In recent years, a demand for the early diagnosis of the occupational deafness, the streptomycindeafness and the deafness in school children has been increased.Since these deafness have characteristic types on the audiograms respectively, the followingmethod of the screening test was performed and found- to be very excellent, being more simpleand easier compared with the ordinary audiometry.1) Prefessional deafness: One thousand one hundred and tmenty-eight ears were examined usinga pure tone of 4000 cps at 30db. The screening errorwas 1.55% and 1.91% in each side.2) Streptomycin deafness: One thousand and forty-five persons were examined using a pure toneof 8000 cps at 15db. without error. It was found in this case that the test of one ear was sufficientto screen the streptomycin deafness.3) School children deafness: Five thousand three hundred and eighty-two ears were examinedusing two pure tones of 1000 and 4000 cps at 20 db. respectively. In each case, the reason whyabove mentioned value of cps and intensity used in the test was discussed and results werecompared with that of the audiometry

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Remarkable loss of bone conduction is often observed on the audiograms of the cases with otitis media or salpingitis. When these facts are considered, some of inner ear deafness might be due to the tympanogenic injury for the inner ear.
To study the subject, animal experiments were carried out and researched for the histopathological changes of the middle and inner ears comparatively. For the comparison, author reported clinical cases recovered from total deafness following to acute middle ear inflammation.
1) Group of bacterial infection: A suspension of Bac. proteus was injected into the right tym-panic cavities of guinea pigs.
2) Group of allergic reaction: An egg white albumin was injected into the right tympanic cavities of sensitized guinea pigs.
In both groups the left ears served as control. In all experimental animals the intravital fixation was performed with WITTMAACK's solution.
The author used a new rapid method for embedding the labyrinth, i.e. Celloidin-Paraffin double.embedding. Two hundred serial sections of 5 thickness were made from each of 53 temporal bones and stained by CARAZZI's Haematoxylin-Eosin.
The stained labyrinthine fluid containing the red and white blood cells and the fibrinoid subst-ances were found in all of the specimens for 48 hours following to the injection of egg white albumin as well as of bacterial suspension.
Endolymph was stained in the basal turn of the cochlear duct and tunnel space in the cases examined 4 hours after the injection. The internal hair cells and the supporting cells were swollen in the allergic group.
In all cases the markedly thickened round window membrane was infiltrated by inflammatory cells and the pathological changes above mentioned were observed most markedly in the perilabyrinthine fluid of Scala tympani adjacent to the round window membrane.
The route of invasion to the cochlea could be found through the round window in all cases, but other routes could not be observed except only one case that showed the pathological changess of the oval window together with round window.
These pathological changes in the inner ear showed a tendency to decrease within about 1 week but the changes in the organ of Corti still remained unchanged in the basal turn.

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Though UIImann and Ishikawa had demonstrated the virus which produced laryngeal papillomas, the virus theory of the development of laryngeal papilloma has not generally been accepted because there has been no further demonstration by others. An attempt was made to demonstrate the causative agent of laryngeal papillomas, by the following experiments.
Thirteen samples were obtained from 5 patients with laryngeal papillomas and inoculated on the chorioallantoic membrane of 7_??_8day old chick embryo.
A) The fresh specimens (within 2 hours after they were obtained) were inoculated on the chrioallantoic membrane and 7 cases out of 12 developed pocks. A passage method was performed on these and the.pock was found in 1 case out of 3 cases.
B) The emulsion of the fresh specimens was prepared grinding in the mortar, filtered through the membrane filter and then inoculated. The pock was found in one case out of 2 cases. A passage method was performed and the pock was found in 1 case.
C) The material frozen (-20-C) and kept (7_??_53 days) in the refrigerator was planted. The pock was found in 2 cases out of 3 cases.
D) No pock was found on chorioallantoic membrane when the material was boiled in Hank's solution (100-C 60 minutes) prior to the inoculation.
Above mentioned results suggest that filtrable agent plays an important role in the development of laryngeal papillomar.

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To obtainn more correct method of the measurement of the bone conduction threshold, the anthor attempted experiments considering many factors, which had influence on the bone conduction threaholds. Following results were obtained :
1. The automatic interrupted descending method for testing tone was- statistically most appropriate. For non-interrupted method, the asscending method should be employed. For the interrupted method, descending method should be employed from the statistical stand point.
2. Bone conduction thresholds of the normal ear is not influenced by the change of measuring order of the frequencies, but in the case of the perceptive deafness, the test should started from the low frequency tones.
3. When the bone conduction vibrator is used on the mastoid or forehead, the location whichever of the vibrator should be individually selected in each case because there are advantages and disadvantages in each location. It is important to Keep the constant pressure to the vibrator.
4. Sensitivity for the bone conduction is higher in those with poorly developed mastoid cells than those with well developed mastoid cells, theoretically and experimentally.

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The author observed temporary threshold shift of thehearinga fter the exposure of the person with normal hearing to an intensive pure tone stlmuli. The threshold shift (temporary loss) returned rapidy toward the normal for a certa nextent within 3 minutes, and then the threshbld remained at a relatively constant. 1evel of hearing loss.The rapid recovery at the heginning was thought to be adaptation process and the hearing loss 3 minute after the stimulation was thought due to fatigue. Therefore, the author measured threshold levels 3 minutes after the exposure to pure tone stimuli.
The 1argetr the intensity of stmut ating, tone, the more.1oss in hearig was observed. However, it was found by the author, s observations. that the fatigue increased unpropotionally with the icrease o fintensity of stimulating tone when thetemporary Ioss over 20db. There fore, theauthot considered the 20db Ioss as "critical level".
From thiss tand pdint of view, the author measured intens ities of pure tonealld. noise to produce 20db loss and obtainedacurve of critical maximal safty leve1.Theshapeoft.he curve was revealed as inversely propotional to that of the resonan cecurve of the extemal auditory canal.
The fatigue produced byvarious pure tone was compared with those various bandn noise (including the frequency of test tone in its cenre of band and being measued at the same level of test tone).
The fatigue for band noise was found to be 5db less that of pure tone. subsequently, maxilnal safty level of intenslty of the nose was also decided by the additional study.

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The acoutical effect is meaured by subjective as well as objective method.In the former, .the minimal audible thresholds of the subjects are meaured respectively by controlling the intensities of various pure tone sources, while they are turned around the subjects from front to side.In the latter, the variation of the sound pressure in the entrance of the external auditory canal are meas- ured by a probe tube microphone for various frequencies.The both results coincide well each other. In addition, the frequency characteristic of the external auditory canal is analyzed by measuring the ratio of sound pressure on the tympanic membrane to the sound pressure at the entrance of the external auditory canal and the ratio of sound pressure in the entrance of the external auditory canal to the sound pressure in the free-field.
A new method of measurement of hearing acuity can be found from the results of the above mentioned experiments and it is also proved by additional several acoustical measurements to be more reasonable than any other method has been used.

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The author mada the cytologic study of the nasal discharge in chronic and acute paransal sinusitis.The results obtained were as follows:
1) Nasal discharge from the patients with chronic sinusitis showed neutrophils, eosinophils, lymphocytes, monocytes, histiocytes and epithelial cells.the neutrophils were predominant in numbers being 98.66%, in which 55.38% were neutrophils with three-lobe nuclei.No changes were observed in the differential cell count during the course of the disease.
2) By the degree of the cellular degeneration, the author classified the nasal secretion into the several types.The regressive type and the regressive-degenerative type were seen in 72.10% of the cases.
3) The majority of the cells in the nasal secretion of acute paranasal sinusitis were neutro- phils being 99.30%, mostly the neutrophils with three-lobe nuclei.
4) Plasmocytes were not seen in the nasal secretion of both acute and chronic paranasal sinusitis.

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The author made the experiment for the cytologic study of the nasal secretion.Chronic par- anasol sinusitis of rabbits was induced using the mixture of Staphylococci albus and agar which was thought one of the substances lower the resistance of the tissue.The results obtained were as follows
1) In the acute stage, the nasal secretion showed a specific change in types during the course of the course suth as initial fresh-cells disease, such as fres hcell type, regressive cell type and then regressive degenerative cell type.In the chronic stage, the intermingled cytologic findings were seen.
2) The cells appeared in nasal secretion in the cases with chronic sinusitis were mainly pseu- do-eosinophils, particularly of pseudoeosinophils with three-lobe and four-lobe nuclei in this order, a small amount of eosinophils, lymphocytes, monocytes, histiocytes and epithelial cells.
3) No evidence of the quantative fluctuation of cells appeared in the nasal secretion was found throughout the course of acute and chronic stages.
4) The mose severe degeneration such as karyolysis and pyknosis was found in pseudo eosinop- hils in the nasal secretion.
5) There was no evidence of existence of plasmocyte and basophils in the nasal secretion thro- ughout the course of acute and chronic sinusitis.

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The author studied the resonance effect of the external auditory canal on bone conduction hearing by connecting glass tubes of different length to the canal respectively.The resonance effect on B.C. hearing resulted in a threshold shift only when the glass tube is more than 3c m in length.
Bekesy reported that the resonance of the mandibular joints caused an increase of bone condu- ction hearing at about 200cps.when the external auditory canal was occluded.According to his opinion the peak of B.C.hearing at 200cps.is due to resonance of the mandibule.Then the aut- hor tested blocked B.C.hearing of three patients whose mandibules were missing because of surgery and found the same resonance peak at 200cps.in their B.C.hearing when the external auditory canal was blocked.Therefore, Bekesy's theory of the blocked B.C.should be corrected.
In order to study the mechanism of the blocked B.C., the author measured by a probe tube blocked and when it opened, and found increased pressure about 10 to 20db in a freguency range of 200 to 1500cps.in the former than the latter.Such an increased pressure was found also in the blocked external auditory canal of the patient with middle ear disease.
In addition the author could hear the tone through an otoscope connected to the subject ear canal when a B.C.vibrator was placed on the mastoid process, and compared the loudness heared by the examiner to the B.C.threshold of the subject.Interesting results were obtained in this study.

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In order to verify the calculated velocities, the author observed with two beam oscilloscope the phase differences between the cochlear microphonics from two paris of electrodes which were inserted into the scalae and apart each other about 2 to 1.4mm.along the cochlear turn while the cochlea was stimulated by pure tone.
The velocities of the progreesing wave were calculated from the phase differences obtained from the author's observation.
The progressing wave decrease in velocity tlong the basilar membrane and their initial velocities are also diffrernt with the frequencies of progressing wave i.e.the progressing wave of high freq- uency are smaller in velocity than those of low frequency.The chrnging rate of velocity of the progressive waves in the cochlea of guinea pig is comparable with that of the human cochlea which has been observed by Bekesy, and the calculated velocities by various authors.In addition, the vibratory mchanism of the basilar membrane can be discussed from the author's observational data.

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A study was made on postmortem changes in the human inner ear by Daito's inner ear irrigating fixation method. The materials used in the present study were 50 ears isolated from 36 autopsy cases which were presented by Tokyo Medical Examiner's Office during the winter season. These materials were divided into 4 groups according to the interval between the death and the fixation of each cases.
The results were as follows:
1. Group 1: Five to eight hours after death (15 ears from 9 cases) The specimen showed no marked change in the stria vascularis. The outer hair cells were atrophic, slender, and contained pyknotic nuclei or voluminous and contained paler and round nuclei. The former type of the cells had a resemblance in shape to those observed in the specimen fixed by intravital method.The cytoplasm of the supporting cells appeared pale and contained fine granules. Furthermore, slight tigrolysis was observed in the spiral ganglion cells without any distinct histological change in their nuclei.
2. Group 2: Nine to fourteen hours after death (11 ears from 11 cases) Slight damage was found in the stria vascularis. The outer hair cells became spherical or flask-shaped. Their nuclei were round in shape. The nuclei of the spiral ganglion cells showed no marked change, while the cytoplasm became atrophic and dark in appearance. Inside the ganglion cells, Nissl's bodies were yet clearly visible. Little change was noticed in the supporting cells in this stage.
3. Group 3: Nineteen to twentyfour hours after death (20 ears from 12 cases) The stria vascularis had undergone dissolution. The outer hair cells became spherical in shape and lost their differentiation, while the inner hair cells tended to deteriolate in this stage. Most of the spiral ganglion cells had pyknotic nuclei and uneven cytoplasm. The bounderies of the supporting cells appeared slightly indistinct.
4. Groups 4: Fortyeight hours after death (4 ears from 4 cases) The endorgan of Corti lost its normal appearance except some supporting cells which were identified even in this stage, viz.Claudius's cells, some of Hensen's cells and some of pillar cells. The endolymphatic space was filled with debris of degenerated cells and plasma cells.
No genuine neuroepithelial degeneration (picture of Collapse) was observed in all specimens examined.

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The author has reported previously that the relation of the maxillary sinuses to rhinitis atroph.icans. Recently, the author studied the development of the maxillary bone with x-ray films and the relationship between the development of the maxillary bone and the occurrence of atrophic rhinitis was confirmed. Seventy cases of atrophic rhinitis were studied, both male and female patients rnging in age from 15 to 60. On the postero-anterior films the following distances were measured: a) From the median suture line of the palatinal plate to the external border of the maxillary bone. b) From is lateral wall of the inferior nasal meatus to the external border of the maxillary bone. c) From the inferior edge of the zygomatic arch to the inferior orbital margin.
The statistical study of these measurements revealed that the maxillary bones in atrophic rhinitis were smaller than that in healthy subject. Embryologically, the inferior concha develops from the maxillary bone, therefore underdevelopment of the maxillary bone causes hypoplasia of the inferior nsaal concha, which is considered the most frequent cause of atrophic rhinitis. This type of atrophic rhinitis with limited development of the maxillary bone and the maxillary sinus, is considered to be constitutional.

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As the reliable findings to determine the indication for sphenoidectomy the author has noticed the endoscopic examination of the spheno.ethmoidal recess, into which the sphenoid sinus opens.The author has developed an endoscopic apparatus for this purpose. With this apparatus we can study pathological condition in the sphenoid sinus. However, to determine whether the radical operation should be performed or not, first we have to open the sinus. In the cases, in wliieh sphenoiditis is suspected, usually ethmoiditis is also present. Therefore, following to the ethmoidectomy, we open the sphenoid sinus. We use tomography to study the relation of the sphenoid sinus to the ethmoid sinus. With this approach, the location of the sphenoid sinus is easily determined and a small trial opening is made.
The author prefers the maxillary approach, and the endonasal approach is avoided as much as possible. For the adaquate exposure of the sinus in the endonasal approach, usually the middle concha is broken. Although it is repaired after the operation, it offen causes postoperative chronic obstruction of the middle nasal meatus. This causes diffiiculty during the immediate postoperative period by obstructing the drainage from the ethmoid sinus.
A short description of the procedure is as follows: The sphenoid sinus is exposed through the maxillary sinus. Then, using special bone forceps designed for this purpose, the anterior wall of the sphenoid sinus is excised.
Thus a wide opening is made between the posterior nasal cavity, the posterior ethmoid sinus and the sphenoid sinus. This allows good drainage from these sinuses.
The author suggests that the removal of the mucous membrane must be done only when the membrane is remarkably swollen. Histologic examination of the mucous membrane of the sphenoid sinuses from these patients, revealed characteristic changes mainly chronic fibrous reaction indicating the process of healing and for these cases, radical operation is not indicated.

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Anatomically, tympanic cavity, mastoid cells and petrous cells are a part of cells in the temporal bone. But otitis media in a narrow sense has meant the inflammation of tympanic cavity.Mastoiditis and petrositis havebeen considered as their complications.

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The authors reported a case of so-called Heerfordt's disease which principal clinical findings are, that of uveitis, parotitis and occasionally facial palsy, lymphadenitis, and dermatitis. Bilateral perceptive deafness was also observed in this case.
This patient was a male of 15 years old, and his clinical finpings were as follows :
When the above mentioned principal clinical findings developed moderately in severity, his hearing loss began to appear and aggravated subsequently gradually.
Examination one month after the onset of these symptoms revealed normal tympanic membranes
By cortisone therapy these otological findings were improved in parallel to the other symptoms, and they disappeared almost two months after the start of the therapy.
The, localisation of this lesion may be considered as internal auditory canal including Ganglion ningial symptoms.
The case report of Heerfordt's disease complicated with the bilateral perceptive deafness was not found in the review of literature.

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Although hearing test in the young children is quite difficult, the author believes that one of the
namely, making the children hear an easy word recorded in a loud voice and small voice and have
him .repeat the same word, is quite simple and effective. Therefore, the author studied this method
and obtained the following results.
1, Two syllabic words are used for the hearing test, and they are classified into two kinds. One
is composed of two monosyllables, each of which is easy to hear, and the other is easy to hear two
syllabic word, both of the words being well known to the children. In the hearing tests using
these two groups of words no significant differences can be recognized in the results. In the final
analysis, easy words that the young children know well are most appropriate for the hearing test.
2.. Employing this method on 299 children of the age ranging from two to eight years having
difficulty with the audiometer test, the hearing test has been done satisfactorily in more than 90
per cent of them.
3. Those who failed to respond to the test were mostly those supposedly to have perceptive
disease with a relatively significant hearing loss.
they will show no fear for the test.
5. In the author's experience, even a very young children showed no displeasure in using a receiver.
6. In the application of this method for the group test on the primary school pupils, When they
were asked to write down the words spoken to them, many failed to write down the words even
in children above the second grade. However, when they were made to repeat these words, even
in first grade pupils the test had been satisfactory.
7. This method when employed with a superior bone conduction receiver, can be useful even for
bone conduction test.

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It is truly not an easy to detect correctly the faculty of hearing in young children, but with many improvements and designs improvised recently including the use of play audiometry with which the children are made actively cooperate or by subjective methods, it has become possible to assay the hearing in young children. However, because of the complexity of apparatus or of the difficulty in the final judgement of deaf grade, many of these methods are not necessarily practical in actual use. Out of the methods of play audiometry I studied Barr's method what I believe to be
the simplest one, and after comparing the results with those in the previous report on the speech hearing tests, the author obtained the following results.
1. As the result of examination of 20 ears in those normal children from 3 years to 6 years, with whom hearing test had been successfully carried out, there was rise of the threshold on the average
2. Of 49 young children suspected of hearing loss, the hearing test was possible in 44 (89.7%).
3. Those who failed to respond to the test were mostly those supposedly to have perceptive disease with a relatively significant hearing loss.
4. Most often young children were unaware of sounds when, sounds were pronounced continuously, but they became aware of the sound at the moment when the sound was shunted.
5. In comparing the results of speech hearing test in young children as previously reported with the present test, the number of children failed to respond to the play audiometry was slightly higher than in the former test.
6. The author believes that this audiometry is very simple and is an excellent method not in any way inferior to other complicated play audiometry.

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The study was undertaken in an attempt to investigate the oto-rhino-laryngological status of the japanese individuals with co-operation of the department of public health, University of Tokyo.Materials used in the study were 376 elderly individuals, including 214 males and 162 females, selected from a population of 5027 inhabitants living in the Totsuka ward, Yokohama City. The age of the subjects ranges between 61 to 85 years. The characteristics of this investigation is the application of random sampling method for selecting the subjects from common people living at their own home, not from those at an asylum for -the aged. Therefore, it is considered that the results of this study revealed the more accurate status of elderly individuals than that of previously performed by another investigator. The findings obtained were as follows.
1) Otologic findings: The eardrum has a tendency to increase its turbidity of senile nature in the advancement of age, while the so-called senile ear-ring was observed through almost all the cases. The pathologic changes of the drum observed in these cases was revealed, in relatively large number to be those of the resi dual inflammatory process of the middle ear (male 32, female 31)
2) Rhinologic findings: Paranasal sinusitis was found to occupy the greatest proportion of the nasal diseases observed in the materials (male 40, female 39). However, one fourths of them showed a different aspect of the disease compared with those of younger generation, in a way that they did not complain of any clinical symptoms, such as rhinorrhea, heavy feeling of the head, hyposnomia etc; that is of the so-called noncomplain. The poliosis of the vibrissae manifest itself somewhat later than that of the hair of the head and it appears more early and frequently in male than in female. The number of cases of physiological hyposmia increases in advanced ages.
3) Pharyngeal findings: Chronic pharyngitis was observed in 10% of the cases of both sexes. Both faucial and lingual tonsils have a tendency to exhibit a gradual increment of involution over 61 years of age, particularly true when in males. Even in case of pharyngitis, the tonsils were found to be free from an inflammatory reaction. Retention of saliva was frequently observed in the hypopharynx, without accompanying the feeling of foreign body. This suggests the presence of paresis of mucous membrane of this region.
4) Laryngeal findings: The omega-form of the epiglottis was seen in 15% of the cases, more frequently in men, while it tends to increase in number only after 61 years of age in females. No difference was seen between both sexes in the findings of the vocal cords. The peculiar pictures of the cord in advanced age-group are those of atrophy or opening of the glottic space at phonation and they tend to be numerous in advanced ages. The cases with these findings were inclined to be aware of the change in voice. Chronic laryngitis was seen more common in males :than in females. (male 21, female 7).
5) In conclusion, a marked difference between sexes was found to be generally present in the oto-rhino-laryngological findings of elderly individuals, particularly in many items of the phenomenon of their involution. This phenomenon has a tendency, as a rule, to make appearance earlier and more markedly in male sex, except the turbidity of the ear drum.

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On 200 students (male and female were at the same rate) of an Academy of Music, the authors investigated their methods of the practice of singing and their subjective fatigue following the practice. In the second place, larygoscopic examination was carried out on 99 out of them befor and after their practice of singing.
The results were as follows:
1. Vast majority of the subjects had the practice for 1 hour each day; thirty minuites each time with intermission of 10 minutes.
2. Signs of dysphonia due to over-practice were noticed in case they had the practice over 3 hours, a day.
3. The subjects complained of fatigue when they practised for 1 hour each time or 2 to 3 hours. each day.
4. It was revealed by laryngoscopic examination that hyperemia in the vocal cords easily manif- ested itself following the practice, while edema was hardly elicited by the practice. Moreover, am appreciable parallelism was found between the grade of subjective fatigue and hyperemia in the. vocal cords. On the other hand, fatigue and edema seemed to have no definite relation to each other.
5. There existed some certain, common tendency as to subjective fatigue, viz., fatigue was ratherr marked in the female as compared with male; being independent of sex, it was more notable in soprano or tenor than in alto or basso, and in those having long vocal career, fatigue was less marked even after vocal practice.
6. Edema in the vocal cords was more incident to alto or basso than to soprano or tenor.

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The variation of cochlear microphonics was observed in normal and decerebrated ginea pigs after the injection of several drugs into the carotid and vertebral arteries, or electrical stimulation to the cerebral cortex.
Following results were obtained:
1) Chemical or electrical stimuli on the central nervous system were reflected to the internal ear as circulatory or respiratory disturbance. Thus, they depressed or disturbed the energy production process in the internal ear. Consequently, the balance between the energy production and consumption process were disturbed and depression of cochlear microphonics was observed.
2) When the balance between autonomic nervous system and central nervous system unified at the level of central cortex was disturbed, this was reflected to the internal ear as circulatory or respiratory disturbance and the depression the cochlear microphonics was observed.

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