The anatomical specificity and clinical value of the area from the mesotympanum to the epitympanum are investigated using human temporal bones.
There was no pathway directly connecting the esotympanum and the hypotympanum with mastoid cells in well pneumatized temporal bones, contrary to previous suggestions. It was confirmed that the tympanic isthmus is the only route connecting the mesotympanum and the hypotympanum with the tympanic attic and mastoid cells.
The condition of adhesion of the tensor tympani fold to the anterior attic bony plate was classified into the following three types: type A (53.8%) characterized by direct adhesion of the tensor tympani fold to the anterior attic bony plate, type B (19.2%) characterized by adhesion of the fold to a site anterior to the bony plate, and type C (26.9%) characterized by a multilocular supratubal space with an unclear anterior attic bony plate. Type A, direct adhesion of the fold to the bony plate, is liable to ventilatory, disturbance, suggesting its involvement in the pathogenesis of tympanic lesions. The height of the anterior attic bony plate was measured using serial sections of well pneumatized human tempo ral bones. It ranged from 0.57mm to 3.60mm, with a mean value of 1.95mm. It is speculated that the bony plate separating the tympanic cavity from the auditory tube clinically interferes with ventilation to the tympanic cavity, thus being involved in the pathogenesis of tympanic lesions.
There is a possibility of locular formation on the medial side of the tympanic membrane in the posterior superior part of the tympanic cavity, in the same manner as on the medial side of the flaccid part of the tympanic membrane. This seems to largely contribute to the high incidence of lesions in the posterior superior part of the tympanic cavity.

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In our department, as the means of testing for brachial deviation in patients with dizziness, at the first examination we request them to perform Fukuda's vertical writing test with the eyes closed (hereinafter, writing test) and the originhitting test. The origin-hitting test was developed by Kato, of our department, in 1968. The patient is requested to rhythmically hit the origin of the coordinates 100 times with a ball-pointpen. If the hit points are concentrated at the origin, the patient's function is judged to be normal. If the points deviate from the origin, the results are classified according to the locus into a linear shift type, scattered belt-like shift type and scattered type.
A total of 338 patients visited our department between 1-17 days after the onset of dizziness and were able to perform the origin-hitting test, writing test and other equilibrium function tests. They were classified into those with central vestibular dysfunction and those with peripheral vestibular dysfunction, and the results of the origin-hitting test and writing test were compar-ed between the two groups. The following results were obtained.
(1) in the peripheral dysfunction group, 78% of the patients showed the liner shift type in the origin hitting test, while 12.8% showed brachial deviation in the writing test.
(2) In the central dysfunction group, 24.4% showed the scattered type in the origin hitting test, while 4.9% showed atactic dysgraphia in the writing test.
(3) When the direction of deviation was compared in the peripheral dysfunction patient group (positive for CP in the caloric test), the incidence of patients showing deviation to the diseased side was 60% in the origin-hitting test, while it was 24% in the writing test.
(4) When the change in the incidence of deviation in the peripheral dysfunction group was analyzed, 80-90% of the patients showed some abnormality in the origin-hitting test by the 3rd day after onset of dizziness. Also, comparison with the writing test, the origin-hitting test showed a higher rate of detection of deviation in each stage of the disease until the stable disease stage.

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The plasma levels of various hormones are known to change during motion sickness, and the degree of change is believed to be related to the susceptibility of a person to motion sickness.
In the present study, healthy adult volunteers were exposed to Coriolis acceleration using a rotary chair, and the changes in the plasma levels of various hormones were monitored. The severity of motion sickness symptoms was graded in accordance with Graybiel's diagnostic scoring method, and the subjects were classified into a high susceptibility group and a low susceptibility group. The changes in the hormone levels were then compared between the two groups.
After the onset of motion sickness, the plasma levels of ADH, ACTH, prolactin, cortisol and adrenalin increased significantly in the high susceptibility group, and the increase was most striking for ADH. In the low susceptibility group, on the other hand, there were almost no changes in the hormone levels.
Although the high susceptibility group showed a significant increase in the hormone levels during motion sickness, it was not clear whether said increases were simply due to a higher responsiveness of the endocrine system (centering on the hypothalamic-pituitary-adrenal system) or due to a higher responsiveness of the individual hormones to the stress of Coriolis acceleration in this group.
In consideration of the finding that the ADH level showed the most striking change and our knowledge of the action mechanism of ADH in the central nervous system, etc., ADH is speculated to play an important role in the development of motion sickness.

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The objective of this study is depict the expiratory airflow passing through the complicated nasal cavity by means of a thermograph using the airflow volume and temperature as the parameters, thereby enabling us to analyze the expiratory airflow dynamics. The expiratory images obtained with a liquid crystal rhinomanometer (LCR) and IR thermographs which measures infrared rays emitted by the expired air as themperature were employed as thermographs, and the 3-dimensional distribution of the expiratory airflow was analyzed.
Not only the expiratory images on the LCR enabled judgment of the state of the airflow through the nasal cavity on the basis of the area of the images, but also when a lateral wall of the nasal model was obstructed and the airflow was analyzed by LCR, the expiratory images on the LCR changed in association with the change in the structure of the nasal cavity. Segmented patterns of the expiratory images which indicate laminar flow of the nasal cavity were seen in 98% of subjects tested by LCR at the time of a health examination, and a bisegmental pattern was observed at an especially high incident. The bisegmental pattern was also obserbed in experiments using the nasal model. This pattern began to disappear during the course of elimination of the anterior half of the inferior turbinate of the nasal model. Thus, the anterior half of the nasal cavity was found to influence the expiratory images. In addition, it was found that the inner region of the expiratory image is attributable to the airflow from the common meatus and the middle meatus, while the outer region of the image is attributable to the inferior meatus.
The dynamics of the expiratory airflow was analyzed on the basis of overall consideration of the IR thermographs recorded along the lateral plane and at various points on the transverse plane of the nasal cavity of the nasal model. The results were almost in accord with the past reports of reserch on intranasal airflow. However, IR thermography also detected an airflow in the upper region of the inferior meatus, which is difficult to observe from the lateral side of the nasal cavity. The expiratory airflow from the epipharynx diverged near the posterior end of the inferior turbinate to the inferior meatus, middle meatus and common meatus, and the expiratory airflow from the middle meatus met the flow from the common meatus near the anterior end of the inferior turbinate. The airflow from the inferior meatus and common meatus appeares to unite to from a single flow at the internal nasal valve region, but it again diverged into two flows outside the nostril.
The above results indicated that the dynamics of the expiratory airflow in the nasal cavity can be analyzed on the basis of the thermograph of the extranasal airflow.

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We reviewed 330 otolaryngological patients (170 males and 160 females) with psychosomatic symptoms who visited the Department of Otorhinolaryngology of the Jikei University School of Medicine during the period from 1972 through 1989.
The personality of each patient was psychosomatically analyzed using the CMI test and Y-G test.
Clinical examination of the patients detected various diseases. The incidence of vertigenous disease, chronic sinusitis and pharyngolaryngeal paresthesia was especially high, about 70% of the patients had at least one of these diseases. Thus, among the various diseases in the field of otorhinolaryngology, these 3 diseases were considered to be the major diseases susceptible to psychosomatic influences.
1. Psychosomatic Symptoms
Autonomic ataxia has been the principal psychosomatic symptom of vertigenous disease, hypochondriac neurosis has been the principal psychosomatic symptom of chronic sinusitis, and anxiety neurosis has been the primary psychosomatic symptom of pharyngolaryngeal paresthesia. Thus, the psychosomatic symptoms differed between the 3 diseases.
2. CMI Test
The CMI test revealed the incidence of patients with neurosis of be 44-74.4% for the 3 diseases. Patients with vertigenous disease tended to be more neurotic compared with psychosomatic symptoms, while neurotic symptoms were less pronounced than psychosomatic symptoms in patients with chronic sinusitis. The results of the CMI test differed between the 3 diseases.
3. Y-G Test
When the Y-G test was performed, the incidence of an unstable, inadaptable type of personality was higher in patients with vertigenous disease or pharyngolaryngeal paresthesia than in the control group. A stable, adaptable type of personality was found in many patients with chronic sinusitis. The results of the Y-G test thus differed between the 3 diseases.
4. Psychogenesis
A psychogenic response was seen in 54.7% of the male patients, while it was seen in 64.4% of the female patients, indicating stronger psychogenic influence in females. The tendency for psychogenesis is strong in vertigenous disease but weak in chronic sinusitis.Psychogenesis differed between the 3 diseases. The psychogenic factors were work, family, illness, etc. Work was predominant in males, while the family was the major factor in the females.
In conclusion, psychosomatic care is also necessary for patients with otorhinolaryngological diseases which are influenced by psychosomatic factors. We should be aware that psychosomatic symptoms, psychogenic factors, the results of the CMI test and the results of the Y-G test differ among the various diseases ac-companied by psychosomatic symptoms.

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Various hypotheses have been proposed concerning the mechanism whereby autonomic neurosis such as pallor, nausea and vomiting appear in patients with motion sickness or labyrinthine vertigo. However, none of them has been accepted as an established theory. Recently, an experimental model in rat using pica as an index has been proposed for qualitative study of motion sickness.
The purposes of this study were (1) to investigate induction of motion sickness in rats by use of rotation stimulation under various conditions using pica as an index, (2) to determine the relation between induction of labyrinthine vertigo by lateral labyrinthectomy and pica in rats, (3) to determine the autonomic blockers on rats undergone lateral labyrinthectomy using pica as an index, and (4) to determine heart rate, R-R interval and coefficient of variation of R-R interval (CV R-R) in rats under rotation stimulation during monitoring by ECG.
From this study, the following results were obtained.
(1) After loading of single rotation only decrease in food intake was observed. Following double rotation, increased number of rotation, increase in intake of non-nutritive substance (Kaolin) was observed, and pica was induced.
(2) In rats undergone lateral labyrinthectomy posture of vertigo and nystagmus developed immediately after the operation and pica which persisted for 4 days was induced.
(3) Pica induced in rats after lateral labyrinthectomy was controlled by s. c. administration of parasympatholytic agent (atropine), while it was not controlled by s. c. administration of sympatholytic agent (propranolol)
(4) During loading of rotation stimulus, the heart rate tended to decrease and the R-R interval tended to be prolonged. On the other hand, CV R-R failed to show any constant tendency.
It was concluded from these results that pica in rats is useful as an index for qualification of autonomic symptoms in motion sickness and labyrinthene vertigo in rats and that the parasympathetic nervous system is involved in its mechanism. However, although relative tonic condition of the parasympathetic nervous system was indicated dynamically as compared to the sympathetic nervous system after induction of motion sickness, the relation with the both nervous system was not elucidated. In this respect it appears that further studies are needed.

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