Pub Date : 2025-12-01Epub 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":"2025-12-01","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}
Japanese cedar pollinosis (JCP) is the most prevalent seasonal allergic rhinitis in Japan. Many JCP patients are also sensitized to Japanese cypress pollen (JCyP), and their symptoms become exacerbated and prolonged during the JCyP dispersal period after JCP. To date, there have been no reports on the development of JCyP-specific allergen immunotherapy. For the future development of a JCyP-specific skin test and immunotherapy, we sought to develop a reference extract for future standardization of JCyP extract determined by the average threshold dilution eliciting a positive response in the intradermal skin test.
Methods
A 1:20 antigen extract (Lot AA) was prepared from JCyP grains by the glycerin extraction method. The protein and allergen concentrations in the extract were determined. After confirming its safety, 3-fold serially diluted solutions of JCyP extract were prepared from Lot AA. The average threshold dilution eliciting a positive response in the intradermal skin test was determined among Japanese subjects with serum JCyP-specific IgE class of 2 or higher according to ImmunoCAP IgE assays or View39 IgE assays.
Results
The protein concentration in Lot AA was 4.7 mg/mL, and the allergen concentration was 18.8 μg/mL for Cha o 1 and 1.1 μg/mL for Cha o 3. In total, 85 individuals were registered for this study and finally, 55 subjects were left for the analysis. The threshold dilution for an intradermal reaction was 36 in 32 individuals (58.2 %), 37 in 8 individuals (14.6 %), 38 in 4 individuals (7.3 %), and 39 in 1 individual (1.8 %); no reaction was seen in 10 individuals (18.2 %). The average threshold dilution was 36.4, which is equivalent to a 1131-fold dilution. No serious adverse events were observed at any of the tested dilutions.
Conclusion
The results showed that Lot AA of JCyP extract exhibited in vivo allergic potency and was safe. Thus, it may be useful as a future standardized antigen of JCyP or a reference antigen for standardizing other JCyP extracts for the diagnosis and treatment of JCyP pollinosis.
目的：杉木花粉症是日本最常见的季节性变应性鼻炎。许多JCP患者也对日本柏树花粉（JCyP）敏感，在JCP后的JCyP弥散期，其症状加重和延长。迄今为止，还没有关于jcp特异性过敏原免疫疗法发展的报道。对于JCyP特异性皮肤试验和免疫治疗的未来发展，我们试图开发一种参考提取物，用于未来标准化的JCyP提取物，该提取物由皮内皮肤试验中引起阳性反应的平均阈值稀释来确定。方法：采用甘油提取法制备1:20抗原提取物（Lot AA）。测定提取液中蛋白质和过敏原的浓度。在确认其安全性后，从Lot AA中制备3倍连续稀释的JCyP提取物溶液。根据ImmunoCAP IgE检测或View39 IgE检测，在血清jcp特异性IgE等级为2或更高的日本受试者中，确定皮内皮肤试验中引起阳性反应的平均阈值稀释。结果：Lot AA蛋白浓度为4.7 mg/mL， Cha o 1和Cha o 3的过敏原浓度分别为18.8和1.1 μg/mL。共有85人登记参加本研究，最后，55人被留作分析。皮内反应的阈值稀释度为32例36(58.2%)，8例37(14.6%)，4例38(7.3%)，1例39 (1.8%)；无反应10例（18.2%）。平均阈值稀释度为36.4，相当于稀释1131倍。在任何测试的稀释度下均未观察到严重的不良事件。结论：JCyP提取物AA批次具有体内过敏效力，安全性好。因此，它可以作为未来JCyP的标准化抗原或其他JCyP提取物的标准化参考抗原，用于JCyP授粉病的诊断和治疗。
{"title":"Trial for developing a reference extract for future standardization of Japanese cypress pollen extracts","authors":"Kengo Kanai , Aiko Oka , Hideaki Kouzaki , Kento Kawakita , Takuya Murao , Takeshi Shimizu , Takaya Higaki , Aya Murai , Mizuo Ando , Kojiro Hirano , Isao Suzaki , Hitome Kobayashi , Minoru Gotoh , Kimihiro Okubo , Mitsuhiro Okano","doi":"10.1016/j.anl.2025.10.001","DOIUrl":"10.1016/j.anl.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>Japanese cedar pollinosis (JCP) is the most prevalent seasonal allergic rhinitis in Japan. Many JCP patients are also sensitized to Japanese cypress pollen (JCyP), and their symptoms become exacerbated and prolonged during the JCyP dispersal period after JCP. To date, there have been no reports on the development of JCyP-specific allergen immunotherapy. For the future development of a JCyP-specific skin test and immunotherapy, we sought to develop a reference extract for future standardization of JCyP extract determined by the average threshold dilution eliciting a positive response in the intradermal skin test.</div></div><div><h3>Methods</h3><div>A 1:20 antigen extract (Lot AA) was prepared from JCyP grains by the glycerin extraction method. The protein and allergen concentrations in the extract were determined. After confirming its safety, 3-fold serially diluted solutions of JCyP extract were prepared from Lot AA. The average threshold dilution eliciting a positive response in the intradermal skin test was determined among Japanese subjects with serum JCyP-specific IgE class of 2 or higher according to ImmunoCAP IgE assays or View39 IgE assays.</div></div><div><h3>Results</h3><div>The protein concentration in Lot AA was 4.7 mg/mL, and the allergen concentration was 18.8 μg/mL for Cha o 1 and 1.1 μg/mL for Cha o 3. In total, 85 individuals were registered for this study and finally, 55 subjects were left for the analysis. The threshold dilution for an intradermal reaction was 3<sup>6</sup> in 32 individuals (58.2 %), 3<sup>7</sup> in 8 individuals (14.6 %), 3<sup>8</sup> in 4 individuals (7.3 %), and 3<sup>9</sup> in 1 individual (1.8 %); no reaction was seen in 10 individuals (18.2 %). The average threshold dilution was 3<sup>6.4</sup>, which is equivalent to a 1131-fold dilution. No serious adverse events were observed at any of the tested dilutions.</div></div><div><h3>Conclusion</h3><div>The results showed that Lot AA of JCyP extract exhibited <em>in vivo</em> allergic potency and was safe. Thus, it may be useful as a future standardized antigen of JCyP or a reference antigen for standardizing other JCyP extracts for the diagnosis and treatment of JCyP pollinosis.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 805-810"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558256","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":"2025-12-01","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}
This study investigates the effects of intratympanic glucocorticoid administration on the inner ear.
Methods
Fifteen Hartley guinea pigs were used and divided into five groups: dexamethasone-treated (n = 5), contralateral dexamethasone-treated (n = 5), hydrocortisone-treated (n = 5), contralateral hydrocortisone-treated (n = 5), and control (n = 5). In the control group, 1 ml of saline was injected into the right tympanic cavity via a ventral approach. In the dexamethasone-treated group, 1 ml of dexamethasone at a concentration of 3.3 mg/ml was injected into the right tympanic cavity using the same method, while the left ear of the dexamethasone-treated group remained intact. In the hydrocortisone-treated group, 1 ml of hydrocortisone at a concentration of 50 mg/ml was injected into the right tympanic cavity using the same technique, with the left ear of the hydrocortisone-treated group also remaining intact.
To assess the effects of glucocorticoids on the inner ear, we measured a cross-sectional area analysis of the scala media at three hours post-corticosteroids treatment using optical coherence tomography (OCT). The degree of a cross-sectional area change was quantitatively measured using a video digitizer.
Results
Ears treated with either dexamethasone or hydrocortisone showed extension of Reissner's membrane and endolymphatic hydrops. Statistical analysis indicated that a cross-sectional area of the scala media increased significantly compared to the contralateral hydrocortisone-treated and control groups.
Conclusions
This is the first report to investigate the effects of intratympanic administration of glucocorticoids on the guinea pig cochlea. Dilated endolymphatic space was observed in the steroid-treated ears. Although the underlying mechanism of these histological changes remains unclear, great care must be taken when administering steroids to patients with endolymphatic hydrops-related diseases, such as Meniere's disease.
{"title":"Effects of intratympanic administration of glucocorticoids on the guinea pig inner ear","authors":"Akinobu Kakigi , Makoto Kinoshita , Yuki Katsutani , Toshihito Sahara , Shinji Yamashita , Kenji Kondo","doi":"10.1016/j.anl.2025.09.005","DOIUrl":"10.1016/j.anl.2025.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the effects of intratympanic glucocorticoid administration on the inner ear.</div></div><div><h3>Methods</h3><div>Fifteen Hartley guinea pigs were used and divided into five groups: dexamethasone-treated (<em>n</em> = 5), contralateral dexamethasone-treated (<em>n</em> = 5), hydrocortisone-treated (<em>n</em> = 5), contralateral hydrocortisone-treated (<em>n</em> = 5), and control (<em>n</em> = 5). In the control group, 1 ml of saline was injected into the right tympanic cavity via a ventral approach. In the dexamethasone-treated group, 1 ml of dexamethasone at a concentration of 3.3 mg/ml was injected into the right tympanic cavity using the same method, while the left ear of the dexamethasone-treated group remained intact. In the hydrocortisone-treated group, 1 ml of hydrocortisone at a concentration of 50 mg/ml was injected into the right tympanic cavity using the same technique, with the left ear of the hydrocortisone-treated group also remaining intact.</div><div>To assess the effects of glucocorticoids on the inner ear, we measured a cross-sectional area analysis of the scala media at three hours post-corticosteroids treatment using optical coherence tomography (OCT). The degree of a cross-sectional area change was quantitatively measured using a video digitizer.</div></div><div><h3>Results</h3><div>Ears treated with either dexamethasone or hydrocortisone showed extension of Reissner's membrane and endolymphatic hydrops. Statistical analysis indicated that a cross-sectional area of the scala media increased significantly compared to the contralateral hydrocortisone-treated and control groups.</div></div><div><h3>Conclusions</h3><div>This is the first report to investigate the effects of intratympanic administration of glucocorticoids on the guinea pig cochlea. Dilated endolymphatic space was observed in the steroid-treated ears. Although the underlying mechanism of these histological changes remains unclear, great care must be taken when administering steroids to patients with endolymphatic hydrops-related diseases, such as Meniere's disease.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 729-734"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356865","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 : 2025-12-01Epub Date: 2025-11-01DOI: 10.1016/j.anl.2025.10.004
Miki Takahara
Sialolithiasis, the formation of calculi in the major salivary glands, is the leading cause of obstructive salivary disease and occurs predominantly in the submandibular gland. Traditional management of hilar or parenchymal stones has often required submandibular gland excision, which carries the risk of visible scarring and potential facial nerve injury. Sialendoscopy has emerged as a minimally invasive alternative for both diagnosis and treatment. Since its introduction in the 1990s and subsequent refinement, it has become standard therapy in Europe and North America, but in Japan, despite national insurance coverage since 2014, adoption remains limited because of technical complexity, high cost of consumables, and limited endoscope durability. A review of the literature and our own 144-case experience demonstrated a 40 % success rate for stone removal using sialendoscopy alone in Japan. Stone mobility was the most important predictor of success, while size greater than about 7.5 mm and parenchymal location markedly reduced success rates. Complications were generally mild and self-limiting: transient glandular swelling and lingual nerve paresis resolved within months, though occasional ranula formation or recurrence required secondary procedures. Similar factors predict outcomes in parotid stones, with reported endoscopic success of about 30–50 %. Fourier transform infrared spectrophotometry of 133 stones showed calcium phosphate and protein as the main components, and a higher calcium phosphate fraction correlated with stronger ductal adhesion and lower success rates. Sialendoscopy is therefore a safe, effective, and cosmetically advantageous alternative to gland excision, and we hope that this review will help lay the groundwork for its broader adoption and continued advancement in Japan.
{"title":"Sialendoscopy for the management of sialolithiasis in Japan","authors":"Miki Takahara","doi":"10.1016/j.anl.2025.10.004","DOIUrl":"10.1016/j.anl.2025.10.004","url":null,"abstract":"<div><div>Sialolithiasis, the formation of calculi in the major salivary glands, is the leading cause of obstructive salivary disease and occurs predominantly in the submandibular gland. Traditional management of hilar or parenchymal stones has often required submandibular gland excision, which carries the risk of visible scarring and potential facial nerve injury. Sialendoscopy has emerged as a minimally invasive alternative for both diagnosis and treatment. Since its introduction in the 1990s and subsequent refinement, it has become standard therapy in Europe and North America, but in Japan, despite national insurance coverage since 2014, adoption remains limited because of technical complexity, high cost of consumables, and limited endoscope durability. A review of the literature and our own 144-case experience demonstrated a 40 % success rate for stone removal using sialendoscopy alone in Japan. Stone mobility was the most important predictor of success, while size greater than about 7.5 mm and parenchymal location markedly reduced success rates. Complications were generally mild and self-limiting: transient glandular swelling and lingual nerve paresis resolved within months, though occasional ranula formation or recurrence required secondary procedures. Similar factors predict outcomes in parotid stones, with reported endoscopic success of about 30–50 %. Fourier transform infrared spectrophotometry of 133 stones showed calcium phosphate and protein as the main components, and a higher calcium phosphate fraction correlated with stronger ductal adhesion and lower success rates. Sialendoscopy is therefore a safe, effective, and cosmetically advantageous alternative to gland excision, and we hope that this review will help lay the groundwork for its broader adoption and continued advancement in Japan.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 764-768"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417842","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":"2025-12-01","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}
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":"2025-12-01","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}
Pub Date : 2025-12-01Epub 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":"2025-12-01","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}
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":"2025-12-01","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}
Lenvatinib, a multi-target tyrosine kinase inhibitor, has demonstrated efficacy in the treatment of various solid tumors, including thyroid cancer. However, life-threatening complications such as fistula formation have been observed in some cases. We report the case of a 47-year-old woman who developed an esophageal fistula following lenvatinib treatment for recurrent thyroid cancer. The patient initially underwent limited resection of the muscular layer of the cervical esophagus and preservation of the mucosa, followed by prophylactic radiotherapy because of inadequate surgical margins. Locoregional and pulmonary metastases developed 8 months postoperatively, and lenvatinib therapy was initiated at a dose of 24 mg. Subsequently, a fistula developed from the esophagus to the cervical skin. Esophageal fistula reconstruction was performed using a deltopectoral (DP) flap. Lenvatinib was resumed at a reduced dose of 14 mg two months after reconstruction. At 18 months after resuming lenvatinib, progression-free survival and adequate oral intake were achieved. The success of the DP flap reconstruction in this case highlights its potential as a durable solution for esophageal fistulas in patients receiving lenvatinib treatment. The robust blood supply provided by the DP flap may counteract the antiangiogenic effects of lenvatinib, thereby enabling continued treatment for locoregional recurrence.
{"title":"Reconstruction of esophageal fistula induced by lenvatinib in thyroid cancer using deltopectoral flap","authors":"Yuji Kanazawa , Yoshiharu Kitani , Maki Kitatsuji , Yusuke Yamamoto , Aya Matsubara , Makoto Suzuki","doi":"10.1016/j.anl.2025.10.005","DOIUrl":"10.1016/j.anl.2025.10.005","url":null,"abstract":"<div><div>Lenvatinib, a multi-target tyrosine kinase inhibitor, has demonstrated efficacy in the treatment of various solid tumors, including thyroid cancer. However, life-threatening complications such as fistula formation have been observed in some cases. We report the case of a 47-year-old woman who developed an esophageal fistula following lenvatinib treatment for recurrent thyroid cancer. The patient initially underwent limited resection of the muscular layer of the cervical esophagus and preservation of the mucosa, followed by prophylactic radiotherapy because of inadequate surgical margins. Locoregional and pulmonary metastases developed 8 months postoperatively, and lenvatinib therapy was initiated at a dose of 24 mg. Subsequently, a fistula developed from the esophagus to the cervical skin. Esophageal fistula reconstruction was performed using a deltopectoral (DP) flap. Lenvatinib was resumed at a reduced dose of 14 mg two months after reconstruction. At 18 months after resuming lenvatinib, progression-free survival and adequate oral intake were achieved. The success of the DP flap reconstruction in this case highlights its potential as a durable solution for esophageal fistulas in patients receiving lenvatinib treatment. The robust blood supply provided by the DP flap may counteract the antiangiogenic effects of lenvatinib, thereby enabling continued treatment for locoregional recurrence.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"52 6","pages":"Pages 725-728"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356851","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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