Experimental studies were performed to determine the best method of facial nerve suturing. The best results were achieved by cutting the nerve in an oblique fashion and approximating the cut ends of the perineurium without tension by end-to-end anastomosis. Wrapping of the anastomosis area did not improve the end result of regeneration of the nerve fibers. When the corresponding fascicles cannot be identified, epineural suture is considered sufficient. Electron irradiation inhibited regeneration of the grafted nerve.
The ideal method of facial nerve suturing is described. In addition, the cases with intratemporal facial nerve grafting and cross-face facial nerve grafting are presented.

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Several cochlear implant systems have been released for commercial use. They are of various types: analog or digital stimulation, extracochlear or intracochlear stimulation, single electrode or multiple electrodes, and single channel or multiple channels.
The type of the implants, especially their speech-processing capacities plays an important role in speech discrimination. In this study, implants are compared in relation to some theories of auditory physiology. They utilize frequency- or placepitch, but they do not yet simulate phase locking of auditory nerve fibers to elicit pitch perception.
To make good use of the auditory brain's formant extracting activity, 10-15 independent speech-processing channels are thought to be essential.
Research on the auditory tract under electrical stimulation is expected to improve the quality of hearing with cochlear implants.

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121 patients (124 ears) of sudden deafness in last 6 years are presented.
63 patients were given medical treatment (Group SGB-) and 58 patients were treated with stellate ganglion block and drugs (Group SGB+).
83.9% of all the cases showed more than 10-dB average pure tone gain, and the difference between the two groups is not significant.
More significantly, in the cases of high hearing loss more than 61dB 89.5% in Group SGB+ showed over 10dB improvement, compared to 75.9% in Group SGB-, and in the cases of high hearing loss with vestibular signs 82.4% in Group SGB+ revealed over 10dB impairement, compared to 40% in Group SGB-.
The results are also observed in relation to the factors associated with prognosis of sudden deafness.

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Seven patients who experienced a rapid onset of simultaneous sensorineural hearing loss with predominantly low tone impairment were seen during one three-month period. No previous report of a similar situation was found in the literature.
Brain stem emcephalitis, due to viral infection, was suspected as the primary cause for the following reasons: 1) all cases occurred within a three-month period: 2) endemic incidence: 3) hive of the seven patients reported previous cold symptoms, excessive work or headache: 4) simultaneous involvement of other cranial nerves (V, VII) in one case.
All patients were given vitamin B₁₂, prednisolone, and careful instructions to avoid excess physical activity. Five patients, who were seen within seven days after the onset, showed complete improvement in hearing in both ears. The other two, who visited on ten days after the onset, showed partial or no improvement. The interval between the onset of symptoms and the beginning of treatment seemed to be the most important prognostic factor.

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Inner ear syphilis is a well-known disorder, associated with various chronic symptoms, which is difficult to treat. The present report describes late congenital inner ear syphilis in a patient followed for about two years. Fluctuating hearing loss responded to long-term steroid therapy. The general treatment of inner ear syphilis is discussed with reference to the previous literature.

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The authors reviewed 26 patients (5 males and 21 females) with functional hearing loss diagnosed and treated at Tokyo University Hospital. The patients were all under 20 years of age.
They were classified into three groups mainly on the basis of the mode of onset of hearing loss, and the characteristics of each group were investigated.
Group 1 consisted of patients who had acute onset of hearing loss, Group 2 of patients who were aware of hearing loss but could not date the onset, and Group 3 of those who were not aware of their own hearing loss until it was detected by a screening test at school. All of the patients in Group 1 were female. In this group, unilateral hearing loss and the type V pattern of Békésy audiometry were frequently observed. Prompt recovery of hearing was common. All the patients in Group 2 were also female. In this group hearing loss was relatively mild, but recovery tended to be delayed.
Group 3 was subdivided into two subgroups according to the time required for the improvement of pure tone audiometric findings. In subgroup A, the patients recovered within three months and the male/female ratio was 4/3. Neither the type V pattern of Békésy audiometry nor abnormal ophthalmological findings were observed. In subgroup B, the patients did not recover within three months, and some showed the type V pattern of Békésy audiometry or abnormal visual fields. There appeared to be definite differences between subgroups A and B.
Representative cases of a 17-year-old girl (Group 1) and a 6-year-old girl (Group 3B) are presented.

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Respiratory activity (gas metabolism) of the middle ear cavity (including the mastoid cells) plays an important role in ventilation by opening and closing the eustachian tube in a normobaric environment. Electron microscopy shows that the submucosal capillaries of the human mastoid cells are structures which facilitate the intra and extravascular transport of substances, suggesting that these capillaries are involved in gas metabolism. The PO₂ (53.7±6.5mmHg: 22 ears) of the human tympanic cavity is lower than the atmospheric O₂ (150mmHg) pressure. This phenomenon suggests that a low PO₂ in the middle ear cavity is useful in preventing infection, and that the gas metabolic function of the mastoid cells, with their characteristic submucosal capillary structure and their larger volume than that of the tympanic cavity, plays an important role in maintaining the ventilatory function of the middle ear cavity. The results indicate that tubal ventilation in a normobaric environment keeps the internal pressure of the middle ear cavity similar to or slightly higher than the ambient pressure by the production of gas tension, which inhibits gas flow from the pharynx to the middle ear cavity.

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A series of 97 consecutive patients with olfactory disturbance was studied clinically. The severity and treatment were correlated with the etiology: common cold, rhinosinusitis, nasal allergy, trauma, drug-induced, unknown origin, etc. These patients were seen in the out-patient clinic of the department of Otolaryngology, University of Tokyo, from 1986 to 1988.
The diagnosis of olfactory disturbance was based on a full history, careful inspection and roentgenographic examination of the nose and paranasal sinuses. Tomography and a rigid endoscope with an outside diameter of 1.7mm were used for observation of the olfactory cleft. A standard olfactory test and an intravenous olfaction test were used not only for estimating the degree of olfactory disturbance and the prognosis, but also for obtaining reference data for diagnosis of the lesion.
Steroid hormones in the form of nasal drops were administered to patients in the head down position as the basic treatment.

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Bilateral tonsillar tumors are very rare. Lymphoepithelioma of both palatine tonsils was diagnosed in a 61-year-old male. The patient's complaints were hemosputum and cervical lymph node swelling. Histological examination of the palatine tonsils disclosed lymphoepitheliomas consisting of large immature anaplastic epithelial cells, associated with lymphoid cells. Clinical examination demonstrated bone and lung metastases. In spite of radiation therapy and chemotherapy, he died four months after treatment was started. To our knowledge, this is the first report of such a case.

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During the past ten years, 211 patients with parotid tumor were treated in the Department of Otolaryngology, Kansai Medical University. The pathological diagnosis were made according to the classification of the World Health Organization (1972).
Of the 211 parotid tumors, 174 were benign and 37 were malignant. The most common tumor was pleomorphic adenoma (106 cases/50.2%), and next was adenolymphoma (25 cases/11.8%). The incidence of adenolymphoma is higher than in any previous report.
However this rising incidence of adenolymphoma has been pointed out in some recent papers. We think that adenolymphoma will be diagnosed increasingly frequently because of advances in preoperative diagnostic techniques and that more patients will be referred for surgery.

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Chondromatous metaplasia is a disease in which formation of cartilage takes place in the soft tissues. It is rarely seen in the vocal cords and false cords of the larynx, and very few reports of chondromatous metaplasia of the larynx have been published. We report here three cases of chondromatous metaplasia of the larynx. Chondromatous metaplasia should be considered in the differential diagnosis of submucosal tumors of the larynx. The diagnosis was made because the tumors were composed of fibroelastic cartilage which was not continuous with the laryngeal cartilage. Palpation with forceps revealed a hard submucosal tumor. On CT scan, the density of the tumor was the same as that of the epiglottic cartilage, and its margins were not clearly delineated. The diagnosis of chondromatous metaplasia was established by histopathological examination. Elastic fiber stain was useful to establish the diagnosis.

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An 11-year-old boy had had a swelling in the right submandibular region since birth. CT scan disclosed a high density area, and angiography revealed that the major blood supply to the mass was from the right facial and lingual arteries. During surgery to remove the entire mass an enlarged jugular vein connected to it was identified. The diagnose is histological examination confirmed of arteriovenous malformation. This is a rare anomaly in the head and neck region. The clinical diagnosis should be confirmed by angiography, since it is difficult to differentiate various vascular diseases. There are specific pathomorphological changes in the drainage areas such malformations, which are called “arterialization of veins”. A-V malformations are of long duration and often progressive in nature, and they may respond only temporarily to surgical resection. Therefore, follow up examinations are necessary to prevent recurrence, as in our patient.

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A case of bilateral carotid body tumors is reported. The patient was a 28-year-old female with a 10-year history of painless and pulsating neck masses on both sides. Enhanced CT scan demonstrated well-circumscribed masses with strong enhancement on both sides of the neck which surrounded the carotid bifurcations. Carotid angiography revealed highly vascularized masses on both sides of the carotid bifurcations.
Resection of each tumor was performed separately under hypotensive general anesthesia. Dissection in the capsular-adventitial plane was successfully performed using a bipolar coagulator under an operating microscope. The common and internal carotid arteries on both sides were preserved. Histological examination of the resected specimens confirmed the diagnosis of carotid body tumors.
This report is the second case of the bilateral carotid body tumors in Japan.

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Two patients with Pickwickian syndrome had severe obstruction symptom of the upper airway. The first patient was a 20-year-old male student, whose schizophrenic reactions obliged us to suspend tonsillectomy; he died of acute respiratory insufficiency caused by acute inflammatory complications. The second patient was a 9-year-old boy, whose sleep apnea was greatly improved after adeno-tonsillectomy. The mechanism of dyspnea in the two cases was discussed on the basis of a review of the literature.

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The concentrations of benzylpenicillin (penicillin G; PG) in sequential samples from the scala tympani (ST), scala vestibule (SV), cerebrospinal fluid (CSF) and serum of guinea pigs after the intravenous injection of 200mg/kg PG were measured by highperformance liquid chromatography. We also investigated PG concentrations in the perilymph of guinea pigs pretreated with the competitive organic anion transport inhibitor, probenecid (PR).
We found a pronounced difference in the clearance curve of PG between ST and SV. Two hundred mg/kg of PR significantly increased the half-life time of PG in the serum, and also increased the PG concentration in the CSF. Pretreatment with the same dosage of PR inhibited the accumulation of PG in the ST and abolished the peaking of PG. This curve was very similar to that in the SV. PG concentrations in the SV were unaffected by pretreatment with PR. These data are analogous to the results of the furosemide experiments reported by Hara et al (1987).
Our data suggest a difference in the anion transport mechanism between ST and SV.

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Secretory otitis media is the most common cause of conduction deafness in children. Since 1982 we have used hyperbaric therapy in a high pressure chamber for children with secretory otitis media. We re-examined 51 patients 3 to 5 years after a series of hyperbaric treatments in an investigation of the long-term effectiveness of hyperbaric therapy. The patients were 3 to 10 years old. 92 ears were re-examined. The average hearing levels at the time of re-examination were 14.4±7.9dB (mean±S. D.), 9.9±7.2dB and 9.6±7.9dB in the low, medium and high tone ranges, respectively. There was no difference from the results at the completion of treatment.
The tympanogram at the initial visit was type B in more than 90% of the patients. However, it was type A in 56 ears (60.9%), type B in 16 ears (17.4%) and type C in 20 ears (21.7%) at the time of re-examination.
The patients were divided into two groups on the basis of the degree of pneumatization of the temporal bones seen in radiologic study. A group with good pneumatization (42 ears) and a group with poor pneumatization (50 ears) were tested. The average hearing level in the good group was 12.7±5.8dB, 6.8±3.9dB and 6.0±4.8dB in the low, medium and high tone ranges, respectively. This group had better hearing levels in the middle and high tone ranges than the poor group with levels of 12.3±5.0dB, 10.0±5.3dB and 11.4±6.8dB, respectively.

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Velopharyngeal competency and respiration through the nose were evaluated one year or more after the folded pharyngeal flap operation in 49 patients: 27 cleft lip and palate, six with complete cleft palate, 16 with soft or submucous cleft palate. It was confirmed that adequate velopharyngeal competency had been attained in all 49 cases on the basis of aerodynamic assessment on the utterance of the mono-syllable plosives Pa·Pi·Pu and the auditory perception of speech. Three of the 16 patients with soft or submucous cleft palate complained of nasal obstruction; nasopharyngeal resistance in the 14 with soft or submucous cleft palate was not statistically higher than normal, as measured aerodynamically. It was concluded that nasal respiration might be slightly affected by the folded pharyngeal flap operation.

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The children with otitis media with effusion treated with tympanotomy, ampicillin rectal suppositories (Herpen®) were given.
1) Herpen suppositories containing 125mg or 250mg of ABPC, were inserted 3 times a day for 7 days following tympanotomy.
2) The effectiveness of the therapy was evaluated by subjective symptoms, ear drum findings, mobility of the ear drum, air-bone-conduction threshold, tympanogram, and acoustic otoscopy. The findings is nearly all the patient improved. Ear discharge after tympanotomy was not observed.
3) Slight diarrhea was occured in 2 patients, and a few complained of anal pain.
The above results indicate that ABPC suppositories are useful in the treatment of otitis media with effusion in children with tympanotomy.

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The therapeutic effect of Broncasma Berna® was examined in 35 children with chronic sinusitis. One ml of Broncasma Berna® was diluted with 1ml of saline, and 1ml of the solution was administered nasally via a nebulizer once or twice a week. The efficacy was evaluated after 8 or 16 weeks of administration.
1. The general effectiveness, determined by rhinoscopy and x-ray examinations, was 80% (28/35).
2. Nasal airway resistance and Saccharin time improved significantly after both 8 and 16 weeks of administration.
3. No side effects were noted.

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