Cochlear implant (CI) technology, surgical technique, and candidacy criteria continue to rapidly evolve. Although outcomes are steadily advancing, there is still room for improvement.
CI patients with residual hearing in the implanted ear can combine both electrical and acoustic stimulation (EAS/Hybrid CI) to improve speech perception, particularly in the presence of background noise. Binaural advantages are found in both adult and pediatric bilateral CI recipients, in terms of improved sound localization and enhanced speech perception under noisy conditions. Instead of widespread implantation in children younger than 12 months, evidence that supports infant implantation, with regard to speech perception and production outcomes, is still limited and of low quality. Long-term, high quality studies concerning both bilateral CI and infants’ CI are needed.
While the long-term reports show that many profoundly hearing-impaired children using CI can develop functional levels of speech perception and production, attain age-appropriate oral language, and achieve satisfactory academic performance, cochlear implantation in younger children should be performed by skilled surgeons, provided that the attending pediatric anesthesiologist is considerably experienced and appropriate pediatric perioperative care facilities are readily available.
In advanced future CI technology, gene therapy and/or regenerative medicine should be introduced to and combined with CI to preserve both auditory and vestibular function even after CI surgery, which might help it reach to a higher stage as the most successful innovation in the rebirth of artificial sense.

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Chiari malformation type I, a congenital condition, the distorts and displaces cerebellar tonsils, inferior cerebellum, and medulla and involoves invagination from the foramen magnum into the upper cervical canal. We report 2 such pediatric cases.
Detailed medical histories were obtained for both the-7-year old girl and the boy, who was 3 years and 7 months old, together with routine equilibrium function examinations, neurootological tests, electronystagmography (ENG), and stabilometry. No choked discs were observed on fundoscopy in either case. Vertical downbeat nystagmus through the Frentzel spectales and saccadic pursuits in circular eye tracking tests (CETT) with ENG both suggested cerebellum and brainstem disturbance in the optokinetic pattern test (OKP), and obvious abnormal ities were seen in upright standing control in stabilometry, confirened in magnetic resonance imaging (MRI) centering on the posterior cranial fossa, especially the cerebellumand brainstem. Both were diagnosed with Chiari malformation type I in T1-enhanced imaging. In diagnosing subjects with dizziness and equilibrium disturbance, we can emphasize the importance of detailed inquiry backed by considerable experience among function the physician involved important information souces in both of these cases.

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A 36-year-old man who had undergone endolymphatic sac surgery suffered from sensorineural hearing loss in the same ear after breathing strongly through his nose and hearing a “pop”. Based on persistent dizzy spells and profound hearing loss, we made diagnosis of perilymphatic fistula and conducted exploratory tympanotomy. We closed the obvious round window fistula during surgery using fascia, reducing dizziness and sensorineural hearing loss.
To prevent perilymphatic fistula after otological surgery, we administered olopatadine 10 mg/day for 2 weeks just after surgery. In comparison to cases not given olopatadine, those given postoperative olopatadine showed an apparent decrease in the incidence of profound sensorineural hearing loss, probably due to perilymphatic fistula.

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Objective: I studied how acute otitis media (AOM) damaged the inner ear.
Subjects: Subjects numbered 94 with AOM 102 ears 16 to 81 years old (average: 44.7 years) seen at Suzuki ENT clinic from August 2007 to July 2009.
Method: All underwent pure-tone audiometry. Inner ear damage was diagnosed under 3 conditions: (1) continuous tinnitus or dizziness, (2) bone-conduction threshold exceeding 25 dBHL and above the threshold of the unaffected side by 15 dB or more at least 1 frequency, and (3) post treatment bone-conduction threshold improving over 15 dB in bilateral cases. Those with inner ear damage were treated by oral mecobalamin and adenosine triphosphate, and many had betamethasone added.
Results: (1) Inner ear damage was noted in 34.3%. (2) One subject reported dizziness without nystagmus. (3) The group with inner ear damage showed significantly higher damage than that without in terms of cochlear symptoms such as hearing loss, tinnitus, and ear fullness and with large blisters on the tympanic membrane. (4) Large blisters on the tympanic membrane were detected in the 8 months from February to September. (5) After treatment, tinnitus disappeared in all cases with continuous tinnitus and without bone-conduction threshold deterioration. In those with bone-conduction threshold deterioration, 91.3% showed complete recovery and 8.7% partial recovery.
Conclusions: Bullous myringitis is associated with AOM-induced inner ear damage. Inner ear damage is not rare, so we must check for that related to AOM. Audiometric testing is recommended in cases of AOM with cochlear symptoms or tympanic membrane blisters.

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Nontuberculous mycobacteria (NTM), a human skin commensal, generally has poor in-vitro susceptibility to standard antituberculous drugs, and surgery is recommended for head and neck infection, but recently studies indicate that combining antibiotics in treating mycobacterial infections helps to avoid drug resistance. In the only case reported thus far to our knowledge, we found positive results in conservative treatment (using clarithromycin) alone in NTM.
A 3-year-old boy with left parotid gland swelling despite two week antibiotic treatment was found in computed tomography (CT) and ultrasonography (US) to have a parotid tumor and granulomatous inflammation. Follow up after four-week clarithromycin administration showed that the mass had disappeared completely.
In conclusion, NTM lymphadenitis is treatable using clarithromycin only.

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Pleomorphic adenoma, as the most common salivary gland tumor, primarily involves major glands, especially the parotid gland. Minor glands involve, mostly the palate, being relatively uncommon in the cheek. The malar region is close to important organs and malignant tumors, making sufficient preoperative examinations important. To date however, few reports have discussed the usefulness of the variety of examinations. We report a case of pleomorphic adenoma of the minor salivary gland originating in the cheek. A 56-year-old man having a minor left-cheek salivary gland tumor found 10 years ago removed en bloc through the oral cavity for cosmetic reasons has experienced no recurrence in the 2 years since. The extracted tumor was 60×40×30 mm and weighed 50 g. We thus strongly recommend computed tomography, magnetic resonance imaging, sialography, facial nerve excitability testing, and cytodiagnosis in evaluating such lesions.

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In a retrospective clinical peritonsillar abscess study, we reviewed 215 cases—169 men and 46 women from 8 to 85 years old (median: 34.5)—hospitalized and treated between January 2001 and December 2009. Of these, 111 (51.6%) were affected on the right side, 99 (46.0%) on the left, and 5 (2.3%) bilaterally. Abscess formed in the superior poles of 192 (89.3%), the inferior of 19 (8.8%), and bilaterally in 4 (1.9%). The smoking ratio was 78.6% in men and 48.7% in women. Bacteriological examination in 127 showed etiological bacteria of 107 strains—70 aerobic—mostly S. milleri (41.4%) and S. pyogenes (31.4%)—and the remainder anaerobic—Bacteroides (29.7%), Porphyromonas (29.7%), and Peptostreptococcus (21.6%). The ratio of antibiotic bacteria resistance was 22.4% to PIPC, 5.6% to FMOX, 11.2% to CLDM, 6.5% to LVFX, and none to IPM/CS. Of our subjects, 141 (65.6%) were treated by incision, 34 (15.8%) by puncture, 38 (17.7%) by antibiotics, and 2 (1.0%) by abscess tonsillectomy. Antibiotics used most often were FMOX combined with CLDM. Among our 28 subjects (13.7%) undergoing tonsillectomy—2 abscess and 26 interval—69.2% felt that acute peritonsillar abscess throat pain was severer than postoperative tonsillectomy pain. Peritonsillar abscess recurred in 26 (12.7%), with younger subjects outnumbering older in tonsillectomy and recurrence of peritonsillar abscess.
We recommend tonsillectomy after acute inflammatory healing in those with peritonsillar abscess recurrence and habitual angina.

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Nasopharyngeal carcinoma has varied symptoms that often trigger its diagnosis, e.g., nasal symptoms, hearing loss, neck lymph node swelling, and diplopia, but rarely dysphagia or dysarthria caused by lower cranial nerve palsy.
We report two cases of nasopharyngeal carcinoma. In case 1, a 74-year-old woman with dysphagia and dysarthria was found in magnetic resonance imaging (MRI) to have a bulky mass from the nasopharynx to the parapharyngeal space, tongue fasciculation, and left vocal cord palsy. Nasopharyngeal biopsy showed keratinizing carcinoma, which caused IX, X, and XII cranial nerve palsy. In case 2, a 77-year-old man with hoarseness and dysphagia was found in MRI to have a bulky mass similar to case 1, left vocal cord palsy, and left oropharyngeal paralysis. Biopsy showed undifferenciated carcinoma. Nasopharyngeal carcinoma caused IX and X cranial nerve palsy. Lower cranial nerve palsy should thus suggest the possibility of parapharyngeal space lesions.

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Fishbones commonly lodge in the pharynx and are usually found in direct vision or pharyngolaryngoscopy. They perforate the pharyngeal or esophageal wall and penetrate the thyroid gland relatively rarely. We report three unusual cases involving fishbone migration to extrapharyngeal space. Case 1 was a 52-year-old woman reporting foreign-body sensation after swallowing a fishbone. Computed tomography (CT) showed a fishbone behind the right tonsil, removed orally in right tonsillectomy and ultrasonography. Case 2 was an 88-year-old woman reporting painful dysphagia. Ultrasonography detected a strong linear echo extending from the esophagus to the left thyroid gland lobe. The bone was removed in endoscopy, followed by an uneventful course. Case 3 was a 93-year-old woman seen for pharyngeal and anterior neck pain, found endoscopically to involve a fishbone stuck in the esophageal wall and removed endoscopically. After removal, cervical CT showed air retained in and around the left thyroid gland lobe. Cervical CT 11 days later showed a thyroid gland abscess. We continued administering antibiotics and drained pus through a syringe, enabling a successful, nonsurgical conclusion. Some 14 cases of fishbones penetrating the thyroid gland have, to our knowledge, been reported, with 13 requiring surgical intervention. Successful conservative nonsurgical intervention thus appears to be the first case in Japan of an acute thyroid abscess so treated.

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Superior vena cava syndrome occurs when the superior vena cava and subsequent collateral veins of the thorax, neck, and head are obstructed, most commonly by a malignant neoplasm such as lung cancer.
We discuss a case due to seminoma. A 31-year-old man referred for further recurrent facial and neck swelling examination, was found in chest radiography to have an abnormal shadow and shown in computed tomography (CT) scan to be a large mass of the anterior mediastinum diagnosed by aspiration cytology as seminoma. After radiotherapy, the tumor shrank markedly and neck swelling disappeared. The man underwent chemotherapy for maintenance after radiotherapy.
Although commonly encountered by pulmonary physicians and surgeons superior vena cava syndrome is rarely seen by otolaryngologists who should consider this disease in subjects reporting afebrile, painless cervical swelling.

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Radiation therapy in head and neck malignancy often triggers mucositis poorly controlled by nonsteroidal antiinflammatory drugs (NSAIDs). To better understand how such pain develops, we studied numerical rating scale (NRS 0-5) pain scores from 30 subjects undergoing 60-72 Gy radiation for newly diagnosed oropharyngeal and hypopharyngeal cancer between March 2004 and May 2009, and divided by treatment into 18 from March 2004 to July 2007, and 12 from August 2007 to May 2009. Opioids were given to those in the first group with severe pain and to those in the second group with milder pain treated earlier.
Tube feeding was required in seven cases (38.9%) in the first group and in one (8.3%) in the second group.
Earlier opioid administration effectively reduced radition-induced mucositis pain.

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Cineradiography enables the second stage of swallowing to be analyzed visually in hyoid and laryngeal movements during swallowing, but cost and preparation time have limited its clinical dissemination.
To overcome this, we computerized quantitative video fluorographic imaging using commercially available DIPP-Motion Pro 2D^® software. This has the advantages of 1) DV images are fed to the computer as animation and analyzed directly; 2) numerous points can be marked and tracked automatically, 3) with coordinate setting and scale correction, movement distance and velocity are measured automatically, and 4) functions synchronizing graphs with cineradiography video facilitate visual understanding.
We quantitatively studied swallowing in 6 subjects without dysphagia. Median hyoid bone movement is 10.5 mm on the abscissa and 16.2 mm on the ordinate. Median laryngeal movement is 9.3 mm on the abscissa and 25.1 mm on the ordinate. Maximum bolus is 1011.3 mm/sec. We analyzed swallowing conveniently and effectively, displaying data with visual information. This makes it a handy tool for analyzing swallowing quantitatively in clinical practice. It also enables us to exchange information effectively with other medical personnel and gain informed consent.

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We studied treatment satisfaction in 1,903 subjects with Japanese cedar pollinosis, seen in Gifu Prefecture institutions in 2009, a mass scattering year. Institution physicians determined the choice of therapeutic drugs. We evaluated subject satisfaction and symptoms by questionnaire using nasal and eye symptom scores evaluated by the visual analog scale (VAS) in the pretreatment stage, in the stage with the severest symptoms, and in the posttreatment stage. Antihistamines were most widely used, followed by topical nasal steroids, and leukotriene antagonists, in this order. More subjects were treated with 2 types of drug combined than with a single drug alone. Satisfaction (very good plus good) was found in 68.8% of 747 subjects. The most frequent cause of dissatisfaction was insufficient therapeutic effect. Higher nasal symptom VAS was significantly related to satisfaction.

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