Digital transformation (DX) was a term proposed by Stolterman et al., who stated that the ongoing development of information technology could be of service to better people’s lives. DX is reshaping interactions between health professionals and patients, decisions about treatment plans, and medical outcomes. Based on key trends from big data, artificial intelligence (AI) and next-generation communication, DX offers the hope for better medical care of prevention, diagnosis, treatment, and welfare for patients. Big data aggregates information about electronic medical records, insurance receipts, patients’ registries, genome/omics, and biological information from wearable devices. AI health programs enable automatic analysis of endoscopic images, CT images, MR images, and voice data to enable diseases to be diagnosed by machine learning of the inputs gathered from thousands of data sets. Next-generation 5G communication is expected to enable smooth telemedicine with little delay, such as for hearing aid fitting and cochlear implant mapping. Telerobotic surgery has also been reported. Emerging digital technologies will change the face of otolaryngological medical care.

Inner ear malformation is a risk factor for recurrent meningitis. Herein, we report one such case, along with a discussion of the repair method. The case was of a 2-year-old boy who developed meningitis at approximately 1 year 10 months of age and was admitted to our pediatric department. We faced difficulties in treating him because had had allergy to antibiotics, and he continued to receive intensive care. Eventually, his condition improved, and he was referred to our department for evaluation of the cause of the meningitis. We found that he had an incomplete partition type II anomaly on the right side and an incomplete partition type I inner ear anomaly on the left side, and the inner ear was thought to be the route of infection for the meningitis. However, there was no inflammation of the tympanic membrane and only a small amount of effusion was present in the tympanic cavity, and he was discharged. One week after discharge, he developed another episode of meningitis and was admitted to our emergency department. Although there was no obvious inflammation of the tympanic membrane, the meningitis was suspected as having been caused by liquorrhea from the inner ear, and once again, clear effusion was detected in the tympanic cavity. After antibiotic treatment, oval window closure was performed. When the tympanic cavity was opened and the stapes footplate was examined, we found a partial defect. When the stapes was removed, a gusher appeared. Connective tissue and auricular cartilage were used as a cuff to close the oval window. Although otitis media of the operated side occurred in the first month after surgery, no meningitis developed. He recovered promptly and has made good progress since then.

Toxic shock syndrome (TSS) is a fatal bacterial intoxication caused by staphylococcal exotoxins. Herein, we report a rare case of TSS developing in a patient after nasal cautery.

A 34-year-old man with allergic rhinitis underwent CO₂ laser-assisted nasal cautery at an ENT clinic. Nasal packing was not performed. Three days later, he presented to another clinic with pharyngeal pain, diarrhea and high fever (≥40℃). He was treated with levofloxacin under a diagnosis of acute pharyngitis, but the symptoms deteriorated. When he was first seen by us on the 7th postoperative day, his nasal cavities were filled with scabs, and marked hyperemia and fur formation were observed on the nasal and pharyngeal mucosae. He also showed erythematous rashes on his forearms and palms, tachycardia (113/min) and hypotension (78/61 mmHg). Laboratory data showed an elevated serum CRP level (37.18 mg/dl), thrombocytopenia (12.4×10⁴/μl), leukocytosis with neutrophilia (29,900/μl, neutrophil 95.3%), and renal dysfunction (BUN 84 mg/dl, Cre 4.56 mg/dl, eGFR 13.41 ml/min). These findings met the criteria of probable TSS. The patient was hospitalized and started on fluid infusions and antibiotic therapy (vancomycin, clindamycin). Cleaning and washing of the nasal cavities were concomitantly performed 3 times a day. His general condition, physical findings and laboratory data promptly recovered. Methicillin-resistant Staphylococcus aureus was detected by nasal culture, although blood culture was negative. The patient was discharged on the 15th postoperative day. When he revisited us 3 days later, desquamation of the palms and soles was observed, confirming the diagnosis of TSS. His clinical course has thereafter been uneventful.

Physicians should be aware that TSS may be induced even by minimally invasive surgeries, such as nasal cautery.

Prediction of pollen dispersion, especially the first day of pollen release and the pollen counts during season, is important for medical care and self-care of patients with Japanese cedar pollinosis. Based on meteorological data collected from 1998 to 2017, we attempted to establish a prediction model for the first day of pollen dispersion. We found that the cumulative temperature over 0 degrees Celsius beginning January 21 seemed to be the most effective model, with the average of 253.9 during this period is predictive of the first day of pollen dispersal. Application of this model to 2018 and 2019 showed an error between the predicted and actual first days of pollen release was 1 day for both years. A prospective observation in 2020 revealed an error of 2 days. We also attempted to establish a prediction model of the total pollen counts during the season. Multiple regression analyses demonstrated that four factors, namely, the average temperature, the sunshine duration and precipitation in previous July, and the total pollen counts of the previous year, as well as three of the above factors, without precipitation, allowed the construction of similarly effective prediction models. Retrospective investigation of the correlation between the predicted and actual total pollen counts demonstrated a high correlation coefficient. Furthermore, a prospective observation in 2020 showed good concordance with the predicted total pollen counts. The proposed prediction models for Japanese cedar pollen release and counts are acceptable, although further improvements would be needed.

Ectopic thyroid gland is uncommon, with a prevalence approximately of 1:100,000–300,000 persons. Ectopic thyroid gland in the anterior cervical region with coexisting normally located thyroid gland is rare.

We present the case of a 67-year-old man who presented with a painless palpable mass in the anterior cervical region. Thyroid function tests were normal, except for an elevated serum thyroglobulin (Tg) level (1,520 ng/ml). Neck ultrasonography and computed tomography (CT) showed a solid anterior cervical tumor measuring 18 mm in diameter, and a 37-mm goiter of the thyroid right lobe. Fine needle aspiration cytology (FNAC) of the anterior cervical tumor and goiter showed no malignant cells in either (class1-Bethesda System), but the Tg level in the aspiration needle washout fluid (NWF) of the anterior cervical tumor was markedly elevated (322,000 ng/ml). The CT revealed that the cervical mass was a separate structure from the thyroid. We suspected either occult lymph node metastasis from thyroid cancer or thyroglossal duct carcinoma, and performed tumor resection and thyroid right lobectomy. Histopathological examination showed ectopic adenomatous goiter and adenomatous goiter of the thyroid right lobe.

Ectopic thyroid gland with a coexisting normally located thyroid gland should be considered in the diagnosis of a cervical mass. It is necessary to consider the possibility of malignancy and also carefully consider the indication for surgical intervention. We present a criteria for surgery of an ectopic thyroid gland.

In this case, a long-term follow-up is needed, since tumor recurrence after surgery performed 20 years ago was suspected.

We performed a retrospective study of 12 patients with glottic cancer who underwent vertical partial laryngectomy at the Department of Otolaryngology, St. Marianna University School of Medicine, from April 2008 to March 2018. All patients were male, with a median age of 64.5 years (range 40–79 years). The median follow-up period was 109 months (range 20–134 months). Vertical partial laryngectomy was performed as salvage surgery after failure of a full course of radiotherapy. Local recurrence occurred in 2 patients after vertical partial laryngectomy, but they were salvaged by subsequent total laryngectomy. Swallowing dysfunction occurred in 1 patient after vertical partial laryngectomy, and this patient was also treated by subsequent total laryngectomy. The 5-year overall survival rate of patients treated by vertical partial laryngectomy as salvage surgery was 91.7%. The 5-year larynx preservation rate after salvage vertical partial laryngectomy was 75.0%. The 5-year local control rate after salvage vertical partial laryngectomy was 81.8%. Thus, vertical partial laryngectomy for glottic cancer is useful as salvage surgery after failure of a full course of radiotherapy in patients with glottic cancer. Subglottic extension and paraglottic space invasion might be risk factors for local recurrence and swallowing disorder after salvage vertical partial laryngectomy. Diagnosis of extension of recurrent tumor in the anterior commissure manifesting as ulcer formation was very difficult. We performed laryngomicrosurgery (LMS) prior to salvage surgery in all patients who were suspected as having developed local recurrence after radiation failure for glottic cancer. In addition, we carried out intraoperative frozen section diagnosis during salvage surgery in glottic cancer patients with local recurrence after radiation failure. LMS and intraoperative frozen section diagnosis were important for local control of recurrent tumor after radiation failure in patients with glottic cancer.

We examined the relationship between patient factors, tumor factors, inflammation/nutritional factors, inflammation/nutritional compound factors, and overall survival (OS)/disease-free survival (DFS) in 40 patients of oropharyngeal squamous cell carcinoma who had received primary treatment at our institution between November 2014 and July 2019. We selected age, sex, smoking (Brinkman index), drinking habit, presence/absence of double cancer, and body mass index (BMI) as the patient factors; primary subsite, TNM classification (UICC/AJCC, 8th edition), and p16 immunostaining status as the tumor factors, serum levels of albumin, hemoglobin, and peripheral blood lymphocyte count, neutrophil count and platelet count, and serum C-reactive protein (CRP) as inflammation/nutritional factors, and the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and modified controlling nutritional status (mCONUT) as inflammation/nutritional compound factors. The Kaplan-Meier method and log-rank test were used for calculating and comparing the OS/DFS. Multivariate analysis using the Cox proportional-hazards model was conducted using, as explanatory variables, variables that were identified as significant with p<0.05 in the univariate analysis. The OS follow-up period was 2–45 months (median, 15 months), and the 3-year OS was 77.8% (95% CI=0.583–0.889). Factors that had significant influence on the OS were the age, Brinkman index, serum CRP, NLR, PLR, CAR, PNI, and mGPS. The DFS follow-up period was 1–45 months (median, 12 months) and the 3-year DFS was 54.7% (95% CI=0.296–0.670). Factors that were identified as having a significant influence on the DFS were the Brinkman index, platelet count, PLR, and mGPS. However, multivariate analysis did not identify the Brinkman index as an independent poor prognostic factor for either the OS or the DFS. However, because it is suspected that the Brinkman index is a significant prognostic factor, it is suggested that a better prognostic classification may be obtained by combining all these factors. We suggest that biomarkers derived from routine laboratory tests can contribute to identifying the risk of recurrence and selection of appropriate treatment in patients with oropharyngeal carcinoma.

Fine-needle aspiration biopsy of the thyroid is essential to accurately diagnose thyroid tumors. We report a case in which diffuse thyroid swelling developed immediately after fine-needle aspiration biopsy of the thyroid in a 42-year-old man who underwent ultrasound-guided fine-needle aspiration biopsy for a left-sided thyroid tumor. The patient developed neck pressure and swelling immediately after the biopsy, with diffuse swelling across the right side of his neck. Immediate thyroid ultrasonography and computed tomography revealed swelling, cracking, and vasodilatation throughout the right lobe of the thyroid. Visual inspection performed 4 hours after the puncture showed reduction of the neck swelling, and physical examination and imaging studies revealed subsidence of the swelling the following day.

Neck swelling after puncture is commonly attributable to hematoma formation and transient thyroid enlargement in response to puncture stimulation. While the precise mechanism underlying the development of diffuse thyroid swelling remains unclear, we speculate that puncture stimulation releases vasodilators that increase the vascular permeability and blood flow to the area, resulting in rapid diffuse thyroid swelling.

It is necessary to closely monitor patients in the hospital for approximately 30 min after the puncture before they are discharged. Ultrasonography and careful follow-up are warranted to distinguish between hematoma and transient thyroid enlargement in patients with post-puncture neck swelling, for prompt administration of appropriate treatment.

This study was performed to analyze the characteristics of patients with a definitive diagnosis of mumps outside the sentinel surveillance population. Patients aged 15 years or older who visited the otolaryngology department of Yamaguchi Rosai Hospital between October 2015 and April 2017 were included. A definitive diagnosis of mumps was obtained in 8 patients, based on the detection of mumps-specific IgM antibody in the blood. There were 4 male and 4 female patients, ranging in age from 16 to 44 years, with a mean age of 31.4 years. None of the 8 patients had received mumps vaccination. In regard to the swelling of the salivary glands, a single swelling was observed in 4 patients and multiple swellings in the remaining 4 patients. The most commonly affected salivary gland was the left parotid gland (7/8 patients; 87.5%). The complications included hearing loss in 2 of 8 patients, and vertigo and orchitis in one patient each. There were no significant differences in the peripheral blood white blood cell count, serum CRP level, or antibody index between the patients with and without complications. However, the serum amylase level was statistically significantly higher in patients with complications than in those without complications, suggesting the possibility that elevated serum amylase may be marker of the development of complications.

Fisher syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. It is considered as a variant form of Guillain-Barré syndrome, which is associated with anti-ganglioside antibodies.

Herein, we report two cases of Fisher syndrome. Case 1 was a 49-year-old man. He presented with the complaint of double vision 7 days after the onset of symptoms of an acute upper respiratory infection. Computed tomography revealed sinusitis in the sphenoid sinus. Subsequently, the patient developed abducens nerve palsy and loss of tendon reflexes in the lower limbs. Case 2 was a 48-year-old man. The patient presented with the complaint of dizziness 10 days after the onset of a fever. Subsequently, the patient developed disturbance of the upward, downward and inward ocular movements. Because in both cases, external ophthalmoplegia appeared after a upper respiratory infection, we checked for the presence of anti-ganglioside antibody in the serum. As Case 1 was positive for anti GT1a antibody and Case 2 for anti GQ1b antibody, both were diagnosed as having Fisher syndrome. Both cases recovered spontaneously within 2–4 months.

Venous malformations commonly occur in the head and neck region, in the mucous membrane of the nasal and oral cavity. Venous malformations are found in the extremities in 40% of cases, in the trunk in 20% of cases, and in the cervicofacial area in 40% of cases. However, they are rarely encountered in the parapharyngeal space. We report our experience of surgical treatment of a patient with this rare tumor. The patient was a 21-year-old man who presented with a left mandibular swelling and was admitted to a nearby hospital. He was referred to our hospital for examination and treatment. Contrast-enhanced computed tomography (CT) revealed a bulky tumor with some calcification in the parapharyngeal space; on contrast-enhanced CT, the tumor showed few enhanced effect in the arterial and venous phases. Additional enhancement MRI showed the lesion as a low signal intensity on T1-weighted images and as high signal intensity on T2-weitghted images and contrast-enhanced MRI showed few enhanced effect of the lesion. Based on these findings, we suspected venous malformation and performed surgical excision. Histopathology confirmed the venous malformation and the lesion was diagnosed as a cavernous angioma. Vascular malformations in the head and neck region should be precisely diagnosed so that appropriate multimodality treatment can be undertaken.