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 over the long term. Patients with Japanese cedar pollinosis who received this treatment from 2014 to 2017 were enrolled in this study. The clinical usage level, satisfaction level, and adverse effects of this treatment were investigated using a questionnaire among three groups patients treated from 2014 to 2017. The clinical usage level was more than 90% in all three groups, which was within acceptable limits. The subjective symptoms improved and the patients were satisfied with this treatment in all three groups. Of 356 patients, 32 (9.2%) developed adverse effects with those involving the oral cavity and throat being the most common. 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 the first season than in the second season and third season (26.5%, 0% and 2.9%, 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 appropriate management of adverse effects is mandatory for safety.

　We reviewed the data of 10 patients with parotid gland sialolithiasis who were treated at our hospitals over the last 7 years (four patients were treated surgically, the stones discharged spontaneously after conservative therapy in three patients, and the stones remained in the parotid gland or Stensen's duct in three patients). One patient with bilateral punctate multiple sialoliths in the parotid glands was diagnosed as having Sjögren's syndrome. All the stones that discharged spontaneously, within two months of conservative therapy by parotid gland massage, were <2mm in diameter. Surgery included extraction of the sialoliths by sialendoscopy alone in two patients, a sialendoscopy-assisted transfacial approach in one, and a transfacial approach without sialendoscopy in one. For one patient undergoing sialendoscopy, we used supplemental ultrasound during the operation to locate the sialolith and evaluate the stone residual. For one patient in whom assessment of the stone by sialendoscopy was difficult, we switched to the transfacial approach, in which we initially inserted a lacrimal bougie that was thinner than the sialendoscope into the Stensen's duct via the oral cavity into the hilar region, and identified the duct by palpating the bougie from the transfacial surgical field. Then, the sialendoscope was inserted through the small slit of the Stensen's duct made in the hilar region. Although sialendoscopy is a useful tool for visualizing and extracting stones, in some cases stones are difficult to reach by sialendoscopy. Therefore, we believe that patients should be informed preoperatively about the potential need for a transfacial approach even for favorable sialoliths.

　Superior semicircular canal dehiscence syndrome (SSCDS) is important to differentiate from patulous eustachian tube (PET). We report a 50-year-old woman with SSCDS accompanied by PET who presented with dizziness. She visited our hospital with a month's history of gradually progressive dizziness associated with left autophony. She also gave a history of having suffered from bilateral autophony for the previous one year that was relieved by lying down in the head-down position. The diagnosis of PET was aided by positional-change eustachian tube function testing, which revealed no show sound- or pressure-induced eye movements. Ocular VEMP testing to ACS 2 kHz tone bursts revealed a large amplitude of 46 μ V on the left side and a low threshold of 80 dBSPL. CT revealed superior (anterior) semicircular canal dehiscence on the left. We administered conservative treatment for the PET. As the PET improved, the dizziness also resolved.