Reactive oxygen species (ROS)-generating enzyme Nox3 is expressed in the inner ear and is considered necessary for otolith formation We hypothesized that Nox3 expressed in the middle ear mucosa affects postoperative hearing following tympanoplasty. We analyzed the expression of Nox in the middle ear mucous of patients who underwent tympanoplasty for chronic otitis media and cholesteatoma. The Nox2 expression was high in cases where postoperative hearing was not improved or where the tympanic membrane was perforated after tympanoplasty. Further studies will be needed to determine how Nox2 affects the postoperative course of otitis media.

Our previous study reported that 45° head-down postural rotation (HDR) induced a transient decrease in arterial blood pressure (ABP) in anesthetized rabbits. We hypothesized that vestibular organs induce a decrease in the ABP through the inhibition of the sympathetic neural outflow during HDR. To test this hypothesis, we examined the responses of the ABP and renal sympathetic nerve activity (RSNA) to neck flection (NF) in urethane-anesthetized rabbits. The animals were placed on a table in the prone horizontal position. The head was rotated downward to a 45° NF position over 5 s and maintained in that position. NF induced a suppression of the RSNA, followed by a transient decrease (11 ± 3 mmHg ; mean ± SE) in the mean ABP at 7.4 ± 0.4 s after the onset of NF. NF in the lateral position did not induce a significant change. The administration of hexamethonium bromide suppressed the NF-elicited decrease in the ABP, suggesting that this decrease was induced by the suppression of the autonomic neural outflow. In vestibular-lesioned animals, the ABP did not show a significant decrease during NF. These results suggest that head-down rotation around the left-right axis through an HDR and NF stimulates the vestibular organs, which likely elicits a decrease in the ABP via the inhibition of sympathetic activities.

Vertebrobasilar insufficiency (VBI) can be difficult to diagnose in otolaryngology clinics and at the present time there is no established treatment. In the present study, we diagnosed VBI and scored its severity (VBI score) based on a "diagnosis from medical history" according to "Materials for Standardization of Vertigo Diagnosis", which was prepared by the Japan Society for Equilibrium Research. We examined the involvement of shoulder stiffness in the onset and aggravation of VBI. We compared patients who were not aware of shoulder stiffness due to VBI at the onset of vertigo and who were treated with ATP + Ibudilast (group A) and patients who were aware of shoulder stiffness at the onset of vertigo and who were treated with ATP + ibudilast + eperisone hydrochloride + xenone laser with additional treatment for shoulder stiffness. The patients in group C showed significantly higher VBI and DHI scores before the start of treatment in comparison to the patients in group A. After 4 weeks, the VBI and DHI scores of the two groups did not differ to a statistically significant extent. The treatment of shoulder stiffness was effective. The muscle hardness of the trapezius in group C showed significant improvement at 4 weeks after the initial diagnosis, supporting our results.

We conducted a retrospective study to determine whether or not antihistamine treatments led to an improved satisfaction and symptom relief in cedar pollinosis patients according to a treatment-specific questionnaire. A total of 121 cedar pollinosis patients > 12 years old were evaluated. The treatment satisfaction rate among revisited cases was 78%, which was increased according to the questionnaire compared to the previous year (71%). The nasal symptom score was lower in the treatment group (revisited) during the peak pollen dispersal period (p < 0.05) and the late pollen season (p < 0.01) than in the non-treatment group. Furthermore, the degree of disturbance of the quality of life was also lower in the treatment group than in the non-treatment group during the later stage of the pollen season (p < 0.01). In addition, the nasal symptom scores of 37 revisited patients showed a significant improvement compared with the score before treatments (p < 0.05). These findings suggest that using a questionnaire improves patient satisfaction and the therapeutic efficacy. The treatment policy was able to be unified for 96% of patients using the treatment-specific questionnaire, even if they were treated by multiple part-time doctors.

The Nastent^® (Nastent, Inc., Tokyo) is a nasal airway stent (NAS) released in July 2014 for the management of obstructive sleep apnea syndrome (OSAS), but there are few reports on the tolerability and effectiveness of this NAS. The purpose of this study was to assess the tolerability and evaluate the effectiveness of using a NAS in OSAS management in our clinic. In this study, out-of-center sleep testing (OCST) using Watch-PAT^® was performed with and without insertion of a NAS or OA (oral appliance). The testing revealed no marked difference in the sleeping time by the insertion or lack of a NAS or OA, and some patients were able to wear a NAS for a long period of time 17.4 ± 20.9 months (0.1 to 52 months), with significant improvements noted in the snoring index and lowest SpO₂ (saturation of percutaneous oxygen) with a NAS. As a result, OSAS therapeutic approaches other than the NAS were selected for 6 (54.5%) subjects who wanted to use a NAS. In conclusion, the present study indicates that it is necessary to explain the possibility that the use of a NAS may not always achieve satisfactory results and we therefore recommend OCST with and without the insertion of a NAS.

Introduction : The treatment strategy of malignant tumors is generally decided based on the preoperative pathological diagnosis. We encountered a case of slow-growing mucoepidermoid carcinoma at the root of the tongue that could not be preoperatively diagnosed by a biopsy. Case : A 59-year-old woman had felt something was wrong with her oral cavity, and a cystic-elastic hard mass had been noted on the left-side of the tongue root 5 years earlier. No evidence of malignancy had been indicated through several histopathological examinations. Because the mass had shown growth, tumorectomy was performed. The postoperative pathological findings indicated it to be a low-grade mucoepidermoid carcinoma. While the resection margin was negative, we will conduct close follow-up going forward. Discussion : The degree of malignancy of mucoepidermoid carcinoma is determined based on the histopathological findings, and the treatment strategy is decided based on these findings as well. Therefore, it is important to acquire preoperative pathological findings. However, this can sometimes be difficult. Surgical resection is selected as the initial treatment in rare cases. In the present case, the excisional area of the tumor was inadequate because we were unable to obtain evidence of malignancy before the operation. Although we decided to perform careful observation without any additional treatment in this case, in retrospect, perhaps we should have chosen adjuvant chemotherapy or irradiation. Conclusion : We encountered relatively rare case of mucoepidermoid carcinoma occurring at the root of the tongue with a long-term follow-up. It is important to evaluate the malignancy based on pathological findings before performing surgery to ensure proper treatment, although this is often difficult.

Streptococcal toxic shock syndrome (STSS) is a rapidly advancing and deadly disease. We herein report a case of STSS from the head and neck region. A 79-year-old man presented with facial swelling and sore throat and went into septic shock 2 h after his visit. In response to his deep neck abscess, we performed emergency incision drainage. We suspected STSS based on the findings of a smear stain from the wound leachate and the rapid clinical course. Group A hemolytic streptococcus was detected from the bacterial culture of the wound leachate on the fourth day of the disease, leading to a definitive diagnosis. We suspected this disease early on, started appropriate antimicrobial administration, performed multidisciplinary treatment, such as respiratory circulation management and continuous hemodialysis filtration, and were ultimately able to save his life.

Lemierre's syndrome is a disorder in which bacterial infection of the head and neck region leads to thrombosis of the internal jugular vein ; left untreated, this condition can also result in metastatic infections in the lungs and joints as well as bacterial sepsis. An early diagnosis and treatment are important for preventing these pathologic outcomes. We herein report the case of a 30-year-old male with internal jugular vein thrombosis secondary to a peritonsillar abscess accompanied by septic emboli in the lung. The criteria proposed by Yamamoto and Sugiura et al. were used to facilitate a rapid diagnosis of his condition prior to obtaining results from blood cultures. While Lemierre's syndrome is a fairly uncommon diagnosis at this time, its incidence has been increasing given the current pressure to limit the use of antibiotics. Antimicrobial use is currently restricted in Japan due to efforts designed to curb the emergence of drug resistance; as such, we may begin to see more cases of this disease. Although rare, some patients with infection of the head and neck region do develop Lemierre's syndrome ; as such, frequent follow-up of all cases of acute pharyngitis is necessary, notably for those patients not treated with antimicrobial agents.

Lipomas of the hypopharynx are considered rare. They do not usually cause any symptoms. However, depending on the location and size of the tumors, they sometimes cause serious symptoms, such as dysphagia and suffocation. We herein report a case of a pedunculated hypopharyngeal lipoma without infiltration that was resected by endoscopic laryngo-pharyngeal surgery (ELPS). Although lipomas are benign and slow-growing tumors, it is difficult to differentiate between lipomas and liposarcomas. Therefore, incomplete resection may lead to a risk of recurrence. ELPS, which provides surgeons with a wide surgical field and helps them visualize the entire tumor, is an effective technique for completely excising hypopharyngeal lipomas.