Intractable Eustachian tube (ET) disease, especially patulous ET, is a condition in which the ET is open for a prolonged or constant period, resulting in unpleasant aural symptoms such as voice and breathing autophony and aural fullness. We have worked on the diagnosis and treatment of this disease using various approaches. In particular, we have conducted a physician-initiated clinical trial of the Kobayashi plug surgery, which will be covered by national health insurance in 2020. We will continue our efforts to further elucidate the pathogenesis of the disease and improve treatment outcomes.

Vestibular migraine (VM), which is clinically characterized as recurrent vertigo, affects approximately 4–10% patients in outpatient clinics. However, many patients preclude precise diagnosis due to many reasons, including the non-interest of otolaryngology clinicians in headache cases because patients who visit otolaryngology clinics usually do not complain of headaches as their chief complaint. For the treatment of such patients, calcium blockers, antidepressants, anticonvulsants, and beta blockers are used as treatment options. New lines of treatment involving anti-CGRP (calcitonin gene-related peptide) injection are expected for the treatment of VM. Vestibular neuritis (VN) is characterized by the sudden occurrence of intensive vertigo, and typically the attack of such vertigo occurs only once. A meta-analysis demonstrated that oral steroids are effective in the acute stage of VN for recovering canal paralysis 1 month, but not 1-year, after the disease onset. Furthermore, vestibular rehabilitation may provide relief from dizziness and improve quality of life.

Despite improvement in recovery rates of peripheral facial nerve palsy, some patients continue to show sequelae. Treatment of sequelae is often challenging, and appropriate rehabilitation is important to prevent onset or worsening of sequelae. Reportedly, in addition to rehabilitation, plastic surgery and botulinum toxin therapy are useful for management of sequelae. Make-up therapy is also useful to improve the symmetry of facial appearance to enhance patients’ quality of life and minimize depression. This article focuses on approaches to the optimal management of the sequelae of facial nerve palsy.

Adhesive otitis media and pars tensa cholesteatoma are associated with postoperative tympanic membrane re-depression, re-adhesion, and recurrence of cholesteatoma and have a poor postoperative hearing improvement rate. However, few cases have been studied in children and young people. Therefore, we present a comparative analysis of the first surgical cases of pars tensa cholesteatoma, including those with adhesive otitis media, in children/young people and adults.

The cases were diagnosed with pars tensa cholesteatoma and were operated on by the same surgeon from March 2012 to April 2021, with 30 ears in children and young people under 18 years and 32 ears in adults. The assessment areas were adhesion site, presence or lack of aeration, mastoid cell formation, staging of cholesteatoma, surgical method, hearing acuity, and recurrence rate.

Several Stage Ia cases were observed, even in situations with advanced adhesion in children and young people. Furthermore, type I surgical intervention was possible with satisfactory postoperative reaeration in many cases. Meanwhile, there were multiple cases with advanced adhesion stages in adults, and the patients tended to need ossiculoplasty or staged surgery. The postoperative course of pars tensa cholesteatoma in children and young people tends to be better than that in adults, and an early diagnosis and active surgery are crucial.

Recurrence of middle ear cholesteatoma due to a retraction pocket is one of the postoperative problems. Preserved canal wall mastoidectomy has a higher risk of recurrent cholesteatoma than the removed canal wall approach. However, removed canal wall mastoidectomy predisposes the risk of postoperative cavity complications. Therefore, a surgical method for recurrent cholesteatoma has not been established. We analyzed the clinical features of 39 ears with recurrent cholesteatoma that underwent unplanned revision surgery between January 2017 and December 2020. The period from the previous surgery to the unplanned revision surgery was less than 5 years for 17.9% (7/39 ears) and more than 5 years for 82.1% (32/39 ears). In the previous surgery, canal wall preserved mastoidectomy with scutum removal (M1a/b + M2a) was performed in 84.6% (33/39 ears), and mastoidectomy with whole canal wall removed (M2c) was performed in only 15.4% (6/39 ears). The site of recurrence in the M1a/b + M2a group was the attic in 51.3% (20/33 ears), pars tensa in 18.2% (6/33 ears), and both the attic and pars tensa in 21.2% (7/33 ears). The posterior canal wall preservation rate of the M1a/b + M2a group was 42.1% (8/19 ears) in poor mastoid cell development cases and 64.2% (9/14 ears) in good mastoid cell development cases. The posterior canal wall of poor mastoid cell development cases tended to be difficult to preserve in unplanned revision surgery. Patients with a preserved posterior canal wall did not require any postoperative care, though it is necessary to pay attention to possible recurrence in the future. It is important to flexibly select the mastoidectomy approach in case of unplanned revision surgery for recurrent cholesteatoma considering the balance between curability and quality of life.

Forty-eight severe cases of Bell’s palsy (33 cases) and Hunt’s syndrome (15 cases) treated at the Department of Otolaryngology, Keio University Hospital from January 2012 to March 2020 were reviewed retrospectively, and the treatment outcomes and postoperative hearing loss of transmastoid facial nerve decompression were examined. The recovery rates of the surgery and the conservative treatment groups were compared for both diseases. In Bell’s palsy, there was no significant difference between the rates with the surgery group (n = 18) being 44.4% and the conservative treatment group (n = 15) being 33.3% (p = 0.52). Whereas, in Hunt’s syndrome, the surgery group (n = 9; 66.7%) showed significantly better outcomes compared to the conservative treatment group (n = 6; 0%) (p = 0.02). In addition, we compared hearing levels before and after the surgery to examine side effects on hearing. As a result, elevated threshold from 5 to 15 dB was observed at 0.25, 0.5, 2, 4, and 8 kHz on air-conduction hearing, and at 2 and 4 kHz on bone-conduction hearing. In conclusion, these results suggested that facial nerve decompression may have therapeutic efficacy for severe cases of Hunt’s syndrome, and increase the chance of postoperative hearing loss. Therefore, indications should be carefully evaluated prior the surgery.