The gut microbiota (GM) is known to play an important role in health, producing vitamins and short-chain fatty acids, and regulating the immune system, and an imbalance of the GM (dysbiosis) has been implicated in several pathological conditions, including allergic diseases. Although previous reports have suggested that administration of Lactobacilli and Bifidobacterium as probiotics is effective against allergic rhinitis, few studies have investigated how the GM is involved in the sensitization to inhaled allergens.

Recently we analyzed fecal samples for bacterial 16S rRNA using next-generation sequencing in local residents. As a result, it is revealed that low counts of Bacteroidales and high counts of Bifidobacteriales or Lactobacillales in the GM suppressed sensitization to house-dust.

Furthermore, it is necessary to longitudinally examine the involvement of the GM in the onset of allergic rhinitis.

Sudden sensorineural hearing loss (SSNHL) often accompanies vertigo. A 52-year-old man with SSNHL showed persistent geotropic direction-changing positional nystagmus (DCPN) in the head-roll test, which was at first thought to occur due to “a light cupula in the horizontal semicircular canal on the affected side.” Six days later, the positional nystagmus changed to left beating direction fixed nystagmus (paralytic nystagmus). Furthermore, two months after discharge, the nystagmus changed to transient geotropic DCPN (“canalolithiasis” in the horizontal semicircular canal on the affected side), and subsequently turned again into persistent apogeotropic DCPN, thought to be caused by “cupulolithiasis;” this pattern persists until now. In the early stage, increase in the protein content of the endolymph, caused by the inner ear damage associated with SSNHL, may have increased the specific gravity of the endolymph, with consequent decrease in the relative specific gravity of the cupula, resulting in a “light cupula.” Thereafter, a possible gradual otolithic production of endolymph may have caused the mixed phenomenon of both “canalolithiasis” and “cupulolithiasis.” Finally, only “cupulolithiasis” has persisted for more than 3 months, and exercise therapy aimed at releasing the attached otolith onto the cupula, has not been entirely effective. These phenomena were thought to reflect a more severe chronic degenerative stage of SSNHL with vertigo than cupulopathy alone. Brain MRI showed no abnormal findings, while MRA showed serpiginous vertebrobasilar arteries. Hemodynamic vertebrobasilar insufficiency may cause peripheral hypoperfusion in the labyrinth, which could affect the density or viscosity of the endolymph. We speculate that disruption of endolymphatic homeostasis in SSNHL could have been involved in the transition of the nystagmus patterns in this case.

In cases with an adhesive tympanum, such as that associated with adhesive otitis media and cholesteatoma with adhesion of the ear drum, a ventilation tube is usually placed through a fascia graft, or a staged operation for insertion of the silastic plate in the tympanic cavity is performed to prevent postoperative re-adhesion.

However, since re-adhesion is still observed in some cases after these surgical approaches, we attempted to perform cartilage tympanoplasty. However, thinly sliced cartilage often curls unacceptably, making its placement difficult and less precise.

A perichondrium/cartilage island flap made from full-thickness tragal cartilage is an excellent graft, as it allows a better fit in the middle ear and never curls. The perichondrium, backed with full-thickness cartilage, shows rapid epithelialization and provides a good morphological shape of the ear drum. The tympanic cavity is secured by the rigidity of the full-thickness and the flap is maintained by the handle of the malleus or columella.

We used a tragal perichondrium/full thickness cartilage island flap for cartilage tympanoplasty in 9 cases of adhesive otitis media and 6 cases of cholesteatoma with adhesion of the ear drum. The island flaps were placed in an overlay fashion in cases with total adhesion of the ear drum, while they were placed in an underlay fashion in cases with partial adhesion of the ear drum.

All cases in which a tragal perichondrium/cartilage island flap was used for tympanoplasty showed a good morphological shape of the ear drum, and none of the cases showd postoperative re-adhesion of the ear drum.

According to the guidelines (2010) proposed by the Japan Otological Society, the hearing results of tympanoplasty using a full-thickness tragal island flap are better than those of surgery using a thinly sliced cartilage.

We recommend full-thickness grafts for cartilage tympanoplasty in cases of adhesive tympanum, because of the possibility of more precise reconstruction and better hearing results as compared to the results obtained with a thinly sliced cartilage.

Middle ear adenoma is a rare benign neoplasm, accounting for <2% of all ear tumors. These tumors show both cytomorphologic and immunohistochemical evidence of dual neuroendocrine and mucin-secreting epithelial differentiation. Herein, we report a rare case of middle ear adenoma, with the diagnosis confirmed by immunohistochemical evidence of epithelial and neuroendocrine differentiation.

A 45-year-old man presented to our hospital with a history of impaired hearing in the right ear. Otoscopic examination revealed a reddish and non-pulsatile mass protruding from the middle ear into the external auditory canal. A pure-tone audiogram showed evidence of conductive hearing impairment on the right side. Computed tomographic (CT) examination showed a soft tissue mass in the middle ear extending into the external auditory canal. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed an enhancing solid mass in the middle ear. Histopathologic examination of a biopsy specimen revealed the diagnosis of middle ear adenoma.

The tumor was surgically removed and immunohistochemical analysis of the resected specimen revealed positive staining for AE1/AE3, CK7, CK 5/6, chromogranin and synaptophysin, confirming the diagnosis of middle ear adenoma. Nine months after the surgery, tumor recurrence was observed behind the tympanic membrane. The recurrent tumor was also completely removed and tympanoplasty type III-c was performed. The postoperative course after the second surgery was uneventful, and follow-up has revealed no evidence of recurrence has been noted until now, 28 months since the surgery.

Middle ear adenoma is a benign neuroendocrine tumor arising from the middle ear mucosa. Saliba et al classified 94 cases of middle ear glandular tumors into three groups based on the presence or absence of neuroendocrine markers and metastasis; the most common was neuroendocrine adenoma of the middle ear (NEAME) (76%) (positive immunohistochemistry, negative for metastasis), followed by middle ear adenoma (MEA) (20%) (negative immunohistochemistry, negative for metastasis), and the least common was carcinoid tumor of the middle ear (CTME) (4%) (positive immunohistochemistry, positive for metastasis and/or carcinoid syndrome). According to this classification, our case was classified as NEAME. Surgical management is the recommended treatment and should be tailored to ensure complete excision. Recurrences have been reported to develop in 18%–22% of patients, and long-term follow-up is required because of the late presentation of recurrent and metastatic disease.

The number of outpatients with cedar pollinosis is known to increase markedly with the dispersal of cedar pollen in the spring in Japan. However, there are no reports yet on the total number of outpatients during the pollen season. In this study, we investigated the total number of outpatients and the number of cedar pollinosis outpatients during the 8-week period from early February to last March at our clinic in 2019, when the cedar pollen dispersal in the air was high and in 2016, when the cedar pollen dispersal in the air was low. In 2019, the cedar pollen dispersal in Omura City was 8,305 counts/cm², and 1,171 cedar pollinosis patients visited the outpatient clinic. The average number of first-time outpatient consultations for cedar pollinosis during the 8-week period was 26.4, and the number of repeat consultations was 18.6. The average number of first outpatient consultations for conditions other than cedar pollinosis was 42.6, and the number of repeat consultations was 39.4. The amount of pollen in the air in the 4th week of February was extremely high at 4,787 counts/cm², the total number of outpatients was 172.4, and the number of first consultations for cedar pollinosis was 74.8.

In 2016, the cedar pollen dispersal in the air in Omura City was 824 counts/cm², and 540 cedar pollinosis patients visited the outpatient clinic. The average number of first-time consultations for cedar pollinosis during the 8-week period was 11.9, and the number of repeat consultations was 7.6. The number of first consultations was 21.2 in the first week of March. The average number of first outpatient consultations for conditions other than cedar pollinosis was 44.0, and the number of repeat consultations was 42.7. We had vaguely recognized that there was a difference in the number of outpatients between years with high pollen dispersal and low pollen dispersal at our clinic, but here, we have revealed that the relationship between the number of cedar pollinosis outpatients and the total number of patients during the pollen season with specific numerical values.

Eruption of a tooth into the nasal cavity is rarely encountered. We report a case of an inverted supernumerary tooth in the nasal cavity. A 16-year-old man was referred to our hospital after examination at a local otorhinolaryngology clinic for right nasal obstruction. CT revealed a tooth-like structure in the right nasal cavity. Endoscopic surgery was performed under general anesthesia. The tooth-like structure, protruding from the floor of the nasal cavity and extending to the maxilla, was endoscopically removed in spite of its being strongly adherent to the floor of the nasal cavity. The diagnosis was an inverted tooth caused by abnormal eruption of a supernumerary tooth into the nasal cavity. Inverted intranasal eruption of a supernumerary tooth is rare: the majority of supernumerary teeth have been reported in the maxilla and impacted. We, otorhinolaryngologists, should bear in mind the possibility of inverted intranasal eruption of a tooth when a calcified structure is noted on the floor of the nasal cavity.

Ingested fish bone foreign bodies are not unusual, and in most cases, these foreign bodies are easily removed. However, it is difficult to diagnose and extirpate foreign bodies buried in the tongue, because there are no anatomical landmarks, such as bones, around the foreign bodies. We encountered a case with a fish bone foreign body buried in the tongue muscle. A 53-year-old woman developed pain in the tongue immediately after eating a cod, and presented with a persistent sore throat. CT imaging revealed a foreign body in the floor of the mouth and she was referred to our hospital. We attempted to remove the foreign body under local anesthesia, but it was difficult. Therefore, we performed surgery under general anesthesia. We inserted a skin staples into the tongue prior to the preoperative CT imaging, as an anatomical marker to identify the location of the foreign body in the tongue. As we were able to identify the accurate location of the fish bone buried in the tongue on CT due to our use of the skin staples as an anatomical marker, we could remove it easily.

It may be difficult to identify the precise location of a foreign body buried in the tongue. Our use of skin staples as an anatomical marker proved to be useful for removal of the foreign body buried in the tongue.

Background: Endoscopic laryngo-pharyngeal surgery (ELPS) involves the use of long-handled instruments inserted via the narrow oral and pharyngeal cavities. Acquisition of skill in ELPS involves a steep learning curve. Since no ideal training model has not been established yet for ELPS, we developed the Versatile Training Tissue (VTT) mucosal model.

Method: Nine medical students were enrolled in the surgical simulation training program using the VTT model and their transition in the performance of maneuvers was estimated using a questionnaire survey after the training.

Result: After the training, the students became more interested in head and neck surgery (mean score 6.9 before training vs. 7.8 after training; p=0.0044 after training). The training experience also increased the students’ interest in cancer treatment (mean score before training 7.3 vs. 7.9 after training; p=0.0019).

Discussion: For less experienced ELPS operators, the VTT mucosal model is useful to learn the first step of the surgical techniques. The surgical simulation training increased the participants’ interest in this field of surgery.

Conclusion: The VTT mucosal model is useful to train less experienced operators in the first step of the surgical techniques of ELPS.

Herein, we report a case of subglottic stenosis caused by intubation with a double-lumen tube (DLT).

An 80-year-old woman underwent video-assisted thoracoscopic surgery (VATS) for lung cancer. The patient was intubated preoperatively with a 32 Fr DLT. However, since it was difficult to pass the tube through the subglottic space, the tube size was changed to 28 Fr. One day later, the patient complained of hoarseness. Fiberoptic laryngoscopic examination revealed subglottic stenosis caused by mucosal edema. Emergency tracheostomy was performed under local anesthesia. By 18 days after the VATS, the subglottic stenosis had completely resolved.

The findings in this case suggest that the subglottic stenosis was caused by mechanical damage caused during endotracheal intubation with the DLT. Case reports of subglottic stenosis after intubation with DLT are common among women of age group. Clinicians should be aware of the possibility of subglottic stenosis after extubation, especially in elderly women.

Necrotizing lymphadenitis usually manifests itself with fever, lymphadenopathy and lymph node tenderness, and is more common in young women. At present, the cause of necrotizing lymphadenitis is unknown, but virus infection or vasculitis is believed to be involved. Most patients improve spontaneously and have a good prognosis, but some patients develop complications. To make a definitive diagnosis, lymph node biopsy is sometimes needed.

We report the case of a 14-year-old girl who presented with high grade fever, cervical lymphadenopathy, bilateral brachial plexus neuritis, and left conjunctival injection. Cervical MRI showed left cervical lymphadenopathy, but brain MRI revealed no abnormalities. Lymph node biopsy was performed because of persistent high grade fever and cervical lymphadenopathy, which revealed the diagnosis of necrotizing lymphadenitis. The patient’s fever and cervical lymphadenopathy improved soon after the start of treatment with prednisolone. The bilateral brachial plexus neuritis improved over a period of 3 months after the start of steroid treatment.

Necrotizing lymphadenitis and brachial plexus neuritis are diseases with no known cause, but virus infection or vasculitis is believed to be involved. In the field of neurology, doctors sometimes encounter patients with so-called neuralgic amyotrophy (NA), which is characterized by unilateral upper extremity pain, muscle atrophy and paralysis. NA is a type of idiopathic brachial plexus neuritis. Our case meets the clinical criteria for the diagnosis of NA, and the NA in this patient was thought to be a complication of necrotizing lymphadenitis.

Concurrent chemoradiotherapy (CRT) is one of the standard treatment strategies for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). While high-dose cisplatin (CDDP) administered every 3 weeks is the most commonly used chemotherapy regimen for these patients, this regimen can often not be successfully completed in all patients due to the occurrence of severe adverse events. In the present study, we conducted a retrospective review of the data of HNSCC patients treated with high-dose CDDP-CRT and examined the factors that affected the rate of successful completion of CDDP treatment.

Between 2012 to 2019, a total of 122 patients were enrolled for in this retrospective analysis. We defined CDDP completion as successful administration of a cumulative dose of ≥200 mg/m², and CDDP full dose as 300 mg/m². The associations of various clinical factors, such as the gender, age, year of treatment, primary tumor site, body mass index (BMI), pretreatment laboratory data (serum CRP, serum albumin, creatine clearance), and percent body weight loss during the treatment period with the rates of CDDP completion and rate of full dose administration were analyzed.

The cumulative CDDP dose was ≥200 mg/m² (CDDP completion) in a total of 96 (79%) patients, and 300 mg/m² (full dose) in 38 (31%) patients. While univariate analyses identified pretreatment serum albumin, year of treatment, and percent body weight loss during the treatment period as factors that significantly affected the CDDP completion rate (CDDP dose ≥200 mg/m²), age (70 years old and over), pretreatment BMI (over 25), and percent body weight loss were the only factors identified by multivariate analysis as showing independent statistically significant association.

The present findings suggest that pretreatment parameters, especially the age, BMI, and weight loss during CRT significantly influence the high-dose CDDP completion rate during CRT with high-dose CDDP.