Sudden deafness (SD) is a type of perceptive deafness that has an abrupt onset of unknown origin. Its etiology has been much discussed and it has been speculated that sudden hearing loss is due to vascular disturbance in the inner ear, viral infection, labyrinthine window rupture, and cochlear hydrops, as well as causes.
Since SD was designated as a specific disease by the Ministry of Health and Welfare in Japan in 1973, and a research team was organised, studies on SD have rapidly advanced.
SD occurs in 3, 000 to 5, 000 people a year in Japan, but this incidence is not high. However, it is particularly noted as one of the most remarkable sensorineural hearing losses, because of hearing recovery in earlier stage.
Present study was conducted to clarify etiology, therapy and prognosis.
Concerning the etiology, the influence of viral infection seems to be considerably high if not always the primary cause.
As for the treatment, the possibility of spontaneous recovery must be taken into consideration in evaluation of the effect of treatment. It is not conclusive which treatment is the best.
Among various factors concerning the prognosis, the most important one is the degree of hearing loss on the day after onset by multiple regression analysis.

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Nuclear magnetic resonance scans (NMR-CT) were performed on patients with posterior fossa disorders such as acoustic neurinoma, cerebellar tumour (gangliocytoma), epidermoid tumour and spinocerebellar degeneration, and compared with X-ray computed tomography (CT) scans.
The advantages of NMR-CT include lack of bone artifact, variety of image planes, transverse, sagital and coronal imaging, and high ability to differentiate tissues. The disadvantages include prolonged data accumulation time, lack of bone detail and calcification, limited spatial resolution and suitability of patients.

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Since Politzer and Bezold proposed the hydrops ex vacuo theory to explain the pathogenesis of middle ear effusion, it is generally accepted that middle ear effusion arises as a result of a negative pressure in the middle ear cavity, following eustachian tube dysfunction. In recent years, many investigators have recorded middle ear pressure by means of indirect methods such as tympanometry, however, there are few reports on the direct measurement of middle ear pressure.
The application of a pressure microtransducer for direct measurement of middle ear pressure is currently being developed in our laboratory. The present paper describes the details of the instrument for middle ear pressure measurement and its application in patients with middle ear effusion, demonstrating patients with positive and negative middle ear pressure in both ears.

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Our method of improving hearing for patients with old radical cavity is presented. Tympanoplasty is generally indicated for cases of persistent aural discharge with no severe tubal dysfunction. A preserved homologous septal cartilage plate was used to reconstruct the aerated tympanic cavity and to hold the columella material. For cases with insufficient opening of the eustachian tube, staged operations were performed following reopening of the tube and insertion of the protrusive part of silicone plate. The functional results were satisfactory in 12 cases followed over 1 year (success rate in 100% of the modified type III and in 57% of modified type IV).

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Auditory tubes that do not open upon swallowing can not be evaluated using sonotubometry alone. Thus, the change of intranasal pressure and tubal opening and closing function were examined and compared by combining sonotubometry and Valsalva's maneuver.
The procedure of this combined method was as follows: When the auditory tube opened as a result of gradually increased intranasal pressure, sound loading in the nasal cavity is simultaneously transmitted via auditory tube to the external auditory meatus microphone. The pressure at this point is then read. The maximum pressure level in the nasal cavity was set at 500mmH₂O.
Consequently, the tubal opening pressure was found to be 324.9±140.2mmH₂O in 23 out of 26 cases (46 ears). Valsalva's maneuver faied in 3 out of 26 cases, ultimately providing a positive rate (success rate) of 88.5% in 23 out of 26 cases.

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Pharyngeal orifices of the Eustachian tube were observed by a flexible endoscope in 100 cases of cleft palate. Cleft palates frequently showed abnormal movement of the pharyngeal orifice, which were classified into four types: 1. no opening of the orifices during swallowing (8.5%), 2. closure of the orifices during swallowing (4.2%), 3. opening of the orifices during phonation (28.9%) and 4. closure of the orifices during phonation (15.5%). The ears with abnormal movement of the pharyngeal orifice during swallowing showed decreased hearing, whereas the ears with abnormal movement during phonation had normal hearing. Dysfunction of the tensor veli palatini muscle in cleft palates was thought to cause failure of tubal opening during swallowing. On the other hand, both the abnormal course and attachment of the levator veli palatini muscle in cleft palates was considered to be responsible for other types of abnormal movement of the pharyngeal orifice. Therefore, formation of the levator muscle sling in palatal surgery would be very important in the prevention of ear diseases due to tubal dysfunction in patients with cleft palates.

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This is a case report of two patients with cystic lesions in the parotid region. The diagnostic value of CT sialogram is discussed.
A 62-year-old male had a swelling in the left parotid region which felt cystic on manual palpation. A CT sialogram clearly demonstrated a cystic mass superficial to the parotid gland. Histologically, the mass was an epidermoid cyst.
A 9-year-old male had pain and swelling in the right parotid region which was not reduced by antibiotic therapy. An extraparotid abscess was diagnosed by CT sialogram 14 days after the onset.
CT sialogram is effective in differentiating intrinsic from extrinsic parotid lesions and also shows the relationship of the tumor mass to the facial nerve and helps to differentiate between benign and malignant neoplasms.

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The management and reconstruction of pharyngo-cutaneous, and esophago-cutaneous fistulae after head and neck cancer surgery are most important and difficult problems. Various kinds of flaps, such as local flaps, distant pedicled flaps and myocutaneous flaps have been used in primary and staged pharyngo-esophageal reconstructions.
In most cases of head and neck cancer, preoperative and postoperative irradiation therapy is required. It is well known that reconstructive surgery is very difficult after full dose irradiation, which leads to postoperative complications.
We use delto-pectral flaps and free skin grafts in two cases of esophago-cutaneous fistula, and the postoperative course was satisfactory. These patients are described, and the technical aspects and the results of treatment are discussed.

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Adrenergic innervation of the eustachian tube of the guinea pig pretreated with 5-hydroxydopamine was studied by electron microscope. Adrenergic nerve terminals were not found in the epithelial layer. Two types of adrenergic nerve terminals were found in the lamina propria. One innervated the area along the blood vessel wall and the other ran quite independently of the blood vessel. Most of the adrenergic nerve terminals around the arteries were located just beneath the smooth muscle layer. This finding suggests that blood vessel functions of the eustachian tube are also regulated directly by the autonomic nervous system. The finding of free terminals suggests that some neurotransmitters are released from the free terminals, migrate, and influence effector organs, such as goblet cells of the tubal epithelium. Some of the nerve terminals were observed close to the myoepithelial cells of the tubal gland: however, most of the nerve terminal innervation was detected in the vicinity of the blood vessel close to the eustachian tubal gland. No clear adrenergic innervation was detected in the intraacinal region. Adrenergic nerve terminals were usually observed in the vicinity of the blood vessel close to the paratubal muscle. Interestingly, however, some adrenergic nerve terminals were also observed among the bundles of the paratubal muscle with no relation to the blood vessel. Adrenergic nerve terminals were seldom seen outside the tubal cartilage.

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The transsphenoidal approach to pituitary adenoma (Hardy's operation) is a safe method which does not cause nasal dysfunction. Some patients, however, have suffered from olfactory disturbances after Hardy's operation. Three groups of patients were studied.
Group 1 patients had hyposmia which soon improved after removal of the nasal tampon. The patients of group 2 had prolonged olfactory disturbance. Group 3 patients had hyposmia which improved three to seven weeks, it was assumed that the hyposmia of this group was caused by treatment with Chlorhexidine digluconate (Hibitane^®) solution which was used for preoperative disinfection of the nasal cavity.
To test the posibility of olfactory impairment by Hibitane, the nasal cavities of guinea pigs were irrigated three times with 5ml of 0.5% Hibitane solution. Saline solution was used as a control. Under Nembutal^® anesthesia, olfactory epithelium from the superior-posterior part of the nasal septum was examined 3, 7-10, 14-17 and 30-35 days after Hibitane treatment. The samples were examined by light microscopy and scanning electron microscopy. Degeneration of the olfactory epithelium was evident over extensive areas three to seven days after treatment. Regeneration of the epithelium started at 14-17 days, and the surface appeared nearly normal at 30-35 days. These results suggest that olfactory epithelium is injured by Hibitane solution and recovers within about one month.
Povidone iodine (Isodine^®) solution (100mg/ml) was applied by the same method, but there was no change in olfactory epithelium.

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Mesopharyngeal pressure was measured in 26 children with or without airway obstruction during the night. A miniaturized pressure transducer was introduced via a naris of either side to the mesopharynx, and the pressure was directly sensed at the tip of the transducer. The absolute value of the difference in the pressure between the expiratory and the inspiratory phases was defined as the mesopharyngeal pressure. The mean value of the mesopharyngeal pressure over a time interval was calculated by integrating the pressure record. The acoustic signal, airflow and thoraco-abdominal movement were also monitored simultaneously.
The following results were obtained: the maxima of the values of mesopharyngeal pressure, and the severity of the clinical symptoms and signs were not related to the grades of adenotonsillar hypertrophy or Apnea Indices. However, the maxima and the mean values were related to the seventies. Fifteen children with airway obstruction underwent adenotonsillectomy. All were relieved of symptoms and signs, and the values of mesopharyngeal pressure remarkably decreased. The patients after the operation and the children without airway obstruction had values of less than 10cmH₂O.
The data suggest that the measurement of mesopharyngeal pressure is clinically useful, and may be performed for the purpose of evaluating the degree of constriction of the upper airway tract, since this method is non-invasive, and easily carried out.

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Twenty-six patients consisted of 16 males and 10 females with ages ranging between 38 and 81 years, suffering from tinnitus without vertigo and hearing loss who were previously unsuccessfully treated with other drugs.
They were treated with Myonal^® alone and combination with kallidinogenase and minor tranzuillizer for drug therapy.
The results in combination therapy were summarized as follows: in three patients (17.6%) the tinnitus was abolished entirely in a few days; improvement within 3 weeks such as abolition or marked reduction of the tinnitus was reported by eight patients (47.9%); in two patients (11.8%) the tinnitus was reduced slightly after 3 weeks or more: and no change was reported by four patients (23.5%).
The treatment of Myonal^® alone, however, not so effective to the tinnitus as the combined treatment: the efficacy rate with excellent and good was only 22.2%.
There were no side effects in these treatment.
The results of the study suggest that the clinical usefullness of Myonal is evaluated only in combined treatment with other drugs.

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TMS-19-Q is a new semisynthetic macrolide derived from leucomycin A₅. The clinical usefulness of TMS-19-Q·GC tablets (TMS) at a daily dose of 600mg was compared with that of midecamycin (MDM) at a daily dose of 1200mg in 185 patients with suppurative otitis media.
The trial was made by double-blind controled study and the results obtained were as follows:
1. The overall efficacy rates of TMS and MDM in acute suppurative otitis media were 77.8% and 69.4% judged by the doctors and 80.6% and 66.9% judged by the committee members respectively.
The rates of TMS and MDM in acute exacerbation of chronic otitis media were 58.3% and 49.1% judged by the doctors and 55.0% and 47.2% judged by the committee members respectively. However, there was no significant difference between the drugs.
2. On further analysis of the data regarding various background characteristics, TMS was significantly different from MDM in the cases with the infection of susceptible strains (MIC≤3.13), single infection of Staphylococcus aureus and with the severity grades of mild (initial clinical scores:≤2.67) and severe (scores:≥4.00). TMS was also statistically superior to MDM in terms of improvement of otalgia at day 3 in acute suppurative otitis media.
3. The frequency of side effects was 1.8% (2 cases) in TMS and 5.5% (6 cases) in MDM and almost all were slight gastrointestinal effects.
These results suggest that TMS is a useful drug for the treatment of suppurative otitis media at a daily half dose of MDM.

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