An immunohistochemical study was made on the distribution of neuropeptides in 36 surgical specimens of the inferior nasal turbinate mucosa obtained from 32 patients with allergic rhinitis. Eleven patients (15 specimens) of the 32 underwent chemosurgery in which trichloracetic acid (TCA) was used before excision. In these patients a watery nasal discharge remained even after TCA application, although the nasal obstruction decreased. As a control, 6 specimens obtained from 6 patients with non-allergic rhinitis were also studied. In the present study, the distribution of Substance P (SP) was examined as an index of the sensory nerve, whereas that of Vasoactive Intestinal Polypeptide (VIP) was examined as an index of the parasympathetic nervous system. The distribution of nerve fibers showing a positive reaction specific to each of the two types of neuropeptides was examined in the frontal sections of the specimens at distances of 5 and 15mm from the anterior tip of the inferior turbinate. In particular, the modes of the distribution in the superficial and deep layers of the mucosa were compared. It was found that, in the patients with allergic rhinitis who had not undergone TCA treatment, both SP-positive and VIP positive fibers were abundant in the anterior portion of the turbinate immediately beneath the basement membrane. In those patients who underwent chemosurgery prior to excision, SP-positive fibers were very scarce in both superficial and deep layers, whereas VIP-positive fibers appeared to exist only in the deep layer around the remaining nasal glands. In the specimens obtained from patients with non-allergic rhinits, there was no appreciable difference in the pattern of distribution of SP-and VIP positive fibers among different sites of the specimens. The present study would indicate that chemosurgery using TCA inhibited the appearance of neuropeptides and resulted in improvement in clinical symptoms. However, in those patients having a continuous watery discharge even after TCA treatment, the function of the remaining nasal glands might be responsible for the symptom, although the contribution of VIP to the increase in vasopermeability should also be taken into consideration. Further studies are needed to determine the distribution of neuropeptides around the vessel walls.

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Herpes simplex virus type 1 (HSV-1) infection of the facial nerve has been strongly suggested as a cause of Bell's palsy. The author's group have produced a transient and homolateral facial paralysis in Balb/c mice by inoculating HSV-1 onto the auricle, simulating the symptoms of Bell's palsy. To clarify whether and how age and specific immunity against HSV-1 are involved in the pathogenesis of facial nerve paralysis, age dependent susceptibility to the virus and passive immunization with anti-HSV-1 antibody or immunized splenic T cells were investigated in a mouse model system.
Following inoculation of HSV-1 into 3-week-old mice, 80% of the animals died whereas only 13% of 4 to 5 week-old mice died, and 50% developed facial nerve paralysis 1 week after the inoculation. No 6-week-old mice died and 6% developed facial nerve paralysis. Although all mice showed seroconversion of neutralizing antibody regardless of the presence of facial nerve paralysis, six-week-old mice and 4-week-old mice without facial nerve paralysis produced higher titers of anti-HSV 1 antibody than 4-week-old mice with facial nerve paralysis. This results suggested that the age and the immunological potential of mice are closely related to the pathogenesis of facial nerve paralysis.
Passive transfer of either anti-HSV 1 antibody or HSV-1 immunized splenic T cells into 4-week-old mice prevented development of facial nerve paralysis and death if they were transferred within 3 hours postinoculation. However, a similar transfer 48 or 96 hours after HSV-1 inoculation did not produce such protection. HSV-1 DNAs were detected in the facial nerve as early as 48 hours postinoculation by polymerase chain reaction (PCR). These results indicate that the passive immunization, providing both cellular and humoral immunity, is effective for preventing facial nerve paralysis if performed before virus infects the facial nerve. The nervous system has a blood-nerve barrier (BNB) which privileges it from the peripheral immune system. Therefore, once the virus infects the facial nerve, passive immunity transferred from peripheral vessel might be excluded from the virus or virus-infected cells unless the BNB is broken down.
Bell's palsy is thought to occur during the course of HSV-1 latency in the geniculate ganglion. If we could reactivate latently infected virus and produce facial nerve paralysis again in the animal model, this might provide clues to clarify not only the pathological mechanism of Bell's palsy but also the interacion between immune system and virus reactivation.

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Twelve patients with mucosal melanoma in the head and neck were treated at Yokohama city University from 1975 to 1994.
The sex distribution was 5 male and 7 female, and the age ranged from 40 to 79 year-old. The highest number of patients were in their sixties. In 10 cases tumors arose in the nasal cavity, in one case in the maxillary sinus and in the other case in the oral cavity.
The treatment modality for this tumor consisted of various combination therapies including surgery, radiotherapy, chemotherapy and immunotherapy. Combination chemotherapy consisting of dimethyltriazeno imidazole carboxamide (DTIC, Dacarbazine), amino methyl pyrimidinyl methyl chlorethyl nitrorosourea hydrochloride (ACNU) and vincristine (VCR). Cisplatin (CDDP) was recently used for cases where other chemotherapy was not effective. Surgical treatment in the initial therapy was performed in 8 patients. In three of these 8 cases, the surgical margin was positive. One of them was dead after 9 months, another dead with complication after 1 year and the other survived free of any tumor.
Immunotherapy using OK-432, interleukin-2, LAK therapy and low dose CPM was effective for some patients.
The 5-year survival rate was 44%. Patients with surgical treatments in the initial therapy had longer survival than those without surgical treatments.

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It has been reported that hearing aggravation due to aging is predominantly in the high frequency range and that there are rapid and slow phase of aggravation in hearing level. In the present study, the pattern of aggravation of hearing level due to aging was investigated in 387 adults of over 35 years of age who had visited the Kitasato Health Science Center for a regular health check-up annually for more than 5 years, and were diagnosed as having neither external of middle ear diseases nor hearing impairment of obvious origin at their first visit. The subjects were divided into 8 groups according to their ages in increments of 5 years. Their audiograms were obtained annually, and the results were used to obtain the distribution of the hearing level at each test frequency. All of the subjects were examined for individual changes in audiograms and those who showed 20 dB or more aggravation of hearing in a 1-year period without subsequent improvement were defined as having a rapid phase of aggravation. There were clustering points in hearing distribution at around 30 dB and 60 dB at the test frequency of 8 kHz in those subjects showing a rapid phase of aggravation. Similar clustering points were also noted in those subjects who showed gradual aggravation of 20 dB or more in a 5-year period and who had 20 dB or more aggravation in one year but showed later improvement. As for the test frequencies lower than 4 kHz, there appeared to be a clustering point at around 30 dB. The incidence of the rapid phase of aggravation was then determined in each group, in order to investigate the relationship between aging and the appearance of the rapid phase of aggravation. The rapid phase was already noted in the youngest age group (range, 35-39 years), while the incidence gradually increased up to the 50-54-year group and stayed at a constant level in the 55-69-year groups. The incidence markedly decreased thereafter. The results suggest that hearing aggravation due to aging does not occur at any particular age. Rather, the hearing aggravaion appeared to be closely related to the hearing level, and to manifest itself when the hearing level approaches 30 dB and 60 dB.

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Neuroendocrine carcinomas (NECs) of the head and neck are rare. Between 1980 and 1995, only 163 cases of laryngeal and 30 cases of sinonasal NEC had been reported worldwide. We report two cases of sinonasal NEC. Case 1: A 49-year-old man complaining of left nasal obstruction was admitted to our hospital. A tumor with a tendency to bleed was seen in the left nasal cavity. CT scanning revealed an enhanced mass in the left nasal cavity and both maxillary and ethmoid sinuses. An open biopsy was performed to determine the diagnosis. The diagnosis of NEC was based on light microscopic and immunohistochemical findings. Chemotherapy and radiation were performed, but bone, liver and brain metastasis occurred 15 months after diagnosis and the patient died. Case 2: A 59-year-old man, complaining of right forehead swelling visited our department. CT scanning and MRI revealed that the right ethmoid sinus was filled by a tumor which had invaded the base of the skull. An open biopsy was performed, From the results of light microscopic and immunohistochemical investigations, NEC was highly suspected. Chemotherapy and radiation were performed, but the patient died 6 months after diagnosis. This study shows that there are aggressive types of nasal NEC. although these sinonasal carcinomas were reported in the literature to be not very lethal. The diagnosis, histopathological classification, treatment, and prognosis of sinonasal and laryngeal NECs were reviewed.

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This study was carried out to compare the speech perception ability of patients using hearing aids with hearing levels of 81dB or more (55 patients) and those with cochlear implants (67 patients). The patients with hearing aids were divided into group A (hearing levels 81-90dB, 7 patients), group B (91-100dB, 11 patients), group C (101-110dB, 19 patients), group D (111-120dB, 7 patients), and group E (121-130dB, 6 patients). The patients with cochlear implants were using the strategies of F0F1F2 (14 patients), MPEAK (32 patients) and SPEAK (21 patients). Speech perception tests of monosyllables, words, and sentences under conditions of auditory plus vision were administered. The means and standard deviations of the percentages giving the correct answer in F0F1F2, MPEAK and SPEAK were 45.2±14.7%, 45.7±14.6% and 62.6±15.9% for monosyllables, 44.8±18.9%, 56.3±15.0% and 73.4±15.5% for words, and 64.0±26.4%, 60.5±15.9% and 84.7±13.8% for sentences. In comparison with the results for patients with hearing aids, the speech perception for F0F1F2 and MPEAK was equivalent to that of group C, and that for SPEAK was better than that of group B but poorer than that of group A. In other words, the speech perception ability in conventional cochlear implant strategies-F0F1F2 and MPEAK-corresponded to that of patients with hearing levels of 101-110dB, but that in the new strategy, SPEAK, gave better results than 91-100dB.

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Electrocochleographic cochlear microphonics (ECochG-CM) and Evoked Otoacoustic Emissions (EOAE) were recorded for 17 patients with acoustic neuromas to assess their cochlear functions. ECochG-CM was recorded by a transtympanic needle electrode technique. The acoustic stimuli of EOAE were short tone bursts and thresholds of detection of the slow components were determined. In 13 of the 17 patients, elevated detection thresholds of ECochG-CM and/or abnormal interaural differences in detection thresholds of the slow components of EOAE were observed.
The patients with hearing loss and an elevated detection threshold of CM were believed to have cochlear impairments. Those with hearing loss and a relatively low detection threshold of CM were thought to have cochlear nerve damage and a smaller degree of cochlear impairment. The correlation of ECochG-CM and EAOE was 0.799. Both ECochG-CM and EOAE were useful in evaluating the cochlear functions of patients with acoustic neuromas. Although EOAE was easier to apply clinically, ECochG was indispensable when detailed examinations of cochlear functions were necessary.

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The color of the nasal mucosa was quantitatively studied. Chromaticity of the nasal mucosa was indicated by two parameters, x (red component in RGB) and y (green in RGB) values, measured with a chromameter (MINOLTA Co., CS-100).
According to preliminary studies in normal subjects, the following conditions were thought to make the method suitable for measuring the color of the nasal mucosa. 1) The chromameter can be held in the hand. 2) Brightness on the nasal mucosa should be kept as constant as possible. 3) The inferior turbinate mucosa is easier to measure than the septal one.
In the preliminary study there was no significant difference in chromaticity measurements among the examiners. Chromaticity of the inferior turbinate was compared among patients with perennial nasal allergy (PNA, n=19), with cedar pollinosis (CP, n=11), and normal subjects serving as a control (n=15). The x values in the PNA and CP groups were significantly lower than those in the control group (p<0.01), and the y values were significantly higher (p<0.02). The results agreed with the macroscopic observations made by trained rhinologists. The x values increased when azelastin was administered in five of the PNA group. This increase was related to improvement of their subjective symptoms. Quantitative analysis of the nasal mucosal color could be useful for objective evaluation of the clinical course of allergic rhinitis.

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A cylindrical model consisting of a single or plural acrylic plates with holes of various cross-sectional areas was ventilated by a Harvard pump. Pressure flow curves of the combinations were drawn and analyzed according to the percent expression method. The length of the cylinder through the same cross-sectional area did not influence the ventilatory resistance. Divergent flow toward the downstream part decreased the resistance, but convergent flow from the upstream part did not Simultaneous setting of convergent flow from the upstream part and divergent flow to the downstream part decreased the resistance most effectively, as much as approximately 70% of the original resistance. Two separately positioned cross sectional areas in a respiratory circuit increased the resistance about 1.4 times when the separation length was more than 3cm, while the resistance remained between 1 and 1.4 times when the separation was shorter than 3cm. The average values of the minimum areas measured by acoustic rhinometry were usually much larger than expected from the present study. One of the factors affecting this difference may be that the axis from the nostril to the choana is complicated enough to significantly modify the aerodynamics of the nasal cavity.

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