Band-limited light endoscopy is useful in endoscopic diagnosis for chronic epipharyngitis. This paper outlines a draft diagnostic standard, presents the differences between the endoscopic findings of acute epipharyngitis and chronic epipharyngitis, and describes the differences in pathological conditions. The usefulness of epipharyngeal abrasive therapy （EAT） for epipharyngeal canopy is also described, based on the embryological point of view of the pharyngeal bursa and Tornwaldt’s disease. The paper reports on how to use EAT auxiliary devices such as nasal scissors, tweezers, and suction tubes, and outlines the main points when performing endoscopic EAT.

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[in Japanese]

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In order to promote parotid surgery, it is essential to ensure its safety. The facial nerve travels in the parotid gland in various ways, and even if the facial nerve is preserved intraoperatively, facial paralysis may occur postoperatively. The use of intraoperative nerve monitoring （IONM） can safely identify the facial nerve, reduce the risk of postoperative facial nerve palsy, and shorten the operative time. However, IONM has the disadvantage that it is susceptible to the effects of muscle relaxants during induction of anesthesia, and these effects vary from person to person. A muscle relaxant monitor is useful to confirm the effects of muscle relaxants. Safe and reliable parotid surgery should be achieved by using IONM with sufficient anatomical knowledge and considering the effects of muscle relaxants.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We performed epipharyngeal abrasive therapy （EAT） on 154 patients with chronic epipharyngitis and evaluated subjective symptoms and endoscopic findings. A prospective study by the Epipharyngeal Abrasive Therapy Review Committee is currently being conducted （EATRC study）, where endoscopic findings （color tone, swelling, mucous adhesion, and postnasal drip） and bleeding during abrasion are evaluated on a 3-point scale. In a study conducted in 2020 （2020 study）, redness （color tone） and swelling were evaluated on a 4-point scale; therefore, we applied this to the evaluation method of the EATRC study to compare the results. The improvement rates of color tone and swelling were 65.8％ and 63.0％, respectively, in the 2020 study, and 54.6％ and 48.6％, respectively, in the EATRC study. The improvement rate of the total score was 94.2％ in the 2020 study and 93.5％ in the EATRC study, and the improvement rate of the total score excluding bleeding was 81.8％ and 75.3％. In both studies, there was a significant correlation between improvement in the chief complaint and redness, bleeding, and total score. Although bleeding is useful for judging the severity of the disease before treatment, it seems necessary to consider whether to include measuring treatment effect because it disappears or improves after EAT in most cases.
Black spots and granular changes, which are characteristic of nasopharyngeal endoscopic narrow band imaging in chronic epipharyngitis, were also examined on a 3-point scale. Before treatment, the prevalence of black spots and granular changes were 83.8％ and 64.3％, respectively, and the improvement rates were 65.9％ and 54.8％, respectively.

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Upper endoscopy or esophagoscopy is often selected for transoral removal from the cervical esophagus, and the Sato-type laryngoscope is a useful device during this procedure. The present case was a 63-year-old female who complained of dysphagia the day after she had ingested codfish soup. We could not find a fish bone when using a flexible laryngoscope, but found one in the cervical esophagus on CT. We decided to perform surgery under general anesthesia. A Sato-type laryngoscope provided a wide field of view in the entrance of the esophagus, and we succeeded in removing the fish bone safely. It was considered that the successful removal was made possible by the wide field of view of the hypopharynx and the entrance of the esophagus, and that there was little risk of pushing the fish bone because the tip of the Sato-type laryngoscope was at the larynx.

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