A 77-year-old female was found to have a small acoustic neurinoma which was removed totally with a translabyrinthine approach. The surgical treatment should be determined in consideration of the general condition, tumor size, and the contralateral hearing level. When these conditions permit, even in elderly patients the total removal is desirable.

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Sixty patients with peripheral latero-vestibular disorder were examined with the head-shaking test (HST) and ENG.
1) Monophasic nystagmus was observed in 17 patients (28.3%), biphasic in 36 patients (60.0%) and triphasic in 4 patients (6.7%).
2) In 48 patients (80.0%), the first phase of nystagmus was directed to the nonafrected side and in 4 patients (10.0%), to the affected side. Rotatory nystagmus was observed in 2 patients (3.3%) and downbeating nystagmus in 1 (1.7%).
The HST is an important aid in detecting latent imbalance in the vestibular system.

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To clarify the inner ear disturbance in cases of chronic otitis media (COM) with labyrinthine fistula, the pure-tone thresholds, positional nystagmus under Frenzel glasses and ENG were investigated. All 18 patients had a fistula of the lateral semicir-cular canal. Sixteen had cholesteatoma and two had no cholesteatoma but had had middle ear surgery. Advanced sensorineural hearing impairment and a high incidence of spontaneous nystagmus were found in these patients when compared with COM patients without labyrinthine fistula, whereas the quantitative analysis of ENG recordings in cases of labyrinthine fistula showed results almost equal to those with-out fistula. Thus it can be said that the inner ear disturbance in patients with labyrinthine fistula progressed gradually to the same degree as in those without fistula.
During the surgery for cholesteatoma, the cholesteatoma-matrix was removed from the semicircular canal fistula. After the fistula had been patched with free autografts of bone and fascia, tympanoplasty was performed in all cases. The average pure-tone threshold was significantly improved from 79.3dB to 68.5dB.

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The present state of knowledge concerning hearing loss due to mumps is described. The diagnostic criteria for hearing loss have been proposed by the Acute Profound Deafness Research Committee under the auspices of the Ministry of Health and Welfare. These criteria are the first to be developed since hearing loss was defined more than 100 years ago. The incidence of hearing loss is not high. However, mumps is still one of the important causes of profound hearing loss, as mumps often occurs without symptoms. Prevention of hearing loss will be an added benefit of anti-mumps vaccination.

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The biochemical characteristics of middle ear effusion reflect the inflammatory changes in the middle ear cavity. In this study, prostaglandins (PGE₂, TXB₂, 6-keto-PGF₁α) in middle ear effusions of patients with secretory otitis media were measured by radioimmunoassay (RIA).
Fifty samples of middle ear effusion were obtained from 45 patients aged 3 to 76 years who were divided into three groups; 1) children (23 samples; mucoid 19, serous 4), 2) adults (18 samples; mucoid 2, serous 16), and 3) patients with cholesterol granuloma (9 samples).
Middle ear effusions in groups 1 and 3 contained higher concentrations of pros taglandins (PGE₂, TXB₂) than these in group 2. Even in group 2, however, the concentration of PGE₂ was higher in the middle ear effusions than in the serum.
These results suggest that prostaglandins play an active role in maintaining the inflammatory response in the middle ear, especially in children and in patients with cholesterol granuloma

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This paper examines the cause of fever of unknown origin which occurred on two occasions previous to surgery in a patient with chronic paranasal sinusitis. Examination ruled out infection and allergic reaction to medication as possible causes of the fever. Reference to pharmaceutical literature revealed that pentazocine, one of the drugs used in premedication, activates a σopioid receptor, which has a temperature elevating effect. There have only a few clinical reports of temperature elevating following the administration of pentazocine.

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In the treatment of ranula, excision of the cyst or fenestration of the cystic wall in the oral floor are usually used. Recently, laser surgery and cryosurgery have also been used to treat this disease. We have developed a simpler method. After the contents of the ranula have been removed by puncture, 10% silver nitrate solution is injected into the cavity. Suction and injection of the solution are repeated several times, and the final complete suction ends the operation. Postoperative reaction of local tissue is not severe. We have treated seven patients with ranula by this method, six successfully, one patient relapsed. The details of this technique are reported.

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A whitish hairy tumor was located in the middle section of the lateral aspect of the tongue next to a slightly elevated flat tumor. An area of leukoplakia 3-4mm in width surrounded these two protruding lesions. This rare oral lesion was examined morphologically with light and electron microscopy. No malignant cells were seen. Both protruding lesions consisted of keratinizing squa, mous cell layers which included many hairy units (basement membrane-squamous cell layers surrounding a loose connective tissue core). The leukoplakia area showed no hairy units. Candida-like structures were present on the leukoplakia surface. The relationships among candidal leukoplakia, malignant change and systemic disorders (AIDS etc.) are discussed.

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Because of changes in sexual mores, the oral cavity is increasingly becoming the site of primary infection for sexually transmitted diseases. A 28-year-old man who had severe tonsillitis needed hospitalization for parenteral fluid therapy. The tonsils were red and edematous without lacunar exudates. There was a shallow ulcerative lesion on the right posterior pillar. He had engaged in orogenital sex (cunnilingus) two weeks previously. Culturing swab from the ulcerative lesion and immunofluorescent technique showed herpes simplex virus type 2. The initial leukocyte count was 6400/mm₃ with 56% neutrophils, 23% lymphocytes and 21% monocytes. Interestingly, the serum anti-EB virus titer was elevated during the acute phase (VCA γ-G 1 : 80 initially and1 : 20 in the convalescent phase). It seemed likely that endogenous reactivation of latent EB virus occurred in the tonsillar B-lymphocytes in a heterogenous response to HSV-2. One month later culturing swab from the tonsil was negative and the serum titer of anti-HSV type 2 was 1 : 4.

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The effect of tumor growth on Eustachian tube function was analyzed by correlating tubal function (ventilatory function and clearance function) and tumor staging, assessed by CT scans and endoscopy of 30 cases (56 ears) of nasopharyngeal carcinoma. CT-staging was closely correlated with endcscopic results, but the former was more specific than the latter. Impairment of active opening and clearance function increased as tumor growth progressed. A similar correlation was found between the incidence of otitis media with effusion (OME) and tumor growth. However, passive opening was not impaired until the parapharyngeal space was completely occupied by tumor. Negative pressure equalization function showed the most impairment, followed in order by positive pressure equalization function, clearance function and passive opening. These results indicate that extension of tumor around the tube caused tubal dysfunction with subsequent development of OME.

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Magnetic Resonance Imaging (MRI) was used in the examination of three patients with nasopharyngeal malignant tumor and cranial nerve symptoms. Coronal and saggital sections were very useful for determining skull base invasion. Its high contrast resolution enabled us to visualize several cranial nerves directly. Differen-tiation between tumor and effusion in the paranasal sinuses was easy especially in T2 weighted images. Bone destruction could also be detected as bone marrow replacement by tumor or as interruption of the black line of compact bone. Local relationships of tumor and large blood vessels were visualized by MRI without invasive contrast enhancing methods. Despite such advantages, in one patient whose symptoms were highly suggestive of cranial invasion, no cranial invasion was detected by CT or MRI.

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Vascular reconstruction is necessary when tumors invade the carotid artery and or jugular vein. We describe two such cases and discuss the operative technique.
The first case was a 46-year-old man with laryngeal carcinoma and the second was a 69-year-old man with hypopharyngeal carcinoma. Both had neck metastases which involved the large blood vessels. Neck dissections were performed and the carotid artery and jugular vein were reconstructed with a section of the great saphenous vein. Blood flow was monitored with digital subtraction angiography (DSA). In the first case, the right carotid artery and jugular vein showed good blood flow. The left jugular vein and right carotid artery in the second case were obstructed a few months later. There were many problems during surgery. Maintenance of cerebral blood flow is the most important consideration. Internal shunts were useful in maintaining sufficient cerebral circulation during the operations.

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The definitive tumor associated antigen for monitoring head and neck malignant tumors has not yet been found. The purpose of this study is to evaluate the clinical usefulness of existing tumor associated antigens. Blood samples drawn before and after treatment from 61 patients with malignant tumors of the head and neck were tested with radioimmunoassay for SCC (Squamous Cell Carcinoma Related Antigen), NSE (Neuron-Specific Enolase), Ferritin, CEA (Carcinoembryonic Antigen), CA 19-9 (Carbohydrate Antigen 19-9) and AFP (α-Fetoprotein). Serum levels exceeding the normal range of each antigen were defined as “positive”. Sera from 28 out of 59 patients (47%) were positive for SCC, and 20 of 40 (50%) were positive for NSE. Although there was no statistical correlation between the serum levels of SCC and NSE (r=0.063, p>0.05), 75% of patients were positive for SCC and/or NSE. It is worthy of notice that 84% of the serum samples from patients with squamous cell carcinomas of the head and neck were positive for these two antigens. Only 38% and 7% of the sera were positive for Ferritin and CEA, respectively. No sample was positive for CA 19-9 or AFP. Therefore, these 4 antigens were not considered to be useful in the detection of head and neck malignancies. The authors conclude that SCC and NSE are of great value in the diagnosis and monitor of malignant tumors of the head and neck.

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The patient was a congenitally deaf and dumb 23-year-old female with cerebral palsy and hyperthyroidism. She had had occasional slight oral bleeding and difficulty swallowing for about 7 months. A foreign body in the esophagus was detected by chance when she visited the pediatrics department of our hospital for follow up of hyperthyroidism. The foreign body (a curtain hook) was removed by lateral esophagotomy.

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Two cases of unusual foreign bodies (crabell) in the bronchus are reported.
The first patient was a 29-year-old male who aspirated a crabshell into the bron-chus when he was eating a crableg. Bronchoscopy was carried out but removal of the foreign body was difficult as the crabshell had many spikes which stuck into the wall of the bronchus.
The second patient was a 51-year-old male who aspirated a crabshell into the bronchus in the same way. In this case, after removing some of the stuck spikes, we could easily take out the remaining fragment.
Some clinical features of this bronchial foreign body (crabshell) and technique of removal are discussed.

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The ventilation and clearance of the middle ear were measured by radioisotope imaging techniques in order to gain a clear picture of the mechanism of ventilation. Radioactive xenon gas was insufhated into the middle ear of 9 normal subjects via the Eustachian tube, and observed by scinti camera. The volume was calculated with the passage of time. Approximately 11% of the insufflated gas immediately entered into the middle ear cavity and mastoid air cells in spite of the fact that the middle ear and mastoid air cells are a closed cavity. The gas in the middle ear diminished at a rate of 6% of volume per hour and it was thought to be absorbed mainly into the middle ear mucosa at a regular rate in the resting state.

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Using our new 3-D reconstruction system, we reconstructed the bony structure of human temporal bone from the histological sections cut horizontally. The details of temporal bone structure were clearly visible. This system has some original features. First, we can look at the reconstructed structure from any direction. Second, it is possible to observe its internal aspects by using the ''drill mode''which can delete desired portions for desired sizes.
The 3-D reconstruction by this method is useful not only to understand the complicated structure of the human temporal bone, but also for simulations of ear surgery.

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Using an ultrasonic nebulizer, 6 ml of Broncasma Berna solution diluted 12-fold with saline was given intranasally at a single dose to 15 patients with chronic sinusitis two or three times a week over a period of 4 weeks, and the ciliary movement of the nasal mucosa before and after the treatment was measured. Ciliary movement was increased markedly in 7 patients, and slightly in 7 but was slightly decrease in 1.
Nebulization with Broncasma Berna was found to enhance nasal mucociliary move-ment.

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Fifteen patients who underwent surgery in the head and neck region were administered loxoprofen sodium of 60mg t.i.d. for 19.1 days (mean period). Ten of the 15 patients felt improvement of the symptoms within 30min after the administrations. The drug was remarkably or moderately effective in 12 of 15 patients. No side effects were observed. The rate of usefulness for the drug was 80%.

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