Taku Yamashita

Background: This study compared surgical and functional outcomes between anterolateral thigh (ALT) flap and free jejunal transfer (FJ) reconstruction after pharyngolaryngoesophagectomy. Methods: We retrospectively reviewed 53 patients undergoing pharyngolaryngoesophagectomy with immediate reconstruction: 33 with ALT and 20 with FJ. Surgical and functional outcomes and postoperative CT findings were compared. Results: FJ was preferentially selected for caudally extended defects requiring deep esophageal anastomosis, whereas ALT was mainly used for cranial defects. Surgical outcomes, dietary status, and hospital stay were comparable. Anastomotic stricture occurred in 1 ALT patient (3%) and 2 FJ patients (10%). ALT conduits were more frequently lateral to the trachea on CT (70% vs. 45%), with comparable dietary status. Speech acquisition was higher with ALT. Conclusions: Patient‐ and defect‐based selection achieved comparable outcomes with low stricture rates. ALT is a laparotomy‐free option for selected patients, whereas FJ may be preferable for caudally extended defects requiring deep mediastinal anastomosis.

Recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) carries a poor prognosis; however, immune checkpoint inhibitors have emerged as critical therapeutic options. Although the KEYNOTE-048 trial established the efficacy of pembrolizumab, the population was restricted to major sites (e.g., oral cavity, oropharynx, hypopharynx, and larynx), excluding subsites such as the paranasal sinuses and nasopharynx. To evaluate outcomes in these populations, we conducted a multicenter retrospective study of 167 patients with R/M SCCHN treated with pembrolizumab between December 2019 and February 2022. The cohort comprised 127 patients with tumors in included sites and 27 in excluded subsites. Primary endpoints included overall survival (OS), progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and immune-related adverse events (irAEs). In the excluded subsite group, median OS was 15.2 months (1-year rate: 70.6%), and median PFS was 4.9 months (1-year rate: 21.2%). The ORR was 22.2% and the DCR was 59.3%. The incidence of irAEs was 25.9%, with Grade ≥ 3 events in 3.7%. Survival outcomes did not differ significantly from those in included sites. These findings suggest the potential efficacy and safety of pembrolizumab in subsites excluded from KEYNOTE-048, warranting validation in prospective trials.

BACKGROUND: Meniere’s disease (MD) presents with vertigo and fluctuating auditory symptoms, linked to endolymphatic edema. Increased antidiuretic hormone levels due to stress suggest that hydration therapy (HT) can suppress this hormone. This study examined hearing outcomes in patients with MD treated with HT and factors influencing hearing fluctuations. METHODS: The study included 188 participants (45 men and 143 women) with definite MD who were followed for over 4 years with HT (35 mL/kg water daily). Clinical characteristics, hearing thresholds, and hematological findings were analyzed. The average hearing threshold at low frequencies (125, 250, and 500 Hz) was measured at the first examination (pre-HT) and 4 years after HT (post-HT). Factors affecting pre-HT hearing thresholds, changes between pre-HT and post-HT, and factors influencing hearing changes during HT were investigated. RESULTS: Advanced age, male sex, disease duration, high creatinine level, low estimated glomerular filtration rate, and high white blood cell (WBC) counts correlated with poor hearing thresholds. No significant increase was observed in hearing thresholds between pre-HT and post-HT, with 70% showing stable or improved hearing after 4 years. Poor initial hearing threshold, high WBC count (P=.032), and high neutrophil count (P=.0090) were less likely to cause hearing deterioration. CONCLUSION: Hearing remained stable for over 4 years after HT. High WBC and neutrophil counts correlated with poor prognosis due to stress-related inflammation. Dehydration, elevated WBC counts, and stress may worsen outcomes, suggesting that HT effectively manages MD by stabilizing hearing and reducing stress.

BACKGROUND: In Japan, edaravone, a free radical scavenger, is used clinically to reduce neuronal damage after acute cerebral infarction. In this study, a clinical trial has been designed utilizing intratympanic edaravone injection (ITE), which was hypothesized to exhibit high transitivity into the inner ear, with the aim of identifying an improved treatment modality for patients with idiopathic sudden sensorineural hearing loss (ISSHL) presenting with profound hearing loss. METHODS: Between April 2012 and December 2015, 17 patients with ISSHL, with mean hearing levels equal to or greater than 90 dB HL at the time of the initial visit, were treated with ITE. Fourteen patients with ISSHL under the same conditions were extracted, who received intratympanic steroid injection (ITS) in the department between January 2015 and December 2019 as a historical control. The hearing thresholds were compared between the ITE and ITS groups. RESULTS: The improvement between the initial and final hearing levels was significantly greater in the ITE group than in the ITS group at 250- 1000 Hz. The average hearing improvement was 49.1 (± 21.0) dB in ITE group and 35.2 (± 11.8) dB in ITS group, and the degree of improvement was significantly greater in ITE group. No detectable adverse events associated with ITE were observed in patients’ subjective symptoms. CONCLUSION: The final hearing thresholds of patients treated with ITE were significantly better than those of patients treated with ITS. It has been concluded that ITE treatment may be useful in future clinical studies.

Background: During hearing aid (HA) fitting, individuals may experience better speech discrimination at normal speech levels and worse discrimination at loud speech levels than without an HA. Therefore, we investigated factors that worsen speech discrimination when the speech sound level increases. Methods: Speech discrimination was measured in patients aged >20 years who had average hearing thresholds <90 dB on pure-tone audiometry. An insufficient benefit was defined as speech discrimination being better at 65 dB sound pressure level (SPL) with HAs than without HAs and worse at 80 dB SPL. Results: Of the 251 participants (296 ears), 229 and 25 had sufficient benefit and insufficient benefit, respectively. Functional gains (FGs) of sufficient benefit were approximately 1/3 gain (1/3 G) at 500 and 4000 Hz and slightly larger at 1000 and 2000 Hz. Functional gains of insufficient benefit were approximately 1/2 G at 1000 and 2000 Hz, smaller at 500 and 4000 Hz, and approximately 1/3 G at 250 Hz. Moreover, the difference between 1/2 G and FG was significantly larger in the sufficient benefit group at 250 500, and 4000 Hz than in the insufficient benefit group. Additionally, the average compression ratio at 50-80 dB SPL in the insufficient benefit group was approximately 1.1 to 1.2, slightly lower than the standard values. Conclusion: Adjusting the compression ratio and lowering the FG to approximately 1.5 and 1/3 G, respectively, may help improve speech discrimination if it worsens with increasing sound levels during HA fitting. Cite this article as: Nitta Y, Sano H, Furuki S, Umehara S, Hara Y, Yamashita T. Consideration of sufficient and insufficient benefits in hearing aid fitting. J Int Adv Otol. 2024;20(6):502-506.

Mammalian auditory hair cells transduce sound-evoked traveling waves in the cochlea into nerve stimuli, which are essential for hearing function. Pillar cells located between the inner and outer hair cells are involved in the formation of the tunnel of Corti, which incorporates outer-hair-cell-driven fluid oscillation and basilar membrane movement, leading to the fine-tuned frequency-specific perception of sounds by the inner hair cells. However, the detailed molecular mechanism underlying the development and maintenance of pillar cells remains to be elucidated. In this study, we examined the expression and function of brain-specific angiogenesis inhibitor 3 (Bai3), an adhesion G-protein-coupled receptor, in the cochlea. We found that Bai3 was expressed in hair cells in neonatal mice and pillar cells in adult mice, and, interestingly, Bai3 knockout mice revealed the abnormal formation of pillar cells, with the elevation of the hearing threshold in a frequency-dependent manner. Furthermore, old Bai3 knockout mice showed the degeneration of hair cells and spiral ganglion neurons in the basal turn. The results suggest that Bai3 plays a crucial role in the development and/or maintenance of pillar cells, which, in turn, are necessary for normal hearing function. Our results may contribute to understanding the mechanisms of hearing loss in human patients.

The development of more sensitive biomarkers for the detection of early-stage head and neck squamous cell carcinoma is needed.This study was performed to assess the value of serum p53 antibody (s-p... 背景：有必要开发更敏感的生物标志物用于检测早期头颈部鳞状细胞癌。目的：本研究旨在评估血清 p53 抗体 (s-p53-Ab) 作为口咽癌的生物标志物的价值。材料与方法：采集 71 位口咽部癌患者的治疗前血清, 117 名健康志愿者作为对照, 并使用酶联免疫吸附测定（ELISA）分析s-p53-Ab。结果：以 1.3 U/mL 作为区分值, 71 例患者中有 14 例（敏感性 19.7%）, ...