Stability of posture and gait is improved by growth and decays with aging. Maturational changes and deterioration of static posture with aging have been determined by using gravic body sway tests. In this study, we constructed a new system, the Body Tracking Test (BTT), to evaluate dynamic body balance function as opposed to static balance. Preliminary results of the study were previously reported elsewhere. Healthy volunteers of various ages (total, 516 persons) were subjects of the study. The principle of the BTT is for the subject to attempt to track an optical moving target displayed on the computer screen by shifting his or her body center of gravity that was also displayed on it. The target moved for a span of 15 cm horizontally on the 14-inch screen. The movement was lateral and antero-posterior (horizontal and vertical) in direction at a constant velocity of 0.125 Hz. The recording was for 60 seconds. In BTT the gain for target against tracking was fixed to 2.0 (target: tracking=1: 2). The target was 100 cm anterior to the platform where the subject was to stand erect with the feet close together. The criteria for evaluation of the tracking function were determined by our preliminary study, the principle of which was to judge the rate of accordance of the tract of the moving target with that of body tracking. The score was divided into five ranks from A to E. We called it “The 5 grade evaluations of tracking ability”. Agedependent changes in the score were obtained and the statistical significance of the value was determined by χ² analysis. With regard to both the lateral and antero-posterior tracking abilities, there was an apparent improvement by maturation. The high school students reached the adult level in lateral tracking but not in antero-posteior tracking ability. Also, the tracking ability started to deteriorate after age 40. It is apparent from this study that the balancing or dynamic postural control differs between youth and the elderly, i. e.; lateral control seems to improve faster in youths and older persons tend to balance better in the antero-posterior directions. The BTT requires visual as well as proprioceptive information for its function. Moreover, dynamic maintenance and shifting of muscular tone and strength are prerequisite. In addition, for BTT, reflective postural control is strongly aided by training in terms of efficiency and skills that require higher cerebral functions. The BTT described here thus appears to represent a cumulative effect of the sensory, visual, motor and higher cerebral functions.

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It is well known that sensorineural hearing loss rarely occurs after middle ear surgery. Five cases of postoperative sensorineural hearing loss were reviewed. These operations amounted to 0.9% of all middle ear operations in which the first author was involved. The causes of hearing loss were believed to be labyrinthitis through the fistula in cholesteatoma case 1, and acoustic trauma from the bone-cutting burr in cases 2 and 3. In cases 4 and 5 postoperative sensorineural hearing loss occurred several months after stapes surgery and the causes of hearing loss were unknown. On the basis of the available literature discussion focused on management of labyrinthine fistula, the acoustic effect of the bone-cutting burr and the possibility of sensorineural hearing loss caused by stapes surgery.

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This study was performed to examine the influence of lidocaine HCl on evoked otoacoustic emissions (EOAE) in tinnitus case. EOAE were recorded before and after intravenous injection of lidocaine HCl in 19 patients with unilateral tinnitus. EOAE amplitudes were significantly increased after injection of lidocaine HCl for 10 minutes. Between the effective group and the non-effective group of lidocaine HCl for tinnitus, significant differences were recognized after injection of lidocaine HCl for 10 minutes. These results suggested that lidocaine HCl stimulated cochlear mechanics. Significant differences were not recognized at any time between the group of hearing loss with unknown origin, the group of Mèniére's disease and the group of tinnitus without hearing loss.

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In the long-term observation (9-22 years) of 45 hearing-impaired children, using our own “Hearing Test Progress Table”, 36 (80.0%) showed fluctuation of the hearing threshold. Twenty-nine of the 36 patients had acute progression of hearing loss. Three peaks of onset of the acute loss were observed: at age 6, 10, 16 years in girls, 7, 11 and 16 years in boys. Twenty-three of the 45 (51.1%) have been able to maintain their good thresholds throughout these periods, with 14 cases of hearing loss restored by our successful treatment of acute sensorineural hearing losses (1-6 times). Twenty-two of the 45 children (48.9%) could not maintain their initial thresholds: gradual hearing deterioration in 7 of the 22, and acute hearing loss (1-10 times) in the remaining 15 cases. Although these 15 patients could not maintain their initial hearing thresholds until the end of the observation period, active treatments for their acute losses were successful in the early period, and almost all patients were able to maintain their initial hearing thresholds until graduation from elementary school. Our “Hearing Test Progress Table” is based on the results of pure-tone audiometry for each frequency on every audiometry test. The management (including guidance and treatment) using the table is very effective.

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Use of a maxillary prosthesis is now considered one of the good methods to ameliorate the crippling caused by the defect in the maxillary-palate area after an ablative procedure for a maxillary tumor and it consumes no physical resources from the patient. There has been dabate on whether the prosthesis should be made in the very early postoperative days or after the wound is stabilized. In this study, changes in the area of the defect in the palate after surgery were investigated by using plaster models from clinical cases we have experienced. Twenty-one cases were investigated according to the following features: “maxillary sinus cancer”+“more than 1, 5 years of followup for maxillofacial prosthetics”+“presence of more than two casts of the case”. These casts were photographed from a distance of 1.5m, and the photographs were enlarged to the original size of the cast, then the defect area was measured with a Planimeter (Uchida Co. Ltd). The area of the defect had shrunk in 16 cases. It took over 1 year to get stabilized in 80% of the cases. It is believed to take around 3-5 years for all cases to become stable. This tendency had no relationship with the pattern of the defect, the stroke of the mouth opening, the pattern of the rest of the teeth, or the defect area itself. These findings suggest that it may be adivisable to start the prosthetic work as early as possible rather than waiting for stability of the defect wound, to improve the patients's QOL.

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We performed neuro-otological investigation of vertical oculomotor disorders in 35 patients with degenerative diseases [progressive supranuclear palsy (PSP) and spino-cerebellar degeneration], and obtained the following results: 1) In the patients with PSP, in addition to vertical oculogyric disorder both saccade and pursuit eye movements were disturbed, and the disturbance of saccade movement was greater. Even the patients without an oculogyric disorder were all found to have decreased saccade velocity, suggesting that this disorder may occur earliest in PSP. 2) In olivo-ponto-cerebellar atrophy (OPCA), saccade movement was less disturbed than that in PSP. In contrast, pursuit movement was disturbed more frequently. 3) In late cortical cerebellar atrophy (LCCA), vertical ocular movement was hardly disturbed compared with OPCA. 4) Concerning dentate nuclear degeneration, we cannot reach a conclusion because of the few cases studied, but a variety of oculomotor disorders were seen; both saccade and pursuit movements were disturbed, but saccade movement was less disturbed than in PSP. 5) In visual suppression tests, enhancement in the light area was frequently seen in the patients with PSP and OPCA, but none with LCCA showed such change. In addition, enhancement of the light area under visual suppression was significantly correlated with vertical oculomotor disorder.

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En bloc resection of the temporal bone for squamous cell carcinoma of the middle ear was performed by the postauricular transtemporal and retromastoid approaches. The patient was a 70-year-old woman whose tumor extended to the middle and posterior cranial fossae. Temporal and retromastoid craniotomies were carried out, then the temporal dura and the cerebellar dura, and the transverse and sigmoid sinuses were exposed. The temporal dura and the cerebellar dura were opened, and the transverse sinus was ligated at the junction with the sigmoid sinus. After that, the tentorial dura was incised, the incision extending anteriorly to the middle cranial fossa and transecting the superior petrosal sinus. Consequently, a wide view into the middle and the posterior cranial fossae was obtained. In the posterior fossa, cranial nerves VII and VIII were divided. On the other hand, nerves IX, X and XI were preserved at the dural incision on the posterior surface of the temporal bone. Subsequently, in the area of the carotid canal, the temporal bone was drilled toward the medial side of the internal auditory canal and also posteriorly down to the jugular bulb. At this stage, the temporal bone and the soft tissue attachments, such as the middle and posterior cranial fossa dura, and the sigmoid sinus, were separated from the pyramidal apex and the clivus. The dural defect was repaired with a free pericranial graft. A rectus abdominis muscle flap was transferred to reconstruct the defect of the skull base resulting from the temporal bone resection. Postoperative complications like CSF leakage, meningitis and lower cranial nerve damage, were not seen after the treatment. The patient has shown no evidence of recurrence for the 28 months since the surgical treatment, and has not complained of any problems with swallowing or conducting conversations in daily life. With the contribution of recent developments in skull base and reconstruction surgery, more aggressive en bloc resection of the temporal bone can be carried out on patients with advanced middle ear carcinoma. These developments will also make it possible for patients whose prognosis was previously thought to be poor to have a chance for a cure.

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It has been demonstrated that CYFRA 21-1 (ELISA kit), which recognizes the soluble cytokeratin 19 fragment, is useful for assessing circulating tumor antigens in sera of patients with lung cancer. In this study, we compared the clinical significance of this new marker with the established squamous cell carcinoma antigen (SCC Ag), using sera from patients with head and neck malignant disease, healthy controls, and supernatants of established cell lines derived from squamous cell carcinomas and adenocarcinomas. The subjects were: Group A, 39 patients with malignant disease of the head and neck. Group B, 11 patients considered to be tumor-free after treatment. Group C, 67 patients with benign disease or healthy volunteers. Culture supernatants: 11 cell lines established from squamous cell carcinomas and adenocarcinomas. Serum levels of CYFRA 21-1 and SCC Ag of group A were significantly higher than those of group C. This finding suggests that CYFRA 21-1 is useful as a tumor marker as well as SCC Ag. CYFRA 21-1 and SCC Ag levels of patients in group A at the early and progressive stages of disease were comparable to the levels in group C. Both tumor markers are therefore useful for diagnosis of in the early stage of cancer. We attempted to set a cut-off level of CYFRA 21-1. The sensitivity of CYFRA 21-1 is higher than that of SCC Ag, especially in patients in the early stage of the disease. This finding indicates that the CYFRA 21-1 is preferable to SCC Ag as a tumor marker for the diagnosis of patients even in the early stages of malignant disease. The levels of CYFRA 21-1 in culture supernatants derived from tumor cell lines are higher than those of SCC Ag in all cell lines. The levels of CYFRA 21-1 are measurable, with levels varying with the cell line. There appears to be no correlation between the level of CYFRA 21-1 and the character of the cell lines, but this issue remains to be further investigated.

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