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Heerfordt syndrome, a subtype of sarcoidosis, is characterized by uveitis, swelling of the parotid glands, facial paralysis and low grade fever. In this study we describe a patient with incomplete Heerfordt syndrome who had three of these key symptoms (all except uveitis), with additional symptoms of dysosmia and rashes on the legs. Pathological study of the parotid glands and the rash on the legs revealed non-caseous granulomas and Langerhans' giant cells. Facial paralysis was resolved before starting the treatment and other symptoms were improved with the systemic administration of steroids. As dysosmia results from impairment of the central nervous system, this suggests that sarcoids infiltrate from the meninges to the olfactory nerve.

We made experiments of the inferior collicular potentials in acoustic and electrical stimulation for the purpose of studying fundamental issues for cochlear implantation. Guinea pigs with normal Preyer's reflex were used for this study. The results were as follows: (1) in acoustic stimulation relatively wide and large waveforms were gained but in electrical stimulation sharp and narrow ones were gained, (2) in acoustic stimulation the input-output curve of latency and amplitude was biphasic but in electrical stimulation it was monophasic. For this reason, in acoustic stimulation by click, when the intensity is low (under 80 dB SPL) stimulus site would be comparatively low frequency fibers. When the intensity is high (over 80 dB SPL) the stimulus site would shift to high frequency fibers. Therefore, many more neighboring fibers start responding. This results in biphasic input-output curves of latecy and amplitude. By electrical stimulation, however, it would be possible to stimulate only a restricted area among the bipolar electrode. Therefore, as the intensity increases, the response amplitude increases and becomes saturated at a constant level. This results in monophasic input-output curves of latency and amplitude.

In order to avoid direct damage to the teeth by a laryngoscope a prosthesis was devised. The prosthesis was made from polyester resin with thermo-plasticity following a model of the dental arch in each patient. Thus, the prosthesis perfectly fitted the dental arch of each patient and did not disturb the scopic view during laryngomicrosurgery.

Positive cytology of the sputum of two patients undergoing screening tests for lung cancer led to a diagnosis of cancer of a maxillary sinus.Case 1 was a 55-year-old male who had been treated for chronic bronchitis for several months. His sputum cytology was class V. Roentgenographic and endoscopic examinations of the lower airway showed no abnormalities, but MRI revealed an abnormal shadow in the left maxillary sinus. Open biopsy of the maxillary sinus was performed under general anesthesia. Hsstological examination showed squamous cell carcinoma.Case 2 was a 57-year-old male who had a cytological test of his sputum as part of a routine physical examination. The result was class IIIb. No malignancy was seen in roentgenographic and endoscopic examinations of the lower airway but CT revealed an abnormal shadow in the right maxillary sinus. Biopsy of the maxillary sinus lesion was performed under general anesthesia, and histological examination showed a papilloma with a tiny focus of squamous cell carcinoma.We examined the sputum cytologically in three other patients with maxillary sinus cancer and three with recurrences of this malignancy. Malignant cells were found in the sputum samples of two of the three patients with untreated advanced maxillary sinus cancer and in the sputum of two of the three with recurrent maxillary sinus cancer.The authors conclude that cytological examination of the sputum is useful in the diagnosis of head and neck cancer.

In patients with HIV infection, oral and pharyngeal pathology frequently occurs, but there have been no reports on cases of deafness in Japan. Herein, the authors report two cases of sensory neural hearing loss in hemophilia A patients infected with HIV through factor VIII concentrates. Case 1 was a 16-year-old male with hemophilia A. He had been administered factor VIII concentrates starting at 6 months after birth. At 8 years of age, HIV antibodies were positive. He was diagnosed as having AIDS after suffering from pneumocystis carinii. He complained of right otalgia and slight vertigo during treatment for a relapse of the pneumocystis carinii. He underwent otological examinations at our department. The right tympanic membrane showed opacification and serous otorrhea was noted. Acute otitis media was diagnosed and tympanotomy was conducted. Afterwards, the right tympanic membrane developed a large perforation and sensory neural hearing loss occurred. Case 2 was a 49-year-old male with hemophilia A. He had been administered factor VIII concentrates from the age of 23 years. At 48 years of age, HIV antibodies were positive. The patient complained of sudden deafness in the right ear and slight vertigo. He underwent otological examinations at our department. The tympanic membrane was normal bilaterally, but sensory neural hearing loss was found in the right ear. It was presumed that acute otitis media directly involving the inner ear had caused a perceptive disorder in case 1 while a pattern of sudden onset of deafness was apparent in case 2.

A case of a large epiglottic cyst is reported. The patient was a 79-year-old man who complained of an abnormal sensation in the larynx during phonation. On examination, he was found to have a massive epiglottic cyst arising from the lingual surface of the epiglottis, displacing it in a posteroinferior direction and almost totally occluding the pharynx. No view of the larynx could be obtained indirectly. The huge cystic mass was an obstacle to conventional intubation for general anesthesia. An endoscopically guided nasal intubation was therefore undertaken using a fiber-optic laryngoscope. The fiber optic laryngoscope was easily maneuvered past the cyst and an anesthetic tube railroaded through the larynx. The cyst was removed using a tonsillectomy snare under direct laryngoscopic observation.Histopathological examination revealed a lymphoepithelial cyst, whose walls were lined by stratified squamous epithelium accompanied by abundant lymphoid tissue.

To demonstrate the immunohistochemical properties of thyroid cancer, we used antithyroglobulin antibody staining and anti-PCNA antibody staining in a studies of six patients (two males and four females), four with undifferentiated thyroid cancer and two with papillary carcinoma of the thyroid who were treated at Tokyo Medical College Hospital. One of the patients with undifferentiated cancer also had papillary carcinoma. Observations were carried out separately of cells from undifferentiated and papillary carcinoma sites.The evaluation method was a qualitative examination of anti-thyroglobulin antibody staining and anti-PCNA antibody staining of 1, 000 cancer cells. All the cells showing uniform staining of the nucleus were considered to be labeled cells. The percentage of positive staining was calculated.All of the undifferentiated cancers were negative for anti-thyroglobulin antibody staining, whereas all of the papillary carcinomas were positive.The rate of positive anti-PCNA antibody staining was 10.8-35.5% in the undifferen-tiated cancers and 1.2-2.8% in the papillary carcinomas. A clear difference in anti-PCNA antibody staining was thus found between these two types of thyroid cancer.Undifferentiated cancer of the thyroid is a comparatively rare disease. In the present study, also, the number was small, and it was thus impossible to demonstrate clearly a statistically significant correlation between the results of immunohistochemical staining and the outcome. However, undifferentiated cancer and papillary carcinoma showed definite characteristic patterns of staining which corresponded with the differences in their outcome and presumably with their degrees of malignancy.

Methamphetamine activates catecholaminergic neurons and releases noradrenalin from their nerve endings in the central nervous system. Many reports have described the distribution of methamphetamine in the central nervous system after systemic administration. However, there have been only a few studies on the effect of this drug on peripheral organs, and known dealing with the inner ear.The authors used immunohistochemical methods to investigate the effect of methamphetamine on the pheripheral auditory system. Methamphetamine was administered to guinea pigs via intraperitoneal injection. The distribution of methamphetamine in the cochlea was studied by light microscopy following its immunohistochemical staining, and the methamphetamine concentration in the serum was also measured.1. Histochemical examination revealed that methamphetamine was present in the hair cells of the organ of Corti, spiral ligament and spiral ganglion cells 30 minutes after administration.2. The drug concentration in the serum rose rapidly, and then dropped in a logarithmic way with time until it became nearly horinzontal after 6 hours.The results suggest that methamphetamine penetrated the blood-labyrinth barrier (BLB) and then reached the organ of Corti, although some methamphetamine took a route to the inner ear via the cerebrospinal fluid. The pharmacological effect of methamphetamine on the cochlea was excitation of the sensory cells, the afferent nerve fibers connecting to them, and the spiral ganglion cells.

モルモット1匹あたり10mg/kgのメタンフェタミンを腹腔内注射し, 同剤が聴覚系に及ぼす影響をプライエル反射域値測定器やABRを用いて測定した。 この結果, プライエル反射域値は薬剤投与後30分, 60分で有意に低下した。 一方, ABRについては, 薬剤投与後ABRのI, II, IV波潜時は240分まで, III波潜時は180分までに有意に短縮し, 波間潜時についてもほぼ同様の傾向を示した。 しかし, 振幅や域値については, 薬剤投与前後で変化がみられなかった。 以上より, メタンフェタミンは聴覚伝導路全搬において, 潜時を短縮させる作用をもつことが判明した。

Castleman's lymphoma was diagnosed of the neck in a 21-year-old female.The patient complained of a gradually enlarging tumor on the left side of her neck. The preoperative diagnosis was lymphoid hyperplasia. The tumor was removed and identified histologically as a hyaline-vascular type of Castleman's lymphoma.Immunohistological studies were performed to clarify the nature of the tumor. All elements of a lymphnode were present follicles, germinal centers, and intrafollicular spaces, plasma cells produced both κ and λ immunoglobulin. There was little evidence of inflammation and most of the lymphocytes were B cells. The tumor was therefore classified as a lymphoid hamartoma.

The present study indicates that conservative therapy should be chosen initially and repeated operation is not recommended. were adults with the age ranged from 20 to 81 years. The ratio of male to female was 2.6: 1.The majority of the patients had a sore throat, odynophagia and dysphagia with mild to severe fever. Some patients complained of dyspnea increased in the supine position and decreased in the sitting position, suggesting that a swollen epiglottis dropped down backwards to obstruct the laryngeal orifice in the supine position. This kind of dyspnea is a characteristic symptom in acute epiglottitis.Tracheotomy was performed in two and tracheal intubation in one, and no death occurred.Lateral neck roentgenograms were obtained in 16 cases in the course of acute epiglottitis.The diagnosis of the disease was roentgenographically confirmed in 81 per cent of the cases, but in each case the diagnosis had been made initially by indirect laryngoscopy. The intervals between the onset of symptoms and doctor contact and hospitalization were within 7 days.Antibiotic therapy was done in most cases. Most signs and symptoms resolved in three to five days, with a dramatic decrease in pain and dysphagia within 24 hours.Epiglottic swelling resolved in seven to eleven days and 70 per cent of the cases were discharged within that time.

The authors have questionnaired 67 ENT practitioners in Tochigi prefecture on acute epiglottitis. Several interesting answers have been obtained.Almost a half of doctors have had an impression that incidence of this disease gradually decreased in recent years.Eleven per cent of doctors have pointed out that acute epiglottitis occurred more frequently in children than adults. This tendency is noted in U.S.A. and often European countries. However, previous several reports in Japan have indicated that the disease more frequently affects adults than children.All the doctors (100%) have made a diagnosis of acute epiglottitis by indirect and/or direct laryngoscope, with reference to several characteristic symptoms of the disease.The majority of doctors have not regarded an incision of the edematously swollen epiglottis as the first choice of the surgical treatment. Penicillins and/or cephems have been most commonly used in cases.Some doctors have encountered the patients who died because of airway obstruction in the course of the desease.

Expression patterns of cytokeratins (CKs) in normal skin, in pars flaccida type cholesteatoma (PFTC), and in pars tensa type cholesteatoma (PTTC) were examined by means of one- and two-dimensional electrophoretic techniques. Both CKs 14 and 5 pair (CKs 14/5) and CKs 10/1 were found in all materials. Neither CKs 16/6 nor 19 was found in the skin. CKs 16/6 and 19 were both found in 3 out of 5 PFTCs, only CKs 16/6 in 1 out of 5 and neither CKs 16/6 nor 19 in 1 out of 5. CKs 16/6 and 19 were both found in 1 out of 3 PTTCs, only CKs 16/6 in 1 out of 3 and neither CKs 16/6 nor 19 in 1 out of 3. There was no significant difference in the CKs expression patterns between PFTC and PTTC. The expression of CKs 16/6 and 19 suggested that their matrix epithelia were hyperproliferative. However, not all of the cholesteatomas were always hyperproliferative. Patterns of the terminal differentiation of CKs 1, 5, 10 and 14 in the PFTC or the PTTC were basically the same as those in the skin. In the cholesteatoma, eack CK gradually diminished in molecular weight in the cornified layer and debris. Desmosomal proteins were abundant in skin but not in cholesteatomas.

Hiraide F, Watanabe K, Funasaka S, Kakoi H. The blood vessels in Reissner's membrane of the rat. Acta Otolaryngol (Stockh) 1994; 114: 1–3.Blood vessels on Reissner's membrane were electron-microscopically found in 24 out of 30 rats of the Wistar strain. The vessels were noted in the upper turns, mainly in the third turn of the cochlea. They originated from radiating arterioles in the upper spiral ligament and took straight courses radially down to the spiral limbus, and further to the modiolus, running along the surface of the scala vestibuli side of the membrane. Their diameter was approximately 4 µm. Bifurcated blood vessels were occasionally detected in 3 out of the 24 rats that possessed the vessels in the membrane. From the morphological point of view the blood vessels in Reissner's membrane may possibly have some function in the inner ear of the rat.

This report describes the histopathological changes in the temporal bone of a 71-year-old man who died of meningitis and epidural abscess complicated by primary squamous cell carcinoma of the middle ear. The present case is unusual and differs somewhat from previously reported cases of the primary squamous cell carcinoma of the middle ear in three respects: 1) an extensive invasion of the cancer into the membranous labyrinth, 2) cholesterol deposits in the cochlear spiral canal, and 3) presence of ossifying labyrinthitis. Among these findings, extensive involvement of the inner ear by cancer destroying the lower part of the otic capsule is particularly unusual. It is assumed that squamous cell carcinoma overcame the biological resistance to neoplastic infiltration which probably exists in the otic capsule and the membranous labyrinth.

Two patients with sudden progressive profound hearing loss resulting from Ramsay Hunt syndrome are reported. Case 1: A 63-year-old woman was admitted to Jichi Medical School Hospital with sudden, progressing deafness of the left ear, vertigo, sore throat, and hoarseness. An otoscopic examination revealed the external ear and the tympanic membrane to be normal. Pure-tone audiometry revealed profound deafness in the left ear. A horizontal nystagmus in the non-affected direction was observed by gaze nystagmus test. An endoscopic examination revealed herpetic vesicles and shallow ulcers on the left side of the pharynx and the larynx. There was complete paralysis of the left recurrent nerve. Hearing acuity of the left ear did not recover at all with steroid hormone therapy. Case 2: A 75-year-old man was referred to the ENT Clinic by a dermatologist for hearing evaluation in Ramsay Hunt syndrome. The man had noticed severe otalgia and sudden progressive deafness of the right ear approximately 2 weeks prior to admission. Physical examination revealed herpetic vesicles and ulcers in the right external ear and lateral neck. Complete paralysis of the right facial nerve was noted. Profound hearing loss in the affected ear was observed by pure-tone audiometry. A gaze nystagmus test revealed a horizontal nystagmus in the non-affected direction. No recovery of the cochlear function was noted following administration of antiviral drug. The pertinent literature is briefly reviewed.

This paper is reported about the otoneurological findings and the neuroradiological results containing air or metrizamide CT cisternograpy in the six patients with acoustic tumors less than 1.5cm in size located within the internal auditory canal (intracanal type) or projecting into the cerebellopontine cisterna (cisternal type).1. The six patients had asymmetric neurosensory type hearing impairment and more recruitment phenomena than signs of retrocochlear lesions on the basis of false negative results in this research. Therefore, the ABR test should be used only a screening test.2. The three patients were tested by electronystagmography and their response to the bilateral caloric test was normal.3. Petrous tomograms revealed an enlargement of the internal auditory canal in only three of these patients. Conventional CT scans gave false negative results in five patients. A new radiological technique, air or metrizamide CT cisternography, revealed small acoustic tumors in all six patients. These were confirmed at surgery.

Cervical periesophageal abscess is one of the complications of foreign bodies in the cervical esophagus. A case of dysphagia due to traumatic cervical periesophageal abscess is reported. The patient was a 58-year-old female who had complained of dysphagia and a foreign body sensation in the larynx for approximately 2 days after a piece of large fish bone was ingested inadvertently. Roentogenological examination revealed a marked thickening of the periesophageal region caused by submucosal emphysema and abscess. Clinical symptoms and roentogenological reviews confirmed the diagnosis. Therefore, the abscess was widely opened by the lateral cervical incision, but no foreign body was found. The submucosal emphysema was supposedly caused by active mobility of the foreign body and the abscess occurred by secondary infection. The main cause of dysphagia was the mechanical obstruction by emphysema and abscess, disturbing the passage of bolus and the elevation of the larynx.

正常および滲出性中耳炎の中耳粘膜上皮を走査型電子顕微鏡により観察し, 表面微細形態の変化を比較検討した. 正常中耳では線毛細胞は鼓室の底および下方部に密に存在しており, 上皮細胞の70～80%が線毛細胞であった. 線毛細胞は1細胞につき80～200本, 平均120本の線毛を有していた. 線毛の長さは平均7μであった. しかし, 乳突洞, 乳突蜂巣では線毛細胞の密度は粗となってき, 上皮細胞の95%以上が無線毛細胞であった. 従って鼓室下部の線毛細胞は middle ear clearance に重要な役割を果しているものと思われる. 滲出性中耳炎の中耳粘膜では杯細胞の分泌亢進像が観察された. またところどころで細胞表面に小間隙がみとめられ, そこから炎症性細胞とともに上皮下より液体の流出してくる像が観察された. 恐らく上皮下血管由来の液体が中耳腔に流出してきたものと思われる. 線毛細胞の, 特に線毛に形態異常がしばしばみとめられた. 特徴的な線毛の形態異常は短線毛, 線毛数の減少, コブ形成, 癒合線毛, 巨大線毛などであった. これらの異常線毛は middle ear clearance を阻害し, 中耳液の貯留を助長しているものと推測する.

Cryosurgery is gaining more and more importance as a therapeutic modality within the field of head and neck surgery.Cryosurgery was performed in two patients with hemangioma arising from the entrance of the esophagus.Case 1: A 41-year-old woman was referred for the diagnosis of hemangioma in the entrance of the esophagus which had been present for approximately five years. The patient felt slight pain on deglutition and sometimes noticed hemoptysis. The lesion was treated with cryoapplication of -60°C on its surface through the direct laryngoscope under general anesthesia. Cryoapplications were repeated by overlapping frozen areas during treatment. The duration of the individual freezing cycles ranged from one and half to three minutes. Over a period of 3 weeks the patient received 2 cryosurgical treatments. Postoperative healing was uneventful. After 3 weeks following 2nd cryosurgery the lesion disappeared without leaving a remarkable scar. No recurrence was noted after one-year follow-up.Case 2: A 54-year-old man was admitted to the hospital with a history of foreign body sensation in the throat. Endoscopic examination revealed a dark, blue swelling in the entrance of the esophagus, suggesting a hemangioma. The lesion was frozen in three applications of -60°C each time. The frozen region was overlapped to compass the entire tumor. After thawing the frozen areas began to swell. In 24 hours it was almost twice of its original size. Then the necrotic tissue was well demarcated from vital tissue and on the seventh postoperative day the brownish lump exfoliated and showed a persistent smaller tumor. Total regression of the hemangioma and overgrowth of normal mucosa followed with a satisfactory functional result. No further growth was observed after six-month follow-up.The general treatment of the hemangioma in the larynx, hypopharynx and esophagus was briefly discussed.

A case of dysphagia due to traumatic cervical emphysema is reported. The patient was a 51-year-old female who had complained of a foreign body sensation in the throat. She thought that she might have pharyngeal cancer. She occasionally found a firm mass in the lateral region of the pharynx (this was actually a lateral pharyngeal band). She tried to remove it by an iron needle stick. The patient noticed cervical swelling after repeated swallowing action.Roentgenographic examination revealed a marked thickness of the posterior wall of the hypopharynx due to submucosal emphysema. Submucosal emphysema disturbed mechanically the elevation of the larynx and the movement of the epiglottis. Thus, the bolus of food was easily aspirated into the tracheal lumen.Cervical emphysema disappeared in approximately 2 weeks after the injury of the pharynx without any intensive antibiotic therapy.

Two cases of hearing disorders with progressive muscular atrophic diseases were reported. The case 1 is an 11-year-old boy with facio-scapulohumeral type of muscular dystrophy, whose audiogram showed the sensorineural type of bilateral deafness with gradual form of high tone loss. The case 2 is a 29-year-old female with congenital multiple arthrogryposis complaining of progressive hearing impairment of both ears. The audiogram showed sensori-neural deafness. Her hearing acuity became worse as the muscular atrophy proceeded. The hearing impairment of both cases might be due to the pathological change in the inner ear because they had recruitment phenomena and bone conduction disorders.

Remarkable morphological changes of the fiber arrangement was observed in the middle lamina propria of the pathological human tympanic membranes. These changes were present mainly in the middle zone of the pars tensa. There were several fibers running in entirely different directions among the regularly arranged radial and circular fibers. These abnormal fibers had a tendency of forming fiber bundles of varying sizes and lengths. It is stressed that the normal fiber arrangement was undoubtedly disordered in the healing process of the inflamed middle lamina propria of the human tympanic membrane.

Five males and nine females aged 14 to 58 years were treated for hemangioma of the nasal cavity and paranasal sinuses from 1979 through 1984. There were eight cases of capillary, four of cavernous and two of non-specific hemangioma. The most frequent symptoms were nasal bleeding, noted in 11 patients (78%), and nasal obstruction, in five cases (36%). The lesions originated most often in the nasal septum, then the inferior turbinates. Eight patients were treated by local excision, three by cryosurgical procedures, two by cryosurgery plus excision and one with cryosurgery followed by an Nd-YAG-LASER procedure. The histological classification of these lesions and the clinical features are discussed.

A case of dysphagia with acute onset due to polyneuritis cranialis is reported.The patient was a 29-year-old female who had complained of dysphagia and hoarseness for approximately two weeks following common cold.Clinical symptoms of dysphagia, right soft palate paralysis, right vocal cord paralysis and right accessorius cranial nerve paralysis commenced in two weeks after upper respiratory infection possibly by virus. Clinical diagnosis was made of dysphagia with sudden onset due to polyneuritis cranialis on the basis of the following findings:1) The onset of symptoms (C2-3) was rather abrupt following upper respiratory infection.2) The paralysis of right IX N. glossopharyngeus, X N. vagus and XI N. accessorius was present.3) Initial clinical symptoms disappeared in 40 days under therapeutic regimen of Vitamin B1, B12, corticosteroid and antibiotic administration.4) The paralysis of right VII N. facialis and XII N. hypoglossus occurred in 4 months after disappearance of initial symptoms.5) The paralysis of VII N. facialis disappeared in 2 months under the same therapeutic regimen as applied for initial clinical symptoms. However, XII N. hypoglossus remains paralyzed.

A recurrent case of Forestier's disease in a 65-year-old female is reported. The patient complained of dyspnea and dysphagia at the age of 58 years. She was diagnosed as Forestier's disease after the X-ray examination of the spine. The cervical roentgenogram revealed bony proliferation of anterior margin from C3 to C6 and ossification of posterior longitudinal ligament from the level of C6 to C7 It was considered that the symptoms was caused by stenosis of the pharynx and cervical esophagus due to the pressure by bony proliferation.The symptoms were diminished by resection of the bony proliferation. Three years after, however, the symptoms recurred and the cervical roentgenogram showed bony proliferation from C3 to C6. Re-resection was performed 7 years after the first resection and the symptoms were lessened, again.Literatures on the pathogenesis, diagnosis and treatments for Forestier's disease were reviewd. In this review we found many reports about dysphagia due to Forestier's disease but a few about dyspnea. More over in the surveyed literatures, there was no case report in which re-resection of bony proliferation was performed for a treatment of Forestier's disease.

Histochemical studies on the distribution of various oxidative and dephosphorylating groups of enzymes have been made in the normal mucous lining of the middle ear in the guinea pig, cat, squirrel monkey and man. In general ciliated cells showed more strongly positive activity than other epithelial cells lining the middle ear cavity for various oxidative enzymes and hydrolytic enzymes except alkaline phosphatase in these animal species. Marked alkaline phosphatase activity was detectable on the cilia of the cat, whereas no enzyme activity was found on the cilia of other species. The significance of histochemical findings in the middle ear mucosa of several animals was discussed in light of physiological and pathological considerations.

Histopathological findings of temporal bones from 3 cases of congenital anomalies were reported. These included 2 cases of Mondini type inner ear hypoplasia/dysplasia and a case of hypophosphatasia.Case 1: A two months old girl with hydrocephalus died of pneumonia on October 9, 1968. The temporal bones showed Mondini type hypoplasia of the inner ear. The cochleae were of a single coil. (the right cochlea: 8.5mm long, the left: 9.5mm long.) The organ of Corti was normal. There was a PAS positive deposit in the basal cell layer of the stria vascularis and the spiral ligament adjacent to the stria. No marked change was noted in the vestibular system.Case 2: A 17 months old boy with the cleft lip and the cleft palate, showing Mondini type inner ear dysplasia. This case was already reported in December issue of Annals of Otology, Rhinology and Laryngology, 1970.Case 3: A full-term girl of hypophosphatasia. This was documented and discussed in detail in December issue of Journal of Laryngology and Otology, 1968.

Detailed anatomical characteristics of normal middle ear epithelium and a topographical distribution of cell types are described for the squirrel monkey. The following cell types were classified by using electron microscopy: 1) ciliated tall cell; 2) ciliated small cell; 3) non-ciliated columnar or cuboidal cell; 4) non-ciliated thin cuboidal or flat cell. Ciliated cells were found in the region of the Eustachian tube, anterior mesotympanum and hypotympanum. Columnar cells were found anterior to Jacobson's nerve and flat cells posterior to this nerve which served as a reference mark. Such findings are important in understanding normal physiology and are of special interest in interpreting pathological inflammatory alterations in man and animals ranging from mild (acute serous otitis media) to severe (chronic serous otitis media and mastoiditis).