Canal wall down tympanoplasty with mastoid obliteration for aural cholesteatoma has been performed in our hospital. After complete eradication of a cholesteatoma by canal wall down technique, the dissected bony canal wall is reconstructed and the opened mastoid cavity is obliterated. Recently, we have employed compressed bone dust fixed by a fibrin adhesive as a new material for canal wall reconstruction and mastoid obliteration.
At the time of mastoid bone drilling, healthy bone dust called bone pate is collected. The bone pate is rinsed with physiological saline containing antibiotics and then dried. The pate is mixed with a fibrin adhesive and fixed into a plate of about 4 mm thickness. Finally, the plate is compressed into a 2 mm-thick bone pate plate. Scissors can cut the compressed plate easily. It is especially useful for reconstruction of the dissected canal wall, mastoid obliteration with bone chips and covering the obliterated mastoid cavity.
This new material can achieve a smooth and steady postoperative posterior bony canal. Bone pate plate, which is easy to make and easy to handle, should be a useful reconstructive material in cholesteatoma surgery.

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Based on imaging data for pediatric acute otitis media (AOM), we followed up 0-to 1-year-old children with otitis media retrospectively and propose a pathological classification of tympanic membrane (TM) findings on AOM into 5 stages, then assessed results for consistency and validity.
Subjects were 2, 137 children between 0 and 6 years of age who visited our clinic during the 39-month study and were treated for AOM diagnosed on first visit.
Results : Age-specific AOM incidence was 85.5% under 1 year of age and 88.4% at 1 year. The incidence of AOM decreased with each additional year of age.
Classification results showed that children with AOM stages 4 and 5 accounted for half of all cases in the groups aged 0 and 1 year, consistent with previous reports of frequent cases in infants whose symptoms had worsened. Of groups aged 2 and 3, 25% had AOM stage 4 or 5, and the number of severe cases decreased with each additional year of age.
In recovery, 80% of those aged 0 and 1 year was cured of AOM stage 1 within 1 month, and the rate decreased to 55-60% in cases of AOM stage 5. Of bilateral cases 48.6% were cured within 1 month in the group aged 0, as were 80.5% of unilateral cases, suggesting that unilateral cases have more favorable results in healing than bilateral, and that recovery improved with each additional year of age.
Conclusion : We found that our classification meets requirements for consistency and validity.

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Aquired subglottic stenosis is caused by infection, trauma from prolonged intubation and external airway injury, systemic disorders and other etiologies. idiopathic stenosis of the subglottic airway is diagnosed by exclusion and is extremely rare and not well documented in the literature. We report a case of a 28-year-old woman, complaining of stridor and dyspnea. A laryngoscopic examination revealed a circumferential subglottic stenosis about 2.5cm from the glottis. CT and MRI studies showed intratracheal stenosis of soft tissue without any damage to the tracheal cartilage. Traumatic, iatrogenic, infectious and specific inflammatory processes were excluded. The stenotic scar was managed by an external tracheal incision after tracheostomy using an endoscope, without cutting the cricoid cartilage, and a silicone T-tube was inserted into the resection site. No sign of re-stenosis was observed from removal of the tube and the tracheostomy stoma was closed 9 months after the surgery. The diagnosis and the treatment of idiopathic subglottic stenosis are discussed.

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Serial endoscopic observation of the nasal septum in out patients setting showed 3 cases (a 42-year-old man and 83-year-old and 24-year-old women) with deficiency of the posterior end of the nasal septum. Computed tomography showed a short vomer allowing a greater distance from the posterior end of the nasal septum to the posterior wall of the nasopharynx. In these cases, curved retraction of the posterior end of the vomer bone is also noted.
The large space in the nasopharynx in these cases allowed an extensive view of the posterior part of the lateral nasal wall of the opposite side and the orifice of the eustachian tube. It was noteworthy that all 3 cases were associated with severe deflection of the septal cartilage.

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We experienced a rare case of Warthin's tumor occurring in the bilateral parotid glands and unilateral submandibular gland. A 64-year-old man with bilateral painless lumps below both ears was found to have multiple tumor lesions in the bilateral parotid glands and right submandibular gland MRI and US examinations. A bilateral superficial parotidectomy, right submandibular tumor excision and left deep lobe parotidectomy were carried out. Microscopically, these tumors exhibited the pathological pattern of Wathin's tumor. The right submandibular tumor was considered to be of submandibular gland origin, because normal gland tissue was observed around the tumor-ous change. Warthin's tumor is known to occur in multicentric lesions, but cases in which it occurs in both the parotid and submandibular glands are very rare.
Wathin's tumor has a multicentric nature. Therefore, not only pre-operative examinations but also a careful palpation of the operation field should be carried out, and suspicious masses and LNs should be excised.

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Using questionnaires, we studied the measures patients with Japanese cedar pollinosis took to avoid contact with pollen in 2000. Subjects were 1, 365 patients over 18 years old who visited ear, nose, and throat (ENT) clinics during cedar pollen dispersion in 2000. Of these, 509 (37.3%) took preventive care such as wearing a face mask (71.3%), staying indoors (22.6%), wearing glasses (19.5%), drying clothes and futons indoors (16.5%), washing the face, gargling and blowing the nose after going out (6.5%), and keeping windows and doors closed (2.8%).
We found no significant correlation between preventive measures and nasal symptom severity. Preventive measures correlated significantly with patient suffering. We concluded that the reason for this high correlation was because patients with many symptoms, such as nasal, eye, pharyngolaryngeal and dermatic, practice whole-body preventive care.

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[in Japanese]

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