Burow's solution is a 13% aluminum acetate solution that is widely used for the treatment of otitis externa and chronic otitis media. The ototoxicity of this solution was reported by our group using animal studies focused on compound action potentials. Histopathological changes of the cochlea were reported by Suzuki et al., who applied Burow's solution on the round window membrane for one hour or two hours and harvested the temporal bones seven days later. In the present study, Burow's solution was used to fill the middle ear cavity of guinea pigs, and the temporal bones were harvested at 30 minutes, 24 hours and four weeks later. The 20 micron thick specimens were stained with Hematoxylin and Eosin, and the chronologic changes of the cochlea were studied with an image-filing software program. The spiral ganglion cells in the lower turns were reduced in number, and there was prominent protein precipitate in the inner ear fluid in the lower turns, indicating that the Burow's solution penetrates the round window membrane and diffuse towards the upper turn. The round window membrane was found to be thinner at four weeks, suggesting damage by the acid. New bone formation in the middle ear cavity was speculated to be occurring due to inflammation of the middle ear mucosa.

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A 68-year-old male presented with a history of hoarseness since 1987. He had originally visited our hospital in February 1990, at which time a tumor was detected on the right side of the cricoid cartilage. In December 1992, local tumor resection and tracheostomy were performed to preserve the laryngeal framework. A histological analysis of the excised specimen indicated chondroma. Thereafter, a tumor recurred on the right side of the thyroid cartilage,and local tumor resection was subsequently performed in November 2006. The postoperative diagnosis was Grade I chondrosarcoma. Later, further tumor recurrence was detected on the left side of the cricoid cartilage, for which local tumor resection was performed in July 2013. Currently, the patient is free from disease. Following local resection without total laryngectomy for tumor recurrence after several surgeries, the patient has achieved a good quality of life. It is important to consider the use of partial laryngectomy or tumor resection to preserve the laryngeal function in patients with low-grade chondrosarcoma.

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We herein report a case of suspected cough syncope, in which the patient repeatedly experienced coughing (usually when drinking a liquid), resulting in a loss of consciousness or syncope. An endoscopic examination of the pharynx and larynx showed poor swallowing, and aspiration was detected by fluorography using iotrolan as a contrast agent. However, aspiration was not detected when barium, which has high viscosity, was used as the contrast agent. We believe that aspiration due to the swallowing problem may have triggered the coughing,resulting in syncope. The patient underwent swallowing rehabilitation and was advised to avoid some types of fluids,which resulted in an improved condition, including a decrease in the coughing and syncope attacks.

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Penicillin-based antibiotics (PCs) are contraindicated for infectious mononucleosis because rashes occur as an adverse reaction in a high percentage of cases. On the other hand, PCs are the first-line choice of treatment for acute bacterial pharyngitis/tonsillitis, where the main causative organism is group-A beta-hemolytic streptococcus. We recently experienced a case of infectious mononucleosis accompanying a group-A beta-hemolytic streptococcal infection. The patient was a 20-year-old female with chief complaints of pharyngeal pain and pyrexia. Pus was observed on the epipharynx and palatine tonsils, and the results of a rapid test for group-A beta-hemolytic streptococcus were positive. An automated hematology analyzer revealed a lymphocyte-dominant increase in white blood cells, so we performed liver function tests and a test for Epstein-Barr (EB) virus antibodies and also administered ceftriaxone. The bacterial tests confirmed group-A beta-hemolytic streptococcus in the epipharynx and palatine tonsils (3 +). Blood tests showed decreased liver function, atypical lymphocytes and EB virus infection,so infectious mononucleosis was also diagnosed. When selecting an antibiotic for the treatment of acute pharyngitis/tonsillitis in a patient testing positive for group-A beta-hemolytic streptococcus in a rapid test, it is necessary to measure the differential white blood cell count, while bearing in mind the possible complication with infectious mononucleosis.

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Dexamethasone cipecilate is a corticosteroid nasal spray whose local durability has recently been improved by the introduction of a liposoluble functional group to its chemical structure. There are two devices for inhalation：a capsule loading device (Twin-lizer) and a multiple inhaler. In this study, we compared the handling and tolerability of these two nasal spray devices in patients with allergic rhinitis. The characteristics of device handling and preferences were assessed according to a questionnaire, with the responses recorded on a five-point ordinal scale. Consequently, the device handling results showed that the multiple inhaler was rated more favorably than the Jetlizer inhaler in terms of the ease of correct inhaler use, and 63.1% of the patients reported that they would be happy to receive the multiple inhaler. In addition, the multiple inhaler was preferred by 85.7% of physicians with respect to the instructions for application. Therefore, the administration of dexamethasone cipecilate with a multiple inhaler may be superior in terms of patient compliance with instructions.

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