We report 2 cases of posttracheostomied tracheoesophageal fistulas (TOF) intubated long-term. Surgical management involved a sternocleidomastoid myoflap (SCMF) used to reinforce the area. The result was satisfactory. SCMF is easily treated when the TOF is cervical and the SCMF has adequate volume for use as a myoflap and sufficient blood flow. We concluded that this method is effective for treating TOFs, in the neck.

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An automated auditory brainstem response (AABR) testing apparatus (Natus ALGO 2 ^®) was used to auditorily screen neonates born at our hospital to identify those with congenital deafness. Screening was conducted in 1, 321 (86.6%) of 1, 525 neonates born from February 1999 to January 2001.Screening was explained to guardians of neonates to obtain consent before the procedure. Mean neonate body weight was 3047.5g and mean gestational age 274.6 days.
Screening was conducted in the neonates whose guardians gave consent and was repeated in those judged to need referral or those in whom the first screening could not be done due to noncooperation. Neonates judged to need referral after the second screening were examined by pediatricians and otolaryngologists. Those who needed detailed investigation were referred to a specialist hospital.
The first screening test was passed by 1, 300 neonates and failed by 21 (1.6%). The final result was that the test was passed by 1, 318 neonates and failed by 3 (0.2%). All the 3 neonates who were finally judged to need referral were found to have moderate or severe deafness in subsequent detailed investigation. Comparison of parameters between groups that passed and failed the first screening showed a significant difference in familial deafness (0.4% of the group that passed versus 14.3% of the group that failed). No significant differences were seen in any other parameters tested, including age, body weight, and gestational age.
The AABR test for neonates auditory function was found to be an effective screening method for early detection of congenital deafness. When screening detected abnormalities, cooperation was needed among pediatricians, otolaryngologists, and speech therapists. It thus appears important to establish a management program for deaf neonates when using this screening.

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Many reports suggest stress is related to allergic diseases. We studied the relationship between stress and allergic symptoms in 802 preparatory school students. For the degree of stress, we used Ichige's stress sign questionnaire of 15 physical and 10 mental questions. No good correlation was seen between scores of stress sign and prevalence of allergic diseases. A good correlation was seen, however, between scores of stress sign and allergic symptoms. Students with high stress sign scores reported allergic symptoms such as rhinorrhea, nasal blockage, cough, stridor, and skin itching. From these results, we concluded that some stress may be an important factor inducing and/or worsening allergic symptoms.

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Over a three-year period, we have treated 174 patients for snoring and obstructive sleep apnea syn-drome (OSAS) using laser-assisted uvulopalatoplasty (LAUP). However, postoperative sclerosis of the soft palate as a result of wound healing is a common complication of conventional LAUP. We have modified the conventional LAUP method by preserving the intact mucosal tissue and suturing it on the lateral side using a special device known as “MANICEPS ^® ”. This technique dramatically reduces the incidence of postoperative stenosis in the oropharyngeal space as well as postoperative bleeding. This method is especially useful for the out-patient treatment of patients with snoring and mild OSAS.

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The endonasal approach to paranasal cyst surgery affords a broad, clear operative field, enabling the surgeon to fully open cysts. Some patients, however, require an extranasal approach and some have cysts that cannot be fully opened. We used a computer-aided mechanical arm with a Neuronavigator ^® in endoscopic sinus surgery on 3 patients with paranasal cysts. This system provided surgeons with accurate information on the incision site, and the direction, scope and anatomically high-risk sites. In all 3 cases, cysts were opened maximally. The mechanical arm is somewhat inferior to other systems in ease of use and precision. Unlike electromagnetic systems, however, it is not influenced by metallic surgical instruments or by electrical stimuli or monitoring during surgery. Given that this computer-aided system is also relatively inexpensive further leads us to conclude that this is a potentially very useful surgical aid.

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[in Japanese]

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