The Japanese Clinical Practice Guidelines for Head and Neck Cancer – 2025 Edition were developed to provide clear evidence-based recommendations that reflect recent advancements and evolving clinical needs in head and neck cancer care. Advances in immunotherapy, targeted therapies, surgical techniques, and genomic medicine have expanded treatment options and added new complexities. This edition offers practical, up-to-date guidance to support consistent decision making across diverse clinical scenarios. Compared with the 2022 edition, the guidelines have been substantially expanded to 63 clinical questions (CQs) across 14 categories. A new feature is the inclusion of commentary columns that address clinically important topics not suited to the CQ format, such as special patient populations, novel therapies, and rare malignancies. To reflect the growing role of precision oncology, updated recommendations for molecular-targeted treatments have been added based on specific genomic alterations, in alignment with the current approvals in Japan. While maintaining the structure of previous editions, this edition addresses the changing clinical environment while also helping to inform future discussions and directions in head and neck cancer care.
{"title":"Summary of Japanese clinical practice guidelines for head and neck cancer - 2025 update edited by the Japan Society for Head and Neck Cancer","authors":"Nobuhiro Hanai , Mizuo Ando , Hiroto Ishiki , Nobuhiro Ueda , Susumu Okano , Isaku Okamoto , Hiroyuki Ozawa , Satoshi Kano , Tomonori Kanda , Yuki Saito , Hirotaka Shinomiya , Keisuke Takanari , Toshifumi Tomioka , Hiroshi Fuseya , Yoshitaka Honma , Atsushi Motegi , Koichi Yasuda , Takeshi Kodaira , Hiroshi Kurita , Ken-ichi Nibu , Akihiro Homma","doi":"10.1016/j.anl.2025.09.004","DOIUrl":"10.1016/j.anl.2025.09.004","url":null,"abstract":"<div><div>The Japanese Clinical Practice Guidelines for Head and Neck Cancer – 2025 Edition were developed to provide clear evidence-based recommendations that reflect recent advancements and evolving clinical needs in head and neck cancer care. Advances in immunotherapy, targeted therapies, surgical techniques, and genomic medicine have expanded treatment options and added new complexities. This edition offers practical, up-to-date guidance to support consistent decision making across diverse clinical scenarios. Compared with the 2022 edition, the guidelines have been substantially expanded to 63 clinical questions (CQs) across 14 categories. A new feature is the inclusion of commentary columns that address clinically important topics not suited to the CQ format, such as special patient populations, novel therapies, and rare malignancies. To reflect the growing role of precision oncology, updated recommendations for molecular-targeted treatments have been added based on specific genomic alterations, in alignment with the current approvals in Japan. While maintaining the structure of previous editions, this edition addresses the changing clinical environment while also helping to inform future discussions and directions in head and neck cancer care.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 709-724"},"PeriodicalIF":1.5,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the efficacy and safety of Kobayashi Plug Surgery (KPS) for patulous Eustachian tube (PET) performed under local anesthesia in the sitting position, using intraoperative subjective symptoms to guide plug size selection, and to investigate its effect on revision surgery rates.
Methods
This retrospective study included 61 patients (73 ears) with refractory PET who underwent KPS between December 2023 and June 2025. All procedures were performed under local anesthesia with patients in the sitting position, allowing for real-time assessment of subjective symptoms immediately after plug placement. If symptoms persisted, the plug size was increased intraoperatively. Clinical data, surgical outcomes, plug sizes, and postoperative complications were analyzed. Long-term outcomes were assessed in 29 ears with follow-up exceeding 180 days using PHI-10, Eustachian tube function tests, and revision surgery rates.
Results
Plug placement was successful in 66 of 73 ears (90.4%). Plug size adjustment during initial surgery was performed in 5 ears (7.6%) based on persistent symptoms. Among 29 ears with long-term follow-up (median: 297.5 days), the overall revision surgery rate due to upsizing was 10.3%. However, among the 41 ears that presented with subjective symptoms at the time of surgery, only 1 case (2.4%) required revision surgery during follow-up. PHI-10 scores significantly improved from a median of 30 to 10 (p < 0.001), and sonotubometry sound pressure levels increased from 85 dB to 99 dB (p < 0.005). Tympanic membrane perforation was observed in one ear (preexisting), and ventilation tube placement for otitis media with effusion was required in 4 ears (13.8%).
Conclusion
KPS under local anesthesia in the sitting position allows for intraoperative symptom-based plug size selection, which may help reduce the need for revision surgery, especially in patients with active symptoms at the time of surgery. While the overall revision rate was 10.3%, it was markedly lower (2.4%) among symptomatic cases. Although the findings should be interpreted with caution due to the small sample size and retrospective design, this technique represents a promising approach for improving surgical outcomes in patients with refractory PET.
目的评价局麻坐位下小林塞术（Kobayashi塞术）治疗扩张性咽鼓管（PET）的疗效和安全性，以术中主观症状为指导选择塞的大小，并探讨其对改型手术率的影响。方法回顾性研究包括61例（73耳）难治性PET患者，于2023年12月至2025年6月间行KPS。所有手术均在局部麻醉下进行，患者为坐位，可在置入导管后立即实时评估主观症状。如果症状持续，则术中增加塞的大小。分析临床资料、手术结果、堵头大小和术后并发症。通过pi -10、咽鼓管功能测试和翻修手术率对29只耳朵的长期预后进行评估，随访时间超过180天。结果73耳中66耳植入成功，成功率90.4%。根据持续症状，在初始手术期间对5只耳朵（7.6%）进行耳塞大小调整。在29只长期随访耳中（中位297.5天），因增大而进行翻修手术的总体比例为10.3%。然而，在手术时出现主观症状的41只耳朵中，只有1例（2.4%）在随访期间需要翻修手术。pi -10评分从中位数30分显著提高到10分（p < 0.001），声压级从85 dB提高到99 dB （p < 0.005）。1耳（既往）鼓膜穿孔，4耳（13.8%）因中耳炎积液需放置通气管。结论坐位局麻下kps术中可根据症状选择栓的大小，尤其对于术中症状活跃的患者，可减少翻修手术的需要。虽然总体修正率为10.3%，但在有症状的病例中明显较低（2.4%）。尽管由于样本量小和回顾性设计，研究结果应谨慎解释，但该技术代表了改善难治性PET患者手术结果的有希望的方法。
{"title":"Intraoperative symptom-guided plug size selection in sitting position Kobayashi plug surgery for patulous eustachian tube","authors":"Takeshi Oshima , Marin Yoshida , Hideshi Shindo , Hidetoshi Oshima , Ryoji Hirai","doi":"10.1016/j.anl.2025.09.007","DOIUrl":"10.1016/j.anl.2025.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of Kobayashi Plug Surgery (KPS) for patulous Eustachian tube (PET) performed under local anesthesia in the sitting position, using intraoperative subjective symptoms to guide plug size selection, and to investigate its effect on revision surgery rates.</div></div><div><h3>Methods</h3><div>This retrospective study included 61 patients (73 ears) with refractory PET who underwent KPS between December 2023 and June 2025. All procedures were performed under local anesthesia with patients in the sitting position, allowing for real-time assessment of subjective symptoms immediately after plug placement. If symptoms persisted, the plug size was increased intraoperatively. Clinical data, surgical outcomes, plug sizes, and postoperative complications were analyzed. Long-term outcomes were assessed in 29 ears with follow-up exceeding 180 days using PHI-10, Eustachian tube function tests, and revision surgery rates.</div></div><div><h3>Results</h3><div>Plug placement was successful in 66 of 73 ears (90.4%). Plug size adjustment during initial surgery was performed in 5 ears (7.6%) based on persistent symptoms. Among 29 ears with long-term follow-up (median: 297.5 days), the overall revision surgery rate due to upsizing was 10.3%. However, among the 41 ears that presented with subjective symptoms at the time of surgery, only 1 case (2.4%) required revision surgery during follow-up. PHI-10 scores significantly improved from a median of 30 to 10 (p < 0.001), and sonotubometry sound pressure levels increased from 85 dB to 99 dB (p < 0.005). Tympanic membrane perforation was observed in one ear (preexisting), and ventilation tube placement for otitis media with effusion was required in 4 ears (13.8%).</div></div><div><h3>Conclusion</h3><div>KPS under local anesthesia in the sitting position allows for intraoperative symptom-based plug size selection, which may help reduce the need for revision surgery, especially in patients with active symptoms at the time of surgery. While the overall revision rate was 10.3%, it was markedly lower (2.4%) among symptomatic cases. Although the findings should be interpreted with caution due to the small sample size and retrospective design, this technique represents a promising approach for improving surgical outcomes in patients with refractory PET.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 704-708"},"PeriodicalIF":1.5,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study had two primary objectives: first, to standardize a sound localization test across multiple facilities in Japan, and second, to use this standardized test to analyze sound localization ability in patients with unilateral hearing loss (UHL) and identify related clinical and demographic factors.
Methods
Sound localization tests were conducted at 11 facilities, enrolling 59 UHL subjects and 77 normal-hearing controls (Ctrl). The first part of the study focused on standardizing the test protocol and establishing reference ranges and cut-off values. The second part analyzed the sound localization ability in UHL patients, measured by the root mean squared (RMS) error. The association between RMS values and factors such as residual hearing, contralateral routing of signal (CROS) hearing aid use, and Hearing Handicap Inventory for Adults (HHIA) scores were analyzed.
Results
Reference ranges and cut-off values for the standardized sound localization test were successfully established. UHL subjects exhibited significantly higher RMS values (i.e., poorer localization) compared to controls. The use of CROS hearing aids did not improve performance, and the contribution of pinna-induced spectral cues was limited. Significant associations were found between RMS values and both sound presentation position and the number of audiogram frequencies with thresholds better than 40 dB and 50 dB, with the 50 dB threshold criterion being a more prominent factor. HHIA emotional and social scores were significantly associated only with age and not with sound localization performance or other audiological factors.
Conclusions
The standardized sound localization test proved to be a reliable tool for multicenter studies. Patients with UHL have significantly impaired sound localization. Residual hearing in the impaired ear, even if limited, was found to aid localization, whereas the benefits of CROS hearing aids and monaural spectral cues were negligible in our cohort. Since only age influenced the self-perceived hearing handicap (HHIA scores), it is crucial to consider restoring binaural hearing not just to improve sound localization but also to address the broader quality-of-life issues associated with UHL.
{"title":"Impact of hearing impairment in unilateral hearing loss: A multicenter study of standardized sound localization tests in Japan","authors":"Takashi Ishino , Tadao Yoshida , Satoshi Iwasaki , Naoki Oishi , Yusuke Matsuda , Tetsuya Tono , Kazuma Sugahara , Hiroshi Yamazaki , Sumito Jitsukawa , Hiroshi Nakanishi , Ryosuke Kitoh , Takashi Sato , Kazuki Nishida , Takashi Oda , Rikuto Fujita , Tomohiro Kawasumi , Chie Ishikawa , Manabu Nishida , Nobuyuki Chikuie , Yuichiro Horibe , Sachio Takeno","doi":"10.1016/j.anl.2025.09.010","DOIUrl":"10.1016/j.anl.2025.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>This study had two primary objectives: first, to standardize a sound localization test across multiple facilities in Japan, and second, to use this standardized test to analyze sound localization ability in patients with unilateral hearing loss (UHL) and identify related clinical and demographic factors.</div></div><div><h3>Methods</h3><div>Sound localization tests were conducted at 11 facilities, enrolling 59 UHL subjects and 77 normal-hearing controls (Ctrl). The first part of the study focused on standardizing the test protocol and establishing reference ranges and cut-off values. The second part analyzed the sound localization ability in UHL patients, measured by the root mean squared (RMS) error. The association between RMS values and factors such as residual hearing, contralateral routing of signal (CROS) hearing aid use, and Hearing Handicap Inventory for Adults (HHIA) scores were analyzed.</div></div><div><h3>Results</h3><div>Reference ranges and cut-off values for the standardized sound localization test were successfully established. UHL subjects exhibited significantly higher RMS values (i.e., poorer localization) compared to controls. The use of CROS hearing aids did not improve performance, and the contribution of pinna-induced spectral cues was limited. Significant associations were found between RMS values and both sound presentation position and the number of audiogram frequencies with thresholds better than 40 dB and 50 dB, with the 50 dB threshold criterion being a more prominent factor. HHIA emotional and social scores were significantly associated only with age and not with sound localization performance or other audiological factors.</div></div><div><h3>Conclusions</h3><div>The standardized sound localization test proved to be a reliable tool for multicenter studies. Patients with UHL have significantly impaired sound localization. Residual hearing in the impaired ear, even if limited, was found to aid localization, whereas the benefits of CROS hearing aids and monaural spectral cues were negligible in our cohort. Since only age influenced the self-perceived hearing handicap (HHIA scores), it is crucial to consider restoring binaural hearing not just to improve sound localization but also to address the broader quality-of-life issues associated with UHL.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 690-703"},"PeriodicalIF":1.5,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recent development in endoscopic imaging has led to the detection of superficial laryngopharyngeal carcinomas and the effectiveness of endoscopic resection for superficial pharyngeal squamous cell carcinoma have been reported. However, the en bloc and complete resection rates were not sufficient. To identify the precise incision and dissection lines, ensuring a clear operating view is important. Although underwater condition during dissection is useful, saliva, bleeding, and produced floating matter make the operating view worse as the dissection process continues. We presented new method; continuous water perfusion method (CWPM) may contribute to ensuring a clear operating view during dissection of endoscopic resection for superficial pharyngeal squamous cell carcinomas.
{"title":"New method; continuous water perfusion method during endoscopic resection for the superficial pharyngeal squamous cell carcinoma","authors":"Naohiro Nakamura , Tomofumi Sakagami , Kensuke Suzuki , Takuo Fujisawa , Takuya Shijimaya , Sanshiro Kobayashi , Masataka Masuda , Yu Takahashi , Tomomitsu Tahara , Makoto Naganuma","doi":"10.1016/j.anl.2025.10.002","DOIUrl":"10.1016/j.anl.2025.10.002","url":null,"abstract":"<div><div>Recent development in endoscopic imaging has led to the detection of superficial laryngopharyngeal carcinomas and the effectiveness of endoscopic resection for superficial pharyngeal squamous cell carcinoma have been reported. However, the en bloc and complete resection rates were not sufficient. To identify the precise incision and dissection lines, ensuring a clear operating view is important. Although underwater condition during dissection is useful, saliva, bleeding, and produced floating matter make the operating view worse as the dissection process continues. We presented new method; continuous water perfusion method (CWPM) may contribute to ensuring a clear operating view during dissection of endoscopic resection for superficial pharyngeal squamous cell carcinomas.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 687-689"},"PeriodicalIF":1.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To describe the establishment and initial findings of Japan’s first comprehensive nationwide registry covering cochlear implants (CIs), active middle ear implants (AMEIs), and bone conduction implants (BCIs), launched in 2023. The registry aims to improve national data collection, support evidence-based policymaking, and track trends in surgical practice and patient demographics.
Methods
A web-based electronic data capture (EDC) system was implemented to replace the previous paper-based reporting system. Between January 2023 and December 2024, data were voluntarily submitted by participating facilities across Japan. Collected data included patient demographics, implant types, hearing thresholds, etiologies, and manufacturer information. Registry completeness was assessed by comparison with Japan’s National Database of Health Insurance Claims (NDB).
Results
A total of 1880 patients were registered, and 1809 patients with surgical information entered from 104 facilities were selected for analysis, comprising 1723 CI cases and 86 AMEI or BCI cases (11 VSB, 22 BB, 53 Baha). Among 605 pediatric CI recipients, early-age implantation was increasingly observed, with 58 patients (10 %) aged under 1 year and 183 (30 %) aged 1 year. Among adult CI recipients, 271 patients were aged 75 years or older, including 40 patients aged 85 years or older. Additionally, simultaneous bilateral CI surgery was performed in 265 patients, of whom 175 were children, reflecting the expanding indications. Patients with better ear thresholds <90 dB HL accounted for 33 % of adults and 29 % of children. Congenital hearing loss predominated in children, while acquired causes were more common in adults. Among cases with a known etiology, hereditary deafness was the most common (24.5 %), although 39.6 % of etiologies were unknown. CI data completeness reached 73 % compared with NDB, indicating strong nationwide participation and a high level of data reliability.
Conclusion
This is the first comprehensive report from the national registry in Japan that includes not only CIs but also AMEIs and BCIs. The registry demonstrated reliable data capture and highlighted important trends in patient demographics and surgical practices. Continued data collection will enhance clinical decision-making and support policy development, ultimately improving care for auditory implant recipients.
{"title":"Establishing a comprehensive national auditory implant registry in Japan: Trends and demographics from the first two years (2023–2024)","authors":"Ayu Akazawa , Takeshi Fujita , Kensuke Uraguchi , Megumi Kitayama , Taku Ito , Yasuhiro Osaki , Kyoko Shirai , Haruo Yoshida , Norio Yamamoto , Katsumi Doi , Satoshi Iwasaki , Naoki Oishi","doi":"10.1016/j.anl.2025.09.009","DOIUrl":"10.1016/j.anl.2025.09.009","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the establishment and initial findings of Japan’s first comprehensive nationwide registry covering cochlear implants (CIs), active middle ear implants (AMEIs), and bone conduction implants (BCIs), launched in 2023. The registry aims to improve national data collection, support evidence-based policymaking, and track trends in surgical practice and patient demographics.</div></div><div><h3>Methods</h3><div>A web-based electronic data capture (EDC) system was implemented to replace the previous paper-based reporting system. Between January 2023 and December 2024, data were voluntarily submitted by participating facilities across Japan. Collected data included patient demographics, implant types, hearing thresholds, etiologies, and manufacturer information. Registry completeness was assessed by comparison with Japan’s National Database of Health Insurance Claims (NDB).</div></div><div><h3>Results</h3><div>A total of 1880 patients were registered, and 1809 patients with surgical information entered from 104 facilities were selected for analysis, comprising 1723 CI cases and 86 AMEI or BCI cases (11 VSB, 22 BB, 53 Baha). Among 605 pediatric CI recipients, early-age implantation was increasingly observed, with 58 patients (10 %) aged under 1 year and 183 (30 %) aged 1 year. Among adult CI recipients, 271 patients were aged 75 years or older, including 40 patients aged 85 years or older. Additionally, simultaneous bilateral CI surgery was performed in 265 patients, of whom 175 were children, reflecting the expanding indications. Patients with better ear thresholds <90 dB HL accounted for 33 % of adults and 29 % of children. Congenital hearing loss predominated in children, while acquired causes were more common in adults. Among cases with a known etiology, hereditary deafness was the most common (24.5 %), although 39.6 % of etiologies were unknown. CI data completeness reached 73 % compared with NDB, indicating strong nationwide participation and a high level of data reliability.</div></div><div><h3>Conclusion</h3><div>This is the first comprehensive report from the national registry in Japan that includes not only CIs but also AMEIs and BCIs. The registry demonstrated reliable data capture and highlighted important trends in patient demographics and surgical practices. Continued data collection will enhance clinical decision-making and support policy development, ultimately improving care for auditory implant recipients.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 679-686"},"PeriodicalIF":1.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the clinical features in a large cohort of patients who underwent cochlear implantation in Japan, including the number of simultaneous bilateral cochlear implantation, proportion of postoperative infectious complications, and factors associated with postoperative infectious complications.
Methods
This retrospective cohort study extracted data of 7893 patients who underwent 9427 cochlear implantations from a Japanese national inpatient database between July 2010 and March 2021. We determined the number of cochlear implantations, patient age, number of simultaneous bilateral surgeries, and incidence of infectious complications. The factors associated with postoperative infection were analyzed using a multivariate logistic regression model.
Results
Pediatric cases were predominant until 2016, whereas adult cases surpassed pediatric cases beginning in 2017. The proportion of patients aged > 1 year and 6 months decreased gradually since 2014. The number of simultaneous cochlear implantations increased steadily since 2016. The incidence of postoperative infection was 4.8 %. Postoperative infectious complications were significantly associated with age < 2 years at surgery, inner ear malformations, and medium hospital volumes in pediatric patients. In adults, chronic otitis media and comorbid diabetes mellitus without complications were associated with postoperative infectious complications.
Conclusions
The trends in patient age and the number of simultaneous surgeries in Japan are consistent with the revised guidelines. The incidence of postoperative infections was 4.8 %. The factors associated with postoperative infection differed between pediatric and adult patients. These findings may help surgeons in the management of cochlear implantation.
{"title":"Clinical features of cochlear implantation in Japan and factors affecting postoperative infection","authors":"Megumi Koizumi , Akinori Kashio , Miho Ishimaru , Hiroki Matsui , Kiyohide Fushimi , Hideo Yasunaga , Tatsuya Yamasoba","doi":"10.1016/j.anl.2025.09.001","DOIUrl":"10.1016/j.anl.2025.09.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the clinical features in a large cohort of patients who underwent cochlear implantation in Japan, including the number of simultaneous bilateral cochlear implantation, proportion of postoperative infectious complications, and factors associated with postoperative infectious complications.</div></div><div><h3>Methods</h3><div>This retrospective cohort study extracted data of 7893 patients who underwent 9427 cochlear implantations from a Japanese national inpatient database between July 2010 and March 2021. We determined the number of cochlear implantations, patient age, number of simultaneous bilateral surgeries, and incidence of infectious complications. The factors associated with postoperative infection were analyzed using a multivariate logistic regression model.</div></div><div><h3>Results</h3><div>Pediatric cases were predominant until 2016, whereas adult cases surpassed pediatric cases beginning in 2017. The proportion of patients aged > 1 year and 6 months decreased gradually since 2014. The number of simultaneous cochlear implantations increased steadily since 2016. The incidence of postoperative infection was 4.8 %. Postoperative infectious complications were significantly associated with age < 2 years at surgery, inner ear malformations, and medium hospital volumes in pediatric patients. In adults, chronic otitis media and comorbid diabetes mellitus without complications were associated with postoperative infectious complications.</div></div><div><h3>Conclusions</h3><div>The trends in patient age and the number of simultaneous surgeries in Japan are consistent with the revised guidelines. The incidence of postoperative infections was 4.8 %. The factors associated with postoperative infection differed between pediatric and adult patients. These findings may help surgeons in the management of cochlear implantation.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 672-678"},"PeriodicalIF":1.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-06DOI: 10.1016/j.anl.2025.09.008
Chia-Hsuan Lee , Che-Yi Lin , Kun-Tai Kang , Wei-Chung Hsu
Objective
To analyze hospital readmission and mortality rates within 1 year after discharge with pediatric tracheostomy.
Methods
Data were obtained from Taiwan’s National Health Insurance Research Database. All inpatients aged <18 years who underwent tracheostomy between 2001 and 2019 were identified using International Classification of Diseases codes. All-cause readmission and mortality rates at 30, 90, 180, 270, and 365 days after pediatric tracheostomy were calculated, and factors associated with readmission and mortality at 1 year after tracheostomy were analyzed.
Results
A total of 1911 children who underwent tracheostomy were included. At 1 year after tracheostomy, 1485 (78 %) children experienced hospital readmission, and 273 (14 %) died. The accumulated readmission rates at 30, 90, 180, 270, and 365 days were 32 %, 56 %, 69 %, 74 %, and 78 %, respectively. The accumulated mortality rates at 30, 90, 180, 270, and 365 days were 2 %, 6 %, 9 %, 12 %, and 14 %, respectively. Children who experienced readmission within the 1-year follow-up period were significantly younger (8.3 vs 9.9 years) and less indicated for trauma or head injury (33 % vs 39 %), and they had longer intensive care unit stays (38 days vs 30 days) and hospital stays (62 days vs 51 days) than had those without readmission. Multivariable analysis revealed that infants (HR = 1.20, 95 % CI: 1.01 to 1.44) and toddlers (HR = 1.24, 95 % CI: 1.04 to 1.48) were at significantly greater risk of readmission than were adolescents during the 1-year follow-up period. Mortality risk within this period was significantly higher among infants, toddlers, preschoolers, and school-aged children than among adolescents.
Conclusion
Children at young ages are at greater risk of readmission and mortality following tracheostomy.
{"title":"Hospital readmission and mortality after discharge with pediatric tracheostomy: A one-year population-based cohort study in Taiwan","authors":"Chia-Hsuan Lee , Che-Yi Lin , Kun-Tai Kang , Wei-Chung Hsu","doi":"10.1016/j.anl.2025.09.008","DOIUrl":"10.1016/j.anl.2025.09.008","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze hospital readmission and mortality rates within 1 year after discharge with pediatric tracheostomy.</div></div><div><h3>Methods</h3><div>Data were obtained from Taiwan’s National Health Insurance Research Database. All inpatients aged <18 years who underwent tracheostomy between 2001 and 2019 were identified using <em>International Classification of Diseases</em> codes. All-cause readmission and mortality rates at 30, 90, 180, 270, and 365 days after pediatric tracheostomy were calculated, and factors associated with readmission and mortality at 1 year after tracheostomy were analyzed.</div></div><div><h3>Results</h3><div>A total of 1911 children who underwent tracheostomy were included. At 1 year after tracheostomy, 1485 (78 %) children experienced hospital readmission, and 273 (14 %) died. The accumulated readmission rates at 30, 90, 180, 270, and 365 days were 32 %, 56 %, 69 %, 74 %, and 78 %, respectively. The accumulated mortality rates at 30, 90, 180, 270, and 365 days were 2 %, 6 %, 9 %, 12 %, and 14 %, respectively. Children who experienced readmission within the 1-year follow-up period were significantly younger (8.3 vs 9.9 years) and less indicated for trauma or head injury (33 % vs 39 %), and they had longer intensive care unit stays (38 days vs 30 days) and hospital stays (62 days vs 51 days) than had those without readmission. Multivariable analysis revealed that infants (HR = 1.20, 95 % CI: 1.01 to 1.44) and toddlers (HR = 1.24, 95 % CI: 1.04 to 1.48) were at significantly greater risk of readmission than were adolescents during the 1-year follow-up period. Mortality risk within this period was significantly higher among infants, toddlers, preschoolers, and school-aged children than among adolescents.</div></div><div><h3>Conclusion</h3><div>Children at young ages are at greater risk of readmission and mortality following tracheostomy.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 664-671"},"PeriodicalIF":1.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.anl.2025.09.006
Naotaro Akiyama , Tomomi Yamamoto-Fukuda , Hiromi Kojima
Objective
Middle ear cholesteatoma (Cholesteatoma) consists of proliferative epithelial cells. In the previous study, we demonstrated that histone H3 acetylation at lysine 27 (H3K27ac), associated with high transcriptional activation, was accumulated in the Cholesteatoma. In this study, we firstly investigated the expression of H3K27ac and histone acetyltransferase, p300 in human Cholesteatoma tissues. And then, we investigated the effects of a p300 inhibitor, C646, against Cholesteatoma growth.
Methods
Immunohistochemical analysis was demonstrated in the human Cholesteatoma specimens using anti-p300 and anti-H3K27ac antibodies and in the KGF-induced Cholesteatoma mouse model after p300 inhibitor administration using anti-p300, anti-H3K27ac, and anti-Ki67 antibodies.
Results
The expression levels of p300 were significantly increased and colocalized with H3K27ac in the human Cholesteatoma specimens. Moreover, C646 decreased proliferative activities of Cholesteatoma cells in the KGF-induced Cholesteatoma mouse model.
Conclusion
We demonstrated that inhibition of the H3K27ac may be a potential treatment strategy for Cholesteatoma from a new perspective.
{"title":"Effect of histone acetyltransferase inhibitor against middle ear cholesteatoma in mouse model","authors":"Naotaro Akiyama , Tomomi Yamamoto-Fukuda , Hiromi Kojima","doi":"10.1016/j.anl.2025.09.006","DOIUrl":"10.1016/j.anl.2025.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>Middle ear cholesteatoma (Cholesteatoma) consists of proliferative epithelial cells. In the previous study, we demonstrated that histone H3 acetylation at lysine 27 (H3K27ac), associated with high transcriptional activation, was accumulated in the Cholesteatoma. In this study, we firstly investigated the expression of H3K27ac and histone acetyltransferase, p300 in human Cholesteatoma tissues. And then, we investigated the effects of a p300 inhibitor, C646, against Cholesteatoma growth.</div></div><div><h3>Methods</h3><div>Immunohistochemical analysis was demonstrated in the human Cholesteatoma specimens using anti-p300 and anti-H3K27ac antibodies and in the KGF-induced Cholesteatoma mouse model after p300 inhibitor administration using anti-p300, anti-H3K27ac, and anti-Ki67 antibodies.</div></div><div><h3>Results</h3><div>The expression levels of p300 were significantly increased and colocalized with H3K27ac in the human Cholesteatoma specimens. Moreover, C646 decreased proliferative activities of Cholesteatoma cells in the KGF-induced Cholesteatoma mouse model.</div></div><div><h3>Conclusion</h3><div>We demonstrated that inhibition of the H3K27ac may be a potential treatment strategy for Cholesteatoma from a new perspective.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 657-663"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic neck dissection (END) has been developed in Asia; however, it is necessary to validate a technique that has a short learning curve and is easy to introduce. The purpose of this study was to determine the approach with the easiest introduction and shortest learning curve using donated cadavers fixed with the Thiel method.
Methods
A total of four different approaches were examined. Each approach was evaluated by a questionnaire administered to five head and neck surgeons, the extent of dissection was confirmed, and the number of dissected lymph nodes was counted.
Results
Endoscopic supra-omohyoid-neck dissection (SOHND) by entering from the anterior margin of the sternocleidomastoid muscle (SCM) through a retroauricular (RA) approach was the most highly rated in the questionnaire, and the extent of dissection and number of lymph nodes dissected were reasonable in this study. Jugular neck dissection (JND) by entering the anterior margin of the SCM from the subclavian was the second highest scoring approach, but further advances in instrument development and technique are needed.
Conclusions
Endoscopic SOHND by the RA approach was considered optimal. Endoscopic JND by the subclavian approach was the second most promising approach.
{"title":"Evaluation of the optimal approach for endoscopic neck dissection using Thiel cadavers","authors":"Takashi Maruo , Toshifumi Tomioka , Wataru Okano , Takashi Mukaigawa , Takahiro Fukuhara , Hiromu Nakamura , Takuma Takeuchi , Munekazu Naito , Naoyuki Hatayama , Yasushi Fujimoto","doi":"10.1016/j.anl.2025.09.003","DOIUrl":"10.1016/j.anl.2025.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>Endoscopic neck dissection (END) has been developed in Asia; however, it is necessary to validate a technique that has a short learning curve and is easy to introduce. The purpose of this study was to determine the approach with the easiest introduction and shortest learning curve using donated cadavers fixed with the Thiel method.</div></div><div><h3>Methods</h3><div>A total of four different approaches were examined. Each approach was evaluated by a questionnaire administered to five head and neck surgeons, the extent of dissection was confirmed, and the number of dissected lymph nodes was counted.</div></div><div><h3>Results</h3><div>Endoscopic supra-omohyoid-neck dissection (SOHND) by entering from the anterior margin of the sternocleidomastoid muscle (SCM) through a retroauricular (RA) approach was the most highly rated in the questionnaire, and the extent of dissection and number of lymph nodes dissected were reasonable in this study. Jugular neck dissection (JND) by entering the anterior margin of the SCM from the subclavian was the second highest scoring approach, but further advances in instrument development and technique are needed.</div></div><div><h3>Conclusions</h3><div>Endoscopic SOHND by the RA approach was considered optimal. Endoscopic JND by the subclavian approach was the second most promising approach.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 643-650"},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To clarify the clinical characteristics of patulous Eustachian tube (PET) based on the Japan Otological Society (JOS) diagnostic criteria and to assess the diagnostic contribution of individual symptoms and objective findings.
Methods
We retrospectively analyzed patients diagnosed with definite PET or non-PET at a subspecialty Eustachian tube clinic between June 2019 and July 2025, excluding possible PET to minimize diagnostic uncertainty. Demographics, background factors, symptoms, and objective test results—including tympanic membrane (TM) flutter, tubo-tympano-aerodynamic graphy, and sonotubometry—were examined. Logistic regression identified independent factors, and receiver operating characteristic (ROC) curves were generated to evaluate diagnostic performance.
Results
Among 1009 patients (1613 ears), definite PET was associated with habitual sniffing (OR = 8.18), history of weight loss (OR = 1.78), and, in females, low-dose estrogen–progestin use (OR = 7.31). Lower body mass index and younger age also showed significant associations. Voice autophony (OR = 4.09) and breathing autophony (OR = 9.98) were the most predictive symptoms. Objective findings demonstrated high diagnostic accuracy, with TM flutter showing the highest odds ratio (OR = 42.17). The seven-symptom model achieved an area under the ROC curve (AUC) of 0.862.
Conclusion
This large-scale study identified key background factors and symptoms valuable for PET diagnosis and confirmed that objective tests have strong discriminatory ability, supporting earlier and more accurate clinical decision-making.
{"title":"Clinical characteristics and diagnostic value of symptoms and objective findings in patulous eustachian tube: a large-scale study based on the Japan Otological Society criteria","authors":"Hidetoshi Oshima , Marin Yoshida , Hideshi Shindo , Ryoji Hirai , Takeshi Oshima","doi":"10.1016/j.anl.2025.09.002","DOIUrl":"10.1016/j.anl.2025.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>To clarify the clinical characteristics of patulous Eustachian tube (PET) based on the Japan Otological Society (JOS) diagnostic criteria and to assess the diagnostic contribution of individual symptoms and objective findings.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients diagnosed with definite PET or non-PET at a subspecialty Eustachian tube clinic between June 2019 and July 2025, excluding possible PET to minimize diagnostic uncertainty. Demographics, background factors, symptoms, and objective test results—including tympanic membrane (TM) flutter, tubo-tympano-aerodynamic graphy, and sonotubometry—were examined. Logistic regression identified independent factors, and receiver operating characteristic (ROC) curves were generated to evaluate diagnostic performance.</div></div><div><h3>Results</h3><div>Among 1009 patients (1613 ears), definite PET was associated with habitual sniffing (OR = 8.18), history of weight loss (OR = 1.78), and, in females, low-dose estrogen–progestin use (OR = 7.31). Lower body mass index and younger age also showed significant associations. Voice autophony (OR = 4.09) and breathing autophony (OR = 9.98) were the most predictive symptoms. Objective findings demonstrated high diagnostic accuracy, with TM flutter showing the highest odds ratio (OR = 42.17). The seven-symptom model achieved an area under the ROC curve (AUC) of 0.862.</div></div><div><h3>Conclusion</h3><div>This large-scale study identified key background factors and symptoms valuable for PET diagnosis and confirmed that objective tests have strong discriminatory ability, supporting earlier and more accurate clinical decision-making.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 651-656"},"PeriodicalIF":1.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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