Audiometric survey and endoscopic study of the external auditory canal were performed on a group of 31 professional divers, all of whom had experienced frequent exposure to dysbaric conditions.
The results are as follows.
1) Over 40% had exostosis of the external auditory canal. There was no relationship between the incidence of the exostosis and the length of their occupational career as a diver. Many of the divers had hearing loss whether they had exostosis or not.
2) Over 70% had sensorineural hearing loss, taking into account hearing loss due to aging. Most had no experience of inner ear barotrauma on descent, causing sudden a shift in hearing threshold. Deafness was related to the length of their occupational career as a diver.
In conclusion, we speculate that repetitive small changes in barometric pressure on the outer ear influences the pressure on the middle ear and further on that of the perilymph, finally damaging the inner ear auditory system.

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Two recent cases of cervical necrotizing soft-tissue infection are herein presented.
Case 1. A 52-year-old man with uncontrolled diabetes was hospitalized because of an erythematous swelling of the left side of his neck and high grade fever. Fetid yellowish pus exuded from the left parotid area. The swelling extended from the left temporal area to the left supraclavicular fossa, with necrosis of the parotid gland, sternocleidomastoid, masseter and a portion of the strap muscles.
Wound cultures revealed Staphylococcus aureus and α-hemolytic streptococcus. No anaerobic bacteria were detected. Treatment consisted of intravenous administration of antibiotics, control of diabetes with insulin, and debridement of the necrotic tissue, which left an epidermal defect in the initially swollen area. Transfer of a forearm free flap was done after the growth of healthy granulation tissue over the affected area.
Case 2. A 55-year-old woman with rheumatoid arthritis was transferred to our hospital after tracheotomy performed in another hospital because of dyspnea due to severe crepitant swelling of her cheeks and submandibular areas bilaterally, and her left temporal area. A copious amount of fetid pus exuded from the incisions made in the left temporal area, left cheek, and right submandibular area. There were bilateral diffuse rales.
Culturing the pus revealed α-hemolytic streptococci, while MRSA and Psuedomonas aeruginosa were detected from cultures of sputum. No anaerobic bacteria were found. After intravenous administration of antibiotics, infected wounds and pneumonia were ameliorated, and necrotic subcutaneous tissue and fascia were debrided. The patient was discharged with a residual depression in her left cheek and a scar on her left temporal area.

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Clinical application of the standardized “scratch and sniff” olfactory test in Japanese is described. Over 300 subjects participated in three experiments. In experiment 1, 29 odorants used in the smell identification test were rated as to their experiences. The ratios of the experiences in each combination of odorants were compared. In experiment 2, the test was applied to normal subjects. Average test scores decreased as a function of age, with the greatest decline occurring between the sixth and tenth decades of life. In experiment 3, the test was shown to differentiate between subjects with olfactory disorders and normal controls. This self-administered test now makes it possible to rapidly and accurately assess general olfactory function in the laboratory, clinic, or through the mail without complex equipment or spaceconsuming stores of chemicals.

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Fifty three cases of Reinke's edema were classified into 3 groups according to Yonekawa's proposed classification. Of these cases, 14 were Type I, 22 were Type II and 17 were Type III. In each case, psychoacoustic evaluation using the “GRBAS” scale and phonatory function tests (fundamental frequency, air flow rate, sound pressure level and maximum phonation time) using Nagashima PS-77 phonatory function analyzer were performed.
Psychoacoustically, the voice quality before surgery was estimated moderately impaired, in general, with high grade Roughness accompanied by Asthenisity and Strainedness. Cases with more severe lesions showed much worse psychoacoustic evaluation results and severely impaired phonatoy function, but they also showed greater improvement after surgery. Phonatory function improved significantly within a month and psychoacoustic evaluation improved significantly from 1 to 3 months after surgery, though neither returned to the normal range.
In conclusion, we consider that surgical therapy is appropriate in Type II and III cases, with voice therapy and cessation of smoking also necessary for good recovery.

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Among 80 patients with low tone sudden deafness (LTSD) who visited our department over the past 15 years, there were 6 cases (7.5%) who subsequently progressed to Meniere's disease. The clinical and audiological processes of the 6 patients were studied in detail and the following results were obtained.
(1) In these 6 patients, the time between onset of LTSD and the diagnosis of Meniere's disease ranged from 4 months at the shortest to 6 years and 8 months at the longest, 2 years and 9 months on average.
(2) Two pattern types were seen in the change from LTSD to Meniere's disease: changing within a short period of time after recurrence of an LTSD-like attack, and changing after more than one year without recurrent attack.
(3) The monoattack-nonrecovered type of LTSD and the recurrent type of LTSD within three months after the onset (short-term prognosis) frequently progressed to Meniere's disease.
(4) There were no close relationships between subjective symptoms and audiological features in the pre-Meniere's disease period (from the onset of LTSD to the recurrence of vertigo with cochlear symptoms).
(5) The 6 patients showed various audiogram shapes at the time of progression to Meniere's disease; 3 cases with the slightly rising type, 1 with the high frequency-impaired type, and 2 with the moderate, gradual and flat type.
(6) Of the 6 patients, 3 had good hearing during long term observation. At least 2 patients seemed to have the mild type of Meniere's disease.
From the results mentioned above, endolymphatic hydrops was considered to be a likely possible cause of LTSD, especially the monoattack-nonrecovered and recurrent types of LTSD. Though the patients with Meniere's disease who had cochlear symptoms prior to vertigo were suspected to have LTSD-like hearing impairment at the time, it seemed difficult to ascertain the exact hearing impairment from their medical histories or audiological findings at the time of initial consultation.

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The speech and language training for deaf children at our clinic is performed using a multisensory method, which consists of reception and expression training for sign language and fingerspelling as well as auditory training, lip reading, and written language training (the Kanazawa Method). We have already reported that acquisition of written language is not dependent on oral language, and that written langauge is easier to learn than oral language for deaf children. In the present investigation, we analyzed the acquisition of comprehensible and expressive vocabulary in sign language and fingerspelling.
The subjects were two children congenitally deaf at levels higher than 105dB. Recorded language samples by the age of 48 months were analyzed. Acquisition of sign language was found to be significantly easier than acquisition of oral language. The development of expressive noun words, function words, and Wh-question words in sign language at the early period was almost equivalent to that of hearing peers, and then the sign language appeared transfer to the oral language. These results suggest that early presentation of sign language with written and oral language is effective in the acquisition of communicative attitudes, function words and interrogative sentences which are most difficult for the hearing-impaired. It was shown that early presentation of sign language with written and oral language serves to promote acquisition of oral language.

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Our previous reports showed that second formant information, using a speech coding method, could be transmitted through an electrode on the promontory. However, second formant information can also be transmitted by tactile stimulation. Therefore, to find out whether electrical stimulation of the auditory nerve would be superior to tactile stimulation for our speech coding method, the time resolutions of the two modes of stimulation were compared.
The results showed that the time resolution of electrical promontory stimulation was three times better than the time resolution of tactile stimulation of the finger. This indicates that electrical stimulation of the auditory nerve is much better for our speech coding method than tactile stimulation of the finger.

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The effects of long-term electrical stimulation of the auditory nerve on the morphology of the cochlear nucleus were investigated in young pharmacologically deafened kittens.
Comparing the amplitude of EABR with the soma area, there was a strong positive correlation between the amplitude of EABR and the soma area of neurons within the anterior ventral cochlear nucleus on the stimulated side. However, there was no correlation between the amplitude of EABR and the soma area of neurons within the unstimulated anterior ventral cochlear nucleus.
In addition, there was no correlation between the amplitude of EABR and the survival rate of spiral ganglion cells.
This showed that EABR may be affected not only by the survival rate of the spiral ganglion cell, but also by the development of the central auditory nervous system in kittens, which were deafened under the development of the central auditory nervous system.

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In the past 20 years from 1970 to 1990, 21 patients with maligancies of the ear were treated at Cacer Institute Hospital. The primary sites were the auricle and cartilaginous external auditory canal (groupl: n=8), the bony external auditory canal (group 2: n=6) and the middle ear (group 3: n=7). In group 1, pathological types were squamous cell carcinoma in four patients and basal cell carcinoma in the other four patients. Seven patients were treated by surgery alone, and the remaining patient was treated by interstitional implant radiotherapy. No recurrence have been noted up to today in this group. In group 2, pathological types were squamous cell carcinoma in four patients and adenoid cystic carcinoma in the other two patients. All of the six patients underwent external canal resection or subtotal temporal resection. Two patients received postoperative radiotherapy. A five year survival rate of group 2 was 60%. In group 3, pathological types were squamous cell carcinoma in six patients and undifferentiated carcinoma in the remaining patient. Most of them underwent radical mastoidectomy followed by irradiation. However, all the patinets died within two years after treatment. In group 2 and 3, cytodiagnosis was useful for early discovery. In group 2, temporomandibular joint seemed to be a key point in surgical treatment. In group 3, the combination of conservative surgery with radiotherapy was not a radical treatment. This suggested it necessary to perform subtotal temporal resection to treat malignancy of the middle ear.

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Intravenous lidocaine was administered in 155 cases (196 ears) with tinnitus. The injection of lidocaine, at a dose of 60mg in men and 40mg in women was repeated five times. The intensity of tinnitus was evaluated along a scale ranging from 0 to 10, indicating the level prior to injection. A scale ranging from 0 to 7 was estimated to be effective. After evaluation of the drug by using a double-blind test, indications for therapy were analyzed statistically according to clinical characteristics.
The results obtaind were as follows:
1) The effect was confirmed by using a double-blind test.
2) The effective rate was 60.2%.
3) Older cases, especially with presbyacusis, had the best indications for therapy.
4) From the clinical viewpoint of the characteristics of tinnitus, cases with hearing levels above 40dB or with dull onomatopoeic sounds were considered to have better indications for therapy.
5) None of the side effects experienced were severe, and all were transient.

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This report deals with factors which trigger motion sickness. The author has focused on the clinical examinations applied to motion sickness cases. Relationships between clinical data and susceptibility to motion sickness were investigated.
The following results were obtaind:
1. CV R-R (coefficient of variation of R-R intervals on EGG) in the frequent motion sickness group showed higher values than in the occasional motion sickness group. This result suggests a hyperfunction of the vagus nerve.
2. In caloric testing with ENG, the motion sickness group showed lower values of duration and eye speed than the occasional motion sickness group. On the other hand, the frequent group showed higher values of laterality in eye speed than the occasional group.
3. With the visual suppression test, the frequent motion sickness group showed higher values than the occasional motion sickness group. On the other hand, there was a significant difference between the frequent motion sickness group and the occasional motion sickness group in terms of laterality of visual suppression values.
4. In testing fluctuation of CV R-R in response to optokinetic stimuli, the frequent motion sickness group showed elavation of CV R-R values after optokinetic load. On the other hand, the occasional motion sickness group showed deppression of CV R-R values after the same load.
5. Among clinical examinations designed to diagnose susceptibility to motion sickness, CV R-R, the caloric test, the visual suppression test and OKP testing can produce sufficiently accurate results for clinical investigation.

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To clarify the existence of the vertical component during a caloric nystagmus and the existence of a second phase of the nystagmus, 194 induced incidents of a caloric nystagmus in 29 normal subjects have been analyzed.
Each nystagmus episode was recorded by using ENG and an infra-red video camera. The caloric stimuli were given by pouring 5 ml of water at 20°C into the ear at an ear-up position. After irrigation, each subject then assumed a supine or a prone position, with the head bent 30 degrees forward in either position. All recordings contained vertical components that depended on the supine or prone head position and not on the side of the stimulated ear, i. e. an up-beating nystagmus resulted in the supine position and a down-beating nystagmus in the prone position. Further, the vertical component was far stronger in the prone position. In contrast, the horizontal component had larger velocities and was of longer duration in the supine position than in the prone position. When the first phase of the caloric nystagmus ended, the body position was changed 90 degrees, i. e., to a sitting position or a right-ear-down or left-ear-down position. All trials showed a horizontal component during the secondary phase when the head assumed the sitting position. As for the ear-down positions, only when the irrigated ear was moved upwards from the prone position during the secondary phase, an up-beating vertical nystagmus resulted in almost all the trials.
These findings suggest that a caloric nystagmus may originate not only from the lateral semicircular canal but also from the vertical canals, and the second phase of a caloric nystagmus may be strongly influenced by the otolithic organs.

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It is well known that the “placental form of glutathione S-transferase” (GST-π) is present in high concentrations in most human carcinomas. However, its expression in head and neck carcinomas have not yet been reported. The author investigated the expression of GST-π in the tissue of pharyngeal and laryngeal carcinomas by the immunohistochemical procedure, and the following results were obtained:
1) GST-π was positive in 80% of laryngeal carcinomas (35 cases) and 52.8% of pharyngeal carcinomas (36 cases) As a rule, well differentiated squamous cell carcinomas showed stronger expression of GST-π than poorly differentiated squamous cell carcinomas.
2) Although normal epithelia of the pharynx and larynx showed negative GST-π, it should be noticed that 54.6% of precancerous epithelia (11 cases) showed positive GST-π.
3) Most patients treated with radiotherapy showed the diminution of GST-π expression after the irradiation. However, co-relation between the strength of initial GST-π expression and the effectiveness of radiotherapy was not observed (p<0.01)

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