Recent developments in implantable hearing devices have led to rapid progress in new devices such as electric acoustic stimulation (EAS), middle ear implant (VSB), and bone-conductive implants (BONEBRIDGE), in addition to cochlear implants and bone-anchored hearing aids (Baha^®), and have greatly increased treatment options. These new implantable hearing devices can now be used to treat middle ear diseases, congenital aural atresia, and cases of high-frequency sensorineural hearing loss that cannot be adequately compensated for with conventional otologic surgery. However, there are a variety of surgical indications for these new implantable hearing devices, with some devices being indicated based on only hearing level, others based on speech discrimination, and still others based on the experience of surgery or the type of anomaly. There is still no organized workflow for recommending the use of different implantable hearing devices in different cases. Furthermore, even if a patient has adaptive hearing at the start of use of an artificial hearing device, there are problems such as the device becoming difficult to use as the patient’s hearing progresses out of the adaptive range. This section summarizes the characteristics and limitations of various implantable hearing devices and discusses appropriate selection and hearing images (personalized medicine).

Herein, we describe a rare case of gustatory disturbance caused by an astrocytoma of the left temporal-parietal lobe. A 65-year-old woman presented with a 1-month history of dysgeusia and a sense of discomfort in the oral cavity, pharynx and larynx. ENT examination showed slight papillary atrophy in the tongue. Qualitative and quantitative assessment of taste perception was performed. Electrogustometry revealed no abnormalities. Evaluation of taste acuity by the filter paper disc method showed poor recognition threshold in the area of the left chorda tympani nerve, left glossopharyngeal nerve and right greater petrosal nerve. During this examination, the patient’s complaints included parageusia, hypergeusia, and mild paresthesia. When bitter taste was presented in the area of the left greater petrosal nerve, the patient complained of mild pain. Dissociation between the detection threshold and recognition threshold was observed. The gustatory disturbance gradually worsened, with the patient began to complain of a constant feeling of bitter taste and paresthesia in the regions of the oral cavity, pharynx and larynx, in spite of zinc replacement therapy. The patient later developed dysarthria and headache. A brain MRI revealed a left temporal-parietal lobe tumor. Thus, in patients with a short history of dysgeusia who show no recovery within 3 months, more detailed examination needs to be performed to identify the possible cause of dysgeusia. Laterality and aggravation of the gustatory disturbance with time seem to be important clues pointing towards a brain tumor. In particular, patients with gustatory disturbance accompanied by paresthesia of the oral cavity, pharynx and larynx need to be carefully followed up.

We present the treatment outcomes of 17 patients (17 ears) with congenital cholesteatoma who underwent tympanoplasty at our department between April 2004 and September 2019. Tympanoplasty type I was performed in 7 of 17 ears, and staged tympanoplasty was selected for the remaining 10 ears (Type IIIc: 3 ears; Type IIIi-I: 1 ear; Type IVc: 3 ears; Type IVi-M: 3 ears).

The overall success rate of hearing improvement, according to the criteria of the Otological Society of Japan (2010), was 82.4% (14 of 17 ears). Residual recurrence was found in 2 ears treated by Type-I tympanoplasty. Residual cholesteatoma was observed during the second operation in 3 of 10 ears treated by staged tympanoplasty. These results indicate the usefulness of staged tympanoplasty for the prevention of residual cholesteatoma.

We have been using Teflon piston, without MRI restriction, as the first choice for laser stapedotomy since 2014. In cases where the Teflon piston ring is difficult to insert over the incus, a portion of the piston ring is trimmed for insertion. In this study, we investigated the postoperative hearing results of stapes surgery.

A total of 44 ears (30 with otosclerosis and 14 with ossicular malformation) who underwent initial stapes surgery at our university hospital between January 2014 and March 2021 were included in the study. The mean air conduction and bone conduction thresholds and the air-bone gap were assessed, and the postoperative hearing outcomes were judged based on the 2010 guidelines of the Japan Otological Society. The prognostic factors for postoperative hearing outcomes were also analyzed.

In all cases, stapedotomy was performed using a CO₂ laser. The preoperative mean air conduction threshold was 58.3 ± 18.5 dB, and the postoperative mean air conduction threshold improved significantly to 36.2 ± 21.2 dB. On the other hand, the preoperative and postoperative mean bone conduction thresholds were 27.8 ± 13.7 dB and 25.5 ± 15.3 dB, respectively, the difference not being significant. In addition, the mean air-bone gap was 30.5 ± 12.4 dB preoperatively and 8.4 ± 14.2 dB postoperatively, indicating significant improvement. Postoperative hearing was successfully restored in 36 ears (81.8%). The success rate was significantly lower when the Teflon piston ring was removed. In some cases with unsuccessful surgery in which the piston ring was trimmed, the piston ring fell out of the long process of incus.

Trimming the ring of the Teflon piston makes it easier to insert the piston over the long process of incus, but it may also cause the piston ring to fall off easily after surgery. Therefore, it might be preferable to use the Teflon piston in its original form without trimming during stapedotomy.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a form of necrotizing vasculitis that is characterized by the presence of few or no immune deposits. Recently, otological symptoms such as tinnitus, vertigo and hearing loss, not previously described to be associated with AAV, have been reported in patients with AAV. Herein, we report three cases of otitis media with ANCA-associated vasculitis (OMAAV). All three patients showed a good response to steroid therapy. Oral steroid therapy could be temporarily discontinued in the patients during the COVID-19 outbreak without recurrence of the symptoms associated with OMAAV. In conclusion, we could consider temporarily tapering the steroid dose in patients with OMAAV who show remission of the symptoms.

The incidence of allergic rhinitis caused by Japanese cedar pollen has been increasing in recent years. Treatment of seasonal allergic rhinitis includes oral treatment centered on second-generation antihistamines, topical steroid sprays, sublingual immunotherapy, etc. In addition, omalizumab, an anti-IgE antibody preparation, was approved in December 2019 for use in patients with severe or very severe symptoms who show inadequate response to existing treatments. During the 2020 cedar pollinosis season, which was the first cedar pollen season in Japan after the approval of omalizumab, we treated some patients with cedar pollen-induced seasonal allergic rhinitis with omalizumab at our hospitals. We report the clinical effects of the drug administered during the pollen season in 2020 and the effects of re-administration of the drug again in 2021 in patients with Japanese cedar pollinosis.

In 2020, omalizumab was administered to 4 patients with severe symptoms and 1 patient with very severe symptoms. One of the patients received the drug for 2 weeks, while the remaining four patients received the drug for 4 weeks. All the patients showed improvement of symptoms after treatment, as compared to the symptom severity before the start of treatment. Of the 5 patients, 4 requested omalizumab treatment again in 2021, so that 80% were re-administered the drug in 2021. These patients received omalizumab statically significant earlier in 2021 as compared to 2020 (p = 0.014: Mann-Whitney U test). Only one of the patients also received sublingual immunotherapy. Even patients receiving sublingual immunotherapy could show severe allergic symptoms during the cedar pollinosis season, and omalizumab was effective even in the patient who showed symptoms while receiving sublingual immunotherapy at our hospital. Even when omalizumab treatment was started from the middle of the Japanese cedar pollen season, the intranasal findings improved after 2 weeks. Assessment of two patients with intranasal findings by the Japanese Rhinoconjunctivitis Quality of Life Questionnaire confirmed improvement of the nasal symptoms in patients who were treated with omalizumab. Omalizumab appears to be a useful drug for seasonal allergic rhinitis, but further studies are needed to confirm the findings.

We analyzed the clinical profiles of 42 patients who had been diagnosed as having parotid cancer and were treated initially by surgery between 1999 and 2019, and examined the treatment results and prognostic factors influencing the disease-specific survival (DSS) rate in the 27 patients who had been followed up for more than five years (including deaths within five years).

Preoperative diagnosis of parotid cancers is challenging, because the condition is rare, with diverse histologic types. The sensitivity of fine-needle aspiration cytology (FNAC) for the diagnosis of malignancy was 40.6%, and the accuracy rate of diagnosis of the histopathological type was 14.3%. The sensitivity of operative rapid pathologic diagnosis of malignancy was 91.7%, and the accuracy rate of diagnosis of the histological type was 39.5%. The preoperative accuracy rates of diagnosis of the histological type were low.

According to the UICC TNM classification, 8th edition, the tumor stage was classified as T1, T2, T3 and T4 in 7, 15, 9, and 11 patients, respectively, and nodal involvement was classified as N0, N1, and N2 in 33, three, and six patients, respectively. The most common histopathological type was adenoid cystic carcinoma (10 patients, 24%), followed by mucoepidermoid carcinoma (8 patients, 19%). Local recurrence, neck recurrence, and distant metastasis developed in 7 (17%), 6 (14%), and 14 (33%) of the 42 cases, respectively. In most cases (86%), the distant metastases were in the lungs.

In the 27 patients who could be followed up for more than 5 years, the 5-year disease-specific survival rate was 61.4%, and the 10-year disease-specific survival rate was 45.5%. Univariate analysis identified presence/absence of preoperative pain (presence), presence/absence preoperative facial paralysis (presence), histologic type (high-grade), clinical T grade (T3 and T4), and clinical Stage (III and IV) as being significant determinants of the DSS, with the conditions listed within the parentheses being associated with a poorer DSS.

Syphilis is a chronic systemic infection caused by Treponema pallidum, with a wide spectrum of symptoms depending on the disease stage and host condition. Herein, we present the case of a patient with syphilitic lymphadenopathy who was initially suspected as having malignant lymphoma.

A 27-year-old man presented to our hospital with a swelling in the left submandibular region that had gradually increased in size over the previous one month. Blood tests showed increased C-reactive protein (CRP) and soluble IL-2 receptors. Neck ultrasonography revealed a well-defined mass measuring 2 cm in diameter. Contrast-enhanced cervical CT showed a well-defined mass, consistent with the findings of ultrasonography, and the patient was diagnosed as having submandibular lymphadenopathy. Fine needle aspiration cytology from the lymph node revealed a mixture of medium to large lymphocytes, but mainly small lymphocytes. The patient was suspected as having malignant lymphoma, and scheduled for lymph node biopsy under general anesthesia. However, the biopsy was suspended on account of the patient having fever, sore throat, and rose spots in the anterior chest at admission. Blood examination conducted for suspected syphilitic lymphadenitis revealed TPHA qualitative (+), syphilis RPR (+), and syphilis RPR: 25.1 R.U. Thus, a final diagnosis of left submandibular lymph node enlargement due to stage 2 syphilis was made, and the patient was started on systemic antibiotic therapy.

Unlike general bacterial infections, syphilitic lymphadenitis is characterized by the absence of pain or inflammatory symptoms, and early lesions resolve spontaneously, which could easily be mistaken for spontaneous healing. In addition, early syphilis can present with a variety of non-specific symptoms, and malignant lymphoma may be suspected, leading to unnecessary biopsy. Therefore, it is important to keep in mind the possibility of syphilitic lymphadenitis in patients presenting with cervical lymphadenopathy, with careful attention paid to the history and clinical findings.

Renal cell carcinoma is well-known to be associated with distant metastases, but metastasis to the head and neck region is infrequent. We report two cases of renal cell carcinoma with solitary metastasis to the thyroid gland diagnosed more than 10 years after the initial treatment for the renal cell carcinoma.

Case 1: The patient was a 64-year-old man, who had undergone partial right renal resection for right renal cell carcinoma 17 years ago, and was follow-up at our urology department. He was referred to our department with a left thyroid tumor that had been detected by CT imaging during follow-up. Fine needle aspiration cytology proved non-diagnostic, so that left thyroid lobectomy was performed. Histopathology of the resected specimen revealed the diagnosis of thyroid metastasis from renal cell carcinoma.

Case 2: The patient was a 76-year-old man, who had undergone partial right renal resection for right renal cell carcinoma 24 years ago. He was diagnosed as having a right thyroid tumor by imaging and visited our department, where he was initially followed up as a case of benign thyroid tumor. However, the tumor was found to grow, and right thyroid lobectomy was performed. Histopathology of the resected specimen revealed the diagnosis of thyroid metastasis from renal cell carcinoma.

Renal cell carcinoma is a malignant tumor that develops from the renal tubular epithelial cells, and numerous reports have indicated that metastasis could occur from an early stage, as well as many years after the diagnosis. The most frequent site of metastasis in case of renal cell carcinoma is the lung, whereas thyroid metastasis is rare, possibly due to the high blood flow velocity in the thyroid. On the other hand, solitary metastases to the head and neck region have been reported, and the spread is considered to occur via the paraspinal venous plexus. In this article, we have reported two cases of renal cell carcinoma with thyroid metastasis encountered at our department, with some review of the literature.

Sinonasal malignancies are usually treated by surgical resection and the procedure is selected depending on the extent, stage, and primary site of the disease. Advanced-stage tumors can invade and destroy the bones and/or cartilages that make up the face. In such cases, osteotomy for bulky tumor resection with exposure of the anterior maxilla, nasal bones, infraorbital rims, and orbital floor might become necessary, which wound have cosmetic consequences. Herein, we report the case of a 55-year-old man with advanced nasal septal carcinoma, whose initial presenting symptom was ipsilateral nasal bleeding. Nasal endoscopy showed erosion of the nasal septum on the left side and biopsy of this site revealed the diagnosis of squamous cell carcinoma. The tumor was found to invade the nasal bone, hard palate and maxilla, so that the patient needed surgical resection with wide osteotomy. Considering the cosmetic aspect, we chose the midfacial degloving approach for resection. The procedure enabled us to resect the tumor under direct visualization. The tumor was completely resected with endoscopic assistance and use of a surgical navigation system. Surgery via the midfacial degloving approach with the use of a surgical navigation system may be a useful approach for the treatment of advanced nasal septal carcinoma.

Chondrosarcoma (CS) is a primary malignancy that often arises in the pelvis, ribs, or femur. It accounts for 20% of all malignant bone tumors, but for only less than 0.1% of all malignancies in the head and neck region, and is a rare tumor. We report a case of CS of the hyoid bone.

A 65-year-old woman presented to us with an 8-year history of swelling of the neck on the left side. Endoscopic examination revealed a submucosal tumor protruding into the left oropharyngeal lumen. There were no lower cranial nerve palsies or dysphagia/speech disorders. Imaging revealed a tumor localized in the left lower jaw space, measuring approximately 40 mm in diameter. Open biopsy was performed, which revealed the diagnosis of CS. Tumor resection was performed under general anesthesia, and the operation could be completed without complications. Postoperative histopathology revealed the diagnosis of CS of the hyoid bone. No evidence of recurrence has been noted until now, one year since the operation.

We encountered a case of primary CS, a rare tumor in the head and neck region, of the hyoid bone. An accurate diagnosis was made by open biopsy, and the tumor was safely resected. Although CS usually carries a relatively good prognosis, the recurrence rate is high and long-term follow-up of the patients is required.

Hemangiomas could be divided into hemangiomas in a narrow sense and vascular malformations. Cavernous hemangioma is considered as a vascular malformation, and rarely occurs in a muscle. Our patient reported herein was a 6-year-old boy, who visited our hospital with a history of painless swelling in front of the left ear, redness in the area and facial paralysis. Ultrasonographic imaging revealed a tumor with some calcifications in the left masseter muscle. Computed tomography revealed a tumor with 3 calcifications, which were identified as non-signal areas on magnetic resonance imaging. The tumor was surgically excised, and histopathologic examination confirmed the diagnosis of cavernous hemangioma. After surgery, the patient developed no complications such as facial paralysis or trismus, and as of 4 months after the surgery, no recurrence of the tumor was observed. We report this case with a review of the reports of other cases of children with cavernous hemangioma in the masseter muscle from Japan. Although most of the reported cases were treated by surgical excision through an S-shaped incision, the most appropriate procedure is selected taking into account the location and blood flow pattern of the tumor, the patient’s wishes, etc.

The initial symptoms of COVID-19 are similar to those of the common cold or influenza. Some patients also experience gustatory and/or olfactory dysfunction; in particular, olfactory dysfunction in young patients can decrease the quality of life (QOL). We examined the course of gustatory and/or olfactory dysfunction in 33 staff members of our hospital infected with COVID-19 diagnosed between April 1, 2020, and May 31, 2021. Gustatory or olfactory dysfunction was the second most common symptom at the first visit. It was also the most common symptom throughout the observation period, and was observed in 66.7% of the infected individuals. The symptoms of COVID-19 often persist for a long time after the onset, and the findings in our case series corroborated this, with gustatory and/or olfactory dysfunction still present two months after the disease onset in 21% of patients and four months after the disease onset in 18% of patients. Because the gustatory and/or olfactory dysfunction was persistent, we administered Kampo medicines, but olfactory training should be used in the future, and protection against the infection is the utmost importance. The infection rates classified by occupation were as follows: 6.8% in nurses, 0.9% in doctors, 4.5% in pharmacists, 2.8% in cooks, and 2.2% in clerical workers. Comparison of the infection rates between nursing and non-nursing occupations shows that the infection rate was significantly higher in nurses. Thus, nurses appear to be at a relatively high risk of COVID-19 infection. Since a significant proportion of nurses are young people, they are more likely to develop gustatory and/or olfactory dysfunction in association with COVID-19, and, therefore, more likely to suffer a decline in the QOL. For this reason, nurses should take appropriate measures to protect themselves against COVID-19 infection.