We experienced three female patients with sudden sensorineural hearing loss. All the patients showed elevation of anticardiolipin antibody in the serum. Immunoglobulin (Ig) M anticardiolipin antibody was present in case 1 (a 34-year-old woman). IgG anticardiolipin antibodies were present in cases 2 (a 50-year-old woman) and 3 (a 9-year-old girl). The patient in case 1 showed hearing disturbance of low tone in the left ear and normal vestibular function in both ears. The case 2 patient had an average hearing level of 81.7dB at 0.5, 1, and 2kHz and severe canal paresis in the right ear. In case 3 the patient showed an average hearing level of 53.3dB in the right ear and normal vestibular function in both ears. It was suggested that thrombosis which might have been induced by anticardiolipin antibody could have caused the sudden sensorineural hearing loss in these patients. Steroid therapy cured the hearing disturbance completely in case 1. Steroid and prostaglandin E₁ therapy did not improve the hearing disturbance in case 2. Steroid, prostaglandin E₁, and ticlopidine hydrochloride therapy improved the hearing disturbance in case 3. It appears that not only steroids but also prostaglandin E₁ and ticlopidine hydrochloride therapy may be effective in patients with sensorineural hearing loss associated with anticardiolipin antibody.

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It is well known that an initial treatment with several kinds of antiallergic medicines is useful for patients suffering from Japanese cedar pollinosis to reduce nasal symptoms during the pollen season. Also topical corticosteroids show a preventive effect as antiallergic medicines.
In this study, the preventive effect of topical corticosteroids with antiallergic medicine as an initial treatment was evaluated during the 1995 cedar pollen season, a season in which a high pollen count was anticipated.
Twenty-five patients with cedar pollinosis were selected and divided into two groups, A and B. A topical corticosteroid (fluticasone propionate; Flunase) as well as antiallergic medicine (azelastin) were administered to patients in group A 4 weeks before the beginning of the pollen season. In group B, only antiallergic medicine was given at the same time as group A and a topical corticosteroid was administered after the appearance of the symptoms. Nasal symptoms and mucosal conditions of the nasal cavity were monitored throughout the pollen season. The inflammatory cells in the mucoepithelial layer of the nasal mucosa were also periodically evaluated by immunohistochemical staining. Nasal symptoms and mucosal conditions in group A were significantly improved compared with patients in group B. The infiltration of macrophages in the mucoepithelial layer of the nasal mucosa was strongly inhibited in group A. The numbers of mast cells and EG2 positive cells in group A were not significantly different from those in group B during the pollen season. According to these results, although not all inflammatory cells were inhibited, the initial treatment with Flunase aqueous nasal spray in addition to the conventional initial treatment with antiallergic medicine is very useful for reducing symptoms even in a season with a large amount of cedar pollen.

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Nasal polyps, in general, have been histologically classified as edematous, adenocystic and fibrous types. It has recently been pointed out that eosinophilic infiltration in nasal polyps has increased along with an increase in nasal allergy.
The purpose of this study was to classify the nasal polyps histologically and to examine the mode of infiltration and activation of eosinophils by means of immunohistochemistry.
The subjects were 101 patients who underwent surgery for nasal polyps. There were 66 males and 35 females ranging in age from 12 to 76 years. Resected polyps were fixed in formalin, embedded in paraffin, and sliced at a thickness of 4μm. Hematoxylin-eosin staining and streptavidin-biotinyl peroxidase complex staining were used to detect eosinophils.
The results were as follows: 1) The nasal polyps were, histologically, edematous in 88.1%, adenocystic in 47.5%, and fibrous in 19.8%. 2) The number and distribution of EGl-positive cells and EG2-positive cells were almost the same in the superficial layer of the lamina propria. This study suggests that eosinophilic infiltration into nasal polyps occurs mainly in edematous polyps and that the majority of the infiltrating eosinophils are activated.

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The role of proprioceptive input from cervical receptors in vestibular compensation was investigated. Vibratory stimulation to the dorsal neck muscle was given to patients with unilateral vestibular lesions. The length of the displacement of the center of gravity, maximum sway length, and sway area increased markedly during vibratory stimulation to the dorsal neck. In patients in whom compensation had been achieved, a position vector to the side of the lesion increased and the center of gravity moved to the side of the lesion. From these results, it can be speculated that cervical input plays an important role in the process of vestibular compensation.

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An analysis of 41 patients with hypopharyngeal cancer treated between April 1985 and March 1996 is presented. Our guidelines for the treatment of hypopharyngeal cancer are a combination of chemotherapy, radiotherapy and surgery. The schedule of combination therapy is as follows: chemotherapy first, preoperative radiotherapy second, and surgery last. The surgery for hypopharyngeal cancer is pharyngolaryngoesophagectomy with radical neck dissection. In many cases free jejunum transplantation was used for reconstruction. The mean age of the patients was 64.8 years, and there were 39 men and 2 women. There were 33 cases of pyriform sinus type, 4 cases of postcricoid type. 3 cases of retropharyngeal type, and 1 case of unclassified type. Histopathologically, there were 40 cases of squamous cell carcinoma and 1 case of anaplastic carcinoma. Five-year total survival rates were 23.0% and 5-year survival rates at each tumor stage were 0% (T-1), 19.9% (T-2). 32.4% (T-3). 0% (T-4). There were no statistically significant differences between tumor stages. Five-year survival rates for each nodal stage were 14.1% (N-0), 54.5% (N-1), 0% (N-2), 0% (N-3). The survival rate for stage N-1 was significantly better (p<0.05) than that for stage N-2. Five-year survival rates for all stages were 0% (I), 0% (II), 46.3% (III), 0% (IV). The survival rate for stage III was significantly better (p<0.05) than that for stage IV. Twenty-five patients were operated on with or without chemotherapy and radiotherapy and, 16 patients received nonsurgical treatment. The 5-year cause-specific survival rate for patients who underwent surgery was 57.7% and for patients who underwent nonsurgical treatment was 0%. The survival rate for the radical treatment group was significantly better (p<0.05) than that for the nonradical treatment group. The 5-year cause-specific survival rate for patients who underwent radical radiotherapy was 0%. That for patients who were treated by chemotherapy was 51.4% and for patients who were not so treated was 20.1%. The results of this study suggest several significant conclusions: 1. Stage is not a good predictor of outocme in hypopharyngeal cancer. 2. Patients undergoing surgery with or without chemotherapy and radiotherapy as the primary treatment enjoyed improved survival. 3. Radical radiotherapy provided poor prognosis. We think that chemotherapy provided some survival benefit.

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We reviewed 79 patients with squamous cell carcinoma of the lateral wall of the oropharynx who received treatment at the Cancer Institute Hospital, Tokyo, between 1971 and 1990. There were 67 men and 12 women, aged 31 to 81 years (average 59.2 years). The tumors could be staged by TNM classification (UICC 1987) as follows: Stage I 0, Stage II 12, Stage III 27, Stage IV 40. It must be noted that more than 50% of the tumors were classified as stage IV. As the initial treatment, 50 patients underwent radical radiotherapy, and the remaining 29 were treated mainly by surgery after pre-operative radiation. Some patients underwent adjuvant chemotherapy, but the role of chemotherapy was not considered in this study. The purpose of the present study was to derermine the prognostic factors and to determine the survival rate after each treatment modality. The results were as follows: i) Patients with either T4, over N2b or a stage IV tumor had a significantly poor prognosis. ii) Cox multivariate analysis revealed that age, local extension (base of tongue, anterior pillar, soft palate and mid-line), pathological findings (poorly, moderately or well differentiated), tumor type (exophytic or endophytic) were not useful prognostic factors. iii) Radiosensitivity was not reflected in the survival rate judging from the high recurrence rate (44%) after radical radiotherapy. On the other hand, local recurrence after radical resection was seen in 18% of the patients. iv) Analysis of the data supported the recommendation of surgery after preoperative radiation as the treatment for stage III patients. It seems difficult to find the best treatment modality for stage IV patients in order to improve the survival rate, and this is an issue that still remains to be resolved. v) From the study of the surgical specimens, we are unable to demonstrate a significant survival advantage of the patients with a high grade radiation effect, or patients with no vessel involvement.

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To determine the locations of congenital cholesteatomas and to elucidate the relationship between ossicular anomalies and congenital cholesteatomas, congenital cholesteatomas from our patients and those reported in the Japanese literature were investigated.
We analyzed 40 ears with congenital cholesteatomas (38 patients) experienced by us during the past 9 years. Our criteria of congenital cholesteatoma were as follows: 1. The tympanic membrane manifests neither retraction, perforation, nor granulation. 2. There is no continuity between the tympanic membrane and the matrix of a cholesteatoma. Twenty patients with past histories of otitis media were included. Thirty-three patients (87%) were males and 2 had bilateral congenital cholesteatomas. The ages of the patients ranged from 2 to 46 years (mean: 10.7). A survey of the Japanese literature revealed 55 additional cases of congenital cholesteatoma reported by others.
Among this total of 95 congenital cholesteatomas in Japanese patients, 14 occupied the anterosuperior quadrant (ASQ) of the mesotympanum, 33 were located in the posterosuperior quadrant (PSQ) of the mesotympanum, and the remaining 44 including those in 4 ears with multicentric congenital cholesteatomas, were too extensive to identify the origin. This observation of the predominantly PSQ location of small congenital cholesteatomas is contrary to that reported in the United States, in which congenital cholesteatomas were usually found in the ASQ.
Another finding was the frequent association (17 ears) of presumed congenital anomalies of the ossicular chain (absence of the long process of the incus and/or the superstructure of the stapes) with a small congenital cholesteatoma in the PSQ and attic. It is also noteworthy that the association of ossicular anomalies was more common in membraneous cholesteatomas, the socalled open-type congenital cholesteatomas (13 ears), than in cystic cholesteatomas (4 ears). The present study revealed that small open-type congenital cholesteatomas occupying the PSQ and attic were frequently associated with ossicular anomalies.

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A change in gustatory function is generally well known as one of the manifestations in the early stage of pregnancy. However, there have been comparatively few studies of the changes in taste and gustatory function resulting from pregnancy. In particular, so far there have been no reports of investigations of two or more pregnant women in which gustatory sense in the same pregnant woman was examined serially over time. In this study, gustatory tests were performed over time on pregnant women having a normal course, so as to examine in detail the changes in gustatory function resulting from pregnancy.
Selected for this study were 97 healthy pregnant women (ranging in age from 21 to 36 years, with an average of 27.9±3.2 years). Gustatory tests were performed by electrogustometry and the filter-paper disk method over the areas of the chorda tympani nerve and glossopharyngeal nerve. Of the 97 subjects, gustatory tests could be performed serially with time throughout the duration of pregnancy in 32 subjects (from 21 to 34 years old, with an average age of 28.3±2.9 years), and changes in gustatory sense with progress in pregnancy were analyzed statistically. In addition, serum trace elements were measured in 72 of the subjects. Thirty non-pregnant healthy women (from 18 to 34 years old, with an average age of 24.8±4.3 years) were used as control. The gustatory test was performed by the same person in all cases. An increase in gustatory threshold was observed in pregnant women as compared with that of non-pregnant women. Especially, a tendency of a marked decrease was noted in gustatory function in the first trimester. A marked change in secretion of hormones in the early stage of pregnancy is considered to be the underlying cause of such a decrease in gustatory function. The serum zinc level was in the normal range in the early stage of pregnancy, but it tended to decrease over the period from the midtrimester to the third trimester. Therefore, it is difficult to explain dysgeusia in the early stage of pregnancy as being associated with a deficiency of zinc.

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Treatment with low-dose consecutive cisplatin (CDDP) was performed on six patients with recurrent and distant metastasis of head and neck squamous cell carcinoma. All patients were men, and their ages ranged from 64 to 86 years with an average of 75. Primary treatments were radiotherapy and surgery in three patients, chemotherapy and radiotherapy in two patients, and radiotherapy, regional chemotherapy and surgery in one patient. Two patients had laryngeal recurrent carcinomas, one patient had nasopharyngeal recurrent carcinoma, one patient had recurrent metastatic neck lymph node and two patients had distant metastasis (lung and brain). CDDP was administered over consecutive seven days, with a daily dose of 10mg/m² as continuous drip infusion for 148 hours from day 1 to day 7. Four patients received two courses, while two patients received one course. The overall response rate was 33%, which was restricted to a partial response in two patients. These patients were still alive about one year after treatment. No toxic effect was observed. The present study indicated that low-dose consecutive CDDP was safe and efficacious for patients with recurrent head and neck squamous cell carcinoma.

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