There are a few reports about the relationship between adult-onset otitis media with effusion (OME) and mastoid pneumatization, however, the results are conflicting. The purpose of this study was to determine the effect of mastoid pneumatization on the onset and/or prolongation of adult-onset OME. In this study, 66 patients (88 ears) with adult-onset OME older than 20 years old were included. In regard to the improvement rate by conservative therapy, the improvement rate in the young-age group of patients less than 50 years old tended to be lower than that in the old-age group of patients older than 50 years old. This result indicates that the characteristics of OME might differ between the young-age group and the old-age group. In the young-age group, poorly pneumatized mastoid is a risk factor for the onset and/or prolongation of OME, which suggests that the characteristics of OME in the young-age group are similar to that in children. On the other hand, in the old-age group, poorly pneumatized mastoid is a risk factor, but not prolongation of OME. It is thought that other factors affect the prolongation of OME in the old-age group.

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The differential diagnosis of dizziness can be relatively easily made in patients presenting with nystagmus and abnormalities in the equilibrium test. However, diagnosis and treatment are often difficult in dizzy patients without nystagmus or abnormalities of the equilibrium test. Patients of orthostatic dysregulation (OD) belong to the latter category. We report on 31 cases of OD diagnosed according to Ooguni's criteria, who were treated by Kanpo medicine. The subjective symptoms were followed by using a visual analogue scale, and the objective assessment was performed by the Schellong test. At 2 weeks and 4 weeks after the start of treatment, improvement in the VAS score was noted. The Kanpo medicine was also noted to be effective for the subjective symptoms. By 2 weeks after the start of treatment, the number of positive results of the Schellong test had decreased. Marked improvement of the VAS score was noted in the Schellong test-positive group. We analyzed the VAS scores and Schellong test results according to the sex and age, and marked improvement of VAS score was noted in the male group and the aged layer at 2 weeks after the start of treatment.

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Chronic rhinosinusitis manifests with symptoms like pinched nose, nasal discharge, postnasal discharge, and altered sense of smell, etc. and is a disease that is associated with much unpleasantness in daily life due to the symptoms.
The operation medical treatment is general with the small dose using macrolide treatment by the chronic administration as preserved medical treatment. The case with a scarce improvement becomes the object of the operation medical treatment by preserved medical treatment. Up to now, the operation medical treatment, especially the subjective symptom after it operates in the nose under the endoscope and the report of QOL have been examined for the chronic rhinosinusitis patients operated at four facilities in the hospital related to this classroom in one year in the nose under the endoscope because it is few. It questioned the patient on the subjective symptom and QOL concerning the rhinosinusitis symptom by the questionnaire form at three time of after the operation of a long term (6∼18 months) in a short term (1∼3 months after the operation) before the art, and the statistical work was done. The degree of improvement of the subjective symptoms improvement and QOL had a significant difference in a multi item in a short term and a long term of after the operation in the chronic sinusitis patient whole as a result of the examination after the operation and it was admitted. The usefulness of the operation in the nose under the endoscope to the chronic sinusitis was confirmed by this examination.

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A surgery for the frontal sinus mucocele is one of the most difficult operations among endoscopic sinus surgery (ESS), because of the high incidence of the recurrence. The Frontal trephination is originally developed to point out nasofrontal duct during ESS. We used the frontal trephination to treat the frontal sinus mucocele. The instrument enabled to clean up nasofrontal duct after surgery and to keep patency of the duct.

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The postoperative care after endoscopic sinus surgery is very important, and it is above all important to remove crusts using endoscopes. ENF-Y0002 [Short endoscope (Semi-rigid type)], the electronic fiberscope which is under development by Olympus Corporation, has characters of both rigid and flexible endoscope. We used it for observation and treatment after endoscopic sinus surgery and we examined the usefulness and reported refinements.
Although there is still room for the development, a possibility to become the useful instrument for the postoperative care is suggested.

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In this paper, efficacy of forceps type bipolar coagulator and vessel clip forceps in the endoscopic nasal surgery was compared with the conventional bipolar coagulator and disposable vessel clip. The forceps type bipolar coagulator was very useful for coagulating a small area, especially cranial base and lateral side of paranasal sinuses, and could keep the clear endoscopic view with aspiration of bleeding and the mist due to coagulation itself. However, the conventional bipolar coagulator was more effective in case of massive coagulation and bleeding from middle portion in nasal cavity than the forceps type bipolar coagulator. The vessel clip forceps was easy to use in the nasal cavity and could sufficiently clip the sphenopalatine artery. Moreover, the cost for clip is also cheaper than the disposable vessel clip.

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Endoscopic frontal sinus surgery has technical difficult. We used mini-trephine^® system for the case of those were difficult of frontal sinus opening. We have experienced a case of recurrent frontal sinusitis treated with mini-trephine^®. This system was valuable and safe to find the nasofrontal duct surely.

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Contact endoscopy is a noninvasive tool that allows in vivo and in situ examination of superficial mucosa. Its use for early diagnosis of cancerous lesions of the larynx has not been evaluated very well. In the present study, comparison of contact endoscopy with paraffin section histopathology was performed in 12 patients with laryngeal tumor and 2 patients with vocal fold polyp.
The result showed that contact endoscopy provides information on microscopic diagnosis and laryngeal lesion margins, and enables visualization of the laryngeal mucosa microvasculature. Also, the contact endoscopic findings of superficial cells of the mucosa stained with methylene blue were accurate compared to the paraffin section histopathology, except the tumor with hyperkeratosis.

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The objectives of this report were to compare clinical course and therapeutic processes in cases of postoperative facial palsy. Case 1 complained of right-side hearing loss and otorrhea caused by middle ear cholesteatoma. This case was diagnosed as delayed facial palsy (DFP) after middle ear surgery and conservative therapy was conducted. In this case, facial palsy occurred suddenly and recovered from H-B grade 5 to grade 2 by 6 months postoperatively. Case 2 involved incidental detection of petrous bone cholesteatoma (PBC), classified as supralabyrinthine cholesteatoma by Sanna and as supralabyrinthine apical cholesteatoma by Moffat-Smith. Postoperative facial weakness gradually increased within 1 month, reaching H-B grade 5 by 6 months postoperatively. And granulation tissue revealed on MRI was coincident with facial palsy.
In this case, conservative therapies proved ineffective and revision surgery was selected. This case was managed with a cable graft using the great auricular nerve.
We experienced such rare facial palsy and reaffirmed the significance of intraoperative neuro-monitering.

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We developed the electrodes of intraoperative continuous facial electromyography, and of newly invented continuous cochlear nucleus action potentials for postoperative facial and hearing preservation in acoustic neuroma surgery. 62 consecutive patients underwent retrosigmoid acoustic neuroma surgery during 2007∼2008. Overall excellent facial nerve function (HB 1-2) was maintained in 59 out of 62 patients (95%). Meanwhile overall hearing was preserved in 53 out of 62 patients (85%).

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A 77-year-old woman had infratemporal fossa abscess. We approached from the nose under the endoscopy assisted by navigation system, and drained the abscess successfully. An approach by transnasal endoscopy with navigation may be a useful way for minimum invasive surgery in the infratemporal fossa.

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The main office based 3D-CTs, the Accuitomo, CB Throne, CB MercuRay and xCAT ENT, were reviewed in the eight ones manufactured by the six companies in the world: are of floor for place, resolution, Field of view, etc.. Of the four, the accuitomo was used in our office. To obtain clear view of stapes, reconstructions were repeated in two steps.
First step: on the coronal image, the slope of the stapes was turned from oblique to horizontal.
Second step: on the axial image, the slope of the stapes was turned from oblique to horizontal. Then the crura of the sapes were displayed on the sagittal image. In the same way, two cases (i.e. stapes fixation and deficit of superstructure of stapes) were presented. Multi-Slice CT (MSCT) blurs fine and minute bony structures. Artifacts due to implanted metal reduce the diagnostic accuracy based on MSCT. To eliminate such shortcomings of MSCT, a high resolution cone beam CT (CBCT) scanner with a flat panel detector, named Accuitomo, has been developed. The Accuitomo can provide detailed and clear images of stapes in the temporal bone.

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Image evaluation by computed tomography (CT) of the temporal bone region has great advantages for clinical diagnosis. At present, high resolution CT (HRCT) is indispensable to the clinical diagnosis of temporal bone-related disorders. Recently, however, multi-detector CT (MDCT) has allowed the imaging and identification of more detailed pathological changes. In this study, we evaluated the temporal bone region with a diagnostic imaging device, cone-beam CT (CBCT), which offers images with higher resolution than those from MDCT. Herein, we assess pathological changes in the temporal bone trauma using this equipment and report on it's utility. The images obtained using this CBCT system were of great value in the diagnosis of temporal bone traumatic diseases and were useful for the visualization of minute configurations, which can then be used in the planning of surgical intervention.

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The pET symptoms are tended to be masked in the recumbent position. CT for pET should be examined in the sitting position. CT was performed under the resting and Valsalva's condition. Completely open ET was observed in 79.2% of the pET group (n=111), but in none of the control group (n=30). The average ET-gram showed an occlusive zone (OZ) in medial to the isthmus under both conditions in only control group. Trans-tympanic silicone plug insertion was thought to be reasonable technique because of obliteration approach to isthmus. Office-based CT examined in the sitting position is useful for diagnosis and evaluation of pET.

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It is very difficult to master surgical skills of otomicrosurgery and endoscopic sinus surgery because of the anatomical complex. There are several ways to get surgical skills before involving real surgery especially for young surgeons.
This paper intends to introduce the concept of surgical dissection in the field of nasal surgery using human cadaver and point out some problems using human cadaver. Also future surgical training systems such as computer simulated surgical training system are described. Furthermore 3D-CT images obtained by Office-Based 3D-CT is useful for understanding surgical anatomy. Prediction by Office-Based 3D-CT images and cadaver dissection is highly educative and surgical planning using Office-Based 3D-CT may contribute to safe and efficient outcomes.

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Objective: Resistant strains of non-typeable Haemophilus influenzae (NTHi) are one of the principal causes of recurrent acute otitis media (otitis prone), rhinosinusitis, and pneumonia in young children. β-lactamase-nonproducing ampicillin-resistant (BLNAR) strains are particularly common in Japan, and β-lactamase-producing amoxicillin-clavulanate resistant (BLPACR) strains are now emerging. We investigated the nasopharyngeal carriage status of these resistant strains among children attending a same day care center during a 10-year period.
Methods: From 1999 to 2008, we obtained nasopharyngeal swab specimens from young children attending a same day care center and examined the incidence of resistant strains of NTHi. Antimicrobial resistance of NTHi was identified based on PCR analysis of mutation of the penicillin binding protein (PBP) genes. Pulsed-field gel electrophoresis (PFGE) was performed to examine the clonal relationship of each resistant strain.
Results: The prevalence of resistant strains of NTHi among the children attending this day care has significantly increased during the past 10 years and most of this day care children recently have resistant strains with PBP gene mutations in their nasopharynx. Genetically BLPACR (gBLPACR) strains have rapidly increased since 2007 and PFGE analysis demonstrated that all gBLPACR were clonally identical. This is the first report of apparent clonal dissemination of gBLPACR strains of NTHi occurring in a certain environment such as day care.
Conclusions: The rapidly increasing prevalence of resistant strains, in particular gBLPACR, in this day care center may predict a high incidence of these resistant bacteria from clinical isolates in the near future and potential serious medical problems worldwide.

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The use of nanobiotechnology in drug delivery systems (DDS) is attractive for advanced treatment for cancer and genetic diseases. Polymeric micelles, self-assemblies of block copolymers, are promising nanocarrier systems for drug and gene delivery. Our recent efforts on the design and preparation of super-functionalized nanodevices are highlighted.

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Objective: To develop a surgical navigation map made of silicone rubber sheet for use in the nasal cavity.
Method: A print-out of a life-sized sagittal CT sectional image showing the outline of the nasal septum of one side of the nasal cavity was produced. Then, an outline (L1) was drawn of the nasal septum (lower nostril-bottom of the nasal cavity-anterior wall of the sphenoid sinus-skull base-upper nostril). Important targets were marked, such as a line (L2) between the entry point on the anterior wall of the sphenoid sinus (P1) and the upper nostril. A piece of a silicone rubber sheet (KOKEN CO. Ltd., Japan, 0.5 mm thick) was cut out following L1, and the marked targets were copied on by punching small holes of different shapes through the silicone sheet.
After septoplasty, the sterilized piece of silicone sheet was placed into the nasal cavity and fitted to the curves of the bottom of nasal cavity to the nostril along the reconstructed nasal septum. The punched holes provided the positions or the directions of landmarks when performing endoscopy.
Results: More than 200 cases requiring endoscopic sinus surgery (ESS) have been operated on without any complications. Pre-operative preparation took about 20 minutes, and several minutes were required to insert and position the silicone sheet during the operation. Once the silicone sheet was fitted, the punched holoes showing landmarks were easily located by endoscopy. Positional errors were small enough to perform ESS and were no more than 2 mm.
Discussion: Because it is a projection map onto the nasal septum, accuracy is good in the sagittal plane. The silicone sheet works as a navigation aid for such targets that can be well located in the sagittal plane.
Conclusions: The surgical navigation map is easy to use without expensive equipment or an extra monitor.

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We described a case report that iPlan (Brain LAB) was very useful for the operation of post operative multiple maxillary cyst. iPlan is a software of Vector Vision. This software converts DICOM data of CT or MRI images to the original data for Vector Vision. iPlan has many useful functions. Object creation is one of them. It can make several objects that mean multiple lesion such as maxillary cysts. This function helps surgeons with their operation which is difficult to identify multiple cysts. We can fully realize the lesion of size, location and number when we use this function.

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During the year 2009, our navigation system offers various products upgrades for our platform and application. The single modality, Kolibri and the multiple modality system VectorVision (VVflex/compact/VV/Sky) have now access to both application “Essential” and “Unlimited”. As a result of these upgrades, our application ensures the superior performances and expectations of each individual surgeon.
BrainLAB is committed to providing truly innovative software that will leverage surgeon's skills, providing patients with consistently better process of treatment. We will continue to dedicate a development of our navigation system, and try to increase the efficiency of our navigation system throughout Japan.

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Because the evaluation of utility of the navigation surgery changes depending on the skill of surgeon and the anatomical individuals, the evaluation by the high levels of evidence is not obtained easily. We examined past documents and result of the questionnaire, study and tried the arrangement of the content like accuracy, clinical utility, the adjustment, coexisting illness, the education, and the problem.

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We have developed a new navigator using white light 3D scanner. It is completely frameless and markerless, it features semi-automatic registration without direct contact with patients, and it updates registration and tracking information when patients move. Our other modified system provides information about navigation by indicating the location of the center in an endoscopic view.

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Even if the same disease and surgical method, an indication of the navigation surgery will be changed by the reason of the clinical condition of the patient, feature of the lesion, an anatomical individuality, the ability of the surgeon's skill and the experiences. This time, we inspected what kind of scene navigation was required by the different levels of surgeon. Through this experiment, we have an impression that the understanding of the clinical anatomy when we used navigation system together is becoming faster and more precise. Finally, We want to do a new proposal about need and indication of the navigation surgery.

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The navigation system makes to a necessary, indispensable for the safe, accurate operation by neurosurgery, the otolaryngology, the orthopedics, and the dental surgery, etc. and the adaptation. In the otolaryngology area, the navigation surgery has increased the occasion to use it for not only the rhinology operation but also the otology operation and the head and neck surgery. However, it is used in the vicinity of the bone organization such as the eye socket, the skull bases, and the side of the head bones in most operation.
This time, we groped for the utilization of the navigation system in the neck operation. The osseous tissue is only a cervical vertebra in the neck operation, and it is impossible to use the cervical vertebra for the registration. The position of the head retroflexion during operation is different from the location of CT for registration, so these might produce the gap of the navigation. Furthermore, a head of the patient and body part moves by operation. The introduction of intraoperative CT, fixing of a head and the body part and an upgrade of software are important for these problems.

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We present navigation methods and Medtronic products in the otorhinolaryngological area and describe innovation in registration and future development.
As a member of Medtronic Group, our company has been selling surgical navigation systems StealthStation TREON and TRIA. And one of the group divisions Medtronic Japan ENT Business, with lineup including drills for rhinological surgery and those for otological surgery which can be easily connected to the navigation systems, is aiming at providing total support to otorhinolaryngological surgery as the Medtronic group.
For navigation, there are basic registration methods: point registration using the markers; and surface registration in which registration precision is enhanced by registering surface points to effect surface alignment. In addition, we propose a method to complete registration more easily and in shorter time by the use of TRACER registration that acquires hundreds of points in a short time simply by tracing with the probe.
As future development, we are carrying forward to introduce magnetic-field-based navigation system that may solve the problems of instrument size and spacial limitation.
We will continue to pursue further user-oriented products through improving systems and propose new special instruments and integration with peripheral devices.

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