Seven cases of perilymphatic fistulae due to closed head injury are presented. All the patients suffered rotatory vertigo and/or dizziness with varying degrees of sensory hearing loss and tinnitus. Three of the patients complained of the sensation of water leaking in the ear. Perilymphatic leak from the round window or from both the round and oval windows was confirmed by an exploratory tympanotomy in all the cases. Rupture of the round window membrane was observed in three cases. Repair of the window membrane using the tragus perichondrium and Gelform provided effective control of vertigo in all the cases. Improvement in hearing was significant in three patients operated on 19, 22 and 69 days after the onset. In two patients operated on about 40 days after the onset and two others treated about a year later, no improvement of hearing was gained. Our own clinical experience as well as animal experiments indicates that surgical treatment should be carried out at the earlier stages of the disease, i. e. up to two weeks after the onset.

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The changes of AP and SP responses induced by various kinds of sound stimuli were studied by means of the transtympanic needle electrode technique in electrocochleography. Sound stimuli used were tone bursts of 8, 4, 2, 1, 0.5KHz and clicks of one cycle of 4KHz. Twenty-five subjects with normal hearing were tested for this study. The results obtained were as follows:
The highest AP potential was recorded from around the round window. The tone burst of 4KHz and the click of 4KHz yielded the highest AP potential among the various sound stimuli.
The most stable AP wave form and the most stable -SP/AP ratio were obtained by the sound stimuli of the click and the tone burst of 4KHz.

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Only a few reports are available on the amount of antibiotic in the pathological tissue of patients with otitis media. In the present report, the concentration of cefazolin sodium (CEZ), a basic drug on the cephalosporin group was studied in the otitis media inflicted tissue of 50 ears of patients operated on for chronic otitis media.
Each patient received 2g of CEZ dissolved in 100ml of physiological saline solution by means of intravenous dripping delivered in 60 minutes, immediately after which the granulation in the antrum-epitympanum or on the remnant tympanic membrane was collected as the specimen for investigation. At the same time, venous blood and the temporal muscle fascia were collected as controls.
Analysis was made with the Disc method. The amount of CEZ detected in the granulation from the afflicted tissue was found to be more variable than the one in the venous blood or fascia. Moreover, it tended to be greater than the one detected in the fascia of the healthy tissue.
Taking the histopathological findings of the detected tissues into consideration, the amount of CEZ was found to be the largest in diffuse inflammation, followed by localized inflammation and then old lesion.

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1) Types of phlogogenous bacteria, their incidence and seasonal characteristics were studied in 586 cases of acute purulent otitis media seen at a primary care hospital in Tokyo during a one-year period between July 1979 and June 1980.
2) Paracentesis was performed on 406 cases and middle ear effusions were collected. As a result, 425 strains of pathogens were detected. They included Streptococcus pneumoniae (49.9%), Haemophilus influenzae (32%), Streptococcus pyogenes (7.5%) and Staphylococcus aureus (5.9%).
3) In 168 cases in which otorrhea was found, 221 strains of pathogens were detected as follows: Streptococcus pneumoniae (26.2%), Haemophilus influenzae (23.5%), Streptococcus pyogenes (14%) and Staphylococcus aureus (21.3%).
4) Thus, a high probability of detecting Streptococcus pneumoniae and Haemophilus influenzae in patients who undergo paracentesis was statistically confirmed as well as that of Staphylococcus aureus and Streptococcus pyogenes in those with otorrhea.
It is necessary to indicate the method of sampling when discussing the phlogogenous bacteria involved in otitis media.
5) The incidence of detecting Haemophilus influenzae is higher in winter, Streptococcus pneumoniae in spring and Streptococcus pneumoniae in spring and Pseudomonas aeruginosa in summer.
6) The correlation between the detection rate of Hemophilus influenzae and the number of absentees in elementary schools was also studied.

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A rare case of osteoma of the external auditory canal in a 19-year-old male patient was reported. Osteoma was removed surgically. The tumor was a solitary, pedunculated bony growth attached to the tympanosquamous suture. On scanning electronmicroscopy multiple fibrovascular channels were observed throughout the osteoma. The differentiation between osteoma and exostosis was discussed clinically, histologically and microscopically.

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The height and breadth of the inferior nasal meatus were evaluated using Polytomographic frontal sections at 1, 3, 4 and 5cm from the nasion. Eighty-five normal adults, 45 males and 40 females and those who underwent the Caldwell-Luc operation, composed of 60 males and 15 females were included. Common to both males and females, the breadth showed a statistically significant increase at 3 and 4cm sections. The increase amounts to 20 to 30% of the breadth seen in normal adults. The height did not show any significant change. The height in males showed a slight decrease and was slightly increased in females; the change amounts to only 5 to 6% of the height of normal adults.
Our previous report confirmed that the orbital floor of postoperative patients was located lower in comparison with those who did not receive an operation. The lowering of the orbital floor and the lateral transposition of the lateral wall of the inferior nasal meatus result in the decreased diameter of pars membranacea (or the communication to the middle meatus). The postoperative course of maxillary sinusitis is adversely affected by this decrease in diameter. In view of the present report, routine making of a nasoantral window at the inferior nasal meatus is discouraged.

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Clinical evidence of recurrent and massive nasal bleeding was discussed in a 58-year-old man who suffered from cancer of the upper jaw and was treated with radical operation and irradiation of ⁶⁰Co. Eleven years after the operation, nasal bleeding first occurred and such was repeated 13 times in all during a 2-year period.
The angiogram of the carotid artery revealed that an aneurysma was located at the internal carotid artery on the left side. The aneurysma was successfully treated with neurosurgical technics, without any significant sequela. This procedure also led to suppression of the nasal bleeding mentioned above.
The cause of recurrent and massive nasal bleeding in this case was discussed, with reference to the reports hitherto made.

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A 9-year-old girl who complained of a painless swelling of the tonsil on the left side and was diagnosed as having malignant lymphoma was reported. At the consultation in our clinic, clinical examination revealed that the left tonsil was slightly swollen and the surface of the upper pole was irregular, with no swelling in the regional lymphonodes or those in other parts of the body. Histological examination showed no malignancy. After removal of the left tonsil, it was found that the left tonsillar tissue was non-Hodgkin's lymphoma and the clinical stage was classified as IA. After the operation, she was treated by irradiation and chemotherapy, with no signs of recurrence.

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Three patients with early-stage laryngeal cancer (glottic, T₁N₀M₀) were treated by the surgery of Conley's glottis reconstruction. Abilities of swallowing and phonation after the surgery were found to be satisfactory. The surgical procedure was improved in the following two points: 1. The vocal cord was made by a skin ridge instead of a skin roll to facilitate voice production. 2. An opening was made in the thyroid cartilage to avoid excessive pressure on the base of the skin flap. The case indicated for this surgery has the indication of irradiation, too. This surgical procedure, however, seems to be more suited for the treatment of early cancer of the glottis in which preservation of acceptable voice is intended.

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We report here our experience with the surgical treatment of thyroid cancer cases in which cervical tumor extended to the sternum or metastatic lesions developed in the mediastinum. Of recent five cases, two cases were recurrent cases. Besides resection of thyroid and neck tumors, the following surgical procedures were performed in this series: median sternotomy (one case), upper median sternotomy (one case), resection of the upper part of the sternum including the median portion of the bilateral claviculae and of bilateral ribs (two cases), resection of the left clavicula only (one case). Additional resection was made of the tracheal wall (three cases) and the common carotid artery (two cases) in which replacement by a saphenous vein graft in one case and end to side anastomosis with the subclavian artery in the other case were performed. In a patient with lung metastasis who was planned to be followed by ¹³¹I treatment after surgery, pleuritis carcinomatosa occurred postoperatively and the general condition deteriorated gradually. Four other patients are following favorable courses at the present time.

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The problem of aging has attracted the interest of many reserchers. So has presbycusis, aging of the cochlea. However, the pathogenesis of presbycusis is not yet understood completely. The purpose of this study is to examine the cochlea of aged humans using an electron microscope to characterize presbycusis. Two cases were available. The first case was an 80-year-old male, who suffered from hypertension and died of a cervical tumor. The second case was an 88-year-old male who suffered from severe diabetes mellitus. Of the two cases, the most characteristic finding was accumulation of lipofuscin granules, which were scattered diffusely in all the component cells of the cochlear duct. In the first case, the outer hair cells in the basal turn were severely degenerated, but those of the upper turns had maintained a fairly good shape. The vascular stria of the first case was normal.
In the second case, the patient who had suffered from diabetes mellitus, the main pathological changes existed in the vascular stria. At the apical turn, strial atrophy was observed. At the lower turn, protrusion of marginal cells into the scala media and intercellular edema in the intermediate cell layer were prominent. These pathological changes resembled that of the K. K. mice which are a spontaneous diabetic animal.
We identified the first case as sensory presbycusis and the second case as strial presbycusis.

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The effect of the duration of tone bursts on the slow vertex response was studied under awake and sleeping conditions. Two kinds of 1, 000Hz tone bursts were used as stimuli. The rise-times, plateaus and decay-times of the tone bursts were 5-32-5msec and 5-2-5msec, respectively. The slow vertex response to the tone bursts was recorded in 6 subjects. Under the awake condition, the N₁-P₂ amplitudes to the 5-32-5msec tone bursts were significantly larger than those to the 5-2-5msec tone bursts. However, during sleep stage IV, there were no differences in the N₁-P₂, P₂-N₂ and N₂-P₃ amplitudes between the responses to the two kinds of tone bursts. These results indicated that the positive duration effect observed in the awake condition disappeared in the sleeping condition. The frequency-selectivity of the slow vertex response may not be significantly better than that of early components under the sleeping condition.

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The clinical effect of MOM (9, 3-di-o-acetyl midecamycin) was evaluated in 10 cases of acute purulent otitis media and 12 cases of acute lacunar tonsilitis. The MOM levels in the serum were assessed 0.5, 1.0, 3.0, 4.5 and 6.0 hours after oral administration of 200mg of MOM, and its levels in the tonsillar tissue were also assessed 1.0 to 3.0 hours after that administration.
The following results were obtained.
1) Satisfactory effects were obtained in 50% of the patients with acute purulent otitis media and 67% of those with acute lacunar tonsillitis.
2) No side effect was observed except in only one patient who showed slight GOT and GPT elevation one week after the treatment. He had had a history of chronic liver disease of several years' duration, and the elevated values were not necessarily attributed to the drug administration.
3) In most cases, serum levels of MOM showed a peak 30 to 60 minutes after administration. But the peak was seen 3.0 to 4.5 hours after administration in a few cases. The average level in the serum was 639.11ng/ml. In some cases, its level was more than 1, 000ng/ml.
4) Good transmigration into the tonsil was proved in all of the cases, and the average tonsillar concentration was 370ng/g.
5) From the results of this series, MOM seems to be a useful drug in the treatment of acute purulent otitis media and acute lacunar tonsillitis, particularly in mild or moderate cases without other basic diseases.

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The therapeutic effect of Ifenprodil on definite Meniere's disease and possible Meniere's disease was clinically studied in 20 out-patients from the Department of Otolaryngology of the University of Tsukuba for 5 months from November 1980.
The results obtained are as follows:
1) As to the subjective symptoms, Ifenprodil was effective in 85% of the patients. No significant differences in the effect of Ifenprodil on the subjective symptoms were observed between definite Meniere's disease and possible Meniere's disease.
2) As to the objective symptoms, Ifenprodil was effective on the Mann's test (83.3%) and the nystagmus test (50%), but not effective on the hearing test (15%).
3) The labyrinthine preponderance was measured by the computerized rotary chair system. Improvement of the labyrinthine preponderance was statistically significant (P<0.01: t) after 4 weeks' medication of Ifenprodil.
4) Only one side effect of gastric discomfort was observed in one case, which was not severe.
5) In the light of these results, Ifenprodil appears to be effective for the treatment of Meniere's disease and peripheral dysequilibrium.

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Seaprose-S was administered to 20 patients with chronic sinusitis. The age of the patients ranged from 4 to 73 years. The dose was 45mg/day in the young patients under 11 and 90mg/day in the older patients. The mean duration of administration was 40 days.
Subjective symptoms, nasal findings and X-ray findings of the paranasal sinuses improved in about 60% of the patients. Particularly good responses were noted in the patients complaining of hyposmia, which may be attributed to the drug's effect of controlling swelling in the olfactory mucosa.
This drug can be recommended for treatment of chronic sinusitis with hyposmia.

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