Two cases of psychogenic hearing loss accompanied by otalgia are reported. Case one was a 10 year-old female. She had been treated with anticonvulsant for epileptic seizures since two years of age. She complained of right otalgia immediately after a ball struck her temporal region. The otological examination revealed right profound hearing loss without inflammatory changes in the ear, nose and throat. Because of a normal auditory brain-stem response (ABR) threshold, functional hearing loss caused by a psychogenic disorder was suspected. Three weeks later she again complained of severe right otalgia and visited our hospital at midnight, but no abnormal findings which would cause otalgia were evident. A subsequent psychological examination revealed that her symptoms occurred as a psychogenic reaction to anxiety about the unexpected occurrence of epileptic seizures. The ophthalmological examination also showed psychogenic visual disturbances with ocular pain.
Case two was a 9 year-old female who complained of sudden left otalgia with bilateral hearing loss. Otorhinolaryngological examination revealed no organic changes which might cause otalgia and ABR revealed non-organic hearing loss.
In both cases, the otalgia was accompanied by psychogenic hearing loss. If acute otalgia with acute hearing loss is not accompanied by organic changes, the change in hearing threshold can be considered psychogenic and further examination especially ABR is useful.

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Ninety-seven patients who suffered from sudden sensorineural hearing loss were treated with high doses of steroids with or without PGE₁. Using follow-up audiograms obtained one month after initial treatment, recovery rates were compared in these two groups. The overall recovery rate of the patients treated with PGE₁ was 72% and this was significantly higher than that of the patients treated without PGE₁ (44%). Especially in the 50 and older age group, PGE₁ had a statistically significant effect on the recovery of hearing, even in patients with severe hearing loss. These results imply that the primary cause of sudden sensorineural hearing loss is the obstruction of circulation in the blood vessels which supply the inner ear.

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Large vestibular aqueduct (VA) syndrome is a distinct congenital inner ear anomaly characterized by a large aperture in the vestibular aqueduct. Among our outpatients with sensorineural hearing loss (SNHL) of unknown etiology evaluated between 1995 and 1997, the nine patients (17 ears) with large VA are presented.
Their history, in addition to results of physical examination, computed tomography, serial audiograms and vestibular function, were reviewed. The average hearing level of the 17 ears was 70.7dB. Eight ears had severe hearing loss, four ears demonstrated more hearing loss in the highfrequency range than in the low-frequency range, and two ears had normal hearing. Positional nystagmus and positioning nystagmus were found in seven cases. Caloric test findings were as follows; four ears had canal paresis, six ears had vestibular dysfunction and three were normal. CT showed three cases with inner ear anomalies other than large VA syndrome.
Fluctuating, or progressive SNHL was present in four of five patients who were followed over a period of three years. Stable SNHL was present in the one-year-follow-up cases. These observations indicate that the functionality of the inner ear in patients with a large VA varies over the longer term. In three of the cases with fluctuating or progressive SNHL, conservative therapy was performed including intravenous steroid therapy, stellate ganglion block, and Co₂ inhalation, which seemed to be of a little benefit. In one patient who became deaf 14 years after the initial examination, cochlear implant surgery was performed. Effective therapy to prevent fluctuating or progressive SNHL remain unknown.

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A 54 year-old male complained of otalgia and hearing impairment in the right ear. A hard mass had completely obstructed the external auditory canal (EAC), and pure tone audiometry showed severe hearing impairment in the right ear. CT and MRI revealed a bony mass at the opening of the EAC and cholesteatoma in the EAC, tympanic cavity and mastoid cavity. Surgery was subsequently performed. The mastoid tip was plugged with hemorrhagic granulation, presumably due to an old Bezold's abscess. The cholesteatoma had destroyed the horizontal portion of the Fallopian canal and none of the three ossicles could be found. Fourteen months later, his hearing showed partial improvement even though a radical mastoidectomy had been performed. To date, there is no sign of recurrence.

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The efficacy of low-dose long-term macrolide for treatment of intractable eustachian tube (ET) stenosis in 20 patients (21 ears) with otitis media with effusion or chronic suppurative otitis media was evaluated. A single daily dose (400-500mg) of erythromycin or clarithromycin was administered for 2-7 months, and ET function was assessed by a modified inflation-deflation test or catheter inflation before and after the course of medication. ET stenosis improved in 10 of the 21 ears (47.6%). The rate of improvement was higher in patients with chronic sinusitis than in those without chronic sinusitis. These results indicate that low-dose long-term macrolide treatment may be useful for treatment of intractable ET stenosis.

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Osler's disease (hereditary hemorrhagic telangiectasia) is characterized by an abnormality of the peripheral blood vessels which often causes recurrent epistaxis which is difficult to control. Intranasal dermoplasty, laser therapy and estrogen therapy have proven to be effective, but the latter has been associated with several fatal complications. We describe a 72 year-old man who went to the USA to receive estrogen therapy. After 6 months of estrogen use, he developed thromboses of the portal vein and the superior mesenteric vein, a severe complication. Emergency abdominal surgery was subsequently required. We should remain aware of the potentially serious side effects of estrogen, therapy in the treatment of this disease.

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We report a 61 year-old male with a rare case of synchronous bilateral carcinoma of the maxillary sinuses. An MRI revealed a large tumorous mass that extruded from the left maxillary sinus; tissue of the same density was recognized in the right maxillary sinus which had intact bony walls. The left maxillary sinus was opened using Caldwell-Luc procedure, and the tumor was diagnosed histologically as a moderately differentiated squamous cell carcinoma. The right maxillary sinus was subsequently opened using the same method, and the bilateral tumor was diagnosed histologically as a poorly differentiated squamous cell carcinoma.
Based on a careful analysis of the clinical findings, image analysis and histopathological evidence, we concluded that these tumors had developed independently in each sinus and this was a case of synchronous primary double cancer.
A literature review revealed that 67 cases of primary carcinoma in the bilateral maxillary antrum were reported, 27 of which were male, 21 were female. The sex of the remaining 19 was not reported. The patients' age ranged from 34 to 84 years. Differences in histopathological findings between the first and second cancer were reported in only 9 cases. The interval between detection of the first and second cancers varied from one case to another, but in 55 per-cent of the patients the interval was less than 5 years, and in 85 per-cent the interval was less than 10 years.

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Three cases out of 65 pleomorphic adenomas (4.6%) in our clinic were characterized by cystic regions. The present report, comprises a histological study of these cases of pleomorphic adenoma with cystic structures histologically.
Case 1: The pathological diagnosis was a pleomorphic adenoma with cystic structures in the submandibular gland. Macroscopically, the cyst had a very thin wall and contained a clear brown liquid. The inner surface of the cyst was not smooth and was lined by one layer of squamous cell without mucus- producing cells. The adjacent area of the cyst and the surface projecting into the cyst were composed of a myxoid area and sheets of small cubic or spindle-shaped tumor cells. The cyst contained eosinophilic mucin. The histogenesis of this cyst was speculated to occur as follows: eosinophilic mucin was probably secreted by cells of epithelial origin; the mucin was retained and extended into the myxoid area to form a large cyst.
Case 2: The pathological diagnosis was a pleomorphic adenoma with cystic structure in the parotid gland. The cyst was filled with a gel-like material. The inner surface of the cystic lumen was lined with stratified squamous cells. Since eosinophilic material in the cyst was keratinized forming epithelial plugs in this case, we speculated that this cyst was similar to the so called epidermoid cysts.
Case 3: The pathological diagnosis of this case was the same as that of case 2. The cyst was filled with a clear brown liquid. Histologically, the major part of the tumor was composed of a myxoid area. The cyst-like structure was localized within this myxoid area. In this case, we speculated that the cyst was formed by a degenerative change in the myxoid area.

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The location of laryngeal lesions sometimes complicates surgical treatment of laryngeal disease using laryngo-microsurgery. For treatment of these cases, laryngeal-fiberscopy via laryngeal mask airway (LMA) was performed. LMA is a very useful device which provides an oropharyngeal airway and offers an alternative to endotracheal intubation and standard mask anesthesia in these cases. Fifteen patients in whom laryngo-microsurgery was seemed difficult, were chosen for this study. Of these 15 patients, 4 were diagnosed with vocal cord polyps, 4 with papilloma, 3 with carcinoma, 2 with leukoplakia, 1 with a cyst and 1 with an angioma. The technique of laryngeal fiberscopy via LMA readily allows full examination of the larynx and trachea. This method facilitates precise biopsy and laser surgery of both the larynx and trachea. Use of the LMA is also recommended for treatment of cases of papilloma or malignancy, because it minimizes the risk of dissemination of malignant cells or papilloma cells to the trachea and lung. We concluded that this procedure is potentially very advantageous when laryngo-microsurgery is difficult to perform.

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Mucoepidermoid carcinoma of the larynx is an uncommon malignancy. We reviewed 308 laryngeal cancers seen over an 18-year period at Kurashiki Central Hospital and found five cases of mucoepidermoid carcinoma (1.6%). This tumor is difficult to diagnose histologically from biopsy specimens and is often initially diagnosed as squamous cell carcinoma. The true incidence of this tumor could be higher than is believed because of frequent misdiagnosis as squamous cell carcinoma. Two of the five cases at our hospital were reported as squamous cell carcinomas based on biopsy results. Surgical treatment was performed after preoperative radiotherapy. Total laryngectomy was performed in four cases and extirpation of the tumor by laryngomicrosurgery was performed in one case which was of the supraglottic type (T1). Our clinicopathological study of the efficiency of radiotherapy revealed that this tumor responds poorly to radiation treatment. The treatment of choice is surgery. This tumor is classified histologically as either low-grade malignancy or highgrade malignancy. The prognosis is relatively good in cases of low-grade malignancy and poor in cases of high-grade malignancy. All five cases of the cases evaluated in the present study were high-grade malignancy.

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We performed a clinical, statistical review on 365 cases of laryngeal nerve paralysis (LNP) referred to our clinic between January 1983 and December 1996. There were 238 males and 127 females, including 16 and 9 cases of bilateral paralysis, respectively. The causes of the paralysis were non-surgical in 211 cases (idiopathic in 118, lung cancer in 19, cerebrovascular disease in 16, mediastinal tumor in 9, thyroid cancer in 9, neck tumor in 9, esophageal cancer in 8, aortic aneurysm in 8 and 15 others, whereas 154 cases were due to surgical operations (esophageal surgery in 47, lung surgery in 31, thyroid surgery in 27, intubation in 24, cardiovascular surgery in 13, neck surgery in 7 and 5 others). The left vocal fold was more commonly affected and the paralyzed vocal fold was fixed in a paramedian position in the majority of the cases. Aspiration was observed in 94 out of the 365 cases (25.8%). Aspiration was also noted in 3 out of 3 neck injury cases, 23 out of 47 esophageal surgery cases and 4 out of 7 neck surgery cases had a high risk for aspiration. Transcutaneous intracordal silicon injection has been the main option for the surgical treatment of unilateral LNP in our clinic. However, silicon injections are becoming controversial because of the decision of the Food and Drug Administration with respect to breast-implans in 1992. Therefore, other methods such as autologous fat injection or thyroplasty have been replacing silicon injections in recent years.

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The authors investigated indication for phonosurgery for treatment of unilateral vocal fold paralysis based on laryngeal tomographs taken during sustained phonation of the vowel/u/, using a computed radiography system. As pre-operative quantitative indices, the thickness ratio (the ratio of the frontal sectional area of the paralyzed vocal fold to that of the other side, TR) and the level difference (the distance between the upper surfaces of the bilateral vocal folds, LD) were measured from pre-operative laryngeal tomographs. The TR represented a quantitative index of atrophy of the paralyzed vocal fold and the LD represented the level difference between the bilateral vocal folds. Results of phonosurgery were evaluated by post-operative mean air flow rate (MFR) and the AC/DC ratio, effective value of the AC component of expiratory air flow divided by mean flow rate (DC). The results were as follows;
1. Thyroplasty type I was indicated for the cases whose pre-operative TR was below 0.7 and LD was below 0.5mm.
2. A combination of thyroplasty type I and arytenoid adduction was indicated for the cases whose pre-operative LD was above 0.5mm and TR was below 0.7.
3. Intra-cordal injection of collagen was not indicated for the cases whose pre-operative TR was below 0.5 or LD was below 1.0mm.

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Suplatast tosilate is a novel drug which specifically suppresses the production of IgE antibodies. We evaluated the efficacy of suplatast tosilate given before or during the pollen season. Suplatast tosilate 300mg (one capsule each, t. i. d.) was administered orally either before the onset of pollen scattering or during the pollen season. Efficacy was evaluated by nasal symptoms, rhinoscopic findings, and the nasal symptom diaries of the patients. Global improvement rate was 80.6% with preseasonal administration and 18.8% with seasonal administration as demonstrated by “moderate” or “marked” improvement. The improvement rate, as evaluated by the patients, was 75.0% with preseasonal administration and 46.7% with seasonal administration. Neither total serum IgE nor cedar specific IgE decreased significantly after administration of suplatast tosilate, in either group. Evaluation by symptom score and symptom-medication score designed for allergic rhinitis revealed the efficacy of preseasonal administration, especially in the early stages of pollen scattering. These results suggest that suplatast tosilate is effective as a prophylactic drug for treatment of Japanese pollinosis.

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The effects of candy containing oolong tea stem extract on pharyngeal discomfort were studied in 65 patients with allergic rhinitis, pharyngolaryngitis or similar ailments at 6 hospitals. Four candies containing the extract (33mg, 50mg or none) were administered daily for 2 weeks. Significant improvement in throat symptoms such as thirst, pain, feeling of occlusion and hoarseness of voice were found in the treatment groups but not in the placebo candy group. Both treated groups showed a tendency toward high total improvement and usefulness compared to the placebo group. The patients self-evaluated as “slightly improved” or better in about 75% of the patients in both treated groups and 44% in the placebo group. No severe adverse reactions were observed.
In conclusion, the results suggest that oolong tea stem extract may be very effective for pharyngeal discomfort caused by allergic rhinitis and laryngitis or other complaints.

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