Rhinomanometric examination using an active anterior method is a very simple and highly reproducible method. It can evaluate the extent of nasal constriction, which is a unmeasurable subjective symptom, in terms of an objective index of “nasal resistance.” In this study, the usefulness of rhinomanometry in the rhinologic examination and assessment of the effccts of nasal surgery were investigated.
The nozzle anterior method, which can perform rhinomanometric examination during the limited time of an rhinologic examination, has proved to be an outstanding method. The extent to which the nasal cavity is constricted could be determined more accurately by using nasal resistance figures measured in advance. Total nasal resistance was well correlated with the “feeling” of the nasal constriction in most cases. However, many persons with favorable total nasal resistance complained of symptoms of nasal constriction when the difference between right and left nasal resistance was great.
In our nasal surgery, one or more of various procedures, such as septum correction, conchotomy, endonasal sinusectomy with lateral wall correction and radical operation of maxillary antrum, are carried out, depending on the symptoms present in the particular case in order to reconstruct the morphology of the nasal sinus so as to ensure physiological air flow within the nasal cavity. The effectiveness of nasal surgery for persons with nasal constriction has been acknowledged for a long time. The rhinomanometric measurements carried out before and after the nasal surgery have proved objectively that nasal resistance was significantly improved by the operations.
As shown above, rhinomanometry has proved very useful in measuring the extent of nasal constriction. However, even if the air flow within the nasal cavity is disturbed in part, rhinometric measurements may sometimes suggest low nasal resistance when there is a space in the nasal cavity through which air can flow. Utmost care should be taken in rhinometry to avoid such problems.

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We investigated the characteristics of the measured value obtained with the heptachord pitch-matching test (HPMT), compared with those of ordinary pitch-matching test (OPMT) We measured the pitch of tinnitus twice using both methods at various intervals. The coefficient correlations between the values of HPMT and OPMT were high at both the first and second tests (r=0.934, n=73, r=0.965, n=27). In 27 cases showing the same onomatopoetic sound at the first and second tests, coefficient correlations of the measured values were high in both methods comparing the values between the first and second test (OPMT: r=0.910, HPMT: r=0.948). In cases showing the same measured values at the first and second test using OPMT, a high coefficient correlation was also shown in both measured values using HPMT (r=0.995, n=19).
From these results, it is considered that the reproducibility and the reliability of the HPMT are satisfactory. Considering the small size of the minimum unit width in HPMT, it is suggested that we can examine the minute pitch of tinnitus as the approximate frequency values of tinnitus pitch using HPMT as opposed to OPMT.

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A clinical study was made of ossicular fixation in 419 ears of initial surgical cases of simple perforated otitis media, which were operated on between 1970 and 1989. The incidence of ossicular fixation was 28.9%(121 ears). Among the cases of ossicular fixation, tympanosclerosis, which is existence of hyalinosis and calcification around the ossicles was found in 62 ears (14.8%), malleus fixation due to fibrous and osseous changes in the anterior and/or lateral ligament was found in 48 ears (11.5%), and osseous fixation of the malleus and/or incus in the epitympanum was found in 11 ears (2.6%). The number of cases of ossicular fixation tended to increase year by year. Malleus fixation of the anterior part of the malleus and tympanosclerosis were found predominantly in females. Especially tympanosclerosis was present in twice as many in females as in males. Also, tympanosclerosis was very closely associated with calcification of the tympanic membrane (74.2%). The audiograms of these ossicular fixation cases generally showed curves indicative of stiffness.
Our data indicated that type I tympanoplasty, not myringoplasty, should be performed in onethird of chronic otitis media cases.

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Among the patients who visited the outpatient clinic of the Department of Otorhinolaryngology, the Jikei University School of Medicine, during the 7 year-period from 1984 through 1990, 1632 patients had a chief complaint of nasal hemorrhage. The details of those cases were statistically analyzed. Generally, the incidence of this disease was high in children (10 years or younger) and adults aged 40 years or older, while, as a function of the season, the number of patients visiting the outpatient clinic was large in June and the winter months (December through February). Regarding the severity of the nasal hemorrhage, elderly patients (65 years or older) accounted for a high percentage of the patients who required hospitalization. Regarding the site of hemorrhage, cases occurring in the posterior region of the inferior turbinate, the side wall of the inferior meatus and the olfactory fissure tended to outnumber those in Kiesselbach's area. In elderly patients, the percentage of patients with a past history of hypertension was higher than in the other age groups, and many patients required treatment for hypertension after healing of the nasal hemorrhage. Moreover, some of the elderly patients had a complication of a malignant tumor, such as cancer of the maxillary sinus or malignant lymphoma. Thus, when treating nasal hemorrhage in elderly patients, it is necessary to elucidate the cause of the hemorrhage, taking into consideration such potential underlying diseases as hypertension, heart disease and malignant tumors.

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We reviewed the changes in operative treatments of otolaryngological diseases in 40 years during the period from 1949 to 1988 at the Aoto Hospital, The Tokyo Jikei University School of Medicine.
On average, 500 to 600 otolaryngological operations were performed in one year in the hospital during the period.
Radical operation of the paranasal sinuses for chronic sinusitis made up about 80% of all nasal operations, while 90% consisted of nasal surgery each year during the period from 1949 to 1958. The number of conservative sinus operation in creased after 1960 and comprised about 40 to 50% of all nasal operations during the period from 1969 to 1988. The number of radical sinus operation is on the decrease.
The changes in operative treatment are also seen in ear surgery. Radical mastoideotomy, which had comprised 70% of all the ear surgery during the period from 1949 to 1958, decreased to 10 to 20%, while tympanoplasty increased to 90% after 1956.
The numbers of laryngomicrosurgery and middle ear tube insertion have increased during the last several years.

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A 28-year-old man developed the leftward gaze difficulty after severe frontal head blow at the traffic accident. MRI disclosed right frontal lobe (area 10) contusion. At leftward gaze his left eye could not adduct sufficiently, whereas right eye could adduct fully but could not hold adduction position for a while and retuned to the midposition. His left eye, however, could adduct for a moment when his right eye was covered. On the other hand, his right eye could hold adduction position at leftward gaze when his left eye was shaded. The limitation of adduction of his left eye was overcome by the oculocephalic reflex (OCR) maneuver. His vertical eye movements and convergence remain intact. In his electrooculogram (EOG) recordings, his OKN responses were normal on both directions. In ETT testing, his ocular pursuit was well with small saccadic movement. Together with these things, such oculomotor disturbances was thought of as a unilateral “supranuclear” lateral gaze/fixation palsy.
In other neurological examinations, there were no abnormal findings except the neuropsychological disorder. After his head trauma, he himself recognized the lack of his ability to pay attension and to plan of complex behaviors and slowing of thought process, which is supposed to be derived from his prefrontal lesion.
The frontal eye field (FEF), which consists of areas 8, 6 and the prefrontal cortex-area 9, has been regarded as one of the cortical eye movement center. There is the close connection between FEF and PPRF. In a recent lesion study of FEF, the fixation is also disturbed. Therefore, we suppose that the prefrontal lobe damages disturbed the connection to FEF, which in turn caused the such a unilateral, supranuclear gaze/fixation disturbances.

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