One hundred and twenty eight cases of tympanoplasty with ossiculoplasty type III and IV in Niigata University hospital were evaluated. The hearing results were classified as successful when the postoperative hearing level met at least one of these three conditions: 1) air bone gap less than 15dB; 2) hearing gain more than 15dB; or 3) hearing level above 30dB.
Success was obtained in 88 (68.8%) of 128 ears with ssiculoplasty type III and IV. Ossiculoplasty type III with columella interposition showed the most excellent success rate of 75.0%, and type IV with columella interposition showed the second best success rate of 70.8%. The presence of the stapes superstructure and mallear handle is thought to be the most valuable factor in obtaining a satisfactory hearing result in tympanoplasty with ossiculoplasty type III and/or IV.

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The clinical features of 14 patients with deafness due to mumps who underwent treatment in Jichi Medical School Hospital from April 1993 to March 2003 were reviewed. The diagnosis was made according to the criteria for diagnosis of mumps deafness determined by the Acute Profound Deafness Committee set up by the Ministry of Health and Welfare, Japan.
The number of patients with mumps has gradually increased since 2000, and the number of patients in 2002 was about 3 times greater than that in 2000.
The age distribution of the patients in our hospital was 3 to 34 years old and half of the patients were 5 to 9 years old. The onset time of hearing loss in 10 cases was within 8 days after the appearance of parotid swelling. All 14 patients had unilateral total deafness or profound sensorineural hearing loss. Nine were treated with corticosteroids. Hearing loss did not improve after treatment in any patient. The importance of mumps vaccination should be reconsidered.

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The etiology of sudden sensorineural hearing loss is unknown, but viral infection is suspected as one possible cause. We retrospectively studied 102 sudden sensorineural hearing loss patients to evaluate the efficacy of acyclovir therapy. Acyclovir had been administered to 25 patients as single therapy or in combination with corticosteroid or batroxobin. They were given 750mg of acyclovir per day intravenously. These patients were compared with the other 77 patients treated without acyclovir. Hearing recovery was assessed by the criteria of the Sudden Deafness Research Group of the Japanese Ministry of Health and Welfare. In the patients treated with acyclovir, the rate of complete recovery was 56.0%, the rate of recovery was 80.0%, and the rate of efficiency was 88.0%. We found significantly better recovery in the group therapy by acyclovir than in the group without acyclovir.

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Endoscopic endonasal sinus surgery was conducted in 92 patients who had chronic sinusitis with moderate or severe olfactory dysfunctions.
Improvements of olfaction in these patients were investigated by employing T & T olfactometry, a standard olfactory test procedure used in Japan, before and after the surgery. In measurements made 6 to 12 months after surgery, 67 had improved olfaction, while 25 showed no improvement. Statistical analysis was performed to identify the factors that may affect the olfaction outcome after endoscopic endonasal sinus surgery.
Factors investigated included age at the time of surgery, complication with allergic rhinitis or bronchial asthma, nasal symptoms (nasal congestion, rhinorrhea, and postnasal drip), results of pre-surgical T & T olfactometry, endoscopic findings of the olfactory cleft, intravenous olfaction test (Alinamine^® injection test), and severity of chronic sinusitis observed by CT.
The following were detected significantly more frequently in the group with no improvement in post-operative olfaction: duration of olfactory dysfunction of 7 or more years, history of surgery of the nose and paranasal sinuses; lack of response to the pre-operative intravenous olfaction test; and the formation of polyps at the olfactory cleft, which was detected during the pre-operative endoscopic examination. We concluded that these factors most markedly affect improvement in olfaction after endoscopic endonasal sinus surgery for chronic sinusitis.

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Primary malignant melanoma of the nasopharynx is a rare disease with poor prognosis. There has been no established treatment for the disease.
We report herein a case of a 75-year old man, who was referred with hearing impairment and nasal obstruction. Clinical examination demonstrated left middle ear effusion and nasopharyngeal mass. The histological examination indicated malignant melanoma. Magnetic resonance imaging (MRI) showed a gadolinium-enhanced mass on the left side of nasopharynx. Imaging studies could not detect distant metastasis. The patient received combined chemotherapy with DAV treatment (DTIC+ACNU+VCR), but there was no response. Intratumoral administration of Interferon-beta inhibited tumor growth and X-knife was also effective in significantly decreasing tumor size. These therapies may be helpful in the local treatment of malignant melanoma, thus improving the patient's quality of life.

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Only 2.9% of head and neck schwannomas are found in the nasal cavity or paranasal sinuses. A 47-year-old man preseted with a complaint of left nasal obstruction, rhinorrhea, epiphora and left facial pain. At first, a malignant tumor was suspected, because computed tomography showed a large mass and bony destruction of the left maxillary sinus.
It was difficult to make the diagnosis of schwannoma. On biopsy, the intraoperative findings was non-malignant tumor (schwannoma or neurofibroma). Then, complete endscopic excision of the tumor was performed by the Caldwell-Luc method. It is important to resect widely as soon as possible because of the possibility of malignancy.

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We report the case of a child patient with blood boil of the maxillary sinus. The patient, a 10-year-old female, visited our clinic suffering from right nasal obstruction and bleeding. Due to considerable loss, she had received a blood transfusion prior to her visit to our clinic, and required definite diagnosis and intensive treatment. A computed tomography scan and magnetic resonance imaging showed the presence of a large mass with heterogeneous enhancement occupying the entire right maxillary sinus.
At first, a endoscopic nasal surgery was performed for histological diagnosis as well as tumor extirpation. However, extirpation of the entire tumor could not be completed due to increased nasal bleeding. Tumor extirpation by trans-maxillary approach was thus performed, and a hematoma-like mass occupying the maxillary sinus was totally removed.
The mass lesion was diagnosed as a so-called ‘blood boil’ by the histopathological examination, local findings during the operation, and clinical procedures. No recurrence has been observed to date.

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Polymorphous low grade adenocarcinoma (PLGA) is a low grade malignant neoplasm mostly arising in the palate. We report a case of PLGA in the oral floor of a 60-year old man. He had an indolent tumor in the oral floor on the right side for about 30 years. Oral examination revealed a 4cm hard mass without mucosal ulceration. Since the tumor was thought to be benign, it was enucleated in the first surgery. Histological diagnosis was PLGA, as the tumor showed an infiltrative growth pattern without a capsule and a broad spectrum of architectural morphology including solid, tubular and cystic patterns. After the diagnosis of PLGA, an additional removal of the oral floor tissue and a dissection of the submandibular region on the right side were performed as the second surgery. The tumor has not recurred or metastasized in 6 months of follow-up, but close observation will continue.

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A rare case of PTP foreign body in the larynx is reported. The patient was a 58-year-old female who complained of foreign body sensation in the throat and cough without dyspnea. She did not remember swallowing a PTP. The PTP was safely removed from the larynx by direct laryngoscopy under neuro lept analgesia. Three months after removal, contact granuloma occurred on the bilateral posterior vocal cords. It was controled by steroid inhalation and tranilast. The methods of anesthesia and operation are discussed.

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We report eight cases of polypoid vocal cord treated by KTP laser.
Clinical grade of polypoid vocal cord, I, II and III was noted in 2, 4 and 2 of the patients respectively.
We evaluated the voice before and after each procedure with GRBAS classification and finding of larynx stroboscopy.
In our surgical method, vocal cord edema is aspirated by the KTP laser without incising the mucosa of vocal cord by surgical knife.
All our cases showed improvement in GRBAS classification and in the findings on larynx stroboscopy.
Especially the patients demonstrating grade I or II improved after a single surgery.
For patients demonstrating grade III, the necessity for repeated surgical treatment was suggested.

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We report the results of superselective intraarterial cisplatin (CDDP) infusion therapy combined with irradiation for 23 patients, mainly advanced head and neck carcinoma. All patients received intraarterial CDDP infusions with intravenous sodium thiosulfate (STS) neutralization. CDDP infusion was performed by the Seldinger's technique in 16 patients and by the implanted intraarterial reservoir system in 7 patients. STS was also infused by the reservoir system implanted at the forearm in most patients.
An overall response was observed in 21 of the 23 (91.3%) patients. Complete and partial responses were achieved in 16 (69.6%) and 5 (21.7%) patients, respectively. There were no patients with worse than grade III complications. We concluded that superselective intraarterial infusion therapy with a high dose of CDDP and STS was very effective for the management of advanced head and neck carcinomas and we recommend the implantable reservoir system for both CDDP and STS administration as an easy and low-invasive method.

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We report a 51-year-old female with a large neurilemmoma of the cervical vagus nerve in the right parapharyngeal space. She had an 8×5cm, elastic soft, round tumor in her right submandibular region. We successfully performed intracapsular resection of the huge neurilemmoma under rigid endoscopic guidance by cervical approach. This surgery was done with no operative complications, but right vagus nerve palsy occurred. Our findings suggest it is useful to use a rigid endoscope when performing intracapsular resection of a parapharyngeal neurilemmoma.

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We report an intractable case of Kasabach-Merritt syndrome with neck hemangioma in an infant. A four-month-old girl presented with hemangioma of the right neck and thrombocytopenia known as Kasabach-Merritt syndrome. It is the most common vascular disease in the pediatric age group. Initially, we treated the hemangioma with steroid (predonisolone), surgery and embolization.
However each therapy was unsuccessful, and therfore we finally treated the patient with radiation therapy (9Gy) and the hemangioma was well controlled.
From our experience, radiation therapy may be effective for hemangioma with Kasabach-Merritt syndrome if the tumor is not completely resected by surgical procedure.

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Deep neck infection is still a relatively common emergent condition in otolaryngological practice. We recently experienced a case of 57 year-old male who developed neck swelling with mild dyspnea and dysphagia after perioral administration of antibiotics by an internist for peritonsillar abscess. ENT examinations revealed a painful neck swelling with severe peritonsillar swelling extending to the hypopharynx in the left side. CT examination indicated abscess formation with gas in the neck extending to the upper mediastinum. Peritonsillar drainage was begun on an emergency basis, followed by tracheotomy and cervical drainage. The neck incision was kept open, and the patient was treated with intravenous antibiotics together with human immunoglobulin. The postoperative course was uneventful, and the mediastinal abscess was absorbed without direct drainage. We considered that immediate cervical drainage was essential for the treatment of acute deep neck infection. For the evaluation of the effect of treatments, CT examination and the measurement of CRP and WBC count appeared to be most useful.

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