We report 4 cases of olfactory neuroblastoma with anterior cranial fossa extension treated by craniofacial surgery. Three patients have been alive and well for 4 years, 1 year and 11 months after the initial treatment without major surgical complications but one patient died of local recurrence 11 months after treatment.
Multidisciplinary surgery for olfactory neuroblastoma with intracranial extension permits radical tumor excision and reconstruction of the anterior skull base.
This one-stage procedure combining neurosurgery and plastic surgery with pre or post-operative radiotherapy is considered to be essential for eradicating this tumor.

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Intracordal injection therapy is a surgical therapeutic modality for glottic incompetence caused by unilateral laryngeal paralysis. Atelocollagen, which has recently been attracting attention as a material for use in intracordal injection therapy that supplants silicon, was initially claimed and expected, by virtue of its salient biophysical properties, not to cause impaired wave-motion of the vocal mucosa when injected into the submucosa.
Unfortunately, however, our attempt to use this material for the same purpose proved disappointingly unsuccessful, with vocal sounds produced thereafter being metallic, vocal folds becoming tense and consequently transforming the site into a muscular coat of vocal muscles.
During the past 3 years, we at the Department of Otolaryngology of the Jikei University School of Medicine, have performed intracordal injection therapy with atelocollagen on 20 patients diagnosed as having unilateral laryngeal paralysis under local anesthesia using a flexible fiberscope and a stroboscope under a video monitoring system. Comparisons were made of the voice before and after injection in 6 patients receiving submucosal injection and 14 given intramuscular injection of the material.
In some autopsied patients, histological findings of the treated vocal cords were scrutinized and problems regarding atelocollagen injection were investigated.
Judging from pathological findings of the vocal cords after atelocollagen injection and the clinical results of this therapeutic procedure, it seems most appropriate to inject this plastic material into the vocal muscles. This will prevent atelocollagen diffusion and maintain unimpaired wave -motion of the vocal mucosa, thus resulting in an acceptable voice quality.

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Although glucocorticoids are sometimes used for the treatment of vertigo in certain disorders such as Meniere's disease, the mechanism underlying anti-vertigo effect remains unknown. The present study was performed to examine the effects of a glucocorticoid, dexamethasone, on neuronal activity in the medial vestibular nucleus (MVN) to determine whether or not the drug acts directly on the MVN neuron using α-chloralose-anesthetized cats which were fixed in a stereotaxic instrument placed on a turn-table. Single neuronal activities in the MVN were extracellularly recorded with a glass-insulated silver wire microelectrode attached along a seven-barreled micropipette. Each pipette was filled with dexamethasone phosphate (0.1M), monosodium glutamate (1M), glutamic acid diethylester (GDEE) (0.05M: a non-selective glutamate receptor antagonist), CoC1₂, (0.1M: a non-specific calcium channel blocker), RU38486 (0.01M: glucocorticoid receptor antagonist) or potassium canrenoate (0.1M: a mineralcorticoid receptor antagonist). These chemicals were microiontophoretically applied to the immediate vicinity of the target neuron being recorded. The effects of the drugs were examined on type I neurons which were identified according to responses to rotation: the neuron showed an increase and a decrease in firing with ipsilateral and contralateral rotation to the recording site, respectively. Microiontophoretically applied dexamethasone (50-200nA) dose-dependently increased spontaneous firing of
MVN neurons. However iontophoretic application of GDEE did not affect the dexamethasoneinduced increase in firing of the MVN neurons but inhibited glutamate-and rotation-induced firing. Microiontophoretically applied Co²+ did not affect dexamethasone-, glutamate-and rotationinduced firing. However, dexamethasone-induced firing was dose-dependently suppressed by iontophoretic RU38486, but not by canrenoate. Then a microdialysis study using α-chloraloseanesthetized cats was performed to determine whether or not dexamethasone affects the release of glutamate from vestibular nerve terminals. The microdialysis probe (CMA/10, 2mm) was inserted into the MVN and perfused with Ringer solution at 2ml/min. Samples were collected at 10-min intervals. Endogeneous glutamate was measured using the HPLC-ECD method. When repetitive stimuli (200μsec duration, 0.5mA and 5Hz) were given to the vestibular nerve for 10 min, an increase in the release of glutamate was observed. Dexamethasone did not produce spontaneous or stimulation-induced release of glutamate. These results suggest that dexamethasone acts directly on the MVN neuron to excite neuronal activity through glucocorticoid receptors on neuron membranes, but the excitation is not due to the release of glutamate.

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A one-step PCR system was developed for detection of two types of EBV, using a single pair of primers that were complementary to both sequences coding the EBV nuclear antigen (EBNA)2, and encompassing a large deletion in the sequence of type 1 EBV. Type 1 and type 2 EBV were detected simultaneously by polyacrylamide gel electrophoresis and ethidium bromide stains after amplification. The specificity of amplification was confirmed by Southern blot hybridization with the oligonucleotide probe that was complementary to both EBNA-2 regions.
Additionally, two pairs of type specific primers were synthesized from divergent sequences in the EBNA-2 regions of type 1 and type 2 EBV.
The PCRs were employed for analysis of the EBV genotype in the oral cavities of healthy donors and patients with various tonsillar disorders.
EBV was detected in 60 samples from healthy donors and patients with various tonsillar disorders. Fifty-six contained type 1 and four type 2. Double infection was not seen in either healthy donors or patients. These results indicate that type 1 EBV is highly dominant in Japan.
It is interesting to note that patients with acute tonsillitis and palmoplantar pustulosis showed a statistically higher frequency (P<0.01) of EBV excretion than healthy donors.
In examining anti-EBV viral capsid (VCA) -IgG antibody titers and EBV excretion in the oral cavity, EBV excretion was not found to correlate with the VCA-IgG antibody titers.

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The polymerase chain reaction method (PCR) was employed for the analysis of EBV genotypes in nasopharyngeal carcinoma, malignant lymphoma of head and neck origin and infectious mononucleosis. In nasopharyngeal carcinoma, type 1 EBV was detected in 12 cases and type 2 in one. Type 1 EBV was also detected in 3 out of 8 malignant lymphoma and 2 infectious mononucleosis. These results indicate that type 1 EBV is strongly predominant in nasopharyngeal carcinoma and
predominant in malignant lymphoma and infectious mononucleosis. Our results may reflect the general prevalence of these two types of EBV in Japan, as we previously reported.

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In a previous study, endolymphatic hydrops was induced in 36% of guinea pigs immunized with type II collagen and a dominant negative SP was recorded from these hydropic animals. These results suggested that the immune response to type II collagen may have a role in the etiopathology of some cases of Meniere's disease. In this study, we evaluated the levels of serum antibody to type II collagen and three other immune indexes in patients with Meniere's disease, especially those who showed negative SP dominance on electrocochleography. Twenty-nine Meniere's cases, 22 normal volunteers serving as controls, 28 RA cases, and 9 patients complaining of vertigo were examined to detect serum immune indexes. Meniere's patients exhibited high values of serum antitype II collagen antibody as compared to control subjects. Furthermore, total IgG, C3, anti-type II collagen antibody and circulating immune complex were increased with the highest levels being in the RA group, followed by Meniere's disease and then the control group. These results probably reflect the extent of immune reaction development. The immune response may be generalized in RA cases and/or local in Meniere's disease. Our study results suggest the development of certain immune status abnormalities in our cases, which lends support to the idea of an immunologic disorder playing a role in the etiology of some cases of Meniere's disease.

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The effect of aging on middle ear function has not been investigated thoroughly, as there is no simple measuring apparatus except for the conventional impedance meter (IM). However, the reliability of the IM is insufficient, because the stimulus frequency is fixed and the information provided by the IM is minimal. We have developed a sweep frequency middle ear analyzer (MEA), which provides much more information on middle ear dynamic characteristics than a conventional IM, and have obtained various measurements with this device.
In this paper, middle ear dynamic characteristics of 187 normal subjects (309 ears) ranging from a 4-year-old child to an elderly person, 79 years old, were measured with the MEA in the middle ear resonance frequency region where dynamic characteristics can be seen clearly, and the effect of aging on middle ear dynamic characteristics was examined.
The main results obtained were as follows: Middle ear mobilities tend to increase up to the twenties, then decrease up to the forties. Subsequently, a clear difference between those of males and females is observed. The middle ear mobilities of males decrease gradually with an increase in age. In contrast, although the standard deviation values are large, those for females tend to rise with increasing age.

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The sympathetic nervous system, which originates in the superior cervical ganglion (SCG) and is distributed in vestibular end organs, has been proposed to have some influence on vestibular function. The present investigation was conducted to assess the effects of unilateral electrical stimulation of the SCG, administration of a vasopressor drug, and introduction of KCl (0.7 M/ml) into the tympanic cavity on vestibular function in alert guinea pigs. Nystagmus was not observed as result of electrical irritation of the SCG (22 test animals), infusion of the KCl solution into the middle ear cavity (5 test animals), or the combination of SCG stimulation and vasopressor drug administration (7 test animals). However, when the SCG was stimulated electrically after introduction of the KCl solution into the ipsilateral cavity, nystagmus and postural deviation were observed (5 out of 12 animals). Furthermore, after the administration of a vasopressor drug to these 12 animals, irrespective of the manifestation of nystagmus, the same changes took place in response to the electrical stimulation (7 animals). These results suggest that SCB stimulation is a provocative factor for nystagmus, that infusion of KCl solution into the tympanic cavity induces a hypersensitive state in the inner ear, and that high blood pressure increases this hypersensitivity.

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Inverted papillomas in the nose and/or paranasal sinuses exhibit a high recurrence rate, and an association with malignancy. Early diagnosis and aggressive surgical therapy are thus essential.
Seventeen cases of inverted papilloma seen at Saitama Cancer Center over a 17-year period were reviewed.
Common presenting symptoms, the primary papilloma sites and the results of surgical treatment were as follows.
1) Almost all patients complained of nasal obstruction. The usefulness of nasal biopsy of the tumor was confirmed, with 12 cases being diagnosed as having inverted papilloma pre-operatively. Inverted papilloma without squamous cell carcinoma caused osseous thinning, but did not destroy the bone.
2) It was found that the primary site of the papilloma involved the lateral wall of the nasal cavity. Lateral Rhinotomy was therefore recommended as a standard treatment.
3) The recurrence rate was 1/12 after Lateral Rhinotomy. Two cases had complaints associated with the Lateral Rhinotomy, nasolacrimal duct stenosis, and a scar in the median corner of eye.
4) Only one case had concomitant squamous cell carcinoma in the nose and maxillary sinus. This patient received chemo therapy, radiation therapy and finally maxillectomy, but the inverted papilloma recurred several times. Six years later, squamous cell carcinoma recurred and lead to this patient's death.

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