Early identification and intervention for hearing loss is supposed to reduce delay in language development. Universal newborn hearing screening (NHS) programs are already being implemented in many countries worldwide. However, only a small number of economic evaluations have been conducted to examine the long-term cost-effectiveness of NHS.

　The aim of this study was to evaluate the short-and long-term public benefits and financial costs of NHS, and the improvements that could be effected to increase its cost-effectiveness.

　We conducted this cost-effectiveness analysis using the data of the Okayama Prefecture Project on NHS. The cost-effectiveness analysis, conducted from the societal perspective, compared the projected outcomes of 1) NHS for a hypothetical birth cohort of 16,000 infants, and 2) no newborn hearing screening. The probability and cost estimates for the decision model were obtained from the data of the Okayama Prefecture Project on NHS. We constructed a retrospective-cohort model to estimate the costs of education (elementary school and junior high school) and welfare up to the age of 20 years for the bilateral hearing impaired.

　About 90% of newborns in Okayama Prefecture were screened, including with the automated auditory brainstem response (AABR) technology. The initial referral rate was 2.30%, which dropped to 0.55% after the second-stage screenings, and the prevalence rate of bilateral hearing loss was 0.13%. The total cost of NHS for 16,000 infants and of hearing examination for the referred infants was estimated to be 93,308,160 yen, and the estimated cost of hearing examination for hearing-impaired children who had not undergone UNHS was 621,504 yen. In compulsory educational institutions, the rate of advancement to local public schools was 7.6% higher than that to special support schools. The welfare allowance for children with disabilities was 8.8% lower. The total public costs of NHS, examination, education, welfare and hearing aid/cochlear implant was 795,939,526 yen for the children who had undergone NHS, and 807,593,497 yen for those who had not undergone NHS. Even if NHS is fully paid for by public fees, the amount is likely to be reimbursed.

　Reduction of compulsory education expenses and welfare allowance for children with disabilities reflects the improvement of the communication skills through hearing of hearing-impaired people. There is a statistical limitation to this interpretation, because changes in the acceptance status of compulsory education for the disability could have contributed to the reduction of the education expenses. However, we conclude that early identification by NHS results in lower costs of education and welfare, and that NHS offers has the potential for long-term cost savings compared with no screening.

　Objective: To analyze the factors influencing the postoperative air-bone gap after stapes surgery in patients with otosclerosis.

　Study design: Retrospective clinical study

　Material and Methods: In this study, we evaluated the data from 113 ears of 98 patients who had undergone stapes surgery between April 2007 and October 2016. The air conduction thresholds and bone conduction thresholds in the patients were determined at frequencies of 0.5, 1, 2, and 3 kHz, before surgery and 6 months after surgery. A postoperative air-bone gap of less than 10 dB was defined as success. We performed univariate analysis of factors that could potentially affect the success rate, as follows: sex, age, bilateral or unilateral surgery, procedure performed (stapedotomy or stapedectomy), technique (CO₂ laser or manual perforator), piston (Teflon or Teflon-wire), operator, preoperative hearing level (air), preoperative air-bone gap, and operation time. Then, we performed multivariate logistic regression analysis.

　Results: The success rate at six months after the surgery according to the criterion mentioned above (postoperative air-bone gap≦10 dB) was 67%. Univariate analysis revealed statistically significant correlations between the postoperative air-bone gap and the gender of the patient, surgical procedure performed (stapedotomy or stapedectomy), preoperative hearing level (air), preoperative air-bone gap, and operation time. Multivariate analysis identified male gender (OR 2.74), unilateral surgery (OR 2.81), higher preoperative air conduction threshold (OR per 1dB increase=1.05), and longer operation time (OR per 1 minute increase=1.02) as independent risk factors. However, the method of fenestration, devices used for fenestration, use of prostheses or the operator exerted no significant influence on the success rate.

　As the benefit of binaural hearing has become increasingly apparent, the use of binaural hearing aids and cochlear implants should be considered when possible. We report two cases in which the patients had poor maximum discrimination scores at their first visit but showed an improvement to a sufficiently practical discrimination level after using binaural hearing aids for 1 year. The maximum discrimination scores for the two subjects were 30% and 55%, respectively, at the time of their first visits, and these scores improved to 80% and 95%, respectively, with the use of binaural hearing aids. The hearing loss in each case was characteristic of a bilateral horizontal type, in pure tone audiogram, with severe tinnitus. The improvement was due primarily to the use of binaural hearing aids, proper fitting of the hearing aids, and hearing training.

　Lower cranial nerve palsy due to reactivation of varicella-zoster virus (VZV) is usually accompanied by facial palsy as one of symptoms of Ramsay Hunt syndrome. However, if lower cranial nerve palsy without facial palsy is seen, it is not easy to diagnose VZV-associated lower cranial nerve palsy. In such a case, malignant or central diseases should be ruled out, and then a serological confirmation for VZV reactivation should usually be performed. However, the serological test for anti-VZV antibody usually takes a long time, resulting in a delay in the diagnosis and start of treatment, and a poor treatment outcome. We encountered two patients who presented with dysphagia and hoarseness due to acute lower cranial nerve palsy caused by VZV reactivation, in the absence of facial nerve palsy. To construct a diagnostic algorithm for VZV-associated lower cranial nerve palsy without facial palsy, we examined the characteristic symptoms and clinical course of these two patients as well as of 22 other patients reported in the literature.

　Data of a total of 35 patients with head and neck squamous cell carcinoma seen between 2007 and 2016, with distant metastases detected at the first examination were retrospectively reviewed. The median survival time of the 16 patients without any treatment (only best supportive care) was 87 days, while that of the 19 patients who received treatment was 343 days. There was a significant difference in the 1-year survival rate between the two groups (6% and 53%). The one-year survival rate in the palliative radiation group was very low (0%), and the median survival time was only 127 days. Chemotherapy, chemoradiotherapy, and molecular-targeted therapy improved the survival rate and prolonged the median survival time to over 350 days. Thus, even if a patient is diagnosed as having distant metastasis at the first examination, it should not be a reason to withhold treatment. Treatments for both the distant metastasis and primary tumor are recommended in such cases, taking comorbidities and adverse events associated with the treatment into account, because appropriate treatment has the potential to prolong the survival time.