A 45-year-old man who had been treated with propylthiouracil (PTU) for Basedow's disease presented with sudden deafness on his left ear. Since he had suffered from sudden deafness in his right ear for 7 months, he thus noticed bilateral hearing loss, and thereafter was admitted to our hospital. A urinalysis revealed hematuria and proteinuria on his first visit. He thereafter showed fever and arthritis in the course of the treatment, and we therefore thought that microscopic polyangitis by PTU may have occurred. After discontinuing PTU treatment, the hearing loss and other problems improved while, inaddition, the high levels of Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) returned to normal values. It is generally know that microscopic polyangitis sometimes occurs as a side effect of PTU treatment, and various symptoms can thus be induced. Sudden deafness, like that observed in this patient, correlated with the findings on similar patients published in other otological studies.

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We experienced a case of nasopharyngeal angiofibroma. A 43-year-old male who had been diagnosed to have fibroma of the maxillary sinus and had been operated on 22 years previously. Unfortunately, the tumor recurred and he thus visited our hospital. Both angiography and computed tomography were performed and he was again operated on. We could not resect the tumor totally so he was irradiated after the operation. However, the tumor continued to grow after the operation. We resected the tumor many times. The tumor became enlarged after those operations. He was finally irradiated up to 100.5Gy. However, the tumor could not be controlled. Other conservative therapies, such as injections, cryosurgery, IL-2, estrogen, chemo therapy, etc. all proved to be ineffective. A skull base operation was performed, but the tumor could not be controlled. At last, the tumor changed into angiosaracoma, and he eventually died. Angiofibroma is a histologically benign tumor, however, it should be treated as a clinically malignant tumor.

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A survey of allergic rhinitis was carried out in the Tohoku region from August 2001 to January 2002 using a questionnaire regarding general physical conditions, major nasal symptoms, QOL, rhinoscopical findings, and medications. Correlation between nasal symptoms and QOL was examined in 940 patients with perennial allergic rhinitis. Of three nasal symptoms, nasal obstruction was most correlated with QOL. The effectiveness of anti-allergic drugs on the perennial allergic rhinitis was estimated from nasal symptoms and QOL in 635 patients who filled out two questionnaires with an interval of two to four weeks. The group of patients treated with a combination of leukotriene receptor antagonist and antihistamines (n=247) showed significant improvement of nasal obstruction and rhinorrhea compared with the group treated with antihistamines alone (n=148). The former group showed a concurrent improvement of QOL scores along with the improvement of nasal symptoms. Therefore, the selection of anti-allergic drugs according to the nasal symptoms is important for the improvement QOL.

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In 2001 the pollen count in Japan was expected to be high. We therefore investigated the effect of perirolast potassium on patients both before and after the start of the pollen season in 2001. Regarding the three major complaints associated with pollenosis: including sneezing, rhinowhea and nasal obstruction, the Symptom score, Medication score and the Symptom Medication score all tended to inhibit the symptoms in patients before the start of the pollen season. In particular, the Symptom medication score in patients before the start of the pollen season showed a significant inhibition at the times of peak pollen scattering. These results suggest that pemirolast potassium might be a useful treatment for patients before the start of the pollen season.

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Twenty patients with chronic cough due to gastroesophageal reflux disease were treated with oral administration of ransoprazole. Ransooprazol of 30mg/day was administrated during 8 weeks. Mucosal erythema of posterior vocal cord and/or arytenoid was found in all patients. Of 20 patients, cough was disappeard, deminished, and unchanged in 9, 7, and 4 patients, respectively. Of 15 patients with heart burn, cough was disappeared, deminished, and unchanged in 8, 6, and 1 patient, respectively. Of 5 patients without heart burn, the efficacy of proton pump inhibitor was 40%.

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We report three pediatric cases (8-year-old boy and girl, 16-year-old boy) complaining of persistently abnormal throat sensation induced by gastroesophageal reflux disease (GERD) without other causal disease. At first, we could not make differential diagnosis between GERD and psychological symptom or “tic” from their symptoms (persistent throat cleaning, abnormal throat sensation). Laryngoscopic finding revealed that posterior glottic lesion (especially, interarytenoid mucosa) was swollen with redness, and the lesion was in agreement with the point of abnormal throat sensation by palpation with the end of laryngeal fiberscopy. Those suggested that their symptoms might be caused by GERD, but esophagography and esophagoscopy provided no conclusive findings. So, we took empiric therapy using proton pump inhibitor (lansoprazole 10-15mg/day) for 8 weeks. After the therapeutic trial, their symptom had improved completely with laryngoscopic findings.

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Six patients with globus sensation due to gastroesophageal reflux were treated with oral administration of lansoprazole or lansoprazole + mosapride citrate. At first, 30mg/day lansoprazole was administered to all patients for 4 weeks. Lansoprazole was effective in three patients, who took further 30mg/day lansoprazole for 4 weeks. It was supposed that chemical damage to the esophageal mucosa provoked the globus sensation in three patients with good response to lansoprazole. Other three patients with poor response to lansoprazole were treated with 30mg/day lansoprazole + 15mg/day mosapride citrate for 4 weeks. Lansoprazole + mosapride citrate was effective in two patients. It was supposed that mechanical stimulation to the esophageal mucosa provoked the globus sensation in those two patients.

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When glubus sensation which is resistant to proton pump inhibitor treatment, it is very hardly to determine that it is related to gastroesophageal reflux disease. In Japan it has barely been recognized that the presence of resistance to proton pump inhibitor treatment and slowly responder to vtreatment. In two cases who were resistant to 15mg lansoprazole, their globus symptoms were relieved with both of life style modification and combination therapy, specifically 20mg rabeprazole, 15mg mosapride and 48cc Maalox. Especially in one case her globus sensation had been relieving so slowly that it took almost one year until healing it. Our self-administered symptom diary was a powerful tool for its convenience and to evaluate symptoms objectively in out-patient unit. To evaluate their symptom correctly and objectively were useful not only for fair treatment response determination but also for improvement of life style. Those cases suggested that in some cases close-up evaluation of symptom and strong long-span medical therapy were required, when treating globus sensation as gastroesophageal reflux disease.

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