Eustachian tubal function was determined in two age groups: children from 4 to 14 years old and adults from 23 to 74 years old. The test group of children consisted of 224 normal ears while the test group of adults consisted of 106 normal ears. Tympanometric tests were performed on 1, 484 children from 4 to 11 years old who attended either preschool or elementary school. A retrospective analysis was done of patients diagnosed with otitis media with effusion (OME) who first visited our outpatient clinic from 1988 to 1992. 1) The beginning age of change in the Eustachian tubal function from the pressure opening type to the swallowing dependent adult type, regarding the decrease in the incidence of type C and type B as well as a reduction in the number of OME cases, was found to be 8 years old for all test groups. 2) A deterioration of the Eustachian tubal function began from the age of fifty. As a result, adult type OME occurred more often in those patients over fifty.

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Auditory brainstem response (ABR) testing has been a major tool in the diagnosis of neurootogenic diseases like the acoustic tumors, because of its high sensitivity. Several investigators have reported the sensitivity of ABR testing in the diagnosis of acoustic tumors as 90% or greater. Recently, with the availability of improved imaging modalities, some patients who had normal ABRs were diagnosed to have acoustic tumors. Some investigators have therefore reported that ABR had a much lower sensitivity than expected. To evaluate these reports, a series of 50 cases of (55ears) acoustic tumors who attended the out patient clinic at the Nippon Medical School were analyzed. The ABR abnormalities were classified into one of the following categories: 1. Partial wave disappearance. 2. Prolongation of the latency, wave I to V. 3. No response. I lears (20%) showed partial wave disappearance. 27ears (54%) showed prolongation of the interpeak latency, wave I to V. 16ears (30%) showed no response. Thus, all patients with acoustic tumors had abnormal ABRs in our series. Our results suggest that ABR testing when carried out by specialized hands is a valuable method in the screening of acoustic tumors.

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This open method as an operative technique is useful for primary cholesteatoma but there are some postoperative problems which are caused by the opened mastoid cavity. Mastoid obliteration, using the retroauricular pedunculate connective tissue flap (RPCTF) or RPCTF with an inferior tubinate mucosal graft, was performed on 26 patients (28 ears) with either primary cholesteatoma (16 ears) or mastoid cavity problems (12 ears) during the period from June 1991 to December 1993. For 16 ears (cholesteatoma: 9 ears, mastoid cavity problems: 7 ears) a mastoid obliteration using RPCTF was performed. For 12 ears (cholesteatoma: 7 ears, mastoid cavity problems: 5 ears) mastoid obliterations using RPCTF with inferior tubinate mucosa were performed. No reccurence was observed in 16 cholesteatoma patients inclnding 21 ears in which tympanoplasty was performed, and the postoperative hearing was good in 14 ears (67%). Postoperative problems after the mastoid obliteration included: otorrhea in 4 eais (14%), ear drum retraction in 6 ears (21%) and drum perforation in 1 ear (4%). Mastoid obliteration using RPCTF with inferior tubinate mucosal graft is easy and useful for the reconstruction of the tympanic cavity and posterior wall of the external auditory canal.

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A series of 27 patients with nasal allergies treated with 80% w/v trichloroacetic acid application to the inferior turbinate were evaluated prospectively. A significant improvement was obtained in the allergic symptoms, especially in nasal obstruction and watery rhinorrhea. Long term satisfactory results were obtained when the anti-allergic medicine was taken regularly. No severe side effects were observed after application. Based on these observations, the local application of trichloroacetic acid is thus considered to be an effective, safe and simple treatment for out-patients suffering from nasal allergies.

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Three cases of cervical and mediastinal emphysema caused by vocal exercise are reported. There have been several reports of mediastinal emphysema complicating asthma, but such cases caused by vocal exercise are very rare. Mediastinal emphysema is thought to develop in the following way: There is a sudden increase in the airway pressure which then results in high pressure on the alveoli, and this causes a rupture of some alveoli, and, as a result, air then leaks into the pulmonary stroma. Such emphysema of the pulmonary stroma thereafter develops into mediastinal or cervical subcutaneous emphysema. Based on the findings of other reports, we therefore consider that the damage of the cervical trachea observed in these cases might thus be one of the origins of mediastinal emphysema.

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A case of 57-year-old male complaining of the right cheek swelling and pain was reported. Image diagnosis consiting of X-p, CT scan confirmed a sialolithiasis of the parotid gland locating at the anterior end of the gland. For the extraction of the stone, transcutaneous approach was employed. During the operation, careful dissection of the cutis and gland was required for avoiding facial nerve injuring. Preoperative staining of the Stensen's duct was effective to differentiate the duct from the nerve. After the extraction of the stone a draining tube was set through the duct. Postoperative course was uneventful. This technic is convenient for the surgical treatment of the stone locating in the duct over the masseter muscle.

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A rare case of irritated seborrheic keratosis of the right external auditory canal is reported. A 17-year-old male complained of bloody otorrhea and pruritus. A dark brownish verrucous mass with a papillomatous surface was recognized in the posteroinferior aspect of the external auditory canal, and it was soft and hemorrhagic. The audiogram was within the normal range, and an X-ray examination showed a good pneumatization in the mastoid without any pathology. A CT scan demonstrated a narrowing of the external auditory canal due to the mass. Histologically the mass exhibited parakeratosis acanthosis, many squamous eddies and mild chronic inflammatory cell infiltration, and was thus diagnosed patholigically as irritated seborrheic keratosis. Extirpation was done under local anesthesia. Following the removal of the mass no complications or signs of recurrence have observed in the subsequent four years and four months.

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We report a case of retropharyngeal abscess with dyspnea in infant. This case was a 11 months-old boy and he was hospitalized to pediatrics complaining of left submandibular swelling and fever. The following day he was introduced to our department due to dyspnea. X-ray examination and flexible endoscope led the diagnosis of retropharyngeal abscess. Symptoms were remarkably improved after an emergent drainage by an intraoral approach under general anesthesia, and the following antibiotic therapy led the complete recovery after three weeks. The importance of the early diagnosis and treatment of this disease was discussed.

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When an air-conducted sound is loaded into one ear, the sound reaches the same inner ear via the external and middle ear which is the so-called air-conduction pathway. We thus define conduction loss (CL) as the relative loss of sound transmission in a damaged air-conduction pathway with conductive disorders in an intact air-conduction pathway. In most cases the Air-Bone gap (A-B gap) is equal to the CL. However, when the CL exceeds the interaural attenulation for air conduction (IaA), then the A-B gap is equal to IaA. Therefore, the A-B gap never exceeds IaA (A-B gap ≤ IaA). This relationship is therefore potentially considered to be of great importance for masking in pure tone audiometry.

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The present study was conducted to clinically evaluate grepafloxacin (GPFX) in the treatment of otorhinolaryngologic infections, and the following results were obtained. 1. The clinical efficacy was 88.3% for otitis media, 80.0% for otitis externa, 83.7% for sinusitis, 84.6% for tonsillitis, 80.0% for other infections, and 85.1% overall. 2. The bacteriological efficacy by clinical isolate was 91.2% for Gram-positive bacteria, 94.4% for Gram-negative bacteria, and 91.3% overall. 3. Adverse drug reactions, mainly consisting gastrointestinal symptoms, were reported in 9 of 150 patients (6.0%). Abnormal clinical laboratory test values, mainly an increase in s-GPT, were found in 6 of 83 patients (7.2%). 4. The usefulness of GPFX was 85.2% for otitis media, 72.7% for otitis externa, 88.4% for sinusitis, 84.6% for tonsillitis, 80.0% for all other infections, and 84.0% overall. Based on the above tindings, GPFX is there fore considered to be useful in the treatment of otorhinolaryngologic infections.

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