30-year-old woman with a huge pleomorphic adenoma of the parapharyngeal space was admitted to our clinic. She complained of a palpable mass at the submandibular region, a bulge of the lateral pharyngeal wall, snoring and aural fullness. During preoperative examination we performed X-p, sialography, CT scan, CAG, and Ga scintigraphy and concluded that the tumor was occupying the parapharyngeal space from the skull base to the submandibular region. CT-sialography was especially useful for evaluating the extent of the tumor. The tumor was removed by mandibulotomy using a cervical-transpharyngeal approach. This approach is appropriate for removal of a huge tumor of the parapharyngeal space.

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Parapharyngeal abscesses are thought to be dangerous because of the threat of death from carotid rupture, thrombophlebitis, mediastinitis, etc. However, availability of antibiotics has reduced the death rate. In this paper, two contrasting cases of parapharyngeal abscess are reported. In the 1st case, an abscess ruptured into the hypopharynx causing mediastinitis. Severe general complications followed and the patient died. In the 2nd case, a complete cure was obtained by suitable treatment. CT scan is a convenient tool for diagnosis. Chemotherapy, incision and drainage are the basis of treatment. Recently, however, anaerobdic infection and opportunistic infection have increased, making the treatment of infectious diseases more difficult. Proper selection of antibiotics, a well-defined incision, adequate drainage and surveilance of the general status will help determine a favorable prognosis.

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A 60 sec body sway test with the eyes closed was analysed using a NEC computer PC-9801 to compare patients in the acute attack and the quiescent stages of Meniere's disease. The following results were obtained: The time course of the sway area in patients in the acute attack stage showed a characteristic linear instability in contrast with patients in the quiescent stage. In the subacute stage a discrepancy was observed between three parameters in eight directional components; length, velocity and acceleration. These findings indicate that the compensatory process of postural control may be strictly evaluated by stabilometry.

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Two cases of lichen mucosae oris which had been treated as intractable stomatitis were reported. Case 1: A 49-year-old female reported experiencing oral pain for about 5 years when she consulted the ENT clinic in her neighborhood. She received treatment for leukoplakia and stomatitis, but it was intractable. The histopathological diagnosis of the oral mucosa was lichen planus. Her clinical symptoms were improved after treatment with vitamin A and other drugs. Case 2: Oral pain was experienced for about 5 years after treatment of dental caries by a dentist using metals in a 75-year-old female. She consulted an ENT clinic in her neighborhood and received treatment for stomatitis. Her oral mucosal lesion was intractable. The histopathological diagnosis of the mucosa was lichen planus. Corticosteroid containing ointment and gargle were applied on her oral mucosal lesion and her clinical symptoms improved. Etiology and treatment of lichen mucosae oris were discussed.

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Two patients with sudden progressive profound deafness resulting from Ramsay Hunt's syndrome are reported. Case 1: A 63-year-old woman was admitted to Jichi Medical School Hospital with sudden progressive deafness of the left ear, vertigo, sore throat and hoarseness. She could not take any food and drink for a couple days due to severe odynophagia. An otoscopic examination revealed that the external ear and the tympanic membrane to be normal. Pure-tone audiometry revealed a profound deafness in the left ear. A horizontal nystagmus in the non-affected direction was observed by gaze nystagmus test. An endoscopic examination revealed herpetic vesicles and shallow ulcers in the left side of the pharynx and the larynx. There was a complete paralysis of the left recurrent nerve. Hearing acuity of the left ear did not recover at all by steroid hormone therapy. Case 2: A 75-year-old man was referred to the ENT clinic for hearing evaluation in Hunt's syndrome by dermatologist. The man noticed severe otalgia and sudden progressive deafness of the right ear approximately 2 weeks prior to admission. A physical examination revealed herpetic vesicles and ulcers in the right external ear and lateral neck. A complete paralysis of the right facial nerve was noted. A profound hearing loss was observed in the affected ear by pure-tone audiometry. A gaze nystagmus test revealed a horizontal nystagmus in the non-affected direction. No recovery of the cochlear function was noted by an administration of antiviral drug. The pertinent literature is briefly reviewed.

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About 10 years ago, the authors reported intranasal puncture and drainage of “postoperative cysts of maxillary sinus”, as a conservative method of treatment. Three indications discussed are: 1. the extension and swelling of the lateral wall of the inferior nasal meatus, 2. bone defect of the lateral wall detected on palpation with a swab, 3. mucosal extention and swelling of the middle nasal meatus. On this report, a new indication was added: closed cysts within the inferior nasal meatus on the imaging film of the CT-scan. In these cases, we can perform puncture and drainage of the inferior meatus. This newly added indication significantly widens the range of conservative treatment of “postoperative cysts of maxillary sinus”.

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In order to evaluate the clinical usefulness of carbocisteine (S-CMC) in the treatment of chronic paranasal sinusitis, a double blind trial was carried out by comparing S-CMC with L-cysteine ethylester hydrochloride (L-cysteine) as a control drug. S-CMC group (S-Group) was administered orally two tablets of S-CMC and one placebo tablet in place of active L-cysteine (1,500mg of S-CMC/day), and L-cysteine group (L-Group) one tablet of L-cysteine and two placebo tablets in place of active S-CMC (300mg of L-cysteine/day) t, i, d, after meal for four weeks. Following results were obtained: 1) The ratio of excellent or good utility of S-Group was significantly higher than that of L-Group. 2) The ratio of marked or moderate improvement of S-Group was significantly higher than that of L-Group. 3) The improvement ratio for subjective and objective symptoms of S-Group was significantly higher than that in L-Group. 4) No significant difference was found in the judgement of X-ray findings between the two groups. 5) In the respective evaluation items classified as subjective symptoms (rhinorrhea, postnasal drip, nasal obstruction) and as objective symptoms (volume of rhinorrhea, mucus rhinorrhea, postnasal drip), S-Group showed significantly superior improvement ratio in those items to L-Group. 6) Side effects were observed in two cases (1.5%) in S-Group and one case (0.8%) in L-Group. The side effects were not serious and disappeared soon after the administration was discontinued. From the above results, it is concluded that S-CMC is highly effective in the treatment of chronic paranasal sinusitis.

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Nasopharyngeal specimens were taken from 212 children attending the Akita Red Cross Hospital from April 1986 to March 1987. The study was designed to compare the nasopharyngeal and nasal flora in children with acute inflammatory otorhinolaryngological diseases to the nasopharyngeal and nasal flora in children without such observable diseases. In this report, the subjects were limited to those children who had no prior episodes of secretory otitis media. Results show that H. influenzae was found more frequently in children with acute inflammatory diseases of the ear, nose, and throat than in children without such diseases.

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A clinical study was conducted to evaluate the utility of Ceftriaxone (CTRX) in paranasal sinusitis, and the following results were obtained. Clinical efficacy was evaluated by the physician in charge to be 93.5% in acute (43/46) and 89.5% in chronic (17/19) infections, showing an excellent improvement rate. Clinical efficacy evaluated according to standardized criteria was 92.6%(25/27), and 91.7%(11/12) respectively, also indicating a high improvement rate. Bacterial efficacy, measured by the bacterial eradication rate, was 92.3%(42/45). Side effects were observed in 2.9%(2) of the cases, but both of these were of slight degree. The transfer of CTRX into the tissue membranes of the maxillary antrum was high: 76.5% at 60 minutes and 114.8% at 100 minutes when compared to blood concentrations at the same points in time.

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Ceftriaxone (CTRX), a parenteral cephalosporin antibiotic, was examined for its clinical utility in the treatment of purulent otitis media, and the following results were obtained. CTRX concentrations in the tissue membranes of the mastoid antrum were 15.73±8.83μg/g at 30 min. and 9.88±8.97μg/g at 60 minutes after intravenous injection with one gram of CTRX, while corresponding serum levels were 50.23±9.98μg/ml and 37.97±9.75μg/ml, indicating CTRX's good transfer into the tissues. Clinical efficacy was evaluated in 47 out of 50 cases that recieved CTRX; three cases were excluded, or dropped out. Of the 47 cases, 13 had acute otitis media, and 34 had chronic otitis media; 33 cases had a single infection, and 14 had mixed infections. In 38 cases, the drug was administered by intravenous injection, while 8 received CTRX by drip infusion. 29 cases received a one gram dose daily, and 15 received two grams once daily. The treatment period ranged from 3 to 11 days. Efficacy of CTRX was rated by the physician in charge at 72.3% in the 47 evaluated cases ; 76.7% if the 4 cases with Pseudomonas infection were excluded. Efficacy was observed in 72.4% of the 29 cases that received a one gram once daily dose CTRX and 73.3% of the 15 cases that received 2g once daily. When cases with Pseudomonas infection were excluded, the percentage of cases where efficacy was noted rose to 77.8% and 76.9%, respectively. When clinical efficacy was evaluated by the committee, efficacy was observed in 68.1% of the 47 evaluated cases, and in 72.1% of the 43 cases without pseudomonas infections, indicating percentages of 4 to 5% lower than those evaluated by the physician in charge. The bacteriological efficacy of CTRX was also examined. The causative pathogen was eradicated in 78.8% of the 33 cases with a single pathogen, and in 76.9% of the 14 cases with mixed infections. When pseudomonas infection cases were excluded, eradication was achieved in 80.6% and 90.9% respectively. The eradication rate for 22 strains of Staphylococcus aureus was relatively low, only 66.7%, but it was satisfactory for other bacterial strains, except Pseudomonas. Side effects were seen with CTRX. One case each of facial edema, erythema, and an edematous rash were seen, and laboratory findings revealed the ocurrence of leukopenia in two cases. It is considered from the above results that CTRX is highly clinically useful in once-a-day administrations of one or two grams, even for Staphylococcal infections.

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Thirty-five patients with dysequilibrium and/or hearing disturbance were administered Takeda-Calan® to evaluate its clinical effects. The subjects were grouped as severe, moderate, and slight grade by the severities of symptoms and signs. Satisfactory effectiveness was obtained in 44.4%, 64.3%, and 83.3%, respectively in the three groups. As for the symptoms and side effects themselves, improvement was seen in 80.8% of dizziness, 61.9% of tinnitus, and 37.5% of sensorineural hearing loss. No appreciable side effect appeared.

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