Introduction

The Department of Otolaryngology–Head and Neck Surgery at Hokuto Hospital was established in 2007. As the core hospital in eastern Hokkaido, Japan We provide high-quality care to patients with diseases affecting the ear, nose, throat, and head and neck areas. More than 15,000 people visit our department, and 750 patients are hospitalized each year. Surgery was performed on 450 patients, including tympanoplasty, endoscopic sinus surgery, laryngomicrosurgery, neck dissection and thyroidectomy, etc. For treating head and neck cancer, we combine surgery with chemoradiotherapy. We aim to perfectly cure our patients and to preserve speech and swallowing functions in them. We collaborate with regional clinics, other hospitals and health care professionals to develop a team-based approach to medicine. Every member of the stuff takes pride in striving to provide the best leading-edge medical care to all patients.

 

 

 

We are an authorized institute for:

• Training Institute for Specialists by the Oto-Rhino-Laryngological (ORL) Society of Japan
• Training Institute for Specialists by the Japan Broncho-Esophagological Society
• Associate Training Institute for specialists of Head and Neck Cancer by the Japan Society for Head and Neck Surgery
• Training Institute for Specialists by the Japan Association of Endocrine Surgeons and the Japanese Society of Thyroid Surgery
• Training Institute for General Clinical Oncologists by Japanese Board of Cancer Therapy

Allergic Rhinitis

Allergic rhinitis is a type of allergy that affects the greatest number of people. It is estimated that from 10 to 30% of people in Japan are affected. Allergic rhinitis, also known as hay fever, is a type of inflammation in the nose which occurs when the immune system overreacts to allergens in the air. Signs and symptoms include a runny or stuffy nose; sneezing; red, itchy, and watery eyes; and swelling around the eyes. The fluid from the nose is usually clear. Symptom onset is often within minutes following exposure. The symptoms can affect sleep, the ability to work, and the ability to concentrate at school. Those whose symptoms are due to pollen typically develop symptoms during specific times of the year. Some people with allergic rhinitis also have asthma, allergic conjunctivitis, or atopic dermatitis. In the Hokkaido area, birch pollen allergy is identified as the cause in 50% of all allergy patients, and 30% of patients allergic to birch pollen have oral and pharyngeal hypersensitivity to fruit such as apples. This is called an oral allergy syndrome (OAS) or pollen food allergy syndrome (PFAS).

Argon Plasma Coagulation (APC) for allergic rhinitis

We perform Argon plasma coagulation (APC) for allergic rhinitis patients with severe nasal obstruction under local anesthesia.

Endoscopic Sinus Surgery (ESS)



Indication for ESS:

Chronic sinusitis with nasal polyp
Recurrent acute sinusitis
Fungal sinusitis
Eosinophilic sinusitis
Inverted papilloma
Allergic rhinitis with severe nasal obstruction
Nasal septal deviation
Postnasal bleeding



We conduct more than 80 endoscopic sinus surgery (ESS) under general anesthesia each year.

We routinely use endoscopy (VISERA Pro, Olympus), microdebridder system and endscrub (IPC ENT system, Medtronic) and Hydrodebridder irrigation System (Medtronic).

Electromagnetic tracking navigation system (StealthStation S7, Medtronic) is also equipped.　We can perform ESS safely, rapidly and easily by using these newly developed instruments,.

Upper respiratory tract infection

We treat a lot of patients with upper respiratory tract infectious disease including acute pharyngotonsillitis, peritonsillar abscess, acute epiglotitis and deep neck abscess.

We assess the severity of acute pharyngotonsillitis with scoring system.

 
 

We administer intravenous injection of penicillin (Ampicillin/ Sulbactam) to the patients with upper respiratory tract infectious disease.
We incise and drain to the patients with the abscess.
We conduct Quinsy tonsillectomy for the treatment of inferior type of peritonsillar abscess.

 



Swallowing disorder

A swallowing disorder is usually caused by a central nervous system disorder such as cerebral infarction and hemorrhage, neuromascular disease, or as a side effect of surgery for head and neck cancer. This condition is more common in older people. We routinely evaluate the degree of swallowing disorder by using videofluorography (VF) and videoendoscopy (VE). Speech-language-hearing therapists (ST) teach patients to perform and practice many exercises to improve swallowing during their dysphagia rehabilitation. To improve swallowing function in patients with brain stem infarction such as Wallenberg syndrome, we perform surgery called cricopharyngeal myotomy and laryngeal suspension. Surgery to prevent aspiration, including laryngotracheal separation and total laryngectomy, is indicated for the patients with severe repeated aspiration pneumonia.

Obstructive Sleep Apnea Syndrome (OSAS)

OSAS is the most common type of sleep apnea; it is caused by complete or partial obstruction of the upper airway. This condition is characterized by repetitive episodes of shallow or paused breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. Severity of OSAS measured by the apnea hypopnea index (AHI) is assessed with the apnomonitor and/or polysomnography (PSG). Patients with an AHI greater than 40 are advised to use nasal-continuous positive airway pressure (CPAP). More than 100 patients use nasal-CPAP in our outpatient clinic; most of them sleep well. We recommend uvulopalatopharyngoplasty (UPPP) for patients with tonsillar hypertrophy.





Chronic otitis media and cholesteatoma

 

Chronic otitis media results from a perforation in the eardrum and an active bacterial infection within the middle ear space that has lasted for several weeks or more. There may be enough pus present that it drains to the outside of the ear (otorrhea). Hearing impairment often accompanies this disease. Cholesteatoma involves a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Although cholesteatomas are not classified as either tumors or cancers, they can still cause significant problems because of their erosive and expansive properties. They may result in the destruction of bones in the middle ear, which requires surgery. They may, as well, spread through the base of the skull into the brain. Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum and/or the small bones of the middle ear after removal of granulation and/or cholesteatoma. Common graft sites include the temporalis fascia. We perform more than 20 operations in patients with chronic otitis media and cholesteatoma each year. Canal wall down tympanoplasty with reconstruction of soft posterior meatal wall is usually our method for treating cholesteatoma.

Ear tube insertion for recurrent acute otitis media and otitis media with effusion

The insertion of an ear tube reduces the occurrence of middle ear infections and allows the drainage of excess fluids. The most common indication for insertion of an ear tube remains recurrent acute otitis media (AOM) in children and persistent otitis media with effusion (OME) with conductive hearing loss. We insert ear tubes into more than 50 children each year under general anesthesia.

Facial nerve paralysis

Facial nerve paralysis is one of the diseases that commonly lead to the loss of facial expression. We treat more than 70 patients with facial nerve paralysis, including 80% with Bell’s palsy and 20% with Ramsay-Hunt syndrome each year. Patients with severe facial nerve paralysis are hospitalized and treated with intravenous prednisolone tapering from 120mg, low-molecular dextran, vitamin B12, ATP and glycerin. Speech-language-hearing therapists (ST) perform rehabilitation of facial muscles in these patients. We assess the possibility of the mitigation of facial nerve paralysis by electroneurography (ENoG). Patients with severe facial nerve paralysis who do not improve with steroidal therapy and ENoG < 10% are considered for facial nerve decompression. We inject botulinum toxin (Botox®) to the ocular and zygomatic muscle to improve pathologically associated movement.

Sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSHL), commonly known as sudden deafness, occurs as an unexplained, rapid loss of hearing –usually in one ear– either suddenly or over several days. We treat more than 80 patients with this disease each year. Patients with severe hearing loss are hospitalized and treated with intravenous prednisolone tapering from 120mg, low-molecular dextran, Vitamin B12, ATP and glycerin. Hyperbaric oxygen (HBO) therapy is also used for our patients.

Head and neck cancer

We provide patient-centered care from a multidisciplinary team that focuses on treating cancers of the head and neck. Head and neck cancers and benign tumors are originated in:

žEar

žNose and sinus cavity

žLarynx (Voice box)

žNasopharynx

žOropharynx (tonsil, base of tongue)

žHypopharynx

žOral cavity (tongue)

žSkull base

žSalivary glands

žThyroid gland

žParathyroid gland

 

Head and neck cancer team at Hokuto Hospital includes not just head and neck surgeons, but it also includes radiologists, oral surgeons, dentists, and plastic surgeons. Others in many subspecialties—neurosurgeons, ophthalmologists, doctors practicing palliative medicine, pathologists, anesthesiologists, pharmacists, speech therapists and experienced head and neck cancer nurses—work closely with our core team to deliver comprehensive and personalized care to our patients with head and neck cancer.

We can provide microvascular reconstruction using a free flap for surgical defects after removal of head and neck cancers. We can also take a proactive stance for chemotherapy with anticancer drugs including molecular target drugs and image-guided, intensity-modulated radiation therapy (IG-IMRT). Patients diagnosed with head and neck cancer face unique challenges that can greatly affect quality of life. Unlike other malignancies, head and neck cancer has the potential to significantly affect a patient’s appearance, speech, swallowing, and other senses. We proactively work to optimize each patient’s quality of life and provide the best treatments for preservation of speech, taste and swallowing functions, as well as maintaining overall physical appearance.

 

TomoTherapy (Intensity modulated radiotherapy)

TomoTherapy combines the use of CT scans with a radiation treatment device. It is an advanced system that delivers image-guided, intensity-modulated radiation therapy (IG-IMRT). TomoTherapy for radiation treatment is extremely precise and advantageous as it delivers sufficiently low exposure to organs at risk, such as the salivary glands, brain stem, spinal cord, and optic pathway. It uses daily CT imaging to guide the radiation field. A typical course of radiation therapy involves a daily visit from the patient to the hospital on Monday through Friday. The full daily TomoTherapy procedure takes 10 to 20 minutes for the patients. We installed and begun using TomoTherapy in 2005 and were the first TomoTherapy users in the Asia-Oceania area.

 

IA chemoradiation

Super-selective intra-arterial infusion chemotherapy for advanced head and neck cancer

(IA chemoradiation)

We provide advanced head and neck cancer patients with the treatment strategy of radiotherapy and concurrent super-selective intra-arterial chemotherapy with cisplatin neutralization by sodium thiosulfate (IA chemoradiation). IA chemoradiation is effective to maintain quality of life and speech and swallowing function for the patients

Indication for IA chemoradiation

•Maxillary sinus squamous cell carcinoma, stage III, IV

•Oropharyngeal squamous cell carcinoma, anterior wall type

•Hypopharyngeal squamous cell carcinoma, stage III, IV

•Laryngeal squamous cell carcinoma, stage IV

 

Thyroid surgery

The thyroid gland is located in the front of the neck just below the larynx. The thyroid gland is one of the endocrine organs; it absorbs iodine from the bloodstream and produces thyroid hormones. Thyroid hormones regulate a person’s metabolism. A normal thyroid gland appears butterfly-shaped and has a weight of 10 g–15 g. A healthy thyroid gland is not palpable. If a tumor develops in the thyroid, it is felt as a lump in the neck.

 

Examination for Thyroid nodule

 

Video Assisted Neck Surgery (VANS)

VANS is a new surgical procedure for thyroid surgery, which was developed by Professor Kazuo Shimizu in 1998. Conventional thyroid surgery requires more than a 6-cm long incision in the anterior neck. As thyroid diseases are particularly common in women, the scar left in the skin can be a cosmetic problem. We introduced endoscopic thyroid surgery (VANS) in 2009. Using this procedure, just a 3-cm skin incision is made in the lateral chest wall below the clavicle. So far, we have applied VANS methods for patients with mainly benign tumors.

Members

Nobuyuki Bandoh

Vice-Director, Hokuto Hospital

Chairman, Head and Neck Cancer Center, Hokuto Hospital

Chief, Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital

Clinical Professor, Asahikawa Medical University

Part-time instructor, Asahikawa Medical University

Education:

1992 M.D. awarded

2002 Ph.D. awarded

Previous appointments:

1998-2008 Instructor, Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University

2001-2003 Research Affiliate, Department of Immunology, Roswell Park Cancer Institute, Buffalo, New York, USA

2005 Completion of training course of temporal bone dissection, House Ear Institute, Los Angeles, USA

2008-2009 Assistant Professor, Asahikawa Medical University

2009- Chief, Otolaryngology-Head and Neck Surgery, Hokuto Hospital

 

Board Certification:

Board Certified Otorhinolaryngologist by the ORL Society of Japan

Board Certified Bronchoesophagologist by the Japan Broncho-Esophagological Society

Certification as a Specialist of Head and Neck Cancer by the Japan Society for Head and Neck Surgery

Certification as a Specialist by Japan Association of Endocrine Surgeons and the Japanese Society of Thyroid Surgery

General Clinical Oncologist by Japanese Board of Cancer Therapy

American Association for Cancer Research (AACR) active member

 

 

 

Takashi Goto

Chief, Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital
Assistant manager, Head and Neck Cancer Center, Hokuto Hospital
Clinical Associate Professor, Asahikawa Medical University
Part-time instructor, Asahikawa Medical University
Member,Sun International Clinic

1997　M.D. awarded

2010　Ph.D. awarded

2007 Staff, Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital

2005 Otology surgery training at Michigan University in USA

2008 Otolaryngology surgery training at British Columbia University in Canada

2011 Nose surgery training at Marburg University in Germany

Board Certification:

Board Certified Otorhinolaryngologist by the ORL Society of Japan

General Clinical Oncologist by Japanese Board of Cancer Therapy

 

Michihisa Kohno

Member, Department of Otolaryngology-Head and Neck Surgery

2014 M.D. awarded

 

 

 

 

 

References

1)      Bandoh N, Goto T, Akahane T, Ohnuki N, Yamaguchi T, Kamada H, Harabuchi Y, Tanaka S, Nishihara H: Diagnostic value of liquid-based cytology with fine needle aspiration specimens for cervical lymphadenopathy. Diagn Cytopathol, 44: 169-176, 2016

2)      Takahashi Y, Bandoh N, Miyamoto A, Kamada H: Single-fraction helical tomotherapy for ameloblastic carcinoma. J Oral Maxillofac Surg, 74: 302-306, 2015

3)      Tempaku A, Takahashi Y, Ikeda H, Yamauchi S, Goto T, Bandoh N, et al.: Usefulness of C-methionine positron emission tomography for detecting intracranial ameloblastic carcinoma: A case report. Oncol Lett, 8: 1509-1512, 2014

4)      Bandoh N, Yoshizaki T, Ishida Y, Goto T, Takahara M, Hayashi T, Harabuchi Y, Kumai M,Yamanaka N: Evalution of the clinical efficacy of antibiotics using a scoring system for acute pharyngo-tonsillitis. Adv. Otolaryngol ,72: 212, 2011.

5)      Bandoh N, Ogino T, Katayama A, Takahara M, Katada A, Hayashi T, Harabuchi Y: HLA class I antigen and transporter associated with antigen processing downregulation in metastatic lesions of head and neck squamous cell carcinoma as a marker of poor prognosis. Oncol Rep, 23: 933-939, 2010.

6)      Goto T, Bandoh N, Nagato T, Takahara M, Harabuchi Y, Tokusashi Y, Miyokawa N: Primary small cell carcinoma of lacrimal sac: case report and literature review. J Laryngol Otol, 124: 1223-1226, 2010.

7)      Ota R, Katada A, Bandoh N, Takahara M, Kishibe K, Hayashi T, Harabuchi Y: A case of invasive paranasal aspergillosis that developed from a non-invasive form during 5-year follow-up. Auris Nasus Larynx, 37(2): 250-4, 2010.

8)      Yoshizaki T, Bandoh N, Ueda S, Nozawa H, Goto T, Kishibe K, Takahara M, Harabuchi Y: Up-regulation of CC chemokine receptor 6 on tonsillar T cells and its induction by in vitro stimulation with alpha-streptococci in patients with pustulosis palmaris et plantaris. Clin Exp Immunol, 157: 71-82, 2009.

9)      Goto T, Bandoh N, Yoshizaki T, Nozawa H, Takahara M, Ueda S, Hayashi T, Harabuchi Y: Increase in B-cell-activation factor (BAFF) and IFN-gamma productions by tonsillar mononuclear cells stimulated with deoxycytidyl-deoxyguanosine oligodeoxynucleotides (CpG-ODN) in patients with IgA nephropathy. Clin Immunol, 126: 260-269, 2008.

10)   Chang CC, Ogino T, Mullins DW, Oliver JL, Yamshchikov GV, Bandoh N, Slingluff CL, Jr., Ferrone S: Defective human leukocyte antigen class I-associated antigen presentation caused by a novel beta2-microglobulin loss-of-function in melanoma cells. J Biol Chem, 281: 18763-18773, 2006.

11)   Bandoh N, Hayashi T, Takahara M, Kishibe K, Ogino T, Katayama A, Imada M, Nonaka S, Harabuchi Y: Loss of p21 expression is associated with p53 mutations and increased cell proliferation and p27 expression is associated with apoptosis in maxillary sinus squamous cell carcinoma. Acta Otolaryngol, 125: 779-785, 2005.

12)   Bandoh N, Ogino T, Cho HS, Hur SY, Shen J, Wang X, Kato S, Miyokawa N, Harabuchi Y, Ferrone S: Development and characterization of human constitutive proteasome and immunoproteasome subunit-specific monoclonal antibodies. Tissue Antigens, 66: 185-194, 2005.

13)   Wang X, Campoli M, Cho HS, Ogino T, Bandoh N, Shen J, Hur SY, Kageshita T, Ferrone S: A method to generate antigen-specific mAb capable of staining formalin-fixed, paraffin-embedded tissue sections. J Immunol Methods, 299: 139-151, 2005.

14)   Bandoh N, Hayashi T, Takahara M, Kishibe K, Ogino T, Katayama A, Imada M, Nonaka S, Harabuchi Y: VEGF and bFGF expression and microvessel density of maxillary sinus squamous cell carcinoma in relation to p53 status, spontaneous apoptosis and prognosis. Cancer Lett, 208: 215-225, 2004.

15)   Bandoh N, Ogino T, Hayashi T, Nonaka S, Harabuchi Y, Miyokawa N, Ferrone S: HLA class I antigen defects in maxillary sinus suquamous cell carcinoma: potential prognostic significance. International Congress Series (IFOS) 1240: 487-488, 2003.

16)   Bandoh N, Ogino T, Hayashi T, Kishibe K, Takahara M, Imada M, Nonaka S, Harabuchi Y: Value of biological factors for prognosis in maxillary sinus squamous cell carcinoma: p53 gene  mutations and apoptosis. International Congress Series (IFOS) 1240: 489-490, 2003.

17)   Bandoh N, Chang CC, Cho HS, Wang XH, Ogino T, Harabuchi Y, Whiteside TL, Ferrone S: HLA class I antigen downregulation in human head and neck squamous cell carcinoma cell lines: Role of antigen processing machinery defects. Proc. Amer. Assoc. Cancer Res. (2nd ed.), 770: 3868, 2003.

18)   Ogino T, Bandoh N, Hayashi T, Miyokawa N, Harabuchi Y, Ferrone S: Association of tapasin and HLA class I antigen down-regulation in primary maxillary sinus squamous cell carcinoma lesions with reduced survival of patients. Clin Cancer Res, 9: 4043-4051, 2003.

19)   Bandoh N, Hayashi T, Kishibe K, Takahara M, Imada M, Nonaka S, Harabuchi Y: Prognostic value of p53 mutations, bax, and spontaneous apoptosis in maxillary sinus squamous cell carcinoma. Cancer, 94: 1968-1980, 2002.

Presentations:

1.       Bandoh N： Screening, diagnosis and treatment for thyroid carcinoma at Hokuto hospital, 3rd Japan-Russia International conference, June 4, 2016, Obihiro, Japan.

2.       Bandoh N, Goto T, Akahane T, Kamada H, Ohnuki N, Yamaguchi T, Nishihara H: Liquid-based Cytology in Fine-Needle Aspiration for Head and Neck tumors, The Joint Meeting of 4^th Congress of Asian Society of Head and Neck Oncology& 39^th Annual Meeting of Japan society for Head and Neck Cancer, Kobe, June 3-5, 2015

3.       Bandoh N, Goto T, Kato S, Kamada H: Analysis of Patients with Thyroid Carcinoma Detected by FDG-PET Cancer Screening, 20th IFOS World Congress, Seoul, June 1-5, 2013

4.       Bandoh N, Goto T, Miyamoto A, Kamada H: Analysis of head and neck cancer patients treated with intensity modulated radiotherapy (IMRT) by Helical Tomotherapy, 20th IFOS World Congress, Seoul, June 1-5, 2013

5.       Goto T, Bandoh N：EBV-positive thyroid diffuse large B cell lymphoma of elderly: A case report, 13th Asian Association of Endocrine Surgeons Congress 2012, Singapore, March 26-28, 2012

6.       Goto T, Bandoh N: Primary small cell carcinoma of lacrimal sac: A case report, The 1st Congress of the Confederation of European ORL-HNS, Barcelona, Spain, July 2-6, 2011

7.       Bandoh N, Goto T, et al: Evalution of the clinical efficacy of antibiotics using a scoring system for acute pharyngo-tonsillitis, The 7th International Symposium on Tonsils and Mucosal Barriers of the Upper Airways, Asahikawa, July 7-9, 2010