Devices to provide substitute for visual or hearing sensation have been developed in recent years. However, compared to a marked improvement in artificial audition such as cochlear implant, devices for artificial vision such as retinal implant, optic nerve implant and cortical implant have not developed to the level of daily use for the blind. The poor outcome of artificial vision appears mainly due to the limited number of electrodes in the prosthesis compared to a huge number of receptive cells for vision, but is also partly due to the difference between speech and visual images in the process required of their recognition. Auditory language mediated through voice can be recognized by mere pulse signals without formant information to characterize vowel sounds, and formation of cortical networks during the speech acquisition period appears to compensate for limited auditory information through the cochlear implant. However, visual information should include not only letters or characters for communication, but every environmental images for daily life. Hybridized retinal prosthesis to overcome the limited number of electrodes will be developed. In the near future, exchange of information between the ophthalmological and otological fields will become more important to improve these artificial devices for vision and audition.

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Twenty-one cases of psychogenic hearing loss in children during the past 14 years at Oita Medical University were reviewed. Six cases were boys while fifteen cases were girls.
The chief complaint in thirteen cases was hearing loss. Other ear symptoms included otalgia and tinnitus. Six cases were unaware of hearing loss, but were detected by routine hearing screening at school. Bilateral hearing loss was observed in thirteen cases.
Psychological problems related to troubles at school or at home were observed as causative factors, and there was a tendency for the former to be more prevalent in older children. Only 7 cases had undergone psychiatric consultation. Eighteen cases (85.7%) showed normal pure tone thresholds during the clinical course. Two cases showing changing thresholds did not undergo psychiatric consultation.
Psychogenic visual disturbances are known to be one of the complication of psychogenic hearing loss. Fifteen cases were referred to the department of ophthalmology at our hospital. Eleven cases showed abnormal ophthalmological subjective examination despite no abnormal objective findings. Referral to an ophthalmologist can facilitate diagnosis.
The first step in the treatment of psychogenic hearing loss is thought to be appropriate diagnosis. Therefore, the otolaryngologist should carefully check the patient's individual circumstances, and when needed, refer patients for psychiatric consultation or to an ophthalmologist.

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We tried to establish a subjective quantitative analysis of anxiety or equivocal symptoms like dizziness or tinnitus to examine the relationship between anxiety and dizziness or tinnitus. Anxiety was evaluated by the State-Trait Anxiety Inventory (STAI). Symptoms like dizziness or tinnitus were evaluated by Visual Analogue Scale (VAS). Tandospirone Citrate was administered to anxiety. STAI score and VAS score changed in parallel, through the period of medication, and patients whose State Anxiety score were decreased showed improvement in their symptoms. Patients whose Trait Anxiety score was high (V) at the beginning of medication were resistant to the medication. We concluded that STAI and VAS might provide some useful information for medication of anxiety in patients with dizziness or tinnitus, and be very useful in routine therapy.

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The skills need for ear surgery are best developed by dissecting a temporal bone. However, only a limited number of trainees can be afforded this opportunity because of a scarcity of available bones. A simulated model potentially serves as optimum material for training. A simulated 3-dimensional model of human temporal bone was prototyped using a selective laser sintering method. The powder layers were laser-fused based on detailed CT data and accumulated to create a 3-D structure. Conventional surgical instruments and microscope were used to investigate the validity of this model as a training material. The model was as hard as a real bone and well reproduced surface structures. The model could be shaved using a surgical drill, bur and suction irrigater in the same way as that during actual surgery. The malleus and incus were reproduced. The semicircular canals, oval and round window niches were identified. Cavity structures, such as semicircular canal, vestibule, antrum and air cells were filled with the powder material that had to be removed using a pick and suction irrigater during dissection. The 3-D prototyped model using selective laser sintering serves as good training material for middle ear surgery.

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Papilloma in the nasal cavity is a histologically benign neoplasm. However, it exhibits frequent local recurrence and is often associated with malignancy. Therefore, it is recommended that it be treated as a malignant tumor. We report a case of inverted nasal papilloma with malignant change in a 57-year-old female. This patient had suffered from nasal obstruction on the left side since December 1997. She visited a neighboring ENT clinic and underwent an excision of nasal polyp, which was diagnosed as an inverted nasal papilloma in January 1998. She was advised to undergo extended surgical treatment, however, she left it untreated for almost four years. In February 2002, she visited us because of severe headache and underwent extended Denker's operation. Chemotherapy and radiation therapy were added because the tumor was proven to be an inverted papilloma with squamous cell carcinoma. Unexpectedly, a recurrence was found in the anterior part of the nasal cavity in August 2002, and a component of spindle cell carcinoma appeared in the recurrent tumor. She was treated again by chemotherapy followed by extended maxillectomy, however, bone metastasis was found in October 2002. Since then, her general condition showed rapid deterioration and she died in November 2002.

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Mycosis in the paranasal sinus is commonly found in the maxillary sinus, but rarely in the sphenoid sinus. In this paper, three cases of sphenoid sinus mycosis are reported and the clinical feature are compared with the 25 other cases reported in Japan since 1968. Our three patients had complained of headache and eye pain, which were thought to be characteristic symptoms in the 25 previous cases. One of the three patients had onset with a background of rheumatoid arthritis and needed steroid medication, but the other two patients had no improvement with medication for sinusitis. By CT scanning and MRI, a localized sphenoid sinus lesion was detected as a characteristic findings for paranasal sinus mycosis, showing irregular mosaic contras on CT scanning and low intensity signal on T1 and T2 MRI imaging. The definite diagnosis was made by means of histological examination for a block age in the affected sinus cavity. Endoscopic sphenoidectomy was performed through the parsnaslis of the anterior wall of sphenoid sinus and was usefull for total removal of the lesion.

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The patient was an 86-year-old woman who had experienced nasal discharge and tearing of the left eye since August 1996. When she began noticing left nasal obstruction in December of the same year, she was referred to our clinic and examined in July 1997. A tumor that filled in the left nasal cavity was observed, and biopsy of the tumor led to a diagnosis of fibroma. Since the patient was elderly and had thrombocytopenic purpura as a complication, her condition was observed. In May 2000, the patient came to our clinic complaining of redness of the skin around the left eye, pain, a tumor in the medial angle of the left eye, and decreased visual acuity in the left eye. Because the computed tomography (CT) findings showed growth of the fibroma, left lateral rhinotomy was performed under general anesthesia, and the tumor, which extended from the nasal cavity to the anterior and posterior ethmoid sinuses, was excised. The tumor was attached to the posterior part of the nasal septum in the left nasal cavity, which was considered the primary site. The excised tumor measured 50mm×50mm×43mm in size and weighed 60g. The pathohistological diagnosis was fibromatosis. The visual acuity of the left eye improved postoperarively.

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Tumors of the parotid gland are fairly frequent among head and neck tumors. In thirty six patients, tumors of the parotid gland were surgically resected in the Department of Otolaryngology, Nikko Memorial Hospital between 1996 and 2001. Pathological examination demonstrated that the most common type of tumor was pleomorphic adenoma (50.0%), followed by adenolymphoma (22.2%). Preoperative examinations including ultrasound echography, MRI, sialo-CT, radioisotope imaging and fine-needle aspiration cytology were performed. Because neither examination was sufficient for diagnosing the malignancy of tumors by single examination, multiple examinations were necessary to establish the correct diagnosis. For resection of benign parotid tumor, partial parotidectomy for sixteen patients and superficial parotidectomy for ten patients were carried out. In two patients with high-grade malignant tumors, total parotidectomy combined with neck dissection was carried out. Postoperatively, facial paresis occurred in 7 cases (21%) and Frey's syndrome occurred in 3 cases (9%).

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We reported a case of 3-year-old girl initially suspected of having retropharyngeal abcess by fever, pharyngeal findings and CT imaging. The confirmed diagnosis of retropharyngeal cellulitis with Kawasaki disease was made postoperatively.
In the differential diagnosis of fever of unknown origin and pharyngitis in an infant, physicians should consider not only unsual infectious diseases but also Kawasaki disease, because the frequency of infant and toddler age 5 or less crisis in Kawasaki disease is high.
In diagnosis and treatment of retropharyngeal disease with Kawasaki disease, the differential diagnosis between abscess and cellulitis by CT is difficult, although CT is useful for diagnosing the location and extent of retropharyngeal disease.

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Acute epiglottitis results in inflammation of supraglottic structures and finally causes airway obstruction. In the present study, we examined the clinical findings of acute epiglottitis with special reference to flexible fiberscopic findings and indication of tracheostomy. Twenty-nine patients with acute epiglottis hospitalized and treated at the Department of Otolaryngology, Hyogo College of Medicine, between January 1998 and January 2003 were examined in this study. According to the flexible fiberscopic findings, we deviled patients into four groups. Group I was comprised of patients with swelling limited to the epiglottis, Group II included those with swelling in the epiglottis, arytenoids and aryepiglotic fold, and Group III was comprised of patients with unilateral vocal cord obstructed due to the swelling of the false vocal cord and Group IV was those with fully obstructed vocal cords. Tracheostomy was performed in 2 cases (50%) in Group III, 3 cases (100%) in Group IV and no cases in Groups I and II. In spite of the intensive treatment, four cases deteriorated rapidly within 48 hours. We speculated that observation is mandatory during the first 48 hours of treatment. Physicians have to consider that the patients with obstruction of unilateral vocal cord due to the swelling of the false vocal cord (Group III), or bilateral obstruction of vocal cords (Group IV) have a high risk of airway obstruction and tracheostomy is indicated.

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We report a case of low-grade fibromyxoid sarcoma of the submandibular region. An 83-year-old woman presented with a mass in her left submandibular region that had been enlarging for 3 months. At first, it seemed to be lymphadenitis and we observed it for several months. But it enlarged and grew to be painfull. CT imaging revealed a tumor outside the submandibular gland. We resected the mass and it was subsequently diagnosed as a low-grade fibromyxoid sarcoma, a very rare tumor.

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We determined the usefulness of computed tomography (CT), ultrasonography (US) and Tc-T1 subtraction scintigraphy for preoperative diagnosis in 12 patients with primary hyperparathyroidism, all of which were solitary adenoma.
Seven (63.6%) of 11 tumors were detected by CT, 7 (58.3%) of 12 tumors were detected by US, and 7 (63.6%) of 11 tumors were detected by Tc-T1 subtraction scintigraphy. Of 7 tumors with size >10mm, 6 (85.7%) were detected by CT, 5 (71.4%) were detected by US, and 6 (85.7%) were detected by Tc-T1 subtraction scintigraphy, whereas only 1 (25%) with a diameter of 10mm was detected by each of CT or Tc-T1 subtraction scintigraphy and 2 (40%) with diameters 10mm were detected by US. Of 6 tumors situated behind the thyroid gland or intra thyroid gland, 5 (83.3%) were detected by CT and all 6 (100%) were detected by US, T1-Tc subtraction scintigraphy, which was employed for 5 tumors, detected all 5 (100%). However, in the tumors situated beneath the thyroid gland only 2 (40%) of 5, 1 (16.7%) of 6 and 2 (33.3%) of 6 were detected by CT, US and Tc-T1 subtraction scintigraphy respectively. In 5 tumors without thyroid disease, 4 (80%) of 5 were detected by both CT and US, 3 (75%) of 4 were detected by Tc-T1 subtraction scintigraphy. However, in 7 tumors with thyroid diseases (papillary carcinoma, follicular carcinoma, follicular adenoma, chronic tyiroiditis, and adenomatous goiter), 3 (50%) of 6 were detected by CT, 3 (42.9%) of 7 were detected by US and 4 (57.1%) of 7 were detected by Tc-T1 subtraction scintigraphy.
Location of tumor was the factor most likely to make appropriate diagnosis difficult for primary hyperparathyroidism by any assessment method.

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Recent advances in stem cells research and its application to medicine are reviewed. Stem cells are composed of embryonic stem cells (ES cells) and somatic stem cells, in which neural stem cells, hematopoietic stem cells, mesenchymal stem cells, and other forms have already been identified. Stem cells have a possibility of regenerating damaged organs, which were difficult to transplant, and may be able to serve as a source of donor organ to be used for transplantation. In nervous systems, ES cells, neural stem cells and mesenchymal stem cells are investigated to regenerate damaged central and peripheral neurons. ES cells and neural stem cells are reported to form synapses with host neurons when they are transplanted into the brain or spinal cords. Mesenchymal stem cells are reported to differentiate into neurons in vivo and are expected as a source of cells used for stem cell therapy in the future. The possibility of stem cell transplantation for the treatment of inner ear hearing loss is also discussed.

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