For the treatment of chronic tinnitus, sound therapy is performed for the auditory pathway, the source of tinnitus occurs, and educational counseling is performed for the pain network, which worsens it. At our department, we clarify the condition of each patient through detailed interviews, examinations, and hearing tests, and examine the disability and psychological distress caused by tinnitus and hearing loss in detail. We use the Tinnitus Handicap Inventory (THI) to evaluate impact of tinnitus on the quality of life of the patients. All patients receive educational counseling. Some cases receive tinnitus retraining therapy (TRT) combined with appropriate sound therapy with hearing aids or environmental sounds. If they complain of insomnia or anxiety, we prescribe psychotropic drugs or request a psychiatry consultation.

　The aim of this study was to report the effects of treatment for tinnitus at our department. A total of 225 patients with chronic tinnitus with THI scores at the first consultation of 18 or higher were included in this study. Of the 225 patients, 114 did not desire additional treatment or follow-up consultation, and these patients tended to have low THI scores. Conversely, the THI scores in the 38 patients who had been prescribed psychotropic drugs tended to be high. Of the 111 patients who were evaluated more than once, the THI scores improved in 85 (77%) patients. Among these, THI scores improved in 35 (88%) of the 40 patients with hearing loss who had received sound therapy with hearing aids, and THI scores improved in 31 (84%) of the 37 patients without hearing loss who had received sound therapy with environmental sounds. However, THI scores improved in only 19 (56%) of the 34 patients with hearing loss who had received sound therapy with environmental sounds. These findings suggest that the beneficial effect of sound therapy with environmental sounds was limited to patients with hearing loss. If more patients with hearing loss and tinnitus choose treatment with hearing aids, we believe that it would be beneficial to patients in terms of improvement of their quality of life.

　Eosinophilic chronic rhinosinusitis (ECRS) is commonly complicated by asthma; hence, comprehensive treatment of the upper and lower respiratory tracts is required. At our facility, we have established an airway allergy outpatient clinic, where a respiratory allergist and an ear, nose, and throat allergist conduct consultations at the same time. Mainly, localized treatment with inhaled corticosteroid (ICS) exhalation though the nose (ETN) is proactively prescribed, for ECRS patients who also have asthma. Although the efficacy of treatment with ICS-ETN is high for localized inflammation, long-term continuous treatment is often required along with asthma treatment. While ICSs are well-known to cause oral candidiasis, there are no reports on the effects of continuous ICS-ETN on the bacteria resident in the nasal cavity. We, therefore, investigated the effects of ICS-ETN therapy on the nasal bacterial flora. We included cases in which the results of bacterial culture of nasal discharge specimens could be confirmed prior to nasal surgery at our hospital from January 2014 to December 2017. Furthermore, we compared the results of bacterial culture of nasal discharge specimens among three groups, namely, the ICS-ETN group (n=49), ICS treatment by the conventional inhalation method (n=24), and the ICS-free group (n=172). No significant differences among the three groups were observed in terms of the bacteria detection rate. Importantly, the analysis for subgroup of intranasal and oral corticosteroids-free patients showed the similar results. ICS-ETN therapy is thought to be useful for comprehensive treatment of the upper and lower respiratory tracts over a long period of time, without any adverse effects on the nasal bacterial flora.

　We examined the effect of combined therapy (CT) with intratympanic and systemic steroids for idiopathic sudden sensorineural hearing loss (SSNHL) as compared to systemic steroid therapy alone (SST). The hearing outcome was assessed according to the criteria used in the Ministry of Health, Labour and Welfare of Japan Study.

　A total of 31 patients received CT and 48 patients received SST. There were no statistically significant differences in the background characteristics between the two groups. The rates of complete recovery, significant improvement, slight improvement, and no change in the CT group were 55%, 23%, 6%, and 16%, respectively, while the corresponding rates in the SST group were 42%, 10%, 21%, and 27%. The recovery rate, which was defined as the sum of the rate of complete recovery and rate of significant improvement, was significantly higher in the CT group (p=0.024) than in the SST group. Multivariate logistic analysis identified CT as the only significant factor influencing the recovery rate (p=0.044). The mean hearing improvement was significantly better in the CT group (27.7 dB) than in the SST group (18.3 dB)(p=0.017). When comparing the hearing improvement for different frequencies, hearing improvement in the CT group was significantly better at 250 Hz, 500 Hz, and 4,000 Hz. In regard to adverse events, delayed perforation of the tympanic membrane occurred in 1 case in the CT group.

　In conclusion, our results indicated that CT is more effective than SST for the treatment of SSNHL.

　For otolaryngologists trained in endoscopic sinus surgery, dacryocystorhinostomy (DCR) is considered as a simple procedure. On the other hand, reports of 100% success rates are rare, and re-occlusion of the open lacrimal sac is a significant problem. There have been some reports of the use of individual ingenuity for the surgical procedure. We encountered a case of re-occlusion and felt the need to devise a new surgical technique, and thought that a simple DCR technique using fibrin glue (FibDCR) might be useful for widespread use. After obtaining approval from the ethics committee of the JCHO Sendai Hospital in April 2018, we divided the patients into two groups, the conventional DCR group (122 cases) and the FibDCR group (119 cases). The two groups were comparatively evaluated in terms of the treatment efficacy and postoperative nasal endoscopy scores. The efficacy rate in the FibDCR group was 99.2%, 2.5% higher than that in the conventional group (96.7%), although the difference was not statistically significant. In regard to the postoperative nasal endoscopy score, the rate of wide-open maintenance (Grade 4) was significantly higher in the FibDCR group than in the conventional group. In conclusion, our results confirmed the usefulness and stability of the FibDCR method.

　We report a patient with Adult-onset Still's disease (AOSD) who presented with sore throat as the initial symptom.

　A 68-year-old woman was referred to our hospital with a 2-month history of sore throat. Since she also had high-grade fever (39°C) for two days, we diagnosed her as having pharyngo-laryngitis. Treatment with antibiotics, including a broad-spectrum antibiotic, was initiated, however, the treatment proved ineffective for both symptoms. Thereafter, she developed joint pain, suggesting that she might have a systemic disease. Differential diagnoses for fever of unknown origin were explored. Blood examination and systemic imaging studies excluded infectious disease and malignancy. Laboratory testing revealed leukocytosis, liver dysfunction, and elevated serum CRP and serum ferritin levels. Tests for all the autoantibodies examined were negative. On the 10th day of hospitalization, the patient developed a rash over her limbs, which led to the diagnosis of AOSD. AOSD is a non-infectious inflammatory disease characterized by fever, rash, and joint pain, and negative test results for autoantibodies. While sore throat is included as one of the minor symptoms in the diagnostic criteria of AOSD, patients with AOSD manifesting sore throat as the initial symptom is rare. In cases with persistently high fever and sore throat despite antibiotic treatment, a systemic disease, including AOSD, should be considered.