[Chemotherapy with MTX, 5-FU and CDGP for treatment of newly diagnosed head and neck cancer].

Combination chemotherapy including 5-fluorouracil (5-FU) and nedaplatin (CDGP) with methotrexate (MTX) and leucovorin(LV)as biochemical modulators was performed on patients with newly diagnosed head and neck cancer. We treated 45 patients with MTX, 5-FU and CDGP consisting of 150 mg/body of MTX on day 1 followed by a 3-day continuous infusion of 5-FU at 3,500 mg/m2 and 17 injections of LV at 15 mg and infusion of CDGP at 100 mg/m2. Forty-three patients were concurrently treated with radiotherapy. Seven of the 45 had distant metastasis. In spite of the metastasis, 6 of the 7 underwent radiation therapy only on the primary or cervical metastatic mass because their primary tumor was bulky. Treatment-associated toxicities, e. g., mucositis and myelosuppression were significant but acceptable. The overall response rate was 97.6% with 61.9% of CR.

[Docetaxel (TXT) and irinotecan (CPT-11) as a second-line chemotherapy for platinum-pretreated squamous cell carcinoma of the head and neck].

Cisplatin(CDDP), combined with 5-fluorouracil, is considered one of the most active chemotherapeutic combinations in the treatment of patients with squamous cell carcinoma of the head and neck(SCCHN)and is accepted today as a standard regimen. But second-line chemotherapy for platinum-pretreated patients has not yet been established. Eighteen patients with recurrent SCCHN were treated using docetaxel (TXT) and irinotecan (CPT-11). All of them had been pretreated with platinum included regimen. In principle, our regimen consisted of TXT(50-60 mg/m(2), day 1) and CPT-11(60-90 mg/m(2), day 1, 8, 15). The adverse events were significant, including 13(72.2%)of grade 3 and 4 neutropenia, but acceptable. Seventeen patients were eligible for evaluation of response. Two complete responses (CR; 11.8%)and 6 partial responses (PR; 35.3%)were observed with an overall response rate of 47.1%. Patients pretreated with TXT had a 25.0% response rate (1 PR and 3 progressive disease). We conclude that the combination of TXT and CPT-11 is a worthwhile treatment for platinum-pretreated SCCHN as a 2nd-line-chemotherapy.

[Problems in the evaluation of hearing of infants].

Infant hearing loss should be identified early to prevent delays in the development of speech and language. However, evaluation of hearing of infants is not so easy, because training is required to estimate auidiometric thresholds from behavioral testing such as conditioned orientation response audiometry (COR). Most ENT physicians who are not capable of behavioral testing tend to evaluate hearing of infants only from testing auditory brainstem response (ABR). Information about the infant's auditory response to the environmental sounds could be obtained easily and might be a substitute for a behavioral testing. We administered a questionnaire to the parents to obtain accurate information about the infant's auditory response. Tanaka-Shindo's developmental battery test of auditory function is an established questionnaire with various questions about auditory response and development of speech according to the age of infants from 0-15 month. We administered Tanaka-Shindo's questionnaire to the parents of infants before 8 months, and administered the following questionnaire to the parents of infants over 8 months. (1) If you call out the child's name from behind, does the child turn his/her head? (2) Does the child turn his/her head to any sounds on television, to any small sounds (for example: listened when someone opens the door or opens wrapping paper), or to beeping sounds from electric devices? To investigate the clinical usefulness of the questionnaire to estimate hearing in infants, 79 children (under 4 y.o.) evaluated their hearing at the Tottori University Hospital were studied. Forty-three out of 45 (95.6%) who had normal hearing had yes in the questionnaire, but the 18 who had moderate to severe (60 dB) hearing loss did not have yes in the questionnaire. For the mentally retarded 33 children, 27 out of 29 (93%) who had normal hearing had yes in the questionnaire, but the 4 who had moderate to severe hearing loss did not have yes in the questionnaire. Questionnaire about the infant's auditory response is useful to differentiate between normal hearing and moderate to severe hearing loss. We recommend our questionnaire as screening procedure to most ENT physicians to identify hearing loss in infants. It is important refer patients not evaluated as normal to an ENT physician who is capable of diagnosing the hearing of infants by behavioral testing.

[Hearing outcome of canal wall reconstruction tympanoplasties for the treatment of cholesteatoma].

While the hearing outcome of patients undergoing a tympanoplasty with canal reconstruction is generally thought to be inferior to that of patients undergoing a canal-up tympanoplasty, a direct comparison of these two procedures, performed by the same operator, has not been reported. Consequently, we compared the hearing outcomes of these two techniques and discussed the postoperative complications that could accompany the procedures. Hearing was evaluated in 52 ears with middle ear cholesteatoma. Using the postsurgical hearing result assessment criteria published by the Japanese Society of Otology in 2000, hearing was then evaluated again at least 6 months after surgery. When the data was analyzed according to the type of operation, the success rates (as determined using the above assessment criteria) were 78.6% for type I, 88.5% for modified type III, and 50.0% for modified type IV. The success rate for the modified type III operations was superior to that of the modified type IV operations, and the incidence of a postoperative air-bone gap in the type IV tympanoplasties was significantly larger than that in other groups. Procedures involving external auditory canal surgery can be particularly problematic for the treatment of cholesteatoma. In this series, the same author (KH) performed all the canal-up tympanoplasty procedures that took place during 1990-1996, and all other tympanoplasties, mainly canal reconstruction procedures, that took place during 1998-2001. The success rate was 68.4% (13/19) for the canal-up tympanoplasties, 100% (8/8) for the atticotomies and 76% (19/25) for the canal wall reconstructions. The postoperative success rate in the atticotomy group was significantly higher than the rates of the other groups. Among the canal reconstructive tympanoplasty procedures, a second exploratory surgery was performed in 15/24 cases, and residual cholesteatoma was observed in 3 cases. The major postoperative complications were epitympanic pocket formation (12/24) and taste disturbances, caused by chordal damage (2/24). These findings indicate that tympanoplasties with canal reconstruction improve the hearing outcome, compared with the outcome of canal-up tympanoplasties. However, epitympanic retraction pocket formation, resulting in recurrent cholesteatoma, is a possible complication of both surgical procedures, and new approaches or techniques should be sought to minimize such postoperative changes.