[in Japanese]

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Objective : Gas exchange across the middle ear mucosa maintains a balance between gas produced in the middle ear cavity and blood gas in mucosal tissue, causing changes in the total middle ear pressure (TMEP). In children with otitis media with effusion, histologic changes in the middle ear mucosa affect the healing process, and the measurement of peak TMEP values, which reflect the inflammatory state of the mucosa, can provide information on the severity of mucosal inflammation. We sought to determine whether changes in TMEP in inflammed mucosa are closely correlated with changes in blood flow dynamics and histology in the mucosa.
Methods : Using a rabbit model for otitis media, we measured the peak TMEP with a micropressure sensor and the blood flow in the middle ear mucosa using a laser blood-flow-meter. Mucosal inflammation in tissue preparations was classified into four grades, and the relationship between the inflammatory changes in the mucosa and mucosal function was determined.
Results : TMEP and mucosal blood flow were reduced in inflamed middle ear mucosa. A longer period of inflammatory stimulation induced severe damage to the middle ear mucosa, resulting in reduced mucosal blood flow.
Conclusions : As a testing method reflecting the inflammatory state of the middle ear mucosa, the usefulness of TMEP measurements as a reflection of mucosal gas exchange was reconfirmed. The measurement of blood flow permits the status of the capillary network in the mucosa to be estimated and reflects the tissue histology, thus, it is a useful method for determining the inflammatory status of the mucosa

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A 54-year-old man transferred to our emergency department due to sudden vertigo and left-side hearing impairment lasting several hours was found in clinical examination and audiovestibular tests to have profound sensorineural hearing loss and spontaneous right horizontal rotatory nystagmus. He had no other neurological deficits and was given intravenous steroids.
On day 4, he reported mild numbness in the right hand. MRI showed infarctions in the left pons (basilar artery region) and in the left middle cerebellar penduncle (AICA region). These were followed by a right Babinski reflex, gait ataxia, and delayed left-sided facial palsy with newly left horizontal rotatory nystagmus. Antiplatelet agents and anticoagulation therapy were begun. He recovered completely except for the profound hearing loss.

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Oral appliances (OA) have been developed and applied to the treatment of obstructive sleep apnea syndrome (OSAS); however, the indications for using OA for the treatment of OSAS have been controversial. In this paper, the use of OA therapy as part of a multidisciplinary treatment (combined with surgery and nasal continuous positive airway pressure therapy) for patients with OSAS is reported.
OA were indicated not only for patients whose obstructive positions were at the level of the oropharynx, especially the tongue base in whom OA treatment alone improved the obstructive position and OSAS, but also for patients whose OSAS was not improved by the use of OA alone. OA treatment combined with surgery and/or CPAP therapy has been reported to be an effective multidisciplinary treatment.
OSAS should be treated using a multidisciplinary strategy that combines OA, CPAP therapy and surgery. OA are an important component of multidisciplinary treatments for OSAS.

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This report presents two cases of laryngotracheal reconstructions that followed partial resection of the tracheal wall of the thyroid cancer with tracheal invasion. An endoscope provided us with a clear intratracheal view at the surgical site. With this method, we could resect the tracheal wall under direct visualization. The length of the tracheal defect was from the cricoid cartilage to the third or fourth tracheal ring vertically, and the width of the defect was from one-third to one-half of the tracheal ring. The defect of the laryngotracheal wall were reconstructed with composite nasal septal cartilage grafts. The nasal septal cartilage with the unilateral mucoperichondrium appears to be one of the most suitable grafting materials for laryngotracheal reconstruction surgery in selected cases that required resection of the involved trachea (raging from one-third to one-half of the circumferential trachea). We consider that a composite nasal septal cartilage graft is suitable for the reconstruction of the tracheal wall in adults because it is easy to obtain the graft, and because the transplantation and reconstruction of the larynx and trachea with composite nasal septal cartilage are both safe and relatively simple.

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The infecting organisms responsible for pediatric acute otitis media were examined using bacterial culture inspections and drug susceptibility tests. Furthermore, the curative effect of CDTR-PI was examined. From July 2000 to March 2005, 41 children with acute otitis media consulted the Jikei Hospital's Department of Otorhinolaryngology. Twenty strains of Streptococcus pneumoniae (S. pneumoniae) (24.7 %), 20strains of Haemophilus influenzae (H. influenzae) (24.7 %) and 10 strains of Moraxella catarrhalis (M. catarrhalis) (12.3 %) were isolated from among the 81 strains isolated from the 41 children. In 35 of the 41 children (85.4 %), these three major infecting organisms were involved. The detection rate of drug-resistant bacteria among these three major infecting organisms was mostly in agreement with the results of previous reports. Based on the results of the drug susceptibility tests, CDTR was the most useful antibiotic against S. pneumoniae and H. influenzae. Clinically, the symptoms of the pediatric acute otitis media patients improved after treatment with CDTR-PI. Therefore, CDTR-PI appears to be a very useful oral antibiotic for the treatment of pediatric acute otitis media. However, antibiotics must be used cautious to minimize the appearance of drug-resistant bacteria.

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