Of 382 head and neck cancers in our hospital from 1975 to 1985, 35 cases (9.2%) had multiple primary neoplasms. Four cases had three primary cancers. The ages of these 35 cases ranged from 39 to 83 years (mean age 64.1 years) and male to female ratio was 2.2:1. As to the interval between the first and the second tumor, 13 cases (42%) were synchronous and 18 (58%) were metachronous. Second primary malignancies occured in the head and neck region were 35.5% and those in other regions were 64.5%. As for the other regions, the stomach, esophagus and lung were predominant. Four out of 35 patients survived more than 5 years.
Three cases in which the second or the third primary was symptomless were identified by gastroendoscopy. The most frequent second site of malignancies in cancer patients was the digestive tract in Japan. Gastroendoscopy should be used routinely for the diagnosis of multiple primary cancers, because it shows no motality and low morbidity rate.

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CT findings of 3 cases of the fungal infection of the maxillary sinuses were reported in relation to the operative findings. The characteristic features of CT findings were the intermixture of the high density area with the low density area in the affected sided maxillary sinuses.
Histopathological examinations of the 3 cases showed the fungus filament and the calcification of the mass in the sinuses. One of the cases with marked calcification showed the high density image which looked like the caliculi by the CT.
The high density area of the CT finding in the maxillary sinus appeares to be caused by the increased X-ray absorption due to the calcification.

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The growth rate of the acoustic tumor was measured in 6 cases in which the surgery was deferred with various reasons and the follow up studies were done during the period of the observation. The size of the tumor was less than 12mm in all cases including one case of an ear tumor and the observation period ranged from 4 to 31 months. In one case, the operation was performed 4 months after the diagnosis because of the rapid growth of the tumor but others were still under observation. The growth rate of the tumor determined by CT-Scan was various in each case, ranging from no growth to 21.9mm/year. Excluding the case of no growth, the calculated volume doubling times were 5 years, 8.2 months, 3.2 month (2 cases) and 1.5 months in 5 cases, respectively. Among the various otoneurological examinations, ABR was the most sensitive to the tumor growth. When one must observe the patients of the acoustic tumor without surgery, it is necessary to take into consideration that some of them exhibits the rapid growth.

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We have advocated the new software (MT86PS) for personal computer analysis of sudden deafness, thereby analysing 300 cases of sudden deafness. MT86PS, recorded in a 8 inches floppy disc, can store the data from 5, 000 cases and was found satisfactory enough as regards the capability of data analysis as well as the capacity and time required for input and output of the data.
We also performed multivariate analysis of sudden deafness cases by the aid of Hokkaido University Computing Center. By the multidimensional quantification I and II, it was found that several factors were important with respect to fixed hearing level: i.e. type of audiogram and hearing level at the initial visit, presence of vestibular symptomes and the age of patients. It was also found that the criteria of cure currently used in Japan is unreasonable in that the fixed hearing level is not taken into consideration. Therefore, revision of the criteria was deemed necessary.

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The frequency-response of the maculo-ocular reflex related to horizontal sinusoidal linear accelerations in three different directions (i.e. forwards and backwards, binaurally and diagonally to the head) was studied in normal human subjects. Materials and Method
In 74 normal subjects, eye movements induced by horizontal sinusoidal linear accelerations along the binaural axis, were studied by using an electrically driven chair. A subject was asked to sit down on the chair with head and body restrained. Horizontal linear accelerations produced by using oscillations with an amplitude of 25cm, and frequencies of 0.25, 0.33 and 0.5Hz. The induced eye movements were recorded electronystagmographically with eyes covered.
In all cases, both the gain and phase difference of the eye position versus the head position in the horizontal direction, were calculated from the averaged response of five consecutive swings for each frequency.
In the second stage, the frequency responses related to the sinusoidal linear accelerations in three different directions (forwards-backwards, binaurally, and diagonally) were compared in 20 normals (10 males, 10 females). The gain and phase differences were again calculated in the above-mentioned way, and a statistical test by analysis of variance was used to detect the influence of the following factors; sex, stimulus direction, and frequency of the swing motions. Results
The averaged amplitudes, viz. peak to peak values of the compensatory eye movements induced by passive sinusoidal motions of the head along the binaural axis, with frequencies of 0.25, 0.33 and 0.5Hz, were 3, 4, and 7 degrees, respectively. The gain increased with a slope of about 6 dB/oct in the frequency range from 0.25 to 0.5Hz. The phase difference of about zero degrees did not change significantly.
The gain was largest in cases of the stimulation along the binaural axis, and less, when stimulation was along the diagonal axis (p<0.05). It was negligible in the cases of stimulation along the forwards-backwards axis. However, the significant change in phase difference was not obtained in any of the trials. The responses in both sexes did not show any difference.

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Effects of lincomycin (LCM) and clindamycin (CLDM) in eliminating bad odor were studied in patients who visited our departments and had pus and excreta with bad odor. Specimens taken were analyzed for the degree of bad odor, subjected to microbiological analysis, and analyzed for fatty acids by GLC. The results were as follows:
1) Anaerobes were isolated more than aerobes in the specimens taken from 27 patients with bad odor. Anaerobes accounted for 73.0% of the isolates (++or+++) and their involvement rate was 85.2%.
2) All the specimens were analyzed by GLC for volatile lipid acids. Acetic acid and a variety of other volatile lipid acids were detected. A correlation was noted between the volume of propionic, butyric, and isovaleric acids and the volume of volatile fatty acids other than acetic acid in the relationship between the degree of bad odor and volatile fatty acids.
3) Oral or intravenous administration of LCM or CLDM to 27 cases with bad odor eliminated or significantly decreased the bad odor and improved the symptoms in all the cases. Specimens were taken before and after microbiological items (number of isolated strains and bacterial count) and volatile fatty acids to determine therapeutic effects. A significant effect was recognized in the degree of bad odor, number of isolated strains, bacterial count, and fatty acids other than acetic acid.
From these findings, the antibiotics, LCM and CLDM, are proved effective in the treatment of anaerobic infections and the elimination of bad odor in cases with excreta or pus with bad odor, which strongly suggests involvement of anaerobes.

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In the case complained tinnitus, the hearing loss are usually found in the pure tone audiometry. In this study, the etiology of the tinnitus without hearing loss was investigated using self recording audiometry and analysed by the onomatopoetic expression of tinnitus in 192 tinnitus cases who were
not associated by any hearing loss in the pure tone audiogram.
Results were as follows.
(1) In the 135 audiograms out of 142 tinnitus cases examined by the continuous self recording audiometry, the hearing loss was found in 52 audiograms, that in 36.6%. And 5 audiograms without hearing loss showed the type II of Jerger classification.
(2) In the 70 audiograms out of 57 cases examined by the fixed frequency self recording audiometry, 24 audiograms (34.4%) showed the type II of Jerger classification. But the type III, IV and V of Jerger classification were not found.
(3) No difference was found between the tinnitus case with hearing loss and without hearing loss in the onomatopoetic expression of tinnitus.
Accordingly, it was speculated that the tinnitus case without hearing loss may have hearing impairment which can not be detected by pure tone audiometry.

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25 patients, who complained of positional vertigo within one week of head injury, were studiedneuro-otologically.
In all cases, rotatory nystagmus with vertiginous sensation was observed in positional nystagmus testing. It is suspected that the origin of the vertigo is caused by a partial inner ear disorder, because of the nystagmus findings and the clinical course. The clinical prognosis showed good results in all cases. However, 11 patients who had central nervous system dysfunction on neurootological tests, took a longer time to recover than patients without central nervous system disorder.

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Introduction: Directional hearing test has been considered useful for the diagnosis of retrocochleal deafness. The authors revised the former Interaural Time Difference (ITD) generator and developed a new equipment for directional hearing test by utilizing an electrical circuit and putting a new self-recording apparatus.
Methods: The apparatus was designed in such a way that, if a patient presses the switch button of the same side on the time when the sound image away from the center of their head, this sound image turns over immediately. So the traces of sound locomotion are recorded as sawteeth-like waves by the repetition of the right and left button operation. The amplitude of the waves recorded by this apparatus indicates the interaural time difference between two ears to discriminate the sound image moving in the head. The test sounds used were (1) an interrupted and (2) continued 500Hz narrow band noise at 30dB SL and (3) voice babble. The following groups (257 cases); (A) normal control group of various ages, (B) a group with inner ear deafness, (C) a group with central deafness, were examined using this new equipment.
Results: 1. The rejection limits of amplitudes among normal controls of ages 20 to 59, were (1) 583μsec, (2) 468μsec, and (3) 346μsec. A similar tendency was also observed among children and the aged cases in the normal control group.
2. Although amplitude of waves among children and the aged cases in the normal control group was large, we could estimate reliably the data on children over 7 years old. As for the cases over 60 years old, the amplitude of waves were larger and more scattered than those of children.
3. The amplitudes of waves of adult patients with nerve deafness (especially for 500Hz band noise) were mostly within the rejection limit of values of the normal control group.
4. The distribution of the amplitudes of waves in a group with central disorders resembles that of the aged cases in the normal control group, and the positive rate was higher in cases with acoustic nerve trunk disorders. The author presented a typical case in this report.
5. The factors concerned with the amplitude formation that indicates the directional hearing ability and the clinical usefulness of this device were discussed.

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To evaluate the reliability of conventional tests for facial nerve degeneration, comparison of the thresholds and correlation with prognosis were made between the conventional percutaneous and direct stimulation methods in 11 cases of facial palsy in which decompression operation were performed and follwed up for more than 6 months.
Although all cases showed the findings of complete or high degree nerve degeneration with the preoperative percutaneous stimulation test, the threshold for the intraoperative direct stimulation test varied from 4 volts (normal) to more than 30 volts.
The results of intraoperative direct stimulation test correlated well with prognosis (degree of improvement of palsy score). The cases with thresholds within 30 volts showed good recovery of palsy (more than 32 points of palsy score), while the cases with thresholds more than 30 volts showed plasy scores less than 28 points except one case.
Our results indicates that the direct stimulation method is better than the percutaneous stimulation method as an electrodiagnostic test for nerve degeneration.

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Vocal fold augmentation therapy has been accepted as a choice of treatment for glottic insufficiency due to unilateral recurrent nerve paralysis, vocal fold atrophy and sulcus vocalis. Various injectable materials have so far been investigated and clinically utilized. Although silicone and teflon are materials most widely used currently, our clinical experiences have indicated that they are not totally dependable because of such problems as tissue rection and instability of the volume.
Recently, atelocollagen extracted from young calf skin has been reported to be an excellent injectable material and its application to phonosurgery has been described by Ford without investigating its long-termed safety and histocompatibility, and its effect on the vocal fold vibrations after the injection.
This lack of investigation on the injection therapy of atelocollagen has prompted the animal experiments to study histological attitude of collagen in the vocal fold and the vocal fold vibration after the injection. The collagen at a concentration of 35, 20 and 10mg/ml were injected into canine vocal folds. The follow up period ranged from 3 days to 9 months after the injection. It was revealed that the most suitable concentration of the collagen for maintenance of the contour of the vocal fold was 35mg/ml, although the volume of the vocal fold tended to decrease very slightly during three days after the injection. Histological studies confirmed no inflammatory reaction in the surrounding tissue after the injection and no migration of collagen during the following-up period. Vibrations of the injected vocal folds during phonation were photographed with an ultra-high speed motion camera and frame-by-frame analyses were done. Mucosal wave-like movements were satisfactority preserved even when the collagen stayed in the submucosal superficial layer of the vocal fold. The result indicates that atelocollagen can be injected into any layers of the vocal fold without specific technical care. Owing to this advantage, use of the atelocollagen will expand indication of augmentation therapy.

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To investigate the cervico-vestibular interaction in the control of eye movements, the effects of neck vibratory stimulation on caloric nystagmus were analysed in 58 normal subjects and 57 patients with unilateral labyrinthine dysfunction. Caloric nystagmus was enhanced or suppressed by neck vibratory stimulation in the patients with unilateral labyrinthine dysfunction. Specifically, there was a functional interaction between sensory inputs from the neck proprioceptors and the peripheral labyrinth in the patients with unilateral labyrinthine dysfunction. However, neck vibratory stimulation had no effect on caloric nystagmus in normal subjects. Cervico-vestibular intraction was not observed in normal subjects. These results indicate that the role of the cervical sensory inputs in normal subjects and in patients is different. That is, inputs from the neck proprioceptors have little effect on the control of eye movemonts in normal subjects, whereas the neck inputs are quite important for the control of eye movements in patients with unilateral labyrinthine dysfunction.

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