We perform the simple underlay myringoplasty with fibrin glue as the standard procedure for closing tympanic membrane perforation. In some cases, we use a gelatin sponge to fix the tissue graft instead of fibrin glue. We evaluated the surgical outcomes of myringoplasty in our department and verified our procedure without using fibrin glue. The overall perforation closure rate was 90.5%, and the hearing improvement success rate was 95.1%, which were good results. Ten of 63 ears underwent surgery without fibrin glue, and all of them had perforation closure. This approach without using fibrin glue is considered an option for patients with perforated eardrums who do not wish to use fibrin glue.

Purpose : Okinawa Prefecture has a specific IgE antibody possession status that differs from that of the rest of Japan, so we investigated the changes in this status over the last 10 years. Subjects and methods : Specific IgE antibody test results for house dust mites (mites), house dust 1 (HD), cat dander, dog dander, cedar, Candida, and Aspergillus were analyzed. Results : We analyzed 269 cases with nasal symptoms. The highest positive rates were observed in those with allergic rhinitis. The rate of positivity for at least 1 item was 91.5% in cases of allergic rhinitis, followed by 45.5% in those with eosinophil sinusitis/allergic fungal sinusitis. Regarding those with nasal allergies, 88.2%, 83.2% and 30.2% were positive for mites, HD and cat dander, respectively, which was higher than that in the rest of Japan. In contrast, the rate of positivity for cedar was 8.4%, for dactylis was 6.1% and for ragweed was 3.1%. The multiple antigen-positive rate for nasal allergy was low, and the larger the mite class, the higher the multiple antigen-positive rate. Conclusion : The sensitization rate of mites and house dust is increasing, and guidance on the living environment is essential. In addition, the prevalence of antibodies against cat dander is rising, making it necessary to pay close attention to future trends. Okinawa Prefecture is the best place for health tourism against pollinosis.

Purpose : Nasal allergies in Okinawa Prefecture reportedly have regional characteristics. We herein report the latest changes. Subjects and methods : Specific IgE antibody test results for Dermatophagoides farinae (HDM), house dust 1 (HD), cat dander, dog dander, cedar, Candida and Aspergillus from 2013 to 2021 were examined. In addition, the annual changes among elementary school students diagnosed with nasal allergy for 1993-1995, 2010-2012 and 2017-2019 were also examined. Results : A total of 186 cases of nasal allergies were analyzed. Positive findings were as follows : 88.7% for HDM, 85.5% for HD, 34.4% for cat dander, 17.7% for dog dander, 6.5% cedar, 5.3% for Candida, and 3.8% for Aspergillus. The multiple antigen-positive rates for nasal allergy were low, and the larger the mite class, the higher the multiple antigen-positive rates. Nasal allergy was seen in 8.5% of cases from 1993-1995 but increased to 17.7% and 18.4% from 2010-2012 and 2018-2020, respectively. Conclusion : The sensitization rates of HDM and HD have continued to increase. Rates of nasal allergies increased remarkably in elementary school students over time, underscoring the need to carry out educational activities in the living environment being in together with the local government. In addition, the prevalence of antibodies against cat dander is rising, making it necessary to pay close attention to future trends. Since the rate of allergy to vegetation pollen has remained low, Okinawa Prefecture seems suitable for health tourism.

Bilateral facial nerve palsy (FNP) and bilateral sudden sensorineural hearing loss (SSNHL) are both rare diseases, and their concurrence is extremely rare. We herein report a 24-year-old healthy man who developed sequential bilateral facial paralysis and bilateral sensorineural hearing loss at almost the same time. He first developed left-sided SSNHL, which was resolved through steroid therapy. However, four weeks later, right-sided SSNHL and left-sided FNP occurred, and three weeks after that, right-sided FNP also appeared. Entities such as sarcoidosis and Guillain-Barre syndrome often cause bilateral FNP or SSNHL, but there was nothing of note in his medical history or any remarkable physical findings, laboratory data or imaging studies. Given the lack of evidence of any other diseases, we diagnosed him with bilateral heterochronic metasomatism FNP and SSNHL. He was treated with steroid therapy, and all of his symptoms resolved. FNP and SSNHL both tend to have a prognosis, but their pathogenesis remains unclear in some respects. This case suggests the possible presence of a common cause of these two diseases, such an unknown virus or autoimmune disorder.

We report a case of downbeat nystagmus (DBN) and tremor in a patient who visited our hospital 6 months after the onset of dizziness. Hypomagnesemia was considered as a possible cause based on the results of a serum magnesium examination. Intravenous magnesium sulfate was therefore administered to correct the patient's serum magnesium level. The DBN and tremor almost completely disappeared the following day. Although there have been several case reports of dizziness in association with hypomagnesemia, the authors did not mention DBN. This report is considered to be the first DBN case caused by hypomagnesemia in Japan. Cases of hypomagnesemia, which may be induced by several factors－including excessive diet, long-term proton-pump inhibitor (PPI) intake, and type 2 diabetes－are increasing. In cases of DBN, a serum magnesium examination is as important as head MRI.

We experienced a case of glomangiopericytoma in the left nasal cavity. An 86-year-old man visited our hospital due to recurrent epistaxis. Nasal endoscopy revealed a hemorrhagic tumor in the left nasal cavity extending from the nasal septum to the choana. We performed endonasal tumor resection under general anesthesia. The pathological examination and immunohistological staining revealed glomangiopericytoma. Endoscopic resection was thought to be effective when the tumor stalk was recognized visually with an endoscope.

Pyogenic granuloma is a benign tumor that involves the skin and mucosa and is characterized by inflammatory cell infiltration and capillary hyperplasia. It often develops rapidly, and the most frequent symptoms are recurrent nasal bleeding. We encountered a case of pyogenic granuloma that deviated from the nasal cavity. A 76-year-old woman who was taking aspirin and clopidogrel due to angina pectoris presented with recurrent right-sided epistaxis and swelling of the bridge of the nose. A physical examination revealed a dark-red tumor that deviated from her right nasal cavity. Computed tomography and magnetic resonance imaging showed that the tumor was 30mm in size and strongly contrasted with gadolinium. The base of the tumor was at the nasal septum, so we performed endoscopic nasal tumor resection under general anesthesia. The histological findings showed pyogenic granuloma, and there has been no recurrence for five years postoperatively.

Sinonasal-related orbital infections and intracranial infections are severe complications of pediatric acute sinusitis, which can cause severe sequela and may be life threatening. Immediate surgical management is necessary in many cases; however, there are no defined guidelines for these complications. We report a case of acute sinusitis complicated with epidural abscess and sub-periosteal orbital abscess. The patient was a 9-year-old male. His left orbit showed severe swelling and he was unable to open the eye. Left eye movement was severely restricted in all directions. Computed tomography and dynamic magnetic resonance imaging revealed left sinusitis, left sub-periosteal orbital abscess and a small epidural abscess in the anterior skull base accompanied by an air bubble. We immediately performed endoscopic sinus surgery and made an external superior orbital rim incision. The orbital swelling and eye symptoms improved immediately after surgery. Since he had no neurological symptoms, conservative treatment was selected for the epidural abscess. Streptococcus anginosus was detected from nasal discharge and air bubbles in the epidural abscess indicated anaerobic bacterial infection. The epidural abscess was completely eliminated with the intravenous administration of ampicillin and metronidazole.

Rhinocerebral mucormycosis is a rare disease that rapidly spreads to the brain or orbit, and which is a potentially life-threatening condition. We present our clinical experience with 2 cases. Case 1 : A 73-year-old male who received dialysis due to diabetes, presenting with hematuria, was admitted to our hospital for emphysema cystitis. During the administration of antibiotics, he became unconscious and developed rhinocerebral mucormycosis with cerebral infarction. He was treated with an antifungal drug but died of aspiration pneumonia. Case 2 : A 56-year-old female was admitted to our hospital for acute myeloid leukemia. She developed eyelid swelling during chemotherapy. Antibiotics and antifungal drugs were administrated, but she became blind and developed rhinocerebral mucormycosis. She was treated with an antifungal drug and surgery but died of acute myeloid leukemia.