We use canal wall-down tympanoplasty concomitant with mastoid obliteration as a basic technique to prevent postoperative recurrent cholesteatoma after a canal wall-up tympanoplasty. This approach facilitates complete removal of the cholesteatoma and can prevent recurrence and is useful to maintain a physiological external ear canal. This technique was associated with a recurrence rate of 9.7% for the pars flaccida and 20.4% for the pars tensa-type cholesteatoma. The recurrence rate was higher in patients with the pars tensa than pars flaccida-type cholesteatoma and tended to increase with the lesion stage for both types of lesions. With regard to the surgical method, canal wall-down tympanoplasty concomitant with mastoid obliteration shows the lowest recurrence rate. However, the obliteration technique is unsuitable in a few patients; ossicular fixation and recurrent cholesteatoma may occur in patients with a preserved ossicular chain in whom epitympanum obliteration is not possible. Therefore, this technique is infeasible in such cases. This approach is also unsuitable in patients with well-developed mastoid air cells, owing to the lack of filling material and the risk of recurrence within the obliteration. To avoid the risk of residual recurrence, mastoid obliteration is contraindicated in patients in whom complete cholesteatoma removal is not possible.

The choice of surgical method is based on a variety of factors such as type and extent of cholesteatoma, preoperative hearing, mastoid development, age, and other factors. It is important to select a flexible surgical approach based on the classification of the degree of disease progression.

Children with cleft palate often develop complications associated with intractable otitis media with effusion (OME) due to Eustachian tube dysfunction. We reviewed the results of newborn hearing screening (NHS) tests and OME evaluation and treatment in 77 children with cleft palate who underwent palatoplasty. Of the 73 cases that underwent NHS, 73% were bilateral pass cases. At the first evaluation within 3 months of birth, middle ear effusion was detected in 94% of NHS pass ears and 82% of refer ears. When performing palatoplasty, 75% of 154 ears in 77 cases were indicated for ventilation tube (VT) placement, including 107 with tube placement, 8 with tube placement difficulty, and 1 with residual perforation. No differences were observed in indication rates for VT placement between NHS pass and refer ears. There were significantly more boys and patients with complications in the NHS unilateral and bilateral refer group, and significantly more patients with cleft palate alone in the group indicated for VT tube placement. These results suggest that middle ear effusion in children with cleft palate may increase after NHS tests and may persist until palatoplasty. Regardless of NHS test results, the OME course of children with cleft palate should be carefully monitored.

Abnormalities and weakness of the tensor veli palatini and levator muscles in cleft palates can lead to Eustachian tube dysfunction and, in the long term, to otitis media with cholesteatoma.

From January 2014 to December 2018, 16 ears were treated with tympanoplasty for cholesteatom associated with cleft palate and were followed up for more than 1 year. The main findings of this study are the pathological classifications of cholesteatoma, operative procedures, hearing improvement, residual cholesteatoma rates, and recurrent cholesteatoma rates.

In terms of pathological classifications of cholesteatoma, 66.7% of fresh cases (8 out of 12 ears) were pars tensa cholesteatoma. Canal wall up tympanoplasty (including transcanal tympanoplasty) was performed in 91.7% of cases (11 out of 12 ears). Hearing improvement was achieved in 68.8% of cases (11 of 16 ears) according to JOS criteria.

Residual cholesteatoma rates were 6.3% (1 out of 16 ears), and recurrent cholesteatoma rates were 0% (0 out of 12 fresh cases); postoperative ventilation tube placement was required in 33.3% of cases (4 out of 12 ears).

Thus, use of thin-sliced cartilage to preserve the posterior wall of the external auditory canal is considered a good operative procedure in cases of cholesteatoma associated with cleft palate, which may decrease Eustachian tube function.

Takayasu arteritis is a large vessel vasculitis that occurs in the aorta and its main artery. It has long been known to cause hearing loss, but the specific mechanisms are currently unclear. We report two cases of Takayasu arteritis with hearing loss considered as the initial symptom. Case 1 was a 57-year-old female treated with right otitis media with effusion for a long period of time, following which she was diagnosed with Takayasu arteritis due to headaches and impaired consciousness. Case 2 was a 42-year-old female who initially developed sudden deafness on the left ear that did not improve. In addition, right hearing loss; pain in the left forearm, bilateral lower legs, and finger joints; and detachment of bilateral nails were observed, leading to diagnosis of Takayasu arteritis. In both these cases, steroids improved systemic symptoms, but hearing loss remained. The two cases showed completely different courses, and there is, to date, no typical clinical picture of hearing loss. We should always keep Takayasu arteritis in mind when general pain appears following hearing loss.

Middle ear myoclonus is a pathological involuntary movement of the ossicular muscles and is one of the causes of objective tinnitus. Symptoms include twitching of the eardrums and hyperacusis, which may make diagnosis difficult. We diagnosed the patient in this case with stapes muscle tinnitus based on symptoms that included twitching of the eardrums during loud noises and stapedius reflex responses. In the first operation, surgical tenotomy of the stapedius tendon was performed under general anesthesia, but the symptoms recurred although a temporary course was observed. After that, involuntary movements of the eardrum and unstimulated stapedius reflex, which could not be confirmed by the first operation, showed swaying of the baseline, and we reached a diagnosis of tensor tympani myoclonus. In this case, surgical tenotomy of the tensor tympani tendon under local anesthesia improved symptoms.

There have been many reports showing that surgical treatment is highly effective, but preoperative planning is important to avoid inner ear damage; it is necessary to confirm involuntary movements of the tympanic membrane and contractions of causatives ossicular muscles under local anesthesia.