As many previous authors have stated, there is no universally accepted classification of tinnitus, which seems to be due to various unknown mechanism. Because tinnitus can not be recorded electrophysiologically, it is generally assessed by psychophysical test such as pitch mathcing, loudness balancing and masking tests. Loudness is the most important psychological characteristic of tinnitus, but severity and annoyance are also factors. Loudness is assessed by the test mentioned above. Severity and annoyance are assessed by a severity scale graded according to the patients response to questions.
A standard tinnitus assessment by the Tinnitus Workshop Group of the Japan Audiological Society and indivisual plans for tinnitus assessment proposed by clinicians are discussed. For clinical use, a scale classified into four or five grades seems to be extensively employed. In regard to the effectiveness of treatment of tinnitus, it is concluded that it should be judged at least four weeks after the completion of the proposed treatment.

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Primary position upbeat nystagmus (PPUN) is an extremely rare disease, and there is no general agreement about its etiology. Most investigators believe, however, that it is associated with disorders in areas extending from the brain stem to the cerebellum. We studied the etiology of and lesions responsible for this disease from the results of various tests and examinations conducted in 3 patients who had different clinical courses. Finding 1: Horizontal and vertical eye movements showed dissociation in Case 2, suggesting that different nerve tracts are involved in these movements. Finding 2: All 3 patients showed evidence of disorders in the brain stem and cerebellum, suggesting that the conduction route between the brain stem and the cerebellum was impaired.

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The open method is useful as a surgical technique for aural cholesteatoma or adhesive otitis media, but there are problems that arise from the opened mastoid cavity.
Eighty-five ears with mastoid cavity problems, which had been operated on at our clinic from 1982 to 1991, were examined in this study. Earlier, One operation had been conducted on 52 ears, 2 on 24 ears, 3 on 7 ears, and 4 and 5 on 1 ear each. The average number of operations per ear was thus 1.5. The time since the first operation was 3 years and 4 months to 58 years and 1 month (average, 28 years and 11 months). The initial disease was chronic suppurative otitis media in 24 ears, aural cholesteatoma in 19, acute mastoiditis in 9 and unknown in 33.
The main complaint of 62 patients was otorrhea. Thirty-four were found to have vestibular vertigo when the mastoid cavity was being cleaned. Only 8 labyrinthine fistulae were recognized during operation. In 45 ears the malleus was missing, in 51 ears the incus, and in 37 ears the stapedial super-structure.
The mastoid was obliterated in 69 ears, bone chips were used in 50 ears and hydroxyapatite granules in 19 ears. The canal wall was reconstructed in 10 ears and revision operation was conducted in 6 ears. After mastoid obliteration, otorrhea was found in 6 patients, drum retraction in 6, and drum perforation in 2. In 31 of the 34 patients with vertigo there was good improvement after the operation. Hearing was generally not improved, especially in types 3 and 4 with ossicular reconstruction.

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One-stage tympanoplasty and mastoid obliteration for cholesteatoma otitis media was performed in 37 ears from November, 1988 through December, 1991. Twenty three received modified type III tympanoplasty for 17 attic type and 6 pars tensa type cholesteatomas, and 14 had modified type N tympanoplasty for 4 attic type and 10 pars tensa type cholesteatomas.
A part of the posterior ear canal wall was removed for direct visualization of the cholesteatoma. After complete removal of the cholesteatoma, the mastoid cavity was obliterated with bone chips and cartilage, with bone chips, Palva's flap and cartilage, or with Palva's flap and cartilage. Postoperative hearing was good in 20/23 ears (87.0%) after modified type III tympanoplasty, and in 6/14 ears (42.9%) after modified type N tympanoplasty. Good results were obtained in 18/21 (85.7%) of those with attic type cholesteatomas and in 8/16 (50.0%) of those with pars tensa cholesteatomas. Cholesteatomas recurred in 0/23 ears (0%) after modified type III tympanoplasty and in 2/14 ears (14.3%, pars tensa type) after modified type IV tympanoplasty.
These findings suggest that one-stage tympanoplasty and mastoid obliteration is useful, especially for attic type cholesteatomas.

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Tympanic membrane retraction is one of the important sequelae of otitis media with effusion (OME). In this study, the mechanism of atelectasis of the eardrums was investigated from the point of view of eustachian tube dysfunction.
One hundred and six ears with refractory OME which were not cured by the age of 10 were examined, because many refractory OME cases exhibit various types of tubal dysfunction, including stenosis and excessive patency.
When the relationship between passive tubal function and retraction of the eardrum was examined, the incidence of retraction was found to be significantly higher in ears with low opening pressure of the eustachian tube. Twenty five ears with tubal closing failure, evaluated by the sniffing test, showed a significantly higher incidence of tympanic membrane retraction than did those without evidence of closing failure.
These results suggest that retraction of the eardrum is closely related to excessive patency or closing failure of the eustachian tube.

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In 1992, a nasal allergy questionnare study of randomly chosen junior high school students was conducted in China and Japan during high pollen seasons. The months in which pollen scatters the most in Japan are March and April, and in China August and September. One school in each area was chosen and 200'-400 students in each school were questioned. The schools chosen were in mountanous, agricultural areas (a suburb of Sheiang City in China, and Tsukechi-cho, Gifu Prefecture, Japan), and in urban areas (Beijing City and Sheiang City, China, and Nagoya City, Japan). In Beijing City 17.2% of the students had nasal symptoms (sneezing, nasal obstruction and nasal discharge), in Sheiang City 31.0%, in the surburb of Sheiang City 28.6%, in Nagoya City 28.1% and in Tsukechi-cho Gifu Prefecture 37.5%. It is obvious from these results that the students in the mountainous, agricultural areas had more symptoms of nasal allergy than did those in the urban areas. However, in Sheiang City and Nagoya City the percentage was higher than in Beijing City. Other allergy symptoms appearing in the questionnare included itching of the throat and eyes. Itching of the throat appeared to be higher in China, and itching of the eyes was higher in Japan. Among the students with nasal allergy symptoms, more consulted hospital doctors in Japan than in China. In both countries there was a family history of atopic disease in 15-'20% of the students with nasal allergy.

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A 56-year-old woman visited our hospital because of nasal pain. Physical examination revealed a gray mass in the right nasal cavity. Precontrast CT scan showed a lesion with iso-density relative to the muscles, which had intermediate signal intensity on Ti-weighted MR image and high, partially low, signal intensity on T2-weighted image. The mass was totally removed by an endonasal approach, and histological examination showed interlacing bundles of tumor cells, confirmed as smooth muscle cells by immunohistochemistry and electron microscopy.

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Malignant myoepithelioma was found in the nasal cavity of a 66-year-old woman who presented with a rapidly expanding tumor accompanied by episodes of epistaxis. The tumor was removed by an extended Denker's operation and studied by light and electron microscopy, including immunohistochemical staining. By light microscopy, the tumor appeared to be a poorly differentiated epithelial neoplasm of undetermined origin; however, immunohistochemical examination showed myoepithelial differentiation with malignant potential, indicative of a nasal gland origin. To our knowledge, this is the first case of malignant myoepithelioma of the nasal cavity to be reported.

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The clinical features were correlated with the coronal CT scan appearance of the paranasal sinuses of 49 patients who had received the Caldwell-Luc operation 16 to 58 years ago. The clinical diagnosis at the time of the CT scan was postoperative maxillary cyst in 22 patients, chronic sinusitis in 21 patients, trigeminal neuralgia in 3 patients, radicular cyst, postoperative ethmoid cyst and inverted papilloma in one patient each. The CT scans of the 91 operated maxillary sinuses showed obliterated cavity in 21 cases, small cavity in 46 cases, cystic formation in 24 cases. The authors speculated that some maxillary sinuses which appeared in CT scans as small cavities might cause the clinical symptoms of postoperative maxillary cyst in the future.

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A parotid tumor was found in a 69-year-old female patient with a high serum CA 19-9 value. Several treatments were administered: chemotherapy, operation, postopertive chemotherapy and radiation. The serum CA19-9 value decreased with the reduction of the tumor volume, by stages as each coursed therapy. Histological examination revealed “carcinoma (adeno-squamous carcinoma) in a pleomorphic adenoma.” Immunopathological examination of the specimen proved that the high level of CA 19-9 originated in the adenocarcinoma part of the tumor. We discuss the usefulness of CA 19-9 serum values as a tumor marker of salivary neoplasms.

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Carcinoma of a major salivary duct is very rare and is highly malignant. Originally reported in 1968 by Kleinsasser, its histological features are cribriform and papillary patterns together with comedonecrosis, resemblling duct carcinoma of the breast.
Recently we treated a 66-year-old male who complained of right facial nerve palsy. A CT scan of the neck showed a tumor with a diameter of 2 cm in the right parotid gland. Right total parotidectomy was performed, and salivary duct carcinoma was diagnosed.

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A 15-year-old girl had a branchiogenic fistula from the preauricular region to the parapharynx. Her chief complaint was pain in the right parotid region and in the pharynx. The right lateral wall of the pharynx was red and swollen. There was discharge from the ipsilateral preauricular fistula. After the location of the fistula had been verified by contrast X-ray, the fistula was extirpated. Its course was medial to the facial nerve and reached the pharyngeal constrictor muscle. The histological diagnosis was branchial cleft fistula, a subtype of the first branchial anomaly that is neither type 1 nor type 2 of Work's classsification.

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An 18-year-old man who presented with neck mass was admitted the same day. CT and US demonstrated an abscess of his left carotid space. He underwent drainage by PERCUFLEX® drainage catheter within six hours of his arrival. He was discharged from the hospital 10 days later. Although it is still thought that early open surgical drainage is the most appropriate method for treatment for cervical abscess, early treatment with a drainage catheter such as PERCUFLEX may replace the surgical method; it avoids life threatening complications with good cosmetic results and rapid recovery.

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Although tuberculosis in the neck region is rare, the physician must keep it in mind and rule out malignant tumors in the differential diagnosis of any head and neck masses. We recently treated three patients with TB in the neck region. The diagnosis was confirmed by histological examination of the biopsy specimens. The treatment should be appropriate to the clinical stage. The recommended therapy for cervical scrofula is surgical excision, followed by antituberculous chemotherapy, which can shorten the period of treatment.

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Hypoglossal nerve neurinoma was diagnosed in a 70-year-old female. Neurinoma is common in the head and neck region ; but identification of the nerve of origin is difficult, and neurinoma involving the hypoglossal nerve is rare. Most such neurinomas are intracranial and those of the hypoglossal nerve in the submandibular region are extremely rare. A review of the literature, found only 6 reports of submandibular hypoglossal nerve neurinoma (including the present case). Our patient was treated with open reduction and the tumor was removed from the hypoglossal nerve, which was reconstructed by interposition end-to-end anastomosis with the major auricular nerve. Microscopically, this tumor was an Antonny A and B mixed type tumor. The postoperative condition has been good.
Neurinomas involving motor neurons are treated with tumor enucleation or resection. Tumor enucleation is potentially the ideal treatment ; however, paresis of the nerve of origin and recurrence of the tumor are frequent events. Tumor resection with nerve reconstruction is better surgical treatment if the patient is able to endure the temporary paresis.

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A 58-year-old man complained of hoarseness. He was found to have left vocal cord palsy and a nodule in the left thyroid lobe. US of the thyroid revealed a round tumor with a definite regular boundary echo and an internal echo with a polycystic pattern. CT films showed a noninvasive mass in the left thyroid lobe and a mediastinal mass with a small calcification. No lesion was detected in the right thyroid lobe by US or CT.
The preoperative diagnosis was a benign thyroid tumor and a mediastinal tumor. Histological examination showed a follicular adenoma of the left thyroid, a minute papillary carcinoma of the right thyroid and a papillary carcinoma in the mediastinum. The mediastinal tumor had invaded the left recurret nerve and was considered to be a metastasis from the minute carcinoma of the right thyroid lobe.

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A clinical and histopathological study of 25 patients with nasal polyps is described.
1. The cells infiltrating the nasal polyps were examined. Lymphocytes were found in 100% of the specimens, plasma cells in 96%, eosinophils in 92% and neutrophils in 36%.
2. More eosinophils and neutrophils were present in the tissue just beneath the mucosa of the nasal polyps than in the cores of the polyps.
3. A weak but significant correlation was found between the degree of infiltration with eosinophils in the tissue just beneath the mucosa and the increase of circulating eosinophils in the peripheral blood (Spearman's correlation).
4. The degree of infiltration with eosinophils was significantly lower in patients with X-ray evidence of moderate or severe sinusitis than in patients with little or no sinusitis.

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The therapeutic effect of bifemerane hydrochloride (Celeport®) was studied in 42 patients with loss of the sense of smell caused by the common cold (group C) or head trauma (group T) who failed to respond to conventional treatment such as intranasal administration of betamethasone sodium phosphate. Celeport was administered in a daily dose 150mg tid or 100mg bid for 2 to 20 months. We assessed the effect of Celeport on the threshold of olfactory sensation and perception using the T & T olfactogram. The patients of group C showed significant improvement both in the threshold of olfactory sensation and perception after treatment. On the other hand, those of group T showed no significant recovery either in the threshold of olfactory sensation or perception. The rate of improvement in aged patients with loss of smell caused by the common cold was better than that in young patients. Therefore, we assumed that in aged patients the location of olfactory pathology caused by the common cold is not only the olfactory mucosa and nerve, but also the olfactory central nervous system.

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The clinical efficacy of clarithromycin was investigated in 34 children with chronic sinusitis, and 36 children with secretory otitis media accompanied by chronic sinusitis.
1) Rhinoscopy showed reduced nasal mucosal swelling in 74.2%, decreased nasal discharge in 78.5%, decreased postnasal drip in 89.3% and improved quality of nasal discharge in 88.6%. Follow up X-ray films showed improved opacity of maxillary sinuses in 81.6%.
2) There was improvement in 71.4% in the appearance of the tympanic membrane and in 66.7% in that of the tympanogram.
3) The rate of clinical efficacy was 88.6% (marked improvement, 54.3%; some improvement, 34.3%) for chronic sinusitis and 79.6% (marked improvement, 38.8%; some improvement, 40.8%) for secretory otitis media.
4) No side effects were observed.
On the basis of these results, clarithromycin was judged to be useful in the treatment of children with chronic sinusitis and with secretory otitis media accompanied by chronic sinusitis.

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