Almost over 30 years after its first description, the number of HIV (human immunodeficiency virus) patients are still increasing in Japan. Although HIV infection may produce no clinical symptoms for several years in general, most of develop symptoms that indicate progression of AIDS including HIV-related malignancy after many years of infection. It is well known that up to 80% of HIV-infected patients eventually develop some Ear-Nose-Throat clinical manifestations, such as lymphadenopathy, including candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi’s sarcoma, and non-Hodgkin’s lymphoma. According to Anti-Retroviral Therapy (ART) era, people who get infected with HIV can live a longer much the same to general population. Cancer Incident Rate Ratio (IRR) in HIV patients have shown in Kaposi’s sarcoma (IRR 374.73), Non-Hodgkin Lymphoma (IRR 48.71) compared to general population. Interestingly, incidence of HIV-related malignancy (i.e. malignant lymphoma, Kaposi’s sarcoma) have been decreasing, however non-HIV related malignancy (i.e. colon cancer, lung cancer) have been increasing in HIV-population. In general, biopsy is the only way for making definitive diagnosis for HIV-related/non-related malignancy. The rate of infection due to exposure during medical proceedings in HIV patients (0.1–0.3%) is considered much less than HBV (HBe-Antigen positive: 30%), and HCV (1–3%) patients. It should not be feasible for any surgical proceedings for HIV patients with indication. The Z-score is supportive information for making decision to performing lymph-node biopsy (Sensitivity 97%, Specificity 56%). Appropriate and quick preforming HIV-testing may let a person with high risk of getting infected with HIV live decades longer as general population without developing AIDS. ENT doctors should be aware of the ENT manifestations associated with HIV disease including cancer, and the respective early detection, diagnosis, and treatment.

A 16-year-old Japanese female complaining of long-lasting suppurative otorrhea, otalgia, hearing loss, and vertigo was referred to our university hospital. Antibiotic treatment did not resolve the otorrhea, and tympanoplasty and mastoidectomy were performed. Pathological analysis of the mastoid mucosa revealed an Actinomyces infection in her middle ear. Antibiotic therapy with penicillin for 3 months controlled this infection, and there has been no clinical evidence of infection recurrence in the 4 years following.

Actinomycosis should be considered in cases of suppurative otorrhea with granulation tissue, culture-insensitive pathogens, and bony erosion. Differential diagnoses include malignancy, cholesteatoma, tuberculosis, and otitis media with antineutrophil cytoplasmic antibody associated vasculitis (OMAAV). Culture identification of Actinomyces is difficult; hence, definitive diagnosis for an Actinomyces infection is usually based on pathological examination. Penicillin is the first choice antibiotic for treatment of Actinomyces infection, and prolonged antibiotic therapy for 3–12 months is recommended for preventing recurrence.

It is not clear that some abnormal behavior associated with influenza caused by the administered agent, or influenza itself. In this study, it was examined its incidence by telephone interview. In the past three seasons (2011–2014), the 376 influenza patients who has been diagnosed by the rapid kit or by clinical situation after administration an anti-influenza drug were interviewed by nurses on the next day, or two days later. As a result, 25 cases (6.6%) showed some abnormal behavior. 15 cases in Oseltamivir administration group, six cases in Zanamivir, and four cases in Laninamivir were reported.

No difference was observed about the frequency of occurrence among each drug. There was no severe case. It was not able to determine that the cause of the abnormal behaviors were due to drug or influenza itself.

The incidence of intracranial complications caused by sinusitis is decreased by the development of the antibiotics. However, fatal complications are still occasionally reported. We report a case of pneumococcal meningitis caused by sphenoid sinusitis.

A 32-year-old woman, who has been nursing five-month-child, had a common cold in the middle of January 2014. She has been recognized in a clinic because of a headache in February. She had no fever, and was nursing, so only a painkiller was prescribed. However, she had a high fever and vomiting on the next day, and became loss of consciousness in the midnight, and then was taken by ambulance to our hospital.

The state of consciousness was Glasgow Coma Scale (GCS) E3V1-2M4. She had a stiff neck, and Kernig’s sign was positive. Cerebrospinal fluid examination revealed that cell count was 4736/3, and sugar was 20 mg/dL and that Streptococcus pneumoniae antigen was positive. Computed tomography (CT) images showed pneumocephalos in the brain and soft tissue density in the left sphenoid sinus. We diagnosed as bacterial meningitis caused by the sphenoid sinusitis, and endoscopic sinus surgery (ESS) was performed in emergency.

The left sphenoid sinus was filled with pus, and so we removed it and washed enough. We could not find cerebrospinal fluid leakage nor bone defect in the sphenoid sinus. S. pneumoniae was cultured from the pus. We continued the antibiotic administration and the nasal irrigation after the operation. She recovered consciousness on the next day after the operation, and the blood test returned to normal on the eighth day. She was discharged without complications on the twenty-first day.

We experienced a case of pneumococcal meningitis caused by sphenoid sinusitis, which was caused by hesitation of antibiotics administration for the nursing. Pneumococcal meningitis has a high fatality rate, and the rate of complications was reported to be 30%. The patient was successfully treated without complications by ESS and antibiotic administration.

We report herein on the case of a 54 years old woman with tuberculosis of cervical lymph nodes and lungs. In general, New Quinolone sometimes causes a false negative reaction of tuberculosis. We have experienced suspicious false negative response induced by moxifloxacin. Examining PCR only, we could diagnose the lymph node tuberculosis. Nucleic Acid Amplification Test may be effective for the case of low viability of mycobacterium.

Petrositis is rare occurrence. We present a 5-year-old boy with petrositis due to mucoid type of Streptococcus pneumoniae, which caused inflammation into perapharyngeal space. He complained of left otalgia. CT showed petrositis with inflammatory change in parapharyngeal space. Mastoidectomy was performed, and abscess was drained. Subsequently we administrated antibiotics of carbapenem and clindamycin. Mucoid type of Streptococcus pneumoniae was isolated in pharynx. The patient recovered uneventfully. We considered that the drainage and appropriate administration of antibacterial agent would be very useful for acute otitis media with petrositis, especially due to mucoid type of Streptococcus pneumoniae.

We previously reported that the number of hospitalized children with intractable acute otitis media had increased from 1990 to 2000 because of increasing penicillin-resistant Streptococcal pnuemoniae, and it has gradually declined through to 2006.

In this study, we performed clinical investigations for 17 patients affected with intractable acute otitis media between 2007 and 2014. The subjects were 8 boys and 9 girls of the age from 7 months to 18 months (median 14 months). Twelve patients (70.6%) were in daycare centers. The average number of patients per year in the period from 2007 to 2014 was 2.1, which is apparently decreased compared to that in 2000 of 24.

The isolated bacteria from ear discharges were Streptococcus pnuemoniae in 5 patients and Haemophilus influenzae in 5 patients. Bacteria were not detected from ear discharge in 7 of 17 patients. Among 5 isolated Streptococcus pnuemoniae, 1 was penicillin sensitive Streptococcus pneumonia (PSSP), 2 were penicillin intermediate resistant Streptococcus pneumonia (PISP) and another 2 were penicillin resistant Streptococcus pneumonia (PRSP). Haemophilus influenzae, β-lactamase negative ampicillin sensitive (BLNAS) were detected in 2 patients, and β-lactamase negative ampicillin intermediate resistant (BLNAI), β-lactamase negative ampicillin resistant (BLNAR) and β-lactamase positive AMPC-CVA resistant (BLPACR) were detected in 1 patient each. Seven patients were hospitalized with antibiotics side effects. Fourteen patients were tested for immunological immaturity, 4 patients showed low levels of IgG2 (<80 mg/dl).

Declines in hospitalizations for intractable acute otitis media were sustained through 2014. It has been considered that factors of declining acute otitis media due to antibiotic resistant bacteria were the introduction of pneumococcal vaccine, the issue of clinical practice guidelines for the diagnosis and management of acute otitis media in children in Japan, and the changing indication of some new antibiotics for children. To sustain current situation, we have to continue monitoring the appropriate usage of antibiotics and the change/emergence of drug-resistant strains.

Background: Flexible laryngoscopes (nasopharyngeal endoscopes) are important tools in the everyday practice of Ear-Nose-Throat (ENT) departments. However, reprocessing procedures for endoscopes, especially those without suction or instrument channels (i.e., observation-only scopes), have not yet been standardized in Japan. This study comprised two parts: 1. A questionnaire survey was performed to elucidate the current status of reprocessing procedures for endoscopes in ENT departments in Japan. 2. An ATP bioluminescence test was applied for hygiene monitoring of observation-only scopes to develop an effective reprocessing protocol.

Materials and Methods: The questionnaire asked about the inventory of flexible laryngoscopes, both with and without suction channels, the frequency of laryngoscopy per half day, and the use of scope-washing machines. Regarding the reprocessing protocol for observation-only scopes, questions covered the kind of detergent used for washing, disinfectant, soaking time, and the total time for reprocessing. Each of 30 laryngoscopes was cleaned using 4 different protocols in 3 facilities. Hospitals A and B: A reprocessing protocol in accordance with the UK guideline, which recommends using an enzymatic detergent for washing (Hospital A used a scope-washing machine; Hospital B performed manual washing), followed by soaking in glutaraldehyde. Clinic C “Conventional protocol”: Soak insertion parts in running water for a few seconds, and then in glutaraldehyde. Clinic C “Improved protocol”: Instead of soaking in water, wiping the insertion parts gently with a gauze soaked with a neutral detergent. After soaking in a disinfectant and rinsing, the ATP test was performed using a 3M^TM Clean-Trace^TM Luminometer. The measured ATP was expressed in relative light units (RLU). The RLU results with these washing protocols were compared.

Results: The questionnaire was completed and returned by 25 ENT departments. All 25 departments have scopes without a suction channel. Twenty-three departments have less than 3 scopes. Only 4 departments (16%) have scopes with a suction channel. As for the frequency of laryngoscopy examinations per half day, 18 departments (72%) are under 4 times, while 3 departments (12%) are over 20 times. The extent of washing is only the insertion part at 16 departments (64%) and the entire scope at 8 departments (32%). As for the disinfecting agent, 20 departments use a high level disinfectant, whereas 2 departments use chlorhexidine, and 1 department uses an enzymatic detergent. The total time for the reprocessing procedures is 10–15 min in 7 departments (30.4%) and 15–20 min in 4 departments (17.4%), while one department takes under 5 min. For endoscopes reprocessed in accordance with the UK guideline at Hospital A and Hospital B, the mean RLU was 13.1 and 16.0, whereas it was 76.0 at Clinic C, where the endoscopes were just soaked in running water. After gentle wiping with neutral detergent-soaked gauze, the RLU was improved to 26.6.

Conclusion: ATP hygiene monitoring is a useful tool for assessing cleaning protocols for laryngoscopes.

Skull base osteomyelitis (SBO) is a classically described as a Psuedomonas aeruginosa infection originating from malignant external otitis (MEO). A typical patient with SBO is an eldrly diabetic who presents with temporo-occipital pain and lower cranial nerve palsies. On the other hand, it has been reported that some SBO cases had the atypical nature of the clinical presentation of the disease. We present two cases of SBO with multiple cranial nerve palsies. One case is of a 75 year-old male with diabetes mellitus caused by fluoroquinolone-resitant P. aeruginosa. He was treated by long-term administration of antibiotics and hyperbaric oxygen. The other case is of a 65 year-old male on hemodialysis caused by P. aeruginosa. He was treated by long-term administration of antibiotics.

Endoscopes, which are used for invasive procedures, can be contaminated with various microorganisms such as viruses and Mycobacterium tuberculosis. High-level disinfectants such as phtharal, glutaral, and peracetic acid show wide antimicrobial spectra, and their efficacy do not markedly decrease by organic matter. Therefore, high-level disinfectants are appropriate for endoscope disinfection.

However, since such disinfectants are highly toxic, they should not be used for purposes other than endoscope disinfection. For example, these disinfectants are not used for mouthpieces, cleaning brushes, and water supply bottles. In addition, exposure of the skin to high-level disinfectants causes dermatitis and chemical burns (injuries), and exposure to their vapor causes conjunctivitis, rhinitis, and asthma. Therefore, gloves and waterproof aprons should be worn for their handling, and they should be used only for disinfection with automated endoscope reprocessors. To prevent exposure to the vapor of high-level disinfectants, powerful ventilation systems (draft) are necessary. The ventilation system is placed near the automated endoscope reprocessor below the eye level. In addition, the use of special masks for protection against these disinfectants is recommended.

Intranasal procedures are a basic treatment which enhances the accuracy of diagnosis and effectiveness of topical treatments for nose and sinuses.

For anesthesia for nasal cavity, watch out for the adverse effects resulting from an overdose of Xylocaine and methyl paraben antiseptic when dealing with anesthesia for nasal cavity. For nasal aspiration, remove nasal mucus with a Nelaton catheter. Application of white petrolatum on nasal vestibule is effective for preventing infection and nasal bleeding. For widening the natural ostium of sinuses, carefully use conventional cotton applicator with metal shaft. If saline is used as solution for nebulizer treatment, mucocilliary function will be enhanced. Vasoconstrictors are not needed as nebuliser medicine.

Thermotherapy is safe and can enhance the usefulness of topical treatment for nasal cavity. For a minimary invasive antral irrigation, the use of an endoscope through the middle meatus is recommended. When irrigation of sphenoidal sinus, by selecting an appropriate example case with CT or MRI and an endoscope, it is possible to relieve the symptom quickly, thus to avoid surgical therapy.

The incidence of childhood acute otitis media has increased in children owing to changes in the social environment and development of resistant pathogenic bacteria, and therefore, number of cases resistant to treatment is also increasing. Therefore, it is critical to devise diagnostic techniques and new treatment modalities for this disease as well as for managing the adverse effects. In order to diagnose acute otitis media, quantitative (risk stratification) as well as qualitative diagnostic (pathogenic bacterium and drug sensitive) techniques have been accurately performed, following the treatment algorithm of the Childhood Acute Otitis Media Practice Guideline 2013. However, in case of patients resistant to the treatment, it is critical to develop a treatment modality based on the treatment algorithm. Along with increased administration of the antimicrobial agent, it is important to combine ear-nose-throat (ENT) surgical procedures, such as tympanostomy and eardrum ventilation tube placement procedure. In refractory, recurrent, and prolonged otitis media case, short-term eardrum ventilation tube placement surgery is effective, and early treatment without hesitation is preferable, while taking into account the condition of children with otitis media. Further, in order to prevent antibiotic resistant pathogenic bacteria, appropriate use of antibacterial drugs is critical. Unregulated increased usage of new antimicrobial agents should be discouraged.