A case of big neurilemmoma at the left floor of the mouth in a 31-year old man is reported. The patient complained of sudden swelling at the left floor of the mouth. Angiography was most useful way when the diagnosis was made. Removal of the tumor was performed by intra oral and external approach with mandibulotomy. The tumor was as large as hen egg size. But finally original neuron was not found. Histopathological examination revealed neurilemmoma (type A and B).

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A patient 59-year old woman with a pulsating swelling in the right posterior pharyngeal wall was reported. She did not complain of pharyngeal symptoms. The angiography revealed that the pulsating swelling was a tortuosity of the internal carotid artery. Regarding the treatment were considered: 1) observation, 2) ligation of the carotid artery, and 3) a shunt operation. Observation was thought to be the best method in this case, because of risks involved in the other two methods.

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The fracture of the medial wall of the orbit is mostly accompanied by the disintegrations of the orbital floor or other facial bones. The isolated occurrence in the medial wall is uncommon. This is a report of such case. The diagnosis was made primarily by CT-scan, which was also useful in chosing treatment.

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Oblique facial clefts are very rare congenital malformation of the face. They are classified into 3 groups, i. e. (1) naso-ocular cleft, (2) oro-ocular cleft (median type), (3) oro-ocular cleft (lateral type). Two cases of them are presented concerning history and procedures of plastic surgery. The case 1 belongs to the oro-ocular cleft (lateral type); on the other hand the case 2 belongs to the naso-ocular cleft. The oblique facial cleft of the case 1 is combined with left cryptophthalmus and cleft palate.

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The relationship between the efficiency index of the larynx (AC/DC%, Isshiki) and the S-N ratio of the voice was examined in the pathologic larynges.
Positive correlation was noted in the subjects with vocal cord paralysis. No significant result, however, was obtained in the subjects with vocal cord cancers. And a positive but quite loose correlation was noted in the subjects with laryngeal polyps.
Abnormally high stiffness of the vocal cord is the main cause of the noise in vocal cord cancers. On the other hand, high DC component is responsible to the noise in vocal cord paralysis. These differences concerning the origin of the noise could be the reason for different correlations noted above.

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VOT (Voice Onset Time) が声門病変により影響をうけるか否かについて検討した.
病的喉頭者ではVOTは測定しにくいので, 新たに定義したFAB (Formant Amplitude Build-up) をパラメーターとして用いた. これは子音の開放からF_1～2領域でのエネルギー上昇までの時間を, 等レベル線表示サウンドスペクトログラフ (Voice Print) 上で測定したもので, 病的喉頭者でも測定が可能である.
対象とした音節は/pi/および/bi/であり, 正常人8例, 病的喉頭者26例に発話させた.
正常人においてはFABはVOTに対して, 直線的な対応を示し, 病的喉頭者におけるFABからVOTを推定出来る.
FABは病的喉頭者では, 正常例に比して, /pi/でより広いばらつきを, /bi/でより大きい値を示した. 病的喉頭者間の比較では, /bi/において声門の硬化性病変は喉頭ポリープ例より大きいFABを記録した. 以上の所見は, 病的喉頭者においてはVOTが正常例に比して影響を受けること, また声門の病的条件の違いによっても影響の受け方に差があることを示唆するものである.

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(1) 視神経管骨折で, 受傷から視神経管開放術までの日数は, 視力に対する予后を左右する要因の一つである.
(2) 視神経管骨折の診断で, レーゼ法撮影による骨折確認率は決して高くない.
(3) CT撮影は, 視神経管骨折の確認に有用である.

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1979年滋賀医大開院以来, 1983年3月末まで, 4年6ヵ月間に副鼻腔手術を要して炎症性副鼻腔疾患220例中3例に鼻性視力障害を伴った. これ等3例は全例鼻症状を欠き, 2例は鼻疾患の既往も持たなかった. 又1例を除いて急性炎症症状も呈しなかった. この様な臨床像は文献的に見ても本疾患の特徴とも言えるので, 診断にあたって十分注意を要するので報告した.

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The relationship between the sensation of nasal obstruction and the nasal airway patency was evaluated by using an active-posterior rhinomanometry. The sensation of the nasal obstruction was devided into 5 grades, and the nasal airway conductance was used in order to represent the nasal airway patency as a numerical expression. 115 patients suffering from nasal disease were used in this study.
The standerd deviation of the nasal airway conductance of patients with moderate or high nasal obstruction was smaller than that of patients with slight nasal obstruction. Especially the standerd deviation of nasal airway conductance of patients with no obstruction was about twice as much as that of other patients.
It cannot be decided that the group of nasal disease and health, and the degree of nasal obstructive sensation only by using the nasal airway conductance.
Other factors that cause the nasal obstructive sensation were discussed.
The effects of nasal surgery were represented on the sensation of nasal obstruction and the nasal airway conductance. It was revealed that 77.3% cases, the sensation of nasal obstruction decreased and the nasal airway conductances increased in various degrees after the surgery.

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原発性中耳癌による顔而神経麻痺の3例を報告した. 滋賀医科大学顔面神経外来末梢性麻痺の2.3%が腫瘍によるものである. 報告した3例は, 麻痺潜在性発症, 麻痺の顔面の部分的発症, 三叉神経症状の合併, 易出血性悪嗅耳漏を伴った肉芽の存在, といった, 外耳道, 中耳原発の悪性腫瘍を診るにあたって留意すべき所見を具えていた. 手術した2例では, 神経管の破壊は麻痺の発症からの期間に比し広範囲であり, 以前に報告した側頭骨病理とあわせ考えると, 顔面神経麻痺のある例では, 浸潤はすでに高度であると予測してよい.

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Histopathologic findings of an en bloc resected temporal bone from a patient with a squamous cell carcinoma in the external ear canal and the mastoid were reported. The case was a 75 year-old female died of postoperative impairment of renal function and following meningitis by suture insufficiency. She had had smelly otorrhea and occasional vertigo for three years and otalgia and a mass in the ear for three months. The mass was revealed to be squamous cell carcinoma by biopsies in two occasions. Polytomographies suggested a destructive lesion at the posteroinferior wall of the bony external canal and tumor infiltration fairly restricted in this area. Serially sected specimens showed squamous cell carcinoma invading the posteroinferior wall of the external canal and the adjacent mastoid air cells. Findings of the polytomography coincided well to the finding. However, submucous infiltration of the tumor cells can not be postulated even with this method. Through preoperative check up is mandatory for this aggresive operation.

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Complications from otitis media and mastoiditis in our clinic for the past 4 and a half year were presented. The operations for otogenic complications were performed in 15 out of 190 ear surgeries: subperiosteal abscess in 4 cases, Bezold's abscess in 3 cases, labyrinthitis in 2 cases, petrositis in 2 cases, meningitis in one and facial palsy in 3 cases. Clinical pictures and bacteriology of the complications have been changed with advent of antibiotics. Less was it a disease of children. More often it was seen in the adult patients. Fever and leucocytosis were not reliable signs of the affections. The fact that a third of the complications occured during or shortly after new-year vacation must not be overlooked. High dose of antibiotics were given orally for the patients by otolaryngologists before the complications initiated. It may therefor be concluded that the patients in new-year should be examined carefully with the otogenic complications in mind.

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Surgical treatments of hemifacial spasm and blepharospasm have been reviewed. These conditions have been treated in the past by nerve block, radiofrequency coagulation, complete or partial section of the nerve, anastomosis and by neurovascular decompression. There are two methods with good hope of permanent relief of spasm. One is neurovascular decompression at the facial nerve root exit zone, and the other is hypoglossofacial anastomosis. The former relatively extensive operation has disadvantage of sensorineural hearing loss as the major complication. The latter is not popular for the unnatural facial expression after a long lasting complete facial paralysis by the operation.
Other methods have by no means final solution, and recurrence pushes into submitting to repeated treatments. The history of neurectomy tells that very wide avulse of the temporal and buccal branches is mandatory to get satisfactory results for the patients. Non invasive nerve block has disadvantages of facial palsy of unpredictable period and the recurrence.
No surgical treatments is perfect. Comprehenssive discussion with the patient is necessary prior to surgical procedures.

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In order to save time and effort, an automatic speech audiometer was developed using a microcomputer as a controller.
With this speech audiometer, speech detection threshold test and speech discrimination test were given to 12 ears with normal hearing and 5 ears with impaired hearing. This system was compaired on the same ears with the method using a recorded tape and a audiometer.
Saving effort in speech audiometry was established by this computerized automatic speech audiometer without losing time. Though the time for the tests was not shortened, it allowed the examiner to have some free time during the tests.

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An automatic SISI test was done on 37 ears using a fully-automatic computerized audiometer. The 37 ears consisted of 21 ears without hearing loss and 16 ears with 10 to 90dB hearing loss, 7 of which also had Meniere's disease. As the audiometer controls all the processes of the test, the examiner must only set conditions and watch the responses of the examinee. At end of the test, the audiometer displays SISI graph on the monitor. Two parameters, SISI score and increment magnitude were able to be compared and discussed on one SISI graph.

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Kitahara reported a recording method of momentary sways of the human head during righting reflex with an accelometer. By means of this method, the acceleration element of the head movement and the tilting angle of the plank, which was maintained horizontally by a subject standing on the plank, were registered. 16 normals and 20 cases with vestibular dysfunction were used in this experiment. The results of the tilting angle and the subjective horizontal level of the plank had no significant difference bitween the normals and the cases with vestibular dysfunction. The parameters obtained from the head movement were expected to reflect the vestibular function.

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The authors reported our new method of Galvanic test battery. The principle of the test was as the follows. 1) Left-right spinal responses were recorded by small accelerometer attached to the forehead. 2) The triangle shaped electric stimulation was applyed to the ears of the subjects repeatedly.
Results, 1) The adaptation was obtained in spinal responses by repeated stimulations. 2) The time lag between stimulations and spinal responses were almost fixed. 3) In cases of Meniere's disease, the impression was found that the adaptation was observed in early time.

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頭部の立ち直り反射と, 体の立ち直り反射の相互関係を検討する目的で, 頭部加速度と重心動揺を同時記録する装置を考案し, 検討した. その結果, 次の事がわかった.
1) 開眼時の重心動揺に対し, 頭位は正頭位の事が多い.
2) 閉眼時の重心動揺 (移行) に伴い, これに相当する重力の方向に対する頭部傾斜が認められる. しかし, 頭部傾斜は, 重心移動相当量以上のものではない.
3) 重心の高い人, 低い人で, 一定量の重心移動に際し, 頭部傾斜に差は認めない.
4) 前庭迷路障害例では, 得られる記録図のパターンは, 正常者のそれと全く異なる.

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Isosorbide 投与後1年以上経過を観察し得た66例のメニエール病について, その効果を調査し以下の成績を得た.
1) 回転性眩暈の完全コントロールは42%であった.
2) 非回転性眩暈の消失・軽減を合わせた有効率は68%であった. 耳鳴の消失率は11%であり, 有効率としては36%であった.
3) 頭痛・頭重, 肩こりの有効率は, それぞれ60%と52%であった.
4) 聴力については, 74%が不変であり, 改善悪化とも各13%であった.

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Serum osmolality in patients with Meniere's disease was measured by using Wescore 5100B Osmometer in order to reveal the relationship between the vertiginous attack, the effect of Isosorbide, the effect of glycerol and the osmolality. The following results were obtained.
1. Blood samples taken and tested it various times throughout the day were indicated within 3 mOs/kg change in control group concerning the serum osmolality.
2. There was no significant difference between patients with Meniere's disease and control group concerning serum osmolality.
3. Patients with Meniere's disease in vertiginous attack period were found to have hypoosmolality and patients in attack-free period were found to have hyperosmolality.
4. There was no significant difference between patients with Isosorbide therapy and patients with vasodilater therapy concerning serum osmolality.
5. Positive glycerol test group in Meniere's disease were found to have hypoosmolality and negative group were found to have hyperosmolality.

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Glycerol effect for endolymphatic hydrops is well known as an improvement in pure tone threshold at three hours after glycerol administration. However, a long time effect of glycerol is unknown. In this study, audiometric tests were administered during ten hours after glycerol administration in order to determine the long time effect of glycerol in cases of Meniere's disease, sudden deafness and normal subjects.
The following results were obtained;
1) The long time effect including rebound phenomenon of glycerol in the pure tone threshold did not appear in cases of sudden deafness and normal subjects.
2) The long time effect of glycerol in the pure tone threshold was observed only in cases of Meniere's disease and it was classified into the following four types, “descending type”, “descending and ascending type”, “ascending type” and “unchanged type”.
3) In the classification of audiometric types, the crest type and rising type were mainly occupied by “descending type” and “descending and ascending type” and the falling type was mainly occupied by “ascending type”.
4) The half of Meniere's disease showed rebound phenomenon in the pure tone threshold.

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1) Tinnitus was analysed using a tinnitus analizer with six band filters. 215 cases of Meniere's disease were examined. The analysis revealed that low-pitched tinnitus was observed in 46% of Meniere's disease and 75% of the early stage of sudden deafness. While high-pitched tinnitus was observed in 82% of sensorineural hearing loss and advanced stage of sudden deafness. Also the analysis revealed that wide frequency tinnitus was frequently observed in Meniere's disease.
2) Tinnitus associated with Meniere's disease during attacks showed low-pitched in 64%. The changing of tinnitus between attack and remissional stage was associated with that of hearing loss.

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Regarding the causes of endolymphatic hydrops in Meniere's disease, vascular dysfunction is considered to be one of them. In this present study, autopsy reports, experimental and clinical reports concerning the connection between vascular dysfunction and endolymphatic hydrops were reviewed.
The measurement of Cochlear blood flow, which is considered to play an important role in vascular theory with the hydrops was not performed completely due to the anatomical restrictions and for this reason, many methods and devices were reported. For the purpose of knowing which method is best for measuring it, the methods which had been reported were reviewed.
As the endolymphatic hydrops existed in scala media, it is important to know the blood flow in scala media in order to reveal the connection between vascular disorder and the hydrops. However, up until now, there was no report to measure it by using current method due to the anatomical restrictions. Therefore, the blood flow in the scala media was measured by using hydrogen clearance method, which was considered to be suitable to measure it, in normal guinea pigs and guinea pigs with hydrops. Guinea pigs with hydrops were produced experimentally by cauterizing the endolymphatic sac with 10% silver nitrate solution.
Results are as follows;
1) Vascular dysfunction was considered to be a cause of endolymphatic hydrops from the reviewed literatures. However, there are no reports to make endolymphatic hydrops by vascular occulusion experimentally. The reports in which vascular dysfunction were presumed to be produced due to the existence of endolymphatic hydrops were seen.
2) Hydrogen clearance method is considered to be the best and only method currently for measuring blood flow in scala media from the reviewed literatures.
3) In normal guinea pigs, the blood flow in scala media was 6.7±0.9ml/min/100g (n=14)
4) In guinea pigs with hydrops, the blood flow in scala media was 5.5±0.7 ml/min/100g (n=10).
5) From the statistical analysis, a significant decrease of blood flow in scala media was observed in guinea pigs with hydrops compared with normal ones. (p<0.001)
6) It was suspected that the decrease of blood flow in scala media of guinea pigs with hydrops would be caused by atrophy with stria vascularis, from the histopathological findings.

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In order to elucidate the pathogeneses of tinnitus, the etiology of tinnitus was reviewed in the litrature and the change in the spontaneous activity of the cochlear nerve was examined after the application of sodium chloride crystals to the round window membrane of the guinea pig. The results of this experiment was as follows: In two cases out of three, the spontaneous discharge increased remarkably 10min, after the application of sodium chloride, and the pattern of firing was bursty discharge which normal auditory nerve fibers do not exhibit. On the other hand, the remain showed the hyperactivity temporally and thereafter the discharge was supressed extensively. These abnormal discharges of cochlear nerve fibers was thought to be able to cause tinnitus.

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1. 耳鳴を副作用にもつ薬物を調査し, 耳鳴臨床の資料に供した.
2. これらの薬物の作用機序から, アミンに作用を持つある種の薬物, 抗けいれん剤, 筋弛緩剤が耳鳴の治療薬として有望ではないかと考えた.

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In this paper, clinical characteristics of 3 kinds of tinnitus, i.e. tonal, band noise and tonal with noise background were analysed. Results were as follows:
1) Out of 187 patients with tinnitus, 109 had band noise, 64 had tonal and 14 had tonal with noise background.
2) Residual inhibition was observed in 64% of patients with band noise tinnitus and 49% of those with tonal one.
3) In patients under 60 years old, tonal tinnitus was observed more frequently than band noise tinnitus. While in patients over than 60 years old, band noise tinnitus was observed frequently.
4) In patients with normal hearing, tonal tinnitus was observed frequently. While in patients with sudden deafness, band noise was dominant.

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There are many patients who complain of tinnitus, but it is difficult for otolaryngologists to treat tinnitus. The trend of treatment for tinnitus was investigated by the questionnaires in 1982. The questionnaires were sent to 1200 otolaryngologists selected at random. The results are as follows: most of them (95%) have experienced difficulty in the treatment for severe tinnitus. The treatments that are frequently used are internal medicines (87.8%), inflation of the auditory tube (34%), local treatment (24%), injection (21.5%), physiotherapy (7%), psychosomatic medicines (6.3%), and so on. Most otolaryngologists (80%) consider that internal medicines will be ineffective for the first three months. When the drug therapy was ineffective, the next step was changing the prescription (17%; xylocaine intravenous injection and a herbal medicine), psychosomatic medicine (11.9%), local treatment (12.4%; blockade of the stellate ganglion and inner ear anesthesia), physiotherapy (6.7%; acupuncture), and others (tinnitus masker, etc).
Many doctors do not know what direction future treatment should take. Some of them believe that it is important to find the cause of tinnitus first.

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The purpose of masking for treatment of tinnitus is temporary suppression of tinnitus. So RI is expected for treatment of tinnitus. In this study, we examined factors related to the production of RI.
Correlation was observed between the age, disease of patients and the production of RI. On the other hand, no correlation was observed between the loudness, frequency of tinnitus and RI production.

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Tinnitus is the most common symptom encountered by otolaryngologists, but much progress has not been made in its treatment. It has been treated by using many methods, i. e. surgery, medicine, physiology, and psychology.
Biofeedback techniques have been applied to many medical problems. The best results have been obtained with regard to headaches, tachycardia, and blood pressure control.
This paper discusses favorable results obtained when electromyographic biofeedback training is used in cases of severe tinnitus.

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Fifteen patients with tinnitus were treated with anticonvulsants, tinnitus masker and biofeedback. Eighty five per cent of these patients showed good results. It was emphasized that dosis of anticonvulsants could be reduced by the combined treatment with tinnitus masker and biofeedback.

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