Organized hematoma is a benign pseudotumor formed by bleeding and inflammation in the maxillary sinus and has conventionally been treated by Caldwell-Luc surgery and preoperative embolization. In recent years, endoscopic surgery has been used, and some reports suggest that preoperative embolization may be unnecessary. However, no study of the treatment methods has been performed with adjustments for patient selection bias. At our department, we have begun to gradually adopt less invasive treatment methods. Herein, we report the differences in the blood loss among the treatment methods, with some discussion of the literature.

　Data of 5 patients with organized hematomas treated at the Department of Head and Neck Surgery, Tokyo Medical and Dental University, between November 2018 and June 2020 were retrospectively reviewed. The odds ratios of bleeding by the treatment methods were calculated by multivariate logistic regression analysis of previously reported cases. P-values of less than 0.05 were considered as denoting statistical significance. The patients ranged in age from 13-53 years, and consisted of 3 men and 2 women. Preoperative embolization was performed in two cases. Two patients underwent Caldwell-Luc surgery and three patients underwent endoscopic surgery alone. The Endoscopic Modified Medial Maxillectomy (EMMM) approach was used for the endoscopic surgery. The blood loss ranged from 31 to 384 ml, and the operative time ranged from 1 hour 14 minutes to 2 hours 32 minutes. There was a trend toward less bleeding in the patients who had undergone endoscopic procedures. In a multivariate analysis of previously reported cases, blood loss of greater than 200 ml was significantly less frequent in the endoscopic surgery group than in the external incisional surgery group. There was no significant difference in the outcome depending on whether preoperative embolization was performed or not.

　Endoscopic surgery without preoperative embolization for organized hematoma is safe. EMMM is the most suitable surgical approach, because of the wide surgical field that it affords in the maxillary sinus.

　It is generally agreed that advanced age should not be a contraindication to cochlear implant surgery in the elderly. However, there seem to be a higher incidence of surgical complications and poorer auditory performance with cochlear implants in this population. Thus, it is sometimes difficult to determine if even elderly patients who satisfy the eligibility criteria for cochlear implant surgery are suitable candidates for the surgery. Herein, we present the surgical and hearing outcomes of elderly patients aged 65 years old or over who underwent cochlear implantation at our hospital. The subjects were divided into two groups according to their age at the time of cochlear implantation: the young-old group (65 to 74years, n=16) and the older group (75 years old or over, n=15). The outcomes in the elderly patients were also compared with those in patients who were 64 years old or under who had undergone cochlear implantation (a control group, n=21). There were no significant differences in the duration of hearing loss or in the auditory performance before cochlear implantation among the three groups. The young-old and older groups of patients had more comorbidities as compared to the control group, whereas no significant differences in the duration of hospitalization or complications related to the cochlear implantation were observed among the three groups. After cochlear implantation, no significant differences were observed among the three groups in the hearing threshold, while the speech discrimination score at 65dB HL was lower in the young-old group as compared to the control group. The age at cochlear implantation was negatively correlated with the highest speech discrimination score measured within two years after the surgery. Although cochlear implant surgery is relatively safe even in elderly patients, the indications for cochlear implantation should be determined more carefully in this population.

　Nebulizer therapy is an effective and safe topical treatment for managing rhinosinusitis and is frequently adopted by otolaryngologists in Japan. However, the treatment methods used vary among regions and according to the doctors' preferences. We report the results of a questionnaire survey that we conducted on nebulizer therapy for managing rhinosinusitis. As adoption of nebulizer treatment has also been affected by the coronavirus disease (COVID-19) pandemic, we further investigated the difference in the prevalence of nebulizer use before and during the pandemic.

　In August 2020, we mailed a questionnaire on the use of nebulizer therapy for managing rhinosinusitis to otorhinolaryngologists who were members of the Oto-Rhino-Laryngological Society of Japan, in Aomori, Saitama, Mie, Fukui, Shiga, Okayama, and Kagoshima prefectures.

　More than 90% of the otorhinolaryngologists prescribed nebulizer treatment for managing rhinosinusitis before the onset of the COVID-19 pandemic. In April 2020 (the first wave of the COVID-19 pandemic), the usage rate decreased to 20%, but in August 2020, it increased again to 60%. In terms of the infection control measures adopted, 306 (78.7%) respondents said “ensure ventilation by opening windows,” while 290 (74.6%) said “social distancing.” However, several facilities had adopted new infection control measures. As for measures taken by the medical staff, the usage rate of masks was high, but the rate of wearing gloves was low, suggesting that it is still necessary to educate medical staff on standard preventive measures. Droplet or contact transmission is the main route of transmission of COVID-19. To safely administer nebulizer therapy during the pandemic, each medical institution should adopt and practice sufficient infection control measures.

　I report two rare pediatric cases of pediatric Mycoplasma pneumoniae pneumonia complicating acute epipharyngitis. The patients, both girls, aged 9 and 10 years, presented with the symptoms of fever, sore throat, and headaches. They also had gradually worsening dry cough, but were in good general condition. Based on the endoscopic findings of the epipharynx, visualization of cordlike and cloudy opacities in both lung fields in a chest radiograph, a normal white blood cell count, mildly elevated serum CRP, positive result of the rapid test for M. pneumoniae using a pharyngeal swab, detection of M. pneumoniae by culture from the epipharynx, and elevated serum M. pneumoniae antibody titers, we established the diagnosis of pediatric M. pneumoniae pneumonia complicating acute epipharyngitis. Testing for M. pneumoniae, including rapid testing, is recommended in school-age children presenting with similar symptoms and clinical courses to those described above for the two patients reported herein.

　Superficial siderosis (SS) is a very rare disease that results from chronic or intermittent bleeding into the subarachnoid space, resulting in the deposition of hemosiderin in the brain and/or spinal cord. The major manifestations are hearing loss and ataxic gait, both of which are oft-encountered symptoms in the field of otolaryngology. The present report describes the case of a 77-year-old female patient with bilateral hearing loss and ataxic gait. The patient had visited several hospitals, but no definitive diagnosis had been made. At our hospital, quantitative testing was performed, including the video head impulse test, to evaluate vestibular function, which revealed bilateral vestibulopathy. Brain magnetic resonance imaging revealed low-intensity changes along the Sylvian, interhemispheric fissures, cerebellar folia and brainstem. Finally, the patient was diagnosed as having SS. In general, ataxic gait in patients with SS is considered to be due to cerebellar dysfunction caused by hemosiderin deposition in the cerebellar folia. However, we concluded that our patient suffered from ataxic gait because of bilateral vestibulopathy arising from hemosiderin deposition in the eighth cranial nerve. The patient is scheduled to receive treatment with hemostatic drugs and vestibular balance rehabilitation therapy.