Sudden deafness (SD) is a sensorineural hearing loss with an abrupt onset and of unknown origin.
SD was designated as a specific disease by the Ministry of Health and Welfare of Japan in 1973. Since then, studies on SD have rapidly advanced.
SD is particularly noted as one of the most remarkable sensorineral hearing loss, because of hearing recovery in earlier stage.
Present study was conducted to clarify nationwide epidemiol gical surveys, treatments and prognosis.

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To dissect a cytokine network concerning the bone destruction in cholesteatoma otitis media, surgically obtained cholesteatoma tissues were cultured under various conditions and the culture supernatants were analyzed for the cytokine concentration as well as bone resorbing activity.
The results were as follows: 1) Bone resorbingactivity derived from cholesteatoma tissue was ascribed to IL-1α. 2) TNFα and IL-1α formed a vicious circle by accelerating their own production reciprocally. 3) IL-6, which was induced by IL-1α, proved to be an indirect feedback inhibitor of IL-1α through suppression of TNFα. 4) GM-CSF and TGFα also augmented the generation of IL-1α.
These results suggest that a complicated cytokine network around the vicious cycle between IL-1 α and TNFα was recognized in cholesteatoma otitis media, and that once this network is triggered, it goes in the direction of accelerating IL-1α production and the generated IL-1α would relate to the bone destruction in cholesteatoma.

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A case of benign thyroid tumor causing sudden dyspnea and cardiac arrest is reported. There is no such previous report in the literature.
A 64-year-old female had developed an anterior neck mass of 2-years duration, who had a sudden onset of strider and dyspnea.
She had a cardiac arrest in another hospital. She was revivificated and referred to our hospital for further examination and treatment.
Five days later, she underwent a tracheostomy and subtotal thyroidectomy. Pathology report of the thyroid tumor was diagnosed as a follicular adenoma with intragladular hemorrhage.
Massive hemorrhage in the thyroid gland may be have related to the rapid growth of the thyroid tumor causing airway obstruction.

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A 17-year-old boy with sensorineural hearing loss caused by Kendo practice and his brothers' audiograms were reported with review of rele-vant literature. The oldest brother had a c⁵ dip type audiogram in both ears. His next younger brother (14 y/o) had a dip type hearing loss at 2 kHz in the left ear. His youngest brother (11y/o) had normal hearing on pure tone audiogram.Sensorineural hearing loss caused by Kendo practice is known to progress according to years of Kendo experience. Cause factors of hearing loss in Kendo prctice is thought not only due to noisy enviroment but also due to direct injury against the inner ear by a facer of bamboo sword. Kendo is a Japanese traditional way of sword and now worldwide sport. Routine test of hearing is needed for Kendo players.

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We report two cases of bilateral multiple parotid tumors. We operated on both parotidglands in both patients. Case 1 was a 41-yearold man diagnosed as bilateral malignant lymphoma of the parotid gland thought to have originated in the parotid gland. We found 6 intraparotid tumors and 3 extraparotid tumors on both sides. Case 2 was a 49-year-old man diagnosed as bilateral Warthin's tumor of the parotid gland. We found 4 tumors on the right side and 2 tumors on the left side. CT scan and echogram were performed to both sides in case 1, but the images showed features of benign tumors.Care is required in diagnosing parotid tumors, because malignant lymphoma of the parotid gland origin tends to be misdiagnosed as a benign tumor.

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Although dermoid cyst develops in variousorgans, development on the floor of the mouth is relatively uncommon. Among the various types of dermoid cysts on the mouth floor, teratoid cysts are quite rare. This paper reports a teratoid cyst which originated in the floor of the mouth.
The patient was an 18-year-old female. She visited the department of otolaryngology, Tokyo Medical College, with complaint of indistinct speech that had been pointed out. By examination, a hemispherical mass of 30×40mm was observed on the floor of her mouth. CT and MRI disclosed a mass in the central part of the mouth floor. This mass was diagnosed as a cyst. Under general anesthesia, the tumor was removed surgically by intraoral approach. Histological examination revealed that this was a teratoid cyst because it included the smooth muscle.

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We evaluated 10 cases of deep neck abscess treated in this hospital and report on 4 of them. These are one case with complicated diabetes, one case which recurred after leaving hospital, one case with mediastinal abcess and one case of parapharyngeal abscess.
As for the anaerobic bacteria causing inflammation and the choice of the effective antibiotics, we primarily chose LCM and CLDM and considered that the prescription including penicillins or cephem would be appropriate.
CT scan is useful for the diagnosis, and it is important to check the disappearance of the abcess by CT scan before and after the treatment.
The complicated cases tend to become serious, therefore the blood glucose level is also important.

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Mumps is well known as one of the causes of acute sensory neural hearing loss. There are two hypotheses why mumps hearing loss happens; one is caused by virusemia and the other meningitis spreading to the inner ear by cerebrospinal fluid.
Here we report a case of acute hearing loss with vertigo due to mumps infection. In this case, severe high tone hearing loss was noted. Low tone hearing level slightly recovered after 3 months from the onset. At the onset, caloric test had showed no response on the affected side which recovered 3 months later.
Although it is generally accepted that mumps deafness rarely shows improvement, we should try intensive treatment for patients at the acute phase of mumps deafness.

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To evaluate the efficacy of Roxithromycin (RXM) on chronic sinusitis, 42 patients candidated for this trial. They were orally administrated 300 mg of RXM for a period of 4 weeks. Changes in subjective symptoms and objective findings of the nose were assessed according to a criterion for judgment, and improvements of Xray findings were also macroscopically judged. The improvements of X-ray findings by macroscopical judgment were 20.9% in the maxillary sinuses and 34.6% in the ethmoid sinuses, respectively. Changes in ratio of the optimal densities in the maxillary sinuses/the optimal densities in the orbits were assessed by a computer analysis. The overall improvement was assessed by changes in subjective and objective findings. They were 74.0% with the computer analysis, 42.8% without the computer analysis, respectively.

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To clarify the usefulness of the folded silastic sheet in staged tympanoplasty, 135 patients who had undergone staged tympanoplasties from 1977 to 1993 were divided into 3 groups regarding to the preventive method of re-adhesion between eardrum and promontry wall. No material was inserted into the tympanic cavity for the prevention of adhesion in group A (43 cases). One piece of simple shaped silastic sheet was inserted in group B (32 cases) and a folded silastic sheet was inserted from the tubotympanum to mastoid cavity in group C (60 cases). The findings in the second stage operation and the postoperative hearing results were compared among those 3 groups.
Granulation tissues in the tympanic cavity were less frequently observed in group C (6.5%) than in group A (65.2%) and B (43.8%), andantral blocks were also less frequently found in group C (10.9%) than group A (78.3%) and B (47.8%).
Moreover, the postoperative hearing results in group C were better than in group A or B These results suggest that the folded silastic sheet is more efficient to prevent re-adhesion andproliferation of fibrous tissue in the tympanic and mastoid cavity than the simple shaped one.

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CO₂ lasers have been widely used in laryngomicrosurgery for the treatment of laryngeal lesions. The usefullness of CO₂ lasers in treating early glottic cancer has been well documented. Here we introduce CO₂ laser surgical procedures in laryngomicrosurgery using a direct laryngoscope with postero-lateral side opening. We used a new type of direct laryngoscope featuring an opening from the mid-portion to the posterior end of the right side. This configuration enabled easy insertion of the forceps to perform biopsy through the right postrolateral side opening. The surgery was performed under inhalation anesthesia by endotracheal intubation. In this paper, this is demonstrated with clinical case reports and discussed from the viewpoint of the surgical manipulations required to perform the CO₂ laser surgery precisely.

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[in Japanese]

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