Earlier, I demonstrated that the postural reflex of Magnus, especially the neck reflex, constitutes the basis of the normal posture not only of animals but also of human beings, using the examples of ball-catching in baseball, heading in soccer, a thundergod's picture by Sotatsu Tawaraya and the statue of the Deva King at the Kofukuji Temple. In a reflex physiological analysis of postures, I showed that there existed postures which were incompatible with the neck reflex, as in the case of acceleration toward a certain direction.
In this paper, I have psychologically examined the posture of Christ in a painting which is incompatible with the neck reflex, in contrast to that of a tax collector in the same painting. Examining two of Antoine Bourdelle's sculptures of soldiers, I have attempted, from the viewpoint of reflex physiology, an analysis of fighting postures of the soldiers, who appeared to have been surrounded by their enemies.

View full abstract

In order to evaluate olfactory vertigo a new equilibrium test termed equilibrium test for olfactory vertigo has been devised. In this test, a subject is asked to inhale the vapor of liquid garlic odor through the nostrils for 60 seconds at a natural respiration rate. Ten minutes after the completion of inhalation the subject is examined using various equilibrium tests, such as drift reactions of the upper and lower limbs, the test for spontaneous nystagmus and that for eye tracking. Ten normal subjects and 35 patients with cranio-cervical injury were examined using this new equilibrium test. The results obtained were as follows:
(1) In normal subjects neither vertigo nor ataxia was induced when this test was carried out.
(2) In traumatized patients the appearance and/or increase of vertigo and ataxia were observed with the following results:
i) The test was positive in patients who complained of hyperosmia and experienced vertigo due to olfaction.
ii) Patients with a positive test for olfactory vertigo showed hypersensitivity to adrenaline and the appearance and/or increase of ataxia resulted when this drug was administered. Furthermore, there was a tendency that the pattern of ataxia induced by garlic was similar to those induced by adrenaline.
iii) There was a tendency that the pattern of ataxia due to olfaction was specifically correlated with the locus of lesions in the equilibrium system.
iv) A positive sign of the test for olfactory vertigo was more marked in patients with cerebellar ataxia than in those without. Furthermore, in patients with cerebellar ataxia this tendency became more evident in accord with the severity of the ataxia.
v) Olfactory vertigo was not always accompanied by vertigo of psychosomatic origin, although there was a tendency that patients who showed the latter type of vertigo developed the former type.
vi) Cloxazolam, a minor tranquilizer, which belongs to the Benzodiazepine group, was found helpful in relieving vertigo due to olfaction. However, no beneficial effect was produced in patients who showed both olfactory vertigo and cerebellar dysfunction.
With reference to the above results and those from our previously reported animal experiments, the following conclusions were drawn:
(1) Olfactory vertigo is closely concerned with over-excitement of adrenergic components, particularly those involved in the limbic system, hypothalamus and brain stem.
(2) The cerebellum is not a primary neural element in the production of olfactory vertigo. However, it probably contributes to the enhancement of vertigo of this type, affecting the activity of the primary neural elements described in (1).
(3) The neural mechanism of olfactory vertigo differs from that of psychosomatic origin, although there are some common neural elements between the two.
(4) Procedures which inhibit over-excitement of adrenergic components in the central nervous system are helpful in relieving the vertigo and disequilibrium due to olfaction.

View full abstract

Sixty-six patients showing large tracing amplitudes above 15dB were selected from about 1, 000 patients with sensori-neural hearing disorder.
Thirty-eight of the 66 cases showed a difference in the tracking amplitude between the left and the right ears. It was considered from this data that some of the large amplitude values indicate certain pathological conditions in the central auditory system.
In order to elucidate the causative mechanism for the large amplitude, three groups of patients were selected for investigation from those revealing large amplitudes. These groups are: 1. those showing the type III or type IV trace of Jerger's classification, 2. those with poor speech discrimination despite a normal threshold for pure tone, and 3. patients demonstrating poor discrimination for distorted speech sounds with normal hearing for normal speech sounds. A detailed analysis of these data indicated that abnormally large amplitudes of the Békésy tracing are caused by some types of widespread central lesions.
The results of the binaural separation test in those with pathologically wide tracing amplitudes were analyzed. It was concluded that the wide excursion may be caused not only by disorders in the right hemisphere but also by some types of dysfunction of the whole cerebrum.

View full abstract

Cleft lip nose deformity is usually left to secondary correction when the patient has grown up. This paper describes the special technique developed for correcting drooping of the upper margin of the nostril, which is the commonest and most conspicuous among the cleft lip nose deformities. It is featured by a short marginal incision, wide undermining and a special method of fixation. Postsurgical care to maintain the corrected nasal shape is also emphasized. This technique proved useful after experience with 25 patients.

View full abstract

Vestibular and optokinetic stimulations induce balance disorder and nystagmus. The differences between these two balance disorders were compared. By means of the correlogram between body sway and head tilt, the change of posture was investigated. The posture was evaluated in terms of position and attitude. The continuous correlogram of body sway and head tilt was obtained by the combined use of a gravicorder, an accelerometer and X-Y recorder. The position was expressed by the body's center of gravity and the attitude was expressed by the correlogram, especially by the divergence from the regression line of the correlogram. The correlogram deviated to the slow-phase side of nystagmus on caloric stimulation. This deviation was, however, much larger in head tilt than that in body sway. The correlogram deviated biphasically along the regression line on optokinetic stimulation. The head tilt was proportional to the body sway. Thus, in caloric unbalance, not only the position but also the attitude were changed. In optokinetic unbalance, only the position was changed and the attitude was maintained as before stimulation. These findings indicate that optokinetic disequilibrium was due to disorientation in space, but vestibular disequilibrium was due to disturbance in the relationship between the head and body.

View full abstract

A comparative study of patients subjected to surgery at Tenri Hospital confirmed that the percentage of those with a well pneumatized ear had increased from 11.9% to 39.1% in the period of 10 years. Analysis showed that the increase of the well pneumatized temporal bone in Japanese was not related to the advent of the antibiotic era, nor it related to racial difference. “Masked mastoiditis” resulting from the abuse of antibiotics seemed to be causing it.

View full abstract

The effect of speech therapy in adult patients with cleft palate had been assessed rather pessimistically. But recent advances in speech therapy have gradually changed this view of the prognosis.
This report deals with the results of speech therapy on 23 patients with cleft palate, as evaluated in terms of both articulatory disorders and hypernasality. Basically, our speech therapy consisted of 1. control of air flow in the oral cavity, 2. auditory training, and 3. articulatory practice. For the enhancement of the velopharyngeal function, the “puff up one's cheek” procedure proved more effective than the customary blowing exercise. It should also be emphasized that the candidates for speech therapy be selected strictly on the basis of the findings of the aerodynamic inspection, auditory and radiographic examination of velopharyngeal function. The speech therapy at our clinic is mainly directed toward the correction of articulation disorders and slight velopharyngeal incompetence.
Various methods have been utilized to accelerate carrying-over the speech sounds which were corrected at the level of word into the level of passage or conversation. They are repetition of monosyllables, singing songs, practice in drama, and frequent use of the corrected sounds in daily conversation.
Another important aspect of speech therapy is associated with psychological problems of the patients with cleft palate speech. The solution of the problem, which will promote their social activity, can be achieved by active counselling of the patients or by application of the operant conditioning method.

View full abstract

To see the role of the proprioceptors of the extrinsic eye muscles in the maintenance of body equilibrium we carried out the following examinations. Patients who had sustained head trauma and showed unilateral paralysis of the eye muscles were examined. A prismatic lens, with its base pointed to the ear side, was placed over the paralytic eye and resulting changes in eye and body reflexes were measured using the electronystagmograph (ENG) and statokinesimeter, respectively.
The results obtained were as follows:
(1) Placing a lens over the paralytic eye showed activation in optokinetic nystagmus in 53%, lack of change in 21% and inhibition in 26%.
(2) Patients who developed activation of optokinetic nystagmus when placing a lens over the paralytic eye tended to show simultaneous improvement of the righting reflex. In contrast, patients who developed inhibition of optokinetic nystagmus when placing the lens over the paralytic eye tended to show simultaneous aggravation of the righting reflex.
Furthermore, there was a tendency that in the former group, vertigo due to optokinetic stimulation was reduced, whereas in the latter, vertigo was rather activated.
From these findings, the following conclusions were drawn:
(1) The functional correlation between the retina and the proprioceptors of the extrinsic eye muscles is necessary, in order to have good development of equilibrium function of the eyes and body in response to optokinetic stimulation.
(2) Placing a prismatic lens over the paralytic eye is a good method to analyze the role of the proprioceptors of the extrinsic eye muscles in body equilibrium as related to optokinetic stimulation.

View full abstract

Using the test for the convergence reflex and the test for the righting reflex and convergence reflex (Ushio and Hinoki, 1971), effects of a prismatic lens over the paralytic eye were examined in 33 patients with head and neck injuries, in connection with the disturbance of the convergence reflex and the convergence-induced disturbances of the righting reflex. In the test for the righting reflex and a convergence reflex, the subject is asked to maintain Romberg's position daring which the convergence reflex is induced. The results obtained were as follows:
(1) Disturbance of the convergence reflex was alleviated in 24 of the 33 patients (73%), unchanged in 9 (27%), aggravated in 6 (18%), when a prismatic lense was placed over the paralytic eye with the apex of the lens toward the nose.
(2) Convergence-induced disturbance of the righting reflex was alleviated in 18 of the 33 patients (55%), unchanged in 9 (27%), aggravated in 6 (8%) when a prismatic lens was placed over the paralytic eye.
(3) There was a positive correlation between the results from the test for the convergence reflex and those from the test for the righting reflex and convergence reflex when a prismatic lens was placed over the paralytic eye.
(4) Fourteen patients who fell backward on Romberg's position and had cerebellar symptoms were examined using the test for the righting reflex and convergence reflex and the tests for cerebellar ataxia of the upper limbs. Both kinds of tests were carried out while placing a prismatic lens over the paralytic eye.
Through these examinations, it was found that the above-mentioned falling backward was significantly ameliorated, i. e., at the rate of 85.7% when the former test was carried out. In contrast, improvement in cerebellar ataxia of the upper limbs was less obvious, i. e., at the rate of 28.5% when the latter test was performed.
From a series of examinations, the following conclusions were drawn:
(1) Disturbances of the convergence reflex can be a factor in inducing and/or aggravating bodily disequilibrium due to post-concussion states.
(2) Disturbance of the convergence reflex can induce and/or increase bodily disequilibrium in collaboration with the cerebellar vermis. In contrast, such disturbance does not significantly correlate with the cerebellar hemispheres, with regard to the development and/or increase of bodily disequilibrium.

View full abstract

Tramadol (Crispin) is a non-narcotic analgesic which has strong and longlasting analgesic action, with little effect upon the respiratory and circulatory systems. We used this drug in combination with Atarax-P and atropine as a premeditation for surgery under local anesthesia. 54 patients for sinus surgery and 49 for middle ear surgery were the subjects examined. These drugs were injected intramuscularly about 45 minutes before operation. To evaluate the analgesic action, we graded pain on a scale from 1 to 5. The results were as follows. Good analgesic action was observed in over 90% of patients. Better results were obtained when 150mg of Crispin was used in comparison with 100mg of Crispin. The blood pressure during operation tended to rise in about a half of the patients. This side effect, however, may be controlled, if another drug with stronger sedative action is used concomitantly.

View full abstract

We found that patients with cervical pain often complained of fullness of the ear and moreover, these two complaints tended to change paralleling the course of treatment. To elucidate how tubal dysfunction is induced or enhanced by overexcitement of the cervical proprioceptors, the following examinations were conducted. Patients who suffered from cervical pain with or without fullness of the ear were examined using Kumazawa's tubotympanoaerography, where changes in the pressure of both the external ear canal and the nasopharyngeal cavity were examined using Valsalva's maneuver. In order to see the excitability of the adrenergic components in the central nervous system, the equilibrium test with adrenalin loading of Hinoki was carried out. Before and after procainization of tender spots of the neck, the tubal function and the equilibrium function (the righting reflex) were examined. From the results of the above-mentioned experiments, the following conclusions were drawn. Two types of tubal dysfunction, stenotic and paturous type, are probably induced by means of over-excitement of cervical proprioceptors, with more frequent occurrence of the former type. The activities of the autonomic and the somatic systems of a higher order, which respond to centripetal impulses from the cervical proprioceptors, seem to be considerably different between the two types of tubal dysfunction. Furthermore, it is postulated that in certain groups of patients with cervical pain, tubal dysfunction, particularly tubal stenosis can be produced as a result of hyperexcitability of adrenergic components in the hypothalamo-brain stem system, although the central mechanism of a paturous type still remains unsolved.

View full abstract

In order to study the diagnostic value of the salivary flow test in the determination of the prognosis of facial palsy, results of the above-mentioned test were compared with those of other facial nerve tests. The tests used herein were carried out within one month after the appearance of facial palsy. The results obtained were as follows:
(1) There was a tendency that the results of all the tests used herein were opposite in nature between the patients with complete recovery of facial palsy and those with incomplete recovery.
(2) In order to increase the diagnostic value of functional tests with regard to the determination of the prognosis of facial palsy, the “referent values” of the results from the tests used herein were discussed on the basis of the examination proposed by Galen and Gambino and the “critical points” were then determined.
(3) The results from the salivary flow test were compared under the following four conditions, i. e., at rest, stimulation with sour candy, that with 1/4mol tartaric acid and that with pilocarpine. Among the tests perfomed under the above-mentioned four conditions, the salivary flow test with stimulation of sour candy was the most valuable for the determination of the prognosis of facial palsy.
(4) The results of the following five tests were compared in order to determine the prognosis of facial palsy. The above-mentioned tests included the salivary flow test, salivary pH test, electro-gustometry, nerve excitability test (NET) and stapedius reflex test. From the above-mentioned examinations, the following two facts were noted. First, the salivary flow test was the most valuable when the time of examination after the appearance of facial palsy was not taken into account. Second, the salivary pH test was the most valuable when it was carried out within 10 days after the appearance of facial palsy. In contrast, the salivary flow test was the most effective when it was carried out between 3 weeks and one month after the appearance of this disease.
(5) Combination of the salivary flow test with the salivary pH test and the electrogustometry significantly increased the diagnostic value of the prognosis of facial palsy. This was the case for the combination of the salivary flow test with NET and the stapedius reflex test.
(6) A transient hypersecretion of the impaired salivary gland was observed in the course of facial palsy, in which case there was a tendency toward complete recovery from this disease. Furthermore, there was a tendency that the above-mentioned phenomenon appeared before the development of complete recovery.
From these results, the following conclusions were drawn:
(1) The salivary flow test with stimulation by sour candy was useful in the determination of the prognosis of facial palsy, particularly when this test was carried out a certain time after the appearance of this disease.
(2) Combination of the salivary flow test with the other two groups of facial nerve tests was recomendable for the determination of the prognosis of facial palsy.

View full abstract

Sixteen patients with progressive bilateral perceptive deafness due to unknown causes were examined using various hearing tests and equilibrium tests with the following results.
1. Among the 11 patients examined 11 showed inner ear deafness and 3 showed inner ear deafness combined with retrocochlear one.
2. With reference to the appearance and progress of deafness, the deafness of this type was divided into the following two:
One was frequently observed in younger patients under twenty and was characterized by the tendency that bilateral deafness which appeared simultaneously and deteriorated equally, showed gradual, high-tone hearing loss. Thus, the hearing loss in these patients tended to be similar in pattern. i) between the first and the last examinations and ii) between the right and the left ears. Furthermore, the deafness of this type was rarely accompanied by vertiginous attacks.
The other was frequently found in older patients, of above twenty and was characterized by the tendency that deafness of both ears did not appear simultaneously and did not deteriorate equally. Furthermore, the deafness of this type was sometimes accompanied by vertiginous attacks in anamnesis.
3. Among the 16 patients examined, 4 showed fluctuating hearingloss. Furthermore, one of the 3 patients who underwent the glycerol test showed a positive sign. From the above mentioned findings the following conclusions were drawn:
(1) There may be differences between the 2 groups of patients, younger and older with regard to the etiological factors of the progressive bilateral perceptive deafness due to unknown causes, although both groups showed inner ear deafness. The deafness in the former group may be induced by congenital factors and may be regarded as a kind of premature presbyacusis. In contrast, the deafness in the later may be induced, at least partly, by acquired factors.
(2) Some patients showed findings suggestive of the existence of labyrinthine hydrops. These are valuable in considering the mechanism and treatment of the deafness of this type.

View full abstract

We began to treat this case under the diagnosis of maxillary carcinoma from X-ray finding and inspection, but did not recognized malignancy in pathological examination. After reconsideration, we hit upon Peutz-Jeghers Syndrome from past history and pigmentation around the lip. This syndrome is said to be often associated with the following three signs: (1) pigmentation of melanin around the lip, at the mucosal membrane of the oral cavity, and on the fingers and toes, (2) polyposis of the alimentary tract, chiefly at the small intestine, and (3) hereditary disposition. In postoperative prognosis, polyplike tumor recured in hard palate after 1.5 years. Pathological finding was similar to last time, but we recognized infiltration to bone, disorder of cells arrangement, and increase of atypia. Then we diagnosed this tumor as adenocarcinoma. We have so far been informed of three reports in whom polyp took place at the nose ascide from the alimentary tract, but they were all reported from other departments, and details were unknown. This syndrome has been reported here as it is not generally known as a syndrome related with otorhinolaryngology.

View full abstract

A 21-year-old man, who suffered from Wilson's disease and showed spontaneous up-beat nystagmus, was examined using neurological, neurotological and biochemical examinations.
The results obtained were as follows:
(1) Neurological examination revealed the presence of the Kayser-Fleischer ring, dysarthria, dysphagia and cerebellar ataxia of the upper and lower limbs. CT examination showed moderate cerebral cerebellar atrophy, in addition.
(2) Biochemical examination detected decrease in the ceruloplasmin and copper of the blood serum.
(3) Neurotological examination revealed abnormalities of the oculomotor system, as indicated by spontaneous up-beat nystagmus, inhibitory response to both horizontal and vertical optokinetic stimulation and saccadic vertical eye movements on eye tracking. Furthermore, the spontaneous nystagmus described above was characterized by the following findings:
1) It was intensified in frequency and amplitude when upward gaze was carried out. In contrast, it was lessened when downward gaze was made.
2) It was lessened when the test for spontaneous nystagmus was carried out with Frenzel's spectacles.
With reference to the previously reported investigations and the above-mentioned results, the following conclusions were drawn:
(1) In a certain group of patients with Wilson's disease, the lesion is located not only at the basal ganglia, but also possibly extended to the cerebellum and the brain stem, particularly the midbrain tegmentum.
(2) Dysfunction of the oculomotor system relating to vertical eye movements is possibly reinforced by the simultaneous presence of cerebellar dysfunction, which ensues the appearance of spontaneous up-beat nystagmus.

View full abstract

For the diagnosis of thyroid tumors, palpation, X-ray, RI-scintiphoto and biopsy have been employed. They are, however, insufficient for the determination of the characteristics of tumors, but also cause several side effects, such as spreading tumor cells and haemorrhage.
In order to obtain more accurate information about thyroid tumors without any serious side effects, we employed B-mode ultrasonography to evaluate 223 patients with thyroid tumors. In 84 of the 223 patients tested, the correlation was examined between the results of ultrasonography and the histological findings.
The results obtained were as follows:
(1) On the basis of the presence or absence of echo within tumor pictures, the tumors were classified into the following 3 types, i. e., solid, cystic and mixed. The solid type tended to be malignant. In contrast, in the case of the cystic type, tumors tended to be benign with a few exceptions.
(2) On the basis of echo structures within tumor pictures, the tumors were divided into the following two types, i. e., coarse and non-uniform or fine uniform. The latter echo has been considered to be indicative of benignity. However, the present examination revealed that in 45% of the tumors with the latter echo malignancy was proved histologically.
(3) On the basis of marginal echo structure between tumors and the surrounding tissues, the tumors were classified into the following two types, i. e., smooth and irregular. In the case of the latter type, tumors tended to be malignant.
In contrast, in the case of the former type, tumors tended to be benign with a few exceptions. There were nine patients with malignant tumors, four with cysts and five with encapsulated tumors.
From these findings, we conclude that the classification of ultrasonographic echoes described in (1) and (3) are valuable in determining the characteristics of thyroid tumors.

View full abstract

In 1971 an ectopic solid thymus gland of the neck was first reported in Japan. Since then only a few individual case reports have been published. This article presents one such patient who was recently found and reviews the literature. The embryology of ectopic solid thymus glands and thymic cysts in the neck is also discussed.

View full abstract

Patients who suffered from tenderness of the neck and neurotic complaints of the pharyngo-laryngeal regions were treated by procaine infiltration on the tender spots of the neck. The results thus obtained were then compared with those from the “Equilibrium tests with Adrenaline loading” (Hinoki, 1971).
The results obtained were as follows:
(1) The neurotic complaints of pharyngo-laryngeal regions were beneficially treated by the above-mentioned procainization in about 72% of the cases.
(2) Effects of the procainization were more marked in patients with a positive sign of the “Equilibrium tests with Adrenaline loading” than in those with a negative sign. The ratio of improvement of the above-mentioned complaints was 88.9% and 58.3%, respectively.
From these results, it has been concluded that over-excitement of the proprioceptors and hyperexcitability of the adrenergic components in the central nervous system can induce and/or reinforce neurotic complaints of the pharyngo-laryngeal regions, with a trigger-and-target relationship.

View full abstract

A huge cholesteatoma in a 50-year-old female involving the petrous apex was reported. The prominent features of the case were recurrent attacks of very slowly progressing facial paralysis with a 11-year interval and insidious destruction of labyrinthine function.
The cholesteatoma extended into all the air cell tracts up to the petrous apex, and to the retro- and infralabyrinthine-areas.
The cholestoma destroyed the otic capsule at the crus commune and resolved the dura mater to such an extent that the cerebellum could be seen through it. As she had experienced acute otitis media on only one occasion at the age of 4 and only had a small dry attic perforation, the possibility of a congenital cholesteatoma of the petrous apex was considered in addition to her clinical course.

View full abstract

Thirty-one patients with nasopharyngeal carcinoma who consulted the Department of Otolaryngology, Tenri Hospital, from March 1966 to October 1979 were treated with the following results.
(1) These 31 patients consisted of 20 males and 11 females, and the peak of the age-distribution was between 40 and 60 years old.
(2) The most frequent initial symptom was that of the ear, followed in order by those related to the nose, the neck and cranial nerves. Among the symptoms of cranial nerves those related to the Vth and the VIth nerve were the most marked.
(3) The period between the appearance of symptoms and the consultation at our department was less than 6 months.
(4) Histological examination revealed that the above-mentioned nasopharyngeal carcinoma was composed of squamous cell carcinoma, lymphoepithelioma and anaplastic carcinoma in 23, 8 and 8 patients, respectively. According to the classification of UICC (1978), 23 of the 31 patients belonged to Stage IV.
(5) The 31 hospitalized patients were principally treated using X-rays. Furthermore, among these 31 patients 26 were treated in combination with other procedures, such as chemotherapy, arterial infusion of anti-cancer drugs, palatal fenestration and neck dissection. Through the above-mentioned treatments, the following results were obtained. The three-year survival rate was 62.5%, whereas the five-year survival rate was 33.3%.
(6) Metastasis of the tumor was found in the liver and the bones. Furthermore, three of the 10 hospitalized patients died due to a sudden rupture of the internal carotid artery.

View full abstract

Ten cases of cystic hygroma collected in the last 13 years were discussed with regard to age, sex, site of tumor, histologic findings and surgical treatment. The following results were obtained:
(1) These 10 patients were infants aged from 1 to 6 years, In one half of them the tumor was noticed within 2 years after birth.
(2) In 7 of the 10 cases the tumor was located at the neck, particularly the posterior triangle of the neck.
(3) Total resection of the tumor was carried out in these 10 cases with sequelae in 3 patients. The sequelae included paralysis of the submandibular branch of the facial nerve (in 2 cases) and that of the accessory nerve (in one case). A long-term follow-up was made in 9 of the 10 cases with no sign of recurrence.

View full abstract