Digital transformation (DX) was proposed by Stolterman, who contended that the development of information technology could provide us with a good life. Recently, medical DX has progressed rapidly based on the key trends of big data, artificial intelligence (AI), cloud technology, and next-generation communication. Emerging digital technologies are expected to change the face of otolaryngologic medical care. We summarized recent developments in medical DX in the field of otorhinolaryngology, especially over the last 2-3 years. Big data includes information about insurance receipts, electronic medical records, patients’ registry, and health records. Medical AI programs provide automatic interpretations of endoscopic images, CT images, voice data, etc., to assist in the diagnosis of diseases by machine learning of the inputs gathered from a large amount of data. Telemedicine using the next-generation communication technology 5G is found to be useful to provide consultation for patients with upper respiratory symptoms in this COVID-19 pandemic era. Mobile health includes wearable devices and applications on the smartphone. Medical DX is expected to present better medicine for prevention, diagnosis, treatment, and welfare of patients in the field of otorhinolaryngology.

Superficial siderosis of the central nervous system (SSCN) is a rare condition in which hemosiderin is deposited on the surface of the brain and/or spinal cord, as a consequence of recurrent or persistent hemorrhage in the subarachnoid space. Previously, SSCN could only be diagnosed at autopsy or during a neurosurgical procedure. However, recently, non-invasive diagnosis of SSCN has become possible with techniques of magnetic resonance imaging (MRI), particularly susceptibility-weighted imaging (SWI).

We report a case of SSCN of the central nervous system in a 50-year-old woman who presented with vertigo and gradually progressive bilateral sensorineural hearing loss that progressed to total deafness over a nine-year period. We performed enhanced T1 weighted-inner ear MRI at first, and found no apparent abnormalities. We suggested a hearing aid (HA), but the patient refused. We suggested cochlear implant surgery several times, but the patient resisted it. Eleven years after this first medical examination, the patient presented with severe headache and a floating sensation, and we performed head MRI, including SWI and diffusion-weighted imaging and MR-angiography. SWI revealed diffuse marginal hypo-intensities on the surface of the cerebrum and brain.

SSCN should be considered in the differential diagnosis of patients presenting with unexplained progressive sensorineural hearing loss. Head MRI, including SWI, is a very useful non-invasive tool for accurate diagnosis of SSCN.

Between January 2014 and December 2019, we performed 10 revision stapes surgeries at our hospital for hearing loss. We retrospectively reviewed the data of the 10 cases to determine the causes of failure and evaluate the hearing outcomes. The identified reasons for primary surgery failure were eroded incus (4 cases), dislocated prosthesis (2 cases), prosthesis fixation (3 cases), short prosthesis (1 case), malleus ankylosis (1 case), stapes refixation (1 case), and incomplete previous operation (1 case). In 7 of the 10 cases (70%), successful hearing outcomes, as assessed based on the criteria proposed by the Japan Otological Society (2010), were obtained. The postoperative air-bone gap was 10 dB or less in 3 cases (30%), and 20 dB or less in 8 cases (80%). One patient developed sensorineural hearing loss (≥ 15 dB).

Revision stapes surgery is less likely to be successful than the primary operation, and sensorineural hearing loss as a postoperative complication occurs more frequently after revision surgery than after primary surgery. However, in cases where a definite reason for failure of the primary surgery is identified, hearing improvement is likely to be obtained after revision surgery. We should offer revision stapes surgery proactively to patients, with careful selection of suitable candidates.

Peripheral facial nerve palsy is more frequent in Bell’s palsy and Ramsay Hunt syndrome. We performed a retrospective review of the data of 67 patients with Bell’palsy (29 males, 38 females; median age, 63 years) and 18 patients with Ramsay Hunt syndrome (6 males, 12 females; median age, 53.5 years) diagnosed between April 2015 and March 2020. In the patient group with Bell’s palsy, the initial paralysis score was ≤ 8 in 21 patients (31.3%), 10–18 in 28 patients (41.8%), and ≥ 20 in 18 patients (26.9%), and the final paralysis score was 40 in 45 patients (65.7%), 36 to 38 in 11 patients (16.4%), 32 to 34 in 2 patients (3.0%), 20 to 30 in 7 patients (10.4%), and 10–18 in 2 patients (3.0%). Bell’s palsy was cured in 56 of 67 the patients, corresponding to a cure rate of 83.6%. In the patient group with Ramsay Hunt syndrome, the initial paralysis score was ≤ 8 in 9 patients (50.0%), 10–18 in 6 patients (33.3%), and ≥ 20 in 3 patients (16.7%) and the final paralysis score was 40 in 8 patients (44.4%), 36–38 in 3 patients (16.7%), 32–34 in 2 patients (11.1%), 20–30 in 2 patients (11.1%), and 10–18 in 2 patients (11.1%). Ramsay Hunt syndrome was cured in 11 of the 18 patients, corresponding to a cure rate of 61.1%. The findings of electroneurography were found to be associated with cure/non-cure in patients with Bell’s palsy, whereas the initial paralysis score was significantly associated with the prognosis in patients with Ramsay Hunt syndrome.

We describe the case of a patient with non-intestinal-type adenocarcinoma (non-ITAC) of the nasal cavity, because this tumor is very rare. A-79-year-old woman was referred to us with a 1-month history of pain and swelling behind the nose on the left side and discharge from the left eye. A rubbery, soft lesion measuring approximately 3 cm in diameter arising from behind the left nose was recognized.

The lesion was suspected as a submucosal tumor at the front of the nasal cavity. There was no impairment of vision or eye movements. Cytology was class V (carcinoma), and the imaging findings were consistent with a submucosal tumor at the front of the nasal cavity; no cervical lymph node metastasis or distant metastasis was observed. Tumor resection was performed under general anesthesia. Histopathologic examination of the tumor revealed the tumor as being a non-ITAC, an entity included in the WHO classification of adenocarcinomas. The patient developed tumor recurrence after surgery, and died of metastatic cancer two years one month after her first visit to us. The prognosis of patients with high-grade non-ITAC is poor and multidisciplinary treatment is often considered. Postoperative radiotherapy should be considered based on the histopathology, extent of invasion of the primary tumor, and status of the surgical margin.

Sinusitis is common, but rarely localized to the sphenoid sinus. The sphenoid sinus has an intimate anatomical relationship with the cavernous sinus, internal carotid artery, and many cranial nerves (II, III, IV, V1-V2, VI). Therefore, the spread of infection or inflammation beyond the sphenoid sinus to these structures may result in serious or even fatal intracranial or orbital complications.

We retrospectively analyzed the data of 21 surgical cases of sphenoid sinus disease diagnosed at the Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, between January 2015 and December 2021. We investigated the symptoms, diagnosis, and treatment outcomes.

The most common initial symptom was headache (13 cases), followed by nasal symptoms (6 cases), and ocular symptoms (5 cases). Ocular symptoms included eye movement disorder (5 cases) and visual disturbance (1 case). Nasal endoscopy was performed in all cases, but in 6 cases, the endoscopic examination revealed no abnormalities. Of all the patients with sphenoid sinus disease, 17 had non-neoplastic lesions (inflammation, fungal sinusitis, and mucocele), and 4 had tumors. All the patients underwent endoscopic sinus surgery, and the lesions were completely removed. The cases with eye movement disorder improved or partially improved, but the case with visual disturbance showed no improvement.

Headache associated with sphenoid sinus disease is derived from the trigeminal nerve, and the pain possibly occurs in various parts of the head. In our study, a case of mucocele with eye movement disorder had oculomotor nerve palsy, and a case of inflammation with eye movement disorder tended to have abducens nerve palsy. Early surgical treatment is important to obtain the best chance of improvement of eye movement disorder; however, visual disturbance associated with sphenoid sinus disease may show no improvement.

Myoepithelioma is a relatively rare salivary gland tumor. Herein, we report a case of myoepithelioma of the soft palate. The patient was 48-year-old man who was found, during dental examination, to have a swelling on the left side of the soft palate, and was referred to a local clinic. Fine-needle aspiration cytology revealed ductal epithelial cells and myoepithelial cells, so that the initial diagnosis was pleomorphic adenoma. The patient was referred to our department, and we performed resection of the soft palate tumor. On histopathological examination, the tumor was found to be composed of plasmacytoid myoepithelial cells, and immunohistochemistry showed positive staining of the cells for AE1/AE3, S-100 protein, vimentin, and GEAP. The MIB-1 index, an indicator of malignant cell proliferation, was low (4%). The final diagnosis of the tumor was myoepithelioma, plasmacytoid cell type. Until the last follow-up, one year after the surgery, the patient showed no evidence of recurrence. Because several reports have suggested that myoepitheliomas could show malignant transformation, we propose to carefully follow-up our patient reported herein, with oral myoepithelioma.

Granular cell tumors can occur at any body site. While in about a half of the cases, they arise in the head and neck region, occurrence in the larynx is rare. Based on their characteristic immunohistochemical staining patterns, granular cell tumors are thought to arise from Schwann cells. In all but a small percentage of cases, the tumors are benign. Multiple tumors in the body are seen in 10%-14% of cases. Herein, we report a case of granular cell tumor of the vocal cord.

A 48-year-old Japanese man visited the hospital complaining of neck discomfort. Endoscopy revealed a white tumor on the posterior aspect of the left vocal cord. We suspected granular cell tumor from the biopsy findings, and resected the tumor by laryngeal microsurgery. The histopathologic findings were consistent with the diagnosis of granular cell tumor.

The tumor cells showed positive immunohistochemical staining for S-100 protein. Until the last follow-up at 12 months after the operation, the tumor had not recurred.

Even though granular cell tumors are usually benign, they recur in many cases; it remains arguable if tumor recurrences represent true recurrences or are a reflection of the propensity of the tumor to occur as multiple tumors. We propose to keep our patient under intensive follow-up.

Solitary fibrous tumor (SFT) is a spindle-cell neoplasm that rarely arises from the thyroid gland. The first ever case of thyroid SFT was reported in 1993. Since then, 42 cases have been reported in the literature. The tumor showed benign clinical characteristics in all of the cases, except one, where the patient presented with a local recurrence and distant metastasis.

We report two cases of thyroid SFT. In the first, a 70-year-old man presented with a 4-year history of a gradually growing thyroid tumor. We performed left hemithyroidectomy. Histologically, the tumor consisted of infiltrating spindle cells with no mitoses. The patient was doing well after 2 months. In the second case, a 44-year-old man presented with a 10-year history of an enlarging neck mass and CT showed the mass excluding the trachea in the left thyroid lobe. Fine needle aspiration cytology performed under ultrasound guidance demonstrated a hypocellular aspirate that revealed spindle cells. We performed left hemithyroidectomy. Histologically, the mass had a clearly defined fibrous capsule. The tumor was hypercellular, composed of epithelioid neoplastic cells with cytologic atypia. The mitotic count was markedly elevated to 10/10 high-power fields. After 5 months, PET-CT showed distant metastasis. Postoperative chemotherapy was unsuccessful, and the patient died 29 months after the operation.

The clinical course in patients with SFT is often not consistent with the histologic features. Therefore, recently, Demicco et al. established a risk stratification model based on the age, tumor size, mitotic figure count, and necrosis. We attempted to validate this model for thyroid SFT by applying it to our cases and to the retrospective case series, and were able to identify the case with local recurrence and distant metastasis using this model. Therefore, surgical management to obtain adequate negative margins and long-term follow-up can be recommended by patient selection using the risk stratification model.

During the pandemic of COVID-19, people in many countries were under lock down in their own homes.

Early diagnosis and treatment of cancer patients are important. However, we noted that the number of advanced cancer patients was slightly higher in 2020. We compared head and neck cancer patients who opted for BSC between 2017–2019 and 2020. In addition, we reviewed the number of head and neck cancer first-visit patients between 2017–2019 and 2020 at Kansai Medical University Hospital, and compared disease stage distribution of the patients, stage at first visit, and initial treatment strategy between 2017–19 and 2020.

The number of first-visit patients in 2020 was lower as compared with that in 2017–2019. The disease stage distribution of patients was sililar between 2020 and 2017–2019. Among the first-visit patients, the percentage of patients treated by extended surgery was lower and the number of patients who opted for BSC was significantly higher in 2020 as compared with 2017–2019.

The proportion of patients opting for active treatment during the COVID-19 pandemic could have been lower because of an increase in the incidence of depression.

People’s psychological state could be expected to deteriorate and affect their treatment choices during any global epidemic.

Thyroid follicular carcinoma is the second most frequent type of thyroid cancer after papillary carcinoma. It is derived from the follicular cells of the thyroid gland.

Thyroid follicular carcinoma accounts for about 5%–10% of all cases of differentiated carcinoma, but preoperative diagnosis by cytology is impossible. It is necessary to histologically confirm at least capsular invasion, vascular invasion, or metastasis for differentiating thyroid follicular carcinoma from follicular adenoma, which is a benign tumor, and preoperative diagnosis is difficult. In addition, cases with the diffuse invasive type of carcinoma and distant metastasis are considered to have a poor prognosis, but the invasion type can also be confirmed only pathological diagnosis after surgery, so that the prognostic factors before surgery are not clear.

We investigated the preoperative predictors of distant metastasis in cases of follicular carcinoma.

In 14 patients diagnosed as having thyroid follicular cancer and treated at our department from January 2010 to December 2020, we investigated the age, primary tumor diameter, preoperative diagnosis, preoperative serum thyroglobulin level (Tg), invasion type (microinvasive or diffuse invasive), presence/absence of vascular invasion, presence/absence of distant metastasis at initial diagnosis, and treatment for distant metastasis.

Consistent with previous reports, age, invasion type, and presence/absence of vascular invasion were significantly associated with the risk of distant metastasis. When the serum Tg was examined in detail as a predictor of the risk of distant metastasis among the items that were evaluable preoperatively, we found a clear trend of higher preoperative serum Tg levels in patients with distant metastasis. Also, the t-test showed a significant association of the preoperative serum Tg and the presence of distant metastasis. We hypothesized that the serum Tg is a useful preoperative predictor of the risk of distant metastasis in cases of follicular carcinoma, and patients with follicular tumors with serum Tg levels greater than 500 ng/ml should be aggressively operated upon.

Relapsing polychondritis (RP) is a multi-system cartilaginous disease that is characterized by chronic inflammation and cartilage deformities. The auricular cartilage, nasal septum, and laryngeal cartilage are the most common sites of inflammation in this disease. However, inner ear symptoms are rare. We report the case of a patient with RP who presented with the initial symptom of bilateral hearing loss.

The patient was a 57-year-old woman who was referred to our hospital with the chief complaint of progressive bilateral hearing loss despite steroid treatment. Results of evaluation of the auditory steady-state response (ASSR) suggested bilateral hearing loss; otoacoustic emission (OAE) testing indicated inner ear impairment. The auricular cartilage, which is the most common site of inflammation in cases of RP, was normal. Caloric testing indicated mild canal paresis in the left ear and evaluation of the ocular vestibular evoked myogenic potentials (oVEMP) showed a mild decrease in response on the right side. Laboratory tests revealed increased values of inflammatory markers (serum C-reactive protein level and erythrocyte sedimentation rate) and high serum levels of type II collagen antibody, which supported the diagnosis of RP. Positron emission tomography-computed tomography (PET-CT) demonstrated accumulation of fluorodeoxyglucose in many systemic cartilaginous sites, but not in the auricular cartilage. Histopathological examination of the thyroid cartilage confirmed the diagnosis of RP. With the administration of immunosuppressants in addition to a steroid, the hearing loss recovered significantly, and pure tone audiometry and OAE testing indicated recovery of inner ear function.

RP with hearing loss as the initial symptom is rare. Moreover, it was difficult to diagnose RP in our patient reported herein, in the absence of auricular inflammation. While the hearing loss due to inner ear damage was reversible in this patient, treatment delay could have let to treatment failure. Recovery of the OAE response indicated that the main site of inflammation was the outer hair cells. In such cases, otolaryngologists must consider the diagnosis of RP and make efforts to obtain an early diagnosis and provide prompt treatment.

Postoperative bleeding after thyroid surgery is a life-threatening complication. The aim of this study was to identify risk factors for postoperative bleeding. The medical records of 323 consecutive patients who underwent thyroid surgery between 2012 and 2019 at our hospital were reviewed. Bleeding occurred in 11 of the 323 patients (3.4%). Our analysis revealed no associations of the age, sex, tumor characteristics, or operative factors with the risk of postoperative bleeding. Most patients had symptoms/signs of bleeding, such as cervical swelling, pain/tenderness, and respiratory disturbance. In 5 of the 11 patients who developed postoperative bleeding, the aforementioned symptoms/signs were detected by the attending nurse. Careful observation for up to 24 hours is recommended for early detection of the signs/symptoms of bleeding in patients undergoing thyroid surgery, not only by the surgeon, but also the rest of the care team, including other doctors and nurses attending on the patient.