Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo due to peripheral vestibular lesion. BPPV is classified according to different canal's origin: posterior canal BPPV, anterior canal BPPV and horizontal canal BPPV. In most cases with posterior canal BPPV, canalolithiasis that is free-floating otolith is to cause the syndrome. The movement of canalolithiasis by changes in position of the head induces endolymphatic flow in the posterior canal, resulting in the accompanying nystagmus. The rotation axis of the nystagmus is perpendicular to the affected posterior canal. The canalith repositioning procedure is recommended for the treatment of BPPV. The purpose of this procedure is to relocate free-floating otolith from the posterior canal into the vestibule of the vestibular labyrinth. Horizontal BPPV is induced by lateral movement of the head. The direction-changing horizontal geotropic nystagmus is caused by canalolithiasis of the horizontal canal and the direction-changing horizontal ageotropic nystagmus is caused by cupulolithiasis. Anterior canal BPPV is rare. Because an imbalance in the function of the utriculi in patients with BPPV, otolith detached form the utricular macula is suggested to be a sauce of canalolithiasis and cupulolithiasis.

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Recently, a new artificial dermis was developed as a permanent material for the reconstruction of the skin or mucosal defects. It is composed of two different kinds of collagen; fibrillar and heat-denatured collagen, which are freeze-dried to form a sponge-like structure. These modifications reduce the inflammatory response and increase cellular affinity.
We have been using this artificial dermis in an out patient clinic and in this study, we investigated the effectiveness of this material for repairing tympanic membrane defects and external auditory canal skin defects.
The findings show that the rate of successful repair was 90.9% (20/22 ears) for tympanic membrane defects, and 100% (7/7 ears) for external auditory canal skin defects. We consider this artificial dermis to be very useful for middle ear operations in outpatients settings.

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We report here a rare case of low-grade adenocarcinoma at the posterior edge of nasal septum. A 22-year-old male was referred to our hospital with nasal obstruction. Local findings, CT scan, and MR images revealed a tumor 1cm diameter at the posterior edge of nasal septum. The tumor was completely excised by transpalatal approach under general anesthesia on June 19, 1998. A histopathological examinaton confirmed low-grade adenocarcinoma. He has been free from recurrence of the tumor for two years and half after surgery.

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A clinical study of papillomas in the nose and paranasal sinuses was performed. A total of 17 cases of papilloma was seen at our clinic during the last 11 years and they consisted of 14 males and 3 females with a mean age of 57.9 years. The combination of MRI and CT scan was more useful than CT scan alone to distinguish between papillomas and chronic sinusitis. The recurrence rate was 29%.

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Photo-coagulation by KTP laser is the best method for the therapy of localized and superficial hemangiomas, but is not as effective for the therapy of large and deep hemangiomas. Two cases of hemangiomas treated with photo-coagulation by KTP laser and injection sclerotherapy are reported.
Case 1: A 72-year-old female presented with a huge hemangioma of the soft palate. The first photo-coagulation by KTP laser was markedly effective, but the second photo-coagulation was not as effective. Injection sclerotherapy with 1% Polidocanol was performed. This therapy was effective even though the lesion was spread widely and superficially under the mucosa.
Case 2: A 34-year-old female presented with a hemangioma of the tongue that she had from childhood but had recently enlarged gradually. Injection sclerotherapy with 1% Polidocanol was performed three times and the tumor shrank markedly. Photo-coagulation by KTP laser was additionally performed for the superficial lesion.
The author considers that therapy with injection sclerotherapy using Polidocanol and photocoagulation by KTP laser is safe, easy and effective.

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A 75-year-old woman presented with a several month history of an elliptical and painless tumor in the left side of the parotid gland. Based on MRI and FNABC we made an initial diagnosis of adenolymphoma and removed the mass surgically. Histologic examination revealed sebaceous lymphadenoma. Sebaceous lymphadenoma are rare tumors and to date only 34 cases have been reported worldwide, as reviewed Douglas et al. Sebaceous differentiation in the parotid gland is an expected normal finding in humans. There has been one previous report in which the relation between salivary gland inclusions of the lymph node in the gland and sebaceous differentiation were discussed. We compared this case to other cases reported in the literature and dicussed this disease in regard to genesis and pathology.

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Forty-two previously untreated patients treated for squamous cell carcinoma of the oropharynx from 1975 (opening of the department) through 1999 at our department were retrospectively reviewed in terms of the pathophysiology, survival rate and prognostic factor. The mean age of the patients was 61.0 years (45-84 years), and the ratio of males to females was 2.8:1. Many of the patients were heavy smokers and drinkers. Multiple primary cancer was detected in 14.3% of the patients. Advanced cancer (clinical stages III and IV) was noted in 76.2% of the patients. Among the 40 patients followed up, 12 had received mainly radiation therapy (in combination with chemotherapy in some cases) and 27 had been treated by surgery (in combination with radiation therapy and/or chemotherapy in some cases). One patient received neo-adjuvant chemotherapy, but he died from the adverse effects of this therapy. The 5-year survival rate in the patients treated mainly by surgery was favorable (64.7%). There were no significant differences in patient's background factors or the primary therapeutic strategy employed among the patients. There were significant differences between complete response and partial response or progression in the patients in whom only radiation or preoperative radiation was used (P<0.0042). The favorable survival rate may be explained by the use of surgery as a primary strategy, the use of preoperative radiation, and the use of surgical treatment for cases with T3, N2a or higher grade cancer, irrespective of the effect of radiation. We suggest that it is necessary to assess the effect of radiation therapy early, to consider combining it with chemotherapy, and to attempt a higher salvage rate at recurrence in order to achieve a higher salvage rate.

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The patient was an 82-year-old female with a swelling at the left side of the soft palate. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large cystic tumor in the left parapharyngeal space. The cystic tumor was removed via a cervical approach with mandibulotomy (mandibular swing approach). Postoperative histological examination revealed a pleomorphic adenoma with cystic formation.
Pleomorphic adenoma with large cystic formation is rare in the parapharyngeal space and a differential diagnosis includes branchial cleft cyst, abcess, cystic hygroma, metastatic lymph node with central necrosis and aneurysm. CT and MRI are essential for diagnosis and provide information on the size and location of the tumor. There are several possible approaches to tumors in the parapharyngeal space: transoral excision, cervical approach with or without mandibulotomy and transparotid approach. It is preferable to perform a mandibular swing approach for the removal of the large tumor in the parapharyngeal space.

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To investigate the accuracy and usefulness of combined transcutaneous carbon dioxide (PtcCO₂) and oxygen (PtcO₂) measurement compared with arterial blood gas analysis (PaCO₂ and PaO₂), 10 patients undergoing laryngomicrosurgery under total intravenous anesthesia were studied. The PtcCO₂ values revealed a high degree of correlation with PaCO₂ during anesthesia (r=0.96) and after anesthesia (r=0.93). The PaO₂ values revealed a generally good correlation with PaO₂ during anesthesia (r=0.81), but not after anesthesia (r=0.23). Capnography values are invalid after anesthesia, and an arterial catheter is not always indicated and feasible in microlaryngoscopy. Transcutaneous devices provide an effective method for the non-invasive monitoring of PCO₂ during and after anesthesia, in situations whereas continuous, precise control of CO₂ levels is desired such as laryngomicrosurgery.

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A rare case of small cell carcinoma metastatic to the external jugular vein in a 66 year old female was reported. The patient presented with a rod-like cervical mass, that was stony hard that was not tender. The mass was on the external surface of the right sternocleidomastoid muscle. A CT-scan revealed a mass, 1cm in diameter, in the right parotid gland.
Postoperatively, pathological diagnosis was embolism in external jugular vein from small cell carcinoma of unknown origin.
We also discus small cell carcinoma in the head neck region.

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We report here two cases of spontaneous retropharyngeal and cardiomediastinal emphysema. The patients were a 15-year-old boy, who developed a foreign body sensation in the pharynx after he ran and a 16-year-old boy who developed pain in the anterior neck after he spoke loudly. X-ray and CT examination findings revealed air in the retropharyngeal and cardiomediastional regions in both patients. Antibiotics and a week of rest were prescribed and these complaints disappeared. Sixty-four cases of spontaneous mediastinal emphysema, including our two cases, reported in the Japanese literature in the period between 1992 and 2001 are also reviewed and discussed in this paper.

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We report a case of hyperosmolar nonketotic coma that developed postoperatively in a patient with cancer of the larynx.
The patient was a 69-year-old man, who underwent frontolateral laryngectomy.
He suddenly became comatose on the 17th day after surgery and examination revealed HONKC. A low rate of continuous intravenous drip infusion of insulin and fluid replacement were initiated.
Despite subsequent acute renal failure, sepsis, disseminated intravascular coaglation and rhabdomyolysis, the patient is still alive to date. HONKC is rare as a postoperative complication, but can be fatal.
Careful postoperative care is needed for patients with diabetes mellitus.

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Azunol® ST contains 5mg water soluble Azunol in one tablet, and in this study Azunol® ST was administered into the nasal cavity of 67 patient (nasal group) and into the labiogingival region of the upper jaw in 47 patients (oral group) with common cold in the early stage and the effects were compared to non-administration in 111 patients (control group). In all patients in the nasal and oral groups, one tablet was given before bed. The following results were obtained:
1) The rate of desease of common cold did not significantly differ among the three groups. (x² test)
2) In the nasal and oral groups, the rate of preventing progression was higher than in the control group (P<0.05). (nasal group 90±22%, oral group 91±20%, control group 76±38%)
3) The affected period was significantly shorter in the nasal group than in the control group. (P<0.05), but there was no significant difference between the nasal and oral groups or between the oral and control groups (The period of affection: nasal group 4.29±3.53 days, oral group 6.45±5.84 days, control group 8.06±6.11 days)
4) When the initial symptom was epipharyngalgia, the administration of Azunol® ST in the nasal cavity completely prevented (100%) the progression of symptoms, however, the rate of preventing progression was not significantly different between the oral (61%) and control groups (70%).

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