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A comparative study was made on electrocochleography by the transtympanic and the ear canal recording technique in normal hearing subjects.The results obtained were as follows:The auditory whole nerve action potential (AP) recorded from the ear canal showed extremely low ampliitude but AP latency, wave form and threshold did not so differ significantly from the transtympanic recording technique.Cochlear microphonics (CM) recorded from the ear canal also showed a low output potential as well as AP. Furthermore, there was a limitation of information from the cochlea because of a higher detection threshold of the CM and mixture of the electromagnetic induction wave, Therefore, the transtympanic recording technique is more efficient than that of the ear canal recording technique.

さまざまな時期に蝸電図検査をした突発性難聴患者168名を, 検査日別に5群にわけて, CM検出域値と純音聴力 (蝸電図検査時と聴力固定時) との関係を周波数別に検討した。 早期より, どの周波数においても検査時純音聴力とは関係なく, CM検出域値に応じて聴力の改善がみられた。 CM反応からみた突発性難聴の病態は, 主としてらせん器周辺の障害と考えられた。 固定時聴力を決める不可逆性CM発生機構障害 (主に有毛細胞と考える) と聴力改善の可能性を示す可逆性刺激伝達ブロック (シナプス-聴神経) の両者が種々の割合で存在し, このらせん器周辺の障害の程度により, 特に発症時のCM発生機構の障害の程度により, 予後がほとんど決ってしまうと考えられた。 CM反応をみることにより早期より予後を推定することが可能である。

We had two patients with respiratory tract stenosis and decannulation difficulty after high tracheostomy.In the first case, vocal cord was adhering by trauma, in the second case, granulaions were increasing with great tenacity.But we scceeded the decannulation.The authors discussed the etiology and treatment of traumatic laryngeal stenosis and high tracheostomy.

The author discussed on the formation mechanism of so-called cyst which was frequntly found in the mucous membrane of chronic otitis media or granulation of epidermization difficulty of post operative mastoid wound in histology.Results were as follows;1. There were many grades of so-called cyst formation from the “Hollow” of “epithelium” or “Tasche in germany” to looked like cyst in reality.2. From the point of view formation mechanism of so-called cyst was classified into next 4 groups.Type I. was formed by the hollow of epithelium.Type II. was formed by adhaesion or juncti. on of epithelium which had pappillary processus extended as far as opposite epithelium.Type III. was formed by adhaesion or junction of tow chnged in the papillary epitheliim.Type IV. was formeg by epithelium and regenerated mastoid cells.3. So-called cyst was formed in the mucous membrane with marked inflamation.4. So-called cyst depended on the middle ear pneumatizations grade, and it is apt to rise from the well-developed mastoid cavity.

Absorption of Gelfoam and Spongel, inserted in to the tympanic cavity were discussed in tympanoplasty.This study was undertaken to investigate its relationship with the pneumatisations theory.As experimental animals, pigs and rabbits were used, because the tympanic cavity and mastoidcells of the pigs are well-developed similar to human mastoidcells and the middle ear of the rabbit is constructed as simple antrum, which is called a bulla similar to the under-developed pneumatic cavity.Gelfoam and Spongel were inserted in these cavityies and from ten to fourty days later histological observations were done postoperatively. In the mastoidcells and tympanic cavities of the pigs no remains of Gelfoam were seen, but histologically the homogenous or fibrous gelatin materials stained by eosin were found and inflammatory reaction of the mastoidcells was remarkable. In the cavities of the mastoidcells the small round cells, histiocytes, plasma cells, leucocytes and flat epithel cells were revealed, in which phagocytic functions was noted. The mucous membrane was thickened and oedematous. The small round cells and histiocytes were extensively infiltrated. The tympanic cavity showed a similar reaction with mastoidcells, except a fibrous proliferation of its mucous membrane. In the middle ear of the pigs, the remains of the Spongel were found from ten days to twenty days after the operation. But after the fourty days, no Spongel was found, but the mucous menbrane was oedematously thickened. In the bulla of the rabbit, the Spongel was seen after fourty days and the reaction of the bulla membrane was slight.As control these materials were inserted in to the mucous membrane and skeletal muscles of the rabbits and histologically observed.From this experiment, it was concluded that the Spongel tanpon inserted in the well-developed middle ear might be easily absorbable but in under-developed state absorption was very slight.

Two hundred and four of the postoperative nths to 10 years aftet operation were obserbed. The result were as follows : 1) Difficulty of postoperativ epithelisation of brane perfonation seen in 29 cases, and 62 cases (30.4%) in total. 2) Difficulty of postoperative epithelisation of mastoid cavity in the large mastoid cavity was seen in 28 cases (49.1%) of 57 cases. In the middle large cavity this was seen in 28 cases (27%) of 96 cases and in the small cavity 6 cases (11.7%) of 51 cases. cavity would apted difficulty of postoperative epit. helisption of mastoid cavity. mastoid cavity in the large external auditory canal was seen in 21.7%, and 34.7% in the small Canals. Largeness of the external auditory canal was shoon to influence the dryness of postoperatoid cavity. 4) There was no relation between difficulty of postoperative epithelisation of mastoid cavity and cultivated bacillus. 5) The fungus was detected in 26 cases from the postopestoperative mastoid cavity and external auditory canal, but there was no significance as to toid cavity. Saprophtes was mainly foud.

The authors observed eight cases of intermittent tinnitus which appeared during the course of recovery from peripheral facial nerve paralysis of various etiology. The tinnitus occurred whenever a certain mimic facial muscle contracted voluntarily or involuntarily.As the tinnitus in each case didn't dispaaeared by medical treatment or other conservative therapy, tympanotomy via extenal auditory meatus was made. Under the operating microscope, contraction of the stapedius muscle synchronous with contraction of the mimic facial muscle was observed. The tinnitus had disappeared completely immediately after the tendon of stapedius muscle was sectioned. Thus the existence of tinnitus due to abnormal contraction of stapedius muscle was confirmed.Further, tinnitus in each cases was considered to be an expression of abnormal associated movement involving the stapedius muscle during the course of the recovery from facicl nerve paralysis.Changes of the minimum audible. threshold (air conduction) were measured in each case during the stapedius muscle contracted without sound stimulation, and the results showed a good accordance to the results obtaind from the theoretical and experimental works which had been reported by several authors.In a conclusion, the authors stressed the importance of the stapedius muscle tinnitus in the study of pathogenesis of tinnitus, facial nerve paralysis, as well as in the study of middle ear function.

The authors observed eight cases of intermittent tinnitus which appeared during the course of recovery from peripheral facial nerve paralysis of various etiology. The tinnitus occurred whenever a cert

Barium sulfate was used to study foreign body reaction of the nasal sinus. This substance possesses strong foreign body effect and to the mucous membrane and produces remarkable swelling of the sinus mucosa after instillation into the antrum and the swelling of the sinus membrane can be demostrated roentgenologically.The observation was carried out on the chronic sinusitis patients. X-ray film was taken 24 hours after instillation of barium in the maxillary sinus in 77 cases, and also on the 8th day in 88 cases. All cases were operated after the roentgenological examination. The changes on X-ray films were com pared with that of obtained histological specimens. From this study the following results were obtained: The swelling of the membrane was most remarkable in mild cases of chronic sinusitis which showed minimal swelling of the mucosa on X-ray film. In the cases with extensive rnucosal changes, no reaction to barium was seen.On the other hand, swelling of the mucosa was remarkable in the cases with large sinuses, while it was not so severe in the cases with small sinuses.This reaction of the mucosa consists of edematous swelling and round celhnfiltration with increased eosinophils. Those findingsin the mucosa resembles to the picture of the edematous type of chronic sinusitis. Allergy test proved to be negative in the cases with marked mucosal reaction.The author has previously stated that this reaction of the mucosa could be ascribed to the foreign body effect of the Ba SO4, and not to its chemical stimulation. The mucosal change in chronic sinusitis might be the result of foreign body effect of the infected bacteria which have relatively weak toxisity. This study revealed that the mucous membrane of the sinus displayed different reactions against the same stimuli depending on its grade of pneumatization. The well-developed large sinuses reacts foreign body with edematous change, but this reaction is minimal in the under-developed small sinuses. This reaction against foreign body should be recognized as that of the sinus itself, because the foreign body was insilled in the sinus cavity and not in the mucosa.The author would like to emphasize that this results of the clinical study can serve as the valuable data to understand pathology of chronic sinusitis. Unfortunately our experiment of similar foreign body reaction in rabbits failed to find significant change to confirm these clinical findings.

A 31 years old male who had post traumatic stenosis of the trachea associated with laryngeal nerve paralysis was treated by end-to-end anastomosis of the trachea In this procedure the thyro-hyoid muscles and pharyngoconstrictos were cut and the lower part of the trachea was free from the superior mediastinum before the stenotic portion of the trachea was removed and end-to-end anastomosis of the trachea was performed.Post-operatively no swallowing difficulty was observed even under cineradiography, and the air way was still patent 2 years and 6 months after the surgery.Aphonia was present in the early postoperative stage, but vocal function improved gradually and considerably, and at present, we can observe a good motility of the false vocal cords and the left vocal cord.Improvement of phonetic function has been proved on cineradiogram, radiogram and electromyogram, and according to the results of these observations, the author considered the regeneration of the recurrent nerve.

One hundred sixteen human temporal bones were used for this study. They were classified into six groups radiologically, according to the development of the pneumatization by Schuller's projection.The length of the external aperture of the vestibular aqueduct (VA) was measured to evaluate the development of the funnel-shaped enlargement at the distal VA.The relationship between the pneumatization and the length of the external aperture of the VA was studied statistically.The temporal bone with well-developed pneumatization has a tendency to have a large external aperture of the VA.We can estimate both sizes of the VA and the endolymphatic sac in accordance with developmental grade of the pneumatization.

It was confirmed that the substances injected into the facial nerve through the stylomastoid foramen, reached every part of the inner ear. In sensitized animals, by repeated provocative injections of antigen, acute reversible episodes, very similar to that of Ménière's disease, were observed. The injection of various solutions and the provocative injection into the sensitized animals, resulted in completely opposite reactions. In sensitized animals, the electrophysiological phenomena of the cochlea also showed fluctuations like Ménière's disease.

The polarity of the summating potential wave induced by electrocochleographical examination has an important bearing upon the pathophysiology or the prognostic evaluation of sensorineural deafness. Electrocochleographical examination was performed on cases of sudden deafness, Meniere's disease, progressive sensorineural deafness, sensorineural deafness due to barotrauma, etc. When the polarity of the summating potential showed an increased negative wave, physiological blockage in sensorineural structures was revealed. In other words, under such conditions sensorineural structures have a potential for activity although hearing acuity was damaged. On the other hand, when the summating potential has an increased positive polarity wave, gradual decrease of the hearing acuity was revealed.

• Electrocochleography was performed at first examination in 34 patients with sudden deafness. Recording was made with the use of the transtympanic needle electrode technique. A notable difference in the electrocochleographic findings was shown between the cases of complete recovery or remarkable improvement and the cases of slight improvement or no change. Electrocochleography may be prognostic of sudden deafness at initial onset. (Arch Otolaryngol102:601-607, 1976)

Auditory nerve action potential (AP), cochlear microphonics (CM) and summating potential (SP) were recorded from 6 patients with low-tone hearing loss without vertigo. All these cases showed high AP and -SP amplitude and satisfactory CM response. These findings resembled the electrocochleographic findings of type 1, which is an early stage of Ménière's disease. Hearing returned to normal range in half of the cases but remained hardly changed in the other half. The difference between these two groups could not be clarified electrocochleographically. On the other hand, low-tone hearing loss due to retrolabyrinthine lesion and due to familial sensorineural deafness was shown to have a low AP amplitude.

Estimation of the prognosis of sudden sensorineural deafness is available by reviewing CM responses in electrocochleography (ECochG) even at an early stage of disease after the onset. The detection threshold of CM irrespective of the period of ECochG seems to be the most reliable tool to estimate the final hearing level in pure tone audiogram.

A search was conducted in Hiroshima and Nagasaki for all cases of cancer of the lip, nose and nasal cavity, accessory sinuses, larynx, and the oral cavity and pharynx with their subdivisions occurring during the period 1957-1976 among a large, fixed cohort of atomic bomb survivors. A total of 232 cases were identified, of which 154 (66.4%) were histologically confirmed (definite cases). Among definite cases, cancer of the epiglottis and larynx predominated (31.2%), followed by accessory sinus (24.7%) and tongue (18.8%). Of the 154 definite cases, 141 (91.6%) were squamous-cell carcinomas. Only two sarcomas were identified, neither of which was attributable to radiation exposure. Analysis of both total and definite cases, by both total group and major anatomic site, failed to reveal definite evidence of a radiation relationship. Although a suggestive relationship to radiation dose was found for accessory sinus cancers (P . 0.06) among the definite cases, inconsistencies in the data do not permit the conclusion that the incidence of tumors in this group increased as a result of atomic bomb radiation exposure. The medical literature concerning post-irradiation head and neck tumors is briefly reviewed.

• Electrocochleographies were performed on three patients with deafness resulting from cerebral vascular lesions. Recording was made by the transtympanic needle electrode technique. In a patient who had anterior-inferior cerebellar artery aneurysm that showed fluctuating hearing loss, auditory nerve action potential (AP), cochlear microphonics (CM), and summating potential fluctuate in amplitude in concert with episodes of ischemic hearing loss. This indicates the pathophysiology of reversible impairment of the cochlear nerve and of sensory epithelium of the inner ear caused by disturbance of blood flow into the inner ear. It was also conjectured that the cochlea is hardly impaired in the case with normal AP and CM responses despite the increased threshold in pure-tone audiometry and that the cochlea undergoes irreversible organic changes in the patient who has no AP or CM response in tests after a long period. ( Arch Otolaryngol 107:74-78, 1981)

In experiments using rabbits, the pupil on the side of irritative inner ear lesion showed dilatation, and that on the side of paretic lesion showed constriction. In the clinical observation of patients with unilateral inner ear diseases (134 cases), anisocoria was recognized in 54.5%. In 68.5% of these, anisocoria was induced after applying a drop of neosynephrine. The size of the pupil on the healthy side was smaller in 65.8% than the pupil on the healthy side. Anisocoria in inner ear lesions is believed to be due to vestibulo-sympathetic imbalance through the superior cervical sympathetic ganglion.

The changes of the action potential (AP), the summating potential (SP) and cochlear microphonics (CM) were investigated in reference to the grade of endolymphatic hydrops produced by endolymphatic sac obliteration in guinea pigs. In a few cases with minimum endolymphatic hydrops, super-normal AP was obtained. With an increase of endolymphatic hydrops, CM responses were reduced although AP responses at intensive stimulation were maintained relatively well. It is thought that the polarity of positive SP, as observed in control, was influenced to deflect towards negative SP by an interaction between the increased degree of endolymphatic hydrops and the changes of the biochemical components of the inner ear fluids.

This study was conducted to elucidate the pattern of clinical recovery from partial facial palsy caused by injury to a branch of the facial nerve in rabbits. In the experiment, the state of recovery from palsy was investigated by observing the movement of the m. orbicularis oris of the rabbit at the time of food intake, as well as by observing the evoked wave and muscle contraction caused by nerve stimulation, and the muscle contraction caused by muscle stimulation. Recovery from peripheral facial nerve palsy is complete within 1 month after nerve impairment if over half of the nerve fibers of the impaired nerve are maintained intact without degeneration.

It has been observed through our clinical experience and experimental results that a com-plete recovery of muscle paralysis can not be expect after a severe damage to the innervating nerve, even after evidence of regeneration of the nerve fibers is ascertained. Why does such a condition occur? How much muscle impaired after a nerve was crushed or sectioned? The purpose of this study is to answer to these questions. After the third branch of the facial nerve of rabbits was sectioned to the depth of 1/4, 1/2, 3/4 and then 7/8 in diameter, the degree of muscle contraction induced by stimulating the nerve central to the lesion was evaluated by means of a UL-type strain gage. Moreover, 8 months after the third branch of the facial nerve of rabbits was crushed or sutured after sectioning, the muscle contractibility was estimated and the pattern of evoked waves obtained from the orbicularis oris muscle was observed. These experiments led to the conclusions as follows: 1) The muscle contractibility is kept within normal range if a half of the nerve fibers remain intact. 2) In the case of nerve crush, more than a half of total fibers regenerates and functions normally. Thus, the muscle function recovers completely. 3) In the case of nerve sectioning, more than a half of total fibers does not regenerat and the muscle function does not recover completely. In this case, paralysis never recovers compl-etely.

Facial nerve paralysis was produced by inoculating rabbits with herpes simplex virus. Inoculations were made through the stylomastoid foramen into the facial nerve canal, the subarachnoid space, and the common carotid artery. Subarachnoid and common carotid artery inoculation caused encephalomeningitis, but facial nerve paralysis failed to develop. Inoculation through the stylomastoid foramen produced facial nerve weakness on the third day and severe paralysis on the sixth day. No improvement was noticed after 223 days of follow-up. Regeneration was extremely poor and the nerve tissues were totally replaced by collagen fibers in some animals. Even if regeneration was present, markedly proliferated collagen fibers surrounded the regenerated nerve. In some cases, a typical labyrinthine disturbance resulted which could be ascribed to interneuron spread of the virus.