Laryngomicrosurgery is used to treat laryngeal lesions which develop in the posterior glottis, such as granulomas, by use of a direct laryngoscope and inhalation anesthesia through endotracheal intubation. However, endotracheal tubes obstruct the view of the posterior glottis and complicates the operating procedure. To simplify the procedure, and to allow visualization of the posterior glottis, the endotracheal tube must be placed on the end of the direct laryngoscope and to move it towards the anterior glottis. A direct laryngoscope capable of manipulating the posterior glottis was modified to accomodate easy positioning of the endotracheal tube. A concave ditch was made on the upper end of the direct laryngoscope, making the placement, and movement, of the endotracheal tube toward the anterior glottis easier.

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Laryngomicrosurgery with a direct laryngoscope is widely used to treat laryngeal lesions. A conventional direct laryngoscope is a completely tubular shaped speculum with a side tube for a lightguide. It is inserted through the oral cavity, and surgical procedures are performed with forceps through the speculum. Sometimes bimanual manipulation of the forceps is required. A direct laryngoscope with a wide opening at the posterior end makes bimanual operations easier. However, it is easier to insert a direct laryngoscope with a narrower opening at the posterior end, especially in patients with dental prostheses. The narrower the posterior opening, the more difficult bimanual manipulations become. Thus, we designed an experimental side opened direct laryngoscope and conducted laryngomicrosurgery. Bimanual manipulation of forceps in laryngomicrosurgery was superior with this laryngoscope than in one with a completely tubular shape.

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A revascularized free jejunal transfer was used to reconstruct an intraoral defect after extensive tongue resection in a 56 year old male. This graft has large vessels which simplify the technical aspects of microvascular surgery. The thin, pliable nature of the flap is well suited to replace various complex defects. Since there is little postoperative contraction, the functions of swallowing and speech can be maintained without limiting the mobility of the residual tongue. In this case, the patient's speech, evaluated after the operation, was judged to be “excellent” according to the criteria of Hirose. It is stressed that this is an excellent oral reconstruction material equally comparable with radial forearm flaps.

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Two cases of childhood psychogenic hearing loss are presented. They had been treated as unilateral sensorineural hearing loss with sudden onset for a long time before proper diagnoses were made. After reviewing the clinical course of these two cases, the authors realized that ABR as Well as Bekesy audiometry was of great help in establishing a diagnosis. The incidence of childhood psychogenic hearing loss is increasing, and otorhinolaryngologists must be made aware of the means of proper diagnosis.

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Nineteen vertebral angiographies (VAG) of patients with hemifacial spasms (HFS) were compared with those from a control group. The mean ratio of the diameter of the affected side versus the healthy side at the 3rd and 4th segment of the vertebral artery (VA) was 0.92-1.23 for both groups, which indicated that there was no significant difference in the VA between the unaffected or affected side. The mean angle of the VA at the 4th segment was significantly more acute (74.6 deg±26.6) in the affected side of the HFS group than in the control group (affected side: 122.8 deg±25.1, healthy side 108.1 deg±12.5). The mean VA angle of the healthy side of the HFS group was not significantly different from that of the control group (94.9 deg±40.9). In addition, loop formations at the 4th segment were only seen on the affected sides of 4 cases of HFS. VAG shows the sharp angulation, or loop formation at the 4th segment of the VA on the affected side to be characteristic of HFS cases. These findings seem to imply elongation of the VA due to arteriosclerosis, and to suggest the possibility of neurovascular compression at the cerebello-pontine angle.

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We have created an off-line, personal system for literature retrieval for ENT. Since this system is off-line, it is available at anytime, and from anywhere. Your searches are completed at once, and it is free of charge. The advantage of our system is in its ease of use, unlike commercial database systems such as Medline, and JMED which cost both time and money. Since the capacity of existing personal computers is quite limited, the data available on this system is limited to the main ENT journals. As computer technology continues its rapid progress, the data available on this system will gradually become larger and eventually supersede commercial databases.

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Two cases of antrorhinolitiasis are reported. Case 1. A 55 year old man, who was suffering from a blowout fracture, had a white antrorhinolith in his right ethmoid sinus (10×7×5 mm, 0.3g) Case 2. A 51 year old woman, complaining of right cheek swelling and nasal discharge had an antrorhinolith in her right maxiallary sinus (13×15×15mm. 1.3g). Rhinoliths in the ethmoid sinus are rare, and we had found only three other cases in the literature in Japan. Radiography, especially conventional and computer aided tomography are very useful in diagnosing antrorhinoliths.

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Insertion of a ventilation tube is commonly performed to treat otitis media with effusion, but its indications are obscure. To determine the appropriate timing of tube insertion following conservative treatment from some months and to clarify the factors affecting the prognosis, we evaluated audiograms, typmanograms, the properties and amounts of effusion, the degree of tympanic membrane retraction, age, and years required for healing. The subjects consisted of 163 children (305 ears) aged between 0 and 15 years. After 6 months to 7 years of observation, the appropriate timing for tube insertion could be estimated. However, the direct factor which led to healing was frequently unknown, and age seemed to play a major role.

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The purpose of this paper is to study the chronological changes of antidromically evoked facial nerve response after facial nerve injury. The responses in guinea pigs were recorded between the geniculate ganglion and the stylomastoid foramen after sectioning the facial nerve either totally or partially (half of the nerve) at the geniculate ganglion. Forty-eight hours after total transection, responses almost completely disappeared, and reappeared after 3 weeks. The latencies of the recovered triphasic waves were prolonged after three weeks, but gradually shortened thereafter, and recovered to an almost normal range 2 months after transection. The latencies of the responses one day after partial transection had already significantly been prolonged. From the 3rd to 7th day, the latencies prolonged further, and shortened by the 14th day. From this study, it was shown that this response could be applied to observation of the recovery course of facial nerve injury and to the early diagnosis of facial nerve palsy.

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The chronological changes of the action potential after direct compression and decompression of the facial nerve are studied by observing antidromically evoked facial nerve response. Twelve guinea pigs were used, and a glass micropipette was inserted into the Fallopian canal, between the recording and stimulating site for two minutes. Thereafter, the pipette was removed. During this procedure, the responses were measured chronologically. In 5 of the 12 guinea pigs, the waves disappeared or changed to monophasic during compression. After decompresion, triphasic waves with prolonged latency reappeared and there-after, the latency gradually shortened. From the results of another experiment in which triphasic waves persisted as long as 7 to 10 minutes after apnea, these reversible changes are considered due to disorders of nerve conduction caused by a mere nerve compression, rather than by hypoxia of the nerve tissue. The results of the present studies lead to the possiblility of rapid improvement of facial nerve palsy if facial nerve decompression is carried out immediately after the antidromically evoked facial nerve responses have disappeared.

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The clinical usefulness and optimal clinical dose of N-22 (Mofezolac), a new non-steroidal anti inflammatory agent, were evaluated in cases of pharyngitis, laryngitis, and tonsillitis, at two daily dosage levels of 225mg (3 times/day), and 300mg (3 times/day). A total of 81 cases (37 cases at 225mg, 44 cases at 300mg) were studied. The results are summarized as follows. Of a total of 80 cases evaluated for clinical efficacy (1 case of 81 was rejected due to sinusitis), 61.1% (22/36) of the 225mg group and 63.6% (28/44) of the 300mg group were rated “moderately improved or better” in a final global improvement rating, with no significant difference between the two groups. Symptomatic observation confirms that N-22 demonstrated an excellent analgesic effect against pharyngeal/laryngeal pain in particular. Side effects were recognized in 5 cases. One case of stomach discomfort/rough oral mucosa and 1 case of stomach discomfort alone in the 225mg group; and 1 case of heavy sensation of stomach, 1 case of drowsiness, and 1 case of diarrhea in the 300mg group were observed. None of these side effects were considered to be clinically serious, and no significant difference was found between the two groups. From this study, we found N-22 to be clinically useful with little difference between a daily dose of 225mg and 300mg. We estimate the optimal daily dose for use in pharynitis, laryngitis, and tonsillitis with pain to be 225mg.

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