The middle ear space is divided into the anterior and posterior tympanic cavities. In the former are included the eustachian tube, protympanum, meso-, hypo-, and retrotympanum, and in the latter are included the epitympanum and mastoid antrum with mastoid air cells. The border line between the two cavities is the tympanic diaphragm which is composed of the malleus head and incus body with their related mucosal folds and the anterior attic bony plate with the anterior attic mucosal fold.
In the well-pneumatized ear, the epitympanum communicates not only with the mesotympanum via the tympanic isthmus (posterior route), but also with the protympanum via the supratubal recess (anterior route), in which the anterior attic bony plate is vestigial and the mucous fold is broad and perforated. This is called the membranous tympanic diaphragm type which allows ventilation of the epitympanum even if the tympanic isthmus is closed.
On the other hand, in the poorly pneumatized ear like the cholesteatomatous ear, the supratubal recess is small and the bony plate is long and thick and the mucous fold is vestigial. This type is called the bony tympanic diaphragm type which does not allow ventilation of the epitympanum if the isthmus is closed. The bony tympanic diaphragm in cholesteatoma can be classified into the plate type, pyramidal type, anterior type, and membranous types. These differences in the bony tympanic diaphragm are caused by difference in pneumatization of the pyramidal bone after birth. The bony tympanic diaphragm must be removed for the prevention of recurrence of cholesteatoma treated by the canal up technique.

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A 59-year-old female complained of acute right hearing loss with tinnitus. Headache and left hemiplegia occurred twelve days later, and right cerebral hemorrhage was found by CT scan. Angiography showed defects of the anterior inferior cerebellar artery (RICA) on the right side and severe narrowing of the vertebral artery on the left side. Left carotid angiography revealed that a persistent primitive trigeminal artery originating from precavernous segments of the internal carotid artery supplied the territory of the left AICA.
So-called AICA syndrome can consist of internal auditory disturbances and cerebellar symptoms. But the only symptom of AICA syndrome may be hearing loss, and stenosis of the unilateral vertebral artery can lead to the contralateral AICA syndrome. Angiography of both vertebro-basilar arteries may be necessary to determine the cause of intractable sudden deafness.

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A 19-year-old woman student had sudden hearing loss following attendance at a rock-and-roll music concert. She received the usual treatment for sudden sensorineural hearing loss, and moderate recovery of hearing was achieved.
Electrocochleograms were recorded in both the early and late stages of her illness. In the early period, the amplitude of AP was relatively high at intense sounds. The input-out-put curve of AP was sharp, and AP disappeared suddenly at the threshold of the hearing level. In the late period, a high amplitude of AP at intense sounds, a sharp input-output curve of AP and sudden disappearance of AP at the threshold of hearing level were observed. The threshold of hearing level where AP disappeared in the late period was lower than that in the early period.

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During the past 3 years in a section providing hearing aid service in our hospital, 266 outpatients have been examined and fitting with hearing aids.
We analysed their background factor: age, occupation, diagnosis, complications, hearing level, speech discrimination, use of hearing aids.
Most patients were 50 to 70 years old, their hearing levels were 40-70dB and speech discrimination scores were more than 50% in the hearing aided ears. Their hearing levels varied widely, but speech discrimination scores were generally low, and many scores were less than 10% in unaided ears.
We classified the patients' audiograms into eight types: flat, gradual, mountain, valley, dip, high cut, low deaf, profound type. On the aided side, many ears were gradual type and flat type; the unaided side tended to have the same type.
The main situations in which many patients had trouble were “at meetings or conferences”, “always”, “in the house, watching television, using the telephone”, etc.
We must always consider the patients' backgrounds and individual differences and we put the hearing aids to practical use.

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A 57-year-old male with bilateral Meniere's disease developed sudden sensorineural hearing loss of the right ear with vertigo. Hearing and vertigo responded temporarily steroid therapy. However, after the third episode of hearing loss, hearing of the right ear depended on the dose of steroid: an increase in the dose improved hearing and a decrease worsened it.
The contribution of autoimmunity to the etiology of Meniere's disease is discussed.

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Case 1 was a 24-year-old male and his cholesteatoma was sheet shaped. Case 2 was a 41-year-old female and case 3, a 7-year-old male, both of whom had cystic cholesteatomas along with acquired cholesteatomas. A dissociation between hearing level and subjective symptoms of hearing disturbance appears to be helpful in the diagnosis of congenital cholesteatoma.

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The timing of myringoplasty and factors affecting the results of surgery were investigated in 50 children (4-15 years old) who underwent myringoplasty for the repair of simple perforation of the tympanic membrane.
1. Average success rate of surgery in all age groups was 90%. It was 92.3% in preschool children (4-6 years old) and almost that in the other age groups. Surgery in preschool children can be recommended.
2. The rate of failure was higher for discharging ears or bilateral myringoplasty.

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Japanese cedar pollinosis was studied in 193 new outpatients (78 males, 115 females; 53 children, 140 adults) treated in our outpatient clinic from January 1987 to December 1989.
Japanese cedar and Japanese cypress pollen counts changed each year. The pollen count was highest in 1988, followed by that in 1989 and then that in 1987. The number of new outpatients with Japanese cedar pollinosis showed same tendency. More adults than children had positive specific IgE antibody levels to Japanese cedar pollen. Most of the new outpatients with Japanese cedar pollinosis were also sensitive to other antigens.

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Six patients with intractable epistaxis from the posterior nasal cavity which could not be controlled by conventional packing method are reported. The four men and two wemen were 54 to 75 years of age (mean, 64 years). The site of bleeding was confirmed by angiography by Seldinger's procedure through the femoral artery at the groin or a cut-down approach through the superficial temporal artery. The maxillary artery, which was suspected to be the site of bleeding, was successfully embolized with small pieces of Gelfoame and a few coils. No further epistaxis or complications of the embolism occurred. Super-selective intraarterial embolization is a new and effective therapy for intractable severe epistaxis.

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Pharyngeal flap operations are commonly performed in the treatment of velopharyngeal insufficiency in patients with cleft palate or congenital velopharyngeal insufficiency (CVPI). It has been reported that nasal obstruction following this procedure usually disappears in 4 to 6 months.
As previously reported, the difference between nasal resistance determined by the activeposterior method (Pp) and that determined by the active-anterior method (Pa) is thought to reflect the resistance of the nasopharynx or the pharyngeal flap.
In the present study, we measured nasal airway resistance by both the active-posterior and the active-anterior methods before and after surgery periodically in 13 patients with cleft palate or CVPI, aged 5 to 24 years. The control group consisted of 57 patients with cleft palate without pharyngeal flap surgery, aged 4 to 36 years.
The normal range of (Pp-Pa) was determined to be +0.2Pa/cm³/sec to -0.2Pa/cm³/sec because the value of (Pp-Pa) fell into this range in 55 out of 57 control subjects. The value of (Pp-Pa) returned to the normal range 6-7 months after flap surgery in 11 patients. However, it still remained abnormal 9 months following the procedure in 2 patients with stenosis of the lateral porus. Thus, if the flap operation is performed correctly, breathing through the nose is thought to normalize 6'-7 months after the pharyngeal flap operation.

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A 35-year-old male patient visited our outpatient clinic with sudden onset of right ear fullness. Right tubal stenosis was considered to be responsible for his complaint. A roughsurfaced flat tumor was found close to the right Rosenmuller's fossa, and biopsy was performed immediately under fiberscopy. Whether his hearing loss was due to a conductive or sensorineural disturbance was not conclusively determined because the audiogram was complicated. The tumor was diagnosed histopathologically as not malignant but inflammatory, “epithelioid granulosis in the pharyngeal tonsil”. Physical examinations did not support either sacoidosis or active tuberculosis. The final diagnosis, based on a retrospective study of his lesion, was old epipharyngeal tuberculosis and sudden deafness.

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The basal cell nevus syndrome (Gorlin-Goltz syndrome) is an autosomal dominant disorder. It is characterized by multiple basal cell nevi, multiple odontogenic keratocysts and skeletal abnormalities (ex. bifurcated rib, scoliosis).
Few reports of its clinical features have been published in the oto-rhino-laryngological literature. The diagnostic criteria are not yet clear, except in patients with co-existing skin anomalies and keratocysts. A 20-year-old male visited our clinic with a chief complaint of pain and swelling around the right bucca. He had multiple jaw cysts with an impacted tooth, cysts in both maxillary sinuses with an impacted tooth, protrusion of the frontal bone, a broad nasal root, increased distance between the inner canthi of the eyes, and mental retardation.
The histologic diagnosis of multiple jaw cysts and maxillary cysts was odontogenic keratocysts. So far, there has been no recurrence since the operation.

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We describe a case of hepatocellular carcinoma with metastasis to a paranasal sinus. A 57-year-old male had left exophthalmos and epistaxis caused by a mass in the paranasal sinus. Biopsy of the lesion revealed metastatic hepatocellular carcinoma. He was treated with chemotherapy and radiotherapy but died about 18 months later.

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From June 1984 to March 1991, 25 patients with benign parotid gland pleomorphic adenoma were treated surgically in my department of otolaryngology. Histological study was done to clarify the important factors participating in the formation of the capsule of benign parotid gland pleomorphic adenoma. In the tissues surrounding the capsule of the tumor, atrophy of acinal cells, lipoid degeneration, increase of the connective tissues around the lobules and dilatation of the interlobular ducts, which seemed to be due to compression by the tumor itself, were found. In the capsule wall and/or just outside it, normal duct tissues were seen and in constricted parts of the capsule, vessels were sometimes recognized. In some parts, the increased connective tissues around the lobules were combined with the tumor capsule. Small defects of the capsule were seen in a few cases of Seifert's type 2 tumor (stromal component rich type), and in all such cases newly formed cnnective tissue membranes were seen a little outside such parts. These findings suggest that the parotid gland tissue around the tumor participate in the formation of the tumor capsule.

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This is a clinical and pathological study of 31 patients with submandibular gland tumors treated from July 1978 to December 1990. Eighteen of the tumors were pleomorphic adenomas (benign). Six of the 13 malignant tumors were adenoid cystic carcinomas. The most important clinical sign was the characteristic tenderness associated with malignant tumors. Adenoid cystic caricinoma has a long clinical course. It is classified into three types: cribriform, tubular and solid. The solid pattern type has the poorest prognosis.

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The authors describe a case of clicking larynx, which is characterized by a clicking sound and pain in the neck on swallowing. A 58-year-old woman complained of pain and clicking on both sides of her neck on swallowing. Examination and fluoroscopy showed that on swallowing, the thyroid cartilage entered between the greater hyoid cornua. The thyroid cartilage and hyoid bone were locked together until they reached the end of their downward course, when the sterno-thyroid muscle contracted strongly to separate the locked structures. At the moment of this separation, a click was produced. Both superior cornua of the thyroid cartilage were surgically removed, and the click and pain on swallowing disappeared.

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A 66-year-old man with bilateral internal carotid artery occlusion had a cerebral infarction after an endonasal operation under local anesthesia with so-called cocktail premedication. Because his preoperative physical examination was normal, routine cocktail premedication was given. The operation was performed without any trouble, but after operation, his blood pressure and level of consciousness were reduced and his tongue was deflected posteriorly. CT scan after operation showed cerebral infarction and brain atrophy. DSA (digital subtraction angiogram) proved bilateral old internal carotid artery occlusion. 1231-IMP SPECT (single photon emission computed tomography) showed severe decrease of cerebral blood flow.
In our clinic, 27 of 519 patients (5.2%) operated on under local anesthesia with cocktail premedication had various side effects, but all were transient. This patient had bilateral internal carotid artery occlusion before operation and apparent cerebral infarction due to drop of blood pressure- a rare occurrence. It was impossible to predict bilateral internal carotid artery occlusion at the time of preoperative routine physical examination. To find bilateral internal carotid artery occlusion without symptoms is an important problem to be solved.

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With the use of double staining with propidium iodide and fluorescein isothiocyanatelabeled cytokeratin for the mixed cells in the head and neck cancers, DNA histograms exclusively consisted of epithelial (cancer) cells could successfully be obtained. DNA histograms of the tumors were classified into three type: type I (diploid pattern) for all 10 cases of benign tumors, and type I for 3 cases, type II (aneuploid pattern) for 6 cases and type III (changeable into aneuploid pattern) for 13 cases among the 22 cases of malignant tumors. By the present method, the DNA-index of cancer cells can be accurately evaluated and therefore, it is useful, for the classification of DNA-ploidy. The present study also suggests that the DNA-index of cytokeratin-positive cells is a valuable index of cancer. This method of detecting cancer cells and evaluating their DNA can should prove clinically useful.

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One of the important factors in improving the prognosis of head and neck cancer patients treated with combined therapy is the enhancement of the immunological response of the patients.
Biological Response Modifiers (BRM) are expected to increase this response in cancer patients by augmenting host defence mechanisms. A comparative study was performed on patients with head and neck cancer, who received primary therapy, to evaluate the clinical effectiveness of BRM (lentinan). Twenty two patients were injected intravenously with 2mg of lentinan once a week (lentinan group).
A control group of 23 patients received no lentinan therapy. The clinical effectiveness of lentinan therapy was verified by significant improvements in some of the immune responses. Natural killer cell activity and phytohemagglutinin biogenesis were increased, and immunosuppressive acidic protein and squamous cell carcinoma related antigen were decreased in the lentinan group.
Prolongation of the life span occurred in advanced stage III and stage N patients.
These results suggest that lentinan therapy is useful to some extent in the treatment of patients with head and neck cancer.

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The clinical efficacy of ofloxacin otic solution was evaluated in acute purulent otitis media, exacerbation of chronic purulent otitis media, chronic purulent otitis media, otitis externa and myringitis. Two to ten drops of 0.3% ofloxacin otic solution were administrated once or twice a day for 7 days.
1) The rate of clinical efficacy (excellent and good responses) judged by the doctor in charge was 75.9% (44/58), and judged by the peer review committee it was 61.5% (16/26).
2) The rate of bacteriological elimination was 93.1% (27/29).
3) The efficacy rate was higher in patients with chronic purulent otitis media treated twice a day (84.4% (27/32)) than in those treated once a day (65.4% (17/26)) (P<0.1), but no siginificant difference was observed between the two administration methods in patients with other diseases.
4) In the patients with a history of operation, the rate of clinical efficacy was 83.3% (10/12), similar to that in those without a history of operation (73.8% (31/42)).
5) None of the 71 patients examined had any side effects.
6) It was concluded that ofloxacin otic solution is useful.

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Allergic skin tests for house dust and control tests were done on 136 patients who had abnormal sensation in the throat and no nasal allergic symptoms, such as nasal obstruction, sneezing, or discharge. House dust tests were positive in 28 patients. They were given 2mg of Azelastine orally per day for the course of four weeks. Of the 28 patients, 22 were completed treatment. Subjective symptoms of abnormal sensation in the throat were reduced by more than 50% in 17 of the 22 patients (77.3%). These results suggest that type I allergy is one of the many factors which cause abnormal sensation in the throat.

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