The provision on certification of hearing impairment in the Japanese Law for the Welfare of Physically Disabled Persons was revised in April 2015, to state that “individuals who have not previously obtained a disability certificate related to hearing impairment, if diagnosed with level 2 impairment, must undergo an objective audiometric test, and attach the results,” and that in the event of new appointment of a designated physician related to hearing impairment, the physician must be, in principle, a specialist certified by the Oto-Rhino-Laryngological Society of Japan, “Board-Certified Otorhinolaryngologist”. The objectives of the present study were to determine the following: the number of individuals who underwent certification for hearing impairment and the results of and issues in (particularly in objective audiometric tests) certification; the proportion of otolaryngologists among the designated physicians for hearing impairment certification; the training level of the designated physicians. Questionnaire surveys were conducted at 112 local self-governing bodies (prefectures, designated cities, and core cities throughout Japan), and responses were obtained from 87 (response rate, 77.7%). In comparison with the results in 2014, the number of applicants for certification and the certification rate for level 2 hearing impairment, which now required objective audiometric test results, were lower in 2015. Otolaryngologists accounted for 76.2% of all designated physicians for hearing impairment certification; the figure increased to 96.5% when neurosurgeons and neurologists were included. Only three and two prefectures conducted training regularly and irregularly, respectively, for hearing impairment certification. The lack of training was attributed to the lack of training programs and inability to procure suitably qualified lecturers.
We reviewed the surgical results of ossicular chain-preserving tympanoplasty in patients with cholesteatoma, and evaluated the postoperative outcomes in terms of the hearing outcomes and risk of recurrence of cholesteatoma.
This study was performed on 66 patients with pars flaccida cholesteatoma who were treated by ossicular chain-preserving tympanoplasty (ossiculoplasty type I, 9 cases, type IIIr, 57 cases) from 1991 to 2015.
We examined the cumulative frequency of patients who showed good hearing outcomes by Kaplan-Meier survival curve analysis, and also assessed the ventilation route from the tympanic cavity/epitympanum to the mastoid antrum. Furthermore, we examined cases with recurrent/residual cholesteatoma.
The cumulative frequency of good hearing results was more than 85% in both patients treated by type I and type IIIr ossiculoplasty. However, the hearing prognosis was significantly poorer in patients who underwent type IIIr surgery, in which the incus was taken out temporarily and returned to its original position. There were blockages of the anterior and posterior ventilation routes even in patients with Stage Ib disease, which is represented by localized cholesteatoma. There were 4 cases with recurrent/residual cholesteatoma, including 2 cases of recurrent cholesteatoma and 1 case of residual cholesteatoma in the group that was treated by ossiculoplasty type I, and 1 case of recurrent cholesteatoma in the group that was treated by ossiculoplasty type IIIr.
In the case of ossicular chain-preserving tympanoplasty, it is necessary to pay sufficient attention to prevention of recurrent cholesteatoma. Even if the cholesteatoma is localized, it is important to ensure the existence of sufficient ventilation by temporarily cutting the incudostapedial joint and checking behind the space of the auditory ossicle.
Allergic Fungal Rhinosinusitis (AFRS), a form of refractory rhinosinusitis, is caused by an allergic response to fungi. While AFRS has been reported from Western countries, it has not been studied extensively in Japan. To determine the characteristics of AFRS in the Japanese population, we analyzed 8 clinical cases encountered at our institute and reviewed 29 other cases reported nationwide. Japanese patients with AFRS were 45 years of age, on average, which was lower than the average age of patients with chronic rhinosinusitis. AFRS can be unilateral or bilateral, and was found to be unilateral in 69.7% of the affected Japanese patients. These results are comparable to those reported for AFRS patients in Western countries. Japanese patients with AFRS were found to be most commonly allergic to the fungus Aspergillus. On computed tomography (CT), hyperdensities, indicative of allergic mucin, were detected in the nasal sinus(es) in all cases. Concomitantly, T2-weighted magnetic resonance images (MRI) showed hypointense areas in the nasal sinus (es), also indicative of allergic mucin. Hence, both CT and MRI are useful for diagnosing AFRS. In addition, some studies reported the benefits of postoperative glucocorticoid therapy after endoscopic sinus surgery (ESS). Hence, we determined the recurrence rates in groups of patients that received/did not receive postoperative glucocorticoid therapy, and found similar recurrence rates in the two groups. However, bone erosion was more frequent in the group that received postoperative glucocorticoid therapy, which possibly indicates that the disease was more severe in the group that received postoperative glucocorticoid therapy than in the group that did not receive glucocorticoids postoperatively. Further studies are required to elucidate the characteristics and appropriate postoperative management of AFRS in the Japanese population.
A total of 88 patients with head and neck carcinoma treated with cetuximab (Cmab) between 2013 and 2016 were retrospectively reviewed, and drug-induced interstitial pneumonia (IP) occurred in 7 patients (8.0%). Four of the seven patients had severe IP (over grade 3 according to the Common Terminology Criteria for Adverse Events, CTCAE), and 3 of these patients died of respiratory failure. Forty-three patients showed complete or partial response to Cmab treatment, although 7 cases (16.3%) developed drug-induced IP. Moreover, 5 cases had received treatment by the same protocol, which consisted of repeated induction chemotherapy and bio-radiotherapy with Cmab. Forty-five patients showed stable or progressive disease, but none of these patients developed IP (0%). We suspected that the risk of Cmab-induced IP increased, when the Cmab therapy was high-intensity and had good therapeutic effects.