In ketamine-and pentbarbital-anesthetized adult cats, laser Doppler flowmetry (LDF) was used to investigate the change in blood flow of nasal mucosa induced by electrical stimulation of the cervical sympathetic nerve or sympathectomized vidian nerve. By fixing the cat head on a stereotaxic apparatus and by fixing the probe on a manipulator, the stable values of blood flow could be recorded. Electrical stimulation of the cut peripheral end of the cervical sympathetic nerve induced a intensity-dependent and a frequency-dependent decrease of nasal blood flow. Electrical stimulation of the sympathectomized vidian nerve increased nasal blood flow. The data of this study were similar to previous studies which used other methods. The present study suggests that LDF is a valuable method for the assesment of blood flow change in cat nasal mucosa.

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A series of damped pendular rotation test (DPRT) was performed to examine the effct of neck torsion to vestibulo-ocular reflex (VOR). Before the test, caffeine was given orally to keep alertness during the DPRT. Comparison of DPRT results between frontal and neck twisted positions in normal cases revealed a few changes but these were estimated as normal or negative changes. In pathological cases, when the patients with central and peripheral vestibular disorders were compared (within 165 patients with dizziness), the patients with central vestibular disorders showed significantly positive changes by the neck-twisted DPRT (p<0.005). In particular, the cases with vertebrobasilar insufficiency showed a significantly increased rate of positive changes (p<0.001) by this test procedure.

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The CO₂ laser surgery of inferior turbinate under endoscopy for 41 patients with nasal allergy was investigated. Seven-watt CO₂ laser which the optical fiber guided under endoscopy was applied to the whole inferior turbinate. As a rule, about 14 days after the operation, nasal mucosa has been changed into normal mucosa and subjective symptoms have been improved. The improved percentage of nasal obstruction was higher than any other subjective symptom. In 4 cases who had a recurrence about 90 days after the operation, drug treatment was effective. These results suggested that the CO₂ laser surgery was an effective treatment for nasal allergy.

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Between 1985 and 1994, 10 revision operations were performed by our department after failure of stapes surgery. The most common reason for the revision operations was lack of hearing improvement after the first stapes surgery (6 ears). The causes of failure were refixation of the stapes (2 ears), displaced prostheses (2 ears), excessively small fenestra (2 ears), and mucosal thickening of the oval window niche (1 ear). In two ears, postoperative conductive deficit of 10 dB or less developed. Progressive hearing loss developed in two ears more than 1 year after the first stapes surgery. The cause of the failure was a displaced prosthesis. The hearing in one ear did not recover after the revision operation The hearing in another ear recovered but fluctuated after the revision operation. We speculate that the cause of the fluctuation was endolymphatic hydrops. In one case, dizziness occurred after the first operation. Perilymphatic fistulas were not found during the revision operation, and the cause of dizziness was unclear.

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When recognizing severe retraction or adhesion of debris to the tympanic membranes, the otologist tends to regard these as cholesteatoma or adhesive otitis media, and usually performs ear surgery. Some of these could obtain a stable local condition by conservative therapy as an office procedure. This paper reports five cases, in which ear surgery was avoided by conservative therapy.
Case 1: A 9-year-old girl consulted our clinic with a long history of otitis media with effusion. A deep atticdefect of the left tympanic membrane with relapsing otorrhea and debris was recognized. A stable condition in the tympanic membrane was acquired by conservative local treatment; irrigation, cleaning, antibiotic ear drip, and ventilation tube insertion. Case 2: A 12-year-old girl was referred for further examination of suspected external canal cholesteatoma. Infected granulation and debris of the posterior bony wall defect were recognized in the right ear. Repeated debridement obtained a smooth epithelized posterior wall with a shallow retraction. Case 3: A 28-year-old male showed right otitis media with effusion accompanying the attic wall defect and debris. Cleaning and debridement stabilized the condition of the tympanic membrane. Case 4: A 37-year-old female complained of recurrent bloody otorrhea from the left ear. Pocket-like retraction containing discharging cholesterol granulation was observed on the posterior quadrant of the left tympanic membrane. Enlargement of the pocket orifice and debridement stabilized the condition. Case 5: A 48-year-old male demonstrated a cholesterol cyst in the tympanic membrane and otitis media with effusion from the left ear. An incision was made in the cyst and a ventilation tube was inserted in the middle ear. A clear retraction pocket remained in the posterior half of the tympanic membrane.
Conservative therapy for chronic ear disease not only avoids ear surgery, but also improve the postoperative results when given as a preoperative treatment. Important aspects of this therapy were precise observation under a microscope and fine treatment using otomicrosurgical instruments.

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The combination chemotherapy with cis-dichlorodiamineplatinum (II) (CDDP) and 5-fluorouracil (5-FU) (CF chemotherapy) has been commonly used for patients with advanced head and neck cancer, as neoadjuvant chemotherapy. To improve complete response (CR) rate of CF chemotherapy, we had designed and applied modified CF chemotherapy (5-FU followed by CDDP), however a significant CR rate influencing the prognosis has not been obtained yet. For the purpose of enhancement on cytolytic activity of CDDP plus 5-FU by Methotrexate (MTX) and Leucovorin (LV), in vitro chemo-sensitivity tests were examined. The cytolysis of 5-FU was increased by the addition of LV or MTX. However when MTX was added after 5-FU treatment, thactivity of 5-FU was decreased by the addition of MTX adversely. On the basis of these results of in vitro chemo-sensitivity tests, our new clinical regimen through triple biochemical modulations consisting of 5-FU→CDDP, MTX→5-FU and LV→5-FU was applied for advanced head and neck carcinomas. The intravenous (i. v.) MTX (30 mg/m²) administration was followed 1 hour after by 5-day continuous i. v. infusion of 5-FU (800 mg/m²). Then the concomitant use of LV (20 mg/m²) was added every day from the start of 5-FU until completion of 5-FU infusion on day 5. Thereafter CDDP (60 mg/m²) was administered on day 4. Cycles were repeated every 21 days. Two cycles of this chemotherapy was perfomed for 19 fresh patients with advanced head and neck cancer. The clinical CR rate undergoing this chemotherapy regimen was 37% and this rate was significantly higher than that of modified CF chemotherpy (37% vs 20%, P<0.05).

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Ocular counterrolling (OCR) was measured in 17 healthy subjects, 3 patients with unilateral vestibular nerve section and 1 deaf subject with bilateral labyrinthine defects. OCR was measured throughout a triangular profile (±60°, 2°/sec) of tilt about the naso-occipital axis, using a mechanized whole body tilt device and an infrared CCD video camera.
No significant difference of OCR was observed between two different visual conditions, fixate on an unseen target in the dark and fixate on a single LED light in the light. On the basis of this result, we concluded that the role of vision was minimal on OCR. Two of three cases with unilateral vestibular section showed abnormal OCR values. This abnormalities were greater when tilted toward the normal side. The case with bilateral labyrinthine defects showed abnormal OCR values toward either side. We concluded that OCR measurement was effective to detect the inner ear lesions and evaluate the compensation of vestibular function.

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We investigated the tubal function of young adults without ear disease by inspecting the dynamic movement of the tympanic membrane, sonotubometry, and the impedance method.
On inspection of the dynamic movement of the tympanic membrane, 78.1% were positive at Toynbee's maneuver, 92.2% at Valsalva's maneuver and 91.4% were in sonotubometry. In the impedance method, 77.3% were positive at Toynbee's maneuver and 99.2% at Valsalva's maneuver.
Concerning tube opening time by sonotubometry almost 80% of all cases were distributed from 100 msec to 700 msec and in 7.0% of all cases distribution was over 1, 000 msec.
Also we studied the tubal function of senile persons. We inspected only the dynamic movement of the tympanic membrane. On inspection of the tympanic membrane, 24.4% were positive at Toynbee's maneuver.
As for Toynbee's maneuver on inspection of the tympanic membrane, the difference between the two groups is statistically significant.
Inspecting the dynamic movement of the tympanic membrane is an easy and useful method of evaluating tubal function. We are convinced that the tubal function of senile persons is worse than that of young adults.

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Saccharin was used to perform the ciliary clearance function test in the eustachian tube of children having otitis media with effusion, and in whom a middle ear ventilation tube had been inserted. We simultaneously treated the subjects with carbocysteine, which is claimed to be effective in improving ciliary motion in mucous membranes, and assessed the degree to which eustachian tube clearance had been improved. Of the 52 children in this study, 38 were treated with carbocysteine, 30 mg/kg daily, for at least 14 days, and saccharin time was measured before and after the treatment. The remaining 14 patients served as the control group. They were tested again one month after the initial measurement and their results were compared with those of the carbocysteine group.
In children having otitis media with effusion, eustachian tube ciliary clearance function generally recovered relatively early, but recovery appeared to be affected by the severity of previous inflammation in the mastoid cavity. A comparison of the two groups showed an obvious improvement in saccharin time in the treated group. The longer the period of carbocysteine treatment, the more marked the effect, suggesting that carbocysteine is useful in improving the eustachian tube ciliary clearance function.

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We have reported the pharmaceutical and clinical efficacy of a dibekacin sulfate-ufenamate gauze tampon [DU-GT (I)] which we prepared as an analgesic tampon for use after nasal and paranasal surgery. In order to obtain a more powerful analgesic effect than by DU-GT (I), we then prepared DU-GT (II) by increasing the dose of ufenamate and changing the ointment base composition from white vaseline plus plastibase to plastibase alone. In the present study, DU-GT (II) was used after surgery and its analgesic effectiveness was assessed.
Analgesic effects of DU-GT (II) and a dibekacin sulfate gauze tampon containing no analgesic ufenamate (DKBGT) were compared in terms of the difference in the frequency of the patient's request for postoperative analgesia and the severity of pain felt by the patient wearing the tampon on its evulsion.
The results indicated that the new tampon preparation produces a marked analgesic effect especially on its evulsion. The experimental results also suggest that the release of dibekacin sulfate from DU-GT (II) is more favorable than from DU-GT (I) and thus antimicrobial activity of DU-GT (II) is enhanced. However, in order to obtain effective analgesia on insertion as well as on evulsion, it may be necessary to further improve this tampon preparation, such as by increasing the concentration of ufenamate in the ointment applied to the tampon material.

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[in Japanese]

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[in Japanese]

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