Human locomotion (gait) is a complex motor function, and it developed during the first several years after birth to establish functional synergy for this well controlled whole body movement.
Gaits initiated by inner will are controlled at many levels such as by the vestibular system, visual system, kinaesthetic system and gait control system in the central nervous system. Accordingly, a certain lesion in this controlling system could cause behavioral abnormality and/ or pattern abnormality in a gait. Gait analysis should delineate these abnormalities.
Data obtained by gait analysis using foot switches and electromyography or a tactile sensor (F-scan) in patients with vestibular system disorders are presented. In cases with peripheral vestibular disease, gait instability did occur, which was evidenced by a higher rate of occurrence of abnormality in gait phaserelated parameters, especially in the coefficient of variation of time from hindfoot strike to forefoot strike.
Changes in other variables were greater in subjects with disorders of the central vestibular system. When we examined the patients using a tactile sensor, we found a tendency in the peripheral cases for foot pressure to be greater on the lesion side foot, especially in gait with eyes closed. In central lesioned cases, the irregularity of foot pressure progression was severer than that in the peripheral cases along with a greater irregularity of trajectories of center of force during stance. Also changes in other gait-related parameters were obtained, which were depicted by a greater value of coefficient of variation such as stance, swing, double supports and so on, indicating degree of instability. Some changes showed a certain lesion in patients with a seemingly normal gait.

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We present three cases of lower cranial nerve involvement with herpes zoster. All cases complained of dysphagia owing to X cranial nerve involvement and presented mucosal symptoms of the larynx on one side. In one case, no vesicles were noted in the ear and there was no facial palsy. The others presented VII and VIII cranial nerve involvement in addition to lower cranial nerve involvement.
Due to the lower cranial nerve involvement, varicella-zoster infection should be considered as a possible diagnosis.

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A 35-year-old man who underwent canal down operation for a left middle ear cholesteatoma 30 years earlier, suffered from meningitis. He also developed hoarseness and dysphagia while he was hospitalized. CT and MRI scans showed a mass causing these syndromes. To control infection by Pseudomonas aeruginosa and to confirm the focus of infection, we planned a two-stage operation. We first removed a part of the cholesteatoma and left a drainage tube.
After irrigation through the drainage tube and antibiotics therapy for two months, he underwent a second operation to remove the cholesteatoma completely without leakage cerebrospinal fluid.

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Two cases of the ossicular disruption due to head injury were surgically treated in our department. These two cases also showed conductive hearing loss after the injury. An exploratory tympanotomy was carried out in these two cases.
In the first case, there was a fracture in the left external ear canal, and the fracture led to the middle ear with a fracture of the long process of incus.
In the second case, there was ossific change and adhesion between the malleus and scutum. Almost normal hearing was obtained after tympanoplasty modified 3 types in both cases.
It is difficult to confirm the presence of lesion by conventional hearing and imaging tests. Preoperative approaches to this disease are mentioned from these cases and literature.

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Post-traumatic external ear canal cholesteatoma (EECC) is a rare condition that may present years after the original injury. We report two cases of post-traumatic EECC with a long interval between the injury and appearance of clinical symptoms.
The first case is a ten-year-old girl. She had a history of trauma around the left auricle caused by a dog bite 8 years earlier. She visited our clinic with complaints of pain, discharge, and hearing loss in the left ear. The posterior bony wall of the external ear canal (EEC) was swollen and the EEC was quite stenotic. A CT scan revealed that EECC had grown in the mastoid cavity and pushed the posterior bony wall anteriorily. The second case is a twenty-nine-year-old man. He had a history of trauma of the right temporal bone caused by a traffic accident 5 years earlier. He visited our clinic with complaints of discharge and hearing loss in the right ear. The EEC was filled with otorrhea and debris. A CT scan revealed that EECC had grown in the mastoid cavity with acute otitis externa. At surgery, we removed a cholesteatoma mass from the mastoid cavity and reconstructed the canal wall by fascia and/or cartilage in both cases. Long-term results (20-29 months) showed that hearing was improved and no recurrence was observed.
It is suggested that the trauma was the cause of the epithelial migration from the EEC to the mastoid cavity, resulting in EECC growth in the mastoid cavity, EEC stenosis, and conductive hearing loss. We would like to emphasize that patients with a history of trauma around the EEC should be followed up for EEC stenosis using an otoscope and hearing loss using audiometry to identify the generation of EECC as early as possible.

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Olfactory neuroblastoma is a malignant tumor that arises from the olfactory epithelium. In most cases, the tumor is considered to be radiosensitive, and the therapy is usually a combination of surgery, radiotherapy, and chemotherapy.
Although the efficacy of chemotherapy is currently unclear, we recently treated a 36-year-old male with olfactory neuroblastoma who had a good response to cyclophosphamide. This case was initially treated with radiation, chemothrapy (cisplatin), and surgery. After this initial treatment, he suffered from severe stomachaches owing to Henoch-Schonlein purpura.
During that time, cancer treatment fell behind schedule and residual tumors increased. He was treated with cyclophosphamide for nephrosis owing to purpura and the residual tumors markedly decreased. He was treated with 4 series of cyclophosphamide pulse therapy and complete remission was obtained.

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We have encountered three cases of rhinogenic intracranial complications in the last two years. Case 1: A 17-year-old male had a subdural abscess secondary to acute sinusitis. He had right eyelid swelling (orbital cellulitis) and a frontal subcutaneous abscess. The transfrontal approach (Killian's method) and endoscopic sinus surgery (ESS) were carried out under general anesthesia. Drainage of the subdural space and 6 sessions of hyperbaric oxygen therapy were performed after the surgery. Case 2: A 14-year-old male had a brain abscess secondary to acute sinusitis. He exhibited severe headache and vomiting. Drainage of the subdural space did not improve the symptoms. He was then treated with ESS 9 days after the drainage. Case 3: An 18-year-old male had meningitis and a subdural abscess secondary to acute sinusitis.
He had severe frontalgia and palsy of the left lower leg. ESS was carried out immediately. Hyperbaric oxygen therapy was performed 8 times after the surgery. The subdural abscess disappeared without any neurosurgical drainage. All cases were treated successfully without any complications. Careful observation, prompt diagnosis, and early surgical treatments are required to prevent excessive morbidity and mortality. ESS should be the first choice for the treatment of sinusitis with rhinogenic Intracranial complications.

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We report two cases of inflammatory Pseudotumor of the maxillary sinus. Inflammatory pseudotumor of the paranasal sinus is a rare lesion, simulating a malignant tumor clinically. The first patient was a 40-year-old male complaining of trismus and left jaw pain. The other was a 41-year-old female complaining of trismus and right cheek swelling. CT scan and MRI findings revealed a mass of soft tissue density extending from the unilateral maxillary sinus to the infratemporal fossa with destruction of the maxillary bony wall in both patients. Histopathological examination of the tumors showed diffuse infiltration of plasma and other inflammatory cells, such as lymphocytes and histiocytes in the fibrous stroma. Immunohistochemical study demonstrated the polyclonal nature of the plasma cells. Because steroids were not effective in these cases, partial maxillectomy and coronoidectomy were performed under general anesthesia. We successfully treated trismus during the postoperative courses and there has been no regrowth of the masses.

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Fibrous dysplasia is a benign condition characterized by an increase in fibrous tissue and bone tissue. In the field of otolaryngology, its development is often encountered in the maxillary bone and lower jaw.
Here we report a case of 56-year-old male with fibrous dysplasia in the ethmoid sinus. Computed tomography (CT) revealed a space-occupying lesion of high absorption from the ethmoid sinus to the orbital area.
The dysplasia was totally extirpated with an external nose incision, and was diagnosed histopathologically as fibrous dysplasia of the bone. One year postoperatively, no palindromia has been observed.
The development of fibrous dysplasia in the ethmoid sinus is rare.

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We present two cases of salivary duct carcinoma in this paper. Both cases were middle-aged men. They were treated with total parotidectomy and postoperative radiotherapy. Both cases have been followed up for 18 and 15 months respectively with no evidence of local recurrence or distant metastasis.
Sixty-six cases of salivary duct carcinoma, including ours, have been reported in the Japanese literature. We reviewed the clinical characteristics of this unusual tumor. Most cases were male (90%) and occured in the parotid gland (84%). The average age was 61 years, ranging from 36 to 91. In 44% of patients, parotid tumors are accompanied by facial nerve paralysis. Total parotidectomy or extended parotidectomy followed by radiotherapy was the most common treatment for patients with salivary duct carcinoma in the parotid gland. The prognosis was poor and the 5-year survival rate was 28%.

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Tuberculosis of the parotid gland is not a common disease. We reported here two cases of tuberculosis of the parotid gland. The first case is a 78-year-old man who had a left parotid gland mass for 10 years. We suspected pleomorphic adenoma from the preoperative findings of MRI and performed a parotidectomy. Postoperative pathological findings showed a Warthin's tumor of the parotid gland with tuberculosis. We realized that this case was very rare.
The second case is a 76-year-old woman who had had a left parotid gland mass for 1 month. The mass had rapidly enlarged and adhered to the skin, in addition to the skin becoming reddish. She complained of tenderness at the mass. We suspected a malignant tumor of the parotid gland and performed surgical resections with the skin. Postoperative pathological findings showed tuberculosis of the parotid gland.
Tuberculosis is one of the most important of the re-emerging infectious diseases in the world. We should always consider tuberculosis, because early diagnosis and treatment are mandatory.

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We encountered an infant with a peritonsillar abscess due to pharyngeal injury by a chopstick. Careful follow-up of such injuries is necessary in infants with upper respiratory tract infection because pharyngeal injuries can cause peritonsillar abscess, as in our patient. Only conservative treatment was performed for this patient. Computed tomography was useful for the diagnosis in this case.

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We report 7 cases of acute and recurrent inspiratory dyspnea in which no organic cause could be identified. Patients were from 12 to 68 years old (43.6 in average), consisting of five males and two females. In three of the seven cases, fiberoptic laryngoscopy during an attack of dyspnea revealed laryngospasms following symmetric adduction of the vocal cords. Each patient experienced loud, stridorous noise during inspiration at the beginning of an attack as well as the subsequent inability to inspire. The attacks ranged from several tenths of a second to a few minutes in duration and occurred frequently, several times a day in some cases. Results of physical examinations, lung function tests, roentgenograms of the chest and larynx, and CTs of the lungs and the neck were unremarkable. Laboratory findings including blood gas analysis between attacks were within normal limits. No atopic stigmata were found.
Drinking water or swallowing could sometimes relieve the grade of the attack, and the patient could completely prevent attacks once they understood the condition of the dyspnea and mastered a breathing maneuver during the attack. Previous upper respiratory infection, cough, and sleep apnea were suggested to correlate with the episodes. Our patients did not require drastic maneuvers such as tracheostomy or intubation. Administration of Eperisone hydrochloride and Etizolam proved effective in some cases.
Laryngospasm as a cause of recurrent inspiratory dyspnea is functional, and we suspect that it is not such a rare occurrence. An awareness of this entity could prevent unnecessary tracheotomies.

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In this study, we reviewed the medical records of 14 patients who had visited our institution during the past seven years and had been diagnosed as tuberculous cervical lymphadenitis. Three of 14 patients were males and others were females. Only two patients had past histories of pulmonary tuberculosis. The diagnosis was confirmed by biopsy specimens in 13 patients and the method of therapeutic diagnosis was adapted to one patient.
Statistical reports by WHO showed that the incidence of tuberculous disease in Japan is relatively higher than those in other countries and the number of patients with tuberculous disease shows a gradual increase. Based on those reports, tuberculous cervical lymphadenitis should be considered when examining neck mass.

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Thirty patients with primary hyperparathyroidism (PHPT), who were all surgically treated with a parathyroidectomy, were retrospectively studied. Ultrasonography was the most useful preoperative imaging. Pathological findings revealed 28 adenomas, 1 hyperplasia, and 1 carcinoma. In all cases, only one swollen gland was removed, and values of serum calcium and parathyroid hormone were normalized after surgical treatment. There were no significant postoperative problems. The suggested treatment for PHPT is the extirpation of one swollen gland, which is detected with preoperative imagings.

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The clinical effect of Bepotastine in patients with Japanese cedar allergy was investigated before and after the start of the pollen season. Symptom score, medication score and symptom-medication score were significantly lower in patients treated before the pollen season than in those treated after it started.
These results indicate that Bepotastine is useful for the treatment of Japanese cedar pollinosis.

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The clinical efficacy of ramatroban, a thromboxane A₂ receptor antagonist, was investigated in 48 patients who consulted Masutani ENT Clinic in Osaka between January and May, 2001. Medication was administered and groups were stratified by start time.
In the peak period for Japanese cedar pollen scattering, the pre-treatment group demonstrated better control of nasal symptoms (sneeze, nasal mucus, and nasal obstruction) than the group that started the medication after Japanese cedar pollen scattering started.
Nasal obstruction has also improved by the medication for two weeks in patients who consulted the hospital with nasal obstruction after Japanese cedar and cypress pollen scattering had ended.
There were no side effects in any patients during ramatroban treatment.
Therefore, ramatroban was considered to be an effective medicine also not only for patients with perennial allergic rhinitis but also for patients with seasonal allergic rhinitis. It was thought that the nasal symptom of the pollen scattering period could be controlled by pre-treatment.

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