To determine the adequate evaluation time of the glycerol test, the time course of the pure-tone threshold was investigated before and after (1, 2 and 3 hours) glycerol intake in 54 patients who showed a positive reaction to the glycerol test.
The incidence of positive reaction was 74% at 3 hours after glycerol intake and this value was the highest during the 3 hour observation. There were, however, 14 patients who exhibited positive results only at 1 or 2 hours after glycerol intake. The results of the glycerol test in these patients would be evaluated as negative if evaluated only at 3 hours as is usually done. Thus, the hearing test should be performed every hour for 3 hours after glycerol intake.
Analysis of the hearing threshold at each frequency tested (0.125 to 8kHz), revealed that threshold improvement was greatest in the middle frequency range and smallest at high frequencies. The cause of these differences in hearing improvement was unclear. Further study is necessary to clarify it.

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Forty-three ears of patients 60 years of age older who were treated surgically otitis media from 1979 to 1983 were analyzed. This paper is a sequel to the previous one titled “Chronic Otitis Media in Aged Persons” describing patients treated in our department from 1965 to 1978.
The main difference between the previous and the present reports is that in the earlier period surgery was considered to be indicated only for severe or emergency conditions in this age groups, while in the latter period surgery was performed when indicated, regardless of the patients' age. Tympanoplasty types I and II have increased and radical operations have decreased. Alumina ceramics was formed to be useful for artificial auditory ossicles. Postoperative improvement to an average conversational hearing range can be expected in about a third of all cases of chronic otitis media.
An analysis of the ages of the outpatients examined at our department in 1978 and 1983 revealed that the number of patients over 60 has increased. Chronic otitis media is on the increase, especially among the elderly.

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A bacteriological study was carried out in 285 patients with chronic otitis media who had undergone an operation from 1980 to 1985. The most frequent species was staphylococcus aureus (41.4%), followed by pseudomonas aeruginosa (23.9%), and proteus species (21.7%). Staphylococcus aureus had increased markedly as compared with the results five years ago, but proteus species decreased. Antimicrobial susceptibility to staphylococcus aureus declined. The combined use of cefmetazole with cefsulodin and sulfamethoxazole/trimethoprim seemed to be the best choice for the critical stage of choronic otitis media.

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To evaluate the effect of adenoidectomy on Eustachian tube function, opening pressure was measured before and immediately after adenoidectomy and every month for 5 months in 10 children, and the inflation-deflation test was performed every month for 6 months after the insertion of tympanostomy tubes in 42 children.
The following results were obtained: 1) opening pressure decreased immedeately after adenoidectomy in about half of the children, 2) inflation-deflation test results did not improve after adenoidectomy, at least for 6 months, 3) children with adenoid hypertrophy failed to respond to the inflation-deflation test at all, while 20% of the children treated with adenoidectomy showed a positive response to the test. One can conclude that children with adenoid hypertrophy should be treated with adenoidectomy.

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This is a case report of a 68-year-old male with tumor of the ethmoid sinus diagnosed histologically as adenocarcinoma. The patient had complained of nasal bleeding and was treated with surgery, followed by irradiation, chemotherapy and intraarterial infusion of 5FU. The most important part of the treatment was considered to be surgery. The patient is alive 7 months after the initial treatment without any evidence of recurrence of the tumor.
From 1964 to 1984, 182 patients with carcinoma of the nasal cavity and paranasal sinuses were treated in our university. In 9 cases (4.9%), the primary site was an ethmoid sinus. The histological diagnoses were squamous cell carcinoma (5), undifferentiated carcinoma (3) and adenocarcinoma (1). The 5-year survival rate was 50%, but in cases of undifferentiated carcinoma, or when the eyes were involved, the prognosis was very poor, none of these patients survived for 5 years.

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We experienced two patients with malignant melanoma of the nasal cavity. They received chemotherapy with mainly DTIC. The combined therapy was more effective than single therapy. Moreover, the frequency of development of side effects decreased by the concomitant use of immunotherapy.

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A 29-year-old male complaining of foreign body sensation in the throat, which was diagnosed as primary throat syphilis, is reported.
The patient had no other symptoms. The pharyngial mucous membrane and tonsils exhibited severe erosion and white coating. Although the signs and symptoms were inconclusive, extensive serological testing confirmed the diagnosis of syphilis.
It is important to determine the cause of pharyngial erosion. The diagnosis and medical therapy of the syphilis are discussed.

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Serum levels of squamous cell carcinoma related antigen (TA-4) were measured by a RIA KIT in 34 patients with head and neck cancer. Eight of 13 patients (62%) with untreated head and neck cancer showed positive serum TA-4 levels, while only one of 10 control cases (10%) showed false-positive results. All patients with advanced stages (III and IV) showed detectable antigen levels. Five of 35 samples (14%) with treated cancer and 12 of 17 samples (71%) with recurrence were positive for the antigen. High pretreatment antigen levels declined to undetectable levels after surgery, irradiation and chemotherapy. The findings suggest that TA-4 is a good tumor marker for cancer of the head and neck, specially for squamous cell carcinoma.

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Two cases of follicular dental cyst, rarely seen in the otorhinolaryngology department, are reported.
A 12-year-old female had a mass in the left nasal vestibule. The cyst was extirpated by gingival incision.
A 14-year-old male had a swelling in the right mandibular region. As the cyst was located at the third molar, this was taken out by gingival incision and bone cutting. This case was complicated with adamantinoma, seen on the mucosal surface of the cyst with the appearance of a polypoid tumor.

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It has been reported that sensorineural hearing loss is frequently observed in patients with renal failure. This phenomenon has been confirmed in animal experiments by Ikeda et al (1985). It is known that Ca metabolism is disturbed in cases of renal failure. The present study was designed to determine whether disturbance of Ca metabolism have any effect on cochlear function.
Cochlear potentials were measured in 19 rats on a vitamin D deficient diet. Serum Ca²⁺ concentrations were about half of the normal value, and the rats lost weight on this diet.
N₁ was elicited by click of stimuli and filtered tone bursts of 2, 4, 8 and 12kHz. Narrow-band analysis was performed by low-cut masking, and responses above 8kHz, from 4 to 8kHz 2 to 4kHz were recorded. CM was evoked by filtered tone bursts.
As the vitamin D deficient diet continued, N₁ latency prolongation, depression of CM amplitude and elevation of CM threshold increased. The latency of narrowband APs was prolonged in most regions of the cochlear partition, but the N₁ amplitude and threshold did not change.
It is considered that the influence of Ca²⁺, parathyroid hormone and vitamin D on the cochlea caused these changes in cochlear potentials.

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The cochlea of the two species of hereditary and spontaneously diabetic mice were examined. One species was the non-obese diabetic (NOD) mouse, which becomes diabetic due to severe insulitis as seen in the juvenile onset or Type I diabetes in the human, and the other species was the Kondo-Kasugabe (KK) mouse with characteristics resembling the adult onset or Type II diabetes in the human. The animals were examined morphologically by electron microscopy and functionally by auditory brainstem response hearing test. The lesion in the cochlea of NOD and KK mice were found mainly in the vascular stria, with the pathological changes occurring mainly in the marginal cells and intermediate cells. Protrusions of the surface of the marginal cells into the endolymphatic space, swelling and the vacuolization of the intermediate cell were observed. No changes, however, were noted in the capillary of the stria vascularis.
Severe degenarative changes occurred in the organ of Corti of NOD mice, with some animals exhibiting a total loss of outer hair cell and denuclearization of Deiters' cell on the basal turn. These findings were not observed in KK mice. No degenerative changes were found in the spiral ganglion of either species. A loss of Preyer's reflex of NOD mice and an elevated threshold of auditory brainstem response were observed in KK mice at 5 months of age.

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To observe mucosa regeneration in the mastoid cavity after tympanoplasty using silicone sheeting was examined in 31 patients with cholesteatoma and 7 with chronic otitis media who were operated on with the technique of staged intact canal wall tympanoplasty. In the first operation, the surface of the denuded bone was covered with 0.2-0.5mm silicone sheets. At the second operation 5-14 months after the first operation, 38 specimens from the anterior or posterior wall, and 25 specimens from the innermost wall of the mastoid cavity were taken and studied histologically.
The specimens were histologically divided into four groups: granulation tissue, mixed tissue of granulation and scar, scar tissue and normal mucous membrane. Of the 38 specimens from the anterior or posterior wall, three showed granulation tissue, 16 mixed tissue of granulation and scar, and 19 scar tissue; normal mucous membrane was not found. In 8 patients who were operated on about 12 months after the first operation, only the single or multi-layered flattened epithelium had regenerated over the scar tissue.
Of the 25 specimens from the innermost wall, 14, which had been attic type cholesteatoma, had normal mucous membranes. In 5 of the normal mucous membrane specimens, ciliated cells were observed on the free surface of the mucous membrane.
These results suggest that more than one year is required for regeneration of the mucous membrane in the mastoid cavity after tympanoplasty.

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An investigation of the role of autonomic control in guinea pig nasal mucosa was carried out by neurotransmitter release and computer simulation method.
The nasal mucosa which was removed under pentobarbital anesthesia, was incubated with ³H-NA or ³H-Ach and infused with Krebs-Ringer solution.
The fluids were collected every 2 minutes and were counted by liquid scintillation spectrophotometry.
NA released upon electric stimulation was reduced by Ach in a dose-dependent manner, and this action was inhibited by atropine. Histamine did not induce Ach release from the parasympathetic terminal endings.
Ach had no infuluence of the Ach-release induced by electrical stimulation, but Ach enhanced the spontaneous release of ³H-Ach. We made a micro-computer program that simulates the diffusions of NA and Ach from autonomic terminals to the surface of effector organs, and the bindings to effector organs.
An increase in the number of adrenergic fibers increased the number of NA binding receptors.
An increase in the number of cholinergic fibers increased the number of Ach binding receptors and delayed the beginning of NA binding, and resulted in a decrease in the number of NA-binding receptors. The increase of sensitivity of effector organs and cholinergic receptor in the nerve terminals reduced the number of NA-binding adrenergic receptors, and increased the number of Ach-binding cholinergic receptors.
These results of this study suggested that parasympathetic nervous system seemed to control the ‘timing’ of the beginning of NA binding.

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The present study examined the optimal direction and force of traction to be applied to the muscle process of the arytenoid cartilage during arytenoid adduction technique (Isshiki, 1977) for the best voice. Six fresh human cadaver larynges, ranging from 28 to 78 years in age, were used. All the laryngeal specimens were free of observable pathological and anatomical anormaly. Measurements of the changes in the position and shape of the vocal cord induced by traction were made under a microscope with a L shaped probe mounted on a micromanipulater.
Bowing and shortening of the vocal cord occurred, when the direction of anterior traction was at the level of the vocal cord. Anterior traction of the muscle process on the cricoid level resulted in caudal displacement of the vocal process. The greatest reduction of the glottal chink, without producing either bowing or shortening of the vocal cord was obtained, when the muscle process was pulled anteriorly, either toward the point of anterior-middle third or middle of the thyroid ala, at a level intermediate between the vocal cord and the cricoid. When the muscle process was pulled at an intermediate level between the vocal cord and the cricoid cartilage toward the 2 points, anterior-middle third and anterior half, that is 1.40mm, was 40 to 70g. Under the above conditions, the force required to correct the level difference between the two cords was 40 to 65g, which caused the vertical displacement of 1.12 to 2.10mm. Shortening of the vocal cord caused by traction ranged from 0.42 to 0.94mm.
Traction of the muscle process toward the anterior middle third point of the thyroid ala displaced the vocal cord medially and downward with less force than traction toward the anterior half point.
From the present experiment, it may be concluded that the optimal displacement of the vocal cord can be obtained by traction of the muscle process at the intermediate level anteriorly toward the anterior one-third and half of the thyroid ala.

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The usefulness of Dilazep dihydrochloride, an antiischemic multi activator, was investigated in the treatment of patients with vertigo of central or peripheral origin. A total of 83 patients in 9 hospitals were treated with Dilazep dihydrochloride singly (300mg/day) or in combination with a minor tranquilizer for 8 weeks.
The clinical signs and symptoms were checked every 4 weeks. After 8 weeks of treatment, 64 patients (77.1%) were available for final evaluation.
1. There was subjective improvement in 75.0%, and objective improvement in rate of 39.5%. The overall rate of improvement was 71.9%. The Final overall rate of effectiveness was as high as 70.3%.
2. A layer analysis revealed that the rate of improvement was higher in older than in younger patients, and that improvement of vertigo of central and peripheral origin was almost equal. The rate of improvement of severely affected patients was higher than that of those with mild symptoms.
3. There was no signicant difference between the group treated with Dilazep dihydrochloride and that treated with Dilazep dihydrochloride plus a minor tranquilizer.
4. These results indicate that Dilazep dihydrochloride is effective in the treatment of vertigo. There were no side effects of this drug.

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Forty seven patients with tinnitus were given sodium valproate (400mg orally twice a day) after evaluating the effect of intravenous lidocaine (40-60mg). With lidocaine injection, 19 of 47 patients had complete relief from tinnitus, 19 had partial relief (over 30%), and 9 had no relief Of 38 patients who took sodium valproate over two weeks, one patients had excellent relief (over 80% disappearance of tinnitus by subjective evaluation), 8 had good relief (50-80% disappearance), 16 had partial relief (20-50% disappearance), and 13 had no relief. The effect of sodium valproate correlated with the effect of lidocaine and serum level of sodium valproate. It was considered that the efficacy of sodium valproate would increase when used in combined therapy with other drugs or therapies.

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Twenty patients with perennial nasal allergy were treated with Linovin nebulizer or nasal spray, histamine-carried human gamma globulin.
1. In the group treated with Linovin nebulizer (1/3v) twice a week for 4 weeks, the clinical effect was good in 3 cases (42.9%).
2. In the group treated with Linovin nasal spray (1 or 2v/w) using the device for nose drop, the clinical effect was excellent in 8 cases (61.5%) and good in 5 cases (38.5%).
3. Symptomatic improvement was apparent within two weeks of nasal spray therapy, earlier than in those treated with Linovin nebulizer.
4. No side effects were observed in any patients.
Linovin nasal spray using the device for nose drops is useful for patients suffering from allergic rhinitis.

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