Mitochondrial mutations are known to be one of the causes of non-syndromic sensorineural hearing loss (SNHL). Of these mutations, a 1555A→G mutation has been reported to cause susceptibility to aminoglycoside antibiotics. The pedigrees shown in this study revealed maternal inheritance exclusively of the hearing impairment, consistent with the hypothesis of a mitochondrial inheritance. Although the hearing loss found in these patients sharing the 1555 mutation exhibited individual variation, there were some common features. Many subjects who harbor this mitochondrial mutation exhibited mild, high frequency, progressive hearing loss even without aminoglycoside injections. Regardless of aminoglycoside exposure, the hearing loss was usually associated with permanent tinnitus. Most of our patients had no history of vestibular dysfunction, such as dizziness and/or vertigo. The results presented here support the hypothesis that the A1555G mutation may play a more general role in causing hearing loss. This indicates the necessity for widespread screening of this mutation in the general population.

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Mitochondrial encephalomyopathy is a multisystem disease, affecting predominantly the CNS and skeletal muscles, and is caused by defects in mitochondrial function. There are three distinctive syndromes: KSS (Kearns-Sayre syndrome), MELAS (mitochondrial myopathy, encephalomyopathy, lactic acidosis and stroke-like episodes), and MERRF (myoclonus epilepsy with ragged-red fibers).
Hearing impairment is one of the symptoms of mitochondrial encephalomyopathy. There have been several reports of progressive sensorineural hearing loss in children and adults with this disease. Acute hearing loss has not however, been previously reported. Two patients with KSS and one patient with MELAS, who showed sudden onset hearing loss, are described in this paper.

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We treated 64 patients with perennial allergic rhinitis refractory to conservative therapy by vaporizing the inferior turbinates with a KTP laser. The rate of subjective improvement was 73% at one month after the surgery, 67% at 3 months and 57% at 6 months. The laser surgery had no effect on 11 patients, but a subjective improvement was obtained in 9 out of these 11 patients by revaporization.
We administered a questionnaire to 34 patiens regarding the laser surgery at 3 months after the surgery. The results were as follows: the most discomfort experienced during surgery was the unpleasant smoke generated by the vaporization process; 28 out of 34 patients wished to undergo the laser surgery again in case of a relapse of severe rhinitis.
The vaporized inferior turbinates from four patients were examined histopathologically. At 3 months after the surgery, the squamous epithelium covered the surface of the vaporized mucosa. The number of nasal glands had decreased, and the collagen fibers had increased in the submucosal area. At six months, the epithelium had changed from a squamous epithelium to a pseudostratified ciliated epithelium, and many inflammatory cells could be seen in the interstitial tissues. It seemed that the nasal mucosa had recovered to its initial state of allergic rhinitis by six months after the laser treatment.
KTP laser surgery is an easy and effective treatment for perennial allergic rhinitis, but the longterm effectiveness of this therapy remains to be studied.

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A 75-year-old man without nasal symptoms was found to have nasal septum hemangiopericytoma with sphenoid sinusitis. Tumor resection was performed using an endonasal scope. Histopathologically, the tumor showed no evidence of malignancy, including mitoses or atypia nuclei. Therefore, chemotherapy and radiotherapy were not undertaken after the surgery. There has been no recurrence in this case for one year.

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Myoepithelioma was found in the left nasal cavity of a 67 year-old woman who presented with an expanding tumor, accompanied by episodes of epistaxis. The tumor was found to arise from the nasal septum and was surgically extirpated. The tumor was studied by light and electron microscopy, including immunohistochemical staining. By light microscopy, the tumor appeared to be a poorly differentiated epithelial neoplasm of undetermined origin; however, immunohistochemical examination and electron microscopic study showed plasmacytoid type myoepithelial differentiation indicative of a nasal gland origin.

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In our department, the sublingual gland is typically removed during surgical treatment of a ranula. Of 18 cases treated surgically for ranulas, the major sublingual duct was seen in only one case. In general, the major sublingual duct is seen in 50-70% of general people. In view of this fact, our observations suggest that ranulas occur more frequently in the sublingual gland and do not typically involve the major sublingual duct. Moreover, the histopathological examination of all removed sublingual glands confirmed sialoadenitis. Thus it is necessary to remove the sublingual gland with the ranula to avoid the possibility of recurrence.

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We report a case of liposarcoma of the hypopharynx in a 76 year-old male that recurred repeatedly and was associated with histological changes over a period of 10 years. The initial histological diagnosis was a tumor of the well-differentiated type, and the patient underwent simple extirpation via lateral pharyngotomy. Eight years after the original surgery, lateral pharyngotomy was repeated for resection of a recurrent tumor, which proved to be of the dedifferentiated type. Two years after the second surgery, the tumor recurred again, growing more rapidly, and the patient displayed dyspnea and dysphagia. CT scans and MRI findings revealed a large hypopharyngeal tumor expanding from the mesopharynx to the cervical esophagus. The patient subsequently underwent pharyngolaryngoesophagectomy combined with free jejunum transplantation. The resected tumor was histologically diagnosed as myxoid in type.
Most liposarcomas of the hypopharynx are histologically low-grade malignancies, patients with this disease often survive for years. However, in cases of recurrence, the histological features of the tumor occasionally change to higher-grade malignant types. In view of this possibility, complete surgical excision is very important in the initial treatment of liposarcoma, and physicians should not hesitate to perform wide excision in cases of recurrence.

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A 63-year-old male who developed peritonsillar and cervical abscesses, complicated by acute renal failure, was admitted to our department. Immediate and appropriate fluid transfusion along with relatively low doses of steroid, CLDM and CRP was effective in improving oliguria and general condition, and in decreasing BUN, creatinine, transaminase, amylase, uric acid and blood sugar. Restriction of potassium intake was very important. Treatment for dehydration and infection was successful and the patient avoided hemodialysis.
A multidiciplinary approach by otorhinolaryngologists and kidney specialists is essential for the treatment of this kind of patient. It is usually rare to find a hospital staffed with both otorhinolaryngologists and kidney specialists. The importance of the communication between specialists and hospitals, was illustrated in the treatment of this case.

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The parapharyngeal space is an anatomically complex region in which a variety of neoplasms can arise. Metastasis of a thyroid carcinoma to the parapharyngeal space is very rare. We recently treated two cases of this disease. The first case was a 66 year-old male with recurrent thyroid carcinoma presenting as a parapharyngeal mass, who had previously undergone a hemi-thyroidectomy and modified neck dissection. The second case was a 61 year-old male with accidental thyroid carcinoma metastasis to the parapharyngeal space during surgery for the treatment of hypopharyngeal and esophageal carcinoma. The possibility of metastatis to this region should be considered in the treatment of thyroid carcinoma.

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A rare case of a papillary carcinoma without a cyst arising from the thyroglossal duct remnant is reported. A 70 year-old woman visited our hospital complaining of a mass in the anterior midline of her neck. CT, ultrasonography and MRI showed a solid mass lesion over the hyoid bone, and a nor-mal thyroid gland. Fine needle aspiration biopsy of the mass yielded papillary carcinoma cells. The mass was removed surgically by Sistrunk's procedure, and a histological examination revealed a papillary carcinoma with a small part of normal thyroid tissue. The serum thyrogloblin levels, which had been 172ng/ml, were reduced to 5.4ng/ml after the surgery.

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We experienced a case manifesting acute suffocation. The patient was relieved by surgical extirpation of a benign thyroid tumor. Respiratory distress due to benign thyroid disease is known to be rare. The tumor was located superior to the sterno-clavicular joint, and its lower margin extended inferior to the aortic arch, and compressed the trachea between the sternum and the cervical spines. Therefore the tumor was associated with long-standing tolerance of airway occlusion and acute suffocation was subsequently precipitated by a dry cough. The tumor extending from the mediastinum was completely extirpated. The histological diagnosis of the tumor was follicular adenoma.

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The incidence of deep neck infection has decreased since the development of antibiotics. However, severe cases with serious complications still occur. Three cases of mediastinitis secondary to deep neck infection were treated in our department. Two of these cases were treated successfully with surgical drainage and antibiotics. Computed tomography was useful in both diagnosis and treatment. Moreover, CT was adequate for the evaluation of treatment, efficacy.

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We report two cases of angioedema probably due to a side effect of angiotensin converting enzyme (ACE) inhibitors. In the first case, angioedema of the tongue was so severe that we had to perform a tracheotomy. In the second case, angioedema of the left arytenoid region and entire face was moderate and intubation was not required as the administration of high doses of corticosteroids and antihistamines effectively reduced the edema. Angioedema associated with ACE inhibitors has rarely been reported. Recent use of ACE inhibitors has increased however and the incidence of angioedema as a side effect of ACE inhibitor administration may be greater than generally estimated. Since angioedema can cause upper airway obstruction, we must be aware of this side effect and should be aware of the possible need to maintain an airway, and especially to be prepared for the possibility of surgical intervention. Detailed anamnesis regarding the use of ACE inhibitors will lead to a correct and prompt diagnosis.

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A study was performed to investigate the effects of mizolastine (MKC-431) on nasal symptoms induced by allergen challenge in 12 subjects with a history of Japanese cedar allergic rhinitis. All of the subjects received mizolastine (10mg p. d.) or placebo orally in a random, double-blind and crossover manner for 5 days at 3 week intervals. The subjects were challenged by exposure to cedar extract on the fifth day of administration. Changes in the following measurements were evaluated before and after the antigen challenge: total volume (left+right) of the nasal cavity measured by acoustic rhinometry, symptoms of nasal obstruction judged by subjects, number of eosinophils in nasal washings, and concentrations of chemoattractant in nasal lavage fluid.
The following results were obtained.
1) The volume of the nasal cavity at 1h after antigen challenge was significantly different between the mizolastine and placebo administration groups (p=0.032).
2) The number of eosinophils and the concentration of EPX, IL-16, LTB₄, PAF, and the amount of eotaxin mRNA in nasal lavage fluid was not significantly different between the mizolastine and placebo administration groups.
3) The total number of sneezes during the 30min period after antigen challenge was 0.58±0.79 (mizolastine) and 4.00±5.06 (placebo), showing a significant difference (p=0.038).
4) The symptom score for nasal obstruction at 0.5, 1, 7, 9, 10, 12h after antigen challenge was significantly different between the mizolastine and placebo administration groups.
5) Adverse events and abnormal changes in clinical laboratory findings related to the drug were not observed during the treatment period, although elevation of eosinophils was observed in one subject after the treatment period.
These results showed the effectiveness of mizolastine in the treatment of sneezing and nasal obstruction induced by antigen challenge during early phase reaction. Though no apparent conclusion was obtained from the volume of the nasal cavity, the symptom score indicated the effective reduction of nasal obstruction during the late phase reaction.

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The effect of emedastine difumarate after antigen challenge was investigated on nasal passage patency and the number of inflammatory cells in the nasal secretion of allergic rhinitis patients. The results showed that the change in nasal passage patency after 8 weeks of emedastine difumarate administration was significantly inhibited 30 minutes after the antigen challenge. No significant changes in the number of inflammatory cells in nasal secretion was observed during the acute or late phases.

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