The advantages of the computer-aided three-dimensional (3-D) reconstruction of the inner ear structures are as follows,
1) 3-D visualization of the shapes of those structures from histologic sections,
2) ability to measure the fine structures of the inner ear from 3-D images. To study the inner ear structures, it is necessary to make histological sections for examination under the microscope. Such processing, however, destroys the spatial relationships of inner ear structures that are very important for the evaluation of inner ear function. Furthermore, the quantitative measurement of those structures is not possible from histological sections because the appearance of the two dimensional structures in those sections varies considerably according to cutting angle. The computer-aided 3-D reconstruction method is necessary for the quantitative studies of the temporal bone.
In this paper, the necessity of this method is discussed, and the technique of 3-D reconstruction is described. Some representative examples are presented, and the problems and prospects are discussed.

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Neuro-otological studies were performed on 17 patients who fulfilled the criteria of possible multiple sclerosis (MS). The eye movements of all the patients were examined by neuro-otologists. The routine examination was gaze, positional, and positioning nystagmus tests and ENG test. The ENG test consisted of recordings of smooth pursuit, saccadic eye movements, optokinetic nystagmus, caloric reactions and visual suppression. Abnormal smooth pursuit was noted in 10 of 16 patients (62.5%), examined abnormal saccadic eye movements in 11 of 17 (64.7%), the optokinetic nystagmus in 13 of 17 (76.5%). Only five patients showed CP in the caloric test. We classified the 17 patients into two groups according to the duration of MS: less than 7 years since the onset and 7 years or more since the onset. The eye movements abnormalities were more advanced the long term group on the whole. We describe a few patients observed for a long time.
Their ENG findings corresponded with changes in general condition. We conclude that ENG examinations are indispensable in following MS patients.

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The histopathologic findings in the temporal bones of a 71-year-old male with bilateral deafness and facial paralysis due to DMLC originating from transitional cell carcinoma of the renal pelvis are described.
The patient first noticed progressive bilateral hearing loss on July 17, 1986 (average loss rt. 35dB, it. 46dB) and became totally deaf bilaterally 4 weeks later. Several therapeutic measures had been tried without success to treat his bilateral sudden deafness of unknown cause. In September, he experienced left facial weakness, which progressed to complete paralysis bilaterally. Then he developed other cranial nerve paralyses (III, IV, IX, X) and meningeal symptoms. The CSF pressure was significantly increased as were the protein content and number of cells.
The patient died on October 8, 1986 about 2 months after the onset of otologic symptoms.
The temporal bones were removed 3 hours postmortem for histological study. The histopathologic findings in the two temporal bones were almost identical. The internal auditory meatus was filled with neoplastic tissue, which completely replaced the vestibulocochlear nerve bundles. The neoplastic cells infiltrated the modioli and Rosenthal canals of the cochleae diffusely through the cribrosa area, and some reached the scala tympani of the basal turns bilaterally. There was mild endolymphatic hydrops in the left cochlea and saccule, but the endolymphatic duct and sac appeared normal bilaterally. The facial nerve was completely destroyed by neoplastic cell invasion from the internal auditory meatus to the geniculate portion bilaterally. The external and middle ears were free of tumor.

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This paper reports on a case of unilateral profound deafness which occurred following chickenpox infection. A 5-year-old boy's hearing had been found to be normal by pure tone audiometry before he contracted chickenpox. After the infection, which was confirmed by an antibody titer rise in the serum, the patient was found to be profoundly deaf in his left ear. The similarity of the clinical features of this case to those of deafness following mumps allows us to suppose that a similar pathology underlies these two types of deafness. A review of the literature revealed only two detailed reports of such cases, while several other reports indicated a low incidence of deafness following chickenpox. Accumulation of more such cases is necessary to elucidate the clinical picture of this type of deafness.

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Nystagmus towards the upper ear in both lateral head positions is usually considered to appear in patients with central nervous system lesions, especially those in the brain stem or cerebellar posterior vermis. However, its pathogenesis is still obscure, since several reports have suggested that such positional nystagmus may occur in patients with peripheral vestibular disturbances.
This report describes a patient with positional nystagmus of this type after head trauma. X-ray examination revealed temporal bone fracture. The origin of positional nystagmus in this case was thought to be a peripheral vestibular lesion because the nystagmus was transient and there was no clinical evidence of any disturbance of the central nervous system. Seven cases of such positional nystagmus seen during the last 3 years in Kitasato University Hospital are summarized. Positional nystagmus towards the upper ear is assumed to be an important sign of central nervous system disturbance, but it may occur with peripheral vestibular lesions. It is necessary in the latter case for the positional nystagmus to disappear in the course of time, and other vestibular and neurological findings may indicate the character of the peripheral vestibular disturbance.

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The 93-year-old male with rhinophyma was treated with excision of the rhinophyma and application of a split thickness skin graft. The skin graft did not take completely because of postoperative bleeding. The residual portion of the skin graft healed earlier and had better color and texture than the re-epithelialized portion. The method of applying split thickness skin graft was better than that of the re-epithelialized wound.

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We studied 28 cases of orbital blowout fracture treated in Department of Otorhinolaryngology, Mie University Hospital, from January, 1984 to March, 1989. There were 23 male patients and 5 female patients ranging from 7 to 59 years of age (average, 21.7 years). In the majority of cases was the present injury occurred during fighting. Vertical double vision was in 50%. The degree of double vision was evaluated before and after surgery and classified as severe, moderate, or mild. Double vision was evaluated before surgery, at the time of extubation of the balloon catheter, and about 3 months after surgery. Improvement was better when surgery was performed within two weeks after the injury. These patients also showed better improvement of other injuries postoperatively. Good postoperative improvement was also seen in patients with a negative preoperative forced duction test. Balloon catheter placement in the maxillary sinus for two weeks is considered to be adequate.

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Changes in the concentrations of secretory IgA and IgG in nasal secretions was examined in 20 patients with chronic sinusitis who were treated conservatively. Nasal secretions were collected by the filter paper method and secretory IgA levels were measured by the ETA method and IgG levels by radial immunodiffusion.
1) The concentration of secretory IgA in nasal secretions showed a significant decrease 2 months and 4 to 5 months after treatment.
2) Unlike secretory IgA, the concentrations of IgG in nasal secretions remained unchanged 2 months after treatment. Four to 5 months after treatment, however, it was significantly lower than before treatment.
3) Measurement of secretory IgA and IgG is thought to be useful in evaluating the immunological state of the nasal mucosa.

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Ameloblastoma is a tumor believed to originate from odontogenic tissues and is generally considered to be benign. However, it often recurs postoperatively and in a few case malignant changes have been reported.
Recently we treated a 75-year-old female with an ameloblastoma spreading from the center of the mandible to the left zygomatic bone. She had first noticed the tumor more than 10 years earlier. The only symptom was asymmetry of the face.
The tumor was removed along with the left half of the mandible. Although reconstruction was not performed, her postoperative course was uneventful without dysfunction of mastication or speech.

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Clinical and polysomnographic improvement was documented in 8 patients treated surgically (uvulopalatopharyngoplasty or nasal operation) for obstructive sleep apnea syndrome. The results were as follows:
1. All the patients were completely relieved of clinical symptoms.
2. Polysomnography showed significant improvement of obstructive apnea and quality of sleep, but all the patients were not completely freed of obstructive apnea.
3. Three patients had central apnea after surgery.
4. There is a limitation of surgical treatment for obstructive sleep apnea, so combined therapy is need, both surgical and non-surgical.

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Ultra-sound sonography of the neck was used in the examination of 30 patients with abnormal sensation in the pharyngolaryngeal region and 30 control subjects. In 24 of the patients (80%) and in 15 of the control subjects (50%), the cervical esophagus was behind the left lobe of the thyroid. It is probable that the anatomical relationship in the positions of the thyroid, esophagus and trachea is an etiologic factor in abnormal sensation in the throat.

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We demonstrated the presence of human papillomavirus (HPV) in 3 of 4 patients with laryngeal papillomas by dot blot hybridization (Vira Pap^TM) and Southern blot hybridization.
1. The HPV was type 6 in 2 patients and type 11 in 1 patient.
2. The results of this simple detection test (Vira Pap^TM kit) for dot blot hybridization correlated well with that of Southern blot hybridization. Therefore, this method is useful as a screening test.
3. Dot blot hybridization using serial dilutions of the homogenate of a HPV-positive papilloma revealed that 0.125mg wet weight of the papilloma sample was enough for HPV detection.

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Thyroplasty and/or arytenoid adduction operation were performed in 52 patients with unilateral recurrent laryngeal nerve paralysis, vocal fold atrophy, vocal pitch disorder or spasmodic dysphonia. Phonation was examined before and after surgery. The post-operative results were satisfactory in most of the cases and stable for three to ten months.
Monitoring of the voice and vocal folds with a fiberscope during surgery was especially important to obtain excellent results. The number of operations combining arytenoid adduction and thyroplasty type I, III or IV has therefore increased.
Voice therapy should be performed after surgery in some cases to obtain better results.

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For the differential diagnosis of tumors, we studied the internal echo histograms of 20 head and neck tumors with a 7.5MHz probe; the width of the histograms was of 0%, 25%, 50%, 75% frequency and the echo level was of maximum shades of grey.
1) An analysis of the width of the histograms showed three patterns: mountain type with a narrow base for normal tissue, mountain type with a wide base for benign tumors and bell type with wide base and sides for malignant tumors.
2) There was no statistically significant difference in the echo level of the maximum shades of grey between benign and malignant tumors.

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Tumor of the trachea can cause dyspnea requiring prompt surgery. A 67 year old man had tumor of the trachea which was difficult to pathologically diagnose. It was finally diagnosed as mucoepidermoid carcinoma by electron microscopy.
This patient had been treated for 2 months for dyspnea believed to be due to asthma. He was introduced to the internal medicine department of our hospital and came to us for otolaryngological examination.
We could easily see the tumor with an indirect laryngoscope. It was located 2-3cm below the glottis, was round, pedicled, smooth and occupied almost the entire tracheal lumen. The tumor was removed after tracheotomy under a local anesthesia. The pathological dianosis was clear cell carcinoma with surgical positive margins. A more extensive operation combined with laryngectomy and dissection of the paratracheal lymph nodes was performed.
Mucoepidermoid carcinoma was suspected pathologically by special stainings. The electron microscopic examination revealed mucoepidermoid carcinoma, because epidermoid cells and adenomatous cells were observed from the specimen.
We considered that this tumor was an atypical mucoepidermoid carcinoma.

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A 6-month-old girl who had esophageal perforation caused by a 10cm metal chain was reported.
Roentogenographic examination revealed a chain in the cervical esophagus, subcutaneous emphysema and pneumomediastinum. Even after the chain was removed using an endoscopic technique under general anesthesia, the subcutaneous emphysema and pneumomediastinum became worse.
The perforation of the esophagus was primarily sutured via a lateral cervical incision.
She fully recovered with no post-operative complications.

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We reviewed the present status of our understanding of the various methods of vocal rehabilitation after total laryngectomy with respect to the vibrating portion.
In a pneumolarynx with a rubber membrane, the vocal intensity and the phonating duration can be controlled easily, but it is difficult, although not impossible, to control the vocal pitch. An electrolarynx produces monotonous and noisy sound during phonation, and its vocal control ability is poor at present.
In tracheoesophageal shunt speech and injected esophageal speech, the mucosal membrane vibrates to produce sound at the so called “neoglottis” level. Many authors have stressed the importance of a proper tonicity of the pharyngo-esophageal segment for good voice production. However, there is no conclusive evidence that the vibrating status correlates with speech skill. Voice quality in both speaking methods is a little poorer than in tracheopharyngeal speech, and injected esophageal speech has the added disadvantage of the short duration of phonation.
From the viewpoints of voice quality, vocal control and articulation, tracheopharyngeal shunt speech is considered to be the best method at present, even though it is difficult to control the vocal pitch.
We suppose that the ability to control the vocal pitch would provide one of the most important improvements for vocal rehabilitation following total laryngectomy.

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This study was designed to investigate the effects of acoustic deprivation and stimulation following acoustic trauma.
Symmetrical bilateral cochlear lesions were produced in 33 chinchillas by exposure to a high intensity pure tone (117dBSPL, 2kHz) for 15 minutes. Cochlear thresholds were derived from the cochlear action potentials (CAP) taken prior to and one day after exposure. Then the incudo-malleolar complex of one side was removed so that one cochlea was normally stimulated during the recovery period, while the other was deprived of sound. After a period of one to twelve weeks the OAP's on the non-deprived (nonoperated) side were measured. Hair cell damage in the acoustically deprived cochlea was assessed with scanning electron microscopy. In order to quantify the degree of damage to the sensory epithelium, a hair cell damage scale was implemented based on stereociliary integrity.
The control group consisted of six chinchillas with unilateral ossiculectomy but no sound exposure, and four which received sound exposure only. The cochleas of these animals also were analyzed by scanning electron microscopy.
The most significant result of this study was that the cochleas with acoustic deprivation during the recovery period sustained a higher degree of damage than the acoustically stimulated cochleas.
Another result was that symmetrical cochlear lesions could be produced by strict monitoring of sound pressure balance in both middle ear cavities. Finally, careful ossiculectomy did not affect cochlear morphology.

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Nasal hyperreactivity was induced in guinea pigs by the intranasal installation of toluene diisocyanate (TDI). The signs and symptoms of nasal hyperreactivity were observed, histamine assays of the nasal mucosa, lungs and blood were performed, and the nasal mucosa was examined histologically.
Treatment with nebulized MS-A did not change the symptoms and signs, but it did increase the survival rate. The symptoms of 4 animals were improved, but in 2 they became worse. The histamine content of the tissues of animals treated with 20mg/ml of nebulized MS-A were lower than that of those treated with 4mg/ml of MS-A or saline. The histological study showed more basophilic cells in the epithelium of the animals treated with nebulized MS-A than in the controls. This finding was not related to the effect of this treatment.
These results suggest that nebulized MS-A may cause migration of basophilic cells to the epithelial layer and inhibit histamine synthesis within basophilic cells or inactivate free histamine secreted by the cells of the nasal mucosa.

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It has been reported that histamine could increase the cyclic-AMP level via the H₂-receptors present on the basophilic cells and that H₂-receptors might be responsible for the negative feedback control of mediator release. Therefore, treatment with H₂-blockers might be contraindicated in allergic patients. It has already been reported that Cimetidine increases bronchial sensitivity.
In this study, nasal reactions to Cimetidine and Famotidine treatment were evaluated in 10 healthy adults by the histamine nasal provocation test (HPT) in a double-blind, cross-over trial. The HPT was conducted before treatment and 3 and 7 days after the start of treatment.
The nasal reaction to histamine was not significantly changed by the administration of Famotidine. However, a moderate increase in nasal sensitivity was noted after 7 days of Cimetidine treatment. Nasal sensitivity after 7 days of Cimetidine treatment was significantly greater than that after Famotidine treatment.
We conclude that in patients with nasal allergy and peptic ulcer Famotidine is preferable to Cimetidine for the treatment of digestive tract disorders.

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