Since 26 years ago, we have been operating the extensive turbinotomy with the reconstruction for the congenital septal deviation to the patients with nasal blockade. Sixty-eight was operated for 6 years after begining the operation. In these patients the efficacy for nasal blockade was over than 90% at 1-3 years after operated. However after the 5 years of the operation these efficacy was reduced into 75%. In these cases, all three patients, who had the reoperation for the recurrence of the blocked nose, were under 10 years old with the bronchial asthma. Since 16 years ago, we selected the patients over 11 years old for the operation and gave them the antigen immunotherapy before the operation. By it the efficacy for blocked nose could raise up to 100%.

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A new surgical method was employed in twelve patients with perennial nasal allergies. This surgery was performed under local anesthesia. The submucosal resection of the inferior turbinate bone was performed to improve nasal passages, followed by electrocoagulation of the lamina propria of the inferior turbinate to decrease allergic reactions. The sneezing, watery nasal discharge, and nasal obstruction were improved in over 80% of the patients. A thin crust on the inferior turbinate was seen for only two or three weeks after surgery. This surgery resulted in the suppression of allergic reactions to the intranasal antigen challenge. The eosinophil counts in the nasal smears decreased. The histological examination of the inferior turbinate mucosa showed not only the squamous metaplasia of the epithelial lining, fibrosis and a reduction of edema in the lamina propria, but also the significant decrease in number of the mast cells and eosinophils after surgery. Furthermore, the histamine level in the nasal lavage decreased significantly after surgery. This surgery is apparently a effective treatment modality for patients with perennial nasal allergies.

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The inferior turbinates of over 1200 patients with perennial allergic rhinitis were vaporized by a defocused carbon dioxide laser beam, using specially designed handpieces. The carbon dioxide laser was used under the assumption that the allergic reaction could be inhibited by causing scar tissue formation in the superficial layer of submucosa of the inferior turbinate, where the allergic reaction is considered to occur. Laser surgery can be done under surface anesthesia as an outpatient procedure, and it is painless, with no bleeding. 80% of 156 patients who were checked one year after the laser surgery showed excellent or good results. 78% of 73 patients who were followed for over two years showed excellent or good results ; however, twenty-seven of the 73 patients needed revaporization because of recurrence. Laser surgery is an easy, safe and effective treatment for perennial allergic rhinitis, especially in children.

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Nd : YAG Lasers have been used for excision or vaporaion, but rarely for coagulation. However, we have discovered that laser coagulation of the nasal mucosa is effective in reducing the symptoms experienced by patients with allergic rhinitis. We examined the effect of this laser therapy on 66 adult patients with perenial allergic rhinitis, who tested positively for house dust allergen, and 17 adult patients with seasonal allergic rhinitis to Japanese cedar pollen allergen by CAP RAST test. Results : As for perenial allergen rhinitis. Sufferers 86.4% of patients in laser therapy. When pre-seasonal treatment was performed on those suffering from seasonal allergic rhinitis 62.5% of patients in the laser therapy exhibited excellent results in nasal symptoms.

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We studied 24 patients with perennial allergic rhinitis combined with deflected nasal septum who showed no improvement after treatment with 80w/v % trichloroacetic acid (TCA) on the non-deflected nasal septum side regardless of time course. We determined if TCA was able to suppress reagin dependent allergy by analysis in a two-way classification using the data counting the number of activated eosinophils that existed in the inferior turbinate mucosa of the TCA applied (non-deflected) and non-applied sides. The results showed that the interaction between TCA treatment and eosinophil activation in the applied and non-applied sides was significant (p<.01) and that the ammount of sosinophil activation decreased according to the effects of the treatment.We concluded that if the onset of allergy occursequally and at the same time to both the applied and non-applied sides, we can speculate that eosinophil infiltration to the applied side is decreased due to regional suppression of cytokines effectiveness and that TCA treatment suppress reagin dependent allergy.

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The effectiveness of vidian neurectomy in relieving the symptoms of vasomotor and allergic rhinitis is well established. Since the first description by Golding Wood, various surgical techniques have been reported, namely the transmaxillary, the transpalatal, the trans-septal, and the transnasal. Because they give patients some operative stress and have technical problems, however, they are applied to a very limited number of cases. In this article, a new technique of endonasal vidian neurectomy through a control hole is described. The advantages of this technique include : 1) There is no risk of bleeding from the sphenopalatine artery during the surgery because in this procedure the vidian nerve is approached through the control hole, not the sphenopalatine foramen ; 2) It is possible to operate even on children using the 4mm endoscope because the sphenopalatine foramen is approached from the middle meatus, which is larger than the superior meatus ; 3) There are only two proceduresmaking a short incision on the middle meatal mucosa and creating a small control hole on the vertical lamina of the palatine bone-necessary to reach the vidian nerve ; 4) The blood supply to the nasal mucosa can be preserved normally after surgery because there is no need to ligate the sphenopalatine artery to reach the vidian nerve.

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Photodynamic therapy (PDT) is a recently developed treatment involving the use of a photosensitizer and low power light, usually from a laser, to selectively destroy tumor cells. At present, we perform PDT for head and neck cancer using excimer dye lasers with hematoporphyrin derivative as a photosensitizer. This study attempted to assess the utility and safety of PDT and to investigate the long-term outcome. All 24 patients had squamous cell carcinoma : 15 with laryngeal, 5 with lingual or oral, and 4 with pharyngeal cancer and were treated by PDT. Data were obtained from records from February 1988 through April 1995. Following PDT, 12 of 15 laryngeal cases were classified as complete remissin (CR ), as were 3 of the 5 lingual or oral, and one of the 4 pharyngeal cancer patients. The longest duration of CR in cases treated by PDT alone was 89 months. Photosensitivity was experienced by all patients, but required no treatment. Liver, kidneys and bone marrow showed no abnormal values. There were no clinically relevant adverse reactions and patients with severe complications due to other types of treatment and elderly patients were also treated safely with this therapy.

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When the intact canal wall technique (ICWT) is applied for patients with a low-lying middle f ossa dura, a very narrow space between the posterosuperior bony ear canal and the low-lying dura occasionally hampers the transmastoidal approach to the attic. In such cases, the minimum removal of the lateral part of the posterosuperior bony canal wall is required to complete safe drilling toward the tympanic tegmen, the posterior tympanotomy and the anterior tympanotomy for total removal of cholesteatomas. Because the medial part of the bony ear canal including the scutum can be preserved in most of the cases, the postoperative condition of the ear canal and reconstructed tympanic membrane following this procedure is identical to that following ICWT. Preoperative CT scan is useful for evaluating the extent of bony removal requiring for surgical access to the attic.

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A case of a 4-year-old male with complete type of lateral cervical fistula was presented. The internal orifice of the fistula was recognized at the upper portion of posterior palatine arch, and the external orifice was on the right side of the neck. To confirm the anatomical location of the fistula, fistulography was performed before surgery. The fistula was located from the anterior of sternocleidomastoid muscle, and through the bifurcation of the carotid artery, and penetrated the upper portion of posterior palatine arch. These finding strongly suggested that the origin of the fistula was the second branchial cleft. He had a malformation in his right auricle. Anomaly of the ear frequently occurs from the disturbance in embryonic development of the second branchial cleft. The fistula was totally removed under general anesthesia. Histologically the fistula was composed of squamous epithelium.

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The simple myringoplasty with the use of fibrin glue after Yuasa's method has been commonly applied to the cases with a eardrum perforation. Thereafter, we have attempted to apply the minimally invasive surgery in 280 cases with diseases in the ear including cholesteatoma. It was concluded that tympanoplasty with eradication of diseases in the attic and the mastoid could be successfully performed even in a brief stay in the hospital as a result of many considerations of the surgical procedures as follows : 1) intrameatal skin incision, 2) transmeatal atticotomy with chisels and eradication of diseases, 3) ossiculoplasty with the use of removed ossicles or a tragal cartilage. 4) covering of the bare bone surface of the open mastoid with the chitin sheets (Beschitin-w^®)

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