Electronic videoendoscopy of the pharynx and larynx allows lesions to be visualized with precision. The images obtained using a charge-coupled device (CCD) chip are converted into electric signals and transmitted to the video system center. Clear, dynamic color images are reproduced on a color video monitor through a video system center. The basic components of an electronic videoendoscope system are a flexible endoscope, a video system center, a light source and a color video monitor.
There are two methods of capturing and reproducing dynamic color images in electronic videoendoscopy; the single-plate simultaneous color CCD chip method and the single-plate red, green, and blue (RGB) surface scanning method. In the former method, a color CCD chip built into the distal tip of the endoscope contains multiple color pixels and can simultaneously capture different color wavelength of light. In the latter method, the tip of the endoscope incorporates a monochrome CCD chip that can only provide black and white signals. The color CCD chip simplifies color acquisition but is considerably larger than the monochrome CCD chip, requiring a wider diameter than the distal tip of the endoscope. This is one of the reasons why the single-plate RGB surface scanning method is preferred in a rhinolaryngeal electronic videoendoscope system.
Digital image processing of lesions can be performed by electronic videoendoscopy. The enhanced color images are superior in quality.
Laryngostroboscopy is the most practical method of determining the vibratory pattern of the vocal folds during phonation. However, the laryngostroboscope cannot connect with the electronic videoendoscope system using a single-plate RGB scanning method because of the presence of a rotating wheel filter between the light source and glass fiber bundle of the light guide. To obtain stroboscopic images with an electronic videoendoscope system, a single-plate simultaneous color CCD chip method is necessary.
Recent advances in electronic technology enables production of the electronic videoendoscope system that can connect with a laryngostroboscope. The clear stroboscopic images of vocal fold vibration obtained by this system are described here.
Literature reviews of the history and development of electronic videoendoscopy were also performed from the perspective of diagnostic usefulness.

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Anterior inferior cerebellar artery (AICA) syndrome involves sudden hearing loss, vertigo, and several neurological symptoms and is being reported with increasing frequency due to diagnostic adavances. Herein, we describe 3 cases of anterior inferior cerebellar artery syndrome. Case 1 was a 67-year-old woman with sudden onset of vertigo. Initially, we treated her for sudden deafness with vertigo. Hearing loss improved almost completely by steroid and prostaglandin E1 administration. However, MRI demonstrated cerebellopontine infarction. Case 2 was a 53-year-old woman with hypertension and hyperlipidemia. She had dizziness and headache. CT and MRI demonstrated infarction of the cerebellum and brain stem. Hearing loss and dizziness were improved by steroid administration, control of blood pressure, and antithrombus therapy. She did not have cerebellar symptoms. Case 3 was a 58 year-old man with hypertension, who developed vertigo and vomiting. He demonstrated also hearing loss and ataxia. MRI demonstrated infarction of the cerebellum and brain stem, and otoneurological examination supported these findings. Vertigo and ataxia improved considerably. However, hearing loss was not completely improved. Steroid and prostaglandin E1 administration may improve hearing loss of anterior inferior cerebellar artery syndrome.

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Natural mumps virus infection is believed to induce lifelong immunity and rarely cause unilateral severe sensorineural hearing loss with sudden onset. Unilateral deafness due to mumps virus reinfection had rarely been reported in the Japanese literature. I present a case of unilateral deafness due to mumps virus reinfection.

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In this study we examined 310 patients with sudden deafness treated in our hospital between 1996 and 2001. Seventy-one patients were treated with steroid only (steroid group), 130 patients were treated with steroid and Lipo-PGE₁ combined therapy (steroid-LipoPGE₁ group) and 53 patients were treated with Lipo-PGE₁ only (LipoPGE₁ group).
The improvement rate was 39.4, 67.7 and 81.1% in the steroid, steroid-LipoPGE₁ and LipoPGE₁ groups, respectively. The improvement rate was significantly higher in the steroid-LipoPGE₁ and LipoPGE₁ groups than in the steroid group (p<0.01). No significant difference in improvement rate was noted between steroid-LipoPGE₁ group and LipoPGE₁ group (p<0.05).
These results suggest that the improvement of blood flow in the inner ear may be very important and Lipo-PGE₁ is effective in treating sudden deafness.

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The increase of infant cases of acute otitis media caused by penicillin resistant Streptococcus pneumoniae (PRSP) presents a formidable problem and has, in resent years, both hampered and prolonged medical treatment. From March 2001 to March 2002, we enforced a bacteriological examination aimed at germs of nasopharyngeal origin in an effort to identify the pathogen responsible for 292 cases of acute otitis media at our hospital. The detection frequency of PRSP was 93/292 (31.8%). The age of the patients ranged from three months to 61 years and 85 (91.4%) were infants. In 70 of these 85 cases, we were able to achieve a good outcome. In this series, we examined the treatment progress in these 70 infant cases.
In 27 of these 70 cases (38.6%), PRSP was detected alone. The simultaneously detected bacteria types were Haemophilus Influenzae (H. I) in 24 cases (34.3%), Moraxella Catarrhalis (M. C) in 8 cases (11.4%) and H. I+M. C in 7 cases (10.0%).
Although gender, the existence of mixed infections and the kind of antibiotics initially prescribed were not found to have had a significant effect on the outcome, both age and the existence of eardrum incision did appeared to influence the duration of the therapeutic period.

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We report a 26-year-old male patient with vertiginous sensation and sensorineural hearing loss of high frequency in his left ear after breathing strongly through his nose and hearing a pop sound. Because of his persistent dizzy spells and progressive hearing loss, we diagnosed perilymphatic fistula and performed an exploratory tympanotomy. We closed both oval and round windows with fascia, although we could not find any obvious fistula during surgery, resulting in reduction of dizziness and prevention of progressive hearing loss.
One year after the operation, the patient came to complain about episodic vertigo with left fluctuating hearing loss. His audiogram showed left low tone sensorineural hearing deterioration and a glycerol test revealed endolymphatic hydrops in the left ear. we diagnosed secondary endolymphatic hydrops associated with perilymphatic fistula and performed endolymphatic sac drainage and steroid-instillation surgery. Follow-up for 6 months showed complete relief from vertigo and 11.3dB hearing improvement.

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A 46-year-old male with an earpick-induced trauma in his left ear was referred to our hospital due to profound mixed hearing loss persisting after myringoplasty at another hospital. The preoperative middle ear CT did not demonstrate any ossicular chain dislocation signs. Preoperative tympanometry did not show a clear Ad type, but stapedial reflex was eliminated on the left side. During middle ear surgery, we found the stapedial footplate had subsided and fixed into the oval window, although the ossicular chain seemed to remain intact. After stapedectomy with ossicular reconstruction using Y-shaped cartilage was performed the air-bone gap definitely improved. There have been many reports about ossicular chain dislocation due to earpick-induced trauma, however there have been few reports describing stapedial footplate subsidence into the oval window without ossicular chain dislocation. In the literature, 10-25% of trauma-induced ossicular chain dislocation may just be stapedial subsidence into the oval window. We conclude as that it is necessary to consider stapedial subsidence when treating middle ear trauma, and that stapedial subsidence on its own should be classified as a pattern of ossicular chain disruption.

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Due to varying symptoms, a perilymphatic fistula may be easily misdiagnosed as another inner ear disorder, such as sudden sensorineural hearing loss. We report a case of perilymphatic fistula with a long delay of diagnosis.
A 69-year-old female complaining of left tinnitus and aural fullness was diagnosed with and treated at two different hospitals for sudden sensorineural hearing loss before presenting at our clinic two months after the onset of symptom. Her left audiogram showed scale out and she had not responded to any chemotherapeutic treatment at either of the two hospitals.
Strongly suspecting a perilymphatic fistula, an exploratory tympanotomy was ordered, during which a fracture of the left stapes footplate was found with a perilymphatic fluid leak. The fracture was repaired with a cover of connective tissue with fibrin glue.
As perilymphatic fistulas are difficult to diagnose, an exploratory tympanotomy is mandated in cases where patients complain of gradual progressive hearing deterioration with fluctuation.

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Acute otitis media is one of the most common diseases encountered in ENT clinics, clinical findings in 12 cases (16 ears) with acute otitis media accompanied by elevated bone conduction were analyzed. There were no patients with vertigo as the chief complaint. All but one case had moderate hearing loss on pure tone audiometry. As for the prognosis of hearing recovery, 8 ears achieved recovery level (less than 20dBHL), 8 ears were improved (from 10 to 30dBHL). Treatment involved administration of antibiotics, steroid hormone, vitamin B12 and/or circulation enhancers. The combination of antibiotics and steroid was thought to be the best treatment. We recommend pure tone audiometry as the essential examination for patients with acute otitis media because it is not rare to encounter patients with sensorineural hearing impairment.

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During the period from 1971 to 2002, 48 patients with epistaxis underwent 54 surgical procedures on admission to Kitasato University Hospital. The age of the patients ranged from 17 to 83 years with an average of 44.8 years in males and 54.3 in females. Before admission, approximately half of the patients were unsuccessfully treated at other medical institutions. In those cases, the most common site of epistaxis was the posterior portion of the nasal cavity, although the exact spot of bleeding was often hardly identifiable. As for the general complications, the incidence of high blood pressure was most common, while there was also one case of Osler disease. Even after admission, 3 or more additional bleeding episodes were noted in 24 cases. MRA or selective arteriography was performed in 8 patients, but no positive findings were obtained. As the surgical procedure, clipping of the maxillary artery was performed in 43 patients, and ligation of the external carotid artiery was performed in 3 patients. In the patient with Osler disease, turbinectomy combined with electro-coagulation was performed. We concluded that surgical treatments should be performed for uncontrollable recurrent epistaxis from the posterior portion of the nasal cavity with unidenfiable spot of bleeding. The clipping of the maxillary artery was the most effective treatment in the present series.

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We report a case of foreign body in the masseter muscle. A 73-year-old man sustained a small laceration of the left submandibular region during a fall onto a bush. Thereafter, he could not open his mouth fully. Ultrasound, CT and MRI imaging demonstrated a foreign body in the masseter muscle. Following removal of the wood fragment, trismus was improved.

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We analyzed the efficacy of two different therapeutic procedures in 42 cases with T1 and early T2 tongue carcinoma. Fourteen cases underwent partial glossectomy including 2 cases receiving elective neck dissection, and 28 cases receiving interstitial brachytherapy using iridium in 17 cases, microselectron in 8 cases and iridium with external irradiation in 3 cases. More than 90 percent of cases survived beyond the 5-year follow up and the 5-year disease-specific survival did not show any significant difference between the surgically treated group and the brachytherapy group. However, 5-year disease-free survival showed a tendency toward a high recurrence rate in the brachytherapy group (57.2%) compared to that in the surgically treated group (28.6%). In the surgically treated group there were 4 regional recurrences of which 3 could be salvaged. The remaining one case demonstrated multiple metastases to bone and liver. In the brachytherapy group 10 of 14 regional recurrences occurred in a half year and regional failures caused to death in 2 cases.
Thus successful regional and distant control is crucial for treatment of early tongue carcinoma and awaits novel diagnostic procedures for potentially metastatic nodes which may play a key role in the distant spread of tongue carcinoma.

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We report two cases of tortuous internal carotid artery, both involving 81-year-old women. Case 1 had an abnormal sensation in the pharynx on swallowing, while case 2 had difficulty and mild pain on swallowing. MRA was useful for diagnosis. A pulsating mass was located in the lateral lymphatic band in case 2. She was advised to undergo a biopsy at another clinic, but this would have carried a risk of bleeding.
Previously reported patients with tortuous internal carotid artery have presented with an abnormal sensation in the pharynx, so it is necessary to consider the possibility of tortuous internal carotid artery in elderly patients with this symptom. Tonsillectomy is occasionally performed in elderly patients. There is a possibility of tortuosity of the internal carotid artery, even if a pulsating mass is not seen in the pharynx, and it is important to palpate the palatine tonsil before and during surgery.

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