The aim of this study is to determine the efficacy of cochlear implantation in patients with residual hearing loss. The level of hearing loss in postlingually deaf adults who had cochlear implantation at Miyazaki University hospital between 2009 and 2019 were classified according to pure-tone averages as bilateral severe (group A), severe in the implanted ear and profound in the other (group B), profound in the implanted ear and severe in the other (group C), and bilaterally profound (group D). There were no significant differences in the speech discrimination score among the four groups. Cochlear implantation had a beneficial effect on speech recognition, regardless of the hearing status of the implanted ear. All individuals except for one chose to achieve binaural hearing using a cochlear implant with a contralateral hearing aid in groups A and C. Patients in group A underwent cochlear implantation for reasons such as acute hearing loss or old age. Patients in group B selected implantation in the ear with severe hearing loss because of a long duration of hearing loss in the profound ear or a hearing aid in the severely impaired ear being useless. While implantation in the better hearing ear makes it difficult to use a hearing aid, it is an option in patients with asymmetrical hearing loss, depending on the duration of hearing loss or age. We should therefore provide the patient with the best opportunity to achieve binaural hearing.

A proportion of cochlear implant users demonstrate delayed language development without mental retardation or inappropriate aided hearing level. This condition is referred to as disproportionate language impairment (DLI). We conducted phonological speech-language training for two patients with cochlear implants who showed DLI. Cases 1 & 2 were first referred to our training office at 4 and 6 years of age, respectively. Both patients showed normal range intelligence development and aided hearing levels. However, neither could repeat non-words consisting of 3 mora and were eventually suspected to have phonological difficulties. We conducted phonological awareness training based on the reports of Tanemura et al. A speech-language pathological analysis and training were highly effective for these patients with DLI and phonological difficulties.

We performed myringoplasty using thinly-sliced cartilage in 18 patients of > 65 years of age and examined the outcomes. The otologic surgery was performed under local anesthesia. Temporal fascia and thinly-sliced cartilage with a perichondrium attachment was used as a graft and inserted between the outer epithelial and fibrous middle layers of the tympanic membrane. The perforation closure rate was 94.4% with an overall success rate of 83.3%, as per the criteria for the assessment of postoperative hearing acuity reported by the Japan Otological Society. To perform graft transplantation, we connected the perichondrium attached to the thinly-sliced cartilage to the fibrous middle layer of the tympanic membrane so that it would not be displaced into the tympanic cavity. As the cartilage is rarely necrotic, it can be used as a scaffold at the time of tympanic membrane repair. Furthermore, the inlay method facilitated the flow of blood into the graft from both the outer epithelial and fibrous middle layers of the tympanic membrane, which promoted effective epithelialization. Taken together, the results of our study indicated that otologic surgery under local anesthesia can be performed safely in elderly patients.

Our department has been providing workshops for non-otorhinolaryngologist physicians concerning the use of surgical sponges in nasal packing to treat epistaxis and then evaluating the method. In fiscal year 2017, we conducted an in-depth workshop on nasal packing using surgical sponges that included hands-on training using a medical education anatomy model. The workshop was attended by physicians in fields of medicine other than otorhinolaryngology, and a survey to evaluate the method was conducted upon completion. Since then, participants have been able to successfully apply their training in performing nasal packing for epistaxis using a surgical sponge in various situations, including in the emergency room. We conclude that the nasal packing method for epistaxis using a surgical sponge is both practical and useful, even for non-otorhinolaryngologists.

Ectopic lymphoid nodules (ELNs) were found in the inferior nasal concha mucosa in 27 of 40 allergic rhinitis (AR) cases. There were significant differences between the patients with and without ENLs in the number of the eosinophils in the mucosa, the blood eosinophils %, and in the serum level of IgE. On the other hand, the serum levels of IgG4 in the two groups did not differ to a statistically significant extent. ENLs were detected in the paranasal mucosa of 42 of 75 chronic rhinosinusitis (CRS) cases. The number of eosinophils in the mucosa, the blood eosinophil %, serum level of IgE, and serum level of RF in the groups with and without ENLs did not differ to a statistically significant extent. However, significant differences were observed in the serum IgG4 and IgG levels of the two groups. Based on these results, ENLs are thought to participate in refractory AR through the production of IgE and the accumulation of eosinophils and to participate in CRS via the production of IgG4 and IgG.

Tonsillectomy is one of the most commonly performed surgical procedures for otolaryngologists. However, there has been no report on the relationship between age and postoperative complications. The present study investigated the associations between age and surgical duration. We also examined the relationship between age and factors such as nutrition (days of adequate oral intake), length of in-hospital stay (LOS), and post-operative bleeding (including minimal hemorrhaging) following tonsillectomy. A retrospective study of 115 patients who underwent tonsillectomy for chronic tonsillitis at Fukuoka University Chikushi Hospital from 2016 to April 2019 was conducted. We also examined the effects of post-operative hemorrhaging on tonsillectomy using surgical specimens as a pilot study. The results indicated no relationship between age and the surgical duration. Furthermore, there was no correlation between age and the LOS or days of adequate oral intake after surgery. Chronic tonsillitis patients have a higher post-operative bleeding rate than other patients. Although we examined the relationship between the age and postoperative course using surgical specimens, no useful results were obtained.

We experienced a case involving a 67-year-old man with one of the largest cervicomediastinal lipomas reported in Japan. The lesion extended from the tracheal bifurcation to the left upper cervical region. Radical resection was achieved by cervical and thoracic approaches in several departments. No postoperative complications were noted. A preoperative examination did not rule out the possibility of malignancy; thus, in order to achieve complete resection, the approach should be discussed with multiple departments (otolaryngology, head and neck surgery, esophageal surgery, and respiratory surgery) before the operation.

We report rare cases of intracranial meningioma extending to the middle ear with a review of past reports. Case 1 : A 62-year-old man presented with a complaint of right hearing loss. A gray mass in the tympanic cavity was noted behind the malleus. Imaging tests showed the tumor from the middle cranial fossa extending to the middle ear with osteoclasts in the tegmen tympani. A biopsy was performed through the tympanic membrane and a histopathological examination revealed that the lesion was meningioma. The patient underwent subtotal resection using a middle cranial fossa approach and mastoidectomy. Case 2 : A 45-year-old woman was admitted with left hearing loss. A gray-white mass was observed through the left tympanic membrane. Imaging tests showed a tumor at the posterior cranial fossa involving the jugular bulb and extending to the middle ear. A biopsy was performed through the tympanic membrane and a histopathological examination revealed that the lesion was meningioma. Surgical removal was proposed ; however, she was not willing to undergo surgery. Thus, the tumor growth is currently being observed with MRI examinations. Intracranial meningioma extending to the middle ear is rare ; however, it should be included in the differential diagnosis of middle ear tumors.

We herein report tracheostomy performed due to leg cellulitis in a patient with severe obesity. A 39-years-old man with a body mass index exceeding 66.1 developed a fever, reddening and swelling of his right leg. He was diagnosed with right leg cellulitis and emergently admitted to the hospital. He needed a ventilator due to respiratory failure induced by sepsis. Despite resolving the cellulitis by antibiotics, the patient developed hypercapnia and was difficult to extubate. Due to long-term ventilation, we performed tracheostomy under general anesthesia. We made a convex incision 10 cm long and a subplatysmal flap and then removed subcutaneous adipose tissue from the superior subplatysmal flap to decrease the distance from the skin to the trachea. After dissecting the trachea under the cricoid cartilage, we inserted an adjustable-length and flexible tracheostomy tube, into the trachea. He was able to be weaned from the ventilator, and successful decannulation occurred on postoperative day 84. He was discharged without severe complications.

A 62-year-old man who was initially diagnosed with Stage IVa squamous cell cancer of the hypopharynx, received concurrent chemoradiotherapy with cisplatin. As local recurrence was subsequently observed, he underwent total laryngopharyngectomy with free flap reconstruction. However, unresectable cervical lymph node metastasis was observed 3 months after the surgery. He was therefore treated with nivolumab as first-line therapy. As disease progression was observed after 4 courses of nivolumab, he was then treated with paclitaxel plus cetuximab as second-line therapy. He suddenly lost consciousness at home 2 days after 8 courses of the chemotherapy (11 months after the first administration of nivolumab). As elevated CK was observed in the laboratory test on admission, immune-related adverse events were initially suspected. The patient died without showing a response to steroid therapy, ventilator management, continuous hemodiafiltration and other treatments. The autopsy revealed a lack of cross-striation of skeletal muscle, indicating the existence of rhabdomyolysis. Although there have been few reports on rhabdomyolysis after nivolumab treatment date, this immune-related adverse events (irAEs) may be a potentially fatal adverse event.

We measured and analyzed laryngeal movement during swallowing using a laryngeal motion measurement system (Nodomiru OE-NDMR01) with a 16-photoelectric-distance-sensor array to investigate its usefulness in the evaluation of the swallowing function. Four healthy adult males and two healthy adult females were tested, and clear laryngeal motion curves were obtained in all cases. The obtained data were analyzed, and the following indices were proposed for the swallowing function evaluation: 1) maximum laryngeal elevation distance, 2) peak laryngeal elevation and descent velocity, 3) laryngeal elevation time, and 4) laryngeal elevation arrival time. This system has some points that need to be improved, such as the difficulty of measurement when the laryngeal prominence is unclear, the need for the neck to be extended for measurement, the inability of the laryngeal prominence to be accurately detected at the laryngeal elevation position in some cases, the difficulty of displaying the absolute coordinates, and the inability to simply compare the data with VF data. However, because it is noninvasive, relatively inexpensive, radiation-free, and easy to use, this approach appears useful for elucidating the mechanism underlying swallowing, screening for dysphagia, and promoting swallowing rehabilitation.