This report summaries clinical studies on Meniere's disease (MD) performed in the Department of Otolaryngology, Gifu University School of Medicine.
I Criteria for the diagnosis of MD
Criteria for the diagnosis of MD are proposed. The criteria are composed of the following 3 steps. As a first step, a suspicious diagnosis of MD is made from the clinical history, i. e. (i) recurrent of paroxysmal vertigo, (ii) cochlear symptoms associated with vertigo, (iii) unknown causes, and, (iv) no other neurological symptoms, vestibulocochlear symptom only. Secondly, a definitive diagnosis of MD is made from the results of audiometric, equilibrium and neurological examinations. Finally endolymphatic hydrops is diagnosed by the glycerol test and the test related to negative SP in electrocochleogram.
II Studies on the natural course of MD
Forty patients suffering from MD were investigated.
1. The course of the disease was classified into the following 5 types from the patterns of the manifestations of the spells. Type 1: Recurrence of a definitive spell at long intervals changes to repeated slight spells at short intervals. Type 2: A definitive spell appears repeatedly in the same season once or twice every year. Type 3: Recurrence of spells gradually decreases with time. Type 4: A burst of spells occurrs continuously from the onset of the disease. Type 5: Repetition of single definitive spells and bursts of spells appear with irregular alternation.
2. On studies regarding clinical manifestation of MD, there was one patient whose diagnosis changed from Lermoyez disease to Meniere's disease. Three patients had a clinical history of sudden deafness long before the onset of vertigenous attacks of MD. Furthermore, there were eight patients with orthostatic dysregulation before the onset of MD and one patient with vertigo caused by a transient ischemic attack. These findings suggested a process of establishment of the inner ear disturbance in MD.
3. The average interval between spells distributed from less than 1 month to 29 months. It was very difficult to predict the next attack since the interval of spells in each patient was irregularly dispersed.
III Examination of predisposition to Meniere's Disease
The examination was performed in the following three steps. First general and local etiologic factors were investigated by using a questionaire made for this study. Second, internal and laboratory examinations were carried out. Third the loading equilibrium examination was done. As results, preexsistent hearing loss of long duration, head injuries long before the onset of the disease, hypotension, orthostatic dysregulation, hyperlipemia and anemia were found more frequently in patients with MD compared with control subjects. These abnormalities were estimated as predisposing factors to MD.
IV Evaluation of surgical treatment
Results of ultrasonic operation performed in our department were evaluated by the criteria of the AAOO committee on hearing and equilibrium. Ultrasonic operations were performed on twenty-five patients who were followed for from 1 to 12 years. The results were divided into four classes as follows: class A, 3(12%); class B, 10 (40%); class C, 12(48%); and class D, 0. The ultrasonic operation is applicable to patients with incapacitating vertigo non-fluctuating profound deafness and decreased labyrinthine excitability.

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A case of the subtotal removal of a large recurrent acoustic neuroma by translabyrinthine approach is reported. The operation has enabled the patient to return to her normal routine.
The translabyrinthine approach is usually indicated only for small tumors below 2cm in size and localized in the inner ear meatus. This report suggests that in the case of a patient of advanced age or poor general condition, the translabyrinthine approach can be used effectively, even when the tumor is large or recurrent, for the purpose of tumor decompression.

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A case of meningioma of the anterior cranial fossa infiltrating the ethmoidal sinus is reported. This tumor developed in a 55-year-old woman causing bilateral visual disturbance. Although a maxillar-ethmoidal operation, a frontotemporal craniotomy, a Killian's operation as well as cobalt irradiation were performed and administered successively, the chief complaint was not alleviated.
Secondary extracranial meningioma, or direct extension of the tumor from the cranial cavity into the paranasal sinuses, is very rare. The present patient is the eighth case reported in the world literature during the last forty years.

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Tympanometry using Danplex ZA-20 with a probe-tone of 220Hz was performed on the total of 1, 470 ears with normal hearing and various kinds of hearing impairments. The subjects ranged in age from two to 15 years.
Eight tympanometric patterns from type I to VIII were classified based upon the tympanic membrane compliance, peak pressure and shape of the tympanogram. The classification of tympanograms in this study was similar to the one reported by Jerger, except for type VI and type VII. Type VI and type VII were characterized by great compliance, displacement of the peak toward the side of high negative pressure and a sharp peak at the point of maximum amplitude. The patterns of type VI and type VI have been frequently found clinically among patients with flaccid tympanic membrane or who are in the resolving stage of fluid in the middle ear.
From the above-mentioned results, it was considered that these types are useful in the diagnosis of such abnormal ears.

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The present study is based on the results of tympanoplasties in 39 ears of children. The postoperative hearing results were satisfactory in most cases and the following points were especially stressed on tympanoplasty in children. Operative procedure is advisable to undertake under hypotensive general anesthesia. Procedures of external ear canal and ear drum should be done with great care. In severe cases such as cholesteatomas, tympanoplasty with open cavity should be selected for surgical procedure. Praticular postoperative cares (control of general condition, keeping the external ear packing for 2 weeks, nasal nebulization, etc.) should be given to prevent reinfection of the operated ear.

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Antibody assays for streptodornase B were done on a total of 58 patients with habitual angina together with assays for both blue ASO and anti SK·SD titers. The results are summarized as follows:
1) The antibody titer for streptodornase B ranged from 50 to 1, 600 times by means of the toluidine blue 0 method of Tiesler.
2) There was a low correlation between the antibody titer for streptodornase B and the blue ASO and anti SK·SD titers.
3) It was considered to be significant for diagnosis of streptococcal infection that antibody titers for streptodornase B were widely distributed in sera of patients with habitual angina.

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The system of a TV camera and a video tape recoder in conjunction with a flexible fiberscope is introduced. Medical students can easily see real pathologic changes in the ear, nose and throat using this system. For the convenience of daily use, this system was mounted on the examining cabinet.

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The efficacy and safety of cefaclor (CCL) and cephalexin (CEX) were compared in a double blind study in children with acute purulent otitis media.
Children weighing 5kg or more but less than 12kg were treated with CCL 100mg tid or CEX 100mg qid and those weighing 12kg or more were treated with CCL 200mg tid or CEX 200mg qid.
Clinical response was judged separetely by (1) the physician who actually treated the patients and (2) a panel of the efficacy reviewing committee. Also each physician gave a score of “usefulness” to CCL and CEX.
1. Satisfactory (excellent and good) clinical response was obtained in 51 (86.2%) of the 65 treated with CCL and in 46 (78.0%) of the 59 in the physician evaluation. In the evaluation by the panel, satisfactory clinical response was obtained in 58 (89.2%) of the 65 treated with CCL and in 50 (84.7%) of the 59 treated with CEX. In either case, there was no statistically significant difference between the CCL and CEX groups.
2. In the patients from whom organisms with an MIC of 12.5μg/ml or obtained at a significantly higher rate in the CCL group than in the CEX group, both in the physician evaluation (62.5% vs 20.0%) and the panel evaluation (56.3% vs 13.3%).
3. In the cases from whom Staph. aureus was isolated, satisfactory clinical response as judged by the physician was significantly higher in the CCL group (100%) than in the CEX group (66.7%).
4. No side effect was observed in any of the patients in either of the CCL and CEX groups.
5. There was no statistically significant difference between the two drugs, in the score of usefulness given by the physician.

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A new nutrient preparation for tube-feeding, HINEX-R, which is mainly made of rice and contains three well-balanced cardinal nutrients as well as minerals and vitamins, was administrated to 8 post-operative patients with malignant neoplasms in the head and neck region.
The results of this clinical study revealed the favorable nutritional condition of the patients, favorable effects on hepatic and renal functions, and no digestive disturbances, such as diarrhea or abdominal distention, which frequently occur with the use of other conventional preparations.
HINEX-R, therefore, seems to be a suitable preparation for the nutritional management of patients after major surgery in the field of otolaryngology.

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Quantitative evaluation of Nitromin ototoxicity was examined in guinea pigs given one dose of the drug intravenously. Pathological changes in the cochlear sensory hair cells were then observed under a light microscope following surface preparation after cold phosphate-buffered 2% osmic acid solution fixation. Possibility of frequency specificity of tone pip electrocochleography and modification of input-output functions of cochlear whole-nerve action potentials in absence of outer hair cells were studied by examining the relationship between the degree of outer hair cell damage and the cochlear AP responses.
I) Degree of outer hair cell damage:
At the initial stage, the degeneration of the outer hair cells were the most extensive in the basal turn, and least in the third turn. With the advance of degenerative changes, the damage in the lower turns proceeded rapidly and became more extensive than that in the apical turns.
The outer hair cells in the first row were significantly more vulnerable in each coil. However, at the initial stage, the outer hair cells in the fourth coil were more vulnerable in the third than the first row.
II) Cochlear AP responses in guinea pigs treated with drugs:
Both the prolongation of minimum latency and increase in the width of the AP-SP wave form complex of AP responses to low-frequency (1, 2KHz) tone pip were more prominent than to high-frequency (4, 8KHz) one.
Decrease of the maximum amplitude of AP responses to low-frequency (0.5, 1, 2KHz) tone pip was greater than to high-frequency (4, 8KHz) one, comparing each decrease of that with the degree of the outer hair cell damage in respective coils. Therefore, changes of each parameter at high intensities indicated the decrease of the number and the degree of synchronization of the activity of the auditory units located in the lower turns, especially in the basal turn, regardless of the frequency of the stimulation tone.
The elevation of the threshold of AP response to each frequency tone pip was comparatively correlative with the degree of outer hair cell damage in each coil, respectively.
For the input-output curves of AP responses to 4 and 8KHz tone pips, the L-curve disappeared according to the advancement of the degenerative changes, after which the maximum output of the H-curve decreased respectively to 22.9% and 24.1% of each average output in the normal group, despite the finding that almost all the inner hair cells survived. Accordingly, it was considered that the outer-hair-cell units had a significant influence on the synchronous firing of the inner radial fibers connecting to the inner hair cell system, though the L-response and the H-response component mainly depended on the auditory units originating in the outer and inner hair cells, respectively.
At higher intensities, the polarity of SP as the earlier fraction of AP-SP wave form complex, changed to negative with 4 and 8KHz tone pips and click stimulations in case of severe outer hair cell damage in the lower turns.

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