Transoral surgery (TOS), including transoral robotic surgery, transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngopharyngeal surgery (ELPS), has been used to resect pharyngeal and laryngeal cancers with the objective of improving the functional and aesthetic outcomes without worsening the survival outcomes. The transoral approach allows surgeons to perform oropharyngeal resection without pharyngotomy or mandibulotomy, to maintain the critical muscular framework of the laryngo-pharynx necessary to preserve the swallowing function, and to avoid tissue damage associated with radiotherapy. Previous studies have reported a low rate of percutaneous endoscopic gastrostomy (PEG) dependence and high rate of oral intake following transoral robotic surgery. However, for detailed evaluation of the postoperative swallowing function, a prospective study with objective assessment of the postoperative swallowing function after TOS according to the patient characteristics is required. This might be useful for selecting the most appropriate treatment strategy.

Furthermore, investigation of the mechanism underlying preservation of the postoperative swallowing function following TOS is important to develop a minimally invasive surgical method. To better understand the effects of TOS, we used high-resolution manometry to evaluate the impact of perioperative changes in the swallowing function on pharyngeal pressure events, which showed that TOS allowed the pharyngeal constriction to be preserved in patients without preoperative dysphagia. However, TOS might produce scar formation in the pharynx, which could lead to narrowing of the pharynx and increasing pharyngeal contraction velocity.

While dysphagia is not a common finding following TOS, when it does occur, it can severely impair the quality of life. We evaluated the preoperative predictive factors for postoperative dysphagia in patients undergoing TOS, and found that patients with preoperative aspiration (detected by video fluoroscopy [VF]) might be at a high risk for developing severe postoperative dysphagia. Use of objective examination techniques, such as VF, preoperatively might contribute to accurate prediction of the postoperative swallowing function.

Objective: The aim of this study was to identify the prognostic factors for the hearing outcome in patients with profound idiopathic sudden sensorineural hearing loss (ISSHL) (pure tone average: PTA ≥ 90 dB) receiving triple therapy, namely, intravenous steroid (IVS), hyperbaric oxygen (HBO), and intratympanic steroid (ITS).

Methods: Between August 2010 and September 2020, 263 patients (130 men and 133 women) with profound ISSHL with PTA ≥ 90 dB were initiated on triple therapy within 30 days of diagnosis. Multivariate analysis was performed to identify the prognostic factors for the hearing outcome. The cutoff level was determined by receiver operating characteristic (ROC) curve analysis.

Results: The results of multivariate analysis showed that hearing recovery in the 263 patients with ISSHL with PTA ≥ 90 dB was significantly associated with the initial pure tone threshold (p < 0.05), but not with the presence/absence of vertigo (p > 0.05), patient age (p > 0.025), or interval to start of treatment (p > 0.05). The cutoff level of the initial pure tone threshold was determined as 103 dB. Of the entire study population, 167 patients with PTA < 103 dB were divided into the complete recovery (n = 30; 18.0%), significant recovery (n = 102; 61.1%), slight recovery (n = 31; 18.6%), and no change (n = 4; 2.4%) groups, and the 96 patients with PTA ≥ 104 dB were similarly divided into the complete recovery (n = 1; 1.0%), significant recovery (n = 41; 42.7%), slight recovery (n = 35; 36.5%), and no change (n = 19; 19.8%) groups. According to multivariate analysis, hearing recovery in the 96 patients with PTA ≥ 104 dB was significantly associated with the presence/absence of vertigo (p < 0.05), but not with the patient age (p > 0.05), interval to start of treatment (p > 0.05), or initial pure tone threshold (p > 0.05). The 43 patients without vertigo with PTA ≥ 104 dB were divided into the complete recovery (n = 1; 2.3%), significant recovery (n = 22; 51.2%), slight recovery (n = 16; 37.2%), and no change (n = 4; 9.3%) groups, and the 53 patients with vertigo with PTA ≥ 104 dB were similarly divided into the significant recovery (n = 19; 35.8%), slight recovery (n = 19; 35.8%), and no change (n = 15; 28.3%) groups. Hearing in the patient group without vertigo was significantly better than that in the patient group with vertigo, in the 1-kHz, 2-kHz, 4-kHz, as well as 8-kHz range (p < 0.05). ROC curve analysis revealed a cutoff level of the interval to start of treatment in the 53 patients with vertigo with PTA ≥ 104 dB of 3 days. Better overall hearing improvement was observed in the group with an interval to the start of treatment of ≤ 3 days as compared to the group with an interval to the start of treatment of ≥ 4 days (p < 0.05).

Conclusions: Hearing recovery in the 263 patients with ISSHL with PTA ≥ 90 dB was significantly associated with the initial pure tone threshold. The cutoff level of the initial pure tone threshold was determined to be 103 dB. Hearing recovery in patients with ISSHL with PTA ≥ 104 dB was significantly associated with the presence/absence of vertigo. Hearing recovery was significantly better in the patients without vertigo than in those who developed vertigo in the intermediate- and high-tone frequencies. The cutoff level for interval to the start of treatment was determined to be 3 days in the vertigo group.

Surgery for middle ear cholesteatoma is assigned a lower priority than more urgent surgeries for head and neck cancer or inflammatory diseases, so that there is sometimes a waiting period before the surgery. The objective of this retrospective study was to examine if deterioration of otorrhea or otalgia during the waiting period might be correlated with expansion of the soft tissue mass on coronal CT images. The main results of the present study were as follows: All the five patients who showed expansion of the mass on CT during the waiting period showed deterioration of either otorrhea or otalgia, while none of the remaining seven cases without expansion of the mass on preoperative CT showed deterioration of either symptom. We concluded that infection control during the waiting period for cholesteatoma surgery is critical.

A patient with chronic suppurative otitis media caused by Pseudomonas aeruginosa received multidisciplinary treatment consisting of glycemic control, antibiotics, and surgery. An 88-year-old woman with an infected ear, characterized by tympanic membrane perforation and purulent otorrhea, was treated with antibiotic ear drops at a previous hospital and received oral antibiotics and other ear treatment at our department. However, no improvement was observed, and she could not use a hearing aid. Assuming that the persistent infection was associated with diabetes mellitus, we implemented glycemic control, followed by treatment with intravenous antibiotics and surgery. The surgical procedure was modified, and we grafted a thin slice of cartilage with the perichondrium, which is durable for an infected ear. The postoperative course was favorable. Epithelialization of the graft site was complete by one and a half months after the surgery, and the patient could wear hearing aids again. In patients with diabetes mellitus and chronic suppurative otitis media caused by P. aeruginosa, the infection often persists, and multidisciplinary treatment appears to be effective for controlling the infection.

In recent years, the prevalence of infections caused by nontuberculous mycobacteria (NTM) has increased as the prevalence of tuberculous infections has decreased. Herein, we report a case of Mycobacterium massiliense infection of the external auditory canal. A 52-year-old woman working in a hot spa was referred to our hospital with the complaint of right otorrhea. An elevated lesion was observed in the external auditory canal. A biopsy obtained from the lesion revealed epithelioid cell granulomas and Langerhans giant cells, and Mycobacterium abscessus complex was cultured from the otorrhea fluid. Furthermore, M. massiliense was also identified on nucleic acid chromatography. After the excisional biopsy, we administered clarithromycin treatment for 6 months, and the lesion disappeared. M. massiliense is sensitive to antibiotics, and favorable results of treatment are expected. It is important to identify the subspecies during treatment of NTM infections.

Skull base osteomyelitis is a potentially fatal infection of the external auditory canal.

This condition was originally described by Chandler in 1968. Diagnosis is made on the basis of clinical, microbiological and radiological findings. The disease originates in the external auditory canal and spreads through the osteocartilaginous junction to involve the soft tissues beneath the temporal bone. Initially, osteomyelitis of the skull bone ensues, followed by involvement of the facial and other cranial nerves.

The patient was an 87-year old man, who presented with severe headache, severe otorrhea, and otalgia of the right ear. We made the diagnosis of malignant external otitis, a diagnosis of exclusion, based on the imaging findings. The patient received antibiotic, antifungal and hyperbaric oxygen therapy. After treatment at our hospital for 26 days, the patients’ symptoms were improved.

Headache and otorrhea are commonly encountered symptoms. Otitis with severe headache and a normal serum CRP should raise the index of suspicion for central skull base osteomyelitis or malignancy, and investigation to rule out one or the other should be concurrently.

Although orbital emphysema is a relatively rare condition, intra-orbital emphysema most often develops after maxillofacial injuries, such as an orbital blowout fracture; orbital emphysema is rarely caused by conditions other than trauma. We report a case in which sneezing was thought to have caused orbital emphysema and fracture of the medial wall of the orbit, in the absence of any history of trauma or sinus surgery.

A 25-year-old female patient visited a neighborhood ophthalmologist with a swollen eye after a bout of sneezing, and examination revealed swelling and emphysema of the eyelids, and the patient was referred by the ophthalmologist to our hospital for further management.

Examination at our hospital revealed swelling of the right upper and lower eyelids and a snow-grasping sense and mild tenderness on palpation. No abnormalities were found in the nasal cavity, except for pallor of the inferior turbinate. There was no diplopia, restriction of eye movements, or decrease of the visual acuity. Computed tomography of the orbit and sinuses revealed extensive emphysema under the right upper and lower eyelids, and the posterior end of the emphysema reached the posterior part of the eyeball. In addition, a blowout fracture of the medial wall of the orbit toward the ethmoid sinus was observed. The patient was instructed not to block the nose while sneezing, and prescribed an antibacterial drug for follow-up. After 1 week, the eyelids and orbital emphysema disappeared. No recurrence was observed until the last follow-up at 2 years after the event.

We report a case of laryngopathia gravidarum, in which the patient presented with a sustained decrease in the voice pitch after childbirth. A 31-year-old woman was referred to our hospital with a 3-month history of voice disorders, such as lower voice pitch, difficulty in singing, and voice interruptions, continuing after childbirth. She had noted hoarseness of the voice from the pregnancy, and her voice pitch decreased thereafter. Flexible fiberoptic laryngoscopy revealed mild edema of the bilateral vocal folds. Examinations revealed that the maximum phonation time was shortened to 8.0 seconds, and the fundamental frequency had decreased to 139 Hz. The score on psycho-acoustic evaluation of the voice was G1R1B0A1S1, and the Voice Handicap Index (VHI) was 49. Since the voice disorder was thought to be caused by laryngo-pharyngeal reflux disease, the patient was treated with rabeprazole for one month, with no improvement. At 12 months after childbirth, the patient received oral prednisolone 20 mg/day for 2 weeks, followed by gradual tapering of the dose, which resulted in a slight improvement of her symptoms, VHI, and voice pitch. Voice disorders may occur in the third trimester of pregnancy, but usually recover spontaneously after delivery. While the precise cause remains unknown, it is speculated that they are caused by changes in the sex hormone levels and other biological changes associated with pregnancy, and the psychological stress associated with the care of newborns. Further studies on the mechanism and treatment are crucial.

Fine-needle aspiration cytology (FNAC) for salivary gland tumors is useful for preoperative histological differential diagnosis and estimation of the malignant grade. However, we encounter several cases of discrepancy between the results of preoperative FNAC and results of histopathological examination of the surgical specimens. Therefore, we examined the results of FNAC performed for cases of salivary gland tumors treated at our department.

The subjects were 235 salivary gland tumors that were excised by surgery at our department during the 6-year 9-month period from January 2014 to September 2020. Of the 235 tumors, 177 (75.3%) were benign and 58 (24.7%) were malignant. The accuracy rate, sensitivity, and specificity of FNAC were 93.3%, 70.8%, and 100%, respectively; thus, the sensitivity was low, but the accuracy rate and specificity were high. There were a total of 14 false-negative cases, including for 12 tumors of the parotid gland and 2 tumors of the submandibular gland, with the most common histological diagnosis in these cases being mucoepidermoid carcinomas (9/12 cases). Among the 177 benign tumors, 95 (53.7%) were pleomorphic adenomas, and 55 (31.1%) were Warthin tumors. Among the 58 malignant tumors, 16 (27.6%) were carcinoma ex pleomorphic adenomas, 15 (25.9%) were mucoepidermoid carcinomas, and 11 (19.0%) were adenoid cystic carcinomas.

Although the accuracy rate and specificity were relatively high, we should pay attention to false-negative cases, especially in the case of tumors of the parotid gland.

With the recent development of computer technology, 3D printer enables making an accurate model of CT or MRI. Recently, three-dimensional models of full-scale organs have been used for surgical simulations. In particular, they are useful in maxillofacial surgeries. However, these models were previously monochromatic, which made it difficult to discern the boundary between normal tissues and tumor tissue. We colored the tumor parts in the three-dimensional models, which made surgical simulation easier. In 2 cases, one each of maxillary chordoma and nasal cavity cancer, we performed surgical simulation using three-dimensional models with the tumor parts in color. This enabled more reliable resection with a minimum length of the external incision as compared to that achieved previously using monochromatic models. Three-dimensional models of full-scale organs with the tumor parts in color are useful for grasping complicated three-dimensional structures and reliable resection.

To determine the validity of surgical indications for thyroid diseases, we examined the incidence of postoperative hypothyroidism and possible factors inducing hypothyroidism in 23 patients who underwent hemithyroidectomy during the 5-year period from January 2016 to December 2020 at our department. To ascertain the risk factors for postoperative hypothyroidism, we evaluated the influences of the postoperative pathological diagnosis (benign or malignant), age, preoperative serum thyroid-stimulating hormone (TSH) level, and association of Hashimoto’s disease. Seven (30.4%) of the 23 patients developed postoperative hypothyroidism. Of the 23 patients, 15 (65.2%) and 8 (34.8%) patients were diagnosed by histopathology as having benign and malignant tumors, respectively. Four (17.4%) patients had association of Hashimoto’s disease. Our analysis revealed no significant association of the postoperative pathological diagnosis (benign vs. malignant), age, preoperative TSH level, or association of Hashimoto’s disease with the development of postoperative hypothyroidism. However, there appeared to be a tendency for patients with a high preoperative TSH level and those with association of Hashimoto’s disease to develop postoperative hypothyroidism. We considered that one of the 5 patients with benign tumors who developed postoperative hypothyroidism should have actually been followed up rather than having been treated by surgery. Surgical indications for benign tumors should be considered cautiously, taking into account the risk factors for the development of postoperative hypothyroidism.

Pasteurellosis is a zoonosis with a generally good prognosis; however, it can cause serious disease, especially in patients with a compromised immune system.

Herein, we report a case of pasteurellosis that required extracorporeal circulation, e.g., extracorporeal membrane oxygenation (ECMO) support, owing to severe circulatory failure. The patient was a 62-year-old man who was referred to our center from a nearby hospital because of a sore throat and suspected cervical abscess. Contrast-enhanced computed tomography revealed no abscess in the neck. Shortly thereafter, he went into shock, which necessitated admission to the intensive care unit, and initiation of antibiotic therapy for severe cervical cellulitis. His blood cultures yielded positive results for Pasteurella multocida 3 days after admission, confirming the diagnosis of pasteurellosis. Despite receiving antibiotic therapy, he required ECMO and intra-aortic balloon pumping support for the severe circulatory failure. Subsequently, his condition gradually improved, and he was discharged on post-admission day 50 without sequelae.

The symptoms of pasteurellosis, which is mainly transmitted via wounds and the mouth, are non-specific. In the present case, we could not ascertain the transmission route because there were several contradictions; the route of transmission could have been via a wound or the mouth. Considering that his circulatory failure improved after the institution of extracorporeal circulation support, it might have resulted from left-sided heart failure, which is more common in children. This is thought to be the first report of the use of ECMO to treat circulatory failure in a patient with pasteurellosis.