Pathophysiology of sensorineural hearing impairment which is a common clinical disorder remains yet to be determined. However, some genes responsible for sensorineural hearing impairment have been cloned for the last several years and the mechanism causing hearing impairment has been started to be clarified with the advent of development of molecular genetics. Sensorineural hearing impairment is caused by a point mutation at nucleotide 3243, 1555 and 7445 of mitochondrial DNA. Many forms with nonsyndromic sensorineural hearing impairment by Menderian inheritance have been demonstrated. DFNA 1 to 12 are dominant hearing loss, while DFNB 1 to 12 are recessive form. DFN 1 to 6 are demonstrated to show X linked hearing impairment. Clinical and genetic findings of the above disorders are reviewed. Cloned genes for sensorineural hearing impairment are also described. Mutations in myosin VII A have been identified in DFNB 2. Gap junction protein, beta-2 has been confirmed as a gene responsible for DFNA 3 and DFNB 1. POU 3 F 4 gene causes hearing loss in DFN 3.

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The psychosomatic state of 75 patients with a complaint of lump sensation in the throat was evaluated by the Cornell Medical Index (CMI), the Self-Rating Depression Scale (SDS) and the Manifest Anxiety Scale (MAS).
The results were summerized as follows ;
1. CMI test revealed that I area of CMI was 29% and II area of CMI was 33%.
2. The average of the raw scores of SDS test was 35.8 and the standard deviation was 8.4.<BR.3. The average of the manifest anxiety scalescore was 16.7 and the standard deviation was 8.8.
4. Ethyl Loflazepate (2 mg) etc. were prescribed to 75 patients.
5. We estimated the effectiveness of the medicine. The respective rates of “very good”, “moderate”, “slight” and “no” effectiveness were 39%, 23%, 14% and 24%.
6. The medicine showed greater effects in patients who were evaluated as normal in SDS test and MAS test.

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We measured nasal resistance, nasal peak expiratory flow (PEF), nasal one-second forced expiratory volume (FEV 1.0), nasal one-second forced expiratory volume rate (FEV 1.0%) and nasal blockage index (NBI), and evaluated usefulness of these parameters in assessing nasal obstruction. In addition, reliability of a portable peak flow meter was discussed, especially in its continual use.
Before and after nasal mucosa was shrunk orswelled by administering some medicine into the nostrils, the change and the correlation of these parameters were investigated. Reliability of a portable peak flow meter was examined in the next.
The nasal resistance as measured by a rhinomanometer did not change significantly in any medicine challenge, but PEF, FEV 1.0, FEV 1.0%, and NBI changed in all medicine challenges. The nasal resistance and PEF or NBI weakly correlated with each other, and the correlation was statistically significant. The portable peak flow meter seemed to be reliable.
PEF, FEV 1.0, and FEV 1.0% were useful as means of assessing nasal obstruction, and PEF was the most proper among them because it was easy to measure. It appeared that the portable peak flow meter can be used for continual evaluation of nasal obstruction.

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It is speculated that tinnitus is caused by vertebrobasilar insufficiency in a considerable number of patients. However, clinical findings to diagnose circulatory disturbance in the vertebrobasilar system remain to be clarified. Six cases of tinnitus were reported, where vertebrobasilar insufficiency was considered to be an etiology of tinnitus on the basis of clinical findings such as asymptomatic cerebral infarction, past history of cerebral infarction, nystagmus suggesting central disturbance and marked changes in blood pressure. Tinnitus disappeared after therapy for cerebral circulatory disorder in all six patients. We confirmed that binaural lowfrequency hearing loss of nearly equal extent which was detected by audiometry on the first visit, improved or tended to improve after therapy. Low-frequency hearing loss was considered to be an important audiometric indication of circulation disturbance in the vertebrobasilar system, although it was often overlooked in the clinical setting.

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CT-guided percutaneous drainage for patient with posterior mediatinal abscess was performed successfully. The patient was an 83-year-old female, and her general condition was critical because of early stage of DIC and high fever. Opening of the mediastinum was riskful.
CT-guided percutaneous drainage for mediastinal abscess is a useful method not only for patients in poor condition but also for patients with the indica-tion of opening of mediastinum.

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A case of epithelioid hemangioendothelioma originating from the nasal cavity is reported. A 94-year-old male complained of epistaxis and nasal obstruction. An expanding reddish mass was found in his left nasal cavity, which did not invade in the paranasal sinus. We removed it under general anesthesia, and it was diagnosed as epithelioid hemangioendothelioma pathologically.
We reviewed several cases of hemangioendothelioma reported so far in literatures.
Hemangioendothelioma is a rare tumor and regarded as showing low grade malignancy. Primary therapy is surgical resection. It sometimes develops into malignancy, so we should treat them case by case.

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An 8-year-old boy with severe obstructive sleep apnea (OSAS) was treated. He came to our hospital with the complaint of daytime somnolence and apnea. A Polysomnography was performed, and the patient was diagnosed as having OSAS. His complaint disappeared as a result of weight reduction and adeno-tonsillectomy. Apnea hypopnea index decreased from 68.7 to 6.7, %stage 3+4 increased from 0 to 17.1%, and Sa02 improved. Preoperative growth hormone level was low because of sleep breathing disorder. After operation, a normal peakof growth hormone secretion was observed almost synchronizing with slow-wave sleep 2-3 hours after the patient fell asleep.

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[in Japanese]

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[in Japanese]

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