We have treated over 20 deaf patients with a Nucleus 22-channel cochlear implant for 5 years. Generally, the patient showed satisfactory results in vowel recognition after the surgery, while the consonant recognition rate was poor. Among consonants, voiceless plosives such as p, t and k were mostly misunderstood. The discharge pattern of the electrode revealed that the poor intelligibility would be due to the low discharge rate of the electrode in the cochlea at the plosive consonant portion. In order to develop a new speech processing strategy with higher fidelity to temporal and frequential properties of consonants, we examined a method to increase the discharge rate of the electrodes to 1250 Hz and to extract on accurate formant in voice by FFT. Recently in Melbourne, a new device of cochlear implant, using a similar strategy was developed to afford better perceptual ability to deaf patients. On the other hand, indication of this surgery is expected to be expanded for not only postlingual deaf patients but for prelingual deaf children in our country, although rehabilitation of such case takes much time.

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Cervical sympathetic nerve and bilateral cerebello-pontine angle tumors were found in a 26-year-old female. Her chief compliants were swelling of the left side of the neck and partial hearing loss on the right. There were no cafe-au-lait spots or other skin lesions. No family history of neurilemmomatosis was apparent. Histological examination of the tumors revealed neurilemmomas with Antoni A and B patterns.
There have been few reports of neurilemmomatosis in the literature, usually refered to as “multiple neurilemmomatosis”. To our knowledge, this is the first report of bilateral cerebello-pontine angle tumors combined with cervical sympathetic nerve neurilemmoma.
Neurilemmomatosis is distinguished from neurofibromatosis of von Recklinghausens disease because it lacks café-au-lait spots, neurofibromas, and any genetic components.

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A five-score scale was used to evaluate each of the following three aspects of subjective complaints of patients with tinnitus: 1) loudness, 2) degree of annoyance, and 3) interference with life activities. The tinnitus severity scale was defined as the sum of the scores of these three characteristics. The relationship among these three characteristics was analyzed, and five types of tinnitus were defined from data obtained by the questioning of 346 out-patients. The results were compared with those from 87 in-patients.
(1) The percentages of the types of tinnitus differed between out- and in-patients.
(2) In 74% of the out-patients the tinnitus severity scale was below 9 and in 76% of the inpatients it was 9 or more.
(3) Patients whose scores of annoyance and interference with life activities were higher than those of loudness and patients with scores of 9 or more tended to have physical or psychological problems in addition to their tinnitus.

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Serum antidiuretic hormone (ADH) levels were determined with a radioimmunoassay using a reversed-phase C₁₈ silica column in 200 patients with vertigo, dizziness and/or deafness; 85 of them had a diagnosis of Meniere's disease. The serum ADH level was significantly elevated in patients with Meniere's disease and in others with endolymphatic hydrops; e. g. cochlear Meniere's disease or delayed hydrops. On the other hand, the serum ADH level was rarely elevated in patients without endolymphatic hydrops. The increase of serum ADH in Meniere's disease showed no differences in relation to sex, duration of disease or laterality, but it was closely linked to vertigo attacks. The serum ADH level was very high during the week after an attack of vertigo and dizziness (acute phase), but it fell when the attack ended (remission). These results suggest that disorders of ADH-control in the inner ear are part of the mechanism underlying vertigo attacks in Meniere's disease.

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The results of vestibular neurectomy (VN) were compared with those of streptomycin perfusion into the lateral semicircular canal (SM-perf). Three patients under 60 yearss of age, were treated with VN and three whose age was over 60, were treated with SM-perf. No vertigo spell occurred in any of the patients after treatment. Lateral canal function was abolished in all cases, which was confirmed by ice-water caloric tests. Hearing became better in two of the VN group, but worse in two of the SM-perf group. Tinnitus scores fell to less than half of the scores recorded before the operation in two patients in each group.

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A 9-year-old boy with the Kabuki make-up syndrome visited our clinic. His face had the appearance of a Kubuki actor, and he had cleft palate. Bilateral mixed hearingloss was noted by audiometry, and a caloric test showed bilateral canal paresis. Temporal bone CT showed Mondini dysplasia in both inner ears.

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Four children, aged 9 months to 10 years, with acute mastoiditis were treated at the Department of Otolaryngology, Ishinomaki Red Cross Hospital from January, 1988, to June, 1990.
All had otalgia, abnormal tympanic membranes, and postauricular swelling. No patient had intracranial complications, such as facial nerve paralysis, meningitis, or brain abscess.
Three patients recovered after conservative therapy consisting of intravenous antibiotic therapy, myringotomy and the insertion of a ventilation tube.
One patient had a subperiosteal abscess and was treated with postauricular incision, but mastoidectomy was not performed in any of the patients.

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Magnetic stimulation of the peripheral facial nerve with Magstim model 200 was performed in normal human subjects without any history of facial nerve disorders. Contractions of the orbicularis oris and the orbicularis oculi muscles were evoked by magnetic stimulation around the auricle and were compared with those produced by extratemporal electrical stimulation.
1) Infra-auricular stimulation with Magstim caused configurations and latency similar to those caused by electrical stimulation at the stylomastoid foramen.
2) Contralateral stimulation of any site around the auricle never induced motor evoked potentials of both muscles.
3) Changing the site of stimulation from the supra-auricular to the infra-auricular area tended to shorten the latency period.
4) Ipsilateral stimulation of the right and left sides resulted in different latencies.
Thus, the site of excitation was not defined clearly. We conclude that it is too early to use this method to diagnose conduction block of the facial nerve.

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Various methods have been reported to evaluate the degree of facial palsy. They have, however, some problems concerning their objectivity and reproducibility, because they are based on the subjective assessment. In 1989 one of co-authors, Y. Naito, reported a new method to objectively quantitate the degree of facial palsy using computerized imagedefference system.
The purpose of this study is to devise this new objective method for the clinical evaluation of facial palsy. The patient's face is recorded on a video tape with a CCD camera. The video data are digitized with a video-digitizer (CVI 98 II, Canopus) and analyzed by personal computer (PC 9801XL², NEC) with a frame-buffer (Hyper-Frame+, Digitalarts). The image of the face in motion, eye closing and grinning, is then subtracted from the image at rest, and the white pixels that indicate the difference of the two images are counted. The degree of the palsy is indicated by the ratio of the numbers of pixels on the paralyzed and normal sides.
Eight patients with facial palsy and 20 normal controls were analyzed by this method.
The ratio in the control group was very close to 1:1, while in the facial palsy patients it reflected the degree of the facial palsy. The data obtained with this method was more reprodusible than the facial scores of the same subjects tested with 40-points grading system of Japan.
This new method is considered to be objective and reliable for the evaluation of facial palsy.

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Olfactory neuroblastoma with papilloma was diagnosed by immunohistological and electronmicroscopic examinations. Modified intensive combined indution chemotherapy with arterial infusion of cyclophosphamide, vincristine, pirarubicin and cisplatin as recommended by Sawaguchi et al was strikingly effective in this patient with olfactory neuroblastoma which was resistant to radiation therapy.

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A 34-year-old man with a history of transseptal hypophysectomy complained of nasal obstruction and bleeding. His nasal cavity and nasopharynx were filled with a large tumor. Histopathological examination revealed juveile angiofibroma. Surgical treatment (modified Denker's technique) was performed under general anesthesia. The tumor originated in the area of transection of the nasal septum in the previous hypophyseal operation. The pathogenesis of the tumor is discussed.

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In order to obtain a cue for the differential diagnosis, we evaluated the internal echo histograms of 15 parotid gland tumors (12 benign, 3 malignant) with respect to standard deviation (SD) of the echo level and width of histograms at 0%, 25%, 50%, 75% frequency.
1) The average SD of the echo level of malignant tumors was 8.43, which was significantly greater than that of benign tumors (p<0.05).
2) An analysis of the width of the histograms showed three patterns: bell type for malignant tumors, mountain type with a wide base for benign tumors and mountain type with a narrow base for normal parotid glands.
It is concluded that we can obtain objective information from the SD of the echo levels and the width of histograms for the differential diagnosis of parotid gland tumors.

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A mycotic aneurysm of the intracavernous carotid artery developed following a parapharyngeal abscess in a 55-year-old woman. The patient was admitted to our hospital with a 10-day history of trismus and a 1-day history of low-grade motor aphasia. Her upper left first molar had been extracted by a dentist 4 weeks previously. On the second hospital day, surgical drainage was performed. Despite apparent clinical improvement, total ophthalmoplegia developed suddenly on the 6th hospital day. An aneurysm of the left intracavernous carotid artery was seen on MRI and carotid angiography. It was treated medically. Ophthalmoplegia gradually improved. Our review of the literature revealed no other reports of mycotic carotid aneurysm caused by parapharyngeal abscess.

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The clinical and pathological effects were studied in 13 patients with head and neck cancer treated with preoperative simultaneous chemo (cisplatin·5-FU)-radiotherapy. The effects were excellent especially in neck lymph nodes compared with those of conventional preoperative radiotherapy. The severity of the side effects was almost the same as that of conventional preoperative radiotherapy. We consider that preoperative chemoradiotherapy improves the prognosis in patients with advanced head and neck cancer.

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Total thyroidectomy causes hypothyroidism within one month. It is therefore necessary to administer thyroid hormone soon after total thyroidectomy. However, thyroid hormone preparations are oral use only. We tried transrectal administration of thyroid hormone in therefore of a suppository for three patients with hypopharyngeal carcinoma who had undergone free jejunal autograft reconstruction after total pharyngolaryngectomy combined with total thyroidectomy and had not been able to swallow for more than one month. Suppositories of thyroid hormone after operation could prevent the decline of serum levels of thyroxine (T₄) 3, 3', 5-triiodothyronine (T₃), and TSH. If it is impossible to administer thyroid hormone by mouth after thyroid surgery, transrectal administration of the hormone seems to be useful in the prevention of hypothyroidism.

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An esophageal foreign body in a 7-year-old girl punctured the posterior wall and entered the prevertebral muscle. The anatomy of the hypopharynx and esophagus and the form of the foreign body led to perforation of the wall of the esophagus during the act of swallowing. The foreign body in the prevertebral muscle, which had not been found directly, was removed under fluoroscopy.

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Gas gangrene generally occurs in the extremities, and rarely in the neck.
A 63-year-old male visited our clinic complaining of sore throat and dyspnea. He had fever and swelling in his neck. A CTscan showed gas formation in the soft tissues. We performed emergency tracheotomy and surgical drainage from his neck. We administered antibiotics and performed debridement of necrotic tissues. These treatments were very effective.
Culture of the pus revealed Clostridium perfringens and Bacteroides interrmedium. We diagnosed gas gangrene.

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Effects of Gentamicin on the vestibular sensory epithelia and the behavior were studied using bull frogs. Gentamicin (80μg) was injected into the perilymphatic cistern for 3 days. The behavior was evaluated in terms of static posture, righting reflex, walking, jumping and swimming. Sensory epithelia of three semicircular canal cristae and the utricular macula were observed using scanning electron microscope.
When the unilateral utricular macula was damaged and the other side was intact or less damaged, the frogs tilted toward the side with severer damage. The angle of head tilt tended to increase according to the degree of morphological asymmetry of the utricular macula. The angle of head tilt increased with the period after injection.
When the bilateral utricular maculae were intact or equally damaged, no tilting was observed. These results indicate that the utricle perceives the gravity to maintain the static posture, and that the degree of utricular dysfunction is assessed by tilting posture.

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We performed chemosensitivity tests with MTT assay using KB cells derived from epidermal carcinoma of the mouth. Optical density (OD) for the MTT assay was measured with dual wave lengths: measurement wave (540nm) and reference wave (620nm). Five platinum (Pt) drugs and three anthracycline drugs were tested. The chemosensitivity to drugs was evaluated by the 50% OD of each drug concentration in the control group. CDDP was the most effective Pt drug, followed by 254S, NK121, CBDCA and DWA2114R. No significant difference among the three anthracycline drugs. We observed a linear increase of OD, corresponding to the increase in the number of cells. When we added 0.1M sodium succinate (SS) to 0.4% MTT {3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide}, the sensitivity of this assay was increased five fold.
MTT assay is a precise, rapid, easy and inexpensive experimental system, which should be an useful method of evaluating the effect of antitumor drugs on tumor cell lines.

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Triludan® was administered to 75 patients with Japanese cedar pollinosis to determine its effectiveness and safety. Triludan® was effective not only in patients who started using it before the beginning of the pollen season, but also in those who began taking it after the season had started. The drug was most effective for “sneezing” and “rhinorrhea”, but “nasal obstruction” was not so markedly improved. Side effects were reported by six patients (7.9%), three of whom complained of drowsiness.

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Effects of fibrin glue on experimental incision in rat's skin were studied and compared histopathologically with those of cyanoacrylate glue (Aron-alpha®), suture with silk thread, and suture with silk thread after silicone implantation.
Wounds treated with the fibrin glue showed complete adhesion and absorption 7 days after treatment. Inflammation was milder in the wounds treated with fibrin glue than in those treated with Aron-alpha® or silicone. Tissue repair after treatment with the fibrin glue was comparable to that in the wounds sutured with a silk thread.
These findings indicated that the fibrin glue is tissue compatible and assimilated by the tissue. The foreign body reaction after its application is considered to be minimal. Therefore, fibrin glue was thought to be widely applicable in the clinical field.

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