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Background: Recently, some common foods in daily life, especially lactic acid bacteria, have been found to have anti-allergic effects. We previously isolated a halophilic lactic acid bacterium, Tetragenococcus halophilus Th221, from soy sauce moromi, a mixture of koji and salt solution, and showed that it possesses an immunomodulatory activity that promotes T helper type 1 immunity. Methods: To evaluate the anti-allergic effects of Th221, we performed a randomized, double-blind, placebo-controlled study in 45 subjects with perennial allergic rhinitis (PAR) treated by oral administration of Th221 (high dose, 60 mg/day, 15 subjects; low dose, 20.4 mg/day, 15 subjects) or a placebo (15 subjects) for 8 weeks. Results: There were no significant differences among the groups that ingested Th221 and the placebo group regarding the disease severities, total nasal symptom scores and total nasal sign scores examined by physicians. However, the disease severity examined by physicians significantly improved in the high-dose group at the end of the trial compared with the beginning (p < 0.05). The total score for nasal symptoms of subjects who received a high dose of Th221 also showed a significant improvement at the end of the trial compared with the beginning (p < 0.01). According to the subjects’ diaries, significant improvements in sneezing and rhinorrhea were observed during some periods in the high-dose group. The change in serum total immunoglobulin E improved significantly at the end of the trial compared with the beginning in this group (p < 0.05). The safety of Th221 treatment was confirmed by laboratory tests and inspection of the general condition of each subject. Conclusions: Th221 can be expected to safely improve the symptoms of PAR.

Background: Recently, some common foods in daily life have been found to have anti-allergic effects. We have reported that tomato extract (TE) could possibly inhibit histamine release and mouse ear-swelling responses. Moreover, it is reported that TE could relieve the symptoms for Japanese cedar pollinosis. Methods: To evaluate the anti-allergic effect of TE, we performed a randomized, double-blind, placebo-controlled study in 33 patients with perennial allergic rhinitis (PAR) using oral administration of TE (360 mg per day) or placebo for 8 weeks. Results: We found that the sneezing score significantly decreased in the TE group at the end of the trial compared to the beginning (P < 0.05). There were decreasing tendencies of rhinorrhea and nasal obstruction in the TE group. The patients’ quality of life was significantly improved in the TE group after 8 weeks of treatment (P < 0.05), but not in placebo group. A significant improvement in total symptom scores, combining sneezing, rhinorrhea and nasal obstruction, was observed after oral administration of TE for 8 weeks (P < 0.01). The safety of TE treatment was confirmed by laboratory tests and inspection of general conditions. Conclusions: TE can be expected to safely improve the nasal symptoms of PAR.

Allergic diseases have been increasing in prevalence in developed countries, including Japan. The aim of the present report was to determine the prevalence of allergies in Wakayama prefecture using an epidemiological study. In total, 759 first-year students attending junior high school in Hidaka country, Wakayama prefecture, were surveyed. The results for 699 cases were then analyzed. A questionnaire regarding allergic diseases, specific IgE measurements performed using a MAST26 system (Hitachi Co., Ltd.), and total serum IgE levels measured using RIST (Pharmacia Co., Ltd.) were performed. The prevalence (present + past) of various allergic diseases was 37.9%. The prevalence of rhinitis, including pollinosis, was 31.0%, while that of atopic dermatitis was 26.2% and bronchial asthma was 11.3%. The positive rates for specific IgE antibodies against Japanese cedar pollen was 48.6%. The positive rate for Dermatophagoides farinae, timothy and housedust II were 44.2%, 29.6%, and 28.9%, respectively. Statistically significant differences were recognized between the students with allergic rhinitis, atopic dermatitis, allergic conjunctivitis or bronchial asthma and positive results for D. farinae, housedust II, cedar pollen, Penicillium, Cladosporium, or Aspergillus-specific antibodies. Regarding family history (two generations), a statistical significant difference between family history and positivity for specific IgE antibodies like D. farinae, housedust II, ragweed, cedar pollen or Cladosporium was observed. The total IgE titer was correlated with the number of positive allergen items. The increasing prevalence of various allergic diseases in developed countries remains a mystery, but the hygienehypothesis has attracted some attention. The findings of this epidemiologic study will contribute to basic data on the increasing prevalence of various allergic diseases.

Real time monitoring of airborne pollen has gradually increased because monitoring is laborsaving and provides better real-time information. A problem arose, however, due to differences between the KH3000 (Yamato Co. Ltd) monitor and the conventional Durham sampler pointed out in results of airborne pollen monitoring in Wakayama in 2004. We compared the two monitors for airborne pollen in Wakayama in 2004, which less dispersed than usual. The peak monitored by the KH-3000 monitor was not consistent with the prime period of Japanese cedar and cypress pollen dispersion, especially in February and April, although they correlated highly in March. The inconsistency in February is thought to be caused by snow, and that in April by falsely monitoring beech-tree airborne pollen-which is similar in size-in addition to Japanese cedar and cypress pollen. This report points out the need to take these conditions (snow and other plants pollen) into account when a real time monitor is used for collecting pollen information.

Background Approximately 16.2% of the Japanese population suffers from pollinosis. One of the forms of management is self-care (preventive care), which can be categorized as 'indoor' and 'outdoor'. Outdoor self-care is usually emphasized, but indoor self-care is also important. Considerable pollen is found in indoor dust and this is thought to be one of the factors that worsens pollinosis and enables it to persistent for a long time, even after the pollinating period has finished. Taking this into consideration, we investigated the dynamic state of indoor pollen. Methods Floating indoor house dust was collected in Petri dishes. The amount of pollen in the house dust samples collected was measured using an LCD laboratory highly sensitive Cry j1 assay kit. Results The results showed that, indoors, a lot of Japanese cedar pollen (JCP) was found on the floor (tatami mats, carpets), sofas and curtains. The number of JCP in living rooms peaked in April after the pollinating period and decreased gradually; however, JCP was still found indoors, even as late as the following February. Floating JCP in the house was one-tenth of the JCP levels on the floor. Floating JCP increased on days with low humidity. Air conditioning temporarily increased levels of floating JCP in houses with an air conditioner, but the level of floating JCP decreased rapidly compared with the level of that in houses without an air conditioner. Nasal signs and symptoms disappeared completely at a level of 30 floating pollen counts/day per Petri dish. Conclusion Considerable JCP was found floating indoors with house dust after a pollinating season.

本研究の目的は, 難聴高齢者における聴力低下に伴うストーレス・イベント, 聴力低下に伴うストレス認知, 精神的健康の関連性を検討することであった。調査対象は, 和歌山日本赤十字医療センターを利用していた難聴高齢者235名であった。面接調査は, 聴覚言語療法士によって実施された。構造方程式モデリングによる解析の結果, 性, 年齢, 聴力損失レベルと聴力低下に伴うストレス・イベントのあいだに有意な関連性が認められた。さらに, ストレス・イベントは, ストレス認知を経由して, 間接的に精神的健康に影響を与えていた。なお, ストレス・イベントと精神的健康のあいだには直接的な関連性はみられなかった。これらの結果は, 聴力低下に起因するストレス・イベントやストレス認知から精神的健康に対する効果の軽減を目指した専門的介入策を確立することによって, 聴力低下による精神的健康の悪化を予防できる可能性を示唆するものである。

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。

2個のマイクロフォンにより作られる指向性を周囲雑音に応じて変化させるアダプティブビームフォーミングを搭載したデジタル補聴器 (senso Diva® SD-9M) の雑音存在下における語音弁別に対する有用性を検討した。対象は53歳～81歳の17名で4分法平均聴力は31.3～62.5dBであった。SD-9Mは専用フィッティング装置SP3についてフィッティングした。検査音は67S語表を用い, 正面より60dBSPLで提示した。雑音はスピーチノイズとし, 側面 (90°) または背面 (180°) より70dBSPLで提示した。以下の4条件で語音弁別スコアを測定した。1) 指向性オン/雑音90°, 2) 指向性オン/180°, 3) 指向性オフ (ノイズサプレッションのみ) /90°, 4) ミュージックモード (リニア)/90°アダプティブビームフォーミングは雑音存在下での語音弁別に有用であると結論した。

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。

Self-care is gradually being recognized as important in the treatment of pollinosis, based up to now on data on airborne pollen. To determine the real-time numbers of airborne pollen would be more useful in self-care, however, so we studied the usefulness of the real-time pollen counter. Between Feb. 2, 2001, and Apr. 26, 2001, 4 types of airborne pollen i.e., Japanese cedar, Japanese cypress, black alder, and beech observed in Wakayama City were counted with a Durham pollen counter and a real-time pollen counter (Yamato Manufacturing Co. Ltd.). Correlation between the 2 pollen counters was r = 0.69 for Japanese cedar in March and r = 0.89 for Japanese cypress in April. A high correlation was observed between outcomes of the 2 pollen counters. The amount of pollen from black alder and beech was less than that from Japanese cedar and cypress. Unexpected peaks were observed not related to the pollen number is apparently due to snow. We have taken measure against snow, so we concluded that the real-time pollen counter was useful in counting the amount of airborne pollen over time.

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。

A case of olfactory neuroblastoma is reported. A 71-year-old man visited our hospital exhibiting left nasal obstruction and purulent choanal drip on May 13 1998. Examination showed a large tumor in his left nasal cavity; the surface of it was smooth and bled easily. The patient did not have any visual acuity difficulties and the cervical lymphnodes were not swollen. The patient had undergone surgery for an olfactory neuroblastoma in 1979 in another hospital. CT scan revealed a large tumor in his left nasal cavity and maxillary sinus but which did not extend into the cranial space or eye socket. There was no bone defect. Based on the pathological findings, we made a diagnosis of recurrent olfactory neuroblastoma.The patient was treated using combined therapy; preoperatively, chemotherapy (CBDA+CPA+VP-6) and radiation therapy were performed. Since 19 years previously, 40 Gy radiation therapy was used, we added a further 30 Gy radiation. Subsequently, the tumor was removed completely left lateral rhinotomy approach.The patient is being followed up periodically and to date no recurrence of tumor has been observed. In conclusion, we suggest that long-term follow up is important since it has been previously reported that olfactory neuroblastoma can recur even after a long interval as in this case.

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。

A simple method for office closure of eardrum perforation using an atero-collagen graft used for dermal defects (Terdermis) without fibrin glue was developed. Eardrum perforations were successfully closed in 71.4% of all cases (63 ears) after the initial treatment. Neither skin incision nor the use of temporal fascial grafts was necessary in this method. The merit of the method is that there is no possibility of blood infection because no blood materials are used.

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。

We have an interesting case of sudden sensorineural deafness of both sides with DM. The hearing loss of the left side and diabetic control were progressively aggravated by steroid therapy. We suspected that this was a case related to viral infection. Anti-parainfluenza 3 virus titer increased by anti-virus titer examination. Therefore, we changed from steroid to γ-globulin therapy and performed intensified conventional insulin treatment. Diabetic control was improved and the right side showed excellent recovery. However, the left side experienced deafness. In general, DM produces individual immune dysfunction. Thus, we consider that the hearing loss in both sides was progressively aggravated because of steroid therapy, which induced excessive individual immune dysfunction and viral activation.

近年, ハウリングを抑制するデジタルフィードバックサプレッション付き高度難聴者用補聴器 (以下DFS) が開発され, 我が国には1992年伊丹らにより報告された。 そこでDFSが, 高度感音難聴児に対しハウリングを抑制することでどの程度装用利得を上げることができるのかについて臨床的に検討した。 90dBHL以上の先天性高度難聴児15名26耳を対象とした。 対象耳の聴力レベルは平均106.3dBHLであった。 DFSにより従来の補聴器より1kHzで10.5dB, 2kHzで12.0dB, 4kHzで19.2dB利得を上げることができた。 聞き取りの場面の内容では, 1-2mでの環境音, 会話が改善していた。 6ヵ月の使用で, 新版K式検査において言語・社会領域の改善は見られなかったが, 発話レベルでは改善が見られた。 またDFSによる聴力の悪化は認めなかった。 以上から, 従来の補聴器で充分な装用閾値が得られない場合, DFSを装用してみる価値は充分あると結論した。

We have treated one adult with multiple and one with isolated laryngeal pa-pillomatosis. The former, a 27-year-old male was not controlled with the combination of laser surgery and local injection and systemic administration of α-IFN, but he was cured by local injections of six million units of β-IFN combined with laser surgery. The latter, a 44-year-old male was cured by local injections of three million units of β-IFN and resection. The results indicate that local laryngeal injection of β-IFN is useful in the treatment of laryngeal papillomatosis.

Malignant neoplasms of the sphenoid sinus are very rare. We report here 3 cases of this rare tumor and review the literature.Case 1 was a 46-year-old man with diplopia and lumbago. Case 2 was a 41-year-old man with diplopia and right visual disturbance, and Case 3 was a 51-year-old woman with right visual disturbance. The pathohistological diagnoses were squamous cell carcinoma in Cases 1 and 3 and adenocarcinoma in Case 2. Radiotherapy or chemotherapy was administered, but all three patients died within 10 months after the onset of symptoms.Including our 3 patients, 22 cases of primary malignant neoplasms in the sphenoid sinus have been reported in Japan. The most common early symptoms were not nasal but visual problems. The prognosis of this tumor is very poor.

The clinical efficacy of low dose erythromycin (10mg/kg/day) was investigated in 58 children with sinusitis.1. Intranasal findings were completely cleared in 50.0% of patients, improved in 25.9% and unchanged in 24.1%. Follow-up X-ray films of the sinuses showed complete cure of the disease in 13.3%, improvement in 53.3% and no change in 33.3%.2. The shorter the period of infection, the higher was the response rate.3. Patients below 4 years of age showed a much better response to this treatment than did patients above 4 years of age.4. Treatment for two months is recommended for maximum efficacy.5. Mild diarrhea in one patient was the only side effect observed. In conclusion, our data indicate that low dose erythromycin is useful in the treatment of children with sinusitis.

Histiocytosis-X is a rare disease presenting as 3 clinical syndromes; eosinophilic granuloma, H and-Schuller-Christian disease, Letterer-Siwe disease. Although the clinical expressions of the disease differ, the underlying histopathology appears to be the same. Our patient was a 3-year-old boy with a recurrent neck tumor, who had been treated for left temporal bone eosinophilic granuloma about one year earlier. Our diagnosis was a Hand-Schuller-Christian disease developing from an eosinophilic granuloma, but it was not typical. The pertinent literature on the signs, symptoms, diagnosis, and treatment of this disease is reviewed.

Papilloma is a typical laryngeal benign tumor. Although a laser surgery was used to treat this tumor, recurrence often occurred. In this report, two cases of laryngeal papilloma effectively treated with β-interferon are presented. Case 1 had received laser operations repeatedly. Finally, we did not succeed to remove the tumor by laryngofissure. We then injected 3, 000, 000 IU of β-interferon at the posterior commissure by a direct laryngoscope. As a result, the tumor disappeared. Case 2 was treated with the local injection of β-interferon. The laryngeal papilloma was completely disappeared. We may consider that β-interferon is an expectable agent for papilloma-treatment, not only tumor diminishing factor, but also recurrence preventing factor.

Our aim was to examine the effects of gender, ear asymmetry, and age of infants on various parameters of transient evoked otoacoustic emissions (TEOAEs). Three hundred thirty-two infants (181 males, 151 females) were tested using the ILO292 Otodynamics Analyzer (Otodynamics Ltd, England) as a screening procedure. The subjects were divided into two age groups: group 1, newborn infants prior to hospital discharge (mean age of 4 days), and group 2, infants at the 1-month-old health checkup (mean age of 35 days). Responses to TEOAE stimuli were recorded at 1.0, 1.5, 2.0, 3.0, and 4.0 kHz. There were significant effects of gender and ear (left/right) on the signal-to-noise ratio, response level, and whole-wave and band reproducibility values in TEOAEs. The right ear had higher values of whole-wave reproducibility, response level, signal-to-noise ratio, and band reproducibility than the left ear. Females displayed higher whole-wave reproducibility, response level, band reproducibility, and signal-to-noise ratio values than males. There was no significant difference in response level, signal-to-noise ratio, and band reproducibility between the two age groups. The findings of the present investigation may contribute toward future improvements in neonatal hearing screening based on the community.

There is little information about the relationship between local pollen counts and pollinosis symptoms of the local patients. In this study, we compared patient-reported outcomes (PROs) of Japanese cedar pollinosis (JCP) according to regions.The study was conducted between February 24 and March 8, 2003 (peak pollen season), and 1200 patients were recruited from 15 ENT clinical sites in 4 regions : central Osaka (n = 576), southern Osaka (n = 195), northern Wakayama (n = 234), and southern Wakayama (n = 195). PROs consisted of nasal symptoms, ocular symptom, learning and work impairment, and QOL (SF-36).In non-treatment group, there were significant differences in ocular symptom and learning and work impairment among regions. On the other hand, patients with longer duration of treatment had better symptom relief regardless of pollen level in early treatment group. As to QOL, SF-36 summary scores did not differ among regions in both groups.This study shows that patients without early treatment seemed to be affected by pollen level on their ocular symptom and its related outcomes. In patients with early treatment, however, the treatment duration had bigger impact on PROs than the local pollen counts.

Morphine’s analgesic actions are thought to be mediated through both the central and peripheral nervous systems. L-type calcium channel blockers have been reported to potentiate the analgesic effects of morphine, but the locus of this interaction is not known. In this experiment, we examined the site of verapamil-induced potentiation of morphine analgesia in mice using the quaternary opioid receptor antagonist naloxone-methiodide (NLX-M). Subcutaneous injections of morphine increased locomotor activity and serum corticosterone level, which are mediated by the central nervous system. These central effects were not antagonized by 0.1 mg/kg of NLX-M, whereas this dose of NLX-M partially antagonized the analgesic effect of morphine. Treatment with verapamil potentiated morphine analgesia in a dose-dependent manner. The verapamil-induced potentiation of morphine analgesia was abolished by pretreatment with NLX-M (0.1 and 1 mg/kg). These findings suggest that peripheral mechanisms partially contribute to morphine analgesia and mediate the potentiation of morphine analgesia by verapamil. Keywords:: morphine, peripheral analgesia, calcium channel blocker, verapamil, naloxone-methiodide

Drug adherence is one of the important aspects in caring for patients with allergic rhinitis. To improve clinical efficacy of early treatment for Japanese cedar pollinosis (JCP), we evaluated the effect of drug adherence on patients' outcomes. Patients were randomly selected from 16 ENT clinical sites in Osaka and Wakayama between February 24 and March 8, 2003 (peak pollen season). Efficacy was assessed using patients' ratings of nasal and ocular symptoms and overall assessment in their condition compared with previous season ones. Costs include direct costs of the drugs used for treatment to JCP from January to February. Five hundred one patients taking early treatment were enrolled. Compared to low adherence patients, those who reported higher level of adherence significantly improved overall health condition, and achieved better symptom relief of rhinorrhea and nasal congestion. In multiple logistic regression analysis, the following factors were independent risk factors for low adherence: student (p=0.002), using OTC medications (p=0.006), and short-duration of medication (p=0.001). Low costs were also risk factor for low adherence. We conclude that taking medications for JCP for 22-28 days is the best way to enhance patients' outcomes.

Allergic rhinitis is not fatal illness, but its high prevalence and several symptoms result in substantial medical cost. There is increasing interest in the use of economic evaluations in healthcare; therefore, we investigated patients' willingness to pay (WTP) for prevention and cure from Japanese cedar pollinosis (JCP), and compared WTP values assessed in non-pollination season (June 1998) and pollination season (February-March 2003). Japanese economic woes got worse in 2003 than in 1998. Patients were randomly selected from ENT clinical sites in Osaka, 175 and 645 patients completed WTP questionnaire in 1998 and 2003, respectively. WTP value was lower in 2003 than in 1998, which related to part-time employees and housewives' reducing WTP. Declining WTP value did not associated with the differences in patient characteristics between 1998 and 2003 including age, duration of disease, nasal symptom severity and comorbid condition. These results show that we have to take employment status into account in economic evaluations. Decline in WTP for JCP in 2003 was strongly affected by Japanese sluggish economy, and the WTP seemed to be stable value in individual patients.

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.

The incidence of Japanese cedar pollinosis has been increasing each year in Japan. Japanese cedar pollinosis is a state of allergic response, mediated by IgE. So, it is important to know the state of sensitization against Japanese cedar pollen. The subjects were 1321 nonselective cases who were more than 16 years of age and who live in Wakayama Prefecture. Specific IgE antibodies to Japanese cedar pollen were measured by Lumiward immunoassay system. The results showed that positivity for sera class 2 or higher was 30.9%. Furthermore, the positivity in 1995 was higher than the positivity in either 1985 (13.9%) or 1990 (18.3%). The incidence of specific IgE antibody positivity was higher in males. Also the age distribution of the positivity was highest in the 20-29 years old group, and the positivity was decreased with age. We examined the kinds of factors influencing the positivity of specific IgE antibodies. However, the relation between the positivity of specific IgE antibodies and the various environmental factors was unclear.

It is known that transcatheter intraarterial drug delivery presents a higher concentration of drug in the tumors than intravenous administration only. In our field, a transcatheter arterial infusion from superficial temporal artery into tumor site has been commonly used for the treatment of head and neck tumors.Recently, the intraarterial infusion under its temporary occlusion has been employed in the patients with hepatic tumors using double lumen balloon catheter. In this study, it was intended to use not only intraarterial infusion-occlusion system from superficial temporal artery, but also to reduce the systematic side effects of the drugs recirculating from regional area by means of direct hemoperfusion with charcoal filament.The concentration level of anti-cancer drugs in the tissues received infusion-occlusion chemotherapy was significantly high. The hemoperfusion with chacoal filament, to eliminate the drugs in the blood recirculating from regional areas, worked successfully showing significant adsorption within 180 minutes after infusion.We believe that a new system of intraarterial drug delivery by means of balloon occluded arterial with hemoperfusion proposed in the present study will be much effective for chemotherapy of head and neck tumors.

Magnetic resonance imaging (MRI) was used in the diagnosis of head and neck tumors. The advantages and the problems of MRI are discussed and compared with those of X-ray computed tomography.MRI provides more detailed information about the nature and the depth of in-filtration of tumors, not only because of the excellent soft-tissue contrast, but also because multiple directions can be used. An additional benefit is the much easier identification of cervical vascular structures by MRI.

The serum levels of IAP in patients with tumors of the head and neck were determined by single radial immunodiffusion. It was previously reported that the IAP level in these patients was commonly higher than normal. Statistical analysis of 58 patients revealed that the increase of IAP corresponded not only to the clinical stage of the tumor, but also to the probability of tumor recurrence. In addition, it was apparent that the IAP was significantly related to the PPD skin reaction representing delayed hypersensitivity and T-cell population capable of E-rosette formation.The evidence suggests that the determination of serum IAP is useful in understanding the immune defense of hosts against tumors.

It is known that the endotoxin of gram negative bacteria is not only antigenic, but also has many biological activities. In this study, endotoxin in human middle ear effusions (MEE) was measured quantitatively by the chromogenic substrate method which is more sensitive and accurate than Limulus assay.Fifty samples of MEE from 46 patients aged 2 to 84 years were classified into two groups, 24 mucoid and 26 serous. The endotoxin in the mucoid group was significantly higher (264.6pg/ml) than that in the serous group (27.5pg/ml). This suggests that bacterial endotoxin contributes greatly to induce otitis media with mucoid effusion.Audiometry showed that the majority of those with otitis media and mucoid effusion had conductive type deafness, while mixed type deafness was more common in those with serous effusion.

A 28-year-old male in good general health complained of nasal bleeding. Rhinoscopy revealed a dark red colored tumor with irregular surface in the left nasal cavity. The large tumor of 4×3×3cm in size and 15 grams in weight was surgically removed under general anesthesia. It was confirmed that the tumor originated from the upper part of the nasal septum. The histological diagnosis was a mixed tumor composed of myoepithelial cells with glandular elements. After removal of the tumor, no recurrence has been observed.

Sixty strains of S. pneumoniae isolated from the patients with upper respiratory tract infections were immunologically classified by use of Danish type/group specific antisera. The percentages of S. pneumoniae serologically defined were 23. 3% for Group 23, 20. 0% for Group 19, 13. 3% for Group 6, 10. 0% for Type 3, 3. 3% for Type 4, 3. 3% each for Type 9 and 18, and 1. 6% for Type 14. It was confirmed that in case of acute otitis media Group 19 and Type 3 were characteristic showing 30. 0% and 13.4%, while rhinosinusitis were highly related to Group 23 of S. pneumoniae. An additional analyses revealed that Type 3 of S. pneumoniae were mostly found in the patients over 50 years old, though the patients under 5 years old were related to Group 19.