We treated 346 patients with otitis media with effusion (OME) and 30 (127 episodes) with recurrent acute suppurative otitis media at our outpatient clinic in the 6 years from October 1994 to September 2000.
Of these, childeren under 15 years old numbered 185, mostly boys at a ratio of 1.4:1.0, while patients aged 15 years or older numbered 161, mostly females at a ratio of 1.3:1.0. In children, 24 were excluded due to a lack of diagnostic follow-up, 65(40%) patients improved in conservative management of medication with and without repeated tubal inflation, 79(49%) improved by paracentesis, and 18(11%) recovered with the use of pressure equalization tubes (grommets). Of cases aged 15 years or older, follow-up was not possible in 28. Three (2%) were free of OME by conservative treatment, 116(87%) improved by paracentesis, and 9(7%) by using tubes. The mean durations of tube insertion was 11.3 months in children and 7.2 months in adults, but 5 adults (4%) continue being treated of this writing.
Bilateral cases were 30% of children and 8% of adults with 73% of children affected bilaterally having persistence or recurrence.
Acute purulent otitis media progressed to OME in 22% of children but only in 3% of patients aged 15 or older. In 36% of children and 26% of patients aged 15 or older, acute upper respiratory tract infection coincided with or predisposed to OME. Rhinosinusitis was seen in 19% of children and 14% of adults. Coincident allergic rhinitis was seen in 14% of children and 12% of adults with OME. Nasopharyngeal infection and allergy are likely related to OME development.
The peak incidence of OME was similar to that of recurrent suppurative otitis media in children, so a seminal precipitating factor appears to result in these 2 conditions.

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Nitric oxide (NO) and peroxynitrite play an important role in pathophysiology of several airway diseases. An inducible isoform of nitric oxide synthase (iNOS) is known to be expressed in the nasal mucosa in allergic and chronic rhinitis. Few reports exist, however, on the expression of iNOS in nasal polyps. We detected and localized iNOS expression in nasal polyp tissue. Nasal polyps were obtained from 10 patients following polypectomy, and divided into allergic and infectious groups based on clinical presentation and laboratory testing. One nasal mucosa of the inferior turbinate was also obtained from a cadaver without nasal disease. iNOS expression was studied by immunohistochemistry under light and electron microscopy.
Immunoreactivity for iNOS was localized to the mucosal epithelium, inflammatory cells, vascular endothelium and smooth muscle, and nasal gland. Strong immunoreactivity was shown in the mucosal epithelium of both groups, and weak to moderate reactivity in the mucosal epithelium of the inferior turbinate. Vascular endothelium and smooth muscle of both groups sometimes showed weak to moderate immunoreactivity. Nasal glands of both groups sometimes showed weak immunoreactivity.
A significant difference between allergic and infectious groups was observed in predominant types of inflammatory cells. Neutrophils were predominant in the infectious group (p<0.01), and eosinophils in the allergic group (p<0.0001). About 50%-53% in allergic and 42% in infectious groups-of inflammatory cells showed positive immunoreactivity for iNOS. Immunoreactive cells were neutrophils, eosinophils, and macrophages. Lymphocytes, plasma cells, and mast cells invariably reacted negatively. A significant difference between allergic and infectious groups was observed in predominant iNOS-immunoreactive cells. Ratios of immunoreactive neutrophils to all neutrophils (p<0.05) and to all inflammatory cells (p<0.05) were significantly higher in the infectious group. The ratio of immunoreactive eosinophils to all inflammatory cells was significantly higher in the allergic group (p<0.0001), while the ratio of immunoreactive eosinophils to all eosinophils did not differ between infectious and allergic groups. The ratios of immunoreactive macrophages to all macrophages and to all inflammatory cells did not differ significantly between groups. Electron microscopy showed that degenerated cells with pyknotic nuclei were located next to immunoreactive eosinophils, suggesting the cytotoxicity of NO, peroxynitrite, or superoxide.

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We treated 9 patients with squamous cell carcinoma of the posterior oropharyngeal wall at the Cancer Institute Hospital, Tokyo. All were men averaging 64.1 years of age. One patient each was stage I, stage II or stage III, and 6 were stage IV. Cervical lymph node metastasis was seen in 6 at initial diagnosis. Retropharyngeal lymph nodes were involved in 4, while 5 had second primary cancer such as esophageal, gastric, head and neck cancer. Radical radiotherapy was done for 3 and surgery as initial treatment in 6. Five-year local control was 50% and 5-year disease-free survival was 22%. Total laryngectomy was done for 4 patients. Six died of oropharyngeal cancer and 1 of second primary cancer. Cancer of posterior pharyngeal wall is relatively rare and the prognosis is considered poorer than other types of oropharyngeal cancer for necessitating study to determine which modality may improve treatment results.

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We studied the occurrence of deformation after collection of auricular cartilage. Subjects numbered 28(15 with auricular cartilage collection and 12 without serving as a control group). We measured ear length, ear width, ear attachment length, auricular cartilage length, auricular lobe length, and auricle height, evaluating questionnaires given to subjects. Results showed that the collection of auricular cartilage does not result in deformation. In conclusion, the collection of auricular cartilage has few risks in view of cosmetics.

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The jugular bulb may be present in different positions and dimensions within the temporal bone.
In general, high jugular bulbs were classified into 2 types: lateral in which the jugular bulb protrudes into the middle ear and up into the tympanic cavity and medial in which the jugular bulb is abnormally placed more superiorly and medial to the cochlea.
We report, a unique case of a high jugular bulb which came round from behind of the internal auditory canal and the cochlea protruding into the posterosuperior part of the mesotympanum. It was a very rare pattern of a high jugular bulb which varies in position.
The occurrence of adhesive otitis media caused the high jugular bulb to bleed easily in the only hearing ear.
There would he risks of making the patient suffer severe bilateral healing impairment due to only one hearing ear and excessive hemorrhage in surgical treatment. With only one hearing ear, we should therefore select: transcatheter interventional angiography when the quantity and frequency of bleeding from the jugular bulb increase so.

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We report postpartum hypercalcemia in 2 patients with previous thyroid carcinoma who had undergone total thyroidectomy and total parathyroidectomy and required vitamin D and calcium therapy to control hypoparathyroidism. Postpartum, they required less vitamin D and calcium for satisfactory control. While lactating, they maintained normal serum calcium without supplementary vitamin D or calcium.
Transient remission of hypoparathyroidism symptoms has been observed during lactation. Some studies have shown that parathyroid-related protein (PTHrP) is produced by breast tissue, having an endocrine-like effect. We discuss the mechanism of postpartum hypercalcemia.

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