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Aim:CyberKnife is the most advanced form of stereotactic body radiotherapy (SBRT) system that uses a robotic arm to deliver highly focused beams of radiation; however, a limitation is that it only irradiates from ceiling to floor direction. In patients with posterior lungs tumour who are positioned supine, normal lung tissue may suffer undesirable radiation injuries. This study compares the treatment planning between the prone set-up and the supine set-up for lung cancer in CyberKnife SBRT to decrease normal lung dose to avoid radiation side effects.Materials and methods:A human phantom was used to generate 108 plans (54 for prone and 54 for supine) using the CyberKnife planning platform. The supine and prone plans were compared in terms of the dosimetric characteristics, delivery efficiency and plan efficiency.Results:For posterior targets, the area of low-dose exposure to normal lungs was smaller in the prone set-up than in the supine set-up. V10 of the lungs was 7·53% and 10·47% (p < 0·001) in the anterior region, and 10·78% and 8·03% (p < 0·001) in the posterior region in the supine and prone set-up plans, respectively.Conclusions:The comparison between the prone set-up and the supine set-up was investigated with regard to target coverage and dose to organs at risk. Our results may be deployed in CyberKnife treatment planning to monitor normal tissue dose by considering patient positioning. This may assist in the design of better treatment plans and prevention of symptomatic radiation pneumonitis in lung cancer patients.

Objective:An increasing number of transnasal endoscopic surgical procedures are being performed, and these procedures are now also utilised in the management of malignant sinonasal tumours. This study aimed to evaluate the outcome of endoscopic resection of sinonasal malignancies, with or without chemotherapy and radiotherapy.Methods:Between 2000 and 2009, six patients with sinonasal malignancies (diagnosed on pre-operative biopsy) underwent endoscopic resection at our hospital. The histopathological diagnoses varied and included squamous cell carcinoma, olfactory neuroblastoma, chordoma, extramedullary plasmacytoma and haemangiopericytoma.Results:Surgical resection was combined with chemotherapy and/or radiotherapy in four cases. The mean follow-up period was 43 months. One patient suffered local recurrence of chordoma, 84 months after the first operation, but this was successfully treated with proton beam radiotherapy.Conclusion:These results suggest that endoscopic resection may be a valid alternative to conventional resection in selected cases of malignant sinonasal tumour.

To evaluate the effectiveness and usefulness of transnasal endoscopic surgery for the treatment of odontogenic maxillary cysts.Between February 2003 and February 2008, transnasal endoscopic surgery was performed under general anesthesia in 13 patients (male 6 and female 7, 19 to 75 years old) with odontogenic maxillary cysts that extended to the maxillary sinus. Ten patients had a radicular cyst and three patients had a dentigerous cyst. After the resection of anterior edge of the inferior turbinate, the lateral wall of the inferior nasal meatus was opened. Then, the cyst wall of the maxillary sinus was partially or completely removed under the endoscope.The cyst walls were completely removed in five often patients with a radicular cyst and in all three patients with a dentigerous cyst. Five patients with a radicular cyst received partial resection of the cyst wall. The affected teeth could be preserved in seven of ten patients with a radicular cyst and in one of three patients with a dentigerous cyst. There were no complications, and postoperative courses were uneventful. Follow-up period ranged from 11 to 72 months (mean 42 months), and no recurrence has been noted in any of the cases.Endoscopic transnasal surgery for the odontogenic maxillary cyst is less invasive than conventional dental approach, and most of the affected teeth can be preserved. This technique appears to be a simple and highly effective surgical treatment for the treatment of patients with odontogenic cysts that extend to the maxillary sinus.

Introduction Ameloblastoma is a benign odontogenic neoplasm of the jaw, rarely presenting as a malignant tumor. Although it is very important to discriminate ameloblastoma from ameloblastic carcinoma in order to decide the appropriate operative procedure, this is difficult using conventional CT and MRI. Case descriptions We report a case of maxillar ameloblastoma in a 78-year-old man where FDG-PET/CT was useful for making this discrimination. CT demonstrated a 31 × 43 × 46-mm mass in the left posterior maxillary sinus with destruction of its posterior and lateral wall and alveolar bone. MRI demonstrated a hypo- to isointense heterogeneous pattern on T1WI, heterogeneous hyperintensity with a prominent high-signal spot on T2WI, high signal intensity on DWI reflecting restricted diffusion, and strong heterogeneous enhancement. Because FDG-PET/CT showed mild FDG uptake (SUVmax 2.40) by the mass, ameloblastoma, rather than ameloblastic carcinoma, was considered to be the correct diagnosis. Discussion and evaluation It appears that ameloblastic carcinoma shows intense FDG uptake, whereas ameloblastoma shows mild or moderate FDG uptake, and only rarely intense FDG uptake. Our experience suggests that FDG-PET/CT may be effective for discriminating ameloblastoma from ameloblastic carcinoma. Especially, in cases showing mild FDG uptake, benign ameloblastoma would seem the most likely diagnosis. Conclusions FDG-PET/CT may be useful as an adjunctive modality for diagnosis, treatment planning and surveillance of ameloblastoma and ameloblastic carcinoma.

We evaluated the efficacy of early treatment by ramatroban and antihistamine in patients with Japanese cedar pollinosis by comparing treatment before the start of the pollen season and treatment after the pollen had been dispersed. A pollinosis diary and Japanese allergic rhinitis standard QOL questionnaire (JRQLQ No. 1 and No. 2) were used to evaluate the effectiveness.Huge amounts of Japanese cedar pollen and Japanese cypress pollen were disseminated in Shiga prefecture in 2005. The nasal symptom score, medication score, and symptom medication score showed better outcomes in the early treatment group not only during the Japanese cedar pollen season but also the Japanese cypress pollen compared to the other group. The early treatment group also showed better results in every category of JRQLQ No. 1 and No. 2 compared with the late treatment group. No harmful side effects were observed through the course of this study.We concluded that early treatment by ramatroban in combination with antihistamine in patients with Japanese cedar pollinosis was useful not only for improving symptoms but also retaining the quality of life during such a heavy pollen-producing year.

We report the endoscopic ligation of the maxillary and sphenopalatine arteries for the treatment of intractable epistaxis. From March 2003 to February 2005, 17 patients (12 men, 5 women) with epistaxis were hospitalized in our department. Patient age ranged from 25 to 83 years, with an average age of 62 years. 8 patients were successfully treated using the conventional packing method, 2 patients were treated using electrocauterization, and 1 patient with macroglobulinemia was treated using plasma exchange therapy. 6 patients underwent endoscopic ligation of the maxillary and sphenopalatine arteries while under general anesthesia. The post operative courses were uneventful, and no recurrent bleeding has been noted. Endscopic ligation of the maxillary and sphenopalatine arteries is safer than intraarterial embolization and less invasive than conventional surgical approach for the ligation of maxillary artery. This technique appears to be a safe and effective surgical treatment for patients with intractable epistaxis.

Endoscopic resection of nasal and paranasal sinus tumors is more aesthetic and less invasive than conventional resection, such as Luc's operation and lateral rhinotomy. We clarified the effect of radical endoscopic tumor excision and the control of local bleeding hazardous in endoscopic surgery. Subjects were patients with benign lesions in the nasal cavity, medial wall of the maxillary sinus, ethmoid sinus, and/or sphenoid sinus without concurrent malignant lesions. Although patients selection for malignant tumor excision was based on (1) possible en bloc resection, (2) low-grade malignant tumors, and (3) tumors in the nasal cavity and adjoining paranasal sinus, the final decision was made individual. Subjects were 23 patients with benign tumor (10 inverted papilloma, 9 hemangioma, 2 juvenile angiofibroma, and 2 other tumors) and 4 with malignant tumor (olfactory neuroblastoma, acinic cell carcinoma, squamous cell carcinoma, and chondroid chordoma) in the nasal and paranasal sinus. The tumor was resected en bloc except for patients with inverted papilloma (2 cases) and chondroid chordoma. Recurrence in benign tumors was zero during a mean observation of 21 months. One with chondroid chordoma, however, suffered a recurrent lesion 7 months after the initial operation. The lesion was successfully salvaged by a similar endoscopic procedure and subsequently treated with electron beam irradiation. Preoperative arterial embolization, laser coagulation, and ligation of the sphenopalatine artery were very useful in reducing blood loss during surgery and maintaining a clear endoscopic view. In intraoperative bleeding volume, less than 100 ml of bleeding occurred during surgery in 23 of 27 patients. The endoscopic excision of benign lesions in the nasal and paranasal sinus is thus as effective as conventional radical surgery. Endoscopic removal of malignant lesions remains controversial because of the small number of patients and short postoperative observation.

We evaluated the effectiveness of two navigation systems with optical tracking in endoscopic sinus surgery (ESS). The Signa SP/i Intraoperative navigation system (General Electric Co., Intraoperative NS) is advantageous in acquiring both real time and high-resolution images during surgery, compared to conventional image-guided navigation (Stealth Station TREON, Medtronic Inc., IGNS) that rely entirely on preoperative three-dimensional images. We studied the following in 14 patients treated with intraoperative NS and 19 treated with IGNS: 1) additional time for navigation system implementation, 2) available instrumentations in ESS, and 3) navigation system accuracy. Navigation systems required additional time to prepare ESS. The time lapse from admittance to the operating room to ESS onset was measured in patients under both systems and controls undergoing ESS without any image guidance. Preparation of the intraoperative NS required an additional 52 min and IGNS required 17 min compared to the control group. Based on operative instruments, the intraoperative NS has some limitations arising from the application of a high magnetic field. Surgical instruments must not be attracted by the magnetic field in the operating room. So those used in our study were thoroughly examined and some remanufactured using MR safe materials. All instruments in ESS could be used in surgical guidance during surgery in the IGNS. Anatomic landmarks were accurately visualized using intraoperative NS and IGNS. Intraoperative NS renews the image during surgery, so surgeons could confirm the surgical outcome during ESS. Since the average distant error in both systems was between 1 mm and 2.5 mm, we confirmed that accuracy obtained with both navigation system was suitable for ESS completion. The intraoperative NS renewed the image during navigation. In conclusion, both navigation systems are sufficient for accurate image navigation in ESS, but navigation systems must be selected based on the individual case.

誘発耳音響放射 (TEOAE) の臨床研究から年齢差, 性差, 左右差があることが最近報告されている。当科では平成12年10月より276例 (552耳) の産科入院の正常満期産の新生児に対して入院時あるいは1ヵ月検診時に, TEOAE, 歪成分耳音響放射 (DPOAE) を用いて聴覚スクリーニングを行っている。TEOAEとDPOAEを併せた検査結果では, 初回検査で要精査耳が32耳でその内訳は, 右耳が13耳 (41%), 左耳が19耳 (59%), 男児が20耳 (62%), 女児12耳 (38%) と右耳, 女児で要精査率が低い傾向にあった。今回我々は条件を満たしたTEOAE反応の得られた新生児および1ヵ月児253例506耳を対象としてTEOAEの性差, 左右差, 周波数差について検討した。結果はTEAOE反応が男児よりも女児に, 左耳より右耳において有意に大きいことを示した。周波数の検討では3kHzで他の周波数より大きかった。原因として自発耳音響放射 (SOAE) の影響, 特に蝸牛の解剖学的形態, 有毛細胞に対する遠心線維の抑制効果に性差, 左右差があることなどが示唆される。

今回我々は, 急性中耳炎で日本赤十字社和歌山医療センターを受診し, 内耳障害の認められた43例47耳について検討を行った。 症例は男性19例, 女性24例で, 年齢は16歳から78歳 (平均年齢49歳) であった。 初診時の症状は難聴, 耳痛, 耳鳴, 耳漏, めまい感であった。 内耳障害の診断は聴力検査で少なくとも1周波数以上で15dB以上の骨導閾値の上昇を認めるものとした。 全症例に抗生剤, ステロイド, ATP製剤およびビタミンB製剤の点滴または内服投与を行い, 26耳に鼓膜切開術を, 10耳に鼓膜チューブ留置術を行った。 急性中耳炎に伴う内耳障害は比較的予後が良好とされるが, 8耳で不変例を認めた。 入院治療例と外来治療例では聴力予後に差が生じており, 本疾患では積極的な消炎治療と安静が必要であると考えられた。

5-FU先行型MTX enhanced 5-FUCDGP療法が著効した症例を報告する。症例は71歳男性, 原発不明頸部転移である。初診時右上頸部に鶏卵大の腫瘤を触知。生検にて扁平上皮癌の診断を得た。胸部写真にて左肺に炎症像があり, このため施行した気管支ファイバーにて, 気管に多発性小結節を認め, endobronchial metastasis を疑われたため放射線療法の適応外となり, 化学療法単独となった。後に小結節は悪性でないことが判明したが, 患者が放射線療法を拒否したため, そのまま化学療法を続行した。1クールの投与法は, MTX150mg/bodyを投与後, 5FU600-750mg/bodyを2時間で投与し, 続いて5FU3000mg/bodyを72時間で投与, 同時にLV15mg/bodyを計15回静注した後, CGDP80-100mg/bodyを2時間で点滴静注するものである。化学療法2クール終了時には腫瘤を触知しなくなり, 4クールまで施行した。治療後, 約1年を経過した現時点で再発を認めていない。

We report two cases of orbital abscess. Case 1 was a 16-year-old male who presented with right orbital pain and general malaise. Case 2 was a 43-year-old male who presented with swelling of the right eyelid. CT scans revealed orbital abscess and sinusitis. Both patients were treated with surgical drainage, antibiotics and endonasal operation, and both recovered without any complications. The clinical courses in our patients are reported and we also discuss the infectious route, diagnosis, treatment and causing bacteria based on reports in the literature.

近年欧米ではハイリスク児だけでなく全新生児を対象とした聴覚スクリーニングが施行されるようになってきており, その方法として自動化ABR (AABR) や耳音響放射 (OAE) が用いられている。 当科では平成12年10月より250例の産科入院の正常満期産の新生児に対して入院時あるいは1カ月検診時に, 誘発耳音響放射 (TEOAE), 歪み成分耳音響放射 (DPOAE) を用いて聴覚スクリーニングを行った。 成果はTEOAEの陽性率は91.6%, DPOAEの陽性率は88.0%, 併用によるパス率は94.2%であった。 非パス例に対して1カ月後にOAE再検査を行ったが, 再検査で非パスであったのは2例でそれぞれ生後3カ月, 4カ月のABRで正常反応であった。

NICU乳児に対する聴覚機能と言語発達について検討した。 全例に聴性脳幹反応検査を施行し, 幼児聴力検査にて経過観察を行い, 言語発達遅滞を疑う患児には新版K式発達検査を施行した。 高度難聴は0.4%, 軽度・中等度難聴は2.6%, 言語発達遅滞を8.6%に認めた。 ハイリスク児では難聴が高率に出現するといわれ, 難聴による言語や情緒の発達障害を防ぐ目的で聴覚スクリーニング検査を行っているが, 難聴の出現頻度より, 言語障害の出現率が高かった。 ハイリスク児のフォローアップには聴力と精神運動, 言語発達の総合的側面からのアプローチが必要で, リハビリテーション施設, 言語聴覚療法士, 小児精神科との連携が不可欠である。

補聴器の効果を知るため, 補聴器装用感についてアンケート調査を行った。 99例より100通のアンケートを回収した。 アンケート結果の要約は以下であった。1) 高齢者ほどアンケート結果が悪かった。2) 装用期間が長いほど結果が良かった。3) 耳掛形, 挿耳形, compeletely in the canal type (以下CIC) の順で, 大きいものほど結果が良かった。4) Kアンプ方式の補聴器は静かなところで良く, デジタル式補聴器は騒がしいところで良かった。 また音楽はリニア型増幅方式やKアンプ方式の補聴器が良かった。5) 装用閾値を測定できたもので, 耳掛形, 挿耳形, CICの出力を検討したが, 耳掛形で低音域の利得が少なかった以外は差を認めなかった。6) 4分法の装用利得と近距離での聞き取りには関連があるように思われた。

Background Intractable posterior epistaxis sometimes requires intensive treatment, such as surgery or embolization. Maxillary artery ligation has been widely used for the treatment of intractable posterior epistaxis. It is highly effective, but significant complications may occur, including an oroantral fistula and damage to the infraorbital nerve. Embolization is less invasive and can be performed in poor surgical candidates. However, it has more serious complications, such as facial nerve paralysis and hemiplegia. This investigation evaluates the effectiveness and complications of endoscopic ligation of the sphenopalatine or maxillary artery for the treatment of intractable posterior epistaxis. Methods Between April 2003 and March 2007, 46 patients were hospitalized for the treatment of severe posterior epistaxis in our University Hospital. Thirty patients were successfully treated by anterior and/or posterior nasal packing, and five patients were treated by electrocoagulation. Endoscopic ligation was performed under general anesthesia in 11 patients (6 men and 5 women; age range, 50-80 years). Results Eight patients underwent endoscopic ligation of the sphenopalatine artery, and three patients underwent endoscopic ligation of the maxillary artery through the middle meatus and posterior antral wall opening. There were no complications, and the patients’ postoperative courses were uneventful. Recurrent epistaxis occurred in one patient on oral anticoagulants 15 months after ligation of the sphenopalatine artery, and it was successfully treated by anterior nasal packing. Conclusion Endoscopic ligation of the sphenopalatine or maxillary artery is safer than arterial embolization and is less invasive than transantral ligation of the maxillary artery. This technique appears to be a simple and highly effective surgical treatment for patients with intractable posterior epistaxis.

212 patients diagnosed with sudden deafness between October, 1978 and April, 1998 were reported in our department. In order to clarify the relationship between sudden deafness and diabetes mellitus, the treatment course of 18 patients with sudden deafness, who were affected by diabetes, was analyzed retrospectively. The patients with sudden deafness were divided into two groups (diabetic and non-diabetic) and were analyzed. The following results were obtained:1) The mean age of patients in the diabetic group was 51.8 years, approximately 8 years older than the non-diabetic group. The number of patients with diabetes mellitus increased markedly in the last 10 years.2) There was no significant difference in hearing improvement after treatment as well as in hearing levels between the two groups.3) The rate of patients with dizziness or vertigo in the diabetic group was significantly higher than in the non-diabetic group. The patients with dizziness or vertigo showed a poorer prognosis in their hearing loss.4) There was no relationship between the duration of diabetes and the prognosis of hearing loss. The patients with retinopathy due to diabetes tended to show less hearing improvement.5) Steroid therapy for sudden deafness patients with diabetes was executed without worsening the diabetic condition if insulin was administered adequately.

Background Aquaporins (AQPs) are water-specific membrane channel proteins that regulate water homeostasis for cells and organisms. The purpose of this study was to elucidate the role of AQPs 1, 2, 3, 4, and 5 in normal and diseased human nasal mucosa. Methods Nasal polyps were obtained from eight patients with chronic rhinosinusitis (CRS). Inferior turbinate tissue was obtained from five patients with allergic rhinitis (AR) and from six patients with septal deviation (controls). Expression of AQP1-5 mRNA was examined using reverse transcriptase-polymerase chain reaction (RT-PCR) and immunoblotting, and tissue localization of AQP1-5 was studied by immunohistochemistry. Semiquantitative RT-PCR was used to investigate disease-specific changes in the expression in AQP1, -3, and -5 mRNA. Results Expression of AQP1, -3, -4, and -5 mRNA and AQP1-5 protein were confirmed in normal human nasal mucosa. Immunohistochemical studies revealed that AQP1 was localized in fibroblasts (especially in the subepithelial area) and endothelial cells of blood vessels, AQP2 was localized in the cytoplasm of epithelial cells and acinar cells, AQP3 was localized in the basolateral sites of epithelial cells and acinar cells, AQP4 was localized in the basolateral sites of acinar cells, and AQP5 was localized in the apical sites of epithelial cells and acinar cells. Semiquantitative RT-PCR revealed that there were no significant differences in the mRNA expression of AQP1, AQP3, and AQP5 among control, AR, and CRS patients. Conclusion AQP1, -2, -3, -4, and -5 were present in normal human nasal mucosa. mRNA expression of AQP1, -3, and -5 did not change among control, AR, and CRS patients.

We evaluated the effectiveness of magnetic resonance image (MRI) guidance using an optical tracking system (MRI-guided therapy: MRT) in performing endoscopic sinus surgery (ESS). The profiles of the fourteen patients in the present study were as follows: eleven with mucocele in the paranasal sinus, one with recurrent chronic sinusitis, one with maxillary cancer, and one with Graves' ophthalmopathy. Preparation of the MRT system required an additional 54 min in cases involving general anesthesia, and an additional 17 min in cases involving local anesthesia, in comparison with corresponding control groups undergoing ESS in a traditional operating room. We developed nonmetal probes that were visualized in a real-time mode and assistive devices for the optical tracking system that were equipped to avoid obstruction caused by surgical instruments as well as by the hands of surgeons. Using these unique devices, anatomic landmarks were visualized using the present MRT system. The prognosis of patients was favorable, and in particular, no patients with sinus mucocele showed a recurrence of their lesions. We concluded that the MRT system used here for performing ESS was beneficial, especially in terms of the intranasal marsupialization of sinus mucoceles and for the verification of orbital contents.

Malignant external otitis is a severe infection of the external auditory canal, generally caused by Pseudomonas aeruginosa in elderly diabetics patients. We describe a case of malignant external otitis in a 63-year-old man with severe otalgia, purulent otorrhea and polypoid granulation of the external auditory canal. Local debridement, insulin treatment and 6-week intravenous antibiotic therapy with carbapemens were very effective and the granulation tissue disappeared completely. However, the patient readmitted for recurrent disease 3 weeks later, despite the oral and ear drop administration with new quinolone. No recurrence has been noted after 4-week additional treatment with intravenous carbapenems followed by 3-week treatment with Burow's solution as ear drops.

A newborn hearing screening was conducted on 319 neonatal intensive care unit (NICU) and 1200 well-born nursery (WBN) infants. Mean NICU birth weight was 1997 g and mean gestational age 34 weeks. Auditory brainstem response was studied in screening in NICU infants. Otoacoustic emission (OAE) or automated auditory brainstem response (AABR) was used in primary WBN screening. All infants not bilaterally passing hearing screening before discharge were recalled for outpatient retesting. If the outcome was still failure, ABR screening was conducted. The prevalence of infants diagnosed with hearing loss was 1.1% (16 of 1519). Of these 16, 75% were from the NICU and 75% were at risk for hearing loss. Mean age at hearing loss identification was 12.9 weeks in the WBN and mean age at hearing aid fitting was 16.1 weeks. Mean age at hearing aid fitting was lower for WBN than for NICU infants. Hearing loss identification and hearing aid fitting are thus feasible in NICU and WBN infants in universal newborn hearing screening.

Recently, endoscopic surgery has been applied to cervical exploration. We have developed new techniques for endoscopic neck surgery. We reported on a 53-year-old Japanese man with functioning parathyroid adenoma resected by endoscopic surgery with a neck region-lifting method. A 10-mm midline trocar for the endoscope and two 5-mm lateral trocars were inserted from the anterior chest wall to avoid neck scars. There were no intraoperative complications. The incisions were completely covered by the patient's undergarments. (Otolaryngol Head Neck Surg 2000;123:465-6.)

This report described two patients with small cell neuroendocrine carcinoma of the larynx (patient 1) and maxillary sinus (patient 2). Immunohistological examination was helpful for the diagnosis. Both patients had lymph node metastasis of the bilateral neck, but at the start of their treatment distant metastasis was not detected by conventional clinical examinations including systemic imaging examinations (computed tomography, magnetic resonance imaging, and radioisotope imaging). Patients responded to systemic chemotherapy with or without radiotherapy. Surgical treatment for the resultant primary tumor and lymph node metastasis was effective. However, after initial treatment, distant metastasis appeared in the brain (patient 1) and in the liver (patient 2). They died 16 months (patient 1) and 7 months (patient 2) after their initial diagnoses. Although chemoradiotherapy and surgical treatment was effective for the regional tumor, the treatment of distant metastasis was crucial for acquiring the long term survival.

A 67-year-old man was admitted for vocal cord paralysis and dysphasia. He was suffering from dyspnea attack on aspiration in addition to his chronic obstructive pulmonary disease (COPD). Expansion of the piriform recess by videofluorography suggested vagus nerve palsy. We failed with conservative treatment but succeeded with operative treatment. We performed thyroplasty, adduction of arytenoid cartilage and bilateral dissection of cricopharyngeal muscle in a two-phase operation. The dissection of contralateral cricopharyngeal muscle was especially effective. We suspected the cricopharyngeal muscle of the diseased side had no systole. Tube nutrition was discontinued without dyspnea attack. In the literature, COPD brings potential dysphagia, and so we thought that in this case severe dysphagia occurred after the vocal cord palsy.

Recent reports have indicated that the incidence of multiple primary cancers in patients with head and neck cancer has increased. We investigated 25 clinical characteristics of multiple primary cancers in 210 patients who received their initial treatment against their head and neck cancer at our clinic between 1995 and 2002. Clinical stages of these 210 patients were; stage I, 34 cases; stage II, 21; stage III, 29; stage IV, 108; and unknown, 18. Of these 210 patients, 25 patients with hypopharyngeal, laryngeal or mesopharyngeal carcinoma, had multiple primary cancers were diagnosed simultaneously (68%) or metachronously (32%). The multiple primary cancers were frequently observed in the thyroid gland, mesopharynx, larynx, hypopharynx, esophagus and stomach. There were no significant relationships between multiple primary cancers and smoking or drinking habits. It is important to diagnose multiple primary cancers in patients with head and neck cancers as soon as possible.

We reported a rare case of ear trauma with delayed facial paralysis, ossicular chain dislocation and perilymph fistula caused by an earpick. A 36-year-old male consulted our clinic with a complaint of left otalgia, hearing loss, tinnitus and dizziness after left ear trauma with an earpick. Otoscopic examination showed perforation of the left ear-drum and pure tone audiometory demonstrated a mixed hearing loss with an average air conduction threshold of 53dB on the initial examination. He was diagnosed as having a traumatic ear-drum perforation. Left facial paralysis occurred 6 days after the trauma, then recovered after the intravenous steroid treatment. Hearing impairment did not improve after spontaneous closure of the ear-drum perforation, and exploratory tympanoplasty was performed. At surgery, the incus was dislocated and the anterior and posterior crura of stapes were fractured. Perilymphatic leakage from the fractured footplate was noted. The footplate was covered with temporal fascia and ossicular chain reconstruction was performed using the incus on the foot plate as a columella. Post operationally, the hearing threshold improved with an average air conduction threshold of 31.7dB.