During the past 17 years (1971 to 1987), 7, 419 children with communicative disorders due to various causes visited our speech and hearing clinic for children at Teikyo University Hospital. These communicative disorders were classified into the following six groups according to the anatomical sites of pathology related to speech or language disorders.
1) Retarded development of speech and language due to peripheral hearing loss or central auditory disorders, such as auditory agnosia or pure word deafness.
2) Developmental and acquired language disorders, including mental retardation, infantile autism and aphasia.
3) Developmental motor speech disorders, including specific developmental speech disorder syndrome, developmental apraxia of speech, so-called functional articulation disorders, dysarthria, etc.
4) Speech disorders due to deffects of the peripheral speech organs.
5) Voice disorders.
6) Speech and language disorders caused by psychological or environmental problems.
Although many factors influence the development of language and speech, from a therapeutic view point, it is important to pay attention to psychological and environmental factors, including intelligence, mental energy, cognitive abilities, emotional stability, parent-and-child relationship, environment surroundings, etc.
My clinical and practical experience indicates that those who work for communicatively handicapped children must establish their own methodologies for understanding each child as an individual developing under the influences of many biological as well as psychological and environmental factors.

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Acute cerebellar vermis syndrome was discrived by Kornhuber in 1968 and Sakata in 1971: severe vertiginous attacks evoked in the supine position with the head hanging down during the positional nystagmus test, vertical positioning nystagmus to the lower eyelids, periodic alternative directional changing nystagmus, and no associated cerebellar symptoms in the limbs. It is not with lesions of the otolith.
Recently, we have some times seen patients with the acute cerebellar vermis syndrome who we first thought had infarction or bleeding in the cerebellar vermis. However, radiological studies showed no cerebellar findings indicating either infarction or bleeding. There was only cerebellar, especially vermis, atrophy.
This study of 122 patients shows that the acute cerebellar vermis syndrome is probably caused by cerebellar atrophy. We conclude that cerebellar atrophy, especially of the vermis, is probably the cause of the acute cerebellar vermis syndrome.

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Patients with multi-electrode cochlear implants can distinguish vowels well, but the ‘sounds’ they hear through this device are unknown. In order to simulate vowels through multielectrode cochlear implants, we synthesized waves which have translated formant frequencies using a computer and reverse fourier transformation .Through a digital-analog converter, we heard the synthesized sounds. Each sound is quite different from each vowel, but we can easily distinguish them from each other. With the use of this procedure, cochlear implants can be expected to be improved.

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A statistical study was made on 741 hard-of-hearing adults who visited the rehabilitation center from 1981 to 1987.
The details of the study included age distribution, nature of hearing disorder, period of hearing aiduse, type of hearing aid used and, in future, the correlation between hearing level and discrimination score.
Some problems about the delivery of hearing aids in accordance with the Welfare Law and the necessity for otologists to have more interest in this field are discussed.

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A 33-year-old male visited our clinic complaining of bilateral hearing loss for about ten years. Audiological examination showed a mixed type of hearing loss. Otoscopic examination revealed a normal tympanic membrane. The preoperative diagnosis was otosclerosis, and stapes surgery was performed on the left ear. Immediately after a small hole had been made in the stapes foot plate, perilymph flowed out and gradually increased in volume. The perilymph leak was stopped by a tampon of fascia placed on the stapes foot plate 5 days after the surgery. The hearing was improved a littel. Stapes gushers are discussed briefly from the point of view of predictability, treatment of perilymph leak and prognosis for improved hearing.

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A 21-year-old female presented with bilateral hearing loss. Pure tone audiograms showed 30dB (B. C. 9dB) in the right ear and 32.5dB (B. C. 14dB) in the left ear. Tympanograms were of the type Adpattern in both ears. These results suggested discontinuity of the ossicular chain, and exploratory tympanotomy in the right ear showed otosclerosis coexisting with discontinuity of the incudo-stapedial joint. Stapedectomy, performed by cup piston prosthesis, resulted in a gain of about 25dB. The discontinuity of the incudo-stapedial. joint was probably due to frequent air inflation therapy of the ears.

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Objective tinnitus-when both the patient and examiner can hear a sound originating in the external ear canal-is rare. It may be of muscular, vascular or other origin. In Japan, more than 174 cases have been reported since Kubo described a case of objective tinnitus in 1903. In 63% of the reported cases the origin was said to be muscular.
In this paper, we describe the clinical and physiological features of two cases (children 5 and 8 years of age). In both cases the sound was similar to the clicking together of two finger nails, and analysis with a sound spectrum showed that the frequency ranged from 0 to 10kHz. The tinnitus appeared voluntarily and disappeared during sleep. A review of the literature on the origin and mechanism of objective voluntary tinnitusis included in the present study.

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A 53-year-old woman suffered from objective tinnitus when she spoke. Fiberscopic examination showed that both Rosenmüller's recesses were very deep and the torus tubarius touched the posterior wall of the nasopharynx every time she pronounced a syllable. As soon as they separated, a click was heard. The click was about 100msec after the pronunciation ended and had two peaks from each Rosenmüller's recess. The peak frequency of the click was about 1kHz. We injected silicon into the posterior wall of the nasopharynx near both Rosenmüller's recesses, and the click disappeared.

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A 56-year-old male with a sore throat and high fever was examined and treated in our department. His condition was first diagnosed as right acute peritonsillitis, as he had pronounced pain and swelling in the right peritonsillar region combined with tenderness and swelling in the right cervical lymphnodes.
A 10-day course of treatment with antibiotics did not improve his condition, however. CT scan and Ga scintigraphy failed to eliminate the possibility of malignancy. A biopsy of the right tonsil revealed chronic inflammation without any malignancy. A biopsy of a lymph node from the right side of his neck 10 days later suggested lymphoepithelioma of tonsillar origin. Radiation and chemotherapy with cisplatin and peplomycin were unsuccessful, and the patient died 6 months after diagnosis.
This is one of the few recorded cases of lymphoepithelioma of the tonsil.

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A 67-year-old female patient visited Nagoya Univcrsity Hospital complaining of bloody sputum and swelling of the right side of the neck three years after she had had a three lobe and caudal lobe resection of the liver and pancreato-duodenal resection for advanced gall bladder carcinoma. Inspection revealed a right tonsilar mass and ipsilateral lymphadenopathy of the neck.
Biopsy showed a moderately well-differentiated adenocarcinoma. A diagnosis of metastatic tumor of the tonsil was made as this histological picture corresponded with that of the primary tumor of the gallbladder. Management consisted of surgical resection of the tumor mass and right radical neck dissection with reconstruction by an MC flap. The postoperative recovery was uneventful, and the patient has had no signs of recurrence or evidence of metastatic deposits elsewhere, six months following Surgery.

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Carcinoid tumor of the larynx was diagnosed in a 66-year-old man. The patient had complained of sore throat for ten months. A supraglottic tumor covered with smooth mucosal surface was found. Total laryngectomy was perfbrmed (pT3N0); the pathological diagnosis was carcinoid tumor. The ultrastructural findings showed many secretory vesicles.
The patient had metastases to the neck lymph nodes several times, and repeated neck dissection were performed. Four years after the first operation, the patient died of pulmonary and hepatic metastases.
On the basis of this and previously reported cases, recommendations are made for the management of carcinoid tumor of the larynx.

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From January 1982 to February 1987, 14 patients of glottic cancer were treated with CO₂ laser at Department of Otolaryngology, Saga Medical School. The purpose of this study is evaluated that the application of CO₂ laser surgery for glottic cancer. The results are summarized as follows;
1) Three patients with Tis and T1a were treated only by CO₂ laser vaporization under endolaryngeal microscopy. The selesions were located in the membranous portion of the vocalcords apart from both anterior commissure and vocal process. None of them had recurrences following surgery.
2) On the other hand, we employed combination therapy with laser and radiation for 9 cases. Among these cases, three were T1a with bulky tumors and/or with tumors involved entire membranous portion of the vocal cords, and 6 were T1b. Three cases in T1b were suffered from residual lesions and recurrent tumor safter radiation. Therefore, cordectomy using laser was perormed in one case and observed without recurrence, finally total laryngectomy were performed in the other 2 cases.
3) Selected two cases in glottic T2 were treated with combination therapy of laser surgery and radiotherapy. After treatment, no recurrence has been observed in one case, but the other cases died of local recurrence and distant metastasis. From our experience, independent laser surgery is indicated only in selected cases of Tis and T1a as described as above.

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We analyzed clinically 110 cases of thyroid diseases treated surgically in our hospital from 1982 to 1986 and evaluated the usefulness of topographical imaging such as ultra-sound sonography, radio-isotope scintigraphy and CT-scanning in the preoperative diagnosis.
1) Females predominated in all types of thyroid disease; the male/female ratio was 1:4.2.
2) The disease was benign in 54 cases and malignant in 56. (1:1.04 ratio) Tumors were noted in 80 patients (74%).
3) Malignant tumors were of the papillary type in 64%, follicular in 21%. A differentiated type of histology was seen in 96% of malignant tumors.
4) Malignant tumors were found in 74% of the male patients.
5) The most useful imaging technique for the diagnosis of malignancy was a combination of ²⁰¹T1-chloride delaycd scan and ultra-sound sonography. CT-scanning was useful for diagnosing tumor localization and invasion.

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The author investigated the effect of changing posture and blood flow on the middle ear pressure of humans. First, a sudden change of posture, from sitting to the head down position was induced in 38 normal persons (65 ears) in normal and hyper and hypobaric environments. Then blood flow was changed by SGB or excercise. The SGB procedure was applied to 3 normal persons and 3 patients with sudden deafness, and 9 normal persons were tested during exercise. PO₂ in the middle ear was measured simultaneously with the measurement of the middle ear pressure. The change of pressure was estimated by tympanometry, and the PO₂ value was measured by a sensor introduced into the middle ear via the Eustachian tube.
At both normal and abnormal atmospheric pressures, the middle ear pressure increased when the posture was changed from the sitting to the head down position. Pressure change caused by posture change was 2.4 times greater in a relatively hypobaric than in a relatively hyperbaric environment. When blood flow was raised by SGB or excercise, PO₂ in the middle ear increased, but the pressure decreased.
It was concluded that middle ear pressure is increased by a rise of venous pressure and also by adiminution of middle ear volume caused by temporary swelling of mucous membranes. Middle ear pressure changes due to variations of blood flow may also be related to changes in gas metabolism, especially the production and influence of CO₂.

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The pressure in the eustachian tube was measured in 22 normal subjects by a pressure transducer with a diameter of 1 mm, The pressure was first recorded with the transducer advanced as much as possible, and then recordings were made at 5 mm intervals as it was withdrawn. The internal pressure at rest in the isthmus region was 19.5±20.1 mmHg, and decreased gradually toward the pharyngeal orifice of the eustachian tube. The variation of pressure on swallowing was the maximum at the region of 15 mm-20 mm from the pharyngeal orifice. The duration of movement of the eustachian tube on swallowing was approximately 900 msec. In the region of 15 mm-20 mm from ostium pharyngeum tubae auditivae, the eustachian tube became opened after approx. 300 msec from the beginning of the swallowing movement, remained open for about 300 msec and closed in about 300 msec. The wave-form of the internal pressure on swallowing differed with the regions in the eustachian tube.

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Fundamental and clinical studies were performed to evaluate the usefulness of the injectable cephem antibiotic ceftazidime (CAZ, Modacin^®) in the treatment of otitis media.
1) In the fundamental studies, CAZ 1 or 2g was administered intravenously, and the concentration of CAZ in secretions from the middle ear was measured. The concentration 1 hour to 2 hours and 40 minutes after injection was 3.2-25.6μg/ml, and the penetration rate was 11.2-79.9% of the plasma concentration.
2) In the clinical studies, CAZ 1 or 2g administered intravenously to 29 patients once or twice a day. The clinical efficacy rates were 75.0% (18/24) for suppurative otitis media, and 40.0% (2/5) for otitis media cholesteatoma. Bacteriological studies showed an elimination rate of 69.4% (25/36).
3) No side effects were noted except for slight GPT elevation in one patient.
4) The above results indicate that CAZ is a very useful antibiotic, especially for suppurative otitis media.

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The efficacy, safety and usefulness of flunisolide nasal spray, a corticosteroid for rhinitis, was evaluated in 25 children with allergic rhinitis. The percent efficacy and usefulness of flunisolide were 70.8% and 70.8%, respectively, and clinical symptoms were significantly (p<0.1%) improved irrespective of the severity of nasal signs and symptoms. Adverse reactions were reported in 4.2% of the patients, but all were mild. These results showed that flunisolide nasal spray is a very effective and safe treatment of allergic rhinitis in children.

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Laboratory test results and side effects after feeding with Clinimeal® were recorded in 24 patients with head and neck cancer.
Weight loss was less than 5%; serum total protein and albumin decreased at first, but then increased.
Serum sodium and chlorine decreased, and serum potassium increased.
Diarrhea, abdominal fullness and stool occult blood were seen as side effects, but Clinimeal® feeding could be continued with appropriate treatment. Stool occult blood, observed in 37.5% of the patients was not considered to be due to chemical irritation by Clinimeal® but to mechanical stimulation by the tube, mental stress after operation and postoperative bleeding in the digestive tract.

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