Neurotechnology refers to the use of devices and techniques to sense the brain activity and stimulate the brain. Techniques for brain sensing include non-invasive techniques such as electroencephalography (EEG), functional Magnetic Resonance Imaging (fMRI), functional Near-Infrared Spectroscopy (fNIRS), Magnetoencephalography (MEG), and Positron Emission Tomography (PET), and invasive techniques involving direct implantation of devices in the brain. Techniques for brain stimulation include neurofeedback from brain activity sensed from EEG, fMRI, or fNIRS to reinforce brain functions, Transcranial Magnetic Stimulation, Deep Brain Stimulation (DBS), and Vagus Nerve Stimulation.

A brain machine interface (BMI) is a device that translates neuronal information into commands capable of controlling a computer or robotic arm. BMI has advanced remarkably, with the development of such products as power-assisted robot suits for limb-paralyzed patients, devices for DBS for Parkinson’s disease, and cochlear implants for hearing-impaired patients.

In the field of otorhinolaryngology, sensory organs transmit auditory, equilibrium, olfactory, and gustatory information to the brain, whereas motor organs responsible for phonation, articulation and swallowing, receive direct commands from the brain through the cranial nerves. Application of neurotechnology to these organs could lead to breakthrough medicine with a promising future in the field of otorhinolaryngology.

Vestibular paroxysmia (VP) is a clinical syndrome characterized by recurrent spontaneous vertigo, probably caused by neurovascular compression of the eighth cranial nerve. The diagnostic criteria for VP have been proposed by Strupp et al., and the criteria do not include detection of neurovascular compression of the nerve on MRI. We report three cases of refractory repetitive vertigo that were successfully treated with carbamazepine. They had recurrent vertigo accompanied by tinnitus or headache. Treatment for common vertigo or vestibular migraine proved ineffective. The duration of the vertigo attacks ranged from a few seconds to 30 seconds, and the frequency of vertigo attacks was high, ranging from tens to hundreds of attacks per day, suggesting the possibility of VP. No abnormalities were detected on brain MRI, including the internal auditory meatus or cerebellopontine angle, in either case. All three patients were treated with carbamazepine, which resulted in marked improvement of their vertigo attacks, and were diagnosed as having VP.

We suggest that for patients with repetitive vertigo who do not respond to common treatments for vertigo, diagnostic treatment with antiepileptic medications, such as carbamazepine, should be attempted, taking into account the possibility of VP, even in the absence of abnormalities on MRI.

This study was conducted to determine the appropriate surgical options to improve the hearing outcomes in patients with cholesteatoma who underwent type 3 ossiculoplasty. A total 102 cases of fresh cholesteatoma treated between April 2012 and April 2019 were included. Of the 102 patients, 61 underwent single-stage ossiculoplasty and 41 underwent second-stage ossiculoplasty. The associations of the following variables with the hearing outcomes were analyzed: age, gender, type of cholesteatoma, stage, tympanic cavity invasion, statuses of the stapes and mastoid cell development, stage of surgery, surgical method, type of ossiculoplasty, and type of columella. The hearing outcomes were evaluated on the basis of the mean postoperative air-bone gap. The analysis identified the following prognostic factors for good hearing outcomes: age under 65 years, well-pneumatized mastoid, S0 (no stapes involvement), and surgery without destruction of the canal wall. Second-stage ossiculoplasty was advantageous in terms of the hearing outcomes as compared to single-stage ossiculoplasty for patients with poorly developed mastoid cell structures (MC0 and MC1).

Cavity problems can occur after the open method of treatment of cholesteatoma (mastoidectomy with removal of the whole canal wall [modified radical or radical mastoidectomy]), which is generally preferred for the prevention of cholesteatoma recurrence. In general, conservative treatment for infected mucosa and granulation in the mastoid cavity is performed at the outpatient clinic; however, otorrhea from an infected open mastoid wound may trouble patients for a long period of time after surgery, even if treatment is performed continuously. Therefore, revision surgery is needed for radical treatment in such cases. However, it is sometimes difficult for older adults, patients with severe medical complications and those under pressure at their place of work, to undergo the surgical treatment, which requires several days of hospitalization, general anesthesia and invasive procedures.

To address the above-mentioned problem, we developed a self ear-cleaning doctor-patient feedback method for intractable cavity problems. This method consists of patients cleaning their own ears in their own homes, coupled with observation by an otologist at the outpatient clinic, who may then suggest adjustments to the patient’s cleaning method. In the current study, the effectiveness of the self ear-cleaning doctor-patient feedback method, as well as its safety, was investigated.

Five patients, with a mean age of 51.4 years, were included in the study. All subjects had infections with otorrhea that improved with this method and the treatment could be completed safely in all the patients.

The present study demonstrates the effectiveness and safety of the self ear-cleaning doctor-patient feedback method. We believe that this method may be a viable option for the treatment of cavity problems, especially in older adults, patients with severe medical complications, and those under pressure at work.

The efficacy of transmastoid facial nerve decompression surgery for severe peripheral facial nerve palsy has been under debate for a long time, and continues to remain controversial. Therefore, we conducted a retrospective review of the patients’ backgrounds, timing of surgery, intraoperative findings, and prognosis, in particular, 1) the effect of the period from the onset to surgery on the 1-year prognosis after surgery, and 2) the correlation between the intraoperative facial nerve monitor reaction and the prognosis in 30 cases of delayed recovery from peripheral facial nerve palsy treated by transmastoid facial nerve decompression surgery. The results showed that there was no significant difference in the Yanagihara score at six months after surgery between the patients operated within and over 50 days after the onset, however, in those operated over 60 days after the onset, the Yanagihara score was significantly lower than those operated within 60 days after the onset. There was also a significant correlation between the presence/absence of response to intraoperative NIM and the Yanagihara score at six months after surgery. In other words, patients who responded to intraoperative NIM fared significantly better than those who did not. On the other hand, the prognosis was significantly worse in patients who underwent surgery at more than 2 months after the onset than in patients who underwent surgery earlier, and it is important to make patients aware of this information. From now on, we will continue to do surgery only cases who show no satisfactory response to conservative treatment for severe paralysis and for whom there are no other effective treatment options, and only in cases where the family, including the patient, strongly desires to receive the treatment.

Fish bones are among the most common ingested foreign bodies encountered in clinical practice, and are often embedded in the tonsils or the tongue base. The common presenting symptoms are odynophagia and sharp pricking pain during swallowing. It is rare for ingested fish bones to migrate out of the upper digestive tract to the neck, and in such cases, the swallowing pain and other symptoms disappear until the onset of infection. The patient reported herein was a 76-year-old woman who presented to us with a painful swelling of the right neck and numbness of the right hand. Computed tomography of the neck revealed a linear object of high intensity located between the right sternocleidomastoid muscle and the thyroid gland. She gave a history of having ingested the bone of a sea bream and of having suffered from a pricking sensation about 6 months earlier. We removed the fish bone through a cervical skin incision under 3D-CT and intraoperative ultrasonographic guidance.

Ingested foreign bodies such as fish bones must be promptly removed, as they could otherwise cause infection over time. It is very difficult to find a fish bone after it has become buried in the cervical soft tissue. In this case, CT/ultrasonographic guidance was useful for the diagnosis and removal.

Pyriform sinus fistula is a congenital fistula that often causes acute purulent thyroiditis or cervical abscess. It occurs mainly in children under 12 years old. The current standard treatment is a complete removal of the fistula, but it is often challenging to diagnose and to detect the fistula during surgery due to scar formation resulting from recurrent infections and prior surgical drainages. Herein, we present two cases of pyriform sinus fistula, in which we used a curved laryngoscope to examine the hypopharynx before the neck incision. We were able to detect the fistula clearly and inserted a tube into the fistula to inject the dye, and achieved complete extirpation of the fistula by neck incision. A curved laryngoscope is useful to the diagnosis and treatment of pyriform sinus fistula.

Subglottic stenosis refers to congenital or acquired stenosis of the cricoid cartilage and trachea, and manifests as dyspnea. Acquired subglottic stenosis can be of diverse causation. Tracheotomies are performed in many cases, but long-term insertion of a tracheal cannula is necessary, making treatment difficult.

A 58-year-old woman presented to a local ENT (ear, nose and throat) hospital complaining of wheezing and dyspnea during exercise. She had visited the local ENT hospital several times during the previous 3 years, and had been diagnosed as having asthma and treated with inhaled steroids. As her symptoms did not improve, she visited the Nara Medical University Hospital for further investigation and treatment.

She had no dyspnea at rest, but developed wheezing with dyspnea during exercise. Subglottic stenosis was observed throughout the circumference of the tracheal ring. She had no comorbidities or significant medical history, such as of having undergone intubation or tracheostomy, bronchial asthma, or other upper respiratory diseases. Therefore, we diagnosed the patient as having idiopathic subglottic stenosis. We performed tracheoplasty by resection of the arch of cricoid cartilage and circumcision of the tracheal cartilage and implemented a cannula-free observation protocol. She had no dyspnea after the operation. Eight months after the surgery, her dyspnea and wheezing had improved. Moreover, there was no necrosis of the anastomotic part between the cricoid cartilage and the trachea.

Thus, we avoided the use of a cannula and carefully observed the patient’s course. Based on the findings in this case, we believe that resection of the cricoid cartilage may be useful for treatment and relapse prevention. The limitation of this case study was that this is a report of a single patient and the observation period was short. Further studies are needed to determine the appropriateness of this surgical approach for patients with idiopathic subglottic stenosis.

Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema is commonly known as drug-induced angioedema, and can causes upper airway obstruction. On the other hand, angiotensin II receptor blockers (ARBs) are considered as being useful to avoid angioedema, as they exert their antihypertensive effect without increasing the serum bradykinin levels. However, with the increasingly wide use of ARBs, a steadily increasing number of cases of angioedema associated with ARB use have been reported. Herein, we report two cases of ARB-induced angioedema. A 69-year-old man and a 50-year-old woman who were taking ARBs for the control of hypertension were referred to our hospital for throat edema. As the ARB prescribed was suspected as the cause of the angioedema in both cases, the drug was withdrawn in both, and treatment was initiated with corticosteroids, tranexamic acid, and antihistamines. In both cases, the throat edema improved promptly within a few days, and no recurrence of the symptom has been noted for several years after discontinuation of the ARBs. Herein, we discuss potential therapeutic agents for angioedema, and also the clinical features of ARB-induced angioedema based on a review of 8 cases of ARB-induced angioedema reported in the literature. Angioedema induced by ACE inhibitors and ARBs has been classified as bradykinin-type angioedema as well as hereditary angioedema. The efficacy and safety of a C1-inactivator preparation and a selective bradykinin B2 receptor antagonist for ARB-induced angioedema are expected to be further verified.

Unclassified/undifferentiated sarcomas are defined by the 2013 World Health Organization monograph as a heterogeneous group of sarcomas without evidence of a specific line of differentiation. Notably, malignant soft tissue tumors of the head and neck are extremely rare. We report a rare case of an unclassified malignant pleomorphic tumor of the gingiva.

A man in his early 50s was referred to our hospital by his primary care dentist for evaluation and treatment of an erosive lesion of the right upper gingiva that bled easily. We performed a lesional biopsy and with a presumptive diagnosis of a pleomorphic spindle-shaped malignant soft tissue tumor, right partial maxillectomy with extended resection of the gingival lesion was performed for further evaluation and diagnosis, as well as treatment. Based on the final histopathological findings, the tumor was diagnosed as an unclassified malignant pleomorphic tumor. The patient’s postoperative course was uneventful, without local recurrence or metastasis over a period of 12 months.

Few reports have described malignant soft tissue tumors of the head and neck, and treatment of these lesions involves extended resection. Currently, no standardized treatment protocol is established for unclassified/undifferentiated sarcomas of the head and neck, because extensive resection of lesions at these sites is associated with cosmetic or morphological factors that significantly affect the quality of life of the patients. Therefore, multimodal therapies are warranted for the management of malignant soft tissue tumors of the head and neck.

Further accumulation of cases is necessary to conclusively establish such standardized multimodality interventions.

Mediastinal emphysema is classified into three types according to the mechanism of causation: (1) spontaneous, in the absence of any underlying respiratory disease; (2) symptomatic, secondary to other pulmonary diseases, such as pneumonitis, asthma, and pulmonary emphysema; (3) traumatic, following a traffic accident, blunt trauma, or surgical procedure. This study was conducted to clarify the characteristics of the three types of mediastinal emphysema.

We conducted a retrospective review of all patients presenting with mediastinal emphysema who were treated on an inpatient basis in any unit of our hospital from March 2006 to July 2017. We analyzed the following data: number of patients, age, gender, classification, clinical symptoms, extent of emphysema on CT images, presence/absence of subcutaneous emphysema, treatment methods (antibiotics, fasting and antibiotics, or only rest), number of days to complete resolution of the mediastinal emphysema, and relationship between the treatment employed and the time to complete resolution of the emphysema.

Data of a total of 59 patients (43 males/16 females; mean age, 0–94 years) were included in the study. Ten patients (6, spontaneous; 4, traumatic) were treated at our department. Results revealed that patients classified as having spontaneous emphysema were younger and left the hospital earlier. As for patients with traumatic emphysema, association with subcutaneous emphysema was more frequent and resolution of complications took longer. Patients with traumatic emphysema often had comorbid conditions, such as bone fractures and pneumothorax, and their general condition was generally more serious. The severity of mediastinal emphysema, however, covers the spectrum from mild to severe. Preventive antibiotic therapy may not be needed for patients who are at a low risk for mediastinitis, such as those without esophageal rupture or subcutaneous emphysema. Hospital care may not be needed in milder cases of mediastinal emphysema. We might be able to reduce unnecessary treatment by selecting the appropriate intervention according to the severity of presentation.