Pharyngeal flap construction surgery is a treatment for velopharyngeal incompetence in cleft palate children. Velopharyngeal incompetence is a major cause of dysphemia. In our department, we assessed velopharyngeal competence in 382 cases from 1992 to 2006 by inspection of the soft palate length or movement, lateral view of X-ray, aerodynamic study, nasometry and naso-pharyngeal fiberscopic examination, and evaluated incompetence in 88 cases. In 22 of the 88, we perfomed pharyngeal flap construction because of failed speech therapy. Usually, palatal re-push back was combined with pharyngeal flap construction and we had a satisfactory postoperative course. We should pay attention to the conceivable complications of the operation, such as mouth breathing, snoring, obstructive sleep apnea, bradycardia, cardiac arrest, underdevelopment and otitis media with effusion. Speech therapy has to be still required although these patients have received surgery for velopharyngeal incompetence.

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Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, facial weakness, and gait ataxia. Few reports have carefully examined deafness associated with AICA infarction. We report a patient with vertigo and acute sensorineural hearing loss due to infarction involving the AICA.
A 77-year-old man with hypertension and angina suffered sudden hearing loss in the right ear and vertigo. Neurological examination showed that spontaneous left-beating nystagmus. Pure tone audiogram showed severe sensorineural hearing loss of 73.8dB on the right side. Two days after the initial onset of hearing loss and vertigo, the patient complained of swallowing disturbance, dysmetria of the right limbs and diminished right-sided facial sensation. MRI revealed Brainstem and cerebellar infarction, and angiography demonstrated occlusion of the basilar artery. Anticoagulation treatment was started and the hearing loss and vertigo improved steadily. Follow-up pure tone audiometry at four months showed that the hearing loss in the right ear had improved to 27.5dB. Acute auditory syndrome may be a warning sign of impending pontocerebellar infarction in the distribution of the AICA. The acute auditory syndrome preceding an AICA infarct may result from ischemia of the inner ear. We need to be aware of vertigo and hearing loss symptoms without neurological findings, which may be symptoms of infarction involving the AICA.

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The patient was a 9-year-old girl who had undergone cochlear implant implantation when she was 3 years old for a common cavity anomaly. She received cochlear implant reimplantation because of mechanical failure. The old electrode was removed without difficulty and the new electrode was inserted carefully so as not to become tangled within the inner ear. To accomplish this, repeated plain radiographs were obtained during surgery. On the first post-operative day, she complained of neck pain and otalgia, and her neck was rotated to the right. No other neurological findings were observed and the pain decreased, but the torticollis persisted for 7 days. Computed tomography revealed that her neck complaint was due to atlanto-axial rotatory fixation. With neck traction, the torticollis diminished and good atlanto-axial alignment was obtained.

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A 49-year-old male had visited a nearby doctor with a complaint of massive bleeding from the left auricle. Angiography was performed, and arteriovenous malformation of the auricle was diagnosed. The main feeding arteries were the posterior auricular artery and the occipital artery, as demonstrated by angiography via the left external carotid artery; however, bleeding recurred because a collateral blood supply developed. Between 2001 and 2003, embolization was carried out 3 times, but the treatment was not effective. On July, 2003, he was referred to our clinic for treatment. A papula was detected at the left concha auricle, but pulsation was not palpated. On the other hand, an increase of blood supply was detected by Doppler echography. On August 20, 2003, ligation of several import arteries and extraction of the nidus were performed under general anesthesia. AVM was completely resected with little hemorrhage. The post-operative course was good and there has been no recurrence 8 months after surgery.

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Sixty-three patients (29 men and 34 women) complaining of severe tinnitus were seen at the Department of Otolaryngology, Nippon Koukan Hospital, during a 1 year period (April 2004 to March 2005). Thirty-seven patients (19 men and 18 women) underwent Tinnitus Retraining Therapy (TRT) and were followed for more than 6 months after the end of treatment (continued group). The remaining 26 patients (10 men and 16 women) discontinued TRT after one month (discontinued group). We compared the age, type of hearing loss, origin of tinnitus, Tinnitus Handicap Inventory (THI) score and Visual Analogue Scale (VAS) score, mean hearing level, and tinnitus loudness and pitch match at the time of the first examination between these two groups. One reason for the discontinuation of TRT was thought to be the cost of the Tinnitus Control Instrumentis (TCI). Dip-type hearing loss was observed in many patients in the continued group, while conductive-type hearing loss was observed in many patients in the discontinued group. Regarding the origin of tinnitus, sudden deafness and otitis media were common in the discontinued group. Meanwhile, many of the patients in the continued group had a pitch match of greater than 4kHz. The VAS score, mean hearing level, and tinnitus loudness were also higher in the discontinued group. These results may help physicians to predict whether the use of a TCI will be effective.

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Nasal NK/T-cell lymphoma is a rare subtype of lymphoma with a significantly worse prognosis than other subtypes, and also tends to be commonly found in people of East Asian, Mexican, or South American descent.
Patient 1 was treated with chemotherapy using the CHOP regimen after radiotherapy. At 14 months after the end of treatment the patient demonstrated recurrence to primary site and the jejunum. He is presently alive with this disease at 30 months after the end of treatment. Patient 2 was treated with chemotherapy using the CHOP regimen after radiotherapy, but this schedule resulted in only a partial response to the disease. As a result, chemotherapy was also performed using the DeVIC regimen with 3 cycles. Patient 2 is still alive and has been free of any relapse for 48 months. Patient 3 was treated with concurrent chemoradiotherapy using 56Gy irradiation with the DeVIC regimen. Patient 3 is still alive and has been free of relapse for 12 months. Because of this chemoradiotherapeutic regimen, patient 3 suffered severe mucositis and pancytopenia, and as a result he could not complete chemotherapy, which normally consists of 3 cycles. Patient 4 was treated with concurrent chemoradiotherapy using 56Gy irradiation with the DeVIC regimen. Patient 4 is still alive and has been free of relapse for 6 months. In patient 4, we used 2/3-dose chemotherapy in comparison to the patient 3 dose. As a result, the chemoradiotherapy in patient 4 did not cause any severe side effects. Concurrent chemoradiotherapy using the DeVIC regimen may therefore be effective for the treatment of NK/T-cell lymphoma.

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Human papilloma virus (HPV) has previously been reported to be associated with head and neck squamous cell carcinoma (HNSCC), and oral and tonsillar carcinomas highly tend to be associated with HPV. We treated a married couple with tonsillar squamous cell carcinoma, and both husband and wife had same HPV subtype (HPV-16). Although the husband was initially treated by radiotherapy, local recurrence was found in the tonsil nine months after the initial treatment. The recurrent tumor was surgically treated. The wife was treated by radiotherapy, and neither local recurrence nor distant metastasis have been found so far. There have been no reports of a married couple with tonsillar carcinoma of the same HPV type. Thus, we reviewed the practical features of HPV-related tonsillar carcinoma.

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Sixty-one patients with Basedow's disease were treated by anti-thyroid therapy in Yamada Red Cross Hospital. Of 44 patients who finished this therapy, complete response was observed in 41 patients. Whereas, relapse was observed in 7 of 9 patients who did not finish this therapy. Forty-one patients who maintained complete response were compared with the relapse group included 17 patients. Surgical operation was selected in 7 patients who relapsed during the anti-thyroid drug therapy. The relapse rate was high in the lower age group, and the group of patients who could not take MMI. Therefore, other therapies should be selected in these groups.

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We report six cases of pulmonary metastases of squamous cell carcinoma of the head and neck (SCCHN) treated with modified TPF chemotherapy (docetaxel combined with nedaplatin and 5-FU).
All patients received 4 courses of TPF chemotherapy every 3 weeks, docetaxel 60mg/m² on day 1; nedaplatin 75mg/m² on day 1 and 5-FU 1000mg/body by continuous infusion on days 1 to 4.
Chemotherapy-associated grade 3 fatigue, fever and diarrhea occurred in one patient each. Grade 3 or 4 leucopenia was observed in 2 patients, and thrombocytopenia was in 3 patients.
Clinically there were 3 complete and 3 partial responders. Partial responders died of pulmonary metastases 7, 8 and 12 months after the diagnosis of metastasis. In one of the complete responders, pulmonary metastases recurred 8 months after the diagnosis of pulmonary metastasis, and at 20 months he died of acute myocardial infarction. In another complete responder it recurred 22 months after diagnosis and the remaining patient is free of pulmonary metastasis at 25 months.
Overall, TPF chemotherapy is associated with a high rate of clinical response (100%) and complete response (50%) for pulmonary metastases of SCCHN. However, partial responders died by 12 months after diagnosis, and partial response is suspected not to be related with prognosis.
TPF chemotherapy will improve the prognosis and quality of life.

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Following is the Otorhinolaryngology Department report, by Kitasato University Hospital, on the use of arbekacin sulfate (ABK) and vancomycin hydrochloride (VCM) for treating methicillin-resistant Staphylococcus aureus (MRSA). From March 2005 to February 2006, we performed retrospective research on 13 cases treated with either ABK or VCM. The subjects were 13 cases in which MRSA was detected in this institute's Otorhinolaryngology Department. The cases were evaluated for effectiveness, safety and economy. VCM treatment tended to show superior efficacy over ABK treatment, but safety was found to be equal. Anti-MRSA agents were administered for 8.6 days to the ABK group, and for 10.2 days to the VCM group. The ABK group costs tended to be lower. Considering patient background, the dosage, administration period, and other relevant factors, we concluded that either ABK or VCM may be equally recommended for the initial treatment of MRSA patients.

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It is well known that there are many complications in stellate ganglion block (SGB), but many of them are transient. Delayed severe airway obstruction due to hematoma following SGB is rare. We encountered a case of cervical, mediastinal hematoma and severe airway obstruction after SGB which had been performed for a 28-year old man with facial paralysis. On the day of the 3rd treatment, 4.5 hours after SGB, he suffered severe dyspnea. Cricothyrotomy was performed. Computed tomography revealed a large soft tissue mass extending in the retropharyngeal space from the cervical to mediastinal part. This soft tissue mass consisted of hematoma. We drained hematoma surgically, resulting in a good outcome with no complications. This case accompanied an unusual course of the vertebral artery. We speculated that the needle for SGB injured the vertebral artery and these caused massive hemorrhage in the retropharyngeal space.

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Ginsenoside Rb1 (gRb1) is a main ingredient of ginseng root, which has been prescribed to patients for thousands of years in Asian countries without apparent adverse effects. We investigated the protective effects of gRb1 against ischemic damage of the cochlea. Ischemic insult was loaded by occluding the bilateral vertebral arteries for 15min in a gerbil, which lacks posterior communicating arteries causing the cochlea to be nourished solely by the vertebral arteries. GRb1 was dissolved in isotonic saline. Then, 200μL of gRb1 solution (50μg/200μL) was injected into the left femoral vein 1h after inducing ischemia. Hearing was assessed by recording the auditory brainstem responses (ABR). Seven days after ischemia, the animal showed a 22.5dB increase in ABR threshold, 26.5% loss of the inner hair cells at the basal turn, and 19.3 cells/10000μm² spiral ganglion cell density on average in 6 ears. In the Ischemia-gRb1 group, the ABR threshold increase was 14.2dB, inner hair cell loss was 8.6%, and the density of spiral ganglion cells was 25.8 cells/10000μm². These findings suggest that gRb1 inhibited ischemic injury of the inner ear.

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