Part 1. Changes of Flavin in labyrinthine and cerebrospinal fluid in normal animal and those with experimental injury to the auditory orgarn.
Flavin was not found in labyrinthine and cerebrospinal fluid of normal rabbit, those in aller-gic states due to B.C.G. vaccine and those with injury to the auditory organ by sound. But, flavin was demonstrated in both fluid after the injection of flavin into the subarachnoid space. These results give the ground for the advocate that T. B. allergy is a cause of the so-called "perceptive deafness".
And the changes of flavin in the both fluid prove that the obstruction for the alternating process between labyrinthine and the spinal fluids was decreased.
Part. 2. Changes of Catalase in labyrinthine and cerebrospinal fluid in normal animal and those with exprimental injury to the auditory organ.
Catalase was always absent in labyrinthine and the cerebrospinal fluid of normal rabbits and those Vitamin B1 or Vitamin B2, injection was given. In rabbits in allergic state due to B.C.G. vaccine, catalase appeared in the both fluid, while in those animals Vitamin Bt or Vitamin B2 was injected catalase was decreased. From the resluts of these experiments, injection of Vitamin B1 or Vitamin B2 as therapeutic and preventive means for the labyrinthine disorder was effective.

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Using the foetus of rabbits, the author studied on glycogen in the auditory organs histochemic-ally and made clear the changes of glycogen distribution during the growth of the foetus.

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The source of the sound was placed on the mastoid process and vibration of temporal bone was studied. Vibration pressure of temporal bone was different in each frequency, and that on the out-er surface was higher and more wiaely than that on the inner surface.

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Using radio-active isotope (P 32, Na 24) tracer work was carried outand physiology of production of labyrinthine fluid secretion was studied.
Consequently it became obvious that endolymph and perilymph were separately, produced endo-lymph was mainly from stria vascularis, and perilymph was from spinal fluid and perilymphatic space.

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Using radio-active isotope (p. 32) tracer work was carried on and various kinds of drugs were injected investigating the influence on labyrin thine fluid production. Consequently it was found that atropine sulfate and sodium salycilate inhibit the labyrin thine fluid production and pilocarpine-hydrochloride and quinine hydrochloride stimulate the production.
Tended to restrain labyrinthine fluids secretion, conversely pilocarpinum hydrochloricum and chininum hydrochloricum inclined to promote it.

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The membranous labyrinth of normal guinea pig was studied by the electron microscope, and the following several findings were reported
1. Shape and internal structures of hairs. Relationship of hairs to cuticula and tectorial membr-ane.
2. Smooth and rough surfaced endoplasmic reticulum, and arrangement of mitochondria within external and internal hair cells.
3. Fine structures of supporting cells, reticular membrane, Hensen's cell, tectorial membrane crista spirale, basilar membrane and mesothelial cell.
4. Postmortal changes of hair cells and supporting cells of the organ of corti.
5. Innervation and internal structure of the peripheral fibers of acoustic nerve.
6. Difference of shape and internal structures of nerve end organ at the external and internal hair cells.
7. Flow of the nutritional material within the organ of corti.

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The author studied the theories of caloric nystagmus and their methods of the tests are classified.
Necessary conditions for the caloric test are as follows:
1) Easy performance of the test.
2) Results of test are almost constant and the results obtained by any tester are less variable.
3) Minimal inconvenience for the patient.
4) The test is able to be performed repeatedly.
First the author investigated the temperature and quantity of water for irrigation and discov-ered the suitable method for clinical test on normal sudjects. Furthermore the author confirmed statistically the influence of the position of head of the position of the eyes, an interval, and the use of Frenzel's spectacles upon the nystagmus. Atkinson's method, Z-test were also studied com-paratively.
The outlines of the investigation are as follows:
1) The stimulus is too strong and to excessive when the difference fo temperature of water and tbe body is 10°C or more. The preferable temperature is 27°C, 30°C or 44°C and the suitable quan-tity of water in 20cc or 50cc.
2) Not only duration but latency and number of nystagmus is significant as an indicator of the caloric test.
3) The best head position is 60° retroflection (this position is most sensitive to thermic stimul-ation), but a supine position with a pillow is also allowed for the clinical test.
4) Observations on the nystagmus are difficult when eye position is directed to opposite side. While they are extremely easy when the eye position is directed about 30° to the side of nysta-gmus.
5) Three minutes interval is too short. Six minutes give the more reliable results, but when the more exactness is required, about 10 minutes interval is advisable.
6) The tests done with and without Frenzel's spectcle do not show difference of significance.
7) Nystagmus is clearly observed in Atkinson's method, and the error is minimal, even if the tester is unskilled, and it is recommended as a simple clinical caloric test. This test should be adopted as a "Screening test".
8) Z-test has little difference in latency, duration of nystagmus, standard deviation between the left and right ear, and so it should be performed by all means when the precise clinical examina-tion is required.

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Smears from the nasal side of epipharynx in patients with epipharingitis were stanied, by Pa-pinicolaou's method, microsopic examination was made and following results were obtained:
1. Acute epipharyngitis: In this group, swelling of cells and irregular arrangement of cells are remarkable.
2. Chronic epipharyngitis (without purulent nasal discharge): In this group, cells appear nomal in shape but are larger in size.
3. Chronic epipharyngitis (with purulent discharge): Cells and nuclei are swoller and the out-line of the cells are not clear. (and Mucinous change is also prominent. change are prominent.)

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The heads of three leghorns were stimulated galvanically (4m A. 8V.) for five minutes in two opposite directions passing through both external auditory meati every day for two weeks. The labyrinthine reflexes observed during and after galvanization showed marked changes at the end of two weeks as compared with those prior to the start of stimulation, as follows:
1. The head which had deviated toward the side of anode during galvanization at the beginning, became to deviate in the opposite direction i.e. to the side of cathode at the end of two weeks.
2. Galvanic nystagmus. and especially after-galvanic nystagmus decreased in number of jerks as the day of stimulation went on.
3. Ataxia during and after galvanization decreased with days of stimulation and almost disappe-ared at the end of two weeks.
4. It is very interesting that leghorns which had been stimulated solely with galvanic current for two weeks showed "kinetic labyrinthine reflex" at the first Barany rotation, i.e. deviation of the head during rotation in the direction of rotation after normal deviation, . the reflex previously reported by Fukuda as a functional development of labyrinthine reflex with rotatory training.

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The author has investigated the cases with complaint complain of abnormal sensation in the pharyhx, larynx and esophagus, with the idea which they might be incomplate forms of Plummer-Vinson syndrome.
Quantitative estimation of serum iron was made by the o-Phenanthrolin method. First, the normal values for 10 each of male and female were determined, and it was found that the average for the former is 120 ±30γ%, and for the latter 100±30γ%. Next in 84 cases with complaints of abnormal sensations in the pharynx, laryrx and esophagus serum iron level was examined. In 49 cases (58%), there was a fall in serum iron level. Then iron preparation was given to those cases, and, marked response was seen in 19, moderate in 16, none in 7 and indistinct in 7 cases, indicating the benefical results of iron administration. So that anemia or its prodromal state can be counted as of the factors connected with the appearance of these abnormal sensation.
Studies to find out why anemia can cause these varios abnormal sensation have not been unde-rtaken so far. Hence to solve this problem the anthor conducted following experiments. First ele-ctromygrams of healthy adult dogs and anemic adult dogs were taken during the act of swallowing with leads in the cricopharyngeal and thyreopharyngeal muscles. Though slight individual differ-ences were noted it was found that in the anemic both discharge duration and maximal amplitude showed decrease. Next, electromyograms of healthy adult dogs and anemic adult dogs were taken during the act of respiration with leads in the intercostal muscles. It was found that healthy dogs and anemic dogs showed almost same results.
These findings indicate that in anemia a deterioration in contractile power of muscles exists at the entrance of esophagus. Although it is dangerous to assume that a similar state exists in the human body, proba-bly a similar change also occurs and is felt as various forms of abnormal sensation.

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From the biological significance of thiamine, it is conceivable that the fate of thiamine in the living body is related to the occurrence of chronic sinusitis to some extent.
With this belief, the thiamine contents in the blood and mucous membrane of patients with chronic sinusitis were estimated by the thirochrome fluorescent method and the distribution of thiamine in the mucous membrane was observed histologically.
The values obtained were then compared with the pathological changes in the mucous membr-ane. On one hand, employing rabbits modified experiments on allergic and bacterial sinusitis which are believed to play an important role in the etiology of chronic sinusitis were conducted, and from the dirtribution of thiamine in the blood and mucosa or liver, the difference in thiamine metablism was compared.
Again the changes in thiamine distribution in blood and mucosa during liver obstruction were examined.
The results obtained were as follows.
The thiamine content in blood of patients with chronic sinusitis showed a tendency to decrease slightly in both combined from and free from when compared with the controls.
The differences in grade of decrease according to the pathological changes of chronic sinusitis were almost negligiable, but in cases with round cell infiltration in the moderate degree or more in the mucous membrane there were a decrease of total thiamine and an increase of the free form.
However, total thiamine content increased markedly in the purulent form when compared with the catarrahl initial inflammatory stage, while it was especially low in the fibrous type which is believed to represent the quiescent stage.
The difference in free thiamine according to pathological changes in the mucous membrane was slight.
The thiamine distributed in the mucous membrane of human chronic sinusitis consisted mostly of the combined form, while the intensity of chiochrome fluorescence was strong in the epithelial layer, glandular cells, walls of vessels and parts with round cell infiltration, while it was very weak in parts with haemorrhage, edema and interstitial connective tissues.
Concerning with relation to pathological changes, an increase of total thiamine and a relative decrease of free thiamine were recognized in cases which indicated enhancement of metablism.
In experiments with rabbits, the thiamine content in blood and the intensity of the thiochrome fluorescence in the mucous membrane tended to fall, whether the stress is allergic or bacterial.
These findings differ somewhat according to the strength of stress, and the disturbance of thia-mine metabolism in those elicited or those taking a long course was greater than in groups sensi-tized or groups taking a short course following bacterial invasion.
In these cases there were a slight disturbance in the liver, a fall in hepatic function and a decrease of thiamine content in liver cells.
On one hand, in experimental liver obstruction, the esterification in liver cells and thiamiae in blood and mucosa also showed evident falls.
Thiamine is not only indispensable for metabolism in the living body, but its deficiency induces-a tendency for inflammatory or allergic changes to occur with ease.
From the experimental results mentioned above, it is believed that thiamine deficiency in the mucosa and the disturbances in liver function produce a vicious cycle and from the local disturb-ance in metabolism, there results delay of healing; and these may be said to influence greatly the esta blishment of chronic sinus diseases.

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One hundred and three surgical cases of carcinoma of the maxillary sinus, were examined and the following results were obtained through the clinical observation and the pathological investi-gation.
(1) Nasal obstruction, nasal hyperdischarge, dentalache and swelling of the cheek, etc. had been noticed as the initial symptoms, but those former three symptoms were not characteristic to this disease;
(2) As the type of cancer multiplication the so-called retro-growth type had been most fre-quently observed.
(3) Because of these two aforesaid facts, over 70% of the cases were not diagnosed correctly at the first examination.
(4) Consequently, the prognosis became unfavorable.
(5) No significant relationship was noticed between the histological diagnosis and the prog-nosis, however, a definite relation was found between the pleomorphism of cancer tissue and the prognosis.
(6) Prognosis was considered to be unfavorable in the cases which presented the varied histo-logical pictures, especially so in those cases which presented these pictures due to Tauchi's so-called atypical adenocarcinoma.
(7) Some considerations were made on the histological picture of the parenchyma and the stroma as well as on the correlation between the two and a histological standard is presented by the author, for the purpose of grading the malignancy of cancer tissue.
As stated above, it may be concluded that, in order to make an early diagnosis and treatment possible, the attention must be paid to the atypical symptoms, and that both the pleomorphism of cancer tissue and the type of cancer growth have influence on the prognosis of the disease.

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In Japan, otosclerosis is very rare, but incus ankylosis caused by chronic inflammation of te-mporal bone is very common because acute otitis media, which histologically should be called acute pneumato-cellulitis temporalis in infants has not adequately been treated.
Accordingly, such type of otitis reccurs and develops conduction deafness. with of without perforation in 5-10 years.
Sixteen patients with conduction deafness without perforation whose X-ray findings in Stevers position showed chronic mastoiditis and petrositis; especially chronic mastoiditis were operated in following manner.
A. At first, tonsillectomy and adenoidectomy or only adenoidectomy was performed, together with conservative treatment of chronic sinusitis. When necessary, sinusitis operation was performed to prevent reinfection of tympanic cavity from the Eustachian tube and to improve ventilation through the Eustachian tube.
B. Then, conservative radical operation for ostitis temporalis (complete atticomastoidectomy and complete curettage of periantral portion of petrous pyramid, posterior superior, posterior, posterior inferior and anterior superior cellroute of petrous pyramid) was performed postauriculary to cont-rol the flow of pus from such diseased portion to epitympanic cavity, filling around incus and malleus causing inflammatory incus ankylosis.
C. The third stage of operation is the loosening of incus ankylosis. Incus ankylosis revealed various types such as:
1. Adhesion of anterior edge of crus brevis incudis by granulation, cicatricious or bony tissue.
2. Adhesion of portion of lig. incudis superior or lig. mallei superior by granulation or cicatri-cious tissue.
3. Adhesion of portion of lig. incudis posterior. We used Rosen's needle, Shambough's hook, lupe and suction, etc. Hearing improvemtnt is as follows:
a. An average air conduction (125, 250, 500, 1000, 2000, 3000, 4000, 8000) before operation, showed 31.7db of hearing loss, after operation it showed 13.9db of hearing loss. Hearing improvement was 17.8db.
b. An average air conduction (500, 1000, 2000) before operation showed 30.1db of hearing loss, after operation it showed 13.8db of hearing loss. Hearing improvement was 16.3db.
c. An average bone conduction (125, 250, 500, 1000, 2000, 3000, 4000, 8000) before operation showed 6db of hearing loss, after operation it showed -0.5db of hearing loss. Hearing improvement was 6.5db.
d. An average bone conduction (500, 1000, 2000) before operation showed 1.2db of hearing loss, after operation it showed -2.8db of hearing loss. Hearing improvement was 3db.
D. Adhesion of crus longum incudis by granulation or cicatricious tissue were removed by Rosen technique.
We have not handled so many cases of adhesion of crus longum incudis operation using Rosen technique. These operations have been called incus mobilization.

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1. THE METHOD OF RESEARCH AND A FEW PRELIMINARY EXPERIMENT
The present study was made for the purpose of clarifing defensive function of the tonsils aga-inst infections. Judging from results of many experimental studies undertaken by previous investi-gators, it should be reasonable to consider that immunological method is the most capable for this purpose.
From this view point, use was made extract of the tonsils prepared sterility by ultracentrifuger and freeze-thawing method.
Prior to the study, crypts of the tonsils were bacteriologically examined and Streptococcus hem-olyticus was always predominantly revealed. However, no considerable difference in rate of dete-ction was noticed in varing degree of inflammation.
In cases, in which antibiotics was preoperatibely administrated, less predominant bacilli were proved comparing with non-treated cases.
2. A STUDY OF PROTECTIVE ANTIBODY IN THE TONSIL AND THE SERA FROM TONSILLITIS PATIENTS
The existence of protective antibody were researched, with following result, on the tonsil extract and the sera from tonsillitis patients, which have impotent reference to the immune function mec-hanism of the tonsil.
In the tonsil extract, there find few protective antibody to the Diplococcus pneumoniae-I. The changes of this antibody to the Diplococcus pneumoniae-I in patients sera is in direct proportion to an degree of tonsil inflammation.
Blood antibody titer in sera from tonsillitis patients at convalescense, showed higher degree than the sera from the patients who is in extreme stage. In case treated with antibioticus, blood antibody titer is in the lower level than treated without antibioticus.
Present paper deal with the anamnestic reaction in the patient's sera. So there obtained many chances of inappearent-infection of Diplococcus pneumoniae-I, that appropriate use of antibioticus should be done in case of tonsillitis.
Experimental study was performed on existence of protective antibody to the hemolitic streptc-occus and Streptococcus viridans were isolated from the tonsils, according to the Aizawa, s method based on experimental inflammation theory. As there find no remarkable result, it was considered about reason of this result.
However, there obtained some experiences of ability of bacteria separeted from tonsil. It is seemed as an ability of hemolitic streptcoccus, separeted from acute tonsillitis is stronger than that of chronic tonsillitis or normal tonsil. As Streptococcus viridans, separeted from at any pathological tonsil or using resistance reducing substance at the same time it could not be made the mouse to death in the 0.1cc of fondation of bouillon culture solution.
3. A STUDY OF RELATIONSHIP BETWEEN AGGLUTININ VOLUME AND PROTECT-IVE ANTIBODY TO THE PNEUMOCOCCUS-I IN THE SERA FROM TONSILLITIS PATIENT OR TONSIL
The auther performed the measurement of agglutinin volume to Pneumococcus-1, in the extract at any pathological tonsils and the sera from tonsillitis, for the purpose of research to the contact with tonsil and Pneumococcus-1, also to clear up the significance of protective antibody that has been studied on another time.
The following results were obtained. In the tonsil extract, there find the exsistence of a few aggluti nin to Pneumococcus-1. The agglutinin titer is in direct proportion to the intensity of tonil inflammation, but in the sera, the discrepancy is not remarkable. The agglutinin formation to Pneumococcus-1 is almost the same tendency as protective antibody titer, but no appreciable parall-elism was found among the volume of agglutinin formation and protective antibody.
These patients sera also include protective antibody almostly, if the tonsil include, more or less, agglutinin. It is considered that the inappearent infection through the tonsil is. found rather than many times.

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