Background Transcanal endoscopic ear surgery (TEES) is becoming increasingly popular in otologic surgery and can be considered the first choice for stapes surgery. In this study, we analyzed a case series of TEES for stapes surgery, focusing on the estimation of appropriate prosthesis length using preoperative CT based on postoperative hearing results. Methods We retrospectively examined 31 patients who underwent TEES using a rigid endoscope for stapes surgeries. Postoperative hearing results were good in 27 cases (87.1%) and poor in four cases (12.9%). We reviewed the preoperative CT scans of all the patients and measured the straight-line distance from the incudostapedial joint to the oval window in the coronal images, assuming it to be the estimated appropriate prosthesis length (eAPL). Results The actual length of the prosthesis inserted during the operation was shorter than the eAPL in three of the four cases without postoperative hearing improvement. In the remaining patients, postoperative CT indicated that the prosthesis position was inadequate. Conclusion The measurement of the APL using preoperative CT could contribute to improving postoperative hearing outcomes after stapes surgery using TEES.

BACKGROUND:Meniere's disease is a stress-related inner ear disorder characterized by recurrent vertigo and auditory symptoms. Evidence linking stress-coping abilities to clinical outcomes remains limited. Emotional intelligence (EI), particularly the situation-management domain of the Emotional Intelligence Scale (EQS), may influence symptom improvement through adaptability and behavioral flexibility. OBJECTIVE:To examine whether EI assessed by the EQS is associated with improvement in Meniere's disease. METHODS:This retrospective study included 93 patients aged 23-82 years who had baseline EQS data and a 12-month follow-up. Improvement was defined as a ≥ 1-grade decrease in disease progression, subjective distress, or limitation of daily activities according to the Japanese severity grading system. Patients with grade 0 at baseline were excluded, leaving 88, 81, and 83 patients for the respective analyses. Seven EQS situation-management items were categorized into low, intermediate, or high. Associations with improvement were examined using multiple logistic regression. RESULTS:Improvement occurred in 29.5% for disease progression, 75.3% for subjective distress, and 78.3% for daily activity limitation. Higher influence and tactfulness were significantly associated with improvement in disease progression, whereas no EQS items were associated with the other outcomes. CONCLUSION:Higher influence and tactfulness may contribute to favorable disease progression in Meniere's disease.

IntroductionAge-related hearing loss (ARHL) is linked to dementia, with mitochondrial dysfunction playing a key role in its progression. Deficient mitochondrial tRNA modifications impair protein synthesis and energy metabolism, accelerating ARHL. Mitochonic acid 5 (MA-5) has shown promise as a therapeutic candidate by improving mitochondrial function, reducing oxidative stress, and stabilizing membrane potential.MethodsIn this study, we investigated the effects of MA-5 on ARHL in cyclin-dependent kinase 5 regulatory subunit-associated protein 1 (Cdk5rap1) knockout (KO) mice, which exhibit early-onset ARHL due to abnormalities in mitochondrial transfer RNA (mt-tRNA) modifications.ResultsMA-5 treatment effectively attenuated ARHL progression in Cdk5rap1-KO mice by improving auditory brainstem response thresholds and distortion product otoacoustic emissions. It also reduced spiral ganglion and outer hair cell loss, while preserving the cochlear structural integrity by preventing mitochondrial degeneration in spiral ligament fibrocytes. Mechanistically, MA-5 upregulated the expression of silent information regulator sirtuin 1 and promoted the nuclear translocation of yes-associated protein, both of which are involved in regulating mitochondrial function and cellular senescence. Metabolomics analysis further demonstrated that MA-5 restored mitochondrial metabolism, reduced lactate accumulation, and maintained mitochondrial integrity.ConclusionThese findings suggest that MA-5 is a viable treatment option for ARHL and other age-related disorders associated with mitochondrial dysfunction.

Benign paroxysmal positional vertigo (BPPV) is a typical vertigo disease, and BPPV developing during the course of diseases causing peripheral vertigo, including Meniere's disease, is also known. Between June 2017 and March 2021, 29 (23%) of 124 patients who visited the Department of Otolaryngology, Osaka Metropolitan University Hospital, who were diagnosed as cases of definite Meniere's disease exhibited complicating BPPV and their data were analyzed retrospectively. Out of the 29 cases, 23 (79%) had lateral semicircular canal BPPV, 4 (14%) had posterior semicircular canal-type BPPV, 1 had lateral semicircular canal-type BPPV (cupulolithiasis) + posterior semicircular canal-type BPPV, and 1 had lateral semicircular canal BPPV (canalolithiasis) + posterior semicircular canal-type BPPV. Of the 25 cases, 16 had cupulolithiasis and 9 had semicircular canalolithiasis. The side affected by Meniere's disease and BPPV was the same in 14 of the 29 cases (48%), while opposite sides were affected by the two conditions in the remaining 11 cases (38%). No strong association was found between the severity of Meniere's disease or hearing loss and the development of BPPV. In regard to the timing of onset of the BPPV, in more than a half of the cases, the BPPV developed within 1 month of the diagnosis of Meniere's disease. We consider that it would be useful to identify predictors of the development of complicating BPPV in patients diagnosed as having Ménière's disease.

Objective: To assess the annual incidence of vestibular neuritis (VN) in the Japanese population. Methods: We conducted a mail-based survey targeting otolaryngologic clinics and hospitals across Japan to estimate the annual number of patients who were newly-diagnosed with VN during the one-year period of 2021. Using a stratified sampling method, we selected 1,107 departments and asked them to report the number of new patients with VN and their demographics. The total number of VN patients was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate. Results: The overall survey response rate was 40.5 % (448 departments). The estimated number of newlydiagnosed VN patients in 2021 was 8,861 (95 % confidential interval [CI], 2,290-15,432) The annual incidence of VN was 7.05 per 100,000 population in Japan. The male-to-female ratio of VN patients was 0.96, and the mean age was 60.3 +/- 16.1 years (range 11-94 years). Conclusions: The annual incidence of VN in Japan in 2021 had almost doubled and the mean age had become older compared to the previous study in 1993 (annual incidence; 3.5 per 100,000 per year; mean age: 45 years).

Vestibular migraine (VM) is a disorder characterized by recurrent headaches and vertigo. Meniere's disease (MD) is also characterized by similar symptoms, and it is often difficult to differentiate between the two conditions. Therefore, we focused on differences in the temperament and mood of these patients, including their emotional intelligence and anxiety levels. Emotional intelligence is the ability to respond to self, interpersonal situations, and situations surrounding the self, and can be evaluated using the Emotional Intelligence Quotient Scale (EQS). In this study, we conducted a comparative assessment to explore the differences in the scores on the EQS between patients with VM and patients with MD complaining of dizziness. The subjects were 63 patients with VM and 129 patients with MD. Finally, 32 patients each with VM and MD matched for age and sex were included in the evaluation. Our results showed that patients with VM had lower scores on self-response, interpersonal response, and situational response than the patients with MD with particularly low scores on the subfactors of `self-motivation,' `self-control,' and `leadership'. No significant difference in the State-Trait Anxiety Inventory (STAI) was observed between the two patient groups, although the values were slightly higher in the patients with VM than in those with MD. No significant difference in the DHI or VAS was observed either. The patients with VM showed similar characteristics of previously reported migraine. We were prompted to conduct this comparative study, as there are no comparative assessments by the EQS, until date, of patients with VM, patients with MD, and healthy subjects.

Congenital cholesteatoma is typically an expanding cystic mass of keratinizing squamous epithelium located medial to the intact tympanic membrane in patients with no prior history of perforation, otorrhea and ear. It is generally thought to be a progressive disease and is usually surgically removed upon detection as the first-choice treatment. As such, it is rare to be observed for a long term without progression. Here we report a rare case of congenital cholesteatoma that remained in an undetectable size and did not deteriorate mild hearing loss for 12 years. A seven years old boy was referred to us with right hearing impairment. Pure-tone audiometry found conductive hearing loss with an air-bone gap of 25 dB and a high-resolution computed tomography (CT) scan found the eroded long process of incus but did not detect any soft tissue density indicating congenital cholesteatoma. He initially did not wish to undergo surgery. His hearing level and image finding remained virtually unchanged during the next 12 years of the follow-up period. Twelve years later, endoscopic ear surgery was performed, which revealed a very small cholesteatoma mass, an eroded long process of the incus and ossicular chain discontinuities. We suspect that the cholesteatoma was originally larger, partially eroded the incus, then regressed to a very small size, and remained small for at least 12 years under our observation.

In September 2019, we introduced a tympanic membrane massage device for transtympanic positive-pressure therapy at our institution. This treatment is selected for patients definitively diagnosed as having Ménière's disease (Stage 4) or delayed endolymphatic hydrops with recurrent vertigo attacks, who insist on omit conservative treatment. In the past, surgical treatments, such as endolymphatic sac surgery and selective vestibular neurectomy were considered for patients with the symptoms described above. At present, however, we proactively provide transtympanic positive-pressure therapy using the above-mentioned tympanic membrane massage device, because it is very minimally invasive and easy to perform. Until September 2020, we have provided transtympanic positive-pressure therapy using the tympanic membrane massage device to 24 patients (including 20 patients with definitively diagnosed Ménière's disease and 4 with definitively diagnosed delayed endolymphatic hydrops). In these patients with a definitive diagnosis, the vertigo coefficient was calculated, and the therapeutic effect of this treatment modality was examined. The following six factors were used to calculate the vertigo coefficient: subjective distress level, daily life limitations, number of vertigo attacks per month, and scores on the DHI (Dizziness Handicap Inventory) and VAS (Visual Analog Scale). Our findings revealed the following two useful effects of trans-tympanic positive pressure therapy using the aforementioned device: 1) the scores for subjective distress level and daily life limitations decreased during the course of treatment (p<0.001), and 2) the number of vertigo attacks per month decreased significantly after one month of treatment could be omitted (p＝0.001). Thus, our present study demonstrated that “transtympanic positive-pressure therapy using the tympanic membrane massage device” is an effective treatment method for alleviating the symptoms of intractable Ménière's disease and definite delayed endolymphatic hydrops. Long-term follow-up of the patients is warranted to establish the usefulness of this treatment.

Currently, vestibular rehabilitation approaches used to monitor body position and movement during rehabilitation training require specialized equipment or rely on clinician observation. Thus, a simpler position-sensing approach that can be used to monitor movement during vestibular rehabilitation is required. This study used wearable motion sensors with built-in accelerometers and gyrometers to assess movement in adults. We explored stepping patterns in adults using this motion-sensing system. Six healthy adults (men, age 27.3 ± 5.8 years) underwent a modified Fukuda stepping test (Foulage test [FT]) while wearing a six-axis motion sensor (accelerometer: X-axis, Y-axis, Z-axis; gyrometer: X-axis, Y-axis, Z-axis) positioned at the head, thorax, and lumbar spine. For motion sensor parameters, we calculated the root mean square (RMS), autocorrelation coefficient (AC), power spectrum (PS) of the AC, and Euler angles from the six-axis motion sensor. For the FT parameters, the FT value, step variance, and θ values were calculated. Data were analyzed, and multivariable regression analysis was performed using the FT value, step variance, and θ value as the dependent variables to investigate their influence on dynamic equilibrium. The explanatory variables included the motion sensor parameters, RMS, AC, and PS. Our results suggested that almost no head and lumbar spine movement occurred while stepping with eyes open. Contrastingly, the head and lumbar spine swayed with eyes closed. This accelerometric and gyroscopic device is easy to use, does not require specialized equipment, and can be used to analyze performance in the modified Fukuda stepping test in clinical practice. Inertial sensors have many advantages over other sensing technologies.

Background Although vaccination is recommended for protection against invasive pneumococcal disease, the frequency of pneumococcal pneumonia is still high worldwide. In fact, no vaccines are effective for all pneumococcal serotypes. Fusion pneumococcal surface protein A (PspA) has been shown to induce a broad range of cross-reactivity with clinical isolates and afford cross-protection against pneumococcal challenge in mice. Furthermore, we developed prime-boost-type mucosal vaccines that induce both antigen-specific IgG in serum and antigen-specific IgA in targeted mucosal organs in previous studies. We investigated whether our prime-boost-type immunization with a fusion PspA was effective against pneumococcal infection in mice and cynomolgus macaques. Methods C57BL/6 mice were intramuscularly injected with fusion PspA combined with CpG oligodeoxynucleotides and/or curdlan. Six weeks later, PspA was administered intranasally. Blood and bronchoalveolar lavage fluid were collected and antigen-specific IgG and IgA titers were measured. Some mice were given intranasal Streptococcus pneumoniae and the severity of infection was analyzed. Macaques were intramuscularly injected with fusion PspA combined with CpG oligodeoxynucleotides and/or curdlan at week 0 and week 4. Then, 13 or 41 weeks later, PspA was administered intratracheally. Blood and bronchoalveolar lavage fluid were collected and antigen-specific IgG and IgA titers were measured. Some macaques were intranasally administered S. pneumoniae and analyzed for the severity of pneumonia. Results Serum samples from mice and macaques injected with antigens in combination with CpG oligodeoxynucleotides and/or curdlan contained antigen-specific IgG. Bronchial samples contained antigen-specific IgA after the fusion PspA boosting. This immunization regimen effectively prevented S. pneumoniae infection. Conclusions Prime-boost-type immunization with a fusion PspA prevented S. pneumoniae infection in mice and macaques.

Progressive supranuclear palsy (PSP) has been reported as a disorder mainly characterized by a tendency to fall, vertical supranuclear gaze palsy, and constriction of the body axis, akinesia, and cognitive impairment. Patients presenting with these typical clinical features are diagnosed as having the PSP-Richardson syndrome (PSP-RS). Electronystagmography (ENG) is useful for the detection of ocular motility disorder, which is the main feature of PSP. In cases of PSP, ocular motility disorder in the vertical direction occurs from the initial stage of the disease, and is characterized by prolonged latency and reduced velocity of the saccadic eye movement in the vertical direction. Horizontal saccadic eye movement disorder also occurs after the intermediate stage. Square wave jerks (SWJ) are often recognized from the initial stage of the disease. In terms of nystagmus, the quick phase is impaired due to impaired saccadic eye movements, and impairment of optokinetic nystagmus also starts from the quick phase movements. Pursuit (smooth) eye movement may also be impaired as the disease progresses. On the other hand, the vestibulo-ocular reflex is maintained even after disease progression to a late stage.

The incidence of oral cancer has recently been increasing worldwide, particularly among young individuals and women. The primary risk factors for head and neck cancers, including oral and pharyngeal cancers, are smoking, alcohol consumption, poor oral hygiene, and repeated exposure to mechanical stimuli. However, approximately one-third of the patients with oral and pharyngeal cancers are neither smokers nor drinkers, which points to the existence of other mechanisms. Recently, human microbes have been linked to various diseases, including cancer. Oral pathogens, especially periodontal pathobionts, are reported to play a role in the development of colon and other types of cancer. In this study, we employed a series of bioinformatics analyses to pinpoint Fusobacterium nucleatum as the predominant oral bacterial species in oral and pharyngeal cancer tissue samples. We successfully isolated Fn. polymorphum from the saliva of patients with oral cancer and demonstrated that Fn. polymorphum indeed promoted oral squamous cell carcinoma development by activating YAP in a mouse tongue cancer model. Our research offers scientific evidence for the role of the oral microbiome in oral cancer progression and provides insights that would help in devising preventative strategies against oral cancer, potentially by altering oral bacterial profiles.

日本は結核の中蔓延国であり，肺結核既往のある頭頸部癌患者も多い。今回，喉頭癌に対する化学療法中に肺結核再燃が疑われた症例を経験したので報告する。 症例は61歳，男性。当科初診9か月前に肺結核治療歴があった。喉頭癌の診断にて導入化学療法施行を施行したが，化学放射線療法開始前の喀痰抗酸菌検査にて検鏡陽性となった。結核の活動性の判定は困難であったが，排菌があるため隔離での結核治療を先行した。その後の培養検査で活動性はないと考えられ，結核治療を終了した。喉頭癌治療については，喉頭全摘出術の方針に変更した。 肺結核は稀な疾患ではなく，化学療法時には再燃リスクについても十分な検討が必要である。

Superficial pharyngeal cancer can be treated with curative intent while preserving function using minimally invasive peroral endoscopic resection techniques such as endoscopic submucosal dissection (ESD). However, severe adverse events occasionally occur, such as laryngeal edema requiring temporary tracheotomy and fistula formation. Therefore, we investigated the risk factors for adverse events associated with ESD for superficial pharyngeal cancer. This retrospective observational study was conducted at a single institution, and 63 patients who underwent ESD were enrolled. The primary outcome was the risk factors for adverse events associated with ESD. The secondary outcomes were adverse events associated with ESD and their frequency. The overall adverse event rate was 15.9

Objective In this article, we aimed to describe the Foulage test (FT) and investigate the test-retest reliability of parameters recorded during stepping execution in healthy adults. Materials and methods This was a single-center prospective cohort study conducted at an outpatient clinic. It included five healthy male participants [mean age ± standard deviation (SD): 27 ± 5.4 years]. The FT was performed first with the participants’ eyes open and again with their eyes closed. If the heel height was not within 2-6 cm, the participant was asked to restart. The FT value and variance of steps were automatically calculated. To verify the influence of heel height, measurements were taken at different heel heights. We also evaluated the Romberg ratio (calculated from the parameters with eyes open and closed) and defined it as the dynamic Romberg ratio. Correlations between parameters were also assessed. Results The parameters’ FT value (front-back width of the band of locus shape) and variance of steps plateaued under stable conditions within a heel height of 2-6 cm. FT values and variance of steps were strongly correlated. The dynamic Romberg ratios by FT value and by the variance of steps were also strongly correlated. Conclusions The FT is a dynamic and reproducible equilibrium function test that can quantify agitation with the eyes open or closed in general outpatient clinics, and it may be employed as a clinically useful method for the observation of clinical courses in patients with vestibular disorders.

Key Points:  COVID-19 often cause prolonged olfactory dysfunction.  This study evaluated the relative burden of the COVID-19-related disease in a single-centered cohort of POD patients.  COVID-19-related POD was diagnosed serologically.  In the COVID-19 era, the local burden of POD increased two-fold.  It is important to use pleiotropic approach and robust measures, when we assess OD.