I. Surgical Approach
In Bell's palsy, topognostic examination often revealed a suprastapedial lesion. In such cases, decompression from the geniculate ganglion to the stylomastoid foramen was considered to be a rational treatment. The operation included the following procedures: 1) a transcortical mastoidectomy, 2) a hypotympanotomy, 3) removal of the incus, 4) exposure of the entire horizontal segment of the facial nerve below the geniculate ganglion, 5) exposure of the pyramidal and vertical segments, 6) incision of the nerve sheath, and 1) replacement of the incus. Thus sufficient decompression could be made on the facial nerve from the geniculate ganglion to the stylomastoid foramen. When the incus was replaced exactly in the original position, there remained no permanent hearing impairment.
II. Indication and Results
Decompression from the geniculate ganglion to the stylomastoid foramen was carried out on 51 patients with Bell's palsy. The operational results were compared with those of 77 patients in whom the pyramidal and vertical segments were decompressed. Regardless of the operational timing, a more satisfactory surgical result was obtained in the former group of the patients. In either group, decompression in the acute phase, within 30 days after the onset, ensured a most desirable effect and in the surgery performed in the subacute phase, between 31 and 90 days after the onset, a favourable effect could be obtained. Advantageous effect of the surgery done during the chronic phase, that is beyond 91 days after the onset, could not be confirmed.
III. Findings of the Operation
Decompression from the geniculate ganglion to the stylomastoid foramen was made on 51 patients with Bell's palsy. Edema of the nerve was observed in 88% of all patients. In 49%, the edema was located between the geniculate ganglion and the pyramidal segment, while in 39%, the edema was limited in the vertical segment. Thickness of the nerve sheath was noted in the 48%. A defect of the facial canal was noted in the 42%. The incidence of this bony defect was significantly higher than that found in cases of chronic otitis media. On the basis of these findings, it is concluded that a decompression of the facial nerve up to the geniculate ganglion is reasonable in the majority of patients with Bell's palsy.

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Three families in which 2 or more members have a streptomycin-induced hearing loss are reported. These three families and families which have reported by several authors (Takafuji et al. 1953, Esaki et al. 1957, Kawaguchi 1957, Ohuchi et al. 1957, Horiguchi and Moriyama 1957, Prazic and Subotic 1964, Johnsonbaugh 1974, Tsuiki 1976) were analyzed.
Whether the susceptibility of cochlea to streptomycin is transmitted to the next generation by males or females in each family was examined. In 22 families, the trait which makes the person who possesses it vulunerable to streptomycin is transmitted only by mothers to their sons and daughters. There were only two families, in which fathers transmitted the trait to their offsprings. In the remaining 13 families, the decision whether the trait was transmitted by males or females was impossible, because in these families only members of the same siblings were affected.
Tsuiki and Murai (1971) suggested autosomal dominant inheritance of this trait, but such cannot explain the lack of transmission by males.
To explain this unusual inheritance, two hypotheses are possible. One possibility is autosomal dominant inheritance with a special mechanism which decreases the possibility of male-to-male and male-to-female inheritance. Another possibility is extranuclear inheritance, and such is more probable, at least in our patients.

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A 57-year-old female with tinnitus in the right ear associated with facial movement underwent stapedial tenotomy. Six years prior to the operation she had suffered from Ramsay-Hunt's syndrome in her right face, and from then on noticed of hemifacial spasm, and low pitched noise and slight impairment of hearing in her right ear whenever she moved her face.
Audiometric examination revealed 10-15dB loss of hearing in the right ear in low frequencies when she made a wry face. Facial movement induced a stapedial reflex in the right ear in impedance audiometry.
After resection of the tendon of stapedius muscle, tinnitus and hearing impairment associated with facial movement disappeared completely. Her complaint was an only slight hyperacusis in the operated ear.

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A male infant had an acute otitis media from the age of one month.
He had been treated by several E. N. T. specialists for 5 months when he developed an intractable dry cough.
The patient was referred to our hospital where he was found to have agammaglobulinemia and was treated with several different antibiotics and gammaglobulin given intravenously.
He died on the 12th day of admission.
The body was immediately autopsied and a thymic alymphoplasia was detected.
The final diagnosis was agammaglobulinemia of the Gitlin type.

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We encountered 5 Japanese patients with adenocarcinoma of the parasinuses. Histologic findings were adenoid cystic carcinoma, mucoepidermoid carcinoma (56 year-old, male; 48 year-old, female; 44 year-old, female; 57 year-old, male) and adenoacanthoma (64 year-old, female).
Adenoid cystic carcinoma and mucoepidermoid carcinoma originated in the submucosal mucous gland and had a similar appearance to those which originated in the salivary gland. Occasionally a transitional pattern can be identified.
Mucoepidermoid carcinoma originated in the main duct and adenoid cystic carcinoma stemmed from the peripheral duct near the acinal gland.
Most of the carcinomas were derived from the columnal epithelium and were a squamous cell carcinoma due to metaplasia. However, adenocarcinoma or adenoacanthoma derived from the lining epithelium was also occasionally seen.
Surgical treatment was carried out as the response to radiotherapy was poor. Post-operatively all patients did well. As macroscopic observations are often misleading, the area to be excised should be biopsied and the frozen sections carefully examined.

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A 53 year-old Japanese male had a past history of right femur disarticulation following surgery for chondrosarcoma in December, 1975. He visited our clinic with the complaint of hoarseness in December, 1977. A biopsy of the right vocal cord revealed squamous cell carcinoma and such was treated by right hemilaryngectomy and right radical neck dissection. The post-operation follow-up has proved uneventful. A combined laryngeal cancer and chondrosarcoma is a most rare occurrence.

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Adenoacanthoma from the thyroid gland is rare. In a 56 year old male who complained of dyspnea of two months duration, we detected a large tumor with a hard consistency around the right side of thyroid cartilage. Indirect laryngoscopy revealed right, midline vocal cord paralysis. As his condition was critical, surgery was immediately performed. The tumor was mainly located around the thyroid cartilage and extended downward to the 4th tracheal ring. The interior of the trachea was extraordinarily narrowed. A total laryngectomy which included trachea was done. Histology revealed a typical adenoacanthoma in the thyroid gland. The postoperative course was uneventful and 8 months after the surgery there has been no evidence of a recurrence.

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A multicenter double blind comparison was performed to evaluate the usefulness of Nsp for patients with nasal allergy. A total of 154 patients were studied. Nsp or placebo was intramuscularly injected 10 times at intervals of every other or every third day in dose of 3ml.
The results are as follows:
Nsp was significantly superior to placebo with regard to final global improvement rating and global utility rating with no relation to factors such as sex, age, type, severity and duration of the disease.
Side effects induced were minimum without any significant difference between the two groups.

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非ステロイド系消炎鎮痛剤注射用 Ketoprofen の25mg, 50mg, 100mgについて, 口蓋扁桃摘出術後の嚥下痛を指標として鎮痛効果を検討した. 同時に行なった50mg内服投与とも比較して次の結論を得た.
1) 効果発現は, 注射群では投与量に関係なく5～15分で発現し, 内服群の30分～1時間に比較して明らかに速効性であった.
2) 効果持続時間は, 注射群では大部分が5～12時間で, 投与量の多い群にやや長い持続時間がみられた. 内服群では大部分が4～6時間で, 注射群の方が持続時間は長かった.
3) Ketoprofen 血漿中濃度は, 注射群では注射後5分で検出され, 15分で最高値となり, 以後次第に減少した. 血漿中濃度は投与量に比例した. 内服群では30分後に検出され, 1時間で最高値となり以後次第に減少した.
4) 全例に効果が認められ, 注射群では, 25mg群で著効1例, 有効9例, 50mg群で著効5例, 有効5例, 100mg群で著効6例, 有効4例であった. 内服群では著効2例, 有効8例であった.
5) 副作用は100mg注射群の2例で注射部位より末梢肢にかけて脱力感, しびれ感がみられたが, 1～2時間で消褪し, 一過性であった.

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The gain control of the flocculus is executed with the aid of oculomotor function toward the direction of improving the stabilization of the retinal images during head movements. Visual suppression (VS) of caloric nystagmus occurs also in the direction of stabilizing retinal images of visual surroundings. In fact, VS of caloric nystagmus is lost after total destruction of the flocculus. Under such conditions, optokinetic nystagmus involving smooth pursuit of eye movements and fixation may also be disturbed. In the present experiment using cats, the optokinetic nystagrxmus was investigated after lesions had been induced in the superior colliculus (SC) or the inferior olive (IO), both considered to mediate visual signal to the flocculus. VS of caloric nystagmus, and optokinetic nystagmus remained normal in all IO-lesioned cats. After the SC lesion, loss of VS was always evident, and optokinetic stimuli produced directional preponderance to the left and diminished response to the right in 7 of 9 cats. Hence, the SC is considered to be the one of the main relay nuclei in the mediation of visual signals responsible for the immediate modification of VOR by visual stimuli.

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Histological characteristics of the blockage of the arterial supply to the inner ear and of viral endolymphatic labyrinthitis were studied in connection with the cause of sudden deafness.
In order to produce blockage in the radiating arterioles of the inner ear, plastic beads with a mean diameter of 25.7μm were injected into the vertebral artery of the cat and squirrel monkey. Celloidin sections of temporal bones from animals dissected from between 1 week to 1 year after injection showed various types of localized lesions in the inner ear. A decrease in the number of cells in the spiral ligament and limbus spiralis together with a disappearance of sensory cells and stria vascularis were evident in the damaged region. Proliferation of fibrous tissue and ossification were found in severely damaged tissues.
As an example of viral labyrinthitis, a pair of temporal bones from a 57 year old woman who had had a sudden profound bilateral hearing loss during the course of relapsing polychondritis was studied using both a light and a scanning electron microscope. Inner ear findings at 1 year after hearing impairment matched well with histological characteristics of viral endolabyrinthitis so far reported, namely, encapsulated and dislocated tectorial membrane and marked degeneration of the organ of Corti. Degeneration of sensory cells was also seen in the pars superior as well as the saccular macula of the vestibule.
From the findings quoted above the author concluded that blood circulatory disturbances could be histologically differentiated from viral labyrinthitis as a cause of sudden deafness. Accumulation of temporal bone histologies in cases of sudden deafness is of utmost importance for clarification of the specific cause of this defect.

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Effects of mass imbalance of the vocal cords on the voice and vibratory pattern of the vocal cords were investigated with excised larynges of dogs and also human larynges obtained at the time of autopsy. In general, mass imbalance of the vocal cord produces a phase shift and a difference in amplitude. The weighted vocal cord revealed a lag in phase and vibrated with reduced amplitude. In this case, the frequency of vibration was bilaterally the same with no hoarseness.
Vibratory patterns of the vocal cord in a state of mass imbalance were compared with vibrations synthesized by a computer simulation of a dynamic theoretical model of the vocal cords. Experimental findings were consistent with the results of the computer simulation.

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