Otolaryngologists' participation in home medical care has been discussed before. We conducted did a questionnaire survey of home doctors' opinions about home visits paid by otolaryngologists. The objective of the survey was to understand the current status of home medical care provided by situation of otolaryngologists and to investigate the future issues.
The subjects of the questionnaire survey were 716 doctors who were randomly selected from the home medical care support clinics registered in Osaka. Dermatologists, dentists and urologists were the most frequently requested by the home doctors to visit their home care patients in the past. Ophthalmologists and psychiatrists were also requested, but otolaryngologists and orthopedists were seldom called. Only 13% of the home doctors requested visits by otolaryngologists, and about 90% had never called an Otorhinolaryngologist. The most common indication for otolaryngologist visit requests were dysphagia, impacted earwax, otorrhea, otitis media and epistaxis. There were also some cases of head and neck tumors, including oral, pharyngeal and laryngeal cancer. About 45% of the home doctors had charge of the patients with dysphagia, and they most frequently requested otolaryngologist visits, although a considerable number of them requested dentists and speech therapists to visit. The speech therapists were actually the most frequently involved in the treatment of dysphagia. About 90% of the home doctors expected otolaryngologists to participate in home care. Our research disclosed various problems in the system of home visit request and cooperation/coordination pertaining to special visit requests.
Eosinophilic chronic rhinosinusitis (ECRS) is an intractable disease, mainly characterized by nasal obstruction, nasal discharge, and olfactory dysfunction. Recurrence is common even after endoscopic sinus surgery (ESS). In the present study, the postoperative outcomes of 114 patients with ECRS who underwent their first surgery at our hospital after the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study (JESREC study) established diagnostic criteria in 2015 were examined; the subjects were then classified into three groups according to the postoperative outcomes (good outcome, fair outcome, and recurrence), to examine the factors associated with recurrence. Subjective symptoms and changes in quality of life (QOL) among the three groups were also evaluated. Postoperative observation for one year or more (mean 38 months) showed that 40% had a good outcome, 27% had a fair outcome, and 32% experienced recurrence. Subjective symptoms and QOL improved significantly in all the groups as compared to the preoperative status of these parameters. However, only the rate of improvement of olfactory dysfunction was lower in the recurrence group as compared with that in the good outcome group. Even in the recurrence group, control with postoperative conservative treatment was achieved in those with low polyp scores. Reoperation and biological preparations were indicated for patients with high polyp scores and severe nasal obstruction and olfactory dysfunction, who accounted for less than 10% of all cases.
In recent years, the importance of intraoperative navigation in ENT surgery has been increasing. Multiple studies have proven the advantages and safety of computer-assisted lateral skull base surgery. Herein, we report on the feasibility and usefulness of the StealthStation® navigation system in combination with the O-arm® system for the resection of temporal bone tumors. The technical details, setting of the operating room, advantages, and limits of the method have also been described. From our overall impression, the O-arm-StealthStation navigation system provides some sense of security and confidence to surgeons and may be successfully extended to various types of temporal bone surgeries.
Vestibular nerve dysfunction is one of the most common neuropathies observed in patients with cerebellopontine angle tumors. The video Head Impulse Test (vHIT) and vestibular-evoked myogenic potential (VEMP) have made it possible to evaluate the function of the inferior vestibular nerve. A 22-year-old male patient was referred to our department for preoperative evaluation of a giant chondrosarcoma occupying the left cerebellopontine angle. Preoperative vHIT and VEMP revealed dysfunction of all the semicircular canals and otoliths on the affected side, suggesting impairment of both the superior and inferior vestibular nerves. Postoperatively, the vHIT and VEMP on the affected side showed improvement, confirming that surgery had improved the superior and inferior vestibular nerve dysfunction. In cerebellopontine angle tumors other than vestibular schwannomas, improvement of vestibular nerve dysfunction may be observed after decompression by surgery. The vHIT and VEMP are useful in assessing function of the superior and inferior vestibular nerves before and after surgery.