Preoperative control of hyperthyroidism is considered to be the most important aspect of the surgical treatment of Graves' disease. The standard method of preoperative control in our department is described with special reference to three therapeutic agents: potassium iodide, antithyroid drugs, and sympathetic β-receptor blocking agents. Analysis of the relationship between the preoperative treatment and the postoperative course in 31 patients indicated that a combination of these three agents generally leads to a favorable postoperative course with stable vital signs. Of the β-blockers, β₁-selective blockers such as Metoprolol are recommended. β-blockers should be administered for at least two months before surgery with increasing doses (120-240mg/day) during the week prior to surgery.

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The sonometric auditory tubal function test is incapable of testing auditory tubes which do not open and close with swallowing. Therefore we attempted to evaluate stepwise the impaired function of the auditory tube by combining the advantages of the sonometric auditory tubal function that test with the active opening and passive opening function test which has heretofore been in clinical use. For the active opening function test, we used (1) sonometric auditory tubal function test and (2) Toynbee's test. For the passive opening function test, we used (3) Valsalva's test and (4) inflation of the auditory tube. These tests in the sequence mentioned may be said to stepwise tests for auditory tubal insufficiency. When these tests were conducted on normal subjects, (1) the sonometric auditory tubal function test gave was positive in 89% in normal adults, but a low positive rate of active opening was noted in children (age 4 to 12 years), even though the despite by tympanogram was the A type; (2) Toynbee's method varied the intranasal pressure by about 10mmH₂O, proving changes in the intranasal pressure during the opening and closing of the auditory tube (from positive to negative pressure) to vary with the mode of swallowing; (3) Valsalva's method opened the auditory tube with an intranasal pressure of 332.6±140.8mmH₂O; professional divers required a higher intranasal pressure, and (4) the auditory tube inflation method opening the auditory tube with a mean pressure of 412.4±30.6mmH₂O, but in children aged 10 or less it opened the auditory tube with a pressure as low as 292.2±56.3mmH₂O, indicating a tendency for children to achieve the adult value at the age of 9 to 10.

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A 40-year-old female with right hearing loss had sudden left hearing loss and tinnitus without vertigo. Both ears responded well to steroid (Rinderon) administration with improvement to 43dB on the left and 68dB on the right. We found a pulsating tumor on the right side of the neck, Raynaud's phenomenon and differences in blood pressure between the two radial arteries. The serum level γ-globulin was abnormally high. The CRP was highly positive, and the ESR was increased. Aortography showed a narrowed aortic arch with swelling of the aortic wall. The right neck tumor was biopsied, and the histopathological diagnosis was aortitis syndrome. Continuous steroid administration improved the physical findings and hearing, but mild tinnitus persisted.

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A 34-year old male patient with acute tonsillitis and epiglottitis, whose hematological examination revealed agranulocytosis, was admitted to our clinic. He was treated with antibiotics. The white blood cell count recovered well, but on the 15th day of illness during an acute upper respiratory tract infection, he complained of sudden rotatory vertigo without any cochlear or other central nervous symptoms. Electronystagmography demonstrated canal paresis on the right side and direction-fixed nystagmus toward the left side. The caloric response returned to normal in three days. Spontaneous nystagmus had almost disappeared by 2 weeks and he was free from vertigo or dizzy sensations by 10 days.
This is a case of vestibular neuronitis after severe upper respiratory tract infection, with a relatively short term of agranulocytosis.

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Of the 38 ears operated on from 1978 to 1984 in this series, 71% required reoperation, 26% for revision and 3 % for a second look. Of the 27 reoperated ears, 89% had discharge preoperatively; 80% of them showed improvement postoperatively. Discharge was greatly reduced in 91.3% of the ears treated with the closed method. This figure is significantly higher than the 25% of those improved by the open method. Of the 27 reoperated ears, 48% were believed to have recurrence of cholesteatoma, and in 26% of these there was a disturbance of drainage. Although recurrence of cholesteatoma was found in 66.7% of the ears treated with revision or second look operations, discharge was reduced in all cases. These results indicate that ear surgery should be done by the closed method, especially revision or second look operations in cases of cholesteatoma.

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Drug therapy for slight hemifacial spasm is usually not effective. Surgical treatment (neurovascular decompression) is indicated for severe spasm, and its effectiveness has been reported.
A new method of transcutaneous electrotherapy for hemifacial spasm is described. Electrical stimulation of the facial nerve (0.1 msec-duration, square wave, 1Hz, 5 minutes) resulted in spasm suppression in 17 (81%) of 21 patients with hemifacial spasm. This electrotherapy is indicated for slight spasm or severe spasm when surgical treatment cannot be performed.

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Metastatic choriocarcinoma of the tonsil is very rare. A case of such a metastatic tumor arising 17 months after induced abortion is reported here.
A 34-year-old female visited our hospital with the complaint of continuous bleeding from the oral cavity. A 5×5mm hemonecrotic tumor was found in the upper pole of her left tonsil. The tonsil was completely removed including this tumor, and bleeding ceased.
The histopathological examination of the tumor revealed metastatic choriocarcinoma, so a pregnancy test was performed. It showed markedly elevated human chorionic gonadotropin (HCG) in the urine. The chest radiogram disclosed two abnormal shadows in the left lung field.
A total hysterectomy with right oophorectomy and wedge resection of the left ovary was performed combined with pre- and post-operative chemotherapy. Then left lower lobectomy was carried out.
The lung specimen showed metastatic choriocarcinoma with marked necrosis, although no evidence of tumor was found in the uterus or ovaries.
Follow-up studies for 1 year revealed no signs of local recurrence or distant metastasis, and HCG in the urine remained within normal limits.
A possible mechanism of the metastatic process is discussed with special reference to the characteristics of metastatic choriocarcinoma to the tonsil.

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A 62-year-old male had primary multiple cancers of the palatine tonsil and parotid gland. He visited our clinic because of a sore throat. On examination, a tumor associated with an ulcer was observed in the right palatine tonsil. There was no swelling of the regional lymphnodes. Histologically, the tumor was diagnosed as squamous cell carcinoma. He was treated by irradiation with a total of 6000 rads to the right tonsillar area. The response was excellent and the tumor disappeared.
However, four months after the treatment, a swelling of the left parotid gland region was observed, and a malignant parotid tumor was suspected. Histological examination revealed malignant mixed tumor. After surgery the tumor recurred locally and metastase to the lung were suspected. The patient died about three months later.

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The relationship between the duration of hoarseness and tumor growth was studied in 240 cases of laryngeal carcinoma (glottis carcinoma, 159; supraglottic carcinoma, 81) treated in Gunma Cancer Center. Patients over 70 years of age account for 39.0% of this series are treated less vigorously. Of the cases suffering from glottic carcinoma 56.6% were T1 when they were examined within three months of the onset of hoarseness. However, early detection of glottic carcinoma depends on the nature of the tumor itself, and many patients with T1 carcinoma did not visit their doctors for a long time after they first noted hoarseness. On the other hand, many patients have advanced carcinoma in spite of earlier consultation.

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In 58 patients with abnormal sensation of the pharyngolaryngeal region autonomic function was tested with AUTONOMIC (NEC Co.).
At rest, the coefficient of variation (CV) was normal in 34 patients (59%), below normal in 15 patients (26%) and above normal in nine patients (15%). After five deep respirations the CV increased significantly in 11 patients and decreased significantly in five patients. These results suggest that there are various abnormalities in patients with abnormal sensation in the pharyngolaryngeal region.

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Hypopharyngeal cancer is one of the most dreaded and distressing diseases in the head and neck region with respect to the aggressive treatment modalities employed and its poor prognosis. It is significant for obtaining a better prognosis to estimate histopathologically the modes of growth and spread of this tumor. Twenty surgical specimens removed for piriform sinus cancer were studied histopathologically by whole-organ serial sectioning.
1) The modes of extension of tumor to the laryngeal cartilages were classified into two groups, contact and invasion. Invasion of the cartilage occurred in the ossified parts.
2) The tumor frequently extended laterally outside the thyroid ala with invasion of the thyroid cartilage (25%) or around the thyroid cartilage without invasion (40%). Therefore, the thyroid cartilage did not seem to be a barrier against lateral extension of cancer.
3) When tumor extended medially to invade laryngeal structures, vocal cord fixation occurred in 70%. Vocal cord fixation was due mainly to involvement of the intrinsic laryngeal muscles and not to involvement of the arytenoid cartilage or the cricoarytenoid joint.
4) Upward growth was usually extensive because of the lack of any barrier. Invasion of the false vocal cord occurred by the direct retrograde submucosal route beyond the aryepiglottic fold.
5) Downward extension was relatively slight compared to upward extension.
6) A satisfactory margin of normal pharyngeal mucosa must be removed with the specimen at the time of operation. In piriform sinus cancer at least 2cm is thought to be necessary, in view of the submucosal extension.

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Male Hartley guinea pigs were divided into three groups for different combinations of routes of administration: intranasal-intranasal, intranasal-intracutaneous and intracutaneous-intranasal. Intranasal doses of 0.5ml of 0.4% phenol in saline, or 0.025ml/kg, 0.25ml/kg or 2.5ml/kg body weight of Broncasma Berna were administered to the left and the right nostril; 1.0ml of the drug solution was injected intracutaneously.
The guinea pigs were treated once every day for seven days, and after a rest period of ten days, a second course was administered to some of them at the same dose level and on the same schedule as the first course.
The groups were compared macroscopically and histologically for the development of anaphylactic responses.
1) None of the guinea pigs in any group developed any symptoms such as sneezing or difficulty in breathing during the entire experiment. Intranasally treated guinea pigs which were killed immediately after the first course did not develop signs of anaphylaxis.
2) Histological examination of the nasal mucosa, the pharynx, the larynx, the trachea, and the lungs of guinea pigs which were given different concentrations of Broncasma Berna and killed immediately after the first course showed no significant differences among the different drug concentration groups and only minimal tissue damage. The guinea pigs killed after the second course showed no significant histological differences among the combinations of routes of administration, and their tissue damage was also very slight.
These facts indicate that the intranasal route of administration of Broncasma Berna is very safe.

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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 therapy. Basic studies on ototoxicity, however, are rarely reported.
The present study was performed to examine the influence of intratympanic antibiotic administration on the internal ear in 46 guinea pigs (19 in the fosfomycin group, 17 in the gentamicin group, 10 in the physiological saline group as controls). Fosfomycin sodium solution of 0.2ml (6mg), gentamicin solution of 0.2ml (8mg) and physiological saline of 0.2ml were instilled daily into the tympanic cavity through a silicon tube at the back of the ear of the guinea pig for 10 days.
Electrocochleography (ECoG) was performed to examine the ECoG-threshold in the experimental animals and scanning electronmicroscopy (SEM) was also used to observe the extirpated cochlea after sacrifice. The ototoxicity of gentamicin was observed both functionally and morphologically to almost the same degree. On the other hand no ototoxicity of fosfomycin was noted.
The clinical significance and usefulness of topical administration into the tympanic cavity of these antibiotics are discussed briefly.

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The effect of HISTGLOBIN aerosol therapy was evaluated in 50 patients with nasal allergy.
The patients were given 1/4 vials, three times per week, for four weeks.
1) The rate of subjecive improvement was 70% for sneezing attacs, 74% for nasal discharge and 60% for nasal obstruction.
2) The rate of objective improvement was 68% for nasal congestion and 54% for watery discharge.
3) The over-all effectiveness was excellent in 6%, good in 70%, fair in 10%, unchanged in 12% and worse in 2%.
4) There were no side effects observed in any patients. HISTAGLOBIN aerosol therapy is considered to be effective in the treatment of nasal allergy.

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