The records of 379 patients seen by us have been reviewed; of these, 102, or 28% had hemifacial spasm (HFS). HFS has features common to postparalytic synkinesis and provides much useful information on the nature of misdirection phenomena. It is the purpose of this paper to elaborate on the details of the symptoms and to provide the basis for thorough understanding of the facial nerve.
HFS was 2.8 times as common in females as in males, thus confirming other authors' opinion that the incidence is higher in females. The age of the onset of the spasm and the first clinical visit was after 20 years of age, showing the disorder as being predominant in adult life. The lower lid was involved first in all patient. The spasm spread down to the face rapidly in most cases within 2 years, although there have been contrary opinions in slow progression. Emotional stress and movement of the facial muscles played a definitive role in precipitating spasms. These revealed that psychological factors and positive feedback played a significant role.
Theories on the etiology of the HFS were reviewed. This paper focused attention on ephaptic transmission. We predict that fiber interaction will be an inportant topic in the field of facial nerve research.

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The test of chorda tympani nerve function was administered to 27 patients with peripheral facial paralysis associated with skull fractures. The test of chorda tympani nerve function, a submandibular salivary flow test and an electro-gustmetry were compared with neuronography. All tests were performed within one month after the onset.
Patients with Bell's palsy were also examined as a control. The results obtained were as follows.
1) The results of the preceding three tests were compared in order to determine the prognosis of facial paralysis. Electro-gustmetry is the most valuable in prognostic accuracy, especially in the diagnosis of incomplete recovery.
2) A combination of the chorda tympani nerve function test and neuronography significantly increased the diagnostic value in the prognosis of facial paralysis.

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Recently, the degree of facial paralysis has been described numerically using May's paralysis score method. In complete recovery, the time course of Bell's palsy can be analysed by the following equation.
y=B. log x+A
where y: value of score
x: days post onset
B: recovery rate
A: constant
A pathological process of facial paralysis was analysed by this equation and reviewed from the “axonal flow” point of view.
The integrated EMG represents the strength of the corresponding muscle and its value indicates the degree of paralysis in facial palsy. From the study of an integrated EMG and the paralysis score method, a close relation between the two methods was revealed, with a high value of correlation coefficient. This indicates that the paralysis score method was substantiated by the objective method, namely integrated EMG. To aquire constant results, the same person should rate the paralysis score during the whole time sequence.
Because the facial nerve has several types of branches besides the main trunk, the thread lacrimation test, stapedial reflex test, and integrated EMG enable determination of the site of the lesion and the pattern of recovery. The combined use of these tests with the score method facilitates understanding of the following results.
1) When the stapedial reflex is present and do not disappear, paralysis recovers quickly.
2) Recovery from paralysis is sometimes accompanied by a high value in the thread lacrimation test.
3) The integrated EMG represents patients complaints more accurately than the score method.

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A statistical analysis was performed of 662 cases of facial palsy treated in the Department of Otolaryngology of Kyoto University Hospital from January 1977 to September 1982.
1) Of these, 447 cases (67.5%) were diagnosed as Bell's palsy, 59 (8.9%) as Ramsay-Hunt's syndrome, 45 (6.8%) as traumatic palsy, 45 (6.8%) as operative trauma, 23 (3.5%) as congenital palsy, 15 (2.3%) as otogenic palsy and 28 (4.2%) as of other origin.
2) There were 232 males and 215 females with Bell's palsy, and 28 males and 31 females with Ramsay-Hunt's syndrome.
3) There were 221 cases of Bell's palsy on the right side, 225 cases on the left side. There were 25 cases of Ramsay-Hunt's syndrome on the right side, and 34 cases on the left side. The left sides was more frequently involved both in Ramsay-Hunt's syndrome and Bell's palsy.
4) The number of patients with Bell's palsy and Ramsay-Hunt's syndrome showed a tendency to decrease in November.
5) Most patients in Bell's palsy are between 30 to 59 years of age, and 30 to 49 years in Ramsay-Hunt's syndrome.
6) For recurrent facial palsy, there were 14 cases of unilateral recurrent facial palsy (11 cases were Bell's palsy), 25 cases of bilateral alternating facial palsy (all cases were Bell's palsy) and one case of bilateral simultaneous facial palsy.
7) Of the 61 cases of Bell's palsy, 13 cases (21.3%) had serological findings indicating viral infection. For Ramsay-Hunt's syndrome, 9 (75%) of 12 cases showed significant increase in the titer of antibody to Varicella Zoster virus.

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In facial palsy, the function of the chorda tympani probably reflects the intracanalicular pressure of the Fallopian canal because the nerve fibers of the chorda tympani can withstand pressure better than the motor fibers of the facial nerve even when the intracanalicular pressure is increased. The intracanalicular pressure in the Fallopian canal is caused by nerve degeneration and swelling.
We transsected the facial nerves of guinea pigs and observed nerve degeneration and swelling. We found that the swelling of the nerve began about 8 hours after nerve transsection and continued for about 14 days and then decreased gradually. Therefore, we concluded that the salivary flow and salivary pH tests, which are the methods of testing the function of the chorda tympani, should be done between 8 hours and 14 days after the onset of facial palsy.

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Using a medical infrared ray camera (thermography), we investigated the temperature of the facial skin of 15 healthy subjects and 154 patients with peripheral facial nerve palsy and the following results were obtained.
1) In the healthy subjects, we could scarcely observe a difference in the skin temperature between both sides of their faces.
2) In the patients with peripheral facial nerve palsy, we did not recognize a clear interrelation between the degree of palsy and the thermogram or between the days elapsed after the onset and the thermogram.
3) In the patients of a good prognosis in the 2nd week after their onset we observed elevation of the skin temperature in their buccal and orbicularis oris regions.
4) Further investigation on the criteria of the facial thermogram and the usefulness of the thermography to facial nerve palsy is necessary.

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The proportion of old people in the entire population is increasing. Sixty-eight patients older than 60 with Bell's Palsy were studied. The results showed that in Bell's Palsy in old age, the primary intensity of paralysis was severer and more time was required to recover. However, its pathology was not influenced by viral infection or diabetes mellitus.
These observations suggest that Bell's Palsy in old age must be considered to be different from common Bell's Palsy.

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From chemical analyses of inner ear fluids, it was found that the sum concentration of electrolytes (Na+K+Cl) is higher in the endolymph than in the perilymph and that the perilymph contains a higher concentration of glucose and protein compared to the endolymph. These findings are discussed from the viewpoint of osmotic equilibrium between the endolymph and the perilymph. Considering our previous experiments and other literature, homeostatic regulation may operate in the endolymph to maintain constant chemical composition. The perilymph, on the other hand, can be regarded as an interstitial space fluid, being susceptible to systemic changes in the chemical concentration in the blood. This may imply that there is biological significance in developing osmotic imbalance between the endolymph and perilymph. Recently, some experimental works have been directed to the study of osmotic agents which are currently applied for diagnosis and treatment of endolymphatic hydrops.
On reviewing the above experimental results including our findings, there is discussion of the relationships of fluid dynamics in inner ear fluids among electrolyte concentrations, osmotic pressure and fluid pressure.
Although the endolymphatic system is not directly influenced by systemic change in the serum concentration and by the hemodynamics, some substances are thought to have their sites of action in the stria vascularis. As such substances, aldosteron, amphotericin B, vasopressin, ouabain and diuretics are cited. These substances are supposed to affect the electrolyte transport system in the stria vascularis or in other membrane of the inner ear. Using these substances in experimental study, the mechanism of high potassium in the endolymph and the mechanism of the regulation of the osmotic pressure between the endolymph and perilymph should be clarified in the future.

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Using glass micropipets of 1-5μm in tip diameter and an active nulling pressure measuring system, the hydrostatic pressure of the inner ear fluid was successfully and accurately measured through the round window membrane. The dynamic changes in perilymphatic pressure occurring after inhalation of different gas mixtures (5 percent CO₂ and 95 percent O₂/carbogen, 5 percent and 10 percent CO₂ in room air, 100 percent oxygen) were recorded. The maximal oxygenation of the perilymph combined with minimal increase in perilymphatic pressure was achieved following inhalation of carbogen. The correlation between variations of pressure of the perilymph and of the systemic blood circulation shows that a regulatory system is present in the inner ear vessels. The pressure measuring system used has proven to have all the requirements that are needed for its use in humans.

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A new classification system for labyrinthine anomalies is introduced.
This system takes into consideration the varying degrees of pathology of the labyrinth which have been described in the literature and also includes anomalies which have not been categorized previously.
With this classification system, anomalies of the labyrinth can be classified into two major categories: aplasia and hypoplasia. The hypoplasia category is further divided into three types: combined, bony, and membranous. These three subtypes are further divided into 16 different groups: nine groups in the combined type, three in the bony type, and four in the membranous type, depending on which structures of the labyrinth are involved in the hypoplasia.

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Serum, cerebrospinal fluid (CSF), and inner ear fluids from scala tympani perilymph and scala vestibuli perilymph were collected from normal, anesthetized guinea pigs (Sodium pentobarbital 20-30mg/kg, I. P.) which received both intravenous glycerol injection (1.0ml/kg) and peroral glycerol administration (50W/V%, 12ml/kg). The sodium and potassium concentrations were assessed using microflame photometry.
The following results were obtained.
1) Serum: There was no significant difference between the two administrations in electrolyte dynamics.
2) CSF: With both administrations the sodium concentration was found to be increased rapidly and maintained at high levels until the end of our experiments. The electrolyte dynamics were different with respect to the potassium concentration. It did not change with intravenous administration but with peroral administration it increased slightly.
3) Scala Tympani Perilymph: The sodium concentration was increased with both administrations but the type of increasing curve was different. With intravenous injection the curve was transient, while with peroral administration it was a gradual up-slope curve. No change was observed with intravenous administration with respect to the potassium concentration, while with peroral administration an up-slope curve was seen.
4) Scala Vestibuli Perilymph: The sodium concentration did not change with intrvenous administration, but it changed with peroral administration. An increase in the potassium concentration was produced with intravenous administration but not with peroral administration.
In conclusion, when we use the glycerol test in detecting endolymphatic hydrops, peroral administration of glycerol has been found to be more effective than intravenous glycerol injection. Dehydration occurs most severely 2-3 hours after peroral administration, and the time course resembles the clinical glycerol test.

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Endocochlear potential (EP) and cochlear microphonics (CM) were recorded in guinea pig litters at some stages before and after birth. Endolymph and scala tympani perilymph samples were collected for ions quantification and the cochlei were processed for surface analysis by scanning electron microscopy.
While CM was recorded as early as on the 55th gestation day, EP did not show positive values before the 62nd day. At this stage, the labyrinthine fluids have already acquired their specific ionic composition, although the potassium level in the perilymph was still higher than in adults. The negative potential prevailed for at least 10 days, until the EP altered to positive.
Gradual disappearance of the microvilli and kinocilium was the last change to occur before the sensory epithelium reached a mature shape on the 62nd gestation day (5 days before birth). At the same time, the tectorial membrane appeared to lose its firm attachment to the organ of Corti.

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A theoretical analysis of the EP-generating system was made to constitute a model which can consistently explain the reaction of EP to Lasix administration. For this purpose we modified the circuit model of the cochlea using the concept of “channels” in the stria vascularis. Assuming a mode of blockade by Lasix on these channels which are interpreted as potassium pumps, simulation of this model can predict the EP-decline curves on Lasix administration.

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Planned staged tympanoplasty was performed in 100 patients with extensively diseased middle ear from January 1974 to September 1982. The following results were obtained.
1) Seventy-eight ears had cholesteatomas and 22, non-cholesteatomas. Staged operation with the closed method was performed on 70 ears, that with the open method on 30 ears.
2) Residual or recurrent disease was found at the second-stage operation more frequently in cholesteatoma ears than in non-cholesteatoma ears. Residual or recurrent cholesteatoma was found in about 44% of the 78 cholesteatoma ears and was reduced more often by the open method than by the closed method.
3) Aeration of the middle ear space was obtained more easily by the open method than by the closed method.
4) Postoperative hearing level was maintained within 30dB in 76% of the 79 patients who were followed over 1 year. Satisfactory hearing results were obtained more often by the open method and in the well-aerated middle ear space at the second-stage.
5) No significant difference in hearing results was noted between the modified type III and type IV tympanoplasties.
6) Staged tympanoplasty is indicated mainly for the cases with 1) extensive disease of the tympanic mucosa, 2) severely destructive change of the ossicular tissue, and 3) possibility of residual or recurrent cholesteatoma. The cases in which improvement or maintenance of hearing is a prerequisite and both air and bone conduction thresholds are elevated, are also indications for staged operation.
7) The incus, malleus, CORP, cartilage and temporal bone chip were used as columella materials and better hearing results were obtained in the case using CORP or cartilage.

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CT-scanning of 96 temporal bones was carried out to reveal the extension of cholesteatoma, periossicular drainage, fracture lines, enlarged internal acoustic meatus and anomalies of labyrinthine capsules and ossicles.
The clinical aspects of CT-scanning of the temporal bone (CTTB) were as follows:
1) Inner ear anomalies were observed in 17 temporal bones of unilateral deafness, high tone loss from unknown origin and fluctuant hearing loss. CTTB may explain the pathology of deafness from unknown origin.
2) Inner ear anomalies may be classified into more detailed groups than before.
3) The extension of cholesteatoma, localization and size of labyrinthine fistula can be estimated prior to surgery.
4) Cholesteatoma in a mastoidectomy cavity may be detected.
5) The malleus and incus may be visualized, although the stapes can hardly be found.
6) Fracture lines of a temporal bone, destruction of the internal acoustic meatus may be clearly detected.

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Collagenase activities of the cholesteatoma epithelium, mastoid bone and skin from the bony external auditory meatus were investigated. The collagenase activity was measured directly in homogenates of tissues using the reconstituted radioactive collagen substrate. Twenty-one patients with cholesteatoma were ranked in order of loss of the superstructure of the stapes, existence of eroded bony wall of the Fallopian canal and perilymphatic fistula. The collagenase activity of the cholesteatoma epithelium was higher in the group with a high degree of bone destruction than in the group with a low degree of bone destruction. High collagenase activity may be a factor in the clinical aggressiveness of cholesteatoma.

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First branchial cleft anomalies are rare disorders. A case of a first branchial anomaly with an unusual fistulous tract is presented.
The patient was a 6-year-old boy who complained of white gelatinous discharge from his left ear canal and recurrent abscess in the left submandibular region. Otoscopic examination revealed deformity of the tympanic membrane and a downward excavation of the bony external auditory canal at its deepest potion. Hearing was normal and there was no deformity in his left auricle or other parts of the body. The fistulous tract was extirpated. The tract extended upwards from the submandibular wound, passing medially through to the deep parotid gland lobe and opening into the bony external auditory canal. The tract was found to be lined with keratinized squamous epithelium with adnexal structures and accompanied by cartilage at the junction of the auditory canal.
In the past literature we could not find a case that had a fistulous opening at the bony external auditory canal and a deformity of the tympanic membrane.
We observed collected human fetuses (the fourth to eighth weeks) in order to study these anomalies from the embryological standpoint. We found by chance two other developmental stage fetuses both of which showed duplicated external auditory canal and pinna. After careful comparison with these fetuses, we concluded that the first branchial cleft anomaly with the fistulous tract running through from the submandibular area to the external auditory canal were not derived from these duplication anomalies of the external ear. This type of first branchial cleft anomaly was considered to be closely associated with Reichert's cartilage. In our case we supposed there would be interaction between Reichert's cartilage and the tympanic ring during the latter half of the fetal period.
The deformity of the tympanic membrane was believed to be caused by incomplete closure of the foramen of Huschke.

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We selected 194 patients who visited Kitano Hospital with ear discharge during 2 year period from January, 1981 to December, 1982. We performed a retrospective study of chronic otitis media.
1) The results of the antimicrobial agent susceptibility test revealed that SBPC was the most effective for Staphylococcus epidermidis and Proteus species. Minocyclin was the most effective for Pseudomonas species.
2) Pseudomonas species were isolated with a higher incidence from otorrhea of eosinophil-negative groups.
3) Proteus and Pseudomonas species were isolated with significantly higher incidences from otorrhea of patients operated with types III, IV and Columella Type tympanopalsty.
4) Proteus and Pseudomonas species were isolated with higher incidences from otorrhea of those who had symptoms such as dizziness, vertigo or tinnitus.

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The relation between sudden deafness and viral infection has not been established, though the latter is regarded as one of the causative agents of the former. Six viruses, i. e. herpes simplex, varicella zoster, influenza A and B, mumps and adenovirus are examined with respect to the titers of the complement fixation test in 103 patients (106 ears) for six years from 1976 to 1981. The results are analyzed according to the year of examination, sex and age off the patients, hearing level and prognosis.
For comparison, the same examination and analysis were performed in 298 Bell's palsy patients during the same period. Numerous similar results were found between these two diseases. Herpes simplex and influenza A viruses were the main viruses in these diseases. Male patients suffered more severely from these diseases. There are statistically significant differences between the patients above 50 and those below 49 years of age with respect to the prognoses of both diseases.

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1) Tinnitus was analysed using a tinnitus analyser with six band pass filters. The analysis revealed that low-pitched tinnitus was frequently observed in Meniere's disease and the early stage of sudden deafness, while high-pitched tinnitus was observed in sensory neural hearing loss and the advanced stage of sudden deafness. In general, the pitch of tinnitus was the same as that of deafness.
2) Some patients treated with biofeedback, tinnitus masker, mysoline and tocainide were presented.

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Auditory brainstem responses (ABR) were first recorded in humans by Jewett et al. (1971), having been shown to reflect activities in both peripheral and central auditory systems. Data from single unit studies, lesion studies and clinical studies obtained by many authors suggest that waves I and II reflect synchronous activities in the eighth nerve and cochlear nuclei ipsilateral to the ear stimulated, respectively.
These data also suggest that waves III, IV, V and VI are dependent on the integrity of activities of the higher brainstem auditory nuclei, i. e., superior olivary complex, nuclei of the lateral lemniscus, and inferior colliculus, etc. Identification of the sources of these later waves (III-VI) is, however, less precise than that of early waves (I and II) because of neuro-anatomical and neurophysiological complexities of the upper brainstem auditory nuclei to access. Fortunately, binaurally innervated neurons are present in the higher brainstem auditory nuclei, and binaural interaction is known to occur at most levels of these higher brainstem auditory nuclei.
This fact can present valuable information if studied from the standpoint of binaural interaction where the phenomenon seems to take place in ABR. This paper deals with binaural interaction in ABR to reveal the level of wave where binaural interaction takes place. Binaural interaction in ABR is defined in this paper as any deviation in latency and amplitude of the components of ABR from those of properly masked ABR.
Auditory brainstem responses and electrocochleogram were recorded in response to monaural click stimuli with or without a continuous white noise to the contralateral ear in 24 subjects who were all normal hearing adults. The results were as follows.
1) Neither latency or amplitude of ABR-wave I and EcochG-AP (N1) evoked by clicks at 90dBHL with masking noise at 50dB were altered or degraded by a continuous white noise at 70dB or at silent presented to the contralateral ear (p<0.05). This data implied that a transcranial masking phenomenon did not attribute to the degration of ABR-wave I and EcochG-AP (N1) up to the noise level of 70dB.
2) Contrary to the stability of ABR-wave I and EcochG-AP (N1) depicted as above, the amplitudes of ABR-waves II and VI decreased as the intensity of a continuous noise to contralateral ear increased (P<0.05).
3) Latency of ABR-wave IV showed a statistically significant prolongation with the increase of the intensity of the noise (P<0.05).
4) Both latency and amplitude of ABR-wave V were the most stable to the noise loaded to the contralateral ear.
5) The method of binaural interaction in ABR defined in this paper is concluded to be clinically useful in the detection of brainstem pathologic conditions where a clear distinction between ABR-wave V and the other waves is difficult.

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Ten volunteers, screened to exclude gross otological pathology, and 50 patients suffering from cochlear or vestibular disorder were studied. Auditory thresholds, determined both by Békésy audiometry and pure tone audiometry, were compared.
The results were as follows.
1) In many cases the auditory thresholds measured by Békésy audiometry were lower than those measured by pure tone audiometry.
2) The difference in auditory thresholds between Békésy audiometry and pure tone audiometry was ±10dB in 89-96% of the patients and volunteers.
3) The difference was large at 250, 4000 and 8000Hz in some cases.

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The so-called reversed middle ear reflex in ipsilateral acoustic stimulation is often observed in patients with sensori-neural deafness, facial nerve paralysis or ossicular chain discontinuity, and even in normal subjects under general anesthesia. Thus, the reversed reflex is considered to be rather different from the physiological reflex.
In order to investigate the origin and mechanism of the reversed reflex, experiments were carried out both in ear models and cats using two impedance meters (Amplaid 702). The following results were obtained.
1) Reversed reflexes were observed even in ear models.
2) The amplitude of the reflex in the model increased with the intensity of stimulation and depended on its frequency.
3) A mobile membrane with high compliance was essential for elicitation of the reflex.
4) The reversed reflex was not an artifact produced by some mechanical disorder of the filter in the impedance meter.
5) Contraction of the tensor tympani muscle had no influence upon the reversed reflex The origin of the reversed reflex was discussed based on these results.

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The hearing loss of 101 patients was tested with a whispering voice using a book, KOTOBA NO TESUTOEHON (picture-book for speech test). Seventy-two of the 101 were also tested by standard audiometry, play audiometry and Conditioned Orientation Response Audiometry (COR).
The purpose of this paper is to investigate the relation between this test and other audiometry tests.
The results were summarized as follows.
1) It is appropriate that the diagnostic criteria for normal hearing is a correct response number that is more than five sixth on this test.
2) During this test, it is advisable to observe attitudes and speech sounds of the patients tested.
3) This test has such limits as difficulties in detecting unilateral hearing loss, extremely low-tone deafness, and hearing loss outside of the speech range. Adding to this, the intensity of whispering voice is variable. If we pay attention to these points, this test can be effective for screening.

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A series of experiments using rabbits were made on the functional correlation between the limbic system, particularly the hippocampus, and the oculomotor system to obtain a better understanding of the neural mechanism of neurotic vertigo in humans. Through a series of experiments, the following facts were noted:
(1) When a certain amount of electric stimulation (1msec, 200Hz, pulse waves at 3 volts for 30 seconds per day) was given repeatedly to the hippocampus of rabbits, the animals tended to show a nystagmus-like eye movement. This eye movement appeared with a fairly long latency (about 25 minutes) and was directed to the right and left. The EEG's (the hippocampus, midbrain reticular formation and neocortex) related to the period of latency showed decreased activity of the brain, whereas those related to that of the nystagmus-like eye movement showed increased brain activity. Furthermore, autonomic responses suggestive of parasympathetic nerve irritation were seen in the period of latency, whereas those suggestive of sympathetic nerve irritation were seen in the period of nystagmus-like eye movement. These indicate that after repeated electric stimulation of the hippocampus of rabbits, over-excitement of the adrenergic component involved in this brain is brought about and such ensues over-excitement of the oculomotor system. The over-excitement of the oculomotor system leads to the appearance of the nystagmus-like eye movement mentioned above.
(2) Rabbits which had shown eye movements as a result of either repeated electric stimulation of the unilateral lumbar erector muscles or lesions of the unilateral labyrinth developed eye movements more easily than normal after stimulation of the hippocampus. Furthermore, the eye movements thus induced were similar to those which the animals had developed previously due to the treatments mentioned above. These eye movements tended to appear with a fairly long latency as described in (1).
(3) A nystagmus-like eye movement appeared when repeated electric stimulation was given to the medial nucleus of the mamillary body and/or the septal area of rabbits. The eye movement thus induced was similar to that elicited from the hippocampus. However, reinforcement was found more markedly in the eye movement elicited from the mammillary body than in that elicited from the septal area after intravenous injection of adrenaline and, moreover, a similarity was found between the hippocampus and the medial nucleus of the mammillary body with regard to the reinfrocement of the above-mentioned eye movements. Thus, the importance of the role of the medial nucleus of the mammillary body was noted with regard to the development of the eye movement of hippocampal origin.
(4) A small amount of adrenaline was injected into the hippocampus of rabbits before and after repeated electric stimulation of the cerebellum, particularly the Folium vermis and the resulting changes in the ENG and the EEG's (the hippocampus, midbrain reticular formation, cerebellum and neocortex) were observed. After repeated electric stimulation of the cerebellum, animals tended to develop and/or increase nystagmus-like eye movements when adrenaline was injected into the hippocampus and, moreover, the appearance and/or increase of these eye movements paralleled the arousal state in the EEG's. This finding indicates that the cerebellum plays a certain role in the reinforcement of the ocular ataxia of hippocampal origin, increasing the activity of the adrenergic component involved in the latter brain.
(5) A small amount of cholinergic stimulant (carbachol) and/or adrenergic stimulant (adrenaline) were injected into the hippocampus of rabbits before and after repeated electric stimulation of this brain and the resulting changes in the ENG and EEG's (the hippocampus, midbrain reticular formation and neocortex) were observed. The following facts were noted:
Before repeated electric stimulation of the hippocampus, animals hype

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The effects of optokinetic stimuli of several types upon body balance were discussed. A force plate for measuring the body center of gravity and a Jung-type optokinetic stimulator were used. A separating device for visual field was attached to create a condition of artificial scotoma. Optokinetic stimuli of the whole visual field, peripheral visual field and whole visual field with a fixating point were tested. The results were as follows.
1. The body sway induced by optokinetic stimulation of the whole visual field shows two phasic deviations. In the slow speed range of stimulation, the body deviates in the direction opposite to the rotation. In the high speed range, on the contrary, it deviates in the same direction as stimulation.
2. The former phase may be a coordinative one and the latter one a disturbed phase.
3. Body sway induced by peripheral optokinetic stimulation, whether looking or staring, shows one directional deviation, in the same direction as the stimulation.
4. The body is attracted to the same direction as the stimulation, when a fixating point is set on the screen of the optokinetic stimulator.
5. The states of these latter three conditions are quite similar to that of the second phase of the usual optokinetic stimulation, that is to say, the disturbed phase.
6. The disturbance of body balance of this kind arises from disoriantation in space due to the image slipping on the retina.
7. The subject who has been disturbed is attracted by stimulation and deviates toward the same direction as the stimulation.

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This paper deals with recent advances in anatomical, biochemical, pharmacological and physiological studies on the vestibular system. Fiber connections and characteristics of the vestibular neurons and primary vestibular neurons were discussed in relation to other structures such as the cerebellum, oculomotor nuclei, reticular formation, and spinal cord.
In addition, a review was made of the action of neurochemical transmission on the vestibular system.

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The EMG's of the antagonists of the lower limbs in Romberg's position were recorded in normal subjects as well as patients with disequilibrium and the records were evaluated in relation to bodily equilibrium. The antagonists referred to herein were the anterior tibial muscles and gastrocnemius muscles and the myographic recording was made using surface electrodes. Furthermore, in some patients, the EMG records were compared to the results of the following tests: statokinesimetry, functional tests for autonomic reactions in the central nervous system and psychological and/or psychiatric examinations.
The following facts were noted:
(1) The EMG's thus obtained were classified into the following 5 types, type I, II, III, IV and V. In type I, the EMG's were never found in any of the muscles tested. In type II, the EMG's developed in the bilateral anterior tibial muscles, whereas in type III, they developed in the bilateral gastrocnemius muscles. In type IV, the EMG's developed in the anterior tibial muscles and gastrocnemius muscles and with a crossed combination. In type V, the EMG's were observed in all the muscles tested.
(2) Type I was mainly observed in normal subjects, whereas the other types were observed in patients with disequilibrium. Type III was often observed in patients with disequilibrium of slight degree, whereas type V was usually observed in patients with marked disequilibrium. Type IV was between types III and V with regard to the severity of disequilibrium. Thus, it was noted that the type of the above-mentioned EMG's altered in accord with the severity of the disequilibrium. However, type II was particular in nature and such was sometimes observed in neurotic patients.
(3) A certain correlation was found between the above-mentioned types of EMG's and the results of the equilibrium test with adrenaline loading of Hinoki. For instance, patients with types II and III showed poor positive signs of the equilibrium test with adrenaline loading, whereas those with type V often showed positive signs of this equilibrium test. These findings suggest that there is a certain correlation between the above-mentioned types of EMG's and the activity of adrenergic components in the central nervous system.
(4) A positive correlation was found between the above-mentioned types of EMG's and the size and/or pattern of the sway of the center of gravity when the Romberg test was carried out. For instance, type III tended to relate to the development of the sway of the center of gravity where the size of the sway was within the normal limit and the pattern of the sway showed the centric form. In contrast, type V tended to relate to the development of the sway of the center of gravity where the size of the sway exceeded the normal limit and the pattern of the sway showed diffuse and/or back and forth forms.
From these results, we postulate:
Electromyographic analysis of the antagonists of the lower limbs in Romberg's position is useful for the determination of the severity of disequilibrium and, moreover, is also useful for objective description of alteration of disequilibrium in the course of treatment. Furthermore, the above-mentioned EMG test seems also valuable for the determination of the locus of lesions in the equilibrium system as well as the characteristics of the disequilibrium when it is carried out in combination with the following tests: the statokinesimetry, functional tests for autonomic reactions in the central nervous system, psychological and/or psychiatric examinations.

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Ten normal subjects were selected at random and examined for whole visual field OKN and foveal OKN (one stripe) in stripe distances of 10°, 20°, 30°, 60° and 90° with frequencies of 0.1, 0.3, 0.5, 0.8, 1, 2 and 3Hz. Both R-OKN and L-OKN were carried out to investigate their symmetry and recorded on a D-C ENG polygraph.
The slow phase velocities of whole visual field OKN and foveal OKN were calculated manually on an ENG recorder in regard to both R-OKN and L-OKN, by picking up 10 continuous waves at random.
The results obtained were as follows.
1) The slow phase in foveal OKN had the same characteristics as those seen in ETT. Both seemed to have a common neural pathway.
2) The slow phase in whole visual field OKN was different from that in foveal OKN and showed a more reflexive and more sophisticated character, following a more rapidly moving stripe with the assistance of peripheral vision than that in the latter.
3) L-OKN and R-OKN were symmetrical both in whole visual field OKN and foveal OKN and no differences were found between the two in the ability to follow the stripes and alternating waves as the velocities increases.
4) In order to follow a rapidly moving target, human eyes need peripheral vision besides foveal vision. Therefore, both peripheral vision and foveal vision are necessary to develop the smooth appearance of OKN.

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The equilibrium test for olfactory vertigo was carried out on patients with vertigo due to head and neck injury. The following results were obtained.
(1) The equilibrium test for olfactory vertigo was carried out using the test for spontaneous nystagmus, vertical writing with eyes covered (Fukuda) and the stepping test. Among these, vertical writing with the eyes covered was the most effective for the detection of olfactory vertigo when the equilibrium test for olfactory vertigo was carried out on patients with head and neck injury.
(2) A positive sign of the equilibrium test for olfactory vertigo was more conspicuous in patients with head trauma than in those with whiplash injury.
(3) Some of patients with head and neck injury showed a peculiar phenomenon in the sense that the results from the test for spontaneous nystagmus were worse, while those from the stepping test were improved.
(4) A positive sign of the test for olfactory vertigo was the most marked in patients who had experienced an occipital blow. In contrast, it was the least marked in patients who had had blows in the temporal region and the face. Similar results were obtained when the equilibrium test with adrenaline loading (Hinoki 1971) was carried out on the same groups of patients as above. This means that in the case of occipital blow, over-excitement of adrenergic component involved in the olfactory system is the most conspicuous, which causes olfactory vertigo most markedly.
(5) Among various blows on the skull, the occipital blow caused cerebellar dysfunction most conspicuously. Cerebellar dysfunction is reportedly to reinforce olfactory vertigo. Thus, patients who have experienced both an occipital blow and cerebellar dysfunction show vertigo of this type most conspicuously.

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To clarify the relationship between the exteroceptive and proprioceptive reflexes in the occurrence of nystagmic responses of cervical origin, the following experiments were carried out. That is, a piece of cloth is wrapped around the trunk of rabbits to suspend them in the air so that their four limbs do not touch the ground. The head is then rotated about 90 degrees clockwise around the longitudinal axis of the body. The nystagmus thus induced is termed neck-torsion nystagmus. The nystagmus is recorded from the right eye using an electronystagmograph (ENG) and either the electromyograph (EMG) of the deep neck muscles or the electroencephalograph (EEG) was also recorded. Alteration of the neck-torsion nystagmus is then observed when cutaneo-pressure stimulation is given to the auricle, the trunk and limbs.
The following results were obtained.
(1) The cutaneo-pressure reflex plays a certain role in the enhancement and/or suppression of neck-torsion nystagmus.
(2) The cutaneo-pressure reflex elicited in the auricle reduces the activity of the contralateral deep neck muscles increased due to the torsion of the neck, whereas that elicited in the hindlimb increases the activity of the ipsilateral neck muscles.
(3) The former cutaneo-pressure reflex decreases the activity of the brain through the decrease in the activity of the deep neck muscles. In contrast, the latter cutaneopressure reflex increases the activity of the brain through the increase in the activity of the same neck muscles. Thus, the former decreases the neck-torsion nystagmus, while the latter is related to the increased neck-torsion nystagmus.
(4) The cutaneo-pressure reflex elicited in the trunk suppresses the neck-torsion nystagmus and it is more markedly suppressed when cutaneo-pressure stimulation of the trunk is given on the side of the chin.
(5) The cutaneo-pressure reflex elicited in the forelimbs is not related to the development of neck-torsion nystagmus.

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To understand better the correlation between the cervical proprioceptors and the otolith, in the development of eye nystagmus of cervical origin, the following two series of experiments were carried out using rabbits.
Experiment A: Rabbits with healthy ears were placed in the following five postures and eye deviation and/or eye nystagmus induced in these postures were recorded from the right eye using electronystagmograph (ENG) and the electromyographs (EMG's) of the bilateral deep neck muscles were also recorded. The 1st posture: a piece of cloth is wrapped around the trunk of a rabbit to suspended it in the air so that its four limbs do not touch the ground. The 2nd posture: the animal's head is in the normal position and the trunk and limbs are rotated 90 degrees counterclockwise around the longitudinal axis of the body. The 3rd posture: the animal's trunk and limbs are in the normal position and the head is then rotated 90 degrees clockwise around the longitudinal axis of the body. The 4th posture: the animal's whole body is laid down on the left side. The 5th posture: the animal's head is in the normal position and the trunk and limbs are then rotated above 90 degrees counterclockwise around the longitudinal axis of the body. In experiment A, the following facts were noted.
(1) In the 1st posture, neither asymmetry in the activity of the bilateral deep neck muscles nor eye movement was observed.
(2) In the 2nd posture, only eye deviation was induced together with increased activity of the unilateral deep neck muscles, whereas in the 5th posture, eye nystagmus was elicited.
(3) In the 4th posture, deviation of the eyes, i. e., compensatory eye deviation of otolithic origin developed together with increased activity of the unilateral deep neck muscles.
(4) In the 3rd posture, development of eye nystagmus was the most conspicuous, together with a marked increase in the activity of the unilateral deep neck muscles.
From these results, we conclude the following.
First, the cervical proprioceptors can induce nystagmic responses, whereas the otolith induces only eye deviation. Second, the otolith can play a major role in the enhancement of nystagmus of cervical proprioceptive origin.
Experiment B: Rabbits with healthy ears are placed in the following four postures and eye deviation and/or eye nystagmus induced in these postures are recorded from the right eye using ENG. The four postures referred to herein are as follows. The 1st posture: the same posture as the 1st posture described in experiment A. The 2nd posture, the animal's whole body is rotated counterclockwise on the sagittal plane with its nose up. The 3rd posture, the animal's head is in the normal position and the trunk and limbs are then rotated clockwise on the sagittal plane with its tail up. The 4th posture, the animal's trunk and limbs are in the normal position and the head is then rotated counterclockwise on the sagittal plane.
In experiment B, the following facts were noted.
(1) In the 2nd posture, deviation of the eyes, i. e., compensatory eye deviation of otolithic origin developed around the bitemporal axis of the body.
(2) In the 3rd posture, rotatory eye nystagmus developed around the bitemporal axis of the body. The nystagmus thus induced was small in amplitude and low in frequency.
(3) In the 4th posture, rotatory eye nystagmus developed around the bitemporal axis of the body. The nystagmus thus induced became larger in amplitude and frequency when compared to that of the 3rd posture.
On the basis of these results, we conclude that the otolith does play an important role in the enhancement of nystagmic responses of cervical proprioceptive origin.

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In order to study the correlation between the extero- and proprioceptive reflexes in the development of the righting reflex of the eyes and body, the following experiments were carried out. That is, rabbits with healthy ears are laterally laid down on the left side and the eye deviation thus induced (compensatory eye deviation) is recorded from the right eye (upper side) using an electronystagmograph (ENG) and either the electromyograph (EMG) of the deep neck muscles or that of the extensor muscles of the four limbs was also recorded. Alteration of the above-mentioned eye deviation is then observed when cutaneo-pressure stimulation is given to the trunk and limbs. In these experiments, the following facts were noted.
(1) The cutaneo-pressure reflex elicited in the hind limbs on the upper side induces increased activity of the extensor muscles of the same limb and this is followed by the increased activity of the deep neck muscles on the same side. These lead to the development of eye movement towards the upper eyelid. The eye movement of this type differs in direction and nature from compensatory eye deviation, and thus the former eye movement is considered to be the righting reflex of the eye.
(2) The development of the above-mentioned eye movement, i. e. the righting reflex of the eye is related not only to the increased activity of the proprioceptors of the deep neck muscles, but also to that of the otolith. However, the otolith does exert an excitatory effect on the development of the righting reflex of the eye only when the cervical proprioceptors are well functioning.
(3) The cutaneo-pressure reflex elicited in the forelimb is not related to the development of the righting reflex of the eye.
(4) The cutaneo-pressure reflex elicited in the trunk does exert an inhibitory effect on the occurrence of the eye movement referred to above.

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The glycerol test for endolymphatic hydrops was administered to 51 patients exhibiting symptoms of Meniere's disease. A complete battery of audiometric tests including the SISI, Bekesy, ABLB, speech discrimination and air conduction thresholds was administered pre- and post-glycerol ingestion in order to determine the effect of osmotic diuresis. At the same time, the relation between the ratio of “positive” glycerol test and the duration of the disease, onset age, vestibular response and cochlear symptoms was investigated.
The following results were obtained:
1) Among the special audiometric tests, only speech discrimination scores exhibited changes, but there were no significant differences observed in ABLB, SISI or Bekesy.
2) The ratio of “positive” glycerol test was high in the following cases of Meniere's disease:
a) Vertiginous attack occurring at old ages
b) Hearing loss of a high degree
c) Those who had nystagmus
d) Those who had fluctuating hearing loss
3) The duration of the disease, the frequency of vertiginous attack and CP had no influence on the ratio of “positive” glycerol test.

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The aim of the present investigation is to obtain a better understanding on how the cervical and/or lumbar proprioceptors participate in a smooth performance of stepping. The investigation includes two series of examinations. Examination I: Ten normal subjects aged 18 to 39 were examined. To record movements of the head induced by stepping (Fukuda's method), we devised a new piece of equipment termed a drift meter. Using this equipment, movements of the head from side to side and/or back and forth can be recorded in terms of the angle of deviation of the head from the upright position of the head while standing on both feet.
Deviation of the head from side to side and/or back and forth is averaged using a computer. The averaged registrograms of deviation of the head thus obtained are analyzed in relation to the movements of the feet. The results obtained were as follows.
(1) There was a certain correlation between the movements of the head and those of the feet during stepping and, moreover, this correlation can be reasonably explained on the basis of the theory of the tonic neck reflex.
(2) A rebound phenomenon was elicited in the movements of the head during stepping. This phenomen is conductive to the reinforcement of the tonic neck reflex, through which a smooth performance of stepping can be realized.
(3) The results described in (1) and (2) were observed when the head deviated from side to side and/or back and forth.
Examination II: Ten normal subjects aged 26 to 39 were examined. The deviation of the head during stepping was measured after fixing the waist with a corset and the results thus obtained were compared with those of the deviation of the head without this corset. In addition, patterns of averaged resistrograms of movement of the head were compared under the following two conditions, i. e., stepping with a corset and that without this corset.
The recordings and the method of analysis of movements of the head and feet used herein were the same as those described in examination I.
The following results were obtained.
(1) The deviation of the head tended to increase when the subject's waist was fixed with a corset. This tendency was seen when the head deviated from side to side and/or back and forth. The above-mentioned phenomenon is considered to be a compensatory action of the cervical proprioceptors in response to the limitation of the activity of the lumbar proprioceptors.
(2) A similarity in patterns was found between the averaged registrograms of movements of the head in the above two conditions of stepping.
From the results of examinations I and II, we conclude the following:
(1) The cervical proprioceptors play a major role in the control of the muscle tone of the lower limbs during stepping and such control is realized through the tonic neck reflex.
(2) The lumbar proprioceptors are also responsible for smooth performance of stepping and the role of the lumbar proprioceptors in stepping is realized in close collaboration with the cervical proprioceptors.

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An electrophysiological study was performed to determine whether or not there were direct effects from the medial vestibular nucleus (MVN) on neurons in the ipsilateral lateral vestibular nucleus (LVN) of cats anesthetized with α-chloralose. Moreover, the fiber connection from the MVN to the LVN was examined using the retrograde horseradish peroxidase (HRP) method.
When the stimulus was applied to the MVN, there was monosynaptic spike generation in 18 out of the 75 LVN neurons which were monosynaptically activated by vestibular nerve stimulation. In the other 11 LVN neurons, the monosynaptic spike generation with vestibular nerve stimulation was inhibited by the conditioning stimuli applied to the MVN preceding the test stimulus. When the stimulus was applied to the LVN, an antidromic spike was obtained in 12 out of the 45 MVN neurons which were monosynaptically activated by vestibular nerve stimulation.
When HRP was iontophoretically applied to the immediate vicinity of the LVN neuron monosynaptically excited by vestibular nerve stimulation, HRP-labeled cells were found in the MVN.
These findings suggest that there exist direct fiber connections from the MVN to the LVN and that some of the MVN neurons are playing a role of regulating the LVN neurons, thereby controlling the posture and/or vestibular reflex.

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For the detection of the correlation between the olfactory system and body equilibrium, the “equilibrium test for olfactory vertigo” proposed by Hinoki et al. was carried out. In the present examination, two kinds of odorous substances, Alinamin and a musk-like substance were used. Pieces of filter paper dipped into a solution of Alinamin or the musk-like substance were placed 1cm in front of the subject's nose for 150 seconds. Fifteen minutes later, resulting changes in the equilibrium function were examined by the righting reflex test and Fukuda's stepping test. The equilibrium test for olfactory vertigo using Alinamin and the musk-like substance was carried out on 44 and 45 vertiginous patients, respectively. Furthermore, in the traumatized patients, changes in the equilibrium function due to olfactory stimulations, with reference to the results of the “equilibrium test with adrenaline loading (Hinoki)” were investigated.
The results obtained were as follows:
1) On stimulation with the musk-like substance, improvement of the equilibrium function tended to be more frequent than aggravation. Conversely, on stimulation with Alinamin, the opposite tendency was observed.
2) Patients giving positive results in the “equilibrium test with adrenaline loading” tended to show improvement in disequilibrium when they inhaled vapor of the musk-like substance. In contrast, patients giving negative results in the “equilibrium test with adrenaline loading” did not show appreciable change when they inhaled vapor of the musk-like substance.
3) Patients giving positive results in the “equilibrium test with adrenaline loading” tended to show aggravation of disequilibrium when they inhaled vapor of Alinamin. In contrast, many of the patients showing negative results in the “equilibrium test with adrenaline loading” showed no significant alteration of the equilibrium function when they inhaled the vapor of Alinamin.
With reference to the above results, the following conclusions were drawn.
1) Changes in the equilibrium function due to olfactory stimulation tend to be induced in the existence of hyperexcitability of the adrenergic components in the central nervous system.
2) Moreover, the nature of the changes in the equilibrium function depends on the nature of the olfactory stimulation, i. e. a pleasant odor or an unpleasant odor. Inhalation of an unpleasant odor, which may enhance the activity of adrenergic components in the central nervous system, increases vertigo, whereas a pleasant odor, which may suppress the activity of adrenergic components, decreases or eliminates vertigo.
3) This study suggests that repeated inhalation of a pleasant odor may be helpful in relieving vertigo.

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The origins of the vestibular efferent fibers to the ampulla of the semicircular canals in cats were examined using retrograde transport of horseradish peroxidase (HRP).
Of the three semicircular canals, two ampullae and the cochlea were completely destroyed and filled with bone wax and dental cement to avoid leakage of HRP into the other areas. Thereafter, in the little hole of the remaining ampulla of the intact canal, approximately 0.2mg of crystalline HRP was placed. HRP was applied into the ampulla of the anterior, lateral and posterior semicircular canals of 5, 4 and 5 cats, respectively.
The ampulla of the anterior canal was innervated from the bilateral parvocellular nucleus (PCRN), contralateral gigantocellular reticular nucleus and ipsilateral lateral reticular nucleus (LRN); the ampulla of the lateral canal, from the ipsilateral PCRN and LRN as well as the ipsilateral lateral vestibular nucleus; the ampulla of the posterior canal, from the bilateral PCRN and ipsilateral medial and lateral vestibular nuclei.
These results indicate that each ampulla of the three semicircular canals receives efferent fibers from different reticular nuclei and the vestibular nuclei.

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A 33-year-old woman and a 26-year-old man, who developed horizontal, vertical and oblique nystagmus that changed its direction only under Frenzelglasses, were evaluated by neurological and neuro-otological examinations.
The results were as follows:
(1) The alternating nystagmus was detected only through the Frenzelglasses. It could not be detected under conditions of light, dark with eyes open or with eyes closed. It was elicited by photostimulation of the electric light of the Frenzelglasses.
(2) The nystagmus changed its direction irregularly. In the first patient the main nystagmus was upward vertical and oblique, and in the second it was horizontal.
(3) They suffered from sudden onset of rotatory vertigo for several days or two weeks without tinnitus or impaired hearing.
(4) The righting reflex, Fukuda's stepping test, eye tracking test and optokinetic nystagmus were all in normal range. Caloric nystagmus revealed normal and leftdirectional predominance, respectively.
A similar case report has not been yet reported in the literature and etiology of this nystagmus is unknown, but we concluded the following.
(1) The brain-stem may be responsible for this nystagmus, particularly the midbrain was suspected to be the region of disorder in the first patient and the pons was in the second.
(2) This may be a reversible disorder because it was a short-term illness and organic change or wide-spread lesion could be ruled out.
(3) The most important point of this peculiar nystagmus was that it was elicited by photostimulation under the condition in which the eye fixation was impossible.

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As one of the examinations pertinent to the labyrinthine righting reflex, a special tilt test i. e. The Auto-Tilt Test using the head-inclinometer was introduced herein. In positional vertigo, this test yielded significantly imperfect occurrence of the labyrinthine reflex toward the ipsilateral side of its lesion. In addition, the depressed accuracy of the sensation of deviation which can promote restorative activity was distinctly revealed in the ipsilateral side of the lesion. Data obtained applying this test were informative for routine clinical testing of patients with labyrinthine disorder.

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The combined effect of Isosorbide and steroid on Meniere's disease was examined compared with that of Isosorbide only. Thirty-one cases were treated with Isosorbide only and nineteen cases treated with Isosorbide and steroid.
The results were as follows. Headache and shoulder-stiffness could be controlled in ninety % of the patients by the administration of Isosorbide only. Dizziness and tinnitus were significantly reduced by Isosorbide and steroid compared with Isosorbide only. Hearing was not improved by Isosorbide.

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Electrophysiological studies were carried out to elucidate the effects of diphenhydramine (DP), an antihistamine drug, on neuron activities in the medial vestibular nucleus (MVN) and lateral vestibular nucleus (LVN) of cats using the iontophoresis method. According to latencies of the first spike elicited by vestibular nerve stimulation, neurons in the MVN and LVN were classified into two groups: monosynaptic and polysynaptic neurons. In the MVN, the spike generation of the polysynaptic neuron upon vestibular nerve stimulation was dose-dependently inhibited by iontophoretic application of 100 and 200nA of DP, and that of the monosynaptic neuron was also inhibited by the maximum dose of 200nA of DP. In contrast to the MVN neurons, the LVN monosynaptic neuron remained unaffected with DP up to 200nA, although inhibition of the LVN polysynaptic neuron was obtained with DP of 200nA. These results suggest that DP interferes with synaptic transmission in the MVN neuron more selectively than that in the LVN.

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A case of neurilemmoma on the nasal tip is reported. A 53-year-old female had had a mass on the nose for 15 years. The size of the mass changed with the environmental temperature.
In the surgical approach to the tumor in this region, aesthetic deliberation is demanded.
Antagonistic theories for Antoni B tissue have been described. One is that Antoni B tissue is metabolically active and the other is that it results from degeneration.

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The results of the transorbital approach (17 cases) and transmaxillary approach (13 cases) to orbital blowout fractures were compared. Double vision disappeared in 11 patients by the transorbital procedure and in 9 by the transmaxillary procedure. But both procedures had little effect on enophtalmos. In the transmaxillary approach, the fracture site of the orbital floor was widely exposed and repair was easier.

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Laryngeal framework surgery has been performed on over 100 cases of dysphonia in our hospital for the past 8 years. This paper summarizes surgical knacks for each type of surgery on the basis of clinical experience.
1. Thyroplasty type I.
Difficulty may exist in incising the calcified thyroid cartilage in a window shape. Overcorrection of the paralyzed vocal cord is recommended when the postoperative course is taken into account.
2. Arytenoid adduction
Unilateral vocal cord paralysis with a wide glottal clink is a good indication for arytenoid adduction. Palpation along the cricoid cartilage ridge is the key to locating the cricoarytenoid joint. The knack in preventing complications is not to enter the air-way.
3. Surgeries to change the vocal pitch
Surgery to lower the vocal pitch reduces the A-P distance of the thyroid cartilage, thereby relaxing the vocal cord. “Unilateral shortening first, if insufficient in lowering the pitch, then bilateral procedures” is the policy of surgery. The vocal pitch can be raised either by cricothyroid approximation, chordal injection of steroid or chordal scar formation.
As a future problem, the effect of stiffness and of mobility of the vocal cord mucosa upon the vocal cord vibration should be further assessed.

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The pharyngeal flap operation is useful for the correction of velophryngeal inadequacy, but because of variations in the degree of shrinkage and scar contracture of the central pharyngeal flap, the size of the remaining lateral apertures cannot be predicted. In 1975, Isshiki constructed the superiorly-based “folded pharyngeal flap” without a raw surface. There is minimal shrinkage and scar contracture of the flap. Therefore, the size of the lateral apertures can be predicted. Sixty-six patients with cleft palate, who had been previously operated on unsuccessfully, were treated with Isshiki's operation with several modifications in Kurashiki Central Hospital between 1979 and 1982. The majority of subjects had more effective closure with resultant reduction in nasality.

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The efficiency index of the larynx (AC/DC%, Isshiki, 1976) and mean flow rate (DC flow) were examined in the pathologic larynges using a phonation analyzer devised by Isshiki.
It was revealed that vacal cord paralysis was characterized by a large DC flow and small AC/DC%. A normal DC flow and small AC/DC% were noticed in acute laryngitis. The relationships between the DC flow and AC/DC% in the polyp and polypoid vocal cord were various depending on the subjects. The general trend, however, was that the relationship in the polyp was close to those of paralysis and the relationship in the polypoid vocal cord was close to those in acute laryngitis.
Simultaneous examination of the DC flow and AC/DC% using the phonation analyzer could provide a more detailed description of the aerodynamic aspect of pathologic larynges than before.

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Two cases of severe congenital subglottic stenosis with a glottic web were reported. Congenital defects not related to the larynx were present in both cases. One had interventricular septal defect and cleft palate. The other had a protruding ear.
Case 1: A 3-year-old boy with congenital cricoid stenosis and an anterior glottic web was successfully treated by the “trough” method. After a glottic web and exessive cartilaginous tissue of the cricoid were removed through a laryngotracheal fissure, a trough was formed fixing the laryngotracheal mucosa to the skin of the neck. A silicone tube stent was inserted into the trough to keep the laryngotracheal cavity widely opened. After a period of six months, a silicone T-tube was substituted for the tube stent. The T-tube remained in place for two years. During T-tube stenting, palatoplasy was performed uneventfully. The tracheal fistula was closed with a bipedicle skin flap one year after the removal of the T-tube.
Case 2: A 6-year-old boy with a congenital glottic web and subglottic stenosis was also treated by the “trough” method. A silicone tube stent had been kept in place for 10 days after operation and was replaced by a stent made of silicone dental impression. After a period of three and half months, the stent was lifted from the trough, and the anterior wall of the larynx and the trachea were reconstructed with a composite auricular graft. Correction of the auricle was performed successfully one month after closure of the trough.

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Clinical investigation of unilateral vocal cord paralysis was performed on 56 patients for the level difference on the paralysed cord and evaluation of the usefulness of various audiological examinations.
On tomographic studies of the vocal cord, the paralysed vocal cord was higher than or at the same level as the intact cord and there was no case in which the paralysed cord was lower than the intact one. Inclination of the thyroid cartilage was also noted in more than half of the cases with vocal cord level difference. In 71.4% of the cases, marked enlargement of the ventricle was evident on the paralysed side, particularly during phonation. In addition to this level difference of the cord and inclination of the thyroid cartilage, deviation of the vocal cord on laryngoscopy suggests paralysis of the cricothyroid muscle. This is considered to be the rationale for the approximation between the cricoid muscle and thyroid muscle for surgical repair of hoarseness.
Functional evaluation of the paralysed vocal cord was made using various methods including measurements of respiratory flow rate during phonation, vibration of the vocal cord by stroboscopy and analysis of hoarseness by audition and with a computer. The respiratory flow rates in higher levels of paralysed vocal cords were higher than those with no level difference in cords. Stroboscopic observation revealed that undulatory movements of the vocal cord mucosa on phonation did not correlate with the level difference, but with the position of the paralysed vocal cord. Auditory evaluation of the hoarseness demonstrated higher values on all factors in those with level difference of the vocal cord than those without level difference. Computer analysis of the pitch perturbation showed higher values in those with level difference and the values increased as the fixed position of the vocal cord shifted laterally.
Thus, tomography of the larynx in combination with various other tests is useful in the diagnosis of unilateral vocal cord paralysis and determination of adequate treatment.

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The authors described the statistic of foreign bodies in the trachea and bronchi as encountered in the past ten years. We also described several cases which were interesting from the point of view of clinical findings.
1) Twenty-eight cases of foreign bodies in the trachea and bronchi were observed in the past ten years. Twelve cases were one-year-old babies, that is 43 percent of the total; ninety percent of the total cases were below age 10. The male to female ratio was about two to one. The youngest patient was a seven-month-old female and the oldest patient was a seventy-seven-year-old male.
2) In thirteen of the cases, (46%) penuts were found. In other cases a nail, a safety-pin, four needles, a few kinds of beans and two dental materials, etc were found. Nonradiopaque foreign bodies were found in nineteen cases.
3) Etiology of foreign bodies, especially peanuts, was as follows:
i) Laughing followed by deep inspiration,
ii) surprise at the moment when the patient puts them in the mouth.
4) Twenty-one of the cases were treated within four days. Other cases were treated within six, six nine, ten, eighteen, twenty-six, or seventy-five days. The longest lodgement was seventy-five days.
5) Seventeen of the cases were found in the right bronchi, eight cases in the left branchi and two cases in the trachea. One cases was not precisely located.
6) Twenty-six of the cases were removed by means of upper bronchoscopy and one of the other cases by lower bronchoscopy. Another one was removed by thoracotomy.
7) In the case of vegetal substance such as peanuts, most patients suffered bronchitis or pneumonia, but it was not serious and they were discharged after a few days. The two patients whose lodgements were removed by special methods had no complications, and they were discharged within two weeks after operation.
8) The authors pointed out that the patients who have foreign bodies in the bronchi, especially peanuts, should receive bronchial toiletting.

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