According to the treatment policy of our facility for otitis media with effusion (OME) in children, long-term ventilation tube placement (VTP) has been performed for intractable cases with prolonged middle ear effusion accompanying with suppressed growth of tympano-mastoid air cells. And for cases with adenoid hypertrophy, adenoidectomy was also performed under general anesthesia together with VTP. Furthermore, based on the relationship between duration of the ventilation tube placement and recurrence rate, the ventilation tube was placed for at least 18 months, in general.
In the present study, we examined factors, including the usefulness of adenoidectomy that influences the postoperative course after removing ventilation tubes for cases with OME in young children up to six years old. 161 ears in 161 young children ranging from 3 to 6 year old at the time of VTP were subjected to the study. These patients were hospitalized in our department from August 1980 to May 2008, and observed for one year after removing the tube. In the patients underwent bilateral tube insertion, only one ear exhibiting a less satisfactory prognosis. Subjects underwent VTP alone were categorized into the tube placement group and the subjects underwent adenoidectomy together with VTP into the adenoidectomy group.
In each group of children with good or poor prognosis, no significant effects of placement duration (21.2 months vs 20.0 months) and age (5.1 year old vs 4.8 year old at the time of VTP) on prognosis were seen. The degree of development of mastoid cells at the first visit was significantly greater in the good prognosis group than in the poor prognosis group (p<0.05, 22.5 cm² vs 9.5cm²). Regarding the placement duration and prognosis after removing the tube, significantly higher incidence (p<0.01) of cases with good prognosis was noted in the group with placement duration of 18 months and more than in the group with the duration of less than 18 months, whereas no significant effects of the duration on prognosis were noted in adenoidectomy groups.
Taking into account the fact that VTP must be carried out under general anesthesia in younger children, it was considered that adenoidectomy was desirable at the time of VTP and thereby reduced a possibility of recurrence of OME as the result of early spontaneous loss of the tube, in general.

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Nontypeable Haemophilus influenzae (NTHi) is considered a major pathogen underlying middle ear infection. This study aimed to ivestigate the dynamics of IL-17 in chronic otitis media induced by NTHi in Balb/c mice. NTHi was injected into the tympanic bulla with Eustachian tube obstruction. Middle ear effusions and tissues were collected at day 3, 14 and 2 months after injection. The concentration of IL-17 in middle ear effusions eleveated significantly during experiments when compared to control. IL-17 producing gd T cells and Th17 cells were also increased up to 2 months in the middle ear. Based on these findings, IL-17 producing T cells existed in chronic state of otitis media may play some role for modification of chronic inflammation in the middle ear.

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Objective:Currently, congenital cholesteatomas are often diagnosed at an early stage using endoscopes or microscopes, increasing the number of cases detected in childhood. A congenital cholesteatoma in the middle ear cavity can be removed via a transmeatal approach performed endoscopically with minimal invasion, i.e., without removing the bony canal or disrupting the ossicular chain. We have used exclusive endoscopic ear surgery (EES) for congenital cholesteatomas in children since 2010. This study clarifies the indications for EES for congenital cholesteatomas.
Methods: Rigid endoscopes were used for all procedures. A tympanomeatal flap was elevated, and the cholesteatoma removed under direct visualization. It is important to visualize the base of the cholesteatomas and confirm no residueafterthe removal. For anterior-superior-quadrant lesions, the base of the cholesteatoma is often near the cochleariform process, which can usually be visualized endoscopically. We performed a retrospective chart analysis of the patients who underwent surgery for congenital cholesteatomas.
Results: Nine children were operated on for congenital cholesteatomas between September 2009 and September 2011. No patient had bilateral disease. Six children underwent EES. Five had anterior-superior-quadrant lesions, and the other had a posterior-superior-quadrant lesion. The mean diameter of the cholesteatoma on computed tomography (CT) was 3.6 (range 2.8-3.9) mm. Closed-typecholesteatomas were found in four of six ears, and they were removed relatively easily. Using the staging system proposed by Potsic et al., five of six ears were classified as stage I, and one as stage II. All three patients whose surgery used a canal wall-up tympanomastoidectomy using microscopes (staged operation) had stage III cholesteatomas. There were no iatrogenic injuries to the ossicles or other middle ear structures in both operated groups. Although the follow-up period is short, no recurrence has been found.
Conclusions: Congenital cholesteatomas can be removed safely with EES exclusively. Stage I or II and closed type with a diameter <4 mm are good indications for EES. An early diagnosis is essential for treatment by EES.

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Patients with cholesteatoma are commonly evaluated by using computed tomography (CT). Although CT is useful for anatomical analysis for surgical landmark, it cannot discriminate cholesteatoma from other soft tissue. This limits its preoperative and postoperative usefulness. In Japan, it has been reported that echo-planar diffusion-weighted MR imaging (EP DW) is useful for diagnostic imaging of cholesteatoma. However, EP-DW shows important artifacts and has a low resolution, thus missing small lesions. Bert De Foer et al. reported that non-echo-planar diffusion-weighted MR imaging (non-EP DW) has a thinner section thickness and higher imaging matrix and is less prone to susceptibility artifacts than EP DW. We have been using non-EP DW for detection of middle ear choleateatoma since Jan. 2011. We evaluated 63 patients with middle ear diseases with non-EP DW and operated on 30 ears. Non-EP DW was positive in 21 ears preoperatively and all showed cholesteatoma during surgery. The smallest size of non EP DW positive cholesteatoma was 3mm. Nine ears were negative (1 cholesteatoma, 1 cholesterol granuloma, 1 glomus tumor, 1 chronic otitis media, 3 otitis media with effusion, 1 ossification of external auditory meatus, 1 postoperative cholesteatoma with no residual cholesteatoma). We concluded that non-EP DW is useful for preoperative diagnosis of cholesteatoma, especially in cases with recurrent or residual cholesteatoma.

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Seven patients with CHARGE syndrome who had visited Kanagawa Children's Medical Center between 2000 and 2009 were analysed in this report. Coloboma, retardation of growth or development and hearing loss were observed in all 7 patients. Six cases of the cardiac defect, 2 of atresia of the choanae, and 6 of genital hypoplasia were also observed. Newborn hearing screening was useful to detect their hearing loss in 6 patients. Since hearing loss was one of the most important symptoms for diagnosis of this disease, it was suggested that the newborn hearing screening should be performed for all patients with CHARGE syndrome even without any deformity in otorhinolaryngeal area. It was also suggested that the improvement of communicative environment for the patients with CHARGE syndrome should be obtained with adequate language development with hearing aids and/or speech therapy.

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Burow's solution is effective in treating intractable chronic ear discharge. This solution is not available commercially, and it has to be hand-maid at each institution.
No report has been available on the variation of its efficacy and ototoxicity after manufacturing it.
We studied changes in appearance of the solution, pH, osmotic pressure, bacteriostatic activity and ototoxicity, at 1, 3, 6, and 9months after manufacturing.
The solution became opaque as time progressed due to cristalization of aluminum component. pH was 3.6 at the beginning, 4.0 at one month and did not vary afterwards. Osmotic pressure was 920mOsm at the beginning, and gradually reduced to 600mOsm at 9 months. Bacteriostatic activity did not change at 1 month, but gradually reduced with progress of time. Ototoxicity judged by changes is CAP has not been changed until 3 months, and became dominant for low frequency ranges at 9 months, probably due to conductive component caused by crystallized aluminum. Burow's solution is effective within one month after manufacturing it.

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This paper reports a case of traumatic perilymphatic fistula induced by a ceramic TORP due to the pressure of a tampon for replacement on the tympanum. A 68-year-old female presented to our hospital with conductive hearing loss, and central tympanic membrane perforation and calcification were identified. Tympanotomy revealed calcification around the stapes and stapedial fixation. The stapes was not surgically treated in consideration of the possible occurrence of internal otitis due to poor hygiene in the tympanic cavity, while the incus was conserved for secondary stapes surgery in the case of recurrent stapedial fixation. After slightly mobilizing the footplate of the stapes, the ossicular chain was reconstructed by connecting the footplate and malleus using a ceramic TORP. On postoperative day 19, severe vertigo and hearing loss were observed in the presence of a left-beating nystagmus when a tampon for replacement was pressed on the tympanum; on temporal bone CT scanning, it was shown that the axis of the TORP intruded into the vestibular window. On the same day, exploratory tympanotomy was performed to confirm the displacement of the footplate and intrusion of the TORP axis into the vestibular window. Perilymph leakage from the oval window was also observed. Therefore, the incus was removed for the dissection of granulomatous lesions after surgery, while the tympanum was connected with the oval window using the TORP after removing its axis and closing the oval window with the fascia. On the next day, although no vertigo was observed, hearing had not recovered to the previous level.

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A 34-year-old HIV-infected male has been received treatment for borderline personality disorder (BPD) and therefore standard steroid therapy for the facial paralysis was not indicated. At the initial diagnosis, he showed 22/40 points of incomplete paralysis by Yanagihara grading score. The facial paralysis worsened to 10/40 points in 3 weeks after the onset and his psychiatric symptoms showed exacerbation at the same time. The surgical intervention was controversial, but with the consent of the patients, we performed facial nerve decompression after 20 days of the onset. Significant edema of the nerve was detected during surgery and he showed a remarkable improvement of his facial paralysis just after surgery and subsequently complete recovery after 47 days of the onset.
This case was uncommon in a HIV- infected patient merged with BPD, and it was difficult to accomplish the standard treatment. There were not many reports of facial paralysis accompanied with HIV- infected patients in Japan, but a relatively frequent symptom in the HIV infected person. As for the otolaryngologist, attention should be paid for the onset of facial paralysis in the HIV- infected patients.

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As surgeons, most of our ideas involve new devices rather than new drugs but it could be a new smart phone application or computer program to improve our day to day practice. The purpose of this paper is to encourage the reader to act ..... not be one who later tells friends “I thought of that, but didn't have the time/money to develop it”.
The process starts with understanding what you need that you do not have or, as important, how to do the same thing at less cost. Since I practice in the United States, the rules of developing a new product will be different than in Japan. But the principles are no doubt similar. Does it do a better job? Easier to use? Lower cost? Nothing like it available?

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The evolution of the vertebrate auditory organ was reviewed. In addition to equilibrium and gravitational tasks, sensory epithelia of otolith organ have responded to oscillations of water. The otolith organ such as saccule and lagena evolved into the auditory organ in fish. For terrestrial animals, hearing airborne sounds required the creation of specialized anatomical structures. The middle ear, the periotic canal and the basilar papilla have evolved in the auditory organ of terrestrial animals. In whales, air-adapted auditory organ had to be reorganized to hear water-borne sounds. The pinnae and external auditory canals were lost, and the middle and inner ear capsules fused to form tympano-periotic complex. Sound is conveyed to the middle ear by specialized fatty tissues in the jaw region.

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