A case of otogenic intracranial complication is herein reported. A 56-year-old housewife complained of headache, fever and right ear pain. In her right ear a 65dBHL conductive hearing loss and a retraction of the attic without a cholesteatoma matrix were detected. No facial nerve palsy or vertigo was observed. A CT scan and MM revealed a brain abscess in the right temporal lobe and cholesteatoma in the right middle ear. After the administration of broad spectrum antibiotics, tympanomastoid sugery was perfomed. The brain abscess decreased in size after combined therapy including the removal of the cholesteatoma, as the infectious source, and conservative treatment with Rifampicin for 9 weeks without neurocraninal surgery. The widespread use of antibiotics has resulted in otogenic intracranial complications becoming an increasingly rare disease, however, some studies have recently reported a slight increase in cholesteatomas as primary lesions and brain abscesses in such intracranial complications. Some investigators have also reported that when a brain abscess is small and the neurological conditions have not deteriorated, then surgical treatment may not always be necessary. It seems that the satisfactory clinical course in this case was due to the fact that the abscess was small in size and the neurologic state was relatively well preserved.

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Maintaining an upright posture requires the adequate functioning of an individual's vision, labyrinth, proprioception and plantar mechanosensors. We previously reported that the labyrinth and the plantar mechanosensors mainly monitor the area while proprioception mainly monitors the length of the body sway. Stabilometry was performed on 58 patients (101 times) with either unilaterally severe or complete canal paresis. Both the area and the total locus length of the body sway were evaluated. A strong and significantly linear correlation was observed between the area and the length. In patients with labyrinthine disorders, our results showed that the area increases more that the length in comparison to disorders of proprioception. These findings were similar to those of previous studies of bilateral cases and thus suggest that the labyrinth is the main monitor of the area of body sway. The compensated labyrinthine disorders tend to increase the length per area. When labyrinthine disorders are sufficiently compensated, then the body moves fine and fast to maintain an upright posture.

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Psychogenic hearing loss is the best known disease among all known psychogenic diseases in the field of otorhinolaryngology. This condition is considered to be difficult to diagnose at its initial presentation and it is commonly misdiagnosed as other organic diseases. We encountered two cases of psychogenic hearing loss which were misdiagnosed as cochlear otosclerosis and extra lymph fistula. Moreover, we analyzed the findings of 20 cases of psychogenic hearing loss that were detected between 1993 and 1998 in our institution. The subjects consisted of 5 males and 15 females. In 12 cases, hearing loss occurred in the bilateral ears, while in 8 cases, it occurred in one ear. We found that symptoms such as tinnitus or otalgia excluding hearing loss commonly occurred in patients with hearing loss in one ear and that these subjects visited the hospital sooner after onset than other patients. To accurately diagnose psychogenic hearing loss, objective audiometry must be employed. In such cases, the stapedius muscle reflex is very useful because it is a simple noninvasive technique. Psychogenic hearing loss may occur more frequently in the future due to changes in modern society, school and the surrounding environment.

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Hange-bakujyutsu-tenma-to, a traditional Chinese herbal (kampo) medicine, was administered at 7.5g per day for 8 weeks to 21 patients with dizziness except for those with Meniere's disease, BPPV (benign paroxysmal positional vertigo), and vestibular neuritis, and the clinical effects were studied. After 8 weeks of treatment, 21.1% of the patients showed an improvement in the index of dizziness, 16.7% of the patients demonstrated an improvement in the subjective symptoms, and 33.3% of the patients showed an improvement in the objective symptoms related with dizziness. As a result, Hange-bakujyutsu-tenma-to was found to be useful in 42.1% of all patients. In addition, no side effects were observed in this study. These results indicate that Hange-bakujyutsu-tenma-to is therefore considered to be a useful medicine for the treatment of patients with dizziness and other related symptoms while also demonstrating no severe side effects.

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Mucosa-associated lymphoid tissue (MALT) lymphoma in the head and neck region, such as in the salivaly glands, thyroid gland and orbit, is relatively rare. We herein report a 66-year-old female case of MALT lymphoma arising from the bilateral superficial parotid glands. An MRI scan demonstrated well- defined lobulated masses in the bilateral superficial parotid glands. A left superficial parotidectomy was performed. The pathologis and immunohistochemical findings were consistent with MALT lymphoma. After surgery, radiotherapy was administered to the bilateral parotid glands at a total dose of 46Gy. In addition to the radiotherapy, one cycle of Cyclophosphamide, Pirarubicin, Vincristine and Methyl- prednisolone chemotherapy was performed. There has been no evidence of recurrence up to now. The prognosis of localized MALT lymphoma is usually favorable if the tumor can be treated with surgery and or radiotherapy. However, such cases require a careful follow-up.

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Fifty-five cases who noticed recurrent parotid swelling visited our hospital for about 2 years. We investigated the difference between a young group (under 20 years of age) and an adult group (over 20 years of age). The young group consisted of 16 cases while the adult group comprised 39 cases and thus the adult group showed a frequency which was more than twice that of the young group. It also occurred more frequently in males in the young group, but on the other hand it ocurred overwhelmingly more frequently in females in the adult group. Infantile recurrent parotitis was the most frequent disease in the young group, while 3 other diseases were also recognized. In contrast, chronic sialadenitis with a multiple dilation of the duct was the most frequent disease in the adult group, while Sjogren's syndrome, including a subclinical type, was the second most frequent disease. In addition, 5 other diseases were also recognized in the adult group. The diagnosis of recurrent parotid swelling should first be made after taking a detailed history and various examinations are also needed for the differential diagnosis. We recommend an examination of eosinophils in the saliva since it is very easy to perform and very effective for diagnosing parotitis.

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The diagnosis and treatment of traumatic facial palsy is considered to be difficult because of the severity of the trauma and the severity of associated complications. In this study, a retrospective review of 33 cases of traumatic facial palsy, including 25 temporal bone fractures, were evaluated. A loss of consciousness occurred in 26 of 33 cases (78.8%). A loss of consciousness of more than 1 day occurred in 10 of 33 cases (30.3%). In most cases, facial palsy was detected by either a doctor or family member. The onset of palsy, a loss of consciousness and the severity of palsy were major influential factors in the prognosis of facial palsy. We performed decompression surgery in 6 of 33 cases who showed denervation signs. All cases underwent decompression surgery within 8 days after the onset of the palsy. The recovery level was evaluated based on the 40-point method. All cases had a good prognosis for facial movements with a minimum score of 30 points. In this study, we confirmed that the early exploration of the facial nerve in severe cases helped lead to a favorable recovery of the facial nerve.

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The study of the human mucociliary transportation rate (NMTR) was investigated in 140 healthy subjects. We used macromolecular substance 113m/n-DTPA as a tracer and the Picker-3 Type method (USA) in combination with radiographs. 1. The mean NMTR of 140 normal Chinese individuals (from 5-82 years of age) was 8.1±3.1mm/min. 2. There were marked age-related differences in the NMTR of normals individuals. The groups between 11 and 40 years of age showed the highest rate, followed by the 2 groups aged 5-10 and 41-50 years, respectively, and those aged 51-82 years exhibited the lowest rate. 3. No sexual difference in the NMTR was detected.

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Alginic acid is a naturally occurring substance which may be extracted from brown seaweed. Calcium alginate, when placed in contact with a wound surface, acts hemostatically by providing calcium ions which are necessary for clotting and also for stimulating platelet activation. The usefulness of using a tamponade with calcium alginate fiber after endonasal operations was evaluated in clinical trials. Good results were obtained with little pain or bleeding on extraction. Calcium alginate tampons were thus found to be more useful than conventional gauze tampons regarding insertability and extractability.

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A 17-year-old male visited our hospital for the treatment of severe laryngeal trauma cased by a traffic accident. The thyroid cartilage was cut at the midline. The vocal folds had completely disappeared, and the opening and closing function of the glottis was not observed. There was a fistula in the larynx towards the esophagus. In order to repair the framework of the larynx, a trough was made under the laryngofissure, which was closed using cartilage from the nasal septum. To enlarge the framework, a transplantation of the rib cartilage onto the anterior wall of the larynx was also added. To reconstruct the inner space of the larynx, the esophageal fistula was closed and a portion of the lip mucosa was transplanted after removing the granulation. Consequently, the glottis was formed by the false vocal folds that were so soft that the mucosa was pulled medially into the glottis during inspiration, thus resulting in dyspnea during sleep. Vaporization of the left false vocal fold using a CO2 laser made the glottis wide enough for respiration, and the tracheostoma could thus be closed 6 years after the first consultation.

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A 51-year-old male suffered from bloody sputum and dyspnea after a traffic accident. Although emergency oro-tracheal intubation was carried, he symptoms became exacerbated. Finally, he was sent to our clinic. A CT scan revealed fractures of the thyroid cartilage and emphysema in the subcutaneous and mediastinal regions. An inferior tracheotomy was performed and general anesthesia was introduced to reduce the displaced bone fragments. The laryngeal lumen was completely separated between the true and false vocal cords, and the left pyriform sinus and the posterior wall of the hypopharynx were also completely separated. These wounds were primarily sutured. The tracheostoma was closes 46 days after the operation. Approximately one year after the operation, even though a mild degree of hoarseness persisted, the patient had no difficulty in swallowing. The uneventful course of this patient suggested that the immediate reconstruction of the soft tissue and fractured bone, when possible, is a key to restoring the laryngeal functions when treating laryngeal trauma patients.

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A 41-year-old male underwent emergent tracheostomy due to seizure attack with prolonged consciousness loss. Two months after the closure of tracheostoma, he complained of dyspnea. Bilateral vocal fold fixation was diagnosed and tracheostomy was performed again. Because a decanulation was not achieved due to sustained dyspnea, several kinds of abductor operations for the vocal fold were carried out resulting in unsuccessful outcomes. CT examination demonstrated an extended stenosis of the airway in both glottic and subglottic region, and a cartilaginous defect at the middle of the cricoid arch. These findings suggested that laryngeal perichondritis and subsequent scar tissue formation as complications of tracheostomy were etiologic causes of persisting dyspnea. We performed planned staged operations consisting of 1) widening of the framework of the larynx and proximal trachea, 2) eradication of granulation and scar tissue, and 3) making mucosal deficit region epithelize. Consequently, the series of treatment gave him a relief from dyspnea and the tracheostoma was successfully closed. His clinical course has been uneventful for 4 months after the last operation.

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From 1985 to 1988, 12 patients with tracheal defect due to various reasons had undergone the implantation of a specially-designed hydroxyapatite block in their anterior neck for the reconstruction of trachea. Questionnaire survey with the use of calling was performed to know the long-term outcome of this surgical treatment and some cases underwent the scrutinization of their airway with the use of CT imaging. Of the twelve patients, one patient died of intercurrent disease 4 months after the operation. Although two cases spontaneously extruded the hydroxyapatite block after the implantation, nine cases had suffered from no dyspnea since that reconstruction of trachea with the use of hydroxyapatite block. In 4 cases of the 9 their airway was confirmed to be tightly holded by the implanted block. The implantation of hydroxypapatite has been reported to be a safe and established technique in other fields. However, since the implanted hydroxyapatite block may be extruded spontaneously, the strict follow-up is definitely required for the implanted patients.

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The results of functional surgery in unilateral recurrent laryngeal paralysis were evaluated in thirty- seven cases in our clinic. Our surgical technique and cases are as follows: an intracordal injection through the percutaneous area in fourteen patients, and type I thyroplasty in eighteen patients. As a result, the maximum phonation time (MPT) and air flow rate (AFR) both improved in a similar fashion after both procedures except for two cases. The reason for the treatment failure in these two cases was due to the fact that one case had senile dementia while the other case had inadequate phonation with congenital unilateral vocal cord paralysis. The results regarding voice quality were more satisfactory than for other treatments. these findings suggest that our indications and treatment methods were both satisfactory.

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A silicon prosthesis was extruded into the airway 7 months after thyroplasty type I surgery in a 51-year- old male patient with unilateral vocal fold paralysis. Granuloma came out on the paralyzed vocal fold after prosthesis extrusion and disappeared with no treatment. Arytenoid adduction surgery was performed to improve hoarse voice caused by glottal incompetence. To avoid prosthesis extrusion after thyroplasty type I: 1) position of the fenestration on the thyroid ala 2) size, shape and material of the inserted prosthesis 3) preservation of the cartilage or inner perichondrial membrane should be paid attention to.

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We reported two cases of unilateral vocal cord paralysis with recovery of vocal cord mobility after surgery of thyroplasty type 1. Both cases had normal voice and showed almost normal movement of the vocal cords in the state of a silicon block inserted into the position lateral to the vocal cord. The advantages of thyroplasty type 1 has been insisted to be simplicity and reversibility of technique. In addition, it was revealed that the silicon block do not restrict the vocal cord movement after recovery from the paralysis.

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