The author previously reported that the distribution of K⁺ ions was observed to change in both cochlear tissue and the serum electrolytes after an injury to the inner ear. Therefore various cation, such as K⁺ ions are thus suggested to influence the dysfunctions of the cochlea. The treatment for tinnitus included neuron activating agents, electrolyte effectors and magnets. Although tinnitus with cochlear hearing loss can be controlled by electrolyte effectors alone, it is considered that a good condition can be both more effectively and longer maintained by the use of neuron activating agents. The author thus speculates that some abnomalities in the cell menbrane potential and neurontransmitters might therefore be one of the origins of sensorineural tinnitus.

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Some patients with Meniere's disease may have spells of intense unilateral earache at certain stages during the course of the disease. During an otoscopic examination, no dolorific abnormalities are noted in the drum membrane or the external auditory meatus. Such patients characteristically feel a sensation of pain in the sternocleidomastoid muscle when the muscle is picked up between the index finger and the thumb of the examiner. There were 12 patients with earache attacks encountered by us during a 2month period beginning in April 1994. The episodes occurred during the period of a vertiginous attack in 7 and during an attack-free interval in 5 of these patients. Concerning the etiology of the otalgia, it is postulated that when fatigue continues to mount in the patient, this culminates in the excitement of the inner ear and eventually results in vestibulospinal hyperreflexia, which gives rise to tenderness of the sternocleidomastoid muscle, among the other muscles involved. Rest and oral steroid treatment is the recommended treatment for this symptom. If these measures fail to provide an adequate relief of pain, then an injection of a mixture of corticosteroid and procaine hydrochloride directly into the sternocleidomastoid muscle should certainly prove effective in alleviating the pain.

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A median fistula with a cyst on the roof of the nose is reported in a 2-year-old boy. In this case, the cyst was found to extend to the anterior skull base dura. The fistula and cyst were totally removed under a microscope and the use of ear surgery instruments proved to be effective. A dermoid cyst was verified by a pathological examination. Cases of median fistula on the roof of the nose should be carefully operated on, especially in the case of children, because in such cases there is a highry possibility that the cyst could extend to the skull base. The CT and MR findings are also considered to be extremely Valuable in the diagnosis of such cases.

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Ewing's sarcoma of the maxilla is known to be a rare primary malignant bone tumor. We report a 62-year-old male who presented with Ewing's sarcoma of the left maxilla. In this case, glycogen particles in the cytoplasm of the tumor cell, which is one of the characteristic findings of Ewing's sarcoma, were histologically assessed by PAS reaction. The patient, who received both radiation therapy and multiple-drug chemotherapy (VACA therapy), is still alive with no evidence of metastasis one and a half years after the initial presentation of the tumor.

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A 48-year-old female developed posterior glottic adhesion due to endotracheal intubation for 7days. After an observation of one and a half years, the adhesion changed into a glottic interarytenoid adhesion and was dissected by laryngomicrosurgery. The postoperative course was satisfactory and no further adhesion has since been noticed. After reviewing the cases of vocal adhesion in the Japanese literature, we were able to find a total of 16 cases including our own, but there was no case similar to our patient in which the type of adhesion changed from posterior glottic adhesion into glottic interarytenoid adhesion. The cause, classification and the treatment of vocal cord adhesion are also discussed along with the presentation of the cases.

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A 28-year-old man underwent a resection of a mass on his left anterior neck. The histopathological findings revealed the tumor to be fibromatosis. Nine months later, local recurrence occurred in the same region. After an embolization of the feeding artery, we performed a total resection of the tumor together with a partial resection of the clavicula. The histopathological findings revealed the tumor to be an extra-abdominal desmoid tumor. A total dosage of 50Gy Linac irradiation was given as adjuvant therapy. Extra-abdominal desmoid tumors tend to invade the surrounding tissue and recur locally. A differential diagnosis with fibrosarcoma is also considered to be essential. A total removal of the tumor is the recommended treatment of choice.

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A 60-year-old female, who had consistently presented with the chief complaint of postnasal drip and cough over the last several decades, was diagnosed to have sinobronchitis. A combination of long term Roxithromycin (RXM) treatment and YAMIK sinus catheter therapy after an endonasal operation using the contact Nd/YAG Laser at an out-patient clinic proved to be quite effective in reducing her complaints. In addition, the abnormal shadows seen on an X-ray of the paranasal sinuses and chest also disappeared. This treatment is thus suggested to be a new therapeutic modality for sinusitis in an out-patient clinic.

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The clinical effects of an Erythromycin derivative, Clarithromycin was investigated in 20 patients with chronic sinusitis.
1) The efficiency rates of the subjective symptoms were estimated to be 85% for nasal obstruction, rhinorrhea, postnasal drip and 95% for headache.
2) The improvement rates of the objective signs were estimated to be 90% for nasal mucosal swelling and quality rhinorrhea, 85% for decreased nasal discharge, and 100% for nasal polyp.
3) Follow-up X-rays showed an improved opacity of the maxillo-ethomoid sinuses in 85%.
4) No significant side effects were noted throughout the therapy.
5) Clarithromycin chemotherapy was therefore concluded to be very useful in the treatment of chronic sinusitis.

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We attempted to meaure the minimum sensory threshold for air pressure change in normal ea rs (n=204) by loading air pressure on the auditory canal and the obtained 60% feeling of fullness was considered to be similar to the induced air pressure sensation in the hearing organ based on the findings of a questionnaire given to patients demonstrating ear symptoms of a feeling a fullness. We obtained a nearly±60mmH₂O threshold. Next, we tried to measure the threshold in abnormal ears (n=59), in cases of sensorineural hearing loss (n=40) and diseases of the middle ear (n=19). It was thus recognized that the threshold from the ear with a feeling of fullness was elevated as compared to that of the ear without such a feeling, and the threshold did not correlate with hearing loss, tinnitus or autophony. These findings thus suggest that a minimum sensory threshold for air pressure change could therefore be applicable to an objective estimation of a feeling of fullness in the ear.

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Pharmacokinetic and clinical studies were carried out to evaluate the effectiveness and safety of azithromycin (AZM) for the treatment of otorhinolaryngological infections. The results were as follows: The distribution of AZM to both the humor and tissue was good, in Particular, in the tympanium mucosa, tonsils, maxillary sinus mucosa, ethmodial sinus mucosa and submandibular gland. In addition, these tissue concentrations were also maintained for a long period of time. AZM was orally administered to 180 patients, and most received 250 mg or 500 mg daily for 3 days. The clinical efficacy rates, evaluated in 139 patients, were 73% for otitis media, 77% for sinusitis, 79% for tonsillitis and 74% for pharyngolaryngitis, with an overall efficacy rate of 76%. The bacteriological efficacy rates were, based on the eradication rete, 90% for monobacterial infections caused by Gram-positive organisms, 89% for monobacterial infections caused by Gram-negative orgamisms and 77% for polybacterial infections, while the overall eradication rate was 85%. Side effects were observed in 1 patient (1%) out of 170 patients, while clinical laboratory abnormalities were observed in 8 patients (6%) out of 131 patients who underwent clinical laboratory tests after treatment. Based on the above results, AZM was found to be highly useful for the treatnment of various otorhinolaryngological infections such as otitis media, sinusitis, tonsillitis and pharyngoloryngitis.

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