From 1970 to 1975, 512 patients with chronic otitis media were studied regarding antimicrobial susceptibility of aural discharge.
Bacterial specimens were taken from the middle ear after perforating the tympanic membrane with a sterile cotton stick.
The three-disk method with Petri dishes was used for the antimicrobial susceptibility test.
The results were as follows.
1) Many strains of Staphylococcus aureus were only slightly sensitive to many types of antibiotics, particularly Aminobenzyl Penicillin and Penicillin G. A high sensitivity to Sulbenicillin, Cephaloridine and Gentamicin was noted.
2) Pseudomonas aeruginosa showed good sensitivity to Gentamicin, Sulbenicillin and Colimycin.
3) Proteus mirabilis showed good sensitivity to Aminobenzyl penicillin, Sulbenicillin, Cephaloridine and Gentamicin. On the other hand, many strains of Proteus inconstans showed a low sensitivity to Aminobenzylpenicillin, Cephaloridine and Gentamicin, and good sensitivity to Sulbenicillin.
Thus the first choice antibiotic for chronic otitis media is Cephaloridine.
Patients with chronic otitis media who are being treated for can be prescribed the most effective antibiotic when cultures are done on the aural discharge.

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Tragal cartilage graft tympanoplasty was performed on 23 ears in which previous tympanoplasties or radical mastoidectomy had been unsuccessful. The operation was limited to ears having an aerated cavity around the Eustachian tube orifice and the patent tube. There was granulation tissue with or without cholesteatoma in the athelectatic posterior half of the tympanic cavity and the mastoid. After re-exploring the mastoid cavity, all the residual air cells were eradicated using a diamond bur, and white healthy cortical bone was exposed in all dimensions of the cavity. Pathology around the stapes was cleared but the mucosa in the tympanic cavity remained untouched. The facial buttress and the bony posterior ear canal were lowered as much as possible. If superstructure of the stapes was missing, the cartilage prosthesis was placed on the footplate. The tragal cartilage was fashioned to fit the tympanic annulus anteriorly and the facial canal posteriorly and was placed to seal the tympanic cavity exactly. In five ears, the mastoid cavity was obliterated by an anterior pedicle temporalis muscle flap. The follow-up study from one to seven years confirmed that the smoothly surfaced mastoid cavity dried perfectly in all ears. There was neither adhesion nor a retraction pocket. Epithelial debris or crust was scanty. In 13 ears, postoperative hearing remained within 30dB, and in 8 ears it improved more than 15dB. In two ears, hearing deteriorated more than 15dB postoperatively. Our experiences have proved that the use of the tragal cartilage is beneficial for recostruction of the middle ear in selected cases in which reoperation was required and its advantages are; (1) accessibility in the operative site, (2) availability in an adequate amount, (3) excellent contour and thickness, (4) adequate stiffness and elasticity, and (5) excellent survival capacity without producing tissue reaction and adhesion.

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Removal of the posterior canal wall and broadening of the tympanic annulus were carried out in hopes of attaining a complete elimination of inflammation and cholesteatoma.
The technique was designed so that an antrum cavity and tympanic annulus with a cartilage plate would result. This cartilage plate divided the large excentrated mastoid cavity into two parts, namely reconstructed antrum and residual cavity exposed to the external canal.
A well ventilated middle ear space can be rebuilt using this procedure.

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A Japanese male aged 57, complaining of sudden facial palsy on the right side, was diagnosed preoperatively as “cholesteatoma”. During exploratory tympanotomy a large tumor was found along the Fallopian canal. The histological examination of the tumor revealed facial neurinoma. Difficulty in diagnosis of facial neurinoma was discussed from the viewpoint of the coexistance of cholesteatoma. A search of the literature failed to reveal a report of a similar case.

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Carcinosarcoma, showing simultaneous presence of malignant epithelial and non-epithelial elements, is rare and verification of this diagnosis requires detailed histopathological examination. We observed both malignant epithelial and non-epithelial elements in each tumor of two cases in the maxillary sinus and larynx, using light and electron microscopy.
The first case was found in a 66-year-old female. Under diagnosis of malignant maxillary tumor, she was treated by irradiation, chemotherapy, cryosurgery and surgery, but death followed with a metastases to the cervical vertebra and cervical lymphnodes.
Non-epithelial elements were composed of interlacing bundles and whorls of atypical spindle cells. Under electron microscopy, the cytoplasm revealed an abundant rough endoplasmic reticulum. The intercellular spaces contained varying amounts of collagen and flocculent material. Epithelial elements were islands of tumor cells in the stroma. Under electron microscopy, tonofibrils and desmosomes were noted.
The second case concerned a 78-year-old male. Under a diagnosis of malignant laryngeal tumor, total laryngectomy was successfully performed. On the surface layer of the tumor mass, well differentiated squamous cell carcinoma was noted, while in the subepithelial tissue, interlacing bundle of many atypical spindle cells and a few giant cells were confirmed as fibrosarcoma cells since the morphological character of fibroblasts was evident.
Thus the combined use of electron and light microscopes using different stains is required for the diagnosis of carcinosarcoma.

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The theory that cellular immunity may be the principal component of the defense mechanism against cancer in the living body is generally supported.
That T-cells play a leading role in this cellular immunity appears to be likewise supported.
However, the investigations previously performed by many authors have been done with T-cells from the peripheral blood. If immunity to cancer should exist, lymphocytes in the blood in cancerous tissue or tissue around the cancer (local blood) could possibly provide more pertinent information than that of peripheral blood. Thus, we compared T-cell values between blood obtained from tumor or tissue around the tumor at operation of the maxillary sinus (local blood) and peripheral blood in 15 cases with untreated maxillary cancer. As a result, the T-cell value in local blood was higher than that in peripheral blood, the difference being significant. In a similar study done on 16 patients with sinuitis, (controls), there was no difference between local and peripheral blood.
According to observations of eight patients with maxillary cancer, in whom local blood could be collected during the therapeutic course, there was a tendency for the difference in T-cell value between local blood and peripheral blood to decrease with the progress of the treatment in those in whom the tumor had regressed or disappeared.

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Twenty-five patients who had suffered from pain of both the neck and waist and had tended to develop vertigo and disequilibrium of the eyes and body due to over-excitment of the proprioceptors of these regions were treated with Muscalm, a centrally acting muscle relaxant.
The results obtained were as follows: 1) This drug had a beneficial effect on some symptoms due to head and neck injury. It was more effective in treatment of vomiting, pain of the neck, stiffness of the neck and shoulder, vertigo, tremor of the four limbs, headache and pain of the waist. 2) There was a positive correlation between the improvement of vertigo and that of disequilibrium of the eyes and body. Furthermore, there was also a positive correlation between changes of the pain of the neck and waist and those of vertigo and disequilibrium of the eyes and body.
From these findings, it can be postulated that when Muscalm normalizes the over-excitment of γ fibers involved in the proprioceptors in the neck and waist, hyperexcitability of the proprioceptors described above is first improved, and moreover, abnormal excitment of the equilibrium centers such as the hypothalamus, brain stem and cerebellum through the abnormal centripetal impulses from the proprioceptors is subsequently improved, As a result, the vertigo is relieved.

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The clinical effects of NK-631 were studied in 35 cases of malignant tumors of the head and neck. These materials comprised 17 cases of oral carcinoma, 5 of maxillary carcinoma, 5 of hypopharyngeal carcinoma, 4 of mesopharyngeal carcinoma, 3 of laryngeal carcinoma and 1 of skin carcinoma. Of these cases, 16 were newly diagnosed and 19 were recurrent.
NK-631 was, in most cases, administered on a dosage schedule of 10mg at a time, 3 times weekly, intramuscularly. The effective rate of NK-631 treatment (by not less than 50% regression in area of mass) in these 35 cases was 39.4%, while the effective rate in the fresh cases was 56.3%. The mean total dose was 92.5mg in the new cases, and 130.5mg in the recurrent cases.
In the treatment of primary lesions, a high effective rate was achieved in the cases of oral carcinoma exhibiting exophitic growth.
Histologic findings with passage of time indicated that the effects of no less than grade III were achieved in 3 of 7 cases where histologic examinations were possible. However, these findings were not necessarily in parallel with the total doses administered. NK-631 was also found effective in the treatment of metastases to lymph nodes in 2 of the 7 cases.
No such severe adverse reaction as pulmonary fibrosis which is occasionally encountered in Bleomycin treatment was observed either clinically or in autopsy: thus, NK-631 was assessed by to be far safer than Bleomycin.

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The thick sections of the sensory hair cells and nerve endings of the guinea pig cochlea were observed under the high voltage electron microscope (HVEM). The main advantage of HVEM is that sharp images of thicker specimens can be obtained, as the result of the greater penetrating power of high-energy electrons.
The thickness between 600nm and 1000nm was the optimum range for observation of the inner ear specimens under 1000kV accelerating voltage. Specimens less than 600nm in thickness often lacked sufficient contrast of image, and specimens over 1000nm in thickness were too thick to be clearly defined. The uranyl acetate alcohol solution and lead acetate aqueous solution were used as stains.
The fine structure of the cell organella such as mitochondria, synaptic vesicles, and ERs were often poorly defined due to their increased electron density. However, we concluded that the 1000nm specimens were quite useful for the numerical studies of the nerve endings since the serial thick sections were easily obtained on the grids and the differentiation between the efferent and afferent was possible under HVEM.

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Some pathological changes in the cochlea are difficult to reproduce in animal experiments, therefore related data are few. Primary spiral ganglion loss and selective blockade of the blood supply in the cochlear duct are examples of the aforementioned changes.
A pair of temporal bones with tumor invasion into the modiolus from the internal auditory canals was studied as a model of such subjects.
Totally replaced spiral ganglion cells by the tumor in the basal turns were used as a model of primary nerve degeneration as compared to the intact upper turns. Secondary hair cell degeneration was observed in regions only where tumor cells had invaded and destroyed the ganglion cells. Inner hair cells resisted the invasion more than did the outer cells.
Stria vascularis was intact in the entire length of the cochlear duct, except at the basal ends where the tumor invasion reached radiating arterioles. Our finding supported Lawrence's opinion that the cochlear duct was nourished by two independent vascular systems of the external and internal radiating arterioles.

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This study was undertaken to evaluate the inner ear damage risk of chlorhexidine applied directly to the middle ear in cases of otological disinfection. The effects of this drug applied to the round window niche were investigated not only regarding the various electrical phenomena in the cochlea but also on the morphological findings in cochlea of guinea-pigs. Using a microelectrode, the endocochlear DC potential, the intracellular negative DC potential and the cochlear microphonics were recorded from the basal turn of the cochlea. After application of the drug, the cochlear microphonics showed a marked decline, at first among all electrical phenomena in the cochlea, and then a subsequent decrease of endocochlear DC potential. The deleterious effects of the drug on these potentials were irreversible and progressive, and they reached a magnitude of 10 to 5% of the pre-drug level 30 minutes after the application. The magnitude of the negative DC potential in the organ of corti also began to decrease from about 20 to 30 minutes after the application. In the morphological examination, no remarkable change was observed in the organ of Corti under scanning electron microscope, while the decrease of microvilli and the swelling of cell bodies were evident on the surface of marginal cells of the stria vascularis.
It is well known that cochlear microphonics are generated from the hair cells, while the origin of the endocochlear DC potential probably is in the stria vascularis. From this point of view, although no histological changes were evident on the organ of Corti, it may be concluded that the earlier decline in the amplitude of cochlear microphonics indicates hair cell lesions induced by drug application, and the subsequent decrease of endocochlear DC potential suggests the delayed lesion in the stria vascularis.
Consequently, it must be considered that the topical use of chlorhexidine induces inner ear lesion.

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