Two patients with vertigo, tinnitus and sensorineural hearing loss are reported. The clinical course of the first patient was similar to Meniere's disease and the second patient had sudden deafness and benign paroxysmal positional vertigo.
In both patients, the anterior inferior cerebellar artery compressed the eighth cranial nerve. After microvascular decompression, vertigo improved in both patients, and sensorineural hearing loss also improved in the first patient.
We also reviewed the results of twenty cases of neurovascular decompression.

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Visual suppressions of caloric nystagmus was studied in 86 patients with spinocerebellar degenerations in association with other neurotological examinations.
In 16 of the patients, caloric nystagmus was normally suppressed by visual fixation, while in 41 it was not suppressed, and in 19 it was even enhanced by visual fixation. In 10, the influence of visual fixation on caloric nystagmus could not be evaluated because of deficient caloric nystagmus or of disturbance of the quick phase of nystagmus.
The presence of gaze nystagmus and/or rebound nystagmus was closely correlated with the incidence and degree of the disturbance of visual suppression. Also, disturbance in pursuit eye movement, saccadic eye movement and optokinetic nystagmus was related to that of visual suppression. The presence of positional nystagmus or positioning nystagmus, however, was not related to disturbance of visual suppression.
On the basis of our study of visual suppression, the significance of positional and positioning nystagmus tests was considered to be somewhat different from that of other neurotological examinations.

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Sixty two new cases of Bell's palsy or Hunt syndrome seen during 46 months at our clinic were examined to determine the relationship between the clinical course and the EBV antibody titer.
Anti-EBV VGA IgG titers were significantly higher in patients with a prolonged illness than in those who recovered promptly. However, anti-EBV EBNA titers were lower in the former than in the later group. This findings suggests that cell-mediated immunity of the patients enhances their recovery process.

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A 44-year-old male was referred to our hospital with a spiking fever, a fetid necrotic mass in the left nasal cavity, and erosion in the midline of the hard palate. These clinical findings suggested a lethal midline granuloma. Biopsies were done several times, and the final pathological diagnosis was malignant lymphoma, diffuse pleomorphic type. Immunohistological examination showed a malignant lymphoma of the inducer/helper T cell type. The anti-ATLA antibody titer was 1: 320. On the basis of these findings, this case was classified as ATLL, and treatment with combined irradiation and chemotherapy was instituted. The patient recovered well, and no recurrence has been observed during the one year follow-up.
Midline granuloma is not a pathological entity, and lymphoma is one of the many pathological conditions that may give rise to necrosis in the nose. ATLL is discussed in relation to this problem.

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A 32-year-old woman developed cerebrospinal fluid (CSF) rhinorrhea 13 years after a head injury due to a traffic accident. She had been well until she experienced a difficult delivery 4 years earlier. Since then she had had watery rhinorrhea on exertion. She had suffered twice from meningitis of unknown origin. On a clinic visit for another problem, CSF rhinorrhea was suspected and a further history of fever and photophobia was elicited. RI cisternography and metrizamide CT revealed evidence of right CSF rhinorrhea. A fistula was confirmed at operation, and the defect was successfully sealed of with autogenous fascia and tissue adhesive (Biobond®).

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Autonomic nerve receptors and histamine H₁ receptors in the mucosa of the inferior nasal concha were determined by receptor binding assay in patients with allergic rhinitis, those with allergic rhinitis treated with an NSP nebulizer (NSP group), and controls with chronic sinusitis. The number of acethylchol.ine receptors was significantly higher in the patients with allergic rhinitis than in the control group and significantly lower in the NSP group than in the patients with allergic rhinitis. The numbers of α₁ receptors and β receptors in the patients with allergic rhinitis were significantly lower than in the control group but similar to those in the NSP group. The number of histamine H₁ receptors did not differ among the 3 groups.

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Eleven patients with olfactory disturbances caused by inflammation of the ethmoid sinuses are reviewed, and the functional results of endonasal surgery are evaluated.
Rhinoscopic examination showed the presence of a purulent discharge and mucosal thickening of the superior meatus.
Radiographic examination showed opacity in the ethmoid sinus and the olfactory region.
A standard olfactory acuity test, each side separately in 9 patients and both sides together in 2 patients (20 tests in 11 patients), and an intravenous olfaction test with alinamine were performed before and after surgery.
The standard olfactory acuity test showed that 16 out of 20 (80%) recovered more than 1 grade in the detection threshold, and 15 out of 20 (75%) recovered more than 1 grade in the recognition threshold after endonasal ethmoidectomy.
We conclude that patients with olfactory disturbance caused by ethmoid sinusitis can expect good results of surgical treatment.

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A 53-year-old woman had had right nasal obstruction for several years. Physical and X-ray examinations revealed a nasopharyngeal tumor. The tumor was removed through a transpalatal approach under general anesthesia. The tumor was attached to the roof of the nasopharynx with a thin stem. The pathologic diagnosis was osteoma.

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After the extirpation of tonsils with a wire snare, electrocoagulation and/or ligature have been widely employed for hemostasis. Suture ligature may cause laceration of the major branches of the facial or internal carotid artery. Monopolar coagulator is useful for hemostasis, but the technique may produce severe and deep burns in the tonsillar fossa and delayed postoperative bleeding.
Since 1985 I have performed 88 tonsillectomies with the use of an extracapsular dissection and hemostasis technique with a bipolar coagulator.
In this paper the principles and technique of tonsillectomy with a bipolar coagulator are outlined and recommended because of better control of the bleeding and lower risk of postoperative bleeding.

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Images of the larynx from various points of view were obtained by computer graphics. For reconstructing the three-dimensional structures of the larynx, both nondecalcified serial cross sections of the normal larynx, made by polyester resin embedding technique, and CT scan films of the pathological larynx were used. Following digitization of each slice, the X and Y coordinates were standardized and the Z coordinates were calculated. Then each structure (laryngeal cartilages, muscles, membrane and so on) was drawn shading the hidden structures. This graphic technique demonstrated clearly the whole image of the normal larynx, the spatial relationship between the lumen and the thyroid gland flap of the hemi-laryngectomized larynx, and the difference of the vocal fold level of the paralyzed larynx. The finer cross sections will make it possible to understand the fine structures, such as that of the arytenoid cartilage, when this method of computer graphics is used.

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Observation of systemic immunity is considered to be useful in the evaluation of the treatment of malignant tumors. Lymphocyte subsets were measured with the use of monoclonal antibodies (two color method) in 17 malignant tumors of the head and neck and compared with the lymphocyte subsets in the peripheral blood and metastatic lymph nodes.
Lymphocyte subsets in the peripheral blood of 10 normal persons were measured as controls.
Helper T cells (CD4+, 2H4-) were more numerous in cancer patients, while the NK subset (dull CD8+, CD 11+) and NK activity (CD 16+, Leu7+) were significantly higher in the controls.
In the cancer patients the peripheral blood contained more suppressor T cells (bright CD8+, CD 11+) and NK activity (CD 16+, Leu7+) than did the metastatic lymph nodes.

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In our ORL clinic during the past 11 years (1976-1986) we saw 417 patients with head and neck cancers, 32 of whom developed lung metastases.
1) Metastasis was most common in patients with carcinoma of the nasopharynx, tongue, oral cavity, hypopharynx and major salivary glands. Adenoid cystic carcinoma was the most frequent histological diagnosis.
2) The progression of the lesions of adenoid cystic carcinoma was found to be gradual, even in patients with metastasis. Therefore their survival periods were relatively long.
3) Longer survival periods were noted in patients who received some treatment for their metastases than in those without any treatment.
4) Radiotherapy and chemotherapy for metastatic lesions resulted in longer survival periods than did surgical excision alone.
5) The choice and performance of therapy for these metastatic cases should be individualized by a joint conference of radiologist, chest surgeon and otolaryngologist.

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Forty-three patients with squamous cell carcinomas of the head and neck, who had received no previous treatment, were given combination chemotherapy composed of Cis-platinum (CDDP), Peplomycin (PEP), Adriamycin (ADM) intraarterially or intravenously. Complete remissions were obtained in fifteen (34.9%) and partial remissions in eighteen (41.8%). The intraarterial route was more effective than the intravenous route. The main side-effects were nausea and vomiting (83.7%), anemia (48.5%), leukopenia (69.8%), thrombocytopenia (20.9%), renal toxicity (18.6%), alopecia (65.1%), and hearing loss (30.2%). All side effects were, however, mild and transient. Combination chemotherapy composed of CDDP, PEP, and ADM appeared to be effective for squamous cell carcinoma of the head and neck. Further study should be performed on infusing and effective regional doses of drugs based on the cell kinetics, reciprocal actions of drugs, etc.

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The efficacy of the intratympanic administration of CMC steroid for the treatment of inner ear disorders was investigated in 64 guinea pigs. Dye solution without CMC injected into the middle ear was cleared through the eustachian tube on the first day. When dye plus CMG were injected, they remained in the middle ear in 100% of the guinea pigs on the first day, in 67% on the fourth day and in 33% on the seventh day. The uptake of steroid in the perilymph after the intratympanic administration of CMC steroid was significantly higher than after the intratympanic administration of steroid without CMC on the fourth and seventh days. These results indicate that CMC delays the clearance of steroid from the middle ear and enhances the uptake of steroid in the inner ear through the round window.

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The effect of sympathetic denervation on nasal hyperreactivity was studied in guinea pigs sensitized by the nasal application of TDI (toluene diisocyanate). Signs and symptoms of nasal hyperreactivity were noted, and histamine assays and histological examination of the nasal mucosa were performed.
In TDI-sensitized guinea pigs the histological appearance of the nasal mucosa suggested type I allergy, but the effect of TDI on the nose as an irritant or its effect on the autonomic nervous system could not be excluded. Unilateral superior cervical ganglionectomy performed before sensitization led to more severe sensitization than in the control group. However, ganglionectomy performed after sensitization resulted in less severe sensitization than in the control group; ganglionectomy had no influence on the histamine content or the histological changes in the nasal mucosa of sensitized guinea pigs 6 weeks after operation.
It was assumed that guinea pigs with nasal hyperreactivity had abnormal autonomic nervous function. We concluded that correction of the abnormality of autonomic regulation in the nose by sympathetic denervation inhibited the nasal hyperreactive symptoms. These experimental results suggest that stellate ganglion block may be effective therapy for nasal hyperreactivity.

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Flow Cytometric (FCM) DNA analysis was performed on surgical specimens taken from 17 patients with benign tumors and 26 with malignant tumors of the head and neck. The proportion of proliferative cells showing S, G2 and M phases in the DNA histogram was analyzed and correlated with the pathological findings. In malignant tumors, the “Proliferative Index (P. I.)” was significantly higher than in benign tumors, but in some specimens with malignant pathological findings, the P. I. was low. In such cases, the area occupied by tumor cells was very small. To interpret the cell kinetics of head and neck tumors with FCM correctly, one must take it into consideration that the tissue specimen obtained from the tumor may include both tumor cells and non-tumor cells.

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The effectiveness of serratiopeptidase, a proteolytic enzyme, in 23 adults with chronic sinusitis was examined. The patients received 30 mg of serratiopeptidase p.o. per day for 4 weeks. Neither antiinflammatory agents nor mucolytic agents were given.
The effectiveness of serratiopeptidase on subjective symptoms and rhinoscopic observations was 39%. X-ray opacity of the maxillary sinus was evaluated with a microdensitometer. The pre- and post-treatment data were compared in 14 patients (28 maxillary sinuses). The improvement of X-ray opacity by serratiopeptidase treatment was noted in 36%. Nasal mucociliary clearance (nasal ST) was measured in 21 patients. Before the treatment, nasal ST was decelerate in 12 patients. After the treatment, their nasal ST had not significantly improved. The general effectiveness of serratiopeptidase on subjective symptoms, rhinoscopic observations and X-ray opacity was 46%.

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