Myoepithelioma is a rare tumor of the Salivary gland which accounts for less than 1% of all salivary gland tumors. We herein report a 61-year-old female with myoepithelioma of the parotid gland associated with follicular adenoma of the thyroid gland. She presented with a painless mass in the right parotid region and a painless mass in the right thyroid gland. CT, MRI and fine needle aspiration cytology showed both of the tumors to be benign. A superficial lobectomy of the right parotid gland and a right hemithyroidectomy were performed and no adhesion with the neighboring tissue was seen in either tumor. The histopathological diagnosis was myoepithelioma, spindle cell type, of the parotid gland and follicular adenoma of the thyroid gland. The association of myoepithelioma and follicular adenoma is very rare. The significance and mechanism of this association is also discussed.

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The clinical features and treatment outcome were investigated in 20 patients with adenoid cystic carcinoma (ACC) of the head and neck. The most frequently affected organs were the major salivary glands (9 cases) followed by the sinonasal tracts (6 cases). Seven of the 9 patients were major salivary gland ACC has Ti or T2 disease, whereas all 6 of the patients with sinonasal tract ACC had T3 or T4 disease. Cervical lymph node metastasis was recognized in only one patient. The diseasespecific 5-and 10-year survival rates of the 20 patients were 80% and 62%, respectively. The patients with sinonasal tract and external auditory canal ACC showed worse survival rates than those of the patients with major salivary gland and oropharyngeal ACC. Surgical resections were performed on 18 patients and 11 of these patients showed recurrence in the primary regions. So far, 9 have patients have died of the disease, and 8 of these 9 patients died due to skull base or intracranial invasion, which thus confirms the importance of local control in the treatment of ACC. Postoperative radiotherapy prolonged the interval of recurrence after the initial treatments. The optimal treatment for patients with ACC is surgery with a definite safety margin combined with radiotherapy. To enhance the therapeutic effect of radiotherapy, heavy-ion radiation therapy or concurrent intraarterial infusion chemotherapy and radiotherapy may improve the treatment results for head and neck ACC.

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We herein report a case of subperiosteal orbital hematoma associated with frontal sinusitis. The patient was a 27-year-old male whose chief complaint was right orbital pain and swelling of the right eyelid. A preoperative coronal CT scan revealed a clouded right frontal sinus and a high den-sity mass was identified in the upper right orbit. External drainage of the subperiosteal orbital hem-atoma was performed. After drainage, the patient's symptoms improved.

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Two cases of so-colled “Blutbeule” in the frontal sinus and ethmoid sinus are herein reported. Both cases were operated on by a transcranial approach. Most cases of Blutbeule origined in the nasal cavity of maxillary sinus. Case 1 was operated on by a midfacial degloving technique and a transcranial approach. The midfacial degloving technique is a superior approach from a cosmetic point of view. It is therefore important for surgeons to not overlook this disease because both disease types tend to lack any subjective symptoms in spite of disease progression.

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Numerous studies have demonstrated that a well-designed clinical pathway (CP) is an effective means of sustaining quality while controlling the length of stay (LOS) in the management of certain disease entities. While CP for ENT surgery is also an important tool for improving case manage-ment and outcome assessment, their effectiveness has not yet been well defined in the ENT field in Japan. The objective of this study was to investigate the effect and variance of the CP on the out-comes of patients undergoing endoscopic surgery (ESS). The records of 25 patients who were man-aged by a CP for ESS under general anesthesia from February 2004 to July 2004 were examined. The variance outcome measures including premeditation, the start of postoperative nutrition, LOS, and the length of nasal packing were analyzed by a couse and effect diagram from the CP. The LOS and length of nasal packing were compared based on some factors using a non-parametric analysis (Mann-Whitney U test). Nasal packing was removed on postoperative day (POD) 4, and the LOS was es-tablished as 8 days. The LOS varied from 4 to 14 days. Seven patients required an extended hospital stay (over 8 days, negative variance). Nice patients were discharged by day 7 (by POD 5, positive variance). The reasons for the delay in discharge (negative variance) were due to health insurance related problems in 3 patients, postoperative disease (otitis) in one patient, medical reasons related to the surgical method in one patient, and waiting for surgery in one patient. As for medical risk, there was no difference in the LOS. The nasal packing was removed on POD 4 in six patients. The packing was removed by POD 3 in 19 patients (positive variance). There was no negative variance in this outcome measure. ESS was performed by two doctors. The patients treated by Dr. A had a significantly shorter length of nasal packing than that by Dr. B.(mean: 1.9+/-0.3+/-0.22 days; p<0.02), but no significant difference was seen in the LOS. There were also no differences in the inci-dence of complications of the functional outcomes. The LOS of postoperative maxillary cyst (POMC) was significantly shorter than that of sinusitis (p<0.01, mean 5.2+/-0.37 days for POMC vs. mean 8.4+/-0.35 days for sinusitis). As a result, the implementation and leedback of a clinical pathway are effective methods to control LOS. In addition, the variance analysis information can in-dicate how we should change our current CP to improve the care of ESS patients, thereby enhahcing and refining the surgical procedures in clinical practice.

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Many patients complain of itching in their ears. They have generally been treated by the applica-tion of ointments containing steroids. In this study, bepotastine besilate, an antihistaminic drug, was administered to patients complaining of itching in their ears (T group) to evaluate its effect us-ing a questionnaire (itching score). According to the findings, the symptoms improved with a signifi-cant difference between 3 days and 1 week after administration. Regarding the immediate effect, the symptoms improved as soon as 30 minutes after administration. In comparison to the placebo group (normal treatment group, P group), the score decreased in both the T group and P group from day 1 of treatment, but no significant difference was observed between the T group and P group.

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Even though globus sensations as GERD symptoms are thought to be rare in Japan, in our outpatient units, the patients are aggressively received GERD treatment when they have throat problems. We analyzed the questionnaire which the patients answered at first visit, for the purpose of figuring out the clinical features of patients who had been suffered from globus sensation. 23 new visitors to our out-patients units wrote globus sensations as chief compliants on the questionnaire during the period between January, 2000 and December, 2002. We surveyed questionnaire data of ten good responders, who scored significant better in frequency or magnitude of their symptom within three months after treatment in this period. Good responders had common cold like symptoms but not specific symptoms for GERD. It was reconfirmed the difficulty to diagnosis only from a medical interview. Bringing out the belch for the past week was higher sensitivity than bringing out the heart burn in medical interview, but was not enough to diagnose, for its low sensitivity. When the patient had obvious risk factors in their life style, he would be cured more easily. Writing symptom dairy and life style changing were probably required for effective treatment in addition to the proton pump inhibitor therapy.

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Recently, it could be considered that GERD might play important roles for carcinogenic factor or co-carcinogen of squamous cell carcinoma of the larynx and pharynx, and laryngeal leukoplakia. We report a case of pertinacious laryngeal leukoplakia. 72-year-old man who had been performed microlaryngoscopic surgery, including CO2 laser surgery, three times for nine years had complained of hoarseness. He was not a smoker. His occupation was a professional saxophonist. Past pathological studies for his surgical materials were diagnosed as mild-severe dysplasia. Laryngoscopic findings revealed the legions with leukoplakia on anterior part of bilateral vocal folds, swelling of arytenoid mucosa, pachydermia of interarytenoid mucosa, and vasodilatation of supraglottic mucosa. He did not have typical symptoms of GERD, including heartburn, regurgitation, belching, and so on. And there was no history of abnormal endoscopic finding about the esophagus and stomach for years. So, we took empiric therapy using proton pump inhibitor (lansoprazole 30mg/day). After three months, the legions with leukoplakia of the vocal folds diminished slightly with slight improvement of hoarseness. And after more thirteen months, the legions with leukoplakia disappeared with complete recovering of his voice quality. Since then, the lesion with leukoplakia was not seen for eight months with PPI therapy (lansoprazple 15mg/day).

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The seventy six-year-old male patient complained asthmatic attack, chronic nocturnal cough, chest pain, and globus sensation. Fiberscopic evaluation revealed reflux esophagitis (Los grade A) and posterior laryngitis. Ambulatory esophageal and hypopharyngeal pH monitoring was performed before and after the 8 weeks-medication of proton pomp inhibitor (PPI). Acid reflux was observed 144 times/a day in lower esophagus and 6 in hypopharynx. Mean pH of each site was, however, equally pH 5.4 and the duration of pH lower than 6 was longer in hypopharynx than in lower esophagus. This result indicated poor acid-clearance in hypopharynx. After 8 weeks medication of PPI, mean pH of hypopharynx was turned out to be 6.8 and all his complaints were disappeared. This clinical experience suggested that the prolonged low pH circumstances in hypopharynx was an important etiologic factor for the symptoms of LPRD and that PPI treatment was essential for improving both hypopharyngeal pH condition and ENT symptom caused by acid reflux.

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Lump in the throat sensation is related to gastroesophageal reflux (GERD). The proton pump inhibitors are effective to the patients with GERD. We apply the gastroesophageal fiberscopy to the patients with GERD in order to determine the severity of reflux esophagitis. We administered the proton pump inhibitors to the 257 patients since February in 1999, and acquired the good results. However, we also encountered the 14 patients (male 10, female 4) with recurrent reflux esophagitis. We administered low dose Lansoprazole (15 mg/day) to the 2 patients with severe recurrent esoph-agitis for over 90 days. The low dose and long term administration of Lansoparazole was effective to the patients with severe recurrent reflux esophagitis.

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At the end of this presentation the participants will be able to; 1) Better understand the controversial role of gastroesophageal reflux in patients with ENT complaints. 2) Appreciate diversity of patient complaints with GERD-related ENT disease. 3) Learn about possible laryngeal signs of GERD. 4) Appreciate the treatment difficulties in this disorder.

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