Language appears to be the basis for both individual thinking and cultural exchange inside nations and among nations. However, our knowledge of the mechanism of language recognition, especially at the level of the central nervous system is quite limited because of difficulties in conducting experimental study in human beings.
Recently, several modalities that can visualize brain activities during language recognition have been developed. Positron Emission Tomography (PET) has provided considerable important information about cortical activities related to language. On the other hand, Magnetoencephalography (MEG) provides more precise identification of the activated area in the auditory cortex along with data on the sequence of activation. From these studies, we determined specific activation in the auditory association area for language stimulation, in addition to that in the primary auditory cortex.
Cognitive brain activity for language is ready to be elucidated using these modern technologies, and academic advances in this field would contribute greatly to the management of patients with disturbances in the recognition of spoken language.

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Patients with sudden deafness who were treated either in our department or in our branch hospital between January 1984 and December 1994 were divided into two groups. Group A consisted of 69 patients who were treated with steroids, vasodilators, and stellate ganglion block but without hyperbaric oxygen therapy. Group B consisted of the other 85 patients who were treated with not only steroids, vasodilators, and stellate ganglion block but also with hyperbaric oxygen therapy. Patients in the two groups showed no significant difference in age, or number of patients with vertigo, but the initial audiogram was worse and time from onset to consultation were significantly greater in group B than those in group A. The prognoses of the two groups were analyzed by several issues, such as initial audiogram, time from onset to consult and there was no significant difference.

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Twenty-four patients with Vogt-Koyanagi-Harada disease who were referred by the department of ophthalmology were examined otologically. Eleven patients had hearing impairment on pure tone audiometry. Evoked otoacoustic emissions were measured using an apparatus of our own design. There was a relation between hearing levels and the detection thresholds of otoacoustic emissions.
The regression line in the scatter plot of these values showed a lower coefficient value than that in other inner ear impairments reported previously. It has been reported that Vogt-Koyanagi-Harada disease is induced by an immunological disorder in the melanocytes of the stria vascularis. The pathogenesis of this disease is discussed.

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The first patient was a 31-year-old female complaining of sore throat. Ulcers found in the nasopharynx resembled malignant tumor. A biopsy was taken using a nasopharyngoscope. The pathological diagnosis revealed tuberculosis of the nasopharynx. The second patient was a 36-year-old female and the third patient was a 33-year-old female. Ulcers with white coating were seen in the first two cases and a mass lesion was seen in the remaining case. Chest X-rays of all three patients were clear. Therefore they were diagnosed with primary nasopharyngeal tuberculosis. Treatment with antituberculosis agents greatly reduced the ulcers and the mass.

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Cedar- and cypress-pollen specific IgE antibody was measured by AIaSTAT, CAP-BAST, and MAST in 30 patients with pollenosis and 16 patients with bronchial asthma. The usefulness of each test was evaluated on the basis of the correlation of test results with clinical symptoms. The coefficient of correlation among all tests was 0.75 for cedar specific IgE antibody, and the relative correlation of test results and clinical symptoms was CAP-RAST ‹AIaSTAT › MAST. For cypress specific IgE antibody, the coefficient of correlation between the first two tests was 0.74, and the relative coincidence was ‹AIaSTAT › CAP-RAST. The antibody titer determined by AIaSTAT showed seasonal variations with a rise during the pollen season and a tendency to decrease thereafter.

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Sixteen children with severe chronic sinusitis were treated with the low-dose long-term clarithromycin (CAM) administration. Patients showed marked improvement in the following symptoms; 66.7% for mucosal swelling, 60.0% for volume of rhinorrhea, 60.0% for quality of rhinorrhea and 73.3% for postnasal drip.
Bacterial examinations were also performed before and after treatment. The incidence of H. influenzae was lower during the CAM therapy than erythromycin (EM) therapy, but the ratio of CAMresistant bacteria increased after treatment.

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Adenoid cystic carcinoma is a common malignant tumor which usually arises in the salivary glands but occasionally arises in the nasal or paranasal cavity.
We report an unusual case of adenoid cystic carcinoma in a 39-year-old woman who presented right trigeminal and hypoglossal nerve palsy. MRI showed a diffuse tumor mass in the right paranasal sinuses infiltrating to the base of the skull. We thought the tumor originated in the posterior wall of the right maxillary antrum and the pterygopalatine fossa, then spread posteriorly to the cavernous sinus along the infraorbital nerve and inferiorly along the internal carotid artery.
We concluded that it was too late for a curative resection, and a total of 63.2 Gy radiotherapy was administered. Following therapy, the tumor regressed in size, but did not disappear.

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We encountered a patient with a foreign body retained in the face, who had remained asymptomatic for as long as 40 years. A 62-year-old man consulted our hospital with a chief complaint of left buccal swelling. The past history included amputation of the right thigh because of a traffic accident 40 years earlier. Plain X-ray and computed tomography revealed an opaque, metal-like image adjacent to the masseteric fascia. A foreign body was excised by facial skin incision under fluoroscopy. The excised material was tungsten. This patient had no past history of facial injury. The foreign body may have entered his face at the time of the traffic accident and was detected when the buccal region became swollen as the result of some irritation.

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One hundred two patients with parotid tumor were treated in the ENT Department, Kyoto Pref ectural University of Medicine between 1989 and 1994. Twenty-four of the 102 parotid tumors were Warthin's tumor (adenolymphoma). This incidence of Warthin's tumor was higher than that in any previous reports. This and other recent reports show that the incidence of Warthin's tumor has tended to increase recently, but the reason for this increase is not clear. In general, it is said that Warthin's tumor is found much more frequntly in males than in females, so we reviewed and analyzed 9 clinical cases of Warthin's tumor found in women. The average age of these women was approximately 10 years younger than that of male patients. No substantial differences were seen between male and female cases of Warthin's tumor on CT and Echo findings.

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A 70-year-old female consulted our clinic complaining of persistent pharyngeal discomfort. She presented a pulsating bulge in the left side of the pharyngeal wall without mucosal lesion. CT and digital subtraction angiography confirmed that internal carotid artery had a winding course and compressed the left pharyngeal wall. She has been followed with observation only and hypertension and hypercholesteremia are being medically controlled.

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Reconstructive surgery for head and neck cancers performed during the past ten years is reviewed. The patients were 60 males and 19 females with a mean age of 61.1 years. The reconstructed sites were oral cavity (28 patients; 35%), hypopharynx and esophagus (21 patients; 27%), oropharynx (14 patients; 18%), skin (9 patients; 11%), pharyngeal fistula (6 patients; 8%), and nasopharynx (1 patient; 1%).
We used 66 pedicled flaps (84%) and 13 free flaps (16%). The most common were pectoralis major myocutaneous flaps (43 patients; 54%).
Reconstructive operations have increased over the past ten years, especially free flap trasplantations in 1993 and 1994. The use of free flaps has shortened period of post-operative hospitalization and improved swallowing and speech functions.

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Intracapsular enucleation is thought to be a suitable method for preserving post-operative function of the original nerve following treatment for cervical neurilemmomas. In previous studies, however, post-operative palsy occurred in most cases and there have been seen several cases in which nerve funtions did not recover. In the present study, we performed a modified method of Intracapsular enucleation for two cervical neurilemmomas, the first case involved the facial nerve, the second the hypoglossal nerve. In these cases, post-operative palsy has not been observed since immediately after surgery. Important points in this procedure include (1) making the incision line at a point on the capsule where few nerve fibers exist, (2)ablating the capsule from the tumor as gently as possible, (3) monitoring nerve function using a nerve stimulator throughout the procedure.

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Five cases with deep neck infection are reported. Although our cases did not develop fatal complications, a review of recent literature disclosed these complications.
CT scanning is useful for both the diagnosis and the treatment of deep neck infection.
Determining the appropriatet time for surgical drainage is difficult because antibiotic therapy can mask real conditions. Prompt surgical drainage not only improves the local and general conditions but also prevents the development of fatal complications.

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After a 72-year-old male with glottic cancer received a permanent tracheostomy due to tracheostomal stenosis, dyspnea began to relapse and progress, and flexible fiberscopy disclosed the prominent finding of “a saber sheath type” of tracheobronchomalacia. Histopathological examinations at autopsy disclosed that the cartilage of the tracheobronchial tree was selectively destroyed in worm-eaten shapes or had completely disappeared, and was replaced by collagen fibers. Immunohistochemical examinations demonstrated that CD68-positive and HLA-DR-positive macrophages were present inside the cartilage cavities, and had accumulated at the destroyed portions of the cartilage. These pathological changes indicated that the cartilage of the tracheobronchial tree was selectively destroyed, and immunologically, macrophages with HLA class II antigen directly affected the chondrocytes. We propose a new concept of the immunohistopathogenesis of tracheobronchomalacia.

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A statistical analysis of 334 cases involving foreign bodies in the otorhinolaryngological field treated in our hospital between March 1988 and February 1995 is reported. The 344 cases represented 0.92% of the total number of outpatients (36406) during the same period. We found that 114 cases involved the external auditory canal (34%), 71 cases the nasal cavity (21%), 134 cases the oral cavity and pharynx (40%), and 15 cases the esophagus and trachea (4%). Cases involving the external auditory canal and nasal cavity, especially the nasal cavity, were most frequently found in children under 10 years old. The most frequent foreign bodies were hairs in the external auditory canal. Plastics were most common in the nasal cavity. Foreign bodies in the oral cavity and pharynx were mainly found in the f aucial tonsil, and most of the foreign bodies found in this area were fish bones. There were 14 cases of foreign bodies in the esophagus, and of these, 12 involved items lodged at the first narrowing portion, while 2 cases involved the second narrowing portion. Again, fish bones were the most common foreign bodies found in the esophagus. In the trachea, there was only one case of a foreign body, which involved a peanut.

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Acoustic trauma induces various changes in the cochlea outer hair cells. These changes range from early loss of the sensory hairs to late cell body damage. After the hair cells collapse and disappear, the epithelial surface is quickly repaired. This study was designed to morphologically elucidate the process of epithelial repair. Guinea pigs were subjected to acoustic overstimulation of 4000HZ, 120 dBSPL. The intracellular ultrastructure of the organ of Corti was observed using scanning and transmission electron microscopy. Patterns of outer hair cell collapse were divided at the level of Hensens body. The upper portion of the cell collapsed into the endolymphatic space, while the lower portion collapsed into the tunnel of Corti. After the outer hair cells disappear, the apical portions of the surrounding supporting cells, such as Deiters cells, pillar cells and Hensens cell were quickly extended to repair the defect in the hair cell.

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We evaluated the efficacy of treatment with roxithromycin (RXM: new derivative of erythromycin) for OME patients with tympanostomy tube (TT) from the perspective of reducing refractory OME and preventing complications.
Seventeen ears of 15 patients were treated for 6 months with a single daily dose (150mg) of RXM starting on the day of TT insertion. The other 23 ears of 20 patients were treated by TT insertion only.
The rate of improvement, including “good” improvement, for ears with mucous fluid in the middle ear and poor mastoid pneumatization was significantly higher in ears treated with RXM (50%, 60%) than in ears treated with TT insertion alone (0%, 25%).
These results indicate that low-dose RXM treatment may be useful for OME requiring TT insertion, and in reducing complications caused by TT insertion.

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Roxithromycin (RXM), a newly synthesized macrolide antibiotic, is reported to have anti-inflam-matory and anti-allergic actions as well.
We administered RXM, Rulid® tablets (150 mg twice a day), for 2 weeks to 114 patients with pharyngitis, who complained of an abnormal sensation in the throat, such as a lump, choking or itching.
The therapeutic effect of the medication was evaluated at the end of the first and second weeks of administration and one week after the termination of treatment. RXM was considered to be markedly effective when the abnormal sensation improved by 80% or more, moderately effective if improvement was 50-80%, slightly effective if it was 20-50%, and not effective if it was less than 20%. Of the 114 patients, 7 dropped out and 2 had such gastro-intestinal discomfort that the medication had to be suspended.
In the remaining 105 patients (40 males and 65 females, 25-87 years of age, mean 58.0 years) the medication was markedly effective in 29.5% and effective in 41.0% at the end of the first week; the corresponding figures were 39.0% and 41.0% at the end of the second week, and 49.5% and 30.5% one week after the termination of the medication. These results show the fairly rapid and considerably long-lasting effect of RXM.
The results indicate that RXM is effective in the therapy of patients with pharyngitis accompanied by abnormal sensation in the throat.

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