Cerumenolytic solutions that induce the dissolution of cerumen can remove cerumen without damaging the skin of the ear canal or eardrum. In this study, we conducted a preliminary prospective study to investigate whether or not using a cerumenolytic solution that induces the dissolution of cerumen regularly can prevent the accumulation of cerumen. After having cerumen removed by doctor, patients applied cerumenolytic solution to their ear canal using cotton swabs by themselves regularly. We then assessed the degree of cerumen impaction and the presence of symptoms after four weeks and three months. We investigated 33 subjects (65 ears). In the cerumenolytic solution group, the average score of cerumen impaction before removing cerumen was 1.9, and the accumulation of cerumen was able to be avoided for 4 weeks (0.5) and 3 months (0.0) compared to the control group (1.6 → 1.4). Furthermore, 51.5% of the patients in the cerumenolytic solution group had some symptoms, but the frequency decreased to 9.1% after the application of cerumenolytic solution; the symptoms involved itching of the ear in 76.5% of symptomatic patients. These results suggest that the application of cerumenolytic solution that induces dissolution of cerumen using a cotton swab can safely prevent the accumulation of cerumen.

From 2014 to 2021, we examined the clinical features of 10 cases diagnosed with otitis media with ANCA-associated vasculitis (OMAAV) at our hospital. The first visit dates were 2014, 2015, and 2017 (1 case each), 2019 and 2020 (3 cases each), and 2021 (1 case). The period from the first visit to the start of treatment ranged from seven days to five months, and treatment was able to be started within 26 days from the first in all but 1 case (first visit in 2014). According to the Ministry of Health, Labor, and Welfare standards, ANCA-associated vasculitis was diagnosed in four cases with definitive granulomatosis with polyangiitis (GPA) and six with suspected GPA. Hypertrophic pachymeningitis was observed in one case. Facial nerve palsy was observed in two cases, ultimately improving in both cases. All patients remained alive during the observation period. The diagnostic criteria proposed in 2015 enabled the early diagnosis of OMAAV and facilitated early treatment in collaboration with collagen physicians.

With regard to changes over time (at 3 months, 1 year, 2 years, 5 years, and 10 years after surgery) in speech perception in adults with a cochlear implant, we examined the threshold for wearing an implant device, and the ability to hear monosyllables, words, and phrases, i.e. the ability to perceive speech, to determine the extent of long term changes, the appropriate time point to perform the tests after surgery as an initial evaluation, and whether changes are found as a result of changes in the speech processor. In the threshold for device implantation, the median at 3 months after surgery was already 26 dB, and there was no subsequent change observed. In terms of the ability to hear words and phrases, a significant increase was observed from 3 months (median values of 80% and 87.5%, respectively) to 1 year (median values of 85% and 94.5%, respectively), after which there was almost no change. With regard to monosyllables also, there was almost no change from 1 to 10 years, and therefore, it was considered appropriate to evaluate the effect of cochlear implants at 1 year after surgery. With regard to phrases, the median value was over 90% after 1 year, and considering the ceiling effect of tests, for long-term evaluations in future, we believe that evaluations should be performed using different test methods, such as the hearing in noise test.

The present study aimed to investigate the diseases preceding persistent postural-perceptual dizziness (PPPD) and the efficacy of low-dose selective serotonin reuptake inhibitor (SSRI) therapy in the treatment of PPPD. The Niigata PPPD Questionnaire (NPQ) was used to assess the efficacy of low-dose SSRI (sertraline [12.5 mg]) therapy. We also examined the adverse reactions to low-dose SSRI and the treatment continuation rate. PPPD was preceded by peripheral and central vestibular disease in 69.6% of cases, migraine-related dizziness in 17.4%of cases, orthostatic dysregulation in 11.6% of cases, and unknown conditions in 1.4% of cases. The efficacy rate of low-dose SSRI therapy in the treatment of PPPD was 75.9%. The incidence of adverse reactions was 23.1%, and the treatment continuation rate was 79.2%. The treatment continuation rate and efficacy rate of patients who received low-dose SSRI therapy were similar to those in previous reports with a reduced incidence of adverse reactions. Low-dose SSRI therapy is a promising treatment for PPPD.

We retrospectively analyzed the data of 153 patients (male, n=108 ; female, n=45 ; median age, 35.5 years [range 8-87 years]) with peritonsillar abscess who were treated at our hospital from October 2016 to March 2019. Among the 153 patients, the right side was affected in 79 patients, the left side was affected in 66 patients, and both sides were affected in 8 patients (5.3%). Sixty-nine patients (45.1%) had a history of smoking. Peritonsillar abscesses with the longest diameter located cranial to the palatine uvula were defined as superior type abscesses, while peritonsillar abscesses with the longest diameter located caudally were defined as inferior type abscesses. The diameters of abscesses managed by observation with antibiotics were all shorter than 15 mm. Regarding antibiotic selection, it may be reasonable to expect a sufficient effect with the use of SBT/ABPC as a single agent, as this antibiotic has a broad antibacterial spectrum covering aerobic, anaerobic, and drug-resistant bacteria.

ANCA-associated vasculitis is an autoimmune vasculitis that often develops in systemic diseases, such as renal disorders and pulmonary lesions. However, there have been increasing reports of ANCA-associated vasculitis of otitis media origin and ear-localized type in recent years. A 52-year-old woman with a history of tuberculosis presented with otitis media refractory to antimicrobial agents as well as hearing loss and headache. Although otitis media with ANCA-associated vasculitis (OMAAV) is mentioned as a differential diagnosis for refractory otitis media, the diagnosis was difficult, as ANCA antibodies were negative, biopsy tissue showed no evidence of vasculitis, and there was concern about the possibility of tuberculous otitis media. We ultimately diagnosed the patient with OMAAV by excluding other diseases thorough a collaborative evaluation of other organs, considering the complication of hypertrophic pachymeningitis, which is characteristic of OMAAV. Since we experienced a case of OMAAV that took one year to be diagnosed, we herein report this diagnosis with some discussion of the literature.

We herein report a case of acute sensory deafness that occurred immediately after taking a privately imported phosphodiesterase-5 inhibitor. A man in his 40s developed sensorineural hearing loss after using vardenafil purchased over the Internet. He received systemic prednisolone and discontinued vardenafil, which generally improved his hearing. Although it has been pointed out that phosphodiesterase-5 inhibitors are associated with deafness, this fact is not well known in Japan. It is easy to import phosphodiesterase-5 inhibitor for personal use via the Internet. However, many counterfeit drugs of phosphodiesterase-5 inhibitor are distributed online, causing health hazards. We should always be alert for any medications that need to be discontinued.

Propionibacterium acnes (P. acnes) is gram-positive bacilli known as a cause of acne vulgaris. As P. acnes is less toxic, it rarely causes acute destructive infection. We report the case of 70-year-old man suffering from decreased visual acuity in his right eye due to local ethmoid sinusitis caused by P. acnes. He was admitted to our hospital because of decreased visual acuity in his right eye. Computed tomography showed inflammation in the right orbital apex from the ethmoid sinusitis. We performed endoscopic sinus surgery and P. acnes was detected in a pus culture from the right ethmoid sinus. We therefore diagnosed that the causative microorganism of his sinusitis was P. acnes. Optic neuropathy due to ethmoid sinusitis caused by P. acnes is very rare, and prompt surgery and antibiotic treatment are necessary for a compromised host.

Liposarcoma is a malignant soft tissue tumor that frequently occurs in the limbs and trunk but rarely in the head and neck and even less commonly in the sinonasal area. We herein report a case of well-differentiated liposarcoma of the maxillary sinus. The patient was a 56-year-old male who visited a nearby ear-nose-throat clinic for recurrent epistaxis. A hemorrhagic mass was found in the left nasal cavity, and the patient subsequently consulted with our department. An endoscopic examination revealed a hemorrhagic mass in the middle meatus. Facial enhanced computed tomography showed a mass with heterogeneous enhancement in the left maxillary sinus and bone destruction protruding into the infratemporal fossa. On facial non-enhanced magnetic resonance imaging, the mass had heterogeneity, with a slightly high-intensity signal on T1-weighted imaging and a high-intensity signal on T2-weighted imaging. The mass was suspected of being liposarcoma on a second biopsy. Massive bleeding also occurred in this biopsy, so embolization of the feeding arteries of the tumor was planned to prevent bleeding in subsequent resection. The tumor had not adhered to nearby tissues and was totally resected endoscopically. A pathological examination revealed the tumor to be well-differentiated liposarcoma. The patient was discharged from the hospital with no complications, including epistaxis, and there has been no recurrence or metastasis of the tumor for six months since the surgery.

We herein report a case of dysphagia and voice impairment due to granulomatosis with polyangiitis (GPA) complicated with hypertrophic pachymeningitis. The patient experienced vagal paralysis and consequently displayed midline fixation of the vocal cords and collateral and compensatory muscle tension dysphonia, resulting in breathing and vocal hoarseness. One year after the onset, surgery was performed to adjust the vocal cord position. However, the patient's voice self-feedback and pitch adjustment were poor, and the hypertonic dysphonia remained. Voice function improvement surgery and voice treatment were performed, resulting in improved muscle tone and vocalization. In addition, the patient's subjective impression improved as well. We showed that voice therapy can improve the quality of life of affected patients if GPA disease symptoms are remitted.

We experienced a case in which cancer multi-gene panel testing was performed for a patient with a rare type of head and neck cancer. Namely, salivary duct carcinoma of the parotid gland. In this case, we first detected an overexpression of androgen receptor. CAB therapy was successful. However, the patient's condition subsequently worsened and therefore an extracted cancer tissue specimen was submitted for multi-gene panel testing. An immune checkpoint inhibitor was recommended and administered based on the genetic abnormalities of the neoplastic cells. However, due to the development of an irAE, continuation of the drug became difficult and the outcome was unsatisfactory. The enforcement rate of treatment based on this test is currently low (10%). In addition, we recognized the limitations of enforcement through medical services covered by health insurance. Thus, in order to increase the utilization of this test in order for its usage to spread, governmental approval of this test at the early therapeutic stage is necessary, and the expansion of the indications for the administration of this drug in combination with both insured and non-insured treatments in the current Japanese medical environment is desirable. On the other hand, negative conversion of androgen receptor expression was seen in cancer tissue specimens from this patient whose condition worsened. Therefore, when planning treatment strategies, we must take the intra-tumor heterogeneity which is thought to be an intractable factor into careful consideration.

The development of equilibrium function in children with hearing impairment is reportedly delayed compared to that in healthy children because of an impairment in the peripheral equilibrium sense organ. However, it is also suggested that this underdeveloped function is complemented by the compensatory function of the central nervous system and that this compensatory function is promoted if the equilibrium function is trained in the early stages when plasticity is present in the brain. Children with hearing impairment and their parents are only able to enjoy a relatively small section of the world at large, compared with hearing individuals, because of the communication difficulties faced by the children and because their livelihood domains tend to be limited to those related to children with hearing impairment. We encountered a child with severe hearing impairment due to Waardenburg syndrome whose equilibrium function improved while going to a swimming school with his mother, which may have consequently promoted his integration into local society. In addition, we conducted a questionnaire-based survey involving members of the Association of Parents of Children with Hearing Impairment in Japan, focusing on swimming instruction for children with hearing impairment, and found favorable effects of swimming instructions.