Examination and diagnosis of exophthalmos are described for otorhinolaryngologists. It is at least necessary for physicians to differentiate inflammation, endocrine condition, true tumor, pseudotumor, metastatic tumor and invasion from paranasal sinus disease. Pyocele or mucocele of the paranasal sinuses is one of the most frequent causes of exophthalmos. The following are very important for the diagnosis of exophthalmos: past history such as paranasal sinus operation and inflammation; ocular position; ocular movement; X-ray findings of orbital bones and sinuses; CT-scanning findings of the orbit and paranasal sinuses; and the side and grade of exophthalmos.

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Patients who visited us within one month after contracting the disease were grouped as “new” cases. A thorough review of seventy-six of these patients' past histories, present illnesses, family histories and laboratory data was made. It was expected that abnormal data from these patient's records might disclose the causative factors of the disease.
The past histories indicated that fourteen patients, the largest number, suffered from hypertension, although twelve of them had had it under control.
White blood cell counts were apparently greater for the control groups. The counts were statistically analyzed and were significantly greater (P=0.001) in the patients' groups. In addition, hemoglobin counts and red blood cell counts tended to be higher than the control group's data. Platelet counts, however, were not different. We suspected that blood viscosity might be related to the occurrence of Bell's palsy.
There were only six cases of diabetes mellitus. However, the blood sugar level of patients suffering from Bell's palsy was high in comparison with those in the control groups.

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Preoperative hearing loss, microorganisms isolated from ear discharge, duration of ear complaints, the ages of patients, surgical treatment and postoperative restoration of hearing were studied in chronic suppurative and cholesteatomatous otitis media with destroyed stapedial superstructure. Pre- and postoperative hearing loss were determined by averaging air-bone gaps of 0.5, 1, and 2kHz.
The following results were obtained.
1) Dehiscence of the stapedial superstructure is more frequently found in cholesteatoma than in chronic suppurative otitis media. The stapedial superstructure was more rapidly destroyed in cholesteatoma.
2) Pseudomonas aeruginosa was isolated with a significantly higher incidence from ear discharge of chronic purulent otitis media.
3) Infection of plural micro-organisms was found to have no significant effects on stapedial destruction.
4) Preoperative audiograms showed air-bone gags of 30dB or more at all frequencies in 42.9% of the patients, and 26.6% of them showed air-bone gaps of 30dB or more at all frequencies except one.
5) Postoperative air-bone gaps were around 30dB in 7 of the 13 radical mastoidectomy ears.
6) Postoperative air-bone gaps were 33.9dB for radical mastoidectomy, 29.0dB for type IV tympanoplasty and 25.8dB for modified type IV tympanoplasty.

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A 35-year-old male complained of right otalgia and conductive hearing loss. CT-scanning showed dehiscence of the anterior bone plate of the occipital fossa and herniation of the brain into the middle ear.
Mastoid exploration revealed a mass with a partially thinned dura mater and leakage of cerebrospinal fluid. The thinned dura mater was covered by lyophilized dura with bio-bond.
In view of this case report, the following points should be kept in mind.
1) Application of CT-scanning is recommendable for the diagnosis of meningoencephalocele.
2) A transcortical approach to the mastoid antrum must be carefully performed, taking meningoencephalocele into account.
3) Damage of the dura mater can be repaired with lyophilized dura.

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A case of odonto-ameloblastoma of the maxilla is reported. A 11-year-old girl complained of swelling of the right cheek. The tumor was surgically removed, and histological examination of the tumor revealed odonto-ameloblastoma.

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A 7-year-old boy with a chief complaints of an infra-auricular swelling on the right side and the disturbance in swallowing with pain was found to have a tumor on the right palatine tonsil concomitant with induration around the submaxillary region. Biopsy of the tonsil was performed. The histological and electron microscopic findings demonstrated that the tumor consisted of undifferentiated lymphoblastoid cells with a starry-sky appearance possibly characteristic of Burkitt's lymphoma.
More precise observations by immunocytology and serology confirmed that the tumor was a certain type of Burkitt's lymphoma. Local irradiation and chemotherapy for Burkitt's lymphoma were selected for treatment.
The tumor was initially sensitive to treatment and showed continuous remission until he died after 5 months of treatment.
Autopsy demonstrated that the widespread tumor cells were observed in the spleen, pancreas and mesenteric lymphnodes.
The clinical course and schedule of chemotherapy of this patient is reported in addition to the literature on Burkitt's lymphoma in Japan.

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A 72-year-old man was seen with a one-year history of multiple tumors of the tongue and speech disturbance. On operation, diffusely infiltrated adipose tissues which were not capsulated microscopically were observed all over the tongue. This case was diagnosed as lipoma but clinically there were not as many lipomas as in lipomatosis.

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Spastic dysphonia is a very rare condition. It is, however, less rare in the United States than in Japan. One of the present authors (M. Hirano) had an opportunity to review 37 spastic dysphonia patients at Lenox Hill Hospital in New York with two American clinicians, the other two authors. The purpose of this paper is to provide information on some aspects of this enigmatic voice disorder for voice specialists in Japan. The results are summarized as follows: (1) In a total of 37 patients, 24 had psychogenic and/or somatic factors which the patients thought had some relationship to the onset of their voice disorders. (2) The less the communicative function was associated with phonation, the less the voice spasticity tended to be. (3) The more different from normal the mode of vocal fold vibration was, the less the voice spasticity tended to be. (4) Elimination of auditory feedback resulted in a decrease in voice spasticity in a few selected patients.

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Two cases of thoracic esophageal diverticula and a case of hypopharyngeal diverticulum were reported. Because of few complaint the two patients with esophageal diverticulum did not need therapy.
A 40-year-old man was referred to us with a six-year history of dysphagia and diagnosed as having a hypopharyngeal diverticulum on X-ray examination. A little-finger's-head-sized diverticulum was resected at one stage operation and the postoperative condition was uneventful.

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The effect of the frequency response of a hearing aid on the interrelationship among the most comfortable level (MCL), uncomfortable level (UCL) and speech discrimination score was studied in relation to hearing-aid fitting. Measurements of MCLs, UCLs and speech discrimination scores at the MCL were performed using three different low frequency cut-off slopes of the hearing aid. Twelve individuals with moderately severe sensorineural hearing losses served as subjects.
Low-frequency amplification resulted in elevation of both the MCL and UCL. The degree of elevation of the MCL was larger than that of the UCL. Therefore, low-frequency amplification provided wide audible areas to hearing-aid users. The results also indicated that low-frequency amplification provided good speech discrimination scores for nasals and voiced consonants. On the other hand, high-frequency amplification provided good discrimination scores for voiceless consonants.
Thus, the frequency response for widening the audible area is contrary to that for improving the intelligibility of voiceless consonants. This important problem must be taken into consideration in selecting the suitable frequency response of a hearing aid for an individual with hearing loss.

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The noises which adults and pupils encounter in daily lives were investigated from the viewpoint of selecting hearing aids with the best electroacoustic performance.
The sound levels and one-third octave band spectra of the surrounding noises, such as the noises from traffic, parks, offices, department stores, indoors, and classrooms and playgrounds of schools, were measured.
The equivalent sound levels (Leq) of the noises were more than 70dB (A). The fast A-weighted sound level exceeded 50% of the time (L₅₀) at playgrounds and those at the vestibules of schools were even more than 75dB (A). By A-weighting, the predominant frequency regions of the interior traffic facilities were bands at low frequencies. The peak center frequencies of the outdoor noises were bands at middle frequency regions from 630Hz to 1000Hz. Some of the predominant noise in offices and indoors showed bands at high frequency regions.
In selecting hearing aids for those with sensorineural hearing loss, the results of this survey should be useful.

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The efficacy and safety of flunisolide nasal spray were investigated in long-term repetitive administration in 20 patients with nasal hypersensitivities such as nasal allergy and vasomotor rhinitis.
Flunisolide nasal spray was administered in doses of 200μg/day of flunisolide in 2 puffs to each nostril 2 times every day for 7 to 77 weeks which was the longest administration. When the overall improvement was assessed after 6 weeks of administration, an improvement of ‘improved or better’ was found in all patients. No suppressive effect of the adrenal was found in the results for serum cortisol levels and rapid ACTH test before and after administration. No differences were found in clinical laboratory test values before and after administration, and in all patients where it was possible to conduct a fungi culture test on nasal discharge, the test results were negative.
From the results of this study, flunisolide nasal spray was evaluated to be very useful.

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The efficacy and tolerability of diclofenac sodium suppositories administered 25mg b. i. d. for 5 days to children with post-tonsillectomy pain and inflammation were investigated in a well-controlled study of 40 patients comparing it with the treatment with a non-diclofenac sodium drug. In this trial, diclofenac sodium showed quick onset of analgestic action and was superior to the treatment with a non-diclofenac sodium drug in the analgestic and anti-inflammatory effect after 3 days. There was no difference in efficacy between 2 treatments after 5 days.
Laboratory tests (hematology, serum biochemistry and urinalysis) were normal, and mild vomiting was reported for diclofenac sodium. Plasma concentrations of diclofenac were measured following a single dose of diclofenac sodium 25mg in 5 children.
No difference was observed in the peak plasma concentrations (C Max) or time to reach the peak concentration (t Max) between diclofenac sodium 25mg in children and diclofenac sodium 50mg in adults.

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The analgesic effect of Voltaren suppository was studied with respect to post-tonsillectomy pain in children. A single dose of 25mg of Voltaren suppository was administered to 40 children under 16 years on the day of operation. The clinical response was excellent in 22, good in 10, fair in 4, poor in 1 and uncertain in 3 children. The rate of efficacy was 85%. The effect appeared within 1 hour in the effective cases. No side effect was observed in any of the children.

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Cefotiam, a new chephalosporin, was administered to 19 patients with otolaryngeal diseases with daily doses of 1, 000mg for 5 to 12 days. In acute tonsillitis, the efficacy rate was remarkably high, peritonsillar abscess significantly high, chronic otitis media remarkably high, mandibular myelitis significantly high, postoperative infection of otolaryngologic malignant cancer moderate, and postoperative maxillary cyst significantly high. The bacteriological efficacy rate of cefotiam on Gram-positive bacilli was remarkably high, on Gram-negative bacilli moderate, and on anaerobic bacilli remarkably high. No side effect was observed.

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