Exploring the relationship between plasma substance P and glottal incompetence in the elderly.

We speculated that increased blood-plasma levels of Substance P may serve as an indicator of glottal incompetence, which is usually indicated by reduced maximum phonation time. We performed an initial study to test the plausibility of this hypothesis. Patients with dysphonia caused by glottal incompetence were asked to perform vocal exercises for six months to reduce glottal incompetence and we compared the plasma concentration of Substance P before and after the vocal exercise to detect correlation between maximum phonation time and plasma concentration of Substance P. Based on the results, we further hypothesized that patients exhibiting dysphonia with maximum phonation time less than 14 s, in particular less than 10 sec, caused by glottal incompetence may have increased plasma concentration of Substance P with the results of elevated thresholds of cough reflex associated with subclinical aspiration in airways. Further study is needed on patients with decreased Substance P levels, with low scores on Activities of Daily Living and who are hospitalized with aspiration pneumonia.

Mucinous myoepithelioma: A report of a new variant.

Myoepitheliomas account for approximately 1.5% of all salivary gland tumors and arise most frequently from the parotid gland. Recently, a new myoepithelioma variant, called mucinous myoepithelioma, has attracted widespread attention. These tumors are recognized as a unique subtype of myoepithelioma, characterized by the presence of abundant mucin. We herein report the findings of an 86-year-old Japanese woman who presented with a hard mass of the right parotid gland behind her right ear which was gradually increasing in size. The patient had undergone a fine-needle aspiration biopsy 4 years earlier, and a cytological evaluation of a biopsy specimen had shown features of pleomorphic adenoma. A resection was thus performed and the tissue was found to be an encapsulated, soft and solid mass, and the cut surface was observed to be a capsulated and well-defined tumor lesion with myxoid-looking foci of gray-white coloration. Microscopic examination revealed that this lesion was composed of a proliferation of bland-looking epithelial and myoepithelial cells, arranged in a solid or reticular growth fashion in an abundant myxomatous or hyalinized stroma. These neoplastic epithelial cells had centrally located small nuclei with fine chromatin and abundant clear to eosinophilic cytoplasm, often containing mucin in a uniform pattern. Immunohistochemical staining demonstrated the tumor cells to be positive for AE1/AE3, S-100 and mucicarmine. Our findings suggest this case to be one myoepithelioma variant of mucinous myoepithelioma, and more experience related to this myoepithelioma variant is necessary to better understand its biological behavior and make an accurate diagnosis for a proper treatment.

Adjuvant chemotherapy with S-1 after curative chemoradiotherapy in patients with locoregionally advanced squamous cell carcinoma of the head and neck: Reanalysis of the ACTS-HNC study.

BACKGROUND: Chemoradiotherapy (CRT) has improved organ preservation or overall survival (OS) of locoregionally advanced head and neck squamous cell cancer (LAHNSCC), but in clinical trials of conventional CRT, increasing CRT intensity has not been shown to improve OS. In the Adjuvant ChemoTherapy with S-1 after curative treatment in patients with Head and Neck Cancer (ACTS-HNC) phase III study, OS of curative locoregional treatments improved more with adjuvant chemotherapy with S-1 (tegafur gimeracil oteracil potassium) than with tegafur/uracil (UFT). ACTS HNC study showed the significant efficacy of S-1 after curative radiotherapy in sub-analysis. We explored the efficacy of S-1 after curative CRT in a subset of patients from the ACTS-HNC study. METHODS: Patients with stage III, IVA, or IVB LAHNSCC were enrolled in this study to evaluate the efficacy of S-1 compared with UFT as adjuvant chemotherapy after curative CRT in the ACTS-HNC study. Patients received S-1 at 80-120 mg/day in two divided doses for 2 weeks, followed by a 1-week rest, or UFT 300 or 400 mg/day in two or three divided doses daily, for 1 year. The endpoints were OS, disease-free survival, locoregional relapse-free survival, distant metastasis-free survival (DMFS), and post-locoregional relapse survival. RESULTS: One hundred eighty patients (S-1, n = 87; UFT, n = 93) were included in this study. Clinical characteristics of the S-1 and UFT arms were similar. S-1 after CRT significantly improved OS (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.22-0.93) and DMFS (HR, 0.50; 95% CI, 0.26-0.97) compared with UFT. CONCLUSION: As adjuvant chemotherapy, S-1 demonstrated better efficacy for OS and DMFS than UFT in patients with LAHNSCC after curative CRT and may be considered a treatment option following curative CRT. For this study was not preplanned in the ACTS-HNC study, the results is hypothesis generating but not definitive.

Extravasation mucocele arising from a lingual thyroglossal duct remnant.

Although a thyroglossal duct cyst is a congenital anomaly, it can also appear in adults. Despite the presence of embryological remnants, it is still unclear why the cyst should suddenly develop later in life. We report a case of a 46-year-old male with an extravasation mucocele arising from a long-standing lingual thyroglossal duct remnant. MRI demonstrated a lingual cystic lesion near the hyoid bone associated with a suprahyoid tract-like structure masquerading as a thyroglossal duct cyst. However, histopathological examination demonstrated a mucocele secondary to a rupture of a thyroglossal duct remnant with numerous intramural heterotopic salivary glands. We propose a new mechanism of an acquired cystic formation of this congenital disease that excessive production of mucus from heterotopic salivary glands and a physical trauma such as swallowing may lead to extravasation of mucus from the thyroglossal duct.

Randomized phase III trial of adjuvant chemotherapy with S-1 after curative treatment in patients with squamous-cell carcinoma of the head and neck (ACTS-HNC).

BACKGROUND: We conducted a phase III study to evaluate S-1 as compared with UFT as control in patients after curative therapy for stage III, IVA, or IVB squamous-cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Patients were randomly assigned to the UFT group (300 or 400 mg day-1 for 1 year) or the S-1 group (80, 100, or 120 mg day-1 for 1 year). The primary end point was disease-free survival (DFS). Secondary end points were relapse-free survival, overall survival (OS), and safety. RESULTS: A total of 526 patients were enrolled, and 505 were eligible for analysis. The 3-year DFS rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95%CI, 0.66-1.16; p = 0.34). The 3-year OS rate was 75.8% and 82.9%, respectively (HR, 0.64; 95% CI, 0.44-0.94; p = 0.022). Among grade 3 or higher adverse events, the incidences of leukopenia (5.2%), neutropenia (3.6%), thrombocytopenia (2.0%), and mucositis/stomatitis (2.4%) were significantly higher in the S-1 group. CONCLUSIONS: Although DFS did not differ significantly between the groups, OS was significantly better in the S-1 group than in the UFT group. S-1 is considered a treatment option after curative therapy for stage III, IVA, IVB SCCHN. TRIAL REGISTRATION: ClinicalTrials.gov NCT00336947 http://clinicaltrials.gov/show/NCT00336947.

Hormonal aspects of Ménière's disease on the basis of clinical and experimental studies.

CONCLUSIONS: Endolymph homeostasis is thought to be mediated by the vasopressin-aquaporin-2 (VP-AQP2) system in the inner ear. Endolymphatic hydrops, the morphological characteristics of Ménière's disease (MD), seems to reflect the malregulation of the VP-AQP2 system in inner ear fluid. The elevation of plasma vasopressin (p-VP) level, which is often observed in MD and its related diseases, might be one of the causative factors underlying these diseases. PURPOSE OF REVIEW: Review of the role of the VP-AQP2 system in the inner ear fluid homeostasis and in the formation and development of endolymphatic hydrops. RECENT CLINICAL AND EXPERIMENTAL FINDINGS: A clinical survey has revealed that the p-VP level is often elevated in MD and its related diseases and that the increase in the p-VP level was closely linked to vertigo attacks in MD. Experimental studies have revealed that proteins and mRNAs of aquaporin-2 and vasopressin type 2 receptor were expressed in the stria vascularis of the cochlea and the epithelium of the endolymphatic sac, and that the volume of the endolymphatic compartment was mediated by the activity of the VP-AQP2 system in the inner ear.

Time course of vestibular function changes of experimental endolymphatic hydrops in guinea pigs.

OBJECTIVE: To investigate the relationship between endolymphatic hydrops and vestibular dysfunction. METHODS: 20 pigmented guinea pigs were used: 15 for a hydrops group and 5 for a sham group. Endolymphatic hydrops was produced by electrocauterization of the endolymphatic sac on the left ears. In the horizontal vestibuloocular reflex (HVOR) study, HVOR responses were recorded before and 1, 2, and 4 weeks after surgery in 9 animals of the hydrops group and 5 animals of the sham group. HVOR gain under sinusoidal rotation with a maximal head velocity of 45 degrees /s and frequencies of 0.05, 0.1, 0.2, 0.4 and 0.8 Hz was analyzed. In the nystagmus study, spontaneous nystagmus was recorded in all animals of the hydrops and the sham groups for 1 h in the dark and the maximum slow-phase velocity was measured before and 1, 2, 4 weeks after surgery. Morphological changes in the inner ear were measured light microscopically. RESULTS: In the hydrops group, the HVOR gains at all stimulation frequencies seemed to decrease 1 week after surgery and recover 2 or 4 weeks after surgery; however, there were no statistical differences among HVOR gains in any periods after surgery. The incidence of spontaneous nystagmus gradually increased after surgery and the direction and onset showed large variation. The duration of nystagmus was approximately 10 min. The degree of endolymphatic hydrops showed large variation. In the sham group, HVOR gains at all stimulation frequencies showed no statistically different change in any period after surgery. In the sham group, no animal showed spontaneous nystagmus. CONCLUSION: Experimentally induced endolymphatic hydrops seems to contribute to vestibular dysfunction to some extent. We speculated that when endolymphatic hydrops is progressing, vestibular dysfunction might occur.

Diagnostic value of plasma antidiuretic hormone, electrocochleography, and glycerol test in patients with endolymphatic hydrops.

OBJECTIVE: To investigate the relationship between the plasma antidiuretic hormone (p-ADH) level, electrocochleogram (ECoG), and the glycerol test in patients with endolymphatic hydrops (ELH). PATIENTS AND METHODS: The subjects were 60 patients, including 51 with Ménière's disease (except for cochlear Ménière's disease), 7 with delayed ELH, and 2 with syphilitic ELH. The time period for measurements of the p-ADH level, ECoG and the glycerol test was within 4 weeks. RESULTS: 13 patients showed positive results for all tests. 58 patients showed positive results for at least one of three tests. Only 2 patients showed negative results for all tests. CONCLUSION: The p-ADH level, ECoG and the glycerol test show different selectivity of ELH detection. It is useful to perform all three tests to diagnose ELH.

Electrical recording of otoacoustic emission.

CONCLUSION: Otoacoustic emissions (OAEs) could be detectable as cochlear AC potentials. Spontaneous otoacoustic emissions (SOAEs) were detected either electrically or acoustically, while evoked otoacoustic emissions (EOAEs) could be detected electrically but not acoustically. OBJECTIVE: Many lines of evidence support the hypothesis that SOAEs are produced by spontaneous mechanical oscillation within the cochlea, and perhaps motile properties of the outer hair cells. If this is the case, SOAEs, emitted acoustically in the external auditory meatus, could also be recorded electrically as cochlear AC potential. EOAE is also thought to be produced by vibration of the basilar membrane, generated by the backward-traveling waves. EOAE thus seems to be detectable electrically as cochlear AC potential. In the present study, SOAE and EOAE were recorded both acoustically and electrically in the guinea pigs to examine the correlation between electrically recorded SOAE (ER-SOAE) and acoustically recorded SOAE (AR-SOAE). In addition, a microphonics response (MPR) to tone pip was recorded to analyze the characteristics of the non-linear component and linear component of the AC responses. RESULTS: (1) In 4 out of 20 guinea pigs (20%), SOAE could be detected both acoustically and electrically. (2) Electrical signals of SOAE had a better S/N ratio than acoustical signals. Generally, only some ER-SOAE could be detected acoustically. (3) Almost without exception, the prominent frequencies of multiple ER-SOAEs corresponded to the intermodulation distortion product, or harmonics. (4) ER-SOAEs were suppressed by hypoxia or intense sound exposure and reappeared upon rebreathing or discontinuation of the external tone. During recovery, prominent frequencies showed a transient downward shift in frequency. (5) SOAEs were synchronized in phase with an external tone in the spectral neighborhood of SOAE. The averaged waveform of SOAE synchronized with the external tone was the same with either acoustic or electrical signals. (6) The MPR to tone pip is composed of two components with different frequency characteristics and input/output functions. (7) The non-linear component delayed to cochlear microphonics was markedly saturated at the intensity level of 40 dB peak equivalent SPL. This component was a phase-lock response, not a frequency-locked one. (8) The non-linear component could be separated with Probst's non-linear differential extraction technique. In the MPR to a 4-kHz tone pip, high-cut filtration at 3.5 kHz produced a waveform similar to the non-linear component separated by Probst's method.

Narrow-band evoked oto-acoustic emission from ears with normal and pathologic conditions.

CONCLUSION: Evoked oto-acoustic emission (EOAE), in particular the slow component, is fragile with the inner ear lesions and is apt to disappear in impaired ears. This presence is thought to mean that inner ear is not badly damaged, and that the presence of EOAEs in early stage sudden deafness carries a good prognosis. Narrow-band EOAE analysis would open a potentially promising way to manage sensorineural deafness. OBJECTIVE: The aim of present study was to evaluate the characteristics of EOAEs from pathologic ears by a narrow-band EOAE analysis, which allowed us to investigate amplitude, frequency content and latency of EOAEs simultaneously and also to easily detect weak echoes in cases with inner ear lesions. MATERIALS AND METHODS: EOAEs were analyzed by investigating narrow-band frequency contents of EOAEs, filtered by a 100-Hz step of pass bandwidth in frequency regions from 1.0 to 2.0 kHz, and by 500 Hz of pass bandwidth in the frequency ranges of 0.5-1.0 and 2.0-5.0 kHz. EOAE testing was performed in 40 normal ears and 111 ears with pathologic disorders, including sudden deafness, Ménière's disease and surgically proven acoustic neurinomas. Spontaneous oto-acoustic emission was investigated in some cases. In acoustic neurinoma, especially computed tomography scan and magnetic resonance imaging tests were performed to assess the tumor size. RESULTS: (1) Narrow-band EOAE analysis revealed that EOAEs from normal ears were composed of two main echo trains and several sub-echoes. The main echo trains were divided into a fast component with a short latency of <10 ms and a slow component with a long latency of >10 ms. (2) EOAEs could often be detected from ears with moderate to severe hearing loss >45 dB HL in early stage sudden deafness. The prognosis of sudden deafness was good in cases where both a fast component and slow component were detected in the acute stage within 2 weeks after the deafness onset, and was pessimistic, when either or both of them failed to recover. (3) In Ménière's disease, EOAE was found in 6 (40%) of 15 cases with hearing loss >50 dB, and detected in 54 (90%) of 60 cases with slight to moderate deafness <50 dB HL. Echo duration tended to become shorter, and the slow component decreased in amplitude even in ears with slight deafness <30 dB. The detection threshold of the slow component was also elevated. In ears with more advanced deafness, the slow component disappeared and only the fast component with short latency persisted. Ultimately, the fast component also faded out if the hearing was severely impaired. (4) EOAEs were detectable in 20 (95.2%) of 21 ears with surgically proven acoustic neurinoma, 16 of which had both the slow and fast components. The echo pattern of acoustic neurinoma was basically similar to that of normal ears, but the detection threshold was elevated to a varying degree, although there were some cases with much better detection threshold as compared with severe deafness.

Modification of surgical procedures of type 1 tympanoplasty for non-cholesteatomatous chronic otitis media.

OBJECTIVE: To introduce our modified procedures of type 1 tympanoplasty and to assess their efficacy. METHODS: We modified the surgical procedures of type 1 tympanoplasty and have used these procedures since September 1999. The modified points are enlargement of the facial recess approach, no elevation of the posterior meatal skin and the tympanic annulus, and endoaural repair of tympanic membrane perforation. 51 patients with simple chronic otitis media have undergone this modified type 1 tympanoplasty. Postoperative hearing was evaluated according to the criteria proposed by the Otological Society of Japan. RESULTS: The average follow-up period was 15 months (range 6-35). The hearing result was considered successful when the postoperative hearing level satisfied with at least one of three conditions as follows: (1) air-bone gap <15 dB, (2) hearing gain >15 dB, or (3) hearing level >30 dB. The success rate was 94.1%. The average postoperative air-bone gap, hearing gain and hearing level were 3.9, 10.0 and 29.3 dB, respectively. CONCLUSION: Our modified tympanoplasty is useful to achieve better postoperative hearing results.

Expression of fibroblast growth factor receptors 1-4 in human chronic tympanic membrane perforation.

OBJECTIVE: To locate fibroblast growth factor receptor (FGFRs) 1-4 in human chronic tympanic membrane (TM) perforation. METHODS: A sample of human chronic TM perforation was harvested during myringoplasty. The sample was immediately fixed in 4% paraformaldehyde and embedded in OCT compound. Immunohistochemistry was performed with FGFR 1-4 polyclonal antibodies. RESULTS: FGFRs 1-4 were strongly and weakly expressed in the epidermal and mucosal layer of the TM perforation, respectively. CONCLUSIONS: As it is impossible to perform quantitative analysis based on the fluorescence intensity of each immunoreactivity, the presence of FGFRs 1-4 in the human chronic TM perforation is shown. The expressions of FGFRs 1-4 indicated that the clinical use of bFGF agent is useful for myringoplasty.

Long-term courses of hearing loss in young children.

PURPOSE: The purpose of this study was to clarify the long-term prognosis of young children with congenital or acquired hearing loss. PATIENTS: The subjects consisted of 9 young children (18 ears) in whom auditory training was performed in the Kochi Prefectural Center for Hearing Impaired Children, and the course of hearing could be observed until the age of at least 10 years. METHODS: The annual course of hearing was evaluated based on the results of play audiometry and pure-tone audiometry that facilitated the differentiation of hearing between the left and right ears. In the first examination, stable values were obtained after some tests and used as reference values. As the representative value at each age, the arithmetic mean of the pure-tone averages obtained by all hearing tests performed during the year was used. RESULTS: The course of hearing was observed from 2 to 24 years of age, and the observation period was 6-18 years (mean 13.2 years). Hearing was aggravated in 13 ears, of which 8 (4 patients) showed marked and 5 (3 patients) showed slight aggravation. Hearing was unchanged in 5 ears (3 patients). CONCLUSIONS: Hearing loss often progressed bilaterally. There were two progression patterns: rapid aggravation during early childhood, followed by gradual aggravation, and gradual aggravation over the entire course. The aggravation of hearing may be associated with the degree of impairment and vulnerability of the auditory organs.

Electrocochleographic and pure-tone audiometric findings in contralateral ear of unilateral acoustic neurinoma.

OBJECTIVE: Auditory disorders of the contralateral ear in patients with unilateral acoustic neurinoma have previously been reported using the auditory brainstem response. From our survey of the literature, there is no reported result about electrocochleography (ECoG) in the contralateral ear of acoustic neurinoma cases. In the present study, we reported ECoG and pure-tone audiometric results of the contralateral ears in cases of unilateral acoustic neurinoma and the relationship between ECoG findings and tumor size was discussed. METHODS: ECoG and pure-tone audiometry were performed for the contralateral ears in 27 cases of unilateral acoustic neurinoma, and the relationships between tumor size and contralateral ECoG findings and between pure-tone threshold and ECoG findings were investigated. As for ECoG findings, the negative summating potential to the compound action potential ratio (-SP/AP ratio) was examined. The tumor size was assessed by magnetic resonance imaging. RESULTS: Abnormal -SP/AP ratio exceeding 0.40 of the upper limit of the normal range was found in 7 (25.9%) of 27 ears. Incidences of abnormal -SP/AP ratio were 30.0% in large tumors (n = 10), 33.3% in mid-size tumors (n = 6) and 18.2% in small tumors (n = 11). There was no correlation between the incidences of abnormal -SP/AP ratio and tumor size. Moreover, there was no correlation between the -SP/AP ratio and pure-tone threshold at the ECoG recording. CONCLUSION: These results suggest that any size of acoustic neurinoma may affect contralateral electrocochleographic findings. One possible cause may be dysfunction of the olivocochlear efferent system and another may be endolymphatic hydrops (e.g. delayed endolymphatic hydrops). Currently, however, the causes of -SP/AP ratio increase are still unknown and further investigations are required.

Antidromically evoked facial nerve response in guinea pigs - a long-term follow-up after nerve injury.

CONCLUSION: The present animal experiment supported that the antidromically evoked facial nerve response (AFNR) was useful for the early diagnosis of facial palsy and for assessing its recovery course. OBJECTIVE: Chronological changes of AFNR latencies after nerve damage were investigated to examine whether or not AFNR latency was suitable as a parameter for the assessment of facial nerve function. MATERIALS AND METHODS: AFNR were recorded in guinea pigs with and without the total or partial transection of the facial nerve. Chronological changes of AFNR after facial nerve transection were investigated. RESULTS: 48 h after the total transection, the responses almost completely disappeared, and reappeared after 3 weeks. The latencies of the recovered responses were prolonged then but shortened thereafter. Meanwhile, the partial transection did not result in a total loss of AFNR, but in a decrease of the amplitude and prolongation of the latency. One day after the partial transection, the latencies of the responses had already prolonged. From the 3rd to the 7th day, the latencies progressively prolonged, and then shortened by the 14th day.

Computer simulation of antidromic facial nerve response waveform.

CONCLUSION: An assessment of facial nerve (FN) damage on the basis of antidromic facial nerve response (AFNR) was established by computer simulation analysis. Computer simulation has the advantage of being able to assume any type of lesion. In the near future, computer analysis should provide another experimental method which displaces animal experiments, thus circumventing the ethical dilemma associated with animal experiments. BACKGROUND: AFNR is a promising method to monitor intratemporal FN lesions. Clinical application of AFNR showed that waveform changes reflected the site and degree of the lesion. However, the association between the waveform changes and pathologic conditions of FN remains to be clarified. OBJECTIVE: To analyze the association between waveform changes and the degree and site of nerve degeneration or blockade with the use of computer simulation, and to speculate the degree and involvement of the intratemporal FN lesions underlying the changes of AFNR waveforms. METHODS: AFNR waveform, latency and amplitude changes in various types of nerve conduction block in the intratemporal FN were analyzed with the use of a computer simulation program based on the solid-angle approximation theory. RESULT: The present computer simulation revealed a temporal increase in the peak-to-peak amplitude between 1st and 2nd waves, when the nerve blockade extends 1 mm distally from the recording site. Generally, AFNR in severe palsy cases gradually decreases in amplitude as the waveform change from biphasic to monophasic, ultimately falling into non-response. According to the computer simulation, the decay of AFNR reflects conduction blocking in 63% or more of FN fibers. The amplitude ratio of the first positive/negative wave was indicative of the site of the lesion in relation to the recording site. The ratios were <0.586 when the lesions were situated >1 mm proximal and they were >0.667 when the lesions were peripheral to the recording site.

Early assessment of nerve degeneration using the antidromic facial nerve response.

CONCLUSION: The antidromic facial nerve response (AFNR) is recommended as a monitoring method to detect cases resulting in facial nerve degeneration within 1 week after onset in patients with Bell's palsy and Hunt syndrome. OBJECTIVES: The purpose of this study was to establish criteria for the AFNR to predict the prognosis of Bell's palsy and Hunt syndrome in the early stages, not exceeding 1 week after onset. MATERIALS AND METHODS: 54 patients, including 40 with Bell's palsy and 14 with Hunt syndrome, were examined in this study. All patients were tested for the AFNR within 1 week after onset of paralysis and AFNR waveforms were analyzed. Four AFNR parameters, the total (peak-to-peak) amplitude (T-amp), the amplitudes of the positive wave (P-amp) and the negative wave (N-amp), and the N-amp/T-amp (N/T) ratio, were compared with the outcomes of facial paralysis. RESULTS: In most patients with poor outcomes, T-amp was <4 microV and N-amp was <2 microV. The mean value of the N/T ratio in patients with a poor outcome fell to <0.4 after the 3rd day from onset, while that in patients with a good outcome was stable between 0.4 and 0.6 during the first week.

Initial lesions in Bell's palsy and Ramsay-Hunt syndrome.

CONCLUSION: The antidromic facial nerve response (AFNR) revealed that the initial lesion in both Bell's palsy and Hunt syndrome was mainly located around the geniculate ganglion within 1 week after onset of paralysis. The preoperative AFNR reflected the response near the initial lesion. OBJECTIVES: To review the initial lesion in Bell's palsy and Ramsay-Hunt syndrome using intraoperative monitoring of the AFNR. METHODS: 15 patients, including 8 with Bell's palsy and 7 with Ramsay-Hunt syndrome, were checked for the AFNR before and during transmastoid decompression surgery within 1 week after onset of paralysis. The AFNR monitoring was performed at the posterosuperior part of the anulus tympanicus preoperatively and at 4 points of the facial nerve during surgery. The nerve conduction block sites were diagnosed by the AFNR waveform. RESULTS: The monophasic wave revealing the block site was mainly observed at the geniculate ganglion in both diseases. The latencies of the preoperative responses corresponded to those recorded intraoperatively around the pyramidal segment of the facial nerve.

Total decompression of the facial nerve - superior prelabyrinthine cell tracts approach.

CONCLUSION: The surgical procedure for the superior prelabyrinthine cell tract approach is described in detail. This approach is a safer and less invasive procedure to totally decompress the facial nerve compared with conventional middle fossa approach. OBJECTIVE: To develop a new approach to the meatal and labyrinthine segments that does not require a craniotomy. BACKGROUND: If performed within 2 weeks after the onset of facial palsy, total decompression of the facial nerve enhances the chance of normal or near-normal facial function recovery in cases with massive nerve degeneration. The transmastoid approach and middle fossa approach are usually combined to totally expose the intratemporal facial nerve. However, the middle fossa approach requires a craniotomy in the temporoparietal area. Because of its invasiveness, patients often hesitate to consent to this operation, and as a result the recovery from facial palsy is incomplete. SURGICAL PROCEDURE: The meatal and labyrinthine segments of the facial nerve are exposed by the superior route via the superior prelabyrinthine cell tracts. Partial resection of the zygoma makes this approach feasible.

A totally implanted intra-arterial chemotherapy system for advanced maxillary sinus carcinoma.

CONCLUSION: Both reservoir systems for intra-arterial cisplatin and intravenous sodium thiosulfate infusions are low- invasive, safe and effective procedures for treatment of advanced maxillary sinus carcinoma. OBJECTIVES: To use our reservoir system for intra-arterial high-dose cisplatin infusion therapy in patients with advanced maxillary sinus carcinoma. MATERIALS AND METHODS: Eight patients with advanced maxillary sinus carcinomas underwent treatment utilizing intra-arterial cisplatin (CDDP) infusion and radiation therapy followed by planned surgical resection. For intra-arterial infusion of high-dose cisplatin, both intra-arterial and intravenous reservoir systems were used. RESULTS: CDDP was infused 4-6 times (mean 5.1) and the total dose of CDDP was between 690 and 910 mg (mean 771 mg). The response rate was 100 with 50% CR and 50% PR and all patients underwent medial maxillectomy. Only 1 T(4) patient had local recurrence and 1 other patient had bilateral neck metastasis.