Carcinoma of the external auditory canal is a rare tumor, accounting for about 1% of all head and neck cancers. Although no treatment method has been established yet, surgical treatment is the primary treatment method in cases where resection is possible. At our institution, we adopt surgical treatment, mainly lateral temporal bone resection (LTBR), for cases with T1-T3 disease, and chemoradiation therapy (CCRT) for cases with T4 disease, as the treatment of first choice. We have adopted cartilage conduction hearing aids (CC-HAs) in some cases following LTBR. We examined the short-term outcomes, at two years, in the patients treated at our department.

　This study was a retrospective case review of 22 ears with carcinoma of the external auditory canal in 21 patients who underwent initial treatment at our institution between January 2012 and June 2018. The observation period was 2 to 81 months (median 26 months). The tumors were analyzed using the modified Pittsburgh tumor staging system. The tumor T stage was T1 in four ears, T2 in nine ears, T3 in six ears, and T4 in three ears. CCRT was performed in three ears with T4 disease and one ear with T2 disease, heavy ion radiotherapy was performed in one ear with T2 disease, and surgery (LTBR in 16 ears and partial external auditory meatus resection in one ear) was performed for all the other cases. The surgical margin after LTBR was positive in three out of six cases with T3 disease and negative in all of the cases with T1 and T2 disease. The positive surgical margin was mainly found in the medial wall of the tympanic cavity or cartilaginous portion of the external acoustic meatus. The overall 2-year survival rate was 87.4%; the rate was 100% in the T1 cases, 87.5% in the T2 cases, 75.0% in the T3 cases, and 100% in the T4 cases. Four out of five patients who tried CC-HAs continued to use them after the LTBR.

　The indication for LTBR should be carefully judged in cases with T3 disease. The appropriate indication for LTBR in cases with T3 disease are: 1) a small amount of soft tissue shadow beyond the tympanum in the preoperative CT, and/or 2) a clear boundary between the tumor and the soft tissue around the external acoustic meatus in the preoperative enhanced MRI. In cases with T3 disease not fulfilling these criteria, CCRT should be selected as the treatment of first choice. However, considering the side effects after CCRT, including sensorineural hearing loss and persistent otorrhea in some cases, LTBR with postoperative CC-HAs is one of the optimal treatment options that would allow the remaining hearing ability to be utilized.

　The type/extent of surgery for benign parotid tumors remains a subject of debate. Enucleation of the parotid tumor was the standard technique used at the beginning of the 20th century. However, due to the high recurrence rates in cases of pleomorphic adenoma up to 45%, a more radical approach was sought, and total parotidectomy and superficial parotidectomy began to be adopted in the 1940s. However, these procedures were associated with a high risk of complications, including facial nerve paralysis and Frey syndrome, and partial superficial parotidectomy (PSP) began to be performed. In the 1990s, even more limited surgery, namely extracapsular dissection (ECD), was introduced. ECD does not involve identifying the facial nerve, and the parotid tumor is directly excised with a thin layer of normal parotid tissue around the tumor capsule. A total of 405 patients with benign parotid tumors underwent surgery at our department between June 2016 to May 2020. Among them, ECD was performed in 13 patients, and PSP in 276 patients for superficial lobe tumors. ECD was used for small (<25mm), superficial lobe, and mobile tumors. Dissection was performed using electric knife, and facial nerve monitoring. There was a lower rate of postoperative transient facial paralysis in the ECD group (0.0%) as compared to the PSP group (12.7%). The mean operative time in the ECD group was significantly shorter than that in the PSP group. Although the present results are not sufficient to conclude that ECD is more beneficial than PSP, ECD may be considered as a useful surgical alternative for selected cases of benign parotid tumors.

　We studied the effect of multiple allergen sensitization on the efficacy of sublingual immunotherapy for cedar pollen allergy. The subjects were 457 patients (mean age 28.7±17.8 years; 251 men, 206 women) who were initiated on sublingual immunotherapy for cedar pollen allergy between 2014 and 2019 at a single clinic. The patients were treated with Cedartolen^® (2000 JAU) or Cedarcure^® (5000 JAU), depending on which year the treatment was started in. Concomitant medications were allowed without limitation when symptoms were present. Before treatment, the serum levels of allergen-specific IgE antibody (immuno-CAP method, positive for 0.7 U/mL or more) for herbaceous pollens (orchard grass, ragweed), tree pollen (alder, birch), and mites and animals (dog, cat) were measured. We investigated the severity of the naso-ocular symptoms and general symptoms with a VAS (visual analog scale) at the peak of cedar pollen dispersal in 2020 (Durham sampler 3582/cm2, moderate dispersal year). The concomitant drug score was also calculated.

　Mono-sensitization with cedar pollen was performed in 112 cases (24.5%). The number of cases that underwent poly-sensitization was 116 (25.4%) for one type of allergen, 97 (21.2%) for two types of allergens, 82 (17.9%) for three types of allergens, and 50 (10.9%) for four types of allergens. Some nasal symptoms, such as nasal blockage, became significantly worse during sensitization for mites or animal allergens. However, the VAS values for sneezing, rhinorrhea, congestion, eye pruritus, and general symptoms did not differ according to the number of duplicate sensitizations. The concomitant drug scores also did not differ depending on the number of duplicate sensitizations or the allergens used for sensitization. Poly-sensitization did not affect the therapeutic effect of sublingual immunotherapy for cedar pollinosis.

　We present the case of a 16-year-old male patient, who was diagnosed as having the severe form of X-linked myotubular myopathy (XLMTM). The patient had asphyxia at birth, and underwent respiratory and nutritional management in the NICU after birth. He showed delayed milestones, and grew under the support of NPPV during sleep since the age of 1 year, ate regular meals from the age of 5 years, taking much time to complete meals and frequently choking, and started to walk only at 7 years of age.

　Eleven months prior to the current admission, the patient had undergone surgical correction and posterior fixation for severe scoliosis. After the surgery, he developed hemopneumothorax, which necessitated a tracheostomy. However, the site of the tracheal stoma was inadequate to the corrected erect posture, raising concern about the risk of tracheo-innominate artery fistula and tracheo-esophageal fistula. During the postoperative course, he also suffered from an aggravation of dysphagia, which could not be reversed by rehabilitation.

　The tracheal stoma was closed and relocated to a higher site, where the spinal curve was more gradual. A cricopharyngeal myotomy was performed at the same time. After the surgeries, the patient reacquired his ability for speech and also showed improvement of the swallowing function. Histopathological examination revealed a remarkable fibrotic change of the cricopharyngeal muscle as compared to the omohyoid muscle.

　The main symptoms of SAPHO syndrome are cutaneous and bony symptoms. The most common skin manifestations include palmoplantar pustulosis, psoriasis, cellulitis, and pyogenic sweat glands. Bone symptoms include arthralgia due to bony hyperplasia, and are most common at the sternoclavicular joints. The cause of the disease is unknown, and while the frequency of occurrence has not yet been determined in Japan, it is estimated to occur at an incidence rate of about 0.04% worldwide. There are no established diagnostic and therapeutic criteria, but the long-term prognosis is good. In general, nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of symptomatic treatment. Recently, however, it has been reported that palatine tonsillectomy could improve the joint and skin symptoms. In the present study, we report a case of SAPHO syndrome in which palatine tonsillectomy clearly improved the arthralgia.