The authors performed esophagoscopic examination in ten cases of thoracic esophageal diverticula and classified them into three types according to esophagoscopic views.
In the first type a pouch diverged from the esophageal lumen, the entrance of which was slitshaped or oval, and there was a carina between the esophageal lumen and the diverticulum. Roentgen examination revealed a spherical pouch diverged from the lumen and an obvious partition between them.
In the second type the esophageal wall bulged out like a bow window where the diverticulum occurred. Since the pouch was shallow and the orifice opened widely to the lumen, the lower margin of the orifice appeared step-shaped under esophagoscopy. Roentgen examination showed a shadow protruding laterally like a bow window.
In the third type the esophageal lumen extruded outward in one direction ovally and the esophageal wall adhered to and pulled by the surrounding organs. Roentgen examination revealed a funnel-shaped shadow with a wide orifice and the bottom directed laterally or upwards.
As there was correlation between X-ray and esophagoscopic views, the latter could be inferred before esophagoscopy.
The location of occurrence ascertained by esophagoscopy was situated from 26 to 30 cm in men and from 22 to 26 cm in women measured from the level of the upper teeth. Nine cases occurred on the left wall and one on the right.
Esophagoscopy should be performed in all cases of diverticula as they are likely to be complicated by inflammation or cancer.
It was concluded that thoracic esophageal diverticula were not rare.

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Recently the mechanism of the transmission of sound in the middle ear has been mechanically clarified with the progress of audiology.
Together with this, however, one must make clear the biological conditions under which the middle ear sufficiently performs its function.
As the first step of the studies from this standpoint, the functional structure of the Eustachian tube and its surrounding tissues has been investigated on the cadavers of adults macroscopically and microscopically. The macroscopic study was particularly complemented by the roentogenograms and molds of the tubes of the cadavers.
Thus, it was able to demonstrate the findings in three dimensions objectively. The results obtained were as follows
1. On six cadavers X-ray figures of the tubes filled with the contrast medium by horizontal, vertical and sagittal projection were taken and measured, and the courses of the tubes were also examined.
The tubes of the cadavers appeared as dense, homogeneous shadows in all of the three projections. On the other hand it has been reported that on the living subjects a thin, dense filament and a broader and fainter band are observable in the inferior view (Aschan 1952).
It is inferred that this difference is dependent on the degree of dilation of the tubal lumens, and that the tubal lumen of the living subject is more dilated than that of the cadaver owing to the pressure given to introduce the contrast medium.
2. In order to resolve the question about twisting of the tubal lumen besides its bend, the mold of the tube was made with methacrylic methyl ester, by which it was able to save artificial products in making it. It became clear from the mold that there was no distinct twisting of the lumen and that the long axis of the cartilaginous portion slightly declined posteriorly against that of the osseous portion. These findings might be explained in terms of the dislocation of the anterolateral wall due to the contraction of the tensor veli palatini muscle caused by rigor mortis.
The mold simultaneously made of the fossa of Rosenmueller demonstrated that it reached the middle part of the cartilaginous portion.
3. In the structure of the tube and its surrounding tissues the relation between the tube and its related muscles is the most complicated and unintell igible.
So the three-dimensional relation was examined through the roentogenogram, on which the tube was visualized by filling it with Moljodol and the muscles, by bordering them with fine fuses.
As the result, it was ascertained that the tensor veli palatini muscle arose from the lateral lamina of the tubal cartilage and the membranous lamina in the upper half of the cartilaginous portion and ran apparently laterally to the tubal lumen to reach the hamulus of the pterygoid plate, and that the levator veli palatini muscle arose from behind the tubal lumen and came to touch its bottom below the middle of the cartilaginous portion.
4. In serial sections the difference between the cartilaginous and osseous portions was more clearly shown by the shape of the tubal lumen than by the compos ition of the tubal wall.
This boundary, however, did not always accord with the isthmus anatomical isthmus (Miner).
After such morphological classification of the cartilaginous and osseous portions was decided, classification from the functional point of view should be made into the mobile and non-mobile portions.
5. From the histological investigation the differences concerning the shape of the tubal lumen, the shape and structure of the tubal cartilage and the construction of the tubal wall by glandular and fatty tissues were found out even in the cartilaginous portion.
Consequently it is necessary to divide the cartilagenous portion into two parts ? the upper and lower half - and consider the physiology and pathology of those parts from different standpoints.

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The previously reported method measuring the change of the retraction grade of the ear drum to acoustic stimulation by S. Kawata, Y. Ochiai, M. Esaki and M. Tsuji gave a clue of the observation of the acoustic movement of the ear drum in audiology. It is the purpose of present paper to report the observations and experiments done on ear specimens obtained from fresh human cadavers, and that the movements of the ear drum which acoustic middle ear muscle reflexes caused were recorded objectively through the change of air pressure in the closed auditory canal.
1. The arising portions of the tensor tympani and stapedius muscles were exposed under surgical microscope, and the effects of the contractions of both muscles upon the ear drum and ossicular chain were studied by artificial pull on these muscles along their bone canals. As the result of the experiment, it was ascertained that the contractions of these muscles undoubtedly showed mechanical influer ce on the ear drum and ossicular chain, and the procedure was filmed using 16 mm movie camera.
2. To represent quantitatively the movements of the ear drum of human cadavers the fine changes of air pressure in the closed auditory canal were recorded with an apparatus utilized strain gauge. The reaction modus was different when the tensor tympani or the stapedius muscle was pulled. The former showed the movement correspond to the retraction of the ear drum and the latter the bulge of it. About the mechanism causing the bulge of the ear drum by artificial pull on the stapedius muscle, some consideration was attempted partly on the observations and partly on presumption.
3. Using the same apparatus for measut ing pressure the changes of air pressure of the closed canal to acoustic stimulation were examined in twenty healthy individuals. It was revealed that responses to acoustic stimulation were objectively recorded definitely and there were two different modi of the responses meaning the retraction and the bulge of the ear drums similiar to the reactions obtained by artificial pull on the middle ear muscles of human corpse.
Difference between hearing and reflex threshold was 86.0, 91.4, 89.5, 84.1, 92.7, 106.6 db in each 250-, 500-, 1000-, 2000-, 4000-, 8000cps.
Magnitude of the response usually became larger when acoustic stimulation was increased above refrex threshold. Though the change of retraction grade of the ear drum to acoustic stimulation has been routinely measured on pars tensa of the ear drum, it is a very interesting fact that there was a new type of response coriespond to the bulge of the ear drum other than retraction of it. Considering the result of the observations of the ear specimen, the bulge of the ear drum appears to be mainly due to the movement of pars flaccida. Further studies, however, are required to elucidate the reason of the different response modi in each individual and sometimes in each ear of the same person.

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The cause of so-called “idiopathic hemotympanum” is still a matter of speculation, and no case has ever been reported in Japan.
The 4 cases reported here illustrate the results of clinical examinations and treatment of this disease.
1) The patients, three young men and a girl, suffered from repeated attacks of otalgia, bloody otorrhea and deafness.
One of them was bilaterally affected, while the others were unilaterally affected.
2) These attacks usually followed common colds and in most cases were improved within several weeks, although there was a stubborn tendency towards relapse.
3) The pars tensa of the affected eardrums appeared blackish-blue. In some cases, the pars flaccida was hyperemic and swollen.
4) The discharge from the middle ear cavities was a bloody chocolate-coloured exudation and sterile.
5) Hemorrhagic diathesis and tubal stenosis were not observed. 6) In X-ray examinations the affected ears showed sclerotic or poor pneumatisated mastoid processes, while the unaffected ears exhibited good pneumatisations.
7) The deafness was mainly due to conductive impairments. In some cases, however, hearing losses at high frequencies were greater than at low or middle frequencies.
8) Characteristically, all patients had contracted chronic tonsillitis.
9) Paracentesis and tubal inflation were effective only for short periods.
Three causes of “idiopathic hemotympanum” are conceivable, namely hemorrhagic diathesis, reduced pressure owing to tubal stenosis and inflammation. But the former two must be renounced.
The patients did not accept the operative treatments, and the pathogenesis of this disease has not yet been exactly clarified.
However, judging from the participation of the common colds in such attacks and the poor pneumatisated mastoid processes as are found in chronic otitis media, it is most conceivable that “idiopathic hemotympanum” is an inflammatory disease.

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As a reason why hearing loss in the damaged middle ear is often more serious than 30db although normal stapes function is preserved, the interference of sound waves through both oval and round windows should be considered.
Cochlear microphonics of cats stimulated through both windows were measured to clarify the effect caused by interference.
The amplitudes of cochlear microphonics produced by 40db pure tones through the external auditory canal were equal to the amplitudes produced by 60db pure tones through the round window at 500cps, 1000cps and 2000cps. The amplitudes produced by 90db pure tones through the oval window were equal to the amplitudes produced by 75db pure tones through the round window at 2000 cps.
When contrary phase tones were applied through both pathways simultaneously, the amplitudes showed a remarkable decrease. At 4000cps, however, this decrease was not observed.
When same phase tones were applied simultaneously, the amplitudes increased remarkably. From these results, it became clear that this interference caused a more serious hearing loss when the perforated ear drum was exposed to tones through the external auditory canal.
That there is no decrease at 4000cps is due mainly to different reactions of both pathways in transmitting high frequency sound waves.
In most cases of tympanoplasty in Japan the first aim is to heal chronic inflammation. So it is difficult to reserve the ossicles chain completely. Therefore, exclusion of the round window from the tympanic cavity, preserving the mobility of its membrane, should be attempted.
Judging from the experimental results, microphonics stimulated through the round window are greater than those through the oval window with stapes. Sonoinversion by exclusion of the oval window (Garcia-Ibanez, 1961) is also profitable.
These two methods can lessen deafness to the degree of 30db in spite of the simplicity of the technique.
It should be noticed here that the thicker the graft it is better for alleviating the hearing loss, since such a graft is for keeping sounds from entering the round window.

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Carbohydrate as well as oxygen is most deeply concerned with the metabolism of the inner ear as energy sources of the nerve tissues.
The author formerly investigated the changes in phosphatase acting on adenosine triphosphate (A. T. P.) and diphosphopyridine nucleotide, high energy substances participating in carbohydrate metabolism, by staining the phosphatase in the cochlea of the irner ear of the guinea-pig exposed to white noise.
The authors reported here the effects of diphosphopyridine nucleotide on the animals injected with dihydrostreptomycin and on the patients of inner ear diseases.
(1) The authors could prevent to some extent by the administration of D. P. N. the decrease of the activity of alkali phosphatase observable in the sensory cells of the cochlea of the guinea- pig injected with dihydrostreptomycin.
2) The authors used 30-50mg of D.P.N. singly, or together with 30-50mg of A. T. P. or 30-50mg of V.B1 on 34 cases of inner ear diseases, and obtained favorable results on half of them.

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The author reported here a case of haemangioma of the left masseter which has not been reported in a male in Japan.
The surgical extirpation was performed with a favourable result.

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The authors reported here a rare case of tracheal fibroma, male aged 22 affected by Recklinghausen's disease.
He had suffered from heavy dyspnea during 3years, being treated under such mistaken diagnoses as bronchial asthma, bronchopneumonia or tracheal compression by mediastinal tumor; even he had been tracheotomised.
The authors found a tracheal tumor endoscopically which almost occluded the tracheal canal at the depth of 25cm and ascertained it to be fibroma molle histologically.
The growth was removed under tracheoscopia inferior, and the heavy dyspnea disappeared immediately.

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A man, aged 35, who had an allergic diathesis and had been treated with eye drop of penicillin, had a severe anaphylactic shock immediately after the administration of oral penicillin to treat acute pharyngitis.
The patient, however, fortunately survived by an emergency treatment.

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Sinuectomy, resection of the maxilla and tonsillectomy are usually followed by postoperative buccal swelling or edema of the palatine arch membrane, disturbing swallowing or mastication.The use of potent antiinflammatory agents is desirable for reduction of these symptoms.
Using Tanderil (containing 100mg in one tablet), a metabolite of phenylbutazone, the authors investigated its curative effects against postoperative swelling, edema or local pain. In cases of sinuectomy a priming dose of 6 tab. was given orally, 2-4 tab. prior to and 2 tab. posterior to surgery, followed by 6 tab. dose for 2-3 days. In 22 out of 25 cases swelling inhibiting effects, and in 20 cases analgesic effects were observed. In cases of tonsillectomy a priming dose of 4 tab. was given, followed by equal dose for 2-3 days. In 5 out of 9cases edema inhibiting effects, and in 6 cases analgesic effects were obtained. This drug showed no side effects except slight anemia in 3 cases. It is clinically interesting that Tanderil has an excellent gastrointestinal tolerance.

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