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Objective: Eosinophilic otitis media (EOM) is an intractable middle ear disease recognized by an eosinophil enriched middle ear effusion and mucosa. Although precise pathogenesis of EOM remains unclear, it is characterized by type 2 inflammation. Since IgG4 is an IgG subclass induced by type 2 cytokines such as IL-4 and IL-13, we sought to characterize and compare local IgG4 expression in patients with and without EOM. Methods: Twelve patients with bilateral profound hearing loss, 9 of which underwent a cochlear implant surgery, were enrolled in this study (6 with EOM and 6 without EOM). The surgical specimens were harvested during surgery and were subjected to IgG4 immunostaining. Result: The middle ear mucosa showed the presence of a large number of IgG4-positive cells in patients with EOM, which was significantly higher than that in patients without EOM. Conclusion: Local IgG4 expression was observed in patients with EOM in comparison to those without EOM, suggesting that IgG4 contributes to EOM pathogenesis.

Detailed studies have not been conducted on sound localization and speech perception in noise in patients with unilateral congenital aural atresia (UCAA).To evaluate the benefits of the use of the Vibrant Soundbridge (VSB) for UCAA by performing audiometric and sound localization tests.Four children with UCAA underwent VSB (VORP 503) implantation from 2018 to 2019. Speech perception tests in noise were conducted using the Japanese monosyllable test. The spatial configuration for speech testing consisted of speech presented from the front and noise presented into the normal ear (SThe children's speech perception in noise 6 months after VSB activation was significantly better than before activation (The benefits of VSB use in children with UCAA were revealed using audiometric and sound localization tests.

IgG4-related disease (IgG4-RD) is a chronic inflammatory disease of unknown etiology that causes mass-forming lesion consisting of lymphoplasmacytic infiltrates, fibrosis and sclerosis especially in exocrine tissues. Although chronic paranasal sinusitis is known to be a nasal manifestation of IgG4-RD, little is known whether chronic rhinitis accompanies IgG4-RD. Here we report a case with hypertrophic rhinitis without sinusitis histologically compatible with IgG4-RD. An 80-year-old male complained bilateral nasal obstruction with occasional oral breathing and watery rhinorrhea for several years. Nasal endoscopic examination showed a pale and swollen anterior part of bilateral inferior turbinate leading to almost complete blockade of common meatus. Levels of serum total IgE and IgG4 were normal, and serum specific IgE to major inhaled antigens was negative. Due to resistance to conservative treatments, we performed an endoscopic mucosal resection of bilateral anterior part of inferior turbinate. The pathological findings met the diagnostic criteria for IgG4-RD. Additional examinations did not find lesion suspicious of IgG4-RD in other organs. After surgery, symptoms and objective nasal passage were improved with the use of intranasal corticosteroid. In case of hypertrophic rhinitis with severe swelling especially in the anterior part of the inferior turbinate, IgG4-related rhinitis should be suspected.