We attempted to clarify the genesis and microstructure of the annular ligament in human stapes with a transmission electron microscope and a scanning electron microscope. Experiment material specimens were prepared by excising temporal bones from cadavers. Target regions were then prefixed and excised, including the stapes and fenestra vestibuli from human embryos (at weeks 10, 13, 15, 18, 20, 24, and 28), adults (40-50 years) and the elderly (60-75 years). Results were follows: 1) Fine collagenous fibers of the S-V joint were observed for the first time at 10 embryonal week. and elastic fibers for the first time at 13 embryonal week. 2) Fibroblast cell density in the S-V joint declined in proportion to genesis progression. Distribution of the fibrous component of the S-V joint in adults was the greatest directly under the mesothelial cell layer and less in the middle layer. 3) It was assumed that between 24 and 28 embryonal weeks that the structure of the S-V joint reached its adult state. 4) Observation of the site linking the fibrous bundle to the marginal cartilage suggested that linkage would be more solid in the elastic fibers than in the collagenous ones. 5) As age increased, collagenous fiber volume tended to increase and fibrous bundle course to become more irregular.

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The morphological process of wound healing following abrading of rat laryngeal mucosa with a homemade knife was observed both light and electron microscopically, and the following results were obtained.
1) Repair of the mucosal epithelial defect was initiated from migration of residual basal cells in the surrounding tissue onto the denuded epithelial surface, proceeded with their proliferation and differentiation, and was completed 21 days after sustaining the injury.
2) The regenerated epithelium tended to be excessively hyperplastic and showed an increased number of cells having the capacity of proliferation up until 10 days after abrasion.
3) Tonofilaments in their well differentiated form were seen in those cells of the regenerated epithelium which retained mitotic activity with a derangement of cell differentiation as seen in cancer cells being noted transiently.
4) In the regenerated epithelium there was noted hyperplasia of hemidesmosome and anchoring fibril of a transient duration which made the epithelium look like epidermis morphologically. This phenomenon was considered as “transitory epidermal metaplasia”.

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Damage and repair occurring in the tracheal mucosa following intratracheal intubation were morphologically observed in rats. In the non-treated group, the blood vessel count along the long axis of the trachea from one round of the tracheal wall yielded 117 vessels in average number. The vessels consisted of small artery (3.4%), arteriole (10.3%), capillary (46.2%), venule (31.6%) and small vein (8.5%). In the intubated group, on the second post-intubation day, the vessels increased to 281 in average number, and the proportion of different vessel types was also changed, showing that the capillary and venule were served in the most frequency. Increases in the mitosis of various types of cells, vascular hyperplasia, vasal congestion and the number of neutrophils suggested the occurrence of inflammatory reaction. On the third week after intubation, both the vessel count and the proportion of defferent vessel types, returned to normal. Inflammatory reaction also disappeared, and no granulation or tracheal stenosis was remained.

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A piece of dry temporal fascia were used for experimental myringoplasty following the total removal of the tympanic membrane in twenty one guinea pigs. Then we killed and removed the reconstructed tympanic membranes from the guinea pigs at the intervals of 4, 9, 12, 18, 24, 54 and 100 weeks and observed using a transmission electron microscope. After myringoplasty, the temporal fascia implanted were replaced by nonspecific inflammatory granulation tissues in the early stage and gradually underwent consolidation of the scar tissue. The specific fine fibrils in the tympanic membrane which were quadrangular and less than 10 nm thick did not appear in the restored tympanic membranes. Usual collagen fibrils, which were rarely seen in the normal tympanic membrane, dominated in the fibrous connective tissues of the restored tympanic membranes. The component of the restored tympanic membrane in the myringplasty was indicative of cicatrice tissue.

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The pure tone threshold (PTT) changes in 13 patients with surgically identified perilymph fistula from the round window were compared with those in 7 patients suspected of having a perilymph fistula.
The changes of the PTT after the first audiometry were quite different from the patients with surgically dientified fistula and those with suspected fistula. The PTT in the patients received surgery showed severe hearing loss and exhibited only slight changes until the surgery. Whereas the PTT in the patients without surgery improved quite rapidly after they have received conservative treatments.
The prognosis of the hearing acuity was clearly better in the patients who received surgery shortly after the onset of the disease. The elevation of the hearing acuity in the patients with good prognosis of the hearing was started approximately from the 10 days to 2 weeks after the surgery. After one month of the surgery, the PTT showed relatively stable values.
Thus, when a patient who suspected having a perilymph fistula shows no or only slight improvement of the PTT, in spite of receiving conservative treatments, the surgical procedure should be chosen immediately.

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The causes of the diseases, the execution rate of the neurotological examinations, and the incidence of the abnormal findings of the examination were analyzed and discussed in children under 15 years compared to those in adults. Two hundreds and sixty-two children and 2, 307 adults ranging age from 20 to 39 out of 7, 500 patients who received the neurotological full examination were the subjects of this study.
The frequency of the central lesion was higher in children than that in the adults. This fact reflected to the incidence of the abnormal findings in the neurotological examination. That is, the abnormal findings could be seen with high rate in the eye movements observation and the auditory brainstem responses. The ENG recordings, however, were not able to perform occasionally in young children. Thus, the VTR system using small CCD camera is a quite useful tool for recording eye movements especially in young children.

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Sudden deafness was treated with low molecular weight dextran (LMD) and prostaglandin E₁ (PGE₁) for a comparative study with the steroid therapy. As a result, the complete recovery and remarkable improvement of hearing was noted in 68.1 percent in the LMD and PGE₁ group against 49.6 percent in the steroid therapy group. In patients who received these treatment more than seven days after the onset, the incidence of the complete recovery and remarkable improvement of hearing was significantly higher in the LMD and PGE₁ group than in the steroid group. A significance was recognized between the LMD and PEG₁ group and steroid group in cases of severe hearing loss with the hearing level at the first visit being 61 to 90 dB. The results above suggest that a combinational use of LMD and PGE₁ may be useful.

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Total of 1, 642 patients of nasal allergy were examined as to whether or not there were any side effects during immunotherapy. Only 17 patients had side effects during immunotherapy and there were no fatalities. Six of the 17 patients had history of asthma. Known errors of administration accounted for side effects in 5 patients. Twelve of the 17 patients had a high degree of skin sensitivity (2+ or greater on previous skin test). Ten of the 17 patients had side effects when the immunotherapy dose was increased gradually in the first three months. The time of onset of the reaction was less than 30 minutes in 9/17, more than 30 minutes in 2/17, and not reported in 6/17. From the above study we can infer that immunotherapy is a safe method for treatment of allergic rhinitis.

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We herein reported two patients of extremely pseudocroup. Case 1: A seven year old boy had yellow viscous pus resembling a pseudomenbrane in the glottis bilateral and severe mucosal swelling in the subglotlis. This dyspnea did not respond to inhalation and other treatments, and binally underwent an emergency tracheostomy. Cases 2: A 12 month old girl underwent endotracheal intubation, without satisfuctory improvement of dysprea because the tube was easily obstructed by profuse bloody sputum and finally tracheostomy was carried out. Chest X-ray revealed no causatine abnormal finding. These two case seem to come under the category of bacterial tracheitis, discribed by Jones et al, in 1979. Etiology of this disease remains unknown. Staphylococcus aureus is often detected, as in case 1. Laryngofiberscope was useful in diagnosis, and tracheostomy was necessory to relieve dyspnea.

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Of 285 ears which were operated on for chronic otitis media between January 1980 and March 1989, the postoperative prognosis of 174 ears was followed up for one year or more. 1) Postoperative hearing was still spontaneously changeable in some patients of type III and IV operations one year or more following surgery. 2) Improvements of hearing loss were not different to any significant extent depending upon whether or not the patient had otorrhea or cholesteatoma before surgical treatment, but were different depending on the lesion around the stapes. 3) Malleostapediopexy for type III operation produced satisfactory results. In cases of type IV, combined skin and cartilage flap of the external acoustic meatus proved useful for preventing the rejection of Apaceram® used for columell. 4) There were differences in the type of microorganisms in otorrhea before and after surgery.

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Three ears in two patients of congenital ossicular anomalies without deformities of the external canal and auricle, which suggested the dominant inheritance, were reported. The lack of long process of incus and adhesion of a small oval bone at the head of stapes instead of the lenticular process were observed in three ears. Stapes and malleus handle showed normal structure, and footplates of stapes were mobile. From these surgical findings, it was suggested that these anomalies were caused by disturbance of conjunction of stapedial lobe and incudal genesis in the sixth or seventh embryonic week. The lenticular process was supposed to be developed from stapedial lobe.

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Twenty cases of papilloma of the nasal cavity and paranasal sinuses treated at our facility for 13 years from 1977 to 1989 were studied. For each of these cases, clinical signs, macroscopic tumor appearance, treatment modality, operative findings, pathological features and prognosis were examined. As a result of this study, the following observations were made; 1. No characteristic clinical signs were noted for nasal and paranasal papilloma. Macroscopic tumor appearance at the time of initial examination was most useful for diagnosis, the following features being highly suggestive of papilloma;(a) tumors with an irregular surface and variable sized granular appearance;(b) poorly transparent salmon-pink tumors tinged with white,(c) tumors with a friable surface and ready tendency to bleed, but lacking crusts and ulceration. When suspected to be papilloma by macroscopic findings, a biopsy is requisite. 2. Total excision of the tumor by lateral rhinotomy is a method of choice. 3. There were broad-based and pedunculated tumors. 2 cases originating in the nasal septum demonstrated broad-based tumors. 8 cases demonstrating pedunculated tumors. 6 originated in the middle turbimate 1 each originated in the maxillary sinus and ethmoid sinus. 4. On light microscopy, both inverted papilloma and exophytic papilloma was combined in the same case. No correlation existed between macroscopic growth pattern and histopathological findings.

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The traumatic tympanic membrane perforation by the earpick is not rarely observed in daily ENT clinic. Generally it has no serious complication. But sometimes brings the dislocation of ossicles, inner ear injury and so on. The facial palsy, however, is rare complication of this condition. We reported a rare case of traumatic tympanic membrane perforation not only with inner ear injury, but also with facial palsy by earpick. The facial palsy appeared immediately after the trauma, so decompression of facial canal was performed quickly. Facial canal bone was fractured and the part of the sheath was teared. The distal end of facial nerve was opened. But the nerve itself was not seriously damaged. From the findings during surgical procedure and other examinations, we speculated that the inner ear injury was caused by indirect force through ossicles. After the surgery, facial palsy and inner ear function recovered almost completely.

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