The energy metabolism in living organs (salivary gland and inner ear) was studied by both conventional and topical ³¹P-nuclear magnetic resonances (NMR and TMR) as non-invasive procedures. In isolated perfused salivary glands of the rat and dog, cessation of perfusion caused the tissue level of creatine phosphate (PCr) to decrease rapidly and that of ATP to decrease moderately. Restarting the perfusion caused PCr to recover rapidly with a time constant of 40 sec. Acetylcholine (ACh; 5×10^-6M) induced massive salivation and a simultaneous decrease of PCr. The removal of ACh resulted in a prompt recovery of PCr, with 45 sec of decay, to the resting value. During Na-free perfusion, even in the presence of ACh, only minimal salivation and no decrement of PCr were noted. The surface coil (1.3cm in diameter) was set on the mandibular gland of the dog, in the magnet of TMR. The results of the gland in situ were similar to those of the perfused gland. The ³¹P-TMR was also applied to the inner ear of the guinea pig. Resonances of PCr, ATP, ADP, inorganic phosphate and sugar phosphates were observed. Destruction of the inner ear caused these signals to disappear. By intravenous injection of furosemide did not change the resonances of PCr or ATP.

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Although cerebral arteriovenous malformation (AVM) is frequently seen in the anterior circulation, especially in the cerebral artery, it may also occur in the posterior circulation. Recently, the frequency of AVM in the posterior fossa is increasing, presumably because of improved diagnostic techniques, and including with neurotological examinations.
We recently examined a patient with posterior fossa AVM who had been diagnosed and treated as a case of cerebral infarction in another hospital because his main neurological deficit was hemiparesis. The patient's chief complaints were tinnitus and gait disturbance. Cerebellar signs ipsilateral to the hemiparesis including spontaneous nystagmus test, eye tracking test, optokinetic nystagmus test, auditory brainstem evoked response, gravinometry…etc, clearly revealed the presence of an AVM in the posterior fossa.
This case indicates that neurotological examinations are very useful in the diagnosis lesions in the posterior fossa, which used to be considered a black box.

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A muscle relaxant (Myonal) was used to treat in 184 cases of tinnitus. The reasons that a muscle relaxant was selected are:
1. Muscle tension increases tinnitus.
2. Some drugs that increase muscle tension produce tinnitus as a side effect.
3. Biofeedback training and lidocaine are effective in the treatment of tinnitus. There was a statistically significant difference (P<0.01) between the muscle relaxant group and the control group. Muscle relaxants appear to be effective in the treatment tinnitus.

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Five cases of chronic organic solvent intoxication with cochlear and/or vestibular symptoms are reported.
In all five cases there was slight to moderate sensori-neural deafness, which seemed to be the result of intoxication, but the exact anatomical site of the lesion causing the deafness could not be identified.
The results of neurotological examinations suggested that central vestibular dysfunction was the cause of dysequilibrium.
Neurologically, all five cases presented polyneuropathy which confirmed the diagnosis of chronic organic solvent intoxication. Disturbances of taste and smell were also present in some cases.
Otolaryngologists seem to play an important role in the diagnosis and treatment of such intoxications.

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The patient was an 69-year-old male who complaind of dizziness provoked by loud noises. Ocular deviation to the left was recorded by electronystagmography with sound stimulation of pure tone at 800Hz at 110dB HTL to the right ear. Endolynphatic hydrops of the right ear was detected by drip infusion of glycerol, which relieved low frequency hearing loss and vestibular dysfunction in the caloric test. It was suspected that the pathology was idiopathic endolymphatic hydrops without vertigo or delayed endolymphatic hydrops due to acoustic trauma.

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The authors treated 19 of 32 patients with symptoms of benign paroxysmal positional vertigo (BPPV) by transtympanic injections of a local anesthetic (Lidocaine). Eighteen of the patients experienced complete relief of the vertigo after seven or fewer transtympanic injections. 16 of them after only one or two injections. In patients with complete relief of vertigo after one injection, symptoms and postitioning nystagmus disappeared within 3 days. One of the 19 patients experienced a recurrence of BPPV after 3 months. The longer the clinical course, the more transtympanic injections were necessary. A characteristic nystagmus profile of BPPV was revealed by ENG recordings in the 9 patients in whom the affected side could be determined by other clinical findings. In 7 of the 9 patients, the horizontal fast phase components in the head-hanging position were toward the affected side and in the other 2 they were toward the contralateral side.

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Material collected from the tympanic cavity before and from the mastoid antrum during operation on 58 discharging ears of patients with chronic otitis media was cultured, and the bacteria in these two cavities were compared. Staphylococcus aureus was the commonest organism in the tympanic cavity and Staphylococcus epidermidis in the mastoid antrum. Anaerobic bacteria were found only in the mastoid antrum of a patient with cholesteatoma. In 32 (55%) of 58 ears examined, bacteria were detected in both tympanic and mastoid cavities. In 17 ears (53%), the bacterial strains in the two cavities differed. The necessity of a bacteriological examination of the mastoid cavity during operation in order to select antibiotics for postoperative treatment is stressed.

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From 1971 to 1983, 2, 166 tympanoplasties were performed in Kitasato University Hospital. Labyrinthine fistulas were present in 53 patients (2.4%); 52 of them they involved the bony semicircular canals, and only one had invaded primarily the cochlea wall. Surgery improved hearing in 58% of the cases of labyrinthine fistula due to chronic otitis media (almost the same rate of success for cholesteatoma without labyrinthine fistula). Two patients lost all auditory function after surgery; one of them had a cholesteatoma removed from a fistula involving the cochlea. On the basis of their experience, the authors suggest that the cholesteatoma-matrix covering a labyrinthine fistula can be removed, and the tympanoplasty should be performed in patients with labyrinthine fistula without very poor preoperative hearing.

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Case 1 was first seen for a neck tumor (squamous cell carcinoma), but the primary site later proved to be the auricle. Total removal of the auricle with radical neck dissection was performed. In case 2, leukomelanoderma of the face was associated with a growth on the auricle first diagnosed as cutaneous horn. This recurred after repeated cryosurgical treatments for about a month. Biopsy revealed squamous cell carcinoma. Partial auricular resection was performed. There have been no signs of recurrence in either cases.

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Of 212 patients carcinoma of the oropharynx treated from 1967 through 1982, 24 (11%) had multiple primary carcinomas. Laryngeal carcinomas were seen in 8 cases, esophageal carcinomas in 5 cases, gastric carcinomas in 4 cases, and others in 7 cases. Patients with oropharyngeal carcinomas are at the same high risk of developing carcinomas of the respiratory system and the upper digestive tract as the patients with hypopharyngeal carcinomas previously reported. The age distribution and the sex ratio were similar in the group of multiple primary carcinomas and the group of oropharyngeal carcinomas. The two tumors were found almost simultaneously in 6 cases (25%) and in 19 cases (80%) at intervals of up to 7 years. Both tumors were squamous cell carcinomas 63% of the cases. Radiation induced cancers were present in 5 cases. We emphasize again the risk of developing new carcinomas in patients with oropharyngeal carcinomas.

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A 72-year-old man had had hoarseness and dyspnea for one year. Laryngoscopy revealed a red tumor occupying a wide portion of the posterior wall of the trachea. With the aid of a flexible fiberscope, it was confirmed that the tumor extended 5 to 6cm towards the subglottic region. The right vocal cord was fixed in the midline. Histological examination disclosed adenoid cystic carcinoma. A surgical approach was designed to remove the tumor including the larynx and the right lobe of the thyroid gland at the 10th tracheal ring. Tracheal mobilization was successful, and a tracheostomy was performed in the sternal region. The techniques of tracheal mobilization are discussed with reference to the literature.

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The blood flow in the scala media of guinea pigs with hydrops was measured by the hydrogen clearance method during the administration of eperisone hydrochloride, betahistine mesylate or glycerol and during endolymphatic sac surgery, after a preliminary examination had determined which condition was suitable.
1) It was found that oral administration could be used in this examination.
2) The effects of the drugs were evaluated by comparing in treated and untreated animals.
3) During eperisone hydrochloride administration, the blood flow in the scala media was 9.0±0.7ml/min/100g (n=4).
4) With betahistine mesylate, it was 8.1±1.0ml/min/l00g (n=4)
5) With glycerol, it was 5.6±1.2 ml/min/100g (n=4).
6) During endolymphatic sac operation, the blood flow was 6.6±1.3ml/min/100g (n=4).
7) Statistical analysis showed a significant increase of blood flow in the scala media in animals receiving eperisone hydrochloride or betahistine mesylate, but no significant difference in the glycerol or endolymphatic sac operation.

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Simultaneous cerebrospinal and inner ear pressure recordings performed in the guinea pig demonstrated that variations in the cerebrospinal fluid pressure were transmitted to the endolymph after removal of the round window membrane.

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The aims of this study are to demonstrate the presence of a pressure equalizing system between the inner ear fluids (perilymph and endolymph) and the cerebrospinal fluid (CSF) and the roles of the cochlear aqueduct (CA) and endolymphatic duct (ED) in that system.
The following conclusions are drawn from the measurement of perilymphatic and CSF pressures in cats.
1. After obstruction of the CA, perilymphatic and CSF pressures are identical and interdependent, indicating that they are transmitted by a route other than the CA.
2. After obstruction of both the CA and ED, the perilymphatic pressure becomes independent of the CSF pressure.
3. The respiratory variations in the CSF pressure are partially transmitted to the perilymph after obstruction of the CA and are further reduced when the ED is also occluded.
4. Artificially increased CSF pressure is transmitted to the perilymph without attenuation in normal cats. However, this transmission is markedly reduced when the CA is obstructed. This indicates that there is a limit to the transmission of variations of CSF pressure through the ED. This conclusion raises the question whether equalization of the pressures of the perilymph and endolymph in the presence of abnormal variations in the CSF pressure is possible.
5. After the administration of 30% urea (1g/kg) to cats with patent CAs, the perilymphatic and CSF pressures behaved identically. This suggests that a direct osmotic effect of urea on the perilymphatic pressure cannot be determined if the CA is patent.
6. After the administration of urea to cats with obstructed CAs, the perilymphatic and CSF pressures behaved differently. The fact that the perilymphatic perssure is lower than the CSF pressure, particularly during the first 45 minutes, shows the direct osmotic effect of urea on the perilymphatic pressure.

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The usefulness of lincomycin hydrochloride (LCM) in the treatment of otorhinolaryngological anaerobic infections was assessed.
1. LCM was administered to 25 patients including one infant: 7 with sinusitis, 7 with peritonsillar abscess, 2 with congenital preaural fistula, 2 with buccal cyst, 2 with gingival abscess, 1 with infection of a cervical tumor, 1 with parotid gland abscess, 1 with a cyst of the vestibule of the nose, 1 with acute parotitis and 1 with a submandibular cyst.
2. LCM was administered intramusculary (300-600mg) or by intravenous drip infusion (600mg), 2 or 3 times daily for at least 3 days.
3. LCM was clinically effective in 92% of the patients.
4. It was bacteriologically effective in 96%.
5. No side effects were noted.
6. LCM was confirmed to be a very useful drug for treating anaerobic otorhinolaryngological infections.

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Fifty-one male and 53 female patients with abnormal sensation in the throat were treated orally for two weeks with sulpiride (Dogmatyl^®), and the therapeutic effect was evaluated one and two weeks after the start of treatment and one week after its termination. It was considered to be effective when the abnormal sensation improved subjectively by 50% or more. In one of the 104 patients, side effects were so severe that the medication had to be discontinued. In the remaining 103 patients, the medication was effective in 56% at one week, in 66% at two weeks and in 61% at three weeks. The rate of complete cure was significantly higher in patients with depression (53%) than in nondepressed patients (19%).

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An herbal medicine, “Bukuryouin gou Hangekoubokutou” was administered to 23 patients with abnormal sensation of the larynx.
1. The subjects were 14 males and 9 females, most of them in the 3 th and 4 th decades.
2. The symptoms in many cases were of relatively long duration. Complications were observed in 8 cases (34.8%).
3. Symptoms were relieved or ameliorated in 52.4% of the subjects. The sensation of constriction was completely gone in 66.6%.
4. Of the 23 patients, 18 reported that this medicine was useful: 56.6% very useful and 21.7% somewhat useful.
5. No side effects were observed.
6. The above results indicate that this medicine is a fairly effective herbal medicine.

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