This study was conducted on six patients with sudden deafness who visited our institute during the six year period between April 1996 and 2002, and who were diagnosed to have acoustic neurinoma. All of them complained of tinnitus, five of decreased hearing, one of obstruction sensation of the ear and one of vertigo. Five of them were hospitalized to undergo steroid therapy and PGE1 therapy. An initial audiogram showed a gradually sloping pattern in high-pitched sounds in one patient, a flat pattern in two and a notched pattern in three. As for the steroid therapy, one improved while four showed no benefit at all. Acoustic neurinoma at an early stage, measuring several millimeters in di ameter, is now detectable by improved MRI techniques. The incidence of acoustic neurinoma whose onset is sudden deafness has increased recently, now accounting for 40% of all acoustic neurinoma cases. In addition, to these six patients, we encountered three other patients with acoustic neurinoma who presented with slowly progressing perceptive deafness. Acoustic neurinoma tends to produce a notched hearing pattern more frequently than sudden hearing loss not associated with neurinoma.

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A case of extramedullary plasmacytoma (EMP) of the oropharynx in a 65-year-old female is herein reported. A physical examination revealed a mass lesion in the right soft palate with multiple swollen cervical lymph nodes. A biopsy of the right soft palate showed a proliferation of plasmacytoid round tumor cells having atypical round nuclei and eosinophilic cytoplasm. Im munohistochemically, there was no evidence of monoclonal immunoreactivity. A definite diagnosis of EMP was made based on the histopathological findings, and clinical laboratory findings showed that urinary Bence Jones Protein was positive. We herein describe a case with regional lymph node metas tasis, who showed resistance to radiotherapy. However, a good outcome was provided through the choice of effective chemotherapy. We conclude that in an operable case of EMP, surgery combined with radiotherapy treatment was found to be effective, while inoperable case should be treated using alternative chemotherapeutic regimens.

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Small cell carcinoma is a neoplasm commonly arising in the lungs. However, it rarely occurs in the larynx. We herein present a case of small cell carcinoma of the larynx occurring in a 54-year-old female. We initially performed a total laryngectomy, a thyroid lobectomy and neck dissection without a biopsy of the tumor. The surgical specimen revealed small cell carcinoma. Four months after the surgery, cervical metastases appeared and we performed a lymphadenectomy. Two months after the second operation, multiple bone metastases appeared. Despite the administration of chemotherapy, the patient died eleven months after the initial presentation. Before selecting the initial therapy, all la ryngeal carcinomas must be histopathologically diagnosed. In this case an autopsy was performed and the presence of both general lymph node metastases and distant metastases were confirmed.

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A 41-year-old male with an obstinate ulcer in the pharynx complicated by GERD is herein re ported. A diagnosis of an obstinate ulcer in the pharynx was made when the patient was 36 years old. This time some similar ulcers in the left pyriform fossa and the arytenoids were also found and they did not improve despite the drip infusion of steroids. Therefore, the patient was referred to our hospital. After another type of steroid therapy also proved to be ineffective, we suspected GER based on his symptoms. An RI examination revealed a strong gastroesophageal reflux. Thereafter, his symptoms and physical findings improved by PPI therapy. We consider that the patient had a slow recovery due to an obstinate ulcer in the pharynx which was complicated by GERD.

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We reviewed 31 patients with squamous cell carcinoma of the upper wall of the oropharynx who received treatment at Kurume University Hospital between 1971 and 2001. The five-year survival rate according to the TNM classification (UICC 1997) was 56% and the five-year control rate was 49% (stage I 50%, II 60%, III 80%, IV 0%). We performed a wide resection for advanced carcinomas and the postoperative swallowing function was found to be comparatively good. All 6 patients were able to east at least rice porridge and aspiration was only found in one patient when he drank water. We therefore consider that such a wide resection should be performed for stage II and III upper wall oropharyngeal carcinomas whenever possible.

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One of the disadvantages of using the microdebrider in sinus surgery is that histopathological specimens cannot be adequately taken. We conducted a histopathological examination in sinus sur gery using the microdebrider in 5 cases of chronic sinusitis with a nasal polyp, 1 case with nasal and paranasal sinus squamous cell papilloma, 1 case with maxillary sinus carcinoma, 1 case with nasal sep tum carcinoma and 1 case with adenoid vegetation. In all cases, the collected specimens were not de stroyed and therefore were able to be successfully used for accurate histopathological examinations.

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The literatures on the therapy with Japanese traditional herbal medicine (Kampo therapy) in otolaryngological diseases, which have been published over the past eight years (from 1995-2002) was summarized. The articles were abstracted regarding each respective disease. The cure results using Kampo therapy for major diseases such as: tinnitus, vertigo, allergic rhinitis, paranasal sinusitis, pharyngitis and pharyngeal global sensation were especially watched. It is worthy of note that the significant efficacy of Sho-seiryu-to in allergic rhinitis could be proved in a joint double blind trial in comparison with placebo.

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A flexible tube of 4.9mm in outer diameter and 2.6mm in inner diameter with the tip angle con trollable was newly produced as an instrument for fiberscopic laryngeal surgery. After the bilateral nasal cavities and the pharyngolarynx anesthetized locally, the flexible tube was inserted into the supraglottic space through a nasal cavity under video monitoring with a laryngeal fiberscope inserted through another nasal cavity. A forceps was pushed out from the flexible tube and approximated to a laryngeal lesion with controlling the tip angle and depth of insertion. The lesion was removed care fully with the forceps. Small polyps and epithelial hyperplasias of the vocal folds were easily removed using the tube. The voice was improved after surgery. The flexible tube was useful also in biopsy of the laryngeal tumors.

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An 18-year-old male of traumatic bilateral recurrent laryngeal nerve paralysis was reported. He received anterior cervical blunt injury accompanied with tracheal disconnection by motorcycle accident. Two months after the end-to-end anastomosis of the trachea, he presented our hospital with severe hoarse voice. Fiberscopic laryngeal observation showed bilateral vocal fold fixation at intermediate position. The vocal folds gradually altered their position from the intermediate to the median posi tions in the subsequent 7 months. He underwent laterofixation of the left vocal fold by Ejnell's method and retrieved laryngeal obstruction. The mechanism of the vocal fold shift was briefly dis cussed with literature review.

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Ten patients with unilateral vocal fold paralysis underwent arytenoid adduction under general an esthesia. Five of them additionally performed type I thyroplasty. We compared pre- and post-opera tive phonatory function of these ten patients in the aerodynamic examination and acoustic analysis. A combination of arytenoid adduction and type I thyroplasty was very effective for patients with se vere insufficient glottic closure. Arytenoid adduction, when performed under general anesthesia, can be easily and safely performed even by less experiented surgeons. And additional type I thyroplasty effectively improved hoarseness, in case that voice improvement was still not satisfactory after arytenoid adduction.

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A 18-year-old female suffered from hoarseness and dyspnea caused by a traffic accident. She un derwent endotracheal intubation and was extubated the next day. The symptom was emerged and la ryngeal stenosis and granulation were found by endoscopic examination, before she visited our hospital. The laryngofissure was performed and granulation and cicatrix were removed under general anesthesia. To keep subglottic space wide enough, we covered the glottal lumen with skin flap and placed a stent on the flap. A month later the stent was removed, then we observed the glottic condi tion for a year. There was no sign of restenosis, so we closed tracheostoma. The voice function has improved in both aerodynamics and acoustic parameters.

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Two cases of vocal fold cyst, which occupy the whole part of the intermembranous portion, were reported. The treatment for vocal fold cyst is a perfect extraction under the micro-surgery, the other side we sometimes experience difficult cases; impossibility of complete extractions or happening post operative troubles in spite of completes extraction. It was examined about the way of coping with such difficult cases. Since the risk that troubles happen is high rate in case of large cyst the surgeon is required more careful coping with vocal fold cysts.

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Ejnell's technique has been our first choice in therapy of bilateral vocal cord paralysis. However, some problems have been encountered with this technique during the experience of several cases. These problems and measures taken against them have been assessed. 1. Indication in cases with ad hesion or scar must be carefully decided because Ejnell's technique alone may not give enough glottic space. 2. Position and direction of the needle must be carefully decided before puncture to minimize trauma. 3. The endo-extralaryngeal needle carrier which enables puncture from within the larynx is effective in easy decision of suitable position. 4. A spacer is effective in fixation of the pulling thread. We have found a bio-ceramic button to be suitable as a spacer since the thin profile allows secure fixation of the thread with minimal discomfort, and being nonmetal does not interfere with CT or MRI scans.

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