In traditional medical model, etiology, pathology and its manifestation are very common theme to diagnose or cure clients. However, another point of view is rehabilitative medical view; how the people who have chronic disease or who are aged, or who are impaired would be able to live in their daily life. WHO has been suggested that impaired individuals should be taken into account as a social model in ICF (Ieternational Classification of Function) since 2001. In this article, hearing impairment in Japan is discussed from the view of rehabilitative medicine.

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Chronic rhinosinusitis often recurs after endoscopic sinus surgery (ESS). Recently, a recalcitrant pathophysiology, namely, eosinophilic chronic rhinosinusitis (ECRS), was recognized as one of the risk factors. Therefore, we conducted a prospective study of cases of revision surgery, conducted questionnaire surveys to assess the subjective symptoms and evaluate the quality of life (QOL) before and after ESS. The results revealed no significant differences in the subjective symptoms or QOL scores either before or after the surgery between ECRS patients and non-ECRS patients; both groups improved after surgery. It is suggested that we can obtain good control of the subjective symptoms and QOL by revision surgery by selecting the precise operative method and postoperative treatment procedures.

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A 29-year-old woman visited our clinic with left cervical masses that she had first noticed 3 months previously. She had rheumatoid arthritis (RA) and was under treatment with etanercept, a tumor necrosis factor (TNF)-blocking agent, for the previous 4 years. Fine needle biopsy was performed, but no significant cellular component was found. Imaging examinations, including ultrasound and CT, revealed homogeneous, low-density cervical masses. The left cervical masses were resected under general anesthesia to obtain a definitive diagnosis, and histopathological examination revealed findings consistent with lymph node tuberculosis. Antituberculous treatment was initiated at the Department of Respiratory Medicine of our institution, and the neck swellings gradually resolved. Although various infectious diseases may occur during treatment with TNF-blocking agents, reports of cervical lymph node tuberculosis during etanercept administration are comparatively rare. It is necessary to consider the possibility of lymph node tuberculosis in the differential diagnosis of patients presenting with cervical masses while receiving treatment with a TNF inhibitor for RA.

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We encountered a case of recurrent refractory frontal sinusitis caused by foreign titanium-containing material after frontal craniotomy. After the foreign body was removed, an EMLP was performed to secure a route of excretion, resulting in good postoperative recovery. Thus EMLP may be effective for the treatment of refractory frontal sinusitis.

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