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At Kitano Hospital's Department of Otolaryngology and Head and Neck Surgery, our mission is to provide world-class, high-quality medical care for all otolaryngological diseases. We specialize in treatments requiring advanced techniques, such as regenerative medicine, acoustic neuroma surgery, skull base surgery, and head and neck cancer. For acoustic neuromas (see below), we recommend visiting our specialized outpatient clinic.
Tracheal regenerative medicine is a regenerative medical treatment using an artificial trachea to reconstruct the trachea due to tracheal invasion by head and neck cancers such as thyroid cancer, or to treat tracheal stenosis due to trauma.
Neuroregenerative medicine is a treatment that uses a tube-shaped artificial nerve tube to regenerate nerves (such as the facial nerve and recurrent laryngeal nerve) that have been severed due to cancer or trauma.
This is a regenerative medicine that uses tissue engineering techniques to repair eardrum perforations (holes in the eardrum) that have occurred due to various causes, without making incisions in the skin as in conventional treatments.
Click here for the treatment processPlease see.
Mastoid cell regeneration is a fundamental treatment for intractable chronic otitis media by transplanting the patient's own bone or artificial materials. This regenerative medicine treats cholesteatomatous otitis media and adhesive otitis media from the root, and is supported by the Ministry of Health, Labor and Welfare as part of its Sensory Organ Disorders Project.
The auditory nerve is the collective term for the nerve responsible for hearing (cochlear nerve) and the nerve responsible for balance (vestibular nerve). Tumors arising from these nerves are called acoustic neuromas, and most develop in the vestibular nerve.
When the tumor is small, it causes no symptoms, but as it grows, symptoms such as tinnitus, dizziness, and hearing loss become noticeable, and the symptoms gradually become more severe, such as facial nerve paralysis, facial numbness, and difficulty walking, eventually becoming life-threatening.
The incidence rate is said to be 1 in 100,000, but MRI scans have made it possible to detect even very small tumors, so the actual incidence rate is likely to be higher.
Treatment options for acoustic neuromas include radiation therapy such as gamma knife and cyber knife, and surgery.
Radiation therapy is primarily targeted at elderly patients or those with other illnesses who have difficulty undergoing surgery. It is a gentle treatment, but it cannot be performed multiple times, and if the cancer recurs, surgery becomes even more difficult.
On the other hand, for young patients or patients whose tumors are growing rapidly, future tumor growth will pose a major obstacle, so tumor removal surgery is performed.
If the tumor is small and symptoms are mild, the patient will be monitored with hearing tests twice a year and MRI scans once a year. If symptoms become severe or the tumor shows signs of growing, the following surgical treatment will be performed.
Surgery for acoustic neuroma can be broadly divided into the following three methods, and our department can perform any of these treatments.
This is an approach from behind the ear (pinna), where the bone behind the ear is scraped away to reach the tumor. This surgical method sacrifices hearing, so it is intended for people who have experienced extreme hearing loss due to a tumor. It is intended for tumors up to medium size, but has the advantage of being easier to undergo after surgery compared to other surgical methods.
This is an approach from above the ear (pinna), where the bone above the pinna is removed and the brain is pulled to reach the tumor. This surgery is mainly targeted at small tumors in the internal auditory canal, and has a high possibility of preserving hearing and the facial nerve, but the surgical field is narrow and it is one of the more difficult surgeries. This method is performed in collaboration with neurosurgeons.
This is an approach from the posterior-inferior side of the ear (pinna), where the bone at the posterior-inferior side of the pinna is removed to reach the tumor. This is a surgery that provides a good field of view and is suitable for large tumors, and there is a high possibility that hearing and the facial nerve can be preserved. However, it is difficult to see the end of the internal auditory canal, and it is easy to leave tumors in this area behind. This method is also performed in collaboration with neurosurgeons.
In both treatment methods, we first protect the patient's life and avoid bleeding and postoperative infection, then avoid facial nerve paralysis, and perform surgery with the utmost care to preserve hearing. To date, there have been no cases of bleeding or postoperative infection in surgeries performed in our department, and no patients have developed permanent facial paralysis. Regarding hearing, hearing levels vary at the start of treatment, so it is difficult to generalize, but the hearing preservation rate with the middle cranial fossa approach is over 80%. When it comes to facial nerve and hearing preservation in particular, we perform meticulous surgery using the world's most advanced monitoring system.
As mentioned above, our department is able to select the best treatment method based on the size and location of the tumor, the severity of symptoms, and the patient's age and condition. We also provide detailed explanations of the treatment so that patients can receive it only after they are fully satisfied.
The ear is divided into the outer, middle, and inner ear, and the bone surrounding the ear is called the temporal bone. At our hospital, we perform examinations, diagnoses, and treatments for a wide range of diseases, including those of the outer, middle, and inner ear, and the temporal bone. We aim to preserve function as much as possible, and to actively incorporate new methods to contribute to improving everyone's quality of life.
The ear is divided into the outer, middle and inner ear, and the bone surrounding the ear is called the temporal bone.
Our hospital performs examinations, diagnoses, and treatments for a wide range of diseases, including those of the outer ear, middle ear, inner ear, and temporal bone. We aim to preserve function as much as possible, and actively incorporate new methods to contribute to improving your quality of life.
Whenever possible, we perform surgery from inside the ear for benign tumors of the ear canal, such as cholesteatoma. In addition, malignant tumors of the ear canal, or ear canal cancer, occur in about one in a million people. Treatment for ear canal cancer involves a combination of multiple methods, including surgery, radiation therapy, and chemotherapy. Our hospital also provides treatment for rare diseases such as ear canal cancer.
Chronic otitis media can be broadly divided into three types: chronic suppurative otitis media, which is accompanied by eardrum perforation and ear discharge; cholesteatoma, which grows while destroying bone; and adhesive otitis media, which is accompanied by eardrum collapse and adhesion. All of these can cause hearing loss and ear discharge. The primary treatment for chronic otitis media is a surgical procedure called tympanoplasty, which removes the lesion and repairs the sound transmission system. If left untreated, cholesteatoma in particular can progress by dissolving the surrounding bone, damaging the semicircular canals and facial nerve in the middle ear and potentially causing dizziness and facial nerve paralysis. Furthermore, destruction of the bone at the base of the skull (roof of the middle ear), which separates the brain from the middle ear, can lead to intracranial complications (meningitis, brain abscess, etc.).
If ventilation (air exchange) within the tympanic cavity is not adequate, no matter how well the bones that transmit sound are reconnected, water will accumulate within the tympanic cavity, and the eardrum will collapse, preventing sound from being transmitted properly. Therefore, at our hospital, in addition to standard tympanoplasty, we also perform reconstructive surgery on the mastoid cavity, which plays an important role in ventilating the tympanic cavity (although not in all cases). We provide surgical treatment aimed at maintaining the middle ear in good condition for the long term. This treatment is a near-future type of regenerative medicine, implemented with support from the Ministry of Health, Labor and Welfare's Sensory Organ Disorders Project.
The middle ear contains a series of tiny bones called ossicles. These bones, the malleus, incus, and stapes, are connected by joints that transmit sound from the eardrum to the inner ear.
There are various types of middle ear malformations that occur at birth, such as those in which the connection or shape of these bones is abnormal, otosclerosis, in which the stapes hardens and cannot effectively transmit sound to the inner ear, and ossicular disarticulation, in which the ossicles become dislocated from their joints due to an impact such as trauma. The shape of the ossicles can sometimes be predicted to some extent in advance using a CT scan called a temporal bone targeted CT, which can capture images at very thin thicknesses, or a 3D CT scan, which can visualize three-dimensional structures. Surgery is performed to check the condition of the ossicles, and depending on the condition, in the case of otosclerosis, a bone called a piston is placed to replace the stapes. In cases of middle ear malformations or ossicular disarticulation, the mechanism for transmitting sound may be reconstructed using artificial ossicles or autologous bone.
We also provide surgical treatment for middle ear cholesterol granulomas and middle ear tumors.
Sudden hearing loss is when you suddenly lose hearing in one ear, such as waking up in the morning and finding it difficult to hear in one ear, or suddenly being unable to hear on the phone. The cause is unknown, but possible causes include viral infection in the inner ear, autoimmune disorders in the inner ear, and circulatory disorders in the inner ear.
Sudden deafness is a type of sensorineural hearing loss caused by damage to the hair cells in the inner ear, but research by a Ministry of Health, Labor and Welfare research team has shown that if treatment is started within two weeks of onset, recovery or improvement can be expected in 60 to 70 percent of cases.
On the other hand, the recovery rate is said to be poor in cases where treatment is started late, where dizziness occurs at the time of onset, or where the degree of hearing loss is severe at the time of onset.At our hospital, we provide treatment using steroid preparations, agents that improve cerebral circulation and metabolism, and vitamin B12.
We also offer treatments that involve administering steroids directly to the inner ear.
Our department primarily treats dizziness caused by problems with the balance apparatus of the inner ear. Typical inner ear diseases that cause dizziness include benign paroxysmal positional vertigo, which occurs due to malfunction of the otoliths, vestibular neuritis, which is thought to be caused by viruses, and Meniere's disease, which is thought to be caused by an increase in inner ear lymph. In modern society, there is also psychogenic dizziness caused by the effects of stress, and in some cases the name and cause of the disease are unclear. Depending on the type and severity of dizziness, we perform balance function tests that combine various tests such as nystagmus tests, caloric tests, and center of gravity stabilometry. We also provide drug treatment for dizziness symptoms.
Meniere's disease is said to occur when an increase in a fluid called lymph in the inner ear damages the cochlea and equilibrium. In typical cases, dizziness occurs along with ear symptoms such as hearing loss, and these symptoms recur. Drug treatments such as osmotic diuretics, circulation-improving drugs, and anti-vertigo drugs are the mainstay, but if these are ineffective, surgery called endolymphatic sac decompression may be performed to release the sac where lymph accumulates.
We also provide drug treatment for low-frequency hearing loss and drug and surgical treatment for perilymphatic fistula.
When the facial nerve is paralyzed, the facial muscles (facial muscles) become immobile, causing the face to become distorted and asymmetrical. Facial nerve paralysis can be divided into central and peripheral types, and otolaryngology diagnoses and treats peripheral facial nerve paralysis. The main types of peripheral facial nerve paralysis are idiopathic facial nerve paralysis (commonly known as Bell's palsy), which has an unknown cause, and Hunt syndrome, which is caused by the varicella-zoster virus.
Facial paralysis causes sudden paralysis of one half of the face, making it impossible to close the eyes, and food spilling from the corners of the mouth. It may also be accompanied by symptoms such as decreased taste, decreased lacrimation, hyperacusis, and ear pain. Hunt syndrome causes painful shingles in the auricle and ear canal, and may be accompanied by symptoms such as tinnitus, hearing loss, and dizziness.
Treatment mainly consists of drug therapy with steroid preparations. If facial nerve paralysis is suspected to be due to a viral infection, antiviral drugs are used in combination. Stress and overwork are also said to be bad for this disease. Depending on the condition, patients may be treated as outpatients or inpatients. Steroid preparations can easily raise blood sugar levels, so if there is an underlying condition such as diabetes, patients are generally hospitalized and treated further.
Approximately two weeks after the onset of symptoms, the prognosis is determined based on changes in facial muscle scores, evoked electromyography, nerve excitability tests, and other electrophysiological tests. If the prognosis is predicted to be poor, additional treatment (such as facial nerve decompression) may be performed.
Those with bilateral severe hearing loss who are unable to hear everyday conversations even with hearing aids may be able to regain their hearing through a procedure called cochlear implantation. There are many causes of severe hearing loss, and in many cases, the cause is unknown. By implanting electrodes that replace inner ear cells in the cochlea and then attaching a receiver, the patient can hear at a sufficient volume, albeit mechanically. Our hospital performs cochlear implantation surgery on adults. We have performed this procedure on patients of a wide range of ages, from young to very elderly. Furthermore, after cochlear implantation, speech recognition training (rehabilitation) is required. Our hospital has several speech-language-hearing pathologists on staff who provide support for patients, including postoperative rehabilitation. For those who retain low-frequency hearing but have particularly poor mid- to high-frequency hearing, we offer a residual hearing-utilizing cochlear implantation procedure, which combines hearing aids and cochlear implants.
Artificial hearing devices such as artificial middle ear implants and implantable bone conduction hearing aids are new methods for people with moderate hearing loss who have had little effect from hearing aids, people who cannot use hearing aids due to ear discharge, and people who have had tympanoplasty in the past but have not seen much improvement in their hearing. The choice of which is most appropriate depends on the condition of the patient's ear, the degree of hearing loss, and whether or not they have had otitis media. Even people who have not seen sufficient results from traditional tympanoplasty may be able to achieve better hearing.
We actively perform nasal endoscopic surgery for chronic sinusitis that cannot be cured with conservative treatment. Using high-definition endoscopes and navigation systems, we aim to perform thorough open treatment of the sinuses.
The most painful part of nasal surgery is said to be removing the gauze stuffed in the nose after surgery, but in our department we insert a cotton-like hemostatic agent instead of gauze. Most of the hemostatic material is washed away during nasal irrigation, so there is no need to remove it and there is almost no pain.
A deviated septum and hypertrophic rhinitis can cause severe nasal congestion and can only be cured by surgery. For these conditions, we perform nasal septum correction using a nasal endoscope and submucosal inferior turbinate resection.
In particular, in cases of severe septal deviation, external nasal deformation may occur. If necessary to relieve nasal congestion, external rhinoplasty may also be performed.
Various benign and malignant tumors can occur in the nose, but because the face, eyes, and brain are adjacent to it, they cannot be easily removed. During surgery, we appropriately select nasal endoscopy and external nasal incision to provide adequate treatment while avoiding damage to these important areas.
Diagnosis of head and neck tumors begins with a general examination and throat endoscopy, followed by imaging diagnostics such as CT, MRI, and PET-CT. Finally, qualitative diagnosis is performed through cytology and pathological biopsy. If a diagnosis is difficult, hospitalization may be required for a biopsy under general anesthesia. For neck lumps (tumors, lymph nodes, etc.), fine-needle aspiration cytology is performed during ultrasound examination. This is extremely useful for diagnosing thyroid and salivary gland diseases. Mucosal lesions of the mouth and throat are diagnosed in an outpatient setting by partial resection of the lesion under local anesthesia. Among malignant head and neck tumors, thyroid cancer and salivary gland cancer are primarily treated through surgery. We use nerve stimulators and surgical microscopes with meticulous care to preserve function. We also perform nerve reconstruction surgery in collaboration with plastic surgery to restore facial and vocal cord movement.
Mouth and throat cancer (oral cancer, laryngeal cancer, pharyngeal cancer) undergoes various treatments depending on the stage of the disease. While functional decline is inevitable in advanced cancer, in early-stage cancer, we strive to preserve function and perform minimally invasive surgery that places as little strain on the body as possible. In the case of early-stage pharyngeal cancer, in collaboration with the gastroenterology department, it is possible to remove the lesion and cure it using endoscopic surgery alone, without cutting the skin.
In the case of advanced cancer, we use a combination of surgery, anti-cancer drugs, and radiation therapy. Depending on the lesion, surgery may be necessary, requiring a large excision. In such cases, we work with plastic surgery to perform reconstructive surgery to restore function. By prioritizing radiation and anti-cancer drug treatment, if the lesion shrinks, major surgery may not be necessary. We consult with patients to determine the best possible treatment plan.
If you would like a second opinion or treatment that cannot be performed at our hospital, such as a clinical trial treatment, you may be referred to another hospital.Recently, treatment with new anti-cancer drugs (molecular targeted drugs, etc.) has become possible, and our department is also trying out the latest treatments.
Most cases are squamous cell carcinomas that arise from the epithelial cells of the tongue mucosa, and often occur on the edges of the tongue, on either side of the tongue. Although not as common as other head and neck cancers, this cancer is more common in men over the age of 40. Risk factors for carcinogenesis include smoking, drinking alcohol, and chronic irritation from bad teeth. In the very early stages, it can be difficult to distinguish from ulcers or leukoplakia (a condition that causes the tongue mucosa to turn white) with the naked eye, so a biopsy by a specialist is recommended.
As the disease progresses, symptoms such as pain, bleeding, dysarthria (difficulty speaking), swallowing (difficulty eating), and difficulty opening the mouth appear, and if the cancer spreads to the lymph nodes in the neck, the cure rate decreases. While early-stage tongue cancer can be treated with surgical laser resection or radiation therapy, advanced tongue cancer typically requires a combination of surgery, radiation therapy, and chemotherapy (anticancer drugs).
Surgical treatment for advanced tongue cancer, like other advanced cancers, involves joint surgery with a plastic surgeon to perform tumor expansion surgery, neck dissection (surgery to remove metastatic lymph nodes en bloc), and free flap reconstruction surgery (tissue is temporarily removed from another part of the patient's body, and the arteries and veins are anastomosed to perform neck reconstruction surgery).
Over the 10 years from January 1992 to December 2001, the 5-year survival rate for tongue cancer treated at our department was 64.3%. The rate was 92.3% for early-stage cancer and 30.8% for advanced cancer, with similar results for other oral cancers.
It is the most common type of head and neck cancer excluding thyroid cancer, and originates from the mucosal epithelium of the larynx, the organ of speech production. It is more than 10 times more prevalent in men than in women.
There is a high correlation with smoking history, and approximately 70% of cases develop from the mucous membrane of the vocal cords (glottic cancer), and it is often discovered relatively early on as a symptom of hoarseness. If hoarseness persists, it may be a benign vocal cord nodule or polyp, but we recommend a visit to an otolaryngologist. Diagnosis can be easily made in an otolaryngology outpatient clinic using an indirect laryngoscope or a laryngeal fiberscope (a device that allows an endoscope to be inserted into the pharynx through the nostrils to observe the pharynx and larynx).
Among laryngeal cancers, those that develop above the vocal cords (supraglottic cancer) are often found after they have progressed and metastasized to the lymph nodes. In the early stages of either cancer, radiation therapy is the main treatment. In very early cases where the cancer is clearly limited to the mucosa, surgical removal using laser treatment equipment may be the only option.
In advanced cases, it may become necessary to completely remove the larynx, which is the organ of speech production, but we aim to provide postoperative substitute speech using methods such as electrolarynx, tracheoesophageal shunt, and esophageal speech.
Over the nine years since April 1992, our department has performed surgical treatment in 107 cases (82 benign and 25 malignant), of which 88 were parotid gland tumors (14 malignant). Preoperative diagnosis is performed using CT and ultrasound-guided fine needle aspiration cytology (FNA), and we believe that scintigraphy is not necessary except in special cases. The accuracy rate of FNA in diagnosing benign or malignant tumors is 90%.
In our department, we use a nerve stimulator to check the facial nerve during surgery, ensuring that the nerve is preserved. There have been no cases of permanent facial nerve paralysis as a postoperative complication in cases where the nerve was preserved. Other complications include one case of salivary leakage and two cases of hematoma, but these were cured conservatively. The incidence of Frey's syndrome (a phenomenon accompanied by abnormal sweating, redness, and a burning sensation in the parotid gland area when eating) was 18%, but recently we have been adopting surgical procedures to prevent it.
The prognosis for malignant tumors was a 5-year survival rate of 77.3% for 19 cases excluding malignant lymphoma, according to the Kaplan-Meier method. Although surgery for malignant tumors sometimes involves the concomitant removal of the facial nerve, reconstruction with nerve grafting was performed in three cases, preventing complete paralysis.
Thyroid tumors are more common in women and are usually noticed when a tumor is found in the front of the neck, but they can also be discovered when symptoms include hoarseness or swollen lymph nodes in the neck.
Over the 11 years since 1992, our department has treated a total of 217 thyroid tumors, including 95 benign tumors and 122 malignant tumors. Diagnosis is made using contrast-enhanced CT scans, neck ultrasound, and ultrasound-guided fine-needle aspiration biopsy (FNA) to determine treatment options. In cases where surgery was performed at our department, the accuracy rate of FNA diagnosis of benign or malignant tumors was 87.4%. In the case of benign tumors, surgery is often not performed and the patient is monitored. However, surgery is performed when malignancy is suspected, the tumor is large and poses cosmetic problems, or the patient requests it. While surgery is the basic treatment for malignant tumors, surgery is performed according to the circumstances after considering the tumor's characteristics, location, and extent of spread.
Complications of surgery include postoperative paralysis of the recurrent laryngeal nerve, a nerve that moves the vocal cords just behind the thyroid gland. In our department, we perform surgery to preserve this nerve unless the tumor has invaded it. In cases where the nerve has been preserved, temporary paralysis may occur after surgery, but only 1 in 200 cases (0.5%) experienced permanent paralysis. Furthermore, in cases where cancer has invaded the nerve and it is absolutely necessary to remove the nerve, we also perform regenerative medicine using artificial nerves.
Furthermore, if thyroid cancer has invaded the trachea, a portion of the trachea must be removed along with the cancer. The usual method of reconstructing a resected trachea involves using autologous tissue (cartilage or skin), but this increases the number of surgeries required, and can leave aftereffects of autologous tissue harvesting and wound deformation, making it difficult to detect cancer recurrence. In contrast, our hospital performs tracheal reconstruction using an artificial trachea, which usually requires only one surgery. Tracheotomy is not required, and there are no aftereffects from autologous tissue harvesting. Furthermore, the wound surface is clean, and the reconstructed tracheal section retains a shape and function almost identical to a normal trachea.
Papillary thyroid carcinoma is the most common malignant tumor that occurs in the thyroid gland, accounting for over 90% of all malignant tumors that occur in the thyroid gland. Papillary thyroid carcinoma tends not to progress rapidly as a malignant tumor, and the 10-year survival rate of 109 cases that underwent surgery in our department was 96.4% using the Kaplan-Meier method.
*In addition, depending on the surgery, thyroid hormone production may decrease or stop after surgery, so thyroid hormones may need to be supplemented by oral administration, or the function of the parathyroid glands, which regulate calcium levels in the blood, may decrease, so oral administration of vitamin D preparations or calcium supplements may be required.
Sialolithiasis is a disease in which stones form in the salivary glands or their ducts, most often in the submandibular gland.
Submandibular gland sialolithiasis must be surgically removed unless it is naturally eliminated. There are two methods: the intraoral method, in which an incision is made inside the mouth to remove the sialolithiasis, and the external incision method, in which an incision is made in the neck skin to remove the sialolithiasis along with the submandibular gland. In our department, the intraoral method is the first choice, as it leaves no scars, there is no risk of paralysis of the corners of the mouth, and the hospital stay is short.
In 32 patients in whom salivary stones could be palpated by bimanual examination before surgery, they were able to be removed from the mouth regardless of their location. In patients in whom salivary stones could not be palpated, who had recurrent submandibular gland inflammation, who had recurrence after the intraoral method, or who had multiple salivary stones in the gland, they were removed using the external incision method.
There are four parathyroid glands in total, two on the upper and two on the lower back of the thyroid gland. Abnormalities in their location and number are often observed. In hyperparathyroidism, excessive secretion of parathyroid hormone (PTH) causes high calcium (Ca) levels in the blood, resulting in a variety of systemic lesions, primarily in the bones and kidneys. There are two types of hyperparathyroidism: primary, which is caused by the parathyroid glands, and secondary, which is caused by something other than the parathyroid glands and results in secondary lesions in the parathyroid glands.
Symptoms of hypercalcemia include osteoporosis, pathological fractures due to ectopic calcification, and joint and bone pain. Other symptoms include urinary tract stones, digestive symptoms, general fatigue, and impaired consciousness. Our department cooperates with the endocrinology and nephrology departments in performing surgery, but in most cases of primary disease, it is caused by an adenoma, which is then removed.
In the case of secondary renal failure, most patients undergoing dialysis treatment for chronic renal failure have hyperplasia, with all four glands becoming enlarged. In our department, we generally remove all four glands and transplant parts of them into the forearm.
