The average age of persons with allergic rhinitis is decreasing. The disease is also one with a low natural cure rate. One of the established treatments is allergen immunotherapy. In this study, we examined the adverse effects of sublingual immunotherapy (SLIT) administered for 3 months to children under 10 years of age.
The subjects of this study were children under 10 years of age with allergic rhinitis who received SLIT at our hospital from June 1, 2018 to October 31, 2018. At the end of 3300 JAU (Japan Allergy Unit: JAU), 10000 JAU at 1 week, 10000 JAU at 5 weeks, and 10000 JAU 3 months later, any adverse effect with a score on a VAS of 10 mm or more was considered as a side effect. Side effects were most frequent after 1 week of 10000 JAU, and the frequency decreased from 30 cases (45.5%) to 7 cases (10.6%) after 12 weeks at 10000 JAU. The subjects of the study were divided into 43 cases with allergic rhinitis alone and 23 cases with other allergic diseases also, such as atopic dermatitis and asthma. The incidence rate of side effects was significantly higher in the group with other diseases also at each examination point; in particular, 3 cases (13.0%) had “skin itching” even after 12 weeks at 10000 JAU.
The incidence of perennial allergic rhinitis differs between children and adults and a high proportion of cases with dual sensitization and other allergic diseases. In this study, SLIT was found to be a safe treatment for children, however, the incidence of side effects was higher in patients with other allergic diseases, suggesting that collaboration with other departments is necessary.
To estimate the effects of a virtual reality temporal bone simulator in medical education.
Two hundred and thirty-five medical students undergoing bedside learning were recruited in this study for two years. The same instructor provided the training during the first year, while several instructors provided the training, based on a guidance manual, during the second year. We examined the students' knowledge of anatomy of the temporal bone and administered a questionnaire to determine their comprehension of surgical procedures involving the temporal bone after the training as compared to the level of understanding before the training.
The percentage of correct answers in the examination of anatomical knowledge about the temporal bone after the simulation in the first and second year improved from 51.8% to 83.9% and 49.4% to 80.0%, respectively. The percentages of medical students who responded with “well understood” or “I think I understood” to questions in the questionnaire on comprehension of surgical procedures involving the temporal bone in the first and second year were 84.3% and 76.4% for mastoidectomy, 74.8% and 66.4% for tympanotomy and 67.8% and 52.3% for cochleostomy, respectively. The anatomical and surgical comprehension levels, except for the case of cochleostomy, did not differ between students who received instructions from several instructors and those who received from the same instructor in this study. The training using a virtual reality temporal bone simulator was useful to improve the students' anatomical knowledge about the temporal bone and their comprehension of surgical procedures involving the temporal bone, and to unify the training content, regardless of the instructor because of standardization and customization of the surgical procedure. Thus, the training using a virtual reality temporal bone simulator is one of the most effective tools of medical education for both medical students and instructors.
Schwannoma of the larynx below the level of the false cord is generally removed by laryngofissure. We report a case of schwannoma of the larynx with subglottic extension that was successfully resected by transoral surgery.
The patient was a woman in her early 50s who presented with a 3-year history of hoarseness of voice. Fiberoptic laryngoscopic examination revealed a smooth mass localized in the right false vocal cord of the larynx. Magnetic resonance imaging showed a sharply marginated tumor extending from the right false vocal cord to the subglottis. The tumor was removed under general anesthesia by transoral surgery (endoscopic laryngo-pharyngeal surgery; ELPS). The histopathological diagnosis was schwannoma, Antoni A, B mixed type.
ELPS is mainly performed for superficial carcinomas of the laryngopharynx. It is also effective for removing benign lesions of the laryngopharynx.