An 8-year-old girl complained of a nodule in her nasal vestibule. The nodule was a well-demarcated, dome-like, nodule, reddish-purple in color and elastic soft. The nodule was surgically excised for diagnostic and cosmetic reasons. Histological examination led to a diagnosis of juvenile xanthogranuloma. Juvenile xanthogranuloma is the most common type of non-Langerhans cell histiocytosis. It appears as benign, reddish-yellow, solitary or multiple nodules on the skin, commonly on the face, neck, scalp, or upper trunk. Xanthogranuloma occurs most frequently in infants and children, although adults may also be affected. It is not associated with metabolic abnormalities, hyperlipemia or diabetes but sometimes presents in association with neurofibromatosis and juvenile chronic myelogenous leukemia. No treatment is required because of its self-healing character, although isolated xanthogranulomas are often excised for diagnostic or cosmetic reasons. Xanthogranulomas that cause functional disorder may also be excised. Histologically, histiocytes densely infiltrate mainly the dermis. The cellular infiltrate includes giant cells, Touton cells, lymphocytes, eosinophils and neutrophils. The pathogenesis of xanthogranulomas is not clear, although it is generally considered a reactive granuloma caused by an unknown stimulus. Some reports have described isolated xanthogranulomas occurring at the site of an operation scar or insect bite, suggesting that an external stimulus may be involved in the pathogenesis of some xanthogranulomas. Xanthogranulomas in extracutaneous lesions and visceral involvement have also been reported, the most common extracutaneous site being the eye. Xanthogranulomas in the ear-nose-throat area are relatively rare. To our knowledge, the formation of a xanthogranuloma in the nose, especially in the nasal vestibule, is very rare. We report a rare case of isolated juvenile xanthogranuloma occurring in the nasal vestibule. We believe that an external stimulus may have been involved in the pathogenesis of xanthogranuloma in the present case, since children often touch their nasal vestibules with their fingers.

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We reviewed the case histories of five patients with orbital complications caused by acute sinusitis to characterize the effective treatment of this disease. We treated five patients with orbital complications caused by acute sinusitis in Kanazawa University Hospital between 2002 and 2004. Patient 1 presented with postseptal orbital cellulitis and was successfully treated with intravenous antibiotics. The remaining four patients presented with orbital subperiosteal abscess (SPA) and underwent the surgical treatment (patients 2-5). Of the four patients with SPA, two presented with medial SPA (patients 2 and 3) and the remaining two patients presented with superior SPA (patients 4 and 5). Both patients with medial SPA were children. Patient 2 successfully underwent transnasal endoscopic drainage. Patient 3 initially underwent transnasal endoscopic drainage. However, the patient had persistent periorbital edema and erythema, and a repeat CT on postoperative day 3 showed the anterior extension of the SPA. A second surgical drainage via an external approach was required in this patient. Both patients with superior SPA were adults. Patient 4 underwent transnasal endoscopic drainage at another hospital. However, the patient had persistent periorbital edema and erythema and was referred to our hospital. This patient required combined drainage via both endoscopic and external approaches. Patient 5 initially underwent combined drainage via both endoscopic and external approaches. In summary, medial SPA can be drained via an endoscopic approach in many cases. However, some cases may require drainage via an external approach. Superior SPA may be successfully drained via an endoscopic approach; however, the risk of incomplete drainage appears to be high.

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Seven patients with inflammatory paranasal sinus disease and cystic lesions of the sinuses accompanied by visual disturbances were surgically treated at our institution between 1994 and 2005. The average age of the patients was 54.3 years old. Lesions were found in the ethmoidal sinuses in 4 patients, in the sphenoidal sinuses in 4 patients, and in the maxillary sinuses in 2 patients. Six of the patients first visited the Ophthalmology Department and one patient first visited the Otolaryngology Department. The visual disturbances improved after surgery in 5 patients, but not in 2 patients. The average interval between symptom onset and surgery was 5.2 days in the group in which the visual disturbances improved and 36 days in the group in which the visual disturbances did not improve. Early diagnosis and prompt surgical management are indispensable in the treatment of visual disturbances caused by paranasal sinus disease.

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In the three cedar pollen seasons between 2002 and 2004, we evaluated the efficacy and safety of olopatadine hydrochloride, a second-generation antihistamine, in patients naturally exposed to cedar pollen outdoors. Results show that olopatadine hydrochloride rapidly relieved the main symptoms of pollinosis—sneezing, nasal discharge, nasal congestion and itchy eyes—even at the peak of pollen dispersal. The incidence of sleepiness, the most common adverse reaction to antihistamines, was similar in patients given olopatadine hydrochloride and those receiving placebo, suggesting that it has a favorable safety profile.

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Extramedullary plasmacytoma is a rare plasma cell tumor. We report two cases of extramedullary plasmacytoma, one arising in the nasal cavity and the other in paranasal sinuses. Both patients received chemotherapy, and the response was good. However one patient experienced local recurrences twice. Additional radiation therapy was effective, and no more recurrence developed within 6 months.

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Sarcoidosis is a granulomatous disease of unknown cause that involves systemic various organs. The diagnosis of sarcoidosis is usually made with histopathological examination, characterized by non-caseating epithelioid granuloma. We report two cases of sarcoidosis of the nasal cavity and paranasal sinuses. Case 1 (paranasal sarcoidosis) is a 44-year-old man, who reported internal compression sensation in the left eye. He had pulmonary sarcoidosis at age 34 and uveitis at age 39. His left eye problem led to a checkup in ophthalmology. Brain MRI showed an abnormal signal in the left frontal and ethmoid sinus. Significant changes had occurred in the nasal cavity. Paranasal CT showed soft tissue density in the left frontal and ethmoid sinus. Gd enhanced, T1-Weighted imaging MRI showed a contrasting effect in the left ethmoid sinus. Intranasal endoscopic surgery identified a fragile granulomatous lesion in the left anterior ethmoid sinus. Histopathological examination showed non caseating epithelioid granuloma resulting in paranasal sarcoidosis. Topical steroid was administered for three months after nasal surgery. Case 2 (nasal cavity sarcoidosis) is a 42-year-old man. He reported nasal obstruction, discharge, and intranasal dryness. He had pulmonary sarcoidosis at age 20, uveitis at age 32, and nerve sarcoidosis at age 35. He suffered from nasal obstruction, discharge, and intranasal dryness for 12 years. Dermal sarcoid was seen in the frontal skin. Nasal mucosa were covered by a crust of blood and exudate. Paranasal CT and MRI showed abnormal density in the left ethmoid sinus, maxillary antrum, and frontal sinus. Intranasal surgery was recommended, but no informed concent was obtained. Mucosal biopsy from the left inferior nasal turbinate was performed and a definite diagnosis of sarcoidosis was made. Topical steroid therapy was not administered at the patient's request.

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Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) are the most common pathogens in upper respiratory infections. Increasing antimicrobial resistance of such bacteria, particularly in infants, give rise to a stubborn therapeutic problem. We surveyed these bacteria in the nasopharynx of infant patients with upper respiratory infections. We isolated 160 strains of S. pneumoniae and 162 of H. influenzae, from 234 infants (0-6 years with an average age of 1.6 years) from 2000 through 2004, and subjected them to antimicrobial susceptibility tests by broth microdilution. Penicillin-resistant S. pneumoniae (PRSP) and β-lactamase-negative ampicillin-resistant H. influenzae (BLNAR) were higher in 2004 (20.0% and 52.2%) than in 2000 (7.5% and 30.7%). S. pneumoniae was susceptible to panipenem/betamipron (MIC₉₀=0.06μg/ml) and cefditren pivoxil (MIC₉₀=0.5μg/ml), while H. influenzae was susceptible to levofloxacin (MIC₉₀=0.12μg/ml), ceftriaxone (MIC₉₀=0.25μg/ml), meropenem (MIC₉₀=0.25μg/ml), and minocycline (MIC₉₀=0.5μg/ml). We next surveyed S. pneumoniae and H. influenzae in the nasopharynx of 188 preshoolers (0-6 years with an average age of 2.8 years) in 2004. S. pneumoniae and H. influenzae were detected in 81 (43.1%) and 71 (37.8%) children. PRSP was only 1.3%, but penicillin-intermediate S. pneumoniae (PISP) was 39.5%, indicating potential prevalence of resistant S. pneumoniae. The rate of BLNAR (39.4%) also showed a high prevalence of resistant H. influenzae among preschoolers. We studied the postoperative change of resistant bacteria in the nasopharynx of 6 children (2-6 years with an average age of 3.5 years) who underwent adenoidectomy. Resistant S. pneumoniae and H. influenzae disappeared in 5 patients (83%) 7 to 12 months after surgery, suggesting that adenoidectomy is a promising alternative to control of such resistant bacteria in the upper airway. Epidemiology, prophylaxis, and management of upper respiratory infections caused by resistant bacteria in infants are reviewed based on the literature.

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