Postoperative articulatory functions of patients with tongue cancer have been improved by reconstructive surgery with a radial forearm or recto-abdominal myocutaneous free flap. We examined the postoperative articulatory functions of 10 patients who received reconstruction with a recto-abdominal myocutaneous free flap after glossectomy. The functions were investigated by standardized tests, i. e. a quentionnaires, the 100 Japanese monosyllable speech intelligibility test and a single-word intelligibility test. A confusion matrix was obtained from the results of the monosyllable test. On the basis of resection sites, the present cases were divided into two types: an anterior type and a lateral type.
The results are summarized as follows. There was no significant difference in the results of the quentionnareis between the two types. The mean score of the 100 Japanese monosyllable speech intelligibility test in cases of the anterior type was 48% and in those of the lateral type it was 62%. The mean score of the single-word intellibibility test in cases of the anterior type was 75% and in those of the lateral type it was 83%. In cases of the anterior type, dental and alveolar sounds were often confused with fricatives, whereas in the lateral type, velars sounds were often confused with affricates or flaps. These results suggest that our classification based on resection site was useful for investigating postoperative articulatory functions after partial glossectomy.

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In Japan, the elderly population has progressively increased. It is therefore expected that various social services for the elderly will be demanded. As most of the elderly have hearing impairment due to presbycusis, it is difficult to communicate smoothly with them. To provide the various social services, it is necessary to investigate hearing acuity in the elderly. Accordingly, the Hearing Research Group, which belongs to the Research Project on Aging and Health in the Ministry of Health and Welfare of Japan, investigated the hearing acuity of people 65 years old, or more.
One thousand one hundred ninety two subjects were divided into five groups, Group A consisted of 170 males and 216 females between 65 and 69 years old, Group B, 186 males and 158 females between 70 and 74; Group C, 147 males and 140 females between 75 and 79; Group D, 63 males and 61 females between 80 and 84; and Group E, 29 males and 22 females 85 years old or more. We examined the 175 subjects 80 years old or more. Therefore, it is considered that this study could indicate the present condition of hearing acuity of the elderly of Japan.
The average hearing levels measured at seven frequencies (125, 250 and 500Hz, and 1, 2, 4, and 8KHz) were 35.0dB in group A. 42.1 in group B, 46.1 in group C, 52.1 in group D, and 55.6 in group E. There were no differences in the average hearing level between males and females in any group.
The audiogram pattern indicated a gradually descending curve in most subjects in all groups.
The average speech discrimination rate was 75.4% in group A, 70% in group B, 63.8% in group C, 59.7% in group D, and 52.1% in group E.
The percentage of subjects showing a short increment sensitivity index of more than 70% was 45.2% in group A, 49.3% in group B, 47.9% in group C. 51.6% in group D, and 59.7% in group D.
In conclusion, hearing loss due to aging tended to be more progressive at higher frequencies while hearing acuity of frequencies covering normal speech was preserved. However, the speech discrimination rate decreased relative to changes in the pure tone hearing level. It was considered that the pathology of hearing loss due to aging begins with retrocochlear changes and cochlear factors are added to retrocochlear changes with aging.

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Despite the fact that vertigo has been one of the most frequent complaints encountered in daily practice in an ENT outpatient clinic, it is believed to be the most unwelcome subject for ENT physicians. The reasons are diverse; e. g., the understanding of vertigo is still a difficult task for most physicians and requires time-consuming multiple studies. However, answers to those questions, although speculated a posteriori, are yet to be substantiated. Therefore, we have analyzed the data obtained from multiple questionnaires that were addressed to ENT physicians practicing in Chiba Prefecture in November of 1993. However, those who work in publicly run hospitals were excluded from the study. The study included otorhinolaryngologists who were members of the Society of Otorhinolaryngology of Japan. We received filled questionnaire forms from 76 of 155 members (49%) The age ranged from 33 to 82 years (mean 55.8 years, 68 men and 8 women). From these questionnaires, it became apparent that physicians are not necessarily reluctant to see patients with vertigo. Instead, most ENT physicians appeared to be actively paying attention to this symptom and to be making efforts to approach its diagnosis and treatment. Although we are not certain if the data obtained here represent the majority of ENT physicians, the positive attitudes toward the patients with vertigo/dizziness would certainly encourage those of us who are interested in this particular symptom category.

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It is now well recognized that normal afferent innervation is necessary for development of the auditory pathway. This study investigated the effect of chronic electrical stimulation of the auditory nerve on the size of cochlear nucleus somata of neonatally deafened kittens. Four kittens were deafened by using kanamycin and ethacrynic acid at 10 days of age and implanted at various ages with an active intracochlear implant in the left side and a dummy implant in the right side, and chronically electrically stimulated from ages 98-142 days for approximately 1000 hours at twice the EABR threshold. After chronic stimulation or after an equivalent period in the controls, the animals were injected with 2-deoxyglucose (2DG) and stimulated electrically for 45 minutes, then processed for autoradiography. Then the sections were stained for Nissle substance, and the cross-sectional areas (CSSA) of approximately 33, 000 neuron somata in the cochlear nuclei were measured with an image-analysis system. Soma sizes in regions with 2DG uptake were compared with those without the uptake. The CSSA of 2DG-labeled regions was usually significantly larger than that of the unlabeled regions, but there were no significant right-left differences. Thus, chronic electrical stimulation of a restricted sector of the cochlea is correlated with a larger soma size in the corresponding region of the cochlear nucleus.

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The volume response of vestibular dark cells of the gerbil to a hyposmotic challenge was investigated. Tissues including dark cells were perfused in preparations in which the perfusate had access to both sides of the epithelium and the height of the dark cell layer was measured as an indicator of its volume. We found that dark cells showed a fast and strong regulatory volume decrease (RVD) and prevented cell swelling in hypotonic media. This mechanism was dependent upon extracellular [K^-] and [Cl^-]. Ion selectivity of this mechanism was K⁺=Rb⁺>Cs⁺>Na⁺=NMDG⁺ (N-methyl-D-glucamine) for cations and Cl^-= SCN^-=NO₃^->>gluconate^- for anions. RVD of dark cells was inhibited by K⁺- channel blockers barium, quinidine and lidocaine, by Cl^--channel blockers 4-acetamido-4' -isothiocyanatostilbene-2, 2'-disulfonic acid and 4, 4'-diisothiocyanatostilbene-2, 2'-disulfonic acid, by an Na⁺-K⁺ ATPase inhibitor ouabain and by low temperature, but was not inhibited by a loop diuretic bumetanide, by carbonic anhydrase inhibitors acetazolamide and ethoxyzolamide, by a K⁺-channel blocker tetraethylammonium, by a Cl^--channel blocker 5-nitro-2 (3-phenylpropylamino) -benzoic acid or by an inhibitor of the Na⁺-H⁺ exchanger amiloride. These data suggest that the RVD of dark cells occurs via separate K⁺ and Cl^- channels which are different from those active under isosmotic condition, and is presumably activated by a hyposmotic stimulus.

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Paget's disease of the bone is a chronic, progressive disease of unknown etiology characterized by abnormal bony resorption and deposition. It is a common skeletal disease in Europe and North America, while in Japan it is very rare. Paget's disease of the temporal bone has been reported to cause hearing loss frequently.
We report a 50-year-old woman with Paget's disease who had progressive bilateral sensorineural hearing loss and right vestibular dysfunction. CT and 3 Dimensional CT (3D-CT) images demonstrated resorption of the entire bony labyrinth and its surroundings on both sides and that the temporal bone elsewhere remained intact. Bone scans revealed disease symmetrically in the bilateral otic capsules.
Previous studies indicated that the bone changes in Paget's disease in the petrous pyramid begin in areas best supplied with marrow tissue and that the otic capsule is relatively spared until advanced changes are present in the remainder of the petrous pyramid. But, this patient mainly had foci in the bilateral otic capsules and the pattern was similar to cochlear otosclerosis. 3D-CT was useful for differentiation of Paget's disease and cochlear otosclerosis. The pattern of the affected areas indicated that this is a very rare situation even in the reports of Europe and North America, where the disease is rather common.

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Malignant lymphomas arising in the salivary glands are very uncommon. The vast majority of these lesions are classified as extranodal non-Hodgkin's lymphoma. Clinical presentation, management, histopathology, and outcome in 11 cases of non-Hodgkin's lymphomas of the parotid gland region were reviewed. The ages of the patients ranged from 25 to 80 years (average 56.0 years) and the male to female ratio was 5: 6. Presenting symptoms were painless masses (10 cases) and a painful mass (1 case) in the parotid gland region. None of the patients had facial nerve paralysis. It seems to be difficult to diagnose malignant lymphomas of the salivary glands preoperatively, because an open biopsy of the salivary glands is generally contraindicated. We failed to diagnose malignant lymphoma in the parotid gland preoperatively. The clinical stages were stage I in 5 cases, stage II in 5 cases, and stage III in 1 case. There was no patient with stage IV. Three of the stage I tumors were diagnosed as MALT (mucosa-associated lymphoid tissue) lymphomas. Eight of the tumors were treated surgically and an open biopsy of the parotid gland tumor was performed in 1 case and open biopsy of a neck lymph node in 2 cases for the purpose of diagnosis. After the diagnosis, these cases were followed up with or without radiotherapy and chemotherapy. Follow-up ranged from 6 to 109 months. The 5-year-survival rate was 60%. The outcome for this group was found to be as good as that reported by others.

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We have developed a system that measures the volume of air cells in the temporal bone through computerized digital processing of high-resolution CT images. By using this method, the volume of pneumatization was measured, and the results were compared with the measured area of pneumatization obtained from two conventionally used simple ear X-ray methods (the planimeter and rectangular dimensional methods). A total of 57 ears, from 34 subjects, confirmed as normal by CT were examined.
The average volume of pneumatization measured on CT images was 5.97±4.15ml, and the average areas of pneumatization measured by the planimeter and rectangular methods were 9.08±5.64 and 17.39±9.77cm², respectively. Graphically, when the volume of pneumatization was plotted on the Y axis and the planimeter-measured area of pneumatization on the X axis, a regression formula of Y=0.651X+0.054 was obtained, with a correlation coefficient of 0.89. With the volume of pneumatization plotted on the Y axis and the rectangular-dimensional-measured area of pneumatization on the X axis, the regression formula was Y=0.375X-0.559, with a correlation coefficient of 0.88. Both these correlation coefficients were considered high. Furthermore, 3D models of the air cells in the temporal bone were created and compared for patients with high and low correlations. In order to capture the morphological characteristics of these 3D models, they were examined from four different angles (lateral, upper lateral, anterior lateral and upper medial). The results showed that regardless of whether air-cell growth was present in the direction of the apex partise petrosae in patients with a low correlation coefficient, such growth played a major role in the degree of the correlatiton. Future studies will be required to clarify this point, though it can already be said that 3D models are indispensable for studying the air cells in the temporal bone.
When we compared the volume and area of pneumatization in the temporal bone at different CT cross-sections, we found correlation coefficients in the vicinity of the canalis semicircularis lateralis of about 0.9 or higher. A statistical comparison of correlation coefficients for the CT, planimeter, and rectangular dimensional methods, made by using the CT cross-section with the highest coefficient, found a significant difference between the CT method and the other two methods (p<0.05). In other words, the volume of pneumatization can be estimated more accurately with CT images than with simple ear X-rays.

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The arrangement and numbers of intralaryngeal ganglia and associated neurons in humans and four mammals (dogs, rabbits, guinea pigs and rats) were investigated morphologically and compared with the results obtained in the cat which have been reported previously. Intralaryngeal ganglia were mostly distributed in branches of the internal branch of superior laryngeal nerve in all species, dorsal and/or dorsolateral to the posterior cricoarytenoid muscle in humans, dogs and cats and around the inferior laryngeal nerve in humans, dogs, cats, guinea pigs and rats. The total number of laryngeal ganglionic neurons was 2, 000 to 2, 400 in humans, 300-450 in dogs, 600-800 in cats, 250-320 in rats, and 100-150 in rabbits and guinea pigs. More than 80 percent of ganglionic neurons were present in the supraglottis in all species, except the rat, in which about 60 percent were in the subglottis. Each ganglion in all species existed within the nerve bundle, and was chiefly encapsulated with fibrous tissue, many ganglionic cells, glial cells, Schwann cells, vessels and connective tissue. The present morphological study of intralaryngeal ganglia in humans and four mammals suggests that the laryngeal ganglionic neurons have the same arrangement as in cats.

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The present study was designed to determine the standard values of AP, adapted AP and CM (0.5, 1.2, and 4kHz) of the electrocochleogram using subjects with normal hearing (20 ears, mean subject age 30.4 years). The input-output function, the latency and the threshold were measured in AP. whereas only an input-output curve was made for the adapted AP and the input-output function and the threshold were measused in CM. The CM threshold had the highest positive correlation with the threshold of the conventional pure tone audiometry at 1kHz. These standard curves will be very useful for analysing clinical data.
In order to discuss the aging changes affecting electrocochleograms, the test subjects were divided into two groups, i. e. one group was composed of subjects under 30 years of age (mean: 19.7 y/o, 10 ears) and the other of those 30 years old or over (mean: 41.1y/o, 10 ears). There were no differences in hearing threshold or the threshold of the electrocochleogram between the two groups. The CM threshold exhibited the highest positive correlation with the threshold of conventional audiometry at 1kHz in both groups.
AP and adapted AP showed no difference in any item between the two groups. Although there was no difference in the CM threshold, there was an obvious difference in the CM input-output curves between these two groups at high stimulus intensities of 2 and 4kHz.
It is known that the EP decrement makes CM smaller. However, it is unlikely that this decreased CM response in the older group was due to EP suppression, since this phenomenon was only observed in response to high intensity stimulo and there was no difference in responses to low intensity stimulo. Another possible explanation for this phenomenon is aging changes in the basilar membrane, tectorial membrane and hair cells.
Further studies are necessary to elucidate the etiology of the CM suppression revealed in the present study.

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