A case of Labyrinthitis ossificans in the presence of chronic suppurative otitis media with cholesteatoma diagnosed with CT and MRI was presented.
The patient was a 44-year-old female, whose left middle ear was filled with cholesteatoma. Her left inner ear showed complete loss of functions, but we couldn't decide it to be congenital or acquired . CT and MRI of the inner ear revealed blurring of the cochlea with ossification in the lower part of the basal turn, and abscence of the vestibule.
First, we had thought these abnormal inner ear findings to be due to congenital anomaly, but we reviewed the case postoperatively. 1) In cases of severe inner ear anomaly, hypoplastic temporal bones and narrow internal auditory canals usually are present, but these findings were absent in this case. 2) Compared with the abnormality of the cochlea, that of the vestibule was too severe to interprete the case as anomaly. 3) Arcuate eminence was thought to be present. 4) Abnormality of the cochlea was in the lower part of the basal turn instead of the apical turn as is usually seen in anomaly. These supported the opinion that this was a case of labyrinthitis ossificans rather than anomaly. In this case, cholesteatoma was supposed to have destroyed the lateral semicircular canal first and caused localized labyrinthitis in the vestibule leading to inner ear ossification.
Great care should be taken in diagnosing radiological inner ear abnormality particularly in the presence of chronic otitis media, because in some cases of labyrinthitis ossificans as in this case, differentiation from inner ear anomaly may be very difficult.

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Surgical procedure and operative results were studied on 51 children (57 ears) with middle ear cholesteatoma. The patients who has past history of otitis media with effusion was found in 40.4% and hearing loss over 30dB in 45.6%. A canal wall up procedure was used in 39 ears, a canal wall down procedure in 18 ears. Postoperative trouble such as residual disease, otorrhea and retraction pocket decreased by canal wall down procedure and reconstruction of the posterior canal wall which was done using a cartilage of the tragus and the conective tissue flap.

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Children (0-6 years old) in nursery schools were subjected to periodical examinations using tympanometry which were performed 3 month intervals from June, 1986 to June, 1987. The incidences of secretory otitis media in respect to the ages of children and seasons were investigated as well as the spontaneous progress of this disease. The following results were obtained from the examinations:
1. Type A tympanogram increased as the ages of children (1-6 years old) increased
.2. At the time of each examination, the ratio of each type of tympanogram was not so much fluctuated by seasons. Type A occupied 77-83% of the whole cases of tympanogram and Types C and B were 7-13% and 10-14%, respectively.
3. About half of the children showed Type B, C1 or C2 tympanogram at least once among the total 5 times of examinations.
4. About 72% of the patients with Type C1 tympanogram improved to Type A. However, only one third of patients with Types C2 and B tympanogram showed such an improvement.
5. Among 1 year old children, Types C1, C2 and B tympanogram occupied as many as 37% of patients. However, majority of these types of tympanogram improved to Type A.
6. Majority of the improvement of Type C1 tympanogram was observed in the examination performed in September. Even the patients with Type B or C2 tympanogram sometimes showed transient improvement in September.
This appeared to be because there is little chance of upper airway inflammations in June through September.

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The treatment of chronic serous otitis media with the ventilation tube has been widely accepted. However, many tubes are extubated before healing occurs.
The Koken tube type B^R was inserted into 152 ears of 110 children, aged from 1 to 15 years, to a total of 176 intubations, between 1985 and 1987. The average time from intubation to extubation was 9 months. Hearing loss was markedly improved most of ears after intubation. The recurrence rate was 15.8 percent in the treated ears. There were few complications of intubation such as otorrea (4%), granulation formation (5%) and permanent ear drum perforation (5%). Most of them were controled with conservative theraphy.
There was no instance of cholesteatoma formation secondary to intubation.
From the present study, the Koken tube insertion therapy seems to be one of the most successful treatment of middle ear effusion in children.

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79 patients with bilateral chronic otitis media with effusion (C. O. M. E) who had continuous middle ear effusion more than 6 Mos., were treated uni-laterally with insertion of a long-term ventlation tube (V. T.).
After first 12 Mos., the ventilated side had been remarkablly improved compared with nontube side. However, towards the time of 36 Mos., when the tube was gone, final cure-ratio of each side was likely to converge to the same point of 70-80%.
There was no significant difference between two sides on complications.
Non-tube sides were classified into two groups“B”and “C” according to preoperative tympanogram. “B”-group responded rather poorly to conservative treatment and revealed final cure-ratio of 54-71% in contrast with “C”-group of 71-100%.
If hypothetical conclusion that the final cure-ratio of tube-inserted side and conservatively treated side are converging to the same ponint is true and there is minimum difference on complication-occurrance rate between two sides, ventilatin tube still has benefitial values for treatment of C. O. M. E. especially for hearing disturbances. Preoperative tympanogram also helps making decision of this procedure.

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The C. T. findings in 23 patients with congenital microtia were investigated. There were nine male patients and 14 female patients with an average age of 7 years, 6 months. Left microtia was found in seven and right microtia in 14 patients. In two patients, bilateral microtia was found, for a total of 25 affected ears. Atresia of the external auditory canal was found in 21 ears, stenosis in two ears, and two ears had a normal canal. The C. T. was performed with a window width of 4000 and a window level from 90 to 650, with 2 or 3mm intervals. In 11 patients, only horizontal sections were taken, but in 12 patients both horizontal and coronal sections were obtained.
The conclusions were as follows:
1. Using C. T., the size of the tympanic cavity was measured in three directions; top to bottom, anterior to posterior, and width. Microtia patients had a decreased size in two directions, both top to bottom and anterior to posterior. The growth in the transverse direction was equal to that of the normal side.
2. The growth of the hypotympanum and mastoid air cells are positively related. This relationship is supported by the fact that the eustachian tube, tympanum and antrum are form the same embryologic origin.
3. All patients' ears had some ossicular abnormalities in the malleus and incus on C. T.. But on C. T., recognition of the stapes was difficult and found in only three patients.

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In an effort to obtain the guide for finding out the exact location of internal auditory canal during surgery, we conducted the dimensional measurements of internal auditory canal and middle ear structures by CT target imaging in 40 normal hearing ears of the adults.
The anteroposterior diameter of the porus of internal auditory canal was 8.1±1.6mm (mean±S. D.) and the vertical diameter of that was 6.0±1.4mm. The length of internal auditory canal was 11.8±1.3mm in axial films and was 12.7±2.2mm in coronal films. These values were almost the same to those of previous reports.
The straight line was drawn between the centers of the diameter of bony external auditory canals of both sides in axial films of 8 cases and the relationship between this line and other structures was analysed. The malleo-incudal joint was located slight-anteriorly beyond this line. The anterior wall of the porus of internal auditory canal and the fundus of internal auditory canal were located approximately on this line. The posterior wall of the porus of internal auditory canal was located about 4.5mm posteriorly beyond this line.
The values of dimensional measurements obtained in this study could be of help to find out the exact location of internal auditory canal in surgery of the diseases such as acoustic neuromas and so on.

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A case of giant acoustic tumor which invaded into the vestibule was presented. The patient, 37-year-old, suffered profound hearing loss in his right ear for 5 years without vertigo and tinnitus. Audiogram showed a profound sensory hearing loss, over 120dB, in the right ear. The Caloric response of the right ear was highly depressed. The radiographic examinations of the temporal bone showed a giant tumor, about 5cm in diameter, in the right C-P angle. The internal acoustic canal was destroyed. The tumor was removed totally by both the translabyrinthine approach and the posterior fossa approach. Interestingly, it was found that the tumor invaded into the vestibule at the translabyrinthine operation. The utricular macula and the posterior crista were dislocated by the tumor and the lateral and the anterior cristae could not be identified. The origin of tumor was the inferior vestibular nerve. It was considered that the tumor invaded into the vestibule through the fundus of the internal acoustic canal. The pathological diagnosis was Antoni-A type neurinoma.

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We reported two cases of hemangioma of the middle ear, which appeared very rarely in the international literature. The first case, a 10 years old female, was a cavernous hemangioma in pathological findings. The second case, a 40 years old male, was a mixed hemangioma. We could evaluate exactly the extensions of hemangioma of the middle ear by preoperative MRI, which were compared with X-ray, angiography, CT-scan. We considered that MRI was a useful examination in the diagnosis of hemangioma.

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Two cases of malignant tumor of middle ear were reported. The first case was a 48-year-old woman, who suffered from adenocarcinoma producing much mucoids, which exspanded to nasopharynx through the Eustachian canal. In the second case of a 73-year-old man, the tumor whose pathology was squamous cell carcinoma, situated at the posterior part of the attic, and closed the entrance of the aditus.
In both cases, it was difficult to diagnose from ottitis media. Therefore, biopsy is necessary for diagnosis of middle ear cancer, since chronic ottis media, radiation, fungus infection are important facters in these tumors. Radiation, operation, chemotherapy are useful in the therapy. Subtotal resection of temporal bone is standard operation method.

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A case of ceruminous adenocarcinoma of the middle ear is reported. The patient was a 20-year-old man, who complained hearing loss, tinnitus and ear fullness in the right ear. The reddish white mass with a smooth surface was located in the postero-inferior quadrant of the ear drum. Audiological examinations showed conductive hearing loss, and roentgenological examinations revealed the mass located mainly in the tympanic cavity without destructing the surrounding bony structure.
Because the pathological diagnosis was adenocarcinoma, radical mastoidectomy was performed. No postoperative irradiation was administrated. Diagnostic and therapeutic problems of adenocarcinoma of the middle ear were discussed with the review of literatures.

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We experienced a case of high jugular bulb which protruded into the middle ear cavity. CT, DSA, MRI were performed, and their importance in the diagnosis of the high jugular bulb is suggested.
We made a hypothesis regarding the development of the high jugular bulb as follows; embryologically, narrowing of one side of the transvers sinus results in increased blood flow and enlargement of the sinus on the contralateral side.
If severe narrowing is present, the blood flow further increases and both the sinus and jugular bulb enlarge on the contralateral side. Excessive enlargement of the bulb disturbs formation of the bony wall between the tympanic cavity and jugular bulb, which results in protrusion of the jugular bulb into the tympanic cavity.

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The authors have encountered a case with otitis media exudativa in which profuse hemorrhage was found in myringotomy. The cause of the bleeding was the injury of the abnormally situated internal carotid artery. The patient was a 27-year-old male. His chief complaint was a right-sided mild deafness. The tympanic membrane of the right ear was atrophic and slight pulsatile movement was seen in the inferior quadrant under the operation microscope. The deafness was about 20dB hearing level of mixed type. Tympanogram showed B type curve. With the suspicion of the otitis media exudative with vascular lesion, CT x-ray study was done. High jugular bulb and glomus jugulare tumor were neglected. The internal carotid artery situated just beneath the promontry. The location was abnormally high and situated posteriorly in the tympanic cavity. Furthermore there was the dehiscence or the thinning of the bony wall of the internal carotid artery at the border on the tympanic cavity. In order to avoid the faulty myringotomy, recognition of this lesion is essential and careful observation and manipulation under operation microscope is important.

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Symphalangism is one of hereditary malformations, in which the ankylosis of the paroximal interphalangeal joints is involved. Vesel had reported the first case with stapes fixation accompanied with the paroximal symphalangism in 1960. In this paper, a female aged 11 years, suffered from hearing impairment, hypermetropia and symphalangism since her infancy was reported. Audiometry revealed conductive deafness of almost same grade in both ears. Congenital malformations of the middle ear, such as acomplete blockage of the ossicle chain between the crural arch and the foot plate fixation were detected. Stapedectomy was carried out and then her hearing impairment was improved to the satisfactory level. Hypermetropia was assumed to be one of cardinal symptoms of the case with symphalangism associated with stapes fixation on the basis of the present case.

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The stapedial reflex was studied in humans by impedance audiometry. Contralateral reflexes obtained from 28 patients with Parkinson's disease or syndrome (PA) (52 ears of which hearing level were within 40dB) and 10 controls (20 ears) without any disorders of central nervous system higher than medulla were investigated.
A 500Hz pure tone was used as acoustic stimulus. After reflex thresholds were determined, decay tests were performed. In two ears (two PA patients) no reflex was obtained, and in two ears (one PA patient) decay test showed positive. These patients were excluded for the following examinations. Then 10 reflexes were averaged and recorded with a 500Hz pure tone stimulus of 10dB above the threshold for 500msec (rise/fall time=10msec). PA patients showed longer relaxation time and smaller amplitude.
The authors conclude that the prolongation of relaxation time is characteristic for PA patients. And the authors assume that the prolongation may be attributed to the increased activity of a long latency pathway of the stapedial reflex.

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There are many ways of assesing tinnitus. These are classified mainly into two groups. One is the recording the patients' subjective account, and the others are the quantiative measurements such as loudness balance test, pitch match methods so on. The evaluation of tinnitus by these two methods is, however, not always coincident.
In order to observe closely the correlation between the subjective account and quantiative measurements, the successive evaluation of tinnitus was performed in 14 patients with tinnitus. The patients received tinnitus measurements at every one hour in through 12 conssecutive hours.
The changes in subjective account for tinnitus pitch and the results of pitch match methods were well correlated in most of patients. The subjective changes in loudness and the results of loudness balance test, however, were not always coincident. The results of loudness balance test in ipsilateral ear, especially, showed poor correlation with subjective changes. The loudness balance test in contralateral ear exhibited relatively parallel changes to subjective account. Thus the loudness balance test in contralateral ear is more suitable methods than that in the ipsilateral for expressing the subjective account for tinnitus loudness.

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