Department of Ear, Nose and Throat/Head and Neck Surgery

Contents of medical treatment

When you hear the Department of Ear, Nose and Throat, first you would list up the diseases such as dizziness, deafness, otitis media, paranasal sinusitis (empyema), tonsillitis, vocal cord polyp, and laryngeal cancer etc. Due to the nature of the university hospital, we also treat other malignant tumors (the following malignant tumors in the field of otolaryngology are generally called head and neck cancer) using anticancer drugs and radiation, and surgical operation etc., such as laryngeal cancer, which is most strongly associated with smoking (about 5 times stronger relation to smoking than lung cancer), pharyngeal cancer (cancer of mesopharynx and hypopharynx etc.), which has a strong relation with alcohol drinking, tongue tumor, which is associated with chronic stimulation by dentures, and thyroid cancer etc., which is frequently found as a lump of the neck. Since the clinical department is sometimes called “head and neck surgery” when they mainly examine and treat head and neck cancers, it is easier to understand our department as Ear, Nose and Throat/Head and Neck Surgery. For the purpose of improvement of QOL, we are aiming to provide advanced medical care for patients with the above diseases.

Fields of specialty

Deafness (laser stapes surgery, artificial inner and middle ears), laser therapy for otitis media, surgical operation for allergic rhinitis and paranasal sinusitis, snore, sleep apnea, IgA nephropathy, treatment of tonsillar disease with skin lesion, and diagnosis and treatment for head and neck tumors such as laryngeal cancer, pharyngeal cancer, tongue cancer, maxillary cancer and thyroid cancer etc.

Characteristics of medical practice and skilled treatment

• We perform advanced treatment such as tympanoplasty and artificial cochlear implantation for the purpose of improvement of hearing, intranasal endoscopic operation and laser surgery for paranasal sinus disease, pharyngoplasty for snore and sleep-apnea syndrome etc., navigation operation for acoustic nerve tumor and skull base tumor, and plastic and reconstructive surgery using microvascular procedures for head and neck cancers etc. in our hospital.
• As a characteristic of clinical practice, we perform all-around treatment, immunotherapy and laser tympanic membrane fenestration for intractable and recurrent otitis media associated with drug resistant bacterium and immunodeficiency, and advanced medical care in an individual specialized outpatient clinic such as otitis media, infantile deafness, hearing aid, facial nerve palsy, sense of taste and smell, thyroid gland, dizziness, tumor and plasty etc.
• Six medical specialists qualified by the Oto- Rhino- Laryngological Society of Japan are in our department, and we have past performance in the treatment of patients with ear, nose, and throat diseases and head and neck tumors as described above.

Introduction of the specialized outpatient clinic

1. In our middle ear outpatient service, we perform medical examination and treatment mainly of incurable otitis media such as recurrent otitis media, persistent otitis media, infantile otitis media, and exudative otitis media. Acute otitis media is a typical infectious disease from infancy through childhood and it is said that about 70% of children experience it at least once by 3 years of age. In medical examinations for otitis media, it is important to carefully examine the condition of the middle ear, in other words, the eardrum membrane. We perform a detailed examination of the eardrums using an endoscope and explain a treatment plan, confirming with a patient’s parents. In addition, regarding incurable otitis media in young children, not only antibacterial treatment but surgical treatment such as myringotomy and insertion of a tympanic membrane ventilation tube are also very important. In this outpatient service, we perform myringotomy using a carbon dioxide laser in addition to the safe indwelling of tympanic membrane ventilation tube under general anesthetic. Especially, because myringotomy with a carbon dioxide laser (OtoLAM) can be performed in a short time at an outpatient clinic and the recovery of the wound is favorable, it is a new outpatient surgical treatment friendly for eardrums considering the regeneration of the eardrum membrane. In our middle ear outpatient service, we pursue the cause of incurable otitis media in children and aim to perform a better treatment for otitis media, considering children.

• Medical examination and treatment are performed on Wednesday afternoon. Two physicians, Associate Professor Yasutomi and Assistant Professor Tamakawa, are in charge of this service.

2. In our infantile deafness outpatient service, we perform examination and treatment for children who are suspected to have deafness in newborn infant hearing screening, medical check‐ups for infants and toddlers, and daily life. Since a general hearing test is not possible to be performed in infants and toddlers, we conduct an appropriate examination corresponding to the patient’s age. We also perform auditory brain stem response (ABR) and auditory steady state response (ASSR) as an objective examinations. Once the level of hearing ability is confirmed, depending on the necessity, a hearing aid is adjusted for the patient (fitting). Because children in this age group are in an important period for language development, we perform training to encourage language development cooperating with the school for children with hearing disabilities. We perform cochlear implantation for children with severe deafness who still have hearing difficulty and difficulty in language development even with a hearing aid, and perform hearing training and training for language development after the operation.

3. In our hearing aid outpatient service, we mainly perform hearing aid fitting for adults and elderly people, and also handle problems when it is worn. When the result is not satisfactory in the above young child and adult, depending on the degree, we can perform an artificial cochlear implantation as described later.

4. In our cochlear implant outpatient service, Professor Yamanaka performs a clinical examination and tests to inspect whether a cochlear implant can improve patients’ hearing ability and decides which patients are suitable for cochlear implantation. In addition, we guide patients who actually had cochlear implant surgery through appropriate rehabilitation and, at the same time, perform postoperative management. Patients whose hearing has been recovered by this surgery have been increasing year after year.

5. In our head and neck cancer outpatient service, we ask cancer patients to visit our outpatient clinic once a month, which is to follow the course of their disease for the long term after being discharged from the hospital. Since it is required to perform a long term follow-up and to have knowledge related to the characteristic of the disease, physicians specialized in head and neck cancers with sufficient knowledge and experience are in charge of this work.

6. In our snore and apnea outpatient service, we perform detailed examination for snoring and sleep apnea, patients that have been recently increasing. Detailed pharyngeal examination and, furthermore, examination for a respiratory condition during sleep at home (all-night sleep polygraphy and PSG examination) are performed for patients with snoring and sleep apnea. When abnormally frequent apnea is found in his/her sleep through these examinations, we perform CPAP therapy (attaching a device which prevents apnea by continuous positive airway pressure) and pharyngoplasty as a treatment. We are very appreciated by patients who become free from snoring and sleep apnea, which were bothering him/her for a long time, through these treatments.

7. In our sense of taste and smell outpatient service, we perform a test of taste or smell for patients who feel an abnormality in their ability to taste or smell. We perform the disk method and electric gustatory test for taste, and use an olfactometer for smell. We select a treatment depending on the degree of the disorder.

8. In our dizziness outpatient service, we perform a detailed diagnostic examination for balance disorder and dizziness using the latest dizziness examination apparatus with a computer and conduct an appropriate treatment. Although many patients with dizziness visit various departments such as internal medicine, brain surgery, ophthalmology, and neurology other than otolaryngology, the number of referrals from these departments is recently increasing regarding dizziness examination.

9. In our facial nerve palsy outpatient service, we examine the cause and the degree of the facial palsy using an electrical stimulation test etc. in detail and promptly decide on a treatment plan (infusion or surgical treatment).

10. In our thyroid gland specialized outpatient service, we mainly perform medical examination and treatment for neoplastic diseases including benign tumors in the thyroid gland and thyroid cancer. We examine in detail a tumor developed in the thyroid gland using ultrasonography (echo examination), ultrasound-guided fine needle aspiration biopsy, CT, and PET etc.. When a surgical medical treatment is required, we admit the patient into the hospital and perform surgery for thyroid cancer. We have done many surgical operations for thyroid cancer in our department, and their postoperative results are also good. In addition, we also perform detailed examination and treatment for diseases such as Basedow's disease and Hashimoto's disease, parathyroid tumor, and dysfunction, etc.

Number of surgical operations

The number of major surgical operations is shown in the following table. (2014)

Departments

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