The findings of the IT-MAIS, MUSS and Nottingham tests to evaluate the lingual development in children who have received cochlear implants (CIs) in our department between September 2000 and June 2004 are herein reported. Although improvements in the above scores after receiving CIs were confirmed in all patients, the children who did not receive sufficient speech and language training after receiving CIs demonstrated lower scores than those who received sufficient training. As a result, the importance of language and speech education is clearly indicated after receiving CIs. In another case, the language development was poor despite favorable scores for all of the above three tests, thus suggesting that it is difficult to properly evaluate the progress of lingual perception using these three tests alone. It is therefore necessary to use these tests along with other developmental assessments to accurately evaluate language perception in such patients.

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Based on the observation that salivation decreases with aging, many investigators have suggested a possible relationship between salivation and sex hormones, particularly in women, although the details of such a relationship remain unclear. We hypothesized that ovarian hormones might regulate the number of salivary gland cells by apoptosis, and therefore examined the changes regarding apoptosis in the parotid gland of male and female rats. Apoptosis was thus induced in cultured salivary gland cells in the presence of various sex hormones and any differences regarding apoptosis were therefore examined. Human submandibular gland cells (HSG cells) were cultured with INF-7 for 24 hours and then were cultured further with anti-FAS antibody and estrogen or progesterone to prepare the experimental groups. The cultures were observed over time by phase-contrast microscopy and any cellular changes due to apoptosis were assessed by electronmicroscopy. After 43 hours, a flowcytometric analysis of apoptosis was performed by the TUNEL method and by means of measuring the levels of caspase-3. Apoptosis was suppressed in the cells cultured with estrogen, while it was accelerated in the cells cultured with progesterone. These results suggested that ovarian hormones might regulate apoptosis in the parotid gland, and that estrogen might suppress the apoptosis of parotid gland cells, thereby relieving oral dryness, which is a complaint that tends to increases after menopause.

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We herein report a case of Collet et Sicard syndrome due to a fungal infection associated with MPO-ANCA-related microscopic polyangitis (MPA). The patient was a 71-year-old male who was diagnosed to have MPA at another hospital in 2003 and for which he received medical treatment. In addition, he has also been suffering from coughing and a low-grade fever since the beginning of 2003 and was therefore introduced to our hospital. He received steroid treatment after the diagnosis of Collet et Sicard syndrome was made, and his symptoms and the laboratory findings thereafter immediately improved. He complained of dysphasia and hoarseness since the beginning of 2004 and thus was introduced to our department. Repeated neurological examinations revealed lesions in cranial nerves IX, X, XI, and XII on the right side. A histological examination failed to reveal either any neoplasm or a fungal infection, however, a fungal infection was still highly suspected. As a result, we administered anti-fungal drugs to him and thereafter his neurologic symptoms dramatically disappeared. The importance of assuming the presence of a fungal infection in any cases of compromised host therefore cannot be overemphasized.

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We herein report a case of EED with oral lesions. EED itself is a rare diseases, and such cases with oral lesions are even more rare. The oral lesions in this case consisted of mixed ulcers and scars in the middle of the palate and the skin lesions showed elevated erythema on the dorsal side of the ankle joint. They were histologically very similar to each other. It is know that the serum IgA is elevated in EED patients, and this fact was also recognized in this case. Though EED is rate, some reports say that it is sometimes complicated by chronic tonsillitis or chronic polysinusitis. We there-fore describe this case because EED is not unrelated to otorhinolaryngologists and we should be aware of this disease.

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Lemierre's syndrome is a sever infectious disease following acute tonsillitis or pharyngitis which is characterized by the development of thrombophlebitis of the internal jugular vein with sepsis and multiple metastatic infectious foci. We herein report a case of Lemierre's syndrome. The patient was a healthy 32-year-old male who was admitted to our hospital with symptoms of a high fever and a sore throat. Chest radiography and CT scans reveal a shadow with cavity formation in his lung and pleural effusion. He was treated with the intravenous administration of antibiotics and his gen- eral condition thereafter improved. In cases presenting with severe tonsillitis or pharyngitis, this syndrome should therefore also be included in the differential diagnosis.

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Some reports say that LAUP (uvulopalatoplasty) is a useful surgical treatment method for obstructive sleep apnea syndrome (OSAS). This method, however, unfortunately has no effect on some patients. As a result, we cannot recommend patients to undergo this operation with certainty. We therefore devised an original examination method to evaluate the surgical indications for this treatment modality and named it the Challenge test. We performed this test on 27 patients who agreed to take the test and also showed an AHI score of more than 20. As a result, 12 of 27 patients showed a positive finding for the Challenge test. Thereafter, all 12 of positive patients underwent uvulopalatoplasty, and all showed a significant improvement in the AHI (more than 25%) after the operation. Based on the above findings, we conclude that our newly developed Challenge test is a valuable diagnostic modality for assessing the surgical indication for LAUP in patients with OSAS.

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We evaluated the safety and efficacy of performing multilevel radiofrequency volumetric tissue reduction (RFVTR) for the treatment of sleep-disordered breathing (SDB). Sixty patients with SDB were included in this study. The treatment sites were selected among the soft palate, tongue base, the turbinate, and the tonsils according to the obstruction patterns as determined by dynamic MRI or fiberscopy. Postoperative pain was assessed using the visual analogue scale until 14 days after surgery. The apnea hypopnea index (AHI) and the Epworth sleepiness scale (ESS) were measured before and at least 12 weeks after the completion of each treatment. In the RFVTR treatment group, both AHI and ESS significantly improved (p<0.001) after the treatment. Postoperative pain in the RFVYR treatment group significantly decreased in comparison to that in the UPPP treatment group (p<0.01) from 1 day after the surgery (day 1). In addition, postoperative pain in the RFVTR treatment group significantly declined from day 2 in comparison to the pain on day 0 (p<0.01). In contrast, the pain in the UPPP treatment group only significantly declined from day 5 (p<0.05). In conclusion, multilevel RFVTR was therefore found to be a safe and effective treatment for SDB, if the optimal treatment site can be accurately selectied.

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It is a well known fact that hypopharyngeal cancer patients are often associated with esophageal cancer. We therefore performed laryngeal preservation therapy in 5 patients who suffer from double cancer of the hypopharynx and esophagus. These five patients had both early hypopharyngeal cancer and advanced esophageal cancer. During the operation, the hypopharyngeal cancer lesion was removed using laser surgery. Next, the esophageal cancer was resected and the anal site of the esophagus was closed. Thereafter, secondary anastomosis of the esophagus with the gastric tube via the posterior mediastinal route was done at a later date. The postoperative states of the patients were uneventful and no complications were observed.

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We examined 17 patients with a deep neck abscess who were treated at our hospital over the past 15 years and also review the 430 reported cases in Japan over the past 10 years. There were about twice as many male cases as female cases and the average age was 44 years old. The most frequent cause of this disease was an upper respiratory tract inflammation which included acute tonsillitis (61%), a dental infection (18%), a foreign substance (7%), and the result of continuous medical treatment (7%). Regarding the cause of inflammation, 43% were caused by bacteria (Streptococcus genus) while 27% were caused by anaerobic bacteria. Surgical drainage was require 3d in 84% or 375 of the reported cases. Regarding complications, the most common complication was diabetes in 16%, which was about 3 times the normal rate of diabetes in Japanese (5.5%). In addition, the patients associated with diabetes showed an average hospital stay of 47 days which was substantially longer than that for such patients with out diabetes (36 days). Moreover, such patients with diabetes also demonstrated a 13% mortality rate which was also about 3 times the normal rate of all other cases (4%). Based on the above findings we strongly recommend that surgical drainage should be performed for all such cases. In addition, it is important to administer appropriate antibiotic treatment for anaerobic bacteria. Finally, special caution is required when such patients are also associated with siabetes.

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Although predicting the first day of continuous Japanese cedar pollen emission is important information for cedar pollinosis patients, the reliability of predicting this based on the cumulative daily highest temperatures and mean temperature from January 1^st is poor in regions with a large snowfall, because snowfall and low temperatures during the winter affect the growth of the cedar male flowers. Therefore, we investigated the appropriate initial date for recording the temperatures to predict the first day of continuous cedar pollen emission in Hirosaki City. In addition, we also devised a minimum temperature standard for calculating the cumulative temperature, which is the most useful data for such a prediction. The results indicated that the initial date for temperature recording should be set at January 21st or February 1^st and such predictions were possible from the days in which the daily highest temperature exceeded 3° from the initial date. The amount of snowfall had no effect on the results, thus indicating this to be a useful method for predicting the first day of continuous Japanese cedar pollen emission in regions with a large snowfall.

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The early season treatment of cedar pollinosis patients with cetirizine hydrochloride, which is a sexond generation antihistamine, was continuously performed over the four pollen-scattering seasons from 2000 to 2003. The clinical efficacy of early season treatment in each season was then evaluated based on the nasal symptom score and then the finings were compared to those obtained in patients that were only treated after the start of the pollen scattering season. The clinical efficacy of cetirizine hydrochloride administration was also compared among the four different seasons, when the total amount of scattered cedar pollen differed dramatically from year to year. As a result, the nasal symptom score over the four different seasons was found to be significantly lower in the early season treatment group than in that of the group treated from the start of the pollen scattering season. However, even in the early season treatment group, the percentage of patients who used concomitant medications was higher in the years with greater pollen scattering than in the years of lower pollen scattering. These data led us to conclude that a more intensive theraupeutic strategy, even when administering early season treatment, is thus needed in the treatment of patients with cedar pollinosis at times when the cedar nollen levels reach extremely hieh levels.

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