The relationship between eosinophis and chronic sinusitis was investigated by measuring the concentration of eosinophil cationic protein (ECP). In addition to the blood, a cytological brush was inserted into middle meatus to scrape the nasal membrane, and the concentration of ECP in the collected specimen was measured. There was a moderate degree of correlation between the blood eosinophil count and the ECP concentration in the blood (r=0.543, p<0.01). On the other hand, there was high degree of correlation between the number of EG2-positive cells and ECP of the nasal membrane in the middle meatus (r=0.805, p<0.001), reflecting the amount of ECP in the nasal mucous membrane. The ECP in 10 control group subjects and 14 patients with severe chronic sinusitis and nasal polyps was significantly lower than that in 14 patients with severe chronic sinusitis and asthma (p<0.01). The ECP concentration of the nasal membrane in the middle meatus was significantly lower in patients showing a good postoperative course compared with patients showing a poor postoperative course following Endoscopic Sinus Surgery (p<0.01). These findings suggest that eosinophils are closely related to the pathology and clinical course of chronic sinusitis, and that the ECP concentration of the nasal membrane in the middle meatus reflects the pathology of chronic sinusitis. The ECP concentration thus has potential as a prognostic indicator for chronic sinusitis.

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Infants with upper airway obstruction caused by adenotonsillar hypertrophy often suffer from sudden death. We have performed adenotonsillar operations on patients under 2 years of age. These infants had sleep apnea, dyspnea, poor increase of body weight or cardiac hypertrophy. This is a report on a clinical study on these infants.
Between October 1988 and February 1998 eighteen patients under 2 years of age (17 boys and one girl) had an adenotonsillar operation in our hospital. Three had adenotomy and two had adenotomy and one-sided tonsillectomy. The remaining thirteen patients had adenotonsillectomy.
During the post operative period, all showed remarkable improvement in sleep apnea and dyspnea with the exception of four patients in whom reoperation was required because sleep apnea was brought on again by adenoid rehypertrophy and tonsillar hypertrophy.
Based on this study, we conclude that adenotonsillectomy is effective in infants with sleep apnea or dyspnea caused by adenotonsillar hypertrophy.

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This report describes a new procedure for examining functional deafness with binaural sound stimulation. This new hearing test can estimate the genuine pure tone hearing threshold quantitatively at every frequency by using the ordinary audiometer.
In the case of the nonorganic deafness, even if the hearing disorders are bilateral or hemilateral, we believe that measuring auditory threshold separately, causes the deterioration of the threshold. Therefore, this procedure is designed so that the subject may not be aware of testing the auditory acuity of each ear, and utilizes the response of the phantom sound image in the head by simultaneous binaural presentation of sound stimulation.
Our strategy is based on the following facts. If the normal subject has the same pure tone threshold level in both ears, the phantom sound image is formed in the median plane of the head by the equal suprathreshold tone level presented simultaneously in each ear.
In the case of a unilateral auditory disorder, the sound image is localized to the center of the head only when sound stimulation louder than the threshold level of affeccted ear is given to both ears at the same time. Simultaneous binaural sound stimulation at a lower level than the threshold of the affected ear forms a lateralized sound image to the unaffected ear in the head. For patients with bilaterally similar hearing loss, the sound image is not formed if the stimulation is less than the threshold level of the pure tone.
The band noise in the phase of each frequency with 50 dB HL was given binaurally to 10 normal hearing subjects, and the localization of the sound image formation was examined. This experiment confirmed that around the occipital region of the median plane in all subjects. Furthermore, comparing the formation threshold of the median plane image with the pure tone auditory threshold, proved that there was no significant difference statistically in either value. As a next step, 15 patients with unilateral sensorineural deafness were examined with this technique and we knew that the median sound images would not be formed with stimulation less than the pure tone auditory threshold of the affected ear.
For clinical application, patients were classified into two groups with unilateral (6) and bilateral (2) functional deafness, and examined. Midline sound images definitely were formed with the lower magnitude of sound than the pure tone threshold by hemilateral nonorganic deafness. The difference of the forming threshold of the median sound image and the average of pure tone hearing level of the affected ear were maximum 100 dB, minimum 35 dB, and mean 69.4 dB. Furthermore, the difference of the median image forming threshold and the average hearing level of the unaffected ear were maximum 35 dB, minimum 0 dB, and mean 15.4 dB.
In bilateral disorders, the midline plane sound image was formed with the corresponding level of the pure tone value in one subject, though the other one was determined by the maneuver method because it did not form a midline sound image.
In conclusion, this examination can be readily used to estimate the genuine hearing threshold of the functional deafness.

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Eleven patients (12 ears) with acute otitis media associated with raised bone conduction were studied. The patients were from 19 to 70 years old and came to our hospital between November 1996 through May 1997. Pure tone audiometry revealed mixed hearing loss, but there was no bullous myringitis in all cases. They were treated by oral or intravenous antibiotics, steroids, and myringotomy. Bacteriological examination was done in seven cases, and revealed penicillin resistant Streptococcus pnumoniae in three cases. Complete recovery of hearing loss was obtained in 10 of 12 ears, but sensorineural hearing loss remained in 2 patients. Bacteriological examination and pure tone audiometry in acute otitis media are important for detecting the severity of the disease, determining the administration of steroids, and for the selection of antibiotics.

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Aspergillosis of the paranasal sinus usually affects the maxillary sinus and isolated aspergillosis of the sphenoid sinus is less frequent. Aspergillosis of the paranasal sinus has been generally classified into the non-invasive type and the invasive type. There is controversy whether such difference of invasion depends on impairment of the host's immunological function or aspergillus offense factors. We report three cases of aspergillosis of the sphenoid sinus affecting individuals whose immunological states were different from each other. The prognosis among these cases was also different. These three cases suggest that the difference in the degree of aspergillus invasion may depend on the immunological state of each patient. Therefore, immediate diagnosis and therapy are very important for paranasal aspergillosis in the immunocompromized patient.

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