Sarcoidosis is a systemic granulomatous disease of unknown etiology. The most commonly involved organs are the lymphnodes, lung, liver, spleen, skin and eyes. Uveoparotid fever (HEERFORDT's syndrome) is an unusual variant of sarcoidosis, characterized by parotitis, uveitis, fever and cranial nerve palsy. A case of HEERFORDT's syndrome which involved hearing loss and vestibular hypofunction is presented in the report. The patient was a 28 year-old female who complained of bilateral tinnitus, hearing loss and facial palsy. Chest X-ray showed bilateral hilar lymphadenopathy and a skin biopsy confirmed the presence of epitheloid cell tubercles. The serum angiotensin-converting enzyme level was also high. A diagnosis of sarcoidosis was made on the basis of these findings. Facial palsy and hearing loss were improved by cortico steroid therapy. Cranial nerve palsy of sarcoidosis is discussed in this paper.

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Intral reconstruction of large intraoral defects was done in 12 patients using a latissimus dorsi myocutaneous island flap. For filling up a large amount of the intraoral defect, we cut off much of the latissimus dorsi muscle surrounding the skin portion of the flap. All the flaps were transfered successfully in one stage. Postoperative atrophy of the flap was not common. Consequently, we succeeded in reconstructing a large amount of the intraoral defect. We conclude that the flap is reliable and useful for the intraoral reconstruction.

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23 children with psychogenic hearing loss were clinically observed over a period of one year and the diagnosis, treatment and prognosis of this type of functional hearing loss is discussed. The results are summarized as follows; (1) Many of the patients showed approximately 50dB of sensorineural hearing loss varying from 30dB to scale out, with pure-tone audiometry. The most frequent type of audiomentric curve was ‘flat type’ and was found in 25 ears in the present series, while ‘saucer type’, which has been reported as the most common type in the functional hearing loss was found in only 2 ears.(2) Auditory brainstem response (ABR) revealed essentially normal hearing in all patients in the present study. This suggests that is the most useful diagnostic tool for this type of hearing loss.(3) The high incidence of type V Bekesy tracing obtained in 28 ears (85%) out of 33 affected ears indicates the usefulness of this test in diagnosing the psychogenic hearig loss.(4) In the following examination type V Bekesy tracing changed into either type I or type II in 8 ears (66.7%) out of 12 ears which showed a pure tone improvement.

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The clinical characteristics of myringitis granulosa in 41 ears of 39 cases treated in our clinic during the last 8 years is reported. Of these 39 cases, 20 were male and 19 were female, ranging in age from 10 to 70. The average length of time after the appearance of symptoms was about 6 years. 22 cases had been treated as chronic otitis media. By otomicroscopical examination granulomatous change was observed most frequently in the posterior inferior quadrant of the ear drum followed by the anterior inferior quadrant. Bacteriological examination revealed bacteria similar to that found in otitis media without any causative organism for myringitis granulosa. Twenty-five cases were treated ambulantly by curettage with the edge of a suction tube and corrosion with 10-20% AgNO3 solution followed by steroid-antibiotic ointment. All cases were treated successfully except for one intractable and four recurrent cases. Treatment periods of 20 successful cases were within one month for 15 cases, 1 to 3 months for 4 cases, over 3 months for one case. Symptoms recurred in 4 ears after premature cessation of treatment.

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There are many reports on cancers of the larynx and hypopharynx, but concomitant occult thyroid carcinoma seems to be quite rare. Of 50 laryngeactomies combined with thyroidectomy performed in 8 years at our hospital, occult thyroid carcinomas were discovered in 4 patients when the laryngeal or hypopharyngeal tumors were histologically examined. Three patients were male and one was female. In these 4 cases, concomitant neck dissections were done and one metastasis of the thyroid was found in the lymph node. One patient died from laryyngeal squamous cell carcinoma. Three patients have been alive withont disease. None of these patients exhibited further spread of the thyroid cancer following diagnosis. Other reports on laryngeal and hypopharyngeal carcinomas associated with carcinomas of the thyroid are reviewed and discussed.

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The histopathology of a case of an extremely underdeveloped facial nerve in the Fallopian canal is described. 4 temporal bones of 3 cases of severely damaged facial nerve by congestion are also decribed. The major finding of the former was that the facial nerve ended in the tympanic segment but no abnormality was found in the middle and inner ear structures. In documented, underdeveloped facial nerve cases, including our present case, 6 out of 8 showed that the facial nerve end in the horizontal segment. As for the latter, the major findings of all 3 cases are that there were severe hemorrhages in the Fallopian canal and the destruction of the facial nerve begins in the horizontal segment with the presence of perineurium. From these facts, the system of the blood vessels of the Fallopian canal below the tympanic segment is different from that of the system above it, and the facial nerve bellow this level is presumed to be vulnerable to damage through blood flow disturbances.

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A case of chronic osteomyelitis of the mandible that developed parapharyngeal cellulitis is reported. A fisherman aged 46 had right parotid swelling and severe lockjaw four months after a 8 tooth extraction. Radiographs revealed osteomyelitis localized in the inframandibular notch region of the right ramus. Under general anesthesia the sequestrum was removed intraorally. This case was presumed to develop from either an infection of dental origin or as sequelae to dental conduction anesthesia.

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Osseous choristoma of the tongue is a rare benign tumor which has been reported predominantly in women in the region of the circumvallate papillae or foramen cecum. The patient was a 56 year-old female who has had a mass in the left side of her tongue since infancy. Pathological examination of the mass was performed after surgery. Histological examination of the specimen revealed that it was covered by stratified squamous epithelium, and was composed of a well-circumscribed, lamellated mass of dense bone. From these findings, the pathological diagnosis was determined to be osseous choristoma. The pathogenesis of these lesions has not been established. We propose that these lesions originated from multipotential mesenchymal cells which became lodged in this area during embryogenesis. Contact Nd-YAG laser was recommended for surgical treatment.

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We had 5 cases of MÉNIÈRE'S disease in children aged 6, 8, 12, 13 and 16 years, respectively, during the year of 1985. In 4 of these 5 cases there were vertiginous attacks, while in the remaining 1 case tinnitus was the presenting symptom. In all cases, nystagmus was present and a deviation of labyrinthine origin was noted on the stepping test. Treatment consisted primarily of rest and a drug regimen of steroids and others, leading to disappearance of the nystagmus and deviation in the stepping test. However, the post-attack periods were still fraught with troubles, some of the patients suffered recurrent attacks while others felt less energetic and unable to attend school or had to leave school earlier than usual because of feeling tired. Since these children invariably were suspected of depression (on the basis of difficulty in falling asleep and being low-spirited, particularly on awakening in the morning as reported by their families), anti-depressant therapy was attempted. The response was excellent; the patients became entirely free of symptoms and were able to attend school. While MÉNIÈRE'S disease of adulthood is well known to be complicated by depression, the demonstration that a similar phenomenon dose occur in children also is worthy of particular note. It should be stressed that both MENIERE'S disease and depression in children of school ages are often not understood by the mother, teachers and pediatricians and, accordingly, are likely to be mistaken for school phobia.

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From 1972 to 1984, 1123 patients with head and neck cancer were treated in our clinic. The ratio of the patients over seventy years of age was 248/1123 (22.1%) and that of the patients from seventy to seventy-nine years of age was 201/1123 (17.9%) and that of the patients over eighty years of age was 47/1123 (4.2%). The ratio of the operated patients from seventy to seventy-nine years of age was 109/201 (54%) and that of the patients operated under general anesthesia was 92/109 (84.4%). The ratio of the operated patients over eighty years of age was 17/47 (36%) and that of the patients operated under general anesthesia was 13/17 (76%). The three year crude survival rate of the patients operated under general anesthesia was higer than that of the patients treated with chemoradiotherapy. Diseases found preoperatively besides cancer in patients from seventy to seventy-nine years of age were related to heart 39/92 (42.4%), hypertension 20/92 (21.7%), respiratory tract 9/92 (9.8%) and diabetes mellitus 4/92 (4.3%). Diseases found preoperatively besides cancer in patients over eigthy years of age were also related to heart 6/13 (46%), hypertension 2/13 (15%), respiratory tract 2/13 (15%) and diabetes mellitus 1/13 (8%). Surgical intervention in the patients with head and neck cancer over eighty years of age except advanced cancer, can be performed with safety even under general anesthesia.

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A 6-month-old boy was admitted with a tumor on the right cheek. The tumor was 4×6cm, firm, markedly tender and sugillation of the overlying skin noted. A biopsy specimen showed a benign hemangioendothelioma. The tumor grew rapidly after biopsy with decrease of platelet and fibrinogen, elongation of prothrombin and partial thrombo-plastin time, and increase of fibrin degenerative product in the peripheral blood. The patient was diagnosed as having Kasabach-Merritt syndrome and hemangiomathrombocytopenia syndrome. Radiotherapy combined with steroid therapy was initiated. The tumor was markedly reduced with improvement in the peripheral blood tests. He was discharged in good condition after 5 months and has shown no evidence of recurrence in the last three years.

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The possibility of electronic artificial laryngeal implantation (insertion and fitting to a skin-fold pocket) was studied in 41 laryngetomized patients. The hypophryngeal anterior skin-fold thickness was measured and the correlation between thickness and age, years after surgery, hyoid bone remaining and Body Mass Index were evaluated. An unbalanced electromagnetic type vibration transducer was designed as a voice source. Several psychoacoustic evaluations were performed to obtain the most reasonable voice source. Action potentials of the inferior laryngeal nerve on the occasion of voluntary voicing were recorded and were used as a trigger of the voice source transducer. With further study, the electronic artificial laryngeal implantation should prove useful for voice reconstruction in the laryngectomized patients.

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A 32-year-old female with nasopharyngeal angiofibroma is reported. The patient had suffered from epistaxis on the left side since last year. Post nasal mirror examination showed a large tumor in the nasopharynx. The histopathological report of biopsied tissue was fibromatous lesion. Total removal of the tumor was done under general anesthesia, with a blood loss of 200ml. There has been no evidence of tumor reccurence for 16 months after surgery. It is emphasized that nasopharyngeal angiofibroma must be ruled out carefully even in an elderly female.

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Nineteen patients were treated for cancer of the ear between 1963 and 1985. There were 8 males and 11 females. The mean age was 56 years ranging from 30 to 87. There were 14 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma and 3 cases of other histologic types. UICC TNM classification for skin was used for cancer of the auricle, and Ste11's classification was used for cancer of the external auditory canal and the middle ear. The five-year cumulative survival rate calculated by Kaplan-Meier's method was 52%. The five-year survival rate by location of lesion was 34 % in the auricle (n=3), 73% in the external auditory canal (n=12) and 0% in the middle ear (n=4). The five-year survival rate by T classification was 86% in T₁ (n=7), 22% in T₂ (n=6) and 44% in T₃ (n=6). A new multimodal treatment including neo-adjuvant chemotherapy with cisplatin and peplomycin for cancer of the ear is presented.

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The clinical effectiveness, safety and utility of Ciprofloxacin (CPFX) in the treatment of patients with suppurative otitis media were compared with patients treated with Pipemidic acid (PPA) in a double-blind study. Patients of 15 years of age or over with acute suppurative otitis media, acute exacerbation of chronic suppurative otitis media, and chronic suppurative otitis media were administered either 600 mg of CPFX or 2g of PPA orally for 7 days. PPA is not indicated for gram positive infection. The following results were obtained. 1. The clinical efficacy rate according to doctors in charge of the cases was 63.8 % (83/130) in the CPFX group and 56.6 % (69/122) in the PPA group. A higher efficacy rate was observed in the CPFX group (p<0.1). In the patients with monomicrobial infec- tions, the CPFX group showed a higher efficacy rate (p<0.1), while in the patients with polymicrobial infections, there was no significant difference between the two groups. The clinical efficacy rate in the CPFX group was higher than that of the PPA group in patients with polymicrobial infections of gram positive bacteria (GPB)(p<0.05). In the patients with polymicrobial infections with GPB plus gram negative bacteria (GNB), the rate for the PPA group was higher than that of CPFX group (p<0.05). In the patients with monomicrobial infections with GPB or GNB or polymicrobial infections with GNB, there was no significant difference between the two groups. 2. On the basis of a committee judgement, the clinical efficacy rates in all the cases were 60.3 % (79/131) in the CPFX group and 50.8 % (62/122) in the PPA group. The difference between the two groups was not significant. In patients with polymicrobial infections with GPB, the efficacy rate in the CPFX group was higher than that in the PPA group (p<0.05). A higher rate of the cases with excellent effects was observed in the PPA group in polymicrobial infections with GPB plus GNB (p<0.1). No difference was seen in monomicrobial infections with GPB or GNB or polymicrobial infections with GNB. 3. As for bacteriological effects, the eradication rates in the total cases were 60.9 % (70/115) in the CPFX group and 54.6% (59/108) in the group. The difference was not significant. In patients with polymicrobial infection with GPB, a higher eradication rate was observed in the CPFX group (p<0.1). In the patients with monomicrobial infections with GPB or GNB or polymicrobial infections with GNB or GPB plus GNB, there was no significant difference. 4. Side effects were noted in 5 of 138 cases (3.6%) treated with CPFX and in 10 of 140 cases (7.1 %) treated with PPA. The difference was not statistically significant. 5. The utility rates by doctors in charge of the cases were 67.9 % (89/131) in the CPFX group and 55.7% (68/122) in the PPA group, respectively. The difference was statistically significant (p<0.05). In patients with acute exacerbation of chronic otitis media, moderately severe infection, both monomicrobial infection, and polymicrobial infection with GPB or GNB, the utility rates of CPFX group were higher than those of the PPA group (p<0.05). In monomicrobial infections with GPB or GNB, the CPFX group showed a trend of a higher rate of utility (p<0.1). From these results, it was concluded that CPFX was very useful drug in the treatment of suppurative otitis media caused by gram positive or negative bacteria at a dose approximately 1/3 that of PPA.

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The intrachordal injection procedure is one of the most reliable treatments in improving deficient closure of the glottis. The authors report on the use of injectable collagen for the above purpose. The collagen was extracted from a calf and was injected into the canine vocal fold at concentrations of 35, 20 and 10 mg/ml. The most suitable concentration of collagen for maintenace of the contour of the vocal fold was found to be 35 mg/ml. Histological studies confirmed no inflammatory reaction in the surrounding tissue and no migration of collagen up to 9 months following injection. We conclude that injectable collagen might be a useful implant material in vocal rehabilitation.

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