[in Japanese]

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[in Japanese]

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[in Japanese]

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There is much concern about the acute phase of restarting an oral diet for hospital inpatients who have been prohibited from any oral intake.
We found predictive factors for the successful resumption of oral intake in such patients. A total of 186 subjects who had been hospitalized without oral intake were screened for dysphagia between January 1^st and December 31^st in 2010 (mean age 80.9 years), and formed the study population.
We observed them from the initial consultation day until the discharge. (mean days 32.6)
We examined factors of age, sex, appetite, gag reflex, tongue activity, the repetitive saliva swallowing test (RSST), obeying commands, the status of the laryngopharynx, laryngeal sensation and the 3 ml water swallowing test under endoscopy.
We excluded those who died in hospital after dysphagia screening because they were obviously lost to follow-up. One hundred and twelve patients (60.2%) could resume oral intake, 54 patients could not and 20 (10.8%) died.
Logistic regression analysis identified seven significant factors in predicting the resumption of oral intake : 1) age (p=0.01, OR=0.938, 95% CI 0.903-0.976); 2) sex (p=0.21, OR=2.15, 95% CI 1.124-4.128); 3) appetite (p=0.041, OR=1.983, 95% CI 1.029-3.821); 4) gag reflex (p=0.06, OR=1.932, 95% CI 0.971-3.844); 5) tongue activity (P=0.002, OR=3.825, 95% CI 1.647-8.883); 6) RSST (P=0.013, OR=2.284, 95% CI 1.186-4.397); 7) obeying commands (p=0.02, OR=3.005, 95% CI 1.507-5.993); 8) the status of the laryngopharynx (P=0.668, OR=0.668, 95% CI 0.351-1.272); 9) laryngeal sensation (P=0.081, OR=1.841, 95% CI 0.928-3.650); and the 3 ml water swallowing test under endoscopy (P=0.000, OR=0.226, 95% CI 0.102-0.499).
These predictive factors could be very useful for dysphagia screening to help forecast the successful resumption of oral intake in affected patients.
When the likelihood of dysphagia and the onset of aspiration pneumonia are suggested by dysphagia screening, these factors must be taken into careful consideration when oral intake is to be resumed.

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All 2,184 outpatient surgeries consisting of 18 surgical procedures were carried out for 1,383 subjects in four years from 2008 to 2011 at my clinic. The number of subjects undergoing office surgery ranged from 397 cases down to 308 cases per year with an annual average of 346 cases. The subjects broken down by the main surgical procedures performed comprised 780 cases of myringotomy, 276 cases of coagulator ablation of the nasal mucosa, 94 cases of removal of a foreign body in the external auditory canal and 92 cases of insertion of the ventilation tube: these 4 procedures accounted for about 90% of the total number of patients in my practice. The range indications of the other 14 procedures not only included the ear, nose and throat, but had spread to the salivary gland, the skin and the temporomandibular joint, which demonstrated the necessary skills and flexibility of an otorhinolaryngologist.
Infants and children between 0 and 11 years old consisted about 60% (827/1,383), especially infants between 0 and 5 years old accounted for more than 40% (563/1,383), and so suggested the raison d'être of pediatric otorhinolaryngology surgery.
On the other hand, subjects over the age of 70 accounted for 123 of 1,383 cases (8.9%), and there were three subjects over the age of 90, the oldest patient being 99 years old. The male to female ratio was 867: 516, giving a sex ratio of 1.68.
Recently in Japan under the universal healthcare system, we must emphasize that office surgery, completing the treatment without hospitalization, not only maintains one's expertise as an otorhinolaryngologist and has improved the quality of local healthcare, but also has contributed to the reduction of medical expenses.

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We report herein on a 15-year-old girl with Takayasu's arteritis (TA) in the early pre-pulseless phase who presented with left neck pain and fever. Laboratory examination revealed a high level of C-reactive protein (CRP) and an elevated erythrocyte sedimentation rate (ESR). Findings of ultrasonography, computed tomography (CT), and magnetic resonance imaging and angiography (MRI, MRA) demonstrated a thickening of the left carotid artery but neither stenosis nor dilation of the large vessels. ¹⁸F-fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) after twenty days duration of fever revealed an accumulation of ¹⁸F-fluorodeoxyglucose not only in the left carotid artery but also the wall of the ascending aorta, aortic arch, thoratic aorta, and part of abdominal aorta, which led to the diagnosis of TA in the early pre-pulseless phase. The patient was treated with prednisolone resulting in a marked improvement in both the clinical symptoms and laboratory parameters within a couple of weeks. Stenosis of the left carotid artery was found in MRI, MRA following four months and a definitive diagnosis was reached. We suggest early diagnosis of TA may permit early treatment and improve the prognosis.

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The dissemination of newborn hearing screening has detected children with mild-moderate hearing impairment at an early age. However, there is no nation-wide welfare system for children with mild-moderate hearing impairment in Japan. Under these kinds of social conditions, a subsidized project of hearing aid purchase for mild-moderate hearing impaired children has come into force from April 2010 in Akita prefecture. All 18 candidates who applied for this project were subsidized in Akita prefecture. Eighteen children purchased their hearing aids using this subsidy. The feature of this project was that every child could have access to subsidies as long as their doctor recognized the effectiveness of hearing aids because children with hearing impairment need to learn language. They contacted the hospital, prefectural government and institutes related to hearing loss before this project come into force. We recognized parents who are raising a child with mild-moderate hearing impairment have high interest in this project. Hearing aids can represent a considerable expense for young parents who are raising a child. We encountered some children who had to give up the idea of hearing aids due to their parents' economic circumstances before this project become effective. These situations were completely avoided after this project came into being. This administrative purpose was of demonstrated value in children with mild-moderate hearing impairment.

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