Significance of psychological factors of psychosomatic origin and dysfunction of the cerebellum were discussed, with regard to prognosis of vertigo and/or ataxia due to head and neck injury. For detection we used “Equilibrium tests for neurotic vertigo, Hinoki et al. (1976)” and tests for cerebellar ataxia of the upper limbs, respectively.
The results obtained were as follows;
(1) Psychological factors of psychosomatic origin and dysfunction of the cerebellum were found to be important in the reinforcement of ataxia due to head and neck injuries, which ensued with prolongation of the vertigo. Furthermore, we found that the mode of action of these two factors was not addititive, but multiplicative with regard to prolongation of the vertigo mentioned above.
(2) Administration of Cloxazolam, a minor tranquilizer, combined with procainization of tender areas of the lumbar region was most useful in relieving vertigo of this kind.

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Two cases of the localized metastatic carcinoma to the midline cerebellar structure were studied neuro-otologically.
The first was a fifty-seven year old woman, whose chief complaint was a feeling of unsteadiness.
Computed tomography showed a localized midline cerebellar tumor and this tumor was extirpated.
Neurological examinations revealed truncal ataxia, but no other cerebellar sign.
Neuro-otological examinations revealed the lack of a nystagmus, smooth pursuit eye movement, normal caloric response and normal optokinetic nystagmus.
Vertical downbeat nystagmus was demonstrated by the positioning nystagmus test from sitting to head down position.
The second patient was a fifty-three year old woman who complained of an unsteady gait.
Neurological examinations revealed a disturbance in tandem gait and left finger to nose test.
A cerebellar tumor slightly shifted to the left was demonstrated by computed tomography.
Lateral gaze nystagmus predominantly beating to the left was evident.
Pursuit eye movement and optokinetic nystagmus was slightly disturbed.
Suboccipital craniotomy was performed and the tumor was found to extend into the fourth ventricle from the cerebellar vermis.
The lesion in the second patient as seen at surgery was not only in the cerebellum itself but in the brain stem.
These two localized cerebellar midline tumors revealed the following:
1) Lateral gaze nystagmus was not demonstrated in a pure cerebellar midline lesion.
2) Smooth pursuit eye movement and optokinetic nystagmus was also normal.
3) The most striking finding neuro-otologically was vertical downbeat nystagmus seen on the positioning nystagmus test.

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Cerebral Spinal Fluid (CSF) of 22 patients with Meniere's disease was examined regarding pressure, number of cells, protein, glucose, and IgA, G, M and E. Almost of all values were within normal limits.
There were no differences of each mean value and SD between the irritative and paralytic stage and also between Meniere's diseases and labyrinth related syphilis. Regarding the osmolarity of CSF, 5 of 22 patients showed normal values.
Other peripheral vestibular lesions (vestibular neuritis, inner ear vertigo due to unknown causes, Ramsey-Hunt's syndrome and Vogt-Koyanagi-Harada's disease) were considered to be due to viral infections and immunological disorders.
Thus causes of Meniere's disease may not be revealed in the CSF, and the inner ear fluid should be examined.

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A 48-year-old man who had olfactory-induced attacks of vertigo with tinnitus and impaired hearing for two years was diagnosed as syphilitic hydrops and underwent bilateral Portman's operation at intervals of three months. The vertiginous attacks disappeared but the olfactory induced dizziness continued. We noted that the dizziness could be induced when he inhaled petroleum derivatives and garlic odors. Immediately after intravenous injection of 10mg of alithiamine, nystagmus was recorded on ENG and such was accompanied with salivation. Thus, it would appear that neural mechanisms are directly involved in olfactory induced nystagmus.

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We reported herein variations in normal and abnormal patterns in auditory brain stem responses (BSR). Variations of the normal pattern which could be recorded in healthy subjects, were divided into six types and the first, third and fifth waves were evident. The fifth wave also could be recorded in patients with peripheral hearing impairement, except in those almost totally deaf.
On the other hand, variations in the abnormal patterns seen in the patients with brain stem lesions were divided into two types. In the former type, the latency of the fifth wave was delayed and in the latter type, the fifth wave could not be recorded. Therefore, it is important to check for delays in the latency and defects of the fifth wave when attempting of assess auditory brain stem responses.

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I report herein sensitivity tests (MICs) to antibiotics and treatment courses of patients with chronic suppurative otitis media due to glucose non-fermentative gram-negative rods isolated and identified in the otorrhea.
Isolated six rods of A. xylosoxidans, one rod each of P. maltophilia, Flavobacterium sp. and Alcaligenes, and two rods of A. calcoaceticus showed the lowest MICs to doxycycline, and next to gentamicin, but high MICs to ampicillin and to sulbenicillin.
Doxycycline I. V. in one dose was administrated to six patients with identified A. xylosoxidans which were sensitive at the second tests. Here other antibiotics were sensitive to St. aureus isolated and identified in the otorrhea at the initial tests were not effective.
More than three minutes were needed to inject 100mg of doxycycline in 20ml of 5% glucose solution (doxycycline dosage: 100mg per day).
Doxycycline was effective in three cases (50%), slightly effective in 1 (16.7%) and not effective in 2 (33.3%).
No side effects were observed during the doxycycline I. V. therapy.

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Sjögren's syndrome is characterized clinically by xerostomia, keratoconjunctivitis sicca and rheumatoid arthritis.
A 52 year old female developed weakness and enlargement of the parotid glands in 1969 when a parotid gland biopsy was done, revealing a moderate periductal lymphocytic infiltration moderately.
In 1972, the small joints of her hand and toes started to become progressively deformed. In 1976, she was finally diagnosed as having rheumatoid arthritis and had surgery on her deformed right hand. In 1978, in a parotid gland biopsy we found a complete formation of lymph follicles with germinal centers which mimicked Hashimoto's thyroiditis, pathologically.
Sicca syndrome alone such as xerostomia and keratoconjunctivitis sicca should be separated and termed as Sjögrens disease and only when rheumatoid arthritis or other collagen diseases are included in this disease, should the term Sjögren's syndrome be used.
The diagnosis of Sjögren's disease should be made only when a parotid gland biopsy shows the appearance of lymph follicles with germinal centers or massive lymphocytic infiltration.

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A mixed tumor of the right submaxillary gland was removed surgically from a 20 year old Japanese woman.
Microscopically, it was a “so-called mixed tumor” and consisted of myxomatous, adenomatous, and chondromatous elements.

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In performing tonsillectomies, we observe the following precautions: (1) the operation is performed under general anesthesia with fluothane with nitrous oxide and oxygen. (2) local epinephrine injection for the control of postoperative hemorrhage is avoided as there is the risk of evoking postoperative bleeding from reactive vasodilatation after the peripheral vasoconstrictive effect of the drug has worn off. (3) hemostasis is accomplished by ligation of vessels encountered during extirpation.
During the past nine years, a total of 284 tonsillectomies among patients ranging from three to thirty-eight years were performed, adhering to these three principles. Gratifying results were obtained in 282 cases. Postoperative hemorrhage occurred in 2 patients. Examination of the surgical wound by direct laryngoscopy revealed the cause of bleeding to be loosening of a ligature. Another complication was dislocation of a central incisor in one case.

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This case concerns a fifty-eight year old woman, who underwent laryngo-pharyngoesophagectomy following a diagnosis of hypopharyngeal carcinoma. The stenosis occurred four years and three months after reconstruction of the cervical esophagus, with recurrent fistulae.
1) In this case, the procedure of the initial esophageal reconstruction was performed using regional flaps with partial free skin grafts.
2) Either removal of scars and sutures of mucous membranes at the site of stenosis of gavage feeding does not guarantee an esophageal patency after removal of the tube.
3) The operative management should be a radical replacement of the entire area of esophageal stenosis with a DP flap or a reasonable facsimile.
4) Placement of esophageal dilatative prothesis is an alternative method. Oral ingestion of food through the prothesis is feasible.
5) It should be kept in mind that esophageal fistulae in the neck is probably principally due to narrowing of the lumen, except in the case of recurrence of the tumors.
At present the patient is well and has resumed a daily routine.

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A 49-year-old female complained of a foreign body in the esophagus. An X-ray examination showed an artificial tooth which had 4 hocks, located in the esophagus. This tooth was removed with the patient under general anesthesia. After the extirpation, the patient was given an injection of Vitamin K-2, Transamin, Adona, Reptilase, and Vitamin C. Immediately after the injection, anaphylactic shock occurred. Emergency therapy was employed and she was discharged 12 days later.
Side effects with hemostatics are rare and mild. However, since severe shock may occur, all abuse should be avoided.

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In several controlled trials, sustained release preparation of isoproterenol, a beta-adrenergic stimulant proved to be safe and effective for vertigenous patients, especially in cases of peripheral disorders. We determined the effectiveness of this drug in 30 patients with peripheral vertigo, in an open trial. Concerning vestibular symptoms, i. e. vertigo and dizziness, 80% of the patients experienced relief while on 6 tab/day (45mg/day) for 2 weeks.
The most significant result as determined by the caloric tests was a restoration of the disequilibrium in labyrinthine excitability on the level of 1% of significance. Three patients complained of slight tachycardia, headache and drowsiness (11%).

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The state of degeneration and the resulting reactions were studied in grown cats subjected to damage of the Fallopian canal.
1) By sharply amputating the nerves and obstructing their regeneration, I studied the rate of nerve degeneration and the process of cell number decrease for a period of time, in an attempt to discover a particular pattern.
The degeneration rate was found to increase after the amputation and reached a peak of 33% at 2 weeks. The rate then decreased to 0% in 4 weeks. The number of cells also decreased gradually during the period.
2) Another observation was made by binding and applying pressure to the nerve trunk of 1/2, 1/3 and 2/3 size of the diameter.
As a result, the degeneration of motor nuclear cells reached a peak of 37% in 2 weeks regardless of the severity of pressure. In 10 weeks, the degeneration decreased to near 0%. The rate of decrease in number of cells, however, varied according to the severity of the pressure.
3) In another case, the binding was removed during the course of study and the rate of degeneration and the cell-number decrease was observed in those cases.
The effect of relieved pressure on degeneration reached a peak on or before the 12th day after the operation. This finding parallels observations made in experiments on the decompression of peripheral nerves by Yamamoto & Fisch. (Proceedings, Third Int. Symposium on Facial Nerve Surgery, 1976.)
From the above findings, the dynamics of degeneration of cells were clarified and clinical problems such as partial treatment of Bell's palsy and synkinesis were further explored.

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We report herein two impedance methods for evaluating Eustachian tube function. The principle of these methods consists of recording of impedance in the ear drum during Valsalva's maneuver and swallowings, either with or without nasopharyngeal pressure. The first method involves a simultaneous recording of impedance of the ear drum with nasopharyngeal pressure. For this purpose a pressure transducer attached to the impedance meter (Madsen ZO 72) was utilized after making minor changes in the meter. The second method was a recording of the compliance in the ear drum. The advantage of the latter method is that there is no need for additional apparatus, the X-Y recorder of the impedance meter is sufficient. By these acoustic methods, inflow and outflow of air through the Eustachian tube was recorded as patterns of impedance change. They were classified into three groups; normal, occluded and patent patterns, and a close correlation between clinical findings and recorded pattern was confirmed. These impedance tests have proven to be simple and reliable for clinical use.

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