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Juzen-taiho-to (JTT) is known as a herbal medicine that improves immune function. We evaluated whether JTT has a beneficial effect in otitis-prone children. Twenty otitis-prone infants took JTT at 0.1-0.14mg/kg/day twice a day for three months. The medication compliance rate was 85%. The frequency of otitis media purulenta significantly decreased (t-test, p=.000, Wilcoxon signed rank test, p=.000) by the oral administration of JTT. The number of days of fever (t, p=.000, Wilcoxon, p=.000), antibiotic administration (t, p=.002, Wilcoxon, p=.001), hospital visits (t, p=.014, Wilcoxon, p=.005), and emergency hospital visits (t, p=.000, Wilcoxon, p=.000) also showed significant decreases after taking JTT as compared with before.The onset and progression of infection depends on the balance between the reproductive power of microbes and host defense. The effects of JTT on otitis-prone individuals have not been investigated before. JTT is thought to be one of the effective treatments for otitis-prone cases, and avoiding the overuse of antibiotics would prevent the increase of drug-resistant bacteria both in terms of their number and level of resistance.

Pulmonary edema following acute upper airway obstruction is called negative pressure pulmonary edema (NPPE). The predominant mechanism is increased negative intrathoratic pressure, although hypoxia, cardiac and neurologic factors may contribute. We encountered a case of pulmonary edema after pharyngeal surgery. A 50-year-old male with peritonsillar abscess underwent incision and drainage under general anesthesia. After extubation of the tracheal tube following successful surgical procedure, upper airway obstruction due to laryngospasm and/or edema of the pharynx ensued. The patient developed respiratory distress with vigorous inspiratory efforts. After reestablishment of the airway, pink frothy sputum flowed from his mouth and nose. Chest X-rays demonstrated bilateral diffuse alveolar infiltration. Diuretics, steroids and mechanical ventilatory support by continuous positive airway pressure were effective. The onset of NPPE is usually rapid, and without prompt recognition and intervention, the outcome can be fatal. NPPE appears more frequently in healthy male patients, particularly patients receiving head and neck surgery with or without concurrent airway obstruction. Prevention, early diagnosis, and prompt treatment facilitate an uncomplicated resolution.

We inserted the ventilation tube into seven children for recurrent acute otitis media (rAOM), who could not recover from rAOM in spite of comprehensive treatments including myringotomies, oral or intravenous administration of antibiotics, and administration of immunoglobulin.In order to select patients for the ventilation tube insertion, we followed the indications for surgery as below.1) Recurring otitis media purulenta more than once a month2) Inability to recover from rAOM in spite of comprehensive treatments including myringotomies and peroral or intravenous administration of adequate antibiotics3) Ability to undergo general anesthesia.The average observation times before and after surgery were 8.05 and 5.10 months. During these periods, the frequency of otitis media purulenta significantly decreased (t test, p

We report 7 cases of acute and recurrent inspiratory dyspnea in which no organic cause could be identified. Patients were from 12 to 68 years old (43.6 in average), consisting of five males and two females. In three of the seven cases, fiberoptic laryngoscopy during an attack of dyspnea revealed laryngospasms following symmetric adduction of the vocal cords. Each patient experienced loud, stridorous noise during inspiration at the beginning of an attack as well as the subsequent inability to inspire. The attacks ranged from several tenths of a second to a few minutes in duration and occurred frequently, several times a day in some cases. Results of physical examinations, lung function tests, roentgenograms of the chest and larynx, and CTs of the lungs and the neck were unremarkable. Laboratory findings including blood gas analysis between attacks were within normal limits. No atopic stigmata were found.Drinking water or swallowing could sometimes relieve the grade of the attack, and the patient could completely prevent attacks once they understood the condition of the dyspnea and mastered a breathing maneuver during the attack. Previous upper respiratory infection, cough, and sleep apnea were suggested to correlate with the episodes. Our patients did not require drastic maneuvers such as tracheostomy or intubation. Administration of Eperisone hydrochloride and Etizolam proved effective in some cases.Laryngospasm as a cause of recurrent inspiratory dyspnea is functional, and we suspect that it is not such a rare occurrence. An awareness of this entity could prevent unnecessary tracheotomies.

At our clinic, we encountered 272 cases of facial bone fracture between 1983 and 1993. These patients were analyzed by age, gender, cause and location of the fracture.There were 202 nasal bone fractures, which comprised 59.3% of all facial bone fractures. Males were significantly predominant (75.2%). These injuries mainly occurred during sports, fighting and automobile accidents.While usually single and rather slight bone fractures such as nasal bone fractures occured during sports, more severe fractures involving many facial bones occured in high speed, such as automobile accidents. Moreover, orbital bone fractures mainly resulted from fightings or sports. Precise otolaryngological knowledge and management is indispensable for ENT clinicians.