Due to the widespread adoption of newborn hearing screening in Japan, the number of children under the age of 1 year who visit an otolaryngology department for detailed examination of hearing loss is increasing. Deafness in children with Down syndrome is often caused by otitis media with effusion (OME). We examined the OME morbidity, hearing improvement and complications of tympanic tube placement in order to clarify what kind of therapeutic intervention might be needed for children with Down syndrome who are suspected as having deafness. The subjects were 92 patients who were first seen under the age of 1 year between 2014 and 2018. We investigated the progress of these children after the consultation. We performed tympanic tube placement in 22 of the 92 cases, and the frequency of complications was compared between those who underwent tympanic tube placement before the age of 2 year and those who underwent tube placement after the age of 2 years. The results showed that there was no significant difference in the frequency of otorrhea or permanent perforation even when the surgery was performed early, that is, before the age of 2 years. Children with Down syndrome had a high recurrence rate after tube removal, and in about a half of the cases, the tube was inserted again. It is important to inform the families that repeated tympanic tube placements may be needed. We examined the changes in hearing in 20 patients, and hearing improvement of 10 dB or more was observed in 15 of the 20 cases. The average hearing before insertion was 52.2 dB, but it improved significantly to 37.3 dB after the insertion. Hearing improvement by 10 dB or more was observed in 15 of the 20 cases, in 10 of the 11 cases (90.9%) in whom the tube was inserted in the 1-year-old range, and in 4 of the 7 cases (57.1%) in which the tube was inserted after 2 years of age. We thought that tympanic tube placement might be considered from an early stage for more effective treatment of OME.

　The frequency of cervical lymph node carcinoma metastasis from unknown primary site (CCUP) has not decreased in spite of the improved capabilities of the tools needed for diagnosis. This has been reported as being related to the increasing incidence of HPV-related oropharyngeal cancer. In 2017, the 8th edition of the UICC was revised to require p16 immunostaining and EBER for histological examination of the cervical lymph nodes in CCUP. In this study, we investigated the diagnosis of 27 cases of CCUP that could not be determined by general examination. We performed p16 and TTF-1 immunochemistry, EBER in situ hybridization assay of the lymph nodes and compared the results with the clinical course. Of the 27 cases, the primary was found in 18 cases, including 1 case of nasopharyngeal carcinoma, 12 cases of oropharyngeal carcinoma, 4 cases of hypopharyngeal carcinoma, and 1 case of lung carcinoma. Positivity for EBER was found in the nasopharyngeal carcinoma case, and positive immunostaining for p16 was found in all cases of oropharyngeal carcinoma, confirming its reliability as a biomarker. In addition, the p16 positivity rate was 67% in 9 cases of unknown primary. Other authors have reported that about 80% of CCUP cases are p16-positive, suggesting the need for more careful observation of the lateral and anterior walls of the oropharynx when searching for the primary.

　Perilymphatic fistula is a rare complication of traumatic tympanic membrane perforation. We reviewed the clinical presentation and prognosis of three cases of direct traumatic perilymphatic fistulas. Vestibular symptoms were seen in three patients: one patient had severe paralytic nystagmus, while two patients had only suspected nystagmus. Two patients had endoscopic evidence of stapes deviation and perilymphatic leakage from the tympanic membrane perforation, two patients had stapes entrapment on temporal bone CT, and one patient had labyrinthine emphysema. All patients had resolution of vertigo after surgery, and the hearing improved in all but one of the deaf patients. In patients with persistent vertigo with a history of tympanic membrane trauma, even if the nystagmus is mild, an external lymphatic fistula should be suspected and confirmed by endoscopy or CT, and the patient should be treated surgically.