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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.

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.

Electrocochleography was performed on six patients with posterior cranial Fossa tumors which consist of three cases of acoustic neurinoma of grade II-III, a case of glioblastoma multiforme originating from cerebello-superior pons, a case of astrocytoma of grade III originating from medulla oblongata-inferior pons, and a case of meningioma originating from Meckel's cavity. Recording was made with the use of the transtympanic needle technique. AP input-output functions with acoustic neurinoma were very similar to those obtained in patients with sensorineural hearing loss showing the phenomenon of recruitment. In AP responses recorded from the patients with cerebello-superior pontine tumor and Meckel's cavity tumor, a loss of the positive portion of the potentials (P1) was characteristic. This phenomenon may be due to the compression on the auditory nerve by the growing tumor. The polarity of SP in all cases showed negative deflection without abnormal increment. CM responeses recorded from the patients were the same as in a normal subject. In the cases presented, although the abnormal changes in input-output functions as well as the changes in the wave form patterns of AP responses revealed a lesion of the portions corresponding to the sensory and/or to the neural structure, the presence of a well-developed CM may be explained by the fact that the hair cells remain unaffected. Therefore, it is thought that simultaneous recording of CM and AP gives great promise as a means of differential diagnosis between neural and cochlear pathology.

The purpose of this investigation is to study the site of lesions in mumps deafness by Electrocochleography.Sixteen affected ears of fifteen patients ranging in age from four to fourty-two with the average being 15.5 were investigated. Recording was made in an electrically shielded sound proof room with the use of the transtympanic needle electrode technique. Clicks for measurement of auditory nerve action potential (AP) and short tone-bursts for cochlear microphonics (CM) were used as sound stimuli.Although the audiometric examination in all cases confirmed no response, the following three categories of cochlear pathophysiological features in mumps deafness can be classified according to CM responses.1) No AP response and the well-developed CM response: It seemed to indicate that the neural regions related to the source of AP response were impaired, but the organ of Corti was found to be functioning because the recorded CM responses were the same as in a normal hearing subject.2) Neither AP nor CM response: It seemed to indicate that both the neural and the organ of Corti were impaired severely.3) No AP response and the decreased CM responses: It seemed to indicate that the neural regions were impaired severely, but the organ of Corti were impaired only partially.

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.

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.

Cerebrospinal fluid was examined in 20 patients experiencing sudden deafness. Pressure, protein, glucose and cell counts were measured, virus culture was done, and IgG, IgA, IgM in concentrated cerebrospinal fluid were measured by means of the single radial immunodiffusion method and IgE also by means of the radio-immunosorbent test. Pressures ranged from 110 mm H2O to 330 mm H2O and the mean being 178 mm H2O. Protein and glucose were almost normal, IgG and IgE were normal. In five cases, IgM were demonstrated. IgA ranged from 0.08 mg/dl to 1.7 mg/dl. In two cases, the viruses were cultured and were determined to be Herpes according to morphological features. In the group showing complete recovery and/or improvement, the initial pressure and glucose value were rather low; in the group showing no change, the value of IgA was low. In the two cases where virus was isolated, there was no alteration of pure tone audiometry nor was there any improvement of hearing acuity. The virus isolated from the two cases presented was of low virulence since the number of cells in the CSF was small and the virus grew poorly even after serial cultivation. Accordingly, virus such as these may act one of the causative agents in sudden deafness.

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.

Sr/mmasy.-The properties of drinking in normal and laryngectomized groups were examined. Drinking associated with meals was more frequent in the 76 young and 37 older normal subjects than the 25 laryngectomized persons. The laryngectomized group preferred tea and coffee to water to alleviate thirst sensation, while such a preference was hardly seen in either normal group. Results suggest that the larynx may contribute not only to thirst sensation but may be associated with preference in drinking. Although a dose relationship between thirst sensation and drinking behavior has been discussed (5), we recently (4) pointed out that afferent information from the larynx would contribute to the sensation and emphasized the important role of the larynx in drinking. However, we have little information as to whether the larynx is related to drinking and preference for liquids in humans. The present paper examined the question using normal and laryngectomized subjects by means of a questionnaire. In a young normal group of 76 healthy undergraduates (57 men and 19 women) 74 were 20 to 29 yr. and two were 30 to 39 yr. of age, and in an older normal group of 37 healthy adults (22 men and 15 women) one was 40 to 49 yr. and 36 were over 50 yr. of age. In a group of 30 laryngectomees (23 men and 7 women) three were 40 to 49 yr. and 27 were over 50 yr. of age. The laryngectomees had been operated on from 2 mo. to 5.5 yr. prior to testing. A four-item multiple-choice questionnaire about their drinking behavior was given to the three groups (Table 1). Statistical analysis of frequencies was by chi-squared and p 6 .05. Thirty young and 10 older subjects drank in association with meals, and 29 young and 18 older drank as the occasion required. In contrast, the laryngectomized subjects did not drink with meals and 21 seemed to drink as appropriate for the occasion (Table 1). There was a significant difference in answers among the three groups (Xo? = 21.31). Differences between the young normal and laryngectomized groups and between the older normal and laryngectomized groups were also significant (X33 = 12.71; X33 = 9.00, respectively). In all, 25, 24, and 22 young normal subjects

The purpose of this study was to evaluate the role of the larynx in sensation of thirst and to identify precise areas responsible for the sensation in normal and laryngectomized groups. The present analysis showed that the laryngectomized group was less aware of the sensation and less able to localize it than the normal group. Both groups localized the sensation from the base of the tongue to the larynx as well as in the pharynx.

The efferent nervous system of the guinea pig inner ear is histochemically investigated. Remarkable activity of alkaline phosphatase and acetylcholinesterase is demonstrated by Burstone's (1958) azo dye method and Koelle's (1949) method as modified by Gomori (1952) respectively. The distribution pattern of both enzymes in the efferent nervous system is entirely similar. The intraganglionic spiral bundles, fascicles of the osseous spiral lamina and efferent plexus of the organ of Corti reacted intensely for both enzymes. Afferent nerve fibers give no histochemical reaction for both alkaline phosphatase and acetylcholinesterase. However, spiral and vestibular ganglion cells are rich in both enzymes, though they belong to the afferent nervous system. The significance of both enzymes in the nervous system of the guinea pig inner ear is briefly discussed.