[in Japanese]

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　Intravenous olfactometry (Alinamin^® test) is considered as a useful test to determine the prognosis in patients with olfactory dysfunction, and it is said that patients showing no reaction in this test carry a poor prognosis. However, some patients who show no reaction to this test preliminarily show improvement in response to treatment. Therefore, we need further discussion on the results of intravenous olfactometry. We analyzed the prognosis in patients showing no reaction in intravenous olfactometry preliminarily, and attempted to identify factors that are important for the improvement of olfaction. The results revealed that patients in whom treatment was initiated at an early stage, whose detection threshold in T&T olfactometry was good or whose score on the self-administered odor questionnaire was good showed improved olfaction after treatment. Furthermore, the prognosis after treatment was also good in patients with post viral olfactory dysfunction. It is important not to give up treatment in these patients even if they show no reactions in intravenous olfactometry.

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　Diagnosis of perilymphatic fistula is based on the clinical symptoms, such as history of trauma, and the clinical test results. We examined the differences in the clinical features and clinical test results between patients in whom factors inducing the formation of a perilymphatic fistula could and could not be identified.
　We analyzed the data of 9 patients diagnosed as having perilymphatic fistula during surgery performed at the Departments of Otolaryngology of Kohsei Chuo General Hospital from January 2010 to October 2012. All the patients complained of hearing loss. Some patients did not have vertigo. Factors that induced the formation of the perilymphatic fistula included blowing of the nose in 2 cases, diving in 1 case, ear pick trauma in 1 case, and barotrauma in 1 case. No inducing factors could be identified in four patients.
　None of the patients had vertigo and the hearing improved after the surgery. Seven patients had nystagmus toward the affected ear. In patients presenting with acute sensorineural hearing loss with nystagmus toward the affected ear and fluctuating hearing, we should bear in mind the diagnosis of perilymphatic fistula at an early stage, even in the absence of a typical history of pressure elevation within the inner ear.

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　We are now able to record non-microscopic surgical views inexpensively and easily by using full high-definition video (FHDV) recording equipment for family use. On the other hand, FHDV recording of microscopic surgical views is not easy, when compared with the non-microscopic surgical views recording, because it is necessary to record a microscopic surgical view through a camera which is connected to a microscope and there is little information about how to connect a camera and a microscope. Additionally, there are many standards of FHDV and those connections. Herein we report on our experience in trying to introduce FHDV recording systems for two surgical microscopes.

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　The use of high-definition (HD) cameras and monitors during surgery can provide the surgeon and operating team with more than twice the resolution of standard definition (SD) systems. Although this improvement in visualization offers numerous advantages, the adoption of HD cameras in the operating room can be challenging because new recording equipment must be purchased, and several new technologies are required to edit video. We reported our recording and editing HD video system during surgery in various regions of otolaryngology.

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　Diffusion-weighted imaging (DWI) provides surgeons with a superior imaging tool to more accurately diagnosis cholesteatoma which are to be treated using transcanal endoscopic ear surgery (TEES). Two different DWI techniques are currently in use: non-echo planar (non-EPI) and echo planar (EPI) DWI. In the comparison of preoperative evaluation for cholesteatoma and intraoperative findings by non-EPI DWI and EPI DWI, both positive predictive value (PPV) and negative predictive value (NPV) of non-EPI DWI were high. PPV of EPI DWI was high, however NPV of EPI DWI was low. Therefore, non-EPI DWI is more reliable in identifying cholesteatomas than EPI DWI. Non-EPI DWI can be even further enhanced by the incorporation of MR cisternography (MRC). We combined a 1-mm thin slice non-EPI DWI with MRC and performed color mapping to enhance the visualization of the cholesteatoma by this color mapped fusion imaging (CMFI). Both PPV and NPV were high in the comparison of the preoperative evaluation for cholesteatomas and intraoperative findings. We found that CMFI is a reliable tool for preoperative evaluation of the anatomical location of a cholesteatoma and to determine whether a patient is indicated for TEES to treat cholesteatomas.

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　Introduction: Transoral robotic surgery (TORS) for head and neck cancer treatment is not approved in Japan. We have stared TORS as a clinical trial from August 2011. We presented the result of simulation surgery previously. But larynx and hypopharynx couldn't be exposed adequately because of instrument limitation. In June 2013, a new FKWO retractor become available.
　Aim: We attempted whether larynx and hypopharynx could be exposed and whether 8mm EndoWrist could be handled smoothly in these areas.
　Results: We were able to clearly expose these areas. However the movement of EndoWrist was limited at lateral side of hypopharynx and ventral side of larynx.
　Conclusion: The exposure of TORS was improved but cases of larynxand hypopharynx should carefully be selected.

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　Computer programing for the navigation image analysis was made. We can get the information about that when we use the navigation system during the operation to check the image outputted from navigation system. But this method took a lot of time. So we tried to make such a computer program to analyze the navigation usage timing during the operation. We think that it is useful also as a tool of an operation educational program for the way person of an initial level operator.

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　Brainlab introduces the latest technology with 3 new devices. Brainlab is specialized in surgical navigation system however aiming to provide total medical imaging services using various devices including iPad/iPhone etc. BUZZ provides network hub function for medical imaging in the hospital. QUENTRY CLOUD SOLUSTION provides information sharing among multiple group over the hospital or department. KICK provides improved performance as compact navigation platform.

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　Nasolacrimal duct obstruction used to be treated with extranasal dacryocystorhinostomy before, but nasal endoscopic dacryocystorhinostomy has recently become more common due to the development of nasal endoscopy. We report a 41-year-old man of nasolacrimal duct obstruction secondary to sarcoidosis. Epiphora in both eyes developed and endoscopic-dacryocystorhinostomy was performed to both sides. His nasal cavity was deformed and the mucous membrane was hypertrophic. We used the navigation system and 25G light guide to establish orientation. A 2.5mm diamond bur was used for dacryocystorhinostomy. A Nunchaku-type silicon tube was inserted successfully in the left side, but was inserted only half way in the right side. The left and right tubes were removed a month and 3 months after surgery. The symptom of the left eye disappeared after one and a half year but the symptom of the right eye remained.

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　We used the Sonopet^® ultrasonic bone aspirator for endoscopic sinonasal surgery, including septoplasty (one case), dacryocystorhinostomy (five cases) and surgery for maxillary sinus mucocele (one case). The insertion and maneuverability of the tip of the Sonopet^® in the sinonasal cavities were satisfactory. Bone fragmentation was smooth, gradual and limited on the contact area of the thin tip. Mechanical damage of mucosa and nearby structures was not observed. The Sonopet^® is expected to use as the substitute of the standard surgical drills for sinonasal bone drilling applications.

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