Oto-surgery has been developed using an operative microscope. In the middle ear, however, there is a region where microscopic observation is very difficult because of anatomical features: this is the retrotympanic region where the following important structures exist: stapes, stapedial muscle, tympanic part of facial nerve, pyramidal eminence, tympanic sinus, and round window. It is very dangerous to perform oto-surgery without adequate observation of these structures.
To perform safe surgery with a full operative view, we have developed the use of a rigid endoscope, 4mm in diameter and 15cm in length with 0° and 30° angles of vision, into oto-surgery. The endoscope was introduced into the tympanic cavity through a perforated or elevated tympanum.
Endoscopic observation was monitored on a TV screen and recorded on video cassette. The endoscopic imaging was much clearer and more widely expanded than that with a microscope, because an endoscope can get close to a target, within 5mm, but microscope has 25cm focus lens.
A disadvantages of the endoscope is that the otosurgeon has to hold the endoscope with the left hand and handle forceps or a suction tube with the right. It might be difficult to handle the endoscope and surgical tools together in the narrow external canal.
The endoscope, however, was very useful in oto-surgery, especially to avoid injuring the facial nerve in stapedectomy of otosclerosis, or to find residual cholesteatoma in the tympanic sinus or under the ossicle, and to confirm the position of ossicular reconstructive prosthesis.
Our conclusion is that the endoscope should be used and combined with the microscope to perform safe operations with a full view of middle ear cavity.

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Idiopathic sudden hearing loss is a cochlear type of hearing loss of unknown origin. Between 1996 and 2001, we treated 206 patients, 209 ears with sudden deafness. At our hospital, we have been applying high dose steroid therapy in such cases. In this retrospective study, we report the successful treatment of patients with sudden hearing loss following a second course of steroids. We divided patients into two groups: 46 patients, 47 ears receiving a second course therapy of steroids and 160 patients, 162 ears receiving a single course. An analysis of case report gave the following findings:
1) There were no significant differences in age or gender distributions between two groups. However, sudden hearing loss in the second steroid therapy group was more severe than that in the single group.
2) The second course of steroids caused liver function disorder, gastric colic, and elevated blood sugar, but these symptoms were reversible.
3) Hearing prognosis in sudden deafness classified as Grade 4 at the initial examination was improved by a second course of steroid therapy.
4) At the end of the first course of steroid therapy, 68 patients, 69 ears were diagnosed as showing no effects. In this group, 29 patients, 30 ears were treated by a second course of steroid therapy (group A) and 39 patients, 39 ears were treated without further steroid administration (group B). The rate of marked and fair improvement in group A was significantly higher than that of group B.
These findings indicate that a second course of steroid therapy has a significant beneficial effect on hearing level improvement. Finally, a carefully planned second course of steroid therapy appears to be a safe and effective for inveterate sudden hearing loss.

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Tympanoplasty with canal reconstruction was performed on 16 ears with adhesive type cholesteatoma from 15 children of less than 10 years old during 1998-2002. A staged operation was performed in 14 ears and one-staged in two ears.
Our postoperative results of tympanoplasty in the patients were satisfactory as follows.
There was no recurrence of cholesteatoma in 15 of the 16 ears. In only one ear an extremely small pearl-like residual cholesteatoma was easily removed in a second operation. Also there was no recurrence of adhesion of the tympanic membrane in 15 ears, except for one ear in which partial adhesion still existed after a second operation.
Thus, tympaoplasty for adhesive type cholesteatoma in young children seems to be useful for preventing the recurrence of cholesteatoma, and for the restoration of the adhesive tympanic membrane to the normal position.

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Pyogenic granuloma is a benign rapidly growing hemorrhagic lesion that occurs on the skin and the mucosa. As pyogenic granulomas often occur on the oral mucosa during pregnancy, they are called pregnancy tumours.
We report a case of pyogenic granuloma of the auricle. The patient was a 32-year-old woman who was 36 weeks pregnant. She had been aware of a mass in her right auricle for a month. The mass increased rapidly in size, and bled intermittently. Excision of the lesion under general anesthesia was performed about 3 weeks postpartum. Histologic examination revealed a pyogenic granuloma.

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Hereditary hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu disease) is a systemic disorder of blood vessels. The most common manifestation of HHT is recurrent epistaxis, occurring in almost 90% of patients. Management of epistaxis is usually difficult and many types of treatment have been advocated. Of all these treatments, intranasal dermoplasty is considered the most effective one. It reduces the frequency of epistaxis by removing the telangiectasic mucosa and replacing it with a split thickness skin graft.
We report a 55-year-old woman with HHT and recurrent epistaxis who was treated with intranasal dermoplasty. Postoperatively, she has shown considerable reduction in the frequency and severity of her epistaxis.

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We reported two cases of an inverted tooth in the nasal cavity. Case 1 was a 23-year old female who complained of left nasal obstruction. An inverted tooth was found in the left nasal cavity. Computed tomography revealed the inverted tooth had a short root in the alveolar part of maxilla. We performed extirpation of the inverted tooth by an endoscopic approach. It was easy to remove the tooth by the short root. Case 2 was a 35-year old male who had left cheek pain. There was an inverted tooth in the left nasal cavity. We did not treat with him, because he did not want to do so. Since the improvement of endoscopes and their operator's skills, it has become possible to remove inverted teeth by an endoscopic approach.

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Abducens nerve palsy during pregnancy is an extremely rare condition. The case described herein involved a 26-year-old woman presenting with postpartum chronic sinusitis accompanied by abducens nerve palsy. The patient had complained of sinusitis, but did not receive treatment because of her pregnancy. She complained of headache and fever before delivery, and exhibited diplopia just after delivery. On admission, meningitis and chronic sinusitis were diagnosed. She was treated with antibiotics and sinus surgery, which improved her diplopia. Thereafter, meningitis resolved gradually.
Involvement of the abducens nerve in isolation might be attributable to progressive thrombophlebitis affecting the sphenoid sinus, or direct compression by the thickened dura due to meningitis.
There are several reports in the literature concerning otolaryngological conditions during pregnancy. In our case, it appeared that chronic sinusitis worsened because of hormonal changes during pregnancy in addition to the lack of treatment. This case suggests that careful diagnosis and proper treatment of chronic sinusitis are needed even during pregnancy to avoid serious complications such as meningitis.

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Arteriovenous malformations (AVM) are developmental errors that show a high complication rate because these lesions are hemodynamically active. AVM of the tongue is rare. Treatment for these lesions are difficult and recurrence rates are high. We report a 26-year-old woman with an AVM of the tongue who consulted a physician due to severe bleeding from the right side of the tongue. The lesion was diagnosed by angiography and at first, the feeder artery was determined to be the dilated right lingual artery only. The nidus of the AVM was large enough that surgical resection would require reconstruction of the local flap. Therefore, treatment by embolization was chosen. Embolization by coils was performed peripherally to this artery. Angiography was performed again and showed the left lingual artery also fed this nidus. It was also embolized by coils. After embolization, bleeding from the tongue was stopped and at 22 months postoperatively there are no signs of hemorrhaging.

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A case of right non-recurrent laryngeal nerve recognized during surgery for thyroid cancer is reported. The nerve passed directly and transversely from the right vagus nerve to the larynx. This anomaly of the recurrent nerve is known to be associated with an anomalous origin of the right subclavian artery from the aortic arch. In a case in which the recurrent laryngeal nerve cannot be found, we must always be aware of the possibility of non-recurrent laryngeal nerve during surgery.

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Toxoplasma gondii is a protozoan parasite that infects up to a fourth of the Japanese population. Infection is mainly acquired by ingestion of food or water that is contaminated with oocysts shed by cats or by eating undercooked or raw meat containing tissue cysts. Toxoplasma gondii primary infection is asymptomatic in most patients. The most typical clinical manifestation is isolated cervical lymphadenopathy.
We report a case of chronic right neck lymphadenopathy caused by infection with toxoplasma gondii. A 16-year-old previously healthy male visited our department for evaluation of chronic cervical lymphadenopathy. Physical examination revealed multiple painless lymph nodes with a size of approximately 1.5cm in the right submandibular region. The first histological examination revealed stellate granulomas with central necrosis, which is compatible with cat scratch disease (CSD). Sixteen months later, submandibular lymphadenopathy appeared again. The second histological examination was probable toxoplasmosis, which was confirmed with serological tests. Immunoglobulin (Ig) M and IgG antibodies to toxoplasma gondii were detected, which revealed elevated titers of both IgM and IgG, of 20 and 1, 280, respectively. Both of dye test and indirect latex agglutination test for toxoplasma gondii were 1, 024, respectively. The patient was thought to be infected with toxoplasma gondii following CSD. He was successfully treated with Acetylspiramycin (900mg/day) for four weeks without any evidence of recurrence, or side effect.

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A 22-year-old male was found to have a painless mass in the right lateral cervical region. He has a history of neck injury by glass fragments and underwent the removal of pieces glasses seven years ago. A plain X-ray and CT scan of the neck showed a radiopaque mass adjacent to the internal jugular vein. He was diagnosed as having a glass foreign body which had migrated from the time of the past neck injury, and the glass fragment was surgically removed. As the neck is an anatomically very important region containing a great many vessels, cranial nerves and aerodigestive tracts, it is necessary to identify damage and all foreign bodies in cases of neck injury. Radiological studies such as a plain X-ray and CT scan as well as ultrasound studies are very useful in identifying foreign bodies such as glass fragments.

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Quincke's edema is a non-pitting edema which is usually limited to the skin and the mucous membranes of the face and upper aerodigestive tract. The risk of acute upper airway obstruction makes angioneurotic edema a concern for otolaryngologists because prompt recognition of the condition and immediate therapy is essential for proper airway management.
A retrospective chart review was performed on 8 patients (5 men, 3 women; mean age, 58.6 years) who were given a diagnosis of Quincke's edema at Fukushima Medical University Hospital from 1989 to 2003. The major clinical symptom was edema of the tongue and larynx.
In two of the 8 cases, examination revealed low activity of the inhibitor of the first complement of component (C1-INH). We subsequently diagnosed hereditary angioedema (HAE). Three cases experienced an acute episode of angioedema following meals. We subsequently diagnosed food allergy.
Two patients showed recurrent symptoms. Since Quincke's edema occurs suddenly and disappears after a short duration, it is difficult to make a definitive diagnosis. We reported the clinical details of Quincke's edema with special refference to its diagnosis and treatment.

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The clinical effects of Loratadine on patients with seasonal grass pollinosis were investigated by comparing symptoms, medication and symptom-medication scores before and after treatment. We found that the scores after treatment were significantly lower than those before treatment.
These findings indicate that Loratadine is useful for treating seasonal grass pollinosis.

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