I report 2 cases of external auditory canal necrosis characterized by otorrhea, bone necrosis, and pain-free pseudomonas infection. The 52-year-old man and 76-year-old woman had no diabetes mellitus. Findings in common included bone necrosis, tissue debris granulation tissue, and bone exposed due to slow progressive destruction of the external auditory canal.
Local culture showed pseudomonas infection without keratin debris.
Differential diagnosis included malignant external otitis, benign necrotizing otitis, cholesteatoma of the external auditory canal, keratosis obturans, malignant tumors, and radiation necrosis.
I concluded that chronic bone destruction was due to pseudomonas infection of the ear expanding into the external auditory canal over the long disease process.
My 2 cases differed clinically from diseases cited in differential diagnosis, and we propose that this condition be termed destructive otitis externa.
I also propose that cholesteatoma of the external auditory canal be classified from keratosis obturans due to their different pathologies

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In cases of juvenile acute otitis media, sequential changes occurring in the tympanic membrane should be recorded in image databases. Based on images of tympanic membranes recorded over the last 5 years, we classified acute otitis media into 5 stages, proposed the utility of this classification, and evaluated the clinical course. Subjects were 811 infants and children ranging from under 1 years to 6 years of age were treated at our clinic, under the diagnosis of acute otitis media. These included 168 under one year old, 148 one year old, 81 two years old, 147 three years old, 134 four years old, 78 five years old and 55 six years old. They were observed on days 5, 10, 14 and 20 following initial examination.
At initial examination, about half of infants age 1 year or younger were stage 4 or 5 (exacerbated), while only 25% of those between 2 and 6 years were thus classified. We concluded that once inflammation develops in acute otitis media, most cases progress at least to stage 3 regardless of age.
Among infants 1 year of age or younger, 50 to 60% recovered within 20 days, while about 25% required 2 months or more. Of those in stage 5, about 90% recovered after 2 months. Of children between 2 and 3 years in stage 1, 90% recovered within 20 days ; and even those who had progressed an advanced stage almost all recovered within 2 months.

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We reported 4 cases of acute inflammation of the mastoid process, 3 of whom were cured by antibiotic therapy (drip infusion) and tympanic intubation and 1 of whom was required simple mastoidectomy. Pneumococci were isolated in 2 cases. Taking into consideration the presence of drug-resistant organisms including PISP (Penicillin intermediately resisitant Streptococcus Pneumoniae), culutures should obtained from otorrhea and rhinorrhea in all patients to choose antibitics active against the causative organism. Despite progress in antibitics, acute inflammation of the mastoid process is still relatively high-risk in causing serious complication. These patients require immediate appropriate treatement.

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From August, 2001, we have been using a new laryngeal mask airway (LMA ProSeal) which is a new device invented to offer a higher seal than standard LMA. We investigated complications arising from the use of the LMA ProSeal and compared the occurrence rate of vertigo in stapes surgery between the LMA ProSeal and the formerly used intubation tube. Leakage of anesthesia gas and respiratory movement during the operation were slight, and did not disturb the operative procedure any more than using the former LMA. Moreover, the postoperative complications were few, and the occurrence of postoperative vertigo in stapes surgery was decreased. The LMA ProSeal is a useful device in the otosurgery, and we recommend it' s use in the future.

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[in Japanese]

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[in Japanese]

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