Radionuclide studies are indispensable for the management of thyroid diseases. Tc-99m pertechnetate is the most popular agent in the evaluation of goiter. The I-123 thyroid uptake measurement is recommended in some hyperthyroid states especially in the differential diagnosis between Graves' disease and chronic thyroiditis. Tl-201 chloride imaging is helpful in differentiating cystic lesions from solid tumors and depicting the metastatic and/or recurrent lesions of thyroid cancer. Ga-67 citrate is a useful agent to visualize anaplastic cancer and malignant lymphoma. Generally speaking, differentiation of benign nodules from malignancy and detection of small lesions less than 1cm in diameter are so difficult that sophisticated palpation, plane radiography and ultrasonography are required in addition to scintigraphy.
Internal irradiation with I-131 has been recommended as the most effective therapy for Graves' disease and metastatic thyroid cancer.
The enlarged parathyroid glands can be depicted by Tl-201 chloride imaging.
Salivary gland imaging with Tc-99m pertechnetate is useful in the evaluation of the Sjögren syndrome, and in the differentiation of Warthin's tumor and onchocytoma from the other tumors.
Ga-67 citrate imaging is useful in differentiating maxillary cancer from chronic sinusitis.
Bone scintigraphy can depict facial bone diseases and mastoiditis in their early stage.
Radionuclide andiography and brain scan reveal venous sinus thrombosis and acoustic neurinoma.
Radionuclide cisternography is helpful in detecting cerebrospinal fluid rhinorrhea.
Lung scintigraphy is useful in deciding which bronchus is obstructed with a foreign body.
Up-to-date studies of the cerebral blood flow and its metabolism with noninvasive techniques reveal functional locations of the brain receiving different stimulations, such as hearing, speaking, reading, etc.

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The function of the submandibular gland of 32 patients with Bell's palsy was examined with radio-isotope (RI) scincigraphy using ^99mTc-pertechnetate; and the relationship between the function of the gland and the prognosis of palsy was discussed. Uptake and secretion of the RI in the glands on both sides were measured twice, the first time within 10 days of the onset of palsy, and the second time 3 to 4 weeks after the onset.
The results were as follows: 1) In the case in which the function of the affected side was higher than that of normal side, the prognosis was good. 2) In the case in which the function of the affected side was lower than the normal in the first test but improved in the second test, the prognosis was also good. 3) In the case in which the function of the affected side was lower than the normal in the first test, and worsened in the second test, the prognosis was poor.
In conclusion, the application of RI scincigraphy was thought to be very useful for early diagnosis of Bell's palsy.

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A 35-year-old man with hemangioma in the right auricular and temporal region was treated surgically three times during a period of about one year. The tumor was completely removed with copious bleeding during the procedure. A good result was obtained by applying the modified reconstructive procedure for congenital deformities of the auricle.

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The hearing ability after healing from acute otitis media was tested in infants younger than 5 years. Those tested represented approximately half the number of cases of acute otitis media with repeated recurrence. Hearing abnormalities were recognized in about 30% of the 3 to 4 year-old infants in peep show tests.
Although bone conduction acoumetry was difficult to perform in this age group, tympanometry was performed in 339 cases of infants aged 4-8 years. An attempt was made to find out if this hearing abnormality originated in conductive deafness or in attributable to measurement errors, peculiar to these infants. Tympanograms were obtained from 413 ears (82.4%) with normal hearing and 88 ears (17.6%) with abnormal hearing. These test revealed that 264 ears (63.9%) in the normal hearing group were A type representing more than half the number of cases, 2 ears, B type with 0.5% and 147 ears C type with 36.5%, while 41 ears in the abnormal hearing group were A type with 46.6%, 5 ears B type with 5.7% and 42 ears C type with 47.7%.
Although it was natural that the total of B and C types often observed in tubal obstruction and middle ear diseases was larger than the A type in the normal group, the total of 27 ears of A type in the abnormal hearing groups of 4-year-old infants alone was higher than the total of B and C types, 22 ears. Thus, other than those with conductive deafness, abnormal levels simply due to measurement errors, peculiar to the infantile stage in which the subjects were supposed to be normal in their hearing, were presumably included. Conceivably this is one of the reasons why the hearing abnormality percentage of 3 to 4-year-old infants was relatively higher.

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A report of twenty-five cases with primary paranasal cyst accompanied by ophthalmological symptoms which were treated at Yamaguchi University Hospital during the period from 1971 to 1981 was made and a brief review of the literature was added.
Retrospective study of age, sex, location, first complaints, ophthalmological symptoms, past history, family history and smoking and drinking habits was done showing the following results.
1) Occurence was most frequent in the 4th decade.
2) Incidence was rather more frequent in females.
3) The lesion was most frequently found in the frontal sinus.
4) Fifty-six percent of the first complaints were ophthalmological symptoms and visual disturbance was more frequent than any other ophthalmological symptoms. In addition, visual disturbance in patients with frontal cyst was observed more frequently than previously reported.
5) Paranasal cysts had a tendency to occur after long intervals (about 30 years) following chronic sinusitis, but when there is a history of nasal injury (for example, fracture of the nasal bone) there was a tendency to occur after short intervals (about 15 years).
6) The habits of smoking and/or drinking seemed to take little part in the occurence of the cyst, following chronic sinusitis.

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The patient is a 28-year-old male. When he was skiing, a ski stick of another skier stuck into his right internal canthus and he became blind instantly. The visual acuity on the right side recovered in several days, while the left side remained blind.
A decompression operation of the left optic nerve was performed 21 days after the injury without effect.
The mechanism of the bilateral visual disturbance of this case was suspected to be traumatic arachnoiditis of the optic chiasma.

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A 51-year-old male had had foreign-body sensation in the throat upon swallowing for several years.
On examination, there was a scar at his left mandibular angle, and x-ray examination revealed a shadow of a foreign body in the submandibular region.
Surgery was performed and a metallic foreign body of 40mm in length, 5mm in width and 2mm in thickness was removed.
It turned out by thorough inquiry that the patient experienced a trauma from a gas explosion 12 years before, and the metal wire which was removed surgically had been stuck at the site.
The importance of precise examination of patients who complain of foreign-body sensation in the throat even though there are no objective findings in the pharynx or in the larynx was emphasized, and the mechanism for complaints appearing a long time after injury was discussed.

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A 30-year-old man was anesthetized with GOE (E: Enflurane) slow induction and SCC was given intravenously for intubation. When the anesthesiologist tried oral intubation he noticed rigidity of the masseter muscle and discontinued the anesthetic agents immediately. Two hours after recovery from anesthesia we found port-wine-colored urine. Myoglobine of both serum and urine were 25, 000 and 960, 000ng/dl and serum GOT, LDH and CPK were 586 Ku. 2499 Wu. and 106, 000 Iu., respectively, All the data returned to nearly normal values within seven days. Perspiration was noted though there had been only slight fever (37°C) for several days. Systemic circulation did not show any significant changes throughout the course without slight tachycardia. Diuretics and intravenous transfusion of about 5, 000ml/day were given to maintain a recommended urine output of 200ml/hour in order to preserve anal function.
For prevention of malignant hyperthermia past history, family anamnesis and preoperation test must be examined, however at present prediction is not always possible on the basis of these data. If one suspects malignant hyperthermia, the best therapy is the following: (1) discontinuation of anesthetic agents, (2) rapid and effective cooling, (3) avoidance of hypoxia and (4) treatment of developing acidosis. One should obtain expert evaluation from an anesthesiologist.

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The marginal connection between the tectorial membrane and the upper surface of the organ of Corti in the neonatal golden hamster was studied by SEM with the styrene resin cracking method. In the development of the inner ear, the outer margin of the tectorial membrane makes contact with the upper surface of the third row of the Deiters' cell. This attachment can easily be deformed by the fixation, dehydration and drying procedures and often assumes column-like structures, which are called marginal pillars. Observation was made of the neonatal golden hamsters, which were decapitated under ether anesthesia almost everyday from the day of birth until 16 days after birth.
1) Marginal pillars appeared in the lower turn on the 4th—6th day after birth and were seen most clearly on the 10th—14th day after birth. Marginal pillars disappeared on the 16th day after birth.
2) Marginal pillars were seen on the upper surface of the third row of the Deiters' cell and their attachment to the under surface of the tectorial membrane was found at the medial portion, a short distance away from the outer margin.
3) On the 5th—10th day after birth, the structures similar to marginal pillars were seen on the upper surface of the first and second rows of the Deiters' cell.
Marginal pillars disappear after maturation of the sensory hairs in the golden hamster. Considering the findings from other mammals by other investigators, it seems that marginal pillars have the role of keeping the structural relationship between the tectorial membrane and the sensory hairs during the developing period of the organ of Corti and their disappearance indicates maturity of the organ of Corti.

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The inner ear of guinea pigs with hyperlipidemia induced by hyperlipid food was studied by transmission electron microscopy. The biochemical findings of the serum obtained after 30 days of hyperlipid food treatment indicated hyperlipidemia, especially hypercholesterolemia. No remarkable changes were seen in the hearing level, but small tubular structures were found in the outer hair cells over the region from the middle to the upper turn of the cochlea. Some of the intermediate cells of the stria vascularis were degenerated, but the marginal cells remained almost intact. The vestibular epithelium was not degenerated. In conclusion, the possibility was raised that hyperlipidemia may underlie hearing disturbance.

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In this study an attempt was made to analyse the function of two middle ear muscles, i. e. stapedius and tensor tympani muscles by simultaneous recording of the acoustic impedance of the ear drum and the pressure in the ear canal. Subjects were 100 normal adults and 63 patients with ear diseases. Animal experiments were also carried out to ascertain the results from the humans. The reflex was induced either by acoustic or orbital air jet stimulation.
The results from the normal subjects suggested that the muscle responsible for the reflex was not only the stapedius muscle but the tensor tympani muscle as well.
The tensor tympani reflex was examined in 53 patients who had paralysis of the stapedius muscle due to complete facial palsy. The reflex was also examined in 6 patients with otosclerosis and 4 patients with an interrupted ossicular chain. It was found that the tensor tympani muscle responded to the air jet stimulus in almost all the cases, whereas it responded to the acoustic stimulus in a relatively few cases.
Experiments were carried out in 12 cats under anesthesia with Ketalar. It was revealed that the tensor tympani muscle caused marked inward movement of the drum either by acoustic or air jet stimulation, while it produced little effect on acoustic impedance. On the other hand, the stapedius muscle elicited little change in the drum movement, despite a marked increase in acoustic impedance.
In conclusion, it was suggested that the acoustic reflex was caused mainly by the stapedius muscle, but about 20% of the acoustic reflex was affected by the tensor tympani muscle. Air jet stimulation caused tensor contraction. Increased acoustic impedance in some cases, however, seemed to indicate the involvement of the stapedius muscle.

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The tissue blood flow of the nasal mucosa in normal subjects and patients with chronic rhinosinusitis, nasal allergy and vasomotor rhinitis was studied using the hydrogen clearance method. The hydrogen concentration was measured through platinum electrodes which were inserted into the inferior turbinate during inhalation of hydrogen in each of the subject groups. The blood flow was calculated from the equation proposed by Aukland, F=0.693/T₁/2ml/min/g, where T₁/2 is the half decay time of the hydrogen concentration.
Statistically, no significant difference of the tissue blood flow in the inferior turbinate was found between each of the subject groups. Measurement was repeated at least twice and the values of the tissue blood flow in the first and second measurements were found to be very close.
The tissue blood flow was almost the same if the position of the electrode is limited to within the anterior part of the inferior turbinate. There was no right-left difference in the inferior turbinate blood flow, except for the patients with nasal allergy.
The flow increased during deep-breathing, and immediately after receiving cold stimulation on the hand except for the patients with nasal allergy whose flow decreased after receiving cold stimulation. The flow decreased when the subjects were given nasal spray of a vasoconstricting drug and after parforming breath-holding.
The tissue blood flow was measured in patients with nasal allergy before and after nasal provocation by an allergen-containing paper disc. The flow decreased markedly in the tissue surrounding the allergen disc, whereas it increased in the tissue distant from the disc.
Thus, it is concluded that the hydrogen clearance method is a useful tool for evaluating the blood flow of the nasal mucosa.

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Antibiotics which have ototoxicity should be carefully administered in clinical treatment. Patients with chronic otitis media are often treated by intratympanic administration therapy. Basic studies on its safety regarding ototoxicity, however, have rarely been reported.
The present study was performed to examine the influence of intratympanic antibiotic administration on the internal ear in 24 guinea pigs (12 in the gentamicin therapy group, 9 in the cefsulodin therapy group and 3 in the isonic sodium chloride therapy group as the control). Cefsulodin sodium solution of 0.2ml (20mg), gentamicin solution of 0.2ml (8mg) and isonic sodium chloride solution of 0.2ml were instilled into the tympanic cavity through a silicon tube at the back of the ear of the guinea pig for 4 days. Electrocochleography (ECoG) was performed to examine the ECoG-threshold on the experimental animals and scanning electromicroscopy (SEM) was also used to observe the exstirpate cochlea after sacrifice. Neither worsening of the audioresponses (ECoG-threshold) nor SEM findings were observed in the cefsulodin or control groups.
On the other hand, the audioresponses were reduced in the gentamicin group. A statistically significant intergroup difference between the cefsulodin and gentamicin groups in the threshold of ECoG-responses was observed. Significant structural evidence of hair-cell insult such as swelling and rupture of the cell membrane was observed in the gentamicin group.

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Five patients with acute sinusitis, 2 with chronic sinusitis and 5 with acutely aggravated chronic sinusitis, for a total of 12 patients, were orally administered fosfomycin to investigate the efficacy and side effects. As a result, the efficacy rate was 83.3% according to the criteria for evaluation of the degree of improvement by the physician-in-charge. According to the standard criteria for evaluation, the efficacy rate was 91.7% for the objective and subjective evaluations, 83.3% for the improvement in X-ray findings, 72.2% for bacterial elimination and 72.2% for global evaluation. No side effects were observed in any of the patients. From these results, fosfomycin was considered to be a clinically safe and excellent drug. By administering the drug preoperatively, we also investigated the changes in the serum and tissue levels in 9 patients with chronic sinusitis during the course of radical surgery on the maxillary and ethmoidal sinuses.

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Thirty-seven patients with abnormal sensation in the throat were treated with lysozyme chloride (Neuzym) combined with a minor tranquilizer (Lexotan or Serenal or Cercine) for 2 weeks. Evaluation of the efficacy of the combination therapy was made by analysing the patients' subjective signs and symptoms. The therapy was effective for 68% of the patients in a week, 76% in 2 weeks and 62% in 3 weeks (one week after the cessation of the therapy). The drugs were found to be more effective for the patients with milder inflammation of the throat. Side effects were minimal, and only one patient reported drowsiness.

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Basic and clinical evaluation of Cefotiam (CTM), a second generation cephem, was performed with reference to otorhinolaryngological infections.
1. The susceptibility of isolates from otorhinolaryngological infections to CTM was examined. The MICs of CTM were 0.1-0.39mcg/ml for β-Streptococci, 0.2-0.78mcg/ml for S. aureus, 0.1mcg/ml for S. pneumoniae, 0.39mcg/ml for H. influenzae, 0.1-0.78mcg/ml forPeptostreptococcus, 0.39mcg/ml for B. melaninogenicus, and 25mcg/ml for Fusobacterium.
2. Tissue concentrations of CTM were also examined. Mean concentrations in the palatine tonsilla after rapid intravenous injection of 0.5g in children and 1g in adults were 11.2-28.3mcg/g at 30 to 40 minutes, 1.8-7.4mcg/g at 45 to 60 minutes and 0.6mcg/g at 120 minutes, and 1.7-2.6mcg/g at 60 minutes, 3.3mcg/g at 110 to 150 minutes. Mean concentrations of CTM in the mucous membrane of the maxillary sinus after rapid intravenous injection of 1g was 10-13mcg/g at 30 to 40 minuts, 6.0-8.3mcg/g at 60 minutes, and 2.8-2.9mcg/g at 120 to 130 minutes. Mean concentrations of CTM in otitis media exudates after rapid intravenous injection of 1g were 32.6mcg/g at 30 minutes, 20.0mcg/g at 60 minutes and 1.4mcg/g even at 420 minutes in patients with serious infections, and in moderate infection, 9.2mcg/g at 30 minutes, 7.7-9.9 at 60 minutes and 12.7 at 90 minutes.
3. CTM was administered to 51 patients with otorhinilaryngological infections for 2 to 15 day at daily dosages of 0.5 to 1g by intramuscular injection or intravenous drip infusion (60 to 90 minutes) in one or two divided doses to evaluate clinical and bacteriologic efficacy. In the evaluation of clinical efficacy, 88% (22/25) were rated as effective in acute tonsillitis, 100% (5/5) in peritonsillar abscess, 57.1% (4/7) in chronic otitis media at acute excerbation stages, and 80% (4/5) in acute pharyngitis. The overall efficacy rate was 86.3%. Bacteriologically, eradication was noted in 91% for Gram-possitive cocci: 100% (18/18) for β-Streptococci, 78% (7/9) for S. aureus, 100% (3/3) for S. pneumoniae; 67% for Gram-negative bacilli: 100% (2/2) for H. influenzae; and 88% (7/8) for anaerobic organisms: 100% for Peptostreptococcus, 100% for B. melaninogenicus. Side effects, objective or subjective, or abnormal laboratory findings were not detected.

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