Over-underlay tympanoplasty is a relatively recent method in which the graft is placed laterally to (over) the malleus and medial to (under) the drum remnant and anterior annulus. This new technique was developed to eliminate the disadvantages of the two classical techniques of overlay and underlay myringoplasty. In this study, the results of over-underlay tympanoplasty, carried out in our department, were analyzed for graft take rate, hearing improvement, and postoperative complications. Fifty-two patients, who underwent over-underlay tympanoplasty between 2014 and 2015, were included. The average age at operation was 46.5 years (range, 8 to 74 years). Of the 52 patients, 50 (96.2%) showed a full take of the graft by the 12-month follow-up. There was no statistically significant difference between the size of perforation and graft take rate. The overall postoperative hearing success rate was 90%, according to the 2010 criteria of the Japanese Otology Society. Hearing outcomes were not affected by the size of perforation or type of ossicular chain reconstruction. There were no significant complications such as graft lateralization, iatrogenic cholesteatoma, or infections. However, postoperative myringitis was seen in two patients.

Over-underlay tympanoplasty is an ideal technique for tympanic membrane perforations such as chronic suppurative otitis media or traumatic tympanic membrane perforation because of its effectiveness and reduced complication rates.

We experienced a case of a right petrous bone cholesteatoma with defects in the vertical and horizontal parts of carotid canal. Using the transmandibular fossa approach, we successfully removed the lesions completely without major complications. The patient was a 67-year-old man who had suffered from bilateral profound sensorineural hearing loss and had undergone tympanoplasty in his childhood. Right-sided otorrhea had developed six months prior. A temporal bone computed tomography (CT) scan showed soft tissue density areas extending from the mastoid antrum and the epitympanum to the hypotympanum and the region antero-inferior to the cochlea. The soft tissue density caused a bone defect in the horizontal and vertical portion of the carotid canal. On the basis of CT scan and magnetic resonance imaging (MRI) findings, we diagnosed the lesion as an infralabyrinthine type of petrous bone cholesteatoma. Preoperatively, we planned for a safe complete eradication using the infratemporal fossa approach type B by securing a wide area around the internal carotid artery. During the surgery, we found that the anteromedial end of the lesion was just medial to the middle meningeal artery. Thus, we did not need to transect the zygomatic arch or expose the dura. To secure a wide area that was sufficient to remove the lesion completely, we only needed to dislocate the head of mandible and drill out the mandibular fossa. The postoperative course was uneventful, and there was no recurrence during the following three years.

The signs and symptoms of a perilymphatic fistula (PLF) are non-specific, which makes is particularly difficult to diagnose this condition. Since cochlin-tomoprotein (CTP) is a protein specifically found in perilymph, its detection in the middle ear indicates the presence of a PLF. Therefore, measuring CTP may be useful in the diagnosis of PLF. This retrospective study examined the CTP levels in saline rinses taken from 29 middle ears of 28 patients with suspected PLF. Of these samples, 5 (17%) were CTP-positive, 7 (24%) were CTP- pseudopositive, and 17 (59%) were CTP-negative. CTP was high in patients in category 1 PLF, although this varied widely. In comparison, CTP was relatively low in patients in category 2-4 PLF, although there were no significant differences found between categories 1 and 4. Three of the five samples with positive CTP were taken from patients who had other diseases causing disequilibrium (benign proximal positional vertigo, superior canal dehiscence syndrome or multiple system atrophy). Perioperatively, a fistula was found in one of the seven ears with pseudopositive CTP. CTP was positive in middle ear saline rinses obtained during an operation on 1 of the 17 ears for which CTP was negative preoperatively. Consequently, the above two patients were diagnosed with PLF, indicating that the CTP test had yielded a false-negative outcome. Thus, it is important to repeat CTP testing in patients with suspected PLF and continuing disequilibrium.

To treat facial paralysis that had an unclear timing of onset, a steroid was administered in accordance with standard treatment guidelines for Bell’s palsy. Although paralysis score remained unchanged, the ENoG value improved markedly. However, after 2 weeks, the ENoG value decreased again. Emergency magnetic resonance imaging suggested pineal tumor-related meningeal dissemination, and a biopsy was performed using a neuroendoscope, thereby confirming a diagnosis of a papillary tumor of the pineal region. Detailed medical history taking is important to investigate the etiology of facial paralysis. Examinations should be promptly performed if discomfort is reported.

Eosinophilic otitis media (EOM) is intractable otitis media characterized by middle ear effusion with marked eosinophil infiltration. And it is well known as one of high risk diseases of hearing loss unless appropriate treatment is performed. Diagnostic criteria for EOM have been proposed in 2011 as follows. Major criterion: otitis media with effusion or chronic otitis media with eosinophil-dominant effusion. Minor criterion (two or more among the following four items): 1) highly viscous middle ear effusion, 2) resistance to conventional treatment for otitis media, 3) association with bronchial asthma, 4) association with nasal polyposis.

For the treatment of EOM, topical administration of steroid after removal of eosinophilic mucin is effective. In addition, a combined of anti-leukotriene drugs, phosphodiesterase inhibitors, and second generation antihistamines for long-term management is also used. Moreover, it is important to get good control of asthma in cases of EOM associated with bronchial asthma.

To investigate the positive rate for the Cochlin tomo-protein (CTP: an inner ear-specific protein) detection test among patients with inner ear-related clinical manifestations and to evaluate the clinical characteristics of definite perilymphatic fistula (PLF). We have performed an ELISA-based CTP detection test using middle ear lavage samples from 497 cases of suspected perilymphatic fistula enrolled from 70 clinical centers nationwide between 2014 and 2015. Eight to 50% of patients in category 1 (trauma, middle and inner ear disease cases), and about 20% of those in categories 2, 3 and 4 (external origin antecedent events; internal origin antecedent events; without antecedent event, respectively) were positive for CTP. In category 1 cases, the earlier tested samples showed a higher CTP-positive rate, whereas no differences were observed in the categories 2, 3 and 4. The characteristic clinical features in the earlier tested cases were nystagmus and fistula sign in CTP test-positive cases in category 1, and streaming water-like tinnitus in those in category 2, 3 and 4. The present study clarified that CTP detection test-positive patients exist at considerable rates among patients with inner ear-related manifestations. In addition to this nation wide survey, we have discussed about the window repair surgery, comparing the conventional techniquep and newly developed round window reinforcement.

Recently, drug discovery research for sensorineural hearing loss has gained considerable attention according to progress in research for protection and regeneration of the inner ear. Although sensorineural hearing loss has been known as a common disability, there is no drug that Food and Drug Administration of United States of America. Sudden sensorineural hearing loss is a comparatively rare type of sensorineural hearing loss, while it has several advantages as subjective for clinical trials aiming development of new therapeutics. In this article, recent status of drug discovery research for sensorineural hearing loss and our challenges in research on topical application of insulin-like growth factor-1 for treatment of sudden sensorineural hearing loss are reviewed.

Two stage otoplasty has been common procedure for microtia patients: rib cartilage graft in the first stage, and ear elevation in the second stage operation. We have developed combined surgery in the 2nd stage operation, combined surgery of ear elevation and canal plasty. The possibility of getting hearing ability is estimated utilizing Jahrsdoerfer’s score from the temporal bone CT scan. When the patient’s middle ear is well developed and the patient and family desire to do canal plasty, we plan combined ear elevation with canal plasty for the second stage operation. For patients who are not candidate for ear canal plasty, we have developed a simple procedure for ear elevation making a TPF pocket to cover the cartilage buttress. The details of our surgical techniques and the results of this procedure are described.

Between 1999 and 2015, 200 cases underwent this combined surgery. 67cases of them are bilateral microtia cases and the rest of 133 cases are unilateral cases. Improvement of hearing ability more than 15 dB has achieved in 58% cases. None of the cases accompanied necrosis of the constructed ear. As the complication, necrosis of the retroauricular skin graft has occurred in 6 cases, and facial paralysis occurred in 5 cases. But we have experienced late complication such as the contracture in the entrance of the ear canal, and lateralization of the tympanic membrane. We think further revision of the surgical details should be developed.

Regenerative medicine refers to a treatment by artificial reconstructions of lost tissues and organs. Because regenerative capacity in human is generally limited, this medicine is sometimes a big challenge. In Japan, attempts to translate biomed innovation to the clinical side especially in the regenerative medicine are rapidly being pushed at the national level under its medical conditions where human organs or cells for therapeutic purposes are limited and therefore the social demands for the practical application of regenerative medicine are particularly large. For example, government started new law promoting regenerative medicine with the early approval system of regenerative medical products.

Recent progress in the stem cell biology of the inner ear enables us to harvest, amplify and control cochlear stem cells and to generate inner ear cells from ES/iPS cells. In this article, the outline of regenerative medicine in Japan that crosses industry, academia and government is overviewed; outlines of the steps and hordes required for the inner ear regeneration to be put into practice are listed; then, the recent progress of the inner ear regenerative medicine would be reviewed.