Acute (suppurative) otitis media is the most common organic disease of the upper respiratory tract in children, and it recurs often particularly in infants and young children. Recurrent otitis media is of two types: recurrent acute otitis media and recurrent otitis media with effusion. The former is further divided into two groups: one with repeated acute episodes but no symptoms and normal eardrums between episodes; in the other type are superimposed episodes of acute otitis media on otitis media with effusion.
There are several causes of recurrent otitis media: 1) immaturity of the defense systems, such as immunologic, mucociliary, and eustachian tube functions; 2) affinity of bacterial attachment to the nasopharyngeal mucosa; 3) diseases of organs adjacent to the middle ear and eustachian tube; and 4) systemic disorders, i. e., primary immunodeficiency, dysfunction of neutrophils, and immotile-cilia syndrome.
Recurrent otitis media is usually treated by antimicrobial agents with or without myringotomy, and by insertion of a ventilation tube. Although in America and Scandinavian countries antimicrobial prophylaxis or vaccination is used in the treatment of recurrent otitis media, they are not in common use in Japan.

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A 27-year-old man complained of dizziness immediately after his left ear was sprayed with a fire hose. Otological examination revealed transparent fluid continuing to flow through a small perforation in his left tympanic membrane. On the following day, the tympanic membrane was dry and no transparent fluid was seen. The dizziness disappeared promptly and the sensorineural component of hearing loss was so slight as to be overlooked. At operation 23 days after the accident, there was a constant flow of perilymph from the round window. This case suggests that there are labyrinthine window ruptures with neither vertigo nor hearing loss. Clinical manifestations of labyrinthine window rupture are discussed with reference to so-called “silent fistula”.

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Congenital stapedial foot plate fistula was noted in a 30-year-old woman. The literature is reviewed.
Hearing loss since childhood and a floating sensation during exercise were her subjective symptoms. At 20 years of age she began to have frequent paroxysmal episodes of rotatory vertigo accompanied by nausea and vomiting which persisted for almost 3 years.
During the same period she often felt a fullness of the left ear. Repeated paracen-theses had no effect.
At 28 years of age she began to have watery rhinorrhea when she bent her head forward.
At 27 and 28 years of age, she had suppurative meningitis for which medical treatment was successful.
She visited us for further examination. Her left ear showed otitis media with effusion, and hearing and equilibrium function were absent on the left.
Exudation in the middle ear and deformity of the inner ear were found on roentgenographic examination and computed tomography scan.
Exploratory middle ear surgery revealed a fistula in the anterior part of the stapedial foot plate through which perilymph-fluid was leaking.

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Cerebrospinal fluid leakage rarely ceases spontaneously due to its watery nature and positive pressure. The following technique is employed in our clinic.
The dural defect is covered by a lyophilized dural graft (Lyodura^®) with a cyanoacrylate tissue glue (Biobond^®). Thelateral surface of the graft is covered adequately with Biobond and Polyandroglucuronic acid (Oxycel^®) to make it water-tight. This technique has proved to be valuable in the repair of cerebrospinal fluid leakage.

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A 30-year-old man complained of clicking sound in both ears. Sound analysis showed that the tinnitus had a duration of 0.12 second, a frequency range of 2 to 4.8kHz and an irregular rhythm of 60-120per minute. Nasopharyngoscopy under local anesthesia disclosed spasmodic lateral movements of the lateral tubal wall. Electromyography revealed that only the tensor veli palatini muscle showed drastic and involuntary contractions during episode of tinnitus. Tinnitus disappeared when a bougie was inserted into the tube. These findings showed that the tinnitus was caused by contractions of the tensor veli palatini muscle, what is called a tubal tinnitus.
Inward movement of an incised tympanic membrane demonstrated simultaneous contractions of the tensor tympani muscle and the tensor veli palatini muscle during tinnitus.
An experimental middle ear and tubal model demonstrated that a decrease in the impedance of the tympanic membrane during tinnitus might be attributed to volume expansion of the external auditory meatus by an inward movement of the drum.

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The allergic etiology of otitis media with effusion (OME) is still a controversial topic. Many investigators have reported a high incidence of OME in allergic patients, but an allergic etiology has been denied by others because of a lack of direct scientific evidence proving that the middle ear effusion is an allergic product. To clarify the role of IgE mediated allergy in OME, we studied 97 patients with OME and 370 patients with nasal allergy with routine allergy tests evaluation of hearing and middle ear function and pneumatic otoscopy. A positive allergen skin test was found in 47 of 97 (49%) patients with OME. Allergy tests demonstrated that 25 of 97 (26%) patients with OME had clinically symptomatic nasal allergy. Eardrum examination, hearing tests, and impedance audiometry revealed that 7 of 370 (2%) patients with nasal allergy had OME. The discrepancy between the two groups could not be explained, but it is suspected that subclinical allergy is one of the causative or promotive factors of OME. Further investigations are needed.

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Electrogustometry (EGM) was used pre- and postoperatively to evaluate taste in 34 patients with unilateral chronic otitis media. Intact canal wall tympanoplasty via a facial recessus approach was performed in 27 patients. The other 7 patients had previously had radical surgery, so a revision operation was done. Although none of these patients complained of loss of taste, 20.6% showed abnormal taste thresholds in the chorda tympani innervating area preoperatively. Among the 22 patients with normal preoperative EGM, 6 of the 16 patients in whom the chorda tympani was preserved and 4 of the 6 patients in whom it was sacrificed showed elevated EGM thresholds in the chorda tympani innervating area postoperatively. EGM of the chorda tympani and glossopharyngeal nerve innervating areas in 10 patients showed that cross-over innervation of the chorda tympani was occasionally seen in the posterior third of the tongue. Even when the chorda tympani is sacrificed, the patient may not notice any taste disturbance if there was dysfunction of the chorda tympani preoperatively, if the velocity of diffusion of taste particles is rapid or when the chorda tympani regenerates 3-6 months later.

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Twenty-nine patients with carcinoma of the tonsillar fossa were treated at the Department of Otorhinolaryngology, Nihon University, School of Medicine from January 1964 to May 1984.
1. There were 23 men and 6 women. The incidence was highest in the fifth decade and next highest in the sixth.
2. Only 3 patients (10%) did not smoke or drink alcohol, while 53% were habitual smokers and alcohol drinkers.
3. Histologically, malignant tumors of the tonsillar fossa were most frequently squamous cell carcinoma (26 cases), well differentiated in 8 cases, moderately differentiated in 9 and poorly differentiated in 9.
4. Neoplastic involvement of other organs was evident in 5 (17%) of the 29 cases studied.
5. The 3- and 5-year survival rates were 65% and 55% respectively.
6. Death was due to failure to achieve adequate local resection of the tumor in 5 cases, distant spread of the tumor in 2 cases and concurrence of tumors of other organs in 2 cases.

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A case of osteogenic sarcoma of the left nasal cavity following treatment for familial bilateral retinoblastoma is reported.
A 7-year-old boy with left nasal obstruction and bad odor from the nose was referred to our hospital for diagnosis and treatment.
When he was 10 month old, he was found to have bilateral retinoblastoma, and Linac 5200 rads irradiation, cryosurgery and bilateral enucleation were performed. An elder brother, a cousin and two paternal uncles had retinoblastoma.
The secondary tumor occupied the left nasal cavity and ethmoid sinus, and there was calcification around the middle turbinate. The pathologic examination revealed osteogenic sarcoma. Denker's operation, tumor resection with dura resection and dura plasty under lateral rhinotomy, repeated reduction operation, ⁶⁰Co 5000 rads irradiation and chemotherapy were performed, but the tumor always recurred at the primary site.
The incidence of retinoblastoma is increasing. Despite the high survival rate of patients with retinoblastoma, most secondary malignant tumors are fatal. We emphasize that patients treated for retinoblastoma must be observed carefully to detect secondary tumors at an early stage.

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Adenoacanthoma of the thyroid gland (mixed squamous cell carcinoma and papillary adenocarcinoma) was found in a 60-year-old woman was reported. Adenocarcinoma of the thyroid gland was considered to have been transformed into squamous cell carcinoma in this case. A left hemi-thyroidectomy, total laryngectomy and lymph node dissection were performed. Squamous cell carcinoma recurred in the left neck 6 months later. Conservative radical neck dissection, radiation and B-M therapy were performed. Twelve months after the first operation, she is alive. A patient over 60 years of age with squamous cell carcinoma was thought to have a poor prognosis. Adenoacanthoma should be treated more vigorously in the initial stage.

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Hyperfunctioning thyroid nodules are very rare in Japan. We treated six patients with hyperfunctioning thyroid nodule from 1981 to 1984. All patient were females aged 9 to 52 years. Each patient had a palpable thyroid nodule, and the scintigram showed a hot nodule without hyperthyroidism. Five patients underwent thyroid lobectomy and one thyroid lobectomy with removal of the regional lymph nodes. Pathologically, four nodules were follicular adenoma, one was adenomatous thyroid hyperplasia and one chronic thyroiditis. The resected specimen in the last case contained adenomatous thyroid hyperplasia and follicular adenocarcinoma.

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Isolated frog posterior semicircular canals were used. Three modes of cupula movement were defined:
Movement 1: ordinary swinging-door deflection; Movement 2: cupula top fixation 1 achieved by immobilizing the central top portion of the cupula; Movement 3: cupula top fixation 2 achieved by immobilizing the entire top of the cupula. The ampullary nerve action potentials due to mechanical endolymphatic flow were recorded during these 3 kinds of cupula movements. Cupula top fixation 1 resulted in action potentials which were comparable to those of the swinging-door deflection in terms of the maximum spike count and the stimulus-response curve. Cupula top fixation 2 resulted in potentials with a maximum spike count comparable to that of swinging-door deflection; however, the response increase rate was very low. The time course of the potentials in cupula fixation 1 and 2 was extremely short (about 2-3 seconds) compared to that of the swinging-door deflection. These results suggest that the swinging-door deflection is physiologically the most relevant in providing the optimum response increase rate as well as in maintaining the time course of the tonic response.

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In a study of the fate of homograft cartilages implanted into the middle ear, the transplanted cartilages removed at revision surgery or at the second stage of staged tympanoplasty were examined histologically. The appearance and shape of the cartilages remained unchanged without any evidence of erosion. There was no foreign body reaction or rejection phenomenon. No marked changes were seen in the matrix, but the chondrocytes showed degenerative changes. There was partial absorption of the cartilage and replacement by fibrous tissue when inflammatory changes were present in the middle ear. It is concluded that implanted homograft cartilage can be expected to maintain its stiffness for a long time in healthy, aerated middle ears.

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Ten adult dogs were used in this study. The pharyngeal orifice of the Eustachian tube was obstructed by laminaria or electrocoagulation. The epithelium of the Eustachian tube was observed 1, 3 and 5 weeks after surgery by light microscope and scanning electronmicroscope. One week after obstruction effusion was noted in the middle ear cavity and the cilia of the Eustachian tube lost their metachronal wave. Three weeks later, there were numerous holes in the mucous membrane of the Eustachian tube. At the bottom of the holes, one could see the surface of goblet cells surrounded by adhesive cilia with mucus. At 5 weeks the effusion had progressed and the metachronal wave of the cilia had disappeared completely. Some of the cilia had disappeared and others were deformed.

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Mucociliary function is governed by cilia, mucus, and their interaction. To play their role in mucociliary function, cilia must be present in large number. It has been reported that the ciliary area is reduced in acute and chronic inflammations of the upper respiratory mucosa. However, quantitative observations of the ciliary area in these conditions have not been reported. In this study, ciliary areas of the maxillary turbinate infected with the B strain of Newcastle disease virus (NDV) were quantified with a scanning electron microscope and an image analyzer. The epithelial surface occupied by cilia was calculated by an image analyzer. The ciliary area was expressed as a percentage of the total area examined. Ninety 21-day-old chickens were inoculated intranasally with NDV. The ciliary area and mucociliary transport time were examined periodically. The ciliary area was reduced about 50% on day 5 and then recovered gradually to normal by day 21. The ciliary area was reduced by increasing amounts of inoculated virus. A negative correlation was noted between histopathologic severity and ciliary area. The mucociliary transport time in the NDV infected nasal mucosa increased as the percentage of the ciliary area decreased. In this study, reduction of the area occupied by cilia caused deceleration of nasal mucociliary transport. Quantitative analysis of the ciliary area can clarify the role of cilia in mucociliary dysfunction.

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ADP-induced platelet aggregation was studied in 442 patients with vertigo and equilibrium dysfunction and enhanced platelet aggregation was noted in most of the patients. This result suggested that higher platelet aggregation was “a risk factor” for vertiginous disease.
Therefore, we administered Ticlopidine (Panaldine), a suppressant of platelet activity, to 33 patients and evaluated its clinical effectiveness on their subjective symptoms and objective findings.
The following results were obtained.
1) Ticlopidine was effective in 24 of the 33 cases (72.7%).
2) Ticlopidine reduced vestibular subjective symptoms, but its effect on cochlear symptoms was limited.
3) Among the objective findings, Ticlopidine was effective on nystagmus (gaze, positional and positioning nystagmus), but less effective on the caloric nystagmus test, OKN-test, ETT and Schellong's test. Hearing was not improved.
4) Platelet aggregation was markedly suppressed in 32 of the 33 cases (97%).
5) As to the side effects, only one patient complained of abdominal discomfort, but this was not severe.
These results suggest that Ticlopidine is useful in the treatment of vertigo and equilibrium dysfunction.

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1) The relationship between the expected efficacy index (EEI) and the clinical efficacy of bacampicillin (BAPC) and cephalexin (CEX) in the treatment of acute suppurative otitis media was studied.
2) Fifty-nine patients were analyzed, 27 treated with BAPC and 32 treated with CEX.
3) The clinical efficacy was judged by the clinician to be excellent in 66.7% of the BAPC group and in 31.3% of the CEX group. This difference was statistically significant (p<0.05). As judged by the committee criteria, the clinical response was significantly (p<0.05) better in the BAPC group, (88.9%) that in the CEX group (62.5%).
4) The bacteriological efficacy, expressed by the eradication rate 3 and 7 days after treatment, was 65.4% and 100% in the BAPC group, and 41.9% and 90.3% in the CEX group.
5) No adverse reactions were observed in either group.
6) The EEI calculated from ( ) and ( ) disk method sensitivity was 93.5 with BAPC and 82.4 with CEX. If only ( ) was taken as sensitive, it was 86.9 with BAPC and 59.0 with CEX. The EEI calculated from the MIC method was 89.1 with BAPC and 64.9 with CEX.
The clinical response as evaluated by the committee criteria showed a good correlation with the EEI value calculated from both ( ) disk sensitivity and the MIC method.
These results indicate that the EEI concept is useful for selecting antibiotics in the treatment of acute suppurative otitis media.

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A double blind test was carried out to evaluate the efficacy of Piroxicam (a non-steroidal anti-inflammatory agent) on abnormal sensation in the throat. Piroxicam combined with Diazepam was administered to 63 patients with abnormal sensation (such as feeling of a lump) in the throat and placebo combined with Diazepam to 63 patients for 2 weeks. The therapeutic effects of the medication were evaluated at the end of the first and second week of administration and one week after the termination of treatment. It was considered to be effective when the abnormal sensation improved subjectively by 50% or more. In 3 of the 63 patients to whom Piroxicam and Diazepam were administered, side effects were so severe that the medication had to be suspended. Among the remaining 60 patients, the medication was effectivte in 70% in one week, in 76% in two weeks and in 68% in three weeks. Among the 63 patients treated by placebo combined with Diazepam, the medication was effective in 65% in one week, in 62% in two weeks and in 55% in three weeks. The present study indicates that Piroxicam is effective in the therapy of abnormal sensation in the throat.

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