This study investigated immuno-injury to the inner ear auditory system following inner ear immune response in the guinea pig. The endolymphatic sac (ES) was directly challenged with keyhole limpet hemocyanin (KLH). Auditory brainstem response with click sound stimulation was assessed pre and post KLH challenge of the ES. In systematically presensitized animals, secondary KLH challenge to the ES produced significant elevation of the mean threshold level on day 3 and 17 as compared to that of pre challenge levels. However, no significant prolongation of the latency (N1-N3) was observed. On the other hand, neither phosphate buffered saline injection into the ES nor primary KLH challenges of the ES were capable of elevating the threshold level and changing the latency. These results indicate that elevation of threshold was apparently induced by a secondary immune response of the ES, not by nonspecific mechanical damage to the ES, the central auditory system or KLH toxicity to the inner ear, suggesting that local immune response of the ES is a possible pathogenesis of sensorineural hearing loss.

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Four cases which was suspected of congenital cholesteatoma were treated in the past 15 years. The age of the patients ranged from 4 to 17 years. In all cases, the cholesteatoma arose in the middle ear. In one case the cholesteatoma extended into the mastoid cavity. Tympanoplasty of colummella type III was indicated. Postoperative hearing gain was from 20 to 30dB. Although the incidence is low, otolaryngologists must be aware of congenital cholesteatoma when treating conductive hearing loss with a normal ear drum.

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A quantitative study was performed to analyze movement of the hyoid bone on swallowing in 71 patients with pharyngo-laryngeal neurosis (44 males, 27 females), who had no abnormal findings either morphologically or functionally. The lateral X-ray cine (30 frames/sec) was taken while the patients swallowed the contrast medium in the upright position, and precise movement of the hyoid bone was examined using a motion analyzer.
The movement was divided into 5 phases; initial slow elevation from the resting position (1st elevation phase), then a quick upwards shift to the highest position (2nd elevation phase), where the hyoid bone remained temporarily (static phase), followed by rapid and slow descending shifts towards the resting position (1st and 2nd descending phase, respectively).
The resting position of the hyoid bone is significantly lower in males than in females and it seemed to get lower with age in both sex. When compared to the younger group (age 10-30), the older group (age 60-70) had significantly more distance and longer duration of deglutition in the 1st elevation phase, whereas the 2nd elevation phase did not differ among the age group.
The results of this study indicate that prolongation of the time and distance of the 1st elevation phase are more significant in the older group, which may well explain the cause of delayed of deglutition.

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(Purpose) In the present study we made actual measurements of the normal and affected auricles of patients with unilateral cryptotia and performed a comparative statistical analysis. We also made a compilation of our own cases and other cases reported in Japan, and reported the results of our statistical analyses.
(Methods) The subjects of this survey were 36 patients who came to our outpatient clinic with a chief complaint of cryptotia between 1983 and 1990. Measurements of auricle were made according to the Martin method. We also compiled all cases of cryptotia reported in the Japanese literature to date in which the sex of the patients and affected side were clearly recorded and reviewed associated abnormalities and familial occurrence.
(Results) Auricle measurements of auricle showed the vertical axis of the affected auricle to be significantly shorter than normal, revealing severe shortening of the upper 1/3 of the auricle. There was no statistically significant difference between the normal and affected auricles on the horizontal plane. The results of our compilation of reports in the literature to date show a male-female ratio of 2: 1, a right-left-bilateral ratio of 5: 2: 3, the presence of other anomalies in 9.2% (7/76), and familial occurrence in 6.4% (15/236).
(Conclusions) (1) Based on measurements of auricle, cryptotia is defined as a deformity of the upper 1/3 of the auricle and is produced by the sum total of force vectors operating inferiorly and medially. Moreover, based on the data obtained as a result of the measurements performed in this study, there was greater deformity along the vertical axis, and the downward vector was obviously stronger than the inward vector.
(2) There were 3 cases of unilateral cryptotia with an adhesion-like deformity of the helix in the normal ear, and the theory that the upper portion of the auricle becomes embedded secondary to cartilage deformity seemed plausible.
(3) A compilation of cases in Japan showed a male-female ratio of 2: 1 and a right-leftbilateral ratio of 5: 2: 3, differing little from the ratios in our cases.
(4) Familial occurrence in our cases was found in the patient's mother of 2 cases and a male cousin and uncle in 1 case each, suggesting a strong hereditary influence.

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Several reports have yielded conflicting results on the role of IgG₄ antibody on the surfaces of target cells in immediate type allergy. This study was performed to elucidate whether IgG₄ antibody inhibits IgE-mediated histamine release from target cells after antigenic stimulation, and whether it has reaginic activity.
Serum was obtained from patients with nasal allergy receiving specific immunotherapy for housedust and mites. IgE and IgG₄ were enriched affinity chromatographically using monoclonal antibodies to IgE and IgG₄, respectively, from the pooled sera. Both fraction revealed high antibody activity to Dermatophagoides Farinae antigen.
Peripheral blood leukocytes from three non-allergic donors were passively sensitized with 100 or 300μgms of IgG₄ according to the method of Levy and Osler with a slight modification. Minimal or no histamine release was observed from leukocytes after challenge with both mite antigen and anti-IgG₄ monoclonal antibodies.
Furthermore, to investigate the reaginic activity of IgG₄, leukocytes from patients with nasal allergy were stimulated with anti-IgG₄ antibodies. The leukocytes of only three out of twenty patients released up to 10% histamine regardless of the IgG₄ concentration, while the other patients' leukocytes released minimal amounts of histamine.
Two of the three above-mentioned non-allergic donors were passively sensitized with 100 or 300μgms of IgG₄ either one hour after sensitization with 100 ngs of IgE or simultaneously with the same amount of IgE. After sensitization with 100 ngs of IgE, one showed high-grade histamine release after challenge with 0.5μg/ml mite antigen and the other showed middle-grade release with 0.1μg/ml mite. With the presence of 300μgs of IgG₄, histamine release was significantly inhibited in both donors regardless of the manner of sensitization. A control study was performed by absorbing IgG₄ with Sepharose 4B-mite complex. The inhibitory effect was minimized by the use of mite absorbed IgG₄.
In conclusion, these results strongly suggest that IgG₄ antibody plays an important role as a blocking antibody on the target cell surface in immediate type allergy.

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Operative records of 75 patients with acquired attic cholesteatoma were evaluated and compared with preoperative HRCT findings.
The cholesteatoma extensions were classified into five groups as follows; Group 1 (cholesteatoma limited to the attic, 9 cases), Group 2 (cholesteatoma occupying both the attic and the aditus, 5 cases), Group 3 (cholesteatoma extending down to the posterior tympanum, also occupying an area as in Group 2, 6 cases), Group 4 (cholesteatoma occupying the attic, the aditus and the mastoid antrum, 14 cases), and Group 5 (cholesteatoma extending down to the posterior tympanum, also occupying an area as in Group 4, 41 cases)
Ventilatory conditions, or the existence of soft tissue density, were evaluated by HRCT at such locations as the supratubal recess, mesotympanum, anterior and posterior parts of the tympanic isthmus, epitympanum, and mastoid antrum.
Results are as follows.
In Group 1, all these locations were aerated with the exception of a few cases.
In Group 2, complete opacification was observed in almost all of the antrums.
Soft tissue masses involved the anterior and/or posterior parts of the tympanic isthmus in both Groups 3 and 5.
In Group 3, the posterior part of tympanic isthmus was less aerated than the anterior part of tympanic isthmus.
In Group 5, all locations were filled with soft tissue density except the supratubal recess and the mesotympanum, where some degree of aeration was observed.
These results indicate that blockage of the ventilatory passages is not essential for formation of an attic cholesteatoma. Soft tissue density in HRCT is not the cause, but rather, the result of extension of a cholesteatoma.

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The function of nasal polyp mast cells has not been elucidated despite the large number of these cells observed in tissues. We examined these mast cells histochemically, immunohistologically and functionally.
Ninety-three percent of collagenase dispersed cells in a nasal polyp were formalin-sensitive. These dispersed cells released histamine in reaction to calcium ionophore A23187 in a dose dependent manner, but not in response to C5a, Compound 48/80 or Substance P. From these results, dispersed mast cells from nasal polyps were considered to be analogous to dispersed mast cells from the human lung and nasal mucosa but not those from human skin.
On the other hand, in the reaction with anti-human IgE, dispersed mast cells from a non allergic nasal polyp could not be seen to release histamine. In only 2 of 7 patients, could histamine release in response to Japanese red cedar antigen, from mast cells sensitized passively with the serum of Japanese red cedar pollinosis, seen. Using small tissue samples from polyps, histamine was released by anti-human IgE in allergic patients but not in non allergic patients.
Immunohistologically in allergic nasal polyps, some IgE positive mast cells could be seen, whereas in non allergic polyps these cells were absent.
These observations suggest that mast cells which had accumulated in nasal polyps both with and without allergy were capable of functional histamine release, whereas in the nasal polyps of allergy patients but not in non-allergic patients these cells are involved in IgE mediated reactions.

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Intraluminal pressure change in the pharyngeal phase of swallowing was measured by the station pull-through method, in which a pressure transducer probe was being withdrawn at each 1cm step from a segment 25 to 8 cm from the nostril. The probe had an outside diameter of 5.0mm in size and was loaded with two miniature pressure transducers 3 cm apart from each other.
Electromyogram of the suprahyoid muscles was simultaneously recorded with a surface electrode as an idex of the second phase of deglutition. The three formats to analyze pressure wave forms in swallowing were designed as followings; a swallowing pressure curve showing peak values at each level, a conduction curve of swallowing pressure indicating the times when the peak of the pressure appeared at each level, and a calculation of the onset of relaxation and its duration at the portion of high pressure zone of the upper esophagus (UHPZ).
Analyses of the data in 30 normal subjects revealed the following results. 1) All showed swallowing pressure curves with 3 peaks at the levels of the velopharynx, hypopharynx and cervical esophagus. 2) Normal ranges of the pressure at each level of the peak were 48.2-139 mmHg, 46.4-132 mmHg and 9.0-111 mmHg, respectively. 3) Conduction curves of swallowing pressure showed an “S” like figure in all and the gradient was steep at the level of the oropharynx and hypopharynx. 4) The duration of relaxation at the paroximal end within the UHPZ was shorter than that at the distal in all. The normal range of the duration of relaxation at the paroximal end was 365-833 msec.
Profiles of swallowing in 130 patients with dysphagia showed the following results. 5) Pressure curves in swallowing were classified into 4 pathological patterns of curve depending on the site of a lesion. 6) Two of all showed an abnormal pattern of the conduction curve, which was supposed to be origined by a disorder in the preprogrammed process in swallowing. 7) Two of all also showed abnormally earlier onset of relaxation within the UHPZ. 8) Of all, 3 showed short duration of relaxation within the UHPZ abnormally.

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The purpose of this study was to investigate the process of changes in hearing of pure tones with aging.
Among individuals who had undergone thorough medical examination for the purpose of annual health-checks, 293 males (586 ears) whose hearing level had been examined for five years or more were enrolled in this study. Cases having conductive deafness or known sensori-neural deafness were excluded. Since the most typical change with aging is observed at 8 kHz, the investigation was carried out only on hearing at 8 kHz.
Hearing level increasingly declined with advancing age. Hearing distribution for young subjects showed a peak in the normal hearing level range. This peak decreased with aging, and another peak appeared at 50 dB.
Investigation of differences in hearing in the individuals over the five years showed that most subjects had a hearing level difference of 0 dB up to 54 years of age. From 55 years old onward, however, the difference was 5 dB. This indicates that gradual deterioration of hearing level with aging occurs most frequently.
On the other hand, in some subjects, deafness progressed faster. Thirty-four and a half percent of the subjects had deteriorations of 20 dB or more in a single year during the entire observation period. A deterioration of 20 dB or more was noted in 4 % of the young and 8% of the elderly. Such rapid progression of deafness was believed to be involved in formation of the 50 dB peak in the hearing distribution.

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In order to investigate postural control in the elderly, a stabilometric investigation including fast Fourier Transform (FFT) analysis was conducted in three different age groups. The oldest group was composed of 16 subjects who ranged in age from 75 to 86 years: another group consisted of eight 65 to 74 year olds; the control group was composed of 21 young students. The subject was instructed to stand and look for 30 seconds at a spot in a CRT 50 cm ahead of his eyes, and to control body sway as indicated by the gravitational spot in the CRT. The subject was then told to stand with eyes closed for 30 seconds. Next, a 100 Hz vibratory stimulation was applied to the bilateral Achilles tendon in each trial. The data was filtered with a 10 Hz high cut filter and digitized at 25 Hz, and subsequently analyzed by a microcomputer (PC9801 VM 2). Thus, statistical analysis was performed in terms of area, length, and total frequency spectra from 0.10 Hz to 10.0 Hz in both lateral and antero-posterior directions. Sixteen power spectra of 0.249 Hz step from 0.10 to 3.96Hz were demonstrated in the CRT and were also compared with those of the young group.
When standing naturally, significant increases in body sway were found in terms of area, length, and total frequency spectra in the most elderly group as compared with the other two groups.
There was no significant change in Romberg ratio between the elderly and the young groups. However, FFT analysis confirmed the influence of visual cues.
When vibration was applied, no increases in body sway with regard to these parameteres were demonstrated in the elderly, whereas significant increases were found in the young control group. This was especially evident in the eyes-closed trials, as previously reported. There were few increased frequency ranges in either lateral or antero-posterior sway in the elderly. This might suggest that proprioceptive afferent information play a less important role in elderly than in young subjects.
When the subject was requested to minimize his own sway by utilizing visual feedback, no difference was found in this parameter between the elderly and young groups. However, FFT analysis of the elderly group revealed an increase of the power spectra close to 1.0 Hz in both lateral and antero-posterior sway, whereas increases of approximately 1.0 and 2.0 Hz in the power spectra and a decrease in the power spectrum from 0.10 to 0.29 Hz were found in both directions in young subjects. This result might indicate that the elderly have a comparatively poor ability to adjust posture with fine body sway.
The conclusions drawn from these results can be summarized as follows: The influence of aging is apparent in the upright position. Proprioceptive information plays a minor role in the control of posture. On the contrary, sway is likely to be adjusted continuously by visual and vestibular information. It is speculated that vision could exert an influence over a wide range of frequencies and that the vestibule does regulate sway under 1 Hz.
The problem of whether or not visual feedback is utilized for correcting disequilibrium in the elderly remains controversial.

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A morphological study of the human tympanic plexus was performed. The tympanic nerve patterns on the promontory were classified into two types. The first was the single nerve trunk type, the second the type of nerve which divides into anterior and posterior branches. A tubal branch and a caroticotympanic branch on the promontory were both present in about 90% of the ears studied. Many ganglion cells were distributed on the tympanic plexus. It was concluded that these ganglia were autonomic, based on the nature of their fine structure. We speculate that these ganglia are parasympathetic and that they modulate the functions of vasodilators and secretory glands in the mucosa of the middle ear. In addition, we conducted a fiber analysis of the tympanic nerve and the lingual branch of the glossopharyngeal nerve and made a comparison between them.

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