Otitis media with effusion (OME) is the primary cause of pediatric hearing loss. A clinical practice guideline for the diagnosis and management of otitis media with effusion in children in Japan was published in 2015. It deals not only with OME, but also with lesions of the surrounding organs. OME is diagnosed when an effusion is observed in the middle ear in the absence of evidence of acute inflammation. Observation of the tympanic membrane with a pneumatic otoscope is the most important step to diagnose OME. Tympanometry may be used to confirm middle ear effusion. An age-appropriate audiometric test should be performed before inserting a ventilation tube. Imaging of the temporal bone is useful to estimate the degree of development of the mastoid air cells before inserting a ventilation tube. Clinicians may recommend insertion of ventilation tubes when the bilateral OME has persisted for 3 months or longer, there is obvious bilateral hearing (40 dB and above) and /or observed language development delay. Clinicians also recommend insertion of a ventilation tube in children with unilateral OME when the pathological changes of the tympanic membranes (atelectasis and adhesion) are observed.

Based on a series of studies including brain function tests, we reinforced and improved treatment for tinnitus by developing a tinnitus retraining therapy (TRT) that incorporates the “tinnitus pain model”; our laboratory subsequently introduced this therapy in 2013. This model provides a clinical explanation that tinnitus manifests and worsens through nerve synchronization of the auditory path and the non-auditory path with the pain network. Therefore, the target of tinnitus therapy based on this model is the auditory path generating the tinnitus and the pain network that worsens the tinnitus. The therapy mainly uses “acoustic therapy” and “directive counseling”, which are the same as the original TRT. What characterizes this method is the central use of a hearing aid in the “acoustic therapy” targeting tinnitus patients with hearing loss. TRT incorporating the “tinnitus pain model” would be ideal for the establishment of an outpatient department dedicated to hearing loss and tinnitus. In actual practices, however, many hospitals avoid offering “directive counseling”, as it is often difficult to provide sufficient counseling in a general outpatient setting.

This report examined the tinnitus treatment practice of a municipal hospital with two otolaryngologists. The hospital administered TRT incorporating the “tinnitus pain model” to 62 cases (average age: 68.7 years, prevalence period: 16 months [median]). All the cases were treated with “directive counseling”, while 32 cases used hearing aids as a part of “acoustic therapy”. The tinnitus handicap inventory (THI) score showed a statistically significant reduction after treatment from 49.3±23.0 to 24.8±21.1. The improvement rate, based on an “improvement of 20 THI points or above” and “16 or lower final THI points” as the statistical criteria, was 62.9%. The proactive involvement of municipal hospitals in tinnitus treatment may reduce the frequency of doctor shopping by tinnitus patients and could help to break the “vicious circle” of tinnitus treatment practices.

Congenital cholesteatoma within the tympanic membrane is very rare and is mainly treated with the removal of the lesion, including all of the cholesteatoma matrix and keratin debris. We report the case of a 14-month-old boy who was diagnosed as having congenital cholesteatoma in his right tympanic membrane. The patient presented with a white mass in the inferior portion of the right tympanic membrane. A computed tomography scan of the temporal bone revealed that the mass was located within the tympanic membrane but had not invaded the ossicular chain. Since the mass appeared to have increased at the time of a 1-year-follow up, we surgically removed the congenital cholesteatoma within the tympanic membrane. During the surgery, we removed the matrix under the epithelial layer of the tympanic membrane and thoroughly removed all of the keratin debris. After the surgery, the matrix on the fibrous layer of the tympanic membrane was used to cover the tympanic membrane and external auditory canal as an epithelium. To date, there have been any signs of recurrence. These findings indicate that the removal of the matrix under the epithelial layer as well as keratin debris in the cholesteatoma can lead to the complete healing of a congenital cholesteatoma within the tympanic membrane.

A 56-year-old man presented with left-sided exophthalmos. The patient gave a history of having sustained an orbital blow-out fracture 25 years previously, and the orbital floor had been reconstructed with a silicone implant. CT and MRI showed a mass surrounding the orbital floor implant on the left side. We removed the hemorrhagic cyst arising from the silicone implant by endoscopic surgery. Endoscopic sinus surgery is an effective approach for removing an orbital foreign body.

In this case report, we present two cases in which migrating foreign bodies, a partial denture and a fish bone, were successfully removed from the hypopharynx and esophagus by transcervical incision. The first patient was a 55-year-old male who presented with the feeling of a lump in the throat after accidental swallowing of a partial denture. Although the endoscopist could visualize the foreign body and tried to remove it with the flexible endoscope, the ingested foreign body failed to come within the grasp of the endoscopic forceps. Therefore, the migrating foreign body was removed by transcervical incision. The second patient was a 62-year-old male who presented with odynophagia after accidentally swallowing a fish bone. The fish bone could not be visualized by endoscopic examination, but was clearly detected by three-dimensional-CT imaging. The fish bone was then successfully removed surgically by a transcervical incision. Recently, in most cases, foreign bodies in the hypopharynx and esophagus have been removed using a flexible endoscope. However, in the management of ingested foreign bodies, removal by transcervical incision should be considered in case of any difficulties in endoscopic removal.

We performed a retrospective statistical analysis to evaluate the safety, efficacy and effectiveness of a tonsillectomy for the treatment of immunoglobulin A nephropathy (IgAN).

Forty-four patients were included in the study. The safety and efficacy of the surgical techniques were confirmed by the frequency of postoperative bleeding and the mean operative time, which were equal to those observed after tonsillectomies in patients with diseases other than IgAN. The median duration of hospitalization was 7 days. For comparison, patients were divided into three groups: a non-operative group, a tonsillectomy alone group, and a group with a tonsillectomy followed by the pulse administration of a glucocorticoid (TSP). Statistical analyses were performed to determine changes in the following indices between the pretreatment levels and the levels at one year after the completion of treatment: (1) daily urine protein level, (2) urine red blood cell count, (3) clinical remission rate of urine, and (4) urine clinical remission rates of histopathological prognostic categories at the point of diagnosis. The results showed that the latter two groups that had undergone a tonsillectomy both had significantly better improvements, compared with the non-operative group. However, no statistical difference in the clinical remission rates was seen between the latter two groups, although the rate for the tonsillectomy alone group was higher. The remission rates for the three prognostic categories were 53%–78%, and no significant difference were observed among the categories. In conclusion, surgical therapy for IgAN tonsillectomy was performed safely and with no increase in the hospitalization time. A tonsillectomy alone and TSP were both effective for the treatment of IgAN, although a significant difference between the two treatments was not observed. The accumulation of a larger number of cases treated with a tonsillectomy alone is needed to determine the indications for a tonsillectomy in patients with IgAN.

First branchial cleft fistula is a rare disease among branchial anomalies and is often diagnosed as an inflammatory lesion in submandibular or pinna region. The disease can be difficult to distinguish from an atheroma or epidermoid tumor because the occurrence of multiple infections can obscure the fistula.

Here, we report the case of a first branchial cleft fistula that was diagnosed after two biopsies, and was then surgically treated.

Initially, a computed tomography examination with enhancement was performed to confirm the location and size of the fistula. As a result, the fistula was found to be located close to the mandibular branch of the facial nerve. The tissue surrounding the fistula showed marked scarring, so a nerve stimulator was applied.

The marginal branch could not be confirmed durling the surgery, but postoperative inferior lip paralysis was avoided.

When a total maxillectomy is performed in patients with maxillary cancer, it is important to preserve visual function and maintain the patient’s facial features, since both orbital floors are removed. Various reconstruction methods have been reported. We have performed reconstructions of the orbital floor using a dynamic titanium mesh. The results have been satisfactory in terms of function and cosmetic appearance, since neither diplopia nor infectious symptoms have been observed and minimal post-surgical cheek deformation has occurred. The prosthesis were prepared so as to cover the resected area of the hard palate. The removal of the prosthesis facilitated observations of the cavity. Also, the presence or absence of recurrences and the condition of the reconstruction site could be assessed visually. The titanium mesh that was employed was useful for preserving postoperative visual function, since it has a high biological affinity and can be easily used to replicate the 3D structure of the orbital floors. Compared with a vascularized composite-free tissue transfer, surgery using this mesh requires only a short operative time and the sacrifice of fewer autografts. In contrast to bone grafting, the restoration of ocular alignment is possible, since the mesh can easily replicate the 3D structure of the orbital floors. The mesh, however, may be exposed on the surface of the skin or cause infection if used over a wide area extending to the zygomatic bones, since it is an artificial material. It is important to take the area of reconstruction into consideration when using this mesh, as in the present cases. Here, we report three postoperative cases with follow-up periods of more than 5 years. A lengthy and meticulous follow-up period is necessary for such cases.

Vascular malformation rarely arises in the submandibular gland. Here, we describe two cases of multiple phleboliths in the submandibular glands.

The first case was a 70-year-old woman who presented with a mass in her right submandibular gland. A plain computed tomography (CT) examination showed calcification indicative of sialolithiasis in the submandibular gland.

The second case was a 40-year-old woman who presented with a mass that had repeatedly appeared and disappeared. A plain CT examination showed a sialolith in the right Warton duct and calcification of the submandibular gland.

In both cases, the tumors were removed surgically under general anesthesia. The pathological diagnosis was vascular malformation with phleboliths. The differentiation of phleboliths from sialolithiasis was difficult especially in the second case, which was complicated by the presence of a sialolith in the Warton duct. In this case, additional examinations using ultrasonography or contrast enhanced CT were required.

In cases with sialolithiasis of the submandibular gland with calcification in a submandibular lesion, otolaryngologists should consider vascular malformation in the differential diagnosis.

We report a case of dedifferentiated carcinoma of the parotid gland. A 48-year-old woman presented to us with a mass in the right parotid region. Computed tomography revealed a peripherally enhancing mass in the right parotid gland. The patient was treated by superficial parotidectomy. The tumor was found to be adherent to the marginal mandibular branch of the facial nerve. Intraoperative frozen section analysis revealed a malignant tumor. Thus, resection of the tumor with the affected nerve and the surrounding parotid gland tissue and lymph node dissection were performed. Postoperative histopathological examination revealed the diagnosis of dedifferentiated carcinoma of the parotid gland. There has been no recurrence or metastasis until now, one and a half years since the surgery. Dedifferentiated carcinoma of the parotid gland is a rarely encountered disease, therefore, additional case studies are needed to clarify the characteristic clinicopathological features of this disease entity.