We classified cases of pars tensa cholesteatoma who underwent initial surgery at our institute based on the Classification and Staging of Cholesteatoma proposed by the Japan Ontological Society in 2010.
　Between 2008 and 2012, 34 cases of pars tensa cholesteatoma were treated by surgery in Jikei University. The patients ranged in age from 11 to 68 (average 42.0) years and included 17 males and 17 females. The postoperative observation period was more than a year, with a mean follow-up period of 35 months. In regard to the stages, 14 ears (41.2%) were classified as stage I, 16 ears (47.1%) as stage II and 4 ears (11.8%) as stage III cholesteatoma. Ossiculoplasty was performed for 5.9% cases of Type I, 58.8% of Type II and 35.3% of Type III cases. Successful postoperative hearing outcomes were obtained in 50% of the cases. The recurrence rate of cholesteatoma was 5.9%, which was relatively good in comparison to previous reports. These results suggest that cartilage tympanoplasty and application of endoscopy for ear surgery is useful for minimizing the recurrence rate after surgery.

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　We treated 5 cases of paranasal sinus diseases with visual disturbances in the past two years from April 2011 to March 2013. In all 5 cases―2 rhinogenic orbital complication, 2 rhinogenic optic neuritis and 1 posterior paranasal sinus cyst―endoscopic sinus surgery (ESS) was performed. Visual acuity returned to the expected levels after surgery in 4 cases. The remaining 1 case which was due to a posterior paranasal sinus cyst, did not improve. In the case of severe visual disturbance, despite an emergency operation, it may become permanent. Even if an asymptomatic posterior paranasal sinus cyst is found on CT or MRI, then surgery should be considered as the treatment of choice. In 1 case of acute sinusitis, after the improvement of visual disturbance by surgery, the visual disorder recurred. The cause of the secondary visual symptom was not inflammation of the paranasal sinus but metastasis from breast cancer. Clinical diagnosis should be done carefully, not only taking the findings from CT or MRI into consideration, but also investigating the patient's past history and complications.

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　Rhabdomyolysis causes acute renal failure, and immediate treatment can be effective to prevent severe rhandomyolysis. How to deal with severe rhabdomyolysis at first is important for doctors of otorhinolaryngology to know. We report a rare case of deep neck abscess complicated by severe rhabdomyolysis and acute renal failure.
　A 40-year-old male was brought to our emergency department with a history of fever, right neck swelling and loss of consciousness. The patient was diagnosed as having a deep neck abscess by CT, and as having rhabdomyolysis and acute renal failure by the increased levels of serum CK, BUN and serum creatinine. Emergency drainage with external incision was performed. On the 3rd hospital day, the serum CK increased to 242,900 IU/l, and on the 4th hospital day, the serum creatinine increased to 4.04 mg/dl. Then, on the 4th and 5th day, emergency hemodialysis was performed. After these treatments, the infection resolved and the serum CK levels and renal function parameters returned to normal.

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　The anterior inferior cerebellar artery (AICA) syndrome may manifest with a variety of neurologic symptoms, including hearing loss, tinnitus and vertigo, as the presenting symptom. We report the case of a patient with brainstem infarction who presented with deafness of sudden onset. The patient was a 65-year-old woman who presented with sudden hearing loss and tinnitus in the right ear and vertigo, without any other neurological deficits. At the time of hospitalization, the patient was diagnosed as a case of sudden deafness. Since the patient showed persistent severe nausea and vomiting even after hospitalization, MRI was performed. CT showed no abnormality, while MRI and MRA revealed fresh infarctions of the right middle cerebellar peduncle and cerebellum localized in the territory of the anterior interior cerebellar artery. In daily clinical practice, it is important to bear in mind the possibility of AICA syndrome in patients presenting with acute sensorineural hearing loss and vertigo. We suggest that it is important to perform MRI and MRA in the early stage in such patients, especially those with risk factors for cerebrovascular disorders.

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　A 68-year-old male was found to have a congenital giant cholesteatoma arising from the mastoid extending into the occipital area; he was seen by a dermatologist for ear pain, and was diagnosed as having an inflammatory atheroma. Excision of the atheroma was performed under local anesthesia. However, the lesion had extended into the deeper layers of the skin, and after excising as much as possible, we closed the wound. However, after few months, the patient developed heaviness of the head and otorrhea from the right ear. Computed tomography revealed a giant cholesteatoma extending into the occipital area. Then, the patient was referred to our clinic. Computed tomography of the brain revealed an expanding soft tissue shadow centered on the mastoid of the right ear, and destruction in the posterior cranial fossa. Because of the extension into the occipital area and suspected adhesion to the posterior fossa dura mater, operation was performed by an otolaryngologist, brain surgeon, and plastic surgeon. We exfoliated the membrane of the cholesteatoma from the ear canal, and removed the cholesteatoma. Despite the adhesion to the posterior fossa dura mater, we could successfully exfoliate the membrane of the cholesteatoma, and there was no invasion of the central nervous system. A year after the operation, magnetic resonance imaging of the brain revealed no recurrence of the cholesteatoma. In patients with atheroma in the occipital area or those showing an expanding soft tissue shadow arising from the mastoid process of the ear, the possibility of a giant cholesteatoma must be borne in mind.

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[in Japanese]

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