To determine differences in perception of nasal obstruction in Canadian and Japanese, we assessed subjective and objective nasal patency of 48 patients in Canada and 43 patients in Japan. Mean severity of the sensation of nasal obstruction in Canadian patients was significantly higher than that in Japanese patients, while no significant differences of unilateral nasal resistances were found. Complaints of nasal obstruction in Canadian patients were directly concerned with nasal breathing while Japanese patients complained of indirect matters such as “unable to concentrate on job or study”, or “nasal obstruction or nasal speech pointed out by other persons”. The differences might be related to nationality and anthropological characteristics and should be taken account when comparisons are made between patients from different racial or national backgrounds.

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A 58-year-old man who had had a nephrectomy due to renal cell carcinoma ten years previously, complained of double vision, visual disturbance and headache. Radiological findings of the skull showed an abnormal shadow on the ethemoid sinus and sphenoid sinus. While CT and MRI revealed the finding of tumor and inflammation in the ethemoid sinus and sphenoid sinus. At the first operation under local anesthesia, there was no pathological evidence of malignancy. The second operation were performed under general anesthesia because of severe bleeding and pain at the previous operation, and it revealed a metastatic carcinoma from the kidney. After operation, symptoms such as visual disturbance and headache were improved, but double vision still remained. The origin and metastatic route of this tumor have been briefly discussed.

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Two cases of rhinogenic meningitis induced by diving are reported. They were a scuba diving instructor, and a skin diving fisherman who both had a past history of chronic sinusitis and face or head trauma. They had both dived even though they suffered from acute exacerbation of sinusitis, and a few days later were admitted to our hospital with severe clinical signs of meningitis and intraorbital inflammation with exophthalmos.
They were treated with bilateral sinuses operation and high dose antibiotics. Bacteriological examinations in both cases revealed Streptococcus pneumoniae from both sinus-exudates and also spinal fluids. As a result of suffering cerebrovascular disease during the course of meningitis, the instructor was discharged with right side hemiplegia and the fisherman was discharged with slight paresthesia of the right fingers. The authors warn that diving should be avoided during acute sinusitis, especially in people having a past history of face or head trauma.

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The pathological states of rhinosinusitis in children differ to those in adults. Therefore, we have to carefully choose surgical treatments and methods for each pathological state. We analyzed 390 adults patients whose chronic rhinosinusitis was treated by endoscopic endonasal sinus surgery (ESS) and 42 child patients whose chronic rhinosinusitis was performed by ESS or Modified ESS [MESS: this procedure is quite similar with function ESS (FESS)].
The following observations and recommendations were made:
1. Recently chronic rhinosinusitis is characterised by reduced severity and increasing involvement with allergy.
2. Rhinosinusitis in children is unstable compared with that in adults.
3. The disease is mainly localized in the ethmoid and maxillary sinuses.
4. Conservative treatment has to be selected as the first choice for rhinosinusitis in children. However, polypectomy should be performed where indicated, because rhinosinusitis with polyps is resistant to conservative treatment.
5. ESS is a suitable procedure for patients who are more than 13-14 years old. On the other hand, MESS (FESS) is adequate for patients who are less than 10-12 years old.
6. ESS is the first choice for moderate rhinosinusitis with polyps and the severe rhinosinusitis in adults.
7. Long term follow up with debredment and/or long term administration of Macrolide antibiotics is essential to obtain good postoperative results.

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Clinical Evaluation of Usefulness of Smell Identification Test (international version) in Japanese Elderly Subjects
The smell identification test (SIT) developed in America is used as a test of olfactory function world wide. This test can be self-administered and use microencapsulated odorants which are released by scratching the standardized odor-impregnated test booklet. The present study evaluated the usefulness of SIT in a large group of Japanese elderly people. The age range of the group was 50-92 with a mean age of 61.17 years (SD=9.72). A ratio of the experiences in each odorants using in SIT was determined by questionnaire. An experience rate of 75% was found for the odors of coconut, black pepper, mint, lime and cherry.
A ratio of the experiences in each combination of odorants was over 80% except for the sixth question. Average test scores decreased as a function of age, with the greatest decline occurring in the seventh decade of life. These agreed with the results obtained by Doty. The present study indicated that the SIT (international version) is a useful olfactory function test for clinical practice in Japan.

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We investigated the clinical effects of long term therapy of the Erythromycin derivatives, Erythromycin (EM), Clarithromycin (CAM) and Roxithromycin (RXM), for chronic paranasal sinusitis. Seventy-one children (younger than 15 years old) and 87 adults (older than 16) were divided in 2 groups based on the presence or absence of nasal allergy.
The patients without nasal allergy were divided into the following 3 groups; group-A was treated with EM derivative alone, group-B with EM derivative and S-carboxyl methyl cystein (SCMC) and grourp-C with SCMC alone. Patients with nasal allergy were treated with anti-allergic agent and EM derivative (goup-D) or with EM derivative only (group-E).
Each EM derivative was administered at half the level of the normal doses and each antiallergic agent was given at the normal doses every day for 12 weeks.
The following results were obtained;
1) The improvement rates of symptoms and rhinoscopic findings were 60% (group-A) and 75% (group-B) in children and 60% (group-A) and 52.9% (group-B) in adults respectively. No significant differencee in clinical effects was observed between children and adults in groups A and B.
2) In group-E, improvement rates were 44.4% in children and 100% in adults, a result that showed significant difference.
In 26 children with chronic sinusitis intermittently treated by the administration of EM or CAM for more than 2 years, 5 (63%) out of 8 patients with no nasal allergy showed improvement of symptoms after 4 month-treatment.
While improvement was observed in 15 (83%) out of 18 patients with nasal allergy after 8 month-treatment.
No remarkable side effects were noted in any group.

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Acoustic rhinometry is a new method for evaluating the geometrical distribution of the crosss-ectional area of the nasal cavity as an area-distance curve (A-D curve). In this study, we analyzed how measurements taken by acousttc rhinometry related to those by rhinomanometry. Nasal resistances of adult volunteers (4 males and 1 female) were compared with those of cylindrical models whose A-D curves were adjusted to coincide with those of the volunteers. The nasal resistance of every subject was markedly different from that of the corresponding model. In order to imitate the pressure flow curve of a model with that of the volunteer, the minimum cross-sectional area could be changed, but the A-D curve of the model became increasingly different from that of the volunteer. These results suggested that the relationship between acoustic rhinometry and rhinomanometry was complicated and that one could not substitute for the other.

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Preoperative and post-operative nasal resistances were compared in 20 subjects who underwent intranasal corrective surgery. Post-operative nasal resistances decreased significantly (p<0.001). In addition, post-operative right and left nasal resistances were almost the same. Our result reconfirmed that the nasal surgery should be performed on the basis of nasal physiology and that intranasal corrective surgery is effective for pathophysiological, conditions of the nose.
The indications for the intranasal corrective surgery are considered to be as follows taking into account symptoms and radiologic findings;
1) Total nasal resistance should be above 2.5cmH₂O/L/sec.
2) The nasal resistances on both deviated and concaved sides of the septum should be above 3.5cmH₂O/L/sec after spraying with epinephrine.

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Agger nasi cells, concha bullosa, Haller's cells and deviation of the nasal septum were evaluated with coronal plane computerized tomographic (CT) scanning in patients with normal paranasal sinuses (44 cases) and patients with chronic sinusitis (91 cases). Agger nasi cells were present in 68 (50.4%) of cases. Concha bullosa was present in 39 cases (28.9%), Haller's cells were present in 15 cases (11.1%), and deviation of the nasal septum was present in 64 cases (47.4%). Haller's cells were more commonly encountered in cases with normal paranasal sinuses (20.5%), than in cases with chronic sinusitis (6.6%). Other bony structural variations were noted at a similar frequency in both groups.
Each sinus (frontal sinus, ethmoid sinus, maxillary sinus and sphenoid sinus) of patients with chronic sinusitis was then evaluated separately. Agger nasi cells were observed more frequently in chronic frontal sinusitis and ethmoid sinusitis compared to subjects with normal sinuses. Concha bullosa was observed more frequently in cases with normal frontal sinuses and ethmoid sinuses than in cases of chronic frontal sinusitis and ethomoid sinusitis. Haller's cells and deviation of the nasal septum were observed at a similar frequency in both groups.
Based on these results, it was thought that these bony structural variations sometimes disturbed the reopening of the normal ventilation and drainage pathways of the paranasal sinuses at the stage of acute sinusitis. These nasal ventilatory disturbances may predispose the patient to recurrent sinusitis and may finally result in chronic sinusitis.

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A 77-year-old man was admitted to our hospital because of a nasal obstruction and swelling of the rght side of the hard palate. He had been suffering from the swelling, without uise of medication for 10 years. Recently, he noticed a slow-growing mass of the right hard palate, associated with pain and nasal obstruction.
The tumor, located in the nasal septum, was 2 by 2cm in size, and obstructed the nasal cavity. CT and MRI revealed a 5 by 3cm cystic lesion, occupying both the nasal septum and the hard palate. Fine needle aspiration cytology from the nose and oral cavity indicated a potential epithelial cyst.
Since a complete resection of the nasal septum and the hard palate and subsequent reconstruction was impossible because of the patient's age, we decided to decompress the large nasal cystic lesion. Under general anesthesia, decompression was performed. A final pathological dieagnosis of pleomorphic adenoma with large cyst was made.
Pleomorphic adenomas are often seen in the major salivary glands. In this case, the adenoma was found in a minor salivary gland of the hard palate, from which it progressed into the nasal septum. Since the incidence of large cystic lesion with pleomorphic adenoma is very rare, this case has been repouted.

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The supernatant of a human squamous cell carcinoma of the Head and Neck (SCCHN) cell lines cultured in serum free medium (AIM-V) were found to induce activation of peripheral blood lymphocytes (PBL) as well as purified natural killer (NK) cells and CD4₊ T cells. When the supernatant was fractionated by Amicon filtration into a >30KDa and <30KDa fraction, the growth- and cytotoxicity-promoting activities were consistently in the >30Kda fraction.
Five of 9SCCHN cell lines secreted different concentrations of IL-6. PCI-107 secreted GM-CSF. IL-4 and IL-6 had significant proliferative effect on 8 of the 9 cell lines. All SCCHN cell lines were sensitive to activated natural killer cell supernatant, 8 of the 9 were sensitive to TNF-α, and several of the cell line were sensitive to INF-α, INF-γ and IL-2.
Our results indicate that the culture supernatants of SCCHN cell lines contain a soluble factor (s) capable of activationg NK and CD4₊ T cells and of promoting growth of these lymphocyte subsets in vitro. SCCHN may be good targets for immuno therapy.

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Topical application of capsaicin, a substance extrocted from “red pepper”, that causes neuropeptidergic sensory nerves to degenerate, has been assessed as a treatment for vasomotor rhinitis and nonallergic rhinitis with eosinophils. We investigated the efficacy and adverse effects a series of applications of a 1mM capsaicin suspension and followep the patients postoperative condition up to 12 months. Capsaicin was applied under lidocaine topical anesthesia to the inferior turbinates bibterally 3 times/day, once a week for three consecutive weeks. Acute abverse effects included pain, spotting blood rhinorrhea and nsal congestion. Local pain continued for 10-30 minutes in most cases, and a dry and/or burning sensation persisted for a couple of days in a few cases. The magnitude of the above effects decreased during the series of treatment. Noasthma attacks or anosmia occurred during or after capsaicin application. Two months after treatment, efficacy against sneezing, rhinorrhea and nasal congestion was 55%, 45% and 25%, respectively. However 45% of the improved patients who suffered a recurrence of sympotoms with 12 months after treatment. Thus improvemeno in sneezing, rhinorrhea and nasal congestion was evident in 30%, 20%, and 15%, one year after capsaicin treatment.

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Acoustic rhinometry (AR) has been used in human to measure nasal airway volume in terms of cross-sectional areas as a function of the distance from nostril and high valuation has previously been described.
In this study we applied AR to the study of guinea pig noses and assessed potential of AR by two methods.
Method 1: Comparison between the result of the measurements by AR and by nasal airway resistance was examined after the antigen challenge in bilateral nasal cavity of guinea pigs sensitized with ovalbmin.
Method 2: The effect of histamine (10²μg/ml to 10⁵μg/ml and saline) on nasal volume was examined by AR, using nonsensitized guinea pigs.
A strong statistical correlation was observed between the measurements by AR and nasal airway resistance. The dose-dependent reduction by histamine was observed in AR measurements.
It was concluded that AR is a useful technique to measure the nasal patency in guinea pig.

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Immunohistochemical staining combined with electron microscopy was employed to investigate the distribution of substance P-immunoreactive (SP-IR) nerve fibers in the tracheal submucosal glands of cats. All the intraglandular varicosities were observed to be in close spatial contact with serous cells, mucous cells and myoepithelial cells. These findings suggesed that SP-induced mucus secretion by airway submucosal glands may be caused not only by glandular contraction, but by direct stimulation of both serous and mucous cells.
The distribution of nonadrenergic noncholinergic (NANC) neuropeptides in serous and mucous glands of the nasal mucosa were quantitatively determined in patients with allergic rhinitis (AR) and in patieuts with hypertrophic rhinitis (HR) as a control. The distribution of SP-IR nerve fibers in the serous glands was significantly higher in AR than in HR. The distribution of calcitonin gene-related polypeptide (CGRP)-IR nerve fibers was also significantly higher in both serous and mucous glands in AR. These findings suggest that transmission of nociceptive sensations by NANC neuropeptides may be enhanced in patients with AR, and this could reflect nasal hyperresponsiveness in AR.
In the thiorphan pre-treated normal human nose, the topical application of SP significantly decreased histamine concentrations, the initial cause of sneezing, when compared with topical saline administration.
The results obtained in these studies suggest that NANC neuropeptides could contribute to nasal hyperresponsiveness via orthodromic and/or antidromic effects.

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The results of surgical treatment of paranasal sinusitis in children and adults were analyzed.
Long-term intra-maxillary intubation was performed to treat 24 children (43 sides) with severe sinusitis, which in almost all cases was accompanied by antrochoanal polyps, since 1985. The sinusitis was bilateral in 19 cases and unilateral in 5. Polyps were present on 26 sides and absent on 17. Intubation was often combined with intranasal ethmoidectomy and turbinectomy under general anesthesia after hospitalization.
The results were evaluated on the basis of the x-ray or CT findings alone. “Excellent” means almost complete resolution of the sinus findings, and “good” means more than a 50% decrease in sinus shadow. Two sides were excluded from the analysis because of unknown results at 4 months after intubation. Efficacy was excellent in 59% of the 16 sides without polyps, but only excellent in 12% of the 25 sides with polyps. The total “good” or better efficacy rate on all 41 sides was 51%. In summary, severe sinusitis in children is difficult to be cured by ventilation of the sinus and drainage of the discharge alone.
Although functional endoscopic endonasal sinus surgery has been becoming more common, severe chronic sinusitis with irreversibly diseased mucosa and recurrence after endoscopic surgery are still indications for radical sinus surgery.
The modified Caldwell-Luc procedure without creating a counter opening has been performed to severe chronic sinusitis (436 sides) in adults since 1986. The efficacy and adverse effects of treatment in these cases were surveyed by a mailed questionnaire survey. “Good” results or better were reported in more than 98.6% of the patients in terms of nasal obstruction, hyperrhinorrhea and headache, but only 88% in terms of hyposmia. However, 20% of the patients still complained of facial dysesthesia after 5 years. In summary, radical antrostomy is still necessary in severely diseased sinusitis in adults and yields fairly good results.

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