In this nationwide retrospective study, we sought to evaluate the oncologic and functional outcomes and safety of transoral surgery (TOS) for hypopharyngeal and laryngeal squamous cell carcinomas in Japan and to clarify the appropriate indications for various TOS modalities. Data were obtained from the Head and Neck Cancer Registry of Japan. Patients who underwent transoral or endoscopic resection between 2011 and 2016 were selected. Detailed clinical information was collected from 55 institutions using web-based case report forms. Surgical modalities analyzed included endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), endoscopic laryngopharyngeal surgery (ELPS), transoral laser microsurgery (TLM), and transoral videolaryngoscopic surgery (TOVS). In total, 1825 patients were included (hypopharyngeal cancer, 62.5 %; laryngeal cancer, 37.5 %). Most cases (77.5 %) were T1 or lower, and 90.8 % were Stage II or earlier. TLM is predominantly used for glottic cancers, ELPS/ESD for superficial hypopharyngeal lesions, and TOVS for more advanced tumors, reflecting distinct indications for each modality. The 5-year disease-specific survival (DSS), recurrence-free survival (RFS), and overall survival (OS) were 97.1 %, 84.3 %, and 85.4 %, respectively. The laryngeal preservation rate was 98.2 %. Tracheostomy was performed in 5.0 % of cases, mainly for airway protection; major complications, including pneumonia (2.4 %), hemorrhage (1.1 %), fistula formation (0.4 %), and vocal cord fixation (2.6 %), occurred in <3 % of patients. Postoperative functional outcomes were favorable, with persistent dysphagia (Functional Outcome Swallowing Scale stage ≥ 3) in 1.6 % and tube feeding dependence in 1.8 %. Non-robot-assisted TOS demonstrated excellent oncologic control and functional preservation of the larynx with low complication rates in early-stage hypopharyngeal and laryngeal cancers. Each surgical modality has distinct indications depending on the tumor site, depth of invasion, and institutional expertise. These findings support the use of TOS as a safe and effective treatment option for selected patients. Further procedural standardization and data accumulation are required to refine the indications and facilitate their broader adoption in clinical practice.
CO2 Transoral laser microsurgery (TLM) is a preferred technique for early-stage glottic lesions [1] (Yin et al Auris Nasus Larynx 50(3):415-422, 1), but reconstruction of the anterior commissure remains an unresolved issue. The anterior commissure is a surgically challenging area due to limited accessibility, high incidence of postoperative stenosis and risk of recurrence [2] (Chone et al Arch Otolaryngol Head Neck Surg 133(9):882-887, 2). To share our experience with a single-stage reconstruction technique for anterior commissure defects following TLM, using a buccal mucosal graft secured with sutures and tissue glue, and to present post-surgical outcomes. A series of five cases performed at VPS Lakeshore Hospital, Kochi, over a 1.5-year period (January 2024-April 2025) in patients with squamous cell carcinoma or carcinoma in situ of anterior commissure of glottis following TLM were evaluated. Written informed consent was obtained from all patients. TLM was performed using carbon dioxide laser, followed by reconstruction using a buccal mucosal graft fixed with polypropylene sutures and tissue glue. Outcomes were assessed using Voice Handicap Index (VHI) scores (Johnson et al Am J Speech-Language Pathol 6: 66-70, 3), video laryngoscopic evaluation of graft integrity, and rates of postoperative stenosis or adhesion. All patients remained free of disease at the end of the follow up period. VHI scores indicated acceptable postoperative voice quality. Post operative healing in patients who underwent transcutaneous suture fixation of grafts with tissue glue support demonstrated better and predictable outcomes in terms of stable graft positioning, good vocal cord approximation and minimal fibrosis. This novel, single-stage reconstruction technique allows good healing of anterior commissure defects by preventing stenosis. Functional outcomes measured by VHI are good. It offers a cost-effective alternative to staged procedures while ensuring optimal vocal outcomes.
Serous otitis media (SOM) is a prevalent inflammatory condition of the middle ear. Herniarin (7-methoxycoumarin) is a coumarin derivative with anti-inflammatory and antioxidant properties. This study aimed to investigate the therapeutic potential of herniarin against experimentally induced SOM in rats, focusing on the NRF2/HO-1 and NLRP3/Caspase-1 pathways. Thirty six adult male Wistar rats were allocated into six groups (n = 6): Control, Herniarin 200 mg/kg, Otitis, Otitis + Herniarin 100 mg/kg, Otitis + Herniarin 200 mg/kg, and Otitis + Dexamethasone. SOM was induced by established experimental protocols, and treatments were administered for seven consecutive days. Serum cytokines (IL-1β, TNF-α, IL-18), oxidative stress markers (GSH, SOD, MDA), histopathology, RT-qPCR, and Western blot analyses were performed. Serum levels of IL-1β, TNF-α, and IL-18 were significantly elevated in the otitis group compared with controls (p < 0.0001) and were markedly attenuated by herniarin and dexamethasone. Herniarin restored depleted GSH and SOD levels while reducing elevated MDA concentrations. Histopathological examination demonstrated dose-dependent attenuation of inflammatory cell infiltration, hemorrhage, and tympanic membrane damage. RT-qPCR showed that herniarin suppressed the upregulation of HO-1, NRF2, NF-κB, and Caspase-3 gene expression induced by otitis, while restoring Bcl-2 expression toward control levels. Western blot confirmed that herniarin reduced the expression of NLRP3, Caspase-1, and Caspase-3, and of NF-κB, while increasing Bcl-2 levels. Herniarin exerts protective effects against experimental SOM by modulating the NRF2/HO-1 antioxidant defense system and suppressing NLRP3 inflammasome-mediated inflammation and apoptosis, suggesting its potential as a therapeutic candidate for otitis media.
This retrospective multicenter study aims to provide a comprehensive analysis of the causes of revision and audiologic outcomes in cases that underwent revision stapes surgery (SS) a pure endoscopic transcanal approach over 10 years. This study analyses the outcomes of patients who underwent exclusive endoscopic revision SS between January 2015 and March 2025. These cases were either the authors' own cases or cases referred from other centers for the management of SS complications, as well. A total of 113 patients (42 males (37.2%), 71 females (62.8%), with an average age of 40.4 ± 8.6 years, age range: 10-68, who had previously undergone SS and underwent revision SS were included in the study. The most common intraoperative findings were prosthesis-related troubleshoots (prosthesis being too short (n = 41, 36.3%) or too long (n = 21, 18.6%), prosthesis dislocation from incus: 38 (33.6%)) and incus long process (ILP) necrosis (n = 33, 29.2%). After endoscopic revision SS, the average pre-op ABG value of 29.8 ± 10.1 dB improved to 13.7 ± 5.2 dB postoperatively (p < 0.001). 75.2% (85/113) of patients achieved post-op ABG values below 20 dB. The need for revision in SS depends on various factors, including the surgeon, the patient, and prosthesis-related issues. Endoscopes are advanced diagnostic and surgical tools that provide high-resolution, dynamic and panoramic images of the entire middle ear structures, enabling accurate diagnosis of the problem. The endoscopes permit the surgeon to perform revision SS with a high degree of precision through a purely transcanal approach, thereby achieving audiological outcomes that are consistent with the range of reports in the literature for conventional microscopic revision SS.
To investigate the association between proton pump inhibitor (PPI) use and the risk of peritonsillar abscess (PTA) and deep neck infection (DNI). This nested case-control study utilized data from the Health Screening Cohort of the Korean National Health Insurance Service (2002-2013). A total of 1953 patients with PTA and 5797 patients with DNI were identified and matched with controls at a 1:4 ratio based on age, sex, income, and residential area. PPI exposure was classified according to prescription timing and cumulative duration. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using overlap propensity score weighting while adjusting for potential confounders. Current PPI use was associated with an increased risk of PTA (adjusted OR 2.83, 95% CI 2.17-3.68). For DNI, increased odds were observed among both past PPI users (adjusted OR 1.85, 95% CI 1.55-2.21) and current users (adjusted OR 2.80, 95% CI 2.35-3.34). A duration-dependent association was noted for both PTA and DNI, with progressively higher odds ratios observed with longer cumulative PPI exposure (all p < 0.001). PPI use was associated with increased odds of developing peritonsillar abscess and deep neck infection, particularly among current users and those with prolonged exposure. These findings suggest the need for careful consideration of long-term PPI prescription in clinical practice. However, given the observational design of this study, these findings should be interpreted as an association rather than a causal relationship. Level III.
Post-viral olfactory dysfunction (PVOD) is characterized by a sudden loss of smell following an upper respiratory tract infection. Although various medications, including tokishakuyakusan, zinc sulfate, and vitamin B12, have been used to treat PVOD, their efficacy remains limited. Recently, olfactory training (OT) has been reported to improve sensorineural olfactory loss. This study aimed to evaluate the additive effect of OT combined with conventional pharmacotherapy in patients with PVOD. Patients diagnosed with PVOD who visited the smell and taste clinic of a tertiary university hospital between 2008 and 2024 were retrospectively analyzed. Those treated from 2008 to 2014 received tokishakuyakusan, zinc sulfate, and methylcobalamin (medication-alone group), whereas those treated from 2015 to 2024 additionally performed OT (combination group). Cases of olfactory dysfunction resulting from COVID-19 infection between 2020 and 2024 were excluded. Olfactory function was evaluated using the Japanese standard T&T olfactometry, and improvement was assessed according to the criteria of the Japanese Rhinologic Society. A total of 107 patients were included: 65 in the medication-alone group and 42 in the combination group. The combination group showed significantly greater improvement in olfactory function six months after treatment initiation (p = 0.016). Final improvement was achieved in 90% of the combination group and 69% of the medication-alone group (p = 0.010). The mean time to improvement was significantly shorter with combination therapy (8 vs. 14 months, p = 0.001). Multivariate analysis identified OT as an independent factor associated with improvement (p = 0.009; odds ratio, 4.96; 95% CI, 1.50-16.4). Combining conventional pharmacotherapy with OT produces an additive effect on olfactory recovery in patients with PVOD, increasing the improvement rate and shortening the recovery period. The free-choice OT protocol, allowing patients to select familiar odorants, represents a simple and practical method suitable for clinical application.
Uvulopalatopharyngoplasty has long been a standard surgical treatment for obstructive sleep apnea (OSA). Recently, novel suture techniques such as CWICKs and barbed reposition pharyngoplasty (BRP) have been developed. This study aimed to compare the surgical efficacy of CWICKs and BRP. A retrospective case-control study was conducted involving 21 patients (18 males and 3 females) with OSA who underwent either CWICKs (n = 9) or BRP (n = 12) between April 2020 and January 2025. Outcomes were evaluated using home sleep apnea testing before surgery and two months postoperatively. Both CWICKs and BRP significantly improved the respiratory event index (REI), obstructive apnea index (OAI), and lowest SpO2. No significant differences were observed between the two groups in the improvement rates of REI, OAI, hypopnea index (HI)/REI ratio, lowest SpO2, Epworth Sleepiness Scale, or surgical success. However, only CWICKs significantly improved the HI/REI ratio, suggesting that CWICKs shifted apnea events to hypopnea. The operative time was significantly longer in the CWICKs group compared with the BRP group. In this retrospective, non-contemporaneous comparison of CWICKs and BRP for obstructive sleep apnea, both procedures demonstrated significant short-term improvements in HSAT parameters, including REI, OAI, and lowest oxygen saturation at two months postoperatively. No significant between-group differences were observed in overall respiratory event indices, although operative time was longer for CWICKs. Our results suggest that CWICKs and BRP may provide comparable short-term outcomes in selected patients.
Patulous Eustachian tube (PET) presents with diverse symptoms, including voice autophony, breathing autophony, and aural fullness. Among these, aural fullness is considered non-specific and its clinical significance in PET remains unclear. This study aimed to clarify the clinical characteristics of aural fullness-dominant PET by comparing objective findings according to the dominant symptom. Patients who visited a specialized Eustachian tube clinic between June 2019 and December 2025 were screened. Among 394 patients evaluated using a self-administered questionnaire, 109 patients with definite PET diagnosed according to the 2016 Japan Otological Society criteria were included. Patients who selected only one of the three characteristic PET symptoms were classified into Group A (voice autophony, n = 45), Group B (breathing autophony, n = 10), and Group C (aural fullness, n = 54). Patient background factors and objective findings-including respiratory tympanic membrane (TM) movement, tubo-tympano-aerodynamic graphy (TTAG), sonotubometry (ST) probe tone level, and Patulous Eustachian Tube Handicap Inventory-10 (PHI-10) score-were compared among groups. Multivariable logistic regression analysis was performed to identify factors independently associated with aural fullness-dominant PET. Age, sex, and habitual sniffing did not differ significantly among the three groups. The prevalence of respiratory TM movement differed significantly, being lower in Group C than in Groups A and B (p < 0.005). TTAG positivity exceeded 70% in Groups A and B, while Group C showed a slightly lower rate without statistical significance. ST probe tone levels were significantly higher in Group C than in Group A (p < 0.05). PHI-10 scores did not differ among groups. In multivariable analysis, absence of respiratory TM movement was independently associated with aural fullness dominance (odds ratio 0.24, 95% confidence interval 0.08-0.68, p = 0.008), whereas TTAG findings and probe tone levels were not. Aural fullness-dominant PET exhibits fewer overt dynamic TM findings despite sharing other objective features of Eustachian tube opening with autophony-dominant cases. These results suggest that aural fullness in PET is influenced not only by the degree of tubal opening but also by differences in pressure transmission and symptom perception. Symptom-oriented evaluation integrating subjective complaints with multiple objective assessments is essential for accurate clinical characterization of PET.
Parathyroid carcinoma is a rare endocrine malignancy that is challenging to distinguish from nonmalignant primary hyperparathyroidism before surgery. This study compared the clinical characteristics, surgical practices, and outcomes between patients with parathyroid carcinoma and those with benign disease and evaluated the impacts of preoperative diagnosis and en bloc resection. We conducted a descriptive analysis using data from a Japanese hospital-based administrative database. The study included patients undergoing initial parathyroid surgery between 2008 and 2023. We compared clinical characteristics, treatments, and postoperative outcomes between parathyroid carcinoma and nonmalignant primary hyperparathyroidism. In carcinoma cases, subgroup analyses were stratified whether of en bloc resection was performed. Among 5728 patients, the parathyroid carcinoma and nonmalignant primary hyperparathyroidism groups included 175 and 4754 patients, respectively. A preoperative diagnosis was documented in 16% of carcinoma cases, and 38.9% underwent en bloc resection. Patients with a preoperative diagnosis were more often received en bloc resection. The preoperative diagnosis of parathyroid carcinoma remains challenging. En bloc resection was performed more frequently when malignancy was suspected. These findings highlight the need for improved diagnostic strategies.
Full-thickness cheek defects resulting from advanced oral cavity cancer pose significant reconstructive challenges, with both functional and aesthetic implications. Although free flap remains the gold standard, it is resource-intensive. This study evaluates the folded submental flap as a practical alternative. A retrospective review was conducted of eight patients with oral cavity cancer who underwent submental flap reconstruction between January 2017 and September 2024 at a single tertiary center. Clinical outcomes and complications were analyzed, and aesthetic and functional results were assessed through physical examination and a validated five-parameter scoring system. Eight male patients (mean age: 51.3 years) with full-thickness cheek defects underwent folded submental flap reconstruction. Defect measured 4 × 3 - 8 × 6 cm, flap sizes 9 × 5 - 13×7 cm. Mean operative time was 408 minutes and average hospital stay 17 days. Two minor complications (salivary leakage, wound dehiscence) resolved without sequelae. No flap loss, donor-site morbidity, or locoregional/nodal recurrence occurred during a mean follow-up of 23.8 months. Six patients remained disease-free, one died of distant metastasis, and one of unrelated causes. Functionally, all resumed oral intake prior to discharge, and seven retained clear speech and full mouth opening. Aesthetic assessment showed high satisfaction and mean scores of 8.1-9 across all five parameters. The folded submental flap provides a reliable, functionally effective, and aesthetically favorable reconstructive option for full-thickness cheek defects. It represents a resource-efficient alternative to free flaps in appropriately selected oral cavity cancer patients.
Atypical lipomatous tumor (ALT) is rare in the head and neck, and dumbbell-shaped lesions beneath the zygomatic arch can complicate access. A 58-year-old man presented with an enlarging right temporal mass. Contrast-enhanced computed tomography and noncontrast magnetic resonance imaging showed a 125-mm lipomatous dumbbell-shaped tumor extending into the infratemporal fossa. Incisional biopsy suggested ALT. Marginal en bloc resection was performed using a unilateral coronal scalp incision and intraoral approach with zygomatic arch osteotomy and titanium plate fixation. Histology showed thick fibrous septa with atypical spindle cells; immunohistochemistry demonstrated positivity for CDK4 and weak positivity for MDM 2, consistent with ALT (FNCLCC histological grade 1) with no definite positive margin. At 4 years, no recurrence was seen, with no facial nerve palsy or masticatory dysfunction. Combined coronal-intraoral exposure with zygomatic arch osteotomy may facilitate marginal en bloc resection of temporal-infratemporal ALT.
Intercapsular resection for cervical schwannoma may represent a complete tumor-removal method, considering schwannoma origin and nerve anatomy. However, the conventional "total resection," which requires cutting the originating nerve at both tumor ends, persists, and intercapsular resection is not always considered a complete resection approach. Furthermore, the surgical technique has raised concerns about potential tumor recurrence. The aim of this study was to evaluate whether tumors removed via intercapsular resection for cervical schwannomas were histopathologically confirmed to be completely excised. The analysis included 10 cases of intercapsular resection conducted between November 2020 and July 2021. Excised tumors underwent histopathological evaluation using hematoxylin-eosin (H&E) staining, S-100 immunostaining, and Elastica van Gieson (EVG) special staining. H&E staining identified a pink fibrous capsule in all cases. S-100 staining showed positive results within the tumor but negative results in the fibrous capsule, with no nerve cells detected in the outer capsule layer. EVG staining depicted the capsule in red, indicating a composition of fibrous connective tissue with collagen fibers. These findings confirmed no nerve-cell exposure around the tumor, supporting complete excision. Accordingly, intercapsular resection appears to offer an effective surgical approach for cervical schwannomas-preserving nerve function while ensuring complete tumor removal.
The management of children with cholesteatoma has advanced over the course of this century thanks to innovations in surgical instrumentation and other aspects of care. A narrative review giving a perspective on the contributions of advances such as dedicated equipment for endoscopic ear surgery including powered instrumentation and KTP laser, and other areas including CT and MRI imaging, is provided. These have helped raise the standard of care from achieving a "safe dry ear" potentially with a mastoid cavity, to less invasive approaches that can deliver a functionally and cosmetically normal ear in many cases. Areas in need of further innovative approaches persist in the control of residual and recurrent cholesteatoma and hearing loss. Surgeons are advised to be wary of over-reliance on the use of untested hypothetical mechanisms when considering the adoption of new technologies, such as Eustachian tube balloon dilatation. Improved standards for data collection, analysis and reporting will help ensure that efficacious and cost-effective innovations are adopted in future to further improve outcomes from the care of paediatric cholesteatoma.
Hypoglossal nerve stimulation (HNS) has emerged as an effective treatment for obstructive sleep apnea (OSA) in patients who cannot tolerate continuous positive airway pressure. However, data on Asian populations, particularly Japanese patients, are limited. This study evaluated the operative time and clinical outcomes of HNS therapy in a Japanese cohort. This study included 18 patients with moderate-to-severe OSA who underwent HNS implantation (Inspire UAS system®) at the study hospital between August 2022 and December 2024. Operative time, intraoperative blood loss, and perioperative complications were recorded to assess surgical efficiency. Sleep parameters, including apnea-hypopnea index (AHI), 3 % oxygen desaturation index (ODI), minimum SpO₂, time with SpO₂ < 90 %, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and patient-reported impressions, were evaluated at 6 and 12 months post-implantation. The average operative time was 118.4 ± 48.6 min. Analysis of the surgical learning curve showed a significant decrease in operative time with increasing case number (ρ = -0.876, p < 0.01). Nonlinear regression using a logarithmic model indicated that operative time tended to decrease progressively with increasing surgical experience, with greater reductions observed in the early cases and more gradual decreases in later cases. Adverse events were infrequent, with one patient requiring device explantation. At 6 months, the mean AHI decreased from 30.8 events/hour (/h) to 9.5/h (p < 0.001), ODI from 25.9 /h to 7.2 /h (p < 0.001), ESS from 11.3 ± 6.0-7.3 ± 4.0 (p = 0.006), and PSQI from 11.4 ± 3.6-7.3 ± 3.1 (p = 0.008). These improvements were sustained at 12 months, with high patient satisfaction reported in ≥ 90 % of cases. HNS implantation is safe, and operative time decreases progressively with increasing experience. HNS therapy is effective and feasible for Japanese patients with OSA and produces substantial improvements in both objective sleep parameters and patient-reported outcomes. Despite the small sample size and short follow-up period, this pilot study provides important initial evidence supporting the applicability of HNS in Asian populations.
To provide a strategy for vestibular rehabilitation in accordance with the Japanese Guideline for Vestibular Rehabilitation. Tokyo: Kanehara Shuppan; 2024, edited by the Japan Society for Equilibrium Research (JSER). The Committee for Clinical Practice Guidelines of JSER formulated eleven clinical questions (CQs) concerning vestibular rehabilitation and conducted literature searches on CQs. The Committee for Standards in Diagnosis of JSER proposed an exercise program for vestibular rehabilitation consisting of head motion, balance, gait, and habituation exercises for patients with chronic unilateral peripheral vestibular hypofunction. The Committee for Clinical Practice Guidelines of JSER proposed recommendations to answer each CQ by considering the effectiveness of intervention, strength of evidence, resource implications, and balance between benefits and harm determined from literature review. Vestibular rehabilitation is strongly recommended to improve vestibular symptoms, gaze instability, postural imbalance, and gait impairment in patients with chronic unilateral vestibular hypofunction.
In this study, we evaluated a hospital-wide swallowing screening system implemented for all inpatients at a university hospital since April 2018. We compared the original two-step screening method-combining the Eating Assessment Tool-10 (EAT-10) and the water-swallowing test-with the one-step screening using EAT-10 alone, introduced in April 2020 following the coronavirus disease 2019 pandemic. A retrospective analysis of medical records was conducted to assess screening implementation rates, diagnostic accuracy (sensitivity and specificity), and the number of choking incidents. The two-step method showed 90.1% sensitivity and 79.6% specificity, with no choking events, whereas the one-step method showed 73.6% sensitivity and 91.1% specificity, with three choking events. Both strategies significantly reduced choking incidents compared with those during the pre-implementation period (annual mean: 4.2 events). Sensitivity was higher for the two-step screening, although no significant difference in the number of choking events was observed between the two approaches. The combined two-step screening using EAT-10 and the water-swallowing test offers high sensitivity and is effective in identifying patients at risk for choking. Meanwhile, screening with EAT-10 alone also offers preventive benefits and represents a feasible option for facilities with limited manpower. Implementing hospital-wide screening at admission contributes significantly to safer inpatient care.
This review addresses the surgical management of pediatric nasal septal deviation. We discuss the challenges and considerations unique to children, including growth-related timing decisions, surgical techniques, and potential impacts on craniofacial development and quality of life. A narrative synthesis of recent literature was conducted. Key topics reviewed include the epidemiology of septal deviation in children, associations with complications (e.g. obstructive sleep apnea, sinusitis, cognitive or behavioral effects), timing of intervention in relation to septal growth, operative methods and preservation strategies, and complication rates and outcomes data. The prevalence of septal deviation in children is approximately 30%. Alone it rarely causes severe nasal obstruction, but in combination with conditions such as allergic rhinitis or adenoid hypertrophy it contributes significantly to symptomatology. Untreated nasal obstruction has been linked to craniofacial growth disturbances, sleep-disordered breathing, behavioral issues, and academic decline. Multiple authors now support that septal surgery can be safely performed in children aged six years and older without major detrimental effects on midface development. Critical technical principles include maximal conservation of cartilage and bone (especially in dorsal and caudal zones), avoidance of nasal floor mucosa dissection, and preservation of growth-center zones. Reported complications are low, but revision rates in pediatric septorhinoplasty remain higher than in adults (∼13.5%). Data accumulation suggests pediatric septal surgery is increasingly safe when performed with conservative technique. Surgical indication should be considered in children aged ≥6 who present with septal deviation resistant to medical therapy and who suffer complications such as snoring, OSA, recurrent sinusitis, or severely impaired quality of life. Meticulous operative planning with maximal structural preservation is paramount to optimize outcomes and minimize growth disruption.
Post-treatment imaging surveillance plays a crucial role in the treatment of head and neck squamous cell carcinoma (HNSCC), because early detection of residual disease, recurrence, or secondary malignancy is essential for devising optimal treatment strategies. This review provides an overview of the current status of the role of each available radiological imaging modality for post-treatment surveillance. Tracking morphological changes is the basic approach for locoregional recurrence surveillance, with contrast-enhanced computed tomography (CT) serving as the primary imaging modality. The Neck Imaging Reporting and Data System (NI-RADS) contributes to the standardization of the diagnosis of recurrence through imaging surveillance. Magnetic resonance (MR) imaging is preferred for monitoring tumors near the skull base owing to its superiority in diagnosing bone invasion and perineural spread. Additionally, diffusion-weighted (DW) imaging demonstrates high diagnostic performance in distinguishing residual or recurrent tumors from post-treatment changes. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) demonstrates equal to higher sensitivity than CT and MR imaging for detecting residual or recurrent tumors at both locoregional and distant sites. The high cost of FDG-PET/CT necessitates its efficient implementation at specific times, such as three to six months after the completion of definitive treatment or prior to salvage surgery.
Birch pollen is the predominant tree pollen allergen in Hokkaido, Japan, and is frequently associated with oral allergy syndrome (OAS). However, most previous studies have been hospital-based, and population-level data remain limited. We conducted a cross-sectional questionnaire survey of residents of Hokkaido recruited through 10 medical institutions and their family members. Data were collected on physician-diagnosed birch pollinosis, oral allergy symptoms after food ingestion, demographic factors, residential area, and comorbid allergic diseases. Associations were evaluated using chi-square tests, odds ratios (OR) with 95% confidence intervals (CI), and multivariate logistic regression analyses. A total of 3615 residents were included. The prevalence of physician-diagnosed birch pollinosis was 15.21%, higher than that of other pollen allergies. In multivariate analysis, residential area was an independent determinant of birch pollinosis, with significantly higher odds in northern, central, and eastern Hokkaido than in southern Hokkaido. Female sex, age, perennial allergic rhinitis and food allergy were also independently associated with birch pollinosis. Oral allergy symptoms were reported by 22.41% of participants and occurred in 66.55% of individuals with birch pollinosis. In the multivariate model for oral allergy symptoms, birch pollinosis was a strong independent factor, with additional associations observed for female sex, age, perennial allergic rhinitis and atopic dermatitis. Birch pollinosis and OAS are highly prevalent in Hokkaido. Oral allergy symptoms are strongly linked to birch pollinosis, supporting OAS as a characteristic clinical manifestation of birch pollen sensitization in birch-endemic regions.
To develop simple and effective methods for determining the affected side and promoting early symptom resolution in lateral semicircular canal-benign paroxysmal positional vertigo (L-BPPV) due to canalolithiasis, including its geotropic (L-BPPV-can-geo) and apogeotropic (L-BPPV-can-apo) variants. A total of 146 cases of paroxysmal geotropic positioning nystagmus (PGPN, L-BPPV-can-geo) and 285 cases of persistent apogeotropic positional nystagmus (PAPN) due to peripheral vestibular disorders were analyzed. Positional and positioning nystagmus were observed and recorded using infrared charge-coupled-device equipped video goggles. The healthy-ear-down 135° maneuver (H-135°M) and affected-ear-down 135° maneuver (A-135°M) were used to determine the affected side and serve as canalith repositioning procedures (CRPs). Differences in slow-phase velocity of horizontal nystagmus were compared between L-BPPV-can-apo and L-BPPV-cupulolithiasis (L-BPPV-cup) cases. In L-BPPV-can-geo, the affected side was identified in 98% of cases using the supine head roll test (SHRT), lying-down nystagmus, and H-135°M. A single H-135°M resolved PGPN and vertigo by the next day or the day after in 69% of cases, increasing to 80% after a second H-135°M. Non-PGPN nystagmus occurred in 18% of cases following H-135°M, including posterior canal-BPPV variants, and canalith jam. In L-BPPV-can-apo, the affected side was successfully identified in all cases using SHRT, nystagmus direction in the face-up supine or forward-bending position, and A-135°M. The direction and intensity of nystagmus in representative cases of L-BPPV-can-apo and L-BPPV-cup were consistent with findings expected for a heavy cupula. Among PAPN cases unresponsive to SHRT, a single A-135°M induced a transition to L-BPPV-can-geo in 35% of cases, while 65% remained unchanged indicating L-BPPV-cup. Among PAPN cases of peripheral origin, 2% are classified as L-BPPV-can-geo (utricular side), 44% as L-BPPV-can-apo (canal side), and 54% as L-BPPV-cup. A-135°M is useful in differentiating L-BPPV-can-apo from L-BPPV-cup. Additionally, when a slow-phase velocity of nystagmus in the healthy-ear-down head position is more than twice that in the face-up supine position, L-BPPV-can-apo is more likely than L-BPPV-cup. Canalith jam was observed in both PGPN and PAPN cases, and improved with H-135°M or A-135°M. H-135°M and A-135°M proved effective for both determination of the affected side and treatment of L-BPPV-can-geo and L-BPPV-can-apo cases. Canalith jam typically presents with unidirectional nystagmus either toward the affected or healthy side; however, this unidirectional nystagmus may be accompanied by PGPN or PAPN. The pathophysiology suggests that the directionality of the jam and its location-whether in the anterior or posterior segment of the lateral canal-may influence clinical presentation.