There has been some controversy about the value of facial nerve decompression. A historical review of facial nerve decompression showed that the procedure gained popularity in the early 1970's, but its use has decreased since the late 1970's. One of the reasons for the loss of popularity is that synkinetic movement appeared even in patients who underwent the decompression surgery. Another reason is that it has become clear that the recovery rate is fairly high in patients left untreated.
Our experimental study showed that severely damaged facial nerves swell more than 2.14 times in the initial swelling stage of Wallerian degeneration. Based on the facial nerve to facial canal ratio reported by Ogawa and Sando, a 72% damaged facial nerve swells to fill totally the facial canal at the stage of 2.14 times swelling.
Our experiments on pressure measurement of the interstitial space of the facial nerve revealed that the pressure depended completely on the pressure changes of the cerebrospinal fluid. Lowering cerebrospinal fluid pressure with a hypertonic solution simultaneously lowers the interstitial fluid space of the facial nerve.
Our clinical study showed that mannitol (hypertonic solution) was effective in cases of facial palsy in reducing the appearance of pathologic synkinesis after regeneration of the damaged facial nerve fibers.

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The masseter muscle, which contributes to mastication, originates on the zygomatic arch and inserts into the lateral surface of the mandible. Although relatively rare, benign masseteric hypertrophy and intramasseteric hemangioma are two important conditions affecting this muscle. Patients with these lesions complain of the cosmetic deformity rather than the functional disorder. Unless desired for cosmetic reasons there is little justification for any operative treatment. However, as no report could be found of the esthetic problem being solved by conservative treatment, surgical correction is advised when the chief complaint is esthetic.
Surgical treatment involves resection of the hypertrophied musculature or excision of the tumor with a surrounding margin of normal muscle. We list here the important aspects of surgery of the masseter.
1) Careful preoperative planning, including CT and MRI, is indispensable.
2) An extraoral approach is preferred in most cases. The masseter muscle is exposed through a curvilinear incision around the angle of the mandible for cosmetic reasons. A postauricular incision extending to the submandibular area is used instead of a routine preauricular parotid skin incision.
3) Care should be exercised to identify and preserve the lower branches of the facial nerve. They should either be dissected free and retracted (in case of tumor) or remain on the surface of the muscle (in cases of muscle hypertrophy) to protect them from damage.
4) Ligation of the feeding vessels helps to minimize blood loss.
5) Oozing from the muscle can be controlled by an infrared contact coagulator.
6) Postoperatively continuous suction with a fenestrated polyethylene drain for 2 days and a pressure dressing for 5- to 7-days is recommended to prevent hematoma and resultant scar formation, which causes swelling or trismus.
7) Patients should begin chewing early to prevent trismus.

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Four cases of typical “Patulous Canal” are presented. Two of the patients had von Recklinghausen's disease. Patulous canal is defined as bilateral dilatation of the internal auditory canal without an accompanying acoustic neurinoma.
Bilateral perceptive deafness may rarely accompany this syndrome.
Etiologies of bone changes of von Recklinghausen's disease may be summarized as:
1. Changes in the bone secondary to mass effect of neurofibromas.
2. Intrinsic factors in the initial stage of ontogenesis.
Among the latter, abnormalities of mesodermal tissues are found frequently.
Ontogenitically the skull, especially the temporal bone including the internal auditory canal, are derived from the peri-otic capsule of the cartilaginous neurocranium which is of mesenchymal origin.
The inner ear is derived from the otic vesicle which separates from the epidermal ectoderm.
The presence of bone changes such as dilatation of the internal auditory canal in von Recklinghausen's disease and in other illnesses may suggest that bony changes are accompanied by mesenchymal abnormalities ontogenetically.
The rarity of the complication of deafness may be explained by the low incidence of coincidental involvement of both mesenchymal and ectodermal tissues in congenital and intrinsic abnormalities.
Attention has been focused on the occurrence of similar bony changes, such as dilatation of the internal auditory canal in von Recklinghausen's disease. The possible mechanisms causing these changes are discussed from the embryological viewpoint.

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Serum zinc levels were determined in 67 patients with sensorineural hearing loss including 49 with bilateral hearing loss. The mean level in these patients (69.2μg/dl) was significantly (p<0.01) lower than that in subjects with normal-hearing. However, no correlation was noted between the severity or the causes of hearing loss and the serum zinc level.

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A case of a perilymphatic fistula occurring while flying is reported. A 51-year-old man, suffering from nasal obstruction due to cold, noticed fullness and hearing loss in both ears when his airplane descended. He felt dizzy after landing. The return flight the next day aggravated the symptoms. He came to our clinic three days after the onset of hearing loss. Audiological examination revealed sensorineural hearing loss of 85dB in the right ear and 35dB in the left ear. After treatment with steroid and vitamine B₁₂, hearing recovered in the left ear, but hearing impairment remained in the right ear. Twelve days after the onset, exploratory tympanotomy of the right ear revealed a rupture of the round window. It was closed with perichondrium and fat. The postoperative course was uneventful and the hearing improved to 44dB.

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Clinical trials of staged operation for a multichannel cochlear implant in two deaf patients are described. At the first stage, the tympanic cavity was opened under local anesthesia, and the conditions of the round window and cochlea were examined under an operation microscope. At this time, a round window stimulation was done to assess residual auditory nerve function. One month later the multichannel electrode was implanted.

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The relationship between the viscosity of the exudatives in the middle ear and the changes of the eardrums were studied in 4657 ears (mean age 12.9 years) with otitis media with effusion (OME). Neither retraction nor protrusion was noted in 57.4% of the eardrums.

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A case of neurofibroma in a 46-year-old female is reported. The patient complained of a painful tumor in the external auditory canal. The tumor was 10mm×10mm in size. She had pigmentation on her tongue and buccal mucosa, and had slight scoliosis. A biopsy of the tumor revealed a histopathological picture of neurofibroma with no malignancy. The tumor was almost completely resected by the biopsy. However, the tumor recurred twice within 6 months in other lesions of the same external auditory canal and were resected each time.
Since then we have observed the patient, but no recurrence of the tumor has been seen.

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Two cases of primary carcinoma of the frontal sinus are reported. The first patient, a 77-year-old male was referred with painful swelling in the right frontal region. The histopathological study of the specimen in the nasal cavity revealed undifferentiated carcinoma. Irradiation therapy and removal of the tumor were performed and no recurrence was observed for 5 years after treatment.
The second patient, a 69-year-old male had visited our clinic with a complaint of swelling and pain around the left eye. The histopathological diagnosis was squamous cell carcinoma. Total removal of the tumor with exenteration of the left eye ball was performed, since the mass infiltrated inside of the orbita.
A Kyusor technique was used to remove the tumor that infiltrated in the dura mater during surgery.

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A 41-year-old male visited our department with the chief complaint of foreign body sensation in the oral cavity.
The sensation was first noted a few hours earlier while he was eating raw squid.
On examination, several pieces of foreign bodies were observed in the oral cavity, and they were extirpated.
The foreign bodies were later identified as the sperm-bags and discharging tubes of the squid.

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We studied 15 parotid gland tumors by ultrasonography using 7.5MHz probe with respect to boundary echo, internal echo, posterior echo, and shape. Abnormality of the boundary echo and internal echo was considered to be important findings for differentiating benign and malignant tumors.
Based on the findings of the boundary echo and internal echo in the ultrasonogram, we propose criteria for the differential diagnosis of the parotid gland tumors.

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We report three cases of relapsing polychondritis (RP).
The first patient was a 36-year-old female who presented with perichondritis of left ear with dull pain. Although the pain decreased after administration of predonisolone and Diphenylsulfonate, she developed hoarseness due to edema of the arytenoid. This symptom was improved by dose augmentation of these drugs.
The second patient was 33-year-old female with complaints of right auricular perichondritis, severe coughing and stridor.
The stricture of tracheal cartilage was noted. These symptoms were improved by corticosteroid therapy.
The third patient was 33-year-old female who required emergency treatment for dyspnea and stridor. She had a 10-year history of bilateral auricular perichondritis and a 2-year history of tracheal stenosis, which were being treated by corticosteroid therapy. After tracheoplasty for the stricture, dyspnea and stridor improved dramatically.

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Palygraphic recordings during spontaneous nocturnal sleep were made in four men, three of whom (age range, 35 to 62) had obstructive sleep apnea and one (age, 25) who had no apneic episodes. Continuous recordings were made simultaneously of finger arterial blood pressure, air flow, thoracic movement and mesopharyngeal pressure amplitude. One man with severe obstruction underwent tracheotomy and uvulopalatopharyngoplasty. He was studied again after surgery.
1. When ventilation resumed, the blood pressure of the three patients with obstructive apnea rose. During apneic episodes, the blood pressure of two patients with severe obstruction gradually fell, while the blood pressures of one patient with mild obstruction was not reduced.
2. One patient with severe obstruction showed irregular waves of blood pressure.
3. One patient with severe obstruction, who was studied twice, had remarked fluctuations in blood pressure preoperatively and reducted and stable blood pressure postoperatively.
4. The man with no apneic episodes showed transient elevations in blood pressure without periodicity.
These results demonstrate that blood pressure is affected by repetitive obstructive apnea and that measurement of continuous finger arterial pressure is clinically useful and totally harmless.

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Morphological changes in the vestibular sensory epithelial cells and the vestibular ganglia following gentamicin (GM) intoxication were demonstrated three dimensionally by scanning electron microscopy.
A single dose of 4mg (0.1ml) of GM was injected into the middle ears of guinea pigs through the tympanic membrane. The vestibular organs and ganglia were observed from one day to 6 months after the treatment. Four days after the injection, fusion, ballooning and disappearance of sensory cilia were observed in the vestibular sensory epithelium. These changes were more marked in type I than in type II hair cells. Earlier morphological signs of degeneration were observed in the mitochondria of the supranuclear portion of type I hair cells.
Eater dilatation of the cisterns in the Golgi apparatus as well as of the endoplasmic reticulum were noted. Nerve chalices also revealed disintegration in the earlier phase of degeneration. The changes of the sensory cell progressed and extended from the central toward the peripheral area of the crista and the macula.
These findings suggest that GM may induce some metabolic changes in the vestibular sensory cells which result in fusion or loss of sensory hairs and later complete disappearance of sensory cells.
Changes in the vestibular ganglia were first observed seven days after the treatment. The degenerative process started with destruction of the mitochondrial cristae of the Schwann cells and the ganglion cells. These changes were followed by dissociation of the myelin sheath around the ganglion cells. The cytoplasmic organelles in the ganglion cells gradually deteriorated. At a later stage, the myelin sheath around the ganglion cell disappeared and the number of cells was reduced.
The changes in the ganglia are direct effects of GM.

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The effect of the intravenous infusion of prostaglandin E₁ (PGE₁) on the penlymphatic oxygen partial pressure (PcoO₂) and systemic blood pressure (SBP) was studied in 6 guinea pigs. The polarographic method was used to measure PcoO₂ by placing the microelectrode in the perilymph of the scala tympani through the fenestrated bony wall of the basal turn. PGE₁ produced slight decreases in PcoO₂ and SBP under control anesthetized conditions. The effects of aspirin and prostaglandin I₂ (PGI₂) on the CO₂ response of PcoO₂ was also measured in 21 anesthetized guinea pigs. Intravenous aspirin (300mg/kg) greatly inhibited the CO₂ response of PcoO₂, but it had no significant effect on SBP, arterial partial pressure of CO₂ or arterial pH. This inhibition was partially reversed by the intravenous infusion of PGI₂ (0.1μg/kg/min). These results support the suggestion that PGI₂ participates in the chemical regulation of the cochleovascular circulation.

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A simple and objective method was developed of evaluating the mechanical property of the vocal fold in relating to stiffness by analyzing stress-strain curves. Stiffness of the true and false vocal fold was examined in human and canine excised larynges under various conditions.
1) Stiffness of the membranous portion of the vocal fold was least at the middle and greater around the anterior commissure and vocal process. Stiffness of the false vocal fold was much less than that of the true vocal fold.
2) As vocal fold tension increased, stiffness of the vocal fold increased.
3) Stiffness of the vocal fold was decreased and hysteresis was increased when the thyroarytenoid (vocalis) muscle contracted.

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1) Norfloxacin was given to 53 patients with otitis media. It was effective in 95.0% of those with acute suppurative otitis media, and in 63.6% of those with acute exacerbation of chronic otitis media.
2) Cultures showed elimination of bacteria in 92.3% of those with acute suppurative otitis media, and in 62.5% of those with acute exacerbation of chronic otitis media.
3) The antibacterial activity of Norfloxacin was excellent against both gram-positive cocci and gram-negative rods.
4) No side effect was noted except for diarrhea in one patient.
These results indicate that Norfloxacin is a useful antibacterial agent in the treatment of otitis media.

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The incidence of allergic rhinitis has been increasing, and more drugs have been developed to treat it.
A clinical trial was carried out on 173 patients with perennial allergic rhinitis to determine the efficacy and safety of azelastine hydrochloride, which inhibits neurotransmitter activity, especially leukotriene production and release and histamine release. It is as effective as disodium cromoglicate (DSCG) when administered orally in a single dose of 1mg.
Sugarcoated tablets of azelastine hydrochloride were administered to patients with allergic rhinitis in a dose of 1mg twice daily, in the morning and at bedtime, for 4 weeks.
1) Subjective symptoms (sneezing, nasal discharge, nasal obstruction and disturbed ADL) and subjective symptoms (volume of nasal discharge, swelling of the mucous membrane of the inferior concha, and eosinophilia in the nasal discharge) were significantly improved by both 2 and 4 weeks of treatment.
2) General improvement (moderate or greater) was 31.2% after 2 weeks of treatment and 56.6% at 4 weeks.
3) The stratified general improvement rating was significantly higher in patients with severe symptoms than in those with moderate symptoms.
4) Side effects were observed in 6 patients, 3 of whom had drowsiness, 2 neutrophilia and 1 drug eruption. None of the side effects were serious however.
Those azelastine hydrochloride appears to be a drug of high efficacy and safety in the treatment of perennial allergic rhinitis.

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We report the clinical use of beclomethasone dipropionate inhaler (BDI; Aldecin® inhaler), in the management of contact ulcer and idiopathic granuloma of the larynx.
Patient 1 was a 66-year-old woman with an ulcerative lesion at the posterior end of left vocal fold. The lesion was diagnosed as contact ulcer of the larynx and treated by oral spray of BDI, which resulted in improvement in five months.
Patient 2 was a 66-year-old man with a small mass at the posterior end of right vocal fold. It was diagnosed as idiopathic granuloma of the larynx and treated by oral spray of BDI. His symptoms and laryngeal lesion markedly improved in three months.
BDI appears to be useful in the treatment of contact ulcer and idiopathic granuloma of the larynx.

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