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Tumors arising in the parapharyngeal space are rare. We reviewed 13 cases of parapharyngral space tumors that had been operated on between 1999 and 2004, and investigated the preoperative diagnosis, method of operation, and complications after surgery. Computed tomography, magnetic resonance imaging and fine-needle aspiration cytology were very useful for preoperative diagnosis, judging the extent of involvement and localization, and assessing the pathology of the tumor in the parapharyngeal space. The pathological diagnosis of these tumors was pleomorphic adenoma (6 cases), neurilemmoma (5 cases), ganglioneuroma (1 case), and malignant pleomorphic adenoma (1 case). The cervical approach was the most common, and was used in seven cases. Other surgical approaches included the cervical approach with mandibulotomy (2 cases), cervical-parotid approach (2 cases), and parotid approach (2 cases). First bite syndrome (FBS) has recently been reported as a complication after surgical removal of parapharyngeal space tumors. We experienced 4 cases of FBS. Since FBS was very difficult to treat in these patients, it is necessary to be aware of this syndrome.

We report a 47-year-old woman with polyostotic fibrous dysplasia. She complained of a painless swelling of the left cheek since she was two years old. A craniofacial CT examination showed sclerotic changes of the left maxilla, sphenoid and temporal bone. Bone scintigraphy showed high uptakes at not only these craniofacial bones but also thoracic vertebrae, rib, left humerus and pelvis. A biopsy of the left maxilla bone was performed, and a histopathological examination showed fibrous dysplasia. Therefore, we diagnosed her as having polyostotic fibrous dysplasia. At present, the left maxillary tumor has not progressed. We are continuing careful follow-up.

We reported a patient with pseudogout associated with parathyroidectomy. A 68-year-old woman, diagnosed with primary hyperparathyroidism, presented with serum concentrations of ionized calcium. Patients with hypercalcemia have a high incidence of calcium pyrophosphate dihydrate crystal deposition into joints. Rapid drops in serum calcium levels can cause shedding of these crystals into synovial fluid which may precipitate acute attacks of pseudogout. Furthermore, the patient has diabetes mellitus. Diabetes mellitus inhibits insorption of magnesium which may cause high incidence of calcium pyrophosphate dihydrate crystal deposition into joints, too. It has been well established that acute attacks of pseudogout may be precipitated by parathyroidectomy and/or diabetes mellitus.

A 39-year-old female was diagnosed with left acute otitis media and had paracentesis. Because she had continuous vertigo immediately after the paracentesis, she was sent to our hospital. At first she was treated with conservative therapy, but the severe hearing loss, dizziness and tinnitus worsened, so she underwent surgical exploration of the tympanic cavity 10 days after the onset. During the surgery, there was no dislocation of the ossicle, but perilymphatic leakage from the oval window was observed. The window membrane was repaired with temporal fascia and fat. Although her dizziness disappeared completely, her tinnitus persisted. However, the tinnitus disappeared with time and the hearing loss gradually recovered. This case was possibly a medical accident, but it is important to recognize that perilymph fistula is one of the complications of paracentesis, and when it occurs, it must be diagnosed accurately.

We report a case in which mastoiditis caused meningitis with consciousness disturbance due to acute otitis media in patient with cerebral arteriovenous malformation (following AVM surgery), occurring 14 years after surgery.The patient was a 32-year-old, female. X-ray and CT scan of the mastoid showed clouding and a fusion image involving part of the mastoid cells on the affected side. A burr hole showed the presence of mastoid cells, and thus it was thought to be the route of infection.The patient underwent mastoidectomy. A bone defect was recognized in the middle cranial fossa, but there was no dura mater defect or leakage of cerebrospinal fluid observed. However, leakage of cerebrospinal fluid did later develop 12 days after the initial surgery. Craniotomy was performed over a wider area than that during the previous AVM surgery.An increase in the size of the cerebrospinal fluid fistula and in the degree of granulation was recognized in the osteotomy region and in the dura mater that had been incised during the previous AVM surgery. This case supports the findings of previous reports which indicated that factors such as inner ear deformity or duraplasty in an area behind acute otitis media may be related to intracranial otogenic complications. Craniotomy for AVM may be a potential route of infection for intracranial otogenic complications. The surgical method should thus be selected and managed carefully in order to avoid postoperative onset of such infections.

Primary malignant melanoma of the nasopharynx is a rare disease with poor prognosis. There has been no established treatment for the disease.We report herein a case of a 75-year old man, who was referred with hearing impairment and nasal obstruction. Clinical examination demonstrated left middle ear effusion and nasopharyngeal mass. The histological examination indicated malignant melanoma. Magnetic resonance imaging (MRI) showed a gadolinium-enhanced mass on the left side of nasopharynx. Imaging studies could not detect distant metastasis. The patient received combined chemotherapy with DAV treatment (DTIC+ACNU+VCR), but there was no response. Intratumoral administration of Interferon-beta inhibited tumor growth and X-knife was also effective in significantly decreasing tumor size. These therapies may be helpful in the local treatment of malignant melanoma, thus improving the patient's quality of life.

Sixty-seven patients with epistaxis requiring hospitalization during the past nine years were analyzed statistically. Seven those of 67 patients complained of recurrent epistaxis and were comprisal of an approximately equal number the same of men and women. All patients except one were middle aged or older. Six patients were complicated by systemic diseases, especially hypertension, and were treated with medication. All cases except case 1 showed the same recurrent lesion at the bleeding point. Their treatments during hospitalization included hemostatic medication and tampon. Two cases of recurrent patients underwent brain angiography and arteriovenous malformation was found in one case. We conclude that recurrent epistaxis patients, especially those of the suspected of arteriovenous malformation need to undergo brain angiography recurrent vascular system.

Generally, the prognosis of thyroid anaplastic carcinoma is extremely unsatisfactory. We report here excellent results due to early treatment in a patient with anaplastic carcinoma. The patient was a 74-year-old female, who presented with an enlarged frontal neck tumor, together with cervix and throat pain, and undifferentiated carcinoma was strongly suspected based on aspiration biopsy cytology. The patient was admitted and six days after the first examination, total thyroidectomy was performed, and a diagnosis of anaplastic thyroid carcinoma was made based on the permanent pathological specimen. Postoperatively, EAP (Etoposide, Adriamycin, and Cisplatin) treatment and radiotherapy (56 Gy) were performed, with a subsequent second chemotherapy course. At two years no recurrence or metastasis has been noted and the patient has returned to her normal daily life. In conclusion, if radical dissection of the tumor is possible in the early stages, we consider that in patients with anaplastic thyroid carcinoma immediate operation and radiation and chemotherapy treatment should result in a positive prognosis.

Submucosal turbinectomy with posterior-superior nasal neurectomy has been performed for 20 patients with intractable allergic rhinitis in our institution. The operations were carried out under endonasal endoscopic observation. After the apical mucous membrane of the inferior turbinate was slightly incised and its bone was resected in the submucosa, both the posterior superior nerve and sphenopalatine artery were cut in the sphenopalatine foramen as one mass using a Harmonic scalpel. In the short-term subjective symptoms observed for 2 to 10 months, sneezing, nasal discharge, and nasal obstruction were improved to 90%, 75%, and 100%, respectively. Additionally, no surgical complications such as massive intraoperative hemorrhage, disturbance of lacrimal secretion or facial numbness were observed. Because this operation method was highly effective, was minimally invasive, and very few complications were observed, it is suggested that this is a novel surgical method for allergic rhinitis or vasomotor rhinitis.

We describe twenty patients with secondary hyperparathyroidism (SHP) treated with surgery. The causes of SHP were chronic renal failure with hemodialysis in all the patients. Twelve patients were male and eight were female, ranging in age from 35 to 63 years. The most frequent complaint before surgery was severe joint pain in the knees, feet, shoulders, back and ankles. Of these complaints, bone pain and pruritus such as irritability, diminished rapidly after surgery. Preoperative examinations with an echogram and scintigram were useful for indicating the number and location of parathyroid glands. Patients were treated with a combination of total parathyroidectomy and autotransplantation of autologous parathyroid tissue to the forearm. There were no complications, such as recurrent nerve palsy and bleeding. We conclude that the combination of total parathyroidectomy and retransplantation of parathyroid tissue is one of the best surgical approaches.

Seventy-three cases of oral cancer (tongue: 47, oral floor: 10, buccal mucosa: 10, gingiva: 4, hard palate: 2) treatedinitially from 1985 to 1995 were reviewed retrospectively. The cumulative five year survival rate was 71.4% for all of the patients, and 75.8% for carcinomas of the tongue, 88.9% for carcinomas of the buccal mucosa and 42.2% for carcinomas of the oral floor. Further strategies are required in advanced cases with T4 staging in order to improve the survival rate and quality of life of oral cancer patients.

We report the case of a 62-year-old man with a Squamous cell carcinoma of the thyroid gland which had invaded the hypopharynx. Primary squamous cell carcinoma of the thyroid gland is extremely rare. Its clinical course is very aggressive and the prognosis is poor. The patient underwent a radical resection of the thyroid, hypopharynx, larynx and resection of the trachea and esophagus was conducted concomitantly with bilateral neck dissection. Reconstruction of the terminal tracheostomy in the anterior mediastinum was created using a pectoralis major muscle flap.

Clinical evaluation of pre-seasonal Cot laser surgery was performed to compare pre-seasonal and seasonal administration of the antiallergic drug, Tranilast, for patients with Japanese cedar pollinosis during the cedar pollen season in 1996. Sixteen cases (the laser group) received Cot laser surgery 2-3 months before the pollen began to scatter. Seventeen cases (the Tranilast group) received Tranilast, at least 2-4 weeks before and during the scattering. In the laser group, nasal symptoms were suppressed more effectively than those of the Tranilast group throughout the pollen season. In the laser group, the rate of effectiveness was as high as 70% in patients with sneezing attacks, 56% in patients with rhinorrhea and 82% in patients with nasal obstruction, whereas the rates were 60%, 50% and 67% respectively in the Tranilast group. Comparison of the two groups for seasonal variations of cedar specific IgE antibody, the amount of plasma histamine, the number of eosinophils in the nasal smear and the response to the nasal provocation test, suggested that the allergic reaction in the inferior turbinate was inhibited by the laser surgery. Based on these results, we conclude that laser surgery was useful for the prophylactic treatment of Japanese cedar pollinosis.

We investigated five patients with eosinophilic granulomas of soft tissue in the parotid region. Four patients were male and one patient was female. Patient age ranged from 11 to 42. The patients had moderate to marked eosinophilia in the peripheral blood and high serum immunoglobulin IgE. The lesions of Kimura's disease showed intermediate intensity on T1-weighted MRI and high intensity on T2-weighted images. Four patients were treated with surgical excision of the swollen parts of the facial tumor and received various medication therapies post operatively. One patient was treated with medication therapies alone, without surgical excision. Three patients who underwent full surgical excision recovered without recurrence. The remaining two patients have had repeated recurrences. A combination of surgery and medication is usually effective. However, when combination therapy is not effective, radiation therapy may be an alternative to prevent recurrence of Kimura's disease.

A 40-year-old female consulted our hospital complaining of frontal neck swelling and pain. Topographical imaging suggested a preoperative diagnosis of benign thyroid tumor (left lobe). On 24th Jan. 1996, a left thyroid lobectomy was performed. Histologically, the tumor was diagnosed as a granular cell tumor based on intraoperative examination of the specimen. Immunohistochemical examinations showed positive PAS, S-100 protein and NSE reactivity in the cytoplasm of the tumor cells. Electronmicroscopic findings showed autophagosomes. On the basis of these findings, the tumor was diagnosed as a benign granular cell tumor. Granular cell tumors are commonly found in the tongue, skin and subcutaneous regions. Tumors arising near the thyroid gland are rare. So far, only one case has been reported in Japan. Discussions of this case was made in the context of relevant literature.

In our department, the sublingual gland is typically removed during surgical treatment of a ranula. Of 18 cases treated surgically for ranulas, the major sublingual duct was seen in only one case. In general, the major sublingual duct is seen in 50-70% of general people. In view of this fact, our observations suggest that ranulas occur more frequently in the sublingual gland and do not typically involve the major sublingual duct. Moreover, the histopathological examination of all removed sublingual glands confirmed sialoadenitis. Thus it is necessary to remove the sublingual gland with the ranula to avoid the possibility of recurrence.

Extended surgery for advanced oropharyngeal carcinoma (stage III, stage IV UICC 1987) originating from the lateral wall was performed in 13 patients from 1992 to 1995 using the mandibular swing technique. Histopathologic findings were squamous cell carcinoma in all cases. The primary lesions were T2 in one case, T3 in 6 cases, T4 in 6 cases. The surgical margin of the deep layer was composed of the styloid process, carotid sheath and medial side of the mandibula. En bloc resection encompassing the primary region, dissected neck tissue, internal pterygoid muscle and parapharyngeal tissue was performed. In those cases where the tumor had invaded the mandibula, a marginal or a segmental resection was carried out.Reconstruction of the oropharynx was performed with only a forearm flap in 7 cases, and a pectoralis major musculocutaneous flap in 2 cases. Reconstruction with a forearm flap combined with a pectoralis major muscular flap was needed for obliteration of parapharyngeal and submandibular dead space in 3 cases. Reconstruction of mandibula was performed with a fibular osteocutaneous flap in 1 case.Postoperative complications, included open rhinolalia in 4 cases, dysphagia in 5 cases, and difficulty opening the mouth in 5 cases. Local recurrence was noted in 2 cases, 13 and 10 months after surgery, respectively. The tumor recurred in the region from the anterior arch of the palate to the retromolar area in both cases. Tumors invading this region should be resected with careful determination of the resected area.

A case of metastatic tumor of root of the tongue from the liver which occurred in a 59-year-old man is reported in this paper in conjunction with a relevant literature review. The patient's primary complaint on admission was hemosputum. Total removal of the tumor occupying the root of the tongue was carried out under general anesthesia. The histopathological findings revealed that the tumor was a metastasis of hepatocellular carcinoma. A review of the literature revealed very few reports of pharyngeal metastases derived from hepatocellular carcinoma.

Unenhanced high-resolution T2-weighted fast spin echo MR imaging was compared with enhanced T1-weighted spin echo MR imaging in the detection of acoustic neurinoma.A total of 47 patients with pathologically documented acoustic neurinoma were reviewed, 20 of which underwent high-resolution T2-weighted imaging of the cerebellopontine angle, internal auditory canal region.The size of the acoustic neurinomas ranged from 4 to 50 mm in maximum diameter. The mean maximum diameter was 17 mm, and 6 neoplasms were less than 10 mm in diameter. Nineteen of 20 masses were clearly identified on T2-weighted images. However, small abnormalities on enhanced T1-weighted images corresponded to a hypointense focus on T2-weighted images. All 20 masses were hypointense relative to cerebrospinal fluid on T2-weighted images.High-resolution T2-weighted imaging may be considered an adequate method of examination for the evaluation of possible acoustic neurinoma.

Mucoepidermoid carcinoma of the maxillary sinus is a rare neoplasm. We describe diagnostic difficulties in a case of low grade mucoepidermoid carcinoma of a cystic pattern in a 72-year-old man. The patient complained of double vision and nasal bleeding. CT findings indicated a shadow in the unilateral maxillary sinus as well as bony destruction of the maxilla on the same side. Although biopsies and maxillary operations were repeatedly performed over a period of 7 years, the histopathological diagnoses were chronic sinusitis with necrotic characteristics or squamous cell carcinoma.Several cases of mucoepidermoid carcinoma have been similarly misdiagnosed as squamous cell carcinoma because mucoepidermoid carcinomas contain epidermoid cell components similar to squamous cell carcinomas. Tumor necrosis in our case were extensive and the mucous discharge secreted by mucous cell components in this type of carcinoma may increase pressure inside the cystic tumor causing tumor necrosis. The significance of a differential diagnosis between mucoepidermoid carcinoma and chronic inflammation or squamous cell carcinoma in the maxillary sinus should be emphasized.

A case of cervical thymic cyst is presented, and the literature is reviewed. A 25-year-old-female was found to have a frontal neck mass. At surgery, the thyroid gland was found to be normal, but displaced by a cystic mass. The cyst was lobulated and contain clear fluid. It was removed from the carotid laterally and from the trachea medially.Thymic cysts are unusual neck masses that may occur along the embryologic pathway of migration of the thymus. The mass produces few symptoms, but can sometimes cause air way obstruction. Treatment consists of excision of the cyst and prognosis is usually good. This entity should be included in the differential diagnosis of neck masses.

We report a rare case of thyroid papillary carcinoma that was detected by parenchymatous hemorrhage. A 27-year-old female complained of sudden pain and swelling on the left side of the anterior neck. A CT scan demonstrated a mass measuring 3cm in diameter in the left lobe of the thyroid gland. Based on fine needle aspiration biopsy cytology, the tumor was diagnosed as class IV. Thus, the patient was suspected of having thyroid cancer of the left lobe associated with hematoma, and surgery was performed. At surgery, it was ascertained that the tumor in the left lobe was papillary carcinoma of the thyroid with lymph node metastasis. Therefore left subtotal thyroidectomy with modified neck dissection was performed. It is generally thought that cystic thyroid diseases are benign. However, it has been reported that 20 to 45% of malignant thyroid diseases demonstrate cysts. Therefore, physicians must always keep in mind that thyroid disease exhibiting neck pain and hematoma might be malignant.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. The head and neck are unusual sites for primary MFH, and MFH of the submental region is extremely rare. We encountered a case of MFH in a 60-year-old man who initially showed swelling in the submental region. He died of distant metastasis to lung 15 months after the radical surgery and postoperative chemotherapy.The clinical course and prognosis in this case were described, and the literature was reviewed and discussed.

A 70-year-old man was found to have an immature teratoma in his paranasal sinuses. A biopsy showed components of all three germ-cell layers: neural, epithelial, and glandular elements. MRI revealed a large irregular tumor invading the anterior cranial base. Intra and extracranial approaches were used for total resection. The bony defect of the anterior cranial base was reconstructed with a pericranial flap and temporal muscle flap. The patient was treated with chemotherapy and radiation following surgery. However several pulmonary metastases and effusion appeared, and he died 8 months after the operation.

The clinical usefulness of long-term low-dose roxythromycin (RXM) therapy was studied in 21 patients with chronic sinusitis with the use of the X-ray mucociliary function test. Half the usual daily dose (150mg/day) of RXM was administrated for six months or longer. The symptom efficacy rates for rhinorrhea, nasal obstruction, postnasal discharge and heaviness of the head were 73.7%, 66.7%, 68.8% and 70.6%, respectively. The X-ray mucociliary function test proved that mucociliary clearance function improved and/or mucosal edema in the maxilary sinuses decreased in more than 75% of the patients after RXM treatment. These results suggest that RXM relieves on chronic sinusitis even below the MIC level and that its efficacy may be due to improvement of the mucociliary clearance function.

It has been reported that lymphoepithelial lesions (LEL), including Sjogren syndrome and benign lymphoepithelial lesions (BLEL), often change to low-grade malignant B-cell mucosa associated lymphoid tissue (MALT) lymphomas. In the patient described here BLEL changed to malignant lymphoma in both parotid glands over a 2-year interval. Surgical removal was performed because this malignant lymphoma generally resists to both chemotherapy and radiation therapies, and the prognosis is poor when the lymphoma extends outside the gland.

The YAMIK sinus catheter, which was developed in Russia, is less difficult to use and causes fewer complications than the Proetz displacement method, the standard physical therapy procedure for chronic sinusitis. This method was used once a week for 3 consecutive weeks to treat 132 patients with chronic sinusitis. The only complication was slight nasal bleeding found during receiving negative pressure. An evaluation of subjective symptoms and objective findings showed that headache and nasal secretion were significantly diminished during and after treatment. Its remarkable effectiveness in reducing sinus pressure supports the “hydrops ex vacuo” theory as the mechanism of frontal sinusitis.

A survey was conducted of 201 patients with abnormal sensation in the throat who stopped treatment for various reasons. The respose to therapy and the psychological background were the main focuses. Anxieties about cancer at the first medical examination and desire for treatment for non-cancerous conditions were recorded. The reasons for discontinuing treatment and expectations for help from the staff, etc were considered.1. When treatment was discontinued the intensity of the abnormal sensation was 63% of that recorded at the first examination. The period of ambulatory therapy averaged 3 months.2. The response to therapy was not related to anxiety about cancer. However, the prognosis was better in patients who could ignore symptoms if cancer was ruled out than in those who wanted treatment even though cancer was not present.3. The reasons for discontinuing treatment were closely related to the degree of symptomatic improvement. Remission of symptoms was the reasons for discontinuing treatment in 27.5%; no change in symptoms was the reasons in 10.8%; in a third group some other reasons for discontinuing treatment were noted although the abnormal sensation was 74% as severe as at the first examination.The above results suggest that abnormal sensation in the throat is due to some unknown local and general factors other than psychological.

Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been increasing in recent years.For patients undergoing combined craniofacial procedures for these tumors are reported. In three of these cases, the defect caused by a resection of the skull base was reconstructed with a free rectus abdominis flap.The patients in this series showed no major complications and all have remained free of disease during the short follow-up period.

Cisplatin (CDDP) is one of the most potent and useful anticancer agents for head & neck cancers. The cytotoxicity of this drug is known to include inhibition of DNA synthesis. However, the development of resistance by tumor cells to this drug is an important problem. In order to elucidate the mechanism of CDDP resistance, we established CDDPresistant KB cell lines (KBrc cells) from oral epidermal carcinoma cell lines (KB cells). In this study, we investigated the mobilization of intracellular free calcium ion concentration ([Ca2+]i) to elucidate the mechanism of CDDP resistance in case of contact with a high dose of CDDP (500μg/ml) using these cell lines. Incubation with CDDP markedly increased [Ca2+]i in both cell lines. In contrast, a low dose of CDDP resulted in the reduction of [Ca2+]i toward the resting level. Furthermore, the peak and plateau of [Ca2+]i were higher in KB cells than in KBrc cells, and the speed toward the plateau phase was later in KB cells in comparison with that in KBrc cells. This increase in [Ca2+]i was thought to be due mainly to an influx of extracellular calcium ions. Moreover, the viability of KB cells was lower than that of KBrc cells. It was speculated that KBrc cells possesed the ability to protect CDDP compared with KB cells and the change of [Ca2+]i in KBrc cells was less than that in KB cells. It appears that CDDP can injure cell membranes as well as inhibit DNA synthesis.

An arteriovenous malformation is defined as a congenital lesion of dysplastic vascular origin with large feeding arteries. Previously, attempts at treatment by complete excision of the vascular mass were complicated by severe hemorrhage. With the advantages of angiography, the arteriovenous anomaly can be defined more clearly, and preoperative embolization effectively reduces intraoperative blood loss.This paper describes an extensive arteriovenous malformation supplied by the ipsilateral external carotid artery, internal carotid artery, and vertebral artery and the contralateral external carotid artery. This patient was treated successfully with radiologic microembolization followed by surgical extirpation with little blood loss.

To control the recurrence of nasal allergic symptoms, we performed revaporization with CO2 Laser beam in 27 patients with perennial nasal allergy whose nasal symptoms had been alleviated after the initial laser surgery. Revaporization was effective in 85% of the patients one month after surgery in 78% 2 years after surgery and in 64% 3 years after the revaporization. Patients with relapse within one year after surgery had little improvement in subjective symptoms, while patients with relapse later than one year after surgery responded well, and long-term results were good. No differences were found in the severity of the preoperative symptoms, RAST score, or IgE values between patients with early and with late recurrence.

A rare case of mucus-producing adenopapillary carcinoma of the parotid gland in a 12-year-old man has been reported. The clinical and pathological characteristics of mucus producing adenopapillary carcinoma of the parotid gland and its management have been discussed.

We performed chemosensitivity tests with MTT assay using KB cells derived from epidermal carcinoma of the mouth. Optical density (OD) for the MTT assay was measured with dual wave lengths: measurement wave (540nm) and reference wave (620nm). Five platinum (Pt) drugs and three anthracycline drugs were tested. The chemosensitivity to drugs was evaluated by the 50% OD of each drug concentration in the control group. CDDP was the most effective Pt drug, followed by 254S, NK121, CBDCA and DWA2114R. No significant difference among the three anthracycline drugs. We observed a linear increase of OD, corresponding to the increase in the number of cells. When we added 0.1M sodium succinate (SS) to 0.4% MTT {3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H tetrazolium bromide}, the sensitivity of this assay was increased five fold.MTT assay is a precise, rapid, easy and inexpensive experimental system, which should be an useful method of evaluating the effect of antitumor drugs on tumor cell lines.

We applied a nebulizer therapy to cases of patulous tube and otitis media with effusion (OME) using a new device with which a solution can be nebulized into the Eustachian tube and the middle ear cavity when eardrum perforation exists. In cases of the patulous tube, autophony or feeling of ear fullness disappeared for a longer time after rugal nebulizer therapy compared to that after injection of a mixture of boric acid and salicylic acid powder. In cases of OME, patients were treated by myringotomy and nebulizer therapy with 2% fosfomycin and 0.2% betamethazone for 1 to 2 weeks while eardrum perforation persisted. This treatment in combination with myringotomy and transtubal nebulizer therapy was more effective than treatment by myringotomy alone. From this study, it was concluded that nebulizer therapy to the Eustachian tube and the middle ear cavity is very useful for treatment of patulous tube and OME.

Branchial cysts in the parotid gland are rare. Among 392 parotid masses which we examined and operated on during the past 15 years and 7 months in our hospital nine were branchial cysts. All were identified as second branchial cysts. Ultrasonography showed a septum structure in two of the cysts. Although ultrasonography and magnetic resonance imaging (MRI) provide useful information in the diagnosis of cysts, those which contain non-serous materials are sometimes misdiagnosed as solid tumor.

This paper investigated transmucosal gas exchange in middle ear (ME) pressure regulation mechanisms. In volunteers with normal ears, positive or negative pressure was applied by Valsalva's or Toynbee's maneuver and ME pressure change without transtubal pressure regulation was monitored for 30-40 minutes. ME pressure tends to return to atmospheric pressure independent of applied pressure indicating that transmucosal gas exchange is involved in ME pressure regulation, together with transtubal pressure regulation. Furthermore, we developed a test to evaluate the transmucosal gas exchange capacity and compared normal ears and ears with otitis media with effusion (OME). ME cavity was insufflated with various gases with different compositions (room air, 100% N2, 100% O2 mixed gas with 5% CO2 and 95% O2). The ME pressure changes due to gas diffusion into or out of the mucosa were measured using a pressure transducer connected to the ME cavity. When room air and 100% N2 were insuffiated into the ME cavity, positive pressure were observed in both normal and OME cases. However, insufflation with 100% O2 or a mixture of 5% CO2 and 95% O2 produced quite different results. In contrast to positive pressure by 100% O2 and no significant pressure change by mixed gas in normal cases, remarkable negative pressure changes were observed in OME ears. This result suggests that O2 absorption is accelerated in cases of OME compared to that in normal ears.From our study, we conclude that the transmucosal gas diffusion in OME cases is quite different from that in the normal ears, and that increased 02 absorption in OME may also promote development of negative ME pressure which is thought to play an important role in the pathogenesis of OME.