To find the cause of idiopathic endolymphatic hydrops, we conducted a questionnaire-based study of patients (n=209) and workers in a company (n=3, 410). The questionnaire included items related to lifestyle (n=8), behavior (n=24), stress and stressors (n=22), relaxation (n=11), and physical symptoms (n=5). Further, the degrees to which stressors contributed to the onset of or worsened the disease were investigated by questionnaire in the patient group (n=120). The patients, compared to the workers, had fewer holidays (P<0.0001) and a stronger propensity (P<0.005) to immerse themselves in whatever they do, to be a perfectionist, to worry before doing something, to swallow their disgust, to strive to meet superiors' expectations, and to be easily irritated or touchy. They also had fewer opportunities to enjoy sports and pleasant chats, and they were more nervous about personal relations (P<0.05). Seventy percent of the patients noted that stress was a factor either in the onset or worsening of the disease. Whereas stressors common to every age group were the pressure of business and want of sleep, job-related stressors were often noted by men and home-related stressors by women. Want of sleep, personal relations at work, and troubles at home were remarkable in patients in their twenties, forties and sixties, respectively. The present results suggest that the cause of idiopathic endolymphatic hydrops lies in weariness or exhaustion produced by characteristic behaviors and want of relaxation. A poor prognosis may result from behavioral patterns that are hard to change. New diagnostic standards and new treatment guidelines in the early stage of the disease are required to prevent recurrence.

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Acute sensorineural hearing loss is not relatively rare. One-hundred forty-one sudden deafness and 17 acute low-tone sensorineural hearing loss patients underwent curative treatment between 1991 and 1999.
In cases of sudden deafness, complete recovery occurred in 27.0% of patients, definite improvement in 50.4%, and slight improvement in 73.0%. Prognostic factors were studied by logistic analysis. Important prognostic factors were age and time between onset and beginning of treatment. So, cases of sudden deafness should be treated as soon as possible.
In cases of acute low-tone sensorineural hearing loss, complete recovery occurred in 47.1 % of patients, definite improvement in 58.8%, and slight improvement in 76.5%. Acute low-tone sensorineural hearing loss has better prognosis than sudden deafness. However, some cases need steroids.

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We report two cases of pseudohypacusis with organic hearing loss in which useful diagnostic information could be obtained from otoacoustic emission (OAE) testing.
Case 1 was a 12-year-old female who had complained of fluctuating hearing loss for a few years. Although her initial pure-tone audiogram indicated moderate hearing loss in both ears, speech audiometry strongly suggested that the hearing of her left ear was considerably better than anticipated based on the pure-tone testing. Since the wave V thresholds of auditory brainstem response (ABR) were 70 and 20dBnHL in the right and left ear, respectively, it was suspected that she had moderate hearing loss in the right ear and normal hearing sensitivity in the left ear. However, OAE testing subsequently performed revealed moderate to severe hearing loss in all frequency regions except between 1.5 and 5kHz in her left ear, and this finding was also confirmed by follow-up pure-tone audiometry.
Case 2 was a 54-year-old male whose complaints were left-sided hearing loss and tinnitus developing after a traffic accident. His initial pure-tone audiogram showed moderate to severe hearing loss in the left ear. However, his speech discrimination score for the left ear suggested much better hearing than expected from the pure-tone testing results, and mild hearing loss in the left ear was suspected based on ABR examined later. OAE testing was subsequently performed and revealed moderate to severe hearing loss in the frequency region above 3kHz in the left ear, a finding subsequently confirmed by pure-tone audiometry.
The diagnosis of pseudohypacusis is sometimes difficult in patients with organic hearing loss, as in the two cases presented here. In such cases, frequency-specific information about cochlear function provided by OAE might be helpful for assessment of true hearing loss. From this perspective, OAE testing is considered useful as a diagnostic tool for pseudohypacusis.

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Neurilemoma (Schwannoma) is a benign tumor originating from Schwann sheath. Although it often occurs in the head and neck regions, occurrences in an oral cavity are relatively rare. We have experienced a case of neurilemoma in the glossal muscle. A 13-year-old female patient complained of an intraglossal tumor. A smooth, 2-cm, elastic hard mass without tenderness was palpable in the left side of her tongue. Ultrasound examination revealed a well-margined, low echoic area. The margin of the mass was rich in blood flow. On magnetic resonance imaging (MRI), the mass showed decreased signal on T1-weighted images and increased signal on T2-weighted images. Moreover, the mass was enhanced by gadolinium on T1-weighted images. The encapsulated mass was surgically removed, and the pathological diagnosis was neurilemoma (Antoni type AB). MRI examination may be useful in diagnosing this tumor.

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Preoperative histological diagnosis of parotid carcinoma is more difficult than that of other head and neck carcinomas. Accurate tumor histological analysis is important in satisfactory management of cancer of the parotid gland. Therapy should be carried out according to each histological type because each has a different tumor activity level. We reviewed 45 cases of previously untreated carcinomas arising in the parotid gland that had been treated between 1989 and 2002 and investigated the accuracy of preoperative histological diagnosis and the initial surgery. Fine-needle aspiration biopsy (FNA) of the parotid gland tumors is an accepted, sensitive and specific technique in diagnosing tumors. FNA was performed for all patients with parotid carcinomas, and the FNA findings were compared with the final pathologic diagnosis of the surgical specimen. In 45 cases of parotid carcinomas, FNA correctly diagnoised 27 (13 histologically, and 14 as malignant only), but failed in 18. Because the accuracy of the FNA findings was poor, we performed open biopsy prior to surgery in 13 cases, and an accurate diagnosis of both histology and grading was obtained in 12 cases. The results of FNA findings in all cases and open biopsy in 13 cases showed correct disgnosis in 29 (22 histologically, and 7 were malignant only), but failed in 16. Seventeen of 22 patients accurately diagnosed histologically underwent an appropriate surgical procedure, while 3 of 16 patients diagnosed with benign tumors preoperatively underwent inappropriate procedures. About forty percent of the patients underwent an inappropriate procedure mainly because of the wrong preoperative histological diagnosis. An accurate diagnosis is necessary to schedule an appropriate surgery, which will improve the prognosis of parotid carcinoma.

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Oncocytoma is a rare tumor commonly found in the salivary gland. Here we report a case of oncocytoma arising in the parotid. Fine needle aspiration cytology revealed a moderate number of cell sheets of oncocyte-like cells, strongly suggesting oncocytoma, whereas neither CT scan nor MRI were informative. We believe that fine needle aspiration cytology is a useful diagnostic modality for oncocytoma.

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We present an 11-year-old female with Down syndrome and moyamoya disease who underwent lingual tonsillectomy for obstructive sleep apnea syndrome. She had a palatine tonsillectomy and adenoidectomy at the age of 3 years and had another adenoidectomy for regrowth at the age of 9 years.
At first examination, body mass index was 25.3. Physical examinations showed micrognathia, macroglossia, regrowth of adenoid and a remarkable lingual tonsillar hypertrophy. Her glottis was not inspected with the enlarged lingual tonsil. Preoperative polygraphy demonstrated that minimum value of SpO₂ was 47%, %SaO₂≤90% was 15.6%, and apnea index (AI) was 50.9 in 330 minutes of total sleep time.
Lingual tonsillectomy was performed using an argon plasma coagulator as well as bipolar style electricity solidification. She had to be calmed postoperatively because of mental retardation and moyamoya disease. So nasotracheal intubation with propofol sedation was maintained for one week after the operation. She tolerated these procedures and her daily activity improved 7 months later. However, postoperative polygraphy exhibited no improvement in %SaO₂≤90% or AI, with improvement in minimum value of SpO₂.

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We report two cases of hypothyroidism with clinical symptoms that occurred after radiotherapy for cancer of the head and neck. The first patient underwent total laryngectomy without thyroidectomy for laryngeal cancer and partial gastrectomy for gastric cancer. Radiation of the neck was carried out postoperatively. Two years later, he developed chest pain and pericardial effusion was detected, leading to a diagnosis of myxedema due to hypothyroidism. The second patient received radiotherapy alone for laryngeal carcinoma. Two months later, a low serum sodium concentration and anemia were detected, both of which proved difficult to correct. The cause of these changes was found subsequently to be hypothyroidism.
From the experience of these 2 cases, we measured thyroid function in 37 patients who had received neck radiation for head and neck cancers at our hospital over the past 10 years. In 13 of the 37 patients (35%), hypothyroidism was observed. The prevalence of hypothyroidism was higher in the 13 patients treated with both radiation and surgery, with 6 (46%) showing this condition, compared with 7 of the 24 patients (29%) who received radiation alone. The risk factor responsible for hypothyroidism was not evident from statistical analysis of these cases.
We consider that thyroid function should be evaluated periodically in patients who have received neck radiotherapy, as it is often difficult to diagnose hypothyroidism from clinical symptoms.

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A case of giant substernal goiter with acromegaly is reported. The patient, a 50-year-old male, had increasing exertional dyspnea and noticed an enlarging neck mass. A CT scan of the neck and chest suggested the presence of a substernal goiter extending inferiorly to the aortic arch and compressing the trachea. Median sternotomy was needed for removal of the goiter, which was completely extirpated, weighing 471g. The histological diagnosis was adenomatous goiter. The postoperative course was uneventful, and CT scan showed marked improvement of tracheal patency.

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Internal-arterial chemotherapy was performed in 13 patients with head and neck cancers. We used a retrograde catheter to infuse antineoplastic agents. The tip of the catheter was led selectively into the main feeding artery of the tumor via superficial temporal artery and/or occipital artery. In this study, 4 cases had undergone operational procedures after chemotherapy with or without conventional externalbeam radiotherapy and 8 cases were treated with chemoradiotherapy alone. The other 1 case received chemoradiotherapy after a non-curative operation.
In this study, 11 of the 13 patients completed all therapeutic regimens. The median duration of follow-up was 23.6 months and there was no apparent reccurence in 9 (81.2%) of the 11 patients. One patient died of disease and 1 patient remained alive with disease. There were 10 events of under grade II toxicity and 2 patients died in the following period (grade V).
These results demonstrate that, if the indications are appropriate, internal-arterial chemoradiotherapy is effective, with confirmed organ preservation in patients with head and neck cancers.

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Foreign bodies in the respiratory tract are highly dangerous and need to be treated immediately and appropriately by the otolaryngologist.
In our Department of Otolaryngology over the 20 years from 1981 to 2000, we treated 91 cases of tracheo-bronchial foreign bodies, an incidence of 4.6 cases per year. Two-thirds of patients were male, and 62.6% were 1 year old. Foreign bodies removed in 69.2% of patients were peanuts or other kinds of beans.
Initial symptoms were typically cough, stridor and cyanosis.
The pediatric department performed the initial examination of 50% of patients, and otolaryngologists initially examined only 13.2% of patients.
The accord rate between the unilateral decreased lung sound, emphysema, or atelectasis and the foreign body was high (80.6%, 67.6%, 90.0%).
Chest CT examination was useful to check for the presence of foreign body in the respiratory tract.
It is important for the otolaryngologist to enlighten society on the possible life-threatning danger of respiratory tract foreign bodies in infants.

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In neck surgery, the exposed scars of the primary suture should be fine for favorable cosmetic results. We previously used subcuticular and epithelial nylon sutures, but recently we have been using monofilament synthetic absorbable sutures (Polydioxanone; PDS-II^®) in subcuticular closure to avoid indurations beneath the skin and late foreign body reactions. The scars of surgical incisions closed with PDS-II^® were not inferior to those with nylon sutures, and we report below.
In the prevention of hypertrophic scars, providing tensile relief and eliminating level differences of the skin are most important. The tensile strength of PDS-II^® is retained for about 2 months, which is not long enough. Thus, subcuticular PDS-II^® sutures require sufficient eversion to reduce scar stretching by providing dermal support for longer terms. We call this technique “hypereversion”. This technique does not require the control of degree of eversion according to patient age, and allows uniform sutures.
Moreover, to get fine scars without suture marks, we are using film dressing (Op-site^®) for wound fixation instead of epithelial suture in the early post operative period. When epithelial suturing is eliminated, level differences of the skin must be avoided in the subcuticular closure.

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Day surgery is one of the new hospital menus, characterized by its service-oriented nature. Day surgery has been developed based on the medical philosophy of respecting the patient's lifestyle and enabling the patient to select his own treatment. In the present paper, a review was made on the present situation and future outlook of day surgery in otolaryngological practice from the standpoint of a middle-scale general hospital. It was stressed that (1) safety of the patient, (2) good surgical result, (3) economical efficacy, and (4) patient satisfaction should be taken into consideration for successful day surgery.

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Tuberculosis in Japan has increased recently. Cervical tuberculous lymphadenitis is an extrapulmonary tuberculosis. We report a case of a 29-year-old woman who was 28 weeks pregnant, with cervical tuberculous lymphadenitis, which was diagnosed by tuberculin reaction and polymerase chain reaction test (PCR test) after delivery. The patient was treated with rifampicin (RFP), isoniazid (INH) and levofloxacin (LVFX) as antituberculous chemotherapy for a year, and was treated with INH and LVFX for the next half-year. The baby was treated with bacillus Calmette-Guerin vaccine (BCG vaccine) instead of antituberculous chemotherapy. The patient and the baby were making satisfactory progress. Although antituberculous chemotherapy should be done immediately when a pregnant woman is diagnosed with pulmonary tuberculosis, it should not be done immediately when the pregnant woman has cervical tuberculous lymphadenitis.

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