We investigated the efficacy of combined high-dose steroid therapy and prostaglandin E₁ (PGE₁) treatment for idiopathic sudden sensorineural hearing loss (SSHL). This study was conducted in 324 patients who were hospitalized and treated for idiopathic SSHL with the aforementioned drug combination at the Yamagata City Hospital Saiseikan between January 2012 and December 2017. Data on the patient age, interval (days) from onset to treatment, pretreatment hearing level and posttreatment hearing level were collected from the medical records. Patients were classified as having achieved complete recovery if they had achieved a posttreatment hearing level of less than 20 dB in frequencies of 250, 500, 1000, 2000, and 40000 Hz, or a posttreatment hearing level on the affected side equal to that on the unaffected side. Patients were classified as having achieved good recovery if their posttreatment hearing level had improved by more than a mean of 30 dB in frequencies of 250, 500, 1000, 2000, and 40000 Hz. We defined the improvement rate by the number of patients who had achieved complete or good recovery.

　We examined the complete recovery rate and improvement rate for the entire study population. The complete recovery rate was defined as the percentage of patients who had achieved complete recovery, and was 39.8%. The improvement rate was defined as the combined percentage of patients who had achieved complete recovery or good recovery, and was 52.2% for the total patient population. A multiple logistic regression analysis revealed significant correlations of the interval from the onset to treatment and the initial hearing level with the complete recovery rate, and also a significant correlation of age with the improvement rate.

　The improvement rate in patients in whom the treatment was begun within 7 days of onset was significantly higher than that in patients in whom the treatment was started more than 8 days from the onset.

　We describe the longitudinal changes in the profile of tonsillectomies at a regional base hospital. During the 62-year period from 1955 to 2016, a total 27,623 surgeries were performed in the otorhinolaryngology department, with tonsillectomies accounting for 21.2% (5,852 cases). The percentage of tonsillectomies relative to the total number of otorhinolaryngologic surgeries was high in the 1960's (32%-58%), but decreased thereafter, remaining sustained at about 15%. At the beginning, tonsillectomy was performed under local anesthesia. Both local and general anesthesia were adopted between 1969 and 1987. From 1988 onward, tonsillectomies are only performed under general anesthesia. The number of tonsillectomies in males exceeded that in females during the study period (53% over the total period). The age distribution changed with time; in the 1955-60's, pediatric cases accounted for the vast majority, with the peak rate in 6- to 10-year olds; after the 1970's, a second peak appeared in young adulthood (age 21-25 years). Subsequently, in the early 2000s, the number of adult cases exceeded the number of pediatric cases. Since 2010, the proportion of pediatric cases has increased again and the adult cases are distributed over a wide age range. From the era of a large number of surgeries for patients with recurrent tonsillitis or tonsillar hypertrophy being performed under local anesthesia, general anesthesia has become the mainstay for such surgeries, and strict criteria are used to select the surgical indications. Inflammatory disease can be an indication only after its frequency and severity meet the selection criteria. A consensus has been established for pediatric cases with sleep-disordered breathing and is being established for cases with IgA nephropathy. These could explain the changes in the age distribution of the cases. Tonsillectomy still retains a significant share of the surgeries performed in the field of otorhinolaryngology.

　Patulous Eustachian tube is a condition in which the pressure and sound in the upper airway are transmitted to the middle ear through the Eustachian tube, and usually manifests as muffled hearing and autophony. This study was conducted in 14 patients with failure of Eustachian tube closure associated with scuba diving-related accidents. All the patients underwent audiometric measurements, including hearing testing, tympanometry, and Eustachian tube function testing (sonotubometry and impedance test), as well as were asked to respond to a questionnaire about their history of problems associated with scuba diving. The symptoms were mild in 8 of the 14 patients, including mild ear discomfort, 1 patient was diagnosed as having middle ear barotrauma (MEB) and 5 patients were diagnosed as having inner ear barotrauma (IEB). In 1 patient with MEB, it was complicated by alternobaric vertigo (AV). Eight of the 14 patients developed symptoms when rising to the surface, and 2 patients each suffered from AV and IEB during rapid descent. As compared to the findings in normal control divers, Eustachian tube function testing in divers with failure of Eustachian tube closure revealed a significantly larger degree of patency of the Eustachian tube, and moreover in subjects with PET, sonotubometry revealed that the Eustachian tube functions in the affected ear were significantly worse than those in the healthy ear. There were no significant differences in the results of Eustachian tube function testing between persons with and without inner ear dysfunction. We thought that during rapid descent, the rapid pressure variations and excessive positive pressure caused by the Valsalva maneuver could affect the inner ear; moreover, the air in middle ear cavity expands by decompression when rising, and the resultant excessive positive pressure could affect the inner ear. To prevent pressure-related injuries in scuba divers, we think that divers should be advised to rise as slowly as possible, and swallow their saliva repeatedly to reduce middle ear pressure.