To clarify the role of insects as allergens in allergic rhinitis (AR), specific IgE antibodies (sIgE) to the moth, midge, and cockroach together with 10 other allergens were measured using sera from 560 AR patients, who visited 20 otolaryn-gological clinics nationwide from Hokkaido to Kyushu. Nasal challenge tests were also conducted with allergen disks of these 3 insects in 65 AR patients. Frequencies of sIgE positive to the moth, midge, and cockroach were 32.5%, 16.1%, and 13.4%. Frequencies of sIgE positive to these insects were not affected by patients' residential location, age, medication, or association with bronchial asthma. The prevalence of patients with positive nasal challenge increased depending on the RAST class to the insects. Among the patients whose RAST class were 3 and 4, nasal challenges with cockroach or moth extracts were positive in 55.6% or 61.5%. A strong correlation of sIgE titers was observed between the moth and midge, but the correlation between the cockroach and moth, and between the cockroach and midge were weak. No correlation of sIgE titers was found between house dust mites and these 3 insects. These results show that the moth, midge, and cockroach are inhalant allergens causing allergic rhinitis in Japan.

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To evaluate the therapeutic effect of Roxithromycin (RXM), we studied 56 chronic sinusitis patients with nasal polyps using computed tomography (CT) and electron microscopy in addition to conventional clinical assessment.
The paranasal sinus of subjects was observed clinically before and after daily administration of RXM at 300mg for 3 months all underwent allergy testing for possible complications of allergic rhinitis based on subjective symptoms and objective findings.
Improvement after RXM treatment was seen in 50.3% based on subjective symptoms and 59.1% based on objective findings. Overall improvement was seen in 53.6%. In 41 cases (73.2%) of all patients with chronic sinusitis and complications of allergic rhinitis, no significant difference was seen between patients with and without complications (53.7% in those with complications and 53.3% in those without). In CT analysis the paranasal sinus in 51.8% of all posttreated patients showed obvious improvement.
In electron microscopy in chronic sinusitis patients with complications of allergic rhinitis, pretreated ethmoidal sinus tissues showed high mucous epithelial cell apoptosis in addition to common histological lesions, while posttreatment patients showed only eosinophil apoptosis in the interstitium and no apoptotic epithelial cells. We divided ethmoidal sinus lesions in patients without complications into 3 types and evaluated them as follows: In type 1, pretreated ethmoidal sinus tissues showed plasma cell infiltration and posttreatment cell apoptosis. In type 2, pretreated tissues showed lymphocyte and plasma cell infiltration and posttreated showed only some lymphocytes and no plasma cells. In type 3, proliferation of fibroblasts, most of which showed apoptosis, was seen in addition to apoptotic epithelial cells before treatment, while after treatment, these lesions remained with some apoptotic bodies phagocytosed by macrophages. In type 3 patients relapsed after surgery.
Our findings indicate that RXM treatment had a significant therapeutic effect on chronic sinusitis with nasal polyps with and without complications of allergic rhinitis. We clarify the morphological mechanism of therapeutic effect of RXM on each type of ethmoidal sinus lesion divided by light and electron microscopy.

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Allergic fungal sinusitis is chronic and paranasal, related to fungal allergy. Many papers on allergic fungal sinusitis have been reported in the United State, and the incidence is 5% to 10% among patients with chronic paranasal sinusitis. Although cases of allergic fungal sinusitis have been reported in Japan, the incidence is unclear. We studied allergic fungal sinusitis in 40 consecutive patients-26 men and 14 women-undergoing endoscopic sinus surgery at Keiyukai Sapporo Hospital December 2000 to July 2001. We checked for allergic rhinitis and asthma, a history of surgery for nasal polyps and chronic sinusitis, the presence of nasal polyps, grading of sinusitis via computed tomography, nonspecific IgE and allergen-specific IgE for fungi in serum, eosinophilia in nasal smears, paranasal eosinophilic mucin, and histology and fungal culture of paranasal sinus mucus. None had typical allergic fungal sinusitis, but 1 had eosinophilic paranasal mucin, high IgE, and false-positive IgE for fungi. We studied clinical data and histology of fungi and paranasal mucosa in 9 cases with fungal maxillary sinusitis, but none had allergy or eosinophilc mucin. This suggested that few patients with allergic fungal sinusitis exist among those with chronic paranasal sinusitis.

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A newborn hearing screenig was conducted on 319 neonatal intensive care unit (NICU) and 1200 well-born nursery (WBN) infants. Mean NICU birth weight was 1997g and mean gestational age 34 weeks. Auditory brainstem response was studied in screening in NICU infants. Otoacoustic emission (OAE) or automated auditory brainstem response (AABR) was used in primary WBN screening. All infants not bilaterally passing hearing screening before discharge were recalled for outpatient retesting. If the outcome was still failure, ABR screening was conducted. The prevalence of infants diagnosed with hearing loss was 1.1% (16 of 1519). Of these 16, 75% were from the NICU and 75% were at risk for hearing loss. Mean age at hearing loss identification was 12.9 weeks in the WBN and mean age at hearing aid fitting was 16.1 weeks. Mean age at hearing aid fitting was lower for WBN than for NICU infants. Hearing loss identification and hearing aid fitting are thus feasible in NICU and WBN infants in universal newborn hearing screening.

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Computer-aided navigation in otolaryrlgology has been used mainly for nasal operation and rarely for ear surgery. The reason for its limited use in ear surgery appears to be that microscopic observation may be sufficient in most cases of ear surgery. We report a case of congenital cholesteatoma at the petrous apex operated on using navigation. A 65-year-old man with facial palsy, deafness, and canal paresis in caloric test on the left ear was found in preoperative computed tomograph (CT) showed alarge mass at the apex with an expansively eroded skull base and inner ear. Navigation used for the operation was magnetic (Insta Trak).A probe3.2mm in diameter was moved in the operative field and 3 axial CTs were simultaneously monitored on a workstation to show the tip location. With this image-guided system, cholesteatoma was thoroughly and safely removed. We concluded that navigation should be used for safe surgery, especially in ear surgery at the petrous apex, because anatomical identification is very easy and damage to vita1 areas around the inner ear, nerve, brain, and internal carotid artery could be avoided.

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The nasal mucosa plays an important role in human disease resistance by repeatedly constricting and expanding.
The nasal membrane also shrinks after exercise and thereafter recovers gradually.
We sudied exercise-induced changes in nasal NO, nasal resistance, and a minimal cross-sectional area in nomal subjects and discuss the role of nasal NO.
Subjects were 11 healthy adults (5 men and 6 wemen 24-52 years of age). They underwent a 6-minute fixed-load treadmill exercise, walking about 6 km/hr for 6 minutes.
The nasal NO level, nasal resistance, and minimal cross-sectional area were measured consecutively before exercise, immediately after exercise, and at 5, 10, 15, 20, 25, and 30 minutes after exercise.
Nasal resistance is known to decrease immediately after exercise and thereafter gradually increases until it reaches baseline levels.
The minimal cross-sectional area increases immediately after exercise, but returns to baseline levels thereafter.
The nasal NO level decreases immediately after exercise, but does not show changes parallel to nasal resistance or minimal cross-sectional area. The nasal NO level increases gradually, but then suddenly decreases at around 20 or 25 minutes after exercise. Its level thus shows 2 dips. This pattern is caused by a depletion of the NO substrate. As a result, NO is required by the various exercise-induced changes in many parts of the body. These findings suggest that NO production is related to the maintenance of homeostasis.

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