus. Clinical examination, including CT scan, and X-ray of the temporomandibular joint revealed swelling of the right medial pterygoid muscle and temporomandibular joint arthrosis. The patient was treated with antibiotics and was fitted with a bite opener. He was discharged on the 21st day.

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Caloric nystagmus of a rhesus monkey in the supine and prone positions was recorded three dimensionally using magnetic search coils. In the supine position, the horizontal component of the first phase of caloric nystagmus beat away from the side of water irrigation, and in the prone position toward the side of irrigation. The torsional component was counterclockwise nystagmus for right ear irrigation and clockwise nystagmus for left ear irrigation, both in the supine and in the prone positions. The direction of the vertical component depended upon the head position and not upon the side of stimulation, i. e., up-beating nystagmus in the supine position and down-beating nystagmus in the prone position both in the right and left ear irrigations. The duration and the course of the first phase of caloric nystagmus for the three components were different for each other. The vertical and the torsional components of the first phase of caloric nystagmus may be generated by the two vertical canals. Consideration should also be given to the possiblity that a velocity intergrator centrally processes canal output three dimensionally.

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It is very important to accurately evaluate neck metastases in head and neck cancer. Although palpation is the basic procedure to detect nodal metastases, diagnostic imaging such as ultrasonography, computed tomography, and others are more useful. Two-hundred-twenty-one cases were examined with ultrasonography to evaluate cervical lymph node metastases. Mass lesions were found in 72 out of 158 cases which were examined at their first hospital visit. Thirty-five lymph nodes from ten cases were removed by radical neck dissection, examined histopathologically, and compared with ultrasonographic finding. There were 17 metastatic lymph nodes and 18 non-metastatic. When the lymph nodes were measured in three dimensions, thickness was found to be the best factor to distinguish metastatic lymph nodes from non-metastatic ones. Lymph nodes thicker than 6mm were considered to be metastatic. It is also emphasized that fine needle aspiration biopsy under ultrasonography can be performed safely. This combination is useful for diagnosing cases in which the lymph node thickness was near 6mm.

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Neurilemmoma is a benign tumor of the sheath Schwann cell. The authors encountered a 40-year-old woman who had a tumor of the tongue. The patient, who complained of swelling of the tongue, came to our clinic. The tumor was successfully removed under general anesthesia. It was encapsulated, elastic and soft, and it was histologically diagnosed as neurilemmoma (Antoni A+B). Clinical and histological findings of the neurilemmoma are discussed.

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Measurements of 29 dimensions and nine angles of the cartilaginous framework of the larynx were conducted with 50 excised human larynges, 10 from newborns (five males and five females), 20 from adults in their 20's (10 males and 10 females) and 20 from adults in their 50's (10 males and 10 females). The purpose of this study was to provide a data base for the dimensions and angles of Japanese newborn and adult larynges and to compare differences between males and females, between age groups, and right and left sides. The results are summarized as follows: (1) In newborns, the dimensions and angles did not differ significantly hetween the two sexes, but in adults, the size and angle were found to be significantly greater in males than in females.(2) In adults, the dimensions and angles did not differ among the two age groups.(3) Morphological change of the laryngeal cartilage differed among the two sexes with age.(4) The laryngeal framework was asymmetrical to a greater or lesser extent in all specimens. In newborns, there was no directional preponderance in asymmetry. In aged adalts, there was a directional preponderance in asymmetry.

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The effectiveness of a new nasal spray, SN-A8C, was examined with another nasal spray (Nabel®) in a double blind study. Each bottle was given an idetifying number, but the contents of each were not revealed to the examiner until after the study was completed. Bothe sprays were sprayed into each nasal cavity of six healthy patients. Reactive changes of color and volume of the inferior turbinate were observed at intervals of up to six hours after the application. Also, the subjects' feelings on application of nasal sprays was inquired over a course of time. Results were as follows; (1) The efficacy of reducing redness and volume of the inferior turbinate was almost the same between the two nasal sprays.(2) SN-A8C supassed Nabel in comfort of application.(3) No side effects could be observed with either medicine. Chemically, the main content of SM-A8C is tetrahydrozoline nitrate, which is the same as Nabel. However, gel has been added to SN-A8C, so that the spray remains longer on the surface of the nasal mucous membrane. It was concluded that SN-A8C is useful, because it is effective longer and is more comfortable to use than Nabel. It is recommendable for cases of nasal obstruction.

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The efficacy, safety and usefulness of ketotifen was investigated in patients with perennial allergic rhinitis. Ketotifen nasal spray (0.05mg/puff) was given to 24 patients with perennial allergic rhintis four times daily (0.40mg/day) for 2 or 4 weeks. In the global improvement rating, 43.5% and 70.0% of the cases were rated as “moderately improved” or better at the end of 2 and 4 weeks of treatment, respectively. As for the safety, there were no cases showing abnormal changes in laboratory tests or adverse reactions, demonstrating the safety of ketotifen nasal spray. The usefulness rating, generated by combining these results, suggests that ketotifen nasal spray is very useful in treating allergic rhinitis.

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Serum Levels of immunological parameters (PHA induced stimulation index, Leu 3a, Leu 2a and Leu 7) were measured in 35 patients with head and neck cancer. Following the initial treatment of the primary and metastatic lesion, the patient received Polsaccharide Kureha (PSK, 3g/day) and an immunological survey was done at every 3 to 6 months. The average PHA stimulation index was relatively low. No significant increase of cellular immunity was determined during the course of PSK administration. In patients with PSK administration alone, the stimulation index by PHA tended to increase at 6 months.

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A clinical study on the efficacy of cefteram pivoxil, a new oral esterized cephem, in treating otorhinolaryngological infections was performed. The conclusions drawn from this study are summarized as follows: (1) Cefteram pivoxil was administered to 97 cases: 42 cases of otitis media, 23 cases of paranasal sinusitis, 16 cases of pharyngolaryngitis, 12 cases of tonsillitis and 4 of other infections. Clinical efficacy was tested in these 97 cases with a daily dose of 600mg.(2) The overall efficacy rate was 70.1% (68/97), i. e., the efficacy rate of chief infections was 69.0% in otitis media, 69.6% in paranasal sinusitis, 68.8% in pharyngolaryngitis and 75.0% in tonsillitis.(3) Side effects were observed in 3 cases: 2 cases with slight diarrhea and 1 case with slight abdominal pain which disappeared upon discontinuation or reduction of the medication.

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