Objectives: Verbal communication depends on good hearing and clear speech. Previous studies have shown that cochlear implantation at an early age, long implant experience, and high chronological age contribute to speech intelligibility. However, there are as yet few studies on the long-term outcomes in respect of the speech intelligibility in children with cochlear implants. The aim of our study was to identify the factors significantly associated with speech intelligibility in school-age children with cochlear implants.

　Methods: The study subjects were 84 school-age, prelingually deaf children who had received cochlear implants between the ages of 2 and 11 years. Speech intelligibility was measured using Speech Intelligibility Rating (SIR), which is composed of five hierarchical categories based on the hearing impression.

　We investigated the associations of the following nine factors (age at implantation, implant experience, chronological age, hearing thresholds with the cochlear implant(s), speech perception, verbal and performance IQ as evaluated with the WISC, Japanese reading score, and school type) with the speech intelligibility.

　Results: The mean chronological age at evaluation was 13 years. The children had received their cochlear implants at the mean age of 4.3 years, and had 8.6 years of experience, on average, of carrying cochlear implants (implant experience). The mean SIR score was 4.2 (5 being the best), and almost 60% of the children had an SIR score of 5. The mean speech perception score was 82.6%.

　Factors that were found to be significantly associated with speech intelligibility were speech perception, school type, verbal IQ, age at implantation, and hearing thresholds with the cochlear implant(s); on the other hand, no association was found with the chronological age, implant experience, performance IQ or the Japanese reading score. In particular, speech perception, school type, and age at implantation were identified as significant predictors of speech intelligibility.

　Conclusion: In school-age children with a cochlear implant experience of 8.6 years, good speech perception, mainstream classroom, and early age at implantation were found to be significant predictors of good speech intelligibility.

　The difficulty in the diagnosis of malignant lymphoma is often attributed to various local and imaging findings. We reviewed 36 cases of malignant lymphomas of the nasal cavity or paranasal sinuses diagnosed at our hospital between 2006 and 2016. A detailed review of the local, imaging, and biopsy findings from patient charts and images was conducted.

　Regarding the local findings, abnormalities were easily identified in patients with necrosis, mass formation, and bleeding, but not in patients with inferior turbinate swelling without mucosal change. Overall, we observed 5, 18, 9, and 8 cases of necrosis, mass formation, bleeding, and inferior turbinate swelling, respectively. Regarding the computed tomography findings, only two cases had a permeative spread, in which the tumor spread across the thin bone wall. Malignant lymphoma was diagnosed in all cases based on biopsy findings. One-time biopsy was the most common, although in a rare case, three biopsies were required before making the diagnosis.

　Conclusion: In patients with malignant lymphoma of the nasal cavity and paranasal sinuses, plural cases were observed to have inferior turbinate swelling without mucosal change. In these instances, it was difficult to recognize the abnormal findings. Hence, histopathological examination is advisable in cases of turbinate swelling to rule out malignant lymphoma.

　Purpose: To identify the risk factors for the development of tracheo-innominate artery fistula, which is a serious postoperative complication after laryngotracheal separation and laryngectomy.

　Methods: The subjects were 21 patients with severe motor and intellectual disabilities who had undergone laryngotracheal separation or laryngectomy at Yokohama City University Medical Center. We classified the patients into three groups, as follows: group A (n=2), consisting of patients who needed tracheal cannulation after surgery and had postoperative tracheal hemorrhage; group B (n=6), consisting of patients who needed tracheal cannulation after surgery and did not have postoperative tracheal hemorrhage; group C (n=13), consisting of patients who neither needed tracheal cannulation nor developed postoperative tracheal hemorrhage. We conducted a retrospective review of the preoperatively obtained images and measured the anteroposterior diameters of the trachea and thorax and the Cobb angle.

　Results: The anteroposterior diameter of the trachea in groups A, B and C was 6.6 mm, 14 mm and 13 mm, respectively, with no significant differences among the groups. The anteroposterior diameter of the thorax in groups A, B and C was 21 mm, 35 mm and 40 mm, respectively, with a significant difference between groups A and C (p=0.03). The Cobb angle in groups A, B and C was 81, 24 and 29 degrees, respectively, with significant differences between groups A and B (p=0.04) and groups A and C (p=0.05). Group A patients had shorter anteroposterior diameters of the trachea and thorax, and a larger Cobb angle than group B and C patients.

　Conclusions: The present study showed that preoperative imaging is useful to estimate the risk of tracheo-innominate artery fistula in patients undergoing laryngotracheal separation or laryngectomy. Patients with an anteroposterior diameter of the thorax of less than 20 mm or a Cobb angle of greater than 80-90 degrees appear to be at a higher risk for developing this serious postoperative complication.