Impact of COVID-19 pandemic on the number of otolaryngologic surgeries in Japan.

OBJECTIVE: Previous studies show that the COVID-19 pandemic affected the number of surgeries performed. However, data on the association between the COVID-19 pandemic and otolaryngologic surgeries according to subspecialties are lacking. This study was performed to evaluate the impact of the COVID-19 pandemic on various types of otolaryngologic surgeries. METHODS: We retrospectively identified patients who underwent otolaryngologic surgeries from April 2018 to February 2021 using a Japanese national inpatient database. We performed interrupted time-series analyses before and after April 2020 to evaluate the number of otolaryngologic surgeries performed. The Japanese government declared its first state of emergency during the COVID-19 pandemic in April 2020. RESULTS: We obtained data on 348,351 otolaryngologic surgeries. Interrupted time-series analysis showed a significant decrease in the number of overall otolaryngologic surgeries in April 2020 (-3619 surgeries per month; 95% confidence interval, -5555 to -1683; p < 0.001). Removal of foreign bodies and head and neck cancer surgery were not affected by the COVID-19 pandemic. In the post-COVID-19 period, the number of otolaryngologic surgeries, except for ear and upper airway surgeries, increased significantly. The number of tracheostomies and peritonsillar abscess incisions did not significantly decrease during the COVID-19 pandemic. CONCLUSION: The COVID-19 pandemic was associated with a decrease in the overall number of otolaryngologic surgeries, but the trend differed among subspecialties.

Laryngeal edema in drug reaction with eosinophilia and systemic symptoms syndrome due to sulfasalazine.

We present a case of a 47-year-old man with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The patient had been diagnosed with rheumatoid arthritis and sulfasalazine was prescribed 4 weeks before admission. Initial symptoms with fever and rash worsened even after a discontinuation of the medication, and concomitant symptoms developed including typical manifestations of facial rash and edema sparing the periorbital area, as well as atypical laryngeal edema. Rheumatologists should be aware that sulfasalazine is derived from sulfonamide and can possibly induce DRESS syndrome, one of the life-threatening drug eruptions.

Retrospective study of risk factors for tympanic membrane perforation in the early period after intratympanic steroid injection.

OBJECTIVE: Intratympanic steroid injection (ITSI) can be an effective treatment for sudden sensorineural hearing loss or Meniere's disease. Tympanic membrane (TM) perforation after ITSI is a major complication which needs additional treatment. The purpose of this study is to assess the factors associated with TM perforation after ITSI. METHODS: We obtained the clinical data of patients who underwent ITSI treatment at the Department of Otolaryngology JR Tokyo General Hospital from April 2013 to March 2021. The data included age, sex, treated side, number of injections, average interval between injections, TM anesthesia with Zentöl solution, which contains phenol, any history of diabetes and any concurrent use of oral or intravenous steroids. We evaluated the association between these variables and TM perforation after ITSI using the Student's t-test, the chi-squared test, univariate logistic regression analysis and multivariate logistic regression analysis. TM perforation was defined as a case in which perforation was observed at least once during outpatient visits. RESULTS: Records of 205 ears in 190 patients were analyzed. The overall proportion of TM perforation in the early period after ITSI was 12.7% (26 out of 205 ears), which decreased to 9.3% (19 out of 205 ears) and 5.9% (12 out of 205 ears) at the 1- and 3-month follow-ups, respectively. The proportion of TM perforation in the early period after ITSI without TM anesthesia was 3.5% (5 ears out of 145 ears), which decreased to 1.4% (2 ears) or 0% at the 1- or 3- month follow-ups, respectively. The use of tympanic anesthetics which contain phenol was significantly associated with TM perforation in univariate logistic regression analysis (odds ratio: 15.08, 95% confidence interval: 5.34-42.56, p < 0.001) and in multivariate analysis (odds ratio: 20.76, 95% confidence interval: 6.31-68.3, p < 0.001). All TM perforation cases without TM anesthesia healed spontaneously or with paper tympanic closure treatment. TM perforation in 6 ears out of 21 ears with TM anesthesia did not heal during the follow-up. CONCLUSION: The overall proportion of TM perforations from the early period after ITSI was 12.7%, 9.3% at the 1-month post-ITSI outpatient follow-up, 5.9% at the 3-month post-ITSI outpatient follow-up. Tympanic anesthesia was significantly associated with TM perforation after ITSI, which indicated that TM anesthesia with solutions containing phenol is not recommended for ITSI.

Factors associated with the occurrence of stomal stenosis after tracheostomy in adults.

OBJECTIVE: Although tracheal stomal stenosis can be life-threatening, factors associated with the occurrence of stomal stenosis remain unknown. This study was performed to evaluate these factors in adult patients. METHODS: We retrospectively identified adult patients who underwent tracheostomy from 2010 to 2016 using a Japanese national inpatient and outpatient database. We performed Cox proportional hazard regression analyses to evaluate factors associated with the occurrence of tracheal stomal stenosis. RESULTS: We obtained data on 25,436 eligible patients. The proportion of tracheal stomal stenosis was 0.9%. Tracheal stomal stenosis was significantly less likely to occur in patients with regular use of oral steroids [hazard ratio (HR), 0.28; 95% confidence interval (CI), 0.09-0.88; P = 0.03] and in male patients (HR, 0.75; 95% CI, 0.57-0.97; P = 0.03). The occurrence of tracheal stomal stenosis was significantly associated with use of a mechanical ventilator at home (HR, 2.54; 95% CI, 1.55-4.15; P < 0.001) and a body mass index of <18.5 kg/m2 (HR, 1.45; 95% CI, 1.06-1.99; P = 0.02). CONCLUSION: Our study revealed several factors that are associated with tracheal stomal stenosis. These findings may help physicians to manage tracheal stomas.

Trends in complications after functional endoscopic sinus surgery in Japan: A comparison with a previous study (2007-2013vs. 2013-2017).

OBJECTIVE: Functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis is considered safe and is widely performed. Techniques and devices for this type of surgery have recently been updated. The purpose of this study was to describe the proportions of complications after FESS (2013-2017) and to compare the results with those from our previous study (2007-2013). METHODS: We obtained data on 70,288 patients who underwent FESS from April 2013 to March 2017 from a Japanese national inpatient database. We classified FESS into four types: single sinus surgery (ESS Type 2), multiple sinus surgery (ESS Type 3), whole sinus surgery (ESS Type 4), and extensive sinus surgery (ESS Type 5). We investigated the proportions of complications after FESS, including cerebrospinal fluid leakage, meningitis, orbital injury, severe hemorrhage, and toxic shock syndrome. We performed a multivariable logistic regression analysis with adjustment for within-hospital clustering to evaluate the association between the occurrence of overall complications and patient characteristics. RESULTS: The proportion of overall complications was 0.50%. The proportions of patients with cranial complications, orbital complications, hemostasis operations, blood transfusion, and toxic shock syndrome were 0.11%, 0.04%, 0.05%, 0.30%, and 0.03%, respectively. The extent of FESS was not associated with the occurrence of overall complications. The occurrence of overall complications was associated with the severity of comorbidities and the academic hospital status. Asthma and use of a microdebrider were associated with a lower occurrence of overall complications. CONCLUSION: The proportion of overall complications after FESS in the present study was similar to that reported in our previous study. The extent of FESS and eosinophilic chronic rhinosinusitis were not associated with the occurrence of overall complications.

Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery.

OBJECTIVE: Although sinusitis-induced intracranial complications rarely occur in the current era of antibiotics, they can induce neurological symptoms or death. The authors of this study investigated the association between endoscopic sinus surgery (ESS) and outcomes in patients who had undergone neurosurgical procedures for sinusitis-induced intracranial abscess. METHODS: The authors obtained data on patients with sinusitis-induced intracranial abscess from the Japanese Diagnosis Procedure Combination inpatient data for the period from 2010 to 2017. They excluded patients with fungal sinusitis, orbital complications, immunodeficiency, and malignant disease. They also excluded patients who had received antifungal agents, chemotherapy, immunosuppressants, and antidiabetic drugs. Eligible patients were divided into those with and those without neurosurgical procedures. Propensity score-adjusted regression analyses were performed to examine the association between ESS within the same hospitalization and outcomes (mortality, blood transfusion, readmission, revision neurosurgery, and length of stay). RESULTS: Of the 552 potentially eligible patients, 255 were treated with neurosurgical procedures, including 104 who underwent ESS within the same hospitalization and 151 who did not. ESS was not significantly associated with mortality (OR 0.54, 95% CI 0.05-5.81, p = 0.61), blood transfusion (OR 1.95, 95% CI 0.84-4.51, p = 0.12), readmission (OR 0.86, 95% CI 0.34-2.16, p = 0.75), revision neurosurgery (OR 0.65, 95% CI 0.24-1.74, p = 0.39), or length of stay (percent difference -10.8%, 95% CI -24.4% to 5.1%, p = 0.18). CONCLUSIONS: The present study suggests that ESS may not have significant benefits with respect to reducing mortality, blood transfusion, readmission, revision neurosurgery, or length of stay.

Tranexamic acid and post-tonsillectomy hemorrhage: propensity score and instrumental variable analyses.

PURPOSE: Although post-tonsillectomy hemorrhage occurs rarely, it can be life-threatening. Previous studies showed that tranexamic acid (TXA) had insignificant association with the rate of post-tonsillectomy hemorrhage, but those findings were limited by small sample sizes. The purpose of this study was to examine the effectiveness of TXA in preventing post-tonsillectomy hemorrhage using nationwide database. METHODS: Data of a retrospective cohort of 117,598 patients from 750 hospitals, who had undergone tonsillectomy between 2010 and 2016, were drawn from the Diagnosis Procedure Combination database in Japan and studied. RESULTS: Propensity score-matched analysis showed no significant differences in proportions of reoperation or blood transfusion after tonsillectomy between the treatment (TXA from the day of tonsillectomy) and control groups (1.50% vs. 1.47%, p = 0.64). Instrumental variable analysis also showed no significant differences (odds ratio, 0.98; 95% confidence interval, 0.86-1.13; p = 0.82). Higher proportions of reoperation or blood transfusion were significantly associated with male sex, older age, emergency hospitalization, prolonged anesthesia, and medium hospital volume (annual number of tonsillectomies). CONCLUSIONS: Administration of TXA from the day of tonsillectomy is not associated with reduction in reoperation or blood transfusion rates.

AP-VAS 2012 case report: a case of myeloperoxidase antineutrophil cytoplasmic antibody-positive microscopic polyangiitis with rapidly progressive glomerulonephritis and hearing loss.

A 74-year-old Japanese woman was admitted to our hospital because of fever, fatigue, and hearing loss associated with vertigo. She had a 1-year history of hearing impairment that got worse gradually and had been treated as otitis media with effusion, but without remarkable improvement. After admission, she developed renal dysfunction associated with hematuria and proteinuria. Laboratory tests showed leukocytosis and elevated C-reactive protein. Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) was elevated, but proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) was negative. Renal biopsy revealed pauci-immune focal necrotizing glomerulonephritis with crescents. She was diagnosed as having MPO-ANCA-associated polyangiitis. After treatment with 500 mg methylprednisolone applied intravenously for 3 days, followed by 40 mg prednisolone administered orally, renal function recovered completely. Her hearing also improved. Although otolaryngological symptoms are common in PR3-ANCA associated vasculitis, hearing loss is a rare manifestation of MPO-ANCA associated vasculitis (MPO-AAV). Our case suggests that AAV should be considered in the differential diagnosis of hearing loss.

Impact of obesity on plasma B-type natriuretic peptide levels in Japanese community-based subjects.

The plasma B-type natriuretic peptide (BNP) concentration was recently shown to be inversely correlated with body mass index (BMI). However, very few attempts have been made to associate abdominal obesity and BNP in the Japanese general population. Here, we conducted a cross-sectional study, and examined 339 male and 429 female residents without heart disease in a rural Japanese community who received an annual health checkup in 2006. BNP was inversely associated with both BMI and abdominal circumference (AC) in the age-adjusted regression analysis (p < 0.05). Following adjustment for traditional risk factors, multiple regression analysis revealed that BNP was negatively correlated with AC (p < 0.05), but not BMI. Although metabolic syndrome was not associated with BNP levels, AC had an influence on low BNP levels in the multiple regression analysis using both AC and BMI concurrently (p < 0.05 for AC and p > 0.60 for BMI). These effects were more prominent in men than in women. Collectively, plasma BNP levels are inversely related with obesity, as measured by AC, in Japanese community-based subjects.

Association between perceived stress and plasma B-type natriuretic peptide concentrations.

BACKGROUND: Many patients with heart disease continue to have cardiac events despite receiving optimal treatments for traditional risk factors. Consequently, non-traditional risk factors for heart disease, such as perceived stress, have attracted attention. Associations between perceived stress and plasma B-type natriuretic peptide (BNP) were explored, while controlling for traditional heart disease risk factors. METHODS AND RESULTS: This cross-sectional study examined 360 male and 446 female (age, >40 years) residents of a rural Japanese community who received annual health checkups in 2006. A lifestyle questionnaire was used to obtain information regarding perceived stress and medical history, and routine anthropometric and blood pressure measurements and a laboratory assessment of cardiovascular risk factors, including plasma BNP concentrations and an electrocardiogram, were done. After adjusting for traditional heart disease risk factors, multiple regression analysis showed that perceived stress was associated with BNP concentrations, particularly in women (F=6.12, P=0.026). In addition, multiple tests using Bonferroni's procedure showed that BNP concentrations decreased with perceived stress level in men and women. Similar trends were observed in the sub-analyses of subjects with and without known heart disease. CONCLUSIONS: Perceived stress in our study was negatively associated with plasma BNP concentrations, independently of traditional heart disease risk factors.

Effect of having a sense of purpose in life on the risk of death from cardiovascular diseases.

BACKGROUND: Many studies have focused on disease causality, but few of them deal with health-promoting factors. Thus, we examined the effect of having a sense of purpose in life (ikigai) on mortality from cardiovascular disease (CVD). METHODS: In 1988, we conducted a prospective cohort study of 2,959 Japanese subjects, ranging in age from 40 to 74 years, and followed them till the end of 2003. The level of their sense of purpose in life was evaluated by a self-administered questionnaire. After excluding those with a history of heart disease, stroke, or malignant tumor, 1,618 subjects (832 men and 786 women) who had completed the questionnaire were used in the analyses with Cox's proportional hazards model. RESULTS: During the average 13.3 years of follow up, 249 deaths (172 men and 77 women) occurred as a result of all causes: 32 from heart disease, 31 from stroke, 63 from CVD, and 104 from malignant tumors. The adjusted hazard ratios for death in men with a strong sense of purpose in life, as compared with those with a low sense of purpose, were 0.28 (95% confidence interval: 0.10-0.84) for stroke, 0.56 (0.28-1.10) for CVD, and 0.62 (0.45-0.86) as a result of all causes. In women, no significant relationship was found between having a sense of purpose in life and mortality; this was possibly because the smaller number of deaths reduced the statistical significance. CONCLUSION: We found that in men, having a sense of purpose in life affected the risk of death as a result of all causes, stroke, and CVD.