The relationship between the height of the jugular fossa and the degree of temporal bone pneumatization was studied. The height of the jugular fossa was assessed by computed tomography (CT) and the temporal bone pneumatization was assessed using plane lateral radiography (Shuller method) and CT. High jugular fossae, those which extend up to the level of, or above the lower border of the round window, were found in 21.6% of 504 temporal bones (254 patients) and were found to have a dextral predominance. No significant correlation was found between the height of the jugular fossa and the pneumatization of the temporal bone.

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Parapharyngeal Schwannoma of the cervical sympathetic chain is a rare form of tumor. In most cases, Homer's syndrome follows surgery. On reviewing our department's case records for the past 15 years, we found 7 cases of parapharyngeal Schwannoma. In the two most recent cases, we were able to ascertain the tumor origin by surgical excision from an external approach and were able to make a definite diagnosis of parapharyngeal Schwannoma of the cervical sympathetic chain.

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The indications for and fitting of contralateral routing of signals (CROS) hearing aids were studied in four patients with unilateral hearing impairment, who complained of communication difficulty. We have developed a new canal CROS hearing aid for patients who refuse to wear bilateral earlevel CROS hearing aids for cosmetic reasons.

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The case of a 57-year-old female with recurrent facial palsy, whose daughter had suffered from Bell's palsy, was reported. She had been affected with left peripheral facial palsy about 10 years ago and had recovered completely within 2 months. Peripheral facial palsy of the opposite side appeared in April 1989. Her daughter had also suffered from Bell's palsy in November 1988. Paralyses were mild and complete recovery occurred within 3 weeks for both cases. Recurrent facial palsy is not a rare disease, however, the ratio of positive familial history of Bell's palsy was higher for these cases. The etiology of these palsies is unknown, but there may be some association with hereditary factors. The studies for these atypical facial palsies are useful in understanding the etiology and prognosis for Bell's palsy.

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One hundred and sixteen patients with allergic rhintis due to house dust were treated with immunotherapy. Of these 116 patients, immunotherapy was ineffective for 22. These cases were examined and the following results were observed:(1) Ineffective cases showed a tendency to have atopic factors.(2) Ineffective cases tended to have higher RAST scores than effective cases.(3) Ineffective cases tended to have more severe subjective and objective symptoms. On the basis of the above results, one must decide if immunotherapy is worth continuing or not.

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Bacterial examinations of chronic otitis media from 1976 to 1987 were retrospectively studied. Staphylococcus aureus and Pseudomonas aeruginosa were commonly detected during these 12 years. Proteus species have decreased in detection rate, but glucose non-fermentative gram-negative rod species have increased. Gentamicin-tolerant Staphylococcus aureus have become increasingly more common in recent years.

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The introduction of antibiotics has reduced rhinogenic intracranial complications, but mortality rate is not low even at the present time because of blood-CSF barrier which degrades antibiotic efficacy. Four cases of intracranial complications caused by paranasal sinus infection were reported as follows: Case 1: A 12-year-old male with subdural abscess due to acute frontal sinusitis. Case 2: A 10-year-old female with brain and subdural abscess due to acute frontal sinusitis. Case 3: A 58-year-old male with orbital apex syndrome, meningitis and sepsis arising from a leaking sphenoid sinus pyocele. Case 4: A 20-year-old male with subdural abscess due to acute frontal sinusitis. Clinical diagnosis was supported by CT findings. All of these cases were successfully treated with chemotherapy and surgical drainage. Prompt diagnosis and early treatment is of crucial importance.

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The muco-regulator, carbocysteine (S-CMC, Mucodyne), is clinically used for the treatment of upper respiratory infection, although the pharmacokinetics in our field are not so clear. In this study, the authors evaluated the influence of S-CMC on experimentally induced rhino-sinusitis. Rhino-sinusitis was induced in Hartley strain guinea pigs by exposing them to formaldehyde gas. Ten animals were divided into two groups of five. The first group was orally administered S-CMC at a dose of 200mg/kg for 6 days. The second group (control) was observed without S-CMC. The animals were sacrificed on the seventh day under general anesthesia and the nasal tissues, including the sinuses were examined through histological and SEM methods. Results were as follows: Serous nasal discharge was increased in both groups: however, the control group showed more mucoid fluids remaining compared with the experimental group. The control group also showed more severe inflammation when compared to the control group. It is thought that S-CMC acts on the goblet cells of the nasal mucous membrane and increases the flow of nasal discharge.

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Twenty patients with pulmonary metastases from head and neck cancer were treated with chemotherapy. The following results were obtained: 1. There were three complete responders and six partial responders to the treatment, for an overall response rate of 45%. 2. Two of the three complete responders maintained their condition for longer than one year. 3. The survival period for the responders was much longer than that of the non-responders, and it is thought that this was due to the good performance status of the responders. 4. Chemotherapy for pulmonary metastases of head and neck cancer will be more effective in a patient with: a) a well controlled primary site, b) earlier metastases, c) good general condition, and possibly d) receiving combination chemotherapy with cisplatin.

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In this paper, the postoperative function of larynxes constructed by Hyoid Transposition Laryngoplasty are reported. Thirteen of sixteen cases operated upon were evaluated for their swallowing, nasal respiration, and phonetical functions. All cases had no difficulty in their usual dietary life. although 7 cases had occasional fits of coughing when indesting fluids. Nasal respiration was possible in 3 cases, of which one had a closed tracheostoma. In 7 cases, nasal respiration was possible although could not be continued for more than a few minutes. Twelve cases were able to speak with good articulation. In one case, phonation was a little difficult because of stenosis of the new larynx. Phonetical examinations were made in 11 cases. Maximum phonation time was distributed between 2.5 seconds to 10.5 seconds. The mean exhalation rate was distributed bewween 400ml/sec and minumum. The fundamental speaking frequency was distributed between 200Hz and 60Hz. Voice intensity was distributed between 96dB SPL and 77dB SPL. From the results obtained, some improvements in surgical techniques, especially for nasal respiration, are discussed.

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The incidence of sphenoid sinus mucoceles is rare. Reported here is a case of a huge sphenoid sinus mucocele expanding extramurally into the right pterygopalantine fossa of a 44 year old male. The clinical presentations, computerized tomographic and magnetic resonance imagining characteristics and surgical managment of such lesions is discussed.

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Three cases with traumatic disruption of the ossicular chain are reported; two cases caused by use of earpicks in the auditory canal, and one case caused by a traffic accident in which a head injury resulted in temporal bone fracture. Ossicular reconstruction was performed on the 2 cases caused by earpick injuries, and their hearing improved satisfactorily. Detailed evaluation and descriptions of the surgical techniques are reported.

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Norfloxacin (NFLX) was administered 600mg/day t. i. d. to 37 patients with acute paranasal sinusitis (APS) and acute exacerbation of paranasal sinusitis (AECPS). The clinical efficacy was evaluated for 16 cases with APS and 21 cases with AECPS. The following results were obtained: (1) The overall efficacy rate (cases of excellent and good responses as judged by the attending physician) was 62.2% of all patients, 56.3% for and 67.7% for AECPS.(2) The overall efficacy rate, as judged by committee, was 70.3%. The efficacy rate was 50.0% for APS and 85.7% for AECPS.(3) The bacteriological efficacy rate was 53.4% (including both bacteria eliminated and bacteria exchanged). The efficacy rate was 40.0% for APS, and 66.7% for AECPS.(4) The improvement rate was determined by X-ray findings for 19 cases. The rate of excellent and good results was 36.8%, and that of excellent, good and moderate results was 68.4%. These two rates were 25.0% and 75.0%, respectively for APS and 40.0% and 66.7% respectively for AECPS.(5) Side effects were observed in 1 of the 37 cases (2.7%). No abnormal laboratory findings were observed. From these results, NFLX is judged to be a useful drug in the treatment of paranasal sinusitis.

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In order to investigate the efficacy, safety and usefulness of ketotifen-MR in patients with allergic rhinitis, we administered ketotifen-MR to 32 patients once daily for 4 to 6 weeks. 1) The overall improvement ratings found at the end of the study were 40.6% when cases rated as “markedly improved” were included, 65.6% when cases rated as “moderately improved or better” were included, and 81.3% when cases rated as “slightly improved” were included. In most cases, the improvements appeared within 2 weeks. 2) No adverse reactions or abnormal changes in laboratory values were observed, indicating that ketotifen-MR is highly safe. These results suggest that ketotifen-MR is safe and clinically as effective as, or more effective than other antiallergic agents. In conclusion, owing to its once-daily administration, ketotifen-MR is expected to be easy to take and will be very useful in treating allergic rhinitis.

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Sizofiran is a polysaccharide which is known to be an immunopotentiating agent with anti-tumor effects. We had administered 20-40 mgs of Sizofiran per week, intramuscularly, to nine patients with head and neck malignancies. In addition, the standard treatment with irradiation, chemotherapy, and surgery was carrded out. Comparisons between the Sizofiran-treated group and a similar group, not treated with sizofiran, as a control, were made. Clinical symptoms, and white blood cell (WBC) and lymphocyte counts were evaluated. Both groups showed good clinical prognoses. In the control group, as treatment progressed, the decrease in WBC and lymphocyte counts became obvious. This decrease continued during the treatment period. By comparison, the Sizofiran group showed no decrease in WBC and lymphocyte counts for the same period. These results indicate the effectiveness of Sizofiran in immunotherapy of patients with head and neck malignancies.

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This report describes the superior results we have obtained in the treatment of malignant head and neck tumors with the administration of adriamycin or THP-adriamycin prior to CP treatment (ACP treatment). Twenty-seven cases of malignant head and neck tumor, including 24 cases of squamous cell carcinoma, were treated at our department during the period of November 1985 until February 1989. The results of the 27 cases were CR in 4 cases, PR in 12 cases, NC in 8 cases and PD in 3 cases, with an overall response rate of 59%. Among 14 recurrent cases, 2 were CR, 4 were PR, 6 were NC, and 2 were PD, with a response rate of 43%. On the other hand, the results of 13 cases treated with neo-adjuvant chemotherapy (NAC) were CR in 2 cases, PR in 8 cases, NC in 2 cases and PD in 1 case, with a response rate of 77%. The accumulated survival rate among the 27 cases as judged by the Kaplan-Meier method was 23% at the time of the 24th month.

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Clinical studies on Cefteram pivoxil, a new cephem agent, were carried out in the treatment of ENT infections. Cefteram pivoxil was administered as a daily oral dose of 200 mg t. i. d. to a total of 110 cases, i. e. 43 cases of otitis media, 34 cases of laryngopharyngitis, 17 cases of sinusitis, 8 cases of tonsillitis, 6 cases of otitis externa, 1 case of furuncle of the ear and 1 case of sublingual gland infection. The overall clinical efficacy was assessed in 110 patients as excellent in 48, good in 44, fair in 13 and poor in 5, with an efficacy rate of 83.6%. The bacteriological elimination rate was 84.4% against gram positive organisms and 92.3% against gram negatite organisms, with a high overall elimination rate of 86.7%. Diarrhea, the only adverse effect observed, occured in one case(0.9%). The above results suggest that Cefteram pivoxil is a useful drug for the treatment of otorhinolaryngological infections.

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