A weak point of intravenous olfactometry using Alinamin^® (prosultiamine) solution is that angialgia and fluctuation in the pattern of increase in intranasal smell perception are frequently observed during the test. A previous study reported that modified intravenous olfactometry using a 12-ml solution (6 × dilution by adding 10ml of saline to original 10mg [2ml] of prosultiamine solution) injected for 40 s is helpful for avoidance of angialgia and smell fluctuation. The present study was conducted to determine if the modified intravenous olfactometry is generally useful in many smell centers. A total of 143 normosmic subjects in 15 smell centers participated in this study. They were divided into two groups at random and the original or modified intravenous olfactometry was applied. There were no statistically significant differences between these two groups for latency or duration time of smell sensation, or frequency of the angialgia or smell fluctuation. In conclusion, the modified intravenous olfactometry does not exceed the original test in preventing angialgia or smell fluctuation.

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There is no easy method to evaluate the ability of the nose to warm and humidify inspired air, although it is one of the most important functions of the nasal cavity. It is necessary to insert a sensor into the narrow nasal cavity in order to evaluate the ability to warm and humidify, but this procedure is difficult in outpatient care. It has been shown in several previous investigations that even if the cold, dry ambient air goes into the nostrils, air temperature and relative humidity in the nasopharynx will be about 30°C and nearly 90%, respectively. Generally, the ability to warm and humidify inhaled air in the oral cavity is lower than that in the nasal cavity.
We focused our attention on expiration instead of inspiration. We defined the moisture recovery rate as the ratio of the absolute humidity of expired air and alveolar air (43.93 g/m³).
Eighteen healthy volunteers were examined in this study. Statistically, the moisture recovery rates of the nose were significantly higher than oral rates (P<0.001). The moisture recovery rates of the nose after nasal decongestant administration were lower compared to the values before nasal decongestant administration (P<0.01).
In our study, the nasal cavity collected more moisture from expiration than the mouth. Therefore, a dry feeling in the mouth is caused by only mouth-breathing while this situation does not occur in the nose by only nose-breathing. If the nose is medicated with a blood vessel contraction agent, we feel a dry sensation in the nose because the recovery of moisture falls from expiration. We therefore conclude that the moisture recovery rate is an effective reference for evaluation of the humidification function of the nasal cavity during inspiration.

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Nasal obstruction is one of the major symptoms of chronic sinusitis. Improvement of nasal patency might be one of the important factors for objective evaluation of endoscopic sinus surgery (ESS). In this study, we examined whether assessments of nasal patency provided objective evaluations of the efficacy of ESS.
Nasal patency was measured using rhinomanometry (RMM) and acoustic rhinometry (AR). The factors evaluated for nasal patency were nasal resistance in RMM and cross-sectional area (MCA) and 0.5 cm nasal volume in AR.
Two hundred and twelve patients undergoing nasal surgeries and paranasal sinus surgeries, including 40 nasal septoplasties and/or conchotomies, 11 nasal polypectomies, 11 endoscopic mono-sinus surgeries, 68 endoscopic poly-sinuses surgeries and 84 endoscopic pansinectomies, were recruited for this study. For nasal septoplasties and/or conchotomies, bilateral poly-sinuses surgeries and bilateral pansinectomies, all evaluated nasal patency factors were significantly improved, except MCA in bilateral pansinectomy. In comparisons between uncombined and combined surgery with septoplasties and/or conchotomies and nasal polypectomy, even uncombined surgery demonstrated significant improvement in nasal patency.
The results clearly showed that ESS provides significant, reliable improvements in nasal patency measured using RMM and AR. RMM demonstrated statistically significant reductions in nasal resistance, while AR showed significant increases in the minimum cross sectional area and 0.5 cm nasal volume. We conclude that RMM and AR are reliable tools for evaluation of operative outcomes in endoscopic sinus surgery patients.

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Hemangioma of the nasal and paranasal cavities is a relatively uncommon neoplasm, and few studies on this condition have been reported in Japan.
Sixteen patients (8 male and 8 female) with nasal hemangioma were treated in our department from November 2007 to October 2011. There were 9 cases of pyogenic granuloma and 7 cases of capillary hemangioma. The lesions originated most often in the inferior turbinates (7 cases) and the nasal septa (4 cases). The average age was 47.6 years old with the predisposing age in the 50s and 60s. There was no difference between sexes. Essential symptoms were epistaxis and nasal obstruction, and no patient complained of pain. Local excisions with a transnasal approach were done in all 16 patients and no recurrence was observed. Selective embolization was applied preoperatively and controlled hemorrhage well in one patient.
65 cases of nasal and paranasal hemangioma have been reported since 1980 in Japan as far as we could confirm. The histological classification and the clinical features are discussed in these 65 cases and our experience in 16 cases. Since the classification of hemangioma has not yet been established, early unification is desirable.

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Small cell undifferentiated carcinoma in the head and neck region is very rare. We describe our experience with a rare case of small undifferentiated carcinoma of the sphenoid sinus.
The patient was a 71-year-old woman who had complained of persistent nasal obstruction and nasal bleeding. She underwent endoscopic surgical resection of the sphenoid sinus tumor and neck lymph node dissection.
Histological investigation revealed diffuse proliferation of tumor cells slightly larger than lymphocytes and positive immunostaining for S-100, CD56, and AE1/AE3, leading to the diagnosis of small cell undifferentiated carcinoma.
After the surgery, she received chemotherapy with irinotecan and cisplatin and radiotherapy. Nineteen months after the initial treatment, multiple bone and lung metastases were detected.
The patient desired palliative care and has since been treated with low-dose chemotherapy on an outpatient basis.
Small cell undifferentiated carcinoma has a poor prognosis, and so far there is no established standard therapeutic protocol. Here, we report and further discuss the clinical implications based on a literature review.

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The objective of this study was to establish a standard surgical procedure for endoscopic endonasal resection of olfactory neuroblastomas for future prospective clinical studies. We retrospectively reviewed 5 patients (4 males, 1 female) who underwent primary endoscopic endonasal resection of olfactory neuroblastomas. Of these, the Dulguerov stage at presentation was T1 in 2 patients (Kadish A and B in 1 each) and T2 (Kadish C) in 3 patients. The endoscopic endonasal surgery involved the resection of the middle and superior turbinates, cribrioform plate, ethmoidal fovea and olfactory fila with the intraoperative histological analyses of the margins. The main parameters compared were margin assessment, prognosis, preservation of olfaction, and complications. In one T2 case, tumor cells were identified in the margins of the olfactory fila, while resection with negative margins was achieved in the other 4 cases. No recurrence was found during observation periods ranging from 12 to 51 months (median: 25 months). Olfaction was maintained in 3 patients. No postoperative complications were identified. These findings indicated that more precise studies of intraoperative margin in the olfactory fila and dura matter are required for T2 patients.

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A clinical study of 203 patients with epistaxis requiring hospitalization during the past 9 years (2003-2011) is reported. Epistaxis occurred more frequently in males than in females (male:female ratio, about 2:1). The largest numbers of patients were in their 50s to 70s. Epistaxis occurred more frequently between winter and spring, and fewer patients were seen in the summer. The sites of bleeding were an unidentifiable site (47%), followed by Kiesselbach’s area (24%), inferior meatus (8%), and middle meatus (8%). Overall, 55% of patients were treated with gauze packing, 29% of patients were treated with electrical coagulation, and 8% of patients were treated with balloon tamponade initially. Re-bleeding was observed in 46% of patients. Comparing re-bleeding and non-re-bleeding incidences, the percentage of patients with bleeding from Kiesselbach’s area and treated with electrical coagulation was significantly lower and the percentage with bleeding from unidentifiable sites treated with gauze packing were significantly higher in patients with re-bleeding than in patients without re-bleeding. The percentages of patients with any systemic complications, including hypertension and anticoagulant therapy, were not higher in patients with re-bleeding than in patients without re-bleeding. Many patients required follow-up hospitalization, with 24% due to re-bleeding, 22% due to disturbance of consciousness, and 13% due to desire for hospitalization because of anxiety. Only 13% of patients had difficulty in hemostasis, a so-called absolute indication for hospitalization. The average hospitalization period was 7.8 days, including 10.4 days in patients with re-bleeding and 5.8 days in patients without re-bleeding. We suggest that 4 days is necessary for follow-up hospitalization of epistaxis, because follow-up hospitalization patients often developed re-bleeding, and all re-bleeding incidents occurred within 4 days. The initial treatment for patients with unidentifiable site epistaxis was gauze packing in 67%, with a rate of re-bleeding of 74%, and balloon tamponade in 15%, with a rate of re-bleeding of 50%. In 54% of unidentifiable site patients, the bleeding site was identified during hospitalization. We conclude that follow-up hospitalization, especially for intractable epistaxis, is of benefit to allow quick examination and identification of the bleeding site, and it could shorten the therapy period.

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Fibrous dysplasia (FD) is a benign disorder of the fibro-osseous tissue. We report a case of FD occupying the right nasal cavity. The patient complained of right nasal obstruction and rhinorrhea. CT and MRI examination showed an expanding sclerotic lesion in the right nasal cavity compressing the right orbit and cranial base. We performed partial excision of FD by endoscopic endonasal surgery. The debulking technique was chosen, and most of the FD in the nasal cavity was excised without major complications. His nasal congestion disappeared after the surgery, and nasal resistance determined by rhinomanometry recovered to the normal range. The debulking technique could be considered as a therapeutic option for patients suffering from nasal obstruction caused by FD of the nasal cavity.

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