Taste disorders caused by radiation therapy for head and neck cancer are common, but the details are still unclear. This paper reviews the time course, degree and character of radiation-induced taste disorders retrospectively. Radiation-induced taste disorders appeared one to two weeks after the start of radiotherapy (10-20 Gy), and reached maximum 4 to 5 weeks later (40 Gy). In the 40-70 Gy irradiation period, taste disorders persisted subjectively, but objective recognition thresholds tended to become lower, suggesting taste bud regeneration. Radiation-induced taste disorders recovered within 3 months after the termination of radiotherapy subjectively, and within 6 months objectively. Bitter taste was affected most. A loss of sweet taste depended upon whether the tip of tongue was included within the radiation field. The slope of the taste intensity performance did not change during and after radiotherapy. The main cause of taste disorders during radiation is the damage to the taste cell surface structures, and the effects of damages to the peripheral nervous system governing gustation and the salivary gland may be limited.

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We report a case of Wegener's granulomatosis with hypertrophic pachymeningitis. A 36-year-old man presented with bilateral hearing loss and middle ear effusion. CT and exploratory mastoidectomy findings showed a granulomatous lesion with inflammatory cell infiltration in the mastoid cavity. The laboratory result was positive for C-ANCA. On the basis of these findings, the patient was diagnosed as Wegener's granulomatosis. Middle ear symptoms and signs were reduced by treatment with prednisolone and cyclophosphamide. However, severe headache and diplopia developed. Ga-DTPA-enhanced magnetic resonance imaging (MRI) revealed thickening of the dura mater in the tentorium cerebella caused by hypertrophic pachymeningitis. Further treatment with prednisolone and cyclophosphamide improved these symptoms. The thickening of the dura mater in the tentorium cerebella showed a dramatic improvement in MRI at 5 months after starting treatment.

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A 58-year-old man visited our hospital with complaints of temporal headache, hoarseness, dysphagia and left hearing loss. Palsy was noted in the left soft palate, vocal cord and sternomastoid muscle. And also hyperesthesia was noted in the first branch of the left trigeminal nerve and hypoesthesia in the other branches of the nerve. His left hearing was reduced to total deafness. Enhanced CT scan and MRI showed signs of acute mastoiditis with internal jugular vein thrombosis and inflammation around the sigmoid sinus (sinus phlebitis). The mastoiditis had resulted from infection of MRSA; methicillin resistant Staphylococcus aureus. Mastoidectomy was performed, as the antibiotic therapy with Vancomycin did not work for the mastoiditis. At the time of the operation, inflammatory mucous membrane in the mastoid cavity and the bone defect on the lateral semicircular canal were observed, but neither granulation nor abscess was observed. Two days after the operation, redness around the ear was noted, so the wound was opened. Thereafter, curettage of the granulation with irrigation in the mastoid cavity was repeated. The palsy of the left soft palate improved, and the inflammation decreased. When the MRSA turned to Pseudomonas aeruginosa, the antibiotic drug was changed to Imipenem. However, the temporal headache was not relieved and the inflammation increased again. Therefore, further mastoidectomy with tympanoplasty was performed. At the time of the second operation, a fracture on the middle base of the skull and a fistula on the lateral semicircular canal were observed. Postoperatively, the temporal headache and the inflammation improved. A month after the operation, the palsy of the left soft palate, sensation in the face and the sternomastoid muscle functions recovered. Eleven months after the operation, movement of the vocal cord has been improving gradually.

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Using an endoscopic shaver, we performed global turbinectomy of the inferior nasal turbinate mucosa for 31 patients (20 males and 11 females, aged 14-68 years) with hypertrophic rhinitis refractory to nonsurgical treatment. In addition, we applied 80%W/V trichloroacetic acid to the inferior turbinate after removing the mucosa. The mean follow-up period was 5 months, ranging from 1 to 23 months. Direct visualization with the endoscope allowed more accuracy and the electric motorized shaver ensured quick and extensive removal of excessive mucosa. The inferior turbinates from two patients were examined several months after the removal histopathologically. At 5 months after the surgery, cylindrical epithelium covered the surface of the mucosa. The number of nasal glands had decreased, and the collagen fibers had increased in the lamina propia. The results showed that the treatment was effective in 100% of the patients with nasal occlusion. Watery nasal discharge improved in 4 of the 8 patients who were followed for 6 months. This surgery is an effective treatment for perennial hypertrophic rhinitis, especially in severe cases.

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We report a case of nasal neurinoma. A 38-year-old male presented with left nasal obstruction. Physical examination showed a reddish tumor in the left nasal cavity. Computed tomography and magnetic resonance imaging demonstrated a solitary tumor in the left nasal cavity compressing the nasal septum and anterior ethmoid sinus without bony destruction. The tumor was completely removed by endscopic sinus surgery under general anesthesia. The histopathological diagnosis was Antoni A and B type neurinoma. The postoperative course was uneventful without any signs of recurrence for 7 months after surgery.

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It has been reported that the sensitization to house dust-mites (HD-mites) is one factor which affects the onset of Japanese cedar (JC) pollinosis. So, we investigated whether sensitization to HD-mites affected the incidence and age of onset of JC pollinosis in 126 outpatients and 351 medical students.
Allergic subjects who visited allergy clinics in Hirosaki University Hospital were classified into two groups based on the CAP results for JC and HD-mites; one was JC-positive and HD-mite-negative, and the other was JC-positive and HD-mite-positive. The former showed a higher age at onset of JC pollinosis than the latter. With regard to the CAP score for JC, there were no significant differences. This result seems to suggest that sensitization to HD-mites affects the onset of JC pollinosis.
The medical students were also divided in the same manner. The incidence of JC pollinosis in the JC-positive and HD-mite-negative group was significantly higher than that in the JC-positive and HD-mite-positive group. Regarding orchard grass (OG) pollinosis, the incidence in the HD-mite-negative group was significantly higher than that in the HD-mite-positive group. Since pollinosis is related to the degree of exposure to the dominant pollen antigen, the students were divided by their native area (Kanto area, JC dominant; Tohoku/Hokkaido area, OG dominant). The incidence of JC pollinosis was highest in JC-positive and HD-mite-negative students from the Kanto area, and that of OG pollinosis was highest in OG-positive and HD-mite-negative students from the Tohoku/Hokkaido area. These results suggested that exposure to the dominant pollen antigen is most important to onset of pollinosis, although sensitization to HD-mites affects the onset of JC pollinosis.

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Inflammatory pseudotumor is a benign chronic non-specific granulation consisting of fibroblasts, histiocytes, plasma cells and inflammatory cells. It forms a space-occupying, rounded mass, appearing in various locations, but its occurrence in the paranasal sinus is rare. We report a 63-yeas old man with inflammatory pseudotumor in the maxillary sinus. Hsstopathological diagnosis of inflammatory pseudotumor is difficult, and differential diagnosis from malignant tumor is often a concern for otolaryngologists and pathologists. Indeed our case also resembled malignant tumor, especially nasal NK/T cell lymphoma. In this report, we discussed the clinicopathological features of inflammatory pseudotumor and reviewed the pertinent literature.
The patient presented a left lacrimation and exophthalmos at the initial medical examination. The findings of computer tomography (CT) and magnetic resonance image (MRI) strongly suggested malignant tumor of the maxillary sinus. To establish a histopathological diagnosis, biopsy was performed by nasal endoscopy. Surprisingly, there were no tumor cells seen in the biopsy specimen, and the diagnosis was inflammatory pseudotumor. Seven days later, radical surgery was performed, and the mass was resected completely. Three months after the initial surgery, recurrence in the maxillary sinus was confirmed. The second procedure was carried out, but total removal of the mass could not be achieved. After surgery, local corticoid steroid injections were repeated by administered over a one-week period. However, one year after the last surgery, the mass started to re-grow. A third procedure was performed for volume reduction with a KTP laser. Five months have passed since the third surgery and there has been no change observed in the size of the mass.

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We studied 149 patients (70 male and 79 female) who were diagnosed as having sialolithiasis in the submandibular gland at the Department of Otorhinolaryngology, Nara Medical University between January 1985 and April 2000. We investigated the age, sex, laterality of affected glands, chief complaints, interval from first symptom to consultation, the size and number of stones, composition, and methods for examination and treatment. The age ranged from 4 to 86 years with an average of 39.4 years, the most prevalent age group was the twenties, followed by the thirties and forties. Almost all patients complained of swelling in the submandible on their first visit. About one third reported pain in the submandible area immediately after eating. In this study, CT scanning was the most suitable form of examination for sialolithiasis in the submandibular gland. Treatments consisted mainly of surgical removal of the stones, which were approached from the oral cavity. However, after an attack we sometimes observed the stone was naturally expelled from Wharton's duct during progression of the disease. If the condition of the patient is mild, the course of the disease can be observed for a period of time before the final plan for treatment is determined.

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We treated an extremely rare case of bilateral basal cell adenomas combined with Warthin's tumor in the left parotid gland. The patient was a 65-year-old male who complained of swelling in the bilateral parotid areas. We removed bilateral parotid masses. Histopathological examination demonstrated adenoma and Warthin's tumor. The incidence of bilateral parotid tumors is rare, and synchronous tumors with different histopathological types in a single salivary gland are extremely rare.

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There are many different adenoidectomy methods. One of the most recent techniques is endoscopic adenoidectomy with a microdebrider. Between January and May in 2000, treatment employing endoscopic adenoidectory with a microdebrider was performed on 12 patients (10 male and 2 female) at Takatsuki Red Cross Hospital. The patients ranged from 4 to 9 years in age, with mean age at 5.6 years. All procedures were performed under general anesthesia via an endotracheal intubation. In this procedure, the patient was placed supine in Rose's position with the head extended and the mouth was opened with a Crow-Davis mouth gag. A 4.0 mm, 70 endoscope and drill bar of an XPS system were inserted transorally into the nasopharynx, and the main bulk of adenoid was removed. Next, a 2.7 mm, 0° endoscope was inserted transnasally. Residual adenoid at the superior portion of the nasopharynx was removed completely with the drill bar of the XPS inserted transorally. After the adenoidectomy was completed, gauze was inserted into the nasopharynx transorally to compress the wound and then removed, hemostasis was confirmed.
All patients underwent complete resection of adenoid around the choana, torus tubarius and the superior portion of the nasopharynx and did not show any complications such as hemorrhage and nasopharyngeal incompetence during the course of surgery.
Using this technique, the adenoids can be removed completely and safely without damaging other structures.

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Head and neck tumors presenting as an abscess are extremely rare. We report a case of oropharyngeal squamous cell carcinoma which presented as an abscess involving the oral floor and submandibular gland. We rapidly diagnosed the lesion by cytology of the pus.
We emphasize that the existence of malignancy must be suspected if the etiology is obscure and that pathological exploration of the abscess wall or pus at the time of drainage is effective.

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Recently Coblation Technology has been used to enlarge the pharyngeal space in sleep disordered breathing patients. However, the indications are unclear. In this study, we evaluated Coblation Technology with the epworth sleepiness scale (ESS), visual analogue scale (VAS) for snoring, and apnea hypopnea index (AHI) in 17 sleep-disordered breathing patients. ESS (89%) and VAS (100%) were improved in most cases after surgeries. Of the 17 patients with AHI, 88% had a reduced AHI of more than 50% after Coblation Technology. All of the patients with an AuI under 40 improved remarkably after treatment; however, several patients with an AHI over 40 did not improve as much. Coblation Technology is an effective treatment for sleepiness and snoring in sleep-disordered breathing patients, however, the physician must be careful using it for patients with an AHI above 40.

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Intrathyroidal parathyroid carcinoma is very rare. To our knowledge, only 2 cases of intrathyroidal parathyroid carcinoma had been reported in Japan. Recently, we encountered a case of hyperfunctioning Intrathyroidal parathyroid carcinoma.
A 16-year-old female had complained of thirst, polyposia and polyuria for 6 months. An elastic hard nodule 2 cm in diameter was palpated on the right thyroid lobe. The serum calcium level was 16.2 mg/dl and serum intact-PTH level was 1100 pg/ml (normal value in serum: 10-60 pg/ml). Based on ultrasonography and ²⁰¹T1 subtraction ^99mTc scanning, primary hyperparathyroidism due to a hyperfunctioning parathyroid gland in the right thyroid lobe was suspected. A right lobectomy and local dissection was performed. The tumor was histologically diagnosed as an Intrathyroidal parathyroid carcinoma. The patient was asymptomatic and normocalcemic 29 months after surgery.

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A 25-year-old woman with a more than 16-month history of hyperthyroidism due to Graves' disease visited to our clinic for surgical treatment. Due to hyperthyroidism, accelerated bone formation and resorption resulted in high turn-over bone loss. Total thyroidectomy without parathyroid resection was performed, because anti-thyroid agents thiamazole (MMI), propylthiouracil (PTU) failed to control thyroid function. After thyroidectomy, hypocalcemia appeared and persisted over 2 weeks despite normal parathyroid function. We considered this hypocalcemia in the early post-operative period was due to the pre operative state of the bone, and consider this to be a case of hungry bone syndrome.

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A 51-year-old man was hospitalized to receive radiotherapy for mesopharyngeal carcinoma. After he was treated at a dose of 24 Gy, redness of the neck and high fever appeared, but total WBC count remained within the normal level. After four days, CRP was elevated, and then CT scan demonstrated cervical and mediastinal abscess. In addition to antibiotic therapy, emergency cervical drainage and frequent evaculation of necrotic tissue were effective, resulting in complete recovery from deep cervical and mediastinal abscess. The reason that total WBC count was not elevated in the early stage of his neck infection was probably bone marrow suppression induced by radiotherapy. Therefore, CRP is a more suitable index than total WBC count for early diagnosis of cervical infection of the patient with radiotherapy.

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In recent years, increased incidences of penicillin-resistant Streptococcus Pneumoniae (PRSP) strains and β-lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae strains have been reported. We performed bacteriological studies on 29 Streptococcus Pneumoniae strains and 26 Haemophilus influenzae strains that were isolated in our outpatient department between September 1998 and August 1999.
The mean age of patients from whom bacteria were isolated was 7.3 years, while 14 of the Streptococcus Pneumoniae strains and 15 of the Haemophilus influenzae strains were isolated from patients under the age of 2 years.
The 29 Streptococcus Pneumoniae strains included 11 (37.9%) penicillin-insensitive strains (PISP) and 10 (34.5%) PRSP. The combination of PISP and PRSP strains thus accounted for 72.4% of the total Streptococcus Pneumoniae isolates. Those PISP and PRSP strains were exposed to various oral antibacterial agents, and FRPM, CDTR and CFPN showed excellent antibacterial activity. The 26 Haemophilus influenzae strains did not include any β-lactamase producers, but 14 (53.8%) BLNAR strains were detected, representing a high frequency. Among the tested oral antibacterial agents, CDTR and CFPN showed excellent antibacterial activity against the BLNAR strains. FRPM showed an excellent MIC distribution in relation to the Streptococcus Pneumoniae strains, but its MICs for the Haemophilus inf luenzae strains were high.
Among the currently used oral antibacterial agents, CDTR and CFPN showed excellent MICs for both the PRSP and BLNAR strains.

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