In 2017, the criteria for adult cochlear implantation were revised by the Oto-Rhino-Laryngological Society Japan. Cases with average hearing levels of 70-90 dB and with speech recognition scores of ≤50% were added as candidates for cochlear implantation. We conducted a retrospective examination of the data of our patients with average hearing levels of ≤90 dB who underwent cochlear implantation, and discuss the new criteria. In this study, we analyzed the data of 68 patients over the age of 18 years who had undergone cochlear implantation at our hospital between 2008 and 2018. The subjects were divided into three groups: the “conventional criteria group,” consisting of patients whose preoperative hearing data corresponded to the conventional criteria, the “new criteria group,” consisting of patients who fulfilled the newly added criteria, and the “special case group,” consisting of patients who did not fulfill either the conventional or the new criteria. For each group, we investigated the age at operation, age at onset, cause of the hearing loss and the CI-2004 score at the final visit. In the new criteria group, all the patients had post-lingual deafness, with progressive sensorineural hearing loss of unknown etiology accounting for the majority. The postoperative CI-2004 score was almost equal between the new criteria group and the conventional criteria group, whereas that in the special case group tended to be lower as compared to the scores in the other two groups. In the special case group, two patients who had good speech recognition scores of 45% and 70% in the contralateral ear did not use the cochlear implants during all waking hours. The patients with visual impairment tended to have better speech recognition performance as compared to those without visual impairment. This study suggested that the new criteria might shorten the duration of post-lingual progressive hearing loss of unknown etiology. The speech recognition performance in the patients who fulfilled the new criteria was equal to that in the patients who fulfilled the conventional criteria. Cochlear implantation for special cases such as auditory neuropathy and patients with visual impairment is effective, if we judge the candidates adequately by a comprehensive understanding about the patients. The postoperative speech recognition performance was limited in patients with a difference between the right and left hearing levels who received cochlear implantation on the side with the worse hearing.

　To clarify the current status of end-of-life care for head and neck cancer patients in our district, we reviewed the data of head and neck cancer patients in an end-of-life care setting who were treated at Kagawa University Hospital. The analysis included 62 patients (47 males, 15 females; median age 70 y.o.; range 47-93 y.o.), who were divided into 3 groups: patients who were discharged and received home care service (“home care group”; n=15), patients who were discharged and transferred to regional palliative care hospitals (“regional hospital group”; n=22), and patients who could not be discharged (“could not be discharged” group; n=25).

　The median survival after the decision was made to provide best supportive care was 41 days (range; 0-206 days): 14 days in the “home care” group and 30 days in the “regional hospital” group. Patients in the “could not be discharged” group tended to have temporary tracheostomas. In regard to the patients in the “could not be discharged” group, who died 10-30 days after the decision was made to provide best supportive care, many had hoped that they would be discharged and transferred to a regional care hospital, but their hope was not fulfilled because their general condition had worsened during the waiting period, which was longer than that in the “home care” group. We consider that it is necessary to increase the proportion of patients who receive home care service, since the “home care” group needed a shorter hospital stay than the “regional hospital” group. Recently, we started to conduct clinical skill training seminars for regional doctors and co-medicals, to introduce the materials that are necessary for tracheostoma care, and for acquisition of the skill for tracheostomy tube exchange. We believe that these seminars will contribute to increasing the proportion of patients that receive home care service and to resolving this aspect of end-of-life care for head and neck cancer patients.

　The incidence of granulation tissue formation within the trachea and of the formation of a tracheo-innominate artery fistula is high in patients with thoracic deformities who require tracheal cannulation. Herein, we present a report of three patients with thoracic deformities who underwent aspiration prevention surgery. Since all three patients had tracheal stenosis associated with the thoracic deformity, it was important to perform tracheal cannulation without contacting the tracheal wall at the site of the stenosis. In the two patients who did not require mechanical ventilation, we retained the tracheal stoma, but did not perform cannulation, and in the third patient, who required mechanical ventilation, we placed a tracheal cannula above the tracheal stenosis site. All clinicians who took care of the patients were aware that avoidance of suction around the tracheal stenosis site was important to prevent complications. Tracheostomy and aspiration prevention surgery in patients with thoracic deformity should be performed taking into consideration the high risk of postoperative complications.

　In recent years, balloon dilatation of the pharyngo-esophageal segment has been reported as a treatment modality for dysphagia in the field of rehabilitation medicine. This treatment is used for mechanical obstruction of the gastrointestinal tract, and not for functional disorder of the upper esophageal sphincter, which is the caused of dysphagia developing after medulla oblongata infarction. Use of this treatment modality in such cases is associated with the risk of damage to the cricopharyngeal muscle, which is the muscle forming the upper esophageal sphincter.

　We encountered three cases of prolonged dysphagia developing after medulla oblongata infarction, and strongly suspected that the dysphagia was caused by a tear, and scar formation in the cricopharyngeal muscle by balloon training. In all three cases, the cricopharyngeal muscle was so strongly scarred that it could not have been explained by the medulla oblongata infarction alone. In all three cases, cricopharyngeal myotomy led to improvement of the dysphagia and resumption of oral intake.