In the era of Japan’s super-aging society, local control is currently the only suitable way for patients with locally advanced oral cancer to live out the remainder of their lives in a meaningful way. Until now, in the treatment of locally advanced oral cancer, sufficient functional maintenance has not yet been achieved after surgery due to the need for extensive organ resection and the limitations of functional reconstruction methods. In practice, decision-making support for treatment selection in older cancer patients, who tend to have many comorbidities and reduced ability for comprehension, remains inadequate. There is an urgent need for a training system to raise the standard of multidisciplinary teams playing a crucial role in decision-making, and for reimbursement to allocate the necessary resources. In the treatment of locally advanced oral cancer in the rapidly increasing number of vulnerable elderly patients, combined radiotherapy plus immune checkpoint inhibitor therapy, or neoadjuvant chemotherapy/immunotherapy using biomarkers before limited surgery is expected to be developed to achieve both cure and functional maintenance.

Objective: We investigated the characteristics of vertigo and dizziness developing in children during the coronavirus disease 2019 (COVID-19) pandemic.

Materials and Methods: A total of 56 children aged 2–15 years old (median 12 years) with dizziness seen during the five-year period from April 2017 to March 2022 participated in this study. We performed examinations of the equilibrium function for the diagnosis. In particular, we compared the differences in the distribution of the diagnosis prior to and during the COVID-19 pandemic.

Results: In both periods, the most common diagnoses were orthostatic dysregulation (OD), psychogenic vertigo, Meniere’s disease, benign paroxysmal vertigo, and migrainous vertigo. The patients diagnosed as having vertigo and dizziness during COVID-19 pandemic were significantly older. Furthermore, the main causes were obviously biased towards OD during the pandemic period.

Discussion and Conclusion: The prevalence of OD was about 5% in elementary school students and about 10% in junior high school students. We consider that the prolonged lockdown measures to prevent the spread of COVID-19, including school attendance restrictions, during the pandemic produced chronic stress in children, which increased the potential risk of development of OD.

In general, systemic steroid therapy is used to treat idiopathic sudden sensorineural hearing loss (ISSHL). In Clinical Practice Guidelines for the Diagnosis and Management of Acute Sensorineural Hearing Loss 2018, intratympanic (IT) steroid treatment is recommended as salvage treatment for ISSHL. IT steroid administration is associated with fewer complications of steroid treatment than systemic steroid administration. Some patients develop dizziness or persistent perforation after IT injection. We examined the efficacy and complications of IT steroid treatment in 11 patients with ISSHL who received IT steroid administration as primary or salvage treatment between April 2017 and March 2020 at our hospital. Various methods of IT steroid administration have been described in previous reports, and the optimal method of administration is not indicated clearly in the guidelines. We made 2 holes in the anterior-superior quadrant and anterior-inferior quadrant of the tympanic membrane, and injected dexamethasone through the former. Each patient received IT steroid administraion twice a week for 2 consecutive weeks. In regard to the hearing outcomes, the hearing improved in 8 patients, but remained unchanged in the remaining 3 patients. According to past reports, persistent perforation occur in 2%–20% of patients after IT steroid injection, but the rate in our present series was higher: 5 out of the 11 patients developed persistent perforation; we performed myringoplasty in 2 of the 5 patients. Two holes are made in the tympanic membrane in order to reduce the pressure in the tympanum by injection, but then this may also increase the risk of perforation. The risk of persistent perforation also depends on the preceding systemic steroid dose. IT steroid treatment is useful for ISSHL, although it is important to establish an optimal method of IT injection and devise ways to reduce the risk of persistent perforation.

Cases of tympanic membrane perforation due to trauma are common in general clinical practice. In Japanese patients, such trauma is often caused by cotton-tipped swabs and other tools used for cleaning wax from the ears. Tympanic membrane perforation due to trauma caused by a kendo (Japanese fencing) sword is relatively rare and has rarely been reported.

A 17-year-old male patient visited the clinic complaining of hearing loss in his right ear, which occurred after he was hit and injured on the head while engaging in kendo club activities. A small perforation was observed in the anteroinferior quadrant of the right tympanic membrane. In the hearing test with three frequencies, conductive hearing loss of 40.0 dB was observed in the right ear; a c⁵ dip was also observed. The patient was diagnosed as suffering from tympanic membrane perforation due to trauma in the right ear and treated conservatively. The patient revisited the clinic on the same day, a patch was applied. On the 65th day after the injury, the right tympanic membrane perforation had closed and the hearing had improved to 17.5 dB in the test with three frequencies. Development of a c⁵ dip, however, was observed in the left ear, the healthy side. In view of this case report, attention needs to be paid in the future to the impact of engaging in kendo on hearing loss and other trauma.

An aberrant internal carotid artery running within the tympanic cavity is a rare disease that is seen in about 1% of the population. Herein, I report a case of an aberrant internal carotid artery running within the tympanic cavity. The patient was a 73-year-old man who presented with pulsatile tinnitus, aural fullness, and hearing loss on the left ear. A mass in the left tympanic cavity could be recognized through the ear drum. Existence of an air-bone gap was confirmed on audiometry. CT examination revealed the aberrant internal carotid artery running within the tympanic cavity, which was considered to be pressing against the ear drum and malleus, causing the pulsatile tinnitus, aural fullness, and hearing loss. There is the possibility of massive bleeding, etc., with tympanostomy, and surgical treatment is necessary.

We encountered a difficult case of otitis media with ANCA-associated vasculitis (OMAAV), in which definitive diagnosis and treatment were delayed because serology for ANCA showed a negative result at the first visit.

The patient was a 71-year-old woman who visited us with the complaint of bilateral progressive combined hearing loss. Despite bilateral ventilation tube insertion to treat the otitis media with effusion, the hearing impairment only became worse. Therefore, we started the patient on oral prednisolone as the second treatment option, and the dramatic response to prednisolone led us to strongly consider the possibility of OMAAV. However, based on the initial negative result of serology for ANCA at that time, we rejected the possibility. Approximately a year later, the patient was diagnosed as having bilateral pneumonia, and the serum test for ANCA was positive this time. Based on these serial observations, we finally diagnosed the patient as having eosinophilic granulomatosis with polyangiitis (EGPA), possibly associated with OMAAV.

The main issue here was the long time (almost one year) it took to arrive at the correct diagnosis of OMAAV, which resulted in delayed treatment and unsatisfactory recovery of the hearing impairment. Precise comprehension of both the history of steroid therapy and modulation of hearing during the initial treatment are keys for correct diagnosis of OMAAV. We also briefly review the literature on OMAAV.

Auricular fistula is a common congenital malformation located anywhere adjacent to the external ear. A 29-year-old male patient presented with pain and a reddish swelling on the right ear, and was diagnosed as having an auricular fistula (crural type) at Shinshu University Hospital. Since the sinus tract got repeatedly infected, we planned surgical excision. Due to the presence of inflammatory and granulation tissue, we needed to remove some of the skin and cartilage in the conchal as well as the sinus tract. After the excision, we used retroauricular subcutaneous pedicle flap for reconstruction of the skin defect. This technique is clinically feasible, because the flap has sufficient blood supply, and the donor scar is inconspicuous.

Cerebrospinal fluid (CSF) rhinorrhea is a potentially critical condition, in which the sinonasal mucosa is connected with the intracranial subarachnoid space through a fissure in the skull base and the CSF mixes with the nasal discharge. It could be traumatic or nontraumatic. Nontraumatic CSF rhinorrhea could be caused by spontaneous liquorrhea, meningocele (meningoencephalocele), skull base neoplasm, etc. In cases of spontaneous CSF rhinorrhea, spontaneous wound healing may not be expected. Herein, we report a patient who was diagnosed as a case of CSF rhinorrhea after she presented with the signs of meningitis. The patient was an obese woman in her 50 s, who presented with headache, fever and left rhinorrhea. Transnasal endoscopic examination revealed a meningocele at the olfactory cleft. The defect was repaired successfully using a mucosal pedicle flap obtained from the middle nasal turbinate. Thereafter, we examine the anatomy of the cribriform plate and consider some useful endoscopic techniques.

Carotidynia is a relatively rare disorder characterized by unilateral neck pain or swelling, without physical dysfunction. Although it is thought to arise from nonspecific inflammation of the carotid artery tissue, the precise cause remains unknown.

The patient was a 40-year-old man who presented with electric shock-like pain coursing along the left carotid artery when he applied pressure on the neck, became angry, or was swallowing. Physical examination showed no evidence of organic dysfunction and hematological examination revealed no abnormalities. On the other hand, cervical ultrasonography revealed a low-echoic lesion and local thickening of the wall of the left common carotid artery. Contrast-enhanced T2-MRI revealed a high-intensity lesion and local thickening of the soft tissues surrounding the left common carotid artery. Based on the findings, we administrated only anti-inflammatory agents, considering that there was no evidence of infection. The pain resolved completely after 7 days of treatment and has not recurred. At this time, the patient was definitively diagnosed as having suffered from carotidynia, because the symptom rapidly disappeared with only anti-inflammatory drugs, and no evidence of organic disorder was found.

It is important for otolaryngologists to bear in mind the possibility of carotidynia in the differential diagnosis of acute neck pain. Ultrasonography and MRI examinations are most useful for a precise diagnosis.

Langerhans cell histiocytosis (LCH) is a relatively rare disease characterized by proliferation of abnormal Langerhans cells in various organs. We report the case of a young boy diagnosed as having LCH who initially presented with postauricular swelling.

A one-year and two-month-old boy with a swelling in the right postauricular region was referred to our clinic. CT revealed soft tissue densities with bone destruction in the right temporal bone, and MRI revealed contrast-enhancing lesions in the right temporal bone. The diagnosis of LCH was made by histopathological examination by needle biopsy specimens obtained under ultrasonographic guidance. Subsequently, systemic chemotherapy was administered, and remission was achieved. At present, 24 months later, the child remains in remission. Although LCH is a rare disease, it may occur first in the temporal bone, and this disease should be included in the differential diagnosis of refractory mastoid inflammation in children.

Pleomorphic adenoma is the most common type of salivary gland tumors. The most frequently affected sites are the parotid for major and the palatal region for minor salivary glands. Pleomorphic adenoma arising in the buccal region is rare, and is difficult to resect because of cosmetic reasons.

Herein, we report a case of giant pleomorphic adenoma arising in the buccal region. The patient was an 89-year-old woman who presented with a swelling in the right buccal region. She had undergone resection by an external approach for a diagnosis of buccal pleomorphic adenoma 15 years ago. The tumor, which was located anterior to the masseter muscle, was resected via an intraoral approach, and the pathological diagnosis was pleomorphic adenoma without malignant transformation. Until the present, three years after the surgery, there has been no evidence of recurrence. In summary, transoral removal is a cosmetically feasible approach for minor salivary gland tumors. It is important to determine the surgical approach, including transoral or external incision, in individual cases by considering the histological type, anatomical location, and cosmetic aspects.

This 12-week survey was a prospective, multicenter, post-marketing surveillance study conducted to evaluate the safety and efficacy of rupatadine fumarate (hereinafter referred to as rupatadine) in patients with allergic rhinitis in the real-world setting.

The safety analysis set included 1,332 patients; 58.1% of the subjects were female, 0.1% were children (<12 years old), 10.7% were adolescents (12–17 years old), and 21.5% were elderly (≥65 years old). The incidence of adverse drug reactions (ADRs) was 4.73%, and the incidence of somnolence, an adverse effect of special interest as well as the most common ADR in this survey, was 3.98%. The incidence of ADRs was 4.90% in adolescents, 4.99% in non-elderly subjects (18–64 years old), and 3.85% in elderly, with no statistically significant differences among these age groups. No ADRs were observed in 9 patients with liver dysfunction and 5 patients with renal dysfunction. The efficacy analysis set included 1,219 patients. Of these, 1,186 patients were analyzed for the response rate (great/moderate/mild improvement) during the observation period. The response rate was 91.5%, and no significant differences in the response rate were observed by age (adolescents, non-elderly and elderly) or presence/absence of liver/renal dysfunction. Improvements in the symptom scores for all three symptons of allergic rhinitis (paroxysmal sneezing, rhinorrhea, and nasal congestion) were observed after one week of treatment with rupatadine.

In conclusion, there were no new safety and efficacy concerns in the real-world setting as compared with reports from previous clinical trials.

【Material and method】

The length of consultation per patient was measured by direct observation at the ear-nose-throat outpatient clinics of one university hospital and one city hospital. The consultation time was measured as follows. Direct consultation time: time spent on history-taking and physical examination of the patients; indirect consultation time: time spent in charting, preparing treatment/prescription orders, medical, and writing referral letters.

【Results】

The total consultation time was significantly longer at the university hospital than that at the city hospital, both for the first consultation and the follow-up consultation. For first visits, the ratio of the indirect consultation time to the total consultation time was 49.2% at the university hospital and 24.2% at the city hospital. As for follow-up visits, the indirect/total consultation time ratio was 37.8% at university hospital 24.2% at the city hospital.

【Conclusions】

Assistance of a medical secretary would be desirable, especially for first consultations at university hospital, in view of the long indirect consultation times.