Recently, chlamydial infection patterns have undergone considerable change. Chlamydia trachomatis has, in particular, been described as a major cause of sexually transmitted diseases. Because of the more liberal attitude concerning sexual life-styles and behavior patterns, the oral cavity and pharynx has been increasingly becoming a site of infection for many sexually transmitted diseases.
In the otolaryngeal region, because of oro-genital sexual relations, C. trachomatis infection is presently attracting a great deal of attention. The authors report a case of pharyngitis and cervical lymphadenitis due to C. trachomatis infection contracted from oral sexual activity. Initially, this was suspected to be a case of malignant lymphoma, but histological studies in biopsy specimens of the epipharynx and cervical lymph nodes revealed no malignant cells. Serum antibody titers against mycoplasma and a number of viruses were not elevated while those against C. trachomatis were, based on results of the microplate immunofluorscence antibody technique. C. trachomatis antigen was demonstrated in pharyngeal scrapings by an isolation method and direct immunofluorscence test. In addition, inclusion bodies of C. trachomatis were demonstrated in biopsy specimens from the lateral funiculus of the pharynx by direct immunofluorscence test using a MicroTrak^®.
The authors studied the seroepidemiology of chlamydial infection in healthy controls, patients with acute respiratory infection and patients with inflammation or infection in the otolaryngeal region. Among adult patients with otolaryngeal inflammation, the carrier rate for C. trachomatis specific antibodies was higher than in other groups. In females, especially, the carrier rate for C. trachomatis specific antibodies was very high. This observation suggests that C. trachomatis infection in the otolaryngeal region is not uncommonly caused by oral sexual activity.

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The swallowing function of ten patients showing marked cervical osteophytes were studied by double contrast pharyngogram and manometric examinations. In five cases in which the pharyngeal clearance was B type according to Shuzaki's classification, a significant increase in the maximal swallowing pressure value on the oral side ipsilateral to the osteophytes was often observed. In five cases in which the pharyngeal clearance showed A+A' type (marked impairment), the frequency of significantly decreased maximal swallowing pressure on the oral side ipsilateral to the osteophytes and abnormal waveforms of the swallowing pressure were high. However, no definite correlation was noted between these changes in swallowing function and osteophytesite.
Therefore, there are two possible outcomes of the changes in swallowing function caused by cervical osteophytes: one is a compensatory increase in pharyngeal constriction aimed at maintaining relatively good pharyngeal clearance, the other is impaired pharyngeal constriction and the pharyngeal clearance. These changes in swallowing function would impact on globus sensation.

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We report here a case of serious nasal cavity tissue damage caused by a foreign substance, specifically, a button-shaped battery.
The patient was a three-year-old boy who inserted a button-shaped battery into his left nasal cavity. On examination, we found necrosis of the nasal mucosa, cartilage and bone. In addition, the nasal cavity structure was severely damaged. In a follow-up experiment, we inserted a similar button-shaped battery, pre-soaked in a salt solution, into a rabbit's nasal cavity and measured daily changes in PH and discharge over time. In addition, we assesed how much nasal cavity tissue was damaged in a pathological specimen.
We found that the chief factor mediating tissue damage, among those we tried, was strong base production with lowvoltage discharge. Under these conditions the nasal cavity is damaged in a short time.

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Following direct KLH antigen challenge to the endolymphatic sac (e. sac) in guinea pigs, degeneration of the cochlea was examined histologically by light microscopy. Degeneration was seen in 21 out of 140 animals presensitized systemically from day 1 to 5 weeks post secondary KLH challenge to the e. sac. Degeneration of the organ of Corti, stria vascularis and spiral ganglion cells was seen from day 1 in 19, 17 and 7 animals, respectively. There was no increase in these degenerative processes during the time course. In the period from day 1 to day 4, severe bleeding in the perilymphatic space occurred simultaneously with cochlear deterioration. Three animals showed perilymphatic fibrosis which was noted after the first week post KLH secondary challenge. In constract, animals primarily challenged with KLH (locally administered to the e. sac) showed no cochlear degeneration. These results suggest that a locally mounted immune response in the e. sac can cause direct immune injury to cochlear tissues.

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Carbonic anhydrase (CA) is distributed in a wide variety of animal cells and tissues, especially in cells and tissues involved in rapid exchange or transport of protons, bicarbonate, or other ions. Although localization of this enzyme and its physiological roles in the inner ear have been investigated extensively, full clarification has yet to be achieved. We have conducted a histochemical investigation of CA localization in the inner ear of the guinea pig by Hansson's method, with emphasis on improved fixation. The histochemical reaction for CA activity is localized in the outer and inner hair cells of the organ of Corti, Deiters' cells or nerve endings, inner pillar cells, Boettcher's cells, stria vascularis, spiral ligament, vasculo-epithelial zone and spiral ganglion cells. The physiological roles of CA in the inner ear, particularly in relation to the production or absorption of endolymph, are discussed in this report.

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The histological features of adenoid cystic carcinoma are varied. In general, the tumors are classified into 4 histological patterns: tubular, cribriform, trabecular and solid. Numerous previous reports have indicated that the tubular pattern usually represents a favorable prognosis, the solid pattern a poor prognosis and the cribriform pattern an intermediate prognosis. Therefore, the present study was undertaken to determine precisely the proliferative potential of each histological pattern of adenoid cystic carcinomas.
A silver colloid technique to identify nucleolar organizer region associated protein (AgNORs) was applied to paraffin sections in a total of 16 adenoid cystic carcinomas. A morphometric analysis of highly magnified photographic images of AgNORs in light microscopic preparations was performed. Of the 16 tumors, 8 showed a mixture of different histological patterns in the same section. In comparing the AgNOR number among different histological patterns in the same section, the value was highest for the solid pattern, lowest for the cribriform pattern and intermediate for the trabecular pattern. Moreover, the mean AgNOR number also showed a stepwise increase from the cribriform pattern (2.3±0.3) through the trabecular pattern (2.9±0.2) to the solid pattern (3.3±0.6). There was a significant difference in AgNOR numbers between cribriform and trabecular and between cribriform and solid patterns. Our results indicate that the proliferative potential of histological patterns of adenoid cystic carcinoma is lowest in the cribriform, highest in the solid, and intermediate in the trabecular pattern area. The AgNOR staining technique appears to be of value in estimating the proliferative activity of adenoid cystic carcinomas.

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Malignant tumors sometimes gield a variety of paraneoplastic syndrome.
We report a case of middle ear cancer demonstrating unusual granulocytosis which was considered to belong to this syndrome.
A patient, 67-year-old male, noticed left facial nerve palsy in June 1989, and was operated on under the diagnosis of chronic otitis media.
However, middle ear tumor was suspected during the operatiom, which was confirmed to be squamous cell carcinoma.
He was referred to our hospital for radiotherapy.
Six months after irradiation, spontaneous liqorrhea due to the dural necrosis occurred. When intracranial repair of dura was performed, tumor invasion into the dura was noticed. Subtotal resection of the temporal bone with iridium implant was done in vain to control the reccurent tumor, which spread quickly to adjacent tissues.
A month before the death, progressive granulocytosis without appreciable inflammatory signs started. Numbers of WBC rapidly increased, maximally reaching 88300/cmm.
Plasma G-CSF concentration was assayed at this time, showing about ten times as much as that of nomal controls. It was thus postulated that production of this substance by the tumor was responsible for granulocytosis.

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Possible factors influencing nasal allergy in children were studied using a questionnaire and allergic examination including eosinophil count of nasal discharge, IgE RAST score to house dust and provocation test.
We investigated three groups of children according to the results of allergic examinations. The negative group, the equivocal group and the definite group, respectively, consisted of 40, 49 and 107 children.
We found the prediction value of definite group with eosinophil count of nasal discharge, IgERAST score and provocation test to house dust were respectively 77.0, 89.2 and 78.1%.
Bottle feeding and history of asthma bronchiale occurred more frequently in the definite group.
These observations provide epidemiologic and clinical bases for further investigations of children with nasal allergy.

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Superficial siderosis of the central nervous system (SSCN) in a disease characterized by chronic deposition of hemosiderin in the leptomeninges, subpial tissue, spinal cord, and cranial nerves. Previously the diagnosis of SSCN could only be made at autopsy or during a neurosurgical procedure. Now, however, a diagnosis of SSCN can be made non-invasively by magnetic resonance imaging (MRI).
We present the case of a 50-year-old male with SSCN accompanied by bilateral sensorineural hearing loss which gradually progressed to total deafness over a seven year period. This patient also had associated bilateral caloric weakness with episodes of severe recurrent headaches over the two preceding years. The deafness and gait disturbance, which were his chief complaints, were followed by other neurological manifestations including pyramidal tract signs, anosmia, and ageusia.
High-field MRI on T-2 weighted images of the CNS showed diffuse marginal hypointensity of the cerebrum, brain stem, and cerebellum. Atrophy of the cerebellum and brain stem was also apparent. Low signal intensity along the proximal segment of the acoustic nerve and the facial nerve was noted from the cistern to the internal auditory canal.
Neither bilateral transtympanic promontory nor round window electrical stimulation elicited any sound sensation.
In this case it was thought that the acoustic nerve alone or both the acoustic nerve and the cochlea were affected by this disease. Consequently, cochlear implantation was not indicated. The source of bleeding into the subarachnoid space could not be detected despite thorough examination.
This diagnosis will be made only by physicians who are aware of this rare entity and have knowledge of the characteristic clinical pathology. Further accumulation of living cases and longterm follow-up are needed to better determine prognosis and treatment.

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Contingent negative variations (CNV) were recorded in patients with tinnitus (N=20), abnormal sensations of the pharynx and larynx (ASPL) (N=26) and Meniere's disease (N=19), and compared with those of healthy adults (N=20) in order to investigate the characteristics of their information processing mechanisms in the brain. Patients were also subjected to psychological tests: Depression Score and the Cornell Medical Index test.
CNV (an event-related potential) is a slow negative cortical potential shift and can be recorded during two stimuli presented at a constant interval under conditions in which the subjects are told to press a key as quickly as possible upon an imperative stimulus (S2) following a warning stimulus (S1). S1 was a 1kHz tone burst of 300msec duration at a level of 85dB HL. S2 was a light flash. The interstimulus (S1-S2) interval was set at 2 seconds. The CNV can be divided into three components, early, middle, and late, according to latency. Statistical analysis of CNV amplitudes of the three components showed the following differences between groups.
In tinnitus patients, the mean amplitudes of both the early and middle component were significantly greater than those in healthy adults (P<0.05).
In ASPL patients, the mean amplitudes of the middle component were significantly greater than those in healthy adults (P<0.05).
In Meniere's disease, the mean amplitudes of both the middle and late component were significantly greater than those in healthy adults (P<0.05).
These results indicate that tinnitus patients are hypersensitive to tone stimuli (S1) and Meniere's disease patients manifest considerable preparation and expectancy of imperative stimuli (S2). Our results also show that CNV can estimate the severity of psychogenic factors in such patients, because a correlation between Depression Score and CNV amplitude was observed.

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Autonomic nervous function in 68 vertiginous patients and 33 controls was studied using power spectral analysis of heart rate variability.
First, a system was developed which computes the power spectral density (PSD) of beat-tobeat heart intervals using a continuous non-invasive finger blood pressure recording obtained with the FINAPRESS device. A fast-Fourier transform algorithm was used to compute the PSD. In frequencies up to 0.5Hz, the PSD of heart rate variability contains three major components: a low frequency (P₁), a middle frequency (P₂) and a high frequency (P₃). Each component was normalized by dividing the absolute values by total power (T), and then used as an index of each component.
Second, the effects of passive tilt, respiratory frequency and specific pharmacological sympathetic or parasympathetic blockade on the indices of these components were evaluated in the control group.
The following results were obtained.
1. During passive tilt, the normalized power of P₂ was increased, whereas that of P₃ was decreased.
2. The peak frequency of P₃ was consistent with the frequency of respiration.
3. Sympathetic blockade decreased the normalized power of P₂, whereas parasympathetic blockade decreased the normalized power of P₃.
From these results, I concluded that the normalized power of P₂ and P₃ are quantitative markers of sympathetic and vagal nervous activities, respectively.
Third, the results of spectral analysis in patients were compared with those in controls.
The following characteristics of autonomis nervous function in vertiginous patients were noted.
1. The normalized power of P₃ in patients was lower than that in controls, suggesting that parasympathetic nervous activity at rest was suppressed in patients.
2. The increase of normalized power of P₂with passive tilt was suppressed in patients, suggesting suppression of sympathetic response to passive tilt.
3. In patients with Meniere's disease, during the active period of vertigo attacks, the normalized power of P₂, which is an index of sympathetic activity, was higher than that in the intervals between vertigo attacks.
Fourth, with caloric stimulation in the control group, an increase of the normalized power of P₂was observed during or after the stimulation, which suggests that vestibular stimulation increases sympathetic activity.
I therefore suggest the following:
1. Decreased parasympathetic activity and suppression of sympathetic response were present in the vertiginous patients.
2. Sympathetic activity was increased by vertigo attacks in the patients with Meniere's disease.

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The tympanic membrane is a biomembrane made of thin vibrant material. The tension and strength of the tympanic membrane rely mainly on the radial fibers in the lamina propria. Experimental myringotomy by linear incisions were made at right angles to the radial fiber bundles in the tympanic membrane of 54 guinea pigs. The healing process was observed chronologically by light, polarized light and electron microscopy for two years. The mechanical strength of recovery of the tympanic membranes were then studied using a microtension tester developed by our laboratory. The tensile direction was parallel to the radial fiber bundles of the tympanic membrane, and the tensile rate was 1×10^-3m/sec.
1. Light microscopic observation showed that the radial fiber bundles did not reconstruct continuously even after two years. Polarized light microscopic observation showed that parts of the linear incision of the tympanic membrane contained polarized fibers in place of the normal radial fibers. Transmission electron microscopic observation of the tympanic membranes after four months showed that the radial fibers were cut off sharply, but that the lamina propria had regenerated with different fibers. Several fibroblasts were also observed. Scanning electron microscopic observation through the auditory canal after two years showed that thick masses of scar adhered to the site of the experimental incision of the tympanic membrane. This scar was composed of several layers of collagen fibers. The area of scar adhesion was also observed on the membrane facing the tympanic cavity, but it was thinner than the scars on the meatal side.
2. The tensile strength of the tympanic membrane recovered up to 40% of its original value after two weeks, up to 70% after two months, and up to 90% after four months. Through four to twelve months after trauma, the tensile strength of the experimental tympanic membranes had recovered to almost 100% of their original values.
The results indicate that the experimentally injured tympanic membrane of these guinea pigs underwent incomplete regeneration morphologically, but almost completely recovered tensile strength.

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This investigation was carried out to study practical hearing compensation with hearing aids and the correlation between subjective evaluation (questionnaire survey) and objective evaluation (speech perception test) as an assessment of hearing aid effect in patients with profound hearing loss.
1. Forty-nine patients with hearing levels of 90dB or more (23 men and 26 women) were examined. Their mean and median hearing levels were 105.9dB (standard deviation: 10.4dB) and 106.3dB, respectively. The patients ranged in age from 18 to 74, with a mean age of 47.4.
2. Subjective evaluation was carried out by a questionnaire survey in which the patients chose one of 4 or 5 graded categories in 10 different hearing conditions, and three items of“satisfactory”, “uneasiness” and “effectiveness”Speech sound discriminaiton ability for vowels and monosyllables, and speech intelligibility of words and sentences, were evaluated in audition only (A), vision only (V) and a combination of both (A+V), totaling 12 conditions with hearing aids as the objective evaluation using video tapes materials.
3. The subjective evaluation revealed that 60% of patients with hearing loss of 90-110dB understood“one to one conversation in a quiet place”Speech perception was poorer in“conversation in a noisy place”than in“conversation in a quiet place”Speech perception became poorer in the order of“one to one”, “to a few people”, and“to many people”For subjective feeling, 56.4% answered“satisfactory”, and for hearing aid effectiveness, 78.7% answered“effective”
4. In the objective evaluation, the rates of correct answers were 19.6% in A and 46.3% in A+V for monosyllables, 19.8% in A and 43.4% in A+V for words, and 29.5% in A and 60.0% in A+V for sentences.
5. There were significant correlations (p<0.001) between subjective evaluation of“in a quiet place and one to one conversation” (among other conditons) and objective evaluations of monosyllables, and word and sentence recognition, mostly in A and A+V.
These results suggest that hearing compensation by hearing aids can be evaluated objectively in patients with profound hearing loss when word and sentence recognition tests are performed in addition to the monosyllable recognition test, and it is more practical if vision is examined in addition to hearing for speech perception in patients with profound hearing loss.

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Immunohistochemical studies of proteoglycans and collagens (type I and type IV) in the cochlear duct, and of the effects of cisplatin (CDDP), were performed.
In cells of the organ of Corti and in the middle layer of the stria vascularis, heparan sulfate proteoglycan (HSPG) and collagens (type I and IV) or collagenlike substances were found. HSPG in these locations appeared to play important roles in the production of auditory sense. The tectorial membrane contained HSPG and collagens (type I and IV) However, no data supporting the concept that elements of the tectorial membrane are derived from interdental cells was obtained. In the basilar membrane, no HSPG, chondroitin sulfate (Chs), or collagens (type I and IV) were detected.
The unique structures containing these substances reacted strongly with anti-HS (heparan sulfate), anti-HSPG-CP (core protein) and anti-collagen (type I and IV) antibodies that developed in the middle layer of the stria vascularis after the administration of CDDP. However, no change was observed in the tectorial membrane, the spiral prominence, the basilar membrane, or the spiral limbus. The decrease in HSPG in cells of the organ of Corti, and the changes in the stria vascularis, may help solve the well known contradiction between the severity of morphological damage and of the hardness of hearing.

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