When recognizing severe retraction or adhesion of debris to the tympanic membranes, the otologist tends to regard these as cholesteatoma or adhesive otitis media, and usually performs ear surgery. Some of these could obtain a stable local condition by conservative therapy as an office procedure. This paper reports five cases, in which ear surgery was avoided by conservative therapy. Case 1: A 9-year-old girl consulted our clinic with a long history of otitis media with effusion. A deep atticdefect of the left tympanic membrane with relapsing otorrhea and debris was recognized. A stable condition in the tympanic membrane was acquired by conservative local treatment; irrigation, cleaning, antibiotic ear drip, and ventilation tube insertion. Case 2: A 12-year-old girl was referred for further examination of suspected external canal cholesteatoma. Infected granulation and debris of the posterior bony wall defect were recognized in the right ear. Repeated debridement obtained a smooth epithelized posterior wall with a shallow retraction. Case 3: A 28-year-old male showed right otitis media with effusion accompanying the attic wall defect and debris. Cleaning and debridement stabilized the condition of the tympanic membrane. Case 4: A 37-year-old female complained of recurrent bloody otorrhea from the left ear. Pocket-like retraction containing discharging cholesterol granulation was observed on the posterior quadrant of the left tympanic membrane. Enlargement of the pocket orifice and debridement stabilized the condition. Case 5: A 48-year-old male demonstrated a cholesterol cyst in the tympanic membrane and otitis media with effusion from the left ear. An incision was made in the cyst and a ventilation tube was inserted in the middle ear. A clear retraction pocket remained in the posterior half of the tympanic membrane. Conservative therapy for chronic ear disease not only avoids ear surgery, but also improve the postoperative results when given as a preoperative treatment. Important aspects of this therapy were precise observation under a microscope and fine treatment using otomicrosurgical instruments.

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Changes in pressure in the middle ear cavity and middle ear gas volume were measured in 62 ears having a perforated tympanic membrane (traumatic tympanic perforation in 10 ears, chronic perforated otitis media in 17 ears, and insertion of a tympanostomy tube in otitis media with effusion in 35 ears).
In the patients with traumatic tympanic membrane perforation, changes in middle ear cavity pressure showed elevations that were considered normal, and it was concluded that middle ear cavity volume (measured using the 0.3 ml micro-negative pressure method) and surface area of the mastoid pneumatization on the X-ray film tended to be correlated.
In the 52 ears with chronic otitis media or in which a tympanostomy tube had been inserted, the changes in middle ear cavity gas volume and middle ear cavity pressure suggested a stage of disease at which there seemed to be an inflammatory condition or a pathological condition indicating that the epitympanic cavity was blocked, etc. More specifically, two groups were observed with regard to pressure in the middle ear: a group with traumatic tympanic perforation showed pressure levels that were close to the normal ; and a group in which there appeared to be inflammation and changes in the mucosa of the middle ear.
Measuring changes in middle ear volume in the 13 patients monitored after insertion of a tympanostomy tube in otitis media with effusion was useful tool in evaluating changes in mastoid air cells during the course of treatment and in determining when to remove the tympanostomy tube.
The rate of increase in middle ear pressure in the middle ear cavity was closely related to the physiological gas metabolism, including the mastoid air cells resulting from middle ear disease, and these observations will be important in terms of leaning more about the physiology of the middle ear, especially the physiology of mucosal absorption.

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The subjects studied were chronic otitis media patients treated in the Department of Otorhinolaryngology, Itabashi General Hospital (treatment period: 1993-1994) and in the Department of Otorhinolaryngology, Tokyo Medical College (treatment period: 1988-1990). We performed a detailed statistic analysis of the data on the detected bacteria for a comparative study.
The recently treated patients were infected with S. aureus, P. aeruginosa and fungus in order of decreasing incidence. There was a slightly increasing tendency to single infection. Compared with the results obtained five years ago, the detection rate of Proteus has decreased and the detection rates of ear canal resident floras including Corynebacterium and S. epidermidis have increased. These results suggest the changes in bacterial floras. Regarding drug sensitivity, these bacteria showed high sensitivity to sulfobenzyl penicillin (SBPC), cefoperazone (CPZ) and ofloxacin (OFLX).

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Kimura's disease is a chronic inflammatory disease which often presents as a tumor-like swelling in the head and neck region with formation of lymphoid follicles infiltrated with eosinophils. The lesion is benign, but it may recur after treatment.
This article is a case report of a patients, a 48-year-old male (case 1) and a 56-year-old male (case 2) who presented with kimura's disease. The two cases were managed well by a removal of the mass followed by postoperative steroid treatment and use of tranilast, an anti-allergic drug inhibiting the release of substance such as histamine from the mast cell. There were complete remission of mass for 6 years in case 1 and in 10 months in case 2. These clinical observations suggest that those combined therapy with surgery and medication using steroid and tranilast is a useful treatment of choice in Kimura's disease.

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Three cases of intraparotid neurogenic tumor are reported.
Case 1 is a 27-year-old male as neurofibroma, case 2 is a 39-year-old female and case 3 is a 46-year-old female as neurinoma. The facial paralysis and tenderness were slightly recognized in case 1, but not recognized in the other cases.
Case 1 and case 3 were originated from the main trunks of the facial nerve. Intraparotid neurogenic tumors are rare and show no characteristic findings, so preoperative diagnosis of the disease is rather difficult. When we encounter an unusual tumor in the parotid area, it is necessary to study the relationship with tumor and facial nerve, and to operate carefully.

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This paper reports a case of intranasal button battery causing a septal perforation that occurred in a two-yearold boy. He put an alkaline button shaped battery into his na0sal cavity. Although the foreign body was removed 15.5 hours later without any mechanical damage, it causednecrosis of the mucosa and the cartilage of the nasal septum. This necrosis resulted in a perforation of the septum after 42 days. The most likely mechanism of the perforation in this case was strong alkaline burn caused by the low-voltage current discharge.

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From 1981 to 1984, we studied school children living in Sinagawa Ward, Enzan City and the suburbs of Enzan to know whether our life environment influence the incidence of allergic rhinitis or not.
As a result, the prevalence rate of allergic rhinitis in Shinagawa Ward was the highest. But it was not clear if environment affects the incidence of allengic rhinitis, and if air pollution in Shinagawa Ward had some role. So we studied school children living in Enzan City and the suburbs, we understood that the prevalence rate of allergic rhinitis increased by expansion of the city and rise in population. Changing in life style to European and American may have had some role.
In this research, we found that our life environment may influence the incidence of allergic rhinitis.

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Two cases (sisters aged four and five) with congenital choanal atresia were reconstructed by endoscopic transnasal surgery using laser. Both choanal obstructions were of bony plate in the right nasal cavity. After opening the atresia, we inserted a silastic tube into the nasal cavity. One case developed polypoid tissue around the tube after two months, necessitating extraction of the tube and removal of the granulation, after which the tube was reinserted and left in place for six months. In the other case, the silastic tube remained in place for six months without restenosis. One year after surgery, there was no recurrence of stenosis. Endoscopic transnasal surgery is minimally invasive and an effective method of treating choanal atresia in children.

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There are two different approaches for the reduction of blow-out fractures of the orbital floor, one is through Caldwell-Luc's approach and the other is via the lower eye lid. We have used another approach for the reduction, which is through the middle nasal meatus and fontanelle using a balloon catheter in endoscopic endonasal surgery. We have obtained a good result by this approach. The patient 28-year-old male, diplopia was main complaint. The fracture was only in the floor of the orbit. We diagnosed the fracture on the CT. The number of days between the fracture and operation was seventeen days.
The reduction was performed under endoscopic control, then a Foley-type balloon catheter was inserted through the middle nasal meatus and fontanelle under the microscope. Then the balloon catheter was inflated with water replacing the fracture segments and the orbital contents. The balloon was held in place for ten days. After this treatment diplopia of the case was improved, which was confirmed by an ophthalmologist.
There are numerous literature on the surgical treatment of blow-out fractures of the orbital floor. Usual approach is through Caldwell-Luc's procedure or via the lower eye lid.
Endoscopic endonasal approach has been found to be a useful procedure for the reduction of blow-out fracture of the orbit.

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[in Japanese]

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[in Japanese]

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