It is well known that hearing loss is often associated with anomalads, syndromes involving multiple anomalies. The incidence is especially high in severe cases of facial and visceral malformations. However, otologic features remain unclear in patients with a sequence of various anomalies which can not be classified into any known syndrome. We examined 11 temporal bones from 6 patients with severe visceral anomalies, which could not be classified into any known systemic bone diseases, chromosomal abnormalities, or congenital metabolic disorders. Temporal bone pathology was compared with external and visceral anomalies in each case.
The temporal bones had been removed at autopsy, fixed in 10% formaldehyde, decalcified and embedded in celloidin. Serial horizontal sections were made at 20μm and every tenth section was stained with hematoxylin-eosin.
Most abnormalities in the middle and inner ear were found to have an ectodermal or mesodermal origin. Inner ear abnormalities were noted in 6 temporal bones from 3 patients; the predominant feature was hypoplasia of the semicircular canals. Middle ear abnormalities excluding residual mesenchymal tissue were noted in 5 temporal bones from 4 patients; the predominant feature was an abnormal course of the facial nerve. It was also suspected that auricular and maxillomandibular abnormalities, which are often associated with severe visceral anomalies, indicate a high incidence of disorders affecting the auditory and vestibular systems.

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We studied the directional asymmetry of human vertical optokinetic nystagmus (OKN) and optokinetic after-nystagmus (OKAN) based on two experiments conducted in 22 normal subjects. The results of the first experiment indicated that, during upward optokinetic stimulation OKN is produced by the pursuit system and the velocity storage system, while during downward optokinetic stimulation the velocity storage system plays no significant role. Up-down asymmetry in vertical OKN seemed to be caused mainly by directional asymmetry of the velocity storage system. Furthermore, as the velocity storage function is very important for producing OKN at a higher stimulation velocity, domination of upward slow phase velocity becomes more apparent with a high stimulation velocity. In our second experiment the subjects were exposed to optokinetic stimulation with or without a stable fixation point. When subjects were exposed to optokinetic stimulation with fixation, they felt a rotating sensation within themselves or a moving sensation of the fixation point. When the stimulation disappeared, most experienced an illusion of small dots moving in the direction opposite the stimulation. In this condition some of the subjects showed after-nystagmus the slow phase of which was in the opposite direction. Subsequently the afternystagmus became more distinct, with pursuit of the moving dot illusion. This result shows the existence of a mechanism which produces reverse after-nystagmus by means of a retinal error input. We speculate that these phenomena play causative roles in reverse after-nystagmus (RAN), pursuit reverse after nystagmus (pRAN), and the RAN system.

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To study the present status of blood transfusion in head and neck surgery, we investigated recent cases of intraoperative transfusion in our department. In addition, we present our autologous blood transfusion cases, presently involved in an ongoing clinical trial for patients with head and neck cancer in our department which began in 1989.
1. Investigation of intraoperative blood transfusion cases
There were 37 cases of intraoperative blood transfusion among 677 cases who underwent surgery under general anesthesia during the period from May, 1991 to December, 1993. We divided these 37 cases into three groups according to the amount of intraoperative blood loss: less than 600ml (10 cases), more than 600ml and less than 1200ml (11 cases), and more than 1200ml (16 cases). Average amounts of intraoperative blood transfusion in each group were 195ml, 475ml and 780ml, respectively. As we noted that most of these 37 cases received a blood transfusion of less than 800ml, the majority needing intraoperative blood transfusion during head and neck surgery are potential candidates for autologous blood transfusion. Therefore, we have promoted autologous blood transfusion for intraoperative blood transfusion in head and neck surgery. Thus, the patients undergoing intraoperative autologous blood transfusion increased to seven annually as of 1994.
2. Clinical studies on autologous blood transfusion
Among 677 cases of head and neck surgery conducted during a six year period (1989-1994), we experienced ten cases of autologous blood transfusion. For the prevention of anemia due to repeated blood withdrawal, we administered an iron preparation. Patients who preoperatively showed a low value of Hb (less than 11g/dl) received intravenous drip infusion of erythropoetin. Since some patients selected for autologous blood transfusion, who also received neo-adjuvant chemotherapy and preoperative radiotherapy, exhibited a generally chronic anemia status, an iron preparation and erythropoetin should be preoperatively administered in combination.

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Blood patch is a therapeutic procedure that uses a perilymphatic fistula to repair an inner ear window rupture by filling the tympanic cavity with autologous blood. The experimental study was conducted in 13 guinea pigs. Autologous blood or commercially available fibrin glue was poured into the otic bulla after artificial rupture of the round window. The animals were sacrificed immediately, or 1 to 7 days after the operation. The results showed that the blood or the fibrin glue successfully closed the window rupture by closing directly and by facilitating the formation of granulation at the margin of the rupture. Fibrin glue seemed to be preferable to autologous blood due to its non-toxic nature in the inner ear.

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This study was performed in 37 patients with alcohol dependency. The mean age was 46.3 years and mean duration of heavy drinking was 23.8 years. The mean duration of temperance to the initial examination was 21.4 days and that to the second examination was 82.0 days. The results of the test on body sway in patients with alcohol dependency may summarized as follows. In patients with alcohol dependency the length of and the area covered by the body sway were significantly larger than in the normal group (p<0.05). This significant difference from the normal group disappeared open eyes, but remained with eyes closed (p<0.05). The Romberg quotients of both the length and the environmental area tended to be larger than the normal group mean (p<0.05). The oscillation power spectrum obtained with eyes open and that obtained with eyes closed tended to be low at levels below 0.2Hz and high at range of 0.2Hz to 0.5Hz in the right-left direction. The power spectrum in the anterior-posterior direction obtained with eyes closed was lower than that in the normal group at levels less than 0.2Hz, and higher than that in the normal group at range of 2.0Hz to 3.0Hz on the first examination. After temperance on the second examination, these significant differences had disappeared at all levels. The results of the present study on ocular movements in patients with alcohol dependency may be summarized as follows. Using the oculomotor test, abnormalities appeared in more than 40% of the test subjects for ETT, OKN, OKAN, VS and lateral gaze nystagmus test. According to the report of Matsuoka in 1979, some head positional nystagmus was noted in about 30% of patients with alcohol dependency. In the present study, the rate of appearance was as low as 8%. Ataxic pursuit, vertical positioning nystagmus, decrease of VS, disturbance of OKN and abnormalities of OKAN were found. These results suggested lesions between the brain stem and cerebellum, especially around the upper and lower vermis of cerebellum. After about 3 months of temperance, each test revealed a tendency towards some improvement, but the disturbance appeared to be fixed in some cases. It was important that some improvement in the oculomotor and the central vestibular system was found after about 3 months temperance. These results are quite promising for treatment and recovery in patients with alcohol dependency.

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This study examines the immunohistological localization of proliferating cell nuclear antigen in the nasal and paranasal sinus epithelium from a group of patients undergoing sinus surgery for chronic sinusitis. PCNA immunoreactivity as determined by fluorescence intensity and the density of labeled cells as assessed by confocal laser scanning microscopy. The control group consisted of seven specimens taken from patients with post-operative maxillary cyst and optic nerve canal fracture. In this group, most of the labeled cells were located on the basal cell layers with a few on the intermediate cell layers. The average labeled cell densities were 57.3 cells/ mm² on the basal cell layers and 15.9 cells/ mm² on the intermediate cell layer. The sinusitis group consisted of eleven patients. In contrast with the control group, the sinusitis epithelium displayed a significantly high proportion of goblet and intermediate cells positively stained for PCNA. The average densities were 84.9 cells/mm² on the basal cell layers and 133.1 cells/ mm² on the intermediate cell layers in this group, the latter being nearly ten fold greater than that in the control group. Epithelial PCNA expression was correlated with the degree of inflammatory cell infiltration assessed by serial sections for each sample. A positive correlation was observed between these two factors (R=0.63, Pearson). We believe that epithelial cell turnover is accelerated in chronic rhinosinusitis due to continuous exposure to various pathogens and host immune interventions. In those cases, goblet and intermediate cells would play the major role in enhanced epithelial proliferation.

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The clinical efficacy of erythromycin (EM) therapy has been demonstrated in otitis media with effusion (OME). However, the mechanism of action of this drug is not clear. In this study, to elucidate the possible mechanism of action of EM, we examined the effect of the drug on the expression of neutrophil adhesion molecules such as L-selectin and Mac-1. Furthermore, we examined production of leukotrienes B₄, C₄ (LTB₄, C₄) and prostaglandin E₂ (PGE₂) in rat OME induced by injection of a lipopolysaccaride.
EM down-regulated L-selectin expression, and inhibited up-regulation of Mac-1 expression on peripheral blood neutrophils. Also it inhibited the accumulation of inflammatory cells such as neutrophils and macrophages in middle ear effusion (MEE).
Furthermore, EM suppressed the exudation of plasma protein and the production of LTB₄, C₄ and PGE₂ in OME. These results suggest that EM may exert the antiinflammatory effect on MEE through suppression of leukocyte accumulation the middle ear by affecting the expression of adhesion molecules on leukocytes and inhibiting the production of arachidonic acid metabolitis.

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The volume of the maxillary sinus was estimated by coronal CT scan. The purpose of this study was to compare the estimated volume of the normal maxillary sinus with that of the inflamed maxillary sinus.
Patients were classified following evaluation by CT scan of the paranasal sinuses into 3 categories. Group A: Patients suffered from headache, facial pain and epistaxis, but CT scans of their nasal cavity and paranasal sinus were within normal limits without inflammatory change; 102 patients (40 males and 62 females, aged 15-80 years, mean 49.1). Group B: Patients with bilateral chronic maxillary sinusitis, CT scans of whom showed inflammatory changes in both maxillary sinuses. All of the patients in this group underwent sinus surgery after coronal CT scans; 69 patients (38 males and 31 females, aged 15-68 years, mean 44.7) Group C: Patients with unilateral chronic maxillary sinusitis, CT scans of whom showed inflammatory change in unilateral maxillary sinuses; 14 patients (6 males and 8 females, aged 16-71 years, mean 43.2)
CT scans of these patients were measured by Plannimeter to take the area of each image of the maxillary sinus. Consecutively imaged areas were summated by integral calculus to obtain an estimate of the sinus volume.
Group A normal cases had a mean maxillary sinus volume of 20.5±9.2ml (M±SD), and Group B bilateral maxillary sinusitis patients had a volume of 17.3±7.6ml. The mean maxillary sinus volume in the bilateral chronic maxillary sinusitis patients (group B) was significantly smaller than that in the normal cases (group A) (p<0.01, t test). In both groups A and B, the mean of the maxillary sinus volume in males was significantly greater than in females (p<0.01, t-test), and patients aged from 20 to 29 years old had the largest volume of all the age group. Group C patients with unilateral maxillary sinusitis had a mean maxillary affected sinus volume of 24.2±7.7ml, and contralateral normal sinuses with a mean volume of 26.9±9.3ml. The mean maxillary sinus volume in the affected sinuses was significantly smaller than those in the contralateral normal sinuses (p<0.05, Wilcoxon-test).
The various volumes of the maxillary sinuses and the developmental cause were discussed. Comparison of groups A with B suggested three distinct patterns; 1. the maxillary sinus volume has decreased due to inflammatory changes in the bone; 2. the small sinuses have a tendency to develop chronic inflammatory change; 3. the aeration in the maxillary sinus may be decreased when anatomic variations that may obstruct the ethmoid infundibulum exist.

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