Changes of atmospheric pressure not only cause a sensation of fullness, but also hearing loss and alterations of the tympanic membrane (TM). To determine the relationship between morphological alterations of the TM and hearing loss, positive and negative pressures were applied to the external auditory canal (EAC) in seven normal individuals.
The EAC was closed with a tight air plug. A rigid endscope, and a polyethylene tube for application of pressure, were inserted through the plug. The air pressure applied through the tube was varied gradually from -300 to +300 daPa, while the TM was examined endoscopically and all findings were recorded on videotape. Multiple spots were marked on the TM to assist in evaluating the grade of alteration. Hearing tests were also done while the pressure was changed by 20-daPa intervals.
Analysis of the movement of all spots on the TM showed that the pars flaccida and posterosuperior quadrant were the most mobile regions. Although application of 60 daPa caused marked alteration of the TM which was supposed to induce hearing loss, the hearing threshold shift in all subjects was less than 5 dB. In general, threshold shifts of more than 5 dB were obtained with a pressure between 60 daPa and 160 daPa. However, there was no great difference in the alteration of the TM between 60 daPa and 160 daPa.
Based on the above findings, we concluded that morphological changes of the TM played little part in hearing threshold shifts.

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Various methods, including MRI, ultrasound, nuclear medicine, and FNA are used to diagnose salivary gland tumors. To characterize salivary gland tumors, we simultaneously injected two radionuclides (Tc and Tl) and obtained early and delayed images by SPECT. A total of 52 patients with salivary gland tumors were studied. Among them, 42 had parotid gland tumors and 10 had submandibular gland tumors. A dose of 185 MBq of ^99mTcO₄^- and 111 MBq of ²⁰¹TlCl was injected intravenously. Planar and SPECT images were obtained 15 minutes and 3 hours after injection to assess the localization of the radionuclides and determine whether the lesions were benign or malignant. In the early Tc images, the tumor was seen as a defect. If Tl accumulation in the affected salivary gland was greater than that in the opposite normal gland on late images, a diagnosis of malignant tumor was made. A lower level of accumulation on the affected side was considered to be indicatire of a benign tumor. The scintigraphic diagnoses were compared with those established by pathological examination to assess the accuracy, sensitivity, and specificity of this combined scintigraphic method. All of the above rates were 80% or higher. In conclusion, Tl/Tc combined scintigraphy appears to be a useful method for the diagnosis of salivary gland tumors.

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We have obtained good results after surgery in patients with sleep apnea syndrome, especially severe cases.
The patient was a 46-year-old male with chief complaints of snoring, daytime somnolence and thirst. He began to gain weight and have considerable snoring since his age of about 30 years. He visited our department because his symptoms did not improve after a tonsillectomy was performed at a local clinic. At his first visit, he was 169 cm in height and 81 kg. He tended to fall asleep during meetings and at work. He caused 2 traffic accidents. Nocturnal polygraphy suggested severe sleep apnea with a minimum Sa0₂ of 72% and an apnea index (AI) of 66.5. Uvulopalatopharyngoplasty (UPPP) was performed 1 week after nasal septoplasty and turbinectomy. The nasal airway resistance decreased and the pharyngeal space increased after surgery. His body weight decreased to 70 kg after dietary and exercise therapy during his hospitalization. Snoring and sleep apnea improved and daytime somnolence disappeared after the therapy.
It is important to perform both surgery and comprehensive therapy for reducing body weight in patients with sleep apnea syndrome due to upper airway obstruction.

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A 75-year-old man noticing swelling of the cheek was treated at the Department of Internal Medicine without improvement, so he was referred to the Department of Otolaryngology of Odawara City Hospital for therapy. Scintigraphy, computed tomography (CT), magnetic resonance imaging (MRI), and angiography indicated that a right parotid gland tumor rich in adenoma and blood vessels. Surgery revealed a tumor in the masseter, which was extirpated. Since the patient had a history of renal cancer and the histological type of the tumor was consistent with renal cancer, the diagnosis was metastatic renal cell carcinoma. After surgery, the man underwent treatment with interferon for 2 years and, to date, has remained disease-free.
Renal cancer metastasis to the head-neck region is not rare. We report our findings and review the literature.

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We have been performing fenestrations in patients with intractable mucous lesion of the maxillary sinus that are incurable using conventional Endoscopic Sinus Surgery (ESS), such as recurrent polyps (antrochoanal polyps, etc.), severe lesions involving the entire maxillary sinus and accompanied by asthma, and gigantic retention cysts. To perform the fenestration, a sharp blade is inserted into a control hole on the anterior wall of the maxillary sinus. The mucous lesion is then removed by suction.
Post-operatively, 96% of patients showed no abnormalities in the mucous lesion and no signs of recurrence. Partial paralysis of the upper lip was observed in 2 of 35 patients, and a maxillary artery hemorrhage caused by injury to the anterior wall of the maxillary sinus during the formation of the control hole occurred in one patient.

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Recently, a rapid increase in penicillin resistance (Pc^r) of Streptococcus pneumoniae has been reported in most areas of the world. These penicillin resistant bacteria are becoming less susceptible to other commonly prescribed oral antimicrobial drugs, including extended spectrum cephalosporins. We investigated the bacteriologic and clinical characteristics of the flora of the nasopharynx from healthy children (n=72) in Kanazawa, focusing on the presence of Pc^r S.pneumoniae. The most common strains isolated in children were Moraxella catarrhalis (37 strains, 52%), S.pneumoniae (33 strains, 46%) and Haemophilus influenzae (31 strains, 43%). Of the 33 strains of S.pneumoniae, 23 strains (70%) were identified as having Pc^r. No children had recurrent episodes of acute otitis media and no children showed symptoms of acute otitis media on the medical examination day.
Of the 72 children, 10 were attending nursery school. S.pneumoniae was identified from all these children attending the nursery school. Eight (80%) of these 10 children were carriers of Pc^r S.pneumoniae. On the other hand, S.pneumoniae was identified from only 23 (37%) of the 62 children who were not attending the nursery school. Fifteen (65%) of the 23 children were carriers of Pc^r S.pneumoniae. From these data, prevalence of Pc^r S.pneumoniae is very high in young children in nursery school in Japan.
Our results suggest that there is a strong relationship between exposure to large number of children in the nursery school and nasopharyngeal colonization by S.pneumoniae.

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In this study, nasal discharge specimens of patients suffering from chronic rhinosinusitis were examined for bacteria. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrholis were the main types of bacteria that were isolated from the specimens. The patients were assigned to two groups according to age. The first group consisted of patients aged ten or younger, and the second group consisted of patients aged eleven or older. Haemophilus influenzae appeared more frequently in the first group, whereas Pseudomonas aeruginosa appeared more frequently in the second group (p<0.01, p<0.005). When the patients were divited into two groups according to the presence or absence of nasal polyps and asthma, we found that Pseudomonas aeruginosa appeared at a significantly higher frequency in the group with both nasal polyps and asthma than in the other group. Here, we discuss the efficacy of macrolide treatment, to which Pseudomonas aeruginosa are resistant, and present data on patients with nasal polyps who received macrolide treatment.

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The occurrence of deep neck infections has decreased with the advent of antibiotic therapy. However, treatment still requires careful consideration, since delays in treatment may cause severe complications, such as septic shock or DIC leading to death.
Twenty-nine patients with deep neck infections treated at our hospital between 1990 and 1999 are reviewed. Surgeries were performed in 24 of the 29 cases. Six out of seven cases of mediastinitis secondary to a deep neck infection exhibited a good recovery. The remaining case had received conservative treatments for a deep neck infection and systemic disease, such as diabetes, at another hospital that ultimately contributed to the death of the patient.
These results support the conclusion that appropriate surgical treatment in combination with antibiotic therapy is essential for the control of systemic disease.

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Detection rates of bacteria in various types of specimens from outpatients and inpatients seen at the Department of Otorhinolaryngology, Kanazawa Medical University, during the last 10 years, and the antimicrobial susceptibilities of those isolates were investigated. Particular attention was given to Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). The MRSA detection rate was found to be 2.9% (96/3310 strains) during the period from 1989 to 1991 and 6.7% (391/5837 strains) during the period from 1995 to 1999, revealing an increased detection level for the last 5 years. In particular MRSA was frequently isolated from ear discharges, with a detection rate of 39%. By types of specimens, the MRSA detection rate increased in ear discharges but remained unchanged in nasal discharges and tended to decrease in specimens from the throat/tonsil area. The ratio of MRSA detection to S. aureus detection from ear discharges, nasal discharges, and throat/tonsil specimens significantly increased during the 5-year period from 1995 to 1999 compared with that observed from 1989 to 1991. Drug susceptibilities of MRSA were found to decrease for minocycline, norfloxacin, imipenem/ cilastatin, and cefmetazole, but remained at a high level for vancomycin (VCM) and arbekacin (ABK), indicating that VCM and ABK can still be used as the antimicrobial therapy of choice for MRSA infections.

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[in Japanese]

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