Patients with habitual tonsillitis who underwent tonsillectomy at the Department of Otorhinolaryngology, Yokohama Rosai Hospital between January, 2000 and April, 2003, were followed up for 1 year or longer thereafter were surveyed by a questionnaire. Eighty-three patients who responded to the questionnaire were evaluated.
The answers were analyzed by dividing the patients into 14 aged 7 years or less, 19 aged 8-20 years, 28 aged 21-30, and 22 aged 31 years or above.
The patients consisted of 46 males (mean age 22.0 ± 11.0 years at surgery) and 37 females (22.8 ± 12.3 years).
The times until remission increased with the patient's age in those who had 4-9 episode/year of tonsillitis before surgery, but remission was observed within 3 months in those who had 10 or more episodes/year.
The results of tonsillectomy were very satisfactory in terms of the frequency of tonsillitis.
Fever was resolved within 3 months after surgery in 46 (73%) of the 63 patients who had a fever of 39°C or higher. Habitual tonsillitis causing a high fever could be controlled early after surgery in about 70% of the patients.

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The present study was performed with the aim of establishing an effective primary screening for obstructive sleep apnea syndrome (OSAS). We analyzed 234 consecutive patients who underwent overnight polysomnography in our department from August 2002 through November 2004. The patients were asked to complete questionnaires about OSAS-related symptoms at the time of initial presentation and were categorized according to the following 3 criteria: I) habitual snoring and/or sleep apnea, II) excessive daytime sleepiness and/or the Epworth sleepiness scale ≥ 11, and, III) at least 2 positive items out of 5 minor OSAS-related symptoms proposed by the American Academy of Sleep Medicine. In addition, the fourth criterion regarding physical condition was set: IV) body mass index ≥ 25 and/or hypertension. The requirement to meet at least 2 positive items out of the criteria I, II and IV most effectively screened the patients with apnea-hypopnea index (AHI) ≥ 15 (sensitivity=0.90, specificity=0.62, positive predictive value (PPV) =0.82). Another requirement that meets at least 2 positive items out of the criteria I, II and III yielded the second most effective screening of patients with AHI ≥ 15 (sensitivity=0.93, specificity=0.57, PPV=0.80). Combinations of 3 subjective criteria (I, II and III) were generally prone to result in low specificity. It is concluded that physical information such as obesity and hypertension, besides subjective symptoms, should be taken into account upon primary OSAS screening.

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This study investigated peripheral cholinergic mechanisms in the taste innervation of the lingual papillae of rats. Since it is difficult to reliably mark cholinergic structures in the peripheral nervous system with immunohistochemical methods using choline acetyltransferase (ChAT), we employed ChAT of a peripheral type (pChAT) associated with a splice varient of ChAT mRNA cloned from the pterygopalatine ganglion of the rat. Immunohistochemical staining with pChAT revealed colinergic synapses in the lingual papillae. The study clarified cholinergic innervation in the lingual papillae of rats, and indicated the possibility of cholinergic participation in the taste function.

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Treatment of psychosomatic disease is sometimes quite difficult without collaboration with clinical psychologist. Between October 2004 and May 2005 we had 20 patients with a variety of symptoms caused by psychosomatic origin. There are 3 cases of intractable throat discomfort. Here we present one representative case. A 74 year-old female complained of throat discomfort. She visited our hospital in August 2004. There are no organic abnormal findings during general examination including fiberscope. Since her depression and fatigue were the origin of her throat discomfort, we referred her to a clinical psychologist. Rational Emotive Behavior Therapy was introduced, and only 2 sets of interviews improved her cognitive function. We frequently encounter psychosomatic diseases in otorhinolaryngology. Treatment of these cases requires collaboration with clinical psychologists. We should always keep the mind-body relationship in mind when we examine patients with organic abnormality.

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A retrospective review was performed on 39 (23 males, 16 females, mean age 58years) patients with submandibular gland cancer who received initial treatement at the Kurume University Hospital between 1980 and 2004. In T classification, there were 5T1 cases, 10T2 cases, 14T3 cases 10T4 cases. In N classification, there were 22N0 cases, 4N1 cases 12N2 cases, and 1N3 case. 4 were stage I (10%), 9 were stage II (23%), 8 were stage III (21%), and 18 were stage IV (46%). Histologically, 7 types of tumors were found and the most common histological type was adenoid cystic carcinoma (12 cases, 31%). Total submandibulectomy was performed in 31 cases. Extended submandibulectomy was performed in 8 cases. Radical neck dissection was performed in 27 cases. 9 cases received postoperative radiotherapy. The 5-year and 10-year survival rates as determined by the Kaplan-Meier method were 58% and 48%, respectivery. The 5-year and 10-year survival rates of adenoid cystic carcinoma were 66% and 44%, respectively, for adenocarcinoma 65% and 65%, respectively, and for mucoepidermoidcarcinoma 33% and 30%, respectively. Local recurrence was recognized in 13 cases. 21 patients died of the primary disease (locoregional death: 9, lymph node death: 2, distant metastasis death: 7, complicant death: 1).
This retrospective study indicates the necessity of the radical resection for patients whose submandibular tumors were over T3 and at least supraomohyoid neck dissection even in N0 cases. Postoperative radiotherapy is also useful for patient's local and neck recurrence.

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We investigated the effect of pharyngeal surgery, including tonsillectomy, uvulopalatopharyngoplasty (UPPP), and modified UPPP on sleep constitution in patients with sleep-disordered breathing (SDB). In the group of AHI recovered by surgery, the sleep constitution returned and, therefore, indicated that SDB can be overcome by surgery alone. In the group that required surgery by combining with other treatments, the sleep constitution and AHI remained insufficient. In sleep constitution of five patients after treatment, there is little difference between continuous positive airway pressure (CPAP) and surgery. After surgery, in spite of poor improvement of apnea hypopnea index (AHI), some patients did not complain of the effect of surgery. This means polysomnography (PSG) is necessary to estimate the real effect of treatment.

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A 39-year old female patient with tuberculosis retropharyngeal abscess was reported. In 2004 April she came to our hospital complaining of sore throat. Throat examination showed a bulging abscess at the posterior wall of her pharynx. Computed tomography (CT) of the neck showed a left retropharyngeal abscess and multiple abscesses in the left deep cervical lymph nodes. Needle drainage was performed and 1.5 ml of turbid green pus was drained. The tuberculosis bacilli were proved by acid-fast stain. In treatment of her tuberculosis, we used 4 kinds of tuberculostatics (isoniazid, rifampicin, ethambutol, and pyrazinamide). Swelling in the retropharyngeal wall disappeared, but cervical lymph nodes still remained at 9 months after treatment. Then, we added tuberculostatics for 3 more months. Since then no recrudescence of her symptoms or signs are observed in her pharynx.

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We evaluated the surgical skill of UPPP done in 35 cases in our hospital and discussed its efficacy. Our method of UPPP has three characteristics. First, a mattress suture was applied in the tonsillar bed. As a result there was no failure of the suture. Second, we made a raw surface at a little upper part of the root of the uvula and applied the mattress suture to it. This suture has efficacy of soft palate upword to the oral side. Third, no continuous suture has advantage to present scar formation. We also examined the dynamic MRI for obstructive site and images were divided some morphological obstructive pattern, and assess about efficacy of improvement rate of AHI. The efficacy was over 80% in tonsillar type. But there was 31% efficacy not only soft palate but also tongue rotation type. We concluded that the important factor to have good result of UPPP are surgical skill and adequate indication.

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The male, aged 34 years old, had complained of worsening nasal obstruction and the difficulty of nasal breathing since 5 weeks after tonsillectomy performed in other hospital. The consultation by the otolaryngologists disclosed the stronger nosopharyngeal stenosis caused by postoperative scar and adhesion in soft palate and posterior pharyngeal wall. The palatopharyngoplasty using facial artery musculomucosal flap was performed for his nasopharyngeal stenosis. The postoperative progress for one year was uneventful. The prevention and the management for postoperative nasopharyngeal stenosis are discussed.

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Purpose: To evaluate the efficacy of rapid superselective high-dose cisplatin infusion with concomitant radiotherapy for previously untreated patients with advanced hypopharyngeal cancer.
Patients and Methods: Fifteen patients for whom surgery was contraindicated or who rejected radical surgery were given superselective intra-arterial infusion of cisplatin (100-120mg/m²/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and conventional extra-beam radiotherapy (66Gy/33fr/6.6 weeks).
Results: There were nine patients whom surgery was contraindicated and six patients who rejected radical surgery. During the median follow-up period of 13 months, the 2-year overall survival and preservation rates of larynx were 53.4% nad 78.3%, respectively. Nine (60.0%) patients experienced grade 3 to 4 toxicity, including mucositis (n=7), leukopenia (n=3), anemia, fever, dermatitis (n=2), and thrombocytopenia, neurologic sign, nausea (n=1). There are 12 surviving patients without evidence of desease, 11 of whom are able to have oral intake without feeding-tube support.
Conclusion: We confirmed the efficacy of superselective intra-arterial infusion and concomitant radiotherapy. All arterial catheterizations should accomplished transcutaneously through the femoral artery, and the selection of artery should be decided by angio-CT.

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A 25-year-old woman with a 8-year history of IgM nephropathy (IgMN) presented in September 2002. She had been treated with systemic anticoagulants by her physician, but the renal function gradually worsened. Although she had not had any clinical episodes of tonsillitis, otolaryngological examination revealed chronic tonsillitis. For the elimination of the focus of infections before renal transplantation, tonsillectomy was performed under general anesthesia on October 17, 2002. Then, renal transplantation was successfully performed on November 20, 2002. The renal function has been well maintained, and no relapse was observed at the 3-year follow-up examination. Although the benefits of tonsillectomy for nephropathy, including IgAN, are still a subject for debate, these findings suggest that tonsillectomy might be effective for the treatment of IgMN. Moreover, tonsillectomy might be beneficial for preventing the relapse of nephropathy after the renal transplantation.

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In seven years from January 1996 to December 2002, 156 cases of peritonsillar abscess cases were admitted and treated. These 156 cases were retrospectively analyzed and studied. Also included were 98 cases of deep neck infection of the same period and these 98 cases were also similarly studied and compared.
102 male cases and 54 female cases were included. By age, patients in their twenties (49 cases, 31%) and thirties (37 cases, 24%) occupied more than half of the cases. Patients under ten years of age were only 5 cases (3%).
Two groups of cases of patients more than 65 years of age and cases of those less than 64 were compared in terms of the duration from the onset of symptoms to admission. The former showed a significantly shorter duration (2.5 days vs. 5.75 days). In terms of duration of improvement of signs and symptoms, the group over 65 years of age showed a significantly shorter duration (remove 3 days vs. 4.4 days). As for the duration of admission, no significant differences were seenamong gender, methods of surgical treatment and age distributions.
As for the comparative study with deep neck infection cases, the durations of admission were 14.5 days for deep neck infection, about double the 7.7 days for the peritonsillar abscess. The durations from the onset of symptoms to the admission were shorter in the group of patients over 65 years of age probably because the treatments were initiated somewhat earlier resulting in earlier improvement in signs and symptoms. The durations of admission of peritonsillar abscess were analyzed anddiscussed and the importance of earlier proper management of peritonsillar abscess before advancement and involvement of deep neck infection was confirmed.

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Teratoma of the nasopharynx in adults is rarely reported; rather, it is usually present shortly after birth or in the first year of life with dysphagia and stridor.
We report on a 53-year-old female case with teratoma of the nasopharynx. She complained of postnasal white drip for several years. We conducted endoscopic surgical excision of the tumor under general anesthesia. There were no complications after the surgery and local recurrence has not yet been seen with nasopharyngeal endscopy in 18 months.
Endoscopic surgery for nasopharynx tumor is very useful with low morbidity. We suggest that this approach should be considered as an option for treatment.

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The state of the whole body might be sensitively reflected in the mouth and the observation is extremely important for the otorhinolaryngologist. The mouth is a part of body through which it is impossible to know the whole. However, with a shift in thinking and a different view of the patient, it is possible to observe the whole body. So we tried to discover lichen planus in patients with hemangioma, especially elderly patients with lip hemangioma, on the lips of the mouth. Both showed relations to liver disease. In the former, 81 examples were confirmed during a period of about one year, and liver disease was indicated at 27.1%, including previous history. In these patients and those registered as saliva gland outpatients totalling 51 examples, hepatitis C was confirmed in about 37.2% of the cases. That the mouth reflects the overall physical condition is well known. Understanding and confirmation of this point is considered important for a doctor who specializes in examination of the mouth.

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To compare specificities of two nucleic acid amplification tests for the detection of Neisseria gonorrhoeae and Chlamydia trachomatis with oropharyngeal samples, Becton Dickinson ProbeTec^® strand displacement amplification (SDA) and Roche Amplicor PCR were performed on throat washings of 20 healthy volunteers, consisting of 4 females and 16 males ranging in age from 23 to 42 years old (mean; 32.7 years). As a standard test of gonococcus, a culture was done with throat swabs. A true positive result of N. gonorrhoeae was defined as a positive result by culture. A true positive result of C. trachomatis was defined as a positive result by Amplicor^® PCR. No positive result was seen in ProbeTec^® SDA for N. gonorrhoeae or C. trachomatis and Amplicor^® PCR for C. trachomatis. In 13 samples (65%), positive results for N. gonorrhoeae were shown by Amplicor^® PCR only. According to the definition, these were regarded as false positives. ProbeTec^® SDA was considered an adaptable test with high specificities for detection of both N. gonorrhoeae and C. trachomatis in oropharyngeal samples.

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Intramuscular (infiltrating) lipoma of the tongue is rare and seldom reported in literature. We treated a 72-year-old female with a intramuscular lipoma on the right side of the tongue. The size of tumor was 52 × 21mm. T1-and T2-weighted MR images showed high intense mass with a small area of isointensity. For the treatment of lipomas, surgical removal is usually indicated. But in this case, the tumor was poorly encapsulated, and complete excision was difficult due to diffuse muscular infiltration and tumor size. The recurrence rate of intramuscular lipoma has been reported from 27.3% to 62.5%. However, no malignant transformation has been reported for recurrent intramuscular lipomas. So, we decided to leave it intact and watch how it develops. The patient has been followedup for 44 months after biopsy and no remarkable changes were observed. A review of Japanese literature showed 8 cases of solitary intramuscular lipoma of the tongue.

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It is well known that patients with Gastroesophageal Reflux Disease (GERD) suffer from not only pyrosis but also various pharyngo-laryngeal symptoms, such as itching, the sensation of a foreign body in the larynx, persistent coughing and/or soreness of the throat. With GERD, the most definitive manifestation tools are upper gastrointestinal endoscopy and 24-hour pH monitoring. These diagnostic methods are not comfortable to patients. A clinical study was performed on 51 patients who were diagnosed with GERD by combinations of complicating symptoms and laryngeal findings. These patients were treated using proton pump inhibitor (PPI: sodium rabeprazole, 10 mg/day for 2 weeks). Most of the patients (44 out of 51 patients, 86%) improved their pharyngo-laryngeal symptoms after PPI treatment. Therefore, the combinations of patients' complicating pharyngo-laryngeal symptoms and laryngeal findings were very useful for diagnosis of GERD. On the other hand, in about 15% of the patients, the pharyngo-laryngeal symptoms were unchanged even after PPI treatment. It was proved that these patients for whom treatment was inefficacious complained more frequently of dry cough, and that they tended to have allergic diathesis confirmed by the clinical symptoms and CAP-RAST testing. In order to improve the pharyngo-laryngeal symptoms of these patients for whom treatment was inefficacious, it was plausible that administration of antiallergic agents could be one alternative therapy.

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It is well known that the general population of children with sleep-disordered breathing (SDB) shows dramatic improvements in the physiological parameters of sleep after tonsillectomy and adenotonsillectomy surgeries. However, there are few reports related to the evaluation of the changes in the quality of life for children with SDB after tonsillectomy or adenotonsillectomy in Japan.
We evaluated the effect of tonsillectomy or adenotonsillectomy on quality of life (QOL) in 5 pediatric SDB patients (age range 3 to 7 years; median age 4.6 years) with the translated version of OSA-18, an 18-item QOL survey. Four children who underwent tonsillectomy or adenotonsillectomy showed improvement in physiological parameters of sleep and quality of life after those surgeries. One child with worsened physiological parameters of sleep after surgery due to re-enlargement of adenoid did not show enough improvement in quality of life after surgery. Even in Japan, the OSA-18 can be useful for the evaluation of the effect of surgical treatment on QOL in SDB children.

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This study was intended for the 257 cases of orthognathic surgery for the lower jaw with diacrisis of jaw anamorphosis symptom object. We executed auditory tube function test in pre- and post-operation and conducted postoperative examination of auditory tube dysfunction.
A high rate of auditory tube dysfunction was recognized after lower jaw orthognathic surgery. Consciousness of symptoms of auditory tube functional disorder was seen in 46 examples (17.8%), and auditory tube dysfunction in auditory tube examination was recognized in 159 cases (61.6%). Postoperative auditory tube dysfunction related to results of preoperative tubo-tympano-aerodynamic graphy, but there was no correlation as a result of sonotubometry. Tubo-tympano-aerodynamic graphy was a significant examination to predict aggravation of auditory tube mechanism. It became clear that auditory tube dysfunction brought about natural recovery in an average of 3.48 days. In cases in which auditory tube functional disorder lasted more than 4 days and exhibited subjective symptoms, we performed inflation by the Eustachian catheter and all examples healed in fewer than 14 days. “Sniffing” and “Toynbee development” under nasal obstruction condition exerted negative pressure on middle ear. We surmised that auditory tube dysfunction was induced when the opening of the auditory tube was inhibited due to the negative pressure in middle ear due to “Sniffing” under the state of centric occlusion, the contraction of glossa camera and deglutition under unaccustomed interdigitation.

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We used a cevimeline hydrochloride hydrate (cevimeline) for patients with dry mouth but without Sjögren's syndrome in the following two tests. In the first test 42 patients (3 men and 39 women, mean age 72 yeas old) took cevimeline for 3 months and were examined by subjective symptoms (visual analogue scale; VAS) and stimulated/unstimulated salivary flow. In the second test 10 other patients (3 men and 7 women, mean age 71 yeas old) took cevimeline for 24 months and their stimulated/unstimulated salivary flow was measured. In the first test, over 80% of the patients answered that their dry mouth was improved. Both stimulated/unstimulated salivary flow increased compared to before the test. In the second test, the mean salivary flow rates of 10 patients increased and were maintained for 24 months. These findings indicated that cevimeline might improve the dry mouth of patients who do not have Sjögren's syndrome.

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This study was carried out to compare bipolar scissors tonsillectomy and traditional cold dissection tonsillectomy with snare. Two hundred and twenty five adult patients underwent tonsillectomy (one hundred by bipolar scissors tonsillectomy and one hundred and twenty five by traditional cold dissection tonsillectomy with snare). Using the bipolar scissors, intraoperative bleeding was significantly reduced, especially in the case of the severe fibrous connection between the tonsil and tonsillar bed. Out of 125 cases, 116 (92.8 %) in the bipolar scissors group experienced intraoperative blood loss of less than 10ml. The mean operation time was 45.4 minutes for bipolar scissors tonsillectomy and 45.9 minutes for the cold dissection method. There was no difference between the two groups. The incidence of postoperative hemorrhage was 7 % in the traditional cold dissection group and 8.8 % in the bipolar scissors group. Three patients (3 %) who underwent traditional cold dissection operations and two patients (1.6 %) who underwent bipolar scissors operations required a second general anesthetic for control and repair bleeding. At the viewpoint of reducing intraoperative blood loss significantly, bipolar scissors were useful for tonsillectomy.

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