Introduction: Relapsing polychondritis (RP) manifests as an inflammation of cartilaginous structures throughout the body. Since RP affects cartilage tissues and proteoglycan-rich structures. symptoms appear in the ear. nose. eye. joints, and respiratory system. Otolaryngologists are frequently involved in RP's initial diagnosis. since it is likely to affect the head and neck regions. The etiology of RP remains unknown and it is relatively uncommon. so appropriate treatment remains to be determined. We studied the clinical course and treatment response.
Methods: We studied clinical courses in 12 cases of RP treated at our hospital in the 11 years from 1991 to 2001.
Results: In 11 of the 12 cases. conventional steroid therapy was implemented. Five required steroid pulse therapy, and 7 immunosuppressive drugs to control the disease. Strong initial therapy such as steroid pulse therapy plus immunosuppressive drugs suppressed inflammation and decreased its relapse in severe RP patients. One patient could be controlled only with nonsteroidal antiinflammatory drugs. Side effects such as cataracts and diabetes from steroid therapy or pancytopenia from Dapson were found in some patients. All 12 are alive at present. Six were subsequently released from steroid therapy. Anti-type II collagen antibody was not useful as an indicator for treatment but helpful as one of a complementary factors for diagnosis.
Conclusion: Manifestations of RP are sometimes self-limited, but in most cases, inflammation is recurrent, gradually worsening and finally becoming life-threatening. It is difficult to determine the severity of RP and choose appropriate treatment in its initial stage. Because severe RP cannot be controlled with conventional steroid therapy. strong therapy is indicated in initial treatment if patients have serious symptoms.

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In the 22 years between March 1979 and February 2001, we treated 16 patients 10 men and 6 women aged 10-80 years (mean: 44 years) - with mucoepidermoid carcinoma (MEC) of the salivary gland, evaluating them clinically and histopathologically. Tumor sites included 12 at the parotid gland, 3 at the submandibular gland, and 1 at the minor salivary gland. All tumors were graded histopathologically based on the criteria of Goode et al. as follows : low grade (n=10), intermediate grade (n=1), and high grade (n=5). Female gender was associated with low grade MEC and male gender with high grade MEC (P<0.05). The age at onset in high grade MEC was older than that in low grade MEC (P<0.005). Lymph-node metastasis was detected in 7 out of the 16 patients (44%) associated significantly with high grade MEC (P<0.05). Distant metastasis was detected in 4 of 16 patients (25%). Distant metastasis was significantly associated with high grade MEC (P<0.05). Local recurrence was detected in 3 of 15 patients undergoing surgery (20%). No difference was seen in local recurrence frequency between low and high grade MEC. Survival was calculated with Kaplan-Meier's method. In all 16, 5-year survival was 86% and 10-year survival 75%. Five-year survival in low grade MEC was 100%, whereas that in high grade MEC was 67% (P<0.05). In MEC of the salivary gland, it was suggested that the histopathological MEC grade evaluated by Goode's criteria significantly correlated with gender, age, lymph-node metastasis. distant metastasis, and 5-year survival.

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In 29 ears of 24 patients with auditory ossicle malformation, but without external ear abnormalities, who were operated on at our clinic in the 10 years between June 1993 and June 2002, we studied the condition of ossicles, preoperative examination, surgical procedures, and postoperative hearing improvement. Our study did not include patients with cholesteatoma or those with only fixed stapes but without ossicular deformity. Samples were 12 ears of 11 men and 17 ears of 13 women. We clinically distinguished 3 major categories: (i) discontinuity between the incus and stapes with mobile stapes, (ii) congenital fixation of the stapes with ossicular deformity, and (iii) congenital fixation of the malleus and deformity of the incus with mobile stapes. We classified each category into minor anormalities based on the condition of the long process of the incus, the superstructure of the stapes, and the stapes footplate. We conducted auditory ossicle reconstruction by mobilization of the malleus and incus in 2 ears, by type III tympanoplasty in 5 ears, by type IV tympanoplasty in 13 ears. and by stapes surgery in 8 ears. Improvement in hearing after the operation was observed in 25 of the 29 ears treated.
In the classification of the auditory ossicle malformation without external ear abnormalities, we should evaluate discontinuity or fixation of the ossicles and their deformity. This requires that varied ossicular reconstruction be prepared for surgery. but the possibility of hearing improvement is high, so intensive treatment is needed in many cases of auditory ossicle malformation.

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Contention exists on the development of pneumatization of temporal bone. Many techniques to measure the volume of pnewnatization have been reported, but no techniques for direct surface area measurement. We measured the surface area and volume of human mastoid air cells.
Eight normal temporal bones removed at autopsy were analyzed and fixed in formalin fixative, decalcified, and embedded in celloidin, sectioned at 25μm and stained with H-E for histological examination. Total surface area and the volume of human mastoid air cells were measured using a personal computer. The surface area of pneumatic spaces for the 8 temporal bone specimens ranged from 36.lcm to 163.0cm2 (mean±SD: 89.1±34.0cm2). The volume of pneumatic
spaces for the 8 specimens ranged from 1.53ml to 6.03ml (mean±SD: 4.12±0.97ml).
The surface area of temporal bone pneumatic spaces we determined could serve as useful basic data for determining the physiology of ventilation for the temporal bone and the function of mastoid cells.

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Six cochlear implant recipients with hearing aids in the opposite ear were studied to survey binaural advantage. They were examined in separate tests by using a hearing aid alone, cochlear implant alone, and by using both devices (bimodal condition). Test items used were the Japanese monosyllable word list 67-S and Japanese HINT.
Statistically significantly results were obtained in the bimodal condition, three out of six subjects were successful in the monosyllable word test and all successful in the Japanese HINT. We conclude that all subjects enjoyed binaural advantage in speech perception in bimodal condition with no conflict at the recognition level; even when different sounds from cochlear implant and contralateral hearing aid were received.
The plasticity of the brain is thought to be of importance in the bimodal condition.

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To improve low-pitched voices in cases with polypoid vocal cords, YAG laser irradiation combined with a mucosal suturing technique was attempted in 9 female cases with severe polypoid changes in their vocal cords. A YAG laser beam (5 to 10W) was used to irradiate the upper surface of the polypoid vocal cord. The polypoid content of the cord was gradually coagulated, and the fire edge of the cord appeared to slide up toward the burned area. The polypoid content was then removed and squeezed through an open wound made in the burned area using a conventional method. Bleeding was successfully controlled using the laser. After the excessive mucosal margin was trimmed and the contour of the vocal cord was adjusted, the wound was closed by 7-0 monotilament absorbable suture. Suturing was relatively ease because the mucosal edge was also coagulated. Postoperative evaluations of voice quality revealed an improvement in the GRBAS scale of voice quality as well as an elevation in voice pitch and an upwards shift in the voice range in all cases.

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