In some adult patients suffering from severe bronchial asthma, or aspirin-induced asthma, otitis media occurring in adulthood is very difficult to control. It has to be discriminated, because it is sometimes complicated with sensorineural hearing loss and surgical treatment is rarely effective. In summary the following characteristics were noted : 1) All the patients suffered from severe bronchial asthma the onset of which occurred in adulthood, or aspirin-induced asthma, several years prior to the onset of otitis media. 2) Nasal polyps and chronic sinusitis frequently occurred and heavy infiltration of eosinophils into the polyps was usually observed. 3) In all the patients, both ears were affected although there was often a difference in severity. These conditions were characterized by a gelatin-like secretion. 4) Tympanoplasty was not effective due to mucosal abnormality. Progression of otitis media in these patients was controllable to a certain degree with steroid therapy. However, advanced condition was difficult to control even with such therapy. These patients suffered from a non-atopic type of allergy. The most characteristic features of the middle ear pathology in these cases were the presence of inflammatory granulation tissue and middle ear effusion both marked by a significant infiltration of eosinophils. In the etiopathology of these conditions, it thought to be that eosinophils play an important role. We therefore think it more appropriate to use the term eosinophilic otitis media to specify the condition of patients with the just described characteristics, especially the presence of a significant infiltration of eosinophils.

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Stimulation of the contralateral external auditory canal with positive (200 daPa) and negative (-200 daPa) pressure yielded a downward wave pattern (30-33%) in the test ear, resembling the patterns known to accompany sound-induced stapedial reflex. Since this reflex was not seen in patients with facial palsy, it seems to represent a stapedial reflex. When the contralateral ear was stimulated with pressure and the test ear was simultaneously stimulated with sound, the amplitude of the sound-induced stapedial reflex increased by 97%. When the impaired ear in each of 9 unilaterally deaf patients was stimulated with pressure, a stapedial reflex was induced in 2 patients, suggesting that the otolith in involved in stapedial reflexes induced by pressure stimulation. The stapedial reflex was thought to represent an outcome of the regulation of sound passing from the middle ear to the internal ear following an increase in the conductive impedance of the middle ear. However, considering that the regulation of high, frequency sounds was also seen following stimulation with sound conducted through bone or with pressure, we propose that the stapedial reflex is an outcome of a direct action on the internal ear. In other words, we believe that changes in the internal ear pressure resulting from a lateral deviation of the stapes foot-plate may regulate internal ear impedance.

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Eight patients 4 men and 4 women with a median age of 68 years with non-Hodgkin's lymphoma originating in the thyroid gland were treated at the Japan Red Cross Society Wakayama Medical Center. All patients were treated with radiation therapy and combination chemotherapy. The chemotherapy regimen consisted of pirarubicin, cyclophosphamide, vindesine, and predonisolone administered in 7 cases. According to the LSG classification, the prognosis in 2 cases of medium-sized cell type were poor. Cell types of non-Hodgkin's lymphomas of the thyroid gland thus appear to be significant determinants in patient prognosis.

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Tumors of the submandibular gland are relatively rare in the salivary gland. We treated a patient with clear cell carcinoma of the submandibular gland first pointed out about 20 years ago. Clear cell carcinoma is, at less than 1%, rare among malignant tumors of the submandibular gland. A review of previous reports suggested the period patients suffered from such tumors varied, with the longest being 50 years. Our case and previous reports, emphasize the need for assiduous treatment over the long term however long this may be.

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This paper presents a rare case of nasal ala schwannoma. A 48-year-old man had an 8-year history of a right nasal ala tumor. An MRI revealed that the tumor in the right nasal cavity had invaded and eroded the bone. The tumor was removed without difficulty and pathologically diagnosed as a schwannoma. Schwannoma arise from Schwann cells of the myelin sheaths of peripheral nerves. They may be found in any portion of the body. Schwannomas often occur in head and/or neck lesions. They have also been found in the internal acoustic meatus, the pharynx, the tongue, the soft palate, the larynx and the trachea. While the origin of the tumor could not be clarified, the tumor was thought to have originated from either a branch of the anterior ethmoidal or the infraorbital nerve.

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We treated a case of metastatic malignant melanoma of unknown primary origin. A 71-year-old man with a preauricular tumor underwent surgical resection and was diagnosed with malignant melanoma after immunohistochemical staining for S100 protein and HMB-45 and Fontana-Masson's staining. Lymph node metastasis was suspected. The man was thoroughly examined to determine the primary origin via inspection of all skin, the nasal cavity, pharynx, and larynx, CT scan of the head and chest, and Ga scintigraphy, but the primary origin could not be found.

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[in Japanese]

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[in Japanese]

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