Polysomnographic examinations were performed on normal breathers and those with disturbed nasal breathing.
1. Plugging of the nares of normal infants during sleep caused hypoventilation with decrease in PaO₂. Removal of the obstruction resulted in complete recovery of normal breathing.
2. Polysomnograms of children with large adenoids and adults with bilateral nasal polyps showed marked increase in respiratory intraesophageal pressure-change and alternative breathing consisted of apnea and deep breaths with large snores. Corresponding to this breathing pattern, PaO₂ and PaCO₂ changed in reverse direction to each other. EEG showed the existence of sleep disturbance with stages 2 and 3 predominating.
3. Contrast media dripped into the pharynx through a transnasal tube during sleep was found on chest X-ray films in the lungs in 8 of the 10 infants with large adenoids in contrast to only in 1 of the 7 infants with normal nasal breathing.
4. Flexible fiberscope examination visualized the vibration of the pharyngeal wall mucosa which closed in on each other. Secretions attached to the surface of the mucosa also joined together.
5. The influence of obesity on breathing during sleep was clearly shown on polygraphic recordings. Obesity itself caused narrowing of the upper airway represented with snores in varying degrees. Additional nasal obstruction enhanced the disturbance in ventilation (hypoxia and hypercapnia were intermittently caused by alternation of apnea and deep breaths) and sound sleep (stage 1 and 2 predominance on EEG).
6. Surgical removal of the hypertrophied adenoids or nasal polyps relieved nasal obstruction and resulted in normal sleep-EEG and regular breathing patterns which mean sound sleep and normal breathing.
It has been clearly demonstrated that disturbance in normal nasal breathing during sleep caused more serious trouble to the subject than while awake, even though this evidence has received little attention in general. Suitable treatment for removal of the obstruction in time is strongly recommended to restore sound sleep and normal respiratory function.

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The patient, a 17-year-old female, who was diagnosed as having right cerebellopontine angle tumor on CT-scanning performed in the department of neuro-surgery, was further examined by neuro-otological test. The pure-tone audiogram was quite normal. The caloric response showed moderate reduction, and Stenvers X-ray findings showed no positive findings. For these reasons, acoustic neurinoma had not been initially suspected. Operative and histological findings, however, indicated a typical acoustic neurinoma. Two years later, acoustic neurinoma was found on the opposite site in the same patient. The findings of neuro-otological examination also indicated similar results to those described above.
The present case has suggested that precise thorough examination, including tests for retrocochlear function and tomography of the internal auditory meatus, should be performed, even if the pure-tone audiogram or Stenvers X-ray findings are normal in patients in whom a cerebello-pontine angle tumor is suspected.

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Tinnitus is an otological symptom which is often encountered and is yet difficult to treat. If tinnitus is of cochlear origin then it seems reasonable to assume that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic injections of a local anesthetic (4% Lidocaine) to anesthetize the inner ear and of Decadoron were conducted in a patient suffering from tinnitus.
1. One hundred and sixty-eight patients (220 ears) who had suffered from relatively long-term tinnitus were included in this study. In almost all of the cases the clinical symptoms and the laboratory findings (i. e., the audiogram and caloric test) indicated that the probable lesion underlying the tinnitus was located within the end organ.
In some cases this injection brought a transient (for a few days), slight, neurosensorial deafness in the low-frequency range. This auditory disorder, however, was completely restored without sequelae.
Our results are summarized as follows:
1) in 76 ears, tinnitus was abolished completely
2) in 109 ears, tinnitus was considerably ameliorated
3) in 35 ears, tinnitus was slightly ameliorated or no effect.
2. One hundred and nineteen patients (140 ears) who had suffered from tinnitus were included in this study.
Decadoron was applied to the middle ear cavity by transtympanic injection.
Our results are summarized as follows:
1) in 87 ears, tinnitus was abolished
2) in 39 ears, tinnitus was considerably ameliorated
3) in 14 ears, tinnitus was slightly ameliorated or no effect.

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A type of tympanoplasty was evaluated as the stable surgical procedure for the treatment of otorrhea and restoring hearing. Sixty-seven patients (74 ears) with chronic suppurative otitis media with attic blocking were the subjects of the present study. Type I tympanoplasty produced better results in the extent and rate of the hearing improvement than type III with the columella. Postoperative problems of type I tympanoplasty were lower in incidence than those of type III with the columella. Moreover, problems of the retraction pocket were not observed in the cases of type I tympanoplasty. No differences in the cure rate of otorrhea between these types of tympanoplasty were noted. We concluded that, in patients with chronic suppurative otitis media even with attic blocking, type I tympanoplasty should be chosen in the case of an intact ossicular chain and that a staged operation should be scheduled both in cases of severe inflammation in the attic and of discontinuity of the ossicular chain.

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A case of malignant fibrous histiocytoma of the temporal bone is presented. A 72-year-old female had suffered from right peripheral facial palsy for five years and her hearing had progressively worsened from a few years previously. On January 10, 1980, when she visited the our-patient clinic of the Shishu University Hospital, her right external auditory canal was occupied with a hard tumor. Surgical operation revealed that the tumor had no capsule and was attached to the dura mater and sigmoid sinus.
Histopathologically, the tumor showed characteristic findings of fibrous histiocytoma such as a streaming proliferation of long spindle-shaped fibrous histiocytes, an occasionally incomplete storiform pattern and associated xanthoma cell accumulation.
Fibrous histiocytoma is clinically malignant because of the difficulty of removal and the tendency for recurrence.
A review of the literature on malignant fibrous histiocytoma was made.

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A 4-year-old boy complained of nausea, vomiting, right exophthalmus, and right oculomotor palsy due to a right ethmoidosphenoidal sinus tumor, which invaded the orbit and the middle cranial fossa. The tumor showed a “starry sky appearance” microscopically. The patient received anticancer drugs and radiotherapy. Three months after the initial treatment, tumor cells appeared in the peripheral blood and bone marrow, and they were found to be of L3 Burkitt-type and IgM λ-type B cells. The diagnosis was made of Burkitt's tumor in the right ethmoidosphenoidal sinus, followed by leukemia, which was rated to be stage 4 and la.
Three months later, the patient died. Permission to autopsy was not obtained.

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Carcinoma of the sphenoid sinus is uncommon and metastatic carcinoma in this region is also rare.
This paper summarizes our experience of a 37-year-old woman, whose first symptom was unilateral sudden hearing loss. She subsequently complained of orbital disturbance. With the X-Ray examination of the nose and sinuses, sphenoid tumor was suspected and biopsy of this sinus was performed. The histologic diagnosis suggested metastatic Adenocarcinoma. Her history revealed that 5 years previously she had been diagnosed as having breast cancer and treated by masectomy and postoperative radiation therapy. Whole body bone scinti-scanning was performed and revealed multiple bone metastasis. Radiation therapy was administered to the sphenoid sinus and the bone metastasis was treated with anti-estrogen. The orbital symptoms were immediately alleviated, although hearing loss was not recovered.
In the past one and half years, she has had no local symptoms or signs of recurrence.

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Observation of 26 temporal bones with replacement tympanic membrane revealed that most of the spontaneously replaced tympanic membranes had a certain thin intermediate layer. Histological findings of the border part between the replacement membrane and the remaining one indicated that the epithelial migration played the most important role in the mechanism of perforation closure.
Replacement membranes produced as a result of the conservative closure method and myringoplasty were also observed by light- and electron-microscopy, and the histological structure of the former closely resembled that of the normal tympanic membrane.

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The existence of diabetic hearing impairment has been suspected from clinical experiences. However, there were some discrepancies between clinical audiometric data on hearing loss and lack of definite histopathological evidence on hearing impairment in human temporal bones and in experimental animals. Therefore, using alloxan diabetic mice, we attempted to study diabetic hearing disorder using several methods.
The results obtained were as follows:
1) Biochemical study
Keeping in mind reports that human temporal bones and experimental diabetic cochleae showed accumulation of PAS-positive substance, a ground substance in the connective tissue, i. e., acidic glycosaminoglycans (AGAG), was measured qualitatively and quantitatively.
The result showed gradual increases of AGAG in each tissue more than about three times as much as the normal until after the 60th day of alloxan injection. This fact will cause microangiopathy of such vessels as radiating arterioles of the cochlea.
2) Morphological study
The loss of cochlear outer and inner hair cells and microangiopathy of the radiating arterioles were demonstrated after seven months of diabetic condition by hematoxylineosin staining of celloidin sections and by succinic dehydrogenase and alkaliphosphatase stainings of the surface specimens.
3) Audiometric investigation
The loss of Preyer's reflex and an elevated threshold of the auditory brain stem response were noted after seven months of alloxan diabetes.
The existence of diabetic hearing impairment which has not always been consistently demonstrated was thus confirmed using alloxan diabetic mice. The disagreement with the previous reports may be due to the species difference.

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Two cases of rhinolithiasis, a 69-year-old female and a 76-year-old female, were reported and their rhinoliths were analyzed using several methods. In both cases the nasal calculi located around the middle meatus lacked a so-called “nucleus” and weighed 0.93 and 2.7g, respectively.
Infrared spectrometric analysis, X-ray diffraction analysis, atomic absorption analysis and emission spectroscopic analysis were performed on the rhinoliths as well as on salivary calculi obtained from the Warton's duct of a female aged 25 years for comparison. Both the rhinoliths and salivary calculi were mainly composed of calcium phosphate. However, in general the rhinoliths contained a greater variety and quantity of elements than the salivary calculi. The rhinoliths contained Ni, Ag, Zn, Na, Cu, Ca, Fe, Si, Mg, Pb, Cr, P and Hg. These results may be related to recent air pollution, since the nasal cavity is the first gate of the upper respiratory tract.

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Cerocral (ifenprodil tartrate), an agent which improves circulation in the region of vertebral arteries, was clinically studied in 23 vertigious patients. The therapeutic effects of Cerocral were investigated in 4 cases of hypertension, 2 cases of hypotention, 7 cases of vascular diseases of the brain stem or cerebellum, 5 cases of vertebuao-basilar insufficiency, one case of head injury, 3 cases of otogenic vertigo and one case of unknown origin.
Subjective symptoms improved in 78.3% of the 23 cases and objective symptoms in 82.6%. The final overall improvement rate was 82.6%.
Cerocral was more effective in patients with vertigo due to central origin than in otogenic vertigo. This tendency could be observed not only in subjective and objective symptoms but also in overall estimation. The therapeutic effects on vertigo and dizziness were better than on the cochlear symptoms. The effects on associate symptoms came between these two.

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Azunol-S tablets (AZ-S; containing 5mg of water-soluble Azunol in one tablet), to be inserted into the labiogingival region of the upper jaw, were administered to 21 patients who had undergone tonsillectomy. One tablet was given four times daily for seven days from the day after tonsillectomy. The following results were obtained.
1) The rate of global effectiveness including excellent and good responses was 85.7% and the rate of the above two plus moderate responses was 95.2%.
2) That the time period needed for the white or yellowish coat covering the tonsillectomized wound to disappear was shortened in almost all the patients may be a characteristic effect of AZ-S.
3) No side effects were seen in any of the patients.
From these results, AZ-S was considered to be an effective drug for the treatment of the posttonsillectomy condition.

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