There are two different kinds of ear wax, namely a wet type and a dry type. The wet type can be found in Caucasians and Africans, while the dry type is most common in Asians and Native Americans. Ear wax plays an important role in the protection of the ear canal against microbial invasion, and it is defined as a mixture of secretions from the apocrine glands, which consist of lipids and proteins. The differences in composition between wet and dry ear wax have long been a subject of controversy. The major components of ear wax lipids are fatty acids, cholesterol and ceramides. In this study, we examined the constituents of fatty acids from wet and dry ear wax samples by high performance liquid chromatography. No differences in the components of 7 fatty acids (linoleic acid, myristic acid, oleic acid, palmitic acid, stearic acid, EPA, and DHA) between wet and dry ear wax specimens were found. However, a few components of unknown fatty acids were detected in the wet ear wax. These unknown fatty acids can be further analyzed for the existence of special fatty acids in the wet ear wax. This study will enable us to obtain a better understanding of the function of ear wax.

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A pathogen was examined in 58 patients with chronic suppurative otitis media who visited our clinic during a 1 year and 5 month period from February 1, 2006. We also evaluated the sensitivity of the bacterial species to 7 antimicrobials. Of the 68 bacterial strains identified in 52 patients, 36 (52.9%) and 4 (5.9%) were Staphylococcus aureus and Pseudomonas aeruginosa, respectively. In addition, no bacterial strain was detectedin the samples obtained from the remaining 6 patients. Antimicrobial testing revealed that 29 (80.6%) of these 36 S. aureus strains were resistant to ampicillin. Those 29 strains were highly sensitive to minocycline (96.6%), but showed lower sensitivity to levofloxacin (62.1%), cefcapen (55.2%), cefditoren (55.2%), clarithromycin (48.3%) and azithromycin (48.3%). Three of the 4 P. aeruginosa strains were sensitive to levofloxacin, although these 4 strains were resistant to all of the other 6 antimicrobials.

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A modified pharyngeal tonsillitis scoring system was established for adult patients diagnosed with severe acute epipharyngitis. The patients were treated with 600 mg/day cefditoren pivoxil (t.i.d., CDTR-P high dose) and their clinical courses were monitored using the scoring system. This study enrolled 94 patients with severe acute epipharyngitis who visited the clinic in 2008. The 7-day course of high-dose CDTR-PI resulted in improvement of the severity score on day 8 to 0.23 ± 0.74 (mean ± S.D.) in 93 of the 94 patients (99 %). Adverse drug reactions included diarrhea, which occurred in 13 patients (14 %), however, there were no serious adverse drug reactions. A total of 118 bacterial strains were detected, including 9 strains of β-hemolytic streptococci (8 %), 38 strains of H. influenzae (32 %), 36 strains of H. parainfluenzae (31%), and 23 strains of M. catarrhalis (19 %). The MIC₉₀ of CDTR was as low as 0.5 μg/ml or less for all of these strains. In conclusion, severe acute epipharyngitis is a disease with a favorable prognosis that can be treated successfully with high-dose CDTR-PI.

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A tracheostoma has an adverse effect on the swallowing function. This study compared the swallowing function before and after the manual occlusion of a tracheostoma without a tracheostomy tube. Eight patients with tracheotomas underwent videofluoroscopic swallow studies (VFSS). The swallowing reflex improved in each case after the occlusion of the tracheostoma, because laryngeal penetration of pharyngeal secretions could decrease due to the airflow through larynx. Although the aspiration status did not significantly change, the pharyngeal clearance tended to improve, because the subglottic pressure was maintained and the hypopharyngeal swallowing pressure could effectively act on the esophagus.

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Patients presenting with Bell's palsy are often treated by a modification of Stennert's method in Japan. In cases with the addition of antiviral agents, there is little information about the most appropriate antiviral drugs to use. We compared the efficacy of treatment of Bell's palsy with acyclovir (ACV) or valaciclovir (VACV). The minimum score of palsy was lower in the VACV group than that in the ACV group. However, the success rate of treatment and the duration until recovery were not substantially different between the two groups. These results suggest that VACV may therefore be more useful in the treatment of patients with Bell's palsy than ACV, considering that the intravenous administration of ACV may lead to nervous injury, and that VACV can be administered three times a day, but ACV must be administered five times a day.

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We herein report the case of a 57-year-old male with a carotid body tumor that required the reconstruction of the carotid artery. Contrast enhanced CT scanning was useful for making an accurate preoperative diagnosis. The balloon Matas test was useful to determine the source and location of the carotid artery occlusion. Feeding artery embolization effectively reduced blood loss during surgery. Reconstruction of the carotid artery was performed using an artificial blood vessel, and the patient's postoperative progress has been good, without any postoperative complications.

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