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We report two cases of vocal fold paralysis due to varicella-zoster virus infection. Both patients complained of otalgia and hoarseness and the serum antibody titers for varicella-zoster virus were significantly elevated. Neither patient showed facial palsy, and laryngeal electromyography showed reduced recruitment patterns in cricothyroid muscles and thyroarytenoid muscles on the affected side. These findings indicated the paralysis of the vagus nerve, but not the recurrence nerve. Acyclovir was administrated in both cases and the patients recovered from vocal fold paralysis within 3 months.

Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.

In a series of 191 patients with chronic paranasal sinusitis 54.4% had foreign-body sensation in the throat (FBST). Roxithromycin (RXM) was administered for about 2 months. The post-arytenoid area was examined for pus and the patients were divided into the following three groups: 1) pus present but disappeared with treatment (35 patients); 2) pus present both before and after treatment (9 patients); 3) no pus either before or after treatment (60 patients). Group 1 had much higher rates of recovery from nasal symptoms and efficacy rates than did group 2. The FBST scores of group 1 patients improved with treatment (4.02→3.04), but there was virtually no change in group 2 (3.53→3.64).These results indicate that FBST can be induced by postnasal discharge in patients with chronic paranasal sinusitis and can usually be reduced by treatment with appropriate antibiotics.

Eight patients with voice tremor were studied to characterize laryngeal muscle involvement. Electromyographic (EMG) recordings were made from intrinsic laryngeal muscles, simultaneously with some extrinsic laryngeal muscles, respiratory movement, and voice recordings during respiration, whisper, and phonation. Spectral measures were used to determine the tremor frequency and the prominence of spectral peaks in the EMG, respiratory and acoustic signals, while correlation coefficients were computed between pairs of tremulous EMG signals to measure the synchrony of tremor between muscles. The intrinsic laryngeal muscles were tremulous during respiration and speech, with the thyroarytenoid most often involved. Tremor was also detected in some of the extrinsic muscle recordings and the percentage of muscles with tremor was higher during phonation than during whisper or respiration. Time delays were found between tremor oscillations in laryngeal muscles. Because the thyroarytenoid was affected in all the patients studied, botulinum toxin injections may be beneficial in treatment of this voice disorder.

Summary The benefit duration and side effects following effective treatment of spasmodic dysphonia or voice tremor using botulinum toxin injection were studied following 477 open trial unilateral or bilateral injections provided to 178 patients. A comparison of unilateral and bilateral injections in male and female patients with adductor spasmodic dysphonia demonstrated an increased benefit duration following unilateral injections in women, longer periods of breathiness in men than in women following bilateral or unilateral injections, and a trend for reduced benefit durations following repeated treatments using bilateral injections. Outcomes were similar in the adductor spasmodic dysphonia and vocal tremor groups following thyroarytenoid injection while benefit durations were reduced and side effects lasted longer in patients with abductor spasmodic dysphonia following cricothyroid injections. Long-term benefit > 1 year occurred in 12.3% of patients following injection.

We report the case of a 37-year-old woman with a history of long-standing right-sided sensorineural hearing loss who presented with an acute onset of vertigo and ipsilateral facial palsy. A computed tomographic scan study showed a stenosis of the right internal auditory canal (IAC). Neither generalized skeletal disease nor bony tumors, which may cause the IAC stenosis, were evident. The IAC stenosis found in this patient may be due to congenital malformation. Inflammation, compression or ischemia in the stenosed IAC may have resulted in the vertigo and facial palsy. This is the only case that we are aware of in which IAC stenosis is accompanied by vertigo and facial palsy.