The prognosis of parotid gland carcinoma, which presents with a variety of histological types and different grades, is diverse. The purpose of this study was to examine the prognostic factors and to provide protocols for handling the facial nerve and neck dissection, which are important issues in surgery. Fifty-three patients with parotid carcinoma who underwent initial surgery in our department between 2000 and 2020 were included in the study. The histopathological types were classified into 13 types. Salivary duct carcinoma and mucoepidermoid cancer were frequently observed in 13 (25%) and 12 (23%) cases, respectively. The majority of cases (54%) had a high histological grade. A univariate analysis showed that predictors of a poor prognosis included a high grade, T3 or higher, lymph node metastasis, stage IV, and facial nerve palsy, with lymph node metastasis being a particularly strong predictor. In our department, the treatment policy concerning the facial nerve changed during the study period from “in principle, resection of all branches in case of malignancy” to “preservation as much as possible if detachment is possible.” No significant difference in the survival rates for before and after this policy change was seen, and it was possible to save cases of local recurrence among the cases with preservation. Thus, the policy of preserving the facial nerve as much as possible did not seem to pose a problem. As for neck dissection, there was a risk of metastasis to the entire neck region, and a total neck dissection was considered appropriate. In particular, the rate of lymph node metastasis was high among patients with a high grade and a stage of T3 or higher, and a prophylactic neck dissection should be performed in these high-risk patients even if they are preoperatively negative for cervical lymph node metastasis. In addition, a frozen section biopsy of the level II lymph nodes may be useful for determining the extent of dissection.

　Unlike other congenital diseases, the incidence of congenital cholesteatoma has rarely been discussed. Herein we investigated the epidemiological aspects of congenital cholesteatoma, especially the incidence of the disease. A retrospective medical chart review was performed of patients who had undergone surgical treatment for congenital cholesteatoma in Oita prefecture from January 2000 to March 2021. A total of 48 cases were recruited (mean age, 6.04 years), including one case with bilateral disease. Of these patients, those born between 2000 and 2016 were divided by the year of birth. Then the number of newborn births per year in Oita prefecture was investigated, and the incidence of the congenital cholesteatoma was calculated as 28.0 per 100,000 births. In addition, the analysis revealed that the incidence increased and the age at diagnosis became lower over the years. A comparison of the cases in the first half and the second half of the study period revealed that the number of cases treated by surgery was higher in the second half, although there was no significant difference in the patient age at surgery between the two periods. However, a tendency towards more patients with early-stage disease undergoing surgical treatment was observed in the second half. The most common presenting feature in patients with congenital cholesteatoma was otitis media in children younger than 6 years old, whereas it was subjective hearing loss in most patients older than 6 years old.

　Therefore, the incidence of congenital cholesteatoma was estimated as 28.0 per 100,000 birth. The number of the surgeries for this disease has increased over the years, which could be due to higher efficiency of its detection. In recent years, more and more patients have tended to be diagnosed earlier.

　Sublingual immunotherapy with tablets for the treatment of Japanese cedar pollinosis currently does not have any age restrictions. Until May 2018, the treatment was administered as a liquid preparation, and the indication was for individuals who were 12 years or older. Previous reports on sublingual immunotherapy have not sufficiently examined medication adherence, clinical effects, and side reactions in children and adults. Using the results of a questionnaire that was previously used in past surveys, we have newly analyzed the statistical differences in clinically important factors such as pediatric and adult medication adherence, clinical effects, and side reactions. These results are reported along with a review of the literature. The subjects were 1017 patients with Japanese cedar pollinosis who started sublingual immunotherapy between 2014 and 2018 and were continuing to receive this treatment. The age distribution ranged from 12 to 79 years. Most of the subjects were in their 40s, followed by those in their 10s. At the start of the survey, subjects under the age of 15 years were classified as children and those over the age of 15 years were classified as adults. We distributed a self-written questionnaire at the end of each pollen dispersal season. The survey items included adherence to medication for children and adults, the burden of daily sublingual administration, sex (specific effects of sublingual immunotherapy according to sex), and the duration of illness as adjustment items, as well as the use of concomitant drugs and side reactions. A multiple logistic regression analysis was performed with adjustments for sex, duration of illness, and medication adherence to examine overall treatment satisfaction. The results showed no statistically significant differences between children and adults for all seasons that were analyzed (multiple logistic regression analysis). In other words, sublingual immunotherapy for Japanese cedar pollinosis had the same effect in children as it did in adults.

　This study indicated that sublingual immunotherapy was highly safe and satisfying even in children, and no differences in therapeutic effect were seen between children and adults. In addition, this study showed that relatively mild side reactions appeared during the first season, especially among women. Further analysis of the differences between children and adults regarding how long the therapeutic effect will persist after the end of a 3-to-5-year treatment period is needed.

　Among patients with seasonal allergic rhinitis, there is a subgroup of patients with severe or most severe disease, for whom existing treatments are not sufficiently effective. In December 2019, omalizumab was approved for the treatment of such severe cases of seasonal allergic rhinitis. Because it is a very expensive drug, this study was conducted with the aim of finding precautions for proper use. We analyzed 20 patients with severe Japanese cedar pollinosis treated with omalizumab who visited our department in 2021 and determined the effects of omalizumab on their quality of life and labor productivity using the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ) and Work Productivity and Activity Impairment-Allergy Specific (WPAI-AS). The questionnaire survey was conducted at the time of the first administration of omalizumab and approximately 1 month later, and the results were compared. The results indicated improvement of both the JRQLQ and WPAI-AS scores. In addition, in the final survey, 15 of the 18 patients who were available to respond to our question indicated that they were happy with having used omalizumab for their symptoms that year. As adverse events, one 81-year-old man developed polymyalgia rheumatica after the second dose. The drug proved ineffective in one 53-year-old woman; this patient was sensitized to multiple antigens, and had coexistent bronchial asthma and perennial rhinitis. She showed no subjective improvement of the nasal congestion after omalizumab treatment. For treating the nasal congestion in this patient, the cause needs to be scrutinized more carefully, and the combination of immunotherapy or surgery may be considered. The effects of omalizumab and the satisfaction level with the treatment were generally high for patients with severe Japanese cedar pollinosis, but because it is an expensive drug, it is important to identify the correct candidates for treatment with omalizumab, to ensure appropriate use of the drug.

　Pott's puffy tumor (PPT) was first reported by Percival Pott in 1768, and is a rare disease that is characterized by the formation of a soft subperiosteal abscess on the forehead due to frontal osteomyelitis. A 46-year-old man with no history of frontal surgery, trauma, or underlying disease visited our hospital with the complaints of fever and swelling of the forehead. Imaging showed an osteolytic lesion of the frontal bone caused by osteomyelitis, with a contiguous subperiosteal abscess of the forehead, and soft tissue shadows in the right frontal sinus and other paranasal sinuses. The subperiosteal abscess was drained by external incision, and the sinuses were opened and washed endoscopically. After the operation, the infected lesion was washed and antibiotics were administered. At 10 months after treatment completion, no recurrence was observed and bone regeneration of the osteolytic lesion was confirmed.

　With the widespread use of antibiotics in recent years, the number of reported cases of PPT has decreased, and although it is fairly rare, it is important for otorhinolaryngologists to be well aware of this disease, as it can sometimes become fatal because of secondary intracranial infection.