It is impossible to learn the spoken language for infants with hearing loss of more than 100 dB by the use of hearing aids, as they cannot discriminate speech sounds. Acquisition of a normal language is inly guaranteed for very young children. It is several years since cochlear implants have been popularly applied for the young deaf children, and most of them have shown a remarkable improvement in speech ability after two years' training. Therefore, cochlear implants should preferably be performed for congenital deaf children up to the age of one to three, instead of continuing the auditory-oral training with hearing aids. This recommendation is also reasonable from the study on maturational changes of the auditory cortex of the brain.

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Endoscopic sinus surgery for chronic sinusitis leaves pathological mucosa at maxillary sinus, frontal sinus and sphenoid sinus, and therefore it is interesting to observe how diseased mucosa of pathological sinus takes its healing process after surgery. Outcome of operation was good in some cases even thought they were in severe condition during surgery, while it was poor in some cases even though their condition was not very severe. Therefore, there should be some factors which affect post-surgery healing process other than severity of the disease. We examined maxillary sinus to find out if post-surgery improvement level is related to endoscopic findings and/or pathological findings.
By collecting maxillary sinus mucosa, we examined healing process of chronic sinusitis of cases who underwent endoscopic surgery for the first time. After one year, we examined the condition of the maxillary sinus based on endoscopic findings and classified it into “cured, ” “good, ” “fair” and “poor.” Cured and good were considered as satisfactory healing. We also studied relationship between endoscopic findings and improvement, and between pathological findings and improvement. Then we compared improvement by age, whether sinusitis is unilateral or bilateral, and the presence/absence of nasal allergy or asthma.
There were a total of 122 cases (N=216), their age ranged from 10 to 78 years, they were 89 males and 33 females, and their disease was bilateral in 94 cases (N=188) and unilateral in 28 cases (N=28). Eighteen cases had nasal allergy (N=33), 16 cases had asthma (N=31 ; 4 cases had also nasal allergy but included in the asthma group), and 88 cases had no these complications.
We classified maxillary sinus findings by thickness of mucosa and contents of sinus. Mucosal thickness was classified into mild, moderate and severe. Maxillary cavity findings were classified by contents into (1) none, (2) polyps, (3) cysts and (4) fluids (such as mucosal secretion and pus). Light microscopic findings of edema, fibrosis and cellular infiltration were rated by 3 grades, and their improvement was compared. Cellular infiltration was further classified into mononuclear cell-dominant one and eosinophil-dominant one. The improvement rate (percentage of “cured” + “good” cases) in all patients was 82. 9%, while “fair” and “poor” were observed in 14.3% and 2.8%, respectively. The improvement rate was 92.9% and 79.3% in case with unilateral and bilateral sinusitis, respectively. This rate was 97.0% in cases with nasal allergy and 48.4% in cases with asthma. Overall improvement level of cases with nasal allergy was satisfactory even when compared with no complications. On the other hand, cases with asthma showed poor improvement. when the level of thickness of maxillary mucosa was compared, the improvement rate in cases with mild thickness was excellent (98.7%). The improvement rate was 78.9% and 75.0% in cases with moderate and severe thickness, respectively. When the improvement rate was compared as a function of the contents of the maxillary cavity, it was excellent in cases with no contents (95.1%), and the rate was 89.0%, 82.0%, and 68.0% in cases with fluids, cysts and polyps, respectively. The result was the poorest in cases with polyps.
Regarding light microscopic findings, the severity of edema, fibrosis, infectious cells and infiltration had no relationship with the outcome of the disease. However, the improvement rate was poorer in cases showing eosinophil-dominant infiltration than cases showing mononuclear cell-dominant infiltratoin. Eosinophil dominance was seen in many cases complicated by asthma. There was no significant difference in the improvement rate between cases with nasal allergy and those without it. Even in cases without asthma, the improvement rate was poor when they had eosinophil-dominant infiltration.
The above results

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Hyperresponsiveness of the nasal mucosa to allergens can be studied from two different aspects, its sensitivity and reactivity. The reactivity of the nasal mucosa was studied by a repeated nasal provocation test in volunteers with Japanease cedar pollen allergy in a pollen-free seasen, and the results were analyzed for correlation with symptoms observed in the actual pollen-spreading season. Supposing that patients with pollen allergy are repeatedlly exposed to the same antigens within the same day, 18 volunteers were repeatedly exposed to allergens every one hour for a total of six times in a pollen-free season. The symptoms became somewhat milder as the number of provocations increased, but the difference was not statistically significant.
Supposing that patients are exposed to the same antigens every day, 23 volunteers were exposed to the same antigens once a day for 6 consecutive days. As a result, induced symptoms significanty increased as the days went by, and the levels of triptase and ECP in the nasal lavage significantly increased in a high response group. Of volunteers who participated in the 6-day provocation test, 8 voluteers were obserbed for 3 months in the pollen-spreading season without treatment. The severity of allergic symptoms was clearly different between the high response group and mild response group identified in the 6-day provocation test, suggesting in creased reactivity in the high reponse group. This study demonstrated that individual difference in the responsiveness and augmentation of reponsiveness can be known based on the results of repeated nasal provocation in a pollen-free season. The high-responce group and mild response group as classified by the provocation test were in agreement with the time course of changes in symptoms observed in the actual pollen-spreading season.

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It was reported that nocturnal secretion of growth hormone was impaired in patients with adult Obstructive Sleep Apnea Syndrome (OSAS). Growth hormone secretion in children is strongly associated with slow-wave sleep, and the peak generally occurs 30 to 90 minutes after sleep onset during slow-wave sleep. We studied the effects of sleep breathing disorders in children on growth hormone secretion during sleep.
Subjects and methods :
Subjects : Of children who underwent adenotonsillectomy between July I, 1995 and June 30, 1996, 21 children (13 boys and 8 girls) aged 4-12 years (mean : 7. 10 years) who had had snoring were chosen for this study.
Method : We investigated urinary growth hormone levels of the children undergoing adenotonsillectomy before and after operation using the technique of radioimmunoassay.
Analysis : We compared urinary growth hormone levels determined before and after adenotonsillectomy by statistical analysis.
Results : There was no difference in the levels of urinary growth hormone between before and after operation.
When group 1 children with forced respiration during sleep and group 2 children with no forced respiration were compared, there was significant increase in urinary growth hormane level in group 1 after surgery. But there was no significant difference in group 2 between pre-and postoperative growth hormone levels.
Conclusion : OSAS leads to disordered sleep architecture and impairs the physiologic slow-wave sleep, resulting in decreased growth hormone secretion. OSAS in children often occurs with tonsillar adenoidal hypertrophy.
In children with forced respiration during sleep, urinary growth hormone level increased significantly after adenotosillectomy.
Nocturnal secretion of growth hormone in children with sleep breathing disorders improved after adenotonsillectomy, because the rate of slow-wave sleep increased.

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This time, we studied clinically 33 cases who were histopathologically diagnosed as having parotid tumors during the 6-year period from 1991 to 1996. Of the 33 cases with parotid tumor, 29 cases (88%) had benign tumor and 4 cases (12%) had malignant tumor. In terms of histological type, 15 cases with pleomorphic adenoma accounted for majority of cases with benigh tumor, and malignant tumors consisted of one case each of adenoid cystic carcinoma, moderately differentiated squamous cell carcinoma, acinic cell carcinoma and malignant lymphoma. We studied clinical symptoms, therapeutic methods and clinical courses in these cases.

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The psychosomatic state of 81 patients with a complaint of lump sensation in the throat was evaluated by the Cornell Medical Index (CMI) and the Self-Rating Depression Scale (SDS).
The results were summerized as follows ;
1. CMI test revealed that I area of CMI was 40% and II area of CMI was 43%.
2. The average of the raw scores of SDS test was 35.6 and the standard deviation was 7.6.
3. Minor tranqulizers et al. were prescribed to 66 patients.
4. The effects of the medicine were similar regardless of the results of CMI test.
5. The drugs showed greater effects in patients who were evaluated as normal in SDS test.

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We report a case with an ectopic tooth in the maxillary sinus.
A 34-year-old female was referred with complaint of postnasal drips. On X-ray, an opaque foreign body was found in the right maxillary sinus. On CT scans, it showed the same density as bone and included a low-density region in its center, which appeared to be pulp of tooth. Three-dimensional image reconstruction by helical. CT scans revealed connection between the mass and the posteroinferior wall of the sinus. From these findings, it was considered to be an ectopic tooth. Because it was accompanied by chronic sinusitis, and because we were unable to rule out osteoma, we decided to extract it.
Operation was performed via Caldwell-Luc approach. Since the extract appeared to be a molarlike tooth, and the third molar of the right maxilla was missing, we concluded that the wisdom tooth of the right maxilla had erupted in the maxillary cavity. Possibly, tooth germ of the wisdom tooth got inverted accidentally in the childhood, and erupted in the cavity later.

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[in Japanese]

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