Recent advances in endoscopic sinus surgery suggested the potential for its surgical application to pituitary surgery. A number of institutions have reported the advantage of endoscope use in pituitary surgery, which is now widely accepted, but approaches to the sella vary in the literature. We retrospectively studied sella approaches in endoscopic pituitary surgery as rhinologists. Subjects included 6 cases of pituitary adenoma and 2 cases of Rathke's cleft cyst. A both-nostril transnasal transsphenoidal approach, our standard technique, was used in 6 cases. This approach consisted of elevation of mucoperiosteal flaps, resection of the vomer and sphenoid anterior wall, and opening of the sellar floor. Elevated mucoperiosteal flaps were used to close of the sella after tumor resection. All tumors were removed and no significant postoperative complications occurred. We found the both-nostril transnasal approach to be easy and time-saving and provided surgeon with a broad surgical field necessary to treat large tumors and accidental cases. Postoperative observation of the sella was easy for wide opening of the anterior wall of the sphenoid sinus. In our experience with reoperation, we quickly accessed the sella and easily removed tumors in the second operation. Our technique therefore has an advance in treatment of recurrence. The both-nostril transnasal approach involves the same procedures as median drainage of the sphenoid sinus, so our technique may have advantages in preventing mucocele of the sphenoid sinus as a late complication of transsphenoidal surgery. The transnasal transsphenoidal approach via both nostrils is preferable rhinologically.

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Our understanding of the pathomechanism of benign paroxysmal positional vertigo (BPPV) has improved dramatically. A type of BPPV featuring mixed torsional and vertical nystagmus induced by the Dix-Hallpike maneuver involves the posterior semicircular canal (P-BPPV). The other type of BPPV featuring horizontal nystagmus induced by spine-to-lateral head positioning involves the horizontal canal BPPV (H-BPPV).
In complaints of vertigo or dizziness, 619 patients visited our department last year. Of these, 142 (23%) was had positional nystagmus consistent with a diagnosis of BPPV, 118 (19%) had no nystagmus but were suspected of BPPV due to vertigo episodes. BPPV was the most frequent diagnosis. H-BPPV was not rare, but accounted for 30% of BPPV. Of H-BPPV, 73% featured direction changing geotropic nystagmus, and 27% direction changing apogeotropic nystagmus. H-BPPV resolved faster than P-BPPV. Most cases caused by head trauma were P-BPPV. Transition between P- and H-BPPV was found in 6 cases. Women outnumbered men by about 3 to 2 in both P- and H-BPPV. Peak incidence was found in the those in their 60s and 70s, suggesting that the etiologies of both types of BPPV are essentially the same.

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Since vaccination legislation was revised in 1994, rubella vaccination has been changed from application to all junior high school girls with no history of clinical rubella to application to individual infants and junior high school students. This may decrease the vaccination acceptance rate and increase the chance of pregnant women's infection with rubella causing congenital rubella syndrome (CRS).
We studied 5 children with CRS developed after a 1987-1988 epidemic in Japan to determine how their mothers were infected, and reviewed auditory findings. They were CRS-confirmed or CRS-compatible cases who met CRS diagnostic criteria formulated by the U.S. Center for Disease Control (CDC) in 1983.
Two mothers had not been vaccinated because this was not legislated when they were in junior high school. Three were eligible for vaccination at 14, but 2 were not vaccinated. The children were born in 1991-1997. Complications were low birth weight in 3, delay in neck stabilization in 2, and cataract in 1. No case was serious. Ages at first ENT examination ranged from 3 months to 1 year and 8 months. ABR showed hearing loss of ≥90 dBnHL. They started using hearing aids at 6 months to 1 year and 10 months. Tsumori mental development tests showed delays in developmental age in 2 who started auditory training after ages of 1 year and 6 months.
Findings indicated that infants, students, and potentially pregnant women should be vaccinated. Complete serologic testing are important in pregnant women and fetal rubella infection should be diagnosed early by PCR.

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The nasal valve was studied using coronal scans by computed tomography (CT).
Subjects: Coronal images were 5mm thick obtained from 133 subjects 93 men and 40 women averaging 46 years of age.
Methods: The valvular area was studied in 2 slices containing nasal valve, anterior and posterior slices 5 mm apart.
After defining standard points for evaluation, breadth, height and area were evaluated using NIH Image Version 1.59 from left and right as an unit.
Results:
Results were follows:
1. The breadth of the nasal valvular area is larger in men than in women, and the height greater.
The angle of valvular area is similar in both.
2. A comparison of anterior and posterior slices showed the smallest breadth of valvular area in the anterior slice to be smaller than in the posterior slice. The breadth of the vestivular area below the valvular area is larger in the anterior than posterior slice. The angle in the anterior slice is larger than that in the posterior slice. The area of valvular area in the anterior slice is smaller than that in the posterior slice.

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