Nasal bone fracture is the most common of facial bone fractures caused by facial trauma. In many cases, nasal bone fracture is treated by closed reduction, and the outcomes of reduction can be evaluated only by subjective means such as inspection and palpation. However, such evaluations often leave the operators in doubt as to the appropriateness of the reduction. To overcome this problem, many studies have reported the usefulness of ultrasonography in the diagnosis and intraoperative evaluation of nasal bone fractures. Moreover, recently, the high-performance ultrasound coupling gel pad has become commercially available for medical use. In this study, we examined the usefulness of ultrasonography with an ultrasound coupling gel pad for reducing nasal bone fractures. We evaluated the data of 10 patients diagnosed as having nasal bone fracture by computed tomography. Our results showed that use of the ultrasound coupling gel pad resulted in improved demonstration of the points of the nasal bone fracture and also allowed evaluation of the facial skin of fracture points together. Our results suggest that use of the ultrasound coupling gel pad is very useful for the diagnosis and intraoperative evaluation of nasal bone fractures by ultrasonography.

　Sublingual immunotherapy has been applied to patients with Japanese cedar pollinosis since 2014. However, no studies have been carried out to determine the efficacy of this treatment. Patients with Japanese cedar pollinosis who received this treatment in 2014 and 2015 were enrolled in this study. The clinical usage level, satisfaction level, and adverse effects of this treatment were investigated using a questionnaire in both groups patients treated in 2014 and in 2015. The clinical usage level was more than 90% in both groups, which was within acceptable limits. The subjective symptoms improved and the patients were satisfied with this treatment in both groups. Of 272 patients, 33 (12.1%) developed adverse effects with those involving the oral cavity and throat being the most common (21 patients; 63.7%). Most adverse effects developing during the maintenance phase occurred within the first few weeks. All adverse effects in the present study were minor, and none necessitated treatment discontinuation. The incidence of side effects was higher in first season than in second season (21.4% and 2.2%, respectively). These results led us to conclude that sublingual immunotherapy is an effective therapy for Japanese cedar pollinosis. However, clinicians must bear in mind that the management of adverse effects is mandatory for safety.

　Modifiable risk factors to reduce the incidence of age-related hearing loss remain undetermined. This study was aimed at identifying predictors of hearing loss with aging among middle-aged and elderly Japanese community dwellers.
　Data were derived from the National Institute for Longevity Sciences-Longitudinal Study of Aging. There were 1374 individuals without hearing loss or any missing data at the baseline, who participated in the follow-up study at least once and were followed for up to 10 years. The hearing impairment criterion was a better-ear pure-tone average of greater than 25dB. Cumulative data were analyzed using generalized estimating equations to investigate the factors contributing to the occurrence of hearing loss during the follow-up period. Among 24 independent variables examined, 7 were identified as being significant. Educational attainment was associated with a reduced incidence of hearing loss (multivariable adjusted odds ratio [OR]= 0.759 per 3-years increase, 95% confidence interval [CI] = 0.639-0.900) while body mass index increase was associated with an increased incidence of hearing loss (OR = 1.287 per 5kg/m² gain, 95% CI = 1.029-1.610), consistent with previous reports. A higher total amount of physical activity was associated with a higher incidence of hearing loss (OR = 1.156 per 50METs∗min/1000/y increase, 95% CI = 1.051-1.272), a result that differed from some previous reports. In this article, we discuss our interpretation of the present results with a review of the literature.

　Oral cavity and oropharyngeal injuries caused by a toothbrush are often encountered in children and can occasionally lead to severe complications, including mediastinitis and deep neck infections, depending on the direction of the entry wound. We report four cases of severe oral cavity and oropharyngeal injuries that required admission to our hospital. CT evaluation revealed deep neck emphysema in all the cases, although the wounds in the oral cavity were only slight in 3 of the cases. Case 1, a 2-year-old boy, struck his toothbrush into the retropharyngeal wall and developed dyspnea. He developed a severe infection and widespread emphysema extending from the deep neck to the mediastinum, and required mechanical ventilation. Case 2, a 2-year-old girl developed emphysema in the left parapharyngeal space following trauma from a toothbrush that became impaled in the posterior faucial pillar. Case 3, a 13-year-old girl, developed emphysema that extended into the upper retropharyngeal space. Case 4, a 31-year-old woman, developed emphysema and swelling around the right submandibular gland and parapharyngeal space. All cases were conservatively treated with intravenous antibiotics. Considering our cases, CT examination for foreign body remnants as well as emphysema and deep space infections is strongly recommended in the evaluation of oral cavity and oropharyngeal injuries, regardless of the severity of the oral wound.