The Japanese Rhinologic Society has held a “Hands-on Seminar on Basic Research for Clinicians” led by the Society since 2014. The aims of the seminar are to raise the motivation and skills for basic research among clinical otorhinolaryngologists and to encourage interdisciplinary collaboration through research with universities. The attendees at the seminar are clinicians performing basic research in Japan. The eighth seminar was held at the 60th Annual Meeting of the Japanese Rhinologic Society and the 20th Asian Research Symposium in Rhinology (Otsu), and focused on 1) culturing human airway epithelial cells and fibroblasts for experiments using human nasal mucosa, 2) practical evaluation of nasal tissue by fluorescence immunostaining, 3) preparation of fresh-frozen sections with the Kawamoto film method, and 4) RNA extraction and quantitative PCR analysis from nasal tissues. The first two sessions were conducted through practical training, and the others used video training because of the worldwide COVID-19 pandemic. A questionnaire completed by participants indicated a high level of satisfaction and a belief that the research seminar is needed. The seminar provides an excellent opportunity for rhinologists to obtain ideas for expanding basic understanding of sinonasal disorders, and we believe that it should be continued for as long as possible.

Background: Dupilumab is a fully human monoclonal antibody that blocks the common part of the interleukin(IL)-4 and -13 receptors. It has been indicated for treatment of inadequately controlled chronic rhinosinusitis with nasal polyps (CRSwNP) since March 2020 in Japan. In this study, we investigated the effects of dupilumab on eosinophilic CRS (ECRS) in CRSwNP.

Methods: A prospective observational study was performed in patients who started to use dupilumab from August to December 2020. End points included the SNOT-22 score, nasal polyp score, oral prednisolone (PSL) dose, and blood test data for total IgE, %eosinophils and levels of several cytokines.

Results: SNOT-22 scores decreased after 22/24 weeks of treatment (p < 0.01). Total IgE in blood decreased after an average of 13.3 weeks of treatment (p < 0.01), whereas %eosinophils increased significantly after the same period (p < 0.01). The required oral PSL dose was significantly lower after treatment compared with that before treatment. Vascular endothelial growth factor (VEGF) in blood decreased significantly after 15.6 weeks of treatment, but there were no significant differences in the blood levels of periostin and IL-4.

Conclusion: Patients with ECRS treated with dupilumab had rapid improvement in clinical outcomes. Total IgE and VEGF significantly decreased in the early period after treatment. While %blood eosinophils significantly increased and periostin and IL-4 in blood showed no significant changes.

Powder pharmaceutical preparations of the hemostatic agent sodium alginate have been used to promote wound healing in several surgical fields. In endoscopic sinus surgery, calcium alginate dressing has previously been used to promote healing, but this product has been discontinued. We present our initial experience of use of sodium alginate in endoscopic sinus surgery and we compare the use of this product with that of calcium alginate dressing.

The patients were divided into groups, treated with sodium alginate (n = 39) and calcium alginate (n = 47), with the two groups having similar bleeding volumes and operation times.

Patients treated with sodium alginate had significantly fewer postoperative hospital visits than those treated with calcium alginate (mean ± SD: 4 ± 0.8 vs. 5 ± 1.5days, p < 0.05), and significantly fewer cases treated with sodium alginate required sinus rinse with Mikulitz maxillary sinus cleaning tube compared to those treated with calcium alginate (0 vs. 6 cases, p < 0.05). These results suggest that sodium alginate is useful and safe for promotion of wound healing in endoscopic sinus surgery, as a replacement for calcium alginate dressing.

Purpose: Sublingual immunotherapy for cedar pollinosis was first covered by insurance in Japan in 2014, and the age limit was removed in 2018. Thus, four years have passed since the start of treatment in pediatric patients. In this study, we examined symptoms and quality of life (QOL) in pediatric patients who received cedar sublingual immunotherapy from 2018 to 2020.

Methods: Symptoms and QOL were investigated during the 2021 cedar pollen dispersal period in pediatric patients (age 15 years or younger) who received sublingual immunotherapy for cedar pollinosis at Osaka Habikino Medical Center from 2018 to 2020. Patients who had used antihistamines and nasal sprays for at least one week before the 2021 cedar pollen dispersal period were surveyed at the same time and the results for the two groups were compared.

Results: Pollen dispersal in Osaka Prefecture in 2021 was slightly higher than that in a normal year. Symptom scores, QOL scores, and nasal symptom drug scores were lower in the sublingual immunotherapy group compared to those in the drug treatment group during the 2021 cedar pollen dispersal period. Nasal symptom drug scores in patients who started cedar sublingual immunotherapy in 2018 and 2019 were significantly lower than those in the drug treatment group. Nasal symptom scores did not differ significantly, but there were significant decreases in Face scale scores in the 2018 and 2019 start groups and for the VAS in the 2018, 2019, and 2020 start groups, compared to the drug treatment group.

Conclusion: These results indicate that sublingual immunotherapy is effective for cedar pollinosis. However, continued follow-up is needed to evaluate the long-term efficacy of this treatment.

Correction of caudal septum deviation requires surgical manipulation from the caudal side of the septum. In a case of concomitant external nasal deformity, an external method (i.e. – open septorhinoplasty) is selected, whereas in other cases, an endoscopic method (i.e. a hemitransfixion approach) is indicated. This type of nasal septal deviation is caused by an excessive cartilaginous nasal septum in relation to the bony septum. After the surgeon has separated the nasal septum cartilage from the anterior nasal spine (ANS) and trimmed the cartilage at the posterior nasal angle to ensure proper cartilage size, an anchoring suture is performed to reattach the cartilage and ANS. However suture manipulation is often difficult in the nasal endoscopic method due to the narrow surgical area. In this study, we compared the figure-8 suture and dual knot fixation (DKF) technique as methods of anchor suture for nasal endoscopic septoplasty. Our results show that DKF may be useful as a low-stress suture method for surgeons performing endonasal septoplasty.

An essential aspect of endoscopic resection for nasal sinus tumors is to ensure an adequate working space and to confirm that the tumor stem is clearly visible. Opening the nasal septum provides an ample working space, but also has a risk of large postoperative perforation of the nasal septum. We encountered a case of malignant melanoma of the nasal mucosa that was amenable to endoscopic resection by elevating the septal mucosal flap and opening the nasal septum. The patient was a 70-year-old man with a malignant melanoma arising from the right inferior turbinate. The entire surgical process was performed endoscopically. The nasal septal window was opened by elevating the septal mucosal flap and performing a medial maxillectomy. These procedures provided a working space wherein the endoscope and surgical instruments could be manipulated and the tumor could be shifted laterally. The tumor stem was identified in the inferior turbinate mucosa and we were then able to resect the entire inferior turbinate and malignant tumor en bloc. The nasal septal mucosa on the tumor side was excised and the septal mucosal flap on the healthy side was elevated. Postoperative perforation of the nasal septum was minimal due to use of a novel incision line for the nasal septal mucosa valve on the healthy side. This case shows that creating a nasal septal window by elevation of the nasal septum mucosa is an effective technique for endoscopic resection of malignant nasal tumors.

Synovial sarcoma (SS) is a relatively rare malignant tumor of the soft tissue. The most common site of occurrence is the extremities, whereas SS rarely occurs in the head and neck region. We report the case of a 69-year-old woman who presented with a chief complaint of left epistaxis. A vascular tumor was diagnosed based on gross appearance and imaging findings. Endoscopic sinus surgery was performed and the tumor was resected en bloc. SS was suspected based on histopathological findings and immunohistochemical staining. Fluorescence in situ hybridization (FISH) indicated the presence of the SYT fusion gene, which is specifically expressed in SS, and thus, SS was the final diagnosis. There are no specific CT and MRI findings for SS, and it is difficult to diagnose the tumor based on cytology or angiography. However, immunohistochemistry and genetic tests are useful for diagnosis of SS. Surgical resection is the first choice for treatment of SS and it is important to resect the tumor with a safety margin. However, in the head and neck region, surgical resection with a safety margin cannot always be performed, and multimodal therapy with chemotherapy and radiotherapy may be required. In our case, postoperative radiotherapy resulted in local control, and there has been no evidence of recurrence in follow up for 28 months after surgery.

Pleomorphic adenoma usually occurs in the large salivary glands (parotid, submandibular, and sublingual glands), whereas nasal pleomorphic adenoma is rare. Here, we report two cases of pleomorphic adenoma of the nasal septum. Preoperative clinical and imaging findings did not match histological findings, which made diagnosis difficult. In case 1, preoperative biopsy indicated squamous cell carcinoma and the tumor was removed by lateral rhinotomy. Postoperative pathology revealed a diagnosis of pleomorphic adenoma. In case 2, the first biopsy was suspicious for papilloma, which was inconsistent with clinical and imaging findings. Re-biopsy was performed and a diagnosis of pleomorphic adenoma was made. Endoscopic excision was conducted and the excised specimen was confirmed to be pleomorphic adenoma. We report these cases to illustrate the difficulties with diagnosis of pleomorphic adenoma.

Kallmann syndrome is a rare congenital disorder with hypogonadotropic hypogonadism as the primary symptom and congenital olfactory dysfunction as a secondary symptom. The patient was a 56-year-old male who was found to have significant osteoporosis following a femur fracture. Hypogonadism including Kallmann syndrome was suspected due to his female-like facial features and high voice. He had gynecomastia, little pubic hair and no axillary hair. In puberty he had no change of voice and had a small penis and testicles. He also had no concept of smell and had no response to an intravenous Alinamin test. Olfactory bulbs were bilaterally absent and olfactory sulci were bilaterally hypoplastic in MRI. Due to a low response of gonadotropin in a LH-RH test and impaired testosterone secretion, the patient was diagnosed with Kallmann syndrome. Nasal steroids for anosmia were ineffective. Bone density was restored after testosterone replacement for osteoporosis. While there is no effective treatment for anosmia in Kallmann syndrome, hypogonadism is treatable and early treatment may lead to acquisition of reproductive function and greatly improve quality of life. The role of otorhinolaryngology in congenital anosmia is very important for early diagnosis and treatment of Kallmann syndrome.

Congenital nasal pyriform aperture stenosis causes respiratory distress due to a severely narrowed nasal cavity. Since newborns are dependent on nasal breathing, they can easily suffer respiratory distress and feeding difficulties when nasal breathing is impaired. We experienced a case of congenital nasal pyriform aperture stenosis that was successfully treated with intranasal tube stenting.

The patient was a 53-day old girl. Immediately after birth at another hospital, she had nasal obstruction and feeding difficulties, and continued to have poor weight gain. At age 35 days, she had depressed respiration and required daily High-flow nasal cannula (HFNC) and a feeding tube. Sinonasal CT showed that the nasal pyriform aperture had a minimum width of 5 mm at the level of the inferior nasal meatus. She was transferred to our department at age 53 days for treatment. Nasal fiberscopy and CT findings showed that the bilateral nasal pyriform aperture was very narrow, and the patient was diagnosed with congenital nasal pyriform aperture stenosis. We planned to place tubes in the bilateral nasal cavities, and KOKEN^® nasal airway tubes (I.D. 3.5 mm, O.D. 5.0 mm) were inserted bilaterally into the nasal cavities at age 59 days. However, the tubes were compressed and obstructed on the next day, resulting in nasal breathing difficulty. The respiratory condition stabilized after Portex^® endotracheal tubes (right: I.D. 3.0 mm, left: I.D. 2.5 mm) were inserted into the nasal cavities, and HFNC was discontinued. The bilateral tubes were removed at age 89 days and the patient was discharged at age 98 days. Perforation of the nasal septum and partial adhesion of the inferior turbinate and nasal septum were observed, but respiratory distress and feeding difficulties disappeared. This case shows that intranasal tube stenting is useful and effective as treatment for newborn patients with congenital nasal pyriform aperture stenosis.