Unlike subacute and chronic thyroiditis, acute suppurative thyroiditis with subsequent abscess formation is rarely encountered in clinical practice. The route of infection in recurrent acute suppurative thyroiditis was obscure until Tucker et al first suggested the presence of a congenital fistulous tract extending from the piriform sinus to the side of the neck. The relation between acute suppurative thyroiditis and an internal fistulous tract (piriform sinus fistula) as the route of infection was confirmed by Miyauchi et al. Since then, a number of similar cases have been reported and, at present, piriform sinus fistulae are considered to be the most common route of infection inducing recurrent acute suppurative thyroiditis.
Piriform sinus fistula is a persistent congenital sinus tract, which arises from the apex of the piriform sinus and ends in or adjacent to the thyroid lobe, and is characterized by the exclusively leftsided occurrence. The fistulae are assumed to arise from remnants of the 3rd or 4th pharyngeal pouch, or the ultimobranchial body, but its exact origin remains controversial.
In this paper, we describe two patients with recurrent acute suppurative thyroiditis and abscess caused by infection through the piriform sinus fistula. Repeated barium meal studies demonstrated a thin fistula in one of the two patients. After fistulectomy, recurrent disease developed in one of the two, indicating incomplete removal of the fistula. This patient underwent revision surgery later. Barium contrast studies and endoscopic examination were useful in making the diagnosis accurately, and surgical exploration of the neck with excision of the entire fistulous tract to the level of the piriform sinus is the treatment of choice.

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Angioneurotic or Quincke's edema is a condition characterized by the sudden appearance of temporary edematous areas of the skin or mucous membranes and occasionally of the viscera. The origin may be allergic, neurotic or unknown. This disorder can be classified into two forms: hereditary (inherited Cl inhibitor deficiency) and non-hereditary (sporadic).
We report a case of angioneurotic (Quincke's) edema which appeared in the upper aerodigestive tract of a 76-year-old male. This patient was first seen at our emergency clinic with the complaint of dyspnea associated with a marked swelling of the lips, tongue and anterior neck. Since the patient did not respond well to various medical treatments including steroids, tracheostomy was then performed to alleviate his dyspneic condition after hospitalization. Examination did not reveal any evidence of deficiency or functional impairment of complement components nor a family history of this disorder. Therefore he was finally diagnosed as having a non-hereditary (sporadic) form of angioneurotic edema.
Approximately two months later the patient experienced another episode of edema necessitating tracheostomy again. Since then, however, the patients has remained symptom-free and no treatment has been instituted for more than three years.

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Solitary schwannoma is a benign tumor arising from the Schwann cells in myelinated nerve fibers. The tongue is the most common site of schwannoma in the oral cavity, whereas the oropharynx is a very rare site. We encountered three cases of schwannoma in the oropharynx and oral cavity: one in the posterior wall of the oropharynx of a 27-year-old woman, and one on the tongue of a 15-year-old woman and another on the tongue of a 30-year-old man. There have been only a few cases of schwannoma arising from the posterior wall of the oropharynx reported in Japan and few cases reported even in the English literature. These three cases are presented and the literature reviewed.

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A 42-year-old woman presented with slowly progressive left-sided facial paralysis in association with some hemifacial spasm that had developed over a period of 8 years. A whitish large mass at posterio-inferior aspect of the tympanic cavity was found through the left tympanic membrane and audiometric testing revealed mild conductive hearing losses for lower-frequencies in the left ear. Magnetic resonance imaging (MRI) with gadolinium enhancement showed a large neurogenic lesion involving throughout the mastoid segment of the facial nerve with the peripheral extension beyond the stylomastoid foramen. These findings were confirmed at surgery and intratemporal tumor was totally removed. Unfortunately nerve grafting could not be attempted since the tumor was too large and extended to the extratemporal region beyond the stylomastoid foramen. We should perform MRI on patients with unilateral facial paralysis if possible, since diagnosis and surgery during the early state provide a better prognosis for facial nerve function.

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True malignant mixed tumor, or carcinosarcoma, of the salivary glands is exceedingly rare. We present a case of parotid gland carcinosarcoma occurring in a 57-year-old male patient. His chief complaints were pain and swelling in the left parotid region and difficulty in his mouth open. Despite intensive irradiation, chemotherapy and total parotidectomy, he finally died of local tumor recurrence and distant metastases to the lungs approximately 14 months after the onset of the disease. The surgical specimens and tumor tissue obtained at autopsy revealed typical features of carcinosarcoma consisting of various epithelial and non-epithelial histologic components, including squamous cell carcinoma, undifferentiated carcinoma, chondrosarcoma, spindle cell sarcoma, fibrosarcoma and rhabdomyosarcoma. Immunohistochemical study of the tumor specimens also showed characteristic histochemical diversity and specific features of carcinosarcoma (Keratin, S-100, NSE etc. were positive). Metastatic lesions in both lungs and pulmonary hilar lymph nodes showed the same histological patterns as the original tumor. These findings indicate that this tumor was a true malignant mixed tumor (carcinosarcoma) of parotid gland, as proposed by Batsakis and other investigators.

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A 43-year-old male with a long-standing history of chronic left otorrhea, suddenly developed left otalgia, severe occipital headache and gait disturbance. Five days later, this patient was hospitalized because of deterioration of the level of consciousness, high fever, urinary incontinence, etc.
Examination revealed granulation tissue with thick pus filling the left external auditory canal, suggesting aural cholesteatoma. Computed tomography showed cerebellar abscess of 30 mm in diameter and secondary hydrocephalus in the left hemisphere, possibly of otogenic origin. The patient underwent craniosurgical drainage of the abscess twice by a neurosurgeon together with intensive antibiotic therapy. After his general condition improved, left radical mastoidectomy was carried out and a large mass of cholesteatoma filling the mastoid cavity was removed. There was erosion of the posterior bony wall of the mastoid exposing the posterior fossa dura, where fistulization of the mastoid into the posterior cranial fossa presumably occurred.
Our literature review of otogenic intracranial complications during the past 10 years in Japan indicated that there were 78 reported cases including 42 cases of brain abscess (60%). Almost all patients with otogenic brain abscess had a history of chronic purulent otorrhea, more than half (64.5%)had cholesteatoma and there was a marked male predominance in this disease. Although recent reports in the literature indicate a tendency toward greater reliance on intensive antibiotic therapy, it should be constantly remembered that chronic suppurative otitis media can be a serious disease, particulary when associated with cholesteatoma, and that intracranial complications can be prevented by timely surgical intervention.

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A 41-year-old male visited our out-patient clinic complaining of the sudden onset of multiple symptoms including left facial palsy, severe otalgia with periauricular vesicles, hearing impairment, vertigo, and hoarseness. A tentative diagnosis of herpes zoster oticus associated with multiple cranial nerve involvement was made and the patient was hospitalized for further examination and treatment. Physical examination and detailed laboratory studies demonstrated that the patient had paralyses of the 5th and 7th through 10th cranial nerves on the left side, which were diagnosed as polyneuritis caused by varicella-zoster virus infection (Ramsay Hunt's syndrome).
The patient was treated initially with an anti-viral agent (Acyclovir), then followed by steroid therapy together with other empirical treatment. His 5th,7th, and 9th cranial nerve function was successfully restored but no recovery was noted in his left hearing which remained almost totally deaf. His dysequilibrium and hoarseness gradually improved despite the fact that his abolished vestibular response and vocal cord paralysis remained unchanged.

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Wegener's granulomatosis is characterized by 1) necrotizing granulomatous lesions in the upper and/or lower respiratory tract; 2) generalized focal necrotizing inflammation of arteries and veins; and 3) necrotizing glomerulitis.
A 58-year-old m ale was hospitalized because of frequent epistaxis and headache. On examination, hemorrhagic granulomatous tissue, septum perforation and severe mucosal atrophy were noted in the nasal cavity. After repeated nasal biopsies, the patient was diagnosed as having Wegener's granulomatosis one month later. Although laboratory studies showed no evidence of renal dysfunction throughout the course of the disease, a cavitation in the right lower lung was noted on chest Xray.
The patient was primarily treated with a combination of steroids and cyclophosphamide, but pneumonia and lung abscess later developed. After repeated remissions and deteriorations of the disease for a period of three and a half years following the initial diagnosis, the patient died of respiratory failure at the age of 62.
Recent reports suggest thatre mission or control of the disease for many years can be expected with the use of steroids and immunosuppressants such as alkylating agents in some selected patients when an early diagnosis was accurately made. However, it should be emphasized that great care must be taken to avoid the risk of subsequent infection derived from administration of these drugs.

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Non-traumatic cerebrospinal fluid rhinorrhea (CSFR) has a low incidence. However, it should be considered differential diagnosis of running nose because of the risk of recurrent meningitis.
In the cases of CSFR with intact olfaction, this site should be conserved during surgery if possible to preserve the patient's quality of life. However, there have been few reports of surgery to cure CSFR via the cribriform plate fistulae. We experienced a patient with unilateral spontaneous CSFR via the cribriform plate, which was successfully cured by a newly developed simple transseptal procedure conserving postoperative olfaction.

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Three recent cases of malignant lymphoma with severe complications in the elderly are presented. Case 1: An 80-year-old man with liver cirrhosis, chronic hepatitis B, old tuberculosis and diabetes mellitus was hospitalized because of febricula and swelling of abdominal and cervical lymph nodes. Lymph node biopsy revealed malignant lymphoma (pleomorphic type). After the first cycle of COD-BLAMIV chemotherapy, the varix ruptured. Chemotherapy was stopped because of his performance status and complications. Case 2: A 70-year-old man with chronic obstructive lung disease was hospilized because of abdominal and cervical lymph nodes swelling. He had malignant lymphoma (Hodgkin's disease) and gastric carcinoma. Total gastrectomy was performed after 3 cycles COPP/ABV hybrid chemotherapy, but he died of MRSA infection. Case 3: A 65-year-old woman with liver cirrhosis, chronic hepatitis C and esophageal varix was hospitalized because of a submandibular mass. After surgery, COD-BLAMIV chemotherapy was started since the pathological diagnosis was malignant lymphoma (diffuse large cell). In these three cases, recombinant human granulocyte colony-stimulating factor was effective for neutropenia. We recognize the necessity of evaluation and special care of senile mental disturbance. And we are confident that positive treatment for the elderly is possible based on suffcient prechemotherapy evaluation.

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We retrospectively evaluated 73 patients with Bell's palsy and 27 patients with Ramsay Hunt's Syndrome (herpes zoster oticus) who were treated at our institution between October 1983 and April 1992 in order to identify the clinical features that were well correlated with prognosis for recovery of facial function. They were hospitalized for conservative medical treatment for a few weeks and then followed up at our out-patient clinic for a period of at least 6 months. Treatment modalities consisted mainly of steroids and/or antiviral therapy together with some supportive therapeutic measures.
The results are summarized as follows;
1) Hunt's syndrome (herpes zoster oticus) had a poorer prognosis than Bell's palsy, as already well documented in the literature.75.8% of patients with Bell's palsy and 62.5% of those with Hunt's syndrome had complete recovery. None of the patient with Bell's palsy remained totally paretic but 3 patients with Hunt's syndrome remained unchanged during a follow-up period of 6 months.
2) Complete or incomplete facial muscle paralysis assessed by electrodiagnostic testing results and by repeated physical examination was obviously one of the critical prognostic factors. Ultimate prognosis for patients with incomplete paralysis was excellent; more than 90% and 75% of patients with Bell's palsy and with Hunt's syndrome, respectively, recovered completely. However, recovery profiles for patients in the complete paralysis group were much worse (56% and 41% of patients with Bell's palsy and with Hunt's syndrome, respectively).
3) There was a strong correlation between the patient's age and eventual recovery. In patients younger than 50 years of age, complete recovery was obtained in 93.1% of patients with Bell's palsy and in 85.7% of those with Hunt's syndrome, whereas full recovery of only 60.6% and 30.3% of patients with Bell's palsy and with Hunt's syndrome, respectively, was achieved in patients aged 50 or older.
4) It was also suggested that the longer the intervals between onset of the disease and initiation of the treatment, the poorer the outcome for recovery.

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Ventilation tubes have widely been used for the treatment of otitis media with effusion (OME) to establish aeration of the middle ear cavity. Tube placement results in hearing improvement when the tubes are patent and functional.
We applied the ventilation tubes to 82 patients (146 ears) with OME, who were highly resistant to conventional treatment modalities such as medical therapy and/or myringotomy with fluid aspiration, during a period from December,1984 to July,1991, for approximately 6.5 years.
The patients with OME were divided by age into two groups; pediatric group (aged 13 years or younger,63 patients,119 ears) and adult group (aged 20 years or older,19 patients,27 ears). The mean insertion period of the tubes was 5.3 months and was much shorter in the patients without hearing improvement (3.5 months) than those with substantial hearing improvement (6.4 months). Recurrent disease after extrusion of the tubes occurred after an average of 3.3 months in both the pediatric and adult groups. In the pediatric group, extrusion rate of the tubes was significantly higher in children aged 7 years or younger (40.0%) than in those aged 8 years or older (19.5%). Postoperative complications included: otorrhea in 8 ears and permanent perforation of the tympanic membrane in 1 ear, but otherwise there were no serious complications following ventilation tube placement in this series of patients.
Although the Paparella type I and II tubes were employed in this series of patients with OME, it is speculated that more suitable types of tubes that are available in the market could be selectively applied to each patient to obtain a more successful therapeutic result.

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In our previous communicaiton on an analysis of dizzy patients, we reported that there was a significant difference between patients with dizziness of indeterminate etiology and age-matched healthy control subjects in the incidence of positivity on the Schellong test, while no significant difference was observed between dizzy patients with peripheral vestibular disorder and healthy controls. We speculated that these results may be explained by the fact that a substantial number of patients with orthostatic dysregulation or autonomic imbalance were included among dizzy patients of indeterminate etiology.
We further attempted to analyze data obtained exclusively from 149 adult patients with dizziness of indeterminate etiology (34 males and 115 females), who were not diagnosed with either peripheral or central vestibular dysfunction, conforming to the procedure using the Schellong test to determine whether their symptoms were directly related to autonomic nervous system dysfunction. Ninety age-matched healthy individuals without a history of dizziness or vertigo were selected as controls (42 males and 48 females).
The results obtained in the present study were as follows:
1) Patients with dizziness of indeterminate etiology showed a higher incidence of positivity on the Schellong test than healthy control subjects. The difference between the two groups was statistically significant. Our previous data reported elsewhere were thus confirmed by the present study.
2) Since the five major and six minor items listed in the questionnaire for orthostatic dysregulation are known to be composed entirely of so-called autonomic imbalance symptoms, patients were divided into two groups based on responses to a questionnaire; one having subjective symptoms of autonomic imbalance (6 males and 29 females for a total of 35) and the other not (28 males and 86females for a total of 114). Patients with autonomic imbalance disclosed a higher incidence of positivity on the Schellong test as compared to patients without symptoms. Among the former patients, a decrease of systolic pressure on standing, in particular, was more prominent than that among the latter.

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Shun-ichi Imamura, Kaori Hashimoto, Mayumi Imamura, Izuru Nozawa, Ken-ichi Hisamatsu and Yoshihiko Murakami (Yamanashi Medical University)Peripheral facial palsy caused by secondary malignant tumors of the temporal bone from distant or adjacent primary tumors is thought to be rare. We encountered nine patients with facial palsy resulting from secondary neoplastic invasion to the temporal bone from various primary sites (liver, lung, breast, eyelid, hypopharynx, maxillary sinus, renal pelvis, and leukemia) during a period of approximately 10 years (between 1983 and 1992). The incidence of this type of etiology accounted for 5.2% (9/173) of all patients with facial palsy who were treated at our institution during that period.
We also performed histopathologic studies of the temporal bones acquired from five patients who had presented facial palsy of varying degrees before death due to secondary malignant tumors and the correlation between their clinical and histological findings was investigated.
The results obtained in the present study were summarized as follows:
1) The present study and our comprehensive review of the literature indicated that the most common clinical symptom in patients with secondary malignant tumors of the temporal bone was facial palsy, followed by hearing loss, otalgia, etc.
2) It also became apparent that there were three basic routes of tumor invasion from primary tumors to the intratemporal portion of the facial nerve: 1. hematogenous dissemination of neoplastic cells to the bone marrow or pneumatized area of the temporal bone destroying the Fallopian canal,2. direct extension of malignant tumors adjacent to the temporal bone involving the Fallopian canal,3. leptomeningeal metastatic carcinomatosis involving the internal auditory meatus and destroying the facial nerve trunk directly. Clinical otologic features including facial palsy tended to differ depending on the extension route of the malignancy to the temporal bone and facial nerve.
3) Although metastatic or secondary temporal bone malignancies are rare and the clinical symptoms usually appear late in the course of disease, otologists should be aware of existence of this disease entity, since otologic symptoms such as that for facial palsy or hearing loss may be the only initial sign of tumor in selected patients.

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Kallmann's syndrome is characterized by hypogonadotropic hypogonadism and anosmia. Post mortem studies have revealed either hypoplasia or aplasia of the rhinencephalon in patients who have this syndrome associated with hyposmia and anosmia. Using MRI, we examined the rhinencephalon of patients with Kallmann's syndrome as well as that of patients with anosmia without hypogonadism. In patients with anosmia without hypogonadism, the rhinencephalon was found to be normal under MRI. In patients with Kallmann's syndrome, however, MRI showed underdeveloped olfactory sulci. These findings also indicate the usefulness of MRI in evaluating the anatomy and pathology of the central nervous system.

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Dysosmia as a symptom of nasal and paranasal sinus diseases has stimulated social concern in keeping with the latest changes in lifestyle.
In instituting treatments for nasal and paranasal sinus diseases, there is a tendency to place importance on nasal function, which is especially true for surgical treatment of paranasal sinus disease.
With this in mind, we opened an olfactory outpatient clinic in the Department of Otolaryngology, at Yamanashi Medical University Hospital in 1990 to improve therapeutic results in nasal and paranasal sinus diseases and to actively respond to social needs.
We recently conducted statistical analysis of 102 patients with dysosmia who were seen at our olfactory outpatient clinic between May 1990 and December 1992. This paper presents the results and relevant comments.
Of the 102 patients,57 were male and 45 female. Ages ranged between 9 and 85 years, with males in their 50s and females in their 60s forming the greatest proportion.
Chronic sinusitis and allergic rhinitis were the predominatingly causative disease.
Diagnosis of disturbance by site revealed respiratory dysosmia in 15 cases, olfactory-epithelial dysosmia in 18, combined dysosmia in 40, peripheral nerve dysosmia in 13, and central dysosmia in 16.
Treatment was mainly based on a topical nose drop with suspended steroidal aqueous solution. The improvement rate analysed revealed complete recovery in 39%, improvement in 30%, and no change in 31%.
The standard olfactory acuity test (T & T Olfactometer) and examination of the olfactory cleft region with the Selfoscope (needle-like hard scope) are most important for diagnosing and treating dysosmia.

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Bacterial interference between normal oral flora and pathogens is known to play a significant role in non-specific host defense mechanisms against bacterial infection. In particular, much attension has been focused on a-streptococci with inhibitory activity against group A streptococcus in the oral cavity and throat.
We developed a new method named “filter paper stamp method” to investigate the bacterial interference and this method was found to be simpler and more accurate than previous procedures. The detection rate of a-streptococci with inhibitory activity against group A streptococcus was examined in both healthy individuals and patients with tonsillitis. In healthy individuals, the inhibitory strains increased with age and may reflect the fact that group A streptococcal infection decrease with age. In patients with tonsillitis, the detection rate of inhibitory α-streptococcus in patients for whom tonsillectomy was clinically indicated was much lower than in those not indicated for this surgery. In the patients who received tonsillectomy, the detection rate of the inhibitory strains steadily increased after surgery. It is suggested that studies of α-streptococcus with inhibitory activity against group A streptococcus in the oral cavity and throat are of clinical significance in determining the indication for tonsillectomy and in evaluating the effect of surgery.
We also found that non-pathogenic oral bacteria such as β-lactamase-producing H. parainfluenzae as well as α-streptococci with inhibitory activity against group A streptococcus were of considerable significance in the antimicrobial therapy for tonsillar infection. As a result, bacteriological follow-up studies of both pathogenic and non-pathogenic strains in the oral cavity and throat are of importance in patients with tonsillitis.

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The present study evaluated the efficacy of methylrosanilinium chloride (Pyoktanin) and DF-100in preventing nosocomial infection with methicillin resistant Staphylococcus aureus (MRSA), which was isolated from the inpatients and their surrounding facilities in the Department of Otolaryngology at Yamanashi Medical University Hospital.
Among the 29 patients who were hospitalized in our inpatient ward,14 were found to be MRSA carriers. MRSA was isolated from the nasal vestibule in 13 patients, from the oropharynx in six, and from the tracheostoma in three. MRSA was also detected on the floors of patient's rooms (8 of 11 rooms) as well as those of the nurse station, bath rooms, lavatories, etc.
The floors were meticulously sterilized once a day with DF-100, which was proven to be a potent disinfectant against various pathogens. We also applied 0.01% Pyoktanin hydrophilic ointment to gauze pads covering the tracheostomas as one of the preventive measures against MRSA, since MRSA at the site of tracheostomas tended to spread widely to the surrounding environment of the hospital in the form of droplet infection or contamination. The Pyoktanin ointment was also applied to the nasal vestibule of the MRSA carriers to eliminate MRSA contamination.
Through the use of these countermeasures, the detection rate of MRSA in the ward and patients steadily decreased, and one year later, not a single patient was identified as having MRSA. These results suggest that DF-100 is an advantageous chemical agent to sterilize the hospital environment, since it is not a stimulant nor a volatile chemical. Thus both sterilization of the floors of the ward with DF-100 and prevention of droplet infection or contamination with the topical use of Pyoktanin ointment are useful and effective measures to prevent nosocomial MRSA infection or contamination.

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Sixty patients (38 males and 22 females) with cystic lesions of the sinuses accompanied by orbital symptoms who were treated at our institution between 1983 and 1992 were retrospectively studied.
The patients ranged in age from 14 to 84 years with a mean of 50.1 years. Of 60 patients,45(75%) had previously had sinus surgery for chronic sinusitis. Cystic lesions were found in 19 in the maxillary,16 in the ethmoid, eight in the spheno-ethmoid and seven in the frontal sinuses. The common orbital symptoms noted in order of frequency were orbital pain (29 cases), exophthalmos (25cases), diplopia (14 cases) and visual disturbance (13 cases). These orbital and/or visual manifestations were more frequently observed in patients with cystic lesions involving the ethmoid and/or sphenoid sinuses than in those involving other sinuses.
Among these orbital symptoms, visual disturbance was thought to be the most serious clinical feature, since permanent loss of vision or defect in the visual field might develop unless immediate surgical exploration was carried out. In 10 of 13 patients, visual acuity returned to expected levels within 70 days after surgery. It was suggested that specific surgery on the involved sinuses performed shortly after the onset of visual disturbance tended to show favorable therapeutic results in achieving recovery from visual impairment.
The majority of patients with cystic lesions of the sinuses were successfully treated with endonasal sinus surgery. X-ray tomography, CT-scan and MRI were particularly useful for the early diagosis and for surgical treatment of the lesions.

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Shigetoshi Horiguchi, Ken-ichi Hisamatsu, Shin-ichi Shimomura, Atsushi Kamijo, Mari Nakazawa, Tsutomu Nakazawa, Tetsuya Ganbo, Kimie Ohmori and Yoshihiko Murakami (Yamanashi Medical University)A clinical survey of 148 outpatients with allergic rhinitis who were treated at our allergy clinic between 1988 and 1992 was retrospectively carried out. The patients were screened for allergy by skin tests (scratch and intractaneous reaction) and IgE-MAST.
The following results were obtained:
1) The mean age on initial examination for male patients was considerably younger (23.7 years)than that for female patients (30.7 years), although there was no essential difference in the number of patients by gender.
2) The younger age group (16 years or younger) tended to show a higher positivity to house dust (HD) or to HD-mite allergen in skin tests than the older age group and a more specific result in this regard was obtained in the IgE-MAST scores as well.
3) There were more patients with a positive response to HD allergen among males than among females and inversely, more positive cases involving Japanese cedar pollen allergen were found among females than among males.
4) Peripheral blood eosinophilia (6% or more eosinophils in differential white blood count) was frequently found in the younger age group. They were usually positive to HD allergen on any of the allergen tests employed at our outpatient clinic.

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The efficacy of Tranilast, an anti-allergic drug, in treating otitis media with effusion (OME) was clinically evaluated. One hundred twelve patients (173 ears) were divided into four different treatment groups: Group A was given Tranilast and local treatment (nasal suction and tubal catheterization); Group B received Tranilast, myringotomy and local treatment; Group C only received local treatment (control for Group A); Group D received myringotomy and local treatment without Tranilast (control for Group B). The global improvement rating assessed as “moderately improved or better” was 61.7% in Group A,78.6% in Group B,43.6% in Group C, and 35.0% in Group D. There was a significant improvement in Group A compared to that in Group C (p<0.01). In subjects with OME for a period of less than 2 months, Tranilast was very useful. In subjects with OME for seven months or longer, Group C showed significantly less improvement than Group A, B or D. These findings suggest that some kind of medication is required for OME management.

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The author has been the school doctor at two junior high schools with a combined student enrollment of 1680, and one senior high school with 959 students.
According to the results of a hearing test, three senior high school boys were shown to have hearing loss. All three had been listening to the “Rock music” with 94-100 dB SPL (A) for 2-4 hours a day, for the last 3-5 years. The quantity of noise exposure was sufficient to cause chronic sound trauma judged by my previous TTS2 experiment, etc.
It has been more than ten years since the Walkman R has been on the market. Also environmental noise has been increasing. Taking these things into consideration, it will be necessary to consider hearing loss caused by the use of headphones.

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It is known that some oral streptococci possess inhibitory activity against the growth of pathogenic group A streptococci. To examine the inhibitory activities of oral streptococci in more detail, we used Mitis-Salivarius (M-S) plate in this study to isolate inhibitory oral streptococci against group A streptococci from the oral flora and compared the results with those on blood agar (B-A) plate. Utilizing the M-S plate, we could isolate S. mitis and S. salivarius from the oral bacterial flora selectively, which have been known to have strong growth inhibitory activities against group A streptococci.
We also examined oral bacterial flora of 27 patients who underwent tonsillectomy because of chronic tonsillitis.
1) Using M-S plates, we could isolate more strains of oral streptococci with inhibitory growth actibities from the throat flora than using B-A plates.
2) After tonsillectomy, streptococci with strong inhibitory activities were more frequently isolated using M-S plate than B-A plate.
3) These results suggest the M-S plates are more useful for evaluating post-operative improvement in oral bacterial flora since the isolation rate was much higher using M-S plates than that using B-A plates.

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Human paranasal sinus mucosa was incubated with 10^-8 M PAF or 10^-8 M lyso-PAF, then the PAF concentrations in the incubation medium were measured by radioimmunoassay. PAF was found to be extremely unstable when dissolved in the incubation medium and rapidly degraded for a short period of time. The PAF concentration in the medium reduced by half (50%) within 11.3 min, and fell below 5% of the initial level within 60 min. There was no difference between the reduction rates of PAF concentration regardless of whether the mucosal specimen was incubated in the medium. PAF was also detected in the medium at a concentration of approximately 10^-9 M when the mucosa was incubated in the medium containing lyso-PAF. This suggested that lyso-PAF could be converted to PAF by the action of some enzymes derived from the mucosal specimen. Although both PAF and lyso-PAF at a concentration of 10^-8 M inhibited ciliary activity of the mucosa, the latter showed a much milder and reversible inhibitory effect on mucosal ciliary function.

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The auditory brainstem response (ABR) and compound action potential of the cochlear nerve (AP) were measured in guinea pigs of various ages using click stimuli to examine age-related alternations in auditory function. The animals were divided into the following four age groups: group A (two months of age,20 animals), B (13 to 14 months,20), C (23 to 24 months,7), and D (33 to 34 months,10).
With advancing age, an elevation of the thresholds in both the ABR and AP was observed. The Ni latencies of the AP prolonged and the amplitudes decreased with increasing age. In most se nile animals, the input-output function curves of the AP also showed deterioration compared with those of younger animals. However, the rate of decline in the thresholds of the ABR and AP as well as inputoutput function curves of the AP varied considerably in selected senile animals, suggesting that there were individual variations in the degenerative aging processes of the auditory system.

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To investigate soluble IL-2 receptor (sIL-2R) levels in perennial allergic rhinitis, the sera and nasal secretions from patients with allergic rhinitis and from healthy subjects were subjected to a radioimmunoassay. Significant elevation of sIL-2R concentrations in the sera and nasal secretions was observed in the allergy patients. The concentration of sIL-2R in the nasal secretions was significantly higher than that in the sera of allergic patients (p<0.01), whereas no significant difference was observed between sIL-2R levels in the sera and nasal secretions of normal subjects. These findings indicate activation of helper T cells in the allergic nasal mucosa.

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This study reports the relationship between the glottal space during phonation and subjective and objective measurements of vocal function of fifty subjects with recurrent laryngeal nerve paralysis who were seen at the voice clinic at the University of Wisconsin. Three types of data were collected: 1) GRBAS values of perceptual voice judgments,2) vocal function examination values, and 3) glottal area to vocal cord length ratio. Measurements to determine the glottal area and vocal cord length were computed on a video image of the larynx. The glottal area was defined as the area at the onset of phonation enclosed by a line drawn from the right to the left vocal process and from the anterior commissure to the vocal process along the median side of each vocal cord. The distance between the vocal process and the anterior commissure at rest was defined as the vocal cord length. The glottal area to vocal cord length ratio was then computed. Results demonstrated relations between the glottal area to vocal cord length ratio and other examinations: in the subjects where the grade or breathiness in GRBAS values was high, the glottal area to vocal cord length ratio was high; there were negative relationships between this ratio and the sound pressure level, the maximum phonation time or the intensity range.

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In three cases of Heerfordt syndrome, we evaluated the severity of facial paralysis and topographically diagnosed the site of damage to the facial nerve. One patient with severe facial nerve paralysis showed lacrimal dysfunction, absence of stapedial reflex and taste dysfunction on the same side as facial paralysis, and the site of damage to the facial nerve was diagnosed as the geniculate ganglion. Two other cases showed infrastapedial lesion of the facial nerve. The presence of other cranial nerve disorders, i. e. VIIIth, PCt h and X th cranial nerves, was suspected in two patients. All three patients were treated by administration of steroids. One patient with only mild facial weakness showed rapid improvement but the other two patients were unable to achieve complete recovery. We concluded that positive administration of steroids is necessary in the treatment of facial paralysis associated with severe nerve damage or other cranial nerve disorders.

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The effects of leukotriene D₄ (LTD₄) on human paranasal sinus mucosa were investigated up to 24 hours after administration using a VTR system at a magnification of x 2,500 in vitro. Ethmoidal sinus mucosal specimens were incubated in tissue culture, and after exposure to LTD₄ the mucosal surface profile was viewed under an inverted phase-contrast microscope equipped with a VTR system on a TV monitor. LTD₄ induced ultrastructural alterations, ciliostasis, development of a coarse profile and epithelial cell exfoliation. On an hourly basis, ciliary activity was measured photoelectrically on the screen.
LTD₄ inhibited ciliary activity in a dose- and time-dependent manner at concentrations ranging from 10^-6M to 10-^-10 M, whereas leukotriene E₄ (LTE₄) had a minimal effect on the mucosa even at 10-6 M.
Irrigation of the mucosa with culture medium after 5 min of exposure to 10^-8 M LTD₄ delayed the appearance of ciliary inhibition and alteration of the mucosal surface profile, but had no effect after 15 min exposure. These effects of LTD₄ on the mucosa were blocked by preincubation with the LT antagonists FPL-55712 and Ly-171883.
These results demonstrate the cytotoxic effect of LTD₄ on human airway epithelium in vitro.

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We first introduced the use of Plasti-pore TORPs and PORPs as a new alloplastic middle ear implant for ossiculoplasty in 1980, encouraged by the excellent hearing results reported by not a few otologic surgeons in the U. S. during the late 1970's. Our short-term results were uniformly satisfactory and the success rate of hearing (air-bone gap closure within 20 dB or less) similar to those previously reported could be obtained. However, these results gradually deteriorated with time and the major problem with the Plastipore appeared to be an increasing incidence of extrusion probably caused by rather severe foreign body reaction to this material. The extrusion rate finally reached more than 20% in our series of patients (N=70) during a period of approximately five years. We, therefore, decided to discontinue using the Plasti-pore for ossiculoplasty in early 1985.
Since late 1982, we used several newly developed ceramics for ossiculoplasty along with the use of the Plasti-pore. We attempted to utilize three different ceramic classes that were available on the market as ossicular prostheses: 1) bioactive hydroxylapatite ceramic,2) bioinert aluminum oxide ceramic, and 3) bioactive glass ceramic. Among these, hydroxylapatite ceramic (Apaceram) was found to be far superior to the other two or even to Plasti-pore in its biocompatibility as well as in allowing modification of the shape and size of the implant intraoperatively. Therefore, Apaceram was used almost exclusively for ossiculoplasty from 1986 to the present. The overall hearing success rate (air-bone gap closure within 20 dB or less) was 60% for the total type and 69% for the partial type with a mean of 65% during a follow-up period of eight years. The extrusion rate was approximately 6.5%.
However, long-term follow-up data with the use of these ceramic implants for more than 10years also showed that hearing results tended to deteriorate compared to the short-term results, though this was less evident than in cases using Plasti-pore, despite the fact that the extrusion rate remained essentially unchanged. These data suggest that further efforts should be made to eliminate some of the problems inherent in the use of these alloplastic prostheses to achieve optimal hearing results in ossicular chain reconstruction in otologic surgery.

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