Infections by Pseudomonas are commonly encountered in the field of otorhinolaryngology. In most patients, the infection is localized and does not become severe, but the disease is often refractory to chemotherapy and thus local infection persists. On the other hand, although the incidence is very low, the infection may become so severe as to require intensive care. It is considered to be clinically important to be able to forecast possible aggravation of Pseudomonas infections by investigating why the disease is sometimes refractory to chemotherapy.
In spite of the fact that many strains of P. aeruginosa are sensitive to serum bactericidal activity, infections by this bacterial species are sometimes refractory to chemotherapy and persist locally. In order to elucidate the mechanism of this refractory nature, the author investigated the effect of pus present in the focus of the lesion on the serum bactericidal activity against P. aeruginosa and compared the serum bactericidal activity against this bacterial species among patients infected with P. aeruginosa, patients with other diseases and healthy persons. On the basis of these investigations, the author studied whether or not it is possible to forecast the possibility of aggravation of P. aeruginosa infections.
The following results were obtained.
1. Complement is thought to play an important role in the serum bactericidal activity against P. aeruginosa.
2. It was found that the pus in the lesions of patients with P. aeruginosa infections contains, in addition to the cells of the bacterium itself, some substance which is thought to inactivate the bactericidal activity of the serum.
The patients with P. aeruginosa infections, except for one patient, also had serum bactericidal activity against P. aeruginosa, the same as the healthy persons. Among the patients investigated, only one patient, who had anamnesis of malignant external otitis, did not have any serum bactericidal activity against P. aeruginosa.
The above findings indicated that infections by P. aeruginosa or its clinical course may become aggravated if the patient's serum bactericidal activity against this bacterium is low.

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There has been no established treatment of sudden deafness. We studied the efficacy of Dextran Dextran in the treatment of idiopathic sudden hearing loss in 32 patients who were categorized into two groups Dextran used in group A (20 cases) and Dextran was not used in group B (12 cases). The results of our study showed that as high recovery rate as 90% was obtained from either group. But complete healing rate in group A was as low as 30%, lower than the spontaneous recovery rate 32% to 55%. In conclusion, Dextran was not cunsidered to be useful in the treatment of sudden deafness.

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This paper presents a case of dizziness caused by a cyst in the parapharyngeal space. The patient was a 25-year-old woman who visited us with chief complaints of a sore throat, nausea and dizziness. The cervical CT showed a large cyst in parapharyngeal space. Pathologically, the cyst was diagnosed to be branchial cleft cyst. Dizziness appeared in suspending and rotating head positions. As to its etiology, it was considered that the cyst presses the sympathetic plexus surrounding the internal carotid artery in parapharyngeal space to cause sympathetic functional disturbances of the inner ear on extension of the neck.

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Two cases of intraparotid facial nerve neurogenic tumor are reported. Case 1 is a 28-yearold male and case 2 is a 59-year-old male. We obtained the following interesting results from an analysis of facial nerve neurogenic tumor cases.
(1) The prevalence is high among women in their 40's and 50's.
(2) The prevalence is very high in the temporal bone (particulary the vertical region and the horizontal region).
(3) Most of the histological diagnoses are schwannomas.
The disease features tumors originating at the parotid region. No particular findings are observed except for swelling at the parotid region, and no characteristic findings are seen radiographically. Accordingly, preoperative diagnosis of the disease is rather difficult. The first-choice therapy for the disease is surgical treatment. We discuss the necessity of surgery at an early-stage for a better prognosis of facial nerve paralysis.

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In order to perform conservative treatment of aural cholesteatoma, cerumen and otorrhea in the external canal and debris in the middle ear should be adequately removed. An irrigator to remove debris in the middle ear was made for conservative treatment of cholesteatoma. This instrument keeps water at a constant temperature, and the quantity of water delivered can be controlled. Therefore the debris in a deep attic defect could be removed easily with this irrigator without causing pain or vertigo.

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