We herein report 5 cases of cochlear fistula that were identified by CT scans of the temporal bone. Most of the cochlear fistulas that have been, previously reported, tended to have cholesteatoma as the primary disease. However, 4 of our 5 cases had adhesive otitis media, while 1 case had cholesterol granuloma as the primary disease. No cases were accompanied by cholesteatoma in our cases. One case which we manipulated around the cochlear fistula resulted in an outcome of deafness, On the other hand, in one case in which no manipulation of the cochlear fistula was performed, the patient's hearing was preserved. It is therefore necessary to carefully investigate the cochlear fistula before performing an operation for adhesive otitis media, due to the fact that manipulation around the cochlear fistula can sometimes lead to a severe hearing disturbance.

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The usefulness of a voice prosthesis inserted as a tracheo esophageal (TE) shunt was evaluated for patients who underwent a total laryngectomy. Five patients who used a TE shunt after total laryngectomy and one patient who underwent a hemi-laryngectomy were enrolled in this study. Four out of 5 cases demonstrated fair (10 >) Maximum Phonation Time (MPT), and these 4 cases scored 32/32 in a Communication ADL Test (CADL). One case demonstrated an MPT of less than 3 seconds and a score of 25/32 in a CADL. In the hemi-laryngectomy case, the patient demonstrated a relatively short MPT (5 seconds) and scored 30/32 in a CADL ; however, this patient complained of more fatigue during CADL testing. The TE shunt thus considered to be a practical and useful voice prosthesis for patients who undergo a total laryngectomy.

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The subjects of this study were administered 1 % histamine (Sigma Inc.) intranasally, and the vascular bed of the superficial mucosa at the inferior nasal concha was observed with the use of natural light and narrow band imaging (NBI). Observations were made every minute during a five-minute period. The following findings were reported : 1) In patients with allergic rhinitis, capillary dilation of the inferior nasal concha was noted after a mean of 1.0 minute and interstitial edema was observed after a mean of 2.2 minutes in all patients. 2) The early phase reactions occurred more promptly in patients with allergic rhinitis. 3) Among the non-allergic patients, capillary dilation of the inferior nasal concha was noted after a mean of 2.0 minutes in all patients, and interstitial edema developed after a mean of 3.0 minutes in 3 (42.8%) of these individuals. 4) The development of the early phase reaction was slower in the non-allergic patients in comparison to the patients with allergic rhinitis.

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Autonomic nervous drugs were administered to the nasal mucosa via nasal drops, and changes in the nasal microvasculature were visualized with the use of natural light and narrow band imaging. The following observations were reported : (1) The administration of 0.02% adrenalin (Bosmin^®) induced vasoconstriction after a mean of 1.8 minutes. Vasodilation subsequently occurred after a mean of 4.4 minutes in all 13 subjects. (2) The administration of 0.5% sulbutamol sulfate (Venetlin^®) had no significant effect in subjects without allergic rhinitis. (3) The administration of Venetlin^® induced vasodilation after 5.0 minutes in 25% of patients with rhinorrhea-dominant allergic rhinitis. (4) The administration of Venetlin^® induced vasodilation after a mean of 4.0 minutes in all patients with nasal obstruction-dominant allergic rhinitis. (5) Beta-adrenergic stimulants may promote the synthesis of leukotrienes and other mediators and may lead to nasal obstruction in patients with nasal obstruction-dominant allergic rhinitis. (6) The administration of an anticholinergic drug resulted in vasodilation in 85.7% of the patients with allergic rhinitis. (7) Hyper-responsiveness of muscarinic receptors may therefore occur in patients with allergic rhinitis.

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We herein report a case of Miller Fisher syndrome which was misdiagnosed as rhinogenous optic neuritis. A 43-year old male visited a local ophthalmologist with a chief complaint of visual field disturbance. Rhinogenous optic neuritis was suspected and the patient was urgently referred to our department, where he underwent emergency surgery. However, the symptoms did not improve after the surgery, and the patient developed a positive Babinski reflex and facial nerve palsy. In addition, clinical symptoms suggestive of inflammation spreading to the brainstem were detected. The patient's condition was consequently diagnosed to be Miller Fisher syndrome overlapping with Bickerstaff brainstem encephalitis. MFS must be always considered when making otorhinolaryngological diagnoses, as this syndrome is frequently accompanied by a variety of otorhinolaryngological symptoms.

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We herein report a case of acoustic neuroma with trigeminal paresthesia presenting with fluctuating hearing loss. We made a definitive diagnosis from the MRI confirmation of the tumor at the cerebellopontine angle. This case demonstrates that it is important to understand symptoms related to cranial nerves V and VIII. We therefore reaffirm the necessity of a basic examination of the 12 cranial nerves during ENT outpatient care.

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The preoperative administration of garenoxacin (GRNX) was found to be effective in three cases that demonstrated inflammation before undergoing tympanoplasty. Case one was a 51-year-old female who presented with chronic otitis media. One week before undergoing tympanoplasty, otorrhea developed and granulation on the tympanic membrane was detected. The administration of GRNX for five days caused the otorrhea to subside and the granulation disappeared by the day of the operation. Case 2 was a 45-year-old male who demonstrated cholesteatoma. Both otorrhea and granulation developed four months after the patient underwent tympanoplasty for the first time. GRNX was thus administered for seven days and it reduced the granulation and the otorrhea also subsided. One month before undergoing tympanoplasty for the second time, however, granulation developed again. Although the administration of cefcapene pivoxil did not prove to be sufficiently effective, GRNX had clearly inhibited the progression of granulation. Case 3 was a 55-year-old female who suffered from otorrhea and the posterior wall of external canal was also swollen. The administration of GRNX for seven days reduced the bulging of the external canal wall and the otorrhea had disappeared by the time tympanoplasty was performed. A histopathological examination showed granulomatous inflammation with some giant cells. Therefore, the administration of GRNX is thus considered to be an effective treatment for inflammation before performing tympanoplasty.

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