A 39-year-old welder presented with various ear symptoms after a piece of molten metal flew into his right ear. Immediately after the accident, he experienced vertigo, hearing loss and dysgeusia. After otorrhea persisted for several days, right facial dullness and transient slight facial palsy oc- curred. Computed tomography revealed a round high density foreign body in the anterior epitympanum. The slag was surgically removed and the tympanic membrane perforation was closed using the tympanoplasty II c procedure. The symptoms of transient facial palsy were considered to be the result of inflammation against the slag which affected the horizontal facial canal. A foreign body in the middle ear should thus be included in the differential diagnosis, even though it is a rare occurrence, when a patient with traumatic tympanic membrane perforation with various symptoms is encountered.

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The relationship between tinnitus, vertigo and hyperlipidemia was investigated in 124 tinnitus patients and 29 vertigo patients with hyperlipidemia. Hyperlipidemia was successfully treated in 109 tinnitus patients and 23 of the vertigo patients. Both an improvement in the symptoms and a reduction in the serum lipid were seen in 57 tinnitus and 11 vertigo patients. In the tinnitus patients, a decrease in the serum triglyceride (TG) level was found to be significantly related with the reduction in tinnitus. In the vertigo patients, a reduction in the serum total cholesterol (T-CHOL) was found to be related to an improvement in the vertigious attack. The reduction of phospholipids did not apparently improve the symptoms of tinnitus or vertigo. It appeared that the difference in the lipid levels between the tinnitus and vertigo patients was due to the following mechanism: An elevation of the T-CHOL levels might decrease due to the microcirculation of the brain stem which plays and important role in vestibular compensation. In contrast, higher levels of TG probably directly affected the inner ears regarding hair cells or stria vascularis. We therefore consider that careful examinations and the appropriate treatment of hyperlipidemia are beneficial in the treatment of some tinnitus or vertigo patients.

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A female with dyspnea due to Reinke's edema was treated at our hospital. Her dyspnea did not improve after treatment with drip infusion containing steroids at a previous clinic. At the first examination in our hospital, a tracheotomy under local anesthesia successfully kept her airway open. To improve voice disorders, the vocal cord mucosa was preserved as far as possible by the administration of anti-inflammatory drugs. Later, laryngomicrosugery successfully improved the symptoms of both vocal cord edema and hoarseness. In this case, stenosis of the posterior glottis (considered to be respiratory glottis) due to a giant vocal cord polyp with Reinke's edema and arytenoids swelling were thought to be the cause of preoperative dyspnea.

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Most cases of adult T-cell leukemia (ATL) tend to be diagnosed in internal medicine and dermatology departments because they usually demonstrate lymphoadenopathy and skin rash. The association of local mass lesions in the larynx with ATL is rare. We report the case, of an 82-year-old man who complained of hoarseness with laryngeal ATL. Initially, laryngeal carcinoma was suspected, however, the tumor was pathologically found to be malignant lymphoma. In spite of undergoing intensive chemotherapy (THP-COP), his larynx did not improve. ATL is caused by Human T cell Leukemia Virus, type I (HTLV-I), HTLV-I was found in his serum. The patient showed a good response to the therapy and the tumor in the larynx also gradually disappeared. This case indicates that ATL should therefore be kept in mind when making a differential diagnosis for laryngeal carcinoma.

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Allergic parotitis is rare in cases of recurrent swelling of the parotid gland. We report an extremely rare case of allergic parotitis caused by pollinosis. The patient was a 38-year-old female whose chief complaint was swelling of the left parotid gland soon after experiencing a nasal obstruction due to pollinosis. A lot of eosinophils were observed in the purulent saliva from the left parotid gland. A radio-allergo sorbent test (RAST) showed a positive finding for Japanese cedar, Japanese cypress and ragweed. Sialography of the parotid gland showed a severely dilated Stenon's duct. The patient was treated with anti-allergic medicine and there has been no evidence of recurrence for 4 years. We consider that allergic parotitis may occur due to a reflux of the allergens to the parotid gland through a dilated Stenon's duct. The fact that swelling of the parotid gland occurred soon after the nasal obstruction in this patient suggests that the allergens inhaled by the mouth first collected in the mouth and thereafter refluxed to the parotid gland through the dilated duct, thus resulting in parotitis.

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Epithelial-myoepithelial carcinomas comprise less than 1 percent of all salivary gland neoplasms, and are considered to be low grade malignant tumors. A 74-year-old female was brought to our de- partment with the chief complaint of recurrent swelling in the left parotid gland and facial nerve pa- ralysis despite undergoing several operations. We performed a total parotidectomy with immediate facial nerve grafting using the sural nerve followed by irradiation therapy of 60Gy. A postoperative histopathological examination revealed epithelial-myoepithelial carcinoma characteristically demon- strating a two layer arrangement of tumor cells. There has been no evidence of local recurrence nor distant metastasis for more than 3 years after performing surgery on this patient. As this carcinoma has a high recurrence rate and may result in distant metastasis even with a low grade malignancy, it is necessary to perform a radical surgical resection and follow up the patients for a long period of time.

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Thirty-seven patients with hypopharyngeal carcinoma underwent a pharyngolaryngoesophagectomy at our clinic between 1985 and 1997. Of these 37 cases, 17 died from the primary cancer. Among these 17 deaths, 6 died from local recurrence and 4 died from distant metastasis. The five-year cumulative survival rate was 46.6%. No relationship was found between the pathological effect of preoperative treatment and the prognosis. The prognosis of the patients with cervical lymphnode metastasis was poor. Controlling neck and distant metastasis was thus found to be the most important factor for improving the prognosis after a pharyngolaryngoesophagectomy.

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Adenosine triphosphate (ATP) dissociation poorly in damaged hair cells because a decrease in intracellular proton (H⁺) generation causes an inactivation of the Na⁺ pump. A subsequent increase in the intracellular potential (a decrease in the electrochemical gradient between extracellular and intracellular fluids) is considered to be the cause of cochlear tinnitus. Not only the repair of damaged hair cells but also ATP dissociation due to H⁺ generation is important for a successful treatment of tinnitus. Based on this hypothesis, we measured the H+ generation (the decrease in pH) in both extracellular and intracellular fluid models (analogues) after the addition of 3 anti-tinnitus drugs. *1 The experimental results were: 1) Although there was a decrease in pH (H⁺ generation) in the intracellular fluid model, there was hardly any H⁺ generation in the extracellular fluid model. From this we can conclude that when the Na+ level is low,(Na⁺: K⁺ ratio) H⁺ is generated, but on the other hand when Na⁺ level is high, H+ is hardly generated at all. 2) No correlation was found with the addition and H⁺ generation of the glycometabolic hormone, vitamin B complex and ATP. Three hypermetabolic drugs*2 were effective in 69.6% of the tinnitus cases after 2 to 8 weeks of clinical use, probably due to drug-induced cell regeneration, H⁺ generation, and an improvement in the intracellular potential. If Na⁺ osmosis in hair cells is a cause of cochlear tinnitus, then it is considered to be a secondary cause. We conclude that the magnitute of the H⁺ movement energy or H⁺ generation is therefore the most important cause for the restraint of tinnitus. *1 adenosine triphosphate (ATP), vitamin B complex (B₁, B₆, B₁₂) and Betamethasone (Rinderon) *2 a drip intravenous injection of the 3 hypermetabolic drugs was administered with 5 to 6 drops of co-ferment I (Nyclin (®)

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