Otolaryngological field is located at the front of respiratory tract and situated at the first contact point with invading microbes, and many infectious diseases occurred at the site.
In this paper, I studied causative bacteria and drug resistant strains from otolaryngological field. I described that we would not use antimicrobial agents when an infectious disease being viral infection and should understand about resistant strains against antimicrobial agents by a bacteriological examination. I concluded that we should choose a most suitable and effective agent to an infectious disease by using wide knowledge about antimicrobial agents.

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We report a rare case of incus dislocation to the subcutis of the external auditory canal after a traffic accident. The patient was a 26-year-old woman who had sustained a head injury in a traffic accident. Pure-tone audiometry showed conductive hearing loss in the right ear. Otoscopic examination showed a bony protrusion in the upper part of the right external auditory canal. CT revealed disappearance of the incus, and an incus-like bone was found in the right external auditory canal. The fracture line in the upper part of the posterior auditory canal extending to the fossa incudis was identified during surgery, and the incus was found on this fracture line. Based on these findings, we postulated that the incus was pushed into the subcutis of the external auditory canal by the impact of the skull injury through the fractured upper part of the posterior auditory canal, which was wide enough for the incus dislocation. The dislocated incus was used for ossiculoplasty. The hearing loss suffered by the patient disappeared completely after the surgery.

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A 47-year-old female patient visited an otolaryngologist complaining of earache and hearing loss on the right side and was diagnosed as having tympanitis and treated accordingly. Since there was no improvement in the hearing loss and she had also started experiencing dysphagia in addition, she consulted a neurosurgeon. Imaging revealed a large cerebellopontine angle tumor. She was referred to us for the evaluation of her hearing and swallowing functions, and our initial examination revealed a tumor protruding from the right eardrum. Biopsy revealed that it was a meningioma. Under general anesthesia, we performed a craniotomy and removed the tumor. Pathological examination revealed the same findings as of the meningioma protruding from the middle ear.
Previous reports on the pathway of intracranial meningioma to the middle ear have been inconclusive, suggesting that the pathway can only be estimated based on the clinical symptoms and imaging, and no definite pathway has been established yet objectively. We were able to demonstrate, using 3D contrast-enhanced MRI, that the cerebellopontine angle tumor probably emerged from the cranium through the jugular sinus and extended to the middle ear via the auditory tube.

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We have experienced six cases of primary hyperparathyroidism in our hospital which were treated with surgery, comprising 4 females and 2 males. Clinically, hyperparathyroidism is classified under three types (the bone, biochemical and renal types). Our patients consisted of 2 bone types, 4 biochemical types, and no renal type. Preoperatively, serum calcium and intact parathyroid hormone (I-PTH) levels were elevated and ultrasound echo and Tc-MIBI scintigraphy were performed for all cases. Based on the preoperative examination, we decided on the surgical technique. A circumscriptive parathyroidectomy was performed in all patients. The postoperative pathological examination revealed that the tumors in all patients were adenomas, which was in accord with the preoperative consideration in all cases. Serum calcium and I-PTH levels decreased to within normal limits after the operation. Now all cases are under observation as outpatients. There has been no recurrence or elevation of the serum calcium and I-PTH levels.

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[in Japanese]

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