Recently, various closure methods have been reported for tympanic membrane perforation as an alternative to surgery. We herein report a simple method for closing a tympanic membrane perforation using chitin membrane and eardrops. The procedure was performed on 16 patients (18 ears) with tympanic membrane perforation at an outpatient clinic. The perforation margin was cauterized with silver nitrate, and the perforation was covered with a chitin membrane. The patients were instructed to use antibiotic eardrops daily at home. The overall closure rate of the perforation was 44.4%. In particular, the closure rate was low in perforations due to inflammatory chronic otitis media. Although the rate in the present study was inferior to those in previous studies, this method should be considered as a first-choice alternative to myringoplasty because it is simple and minimally invasive and can be accomplished within a short period of time.

Although osteonecrosis of the external auditory canal has been known to be a serious side effect of bisphosphonates, there are still few case reports on this condition. Bisphosphonates, are bone resorption inhibitors that are a first-line drug for osteoporosis and metastatic bone cancer. In Japan, where the population is rapidly aging, the number of people taking bisphosphonates will probably continue to increase. We experienced 10 cases of bisphosphonate-induced cholesteatoma of the external auditory canal. In addition, we compared our cases to 19 previously reported cases according to the clinical progression classification. In both groups, the condition most frequently developed in elderly women who had been treated with bisphosphonates for a long time. The degree of progression and the duration of administration showed an inverse correlation, and it was found that even if the duration of administration was long, the condition did not necessarily progress. Regardless of the degree of progression, there were many cases of unilateral onset, and there was a tendency for the condition to frequently develop on the inferior and anterior inferior walls of the external auditory canal. Epithelialization was obtained in all cases with local treatment only; however, in the previously reported cases, the post-treatment course was not constant according to the treatment or degree of progression. It is expected that the accumulation of further cases of bisphosphonate-induced cholesteatoma of the external auditory canal will lead to the establishment of medical guidelines; however, at the present time, otolaryngologists should check whether patients take bisphosphonates, strive for early detection and discuss treatment strategies as needed in collaboration with orthopedic surgeons or physicians.

We retrospectively examined the results of tympanoplasty performed by the author from October 2012 to October 2014 for the treatment of chronic otitis media with both perforation and recurrent otorrhea. Otorrhea stopped in all cases (17/17). Thereafter, the eardrum was successfully closed in 16 of the17 cases. In addition, the hearing ability was evaluated at one year after the operation according to the criteria of the Japanese Society of Ear Sciences, and 13 the successfully treated 16 cases corresponded to hearing improvement cases. The above postoperative results are considered to be comparable to those reported from other facilities. At present, performing mastoidectomy together with tympanoplasty is considered to be effective to completely stop otorrhea. These findings suggest that the need for ossicular chain reconstruction is higher in patients with a long-term period of illness than in cases with a short-term period of illness due to the high degree of ossicular chain destruction. As a result, this perspective is therefore considered to be useful for preoperative planning.

HBV-infected patients can suffer lethal consequences if HBV is reactivated through immunosuppressive medicine or chemotherapy and progresses to hepatitis B. We investigated HBV-related serum markers (HBs antigen, HBs antibody, HBc antibody) in patients with peripheral facial nerve paralysis and sudden deafness who received steroid therapies (total of 148 cases subjected to an HBs antigen analysis at the start of treatment). HBs antigen positivity was noted in none of the 148 cases (0 %); HBs antibody positivity was noted in 12 of 33 cases (36.4%), and HBc antibody positivity was noted in 7 of 25 cases (28.0%). No cases of reactivation of HBV or hepatitis B after steroid therapy were noted. Liver dysfunction developed in 2 of 8 patients (25.0%) who underwent regular post-treatment liver function testing. Forty-seven cases were treated with steroids for ≧ 2 weeks, and 101 were treated for < 2 weeks. Reactivation of HBV is thought to depend more on the duration of administration than on the dose of steroids, and the duration of treatment may need to exceed two weeks in order to ensure an adequate quantity of steroids has been administered for treatment. Therefore, when initiating steroid treatment, serum markers associated with HBV (HBs antigen, HBs antibody, HBc antibody) should be measured as an HBV screening analysis.

Although the treatment of allergic rhinitis has become widespread with the advent of anti-IgE antibody preparations, the focus of treatment remains on second-generation antihistamines. We conducted a questionnaire survey, which was delivered via email to otolaryngologists in Saga prefecture and neighboring areas, to investigate pharmacotherapy for allergic rhinitis. Bilastine was the agent most frequently prescribed to otolaryngologists themselves, their family members, and their patients. The prevalence of allergic rhinitis is increasing, and it is important to conduct treatment while considering the effects of each drug, the ease of use, and the presence or absence of side effects.

The diagnosis of perilymph fistula (PLF) is sometimes difficult. We herein report a case of perilymph fistula with hearing improvement in the supine position. The patient was a 54-year-old woman who noticed right hearing loss after a popping sound in her right ear in an airplane 1 year previously. Two weeks before her first visit, she developed vertigo. At the first visit, the pure tone averages of her right and left ears were 30.0 dB and 15.0 dB, respectively, and she had continuous right-sided nystagmus, regardless of her head position. Positive and negative PLF tests were subtle in the right ear. Additionally, the pure tone averages of the right ear showed improvement from 31.7 dB in the sitting position to 15.0 dB in the supine position, which led us to conclude that the patient had a right PLF. Because her vertigo persisted despite hospitalization and bed rest, surgery was performed and perilymph leakage was detected at the round window. Her vertigo was cured after the repair of the PLF. A comparison of the pure tone averages in the sitting and supine positions might be a useful method for detecting PLF and can be performed in any otolaryngology clinic or hospital.

Relapsing polychondritis (RP) is a progressive, recurrent and intractable inflammatory disease of the systemic cartilage that is considered to be an autoimmune disease. Cartilage of the ear, nose, larynx and trachea are mainly affected, and airway involvement can be life-threatening. We herein report a 47-year-old woman with RP. She had auricular, nasal and thyroid chondritis. She had a medical history of cause-unknown stomatitis and vulva ulcer. Since her condition did not improve with high-dose administration of steroids, she was administered immunosuppressants, which successfully controlled her condition. When RP is uncontrollable with steroids, immunosuppressants are indispensable. Since most RP cases with airway involvement are steroid-resistant, combination therapy of immunosuppressants and steroids is recommended for such RP patients.

Glomangiopericytoma (GPC) in the nasal cavity is a relatively new concept that was included in the WHO classification in 2005. We report a case of nasal GPC that recurred 13 years later. The case involved an 82-year-old woman. She had undergone resection of a right nasal tumor 13 years previously, which was diagnosed as a hemangiopericytoma-like tumor. The patient visited our hospital due to relapse and a tumor filling the right nasal cavity was found. CT and MRI examinations showed a tumorous lesion confined to the right nasal cavity. No obvious invasion of the adjacent sinuses or bone destruction was observed. The nasal tumor mass was removed endoscopically, and as a result of histopathological examination, immunohistochemical staining, and a genetic examination (NAB2-STAT6 fusion gene), GPC was diagnosed. Local recurrence and metastasis were also observed. It is classified as a low-grade tumor from the border because it occurs, and the reported local recurrence rate ranges from 7-40%. It is considered to have a good prognosis, with a 5-year survival rate of approximately 90%; however, the development of recurrence after 13 years in the present case demonstrates the importance of long-term observation.

First bite syndrome (FBS) is characterized by severe paroxysmal pain in the parotid region at the first bite of a meal, which gradually decreases as mastication continues. When FBS occurs with no history of head and neck surgery and no evidence of a tumor, it is classified as idiopathic. The effectiveness of Rikkosan has been reported by several studies, and we also experienced a case in which idiopathic FBS improved with Rikkosan. There is no established treatment method for idiopathic FBS. Rikkosan, which is associated with few adverse events, should be considered as a first-line treatment, along with diet therapy.