Cholesterol granuloma has been considered to be associated with long-standing otitis media with effusion (OME). Blue ear drums in cholesterol granuloma do not show the adhesions or retraction pockets which are commonly observed in patients with persistent OME. This indicates that cholesterol granuloma is a different disease from OME.
On the basis of investigations of 8 cases of cholesterol granuloma, it was concluded that the time of occurrence of Eustachian tube dysfunction can be used to differentiate the two diseases clinically. In the ears with OME, Eustachian tube dysfunction occurs during the development of temporal bone air cell structures and inhibits their development. On the other hand Eustachian tube dysfunction in ears with cholesterol granuloma may occur after completion of the development of air cell structures. The degree of maturity of air cell structures may determine middle ear mucosal reactions and lead to specific pathological changes such as cholesterol granuloma.

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Round window tests were clinically examined and compared with promontory tests in 6 cochlear implant candidates. The round window test results showed lower stimulating thresholds and wider dynamic ranges than the promontory tests. To test the promontory tests in different stimulating positions and to compare them more precisely with round window tests, the electrical auditory brainstem response (E-ABR) was ex-amined in guinea pigs receiving Kanamycin (KM) injections (40mg/kg/day for 30 days) that had lost their responses to the auditory brainstem response. The lowest E-ABR stimulating threshold in guinea pigs was recorded at the round window.

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Observation of the external aperture of the vestibular aqueduct has hitherto been possible only in cadavers or dry temporal bones, but by applying three-dimensional surface reconstruction imaging, we succeeded for the first time in obtaining solid-looking images of this structure in living subjects. When the width of the external aperture of the vestibular aqueduct was measured in 58 subjects (10 normal ears, 23 ears with chronic otitis media and 25 ears with Meniere's disease), it was found to be significantly narrower in the affected ears of patients with Meniere's disease than in normal and chronic otitis media ears.

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The anterior epitympanic recess has following three structural types: type A, a main cavity seen above the tensor tympanic fold (TTF); type B, the recess divided into two cavities above and below the TTF; type C, the recess contiguous to the eustachian tube. Several distances related to each type of recess were measured in 48 human temporal bones. The following distances were significantly increased in the order of types A, B, and C: (1) the length of the TTF; (2) the distance from the top of the cavity below the TTF to the inferior border of the tensor tympanic semicanal; (3) the distance from the cog to the anterior wall of the recess.
In addition, a route from the epitympanum to the eustachian tube was made by the intact canal wall method, in 12 human temporal bones. In type C, the route could be widely developed by removal of the cog and TTF. Removal of the bony plate to which the TTF attached was also necessary in types A and B, especially in cases of short TTF.
In the surgical intervention, it is essential to keep in mind the structural variations of the anterior epitympanic recess and the position of its adjacent tissues. The recess should be handled by the method of choice appropriate to each type.

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Ossicular chain reconstruction with hydroxyapatite was performed in 37 patients. Extrusion of hydroxyapatite occurred in six patients (16.2%). Postoperative hearing results were assessed by the following criteria; 1) air conduction hearing level within 40dB, 2) air conduction hearing gain more than 15dB, 3) air-bone gap within 20dB. The first criterion was achieved in 58.3% in type III-modified tympanoplasty (III-C), 42.9% in type IV-modified tympanoplasty (N-C), and 54.8% total. The second criterion was achieved in 45.8% in III-C, 28.6% in IV-C, and 41.9% total. The last criterion was achieved in 83.3% in III-C, 42.9% in IV-C, and 74.2% total. One or more of the three criteria was achieved in 83.3% in III-C, 57.1% in IV-C, and 77.4% total. In some cases without extrusion, postoperative hearing results were not stable.

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Eighty four ears with middle ear cholesteatoma were operated on using a staged intact canal wall (ICW) tympanoplasty between November 1976 and February 1988. In 17 of the 84 ears, a deep pocket-like epithelial invasion into the antrum or the mastoid cavity was found at the second stage operation. These 17 ears have no relation to age and extent of cholesteatoma noted at the first stage operation, and between these and 67 others no difference except bony defects could be seen with regard to their operative findings, such as inflammation and aeration in the middle ear. A bony defect was recognized in 13 of these in either the lateral wall of the attic or the posterior wall of the external auditory canal, through which the pocket developed. The present findings suggest that the bony defect is critical to form the pocket after the ICW tympanoplasty. A reconstruction of the bony defect with obliteration of the mastoid cavity is concluded to be reasonable to prevent pocket formation.

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The source of the sound is usually placed in the nasal orifice in order to evaluate tubal function. We compared the accuracy of sonotubometry with a tubal catheter (catheter method) in diagnosing tubal dysfunction with that of the usual method using a nasal olive tip (olive method) in the same subjects.
Transmissions of the source sound of 8kHz with one third band noise (maximum 115dB) placed at the base of a tubal catheter were recorded at the external ear canal. Sound amplitude and sound duration were calculated by the changes of the 8kHz sound pressure level during swallowing. A level of sound amplitude of more than 5dB was defined as a positive sign.
Some subjects showed no positive signs with the olive method, but positive signs with the catheter method, especially after air insulation. Sound duration with the catheter method was significantly longer than with the olive method, both before and after insulation. The baseline sound, when the subjects was not swallowing, was louder in the catheter method than in the olive method.
These results indicate that there is a much higher incidence of positive signs in sonotubometry with a tubal catheter, than when an olive tip is used, especially after air insufflation. We conclude that sonotubometry with a tubal catheter is a more effective way to evaluate tubal function than the ordinary method.

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Morphological examination of the olfactory epithelium was performed by light and transmission electron microscope in a patient with olfactory disturbance caused by the common cold (viral infection). The patient was a 42-year-old male who visited our clinic about one month after losing his sense of smell. In spite of medical treatment over 3 months, the patient did not recover his olfaction.
Light microscopy revealed normal thickness of the olfactory epithelium and no evidence of atrophy. The number of supporting cells and basal cells were normal but olfactory receptor cells were decreased. Electron microscopy showed no specific morphological abnormality of supporting cells or basal cells, but in the residual olfactory receptor cells there was degeneration of olfactory vesicles, and olfactory cilia were absent. Regenerating cells which develop into olfactory receptor cells were found above the basal cell layer.
These findings indicate that olfactory disturbance caused by the common cold (viral infection) resulted in damage of the olfactory receptor cells.

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To evaluate the present status and problems of nebulizer therapy for chronic sinusitis, we carried out a questionnaire study. Nebulizer therapy was used by 94.2% of the otolaryngologists. This therapy required 3 minutes and was frequently continued for 2-3 months. Antibiotics, represented by aminoglycosides, vasoconstrictors, and mucolytics were often used in combination. Side effects were observed in 39 cases; shock and dyspnea, mostly due to SM and PC, were frequent. The development of drugs exclusively for the nebulizer, improvement in apparatus to enhance drug deposition, and establishment of an effective and safe method are needed.

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A true malignant mixed tumor (biphasic malignancy) is an extremely rare tumor in the minor salivary glands. A 58-year-old female was referred to us with a mass of the buccal mucosa. Examination revealed a left bilobular buccal mass with submandibular lymphoadenopathy. The mass was removed and a left modified neck dissection done. Pathological examination subsequently confirmed a diagnosis of true malignant mixed tumor, the first documented case of such tumor in the buccal mucosa.

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Most patients with the obstruction type of sleep apnea syndrome have adeno-tonsillar hypertrophy. Their pulmonary function is often greatly improved by tonsillectomy. Tonsillectomy was performed in 22 children, only one of whom had sleep disturbance as the chief complaint.
Pulmonary function was tested before and after the operation by arterial blood gas analysis and pulmonary function parameters.
PCO₂ values did not change, but PO₂ rose after the operation. Vital capacity changed little, but FEV_1.0 was found to be decreased one week after the operation.
Therefore, the pulmonary condition, particullary the inspiratory function, improves after tonsillectomy in children without sleep disturbance.

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This paper describes a retrospective study of 36 cases of peritonsillar abscess treated from 1985 to 1989. There were 24 males and 12 females, aged 5 to 95 years old (median age, 40 years). Streptococci were the most common bacteria isolated. Sensitivity tests showed good response to ABPC and CEZ, but not to OFLX. The main therapies used were incision and drainage and administration of antibiotics. The hospital stays ranged from 3 to 24 days.

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Sixty-three patients with foreign body sensation in the throat showing no marked organic diseases were asked about their complaints, the period of onset, therapeutic efficacy etc. All patients were examined by high-voltage radiographs of the pharyngolarynx and classified into six types. We separated the patients into a treated group and a non-treated group. The drugs used were lysozyme chloride only or alprazolam in addition to it.
1. There was no sex difference, the average age was 53.0 years.
2. There was no significant difference in improvement rating for subjective symptoms between the treated group and the non-treated group. The spontaneous remission rate in the non-treated group was about 32%.
3. There was no significant difference between the radiographic classification groups.
4. The longer the period from the onset, the lower the thrapeutic effect.
5. It is very important to explain to patients thoroughly that there are no serious diseases in the throat and to show them the results of radiological examinations and to relieve cancer-phobia.

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Two cases of follicular adenoma and a case of papillary carcinoma in three elderly females who had giant thyroid tumor with rapid growth within several months are presented. Intraglandular hemorrhage and necrosis of thyroid tumor were seen in two patients, one with follicular adenoma and one with papillary carcinoma. Cystic degeneration was seen in the patient with follicular adenoma. Massive hemorrhage, necrosis and cystic degeneration in the thyroid gland may be related to rapid growth of a thyroid tumor.

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Histochemical quantitation of glycoprotein (GP) in the adult human nasal mucosa was performed. Specimens of mucosa were obtained from the inferior turbinates of 18 normal subjects, 33 patients with hypertrophic rhinitis (HR), 37 with nasal allergy (NA), and 65 with chronic sinusitis (CS); and from the middle turbinate of 56 with CS. The GPs in the goblet cells and submucosal gland cells were identified by the combined Alcian blue (AB) at various pH levels and periodic acid Sciff (PAS) staining method with or without sialidase digestion. The GPs in the goblet cells and submucosal gland cells were identified as neutral, sialidase sensitive or resistant sialylated, and sulphated GPs by the stains used in this study.
There was no significant difference between patients and controls in the number of goblet cells containing GPs. In CS, there were fewer goblet cells in the middle turbinate than in the inferior turbinate. The number of submucosal gland cells in NA and CS was significantly higher than in the controls (p<0.01). In CS there were fewer submucosal gland cells in the middle turbinate than in the inferior turbinate. In CS 41% and in NA 28% of the submucosal glands stained with AB-PAS. This difference was significant (p<0.01). The distribution of GPs was not significantly different in patients and controls.
In conclusion: 1) The goblet cell population was not increased in disease. 2) Nearly 90% of the GPs in goblet cells were sulphated. 3) Submucosal gland cells were increased in number in the inferior turbionate mucosa in CS and NA. 4) In NA, the gland cells which did not contain GPs were increased, but in CS, GP-containing cells were increased. 5) The gland cells contained almost the same proportion of neutral, sialidase sensitive or resistant sialylated, and sulphated GPs. These results suggest that the increase of mucus secretion in CS and NA is due mainly to the increase of submucosal gland cells.

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The present study was undertaken to investigate laryngeal microvascular reactivity to histamine in normal guinea pigs.
Twelve guinea pigs were sedated with intraperitoneal sodium pentobarbital, a fissure was made in the larynx, and the intra-laryngeal space was opened. A probe of a spectro-photometric analyzer was placed lightly on the mucosa of the vocal fold and fixed.
Hemoglobin (Hb) concentration and oxygen saturation of Hb were measured continuously by reflectance spectrophotometry; 10μl of isotonic saline was dropped on the laryngeal mucosa in the controls, and 10μl of histamine (104μg/ml) on the mucosa of the experimental animals.
The results were as followed; 1) Visual inspection after histamine provocation showed laryngeal mucosal swelling and dilatation of the microvessels. 2) After histamine provocation, Hb concentration increased (p<0.01) and oxygen saturation of Hb decreased (p<0.01). 3) After saline dropping, these two parameters showed no significant change.
Thus, histamine caused swelling of the laryngeal mucosa and increased the mucosal blood volume. This method is useful for observing allergic reactions in the laryngeal mucosa.

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Allergy and blood-flow disturbances are important pathogenetic factors in Meniere's disease. Ibudilast is a new anti-allergic agent, selectively antagonistic for and exhibiting inhibitory activity against slow-reacting substances of anaphylaxis (SRS-A) and/or leukotriene. This new agent is also a cerebral vasodilator with anti-thrombotic effects.
The therapeutic effects of ibudilast were studied in 22 Patients with Meniere's disease. The Patients were given a 10mg capsule of Ibudilast 3 times daily for 4 weeks.
Seventeen of 22 Cases (77%) were relieved of dizziness after administration for 2 weeks, and 20 of 22 Cases (91%) after 4 weeks. Ten of 21 Cases (48%) were relieved of tinnitus after 2 weeks, and 12 of 21 Cases (57%) after 4 weeks. Fifteen of 20 Cases (75%) were relieved of numbness after 2 weeks and 17 of 20 Cases (85%) after 4 weeks. Hearing at over 10dB in 15 of 24 ears (63%) improved after 2 weeks and in 17 of 24 ears (71%) after 4 weeks.
The results suggest that ibudilast is a clinically useful drug in the treatment of dizziness, tinnitus, numbness, and hearing disturbances in patients affected by Meniere's disease.

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Hange-koboku-to is a Kampo medicine which is supposed to be effective for abnormal sensations, such as a lump or choking, in the throat. Some authors, including the present authors, have investigated clinically the relationship of its efficacy and the severity of the patients' neurotic condition. No complete agreement, however, has been reached. Some have reported that non-neurotic patients respond better to this medication, but others do not agree. No study has been done yet on the relationship between the efficacy of Hangekoboku-to and autonomic nerve dysfunction. The purpose of this study is to determine whether there is any relationship between the effect of Hange-koboku-to and psychosomatic conditions classified with a newly developed method (modification of Abe's method) using the Cornell Medical Index-Health Questionnaire Analysis which places patients into four categories: normal, autonomic nerve dysfunctioning, neurotic and psychosomatic (autonomic nerve dysfunctioning+neurotic).
Ninety-six female patients with abnormal sensation in the throat were classified by a modification of Abe's method into the 4 groups mentioned above and treated with Tsumura Hange-koboku-to (7.5g/day) for 2 weeks. The clinical effectiveness was evaluated 1, 2 and 3 weeks after the start of medication. A reduction of the abnormal sensation, evaluated subjectively, of more than 80% was considered to show excellent effectiveness. The number of patients reporting excellent effectiveness increased gradually to a peak at the end of the 3rd week, indicating that in some patients further improvement occurred after the termination of medication. The percentages of patients reporting an excellent effect in the 3rd week were 49%, 29%, 45% and 37%, respectively, in the normal, autonomic dysfunctioning, neurotic and psychosomatic groups.
The diagnostic procedures of the oriental medicine are quite different from those of western medicine because of the difference in basic concepts. Our results indicate that psychosomatic evaluation of patients by a modification of Abe's method is helpful for physicians trained in western medicine, who do have little knowledge of oriental diagnostic procedures, for determining whether Hange-koboku-to might be useful in the treatment of individual patients.

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