Nasal polyp shows a strong positive reaction in methacholine nasal stimulation test. Although the reason why nasal polyp is produced is still unknown, allergic reaction is one of the factors of affecting nasal membrane to polypoid change.
The aim of this study is that 60 patients who had nasal polyp were separated positive allergic group with negative group by allergen skin test, and compared the hypersensitivities of upper and lower airways each other by means of methacholine nasal inhalation test. Additionary aim of this study is to compare the hypersensitivity between before and after nasal polypectomy. The results showed that in the patients who were positive in allergic test, the forced expiratory volume one second (FEV1.0) and the flow volume curve were statistically lower than in the patients who were negative in allergic test in spite that FEVi.0% was statistically no different. On the other hand, there was no significant difference of the sensitivity of the methacholine inhalation test between 2 groups.
20 cases of 60 patients were performed nasal polypectomy. In the positive allergic patients, marked hypersensitivity of the lower airways was showed 3-6 months after nasal polypectomy from the study about the change of the flow volumes before and after methacholine nasal inhalation test. However, at 12 months after surgery, the sensitivity of the lower airway was improved. On the other hand, the sensitivity of the lower airway in the negative allergic patients was not changed. These results suggest that the nasal polypectomy had better be positively performed not only for the improvement of the nasal symptoms and nasal function but also for the improvement of lower respiratory function, especially in the sensitivity of the lower airway.

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There is a recent trend in Japan that the incidence of severe case of chronic sinusitis is on the decrease.
Chronic sinunsitis usually involves the maxillary sinus bilaterally.
However, in some instances, it involves only one maxillary sinus, right or left, when we are in dilemma whether or not to open the sinus to rule out an early case of malignancy of the sinus.
A total of 90 cases of maxillary sinus disease with unilateral involvement were studied by cytology of the specimen obtained by means of irrigation of the sinus. Three of the cases showed cells of class V, two of them showed mycelium of Aspergillus and one of them showed the infected cell of Herpes virus after Papanicolaou.
Our study has revealed that the results of cytological study of the maxillary sinus conform well with those of histopathological study of the sinus mucosa obtained during operation. It is concluded that cytology of the maxillary sinus is a useful means of diagnosis of early case of malignancy and any other specific diseases.

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Secretory otitis media (SUM) is a common disease.
Treatment is done by many methods, but each treatment method needs a long time to cure this disease. The author injected steroid (Decadron ® 0.5 cc) through the hole in the ear drum made by myringotomy.
Of the 46 ears, 17 ears (37.0%) were cured, 12 ears (26.1%) required observation. 3 ears (6.5%) took a poor course, and fates of 14 ears (30.4%) were unknown.
Above moderate improvement was noted in 29 ears (63.1%).
The results of this method was better than those of myringotomy for treatment of SOR.
A patient, who was not cured after three treatments by this method, may need insertion of a ventilation tube.
This treatment would be indicated to patients with recurrent disease.

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We report otological symptoms and temporal bone findings in a 53-year-old male with bilateral temporal bone cancer (transitional cell carcinoma) which was caused by metastasis from a primary lesion in the bladder. He was diagnosed as sudden deafness and in spite of steroid therapy, the symptoms were aggravated without remission. After admission, CFS examination revealed metastatic leptomeningeal carcinomatosis, and he died about 3 months after the initial visit.
Autopsy revealed transitional cell carcinoma of the bladder and its metastasis to the brain stem and spinal cord.
Pathological study of the temporal bone showed infiltration of carcinomatous cells in the bilateral internal auditory canals.
Rapidly progressive bilateral hearing loss and right facial palsy suggested a possibility of tumor cell invasion into the inner ear through the internal auditory canals.
Temporal bone metastases are probably more common than generally thought.

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Thirty-eight cases which underwent excisional biopsies of the cervical lymphnodes were investigated statistically, clinically and histopatho logically. In 4 cases diagnoses were difficult (1 case of subacute necrotic lymphadenitis, 1 case of metastatic lymphadenitis, and 2 cases of malignant lymphomas).
The 38 cases consisted of 15 cases (39%) of nontumorous lesions and 23 cases (61%) of tumorous lesions. The nontumorous lesions (15 cases) consisted of 8 cases of simple lymphadenitis, 5 cases of tuberculous lymphadenitis, and 2 cases of subacute necrotic lymphadenitis. The tumorous lesions (23 cases) consisted of 6 cases of malignant lymphomas and 17 cases of metastatic lymphnodes.
For the differential diagnosis of subacute necrotic lymphadenitis and malignant lymphoma, a detailed histopathological investigation is necessary. For cases with a diagnosis of metastatic lymphadenitis and unknown primary foci, a prolonged observation of possible causes is important.
When there is no reduction in the swelling of lymph nodes after treatment with antibiotics and antiinflammatory agents, it would be advisable to perform an excisional biopsy of lymphnodes.

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A case report of pharyngeal stenosis, apparently following lingual tonsillectomy, is presented.
A 38-year-old man, with a history of tonsillectomy at 23 years of age, complained of a swallowing discomfort and a change in voice after the surgical therapy for chronic lingual tonsillitis elsewhere at 33 years of age. Bilateral palatine arch adhered to the tongue base and the posterior wall of the pharynx, therefore, the pharynx was stenosed like a pharyngeal “web” postero-laterally. Mild hypernasality and nasal emission were pointed out by speech pathologist, although obstructive airway signs and symptoms was not seen. Because of thin adhesion, surgical correction of the stenotic pharynx was accomplished using contact YAG LASER without flap reconstruction. Postoperatively his complaints was disapeared and there have been no signs of recurrent stenosis for 2 months.
Surgeons should keep the fact in mind that pharyngeal cicatricial stenosis is one of the complications of palatine tonsillectomy and lingual tonsillectomy.

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We experienced a case, where a patient who underwent surgical removal of a hemangioblastoma of the brain stem, only to be left with trismus, dysmasesis, dysphonia, dysphemia and severe dysphagia after the operation. This patient was totally unable to ingest food or drink. We treated this patient by means of rehabilitation, and surgical procedures involving the fields of otorhinolaryngology, plastic and reconstructive surgery and dentistry.
The patient was a 38-year-old female who underwent surgical removal of a hemangioblastoma of the brain stem in November of 1989. During the surgery, the glossopharyngeal nerve and the vagus nerve were inadvertently severed. In addition, Wallenberg's syndrome developed due to vascular occlusion. These conditions resulted in postoperative unilateral paralysis of 5th through 12th nerves, and oral intake was totally impossible. Surgical therapy was carried out in the form of cricopharyngeal myotomy, chalioplasty, adhesiotomy of temporomandibullar joint and rehabilitation was performed. As a result, the patient became capable of oral intake.
Accordingly, we surmised that, for patients such as the one reported here, with severe dysfunction of head and neck area as a sequela of brain surgery, it is essential that multidisciplinary countermeasures be taken soon after the onset of the dysfuncion. Those countermeasures include education of the patient, physical rehabilitation and the cooperation of various medical specialties.

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The authors report a case of 66-year-old female with right epitaxis and swelling of the right cheek.
Pathological examination revealed nonepithelial malignant neoplasm.
After radiation therapy, the tumor was totally resected by upper gingival approach.
Pathological diagnosis was dedifferentiated chondrosarcoma, originating at the ala nasi.
Dedifferentiated chondrosarcoma has a high malignat clinical quality, and we could not resect the tumor radically.

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An outline of evaluations and treatments for swallowing disorders in daily practice is provided. The physiological phenomena of the normal oral preparatory, oral, pharyngeal and esophageal phases of swallowing were described with nerves and muscles which relate to oropharyngeal movements during deglutition. Causes of swallowing disorders were classified by nature and onset. So as to evaluate pathological conditions in dysphagia, contents of interviews with patients, general and local examinations, especially, neurologically for neuromuscular disturbances, fluoroscopy, endoscopy, manometry and electromyography and so on were discussed. How to manage the dysphagia due to neuromuscular disorders in the ENT clinic was also reported. Author emphasized that when the physician examines dysphagia patient, the cause of swallowing problems must be explored.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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