There are patients with bad postoperative courses after surgery for chronic otitis media, and they require revision surgery or medical treatment. The most indicative cause for revision surgery is failure in the surgical technique, recidivum and complications. An open mastoid cavity is a frequently observed complication of middle ear surgery.
It is very important before performing revision surgery to know which surgical method was used in the previous operation and to understand the present pathological condition. CT and MRI can provide reliable information. In the revision surgery, we can not obtain a patient's consent for a surgical procedure without a near hundred percent certainty of a success. It would be preferable to reduce the open mastoid cavity by mastoid obliteration to avoid mastoid cavity problems and recurrent cholesteatoma.

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We attempted to establish a method for stage classification of the clinicopathological state of chronic sinusitis and examined its validity. The subjects were adults with bilateral chronic sinusitis, but no history of sinus surgery. Assessment was performed on the basis of three clinical evidence factors : the radiographic findings (R), the results of allergic examinations (A), and the endoscopic nasal findings (N). The findings were assessed and scored, and each case was classified as Stage I to Stage V on the basis of its total score. The clinical cases (conservative therapy group : 94 cases ; surgical therapy group : 350 cases) were analyzed for intercorrelations among the R, A, and N factors and in terms of the results of therapy. No correlations were fonud among the R, A, and N factors, and it was concluded that they are suitable as independent factors for performing the staging work-up. The R, A, and N factors influenced the results of therapy in both treatment groups. It was concluded that it is important to give careful consideration to the A and N factors before instituting conservative therapy of chronic sinusitis, and to the R and A factors before undertaking surgical therapy. Moreover, the outcome of both the conservative and surgical therapy approaches became significantly worse as the pretreatment disease stage increased. It was concluded that this staging method accurately describes the clinicopathological state of chronic sinusitis, that it reflected in the therapeutic results, and that it will be highly useful clinically.

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To clarify the nature of the reaction pattern of the nasal mucosa in allergic rhinitis, nasal lavage with distilled water was performed in 9 patients with allergic rhinitis to Japanese cedar and cypress pollen in a non-dispersion season, and the protein concentration of the nasal washes was determined. Nasal lavage with saline solution was performed as a control, and the same procedure was performed in normal controls. The total protein, albumin, and 26 kD protein concentrations were higher in distilled water than in saline solution in the both allergic rhinitis patients and the normal controls. In particular, the concentration of albumin was 2.1 times higher in the distilled water lavage fluid in allergic rhinitis. However, the concentration of 26 kD protein was 3.4 times higher in the normal controls. These findings indicate that the nasal mucosa of patients with allergic rhinitis is reactive to distilled water, especially in regard to vascular permeability.

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It is important to identify the precise location of the obstruction in obstructive sleep apnea syndrome (OSAS) in order to select the most appropriate surgical procedures to treat it.
Eight adult OSAS patients were chosen for this study. Nasendoscopy was performed during a sleep study (drug-induced sleep) to identify the precise location of the obstruction. All-night PSG was performed to evaluate the sleep breathing disorder.Intrapalatine resection (IPR) was performed. Mean Apnea Hypopnea Index (AHI) significantly decreased from 45.93 ± 16.02 times/hour before surgery to 15.27±10.81 times/hour (p<0.01) after surgery. The rate of improvement of AHI after the operation was 66.75%, and % stage 3+4 increased significantly, from 2.09±2.24% to 5.14±3.60% (p< 0.05). Mean SaO₂ decreased from 93.2 ± 3.4% to 94.4 ± 1.8%, and %90 < SaO₂ decreased from 17.2 ± 14.9% to 5.8 ± 9.9%. Mean MSLT increased from 403.50±153.90 sec to 569.71±236.63 sec. There was no statistical difference between the preoperative and postoperative mean SaO₂, %90 <SaO₂, or mean MSLT values.
We conclude that IPR is a useful method of treating OSAS when the examination indicates that the obstruction is caused by soft palate.

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One hundred and fifty patients with postoperative maxillary cysts were treated at the Tokyo Medical and Dental University Hospital between 1988 and 1999. Twenty-one of these cases exhibited ocular symptoms. These ocular symptoms included exophthalmos, diplopia, epiphora, and reduced vision.Exophthalmos and epiphora are frequently occurring symptoms. The former symptom is common in patients with central maxillary cysts, while the latter is common in patients with supramedial cysts.
Reduced vision is rare in patients with maxillary cysts, and its pathophysiology is thought to differ from that which is associated with ethmoid and/or sphenoid paranasal sinus cysts.
In the present study, 2 patients experienced a reduction in vision as a direct result of the cyst having invaded the orbita. The eyeball was deformed in both cases, and the reduction in vision is thought to have been produced by retinal degeneration. Prompt surgical treatment and a full ophthalmologic examination, including intraorbital pressure and an examination of the retina, is thus advised to alleviate reductions in vision associated with postoperative maxillary cysts.

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The pathological condition and postoperative course after endoscopic sinus surgery were investigated in patients with chronic sinusitis complicated by asthma. Out of all sinusitis cases operated on during the course of one year, asthma complications were present in 38 cases (14.3%). The improvement in the sinusitis following endoscopic sinus surgery was associated with some improvement in asthma in most cases. In cases complicated by non-atopic adult-type asthma, the sinusitis is usually quite serious in nature. Elevated peripheral eosinophil counts, a positive past history of aspirin-induced asthma, and otitis media complications are often present. In several cases, recrudescence occured about 1 year after the operation. Based on these findings, we recommend that follow-ups and ongoing treatment be provided for a prolonged postoperative period in cases of chronic sinusitis complicated by asthma, especially those cases complicated by non-atopic adult-type asthma.

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Renal cell carcinoma often metastasizes to the lung, bones, and liver, but rarely to the otolaryngologic organs. After citing some references, this report presents a patient with renal cell carcinoma, that metastasized to the maxillary sinus and lungs.The patient survived for seven years and seven months by undergoing conservative therapy.
When renal cell carcinoma metastasizes to the maxillary or ethmoidal sinuses, massive nasal hemorrhage often necessitates frequent blood transfusions. Also, as the metastasized tumor grows, exophthalmus and dermal infiltration can cause double vision and changes in facial features. Tumor progression in the mouth region can cause eating impairment. When these conditions lower the patient's QOL, the metastasized paranasal sinus tumors should be resected. Even if the renal cell carcinoma has metastasized to other organs, such as the lung, the paranasal sinus tumors should be resected as long as the prognosis is relatively favorable, i.e. the following conditions are met : (1) recurring massive nasal hemorrhage, (2) the metastatic paranasal tumor has not progressed into the orbit, base of the skull, epipharynx, sphenoid sinus, frontal sinus or skin on the back of the nose, and its TNM classification is not severer than T 3. (3) the tumor cells are not spindle-type cells, (4) grade 1 cell atypism, (5) delayed-type tumor progression, (6) diploid tumor cells confirmed by a ploidy analysis of intranuclear DNA, and (7) treatment with interferon therapy and chemotherapy for metastatic tumors in other organs. When these conditions are satisfied, the metastasized paranasal sinus tumors should be resected even if the renal cell carcinoma has metastasized to other organs.

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[in Japanese]

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[in Japanese]

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