Otitis media (OM) is one of the most common infectious diseases encountered in children. Acute otitis media (AOM) occurs most frequently in the first year of life, and more than half of all children have suffered from otitis media by the age of 3 years. Otitis media with effusion (OME) is also prevalent in children by the age of 6 years. Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis are the major causative bacteria of acute otitis media. These bacteria are also detected in middle ear effusion fluid sampled from patients with OME. Various factors, including environmental, host, and bacteriological factors, are involved in the recurrence of AOM and transition to chronic OM. Because of the varied manifestations of OM, basic research using animal models is important for investigating the pathology of OM and mucosal immunity, in order to elucidate its basic features as a disease entity. However, results in animal models may differ from the pathological findings of OM in humans, and their applicability to humans with OM needs to be carefully considered. To date, research on mucosal vaccines against otitis media has been conducted mainly in animal models, and intranasal, sublingual, and subcutaneous routes of delivery of mucosal vaccines are being developed with the aim of inducing protective immune responses against mucosal pathogens in the upper airway. In this article, we report on animal models of OM and on the recent approaches adopted for the development of mucosal vaccines, which are expected to lead to clinical application of the vaccine.

We investigated the hearing improvement rate and perforation closure rate after tympanoplasty for chronic otitis media (OMC) at our department. We recruited 194 cases of OMC who had undergone tympanoplasty at our hospital between April 2006 and March 2018. We evaluated the postoperative hearing improvement rate based on the Guideline for Reporting Hearing Results in Middle Ear and Mastoid Surgery (2010), and also the perforation closure rate. The overall hearing improvement rate was 88.1%. The hearing improvement rates in type I, type III and type IV tympanoplasty were 92.3%, 76.5%, and 25.0%, respectively. From 2006 to 2011, we performed atticotomy in combination with type I tympanoplasty in the 17.1% of patients with limited ossicle movement, and the hearing improvement rate was 80.0%. From 2012 onwards, 100% of patients with limited ossicle movement underwent atticotomy in combination with type I tympanoplasty, and the hearing improvement rate improved to 92.9%. The overall perforation closure rate was 89.2%. The perforation closure rate was 89.8% in Grade 1 cases, 88.8% in Grade 2 cases, 88.2% in Grade 3 cases, and 90.9% in Grade 4 cases. There was no difference in the perforation closure rate depending on the size of the perforation. The hearing improvement rate at this hospital was 88.1% and the perforation closure rate was 89.2%, which was comparable to other reports. Hearing results are often reported to be worse for type III tympanoplasty as compared to type I tympanoplasty and for type IV tympanoplasty as compared to type III tympanoplasty, and the present results are consistent with previous reports. Since 2012, our decision to perform atticotomy aggressively for patients with restricted movement of the ossicles was appropriate, both in terms of the efficacy and safety. No relationship was found between the size of the perforation and the perforation closure rate.

Rosai-Dorfman disease (RDD) is a rare histiocytic disorder of unknown etiology, that is characterized by swollen cervical lymph nodes, fever, leukocytosis, and hypergammaglobulinemia. We diagnosed RDD in a 52-year-old Japanese female patient who presented with a 2-year history of right nasal obstruction. The patient had a mass lesion arising from the nasal septum that occupied the right nasal cavity; there was no lymphadenopathy or other typical symptoms. Contrast-enhanced CT revealed an almost uniformly enhancing mass in the right nasal cavity, and there was no evidence suggestive of malignancy, such as bone destruction. We performed endoscopic sinus surgery, and resected the mass. Histopathological examination revealed the diagnosis of RDD. Histopathological examination is essential for a definitive diagnosis of RDD, and emperipolesis (intact lymphocytes taken up by histiocytes) is a characteristic histopathological feature.

As in this case, only extranodal involvement may be observed. Since some cases have systemic symptoms and a poor prognosis, it is important to recognize this disease.

We reviewed the clinical data of 14 patients with mucosal malignant melanoma of the nasal/paranasal cavity from among 78 patients diagnosed as having malignant nasal/paranasal cavity tumors at our hospital between 2008 and 2018. There were 4 men and 10 women, aged 49–85 years (median: 69.0). The clinical TNM classification according to the 8th American Joint Committee on Cancer and the International Union Against Cancer Control (AJCC/UICC) was as follows: T3, 9 cases; T4a, 4 cases; T4b, 1 case; N0, 13 cases; N1, 1 case; stage III, 9 cases; stage IVA, 4 cases; stage IVc, 1 case. The overall 2-year, 3-year and 5-year survival rates (Kaplan-Meier method) were 50.0%, 42.9%, and 42.9%, respectively. The 2-year, 3-year and 5-year local control rates (Kaplan-Meier method) were 42.9%, 42.9%, 32.1%, respectively. Examination of the prognostic factors by univariate analysis showed that the prognosis was significantly poor in patients with cT4 or higher, with tumors in the sinuses, and with distant metastases. Examination of the surgical cases showed that distant metastases developed in 58.3% of cases even after complete resection by surgery. Control of distant metastasis is considered as being a problem that needs to be resolved in order to improve the treatment results of mucosal malignant melanoma of the nasal/paranasal cavity.

Orbital tumors can be of diverse histopathological types. Since the treatment policies differ considerably by the histopathological type, a histopathological diagnosis is essential. In particular, in patients presenting with visual impairment, surgery is needed for both the diagnosis and treatment.

The surgical approaches used for orbital tumors are broadly classified into transnasal, transorbital, and transcranial approaches. The appropriate approach for each case is mainly selected based on the position of the tumor.

We encountered a case of orbital hemangioma associated with visual impairment, that was resected via the transnasal endoscopic approach. A 58-year-old man visited our hospital with the chief complaint of progressive left visual impairment. Imaging revealed a mass lesion at the tip of the left orbit. Dynamic MRI revealed peripheral nodular enhancement, and a cavernous hemangioma was suspected. Since the tumor was thought to be the cause of the visual impairment, surgery was performed for both diagnosis and treatment. The tumor was located outside the muscular cone inside the orbit, which was a good indication for surgery via a transnasal endoscopic approach. After the operation, the patient’s visual acuity improved, and the tumor had not recurred until the last follow-up at two years after the surgery.

Thus, there are orbital tumors that can be resected non-invasively via the transnasal approach, and otorhinolaryngologists can contribute to the treatment of such tumors.

Pott’s puffy tumor refers to a forehead swelling caused by a frontal-bone sub periosteal abscess.

We report the case of a 16-year-old woman with acute rhinosinusitis who developed fever, headache, and a forehead swelling. Her symptoms improved with antibiotic therapy and she was discharged from the hospital on the fifth day. On the sixth day after discharge, she presented with a relapse of rhinosinusitis, and was diagnosed by cranial computed tomography (CT) as having the intracranial computation of an extradural abscess. Endoscopic sinus surgery with debridement of the extradural abscess via a craniotomy was performed in collaboration with the neurosurgeon, along with administration of antibiotic therapy. She was discharged from the hospital on the 22^nd day.

Forehead swelling which developed as a sign of Pott’s puffy tumor in this patient is an important sign of intracranial complications.

Parotid tumors that are initially benign sometimes show malignant transformation. Since surgery is usually performed at an early stage, it is rare for parotid tumors to become huge.

The patient reported herein was a 59-year-old man with a giant left parotid tumor that had remained untreated for about 20 years. He was suspected as having a left parotid gland carcinoma with metastases in the lung and sternum at a previous hospital and referred to our department. Despite the suspicion of distant metastases, surgery was planned to improve the quality of life of the patient, and the patient underwent total resection of the left parotid gland. Facial nerve infiltration by the tumor was observed during the operation, therefore, the facial nerve was resected, followed immediately by reconstruction of the nerve defect.

The excised specimen was 18 cm in diameter and weighed 1830 g, and the histological diagnosis was carcinoma ex pleomorphic adenoma, a high-grade carcinoma. Immunohistochemistry showed strongly positive staining for the androgen receptor and human epidermal growth factor receptor 2. We encountered a case of a large left parotid gland cancer with metastasis to the lung and sternum, in which the tumor had first been noted 20 years earlier. High-grade parotid gland cancer was suspected, and the tumor was found during the operation to have invaded the facial nerve. Therefore, the facial nerve was also resected during the surgery and reconstructed. Tumors of the parotid gland that are initially benign can sometimes show malignant transformation over a period of time. In addition, it is desirable to perform surgery at an early stage, because of the risk of the tumor becoming large, which would make surgery difficult, and increased risk of postoperative complications, such as facial nerve paralysis.

Hemophilia B is an X-linked disease characterized by decreased in blood level of coagulation factor IX activity. Mild to moderate hemophilia is often diagnosed only after surgery or trauma. We encountered a case of hemophilia B, in which the diagnosis was made after the patient presented with recurrent postoperative hemorrhage. The patient was a 4-year-old boy without any remarkable past medical history of bleeding disorders. He was diagnosed as having severe obstructive sleep apnea, and underwent adenotonsillectomy under general anesthesia. Postoperative hemorrhage occurred on day 2 and day 6 after surgery, and procedures for hemostasis were required on both days. He exhibited recurrent hemorrhage and showed a prolonged activated partial thromboplastin time of 62.3 s; therefore, we suspected coagulopathy. Further examination revealed a reduced blood coagulation factor IX activity level, and the patient was diagnosed as having moderate hemophilia B. This case indicates the importance of preoperative screening for coagulation defects, especially before tonsillectomy, as post-tonsillectomy bleeding can be fatal.

Arytenoid adduction (AA) and type I thyroplasty (TP I) are performed to improve the speech function of patients with unilateral vocal fold paralysis. Postoperative complications of AA+TP I include laryngeal edema due to submucosal hemorrhage and blood flow disorder, laryngeal mucosal perforation, dysphagia, wound infection, and hematoma formation. We examined the frequencies of these complications.

The subjects of this study were 118 patients who underwent AA+TP I between April 2012 and March 2017 for the treatment of unilateral vocal fold paralysis. There were 85 men and 33 women, with a mean age of 60.6±15.6 (mean±SD) years. The postoperative complications included respiratory distress in 16 cases (13.6%). Tracheostomy was performed in 3 cases (2.5%) and cricothyroidotomy in 3 cases (2.5%). Other complications included hemorrhage and hematoma in 2 cases (1.7%) and infection and granuloma malformation in 2 cases (1.7%), requiring surgical treatment one month or more after the surgery. Four cases required airway management due to laryngeal edema. The underlying disease was chronic disseminated intravascular coagulation due to aortic aneurysm in 3 of the patients, so that hemostasis was difficult to accomplish. In these cases, it is considered that preoperative measurement of fibrinolytic markers would be useful for evaluating the difficulty in accomplishing hemostasis. Airway narrowing due to abduction failure of the healthy side vocal fold occurred in 2 cases; paradoxical vocal fold motion by surgical stimulation and laryngeal deviation were considered as the reasons for the abduction failure.

Patients with foreign bodies in the external auditory canal, nasal and oral cavities, pharynx, larynx, and esophagus are commonly encountered in Ear, Nose, and Throat (ENT) clinics. We retrospectively analyzed the clinical features of patients with foreign bodies treated at the ENT department of our hospital. We treated 152 patients with foreign bodies between May 2013 and March 2020. The most common single 10-year age group with foreign bodies was the 0–9 years age group (n=30, 20%), with patients aged 60 years old or over accounting for 47% (n=71) of all cases. The major types of foreign bodies were, in that order, fish bones (n=65, 43%), with the bones of sea bream accounting for the largest proportion (22%, 14/65 patients), food lumps (n=38, 25%), reptiles (n=14, 9%), and press-through tablet packaging (PTPs, n=11, 7%). The foreign bodies were predominantly found stuck, in that order, in the esophagus (n=58, 38%), tonsil (n=34, 22%), and external auditory canal (n=26, 17%). Among the patients with esophageal foreign bodies, 83% (48/58 patients) were aged 60 years old or older, and more than a half of them (53%, 31/58 patients) had a medical history of organic diseases causing esophageal stenosis, and central nervous system diseases causing masticatory dysfunction and dysphagia. In the case of fish bones, 11% (7/65 patients) of the fish bones straying into the mucosae could be detected by computed tomography (CT), but could not be detected by endoscopy. These findings suggest that CT is a useful diagnostic modality. The foreign bodies were removed with forceps under direct vision and endoscopy in 65 and 73 patients, respectively. In 7 patients (6 children and 1 adult), the foreign body was removed under general anesthesia. Spontaneous removal of the foreign bodies occurred in 14 patients. With the aging population in Awaji Island, the number of patients with foreign bodies due to masticatory dysfunction and dysphagia seen at the ENT clinic appears to be increasing.

Epistaxis is one of the most common complaints encountered in the field of otorhinolaryngology. Although hemostasis can be achieved by outpatient treatment in many cases, we have also encountered some difficult-to-treat patients who developed re-bleeding or required admission and surgery. We conducted a retrospective analysis of the clinical features of 615 patients with idiopathic epistaxis who were seen at our hospital between 2012 and 2019. We analyzed the patient data and clinical factors associated with epistaxis, including the age, gender, month (season) of visit to our hospital, accompanying systemic complications, bleeding points, procedures used for treatment, history of re-bleeding, and history of hospitalization. The patients with epistaxis were predominantly males in their 70 s. In regard to the season of presentation, patients with epistaxis were encountered more frequently in the winter than in the summer. Most patients had initially been treated by electrocoagulation. Hypertension was the most common underlying disease. Re-bleeding within 7 days after the primary treatment occurred in 11.5% (71/615) of patients. Analysis identified heart and liver disease, and antithrombotic drug use as significant risk factors for re-bleeding. Although in the overall subject population, the bleeding point was most frequently observed in Kiesselbach’s area, the bleeding point was observed more often in the middle nasal meatus or olfactory cleft in the patients with re-bleeding. The most common indication of hospitalization was difficulty in hemostasis, and the bleeding point in most of the hospitalized cases was unknown or in the posterior nasal cavity. The analysis revealed that it may be important to attempt endscopic hemostasis in patients in whom the bleeding point is identified in the posterior nasal cavity.