[in Japanese]

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We studied 48 patients (48 cars) with congenital cholesteatoma who underwent surgery at our department from 1979 to 2000, and investigated symptoms at initial onset, tympanic membrane findings, cholesteatoma configuration and site, type of surgical procedure, and surgical outcome.
Patients were from 2 to 62 years old (mean: 16.7 years), with 60.4% aged 15 years or younger. The symptom at initial onset was hearing loss in most (58.2%, ). Hearing loss was the main symptom in all with open type cholesteatoma, and most of these patients had normal tympanic membrane findings.
The cholesteatoma was located mainly in the superior posterior portion of the tympanic cavity in many patients. The site of involvement was the tympanic cavity in 12 (25.0%), mastoid cavity in 2 (4.2%) and the petrous apex in 1 (2.1%). In many of (31 ears, 64.6%), the cholesteatoma was advanced and extended from the tympanic cavity to the mastoid antrum. For 23 of the 48 ears, treatment was completed in one operation. The remaining 25 ears required staged surgery. Loss of the structure of the upper part of the stapes was seen in 58.3%, of patients. So most underwent type IV ossiculoplast., with types III and I next most common.

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We studied the relationship between vertigo and stress, using an internet survey. A questionnaire posted on our homepage quantified and measured 4 categories: cause of anxiety, behavioral characteristics, means of relaxation, and frequency of vertigo. There were 6065 responses.
Scores for the cause of anxiety were significantly greater and scores of means of relaxation were less in older than younger respondents.
Scores for the cause of anxiety and behavioral characteristics were significantly greater in more frequent than less frequent vertigo. Scores for means of relaxation were less in frequent vertigo. These findings indicate an intimate relationship between the onset of vestibular disorder and stress.

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We examined .395 temporal bones with an intact tympanic membrane to explore the relationship between residual inflammation in the middle ear cavity and development of mastoid pneuntatization. Histopathological changes were studied in the middle ear cavity. Mastoid pneumatization was classified as good or poor based on the extent of mastoid tip development to the lateral semicircular canal. Specimens were 344 temporal bones with well-pneumatized mastoid and 51 with poorly-pneumatized mastoid. Otitis media was noted in 119 (34.6%) bones in the good group and 9 (17.6%) in the poor group. In well-pneumatized mastoid, chronic inflammatory changes were frequently observed at the lower portion of mastoid cells, the round window niche, and the tympanic sinus. In contrast, no such incidence of inflammatoty change was noted in poorly-pneumatized mastoid. Our findings indicate that an intact tympanic membrane does not always mean freedom from mastoid inflammation, especially when the mastoid is well-pneumatized. This makes it important to check for possibile remaining otitis media in patients with a well-pneumatized mastoid. even if the tympanic membrane appears normal.

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To evaluate the therapeutic effect of middle ear pressure pulse on endolymphatic hydrops in humans, Meniett20R was used for 12 months in two severe elderly patients with definite Meniere's disease. The average number of vertigo occurrences in the 6 months before treatment and in the 12 months after treatment started was compared. Numeric values (NV) among patients were calculated and categorized into an improved group (NV=1-40). For hearing function, the pure-tone average (PTA) before and 12 months after treatment started was compared. PTA was calculated based on the following equation: PTA=A+2XB+C)/4. A, B, and C were thresholds of the pure-tone audiometory at 0.5, 1.0, and 2.0kHz. In one case, hearing function was unchanged, but deteriorated in the other. Pressure pulse treatment may thus be useful in severe cases of Meniere's, especially in the elderly, bilateral cases, and in endolymphatic hydrops in a single hearing ear.

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We treated a 62-year-old woman with a cervical necrotizing soft tissue infection of the Streptococcus milleri group. Numerous spot gas images were recognized from the right pharynx to the neck in CT at initial diagnosis, but we chose conservative treatment because abscess findings were not clear. The inflammation improved temporarily, but we operated through an outside incision because symptoms recurred and cervical skin became necrotic after one week. Inside. the fascia were necrotic and an abscess extended from the precordia to the left upper arm and the right axillary region. The cervical skin defect was restored in due course in about 2 months and cured without mediastinitis or sepsis developing. The S. milleri group was detected in pus.
A cervical necrotizing soft tissue infection does not form an abscess mainly in one space as does a normal deep neck infetion and invades fascia space rapidly and widely. We took this disease into consideration and had to intervene surgical rather soon. A review of this case and the literature indicates that the S. milleri group may have become an important pathogen in cervical necrotizing soft tissue infection.

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