The handling of the airway and food passage for foreign bodies is important for the otorhinolaryngologist. Death by suffocation by foreign bodies in the elderly had increased. Cases of foreign bodies in the airway and food passage have been shown, and the correlations explained.
In addition, the reasons a foreign body is missed include the following: the foreign substance is not shown by X-ray, the patient does not recognize the foreign body has been misswallowed, and the doctor does not suspect a foreign body.
It has been reported that there are more than 50 incidents of the food passage being punctured by a foreign body each year in Japan. Attention not only to foreign bodies in the throat but also to foreign bodies in the food passage is necessary.
Furthermore, technology for urgent treatment and preparation are necessary, for any condition. Participation in training, and re-practice of emergency treatment are necessary.

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A 63-year-old male consulted our clinic complaining of right pulsatile tinnitus. Pure tone audiometry demonstrated bilateral gradual sloping type of sensorineural hearing loss. Tinnitus was synchronized with cardiac pulsation and could be heard through an otoscope, recorded with a digital audio tape (DAT) recorder and analyzed with regard to frequency. The vascular murmur heard in his right temporal region suggested intracranial vascular disease and a neurosurgeon was consulted. Angiography demonstrated dural arteriovenous fistula between the inferior petrosal sinus and branches of the external carotid artery. After embolization of the fistula, objective pulsatile tinnitus disappeared. To date, the patient has been disease-free for 1 year.

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Sudden hearing loss or Meniere's disease are frequent diagnoses in case of sudden hearing loss and vertigo, but these symptoms may rarely be caused by cerebrovascular disorder. We recently encountered three patients with cerebellar infarction who demonstrated sudden hearing loss and vertigo as the chief complaints. Two of the patients demonstrated regression following treatment, but one patient suddenly deteriorated and died. We identified an infarct of the anterior inferior cerebellar artery area in all cases, but the general clinical manifestations varied slightly, making it is easy to be made a wrong diagnosis. MRI examination can even depict an early infarct. Therefore it is recommended MRI be obtained early in sudden hearing loss patients with vertigo. Quality of life and cerebellar function may remain almost good if not accompanied by disturbance of consciousness even if cerebellar infarction is not detcted early. However, some cases demonstrated a combination of wide cerebellar infarction and brain stem infarction, presenting grave clinical manifestations, and subsequent fatality. In addition, inquiry into anamnesis is important when cerebrovascular disorder is suspected. In the patient with a history of hypertension, diabetes mellitus, hyperlipemia, arterial sclerosis and heart failure, cerebellar infarction was taken into consideration and we monitored the course carefully. It was also thought that obtaining cranial MRI in the early stage was necessary.

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Relapsing polychondritis (RP) is an uncommon inflammatory disease that mainly affects cartilage tissue in the auricles, nose, and respiratory tract. A 63-year-old man was admitted to our hospital with left hearing loss and tinnitus. His auricle had degenerated, but the tympanic membrane remained normal. His hearing level gradually decreased to 90dB degree. Treatment with a steroid hormone (hydrocortisone) was initiated but the hearing level showed only slight improvement after a few weeks. Three months later, he was hospitalized with right hearing loss and was treated with hydrocortisone at the same dose. However, hearing level continued to decrease. Thereafter, he was treated with 1000mg of methylprednisolone for three days. After one month, slight improvement was seen.
We suggest that hearing loss in RP should be with treated with pulse therapy using a steroid hormone, and that the patient should be followed for a prolonged period.

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We report 2 cases of Lermoyez's disease and a case of Meniere's disease at advanced stages showing hearing improvement following treatment with a combination of Dilazep dihydrochloride and Isosorbide. It is suggested that this combined treatment is quite effective for Lermoyez's disease, suggesting that Lermoyez's disease is caused by both endolymphatic hydrops and disturbance of vascular circulation. Comparison of the hearing improvements among cases for which this treatment was effective and ineffective indicated that this treatment could be useful not only for Lermoyez's disease but also for Meniere's disease when vertigo is under control in patients whose job is not very busy or stressful.

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We report two cases of large vestibular aqueduct syndrome, a rare congenital malformation of the inner ear originally described by Valvassori and Clemis in 1978.
The first case was a 38-year-old woman who had complained of progressive hearing loss since childhood and periodic episodes of recurrent vertigo since 30 years of age. She had been misdiagnosed as having Meniere's disease by previous doctors. The second case was a 9-year-old boy with acute hearing loss several hours after minor head collision. Psychogenic hearing loss was initially suspected, but was eventually ruled out based on diminished auditory brainstem response. When these patients were initially seen in our clinic, both patients showed severe bilateral combined hearing loss on pure tone audiogram. Definitive diagnosis was established by magnetic resonance imaging, which demonstrated expanded endolymphatic ducts and sacs.
Clinical characteristics and possible pathogenesis of large vestibular aqueduct syndrome is discussed with a review of the literature.

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A 65-year-old man complained of severe otalgia, occipital pain, hearing loss and otorrhea was referred to our hospital. Otoscopic examination demonstrated hyperemia and bulging of the left ear drum. The bacteria isolated from otorrhea was a mucoid type of Streptococcus pnemoniae. It was also penicillin-resistant Streptococcus pneumoniae (PRSP). The patient was diagnosed as having mucoid otitis media. Intravenous administration of piperacillin sodium (PIPC) diminished otalgia, occipital pain and otorrhea. However, the patient continued complain of hearing loss and a sensation of ear fullness. Due to acute sensorineural hearing loss, the patient was administered steroids. Nevertheless, bone conduction hearing loss persisted. This is the first report of otitis media demonstrating not only the mucoid type of Streptococcus pnemoniae but also PRSP.

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We reviewed three cases (0.52%) of congenital anosmia without hypogonadism. None of the three cases demonstrated any response to the intravenous olfactory test, or to T & T olfactometry. Each olfactory cleft was normal with endoscopy. Biopsy of mucosa of the olfactory cleft in one of three cases showed that olfactory mucosa could not be detected in the mucosal specimen and that only respiratory mucosa was identified. Hypoplasia or lack of olfactory bulbs and sulci olfactorius was demonstrated on brain MRI in all cases, supporting a diagnosis of congenital anosmia. MRI was useful for the diagnosis of congenital anosmia without hypogonadotropic hypogonadism.

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Acinic cell carcinoma is a rare and low-grade malignant tumor of the parotid gland. We treated two acinic cell carcinomas of the parotid gland, each occurring in a young man (18 and 30 years old, respectively). Based on preoperative examination and MRI findings, we expected to find benign tumors, but they were revealed to be acinic cell carcinomas by the permanent pathological specimens. We performed partial parotidectomy in one case, and subtotal parotidectomy in the other, and preserved the facial nerve in both. There has been no metastasis or recurrence for two years after the operations, but we need to follow both patients for a long time.

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Conventionally, in surgical treatment for submandibular sialolithiasis, removal of the gland has been performed for stones in the gland and transitional region, and transoral removal for ductal stones. Recently, we removed stones in the transitional region using the transoral method under general anesthesia. Transoral removal does not leave surgical scars in the neck and cause facial or hypoglossal nerve injury in comparison with those after gland resection. There is only a risk of lingual nerve injury, but we can avoid such injury with careful procedure. There was no significant difference in surgical duration or intraoperative blood loss between transoral removal and gland resection in our series. Therefore, we conclude that transoral removal should be the first choice for the removal of stones in the transitional region, because of the advantages cited above.

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A case of chondrosarcoma of the larynx is reported. A 77-year-old man consulted our clinic with hoarseness and mild dyspnea. Bilateral vocal cords were fixed at the paramedian line. Magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a mass arising from the cricoid cartilage. Biopsy was performed and the histological examination demonstrated low grade chondrosarcoma. Basis on these findings and clinical symptoms, we performed total laryngectomy. Fifteen months after surgery, there is no any evidence of recurrence.

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Most benign thyroid nodules are treated conservatively. This report reviews transition of benign thyroid nodules in major axis by ultrasonography. We examined 79 patients (109 nodules) diagnosed as those having benign thyroid nodules using fine needle aspiration biopsy (FNAB) and ultrasonography in 1998. None of these patients received any medical and surgical treatments. Nodules that were unchanged or decreased in size accounted for more than 70% of benign nodules. More than 60% of solid nodules did not change or decrease in size. The nodules that were initially smaller, increased in size, while most large nodules were unchanged or decreased. Benign nodules that are unchanged or decrease in size do not have to be treated positively, but nodules that increase in size should undergo repeat FNAB.

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Clinical features of 39 patients with cervical metastasis from unidentified primary carcinoma who underwent curative treatment at the Department of Otolaryngology, Head and Neck Surgery, Kurume University Hospital between 1980 and 2003 were reviewed. Thrity-nine (34 men and 5 women: mean age: 63 years) patients underwent radical treatment. The distribution of N classification in these cases was: N1 3, N2a 6, N2b 14, N2c 4, and N3 12. Histopathologically, 32 cases (82%) were squamous cell carcinoma, 5 cases (13%) were adenocarcinoma and 2 cases (5%) were undifferentiated carcinoma. After the initial treatment of the metastasic lesion, the primary lesions were confirmed in 12 cases (31%), two of which became evident at autopsy. In 10 cases, whose primary site were confirmed during post operative follow up, local control by additional therapy was successful in five cases (50%). In patients with upper or mid jugular lymph node metastasis, ipsilateral tonsillectomy was also performed in conjunction with neck dissection after 1998 and primary cancer was found in five of 14 patients (36%) post operatively. The overall 5-year survival rate as determined by the Kaplan-Meier method was 49%. The 5-year survival rate of 10 cases, in which the primary lesions were identified was 57%. The 5-year survival rate of 29 cases in which primary lesions remained unidentified was 46%. These results indicate the importance of accurate treatment of the metastatic neck nodes to improve survival in patients with unidentified primary carcinoma. We also propose screening unilateral tonsillectomy in patients with metastatic upper or mid jugular lymph nodes.

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