Although the incidence of deep neck infection has decreased following introduction of antibiotic treatment, a review of recent literature cites fatal complications. Between January 1985 and June 1987, 28 cases of deep neck infection were treated at our clinic. Three of those cases, including one of parapharyngeal cellulitis, one of submental abscess, and one of reatropharyngeal cellulitis, are discussed. Both the literature review and our case experience has indicated that, in many cases of deep neck infection, classical clinical signs are absent owing to the masking effect of antibiotic therapy and also that the incidence of anaerobic bacterial infection has recently in creased. CT scannings are useful for both the diagnosis and the treatment of deep neck infection. CT scannings provide information concerning 1) the locus of pathological involvement, 2) abscess formation and 3) indications of vascular complications. Such scannings also may indicate the best approach for surgical drainage. Prompt surgical drainage of the involved space is necessary even if CT scanning finds only cellulitis. The procedure not only restores local and general conditions but also prevents the development of fatal complications.

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Nasal septal abscess is rare today, but prompt diagnosis and treatment are necessary to prevent complications. A 28-year-old male, suffering from a common cold, experienced left nasal bleeding after blowing his nose forcefully. The bleeding episode was followed by bilateral nasal obstruction and slight tenderness at the root of the nose. The patient visited our clinic one day after the appearance of these symptoms. Endonasal examination revealed marked swelling of the nasal septum bilaterally. Successful control of the abscess was obtained following immediate therapeutic puncture of the left side of the septum and administration of antibiotics. No recurrence of abscess nor deformity of the external nose has developed subsequently.

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The olfactory epithelium of patients with anosmia, which was assumed to be caused by chronic sinusitis, was examined immunohistochemically. Specimens were obtained from three patients and treated by the usual PAP method. Neuron-specific enolase immunoreactivity was found in the dendrite and perikarya of olfactory receptor cells in two patients. In these cases, it was assumed that the function of olfactory receptor cells was remnant. In the other case, no reactivity could be found in the epithelium. Thus it was assumed that there was no residue of functional receptor cells and that the degeneration of the olfactory epithelium was due to a cause other than chronic sinusitis. This study demonstrates the usefulness of the immunohistochemical method for diagnosis and prognosis of olfactory disturbance.

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1) In the treatment of localized infectious-type sinusitis in children, irrigation of the maxillary sinus has proven to be an excellent conservative method, resulting in the rapid cure of many such cases. 2) Nearly all cases of maxillary sinusitis in children can be irrigated by killian's cannula through the middle nasal meatus. 3) Maxillary irrigation also led to the rapid resolution of several cases of pediatrics sinusitis caseosa. In seven cases of sinobronchitis in children, cough and expectoration were improved distinctly following several irrigation theatments. Maxillary sinus irrigation led to rapid improvement in several cases suffering from pus retention in the maxillary sinus together with headache and long-term fever of unknown origin. 4) A group treatment setting of maxillary irrigation has proven efficient and seems to elicit fever complaints of pain. Timely advice and encouragement from assisting paramedical personnel to the patient is also important.

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In the examination of a 32-year-old female complaining of a sore throat, a walnut-sized tumor was detected at the center of the tongue base. Diagnostic procedures, including CT scanning, scintigram and ultrasonography suggested the presense of an ectopic thyroid gland. Tissue biopsy confirmed that diagnosis. Therapy was deemed unnecessary. The patient was followed up as an outpatient. Among the diagnostic procedures employed in this case, ultrasonography proved most useful. In addition to the clinical report, comprehensive reviews of the literature concerning the pathogenesis, epidemiological factors, and clinical considerations of ectopic thyroid gland are discussed. Because the vast majority of cases ectopic thyroid gland are first seen by the otolaryngologist, it is imperative that such specialists have a comprehensive knowledge of this rare, anomalous development of that gland.

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A maxillary hematoma was observed in a 40-year-old male chronic renal failure patient who had been maintained by hemodialysis for over 12 years. The patient had suffered constant hemorrhagic nasal discharge for several months. X-ray examination showed a diffuse shadow on the right maxillary sinus. Subsequent surgical intervention revealed the presense of a hematoma with necrosis filling the maxillary sinus. Tissue examination confirmed the diagnosis. The diagnosis and etiology of maxillary hematoma in patients on chronic hemodialysis, as well as the surgical managemest of the condition, was discussed.

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Distant metastases were detected in 20 cases (5.6%) of 358 patients with laryngeal cancer and 16 cases (19.0%) of 84 patients with hypopharyngeal cancer treated from July, 1978 to December, 1983 in the Center for Adult Diseases, Osaka. The most common sites of distant metastases were the lung, the bone and the liver in the order of frequencies, in both malignancies. The development of distant metastases is higher in patients with T3-T4, and N positive supraglottis or transglottis, T2 anterior commissure type glottis, and piriformis sinus cancer.

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We investigated patients who complained of vertigo or dizziness in our clinic from 1984 to May 1985. The number of vertiginous patients was 204 (male 81, female 123) and included 4.2% of the total number of outpatients. The cause of vertigo or dizziness were peripheral disorder (53.4%), central disorder (26.0%) and those of unknown origin (16.7%). Meniere's disease consisted of 30.4% of the peripheral disorders. Among the vestibular tests, abnormal findings were detected most frequently by the righting reflex (69.3%) and deviation reaction(44.6%). Although abnormal findings were not detected more frequently by the OKN test, ET test and caloric test, we demonstrated that these tests were of the greatest value in diagnosis.

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In order to identify recent trends of causes of deafness in children, the author studied case histories of 744 children with sensory neural hearing loss under 10 years of age who consulted the Fukuoka Welfare Center of Disabled Children from 1979 to 1987. The results were compared with those in 477 children who consulted Visual and Auditory Research Institute of Fukuoka Medical Association during one year and six months from 1970 to 1972. The results were as follows. 1) The frequency of familial deafness increased. 2) Among the prenatal disturbances, the frequency of maternal rubella infection was as high as before. 3) The deafness resulting from maternal cytomegalovirus infection was noted as a prenatal disturbance in this study. 4) Among the paranatal disturbances, the frequency of asphyxia was lower than before. 5) Among the causes of postnatal deafness, the frequencies of mumps and meningitis were high.

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A 27-year-old man complaining of a painless mass in the left submaxillary region was admitted to our hospital. By ultrasonic examination, two tumors were identified and they showed a benign pattern. Chest X-ray and all laboratory studies were within normal limits. The tumors were extirpated under general anesthesia. The surgical specimens were smooth in surface. 3.5× 2.5×2.5cm and 2.0×1.5×1.5cm in size. Histologically they were characterized by hyperplasia of lymphoid tissues with follicles and hyalinized blood vessels. Some of these follicles resembled Hassall's corpuscles of the thymus. The present case was a hyaline-vascular type of Castleman's lymphoma.

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Methyl B₁₂ 500μg was administrated to 12 patients with bilateral chronic sinusitis who had recieved Caldwell-Luc's operation. At a one week interval, both sides were operated on. Only after the second operation, Methyl B₁₂ 500μg was administered twice daily. Spontaneous pain, opressive pain, numbness and swelling were compared for 7 days following the operation on each side. Opressive pain and feeling of disorder on radix dentis were not significantly different between the 2 periods. However, spontaneous pain and swelling were clearly milder during the drug administration period, and significant effectiveness of the drug was recognized statistically. The overall improvement of each symptom was evaluated on the basis of 6 grades by referring to the patient's impression and the doctor's objective observation. As a result, only 4 of 12 were evaluated as “improved” or better when the drug was not administered. In contrast, 11 of 12 patients were evaluated as “improved” or better when the drug was given. Therefore, Methyl B₁₂ is expected to play an important role in the healing of nerve injuries caused by surgery.

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It is imperative to establish the effect of a newly developed otic solution upon the inner ear before its clinical application because some kinds of otic solutions may induce sensorineural hearing loss. In the present study, the authors evaluated the influence of Ofloxacin (OFLX) upon the inner ear. Using guinea pigs of the Hartley strain, 24 animals were subjected to a left myringotomy and then divied into three groups. The 10 animals of group (A) were administered 0.3% OFLX otic solution in the middle ear cavity, the 9 animals of group (B) similarly received 0.5% OFLX, and the remaining 5 animals of group (C) received a control solvent only. The solutions were administered continuously for 7 days. The auditory brainstem response (ABR) of all test and control animals was measured both before administration of otic solution and on the 10 th day after final adminisration with a stimulation of 10, 000 Hz using Teledyne Avionics 1000. Finally, the auditory structures were fixed by a method of intravital perfusion and the cochlea were examined pathohistologically. Results indicated no significant difference in ABR recording before and after the examination. Microscopic examination revealed no evidence of damage to the Organ of Corti nor any degeneration of the hair cells in any animals of groups A, B, and C. In conclusion, under the experimental conditions described, OFLX otic solution exerts no discernable adverse effects upon inner ear.

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Cefotiam hexetil (CTM-HE) was evaluated for its efficacy, safety and usefulness in acute tonsillitis, in a double blind manner using cefaclor (CCL) as a control drug. The drug was orally administered after each meal, as a rule, for consecutive 7 days (CTM-HE: 200mg×3/day, CCL: 250mg×3/day). Out of the 231 patients recruited in this trial, 192 (99 on CTM-HE and 93 on CCL) were adopted by the committee for the evaluation of therapeutic efficacy. 1. The clinical responses judged by the attending physicians were positive in 91.9% of the patients on CTM-HE and 88.2% of the patients on CCL (commitee's judgement: 88.9% on CTM-HE, 86.0% on CCL). 2. The bacteriological responses were assessed as “eradicated” in 95.7% of the patients on CTM-HE and 97.6% of the patients on CCL. 3. Adverse events, mainly mild or moderate gastrointestinal tract symptoms, were observed in 7.5% (8/107) of the patients on CTM-HE, and in 4.0% (4/100) of the patients on CCL. No abnormal alterations of laboratory findings were noted in any groups. 4. The usefulness was rated as “very useful” and “fairly useful” in 91.0% of the patients on CTM-HE and 91.4% of the patients on CCL. 5. There was no statistically significant difference between the two treatment groups in any evaluation described above. The above results suggest that CTM-HE is a useful drug for the treatment of acute tonsillitis at the daily dosage of 600mg (t. i. d.).

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Cefotiam hexetil (CTM-HE) was evaluated for its efficacy, safety and usefulness in suppurative otitis media, in a double blind manner using cefaclor (CCL) as a control drug. The drug was orally administered after each meal, as a rule, for 7 consecutive days (CTM-HE: 200mg×3/day, CCL: 250mg×3/day). Of the 240 patients recruited in this trial, 224 (111 on CTM-HE and 113 on CCL) were adopted by the committee for the evaluation of therapeutic efficacy. 1. The clinical responses were positive in 61.3% of all patients with suppurative otitis media on CTM-HE treatment and 60.2% of those on CCL as judged by the attending physicians (committee's judgement: 55.9% on CTM-HE, 63.7% on CCL). 2. The bacteriological responses in all patients with suppurative otitis media were judged as “eradicated” and “replaced” in 64.4% on CTM-HE and 69.7% on CCL. 3. The adverse reactions reported were mainly mild gastrointestinal symptoms and occurred in 5.1% of patients (6/117) on CTM-HE treatment and in 1.8% (2/114) on CCL treatment. Abnormal alterations of laboratory findings were not recognized in any treatment groups. 4. Usefulness evaluation showed that the drug was “very useful” or “fairly useful” in 60.7% of all patients with suppurative otitis media on CTM-HE and 63.7% of those on CCL. 5. There was no statistically significant difference between the two treatment groups in any evaluation described above. The above results indicate that the daily dosage of 600mg of CTM-HE has a usefulness comparable to the daily dosage of 750mg of CCL for the treatment of suppurative otitis media.

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The clinical efficacy and safety of RU 28965 in the theatment of sinusitis was investigated. 1. Twenty-seven patients were studied, including fifteen cases of acute sinusitis and twelve cases of acute exacerbation of chronic sinisitis. 2. The efficacy rates of RU 28965 for acute sinusitis and for acute exacerbations of chronic sinusitis were 93.3% and 91.7% respectively. The overall efficacy rate was 92.6%. 3. In bacteriological studies, the elimination rate was 100% for both gram-positive and gram-negative organisms. 4. No side effects were observed in any of the 27 test subjects. 5. Results indicate that RU 28965 is a drug useful in the treatment of sinusitis.

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An evaluation of the clinical efficacy, safety, and usefulness of TE-031 in the treatment of suppurative otitis media (acute suppurative otitis media and acute exacerbation of chronic suppurative otitis media) was undertaken in a double-blind comparative clinical trial using Josamycin (JM) as the control drug. Patients in the TE group received 400mg/day (in two divided doses) and those in the JM group were given 1, 200mg/day (in three divided doses). The results are summarized below. 1. All patients were included in the clinical efficacy evaluations. Investigators reported efficacy rates of 64.4% and 64.8% for the TE group and the JM group respectively. The drug study committee reported clinical efficacy rates of 63.4% and 61.9% for the TE group and the JM group respectively. When the efficacy of the drugs was analyzed as a function of the type of disease, JM showed an efficacy rate superior to TE in the treatment of acute suppurative otitis media, whereas TE demonstrated greater efficacy in the treatment of acute exacerbation of chronic suppurative otitis media. However, such differences between the two treatment groups were statistically insignificant. 2. Analysis of the improvement in subjective and objective symptoms revealed no significant differences between the TE and the JM groups after 3 and 7 days of therapy. 3. Bacteriological efficacy was evaluated in terms of the eradication rates as a function of the type of disease, the type of infection, and the causative micro-organism. Such evaluations demonstrated no statistically significant differences between the two drug treatment groups. 4. With regard to the safety of the drug regimens, side effect symptoms were recorded in 9 (8.3%) of the TE group patients and in 2 (1.8%) of the JM group patients, demonstrating a higher rate of such symptoms in the TE group. Among the side-effects reported, digestive disturbances were most common, but all subsided either while drug therapy continued or was discontinued. Abnormal laboratory test values reported included an elevated GOT in one TE patient and an elevated GOT in one TE patient and an elevated GOT and GPT in two JM group patients. One JM group patient demonstrated eosinophilia. 5. Drug usefulness was analyzed for all of the patients and also as a function of the two types of suppurative otitis media under study. No statistically significant differences were found between the results in the two drug treatment groups. On the basis of the results summarized above, it was concluded that TE-031 admisistered in daily doses of 400mg is as clinically efficatious as JM administered in doses three times greater, and that TE-031 is a highly useful antibiotic for the treatment of suppurative otitis media.

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An evaluation of the clinical efficacy, safety, and usefulness of TE-031 in the treatment of acute lacunar tonsillitis was undertaken in a double-blind comparative clinical trial using Josamycin (JM) as the control drug. Patients in the TE (test) group received 400mg/day (in two divided doses) and patients in the JM (control) group received 1,200mg/day (in three divided doses). The clinical efficacy of both drugs was evaluated independently by the drug study committee and by a team of investigators. No statistically significant differences emerged in the efficacy ratings done by both groups. The drug study committee calculated efficacy rates of 87.4% for the TE group and 81.0% for the JM group. Correspondingly, the team of investigators reported clinical efficacy rates of 85.4% and 87.3% for the TE group and the JM group respectively. In bacteriological studies, both drugs demonstrated high levels of bacteriolytic potency. The eradication rate (including cases of bacterial replacement) reached 100% in the TE group and 95.6% in the JM group. In drug safety studies, side effects were recorded in 7 (7.3%) of the 96 patients in the TE group and in 10 (11.0%) of the 91 patients in the JM group, results which indicate no statistically significant difference between the two drugs in the incidence of side effects. Similarly, no essential differences emerged between the two drugs in the incidence of abnormal laboratory test values. Such abnormal laboratory values were reported in one patient (2.4%) of the 41 TE group members and in 5 individuals (12.2%) of the 41 JM group patients. The clinical usefulness of the drug administered to the TE group was rated at 83.3%, not statistically different from a usefulness rate of 80.5% reported for the drug used to treat the JM group. On the basis of the results reported above, TE-031 administered in a daily dosage of 400mg (in two divided doses) is shown to be a clinically efficacious, highly useful antibiotic comparable to JM administered in a daily dose of 1,200mg (in three divided doses) for the treatment of acute lacunar tonsillitis.

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Forty patients with acute laryngopharyngitis were administered Rinderon-containing nebulizer therapy in a study designed to evaluate the optimum dosage, efficacy, and side effects of this corticosteroid. A significantly greater number of patients responded favorably to this medication administered in dose concentrations of 1.5mg than patients treated with lower dose concentrations of the drug. Inpatients who received Rinderon-containing nebulizer therapy in doses of 1.5mg for several days demonstrated normal plasma cortisol levels after seven days of such treatment. Results of outpatient studies involving forty patients treated every other day with 1.5mg doses of Rinderon-containing nebulizer therapy indicated that such therapy is more efficacious and elicits fewer side effects than other treatment modalities.

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The clinical effectiveness, safety, and utility of TE-031 (A-56268) was studied in the treatment of paranasal sinusitis. TE-031 was administered orally to 27 patients with paranasal sinusitis in a daily dose of 200-400mg/day in two divided doses. 26 patients participated in the evaluation of the clinical efficacy of TE-031, 16 of whom suffered from acute sinusitis and 10 with actue exacerbations of chronic sinusitis. The doctor in charge rated the clinical efficacy of the drug at 69.2% (18/26), identical to the drug study committee rating of 69.2% (18/26). A utility rate of 65.4% (17/26) was also reported by the physician in charge. Patients with gram positive bacterial infections experienced a bacteria erradication rate of 87.5% (7/8) and of 83.3% (5/6) in patients with gram negative bacterial infections. No side effects and abnormal laboratory findings were reported in any of the 27 patients involved either during or after the study. Based upon the above results, TE-031 has been demonstrated to be a drug very useful in the treatment of paranasal sinusitis.

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In co-operation with several clinics employing the protocol, a study was conducted to evaluate the clinical effectiveness and safety of Cefodizime (CDZM) in the treatment of paranasal sinusitis. Fifty-four patients over 16 years of age were considered for participation in this study, of which 42 were selected as clinical test subjects. Among those patients, 20 suffered from acute sinusitis and 22 from acute exacerbations of chronic sinusitis. Following treatment with CDZM, the doctor in charge judged the drug clinically efficacious in 75% of cases with acute sinusitis, in 68.2% of cases with acute exacerbations of chronic sinusitis, and in 71.4% of all cases studied. Using unified criteria, drug efficacy was rated at 85% for acute sinusitus, 72.7% for acute exacerbations of chronic sinusitis, and at 78.6% for all cases combined. The rate of bacteriological elimination rate was 92.9% for infections involving a single gram-positive pathogen, 100% each for those involving a single gram- negative orgaism, a single anaerobe, or multiple pathogens, and 97.1% for all pathogens. Side effects included one mild case of diarrhoea and one of nausea with loose stool. Abnormal laboratory test values, involving elevated GOT and GPT levels, were reported in one case only. Based upon the above results, CDZM is considered to be a drug useful in the treatment of paranasal sinusitis.

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