Labyrinthine fistulas found during surgery for treatment of chronic otitis media with cholesteatoma, most commonly involve the horizontal semicircular canal. The overall incidence of cochlear fistula, however, is low. In the present study, we report three cases of cholesteatoma with a labyrinthine fistula in the cochlea. No additional fistulas were found in the semicircular canals or vestibule, and the inside of the cochlea was found to be completely dry in all three cases. Case 1 (56y male) had profound sensorineural hearing loss, and case 2 (56y male) and case 3 (20y male) were totally deaf before the surgery. All of them had suffered from persistent and active inflammation for a long period of time. Middle ear computed tomography (CT) could identify the presence of the cochlear fistula. The pathway from the epitympanum to the additus & antrum of the mastoid was found be very narrow in cases 1 and 2 during the surgery. Therefore, large pressure, due to the cholesteatoma may be present at the mesotympanum, and could not be released to the mastoid, potentially causing the development of a large cochlear fistula. In case 3, because middle ear pneumatization was good, and the cholesteatoma was present in a very restricted area on the anterosuperior part of the promontry, a congenital origin arisig from epideromoid formation was suspected.
We also reviewed the 12 additional cases of cochlear fistulas reported since 1974. As suggested previously, the hearing prognosis is very poor in most cases of cochlear fistulas.

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Synkinesis of the facial muscles are common sequelae of peripheral facial nerve palsy. However, treatment for synkinesis is limited. The case of an 18-year-old woman with right-sided Bell's palsy is reported. An electroneurography (ENoG) test showed complete degeneration of the facial nerve on the right side. There was a good possibility that the patient would eventually be troubled by synkinesis. As prophylactic treatment for the prevention of synkinesis, biofeedback rehabilitation was undertaken using a mirror and electromyography. Subsequently, the patient showed no simultaneous activation of the orbicularis oculi during mouth movements, which is the most common clinical symptom of Synkinesis. It is proposed that biofeedback rehabilitation is an effective prophylactic treatment for synkinesis.

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Nasal polyposis is a frequent chronic disease causing unpleasant and embarrassing symptoms for the patients. Although much progress has been made in understanding this disease, little is known regarding the relationship between the clinical findings of the nasal polyps and histopathological findings. In this study, we evaluated the size of the nasal polyps on the basis of nasal endoscopic findings. Next, the relationship between their sizes and their histological characteristics was analyzed. During their ethmoidectomy, nasal polyp samples were taken from 82 patients. The nasal polyps were histologically differentiated by their morphological characteristics, infiltrating cell types, and fibronectin immunopositivity. We then compared these findings to the size of the polyps. Correlations between these histological characteristics were also analyzed statistically. Nasal polyps showing an edematous morphology or fibronectin expression were significantly larger in size. Nasal polyps with infiltration by eosinophils frequently showed edematous morphology and fibronectin immuno-positivity. Therefore, an edematous morphology and fibronectin immuno-positivity were also determined to be closely related. These findings suggest that an interaction between eosinophils and fibronectin might play a role in the generation of edema, which would contribute to the growth of the nasal polyps.

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The case of a leiomyosarcoma which developed in the right maxillary sinnus region is reported rare. A 66-year-old male presented with a chief complaint of recurrent epistaxis from the right nasal cavity. Upon examination, a dark red tumor was found in the right nasal cavity and the gingiva. An X-ray examination revealed ill-defined densities in the right maxillary sinus and ethmoid sinus. Following a biopsy, this case was diagnosed as a poorly differentiated squamaous cell carcinoma. CDDP arterial injection and PEP continuous subcutaneous injection were first performed on the right opened maxillary sinus and 50Gy was then irradiated on the right maxillary portion. However, the tumor remained in ethmoid sinus and the lower wall outside of the maxillary sinus, and therefore a subtotal extirpation of the upper jaw was performed on a wide range of area including the foregoing portions. An immunohistopathological examination led to the definitive diagnosis of a leiomyosarcoma. After he was discharged from the hospital, he experienced a local recurrence of the tumors.
Since the tumor grew despite radical chemical therapy such as CDDP, THP-ADM and CPM, the extirpation of a wide range of area including the right hemipalate was carried out. Furthermore, CDDP, VP-16 and CPM chemotherapies were performed, but the patient still died.

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There has been an increase in the incidence of nasal and paranasal sinus mycosis in recent years. We reviewed 32 cases of nasal and paranasal sinus mycosis treated at our hospital between 1987 and 1996. The 32 patients (9 males and 23 females) ranged in age from 25 to 82 years with a mean age of 61.0 years. The most common observations in patient clinical histories were hypertension followed by gynecopathy, appendicitis, heart disease and diabetes. The most common chief complaint was cheek pain and cheek discomfort followed by rhinorrhea, nasal obstruction and postnasal drip. The mycosis lesion was located in the maxillary sinus in 27 cases, the nasal cavity in 5 cases and the ethomoid sinus in 1 case. In all cases, the diseases were unilateral. A CT scan was performed in 24 cases. In 16 cases, high density areas similar to regions of calcification were seen in the maxillary sinuses and in 9 cases, bone destruction shadows were seen in the walls of the maxillary sinuses. A diagnosis of mycosis was made in all cases by pathological examination of mucosa taken during surgery or biopsy specimens. There was no evidence of mycosis in cultures of rhinorrhea, necrotic debris or mucosa tissue of the nasal cavity or paranasal sinus in 13 cases. We found aspergillosis in 24 cases, candidiasis in 7 cases, and mucor mycosis in 1 case. In 30 cases, surgical procedures were performed and in 2 cases, only antral irrigation was performed.

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We present the case report of hematoma in a left parotic lesion in a neurofibromatosis patient.
A 17-year-old man with neurofibromatosis VIII was admitted to our hospital. He complained of a soft mass which had been enlarging over the past few hours in a left parotic lesion. Computed tomography showed an enhanced area and aspiration yielded a bloody fluid. Therefore we diagnosed a sudden enlargement of hematoma and we decided to perform an operation to stop the bleeding. Bleeding was seen on the surface of the neurofibroma and we stopped the bleeding with sheets of hemostatic collagen fleece (Avitene sheet®). There has been no rebleeding since the surgery.

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This is the case report of a 69-year-old man with a spindle cell carcinoma of the hypopharynx which produced G-CSF. Clinically, the tumor showed resistance to chemotherapy, while the patient was suffering from high fever and leukocytosis despite no evidence of infection. Moreover, the tumor exhibited rapid growth. Microscopic examination revealed, a spindle cell carcinoma which had developed from a squamous cell carcinoma, and which had a bizarre appearance reminiscent of malignant fibrous histiocytosis. The tumor cells of the squamous cell carcinoma and spindle cell carcinoma were immunohistochemically stained with monoclonal anti-G-CSF antibodies. This is the first case of a G-CSF-producing spindle cell carcinoma of the hypopharynx to be reported in Japan.

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The case of a 67 year-old male with a Saccular Cyst is reported. The patient's chief complaint was hoarseness. CT and MRI showed two submucosal lesions side by side in the left ventricle, aryepiglottic fold. These lesions were revealed to be cysts during surgery. The first operation performed was laryngomicroscopic marsupialization of the anteromedial lesion of the larynx. The second operation involved laryngomicroscopic total removal of the lateral lesion of the larynx. A contact-YAG-lazer was used to maintain a dry field, and laryngeal forceps were used to suture the mucosa membrane of the larynx. Histopathology showed the cysts to be lined mainly by columnar epithelium and partially by squamous epithelium. Based on clinical findings, image analysis and histopathological evidence, we concluded that these lesion were Saccular Cysts. The hoarseness was resolved after surgery, and the patient remained asymptomatic without recurrence for a year.

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We performed laryngotracheal separation in four patients with intractable aspiration. All four patients could eat post orally and did not suffer from postoperative aspiration pneumonia. There are other surgical procedures for intractable aspiration which do not preserve vocal function, such as tracheoesophageal diversion (Lindeman, 1975), laryngeal closure and total laryngectomy. We considered this procedure to be simpler, more effective and generally more acceptable. Neither bad breath nor laryngeal reflex resulted. This procedure can theoretically restore the larynx after surgery if the patient's aspiration improves, but practically we never have experienced the case.

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Ten patients with acute laryngotracheal trauma were observed in our department from 1988 to 1997. They included 4 cases with an open injury and 6 cases with a closed injury. All of the open injuries were due to penetration trauma. The causes of the closed trauma were traffic accidents in 5 cases and an attempted suicide in 1 case. In acute laryngotracheal injury, the maintenance of airway patency should be the first consideration. After achieving an airway, open injuries should be treated during the acute phase. In closed injuries, damage to the respiratory mucosa and cartilagenous framework should be estimated by fiberoptic endoscopy and computed tomography. Proper initial management during the acute phase prevents airway and phonation troubles in subsequent chronic phases.

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Two cases of esophageal perforations caused by endoscopy were treated at our hospital.
The cause was flexible fiberscopy in one patient and rigid esophagoscopy in the other patient. Both patients were treated surgically and cured.
We concluded that: (1) rigid esophagoscopy should be performed under general anesthesia; (2) a barium esophagogram indicative of an esophageal perforation should not be a contra-indication; and (3) the operation should be performed as soon as possible, and primary suture of the perforation should also be performed if possible.

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Two cases of obstructive sleep apnea (OSAS) caused by primary hypothyroidism are reported.
The first patient was a 66-year-old man who complained of sleep apnea with an apnea/hypopnea index (AHI) of 50.8 per night as assessed by all night monitoring. Hypothyroidism was subsegently suspected when he showed delayed recovery from general anesthesia following surgery involving UPPP (uvulo-palato-pharyngoplasty). Hypothyroidism was diagnosed on the basis of blood tests. His snoring and apnea improved after 2 months of levothyroxine sodium administration and the AuI changed from 50.8 to 13.0.
The second patient was a 73-year-old man with an AHI of 41.3 per night as assessed by all night monitoring. Hypothyroidism was diagnosed on the basis of blood tests and was suspected because of his slow speech. He was similarly treated with levothyroxine sodium. The AHI did not decrease after treatment for 4 months. His desaturation time (the rate of O₂ saturation less than 90%) improved however, from 56.6 to 31.9, and the symptoms of hypothyroidism also recovered markedly. In both patients, elevated creatine phosphokinase (CPK), dull facial expression, peripheral edema, and slow speech were recognized and these were suggestive of hypothyroidism. The type of sleep apnea was mainly obstructive in both patients.

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Twenty one patients with otomycosis were treated with oral Itraconazole tablets. The patients were given 50mg or 100mg of Itraconazole per day until clinical symptoms improved. The overall effectiveness rates were 42.9% (9/21) with excellent efficacy, 38.1% (8/21) with good efficacy, 4.8% (1/21) with no efficacy respectively. The fungus culture tests were negative in 8 patients among the 15 who underwent fungus culture tests after treatment. A sufficient amount of Itraconazole to be therapeutic was detected in the cerumen of one patient (118.81ng/gr. after 2 weeks administration, and 453.56ng/gr. after 4 weeks administration, respectively), and concentrations exceeded most of MIC (0.063-1μg/ml). An adverse reaction was experienced by only one patient, a 59 y. o. male, who suffered from diarrhea. Abnormal laboratory data were found in a 73 y. o. male, among the 11 patients who underwent blood tests both before and after the treatment, showing minor elevation of GOT and GPT. These observations suggest that Itraconazole is a safe and useful oral medicine for treatment of otomycosis.

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