In terms of end-of-life care, the number of head and neck cancer patients who receive home medical care is expected to increase in the future.

　However, there are few reports as yet. We retrospectively investigated the clinical courses and outcomes in 15 patients with terminal head and neck cancer who received home medical care from our clinic between April 2016 and December 2018. The average age of the patients was 73.7 y.o. and the male: female ratio was 12: 3; the primary cancer sites were as follows: oropharynx/hypopharynx/larynx/oral cavity/thyroid gland. In regard to the previous institutions attended, 13 cases (86.7%) had attended the department of otolaryngology of acute care hospitals and 2 patients (13.3%) had attended internal medicine clinics. Mean observation period: 73.4 days; mean number of visits: 10.6; mean number of emergency visits: 2.0. The reasons for the emergency visits to home by the clinic doctor were death diagnosis, delirium/disturbance of consciousness, nasogastric tube obstruction, bleeding, and tracheal cannula obstruction. In regard to death, 9 patients (60.0%) died at home, which was the lowest home death rate as compared to patients with other organ cancers at our clinic; 6 patients (40%) died in hospital, with a report of difficulty in continuing home care due to excessive family caregiving burden in 5 of the cases. Three patients were referred to their previous hospitals (reverse referral rate: 23.1%, average duration of home medical care: 34 days). There is a possibility that intervention by otolaryngologists could reduce the difficulties in home care for head and neck cancer patients and their families, contribute to the introduction and continuation of home care, and reduce hospital stays in acute care hospitals.

　Developing prognostic tools is a fundamental component in the management of patients with advanced cancer. The clinical course of head and neck cancer varies widely, and no prognostic tools are available for head and neck cancer patients receiving palliative care. Therefore, there is a need to establish a predictive prognostic tool for head and neck cancer patients under palliative care.

　We enrolled 47 patients with pathologically proven head and neck cancer receiving palliative care at Kagawa university hospital from April 2013 to March 2019 to investigate the feasibility of using the palliative prognostic index (PPI) and Glasgow prognostic score (GPS) as predictors of the life expectancy of these patients. The patient demographic data and the indices needed to calculate the PPI and GPS were collected retrospectively from the electronic medical records.

　The median age of the patients was 68 y.o. (range, 54-93 y.o.), and 40 patients were male. Patients were categorized into subgroups by the PPI (18 cases in Group A, 10 cases in Group B and 19 cases in Group C) and GPS (1 case with Score 0, 10 cases with Score 1 and 36 cases with Score 2). There were significant differences in the survival among patients categorized into Group AB and Group C according to the PPI (median survival 65 days (IQR, 34-133 days), 20 days (IQR, 11-30 days) in the patients categorized into Group AB, and C, respectively). There were also significant differences in the survival among the patients with scores of 0-1 and 2 on the GPS (median survival 105 days (IQR, 57-152 days), 26 days (IQR, 17-47 days) in patients with score 0-1 and 2). The sensitivity, specificity, positive predictive value, and negative predictive value for 14-day survival were 88%, 69%, 37%, 96%, respectively, for PPI, and 100%, 28%, 22%, and 100%, respectively, for GPS. The corresponding results for 30-day survival were 67%, 81%, 74%, and 75%, respectively, for PPI, and 95%, 39%, 56%, and 91%, respectively, for GPS.

　This is the first report to evaluate the feasibility of using PPI and GPS as prognostic tools to predict the survival of head and neck squamous cell cancer patients under palliative care. Our results suggest that both PPI and GPS have the potential to be useful as prognostic tools to predict the life expectancy in patients with head and neck cancer receiving palliative care.

　Hearing changes have been reported in patients with hydrocephalus. Most authors have hypothesized that hearing changes in patients with hydrocephalus are due to relative endolymphatic hydrops. We examined the hearing changes in 53 elderly patients who underwent shunt surgery for normal pressure hydrocephalus between January 2012 and March 2018. More than half of the patients already had moderate to severe hearing loss before the surgery. Significant hearing loss after the surgery was observed at 500 Hz in the right ear, and at 125 Hz and 250 Hz in the left ear. Twelve patients (22.6%) showed hearing change by 10 dB or more were at average hearing thresholds of 250, 500, 1,000, 2,000 and 4,000 Hz. Of all the patients, 8 (15.1%) showed hearing loss, and 4 (7.5%) showed hearing improvement after the surgery. The age, sex, shunt technique, side of shunt, shunt system, valve pressure, cognitive functions, physical functions, and body mass index were compared among the groups showing no change, hearing loss, and hearing improvement, and no significant differences were found. The hearing thresholds prior to the surgery were not different between the hearing loss group and the group that showed no hearing change; however the hearing thresholds for low frequencies worsened significantly in the left ear in hearing loss group. The hearing thresholds in the low, middle, and high frequencies were worse prior to the surgery in the hearing improvement group as compared to the group that showed no hearing change, but there were no significant differences between the two groups after the surgery. We agree with previous reports that hearing loss after surgery is due to relative endolymphatic hydrops. We also hypothesize that hearing improvement is due to release from the relative increase of the perilymphatic pressure. One half of the patients with hearing loss showed no improvement, and 3 patients needed to start using hearing aids after the surgery. We think that it is necessary to pay attention to hearing problems as one of the risks of shunt surgery.

　The purpose of this study was to evaluate the feasibility of using the retroauricular hairline incision for resection of benign parotid gland tumors. Parotid surgery is commonly begun with a modified Blair incision, an S-shaped preauricular and submandibular incision that may leave a visible scar. As compared with this conventional incision, the retroauricular hairline incision has clear cosmetic benefits, because the incision was made along the postauricular sulcus and inside the hairline. We selected this incision for motivated patients suspected as having a benign parotid gland tumor. We performed 8 parotidectomies using this incision between March 1, 2017, and June 30, 2017, in 6 females and 2 males, ranging in age from 44 to 82 years old. The indications were pleomorphic adenoma, Warthin's tumor and lymphoepithelial cyst. In all cases, excellent exposure could be obtained using this approach. Although the surgical field was slightly restricted on the front side, a retroauricular incision approach under direct vision is technically feasible, and the facial nerves can be preserved. In conclusion, a retroauricular hairline incision can provide adequate surgical exposure and good cosmetics results.