A primary carcinoid tumor in the middle ear is rare case. Only 41 such cases could be found in the literature, the first of which was described in 1980. We present the case of a 28-year-old male with left- sided aural fullness. We performed canal wall down tympanoplasty with a mastoidectomy and completely removed the tumor which was yellowish soft and dumb-bell shaped in the posterior-half of the tympanic cavity, attic and aditus to antrum. The tumor showed histological features essentially characteristic of a carcinoid tumor, which included a ribbon or festoon arrangement of tumor cells, some formation of anastomosing cords and glandular spaces, and the presence of numerous argyrophillia within many of the tumor cells. We also review 41 previously reported cases regarding their presentation, symptoms, signs, treatments and recurrence.

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A 79-year-old female presented with vertigo and left sudden hearing loss. No other neurological deficits were noted. She was hospitalized due to left sudden deafness and thus was administered steroid therapy. Left trigeminal nerve palarysis, cerebellar symptoms appeared 3 days later. MRI revealed a lesion suggesting an anterior inferior cerebellar artary infarction. She was therefore diagnosed to have AICA syndrome. In some cases, other neurological symptoms appear after vertigo and sudden hearing loss. It is difficult to distinguish AICA syndrome inner ear disorders from other types of sudden deafness of Meniere's disease. As a result, patients at risk for arteriosclerosis who present with sudden hearing loss, should therefore he examined by MRI as soon as possible.

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A malignant tumor of the external auditory canal (EAC) is a comparatively rare disease. We herein report a single case of adenoid cystic carcinoma of the EAC which we encountered. The sub- ject was a 57-year-old female classified as stage T1N0, with a tumor grade 2, based on the pathological malignancy classification of Szanto et al. The patient underwent a radical resection of the EAC, a mastoidectomy and a partial resection of the auricular. Even in cases of T1 in which the tumor is iso- lated in the external auditory canal, when the tumor recurs, the prognosis tends to be poor. Rather than perform a partial resection of the external auditory canal alone, it is therefore considered to be better to also perform a mastoidectomy. It was also thought to be necessary to initially perform a radical resection in the case of adenoid cystic carcinoma based on the advanced nature of the tumor and the extent of the pathological malignancy.

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Neonatal screening for hearing loss has become prevalent nationwide and some prefectural governments have established systems to identify newborn infants with this condition. In June 2002, Nagano prefecture decided to begin such a program and an inaugural operational liaison meeting was held, which resulted in the publication of a check-up manual and the establishment of a screening system. The screening system was started on a large scale in October 2002, however, various prob- lems requiring prompt resolution, have emerged including the lack of both a financial support system for screening costs and a sufficient follow-up system for individuals found to have hearing loss.

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Laryngomalacia is one of the most common causes of stridor during inspiration in neonates. We report a case of laryngomalacia with hyperplastic mucosa of the arytenoids region. A three-yearold boy suffered from apnea during sleep. Using fiberscopy, we observed a hyperplastic arytenoids mucosa, which resulted in a collapsed laryngeal orifice during inspiration. We therefore resected the mucosa of the arytenoids with CO, laser under general anesthesia. There were no post-operative complications. After the operation, we performed flexible fiberscopy and found the collapsing mucosa to have disappeared. In addition, the symptoms of stridor and apnea almost completely disappeared. Four months later no negative changes were observed. This operative method is thus considered to be effective for the treatment of patients with laryngomalacia with hyperplastic arytenoid mucosa.

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We describe a rare case of leiomyosarcoma of the gingival arising in a 68-year-old Japanese woman. The symptoms at presentation included the presence of neck masses and a tumor which was found in the gingival. The diagnosis was made based on pathological and immunohistological analyses of biopsy tissue specimens. Due to the involvement of the common carotid artery by a metastatic lymph node and also according to the wishes of the patient, only radiotherapy was performed. The primary tumor thereafter became quite small, but the cervical lymph node metastatic lesions decreased only slightly in size. Later, distant metastases in the lungs, dorsal, and cerebellum occurred and after a general worsening of her condition, the patient died one year after the initial diagnosis. This was a rare case in which a primary gingival leiomyosarcoma was discovered only after the identification of cervical lymph node metastatic lesions.

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It is not unusual that injuries of the oral cavity occur in children who tend to place pointed objects in their mouths. In most cases such injuries are superficial and limited to the mucosa. However, when the objects penetrate deeply into the cranium and its vicinity, a quick diagnosis and appropriate medical treatment is required. We herein report once such case in which a chopstick foreign body was enclosed in the mucosa of the epipharynx. A 3-year-old girl was referred to our out-patient emergency unit due to a plastic foreign body of the soft palate. At the time of examination, bleeding from the site of injury had stopped, and the patient's general condition was good. We removed a piece of the plastic chopstick at our outpatient emergency unit. A CT scan after removal of the plastic chopstick gave negative results for any foreign fragments of the plastic chopstick. In addition, an endoscopic examinaion of the epipharynx did not show any findings except for the coaguration of the epipharynx. But the shape of the removed shopstick still remained inside. The next day we performed a thin slice CT again and detected the remaining part of the chopstick foreign body enclosed in the epipharynx. The rest of the chopstick foreign body was removed successfully under general anesthesia and she was discharged without any complications.

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We experienced 4 cases of refractory oral ulcers that required several months to heal. Histopathological examination disclosed a benign ulcer in all cases. Regarding the healing process, a whitish change in the mucous membrane around the ulcer increased during the healing process, which later disappeared several weeks after the ulcer had healed.

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An increasing number of patients complain of a reduced taste sensation. We investigated the relationship between this symptom and mild depression, which has been reported to increase recently. Patients with mild depression tent to have only slight mental symptoms, but they show various physical symptoms. When 37 patients with reduced taste sensation were tested using SDS (self-rating depression scale), 10 of them (27.0%) showed evidence of depression. This suggests that about one fourth of the patients who visit otolaryngological clinics due to a reduced taste sensation may have depression, and therefore otolaryngologists need to treat them while keeping the possibility of depression in mind. Particular attention should be paid to patients in whom the chief complaints are very different from test results and those in whom the results of EGM (electrical gustometry) are very different from the findings obtained by the taste paper-disk method. Patients with both a reduced taste sensation and depression tended to show low zinc levels. Since zinc may be involved with depression, we will further examine this relationship in a future study.

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Hypopharyngeal hemangioma is an uncommon neoplasm. We herein present a case of adult hypopharyngeal hemangioma that was successfully treated with an Nd: YAG laser at our hospital. The patient had no untoward effects from the use of the Nd: YAG laser and no excessive bleeding or airway compromise was encountered. An excellent long-term function can be obtained using the Nd: YAG laser without either stenosis or scar formation.

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Four patients suffering from the intractable laryngeal granuloma were treated with a Chinese herbal medicine, called Ri-Kunshi-To (TJ-43), and we analyzed the relationships between the effect of this Chinese herbal medicine on the laryngeal granuloma and the patient's Sho deficiency (excess, deficiency and between the two constitutions). In three patients with the Sho deficiency, their granu- loma disappeared in response to TJ-43. On the other hand, in one patient with the Sho, his granu- loma did not change. TJ-43 is one of the medicines for the patients with a Sho deficiency. These findings suggested that an evaluation of Sho deficiency might play an important role in clinicians suc- cessfully treating patients with laryngeal granuloma using TJ-43.

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