In the past, it was believed that imaging studies of inner ear diseases, such as acute sensorineural hearing loss, did not show any abnormalities. However, with the development of high-resolution MRI, it has become possible to see the inner ear’s fine structures, leading to a better understanding of inner ear pathophysiology. For instance, we discovered that a high signal in the cochlea is linked to hearing prognosis in sudden hearing loss. As MRI images have become even higher resolution, each turn of the cochlea was evaluated and related to hearing prognosis in each frequency range. In Meniere’s disease, we reported that endolymphatic hydrops, depicted by intratympanic or intravenous gadolinium administration, are associated with various symptoms and electrophysiological studies. Recently, we used 17O-labeled water as a new tracer to examine the inner ear with MRI. In the future, advancements in MRI equipment, imaging methods, and contrast agent types and administration may lead to new discoveries in inner ear imaging. We aim to further our research on inner ear pathophysiology through imaging.

One of the advantages of transcanal endoscopic ear surgery (TEES) is a clear and magnified sight it provides during surgical procedure. However, when enhancing the operative view with endoscopy, a large graft in a narrow canal often obstructs surgeons from obtaining a clear view. Therefore, we advocate the use multiple grafts instead of a single large graft to address this issue. In this study, we retrospectively reviewed the medical records of 207 ears that underwent tympanoplasty via TEES for chronic otitis media with tympanic membrane perforation at Osaka Rosai Hospital between October 2014 and September 2020. The total graft success rate was 95.2%. Using single or multiple grafts did not correlate with the graft success rate for each size of membrane perforation. This suggests that using multiple grafts can be effective for any size of perforation when it is difficult to obtain a clear endoscopic view. By providing an optimal operative view to maximize the benefits of TEES, the use of multiple grafts may enable surgeons to operate with precision and enhance the graft success rate.

The purpose of this study is to evaluate the effectiveness of mastoid obliteration while considering postoperative middle ear ventilation in preventing recurrent cholesteatoma and cavity problems in acquired middle ear cholesteatoma. We retrospectively evaluated the surgical outcome of 305 patients with acquired middle ear cholesteatoma who underwent surgery between July 2004 and December 2020. We then compared the recurrent rates of cholesteatoma and cavity problems of the 108 patients, who underwent surgery from July 2004 and December 2010 in which mastoid obliteration was not performed, and 197 patients who underwent surgery after January 2011 in which mastoid obliteration was performed. Mastoid obliteration was performed in patients who were considered to have poor postoperative middle ear ventilation. Postoperative middle ear ventilation was predicted by the degree of mastoid pneumatization and the range of intact middle ear mucosa. Mastoid pneumatization was evaluated using preoperative computed tomography (CT) scan, and middle ear mucosa was evaluated intraoperatively. After performing mastoid obliteration, the recurrent cholesteatoma rates decreased from 15% to 5.1%, and the rates of cavity problems similarly decreased from 17% to 8.6%. Furthermore, the number of cases without recurrent cholesteatoma nor cavity problems significantly improved with mastoid obliteration, increasing from 83% to 90% at 5 years after surgery and 63% to 79% at 10 years after surgery. Consequently, performing mastoid obliteration in patients who are considered to have poor postoperative middle ear ventilation is effective in preventing recurrent cholesteatoma and cavity problems. However, further examination of the prediction method of postoperative middle ear ventilation is required.

Here, we report an example where the Eustachian tube can be intentionally opened and closed at will, independent of actions such as swallowing, licking, sniffing, or the Valsalva maneuver. Moreover, the speed of this process can be freely adjusted. When the Eustachian tube was opened and closed rapidly, rhythmic movements of the soft palate were observed, accompanied by objective tinnitus. It was thought to be due to the arbitrary movement of the tensor palatine muscle, the muscle responsible for the opening of the Eustachian tube. Although the individual in this case had no history of middle ear disease or eardrum retraction, it was thought that there might have been a period of Eustachian tube dysfunction during her childhood to prevent ear symptoms. Some of the cases of muscular objective tinnitus, derived from the Eustachian tube, exhibited patulous Eustachian tube and Eustachian tube dysfunction. The pathology of this case appears to align with these conditions.

Examination of such examples will lead to clarification of the classification of auditory tube dysfunction and its role in pathology. Further accumulation of cases is necessary.

The middle ear implant Vibrant Soundbridge^® (VSB) with a clip coupler was placed onto the stapes in patients with bilateral mixed hearing loss and tympanic membrane lateralization after tympanoplasty. Autologous auricular cartilage was used as the columella. At the one-year follow-up after surgery, the VSB showed good outcomes, and the clip coupler attachment to the stapes was confirmed to be stable. Additionally, the air-bone gap was maintained when the VSB was not activated, and the reconstruction of the ossicular chain using autologous tragal cartilage as a columella remained stable.

Langerhans cell histiocytosis (LCH) is a very rare disease in which abnormal Langerhans cells proliferate. It presents with various clinical manifestations ranging from solitary to multisystem lesions, and some of the cases can be fatal. Herein, we describe a patient with LCH diagnosed with ear symptoms.

The patient was a nine-year-old female with hearing loss and otorrhea of the left ear. She was indicated to have an occupying lesion in the left temporal bone, sphenoidal bone, and clivus based on computed tomography (CT) and magnetic resonance imaging (MRI). Positron emission tomography-computed tomography (PET-CT) detected uptakes of fludeoxyglucose (FDG) in the lesions with osteolytic changes of the left temporal bone and S4 and S5 lesions of the liver. She underwent a biopsy of the tumor in the left sphenoid sinus under general anesthesia, and was diagnosed with LCH. We determined that the uptake in the liver was also a lesion due to LCH, and she underwent chemotherapy according to the LCH-12 protocol for multisystem disease with invasion of risk organs. She has maintained total remission for two years after chemotherapy without central diabetes insipidus.

Meningeal carcinomatosis is a very rare disease wherein a malignant tumor metastasizes through the cerebrospinal cavity such as the meninges of the brain and the subarachnoid space. Cranial nerves VII and VIII palsy usually occur idiopathically and are often treated by an otolaryngologist. However, meningeal carcinomatosis may cause cranial neurological symptoms, such as facial palsy and sensorineural hearing loss. Herein, we present a case of suspected metastasis of small cell lung carcinoma to the inner auditory canal due to meningeal carcinomatosis. The patient developed acute sensorineural hearing loss and floating vertigo, followed by a rapid exacerbation of symptoms and the onset of multiple cranial neurological symptoms in a short timeframe.