Four cases of obliterative otitis media are presented in this report. The four cases had the following common clinical characteristics: recurrent acute otitis media during childhood; a thickened ear drum; type B tympanogram; compact mastoid revealed on X-ray; tympanic cavity filled with fibrous tissue, cysts, and granulation tissue without any calcification; poor mobility but no disruption of the ossicular chain. Post-operatively, none of the cases experienced an improvement in hearing thresholds due to fixation of the stapes. Based on this information, a hearing aid will be recommended rather than surgery to correct the hearing impairment caused by obliterative otitis media.

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Forty-seven cases of laryngeal carcinoma treated at the Department of Otorhinolaryngology, University of Ryukyus Faculty of Medicine from 1980 to 1984 were evaluated. Laryngeal carcinoma occurred most frequently (34%) in the 6th decade of life. Glottic carcinoma was the most common lesion. The crude five year survival rates were 92.9% for stage I laryngeal carcinoma, 77.8% for stage II, 68.7% for stage III, 45.5% for stage IV, and 72.1% for laryngeal carcinoma cases overall.

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On March 12, 1980, our clinic attempted treatment of a pituitary adenoma by low dose radiation therapy using a radioisotope which emits β-rays, inserted into the sella turcica via the sphenoid sinus. Our efforts represent the first trial of this method in China. The patient was a 26 year-old male. In this case, the pituitary adenoma had recurred after craniotomy. The patient refused a second operation, and was subsequently referred by the Department of Neurosurgery to our clinic. His chief complaints were blindness in one eye, impairment of acuity and visual field in the other eye, as well as headache and impotence. Our treatment, which involved transsphenoidal ³²p insertion radiation therapy effected an apparent cure. Over an interval of 3 years, visual acuity returned gradually to the blind eye. A CT, taken 5 years after treatment, revealed no evidence of tumor. Subsequently, the patient's wife became pregnant and delivered a healthy child. No evidence of tumor recurrence has been detected in 8 years of follow-up observation. This low-dose radiation therapy provides an effective alternative to repeat craniotomy in patients experiencing postoperative recurrence of pituitary tumor.

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A case of sphenoidal mucocele after transsphenoidal hypophysectomy is presented in this report. Complaints of visual disturbances are common in most cases of sphenoidal cyst and occasionally remain in spite of treatment. In the case of sphenoidal mucocele, prolactin rose slightly after transsphenoidal hypophysectomy. A recurrence of adenoma was suspected although CT and MRI evaluation revealed a cyst. CT and MRI were effective in the diagnosis of sphenoidal cyst.

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A stimulatory electrode model coated with polyvinyl alcohol gel (PVA gel) was designed to protect the round window membrane of the cochlea. The stability of the PVA gel coating material was investigated histologically and electrophysiologically in a guinea pig model. No inflammatory changes, adhesions, or granulation tissue were observed on round window membrane six months or 12 months after implantation of PVA gel. Impedance measurements were no different between the. PVA gel-impanted animals and controls. These electrophysiological and histological results indicate that PVA gel is a stable coating material for an extracochlear electrode on the round window membrane of the cochlea.

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Vascular leiomyoma usually occurs in the skin of the limbs and is rare in the nasal cavity and paranasal sinuses. A case of vascular leiomyoma in the inferior turbinate of a 72-year-old female is presented in this paper. Partial turbinectomy was performed to relieve nasal obstruction and epistaxis. Literature on vascular leiomyoma of the nasal cavity and paranasal sinus were reviewed and its etiology, signs, and treatment summarized.

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Although Japanese cedar is a major cause of seasonal pollinosis, many other tree pollens such as Japanese cypress, pine, white birch, Japanese alder, and white oak cause sensitivity. The RAST of various tree pollens was investigated in 43 patients presenting with nasal allergy in our clinic in Kumamoto City between February and June, 1987. Twenty-five patients were found to be sensitive to Japanese cedar pollen and seven of the 25 were sensitive to muliple tree pollens. None of the patients were sensitive to any single tree pollen other than Japanese cedar. Sensitization to Japanese cypress can be partly explained by its antigeneity to Japanese cedar, but sensitization to multiple antigens which have no cross reactivity is difficult to explain. Patients with antigens to multiple tree pollens had an HLA type typical of patients with Japanese cedar pollinosis. This suggests that persons genetically susceptible to producing IgE antibody specific to Japanese cedar are likely to produce IgE antibodies to multiple tree pollens.

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A 57-year-old woman presented with dyspnea in a supine position. Laryngoscopy revealed a tumor in the anterior tracheal wall. A biopsy and tracheostomy were performed, and histological evaluation of the tumor disclosed adenoid cystic carcinoma. A two-stage surgical approach was designed to remove the tumor. The tumor and anterior wall of the trachea were removed in the first stage, with cervical trachea left open. Ten months later the trachea was reconstructed utilizing a cervical flap and costal cartilage. The tracheostoma was closed two months after the second operation. Eighteen months after treatment, the woman is alive and shows no clinical signs of recurrence of the tumor. A literature search revealed that adenoid cystic carcinomas are most common in the proximal third of the trachea.

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Safety and efficacy of meropenem (MEPM) in the treatment of suppurative otitis media were evaluated in a multicenter clinical study using a standard protocol. Sensitivity of bacterial isolates to MEPM and distribution of the drug into the middle ear mucosa were also investigated. Twenty-five strains of Gram -positive bacteria (including 13 strains of S. aureus) and 13 strains of Gram-negative bacteria (including 4 strains of P. aeruginosa) were isolated from patients with suppurative otitis media. Gram-positive bacteria showed the highest sensitivity to MEPM, second only to imipenem (IPM), while Gram-negative bacteria were more sensitive to MEPM than the other drugs tested (IPM, ceftazidime, cefoperazone, flomoxef, piperacillin, cefotiam), with a MIC80 of 0.39μg/ml and 3.13μg/ml, respectively. Intravenous drip infusion of 0.5g MEPM over 30 min revealed drug concentrations in the middle ear mucosa ranging from 0.69 to 7.83μg/g, while the tissue/blood concentration ratios ranged from 6.27 to 43.3%. Clinical trials involved a total of 52 patients. The most common regimen of administration was twice-a-day in the dose of 0.5g (48 patients, 93.2%) for 3 to 5 days (28 patients, 53.8%). Clinical efficacy of MEPM was evaluated in 46 of the 52 patients, while safety was assessed in all patients. The physician-assessed clinical efficacy rate (“Excellent” plus “Good”) was 80.4% overall (37/46), 85.7% (6/7) for acute suppurative otitis media, and 80.0% (8/10) for chronic suppurative otitis media, while that of the Efficacy Assessment Committee was 78.3% (36/46). The pathogen eradication rate was 86.1% for cases (39 cases) and 87.8% for strains (46 strains). All bacteria species were eradicated except two strains of S. aureus and one strain each of S. epidermidis, Alcaligenes sp. and P. aeruginosa. No side effects occurred in any of the 52 patients, although an increased serum GTP in two patients and positive urinary sugar in one patient were noted. The results of these studies indicate that MEPM is highly effective in the treatment of suppurative otitis media.

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Safety and efficacy of meropenem (MEPM) in the treatment of paranasal sinusitis were evaluated in a multicenter clinical study using a standard protocol. Sensitivity of bacterial isolates to MEPM and distribution of the drug into maxillary sinus mucosa, sinus secretion and ethmoid mucosa were aslo investigated. The MIC₈₀ of MEPM was 0.39μg/ml, comparable to IPM, and showed the most potent antibacterial activity of drugs tested on the 29 stains isolated from patients with paranasal sinusitis. MEPM concentrations in paranasal tissues after intravenous administration of 500mg of MEPM were 0.35-8.10μg/g in maxillary sinus mucosa, 0.47-6.29μg/ml in sinus secretion, 0.40-6.50μg/g in ethmoid mucosa and 1.71-68.1μg/ml in serum or plasma. A total 29 patients were evaluated by the Efficacy Assessment Committee. The clinical efficacy of MEPM was rated as excellent in 13 patient, good in 14, fair in one, and poor in one, with an overall efficacy rate of 93.1%. Physicianassessed clinical efficacy was rated as excellent in seven patients, good in 15, fair in six, and poor in one patients, with an overall efficacy rate of 7.59%. The pathogen eradication rate was 100% for cases (eradicated in 21 and replaced in 2 of 23 cases), and 100% for strains (eradicated in 30 and replaced in two of 32 strains). No side effects were observed although elevations of GOT and GPT in one patient, GPT in two patients, and GOT, GPT, ALP, and LDH in one patient were noted. The results of these studies indicate that MEPM is highly effective in the treatment of paranasal sinusitis.

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Safety and efficacy of meropenem (MEPM) for treatment of lacunar tonsillitis, peritonsillitis, peritonsillar abscess, and other infectious diseases of the upper aerodigestive tract were evaluated clinically, pharmacokinetically and bacrteriologically. At a concentrations of≤1.13μg/ml, MEPM completely inhibited growth of 56 strains of gram-positive bacteria isolated from the patients with tonsillitis. The inhibitory effect of MEPM on gram-negative bacteria was superior to imipenem, ceftazidime, cefoperazone, flomoxef, piperacillin and cefotiam. MEPM concentrations after intravenous administration at a dose of 0.5g were 0.35 to 2.85ug/g in the tonsillar tissues at 30 to 115 minutes, and 0.55 to 3.8μg/g in the submandibular salivary gland tissues at 30 to 140 minutes. Clinical efficacy of MEPM was evaluated in 86 patients. The physician-assessed efficacy rate, including both excellent and good responses, was rated at 96.6% (83/86), while that of the Efficacy Assessment Committee was 93.0% (80/86). All bacterial pathogens were eradicated except three strains isolated in patients with buccal phlegmon and lacunar tonsillitis. No side effects were observed in 91 cases evaluated, although serum transaminase was elevated in five cases, and eosinophila and neutropenia were each observed in one case. The results of these studies indicate that MEPM is highly effective in the treatment of patients with acute tonsillitis and upper aerodigestive tract infections.

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