Allergic rhinitis is one of the most common allergic inflammation affecting 10-25 percent of the world's population, and its prevalence has increased over the last decade. Allergic rhinitis is not a life-threatening disease, but its persistent symptoms disturb patient's daily life. Moreover, it could be a risk factor to elongate infective inflammations in upper respiratory tract such as otitis media with effusion or chronic rhinosinusitis. In this manuscript, updated information on the pathogenesis of Japanese cedar pollenosis and its treatment strategy are introduced.

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Numbers of patients with sudden deafness who are complicated with atherosclerotic risk factors such as diabetes mellitus and hypertension have been increasing. We measured the level of high-sensitive Creactive protein (hs CRP), which is approximately hundred-times more sensitive than conventional CRP. There is much evidence to suggest that inflammation evidenced by increased levels of hs CRP is associated with acute coronary syndromes such as myocardial infarction and unstable angina. Therefore, hs CRP has been used to predict the risk of acute events in patients with atherosclerosis.
We investigated the relationship between hs CRP and hearing grade/prognosis in 39 patients with sudden deafness. The value of hs CRP in the hearing grade was not significantly different. On the other hand, the value of hs CRP increased according to the worsening of the hearing prognosis. Even in cases without any atherosclerotic risk factors, we noted a value of hs CRP higher than the reference value in 35.7% of the patients.
These findings suggest that sudden deafness may be caused by circulatory disturbance due to vascular inflammation in the inner ear, and that hs CRP could be a novel marker of the hearing prognosis in sudden deafness.

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Although relatively commonly reported in other countries, superior canal dehiscence syndrome has only rarely been seen in Japan. This report describes a case of vertigo associated with right superior canal dehiscence syndrome that the author recently encountered. An 82-year-old female patient presented with vertigo after starting to use a hearing aid in her right ear. Vertigo tended to occur after hearing loud voices or when wearing/removing the hearing aid. Examination demonstrated positive results for both Tullio phenomenon and Fistula symptom. The findings on Treponema pallidum hemagglutination assay (TPHA and FTA-ABS) was negative. Computed tomography of the temporal bones demonstrated dehiscence of the bone only in the right superior semicircular canal. Based on these findings, superior canal dehiscence syndrome was therefore suspected to be the cause of the vertigo in this case. The vertigo resolved after discontinuing the use of the hearing aid. The development of vertigo in this case may therefore have been associated with pressure changes in the external auditory canal due to loud sound stimulations and the wearing/removal of the hearing aid.

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Chickenpox is one of the most frequent infectious diseases during childhood. However, instances of this disorder being complicated by facial paralysis alone are rare. In a 4-year-old girl, chickenpox-related exanthema appeared. Thereafter, right facial movements became impaired, and the girl was diagnosed with facial paralysis. There were no other neurological abnormalities. After 6 weeks of steroid therapy, a complete response was achieved.

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Carcinoma of the external auditory canal is infrequent and the prognosis is poor, especially in the advanced stage. Over the 15-year period, from 1992 to 2006, 17 patients with carcinoma of the external auditory canal were treated in our hospital. Eight patients (47%) were male, and nine (53%) were female. The mean patient age was 60 years old, ranging from 24 to 82 years. On pathological analysis, 11 patients (65%) showed squamous cell carcinoma, four (24%) adenoid cystic carcinoma, one (6%) basal cell carcinoma, and one (6%) verrucus carcinoma. Thirteen patients underwent external canal resection, lateral temporal bone resection, or subtotal temporal bone resection. Four advanced patients treated with radiation or chemotherapy without surgical treatment died within one year. The 3-year survival rate was 76.5%, and the 5-year survival rate was 68.0% using the Kaplan-Meier method. The main finding of this study was that radical resection is a reasonable approach and postoperative radiotherapy is helpful for carcinoma of the external auditory canal.

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We report a 51-year-old male with nasopharyngeal cancer (T4N2cM1) complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following cisdichlorodiamimnine platinum (CDDP), Docetaxel, 5-fluororacil (5-FU) administration. After administration of CDDP, Docetaxel and 5-FU, the serum sodium concentration decreased from 137mEq/l to 117mEq/l. His consciousness level was JCS (Japan Coma Scale) 30. He was diagnosed as SIADH having based on appropriate diagnostic criteria. The sodium concentration and consciousness level were improved with sodium revision, water restrictions and internal steroid use. We must take symptoms of low sodium blood concentration due to SIADH into consideration, and give sufficient attention to the electrolyte balance after chemotherapy.

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A retrospective clinical study was conducted involving 143 patients with laryngeal cancer treated in our department between 1998 and 2006. The subjects consisted of 138 males and 5 females, with a ratio of 28:1. The mean age was 68.1 years old. The subsite of origin comprised 78 (54.5%) in the glottis, 61 (42.7%) in the supraglottis, and 4 (2.8%) in the subglottis. The clinical stage according to the 1997 UICC TMN classification system was I in 53 cases (37.1%), II in 34 (23.8%), III in 20 (14.0%), and IV in 36 (25.2%). The 5-year overall survival rate was 71.2% in the total cases, 84.4% in stage I, 89.6% in stage II, 51.2% in stage III, and 38.9% in stage IV. The disease-specific 5-year survival rate was 88.3% in the total cases, 75.5% in the supraglottic type, 98.1% in the glottic type, and 100% in the subglottic type. The preservation rate of the larynx at 5 years was 83.3% in T1, 56.5% in T2, and 0% in T3 and T4.

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We experienced a patient with a lateral cervical cyst that was unsuccessfully resolved by treatment with percutaneous ethanol injection therapy (PEIT) at another hospital. Paralysis of the accessory nerve subsequently occurred as a direct result of PEIT, and we successfully treated this surgically. The patient, a 35-year-old male, had a swelling in his left upper neck. This swelling was diagnosed as a lateral cervical cyst, and PEIT was administered. After PEIT, he experienced pain in his left upper neck and difficulty in moving his left arm. The complaint persisted for several weeks had passed, and so he consulted Tenri hospital. His left upper neck was swollen and muscle of his left shoulder was atrophic. Sonography revealed that the cyst remained, and an MRI and electromyogram indicated denervation of his trapezius. An operation was conducted to remove the cyst. It adhered to the jugular vein and accessory nerve, but was successfully removed without damaging either structure.
Recently, PEIT has been applied for cervical cysts. It has an advantage over surgical methods because it doesn't require a skin incision, but it should be noted that ethanol injections may cause some irreversible complications, such as observed in this case.

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A rare case of a cyst in the parapharyngeal space is reported. The patient was a 30-year-old male who complained of pain on the left side of the neck. When the patient was initially examined, the posterior wall of the oropharynx was swollen. Based on CT and MRI findings, a tumor was detected in his left parapharyngeal space. It was suspected to be cystic. A fenestration was made the antenor wall of to the cyst, producing a communication between it and the oropharynx. The pathological diagnosis and treatment of parapharyngeal cyst are discussed.

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In 101 patients who were tracheotomized between 2002 and 2006, we evaluated the course until the closure of the stoma. The reason for tracheotomy was classified into 3 groups, i. e. acute inflammatory laryngeal stenosis, stenosis due to tumors, and long-term intubation. Type of anesthesia used, urgency, and interval until closure of the stoma were evaluated. The stoma was closed in all patients except one who was unable to undergo closure of the stoma. We present the patient whose stoma could not be closed. Furthermore, we emphasize the importance of appropriate procedure and management.

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The case was a 78-year-old male, complicated with dementia, who consulted our hospital for pneumonia and appetite loss. When we conducted a CT scan of the lung, we incidentally discovered one Press-Through-Pack (PTP) in the upper part of the esophagus, and a deep neck abscess was suspected around the left lobe of thyroid gland. We removed the PTP by direct esophagoscopy and performed a drainage operation for the deep neck abscess. At 6 days postoperation, inflammatory signs appeared from the abdomen. We therefore conducted a CT scan. Four PTPs were noted in the rectum. These were removed using an anoscope by a general surgeon.
During the 5-year period from 2002 to 2006, 28 patients with esophageal foreign bodies were treated in our hospital. The kinds of foreign bodies were PTP, denture, saburra, fish bone, and others. In 22 patients, foreign bodies were located in the first narrow part of the esophagus. There were no cases of foreign body presenting in many parts of the digestive tract in our hospital. We have to examine all diseases and investigate the possible presence of foreign bodies carefully in patients such as those with dementia.

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