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Multiple primary cancers were found in 23 of 68 patients (34%) with an index cancer in the oral cavity or pharyngeal area treated in our institute from June 1995 to July 1998. Four cases had triple primary cancers. All 68 cases underwent upper and lower gastrointestinal endoscopy as well as ultrasonography of the liver. Lung CT was performed in cases with abnormal findings on chest roentgenograms. Multiple cancers were found in 5 of 25 oral cavity cases (20%), 6 of 14 mesopharynx cases (43%) and 12 of 29 hypopharynx cases (41%). Nine of 23 cases (39%) were synchronous and 14 (61%) were metachronous. Eighteen of 27 (69%) secondary cancers occurred in the upper aerodigestive tract with an especially high incidence (22%) in the esophagus. Gastroendoscopy also revealed 7 neoplastic lesions, aside from cancers, with the total abnormal rate of 24% (24/68). Thus, gastroendoscopy is useful for the diagnosis of multiple primary cancers. The frequency of multiple primary cancers in males (33%) was not different from that in females (35%). The average age of multiple primary cancer patients (65.1 years) was a little higher than that of single cancer patient (62.7 years). Smoking or drinking was not related to the incidence of multiple cancers. The interval between the first and the second cancer in metachronous cancer cases was 25.5 months on average, and within 4 years in 71% (10/14) of the cases. This result suggests that close follow-up including endoscopy should be required for at least 4 years after treatment of oral or pharyngeal cancer. Radical treatment for each of the multiple cancer lesions was performed in 22 of 23 cases, and the mortality rate of multiple primary cancer cases was not significantly different from that of single cancer cases. Among 7 cases who died of disease, 5 cases died of distant metastasis, suggesting that control of distant metastasis is an important issue in the treatment of multiple primary cancers.

In advanced oral or mesopharyngeal cancer requiring reconstruction, preventive tracheostomy have been performed to insure an airway postoperatively. However, tracheostomy often causes difficulty in swallowing and stress in the postoperative period for the patients. We have devised a strategy to avoid tracheostomy as much as possible in the cases requiring reconstruction except for the cases with over 2/3 resection of the base of the tongue or with prospective difficulty of re-intubation. Eleven cases were treated without tracheostomy out of 20 cases operated on with reconstruction in our hospital from 1995 through 1997. These patients were managed under nasal intubation for less than 2 days on average with careful observation postoperatively. In 11 non-tracheostomized cases, 1 case experienced venous thrombosis of a free flap and tracheostomy was performed at the salvage operation. Other 10 non-tracheostomized case were compared with 10 tracheostomized cases who were treated from 1991 though 1995. It was revealed that non-tracheostomized cases tended to have shorter periods until they could speak or eat, and also have a shorter postoperative admission term. In these cases, we have not experienced serious complications such as aspiration pneumonia or dyspnea, instead, special care in the postoperative period was needed. Thus, certain advanced cases who undergo curative resection followed by reconstruction can be managed without tracheostomy. The indication of tracheostomy in surgery for oral or mesopharyngeal cancer should be decided carefully.

To examine whether genetic factors influence the prognosis of cancer patients, several microsatellite markers were used to determine the allelic loss of certain areas of the genome. Three microsatellite markers, D3S1067, IFNA and D9S171 were used to study the loss of heterozygosity (LOH) of 3p21 and 9p21 in 93 head and neck squamous cell carcinomas. Of 57 informative cases, LOH was detected in 27 of 57 (47%) DNA samples obtained from cancer specimens when at least one marker was used. The frequency of LOH was not correlated with the clinical factors. However, the frequency of LOH was significantly higher in the recurrent cases than in the non-recurrent cases, and patients with 3p21 and/or 9p21 LOH tended to survive for a shorter period of time. These results suggested that the allelic loss at 3p21 and/or 9p21 could be correlated with the prognosis of the patients, and that it was a novel prognostic factor independent of other clinical factors concerning head and neck cancers. LOH at 3p21 and/or 9p21 may help to identify head and neck cancer patients with a poor prognosis, who need an intensive postoperative follow-up protocol, or who are suitable for novel investigational therapeutic approaches.

Because of its many advantages, free jejunal transfer has gained wide acceptance for pharyngoesophageal reconstruction after ablative surgery. Because the jejunum is well vascularized, it facilitates good wound healing, and has a low incidence of anastomotic insufficiency, fistula formation and stricture. However, voice rehabilitation in this group of patients can be difficult. Therefore, we performed primary tracheojejunal shunt operations for voice restoration with jejunum siphons using Nozaki's method (type 3). In this procedure, after dividing a section of the jejunum into two segments, the reconstructed neopharyngoesophagus is anastomosed in a side-to-end fashion to the fabricated shunt using the other segment of the jejunum, as an "elephant nose shunt" so called because of its appearance. Voice restoration can be achieved in patients who undergo laryngopharyngoesophagectomy through these reconstructive procedures. We performed this surgery for nine hypopharyngeal cancer patients after total pharyngo-laryngo-esophagectomy. Following placement of the shunt, no special care was required. Only one patient developed a severe aspiration. No leakage was seen and the swallowing function was preserved in all patients. Four of nine patients could speak well following these procedures. A vibratory source is created in the neoesophagus, above the elephant shunt. During speech production, narrowing of the inside and vibration of the jejunal mucosa can be observed using a laryngeal fiber scope. In order to study the acoustical characteristics of shunt speech, voice analysis was performed in patients with restored phonatory function using Computerized Speech Lab Model 4300 (KAY). Irregularities of pitch periods in the voice sample were measured using Jita (the pitch period) and Jitt (relative evaluation of the pitch) for the very short term (cycle-to-cycle), and PPQ (pitch period pertubation quotient) for the short term (cycle-to-cycle with a smoothing factor of 5 periods). Irregularities of the peak-to-peak amplitude were measured using ShdB (evaluation in dB of the peak-to-peak amplitude) and Shim (relative evaluation of the peak-to-peak amplitude) for the very short term (cycle-to-cycle), and APQ (amplitude perturbation quotient) for the short term (cycle-to-cycle with a smoothing factor of 11 periods). The pertubation parameters of shunt speech are larger than normal ones not only in terms of the period but also in terms of the amplitude. These results are similar to those of laryngeal polyps, recurrent nerve palsy and esophageal speech. Recovery of phonation using Nozaki's type 3 method with the elephant nose shunt appears promising for pharyngo-laryngo-esophagectomized patients.

We investigated the relationship between the daily count of pollen scattered, the count of days during the scattering period and the highest temperature during the sugi (Japanese cedar) pollen scattering season from 1983 to 1997, and whether prediction of the count of pollen scattered for the following day is possible. Our studies clearly demonstrated that the count of sugi pollen scattered is small in the early period of the scattering season with some daily variations in amount; this cycle is repeated for several days in the middle period of the season then decreases again in the late period. These findings showed that both the cumulative value of the count of pollen scattered daily and the total count of pollen scattered formed an S-shaped curve when compared with the count of days after the start of the scattering season and the cumulative highest temperature for the season. Predicting the daily count of pollen scattered after the start of the scattering season against the cumulative highest temperature is possible by drawing a regression curve from the S-shaped curve. Also, a regression curve was useful in predicting the total count of pollen scattered during the season from the cumulative count of pollen scattered 10 to 20 days after the start of the scattering season. Using these data, we were able to improve the accuracy for predicting the scattering of sugi pollen.

The dynamic behavior of the middle ear was studied in living guinea pigs by using a laser Doppler vibrometer coupled to a compound microscope. Placing glass microbeads 20 microns in diameter on four points of the tympanic membrane and six points of the ossicles, their velocity amplitudes were measured under a constant stimulus of 65 dB SPL. Velocity responses of the four points on the tympanic membrane differed over the frequency range from 0.1 kHz to 3 kHz. At low frequencies, the malleus and incus rotated around an axis running from the malleus head to the incus short process. At middle frequencies, the whole ossicle had a piston-like motion. At high frequencies, the malleus and incus rotated around a vertical axis running through the ossicles, while the stapes had a hinge-like movement.

It is well known that EG2-positive cells, CD68-positive cells and other inflammatory cells significantly increase after antigen provocation in the nasal mucosa of an allergic patient. However, there are few reports of the immunohistological study if the infiltrating cells in nasal lavage fluid are not seen. In this study, the infiltrating cells in nasal mucosa as well as in nasal lavage fluid were immunohistologically examined by means of monoclonal antibodies 30 minutes after the antigen provocation. Seven patients with perennial allergic rhinitis were challenged by an antigen disk placed on one side of the inferior turbinates and each nasal cavity was irrigated separately 30 minutes after the antigen provocation. About seven days later, these patients were operated on and the nasal mucosa was removed 30 minutes after the antigen provocation. No marked change in CD4- and CD8 positive cells in the nasal mucosa and lavage fluid was found after provocation. On cytospin glass slides, there was a slight increase in the number of CD68 (P = 0.1), EG2 (P = 0.09), and neutrophil elastase positive (P = 0.2) cells. A significant increase in EG2-positive cells was also seen in the superficial layer of the lamina propria (P < 0.05) but not in the deep layer. CD22 positive cells were not seen on the cytospin glass slide, whereas many positive cells were observed in the deep layer of the lamina propria. These results indicate that EG2-positive cells participate strongly in the early phase of the allergic response after provocation in spite of the absence of significant changes in CD4- and CD8 positive cells. Immunohistological evaluation of nasal lavage is thought to be beneficial concerning the movement of each kind of cells. Each kind of cell is thought to fulfill the main physiological role in the epithelial layer or the lamina propria in early allergic inflammation.

The chorda tympani nerve (CTN) is frequently damaged in various inflammatory middle ear disorders. To determine the validity of electrogustometry in the diagnosis of preoperative severity of a middle ear lesion of the posteosuperior portion of the mesotympanum, the threshold determined by electrogustometry was examined preoperatively and was correlated with the intraoperative findings. One hundred and six ears of 97 patients with various middle ear diseases were examined. The patients ranged in age from 5 to 70 years (average, 39.4) : 55 of them were male and 42 were female. In 80 of them the appearance of the tympanic membrane on the opposite side was normal. The disorders were classified as follows: A : Non-inflammatory diseases including middle ear anomalies, posttraumatic perforation of the tympanic membranes and congenital cholesteatoma without infection (n = 10) ; B : chronic otitis media without cholesteatoma (n = 14) ; C : pars flaccida retraction type cholesteatoma (n = 34) ; D : pars tensa retraction type cholesteatoma and adhesive otitis media (n = 15) ; E : surgically treated ears (n = 33). The average threshold +/- S.D.(dB) of each group according to the above classification was as follows : A : -1.0 +/- 4.4, B : -1.5 +/- 6.2; C : 7.4 +/- 13.7; D : 9.6 +/- 18.2; E : 20.9 +/- 16.8. The rates of abnormal threshold of electrogustometry (more than 8dB) of A, B, C, D and E were 0%, 7.1%, 44.1%, 46.7% and 72.7%, respectively. The intraoperative findings around the CTN were retrospectively classified according to the following 5 groups : I : No pathological tissue was attached to the CTN (n = 44); II : the Granulation tissue or matrix of the cholesteatoma was attached to the CTN (n = 19) ; III : the CTN was surrounded by granulation or a matrix of cholesteatoma (n = 3) ; IV : The CTN was not identifiable due to the severe pathological condition of the middle ear cavity, in either surgically treated or untreated ears (n = 16), V : Surgically treated ears in which the CTN was identifiable (n = 24). The average threshold +/- S.D.(dB) for I, II, III, IV and V were 1.9 +/- 9.6, 2.0 +/- 11.7, 16.0 +/- 20.3, 32.0 +/- 7.4, 16.0 +/- 17.0, respectively. The rates of abnormal threshold of electrogustometry (more than 8dB) of I, II, III, IV and V were 27.3%, 31.6%, 66.7%, 100% and 62.5%, respectively. In both the above classification by the disorders and that by the intraoperative findings around the CTN, differences in the average thresholds between the surgically treated sides and the opposite sides with normally appearing tympanic membranes showed a tendency similar to that of the thresholds of the treated sides. In the present study, the threshold of electrogustometry was correlated with the disease and the intraoperative findings during middle ear surgery, and it was higher in adhesive otitis media and cholesteatoma of the pars tensa type. Electrogustometry is a useful preoperative examination to predict the condition of the posterosuperior portion of the mesotympanum.

Basilar membrane vibration was investigated in guinea pigs by using a laser Doppler velocimeter. To monitor the physiological condition of the cochlea, compound action potentials and distortion product otoacoustic emissions were measured before and after each experiment. Sharply tuned (Q10dB : 4.6-7.0) mechanical vibrations were successfully observed in 190 preparations of 15 animals. In these animals, strong compressive nonlinearity of the basilar membrane response and steep phase lag above the characteristic frequency were observed clearly. These findings strongly support the existence of active mechanical elements that play important roles behind the auditory transduction in the cochlea.

It is well known that an initial treatment with several kinds of antiallergic medicines is useful for patients suffering from Japanese cedar pollinosis to reduce nasal symptoms during the pollen season. Also topical corticosteroids show a preventive effect as antiallergic medicines. In this study, the preventive effect of topical corticosteroids with antiallergic medicine as an initial treatment was evaluated during the 1995 cedar pollen season a season in which a high pollen count was anticipated. Twenty-five patients with cedar pollinosis were selected and divided into two groups. A and B, A topical corticosteroid (fluticasone propionate; Flunase) as well as antiallergic medicine (azelastin) were administered to patients in group A 4 weeks before the beginning of the pollen season. In group B, only antiallergic medicine was given at the same time as group A and a topical corticosteroid was administered after the appearance of the symptoms. Nasal symptoms and mucosal conditions of the nasal cavity were monitored throughout the pollen season. The inflammatory cells in the mucoepithelial layer of the nasal mucosa were also periodically evaluated by immunohistochemical staining. Nasal symptoms and mucosal conditions in group A were significantly improved compared with patients in group B. The infiltration of macrophages in the mucoepithelial layer of the nasal mucosa was strongly inhibited in group A. The numbers of mast cells and EG2-positive cells in group A were not significantly different from those in group B during the pollen season. According to these results, although not all inflammatory cells were inhibited, the initial treatment with Flunase aqueous nasal spray in addition to the conventional initial treatment with antiallergic medicine is very useful for reducing symptoms even in a season with a large amount of cedar pollen.

To determine the locations of congenital cholesteatomas and to elucidate the relationship between ossicular anomalies and congenital cholesteatomas, cholesteatomas from our patients and those reported in the Japanese literature were investigated. We analyzed 40 ears with congenital cholesteatomas (38 patients) experienced by us during the past 9 years. Our criteria of congenital cholesteatoma were as follows: 1. The tympanic membrane manifests neither retraction, perforation, nor granulation, 2. There is no continuity between the tympanic membrane and the matrix of a cholesteatoma. Twenty patients with past histories of otitis media were included. Thirty-three patients (87%) were males and 2 had bilateral congenital cholesteatomas. The ages of the patients ranged from 2 to 46 years (mean: 10.7). A survey of the Japanese literature revealed 55 additional cases of congenital cholesteatoma reported by others.

The effect of aging on distortion product otoacoustic emissions (DPOAE) was investigated in 58 ears of 32 volunteers with normal hearing DPOAE levels to tones with a fixed frequency ratio (f2/f1 = 1.2) were measured with the CUBDIS system (MIMOSA Acoustics, USA). Age dependency of DPOAE level was clearly observed both in frequency plots (DP-gram) and input-output functions. In elderly persons, DPOAE levels for higher frequency primaries were significantly lower than in younger persons, when no remarkable change of audiometry threshold was noted. These results imply that the DPOAE level can be a sensitive indicator for age-related cochlear dysfunction.

A statistical analysis was performed in patients with press-through-pack (PTP) foreign body in the esophagus encountered in the Department of Otorhinolaryngology, Tohoku University School of Medicine, from 1986 to 1993. Furthermore, the radiolucency of PTP and the possibility of mucosal injury of the esophagus by PTP were examined by experimental methods. We obtained the following results: 1) The incidence of PTP foreign body in the esophagus increased in the period from 1986 to 1994 as compared with that from 1978 to 1985. 2) PTP foreign body was lodged in the following area: cricopharyngeal narrowing > bronchio-aortic narrowing > hiatal narrowing. 3) Fluoroscopy with or without contrast material and flexible endoscopy were useful tools for diagnosis. 4) Direct esophagoscopy revealed mucosal erosion, hematoma, edema and intact mucosa in 14, 3, 3, and 6 patients, respectively. 5) The period of hospitalization was longer in patients with mucosal erosion than in those with intact mucosa. 6) The base of PTP made of aluminium could be detected as a radiopaque material by lateral projections, suggesting that PTP foreign bodies require roentgenograms made parallel to the base of PTP. 7) Histological study indicated that traumatic lesions in the extracted esophagus manually produced by the sharp corner of PTP were present in the mucosal layer and partially in the submucosal layer, suggesting that esophageal perforation by PTP was generated by additional factors such as secondary infection and iatrogenic trauma induced by esophagoscopy.

We examined intracellular Ca2+ responses of nasal gland acinar cells in order to clarify cellular responses and molecular events with regard to the regulatory mechanism of nasal secretion. The acinar cells of the serous gland, in the guinea-pig nasal septum, were obtained by meticulous and selective dissection with minimal contamination of epithelial lining cells followed by collagenase treatment. The dispersed acini were incubated in an oxygenated solution supplemented with fura -2 acetoxymethyl ester and the intracellular Ca2+ concentration ([Ca2+]i) was measured using fluorescence ratio imaging microscopy. The application of acetylcholine (ACh) to the nasal gland acinar cells induced an initially rapid increase in [Ca2+]i followed by a sustained plateau. The increase in [Ca2+]i induced by ACh was concentration-dependent and ranged from 10(-8) to 10(-5) M. The intracellular Ca2+ response was completely inhibited by atropine, indicating the presence of muscarinic cholinergic receptors. Removal of external Ca2+ with addition of EGTA resulted in a transient increase without a sustained phase. The sustained phase of the [Ca2+]i increase induced by ACh was inhibited by Ni2+, but not by nifedipine. The initial phase seems to be due to mobilization from cytosolic Ca2+ stores while the subsequent sustained phase is dependent on the influx of external Ca2+ ions sensitive to Ni2+. We have demonstrated that increasing the Ca2+ gradient by elevating external Ca2+ accelerates Ca2+ entry, and that depolarization of cells due to elevated external K+ attenuates Ca2+ entry. These findings suggest that the Ca2+ entry process in nasal gland acinar cells is dependent on the electrochemical gradient across the membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

A rare case of extramedullary plasmacytoma of the epipharynx is reported. A 76-year-old woman presented with a one-year history of postnasal drip. Physical examination revealed a mass lesion in her epipharynx without cervical lymph node swelling. Biopsy of the mass showed diffuse proliferation of plasma cells at the light and electron microscopic levels. Immunohistochemical examination demonstrated monoclonal exhibition of IgA and kappa-light chain in the tumor cells. Furthermore, in flow cytometric analysis, the tumor cells were found to be CD10- CD19- CD20- CD22- HLA-DR- CD38++ sIg- EMA+, a typical phenotype of plasmacytoma. Additionally, rearranged bands were identified in Southern blot analysis of the tumor extract using probes for immunoglobulin heavy chain and kappa-light chain. Serum myeloma-protein and urine Bence-Jones protein were negative. Bone marrow examination, X-ray examination, CT scanning and 67Ga- and 99mTc-scintigrams showed no other systemic lesions. She received irradiation of 58 Gy to the epipharyngeal area over 7 weeks, followed by transnasal endoscopic resection using KTP/532 laser. The patient is free of disease six months after surgery, and is currently under close follow-up.

Localization of epidermal growth factor receptor (EGFR) was investigated immunohistologically in 68 untreated patients with squamous cell carcinoma of the head and neck regions. These patients consisted of 16 with cancer of the lips and mouth, seven with mesopharyngeal cancer, six with epipharyngeal cancer, 15 with hypopharyngeal cancer, 10 with laryngeal cancer, 12 with maxillary cancer and two with other tumors (cancer of the auricle and cancer of the eyelid in one patient each). The patients consisted of 57 men and 11 women, with a mean age of 60 years. In cases with a normal oral mucosa, marked expression of EGFR was observed in the epithelial cell membrane, while expression decreased toward the luminal surface. Cancer cells also showed positive staining of EGFR in all patients, but the intensity of staining was inconsistent among them. Among the 32 patients in whom the staining intensity of EGFR was equal to or weaker than that in basal cells of the normal oral mucosa, 12 patients had lymph node metastasis. Twenty-eight of the 36 patients in whom the staining was stronger than that in the normal cells had lymph node metastasis, suggesting that overexpression of EGFR in carcinoma cells is a risk factor for lymph node metastasis of head and neck cancers (P < 0.005). On the other hand, there were no obvious relationships between either the size or the degree of keratinization of the primary lesion and EGFR expression.

Three patients with non-clostridial gas gangrene of the neck are reported. Patient 1 was a 57-year-old man, patient 2 a 63-year-old woman, and patient 3 a 44-year-old man. All three were treated by thorough debridement and precise administration of antibiotics. We also discuss 26 cases (including our 3) of gas gangrene of the head and neck, reported in Japan from 1975 to 1992, from which the following data were obtained: 1. The 26 patients consisted of 17 males and 9 females. 2. They ranged in age from 2 to 88 years, with a mean 56.5 years. 3. Causes included acute pharyngolaryngeal inflammation (46%), dental disease (27%), trauma (8%) and unknown etiology (19%). 4. As a result of bacteriological assessment, the condition was found to be attributable to Clostridium in only 2 patients, and in the remainder the condition was non-clostridial. 5. The mortality rate was 15%. The patients who died were at least 80 years old, and their prognosis had been poor. 6. CT was useful for diagnosis and treatment.

Since the advent of antibiotics, otogenic complications have decreased considerably. However, incomplete antibiotic therapy has altered the clinical course of middle ear disease so as to be more insidious. This paper reports a case of Bezold's abscess associated with cholesteatoma. A 48-year-old man visited our hospital presenting with a 4-day history of right otorrhea and a tender swelling in the right neck. Physical examination showed a febrile patient (38.8 degrees C) with right facial paresis and trismus. A hyperemic, hard and tender swelling was observed in his right neck from the lateral cervical to the mental region. The tympanic membrane was invisible because of granulation and swelling of the posterior wall of the external auditory canal. Intravenous clindamycin and ceftazidime therapy was started immediately. A CT-scan revealed a diffuse shadow with bony destruction in the right mastoid cortex. Extensive abscess formation was also found in the right sternocleidomastoid muscle, in the anterior neck and in the posterior neck. He was diagnosed as having Bezold's abscess associated with cholesteatoma. Radical mastoidectomy and drainage of the neck abscess was performed on the third day under general anesthesia. The mastoid cavity was found to be filled with pus and cholesteatoma debris. A small area of defective bone was found at the mastoid tip, through which there were communications between the mastoid cavity and the abscesses in the neck. Bony destruction was also found in the horizontal and vertical portion of the facial canal. Bacteroides and three kinds of gram-negative rods were cultured from the mastoid cavity.(ABSTRACT TRUNCATED AT 250 WORDS)

Ninety ears (52 patients, aged 3-11 years) affected by secretory otitis media (SOM) were treated by insertion of ventilation tubes (VT). Following insertion of the VT, middle ear air volume of these ears was estimated using an impedance audiometer, at 1, 3, and 6 months postoperatively, and every 3 months thereafter. The middle ear air volume, expressed as the compliance value, increased rapidly for the first 3 months followed by a gradual increase thereafter. A great difference among the compliance values of ears was observed, values ranging from over 10 cc to below 1.5 cc at 6 months, postoperatively. Twelve percent of the ears had compliance values of less than 1.5 cc, and in this group, CT showed opacified and poorly developed mastoid cells. Although the association of upper respiratory disorders such as chronic sinusitis, nasal allergies and cleft palates were found to be more frequent in cases of ears with smaller compliance values, this was not statistically significant. Small compliance values (middle ear air volume) were correlated with the early onset of acute or secretory otitis media, repeated otorrhea after VT insertion and high recurrence rates after the extrusion of the VT.

The forecast of daily Japanese cedar (Cryptomeria japonica) pollen counts was performed in Sendai in 1987, 1988 and 1989. The expected daily maximum temperature was used as a main determinative factor, and the term "pollen index", which is a ratio of a daily pollen count to the rest of the total seasonal pollen count, was devised and proved to be closely related to the daily maximum temperature. In 1987 and 1989, the total seasonal pollen count was very low, and daily pollen counts were in the lowest of three grades, except for a few days of the middle grade. In 1988, a fairly large number of pollen grains were observed, and forecasts of low grade were made for 28 days, middle grade for 25 days and high grade for 10 days, respectively. On the other hand, the actual daily pollen counts of low grade were 36 days, middle grade, 15 days, and high grade, 12 days, respectively. The accuracy of the forecast was 67% in 1988. The reasons for errors and the assignments for the forecast were discussed.

Five cases of bilateral simultaneous sudden deafness were reported. Two patients were male and three patients were female. The age of the patients ranged from five to 54 years. All the five cases were profoundly deaf on both sides. The elevation of the mumps virus antibody titer was found in the three cases out of four in those examined. The recovery pattern of hearing was seen symmetrically on both sides in four cases. Although complete recovery of hearing was obtained in one case and remarkable improvement was observed in two cases bilaterally, no improvement was seen in one case on either side. The last case showed remarkable improvement of hearing on one side with only a slight recovery on the other. Although the prognosis of the five cases of bilateral simultaneous sudden deafness was found comparable to that of the unilateral case by other investigators, the recovery was slower and the prognosis was less favorable in cases with the elevation of mumps antibody titer.

Tumor necrosis factor (TNF) has been reported to have a high selective cytotoxicity to various kinds of tumor cells, but its effect on head and neck cancer is uncertain. To evaluate the effect of TNF on squamous cell carcinoma, we measured TNF sensitivity of six established cell lines derived from esophageal squamous cell carcinomas, TE-1, 2, 3, 4, 5 and 7 as well as L-M, FL, WISH, HEp-2 and THP-1 by means of 3H-thymidine incorporation method. HEp-2 derived from human laryngeal cancer, L-M, TE-3 and TE-4 were sensitive to TNF while THP-1, TE-1, 2, 5 and 7 were not. IFN gamma is known to be an inducer of TNF receptor of some kinds of tumor cells. TE-2 and TE-3 were sensitive to IFN gamma. Combined use of these two cytokines resulted in additive inhibitory effect on TE-2 and 3, but no remarkable synergistic effect on any of TE-1, 2, 3 or 4.

The threshold shift at 500 Hz bone conduction under positive and negative static pressure of 400 mmH2O applied to the external auditory canal was examined in 20 patients of Meniere's disease with fluctuating low tone hearing loss, 21 patients of sensorineural hearing loss without fluctuating and 24 normal controls. In contrast to the 10 to 15 dB threshold shift in the latter two groups (non-fluctuating group, 14.8 +/- 5.1 dB at positive and 11.1 +/- 5.7 dB at negative; normal controls, 13.6 +/- 5.4 dB at positive and 9.3 +/- 5.3 dB at negative), the former showed a significantly smaller shift (3.2 +/- 6.1 dB at positive and 2.3 +/- 4.5 dB at negative) while hearing was depressed. However, when the hearing was improved, the pressure effect became greater even in the former group (11.3 +/- 5.3 dB at positive and 9.1 +/- 4.8 dB at negative). To understand further details of these phenomena, we performed electrophysiological animal experiments. Through a small hole made on the guinea pig's cochlear bony wall, 300 mmH2O pressure was applied to the scala tympani and the threshold of 500 Hz CM was examined in both endolymphatic sac obliterated ears and non-obliterated ears. In 14 non-obliterated ears 21.1 +/- 5.1 dB threshold shift was recorded, whereas it was only 1.6 +/- 2.6 dB in 9 obliterated ears at 4-6th postoperative days. These results seem to reflect that the endolymphatic pressure is great during the early stage of hydrops.(ABSTRACT TRUNCATED AT 250 WORDS)