The following conclusions were reached from the authors' findings and the reports of other investigators in regard to the pathology and etiology of vertigo in patients with abnormal hemodynamics of the vertebral artery.
1. Although there are many variations in the vertebrobasilar arterial system, over half of the patients (about 60%) have a normal pattern. Because the superficial vessels supplying the vestibular nuclei of the brain stem have many variations and branches, although those penetrating the brain stem have few variations and branches, the vestibular nuclei are easily influenced by abnormal hemodynamics of the vertebral artery.
2. Hemodynamic abnormalities of the vertebral artery may be aggravated by changes of the pulse rate, the blood viscosity, and the blood pressure.
3. Abnormal hemodynamics of one vertebral artery causes an imbalance in excitability of both vestibular systems, and central vestibular function is more easily impaired than peripheral vestibular function.
4. A great difference in hemodynamics between the two vertebral arteries is seen during a vertigo attack, but this difference becomes smaller when the vertigo attack subsides.

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The effect of wearing of an air conduction receiver on sound pressure in the ear canal was investigated in 22 ears of 11 normal male volunteers. When a bone conduction receiver (Rion BR-41) on the forehead was activated, sound pressure recorded in the ear canal was larger by about 20 dB in all test frequencies than in the auricular conchal cavity or at a place 10 cm from the canal opening. When an air conduction receiver (Rion AD-02) was worn over the auricle, sound pressures in the ear canal and in the auricular conchal cavity increased maximally at 0.8 kHz by 17.9±4.9 dB and 17.7±7.4 dB, respectively. At higher frequencies, however, they decreased in those wearing the receiver.

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Primary position upbeat nystagmus has been associated with lesions of the midbrain, midline cerebellum, and lower brainstem. However, the precise localization still remains unclear. We report one case of primary position upbeat nystagmus in which magnetic resonance imaging (MRI) showed probable lesions of both prepositus hypoglossal nuclei. Morphological and physiological studies have shown that these nuclei play an important role in vertical eye movements. We conclude that the bilateral dysfunction of prepositus hypoglossal nuclei cause the upbeat nystagmus in our patient.

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There have been several reports that transcutaneous and transtympanic electrical stimulation and electrical stimulation applied to the promontory can suppress tinnitus. Other papers have assessed of tinnitus reduction in patients with cochlear implants. We investigated preoperative tinnitus in cochlear implant candidates and evaluated the effects on tinnitus of promontory stimulation and of cochlear implantation.
Tinnitus was experienced in 90% of cochlear implant candidates. Patients with severely impaired hearing had especially marked tinnitus. Promontory stimulation abolished tinnitus in 22% and reduced it in 50% of patients. The corresponding figures after cochlear implantation were 44% and 39%. The effect continued for several hours after stimulation by the speech processor had been switched off.

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Labyrinthine fistula is a common complication of cholesteatoma, but cochlear fistula is very rare. We report three cases of cochlear fistula found in ears which had previously been treated with radical tympanomastoidectomy, one male and two females, who had developed dizziness 10 to 28 years after the last middle ear surgery. Two patients had no hearing in the affected ear and 80 dB mixed type hearing loss was noted in one patient. At surgery, cochlear fistulas of various sizes were found in the promontory between the oval and round windows. One patient also had a fistula opening into the lateral semicircular canal. In two patients the cochlear fistula was covered with fascia and bone fragments and then firmly sealed with fibrin glue. One patient had obvious infection in the cochlea, so labyrinthectomy was performed. Surgery relieved the fistula symptoms caused by manipulation of the ear. The patient with residual hearing became deaf after surgery.
Cochlear fistula is hard to detect by regular otoscopy. When a patient complains of dizziness upon manipulation of the middle ear, the site where the dizzy sensation is most severe should be recorded as a possible fistula site. CT scan of the bony cochlear wall should be examined carefully to confirm the diagnosis. In addition to fistulas of the semicircular canals, cochlear fistula must be included in the differential diagnosis of dizziness in patients who have had radical tympanomastoidectomy type middle ear surgery.

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Intracranial meningioma is common, 13 to 18% of all intracranial tumors.
However, extracranial meningioma, in paticular middle ear meningioma is very rare. Two of our patients had meningiomas extending to middle ear cavity, a 49-year-old and 59-year-old females. In both cases, it was considered that the tumor had extended to the middle ear cavity through the jugular foramen. This route of extension of tumors causes hoarseness due to invasion of the vagus nerve. In the diagnosis of hoarseness, such intracranial lesions must be kept in mind.

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The results of long-term middle ear ventilation with a Koken tube (wide flange, A type) were retrospectively analyzed chiefly with respect to complications in 43 ears with otitis media with effusion in children aged 3 to 9 years. The average intubation period was 11 months.
The average pure tone air conduction threshold showed remarkable improvement from 34.5 dBHL to 15.9 dBHL. Otorrhea, extrusion and obstruction of the tube were observed in 8 ears (18.6%), 9 ears (20.9%) and 3 ears (7.0%), respectively. No cholesteatoma or granuloma were seen. The ear drum perforation failed to close in 4 of 36 ears (11.1%) followed for more than 6 months after extrusion or removal of the tubes. Scarring of the ear drum was observed in 4 ears (12.5%). Recurrence of otitis media with effusion was seen in 15 of 32 ears (46.9%), in which the ear drum perforation was closed after extrusion or removal of the tubes.
The present results indicate that the Koken tube (A type) is one of the best tubes for long-term middle ear ventilation.

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We evaluated the relationship between nasal obstruction and sleep apnea in patients with various nasal disorders.
The subjects were 38 patients admitted to our department for surgical treatment of diseases of the nose or paranasal sinuses; 20 patients with chronic sinusitis, 11 with deviated nasal septum and 7 others.
Rhinomanometry was carried out on the day before operation to determine nasal resistance. The frequency of apneic episodes was recorded with an apnomonitor on the night before the operation. These patients were considered to have pathological apnea (pathological group) when they had 30 or more apneic episodes during 7 hours of sleep but to be normal (normal group) when the frequency of apnea was lower.
Rhinomanometry and apnomonitor studies were repeated in these 38 patients 7 days after the operation, and the results were compared with the pre operative figures.
Pathological apnea was noted in 19 (50%) of the 38 patients before the operation. The mean frequency was 159.4±117.3 apneic episodes. The mean frequency was 8.0±6.9 apneic episodes in the normal group.
In the 19 pathological patients 7 days post-operation, the incidence of sleep apnea was dramatically reduced to a mean frequency of 81.6±113.8 apneic episodes.
The mean respiratory resistance through both nostrils was reduced to 12.8±6.3cmH₂O/l/sec in the pathological group and to 7.7±4.0cmH₂O/l/sec in the normal group.
Snoring was observed 17 (89.5%) of the 19 in the pathological group and in 10 (52.6%) of the 19 in the normal group.

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Nine patients with congenital anosmia were evaluated clinically and pathologically, and olfactory mucosal biopsy was performed in seven of them. Biopsied mucosa of the olfactory cleft was examined with H . E. and immunohistochemical staining.
All patients were anosmic when tested with T&T olfactometry and intravenous Alinamine, but most of the patients were responsive to chemical irritants. Three of them had a family history of anosmia.
Histopathologically, all specimens showed only respiratory mucosa. Immunohistochemical examination showed an absence of olfactory receptor cells which react with anti-neuron-specific enolase antiserum in all the mucosal specimens.
These results indicate that olfactory mucosa is not present and the olfactory cleft is covered with respiratory mucosa in patients with congenital anosmia.

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Small osteomas of the frontal and ethmoid sinuses usually cause no symptoms. When they enlarge, they may produce symptoms such as facial pain, headache, or infection due to obstruction of the nasofrontal ducts.
A possible unique association of a small osteoma of the ethmoid sinus with headache is described. The headache of a 44-year-old female was completely relieved by removal of the osteoma compressing the anterior ethmoid nerve. The operative findings revealed that the nasofrontal duct was patent and there was no infection in the frontal and ethmoid sinuses.

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Four patients with a pathological diagnosis of fungal sinusitis were tested with magnetic resonance imaging (MRI). The characteristic MRI findings were: 1) comparatively low signal shadow on both T 1 weighted images and T2 weighted images with clear borders and homogeneous signal; 2) signal void spots; 3) high intensity enhancement all around the inner wall of the maxillary sinus, fonticulus nasi, after contrast with Gd-DTPA.
The MRI findings appear to be more characteristic of fungal sinusitis than the CT findings. However air, desiccated secretions, mycetomas, acute hemorrhage, calcium, bone, and enamel all produce signal void spots on MRI. It is impossible to differentiate them from one another by MRI, but it is possible with CT. We should use both MRI and CT to diagnose fungal sinusitis. At present CT appears to be a more reliable first examination, with MRI being used to confirm CT findings.

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A 69-year-old male complained of left cheek swelling which had started about three weeks previously. X-ray, CT scan and MRI showed a pathologic lesion expanding into the left maxillary sinus. We performed exploratory surgery, and found a white mass with much keratin debris. Histological examination showed it to be a verrucous carcinoma, which is a rare type of squamous cell carcinoma, especially in the maxillary sinus. Subsequently we performed a total maxillectomy using a rectus abdominis free flap. There has been no recurrence since the operation.

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Two patients with primary malignant lymphoma (non-Hodgkin's lymphoma) extending bilaterally into nasal cavities and paranasal sinuses were examined by plain X-ray films, CT, and MRI.
Plain X-ray films showed diffuse, uniform bilateral opacification of ethmoid cells and maxillary sinuses, which might lead to a misdiagnosis of chronic sinusitis. The only abnormal finding was bone destruction of the medial orbital rim; it was considered very important not to overlook this finding to avoid misdiagnosis.
Moth-eaten or permeating bone destruction of the nasal septum was found on CT and confirmed by MRI, which showed several very low intensity (no signal) regions dotted along the nasal septum. We conclude that less marked bony wall destruction and apparent mass formation on both sides of the bony wall are characteristic findings of sinonasal malignant lymphoma.

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We describe minor salivary gland tumors of the tip of the uvula, causing elongated uvula in two patients.
Case 1. A 78-year-old woman had a pleomorphic adenoma with an elongated uvula which reached the upper incisor teeth. Case 2. A 66-year-old woman had a monomorphic adenoma with an elongated uvula that always touched the base of the tongue. The elongated portions of the uvulae were excised and the bases were left.
Benign tumors of the uvula, excluding papilloma, are rare, especially at the tip of the uvula. The terminology of elongated uvula has not been established yet. We propose a definition of elongated uvula as uvula touching the tongue all the time.
These cases suggest that the weight of the tumor and traction during swallowing are causative factors of uvula elongated by tumor.

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Chondronecrosis of the laryngeal cartilage is a rare condition, usually occurring as a complication following radiation therapy. We report an unusual case which occurred not after radiation therapy, but with local infection following intra-arterial chemotherapy.
The patient was a 67-year-old male with a carcinoma of the left upper gingiva. He received local radiation therapy of 40 Gy to the left maxilla in conjunction with intra-arterial chemotherapy through the superior thyroid artery. Soon after discharge from the hospital. He developed dyspnea and dysphagia. Tracheostomy was performed to relieve the patient's dispnea, but the underlying cause of his problem remained unknown. Following a hemilaryngectomy, the surgical specimen revealed chondronecrosis of the thyroid cartilage caused by local infection during arterial infusion.
The most probable cause of the chondronecrosis in this patient was perichondritis of the thyroid cartilage.

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A 65-year-old female had complained of hoarseness and malaise in the larynx for two years. Indirect laryngoscopic examination revealed a lightgrey mass in the right posterior part of the subglottic area. Vocal cord movement was good bilaterally. Cervical lymph nodes were not palpable.
Excision of the mass was carried out by a laryngofissure approach. The mass arose from the right posterior lamina of the cricoid cartilage. A cricoid cartilage defect extending for about half its circumference was reconstructed with the use of costal cartilage. Histopathological examination showed low-grade chondrosarcoma. Postoperative laryngeal collapse or stenosis were not found.

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We present nine cases of parathyroid tumor, and a review of the literature on surgical treatment. In seven patients, the histologic diagnosis was parathyroid hyperplasia, which were observed in patients with secondary hyperplasia due to chronic renal failure. The other two patients had adenomas. The preoperative examination with computed tomography (CT) and echogram indicated the number and location of the parathyroid glands. However, more precise preoperative examination was necessary to avoid a false negative diagnosis. In our experience, total parathyroidectomy and retransplantation of autologous parathyroid tissue is one of the best surgical approaches.

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The pH values of endolymph in the inner ear of guinea pigs were studied with the use of H+ selective double-barreled microelectrodes. The pH in the endolymph was similar in the cochlea (7.54±0.06, n=12), in the saccule (7.54±0.04, n=7) and in the utricle (7.53±0.06, n=7) under different DC potentials in each endolymphatic space. The intravenous injection of ethacrynic acid resulted in a significant increase of pH value in the cochlea but not in the saccule and the utricle. The possibility that different mechanisms producing the endolymph pH may exist in different parts of the inner ear is discussed.

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Ischemia of the facial nerve is thought to be one of the most possible etiological factors in idiopathic facial palsy. The blood supply in the facial nerve has been studied morphologically in considerable detail. However, we have little information on its hemodynamics. In the present study we measured blood flow in the facial nerve at the geniculate ganglion using a laser Doppler flowmeter, and we investigated the effect of interruption of the stylomastoid artery and the petrosal branch of the middle meningeal artery on the blood flow in the facial nerve. Interruption of the petrosal artery resulted in almost complete ischemia of the facial nerve at the geniculate ganglion, but interruption of the stylomastoid artery caused no change. Thus, the blood flow in the geniculate ganglion of the facial nerve comes not from the stylomastoid artery but mainly from the petrosal artery.

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There are several useful diagnostic examinations for thyroid disease. The diagnostic value of CT in thyroid disease is still contraversial, although CT has become a routine clinical examination, since the plain CT does not always identify tumors accurately. In this paper, we introduce for the first time thyroid lymphography-computed tomography (TLGCT) which may improve the diagnostic value of CT.
The technique combines CT with thyroid lymphography (Matoba & Kikuchi, 1969).
We performed TLG-CT in 92 patients with various thyroid diseases and 20 normal controls and classified the radiological features into the following 6 types: entire (normal thyroid); moth-eaten (Hashimoto's thyroiditis); defect (follicular adenoma and adenomatous goiter); lobate (papillary carcinoma); localized (various thyroid diseases); and extrathyroid defect (parathyroid tumor).
In addition, we examined the relationship between TLG-CT type and the macroscopic appearance of the cut surface of the thyroid and lymph node metastasis in 20 patients with papillary carcinoma.
The results suggest that papillary TLG-CT type carcinomas have a high incidence of lymph node metastasis.
Our preliminary results suggest that TLG-CT is a potentially valuable diagnostic tool in the detection of thyroid disease and the assessment of the pathologic diagnosis as well as lymph node metastasis.

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We studied the clinical effects of LipoPGE₁ in 23 patients with sudden deafness who also received methylprednisolone (LipoPGE₁ group). Twenty one patients were treated with methylprednisolone without LipoPGE₁ (non-LipoPGE₁ group).
Complete recovery was noted in 10 patients, marked improvement in 4, improvement in 8, and no change in 1 in the LipoPGE₁ group. The corresponding figures were 6, 2, 5 and 8 in the non-LipoPGE₁ group.
The differences were statistically significant. No serious side effects were observed in the LipoPGE₁ group.
These results suggest that LipoPGE1 therapy combined with steroid is effective in patients with sudden deafness.

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The clinical effectiveness, safety and utility of ofloxacin (OFLX) were studied in the treatment of paranasal sinusitis. As a general rule, OFLX was given orally to 89 patients with paranasal sinusitis in daily doses of 600 mg for 5 days to 2 weeks.
The clinical effectiveness was evaluated by the doctor in charge as either excellent, effective, slightly effective, ineffective or worse. The clinical efficacy, defined as number of patients evaluated as either excellent or effective, was 83.3% in acute paranasal sinusitis (25/30), 54.8% in chronic paranasal sinusitis (17/31) and 75.0% in acute exacerbation of chronic paranasal sinusitis (21/28). The overall clinical efficacy was 70.8%. The rate of bacteriological elimination was 87.9%. The rate of sensitivity for OFLX in isolated organisms was 85.0% (51/60 strains). Though side effects were observed in 8 patients (9.0%), most of them were mild digestive symptoms. Therefore OFLX is considered to be useful in the treatment of paranasal sinusitis.

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