A case of AIDS (Acquired immunodeficiency syndrome) diagnosed incorrectly as an abnormal feeling in the pharynx and larynx is reported. A 50-year-old male visited our training hospital complaining of a slight cough on July 18, 1992, after he had already received medical treatment in a private ENT clinic as well as at ENT and internal medicine departments of a public general hospital for two months. On examination no organic lesions could be found. Under diagnosis of an abnormal feeling in the pharynx and allergic larygitis, conservative therapy using anti-allergic drugs and inhalation treatment was initiated and succeeded in reducing his complaints for a while. However, after developing slight swallowing pain, he consulted us again on October 6. On a laryngeal mirror examination a small white mass, which looked like partially digested food, was seen in the left piriform sinus. Fluoroscopy demonstrated irregular saw-like and shaggy patterns all over the esophageal mucosa. Numerous marked reddish and erosive lesions covered with many white fungi were endoscopically observed in the esophagus. The pathological diagnosis was the esophageal candidiasis. No distinct cause for such moniliasis was detected regarding his overall general condition. The patient was therefore examined for a possible immunodeficiency. As a result, both HIV antibody and a decrease in CD 4 cells (125/mm³) indicated the presence of AIDS.

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In order to apply the newly developed anti-fungal agent to ototmycosis, the ototoxicity of lanoconazole (ASTAT solution) was investigated using electron microscopy. The intratympanic injection of 2 and 1% lanoconazole in solvent as well as solvent alone caused a scattered loss of sensory hairs in the organ Corti as well as in the vestibular end organs of the guinea pig. This degeneration was most marked 24 hrs after the last injection but slightly recovered after 7 days. The loss of sensory hairs was a characteristic finding due to the vulnerability of the sensory hairs induced by ethanol which was used as the solvent. Lanoconazole itself may thus be regarded as nonototoxic. Since the application of lanoconazole as an ear drop has revealed no ototoxicity, lanoconazole may thus be applied as an effective drug for the treatment of otomycosis without causing any tympanic membrane perforation.

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A questionnaire survey on the present state of Kampo diagnosis (Sho) was made based on the findings obtained from 25 doctors. The vast majority of responders agreed with the importance of Sho. However, the number of doctors practicing Sho has decreased due to their busy schedules. Among the four methods of diagnosis (questioning, inspection, listening and palptiation), the inspection of the nasal mucosa findings is considered to be unique for otolaryngological clinics. Among the five indexes of diagnosis, the index of asthenia or robust constitution is the most widely adopted, followed by the index of the relativity of the disease conditions. Sho is difficult for most doctors to perform, especially for beginners who have been educated by Western Medicine alone because the systems of oriental and occidental medicine are so fundamentally different. However it is considered important to study Sho in order to correctly practice Kampo medicine.

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An infection of the palatine tonsil by actinomycosis is not so rare because Actinomyces is one of the common indigenous bacteria. However, the cause of a cervical granulomatous lesion has rarely been shown to be due to tonsillar actinomycosis. In this report a case of tonsillar actinomycosis, which is considered to be related to cervical granuloma, is reported. A 25-year-old woman presented with right upper neck painless swelling and torticollis. After antibiotic treatment for one month with no change in the tumor size, the tumor was finally extirpated. The tumor was histologically composed of a non-specific inflammatory granulomatous lesion and neoplastic changes were ruled out. The patient also underwent such examinations as an upper GI series, chest and abdominal CT scanning, an echoexam, a gynecological check, a dental exam and serological study for viral infections, but she had no obvious lesions which were related to the granulous changes in her neck except for severe habitual angina or chronic tonsillitis. Soon after the operation, her symptoms resolved and she was discharged. However, two months later, she suffered from severe tonsillitis again, and she thus decided to undergo a bilateral tonsillectomy to avoid a recurrence of the neck swelling. She was operated on three months after her first visit. Unexpectedly, an examination of her extirpated tonsil revealed an actinomycosis infection beneath the mucosal suface. Since the operation, she has not again suffered from either severe angina or neck swelling. We thus concluded that her tonsillitis was connected to the actinomycosis infection, however, the intractable severe granulous lesion located on the side of her neck was not thought to derive from this infection since the granuloma histopathologically proved to contain some epithelial elements.

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Recently laryngeal tuberculosis has become a rare disease due to the advances of anti-tuberculous chemotherapy and improved sanitary conditions. However, sporadic occurrences of laryngeal tuberculosis have been reported and care should thus be taken when making such a diagnosis because laryngeal tuberculosis is often confused with laryngeal tumors. In this paper, a case of laryngeal tuberculosis is reported. The patient was a 72-year-old male. He had previously suffered from pulmonary tuberculosis 50 years earlier which had been successfully treated. He had also been on steroid inhalation treatment for bronchial asthma for the past 8 years. Diffuse granulomatous lesions appeared on his left glottis and supraglottic space. To rule out laryngeal carcinoma, a biopsy was performed. The specimens showed mild dysplasia and necrosis without any typical pathologic findings of tuberculosis. The final diagnosis was obtained from acid-fast staining. Mycobacterium tuberculosis were cultured from sputum after 4 months. A relapse of tuberculosis was thus suspected due to laryngeal local immunosuppression caused by the steroid inhalation treatment. Steroid inhalation therapy should thus not be prescribed for bronchial asthmic patients with a previous history of pulmonary tuberculosis. It is thus important to check for laryngeal tuberculosis in any patients who have a previous occurrence of tuberculosis since such patients may demonstrate atypical graulomatous lesions in the larynx during steroid inhalation therapy.

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A 57-year-old famale presented with a prolonged cough and pharyngeal pain of about 2 months duration. No abnormality was observed in the nose, oropharynx and supraglottic space, but a radiological examination showed tracheal stenosis and an abnormal mass in the paratracheal space. She was thus diagnosed to have squamous cell carcinoma by a biopsy carried out simultaneously with a tracheostomy. After preoperative irradiation, surgical study revealed not only tracheal carcinoma but also papillary carcinoma of the thyroid. Tracheal carcinoma is regarded as uncommon and is also difficult to diagnose and treat. Recent reports have, however, indicated an improved prognosis thanks to advances in laser operations and a combination of irradiation and surgery.

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Emphysema in the region of the eye may be divided into the following three types: 1) emphysema of the lids (palpebral emphysema), 2) orbital emphysema, and 3) a combination of 1 and 2. In addition, palpebral emphysema is also very rare. Almost all such cases of emphysema have a history of antecedent trauma. We herein report a case of palpebral emphysema with no history of trauma. A 46-year-old female presented to our otolaryngology department with a chief complaint of swelling in the right eyelid. On blowing her nose, her eyelids tended to swell while nasal bleeding was also associated. She apparently had no history of trauma to the head or neck. A CT scan of the orbit revealed the presence of air in the front of the right tarso-orbital fascia.

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A report concerning a 16-years-old girl with school phobia who presented complaining of involunatary tongue thrust. She was an overachiever in school because of a familial problem. We diagnosed her attack to be the result of neurosis, and introduced her to a psychatrist. This case indicated that ENT doctors should thus also be aware of such patients presenting with school phobia related symptoms.

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The optimal dosage of TMK-688 for the treatment of perennial allergic rhinitis was investigated in a double-blind manner. Regarding the final overall improvement rating, 66%, 35% and 44% of the patients either moderately or markedly improved at doses of 10mg/day, 20mg/day and 40mg/day, respectively. As a result, a significant difference was found between the 10mg/day and the 20mg/day groups. The rates of paients exhibiting no adverse reactions were also 85% (10mg/day), 89% (20mg/day) and 86% (40mg/day). In addition, no significant difference was observed regarding the overall safety among the three groups. Five patients in each of the 20mg/day and 40mg/day groups had dermal adverse symptoms. Seven in the 10mg/day, two in the 20mg/day and one in the 40mg/day group exhibited gastrointestinal adverse symptoms. These symptoms all improved and disappeared after the discontinuation of TMK-688. Hypnesthesia was observed in only one patient each in both the 10mg/day and 40mg/day groups. The above findings indicated TMK-688 to be a highly useful drug with a lower incidence of hypnesthesia than that frequently caused by antihistamic agents. Further investigations are thus called for at doses of 10mg/day and lower since the optimal dose of TMK-688 could not be clearly elucidated in this trial.

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An attempt was made to clarify the optimal dosage of TMK-688 in the treatment of perennial allergic rhinitis based on a double-blind study. In the final overall improvement rating, the administration of doses of 2.5mg/day, 5mg/day and 10mg/day resulted in a “moderate and marked improvement” in 40%, 46% and 42% of the patients, respectively. No adverse reactions occurred in 96% (2.5mg/day), 96% (5mg/day) or 90% (10mg/day) of the patients. In addition, no significant difference was observed regarding the overall safety among the three groups. Five mg/day was found to be the optimal dose of TMK-688 since its overall improvement rating and overall safety were revealed to be superior to those at other doses. However when we analyzed the patients whose compliance was 90% or more and who had no acute upper respiatory tract infection, concomitant drugs or concomitant treatment, 41%, 46% and 53% of the patients improved moderately or more in the 2.5mg/day, 5mg/day and 10mg/day groups, respectively. The 10mg/day group showed the highest improvement rate among the three groups and its improvement rating was similar to that in our previous dose establishing study using 10, 20 and 40mg/day. Thus further trial comparing 5mg/ day with 10mg/day is still called for to clarify in the patients with good compliance, without acute infection and concomitant drug which dose is indeed better.

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