According to our experimental studies, two bone metabolic layers are related to growth ofthe mastoid process and expansion of pneumatic cells. One is the outer bone metabolic layer of membranous ossification that extrudes the temporal bone toward the outside. The other is the inner bone metabolic layer, which expands the temporal bone inwards. This two bone metabolic layers work together and this period is restricted to the period of mastoid process development. In this developmental period, if the middle ear inflammatory stimulus is strong enough to inhibit the inner bone metabolic layer, it may cause suppression of pneumatic cell expansion. Furthermore, it may cause suppression of growth of the mastoid process. However, if the middle ear inflammatory stimulus occurs after the period of mastoid process development no suppression of the pneumatic cell and mastoid process will be observed. New bone formation that narrowed the pneumatic space was not observed at all.
Thirty-six human temporal bones were taken from subjects ranging in age from the 30th week of pregnancy to 16 years of age after birth and who had normal ear drum. Two types of bone metabolism, chondral ossification and membranous ossification, were found in human temporal bones. The membranous ossification that was observed in our porcine experiment was also observed in the portions of the tegmen epitympani, posterior wall of the mastoideum and tip of the mastoid process. It was clear thatsuppression of pneumatization and the mastoideum occurred in parts of these membranous ossification points due to the stimulus of inflammation of the midde ear. In our experimental studies, suppression was observed only at thestage of mastoideum and pneumatic cell development. In human temporal bone, in the portions of the tegmen epitympani and posterior wall ofthe mastoideum, these were the membranous ossification points and the development stage was until 4 years of age. The findings of this study suggested that the low development of the middle fossa dura and prominent sigmoid sinus are caused by a continuous inflammatory stimulus of the middle ear before 4 years of age. On the contrary, chondral ossification was observed in two points and the inner bone metabolic layer in these points was not as clear as that of membranous portions. This finding suggested that the expansion of pneumatic cell may not be caused by the inner bone metabolic layer. The middle ear inflmmatory stimulus may not suppress the pneumatization in these points.

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Nasal polyps were obtained from 15 patientsand classified into two groups; allergic nasal polyps and non-allergic nasal polyps. Immunohistochemical study was performed to evaluatethe histamine release of mast cells in both allergic and non-allergic nasal polyps.
According to the degree of histamine release, mast cells were classified into three groups I, II and III, and in each group, the ratio of the number of mast cells to the total number of mast cells in the superficial tissue and connective tissue was calculated.
The results were as follows:
1. More histamine release occurred in allergic nasal polyps than non-allergic nasal polyps in mast cells of the connective tissue.
2. In allergic nasal polyps, histamine was present more in the connective tissue than the superficial tissue.
These results suggest that allergic nasal polyps may form and grow up by an action of histamine released from mast cells in the nasal mucosa.

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We report twenty-four patients with acute frontal sinusitis whose diagnosis has been based on a criterion, of acute frontal headache and radiological shadow in the frontal sinus. The unilateral shadow of the frontal sinus was seen in 23 (96%) patients while unilateral shadow of the paranasal sinuses was seen in 18 patients (83%). Twenty-three patients (96%) who showed shadow finding in the frontal sinus also showed shadow in same side in not only ethmoidal but also maxillary sinuses, but only 5 patients (21%) showed shadow in the sphenoidal sinus. Pain of all patients was relieved by administration of antibiotics and analgesics in a week, and the shadow of the frontal sinus also decreased soon, but that of the maxillary sinus remained in many cases. In these cases, we irrigated the maxillary sinus with saline solution in 18 patiens (75%) and found prulent contents in 17 patients (71%) including cheese-like mass in 5 patients (21%). These findings suggest that non-acute maxillary sinusitis can induce acute frontal sinusitis.

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Fourteen patients, 5 males and 9 females, with aspirin-induced asthma (AIA) who visited ENT clinic were studied clinically from the viewpoint of otolalyngology.
The most common complaint was nasalobstruction (79%). The mean age at onset of nasal symptoms was 32.3 years old and that of bronchial symptoms was 37.3 years old. The nasal symptoms preceded the bronchial symptoms in 9 cases (64%), and the latter preceded the former in 3 (21%). 2 cases had only the bronchial symptoms.
Moderate and sever cases of asthma, including 3 cases of steroid independent asthma, were 12 of 14 cases (86%). Out of 14 cases of AIA, chronic sinusitis was complicated in 13 cases (93%) and nasal polyps were found in 12 cases (86%).
Marked eosinophilic infiltration was observed in these nasal polyps. Eosinophilia was seen in 11 out of 14 patients (79%). Sensitivity to at least one inhalent allergens was found in 8 out of 14 cases (57%).
AIA is the disease which is closely related to an otolaryngologist. The etiology of AIA including the mechanism of the concurrence of chronic sinusitis and nasal polyps with AIA should be studied actively by otolaryngologists.

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Electrocochleography was studied in 5 patients with vestibular neuronitis. The combined summating potential and compound auditory nerve action potential wave form (SP/AP) and the cochlear microphonics (CM) were measured in both ears using the promontory recording technique. SP/AP and CM showed no significant differences or findings in both ears for all cases. The results might be interpreted to indicate lack of the cochlear nerve engagement and the discrete disorder of the vestibular nerve in vestibular neuronitis.

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Temporomandibular Disorders (TMD) has been known for a long time, but the knowledge is still limited. Some clinicians therefore treated TMD patients with only experiential knowledge. In this literature, I explain about the classification of TMD in the Japanese Society for Temporomandibular Joint and the relationships between the signs and symptoms of TMD and the pathological conditions.
Some characteristic symptoms and signs of TMD are observed in common with other diseases; pain, difficulty of mandibular movement, and joint noises. Because of this, it is important to consider ruling out differential diagnosis. It is paramount that clinicians managing TMD patients have sound knowledge of all possible diagnoses that may be responsible for the symptoms regardless of disciplinary boundaries.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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