The use of artificial ossicles in tympanoplasty, especially ceramic ossicles was reviewed. We designed new types of ceramic artificial ossicles whose head was semicircularly removed on both side. They can be easily grasped by ear forceps and a total view of the stapes is obtained through the opening, so the orientation of the tips of PORP and TORP can be done more easily and securely. We described the details of the techniques of ceramic artificial ossicles insertion during tympanoplasty.

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Lesions in the posterior cranial fossa were visualized by single photon emission computed tomography (SPECT) with ¹²³I-IMP (N-isopropyl-p-¹²³I-iodoamphetamine) and ^99mTc-HM-PAO (^99mTc-hexametylpropyleneamine oxime). It is generally held that these radiopharmaceuticals penetrate the walls of cerebral blood vessels and that their accumulations in the brain tissue may reflect the cerebral blood flow.
Six patients with lesions in the central nervous system all showed wider areas of abnormality in SPECT than in X-ray CT, indicating a larger lesion of blood flow disturbance.
In the next series of 11 patients with vertigo or dizziness of unknown etiology, eight had abnormal findings in the scan with ¹²³I-IMP as did four of the nine in the scan with 99mTc-HM-PAO. Thus, most patients with dizziness of unknown etiology may have some vertebral blood flow disorder, which in some cases is not clearly diagnosed by conventional vestibular examinations or even by X-ray CT scan.
The accuracy of these diagnostic measures for otoneurological problems awaits further studies of their sensitivity and specificity.

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The audiometric records of 158 children covering a 5 to 22 year span (average 12 years 4 months) were analyzed statistically and the degree of average initial loss and average relative shift were correlated. The average age at the last hearing test was 19 years 7 month.
It was confirmed that ears with an initial hearing level of less than 90dB (average of 3 adjacent frequencies) showed a higher rate of deterioration (average of 3 adjacent frequencies greater than 15dB) and a greater average shift than ears with an initial hearing level over 90dB. The levels of significance were 0.1% and 1%, respectively.
These results must be kept in mind in the auditory training of deaf children with hearing aids.

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A 37-year-old male visited our clinic complaining of acute onset of right hearing loss and vertigo in the morning after sleeping in the right lateral position with his arm abducted.
Audiological examination revealed sensorineural hearing loss (average pure tone level 70dB), probably of cochlear origin.
Angiography showed stenosis of thoracic outlet portion of the right subclavian artery. Hearing loss and other symptoms disappeared after several days of steroid therapy.
The pathogenesis of hearing loss in this syndrome is discussed briefly from the point of view of the disturbance of the circulation to the inner ear due to subclavian arterial stenosis.

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High resolution CT scanning of the temporal bone in our clinic has provided a more detailed radiological classification of inner ear anomalies than before. The statistical analysis of inner ear malformations based on the theory of quantification II has produced discriminant equations for the measurable diagnosis of hearing impairment and development of the inner ear. This analysis may make it possible to diagnose total and partial deafness on ipsi- and contralateral sides.

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Five of the nine patients in this series had incudostapedial joint separation, two had stapes fixation, one had incudostapedial joint separation and incus fixation, and one had a dislocated stapes foot plate that had no contact with the oval window.
Autografts were used to reconstruct the discontinuity in six cases, and good results were obtained. Stapes surgery was done in three cases, and was successful in two cases.
The etiology of the anomalies observed in these patients is discussed from the standpoint of temporal bone embryology.
The results of pre-operative auditory function tests were evaluated. However, it was difficult to predict pre-operatively by auditory examination which type of ossicular anomalies the patients had.

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There are few ways to evaluate nasal allergy provocation tests objectively and quantitatively. The thread dying test method which was devised for lacrimation test (Kurihashi & Yanagihara) has been also used as a nasal secretion test (Kumazawa et al).
The efficacy of this test was evaluated by nasal provocation tests of 10 patients with cryptomeria pollenosis and 10 normal individuals as controls. The test was compared with Okuda's gradings for nasal allergy. The effect of drug therapy (Tranilast) was also evaluated by this method and by Okuda's subjective gradings. The results showed that 70% of the patients experienced relief and that objective signs of improvement correlated fairly well with subjective symptoms (p<0.1). Okuda's subjective evaluation, however, did not correlate well with changes in subjective symptoms.

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Asthma, aspirin intolerance and nasal polyps form the triad of aspirin-induced asthma (AIA). Eight patients with AIA and nasal polyps, 2 males and 6 females, were seen in our clinic from 1984 to 1986. We examined the relationship between nasal polyps and sinusitis diagnosed by nasal X-ray in AIA with nasal polyps. Four patients had moderate to large polyps and moderate to severe sinusitis, while four mild or no sinusitis regardless of nasal polyps. Hi.stological examination of the nasal polyps of 4 patients showed marked infiltration with eosinophils. In addition, marked peripheral blood eosinophilia was seen in 6 of 7 patients; the highest eosinophil count was 31%. However, only one patient was atopic with a high IgE level and positive skin test. Thus, nasal X-ray examination and the study of eosinophils in nasal polyps and peripheral blood may be useful in diagnosis of AIA.

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Pleomorphic adenoma in the maxillary sinus is extremely rare.
A 33-year-old female had been complaining of purulent nasal discharge. Radiographically, the left maxillary antrum was opaque, showing water density and a soft mass density. The patient was operated on, and a tumor with a cyst was resected. The diagnosis of the tumor was pleomorphi c adenoma. The patient showed no evidence of recurrence of the tumor for 28 months postoperativelly.
The clinical importance and general knowledge of pleomorphic adenoma are reviewed and discussed. In Japan, there have been only two other case reports of pleomorphic adenoma definitely diagnosed in the maxillary sinus.

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This is a clinical study of 55 patients with maxillary squamous cell carcinoma treated in Sapporo Medical College from 1977 to 1985. These patients were treated with a combination of radiotherapy, regional chemotherapy via a superficial temporal artery and surgery. They were divided into three groups according to their surgical procedures, A) necrotomy, B) reduction operation and C) radical operation, respectively. The cumultive 5-year survival rate was 31% in group A, 30% in group B and 47% in group C. The final local tumor control rate was 27% in group A, 40% in group B and 68% in group C. The patients in group C had lower incidences of local tumor rests and recurrence, but a higher incidence of distant metastasis than those in the other groups. The most frequent cause of treatment failure in the patients with cervical metastasis was the failure of local tumor control. When the maxillary tumor was well controlled by either external radiation or radical neck dissection, the prognosis was not poor even in those patients.

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Thirteen patients with hypertrophied lingual tonsils were treated with laser surgery in the ENT department of Heidberg Hospital, Hamburg. Hypertrophy of the lingual tonsils probably develops as a compensatory enlargement following palatine tonsillectomy. It may be true that repeated infection (lingual tonsillitis) in younger patients participates in the development of lingual tonsil hypertrophy. CO₂ laser surgery was used instead of surgical dissection with scissors or a tonsillotome. We conclude that CO₂ laser application is a better treatment of hypertrophy of the lingual tonsil than earlier techniques since it causes minimal bleeding during surgery, only slight postoperative scarring, no damage to surrounding tissues and minor postoperative pain.

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A 50-minute-old male infant N.Y. had dyspnea had a large mass in the pharynx. This tumor was covered with skin and was attached to the upper pole of the right palatine tonsil. It had a helix, antihelix, scapha, lobulus and a pit which resembled an external acoustic meatus. Microscopic examination showed a squamous cell epithelium, stoma consisting of connective and fibrous tissue with glands, hair follicles and cartilage.
The pathogenesis of this dermoid is unknown. It may represent the retention of a more primitive tissue of the auricle in the second internal cleft as early as three weeks in the embryonic stage. Both auricles were completely normal, so this dermoid may represent an included twin.

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A 28-year-old female had complained of left cheek swelling since 15 year of age.
The swelling gradually increased this year, and she wanted therapy for cosmetic reasons. It was very difficult to separate the tumor from the facial nerve because of its invasive nature. Facial nerve palsy continued for two months after the operation. Prior to the operation, echograms and computed tomography were helpful in evaluating this tumor.

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Three cases of so-called tripod malar fracture were treated by maxillary antrostomy for reduction and zygomatico-palatal Kirschner wire fixation (Matsunaga¹⁾). Under general anesthesia, a mucosal incision was made in the gi.ngivobuccal sulcus, and the anterior surfaces of the maxilla and zygoma were exposed. The bulk of the malar bone was reduced by an elevator and then fixed by the Kirschner wire driven from its lateral aspect aimed obliquely through the antrum towards the hard palate. The wire was left in place for four to five weeks and then removed under local anesthesia through a small skin incision made over the wire. Reduction and fixation were satisfactory in all three, and the facial scar was minimum.
Zygomatico-palatal Kirschner wire fixation is considered to be a safe and simple method of treating malar bone fractures.

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Granular cell tumors are relatively uncommon neoplasms of unknown histogenesis which arise in different regions of the body. In the head and neck, these are found most frequently in the tongue. Although the reported incidence of local recurrence after excision or multicentricity is high, these are believed to be benign. Only a few malignant variations have been reported.
This presentation is a case of malignant granular cell tumor of the right side of the neck in a 25-year-old man. The tumor increased rapidly in size and showed local recurrence and metastases to the pancreas, skin, and lymphnodes of the mediastinum. In spite of extensive surgery and chemotherapy, the patient died 268 days after admission. The histology, multicentricity, malignant variation, and therapy of these tumors are discussed.

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Immunodeficiency syndromes are considered to be responsible for some intractable infections of the ear, nose or throat.
In Japan, however, there have been only a few reports of IgG subclass deficiency.
This is a report of four cases of chronic or recurrent respiratory infection considered to be related to low serum levels of IgG subclass.
In two patients with purulent rhinorrhea and productive cough the diagnosis was chronic sinusitis, bronchiectasis and OME. Haemophilus influenza was isolated in sputum cultures. One patient had selective IgG₂ deficiency and the other patient had a low serum IgG₄.
The third patient had prolonged otitis media, had low serum IgG₃ and a diagnosis of Prader-Willi syndrome, the fourth had recurrent otitis media, low serum IgG₄ and a diagnosis of Wiskott-Aldrich syndrome.
Monthly intravenous injections of human immunoglobulin with high concentrations of the deficient subclass and appropriate antibiotic therapy brought about cures of their infections.

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In order to establish an ideal cisplatin (CDDP)-peplomycin (PEP) combined chemotherapy based on pharmacokinetics, we developed a regimen which showed the most potent anticancer activity in fundamental investigations with the use of flow cytometry. The results were described in our first to third reports.
In the present study, we administered CDDP and PEP intraarterially to a patient with left maxillary cancer. Histopathological examination and CT revealed very favorable results, and the efficacy of the regimen was confirmed. The kinetics of cancer cells during this combined chemotherapy were studied in detail by double staining with propidium iodide and fluorescein isothiocyanate after the intraarterial injection of bromodeoxyuridine, and the viability of the cells was determined with fluorescein diacetate. The results suggest that the S phases blocked 24 hours after the intraarterial injection of cisplatin, and the S and G₂M phases are blocked 24 hours after the intraarterial injection of peplomycin. These results were correlated with the data of the fundamental investigations reported previously. Changes in viability correlated were with the histopathological findings.
We believe that application of this method will be helpful in elucidating the mechanism of action of anticancer drugs and concomitant therapy against cancer cells.

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A new method of thyroid allografts in mice was established. Thyroid follicles of C57BL/6J mice were isolated and treated with anti-Ia antibody plus complement in order to eliminate Ia-positive cells. The follicles were mixed with agarose and transplanted under the renal capsule of BALB/c mice. Acceptance of the grafts was verified by histological study 100 days after transplantation. Allografts treated with anti-Ia antibody plus complement were accepted. These findings indicate that Ia-positive cells play a crucial role in the rejection of mouse thyroid allografts, and that the deletion of Ia-positive cells permits allografts to be accepted. Our method presented here may be developed as a strategy for the treatment of patients with congenital or acquired hypothyroidism.

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5-FU and FT-207 concentrations in serum and tumor tissues of four patients with maxillary cancers were measured after treatment with UFT.
1. Initial concentrations of 5-FU in tumor tissues after the administration of UFT (600mg 3 days) were at least 0.05mcg/g, a satisfactory level.
2. Levels of FT-207 in tumor tissue were consistently lower than in the serum, while levels of 5-FU in tumors were about 2-5 times higher than in the serum.
3. 5-FU concentrations in three patients continued to be more than. 0.05mcg/g at 8 hours and were highest at 1 4 hours, indicating that a dose of 600mg/day of UFT maintained effective concentrations.
When combined with radiation therapy and local necrotomy, UFT appears to be an effective anticancer agent for maxillary cancer.

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Myringotomy was performed in 37 ears of 21 children with otitis media with effusion, and their middle ear effusions (MEE) were examined. Tsumura-Saireito was administered in a dose of 3 or 6g/day orally for four weeks following the myringotomy. Fifteen of the 37 ears (40.5%) showed complete or partial recovery on clinical examination.
Both storage modulus (G') and dynamic viscosity (η') of the paired MEEs were determined by an oscillating sphere magnetic rheometer at a frequency of 1Hz under a constant temperature of 25°C. No significant difference was observed in G' and η' between the MEEs before and after treatment. These results indicate that the combination of myringotomy and Tsumura-Saireito did not change the viscoelastic properties of MEE within 4 weeks.

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After infusing LMOX (1 or 2g) intravenously in 57 patients undergoing head and neck surgery, the drug's concentrations in serum and the various tissues were investigated. The maximum concentration in all tissues except the cervical skin was higher with a 2g infusion than with a 1g infusion. The time to reach the maximum concentration i n serum and the tissues were 0.5 hours and 0.5-1.5 hours respectively.
The ratio of the concentration in tissues to that of serum was large in the following order; tongue>salivary gland>nasal or paranasal mucosa>tonsil>cervical fat.
No side effects of LMOX were observed.

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