Therapeutic effect of amidotrizoate, an ionic contrast medium (76% Urografin) for sudden deafness was found serendipitously by Morimitsu in 1973.The characteristics of this therapy are the high complete cure rate of over 50% in non vertigo group, rapid recovery course, and its minimum daily dose of 1.0 ml.However, its pharmacology in the inner ear and also for sudden deafness had been obscure for last 20 years.
Recently molecular biology of the epithelium of blood vessel is developing dramatically. Torihara et al made an electron-microscopic study of the blood vessels in the stria vascularis using kationized poly-L-lysine conjugated colloidal gold and made clear that the luminal surface of the endothelium is charged in negative by glycoprotein with sialic acid.On the other hand, positive charge of the marginal, intermediate and basal cells in the stria vascularis were reconfirmed
by Sadanaga.Therefore, we concluded that the blood cochlear barrier is an ionic charge barrier locating between the vascular endothelium and the cells in the stria vascularis.
If the negative charge is lost by unknown cause, the ionic charge barrier should be broken down and endocochlear DC potential should decrease causing sudden deafness.In this condition, the luminal surface of the endothelium will be charged in positive by remaining function of the strial cells and the negative ionic contrast medium (Urografin) will bond ionic on the luminal surface making a pseudo-barrier which should be effective for the recovery of the original ionic charge barrier. In conclusion, sudden deafness should be a disease due to break down of the blood cochlear barrier in the stria vascularis and the pharmacology of the contrast medium should be an ionic, or molecular bonding on the luminal surface of the endothelium.

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We report a rare case of bilateral sands bronchial foreign bodies due to falling down a sand hill.A-6-year-old male who was suspected of having foreign bodies in his bronchi accompanied by dyspnea was referred to our hospital.The chest X-ray revealed many bronchial foreign bodies especially in the right lung.A 99mTc MAA pulmonary perfusion scintigraphy was performed immediately, which demonstrated the deficiency of right pulmonary perfusion.
We attempted to remove the foreign bodies using a ventilation bronchoscope under general anesthesia.X-ray perspectivity employed during the procedure was very useful for identifying the foreign bodies which were removed by ventilation bronchoscopy.Almost all of the bronchial foreign bodies were able to be removed, but a few remained where they were because of their location in the peripheral bronchi.These bronchial foreign bodies were brought out spontaneously and gradually by conservative treatment following the procedure.

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Encountering a thyroglossal duct cyst derived from the residal tissue of the thyrogrossal duct in clinical practice is often.However, cancer arising in thyroglossal duct remnant is very rare. Recently we have experienced with a case of papillary adenocarcinoma arising in the thyroglossal duct remnant.Sistrunk's surgical technique was used.During one year the patient did not visit the hospital for consultation.About one year after the surgery she visited another hospital because of waist pain.Then metastatic carcinoma in liver was found on CT.The origin was not known.The patient died two months after the waist pain appeared.This paper is areport of our findings and discussion.

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We report a case of 83-year-old male presenting with the mass composed of clustered bacteria and fungus found in the bilateral Rosenmtiller Fossae.The patient had been complaining of discomfort in the throat for one month prior to visit our hospital.Fiberscopic examination revealed a whitish mass residing in the left Rosenmtiller fossa with caseous appearance and a purulent substance in the right Rosenmtiller fossa.CT scan revealed a nodular mass with some calcification in the left Rosenmtiller fossa. The fiberscopic appearance of the lesion was strongly suggestive of nasopharyngeal carcinoma. However, careful cleaning of the nasopharynx disclosed well-developed Rosenmtiller fossae with normal mucosal surface, and bacteriological and histological examination defined the lesion to be clustered bacteria and fungus.It is speculated that the abnormally wide and deep Rosenmtiller fossae and the age-related reduction of local immunological defense mechanism had offered a good chance to the flora to grow massively.

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We report two patients with Kimura's disease (eosinophilic granuloma of soft tissue).Patient 1 was a 17-year-old man who underwent excision of several ill-defined tumors in the right mental region.Histological examination revealed numerous giant follicles with infiltration by eosinophils, plasma cells and lymphocytes.A diagnosis of Kimura's disease was made. Relapse occurred 32 months later, and immediately after that a similar small tumor appeared on the opposite side.Reoperation was performed on the right side, but part of the lesion near the facial nerve was unresectable.The patient was placed on oral oxatomide therapy and has remained under observation with no increase in the size of the residual tumor or that on the opposite side.Patient 2 was a 39-year-old man who complained of itching of the right retroauricular region and the presence of a mass for 3.5 years.The mass was resected, and histological findings similar to those obtained in Patient 1 indicated a diagnosis of Kimura's disease.This patient was also placed on oxatomide therapy, and there was no recurrence 3 months after surgery. However, since this disease has been reported to recur often after a long period, further follow-up is required.

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Though hemangioma is a benign tumor and generally treated by surgical intervention, a preoperative treatment is often required before operation in the nasal cavity and paranasal sinuses because a good visual field is hardly attainable with great blood flow, predisposing to a risk of massive hemorrhage.In order to minimize the amount of bleeding, the tumor must be enucleated as a mass and its operative mode must be discussed case by case.We recently experienced 3 cases of hemangioma occuring in the nasal cavity and paranasal sinuses, which were subsequently enucleated by transpalatal, transmaxillary and transnasal routes respectively. Arterial embolization was combined with external maxillary anastomosis in 2 cases and the amount of bleeding was successfully minimized in all 3 cases, and the results are reported in this article.

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Prognosis was evaluated in 356 ears of 194 patients with otitis media with effusion.The patients were separated into two groups.Group I included 160 ears of 91 patients who did not need treatment with ventilation tubes.Group II were treated with ventilation tubes.
Relationships between prognosis and background factors of the two groups were investigated.
The prognosis was poor in the following cases: male;tympanic memblane was severely retracted;the age at onset of otitis media with effusion was young;the morbid period of otitis media with effusion was long;the volume of the pneumatic space in the auris media was small; the presence of adenoid vegetation;the presence of complication of chronic sinusitis.
However there was no difference in the level of hearing loss between the two groups.

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Two cases of spontaneous cerebrospinal fluid (CSF) otorrhea without inner ear deformity are reported.
A 33-year-old female was diagnosed as having chronic otitis media and operated on to close a perforation of the tympanic membrane and to improve hearing.The promontorium had been wet for6months.At surgery, the leakage of cerebrospinal fluid was found to be from the mastoid area.
A 34-year-old female came to our hospital with chief complaints of a large amount of bloody otorrhea and otalgia, which developed after blowing her nose.The right tympanic membrane could not be inspected precisely because of the drainage.We could not detect the site of the leakage.The patient was operated on by Lambo's procedure1month after first surgery.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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