Introduction: Minimal cross-sectional areas situated at the anterior end of the inferior turbinate have the most influence on nasal patency. To improve persistent nasal obstruction, 2 types of inferior turbinectomies - conventional complete resection including the anterior and posterior mucosa and anterior resection of the anterior mucosa - were conducted and preoperative and postoperative nasal patency and stuffy sensation were compared and analyze.
Objects and Methods: Cases undergoing 2 types of turbinectomies between July 1997 and March 2000 numbered 63 - conventional in 32 (64 sides) and anterior in 31 (62 sides).
Anterior, posterior, and total nasal volume and minimal cross-sectional area were evaluated pre-and postoperativelly using an acoustic rhinometer. The stuffy sensation was similarly evaluated by the visual analog scale (VAS).
Results: All nasal volumes showed postoperative increase under conventional treatments. Anterior and posterior volumes significantly increased under anterior treatment. Comparing the results of postoperative volume posterior volume was significantly larger under conventional treatment than under anterior treatment. Stuffy sensation significantly improved by VAS in both types of turbinectomy, with no significant difference between them.
Conclusion: Anterior treatment to solely increase nasal volume at the minimal cross sectional area showed equal postoperative improvement in VAS under conventional treatment.

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We performed a medical cost analysis on the use of neoadjuvant chemotherapy (NAC) in multi-modal treatments for advanced tongue and oropharyngeal cancer. Twenty-two patients with stage III and IV squamous cell carcinoma of the tongue and oropharynx were enrolled in this study. Two courses of NAC with CDDP and 5-FU followed by radiotherapy were performed in 13 patients who showed a partial response or a complete response after the first course of NAC. The doses of radiation were 60 Gy for 4 patients (rad. group), and 72 Gy for 9 patients who received hyperfractionated radiotherapy with simultaneous Carboplatin (HF rad. group). Radical surgery was performed in 9 patients who did not respond to NAC (surg. group). The mean duration of hospital stay was 89.3 days for the rad. group, 92.0 days for the HF rad. group, and 113.3 days for the surg. group. The mean medical cost was 238700 points for the rad. group, 264846 points for the HF rad. group, and 459468 points for the surg. group. The mean amounts and percentages of cost for NAC were 39473 points and 16.1% for the rad. group, 44802 points and 16.9% for the HF rad. group, and 23451 points and 5.1% for the surg. group. The mean amounts of cost for NAC including examination costs and nursing costs for chemotherapy were 130196 points and 54.5% for the rad. group, 150046 points and 55.7% for the HF rad. group, and 113839 points and 24.8% for the surg. group. The cost of NAC accounted for half of the total cost of chemo-radiation treatment for functional preservation. The duration of the hospital stay was prolonged by NAC, which accounted for a quarter of the total cost for the surg. group. Survival benefits are considered in the analysis of treatment cost-effectiveness for head and neck cancers. In the future, QOL, which is defined as the utility achieved as a result of multi-modal treatments, should also be analyzed along with survival benefits. Cost-utility analyses should include quality-adjusted life years, based upon the cost identification results of our analysis for NAC, to evaluate the efficacy of NAC in multi-modal treatments for head and neck cancers.

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A clinical study of 107 patients with nasal allergies who were treated at Kushiro General Hospital between April 1998 and March 2000 was performed. Radioallergosorbent tests (RAST), X-rays, and nasal smears for the detection of eosinophilia were performed to obtain a diagnosis of nasal allergy. The patients (50 males, 57 females) ranged in age from 3 to 71 years. The RAST was positive for timothy in 22.4% of the patients, 14.0% for birch and 12.1% for mugwort. The most common pollinosis allergen in the Kushiro area was grass pollen. Other pollinosis allergens were birch pollen and mugwort pollen. We measured the daily count of dispersed birch pollen and timothy pollen in Kushiro and Sapporo. Birch pollen and timothy pollen was dispersed earlier in Kushiro than in Sapporo. Nasal allergies in the Kushiro area appear to be related to local characteristics, such as climate and geographical features.

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Monitoring of cochlear function is one proposed clinical application of otoacoustic emission (OAE). To determine the clinical utility of OAE in monitoring, we studied changes in OAE during the glycerol test used to diagnose endolymphatic hydrops. Transiently evoked OAE (TEOAE) and distortion product OAE (DPOAE) were measured before and 3 hours after oral administration of glycerol in 22 ears of patients with Meniere's disease. The positive result in the glycerol test was observed in 11 of 22 ears. TEOAE was recorded using a nonlinear click stimulus, and total echo power (TEP) of the whole response and filtered echo power (FEP) of its mid-frequency (1000-2000 Hz) component were used as TEOAE parameters. The growth functions of DPOAE were recorded at 3 F2 frequencies - 1000, 1500, and 2000 Hz. Changes in the growth function were determined based on changes in 2 parameters - maximum level and detection threshold of DPOAE. When changes in these 4 parameters exceeded 2 standard deviations above mean test-retest variability determined from OAE data for 17 normal ears, they were considered significant. Significant changes indicating improved cochlear function in 4 OAE parameters or the appearance of OAE during the glycerol test were judged positive for OAE.
Regardless of glycerol test results, positive findings were observed in both OAEs whenever a pure-tone threshold at 1000 or 2000 Hz improved. However, even in ears for which pure-tone thresholds at these frequencies did not improve, both OAEs frequently exhibited positive findings. In all ears with a positive result in the glycerol test, positive findings were observed in DPOAE, but not in TEOAE. Of the 2 parameters of TEOAE, FEP always exhibited a positive finding in ears with a positive TEP finding and FEP positivity was higher than that of TEP. In DPOAE, no cases showed a positive finding only at F2=2000 Hz, and DPOAE at F2=1000 Hz could not be detected in 4 ears due to high noise floor. Overall, positive findings were obtained in 14 ears (63.9%) for TEOAE and 20 ears (90.9%) for DPOAE. In only 1 ear were no positive findings observed in either OAE. The sensitivity of OAE measurement as a diagnostic test for endolymphatic hydrops was higher than that of pure-tone audiometry. Of the 2 OAEs, test sensitivity was much higher for DPOAE than for TEOAE.
These results show that OAE measurement detects changes in cochlear function during the glycerol test more sensitively than pure-tone audiometry. They also suggest that FEP is a better indicator than TEP as a parameter of TEOAE, and that DPOAE measurement at F2=1000 and 1500 Hz is sufficient for practical clinical use. However, of the 2 OAEs, DPOAE was considered more appropriate than TEOAE for monitoring during the glycerol test because of its high sensitivity in detection of changes in cochlear function.
In conclusion, clinical use of OAE, especially DPOAE, as a test complementary to pure-tone audiometry during the glycerol test is very useful and will improve the diagnosis of endolymphatic hydrops.

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Factors affecting the subjective loudness of tinnitus were analyzed using quantitative methods. One hundred and eighty-four patients with unilateral tinnitus were studied.
Major factors affecting the subjective loudness of tinnitus were found to be subjective tinnitus pitch, annoyance, diagnosis, pitch-matched frequency, insomnia, age, tinnitus loudness level in dB HL, the duration of tinnitus and the tinnitus loudness level in dB SL at the first axis. Tinnitus pitch and pitch-matched frequency strongly affected the loudness of the tinnitus; high-pitch tinnitus and middle and low frequencies were associated with the subjective loudness of the tinnitus. In contrast, low-pitch tinnitus and a high frequency were associated with the subjective softness of the tinnitus. Thus, tinnitus pitch and pitch-matched frequency are inversely related. Sudden deafness and dizziness were associated with subjective softness of tinnitus, while hearing loss in elderly patients was associated with subjective loudness of tinnitus.
Our results suggest that the level of annoyance from tinnitus and the subjective loudness of tinnitus are closely related.
The relation between these factors should be considered when evaluating patients with tinnitus.

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