We reviewed the preoperative computed-tomographic (CT) and audiological findings in patients who underwent initial stapes surgery at our hospital. The CT findings and the preoperative as well as postoperative audiological findings of 103 ears obtained from 87 patients were analyzed. The CT findings were classified into four groups: a group with no defect (no-defect group; 33 ears), a group with a defect in the anterior oval window (oval-window group; 33 ears), a group with a defect in the anterior wall of the internal auditory canal (internal auditory canal group; 26 ears), and a group with a defect in the pericochlear region (pericochlear-region group; 11 ears). There were no differences in the age, sex, surgical procedure performed, or length of the fluoroplastic piston used among the four groups. Air-conduction thresholds at 2,000Hz and 4,000Hz improved significantly after the surgery in the no-defect, oval-window and internal auditory canal groups, but not in pericochlear-region group (2,000Hz; p=0.074, 4,000Hz; p=0.765). On comparison of the preoperative air-conduction thresholds, preoperative bone-conduction thresholds, and postoperative air-conduction thresholds between two groups, significant differences were found in the postoperative air-conduction thresholds at 4,000Hz between the no-defect and pericochlear-region groups (p=0.017), between the oval-window and pericochlear-region groups (p=0.007), and between the internal auditory canal and pericochlear-region groups (p=0.012). The results indicated that it may be difficult to obtain improvement of the air-conduction thresholds at 4,000Hz by stapes surgery in patients with defects in the pericochlear region.

　Smoking not only increases the risk of stroke, myocardial infarction, chronic obstructive pulmonary diseases, and cancers, but also the risk of tobacco-related ear, nose, and throat diseases, including upper respiratory infections and head and neck squamous cell carcinoma (HNSCC). In Japan, there are only a few ENT outpatient clinics that provide smoking cessation treatment covered by the national health insurance and few reports from ENT outpatient clinics on the results of smoking cessation treatment. The study group consisted of 73 Japanese patients (44 men and 29 women) with a median age of 56 years (range, 24 to 78 years) who had received smoking cessation treatment with varenicline during a 2-year period at the Department of Otolaryngology-Head and Neck Surgery of Hokuto Hospital. The patients were asked about their nicotine addiction behaviors, answered a tobacco dependence screening questionnaire, and underwent measurement of their expired carbon monoxide levels. The patients had received varenicline at the dose of 0.5 mg a day for 3 days, followed by 0.5 mg twice a day for 4 days, and then 1.0 mg twice a day for 11 weeks and were required to visit the hospital 5 times within the 12-week period. The main reason for receiving the smoking cessation treatment among the patients was recommendation by the ENT doctor in (27 patients, 37%), concern about the onset, exacerbation, or recurrence of chronic diseases (26 patients, 36%), or recommendation by the family (8 patients, 11%). Of the 73 patients, 52 (71%) successfully quit smoking following the smoking cessation treatment. Quitting smoking at the second visit (p<0.001) and a larger number of visits to the clinic times (p<0.001) were factors that contributed favorably to smoking cessation by the end of the treatment period of 12 weeks. Adverse events of varenicline appeared in 27 (37%) of the 73 patients, including nausea and vomiting in 20 (27%) patients. The major reason for failure to quit smoking in response to the treatment was discontinuation of varenicline due to the appearance of adverse events (9 patients, 12%). ENT doctors often treat patients with tobacco-related ear, nose, and throat diseases and sometimes also patients with HNSCC associated with smoking. Smoking cessation treatment should be administered at ENT outpatient clinics to promote smoking cessation by a larger number of smokers.

　We report a suspected case of mucosal contact point headache, which was alleviated by the use of a topical decongestant. A 19-year-old woman visited our hospital with severe headache, nasal obstruction, and nasal discharge on the left side. CT showed no evidence of either intracranial illness or rhinosinusitis, and there were no neurological findings to explain the headache. The patient was referred to our department, where we noticed that the left facial pain and headache associated with nasal obstruction were alleviated by the use of a topical decongestant. Nasal endoscopy revealed a severe nasal septum crista that was in contact with the left inferior turbinate. Based on these findings, the patient was suspected of having mucosal contact point headache. Septoplasty and bilateral submucosal turbinectomies were performed for relieving the mucosal contact point, and the headache resolved immediately after the surgery.

　Severe headache with nasal symptoms is usually associated with acute sinusitis. However, mucosal contact point headache should be proactively suspected in patients with a severely deviated nasal septum and/or concha bullosa without evidence of sinusitis. Careful observation for the mucosal contact point as well as a trial of topical decongestants is helpful for the diagnosis. Surgery is one of the treatment options for this entity.

　The rate of endoscopic sinus surgery (ESS) for the management of superior subperiosteal abscess (SPOA) has been increasing. Both the ESS approach by itself and this approach in combination with external approaches have been reported, and the drainage route is generally through the lamina papyracea. A 75-year-old man presented to us with left periorbital edema. CT showed bilateral frontal sinusitis with bony dehiscence in the left lateral frontal floor, suggestive of superior SPOA.

　MRI T2WI revealed a hypointense-to-isotense mass in the frontal sinus, suggestive of a fungal ball. We performed MELP endoscopically, and utilized the area of bony dehiscence as the drainage route for the superior SPOA. A minimal external incision was added, to ensure through and complete drainage of the orbit. Endoscopic drainage via the frontal sinus may be an effective surgical approach for superior SPOA.

　In this report, we describe (1) a flexible high-frequency knife (250mm), (2) shaft-rotatable forceps with a malleable tip (250mm), and (3) a suction coagulator equipped with a water pumping function (200mm) as reusable surgical instruments optimized for trans-oral pharyngolaryngeal surgery, that were developed by us in collaboration with Fujita Medical Instruments Co., Ltd. By using these devices in combination with a high-frequency electrosurgical generator VIO3 (ERBE), we have been able to perform trans-oral surgery for malignant tumors of the pharynx safely and securely. These devices are applicable not only to malignant tumors, but also to various benign diseases, which is expected to contribute to further spread and evolution of trans-oral surgery, including expansion of opportunities to learn surgical techniques in this field.