When we otolaryngologists examine children with the common cold, we have to administer proper primary care and avoid missing any complications regarding otolaryngology, and for any case where serious conditions are suspected, we must refer the patient to a pediatrician. Medicine is commonly prescribed to relieve symptoms in patients affected by the common cold; however, there is not much evidence for the efficacy of such. Parents should be notified of all side effects, and we should prescribe medicine only when the patient is experiencing pain with their symptoms. Complications in otolaryngology affected by the common cold include acute otitis media, acute sinusitis, acute subglottic laryngitis, and acute epiglottitis. For any child patient with the characteristic symptoms of such conditions, we should advise the pediatrician in question to recommend a visit to an ear, nose, and throat (ENT) specialist. Severe symptoms in the acute phase, symptoms that are different from natural common cold conditions, and fever in young children must be relayed to a pediatrician immediately. In this study, we examined 24 children that had contracted the common cold and that were referred to a pediatrician by us during the year from July 2018 to June 2019. Six of the 24 children were hospitalized. The children that were hospitalized were significantly younger, significantly saw more cases of acute otitis media, and had significantly more cases of poor oral intake than those that were not hospitalized. Young children are likely to have poor oral intake due to infection, which is likely to affect their general condition.

Common Cold is classified into the following 4 groups according to the symptoms: Nonspecific upper respiratory tract infections, Acute rhino-sinusitis, Acute pharyngitis and Acute bronchitis. The common cold is usually a viral infection that most people recover from within a week to 10 days. When the symptoms worsen after 7–10 days, it’s likely shifted to the secondary bacterial infection and we have to consider the use of antibiotics. Within the Acute pharyngitis group, we have to be extra careful not to overlook lethal diseases such as deep neck abscess or acute epiglottitis. Among the Acute bronchitis group, a differential diagnosis for prolonged cough is important. Also, sometimes initial symptoms of malignant tumors, collagen diseases, ischemic heart disease can resemble the common cold. To make an accurate diagnosis, detailed inquiry and adequate examination are essential.

In patients with allergic rhinitis, a common therapy is oral antihistamine, but control of daily local symptoms is also important. Although topical nasal spray is also commonly used, it can sometimes leak onto and settle on the bottom of the nasal cavity. On the other hand, administration by nebulizer may enable the delivery and attachment of the small particles of the medicine to the nasal mucosa, making drug delivery effective for allergic rhinitis or rhinosinusitis. This method typically uses topical decongestants and steroids. When this treatment is used in the outpatient setting, the purpose is to wash the mucous membrane to compensate for the use of home medications. In the future, provision of a portable mesh-type nebulizer may enable easier use. The purpose of topical nasal therapy is to maintain physiologic function or to decrease the pathophysiologic problem. The proper administration of local and systemic medications for allergic rhinitis needs to be investigated.

The Drug Delivery System (DDS) technology has attracted much attention since the early 1970s. This technology enabled the development of novel drugs including sustained-release and prodrug preparations. DDS has been linked to improvement of drug efficacy and drug applicability to clinical practice. Understanding the pharmacokinetics and side effects of a drug is particularly critical in patient-tailored medicine. In this article, we described the characteristic pharmacokinetics and side effects of DDS drugs commonly used in the field of otolaryngology.

Acute pharyngitis and acute tonsillitis are upper respiratory diseases frequently encountered in daily medical care. According to the “Guide for the Proper Use of Antimicrobial Agents”, Group A beta-hemolytic streptococci (GABHS) are the only bacterial causes for which antimicrobial treatment is indicated. Furthermore, treatment with antibiotics is not required for cases where GABHS are not detected by rapid antigen testing or bacterial culture. Penicillin antibiotics are the first choice of antibiotics to be administered when GABHS are detected. However, in actual clinical setting, even for GABHS infections, penicillin-based antimicrobial eradication often fails due to severe or mixed infections with β-lactamase-producing bacteria, which are resistant to penicillin antibiotics. As a result, administration of other antibacterial agents (new quinolone antibacterial agents, third-generation cephem antibacterial agents, etc.) is considered necessary in some cases. As with other otolaryngology infections, it is important to determine the etiology of acute pharyngitis and acute tonsillitis and to select antimicrobial agents accordingly. In conclusion, while penicillin antibacterial drugs are the first choice, it is necessary to consider other antibacterial drugs when treating acute pharyngitis and acute tonsillitis due to antibiotics resistance.

With the cooperation of the otorhinolaryngological departments of 12 universities in Japan, as well as their 36 affiliated hospitals and clinics, we conducted the sixth nationwide surveillance (the second survey conducted by the Japanese Surveillance Committee, consisting of the Japanese Society of Chemotherapy, Japanese Association for Infectious Disease, and Japanese Society for Clinical Microbiology) on antimicrobial susceptibility patterns and rates of isolation corresponding to 6 otorhinolaryngological diseases.

The subjects included patients with acute purulent otitis media (148 cases: younger than 6 years of age), chronic otitis media (121 cases), acute sinusitis (158 cases), chronic sinusitis (113 cases), acute tonsillitis (127 cases), and peritonsillar abscess (69 cases: older than 20 years of age) who presented to the medical institutions participating in the survey between December 2015 and June 2017.

The collected swab or incision samples were cultivated for microbial identification, and the drug susceptibilities of the detected bacteria were measured at the Kitasato University Research Center for Infections and Antimicrobials.

This surveillance focused on three gram-positive bacteria (Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus), three gram-negative bacteria (Haemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa), and four anaerobic bacteria (anaerobic gram positive cocci, Prevotella spp., Porphyromonas spp., and Fusobacterium spp.).

Bacterial susceptibilities to 40 antimicrobial drugs were investigated. We were unable to completely resolve the rise in resistant bacteria, such as methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, penicillin-intermediate resistant S. pneumoniae, beta-lactamase non-producing ampicillin-resistant H. influenzae, and beta-lactamase-producing ampicillin-resistant H. influenzae.

We suggest promoting the proper usage of antimicrobial agents to avoid the spread of drug resistant bacteria, and that immunization with pneumococcal vaccines is useful to decrease the case of otorhinolaryngological infectious diseases caused by pneumococci.

Annual influenza virus infections result in significant morbidity and mortality, particularly at extremes of age. Influenza vaccines are the only readily-available and licensed vaccines against respiratory viruses. Although influenza vaccines are currently the major public health tool employed to reduce the burden of influenza, their efficacy is limited.

It has also long been recognized that influenza virus-specific CD4⁺ T cells are important in protection against infection, and that this effect is mediated through mechanisms including direct effector functions and provision of help to CD8⁺ T cells and B cells.

Mice were intramuscularly immunized with A/Puerto Rico/8/1934 H1N1 recombinant hemagglutinin (HA) vaccine, followed 21 days later by trans-nasal boosting with the adjuvants CpG ODN (a TLR9 agonist which favors Th1-type responses) and/or alum (which favors Th2-type responses). Mice were subsequently challenged with a lethal dose (10⁶ PFU/ml) of vaccine-corresponding influenza virus. Fifteen days post-immunization, lymph node T and B cells were profiled using flow cytometry. T cell activation (partial or complete) and differentiation (naïve through memory) states were characterized. B cell differentiation state (pre/pro, immature, mature, and plasma cell) was characterized.

At 40 days after the first infection, mice were challenged with a lethal dose of the same virus at a concentration of 10⁶ CFU/ml. Limited body weight loss was observed in the Alum and CpG group mice. Proliferation of CD3+CD4+CD62+ naïve T cells and CD3+CD8+CD62L- memory T cells in the blood was particularly induced in the Alum and CpG group mice compared with PBS. Multiple adjuvant did not seem to affect the B cells in lung.

This study evaluated the capacity of multiple trans-nasal adjuvants to boost immune responses to intramuscular influenza vaccine in mice, by analyzing T and B cell development, migration of these cells to blood, and T cell responses.

We conducted a clinical examination to determine symptoms and patient characteristics to consider when diagnosing acute bacterial epipharyngitis. Acute bacterial epipharyngitis was defined based on the following criteria: 1) acute onset of throat pain, 2) endoscopic observation of epipharyngeal membrane redness and/or suppuration, 3) detection of foreign bacteria within the epipharynx, and 4) leukocyte infiltration of Gram-stained subject samples. We retrospectively examined the clinical presentations of 219 acute bacterial epipharyngitis cases treated between January 2017 and December 2018. Headache was observed as an associated symptom in 154 cases (70%). Additionally, 154 cases (70%) of acute bacterial epipharyngitis developed in either the spring or fall, and 159 patients (72%) had a complication of allergic airway diseases (e.g., allergic rhinitis and bronchial asthma). Based on these results, patients complaining of throat pain in addition to headaches and/or allergic airway disease should be tested for acute bacterial epipharyngitis.

The physiological contamination of skin and mucous membranes in the ear, nose, and throat regions can be facilitated by pathogenic organisms. Hygienic procedures are essential for ENT institutions in order to prevent the transmission of bacteria, virus, and infections in patients. From August, 2018 to November 2018, 990 questionnaires were sent out to ENT physicians for collecting data on the infection controls. The questions included 1) hand hygiene, 2) packaging of ENT medical devices, 3) disinfection of the nozzle tip of atomizers, and 4) sterilization of medicine bottles.

Three-hundred ninety-nine questionnaires were returned, with a return rate of 40.3%. Hand hygiene was more tolerated in University hospitals than in private practice. The packaging of devices was more frequently performed in University hospitals and city hospitals than in private practices. Although there were no differences in the disinfection of nozzles, all three groups showed moderate deficiencies, with a performance rate of about 30%. Sterilization of medicine bottles was much more often performed in University hospitals than in city hospitals and private practices. In conclusion, ENT clinicians should give more attention to infection control in practice units.

Prospective clinical study: We conducted a bacteriological study of post-myringotomy middle ear effusions (MEEs) and nasopharyngeal swabs (NPSs) in children with severe acute otitis media.

Results 1: There were 45 males (47%) and 50 females (53%), and according to their age distribution 38 of them were 1 year old, the largest age group.

Results 2: The NPS cultures in 94 of the 95 cases yielded 182 strains of bacteria; Streptococcus pneumoniae accounted for 26.4% of the isolates, and nontypable Hemophilus influenza (NTHi) accounted for 35.2%. The MEE cultures yielded 65 strains in 65 of the 95 cases; S. pneumoniae accounted for 24.6% of the isolates, and NTHi accounted for 61.5%. In the NPS pneumococcus-positive/NTHi-negative group, pneumococcus-positives also predominated in the MEEs. In the NPS pneumococcus-negative/NTHi-positive group, NTHi-positives also predominated in the MEEs. In the group that was positive for both bacteria, NTHi were predominantly detected in the MEEs. Underlying these results are the concepts of “competition,” “co-colonization,” and “fitness” of the two species of bacteria as interactions between S. pneumoniae and H. influenzae in the nasopharynx and middle ear.

A 63-year-old man had a history of multiple skull base and facial bone fractures at the age of 21 due to a traffic accident, epidural abscess at the age of 48 and right postoperative maxillary cyst at the age of 53. Facial cellulitis and pus discharge from the right frontal external fistula recurred recently. CT images revealed that the silicon plate placed for reconstruction of fractured right orbital floor in a previous surgery was displaced downward. The nasal cavity, ethmoid and frontal sinuses were filled with soft tissue opacification and augmented bone, and a large bone defect around the right frontal external fistula. Corynebacterium species were detected from the external fistula. Antimicrobial medication, local irrigation from both external fistula and self-nasal irrigation were administered. Since pus discharge was repeated, endoscopic modified Lothrop procedure (EMLP) was performed to control the infection. The augmented bone in the frontal region and the filled granulation tissue were removed to restore frontal sinus space, which were widely opened to the nasal cavity. The infection has not recurred for 9 months after the surgery. This case suggests that EMLP is effective in controlling infection for refractory frontal subcutaneous abscesses that has no bony barrier to the frontal sinus.

We recently treated a patient with cholesteatoma complicated with bacterial meningitis. A 67-year-old man whose chief complaints were nausea and severe headaches was brought to our emergency department via an ambulance. Upon arrival, he was diagnosed with bacterial meningitis, most likely caused by cholesteatoma. Medical management, including intravenous antibiotics, by a neurology team as well as surgical management by an otolaryngology team enabled full recovery without any sequelae. The swift identification of the bacterial source and the immediate surgical intervention for cholesteatoma were thought to be the key factors for the favorable outcome. The intraoperative finding included severe inflammation in the mastoid cavity, most likely due to the long-standing nature of the cholesteatoma. We believe that cholesteatoma must be adequately managed in a timely manner because it can cause severe intracranial complications. If an otic intracranial complication occurs, an interdisciplinary approach involving an otolaryngologist, a neurotologist, and, a neurosurgeon is recommended for the most efficient management.

Foreign bodies accidentally displaced into maxillary sinus are roughly categorized as iatrogenic or traumatic. Recently, there has been a rise in iatrogenic foreign bodies related to dental treatment.

Three cases of maxillary sinus foreign bodies complicated by maxillary sinusitis recently evaluated at our hospital were due to iatrogenic foreign bodies related to dental treatment; two of them were dental implant materials. These types of cases are expected to increase as the indications for dental implant treatment expand, and more procedures are performed.

Here, we report on surgical considerations with reference to the literature, focusing on accidental displacement of implant material into the maxillary sinus.

Deep neck abscesses are formed in the potential spaces between the layers of the deep cervical fascia in severe infections, and, when advanced, cause airway obstruction, sepsis, and necrotizing mediastinitis. These are caused by odontogenic infection, tonsillitis, and other diseases. They are usually associated with mandibular odontogenic infection, and cases related to maxillary odontogenic infection are rare.

A 53-year-old woman received treatment for caries of the left maxillary second molar. One week later, she visited the hospital with fever, swelling and pain in her neck radiating from the left cheek, and difficult breathing. A CT scan showed an abscess with gas production in the deep neck space. She was diagnosed with a deep neck abscess and was transferred to our hospital. The involved molar was extracted, along with drainage of the abscess which presented at the maxillary sinus and deep neck space. Several anaerobic bacteria, e.g., Prevotella intermedia etc., were isolated from the extracted pus. She was administered piperacillin-tazobactam and clindamycin along with lavage of the ecthyma cavity, and was discharged on 13th post-operative day. It is important to give treatment quickly and administer proper antibiotic therapy because deep neck abscesses, usually presenting as mixed infections with several anaerobic odontogenic bacteria, can exacerbate rapidly.

Tetanus is an infectious disease caused by tetanus toxin produced by Clostridium tetani. Tetanus is characterized by muscle spasms and autonomic nervous system dysfunction. Although the incidence of tetanus has remarkably decreased owing to routine implementation of tetanus vaccination in Japan, the disease remains life threatening with a high fatality rate in case without prompt and appropriate treatment.

We retrospectively reviewed the clinical characteristics of eight tetanus patients who were diagnosed and treated at the Sapporo City General Hospital from 2008 to 2019. All patients were more than 40 years old. We predicted that the higher the tetanus antibody value, the milder the clinical symptoms; however, the severity may increase in some patients. Furthermore, laryngoscopy revealed pooling of saliva in the hypopharynx in all cases. All severe cases required a tracheotomy.

These finding suggested that tetanus should always be considered when an elderly person presents with rapidly progressive dysphagia and/or trismus.

Necrotizing fasciitis (NF) is a relatively rare but severe infection that mainly affects the lower extremities. NF is characterized by high mortality rates; therefore, early diagnosis and initiation of appropriate treatment including extensive debridement are important. Unfortunately, otorhinolaryngologists may not always be familiar with the diagnosis and management of NF. We report a case of cervical NF that we diagnosed as cellulitis caused by tonsillitis at the first contact. Notably, the patient’s clinical symptoms and conditions worsened after initiation of conservative treatment. Therefore, we performed external debridement and diagnosed him with NF on the 3rd day of admission. We performed multiple debridement procedures, and he received long-term antibiotic treatment with hyperbaric oxygen therapy, all of which successfully treated this patient. Diagnosis of NF may be challenging, particularly for inexperienced clinicians. A supporting scoring system may be useful to distinguish between NF and cellulitis.

We report a 13-year-old boy with Pott’s puffy tumor (PPT). The patient consulted a general hospital with the chief complaint of fever and forehead swelling. Contrast-enhanced computed tomography showed pan-sinusitis and a frontal subcutaneous abscess, which led to the diagnosis of PPT. Conservative treatment with antibiotics was initiated. Twelve days later, magnetic resonance imaging showed an enlarged frontal subcutaneous abscess and epidural abscess; therefore, the patient was referred to our hospital for surgical intervention. Fifteen days after onset of the symptoms, endoscopic sinus surgery and debridement of the epidural abscess via craniotomy were performed. The postoperative course was favorable, and the patient had no sign of recurrence of the disease 14 months after the surgery. Although PPT has become very rare due to the development of antibiotic therapy, cases are still encountered. Surgical interventions are important in the treatment of PPT that are associated with serious intracranial complications.