The management of only hearing ears remains controversial because of the risk of postoperative hearing deterioration. On the basis of our recent series of 12 only hearing ears at Hyogo College of Medicine from 1999 to 2002, we reviewed the literature and discussed indications for surgery on only hearing ears. The incidence of only hearing ears was less than 2% of ear surgeries in the literature. They comprised mainly cholesteatoma cases in English papers, and otitis media and cholesteatoma cases in Japanese papers. The causes of profound hearing loss on the contralateral ear were mainly former surgery and otitis media in English papers, and otitis media in Japanese papers. Sensorineural hearing loss was a rare cause in both papers. In our recent series, 7 ears (58.3%) showed hearing improvement (of more than 15dB), 4 ears (33.3%) remained unchanged (change within 10dB), and 1 ear (8.3%) showed hearing deterioration (of more than 15dB), which were better results than those in the previous papers. Our surgical concepts are the following: (1) In cases of chronic otitis media, we first recommend simple underlay myringoplasty, and secondly, tympanoplasty without mastoidectomy. (2) In cases of cholesteatoma, we recommend the canal wall down method, leaving matrix on the fistula. (3) When an only hearing ear shows severe combined hearing loss, we recommend informing the patient of the possible necessity of cochlear implant if hearing deteriorates after surgery. Finally, it is needless to say that skillfull surgeons should perform surgery on only hearing ears after special consideration.

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We report a case of glomus tympanic tumor in an 18-year-old male who presented with right hearing loss. Otoscopic examination revealed a reddish mass in the tympanic cavity through the tympanic membrane. Angiographic findings showed that the tumor feeding arteries were the ascending pharyngeal artery and middle meningeal artery. The tumor was completely resected after embolization of the feeder vessels. No recurrence was detected as of one year after surgery.

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Two patients with extensive cholesteatoma in the petrous apex are reported.
Case 1 was a 29-year-old man with left facial palsy for more than 20 years. CT and MRI examinations revealed that massive cholesteatoma in the petrous apex had expansively destroyed the internal acoustic meatus. A joint operation with a neurosurgeon was performed by both middle cranial fossa and translabyrinthine approaches. Cholesteatoma involved the middle and apical turn of the cochlea and anterior semicircular canal. The proximal portion from the geniculate ganglion of the facial nerve had disappeared and could not be identified. The dura mater in the internal acoustic foramen was penetrated and the internal carotid artery was exposed after removal of the cholesteatoma. The internal acoustic foramen was closed with the temporal fascia and the postoperative large cavity was obliterated with abdominal fat.
Case 2 was a 35-year-old man with left hearing loss. CT examination revealed an attic cholesteatoma extending to the petrous apex and widely exposed middle cranial fossa dura. The exenteration of the cholesteatoma was done by both transmastoid and translabyrinthine approaches. The facial nerve was preserved and rerouted. Cerebrospinal fluid leaked out of the internal acoustic meatus upon removal of the cholesteatoma. The internal acoustic meatus was closed with the temporal fascia and the postoperative cavity was obliterated with abdominal fat.
After total exenteration of massive cholesteatoma in the petrous apex, if possible, the postoperative cavity should be obliterated, in order to improve the quality of the patient's life and to shorten the duration of admission. When the cavity is obliterated, concentrative follow-up MRI study should be performed.

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Traumatic perilymphatic fistula due to luxation of the stapes into the vestibule caused by an earpick is extremely rare.
A 27-year-old female suffered severe dizziness and tinnitus in the right side after a traumatic injury obtained while using an earpick. We diagnosed her illness as traumatic perilymphatic fistula due to luxation of the stapes by using multislice CT (MSCT). The image of multi-planar reformation (MPR) especially demonstrated the luxation of the stapes into the vestibule.
The traumatic perilymphatic fistula was observed conservatively, but the patient suddenly suffered severe hearing loss and dizziness after two months. Surgical treatment involving reduction of the stapes and closure of the perilymphatic fistula was performed. The patient has been free from dizziness, but the hearing loss was not changed.
We discussed the diagnostic and therapeutic problems in traumatic perilymphatic fistula as seen in the literature.

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In a recent report, I emphasized that nosocomial MRSA should be reduced to a minimum in order to prevent it from becoming the source of nosocomial or/and inter-hospital epidemics.
A bacteriological study in 1998 revealed that 17 isolates of MRSA accounted for 4.4% of all 386 isolates from otorrhea. As MRSA infections have become more widespread in Japan, culture and sensitivity testing at the initial visit is essential as a guide to proper therapy for the early diagnosis and treatment of MRSA infections.
In this study I examined 16 otologic patients with MRSA infections: 8 males and 8 females. They ranged in age from one month to 78 years.
The sites of major lesions detected under microscopic examination were the external ear in 9 cases, the tympanic membrane in 4 cases, and the middle-ear in 3 cases.
Other bacteria coexisted in 3 cases, and 2 patients suffered recurrence of MRSA infections.
Among the 16 patients with ear diseases caused by MRSA, 4 patients (25%) were not found to have nosocomial infection of MRSA in my clinic but rather nosocomial acquisition. In the other 12 patients (75%), including six with inter-hospital infections, MRSA was detected at their initial visit.
All cases were successfully controlled by means of early diagnosis, appropriate local-treatment, and suitable use of an antimicrobial drug (MINO).

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A 57-year-old man complained of left alinasal tumor and nasal obstruction. On nasal examination, a smooth round tumor arising from the vestibule of the nose was found. A similar tumor had been removed from this region at the age of 17 years, and we considered that the nasal tumor had recurred 30 years later. We performed embolization of the tumor feeding artery and resection through a lateral rhinotomy approach. There has been no further recurrence in this case for 1.5 years.

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Basaloid squamous cell carcinoma (BSCC) is high grade, aggressive variant of squamous cell carcinoma with a predilection for the larynx, hypopharynx, and the base of the tongue. It is found in only 2-3% of cancers in the nasal cavity and paranasal sinuses within the head and neck region. BSCC originating in the paranasal sinuses has rarely been reported. Herein we report the third known case in Japan. An 85-year-old woman presented with a complaint of left nasal obstruction. On examination, obstruction of her left paranasal sinuses, nasal cavity and cervical lymph node metastasis were found. Radiotherapy and chemotherapy were performed, but the tumor size was unchanged and she died of rupture of aortic aneurysm. We suggest that radiotherapy and chemotherapy were somewhat effective in this case. It is important to observe patients closely after treatment because BSCC shows aggressive behavior.

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We report a 25-year-old woman who complained of an increasing throat pain. Physical examination revealed that the mucosa of her oropharynx exhibited butterfly appearance and serological testing showed high RPR and TPHA titers. According to these findings, we diagnosed it as pharyngeal syphilis. After treatment with oral penicillin, the pharyngeal lesion was improved. Because of the increase in the commercial sexual activities, consultations for sexually transmitted diseases of the oropharynx are increasingly common.

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Acute suppurative thyroiditis is an infection originating from the piriform sinus via a congenital fistula. Between April 1987 and April 2002, we treated five patients with piriform sinus fistula with acute suppurative thyroiditis, three boys and two girls with ages ranging from 4 to 16 years. The diagnosis of piriform sinus fistula was made by hypopharyngeal enhancement radiography in all five patients preoperatively. Surgical treatment was performed after reduction of inflammation. Total fistulectomy including partial thyroidectomy was performed in three patients, and partial fistulectomy via piriform sinus to thyroid was performed in the other two patients. Administration of 1% methylrosarilinium chloride orally before the operation clearly distinguished the fistula from the surrounding tissue without any difficulty in the operative field. No inflammatory recurrence was observed in any patient during the follow-up period.

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Five years after a tracheostomy, a female patient visited our clinic with a complaint of progressive hoarseness. Clinical examination revealed severe stenosis caused by cicatricial pemphigoid in the false vocal cords of the arytenoids area. We planned staged surgery. We performed a laryngoplasty and scar resection, and then made a laryngocutaneous fistula. In the second stage of surgery eight months later, we closed the laryngocutaneous fistula. One year after the first surgery, we successfully closed the tracheostomy.

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We report a rare case of primary NK/T cell lymphoma of the hypopharynx and upper esophagus in a 72-year-old man. He had suffered from a sore throat for 5 months, and presented with severe inflammation in the hypopharynx and upper esophagus. We biopsied the lesion 4 times, but there was such extensive necrosis that we could not excise enough tissue from the lesion for histological and immunophenotypic studies.
About 2 months later, we found another lesion in the liver and biopsied it for pathological diagnosis. He died of excessive hemorrhage from the necrotic neck lesion. It was difficult to diagnose primary NK/T cell lymphoma of the hypopharynx and upper esophagus in this case. There are no characteristic symptoms of this disease, and it was necessary to repeat the biopsy for diagnosis.

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A rare case of parathyroid carcinoma associated with hyperparathyroidism and hungry bone syndrome following parathyroidectomy is reported. The patient was a 45-year-old woman presenting with a lower cervical mass. Her symptoms seemed to be typical for parathyroid carcinoma, exemplified by a high level of serum calcium and serum parathyroid hormone, a large cervical mass and pain in the knee joints. Surgical excision of the tumor together with dissection of the neighboring tissues resulted in hungry bone syndrome (HBS), a severely low level of serum calcium which required administration of a large amount of calcium and vitamin D for a prolonged period. The occurrence of HBS is due to increased bone metabolism, and is a relatively rare phenomenon following parathyroidectomy. HBS is predictable based on high preoperative levels of serum calcium, parathyroid hormone, and alkali phosphatase. Both early diagnosis and treatment can reduce the morbidity of parathyroid carcinoma and HBS.

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Renal cell carcinoma can metastasize to any part of the body, and recurrences and/or metastases of this tumor are often found after a long interval from the initial therapy. We report a case of renal cell carcinoma that metastasized to head and neck regions four times in 12 years after nephrectomy was performed.
The patient was a 64-year-old female with left renal cell carcinoma for which left nephrectomy was carried out in April 1991. Two years later, in 1993, metastases were found in the cranial dermis and frontal bone, and were surgically removed. Similarly, metastases were found in the lymph nodes at the left parotid grand and in the left neck lymph nodes in 1994 and 2002, respectively. All of them could be surgically resected, and the patient is still alive without any metastases 12 years after left nephrectomy.
There is no effective chemotherapy for metastases of renal cell carcinoma, so surgical resection is the most effective therapy. Since the clinical course of renal cell carcinoma can be long as in our case, plural resection may not only improve the Q. O. L. of patients but also extend their survival. If the general condition of the patient is good, surgical resection can be attempted for treatment of metastases of renal cell carcinoma.

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The aim of this study was to evaluate the effects of novel leukotriene antagonist, pranlukast hydrate on improvement of quality of life (QOL) as well as reduction of clinical symptoms in patients with allergic rhinitis.
Fifty patients with perennial and/or seasonal allergic rhinitis were administered 450mg pranlukast hydrate daily for at least 4 weeks. The severity of clinical symptoms and QOL were assessed before and after treatment.
After a 4-week period of treatment, the QOL score significantly improved from 2.1±1.5 to 1.2±1.7 (P<0.0001). In addition, the treatment itself did not affect the QOL of the patients. The severity of symptoms was also significantly reduced (P<0.001). The improvement rates were 66.0% (sneezing), 72.0% (rhinorrea), and 82.0% (nasal obstruction).
In conclusion, pranlukast hydrate improves QOL and reduces symptoms in patients with allergic rhinitis.

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