In an investigation of the functional anatomy of the posterior glottis, three sets of studies were conducted: (1) observation and photography of excised human larynxes, (2) histological study of excised human larynxes, and (3) fiberscopic observation in living human beings. 1. There is no anatomical terminology for the structures surrounding the posterior glottis. They can be divided into three parts. We propose to call them the posterior wall of the glottis, the lateral wall of the posterior glottis and the cartilagenous portion of the vocal fold. 2. During vocal fold adduction, the larynx closes posteriorly at the supraglottis but not at the glottis, causing a conic space in the posterior glottis. 3. The area of the posterior glottis accounts for more than half of the entire glottal area. 4. The mucosa of the posterior glottis is lined with pseudostratified ciliated epithelium that is a respiratory epithelium. 5. The posterior glottis can be regarded as a respiratory glottis.

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A 25-year-old male produced a continuous high-pitched tone (6.1KHz, 37.2dB SPL) which was not audible to the patient. He had a sensorineural deafness over 1KHz with a dip of 45dB at 6KHz. The sound was considered to be due to a spontaneous oto-acoustic emission.

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A volumetric method (Boyle's law) was used to measure the middle ear volumes of 104 patients with middle ear diseases.
Regression lines between middle ear volumes and X-ray middle ear areas were caliculated (y=0.93x-0.92) in eight cases of traumatic eardrum perforation.
Average middle ear volumes were 12.00cc in traumatic eardrum perforations, 7.48cc in otitis media chronica (OMG) with good aeration of the mastoids, 3.60cc in OMG with poor aeration of the the mastoids and 2.92cc in retraction pockets.
Mastoid volumes tended to increase until 60-70 days after ventilating tube insertion in patients with otitis media with effusion (OME).
We concluded that volumetric measurement of middle ear volume is clinically useful in assessing the pathophysiology of middle ear diseases and for the better choice of operative procedures in patients with OMG, and also in assessing the ventilation of the entire mastoid cavity in patinets with OME.

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Middle ear cholesteatomas developed in dizygotic twins. In three of the four ears cholesteatomas developed as a result of longstanding otitis media with effusion. In the remaining ear, no cholesteatoma has been formed so far, in spite of severe eardrum retraction. The differences in the clinical course showed that not only Eustachian tube dysfunction but also blockade of the ventilation pathway between the mesotympanum and the epitympanum may play an important role in the development of cholesteatoma. High resolution CT is very useful in the diagnosis of this blockade. More dizygotic and monozygotic twins with cholesteatoma should be studied to decide whether hereditary factors have any significant influence on the occurrence of this disease.

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With the use of ^99mTc, we attempted to measure simultaneously submandibular gland function and parotid gland function, which is thought not to be controlled by the facial nerve, in patients with unilateral Bell's palsy. For comparison, the lachrymal gland function of some patients was measured by the thread method.
We found that facial palsy sometimes affects parotid gland function as well as submandibular gland function. In 60% of the patients the function of the two glands tended to be affected in the same way.
Lachrymal gland function tended to be affected in a similar way to parotid gland function.
We conclude that the chorda tympani and the greater petrosal nerve may influence parotid gland function.

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Relapsing polychondritis is a rare disease of unknown etiology. This is a report of two cases seen from 1979 to 1983. The medical history seems to be the most important factor in the diagnosis of relapsing polychondritis. Two patients were treated successfully with Dapsone without any side effects. Dapsone appears to be useful in the treatment of relapsing polychondritis.

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Two cases of cancer of the middle ear and the deep external auditory meatus are reported.
The first case was a 51-yr-old man with chronic ear discharge. He visited our clinic because of swelling of the preauricular area. A granulomatous tumor was discovered in the right external auditory canal and biopsied. It was found histolosically to be squamous cell carcinoma. He was treated with radical mastoidectomy with neck dissection, chemotherapy and irradiation, but died of recurrent tumor which invaded the dura mater.
A 71-yr-old woman had had a diagnosis of cholesteatoma in childfood. She was treated in our clinic by radical mastoidectomy for acute exacerbation of the cholesteatoma. The pathological diagnosis was chronic inflammation. Five years later, she complained of postauricular swelling, and a radical mastoidectomy was done. Histological findings disclosed papilloma with hyperkeratosis. After the second operation, tumor grew rapidly in the auditory meatus and mastoid cavity. A third mastoidectomy was perfomred with resection of the chondral external auditory meatus. Matter exenterated from the mastoid antrum and middle ear was found to be squamous cell carcinoma. Cobalt therapy was planned, but she died of cachexia.
The early descriptions of intrinsic cancer of the middle ear noted that it often followed long standing chronic otitis media. The estimated duration of otorrhea before a sudden change in symptoms suggested that carcinogenesis took more than 40 years in case 1 and more than 60 years in case 2, chronic inflammation may influence the development of cancer of the middle ear.

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This study was designed to determine the effectiveness of a single antral lavage with and without pipemidic acid (PPA), an oral antibacterial agent, in chronic sinusitis. Fifteen patients, aged 17 to 66 years, were treated with an antral lavage with physiological saline solution at week one (group A). Thirteen patients, aged 14 to 68 years, were treated with an antral lavage at week one and recieved PPA 2, 000mg p. o. per day for two weeks, from week 0 to week 2 (group B).
There was no significant difference in the subjective effect between group A and group B. X-ray opacity of the maxillary sinus was evaluated with a microdensitometer at week 0 and week 2. In group A, the x-ray opacity was 0.597±0.166 at week 0., and was 0.595±0.174 at week 2. In group B, the x-ray opacity was 0.665±0.190 and 0.683±0.176 at weeks 0 and 2, respectively. No significant improvement of x-ray opacity was observed after treatment in either group.
The results indicate that a single antral lavage with and without an antibacterial agent is ineffective on the conservative treatment of chronic sinusitis.

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Some patients with chronic sinusitis do not respond to conservative therapy or radical surgery because of interfering factors. Others occasionally develop postoperative maxillary cysts as a later complication. Various methods of solving these problems have been reported.
We treated 24 lesions in 22 patients with chronic sinusitis by cryosurgery from April, 1975, to September, 1985, at the Cryosurgical Clinic of Kobe University Hospital. These patients had not been improved by two months or more conservative therapy. Some of them had had endonasal surgery (polypectomy, partial ethmoidectomy, etc.) prior to conservative therapy.
The cryosurgical unit was modified so as to be suitable for maxillary sinus lesions. First a small hole was drilled through the lateral wall of the meatus nasi inferior or the fossa canina, and a special probe was inserted through this hole to freeze the inflamed mucous membrane of the maxillary sinus by liquid nitrogen spray.
The results were evaluated by morphological and functional examinations. Of the 24 lesions 15 (62.5%) were improved. It is concluded that cryosurgery is a valuable therapy for chronic sinusitis (mainly of the maxillary sinus).

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We have treated 16 patients with soft palate paralysis, and present two cases here. One patient had a viral infection and the other myasthenia gravis.
Among the causes of soft palate paralysis, the incidence of diphtheria is decreasing, and viral infections and cerebrovascular disorders are most common.
Bilateral paralysis was noted in cases of amyotrophic lateral sclerosis and myasthenia gravis of the soft palate alone. When the paralysis is bilateral, diseases of the nervous system or hysteria should be suspected. In myasthenia gravis the antilex (Edrophonium) test is useful for diagnosis.
In all cases of viral infection, the paralysis was unilateral. In some cases other areas were also paralyzed. Four patients had laryngeal palsy, one had facial palsy, and one had accessory nerve palsy. These cases remind us that the soft palate receives nerve fibers from the nucleus ambiguus.
When viral infection is suspected the measurement of viral antibody titers is useful for diagnosis. In positive cases, we recommend r-globulin or interferon as the intial therapy.

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More and more people depend on life-long hemodialysis as machines and techniques become more sophisticated. Many sufferers of chronic renal failure can now expect to live long and fairly normal lives. Therefore, the number of people undergoing hemodialysis who need surgery for other diseases is on the increase.
Both general surgeons and head & neck surgeons have been removing various malignant tumors from persons undergoing hemodialysis.
We recently treated a 36-year-old woman for cancer of the tongue, who has been undergoing hemodialysis three times a week for the past seven years. We performed a partial resection of the tongue using a CO2 laser while the patient was under general anesthesia. We followed her carefully, and a year later suspected a metastatic lesion in the left side of her neck. She was hospitalized and underwent left radical neck dissection while under general anesthesia. When she had the first operation of partial resection of her tongue and the second operation of radical neck dissection, she underwent daily hemodialysis before surgery and on the third day after surgery hemodialysis with Gabexate mesilate (FOY) without heparin.
With this regimen, we could perform both operations under general anesthesia without any major trouble, such as hyperkalemia or bleeding.
We noted that patients undergoing hemodialysis have many complications during surgery, : acidosis, tendency to bleed, low resistance to infection and hyperkalemia.

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Malignant fibrous histiocytoma is rarely found in the head and neck.
A 65-year-old man, who had been treated for right maxillary cancer with surgery and irradiation in 1963, presented with a tumor 40×30×25mm in the right maxillary cavity. This tumor was histologically diagnoed as malignant fibrous hstiocytoma showing a typical storiform pattern. The tumor was removed successfully with a LASER knife. The patient remains well without recurrence.
This case was a so-called postirradiation malignant fibrous histiocytoma.

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Malignat parotid tumors in children are rare, especially squamous cell carcinomas.
A 10-year-old boy visited our hospital with a parotid swelling on the right side. Sialography, CT-scanning, Ga-scintigraphy, ultrasonography and cytological examination by needle biopsy showed possible malignant tumor, but rapid histological examination of a frozen section during the operation proved negative. The parotid gland was removed totally with prevention of injury to the facial nerve. Postoperative permanent sections of the tumor showed well-differentiated squamous cell carcinoma. He was irradiated with 6000 rads of 60Co and recieved adjuvant chemotherapy. There has been no recurrence.

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The influence of ICP (intracranial pressure) and CPP (cerebral perfusion pressure) changes on the morphology of the ABR was investigated in 59 subjects who were in deep coma. The interwave latency of the ABR was not affected by ICP changes. On the other hand, a prolongation of the interwave latency was found when the CPP was depressed to below 40mmHg, but when the CPP was kept above 40mmHg, the ABR was not affected. It can be concluded that the activity of the brainstem auditory pathway is quite resistant to brain ischemia.

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Animal experiments were designed to test the authors' clinical impression that the facial nerve is frequently hyperexcitable in the very acute stage of intratemporal facial palsy when the damage of the nerve remained neuropraxia. Evoked myograms of the orbicularis oris muscle were recorded before and after clamping of the intratemporal facial nerve of 17 guinea pigs under predetermined constant conditions. In 6 guinea pigs, the evoked responses of the clamped side far exceeded those of the unclamped side. In these animals, electronmicroscopic study revealed that the damage was limited to the myelin sheath.

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It has been established that acetylcholine causes peripheral vasodilatation. Recent studies with in vitro muscle tension detecting devices suggest that, at least in large blood vessels, higher concentrations of the Cholinergic transmitters cause vasoconstriction. Vasodilating responses to acetylcholine are indirect and can be evoked either by decreasing the norepinephrine output from the adrenergic nerve terminal, or by stimulating the endothelial cells to generate yet unknown relaxing agents. In our experiments with in vitro preparations of the vascular smooth muscle of the canine nasal mucosa, the three above-mentioned cholinergic receptors (adrenergic nerve endings, vascular smooth muscle cells, and endothelial structures) were demonstrated. The cholinergic contractions were Ca2+ dependent.

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The Rhino-Maxillo Aerodynamic-Gram (RMAG) in determining is useful the patency of the maxillary ostium of patients with sinusitis.
Irrigation therapy was applied once a week as conservative treatment of sinusitis, and the RMAG findings before and after treatment and the effectiveness of conservative management were evaluated. Sinusitis could be diagnosed more accurately with the help of RMAG. On the basis of these findings, a therapeutic regime was established for the conservative treatment of sinusitis.

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Clinical evaluation of ototopical solution with 3% FOM was performed in 27 patients with chronic suppurative otitis media (15 cases) and its acute exacerbation (12 cases).
1) The overall clinical effect was excellent in 13 cases, good in 9, fair in 5; clinical effectiveness rate was 81.5%.
2) A satisfactory clinical response was obtained not only in single infections but also in mixed infections.
3) No side effects were observed in any of the cases.

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Ketotifen was administered to 30 patients with nasal allergy for 4 weeks.
1) Improvement of sneezing attacks was noted in 68%, of nasal discharge in 69% and of nasal obstruction in 54%.
2) It was very effective in 3%, moderately effective in 43% and slightly effective in 23%.
3) The effectiveness of Ketotifen appeared within 3 days in 3%, within 1 week in 17% and within 2 weeks in 70%.
4) Drowsiness was a complaint in 4 of the 30 patients.

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