Seventeen patients (17 ears) with a sudden hearing loss of more than 60 desibels were treated with interferon-alpha (3 million IU/day for 5 days) plus methylprednisolon (tapered from 500mg/day for 9 days) and vitamin B₁₂ (500μg/day for 9 days). In the 15 patients whose treatment started within 14 days after the onset, the response tended to be better than in patients treated with steroids and vitamins alone, but they were not as good as those reported by Kanamaru et al, who administered the same daily dose of interferon-alpha for 10 days. No improvement was noted in the 2 patients whose treatment was started more than 14 days after the onset. The results indicate that alpha-interferon may be effective in the treatment of sudden deafness of recent onset, but that it should be administered for more than 5 days.

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High-resolution computed tomographic (CT) images were analyzed to determine the normal course of skull and temporal bone development. CT images of 146 ears from 81 Japanese children of varying ages were included in this study. The growth of the skull and the temporal bone was rapid during the first 5 years of life followed by gradual but steady development until the age of 15. The period of rapid growth lasted 1 to 2 years longer than that previously reported in American children. Head growth after surgery should be taken into account for successful pediatric cochlear implant surgery.

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This is a case report of 2 patients with luetic labyrinthitis, whose major symptoms were tinnitus and vertigo. Meningo-neuro-labyrinthitis has been diagnosed because of increased cell counts in the cerebrospinal fluid (CSF) and a positive CSF test for syphilis. The standard treatment for neurosyphilis was administered: i. v. infusion of penicillin G 2×10⁷U/day and oral minocycline 200mg/day. The labyrinthitis of the patients responded favorably. This suggests the importance of early diagnosis and early initiation of treatment in this disease. We conclude that CSF examination is essential if luetic labyrinthitis is suspected, even in patients who have received antiluetic therapy.

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The patient had a cholesteatoma in the external auditory canal which had spread extensively into the mastoid cavity. Surgical removal of the cholesteatoma was followed by successful reconstruction of the ear canal with temporal fascia, pedicled temporal muscle flap, and apaceram granules. The etiology and treatment of cholesteatoma in the external auditory canal is discussed.

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Inverted papilloma of the nose and paranasal sinuses (IP) is a histologically benign disease, but it is noted for frequent local recurrences and its association with malignancy. Medial maxillectomy via a lateral rhinotomy approach has been the standard treatment for IP. The authors treated six patients with IP, three of them with endoscopic endonasal surgery. In one of the other three the IP was resected through an extranasal frontoethmoidectomy under microscopic control. In the remaining two the IP occupied the entire nasal cavity and the ethmoid and maxillary sinuses; medial maxillectomy was performed via a lateral rhinotomy approach. Endoscopic follow-up for seven months to two years (mean, 17 months) failed to identify any recurrence. A wide and clear vision of the operative field and careful control of the operative procedures are the key points in the surgical treatment of IP. If these are satisfied, total excision of IP is feasible with relatively conservative surgery including an endoscopic endonasal approach.

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A patient with right exophthalmus due to exacerbation of relapsing sinusitis who had undergone bilateral radical paranasal sinus surgery in our hospital 6 months earlier visited us and was diagnosed with acquired immunodeficiency syndrome (AIDS) after many tests. The patient was a 36-year-old male who had consorted with prostitutes. Esophageal candiditis and tumors of the liver and the colon were found. Blood tests showed a reduction in lymphocytes, particularly in T-cells and an CD4/CD8 ratio of 0.2. HIV (human immunodeficiency virus) antibody titer was increased. Remission of exophthalmus came after therapy with steroids and antibiotics.

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This is the first report of a case of intraductal papillary adenocarcinoma of the submandibular gland. The patient was a 51-year-old female. The pathological diagnosis of the submandibular tumor was intraductal papillary adenocarcinoma, a different type from salivary ductcarcinoma of salivary duct origin. Intraductal papillary adenocarcinoma of the pancreas is well known, but there have been no report of this type of cancer in a salivary gland. Most salivary duct carcinomas are of high-grade malignancy, and are of parotid gland origin. It was remarkable that the present tumor was of low-grade malignancy. The submandibular gland, submandibular lymph nodes and superior jugular lymph nodes were resected. Two years after operation the patient has had no recurrence.

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During the past ten years, eight patients with malignant lymphoma of the thyroid gland have been treated in our hospital. Their ages ranged from 53 to 84 years (median, 72 years). The male to female ratio was 1:1.
We performed fine needle aspiration biopsy (FNA) in six patients, four of whom were diagnosed assuredly. So FNA was useful in the diagnosis of this disease.
Two patients were treated with surgery, radiation and chemotherapy, two with surgery and chemotherapy, one with surgery and radiation, one with radiation and chemotherapy, and one with radiation only; one patients was not treated.
All three patients with Hashimoto's thyroiditis were disease free, so we concluded that patients with Hashimoto's thyroiditis have a better prognosis than the others.

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We investigated 29 evaluable cases who received concurrent chemotherapy with low dose carboplatin and radiotherapy among 99 cases diagnosed with head and neck cancer at our institute in the 2 years and 5 months prior to December 1993.
Approximately 90% had advanced cancer, and all cases involved squamous cell carcinoma (SCC) except for one case involving adenocarcinoma that metastasized from the lung.
Among 28 cases of SCC which could be assessed by TNM classification, 17 of 25 lesions (68%) showed clinical or pathological CR as determined by tumor volume (T).
CR occurred in one T₁ (100% of evaluable cases), seven T₂ (70%), three T₃ (60%) and six T₄ (67%) cases.
In consideration of the lymphnodes (N), 15 for 20 cases (75%) showed CR, including three N₁ (100%) and twelve N₂ (100%) cases. Five N₃ cases showed no response. From these results, we conclude that it is possible to expectacure of the lesion and functional preservation, even in such advenced cancer using combined therapy alone, if case selection is carefully performed.

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A 72-year-old man, complaining of swelling and slight pain in the left neck, consulted our hospital. Surgery was performed under general anesthesia. The tumor adjoining the left side of the axis measured 2.5×2.5×4cm, and was removed. Microscopically, the tumor consisted of adenocarcinomatous and spindle cell sarcomatous tissues, and was diagnosed as the biphasic type of synovial sarcoma.
The patient underwent post-operative chemotherapy and is currently alive without recurrence or metastasis of the tumor.
Synovial sarcoma is generally a malignant tumor of the soft tissues, usually occurring in the extremities. It is rare, however, for synovial sarcoma to occur in the head and neck.

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Autonomic nervous function was evaluated in 69 healthy cases (60 with habitual snoring and 9 without snoring) using an electrocardiographic R-R interval trendogram and evaluating changes under various conditions.
The autonomic nerve of habitual snorers was unstabled uring rest regardless of the inherent individal characteristics of the autonomic nerve, and the parasympathetic nerve was extremely excitable. Reflecting these conditions, the rate of air flow through the nasal cavity was reduced by 38.24% on average inhabitual snorers, and the difference from the rate of 16.01% for non-snorers, was statistically significant (p<0.001).
This finding indicates that inhabitual snorers with idiopathie snoring, mouth breathing occurs because of a disturbance in nasal breathing that can not be predicated from a findings obtained while the patients is awake is induced by an unusual swelling of the nasal mucosa during sleep.

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Advanced deep neck infection (ADNI) can spread into spaces and cause death rapidly. In 1990 we reported a case of ADNI secondary to tonsillitis, with general deterioration due to duodenal perforation and liver cirrhosis. Since then there have been also many case reports on ADNI, and which some patients have died.
To determine the rational treatment of ADNI, 55 cases were collected from the literature in Japan and were analyzed statistically.
It was conclusions that the most important point is the prevention of the spread of infection, especially downward into the mediastinum. Drainage by a vertical incision is useful, and effective antibiotics must be administered such as clindamycin, lincomycin, cefmetazole, sulbenicillin or imipenem/cilastacin. Special care is needed in the treatment of elderly patients and those with diabetes other diseases in which immunity is reduced.

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The interaction of the endolymphatic flow between the anterior semicircular canal (asc) and the posterior semicircular canal (psc) was studied by three-dimensions in intact membranous labyrinths isolated from bull frogs. The asc and the psc nerves were cut 3mm from the ampullae to prevent neural interaction between the two semicircular canals. Two experiments were performed.
Experiment 1: Changes of psc nerve potentials caused by stimulation of asc. The crus of the asc was cut beside the common osseous crus. A polyethylene tube connected with amicrosyringe was inserted into the crus of the asc. The syringe was driven with a micromanipulator for mechanical induction of endolymphatic flow into the asc. The psc and the asc nerve activities were recorded simultaneously with glass suction electrodes.
Experiment 2: Changes of asc nerve potentials caused by stimulation of psc. The crus of the psc was cut beside the common osseous crus, a polyethylene tube was inserted, and the psc was stimulated in the same manner as was the asc in experiment 1.
In experiment 1, psc nerve activity decreased when the asc was given an excitatory stimulus and increased when the asc was given an inhibitory stimulus. In experiment 2, asc nerve activity decreased when the psc was given an excitatory stimulus and increased when the psc was given an inhibitory stimulus. These results indicate that there is endolymphatic interaction between the asc and the psc.
The volume of endolymphatic fluid flowing between the asc and the psc was estimated to be about 3% of the mechanical endolymphatic flow produced as a stimulus.
The endolymphatic interaction probably enhances the sensitivity of the vestibular organs to various degrees of stimulation.

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Aminoglycoside antibiotics are commonly used in the treatment of serious gram negative infections despite a high incidence of associated ototoxicity. Attempts to elucidate the mechanism of the toxicity or prevent the adverse effects have so far been unsuccessful. Recently the damaging effects of aminoglycoside on the inner ear have been shown to be caused by a metabolite of the drug, implying an enzymatic conversion of the parent compound and glutathione has been suggested to be closely related to the mechanism of detoxication of this metabolite. This study demonstrates the attenuation of aminoglycoside ototoxicity by glutathione. Guinea pigs were given amikacin or amikacin+glutathione by intramuscular injection. Pretreatment with glutathione significantly reduced damage to the outer hair cells of the organ of Corti. This finding suggests that glutathione can reduce aminoglycoside ototoxicity and that it can be considered for clinical use.

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To evaluate the effectiveness, safety and utility of Emedastine difumarate (ED) in the treatment of Japanese cedar pollinosis, a multicentered, double-blind comparative study was performed in 290 patients in 1994.
Patients with Japanese cedar pollinosis were divided into two groups; the first group was treated with ED at a dose of 4mg/day starting two weeks before the season and continuing for the whole season. The second group was given an inactive placebo instead of ED during the pre-season and the early portion of the season and then replaced with ED during the later portion of the season.
As a result, the final improvement rate was significantly higher in the first group than that in the second group.
All subjective symptoms such as sneezing, nasal discharge, nasal obstruction and eye itching were suppressed due to ED treatment.
In conclusion, it was better to continuously administer ED to patients with pollinosis from the preseasonal period till the end of the season.
However, when the ED treatment was started in the midseason, the outcome was good, although less satisfactory than the outcome of continuous treatment given throughout the entire pollen season.

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We studied for two seasons the prophylactic and the rapeutic effect of ketotifen in patients with Japanese cedar pollinosis. We administered ketotifen orally to patients before the beginning of the dispersion of pollen. Ketotifenaqueous nasal spray (ketotifen-ANS) was administered to those with a poor-response to the prophylaxis. Of the patients examined during the season 51.4% showed a marked or moderate prophylactic effective. The poor-response patients were treated with ketotifen-ANS, and in 72.2% there was marked or moderate improvement. Thus, ketotifen-ANS was useful in patients whose symptoms were not prevented by oral ketotifen. The only side effect was sleepiness in 3 patients receiving oral ketotifen. Ketotifen-ANS caused none.
Oral ketotifen and aqueous nasal spray ketotifen are considered to be excellent for the prophylaxis and therapy of Japanese cedar pollihosis.

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Long terme rythromicin (EM) therapy has been reported to be useful in chronic sinusitis. We investigated the clinical effectiveness of low dose long term clarithromycin (CAM) therapy for chronic sinusitis in children. Children were treated with 100 or 200mg of CAM perday for 4 to 18 weeks.
1) Total clearing of subjective symptons was revealed in 93.8% of the patients.
2) Total improvement rates were 93.8% for rhinoscopic findings and 90.6% for X-ray appearance.
3) The clinical effectiveness of CAM therapy tended to be better than that of EM therapy.
4) No significant side effects were noted during the therapy.
It is the refore concluded that CAM therapy is very useful in the treatment of chronic sinusitis in children.

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