The Blink Reflex is a reflective constriction of both orbicularis oculi muscles caused by electrical stimulation of the supra-orbital nerve. The usefulness of the blink reflex test in the prognostic evaluation of peripheral facial palsy was herein investigated. The study included 16 patients with acute idiopathic peripheral facial palsy; namely, 14 with Bell's palsy and 2 with Hunt syndrome. All of them were administered prednisolone by intravenous infusion, and additional Acicrovir was also given to those patients with Hunt syndrome. The Blink Reflex test was applied prior to the treatment, and the ipsilateral blink reflex (R1) was measured. The patients were divided into two groups, consisting of reflex-positive and reflex-negative patients. As a result, 9 reflex-positive patients showed either a complete or moderate recovery, however, the 7 reflex-negative patients showed only a slight recovery. The difference in the two groups was statistically significant. We also showed the possibility of making a prognostic assessment within the first 7 days after disease onset. The blink reflex test therefore appears to be a useful test to evaluate the prognosis of peripheral facial palsy.

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An interesting case of sniff-related cholesteatoma is herein reported. In the CT findings of this case, the tympanic isthmus was open with almost a completely normal mastoid region, and his cholesteatoma was found to have developed into only the supratubal recess area. By performing an anterior tympanotomy, the closure of the ventilatory route from the eustachian tube to the epitympanum via the supratubal recess was recognized, which is usually open in the normal ear. It was thus concluded that the closure of the supratubal recess ventilatory route is therefore absolutely necessary, in addition to habitual sniffing, for the development of a cholesteatoma.

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We report here a case of liposarcoma in the submandibular region. A swelling of the left submandibular region was examined and CT scanning revealed a large tumor on the surface of the left submandibular gland. MRI showed a hypo and high intensity area on both T1 and T2. A needle biopsy was therefore performed, and histologically, a diagnosis of liposarcoma was made. An extirpation of the tumor was performed, including a supraomohyoid neck dissection. The tumor specimen was encapsuled and yellowish-colored on the cut surface. The histological diagnosis was myxoid type liposarcoma without any metastasis to cervical lymph nodes. We considered that a complete dissection had been achieved, and therefore no postoperative therapy was performed. There has been no sign of recurrence or metastasis during the four-year follow-up period.

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We herein report on the long-term voice quality after autologus fat injection of the vocal fold. We evaluated 11 patients in whom more than six months had passed since being operated on. We inject autologus fat into thyroarytenoid muscle. We perform this method for voice insufficiency because of vocal cord atrophy and vocal cord paralysis. After performing the injection, voice quality was found to improve, and the voice quality was thereafter maintained for a long time in an acoustic and aerodynamic analysis. We therefore think that autologous fat injection in the vocal cord is good and reasonable method for the treatment of voice insufficiency.

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We experienced two cases of large dermoid cysts occurring on the floor of the mouth. In case 1, the cyst measured 7×6cm in size and was located over and under the mylohyoid muscle in the left submandibular region. Enucleation of the cyst was performed by a transcutaneous approach. In case 2, the cyst measured 5.5×4.5cm in size and was limited to an area over the mylohyoid muscle in the midline. Enucleation of the cyst was performed by an intra-oral approach. In both cases, the cysts were removed easily and no postoperative complications were experienced. A complete extirpation is the treatment of choice for dermoid cysts occurring on the floor of the mouth. Most important is the selection of an appropriate surgical approach. The risk of damaging the surrounding nerves and vessels is considered to be very low in the midline of the oral floor. Therefore, the intra-oral approach is thus condiered to be suitable for dermoid cysts limited to the area over the mylohyoid muscle in the midline, such as that observed in case 2. While in the case of lateral dermoid cysts extending over and under the mylohyoid muscle, such as observed in case 1, the trascutaneous approach is considered to be better, in order to obtain a sufficient view of the surgical field and avoid damaging any surrounding nerves and vessels.

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We compared the efficacy of levofloxacin (LVFX) of a 200mg bid dose regime with that of a 100mg tid dose regimen in the treatment of an acute exacerbation of chronic otitis media and acute otitis media. A total of 71 patients were randomly assigned to two groups with LVFX 200mg bid (n=38) and 100mg tid (n=33). Both regimens could significantly improve all subjective and objective symptoms (earache, flare of middle ear mucous membrane and eardrum, and quantity and quality of aural discharge). LVFX at 200mg bid healed 28 out of 36 cases (77.7%) within eight days, while LVFX at 100mg tid healed 15 out of 31 cases (48.3%) during the same time period. Regarding the recovery period, a statistically significant difference was observed between both regimens (p=0.02). These results indicate that the aural administration of LVFX at 200mg twice a day is therefore an effective treatment for an acute exacerbation of chronic otitis media and acute otitis media.

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We pointed out several differences between two types of extraesophageal manifestations, namely cough and globus sensation, in gastroesophageal reflux disease by analyzing the data obtained from of pre-treatment questionnaires and symptom diaries. We carefully analyzed habitual factors. Patients who were treated in various ways for gastroesophageal reflux disease and thereafter recovered from their symptoms were enrolled as patients who had suffered from gastroesophageal reflux disease. In comparison to the patients in the laryngoesophageal group (n=13), whose chief complaints were globus sensations, the patients in cough group (n=29), whose chief complaints were cough symptoms, tended to have a significantly higher frequency of eating of “spicy foods”(p<0.05) and “sour foods”(p<0.05), while they also tended to have a shorter sleep time (p<0.05). By analyzing the smaller groups, who had answered a more detailed questionnaire, the patients in the laryngoesophageal group were thus found to have a significantly more frequent feeling of cold intolerance, and they also tended to walk significant less frequently on a daily basis. These results suggested that several environmental factors, such as eating habits and the lifestyle habits, clearly appeared to influence the development of these two different symptoms in some way.

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We treated 12 male and 6 female patients (57.0 years of age on average) with an abnormal sensation in the throat (AST) possibly due to gastroesophageal reflux disease (GERD) with delayed gastric emptying (DGE) and 10 male and 19 female patients (56.9 years of age on average) with AST due to GERD without DGE using an oral proton pump inhibitor (PPI), lansoprazole 15mg/day, for 2 weeks. As a result, a reduction of AST by 50% or more was thus observed in 76% of the patients without DGE, while such an improvement was only seen in 39% of the patients with DGE. A statistically significant difference (p=0.03 by Mann-Whitney U test) was thus observed in the ratio between the two patient groups. Therefore, we recommend the use of some other medications which are expected to improve DGE in combination with PPI for the treatment of patients with AST due to GERD with DGE.

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The 46 th statement in the Montreal Definition of Gastroesophageal Reflux Disease states as follows: In the absence of heartburn or regurgitation, unexplained asthma and laryngitis are unlikely to be related to GERD. However, the results of our retrospective analysis are not consistent with this statement. In our study, 167 suspected-LPR patients were treated with the continuous administration a single dose of a proton pump inhibitor for up to 6 months at Hokkaido University Hospital, Japan, for LPR symptoms between April 2004 and September 2006. Both laryngopharyngeal (throat clearing/annoying cough, voice problems, throat discomfort) and esophageal (heartburn/stomach acid reflux) symptoms were evaluated before and during the treatment using a score sheet modified from the Reflux Symptom Index as proposed by Belafsky. Esophageal symptoms were thus observed in 104 (62.3%) of 167 study patients. The Kaplan-Meier estimate for the laryngopharyngeal symptom-improvement rate showed a similar pattern between the heartburn/regurgitation (+) and (-) groups, thus indicating that, even in the absence of heartburn or regurgitation, acid suppressive therapy offers a comparable relief of LPR symptoms to those in the presence of esophageal symptoms.

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