During the 20 years from 1977 to 1996, 633 cases underwent excisions of parotid tumors (539 benign and 94 malignant) in the department of Otolaryngology of Kansai Medical University. The incidence of Warthin's tumors in the years from (1987 to 1996) was higher than that in the years from 1977 to 1986. On the other hand, the incidence of mucoepidermoid carcinomas was less than in previous reports. Tumors accompanied with spontaneous pain or facial nerve palsy and with invasion to both lobes frequently indicated malignancy. Facial nerve palsy caused by either benign or malignant tumors before operation showed no improvement after surgery. The incidences of facial nerve palsy (1.0% in benign, and 18.3% in malignant) and Frey's syndrome (17.8% in benign, and 18.3% in malignant) after surgery were lower than those in other reports of both benign and malignant tumors. Five-year mortality was 76.1%. All deaths that occurred five years after operation involved highly grade malignant tumors.

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Prognostic factors and treatment outcome of 48 patients with Stage I (29) or II (19) non-Hodgkin's lymphoma of the head and neck were analyzed retrospectively. There were 26 males and 22 females, aged from 15 to 89 years old, with an average age of 57. The primary lesion was located in Waldeyer's ring in 25 patients, the nasal cavity and paranasal sinuses in 13, cervical lymph nodes in 8, and others in 2. Histologically, 2 had low grade lymphoma, 42 had intermediate grade disease, and 1 had high grade disease. The patients were treated with radiation alone (5 patients), chemotherapy according to a cyclophosphamide, doxorubicin, vincristine, predonisone- (CHOP) regimen (8 patients), or a combination of both treatments (35 patients). In univariate analyses, an unfavorable prognosis was associated with age≥60, Stage I disease, and extralymphatic lesion. Multivariate analysis showed that an extralymphatic lesion was a significant independent risk factor for death (p=0.0093). The overall five-year survival rate was 73.5%. Differences in the treatment was not reflected in the outcome. Our results suggest that a combination of chemotherapy (CHOP) and radiation is an appropriate treatment for lymphatic stage I and II non-Hodgkin's lymphoma of the head and neck. However, more intensive therapy is necessary for patients with extralymphatic head and neck NHL.

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We examined the eustachian tube function of 48 patients with adhesive tympanum who had undergone operations. Preoperative tubal openings were observed and determined in 57% of these cases by the dynamic movement of the tympanic membrane, 35% by the impedance method, and 74% by the sonotubometry and was found to be lower than in healthy subject. Futhermore the tubal opening duration in sonotubometry was significantly shortened in patients with adhesive tympanum as compared to healthy subjects. However, in a few cases of adhesive tympanum, tubal opening was prolonged remarkably, and indicated a mixed tendency of stenotic and patulous types. Postoperative tubal opening was not seen in 90.9% of the cases as determined by the inflationdeflation test. Mucociliary function was poor in 81.3% of the cases. No remarkable differences were seen between cases of total adhesion and those of posterosuperior quadrant adhesion by any method. The condition of the tympanic membrane and the tympanic cavity after operation, and the eustachian tube function were not correlated in some cases and indicated possible involvement of other factors.

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The surgical anatomy of the facial nerve (FN), chorda tympani nerve (CT) and round window (RW) in 26 Japanese temporal bone specimens was analyzed. The relationships were classified according to the relative position of these structures and the posterior wall of the external auditory canal (EAC). Most frequently, the widest approach route through the facial recess did not point directly at the RW, but rather at the basal turn. Moreover, the approach route crossed the FN-RW line in a posterior to anterior direction (76.9%) and the CT-RW line frequently crossed the posterior wall of the EAC (92.3%). The latter seemed to provide a critical landmark for avoiding damage to the CT during cochlear implant surgery. Therefore, we recommend inserting the electrode into the basal turn at the promontory.
Several other anatomical indices were measured and we extracted the index which was related to the maximum approach amplitude and direction. Preoperative diagnosis may be possible using these indices.

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A partially implantable middle ear implant using an ossicular vibrator of a piezoelectric ceramic bimorph has recently been developed in Japan as a new rehabilitative method for hearing. Four patients at the Miyazaki Medical College Hospital were implanted with this device between September 1994 and October 1996. Implantation of the internal component was performed under local anesthesia after confirmation of sufficient sensitivity to the ossicular vibrator in an intraoperative vibratory hearing test. All patients regained socially useful hearing with the middle ear implant without any foreign body reactions or recurrence of otitis media. None of the cases showed any elevations of bone conduction thresholds 2 to 4 years postoperatively. Natural and clear sounds without interference noise and howling due to acoustic feedback were highly satisfactory in all patients. However, the first case, who had an implant in an ear following cholesteatoma surgery using the intact canal wall technique, experienced about a 10dB deterioration of the average hearing level with the implant 2 years after implantation. Gradual deterioration appeared to be caused by the retracted tympanic membrane interfering with the mobility of the ossicular vibrator. The following three cases were implanted in ears previously operated on by radical mastoidectomy, showing stable or improving hearing results with the implant. Closure of the external canal skin at the cartilaginous portion at the time of implantation seemed appropriate to maintain a sufficient middle ear space for the ossicular vibrator to work properly. Our case study confirms that the partially implantable middle ear implant is a safe and useful tool for patients with mixed deafness which cannot be satisfactorily rehabilitated by tympanoplasty and/or a conventional hearing aid.

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Factors affecting subjective tinnitus pitch and tinnitus tonality were analyzed with the use of the quantitative method II. Ninety-one patients with unilateral tinnitus of a single kind were studied. Major factors affecting subjective tinnitus pitch were pitch matched frequency, age, puerility and impurity of tinnitus tonality, and loudness of tinnitus. In addition, major factors affecting puerility and impurity of tinnitus tonality were pitch matched frequency, loudness of tinnitus, and nature of the test tone. Furthermore, subjective puerility of tinnitus was associated with middle-pitched frequency and high-pitched frequency, and a loudness level of tinnitus between 25 and 49 dB HL. Whereas impurity of tinnitus was related to low-pitched frequency and noise of the test tone. These results may contribute to the clinical evaluation of tinnitus.

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The prognostic value of preoperative promontory testing was evaluated in Japanese cochlear implant patients. Promontory testing consisted of measurement of electrical thresholds (T), uncomfortable level (UCL), dynamic range (DR), gap detection (GAP), and temporal difference limen (TDL). Patients' performances were measured at 3 months (n=46) and 1 year (n=20) postoperatively, using a standard Japanese audiologic test battery without lip-reading. This study included only postlingual deaf patients who received the Nucleus multichannel cochlear implant.
Wide DRs at low frequencies (50, 100, 200Hz) and good GAP detection (<20ms) emerged as excellent preoperative predictors of the 3-month postoperative performances (P<0.05). In contrast, any measurements could not serve as a good predictor of the 1-year performances.
These results suggest that the preoperative promontory testing provides useful information only for early postoperative performances but that it could not predict the final language performances.

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