Diseases showing bilateral enlargement of the Submandibular glands were evaluated with respect to their clinical and histological features. It is well known that sialolithiasis is one of the most common diseases causing submandibular gland enlargement. Pleomorphic adenoma is also a common tumor of submandibular gland origin. These diseases usually cause unilateral swelling of the gland. This report describes several diseases affecting both glands, as follows: mumps, sialodochitis fibrinosa, Küttner's tumor, Mikulicz syndrome, sialadenosis, sialolithiasis, malignant lymphoma and amyloidosis. Sialodochitis fibrinosa is charaterized by white jelly-like material obtained from Wharton's duct containing numerous eosinophils. Most cases of sialadenosis show parotid gland swellings, however, those associated with anorexia nervosa cause swellings predominantly in the submandibular gland. Malignant lymphoma is a rare tumor arising in the parotid and/or submandibular glands. Our cases resembled Küttner's tumor or sialadenosis on palpation of the glands. Patients with amyloidosis were initially suspected of having Küttner's tumor because very few patients visiting ENT clinics have bilateral gland swelllings caused by amyloidosis. Therefore, the differential diagnosis of bilateral submandibular enlargement is often difficult. In accordance with each case, careful examinations are needed using ultrasonograms, sialograms, RI scintigrams, CT scans, MRI and blood tests. When necessary, we add FNA or open biopsy.

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Sudden sensorineural hearing loss is an important otologic disorder, and some patients are even hospitalized for treatment. In this study, we investigated the factors affecting the hearing prognosis. We also analyzed whether hospitalization induced a good prognosis.
Between January 1989 and September 1997, 196 patients with sudden sensorineural hearing loss came to the Department of Otolaryngology, Hyogo College of Medicine within two weeks from the onset. There were 91 males and 105 females, and their ages ranged from 10 to 79 (mean 50.6) years. The grading system and improvement score depended on the research group on sudden deafness of the Japanese Ministry of Health and Welfare (1984, 1998).
The cure rates of the V character type, the low tone type, dip type and unfixed type were over 50%, whereas those of the high tone type, completly deafness and profoundly deafness were under 30%. The recovery rate was 100% in the teenage group, and 41.7% in the 70-year-old group, in which the younger group had a better hearing prognosis. The cure rate was 51.9% in grade 1 and 13.2% in grade 4, indicating that, the lower the grade, the higher the cure rate. Dysequilibrium was reported by 29.1% of all patients, and by over 50% of the completly deafness and the profoundly deaf patients. The recovery rate in the no dysequilibrium group was higher (60.4%) than that in the dysequilibrium group (24.6%)(p<0.05). The recovery rate of the hospitalized group was 49.5% and that of the unhospitalized group was 50.3%. There was no significant difference between the groups.

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Although vertebral artery aneurysm is uncommon, its rupture causes subarachnoid hemorrhage (SAH). It commenced with tinnitus, and hearing loss advanced during medical treatment as acute sensory neural healing loss. As ABR was revealed as only a wave I extension, MRI was performed. A well enhanced Cerebello pontain angle tumor was shown, and the aneurysm was found in the four vessel study.
The aneurysm was embolized using GDC coils and hearing loss advanced to deafness. It was thought that the unruptured aneurysm was enlarged and put pressure on the acoustic nerve.

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We report a case of unilateral idiopathic stenosis of the internal auditory canal, without middle or inner ear anomalies. The patient, a 17-year-old female, presented with right deafness. High resolution computed tomography of the temporal bone showed stenosis of the right internal auditory canal. ABR stimulated from the right ear showed no response and bilateral DPOAE levels were within normal limits. These results implied that the outer hair cell function was well preserved, although damage to the inner hair cells and/or cochlea nerve was severe. It seems that evaluation by both ABR and OAE is necessary to determine the cause of hearing loss due to idiopathic stenosis of the internal auditory canal.

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A case of acoustic neurinoma occurring in a 5-year-old female is reported. She had complained of hearing loss in her right ear since May 1999, which continued to deteriorate until she was admitted to our hospital in December 1999. Apart from the hearing loss, she did not complain of any other problems. An audiogram revealed 83.3 dB (average hearing level) sensorineural hearing loss in the right ear. An X-ray showed complete destruction of the internal auditory meatus. There was no auditory brain stem response in the second to fifth waves, and MRI angiography revealed an acoustic neuroma. The tumor was very large and was compressing her brain stem. Emergency surgery was performed via a suboccipital approach. After the operation the patient exhibited sensorineural hearing loss, facial palsy, and recurrent nerve palsy on the right side. Two weeks after the operation, the severe symptoms had decreased. The original nerve was not identified in the operation. We suspect that the tumor had grown very rapidly, since it was being nourished by the external carotid artery, and because the patient was very young. Since only 0.3% of acoustic tumors occur in children (under 9 years old), this was a very rare case.

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We experienced 2 cases of a brain abscess secondary to middle ear cholesteatoma. Case 1 was a 73-year-old male. When visiting a local hospital for treatment of a common cold, he suddenly fell into convulsions and was hospitalized. CT and MRI revealed a right temporal lobe abscess and middle ear cholesteatoma. Case 2 was an 18-year-old male. He visited a local neurosurgeon for headache and low grade fever. CT and MRI revealed a left cerebellar abscess and middle ear cholesteatoma.
In both cases, there were no aural symptoms such as otorrhea or otalgia before the brain abscess diagnosis. We want to stress that it is necessary to properly treat middle ear cholesteatoma because of the possible sudden occurrence of brain abscesses.

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Between 1989 and 1998, five revision stapes operations were performed in our department due to unsatisfactory post-operative hearing improvement (3 ears) or progressive deterioration of initial good hearing over time (2 ears).
From the view of surgical findings the causes of poor hearing improvement of the first operation were short prosthesis (3 ears), dislocated prosthesis (2 ears), necrosis of incus long process (1 ear) and scar and granulation (3 ears).
The hearing results of this series showed that the air bone gap closed to less than 10dB in 3 out of five (60%) and less than 15dB in the other two (100%).
We concluded that revision stapes surgery should be offered to patients with unsatisfactory hearing improvement or progressive deterioration of an initial good result over time if no developing sensori-neural hearing impairment after initial stapes operation was found.

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A 31-year-old female patient with bilateral tuberculous otitis media, which was improved by anti-tuberculous chemotherapy and bilateral ear surgery, is reported. In spite of antibiotics and steroid medication, she exhibited large perforations of both ear drums within four months.
Tuberculous otitis media had been considered a rare disease, but its incidence has increased in recent years. Suspecting this disease may be an important factor in making an early diagnosis.

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A 76-year-old female consulted a local physician with chief complaints of nasal obstruction and repeated nasal bleeding. MRI of the head revealed a bilateral tumor shadow in the nasal cavity, and she was referred to our department and admitted. Anterior rhinoscopy demonstrated a probable right-sided hemangioma and left-sided nasal polyp. Subsequent diagnostic imaging led to a suspicion of bilateral hemangioma. After embolization of the feeder arteries, the tumors were removed. Pathological diagnoses was bilateral malignant Stage IE, B cell lymphoma. Tumors on each side were separate and independent without connection. The patient underwent 3 courses of chemotherapy and radiation therapy after surgery. Complete remission was achieved after treatment and there has been no recurrence to date. Review of the literature failed to identify any previous case of separate independent malignant lymphoma arising in both nasal cavities.

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otogenic and rhinogenic intracranial complications have been reported, but it is very rare that intracranial complications from acute suppurative parotitis develop. We report a case of a brain abscess secondary to acute suppurative parotitis. A 71-year-old female who had been taking predonisolone for rheumatoid arthritis developed right preauricular pain and a disturbance in mouth opening. She was referred to our hospital. She was diagnosed as having acute suppurative parotitis and given antibiotics, but she developed headache and high fever after one week. A right parotid abscess was detected by CT. We quickly conducted a drainage operation and administered an intravenous injection of antibiotics. The parotid abscess was curative about three weeks after drainage, but CT revealed a brain abscess in the right temporal lobe. She was referred to a neurosurgeon and treated conservatively.
The brain abscess disappeared and she was discharged three month after the drainage operation.

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Our case and 70 cases of head and neck oncocytoma from the Japanese literature were studied to understand the features of oncocytoma.
A 66-year-old woman was scheduled for breast cancer surgery at our hospital. She was referred to our department following a preoperative CT scan that discovered a right submandibular tumor. Pre-operative examination showed no malignant lesions, so the extirpation of the right submandibular-gland tumor was performed at the same time as her breast-cancer operation. We diagnosed oncocytoma based on the pathological findings. We have been following her up periodically and there has been no recurrence.
We studied the characteristic features, diagnoses, and treatments of 71 cases. Clinical findings showed no specific features and a pathological examination was always necessary for diagnosis. In benign cases, the standard treatment was the extirpation of the tumor. There is no established standard treatment for malignant cases, and surgery, chemotherapy, radiation, or a combination thereof were chosen, depending on the status of the patient.

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Although laryngeal papilloma is a benign tumor, it is difficult to control this disease because of the rapid recurrence after surgery. We reported a patient with recurrent laryngeal papilloma who responded well to a-interferon after laser surgery.
The patient was a 16-year-old man with a history of dyspnea and hoarseness. He underwent laser surgery three times, but the papilloma repeatedly relapsed. We treated him with intramuscular injection of α-interferon at a dosage of 3×10⁶ IU twice a week for 1 year. Symptoms were rapidly relieved by this therapy. We conclude that α-interferon may be effective for recurrent laryngeal papilloma after laser surgery.

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Methylene blue administered intravenously at a dose of 5mg/kg of body weight was employed as an aid to the Intraoperative identification of the parathyroid glands in a patient undergoing surgery for hyperparathyroidism. A 2-cm adenoma was visualized by the staining and safely removed. There was no adverse side effect from this technique.
Localization of the parathyroid glands is often difficult, even for experienced surgeons. Various techniques for preoperative localization such as ultrasound, nuclear magnetic resonance, and technietium-99m-MIBI scan have been proposed, but their reliability varies to a great extent. The intraoperative infusion of methylene blue may be an effective, safe, and easy applicable method to quickly identify the parathyroid glands, thereby shortening the operating time.

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Although Tinnitus Retraining Therapy (TRT) is becoming very popular all over the world, it is still not well known in Japan. In this paper, we will introduce and discuss the theory and practice of TRT.
TRT is based on the theory of Jastreboffs neurophysiological model, which postulates that a number of systems in the brain are involved in the emergence of Tinnitus and the auditory periphery plays only a secondary role. The purpose of this method is habituation by using low level sound and directive counseling.
Though this therapy is thought to be a powerful methods for Tinnitus, there are some uncertainties regarding the roles of sound and counseling.
Larger scale control studies are nescessary to conform its effectiveness and rationalize the theory.

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The clinical effects of Allelock® on patients with seasonal grass pollinosis were investigated by comparing the symptoms, medication and symptom-medication scores before and after treatment. We found that the scores after treatment were significantly lower than those before treatment.
These findings indicate that Allelock® is useful for treatment of seasonal grass pollinosis.

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We investigated the effects of combination therapy with thromboxane A₂ receptor antagonist (TxA₂ RA: Ramatroban) and an antihistamine (Clemastine Fumarate) in patients with perennial allergic rhinitis. There was no significant difference in the three groups: combination group (n=20), the TxA₂ RA (only Ramatroban) group (n=18) and the antihistamine (only Clemastine Fumarate) group (n=9) in terms of global improvement rating. Improvement was significantly better in the combination group compared to that in the TxA₂ RA group two weeks after the start of administration (p<0.05). Moreover, intranasal rhinoscopic findings showed the mean nasal secretion score was significantly decreased in both the combination and TxA₂ RA groups (p<0.05).
These findings suggest that TxA₂ (Ramatroban) in combination with an antihistamine has beneficial effects on rhinorrhea in patients with perennial allergic rhinitis.

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