The mainstay of treatment for carcinoma of the parotid gland is surgical removal, which is often performed in conjunction with postoperative radiation therapy when the tumor has a high grade of malignancy or positive surgical margins. Carbon ion radiotherapy (C-ion RT) offers more precise dose localization in the target lesion and has a greater biological effect on malignant tumors than conventional X-ray therapy. Here, we evaluated the efficacy of C-ion RT against carcinomas of the parotid gland and compared C-ion RT to curative surgery in terms of survivals and adverse events.

　Clinical data from patients with carcinomas of the parotid gland who were treated at Gunma University Hospital between August 2011 and August 2016 in were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were examined between the surgery and C-ion RT groups. Adverse events including facial nerve palsy were also evaluated.

　This study enrolled 33 patients with carcinoma of the parotid. Eleven patients were treated with C-ion RT, whereas 22 patients were underwent surgery. No significant difference in the PFS (p=0.147) or OS (p=0.580) was observed between the two groups. Radiation dermatitis, otitis externa, otitis media, and radiation brain necrosis were found in 11 patients (100%), 9 patients (81.8%), 5 patients (45.5%), and 1 patient (9.1%) treated with C-ion RT, respectively. Interestingly, 3 of the 4 patients with facial nerve palsy showed a partial improvement after treatment with C-ion RT.

　Our results revealed that C-ion RT could be a promising treatment modality in patients with locally advanced and/or inoperable diseases.

　With the emergence of a society with a low birth rate and an aging population, the importance of home medical care associated with the construction of a regional comprehensive care system has been recognized. An increase in the proportion of the elderly population in metropolitan cities, such as Tokyo and Kanagawa, over the next 10 years is expected. This study reports the current status of otolaryngology home medical care in Kawasaki city, a city with a population of 1.5 million.

　The subjects were 101 patients (27 men and 74 women) who received home medical treatment between August 2009 and December 2014. The patient age at the initial visit ranged from 51 to 103 years, with an average of 86.4 years. The total number of home visits throughout the approximately 5-year study period was 193, with an average of 2.9 per month. The number of home visits per patient was 1 to 13, with an average of 1.9. About 80% of home visit requests were related to ears, and about 50% of the total requests were for cerumen removal. A cerumen impaction removal procedure was performed in 43 cases, and it was the most frequently conducted procedure. Among the 51 home visits that were performed because of requests for cerumen removal, cerumen was not actually observed in 8 cases.

　Hearing loss is considered to be a risk factor for dementia, and otolaryngologists must oversee hearing management beginning during the early stages of hearing loss. In addition, pneumonia is the third leading cause of death in Japan, mainly because of aspiration pneumonia caused by dysphagia. Therefore, home medical care for dysphagia is also an extremely important issue in our super-ageing society.

　The medical treatment fee has not yet reached the level where otolaryngologists can actively perform home medical care.

　Although the social need for home visits by otolaryngologists is estimated to increase in the future, the means by which busy otolaryngologists can become involved in home medical care need to be further discussed.

　The vaccination rate for mumps has declined to around 40% because of occasional reports about aseptic meningitis associated with the mumps vaccine that have appeared in recent years.

　Consequently, outbreaks of mumps have periodically reappeared. Although mumps usually causes unilateral hearing loss, bilateral hearing loss can occur in rare cases, leading to considerable socioeconomic disadvantages and the creation of serious obstacles in daily life. However, the actual situation of hearing loss associated with mumps is not well known. The Oto-Rhino-Laryngological Society of Japan conducted a nationwide survey of 5,565 facilities specializing in otorhinolaryngology to investigate hearing loss caused by mumps between 2015 and 2016. Responses were obtained from 3,906 facilities (response rate: 70%), revealing that at least 359 patients developed hearing loss during this period. Among the 335 patients for whom sufficient data was available, 320 patients had unilateral hearing loss and 15 patients had bilateral hearing loss. In addition, the persistent hearing loss was severe or worse in 290 patients with unilateral loss and 12 patients with bilateral loss, even when the ear with better hearing was tested. The patients ranged in age from 0 years to 78 years, and the peak age range was identified as being from 3 years to 15 years, followed by the child-rearing generation in their 30s. Among the 203 patients who were followed from the time of the initial consultation to the final hearing, a worsening of auditory function over time was confirmed in 52 patients; many of them developed profound hearing loss. In contrast, an improvement in hearing was only noted in 11 patients. Because the benefits of vaccination are difficult to recognize, the Oto-Rhino-Laryngological Society should provide information about the value of vaccination for preventing mumps, work to standardize the periodic vaccination schedule, and request the development of new and safer vaccine strains for this disease.

　Year-end and New Year emergency otorhinolaryngology services were started in 1973 at the Central Emergency Medical Center, operated by the Osaka City Emergency Medical Service Corporation, in Osaka prefecture. The system was later expanded, and emergency medical services became available on weekends and holidays in 1978 and weekday nights in 2000. This study examined the transitions in patients treated at Chuo Emergency Medical Clinic between 2003 and 2015 and the transitions in patients sent to satellite hospitals. The proportion of non-emergency patients gradually decreased in the medical record. Among the patients sent to satellite hospitals, a large number required moderate or higher levels of treatment. These numbers were thought to have been influenced by the Emergency Relief Center Project implemented by the Osaka Municipal Fire Department. The improvement of the late-night emergency system after the end of the central emergency clinic remains a future task. Securing satellite hospitals and the necessary budgets will be indispensable for the emergency system. Regular discussions with the relevant departments, such as administration, and the medical association are also needed.