We studied the localization of α2, 8-linked polysialic acid (PSA) and the neural cell adhesion molecule (N-CAM) in the guinea pig cochlea by immunohistochemistry. The mouse monoclonal antibody 735 (MAb735) used in this study has specifically recognized PSA with 8 or more residues. Various cochlea regions showed the colocalization of PSA and N-CAM. Strong immunoreactivity for PSA was seen in such regions as the spiral ganglion cells, the stria vascularis, interdental cells and the tunnel spiral bundle. The staining of the tunnel or inner spiral bundle was stronger than that of the outer spiral bundle. The differences in reactivity with MAb735 between the inner and outer spiral bundle seemed to be related to anatomical differences in which 85-90% of the afferent fibers went to the internal hair cels, while the remainder went to the external hair cells. Strong immunoreactivity for PSA was also observed in the region around the vessels of the plexas cochlearis, which were negative for N-CAM. These findings therefore suggest the presence of PSA in the nerve endings around the vessels.

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The chronological developmental processes of both the endocochlear potential (EP) and the negative endocochlear potential (-EP) were investigated in the basal cochlear turn in ICR-strain mice. The EP developed from 5 to 17 days after birth (DAB). The -EP first attained its mature level on 11 DAB and then increased its negativity between 12 and 16 DAB, but thereafter recovered to its mature level again on 20 DAB. The rate of EP decline during anorexia increased rapidly from 10 DAB, and closely coincided with the day in which the EP began to increase abruptly. The intracellular potentials in the cells in the stria vascularis were measured in the 15 DAB mouse using a hydraulic autodrive micromanipulator. The positive potentials; 44mV and 80mV were observed in a stepwise fashion, while the microelectrode penetrated through the stria vascularis before it could advance into the scala media. A histological investigation revealed that while measuring the EP the microelectrodes used in this study thus clearly advanced into the scala media by penetrating through the spiral ligament and the stria vascularis.

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The purpose of this study was to measure the intracellular free Ca²⁺ concentration ([Ca²⁺]i) in the stria marginal cells of the guinea pig.[Ca²⁺]i in the stria marginal cells was measured using microfluorescence method. Ca²⁺ sensitive dye Fura-2 was microinjected into the stria marginal cell. The resting [Ca²⁺]i in the stria marginal cell was about 100nM. In addition, using the same specimen, the resting [Ca²⁺]i in the stria vascularis was then also measured. The specimen was loaded using the external standard solution containing Fura-2/AM. The value of the resting [Ca²⁺]i in the stria vascularis was almost the same as that in the marginal cell.

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The purpose of this study was to investigate whether or not amidotrizoate (ATZ) combines with positive charged marginal cells in the stria vascularis. We presume that ATZ acts as a barrier in combination with pathological endothelial cells which demonstrate positive charges in sudden deafness. ATZ was perfused into the cochlea duct in guinea pigs anesthetized with ketamine/xylazine. After 1% silver lactate made ATZ insoluable with 6 fixations, AG-particles in the tissue were observed by an electron microscope and then were compaired between ATZ group and control group. The Ag-particles were not observed to specificaly be combined with the endolymphatic surface of the marginal cells in any fixations. The number of Ag-particles in the strial component cells in the ATZ group were more than those in the control group after one fixation. These findings thus suggested that the combination of ATZ and marginal cells might not be strong enough and, as a restlt, ATZ might thus invade the stria vascularis.

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The present study was performed to investigate the effects of asphyxia and furosemide (80mg/kg) on the cochlear potentials (SP, CAP). A silver ball electrode was placed at the round window. The sound stimuli consisted of tone bursts of 4kHz, 8kHz and 16kHZ which were presented through a closed system. The reactions of the SP and CAP to asphyxia closely paralleled the EP changes previously reported.
However, the recovery of the SP change due to a furosemide injection was found to precede that of the CAP change. The higher frequency showed a slower CAP threshold recovery. The enlarged SP/AP ratio during EP recovery might therefore be a possible electrocochleographic parameter for the satisfactory prognosis of sudden deafness.

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The ototoxicity of cisplatin (CDDP) and cis-diammine glycolato platinum (nedaplatin) were evaluated using electrophysiological and histological methods. Guinea pigs were treated with an intravenous injection of CDDP and nedaplatin, respectively. The dose of each drug was 12.5mg/kg and was administered with a one shot injection. An elevation of the threshold and the lack of any response in the preyer's reflex throughout all frequency ranges were observed in the CDDP group. The elevation was limited in the high frequency ranges and the recovery after the elevation was observed in the nedaplatin group. The endocochlear D. C. potential (EP) value was not significantly different between the two groups. The negative EP values were -12.2±8.9mV in the CDDP group and -25.9±10.2mV in the nedaplatin group, and thus were significantly different (P<0.01). The collapse of the stria vascularis and the degeneration or disappearance of outer hair cells were observed while slight histological changes were also observed in the nedaplatin group. These results suggest that nedaplatin may thus have a slight ototoxicity and may therefore be useful as a clinical drug.

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A series of patients is reviewed who all presented with sudden deafness over the past 19 years and were successfully treated with amidotrizoate infusion. The results of the amidotrizoate treatment were as follows: 38.8% had a complete recovery, 23.4% a marked recovery, 18.0% a partial recovery, and 19.8% were unchanged. The findings after a single infusion of amidotrizoate were 52.6% had a complete recovery, 21.1% a marked recovery, 11.8% a partial recovery, and 14.5% were unchanged. Amidotrizoate therapy is thus characterized by a high complete recovery, a rapid efficacy in patients usually presenting within 7 days, an effective improvement in the dip and down slope audiogram shapes, a good improvement with no vestibular symptoms, and effective improvement after receiving the amidotrizoate therapy. Finally, none of the patients in our study suffered any serious complications.

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Since 1990, 36 postlingually deaf adults, including one case of binaural implantation, have been treated with a Nucleus 22-channel cochlear implant. The patients showed satisfactory results in monosyllable, word and sentence recognition scores of 61%, 67%, 75%, respectively, in auditory-visual tests. However, more than half of all patients also complained of hearing annoying background noise while listening to TV or talking on the telephone. The patients who demonstrated a less than 50% monosyllable recognition score were all over 40 years of age at the time of implantation and also had a higher T-level than average.

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Facial nerve stimulation due to an activated electrode array is known to be a potential side effect which can occur following successful cochlear implantation. It may result in a deterioration of sound quality due to a limitation in the dynamic range of the implant. However, the precise mechanisms of this complication still remain to be clarified. Out of 26 adult patients who received the Nucleus 22-channel cochlear implant system in our department from 1990 to 1995, we observed facial nerve stimulation in 2 cases. Both patients noted facial nerve stimulation upon the activation of apical electrodes when the devices were first programmed. The low-impedance current pathways from the scala tympani to the labyrinthine and/or internal auditory canal segments of the facial nerve are apparently enhanced by osteoporotic changes due to either acoustic tumor surgery or labyrinthine syphilis. Such pathological CT findings, especially arround the cochlear capsule, may therefore help predict a greater risk for developing postimplantation facial nerve stimulation.

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The replies to a questionnaire on tinitus in 36 cochlear implant patients were analyzed and evaluated based on the effect of tinnitus suppression following cochlear implantation. Both tinnitus aurium and tinnitus cerebri preceded cochlear implantation in 92% of all patients. After implantation, tinnitus was effectively suppressed with a device in 79% of the operated ears and in 69% of the unoperated ears. Moreover, 45% of the operated ears and 42% of the unoperated ears revealed decreased tinnitus with no speech processor. It is thus considered that the main factors for tinnitus suppression following cochlear implantation included: 1) the so-called masking effect, 2) the suppression of the erethism on the acoustic nerve by electric stimulation, 3) the patient's mental condition and 4) the stimulation of the brainstem and the afferent acoustic nerve fiber. Based on the above findings, the daily use of a device for cochlear implantation may thus allow for a permanent release from tinnitus.

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Total bilateral deafness is a catastrophic but inevitable consequence for most patients with bilateral acoustic neuromas or with an acoustic neuroma found in the only ear with some remaining hearing ability. Since deafness due to an acoustic neuroma is not always associated with complete neural loss and thus a cochlear implant may restore hearing, an attempt should be made to save the cochlear nerve function, especially on the side with a positive response to electrical promontory stimulation. The therapeutic strategy using a Nucleus 22-channel cochlear implant in the treatment of a bilateral acoustic neuroma deafened patient is described.

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The extratympanic recording of electrocochleography (ECochG) has played an important role in the differential diagnosis of various inner ear diseases. We thus performed tympanic ECochG in patients with Meniere's disease before and after the oral administration of glycerol. The enlarged summating potential/action potential ratio in patients with Meniere's disease was shown to significantly decrease after the oral administration of glycerol. We also performed tympanic ECochG in combination with intraoperative monitoring in hearing prevention surgery for acoustic neuroma. The AP responses were clearly recognized with relatively small number of stimulus repetitius even in the relatively noisy operating room. WE therefore confirmed the usefulness of the tympanic ECochG in the glycerol dehydration test as well as in the intraoperative monitoring of the auditory function during acoustic neurinoma surgery.

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Twenty-four ears with low-tone sensorineural hearing loss were studied using tympanic electrocochleography, in order to evaluate the diagnostic significance of the summating potential/action potential (SP/AP) ratio in response to alternative clicks and the AP latency difference to condensation and rarefaction clicks. The patients were clinically divided into two groups ; consisting of 7 with acute low-tone sensorineural hearing hearing loss with-out threshold fluctuation, and 17 with Meniere's disease. Taking the mean +3SD as the normal upper limit, and abnormal increase in the SP/AP ratio or the AP latency difference was found in 10 cases with Meniere's disease. On the Other hand, the average SP/AP ratio decreased significantly in acute low-tone hearing loss patients without threshold fluctuation, thus suggesting a different pathological condition from Meniere's disease. In 2 cases, although the SP/AP was within the normal range, we found a relative increase in the SP/AP ration compared to that in the contralateral ears. It is therefore concludedt hat tympanic electrocochleography is just as useful as transtympanic electrocochleography in clinically diagnosing endolymphatic hydrops.

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The enhanced MRI hearing findings of the inner ear in 124 patients with sensorineural hearing loss were evaluated. MR images were obtained before and after the intravenous administration of gadolinium (0.1mmol/kg). In three out of seventy-nine patients with unilateral healing loss, cochlear and/or the vestibular enhancement was noted on the symptomatic side. The positive cases included those with Ramsay-Hunt syndrome, mumps and so-called sudden deafness. Forty-five patients with bilateral hearing loss showed no enhancement within the inner ear. Although positive gadolinium enhancement of the inner ear may detect inflammatory lesions due to a viral infection, its incidence in sensorineural hearing loss, including cases of sudden deafness, seems to be extremely rare.

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A variety of adverse effects including tinnitus and sensorineural hearing loss have recently been reported with the long-term use of interferon (IFN). We thus attempted to conduct a prospective study concerning the occurrence of IFN induced sensorineural hearing loss. Thirteen patients were studied with pure tone audiometry before, during and at least one month after IFN therapy. Temporary auditory disability of more than 20dB threshold shifts were found in 5 cases. The threshold changes were limited to high frequencies in all cases except for a case with a C5-dip showing a threshold elevation at 2kHz. In 2 affected patients the blood triglyceride levels were markedly elevated after IFN therapy, thus suggesting that a microciculatory dysfunction in the cochlea or lipidosis of the basilar membrane may play a role in IFN induced sensorineural hearing loss.

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We assessed the audiograms of 13 Kendo athletes who were identified out of 506 outpatients with sensorineural hearing loss (SNHL) due to unknown causes. Abnormal audiograms whith a dep demonstrated at either 2kHz or 4kHz were found to feature the early stages of SNHL caused by Kendo (Japanese fencing) Ears with A 4kHz-dip are obviously caused by a loud hitting sound during Kendo practice, however, the causal relationship between Kendo and SNHL with a 2kHz-dip has yet to be clarified. We therefore retrospectively investigated the past history of SNHL patients with a 2kHz-dip. More than half of them had a history of minorhead contusions due to various kinds of accidents as well as due to injuries sustained during regular Kendo practice sessions. These results thus indicate that a 2kHz-dip can be caused by a shock when a person is hit in the head by a bamboos word (“Shinai”) during Kendo practice.

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We herein reported on inner ear anomalies which were found by high resolution CT scanning of the temporal bone with hearing loss. We investigated the time of occurrence for such abnormalities of the inner ear and the relation between the anomalies and the degree of hearing loss. We thus considered that it is more difficult for inner ear anomalies to occur before the 11th week of viviparity, when the cochlea is completed, than after that time. The degree of hearing loss was also found to be related to the extent of cochlea anomalies.

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The cause of sensorineural hearing loss associated xeroderma pigmentosum remains to be clarified. We herein report the results of a neuro-otological assessment of a 7-year-old girl, with group A xeroderma pigmentosum, who showed bilateral basin-shaped sensorineural hearing loss (right 80 dB, left 64 dB). The relatively good speech discrimination scores (right 80%, left 40%) and an ABR with normal morphology and latencies thus suggested cochlear deafness rather than retrocochlear deafness. Tone decay in impedance audiometry and saccadic intrusions in an eye test indicated the involvement of the higher auditory pathways, however, a hearing aid was success-fully fitted into this patient who has since been using it for 2 years. Because hearing loss in xeroderma pigmentosum usually develops between five and seven years of age, repeated hearing tests are necessary for the timely management of hearing loss with auditory amplification. Further studies are called for concerning the mechanisms of hearing loss and to also identify the optimal treatment strategies against a rapid progression of deafness in xeroderma pigmentosum.

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In order to study the developmental patterns of the middle ear space, we utilized a computerized three-dimensional reconstruction method to observe human fetal bones various embryological stages. The observed structural variations of the middle ear compartments, such as the supratubal recess and the attic, appear to result from differences in the degree of expansion of the four sacci (consisting of the anticus, medius, posticus and superior sacci) which originate in the first pharyngeal pouch.

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The supratubal recess (STR) is one of the partitions which make up the anterior aeration route of the middle ear and is considered to continue to develop after birth. To evaluate the mesenchymal tissue (MT) in the STR, an immunohistochemical study of vimentin was performed to determine the various developmental stages of the human temporal bone. Normal temporal bone sections, routinely embedded in celloidin from 1 day after birth to 2 years, were used in this study. Sections were then placed on glass slides. After the removal of celloidin by clove oil and graded alcohol, the sections were placed in hot water (90C) and immersed in 0.3% Triton-X-100 for retrieval. Anti-vimentin antibody (Sigma V9) w as used as the primary antibody according to the ABC method. Thereafter, the specimens were observed under light microscopy. Positive staining for vimentin was observed in the sparse area of the MT apart from the aerated area of the STR at the early stages of development. On the other hand, the dense area of MT adjacent to the aerated areas of the STR at a later developmental stage demonstrated negative staining for vimentin. These results may thus indicate that the absorption of MT with weak cell to cell contact is therefore independent of the aeration of the STR in the developmental stage.

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A new type of stapes prosthesis made of nickel-titanium shape memory alloy was developed and its biocompatibility was examined in twelve dogs. The prosthesis was implanted at the long crus of the incus. Seven ears in five dogs were implanted with the Teflon coated prostheses, while eight ears of seven dogs were implanted with non-Teflon coated prostheses. In addition, four ears of four dogs were operated on without implantation as controls. The dogs were re-operated and the incudes were examined from 88-198 days after implantation. In all ears, the prosthesis was macroscopically found to be well implanted at the desired position. One specimen at 93 days after implantation with a Teflon coated prosthesis and one specimen 97 days after implantation with a non-Teflon coated prosthesis were examined by a scanning electron micrograph. The other were prepared for histological examinations using a light microscope. Based on the microscopic observations in all Teflon coated group ears, the prosthesis was encapsulated with fibrous tissue and was well fixed at the long crus of the incus. The non-Teflon coated group showed young granulation tissue associated with hematoma and myxomatous tissue around the prosthesis. Although the biocompatibility of Ni-Ti alloy remains questionable in regard to its long term implantation, the Teflon coated prosthesis proved to be useful for the stapes prosthesis with a good biocompatibility.

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One hundred and fourteen ears of acquired cholesteatoma were examined using high resolution computed tomography (CT) before and after undergoing canal wall tympanoplasty (ICWT) with an anterior tympanotomy. Several factors revealed to affect the postoperative middle ear aeration. The major factors were as follows; (1) the age at the time of operation,(2) the preoperative aeration in the mastoid, and (3) the surgical findings of the intact stapes superstructure and well-developed mastoid air cells. The minor factors were as follows; (1) preoperative aeration except for the mastoid,(2) the surgical findings of the type of anterior attic bony plate,(3) the type of cholesteatoma (attic or adhesive),(4) the existence of sinusitis and (5) the pathology of the opposite ear. All of factors might be either directly or indirectly associated with the tubal function, the extent of the preservable intratympanic mucous membrane and the patency of the middle ear cavity.

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The eustachian tubal functions were preoperatively examined by a tubal function meter in patients who were scheduled to undergo middle ear surgery for chronic otitis media, cholesteatoma, and other procedures at our department. The results were then compared to the inflation in the Eustachian catheter and CT findings of bony tubal pneumatization. Furthermore, the relationship between the tubal function and the postoperative prognosis was also explored. Tubal stenosis was more frequently suggested by the tubal function meter than by either a catheter or CT. Seven out of nine poor post-operative prognoses showed tubal stenosis in the tubal functional test, and most of them also preoperatively showed abnormal results in inflation by both the catheter and CT findings. In all seven cases, either organic stenosis or an obstruction of the tube was recognized at surgery. Based on these results, it was thus concluded that the tubal function test, inflation by catheter and CT are thus all necessary for an improved prognosis prior to middle ear surgery. However, the two cases with a poor prognosis did not suggest tubal stenosis in any examination. This is considered to be due to the fact that we did not evaluate the drainage ability but mainly the ventilation ability of the eustachian tube in this study.

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In 386 ears with chronic otitis media, who underwent tympanoplasty during the last 10 years in our department, the postoperative hearing results and the condition of the reconstructed tympanic membranes were analyzed. Tympanoplasty Type I, modified Type II, modified Type III and modified Type IV were performed in 338, 3, 36 and 9 ears and the success rates in hearing were 90.5%, 100%, 80.6% and 44.4% respectively. The sclerotic lesions were located in the tympanic membrane in 122 ears (31.6%), around the malleus in 62 ears and on the malleo-icudal joint in 103 ears. In 185 ears with tympanosclerosis, tympanoplasty Type I was performed in 155 ears, modified Type II in 3 ears, modified Type III in 24 ears and modified type IV in 3 ears. In the cases undergoing tympanoplasty Type I, we compared the hearing improvement between the cases with tympanosclerosis and the cases with chronic simple otitis media. Anterior spinotomy and atticotomy were thus found to be good procedures for chronic otitis media with tympanosclerosis in the core demonstrating incomplete positive findings for the patch test. Postoperatively a permanent perforation was observed in 18 ears (4.7%), but no severe complications were observed.

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From 1977 to 1995, tympanoplasty was performed on 18 patients (20 ears) with a perforation of the tympanic membrane following intubation for OME, The ration of success for tympanoplasty was 85 percent, while the failure ration was 15 percent. We investigated the failed cases in detail and discussed some of the potential causes. We thus concluded that a good tubal function before surgery was the most important factor for successfully performing tympanoplasty in such cases.

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A total of 81 patients (104 ears) with otosclerosis were operated on with two different methods of stapes surgery. Fifty-six operations were done using the “total stapedectomy”(TS) technique and forty-eight were done using the “partial stapedectomy”(PS) technique. The postoperative hearing results of the two groups were then compared. The average postoperative air-bone (AB) gap for the three speech frequencies was 5.7 dB in the TS group and 4.0 dB in the PS group. The percentage of successful hearing results was 83.8% in the TS group and 91.7% in the PS group. No significant difference was noted in the short-term functional results between the two groups. The long-term results (ranging from 2-13 years) were evaluated using 35 TS cases and 21 PS cases. Although the enlargement of the AB gap by more than 20 dB was found in 3 TS cases (8.6%), no statistically significant differences could be observed in the AB gap between the two groups. The incidence of postoperative sensorineural hearing loss was 4.8% in the TS group and 1.8% in the PS group. While the PS group appeared to be slightly superior to the TS group with respect to the overall functional results, no statistical significance was observed. Therefore, based on the above findings, no conclusion could be made as to which technique is better to employ during otosclerosis surgery.

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In 105 ears with congenital aural atresia who underwent operated at Miyazaki Medical College, consisting of 64 men and 27 women aged from two to 45 years of age, the condition of the tympanic cavity, the movement of the tympanic ossicles obtained at operation and the postoperative hearing results were all analyzed. The preoperative air conduction, bone conduction and air-bone gap were 68.0dB, 15.2dB and 52.8dB, respectively. The condition of the tympanic cavity was classified into four different types; normal (74%), inflamation (12%), poor development (7%) and impossible to open the tympanum (6%). The form of tympanic ossicles were classified into three types; normal, deformed and absence. The rate of these three types of ossicles were as follows; hammer: normal 20%, deformed 56%, absent 11%, ambos: normal 50%, deformed 48%, absent 2%, stapes: normal 63%, deformed 24%, and absent 13%. The fixation rate of the hammer, ambos and stapes were 51%, 10% and 17%, respectively. Postoperativly, the hearing level of the air conduction, bone conduction and the air-bone gap were 51.8dB, 13.5dB and 38.3dB, respectively. the postoperative hearing levels of tympanoplasty Type 0, Type 1, Type 2 and Type 3 with columella were 63.0dB, 48.2dB, 62.1dB and 51.0dB respectively.

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We analyzed clinical findings of congenital ossicular malformation with a normal external ear canal and normal tympanic membrane consisting of 61 cases and 74 ears, who were all operated on at our clinic in Miyazaki Medical College Hospital from 1978 to 1995. Our ossicular reconstruction surgery results were mostly satisfactory, and the success rate was more than 80% except for 14 exploratory tympanotomy ears. Anomaly related stapes was the most frequent problem and the success rate of the operation seemed to depend on whether or not the stapes footplate was mobile as well as if the oval window was present or not. The causes of failure included the impossibility of vestibular fenestration, a lack of stapes mobility, etc. In some cases, the hearing level decreased more than one-and-a-half years after surgery. We thus presume that the columella either slipped down, a fixed lesion became refixed or a re-closure of a fenestration lesion took place. Postoperatively, all patients needed a long term follow-up. Owing to the abnormal position of the facial nerve, the presence of otitis media with effusion, a young age, etc., we could not perform the desired surgical procedures. For such young children, however, we plan to perform another operation in the near future.

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We presented two cases who complained of hearing loss several years after suffering either head or transtympanic injury. A surgical exploration revealed the stapes to lean and adhere to either the upper or lower wall of the stapes niche. A reconstruction of the ossicular chain improved their hearing loss while their tinnitus also disappeared after surgery. If a patient who suffered head or transtympanic injury complains of tinnitus, vertigo or sensory deafness after a long time, then a leaning of the stapes is suggested and therefore a tympanic exploration is recommended.

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We experienced two cases of attic type cholesteatomas observed in two young sisters. Both cases demonstrated 1) a sufficient growth of the pneumatization of the temporal bones, 2) room in the tympanic isthmus of the middle ear clefts, 3) inflammatory granulation in Prussak's spaces, and 4) cholesteatomas. In the younger sister's case the matrix membrane of the cholesteatoma going through Prussak's space was blocked by the lateral mallear fold. In the elder sister's case the matrix membrane of the cholesteatoma was beyond the lateral mallear fold to both the epitympanum and the mesotympanum. These cases thus show the chronological steps of the occurrence in attic type cholesteatoma. The negative pressure of Prussak's space may therefore cause the retraction and perforation of the pars flaccida of the tympanic membrane and may also reach the attic type cholesteatoma.

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We experienced a case of congenital malleus fixation with a small cholesteatoma. In this case, we were not able to diagnose malleus fixation before the operation. We initially suspected the cause of hearing loss to be due to trouble in the ossicule chain by the attic cholesteatoma since granulation and debris were observed in the parsflaccida of the tympanic membrane of this patient. However, and intact ossicule chain was observed during an atticotomy of the normal anterior mallear ligament, while, in addition, a bony spur of the lateral epitympanic wall was found to be attached to the head of the malleus. The movement of the malleus improved after cutting the bony spur from the temporal bone.

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Three patients with glomus tumor who presented complaining of pulsatile tinnitus were treated by surgery. They included one case each of glomus tympanicum, glomus jugulare, and glomus jugulotympanicum, in which the clinical distinction between the tympanicum extension of the glomus jugulare tumor and the jugular fossa extension of the glomus tympanicum tumor had been difficult. Although the first 2 cases underwent a successful total tumor removal, the latter case had to undergo a repeated partial tumor removal because the initial surgery had been completed before conducting accurate radiological examinations. Based on the above findings, both high resolution CT and MRI help to identify the most appropriate surgical treatment.

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Mortality from intacranial complication has recently decreased in comparison with the preantibiotic era. This reduction in mortality is due to the continuing introduction of new and effective antibiotics, advances in imaging technology and improvements in both patient care and surgical techniques. In particular, recent progress in magnetic resonance imaging has now made it possible to obtain detailed images of the inner ear and intracranial focus lesions. We herein report 2 cases of otogenic intracranial complications. In case 1, a 52-year-old man was admitted to our hospital after complaining of abrupt and left otorrhoe symptoms. He was diagnosed as having acute meningitis secondary to cholesteatoma. A fistula was present at the lateral semicircular canal by mastoidectomy. He was cured by intravenous antibiotic therapy and the removal of the cholesteatoma. In case 2, a 50-year-old woman was admitted with a diagnosed of a temporal lobe abscess of otogenic origin based on the evaluation of another physician. A cerebral herniation occurred twice after her admission. The administration of both antibiotics in massive doses and glyceol, as well as the drainage of cerebral spinal fluid by a neurosurgeon, successfully resulted in the progressive reduction in the size of the abscess.

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We describe two cases of objective tinnitus due to involuntary muscular spasm. The tinnitus in a 5-year-old boy manifested itself as a clicking sound with a peak energy spectrum of 2kHz. A depression of the eardrum and a high compliance value in the impedance audiometry were found to demonstrate a close correlation with the tinnitus. In contrast, another case of tinnitus in a 45-year-old female manifested itself with a peak energy spectrum of 500Hz. A spasm in the soft palate was also found to correlate with the tinnitus. These findings indicate that the one type of tinnitus was caused by spasms in the tensor veli palatini muscle and the tensor tympani muscle while the other case of tinnitus was caused by spasms in the levator veli palatini muscle.

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