When surgery is performed under general anesthesia in adult patients with obstructive sleep apnea (OSA), the risks include difficulty in securing the airway after induction of general anesthesia, postoperative pharyngeal obstruction, and REM rebound. In particular, tonsillectomy under general anesthesia in adult patients with OSA is associated with the potential for further upper airway obstruction due to wound and airway edema and difficulty in endotracheal intubation due to postoperative bleeding. Therefore, when considering tonsillectomy under general anesthesia in patients with severe OSA and severe obesity who are expected to have severe upper airway narrowing, tracheostomy has been used as a prophylactic measure for safe and reliable securing of the airway. In this study, we reviewed the characteristics of 77 adult patients who underwent tonsillectomy under general anesthesia for OSA at the Department of Otolaryngology, Aichi Medical University, over the past 10 years and examined whether the risk of postoperative bleeding could be retrospectively predicted from the analysed factors.

　　Significant differences were found between the tracheostomy and non-tracheostomy groups in the body mass index, severity of OSA, sleep architecture, severity of hypoxemia during sleep, frequency of postoperative bleeding and hemostasis, prevalence of a low soft palate, prevalence of enlarged palatine tonsils, intubation difficulty, prevalence of upper airway stenosis, and use of indirect laryngoscopy during intubation and the BMI were identified as factors predictive of postoperative bleeding and hemostasis. In addition, the cutoff values of the BMI for predicting airway compromise and considering tracheostomy were investigated.

　　Prevention of postoperative airway obstruction after palatoglossal tonsillectomy in adult patients with OSA is discussed.

　　We examined the characteristics and long-term progression of late-onset hearing loss in children with congenital cytomegalovirus (cCMV) infection. From 1998 to 2023, we encountered a total of 38 cases of cCMV infection, with a recent increase in the number of cases diagnosed through CMV DNA testing of the dried umbilical cord by real-time quantitative PCR and a prospective cohort study involving CMV antibody screening of pregnant women. In the neonatal period, the hearing status in the children were as follows: bilateral hearing loss in 4 cases, unilateral hearing loss in 9 cases, normal hearing in 21 cases, and unknown status in 4 cases. At the most recent evaluation, there were 14 cases of bilateral hearing loss, 7 cases of unilateral hearing loss, and 17 cases with normal hearing. Four children were found to have hearing loss at the initial visit to our hospital, despite passing bilateral NHS, and were diagnosed as having late-onset hearing loss. One of these children was diagnosed as having had cCMV infection in the neonatal period, following seroconversion of maternal antibodies, and had received antiviral therapy. The following characteristics were observed in the cases of late-onset hearing loss: First, the onset of hearing loss was between the ages of 1 and 5 years. Second, in 3 cases, excluding those with profound bilateral hearing loss at the initial diagnosis, differences in hearing levels between the ears were observed. Third, in these 3 cases, the hearing loss progressed and steroid therapy had limited effect. Fourth, the proportion of children with motor developmental delays was significantly higher in these children as compared with that among asymptomatic children with no hearing loss.

　　In cases of asymptomatic cCMV infection with motor developmental delays observed from infancy to early childhood, thorough hearing evaluations should be performed. Early detection of asymptomatic cCMV infection through urine testing of all newborns is crucial, along with the establishment of treatment guidelines for late-onset and progressive hearing loss.

　　Peritonsillar abscess is a condition that occurs secondary to acute tonsillitis, and can lead to serious complications such as spread of inflammation to the deep neck and mediastinum, airway obstruction due to laryngeal edema, and internal jugular vein thrombosis. In 2018, we introduced immediate tonsillectomy as a treatment strategy for patients with severe peritonsillar abscess for whom conservative treatment and oral incisional drainage alone are considered insufficient. In this study, we reviewed 8 cases of peritonsillar abscess in children who visited our hospital during the 10 year period from 2013 to 2023. We also report six children with peritonsillar abscess who underwent peritonsillar tonsillectomy. Five of these cases were diagnosed as having a peritonsillar abscess within a short period of 4 months and were treated by peritonsillar tonsillectomy.

　　The optimal method of intracordal injection (shallow of the lamina propria or muscular layer) of trafermin for voice improvement is not yet clear. We retrospectively reviewed the medical records of 26 patients with vocal fold atrophy and other disorders who underwent intracordal trafermin injection under general anesthesia at our hospital between 2014 and 2023. The endpoints of the study were changes in the Voice Handicap Index and Maximum Phonation Time after the injection as compared with the values prior to the injection. Voice improvement was more pronounced in the group that received trafermin injections into the shallows of both the lamina propria and muscular layers than in the other groups, with particularly significant improvement noted in patients with vocal fold paralysis. Analysis by disease and site of injection showed statistically significant differences.

　　 Trafermin injection into the shallows of both the lamina propria and muscular layers may be effective for improving the voice.