野田 昌生

OBJECTIVE: To evaluate whether the decline in tonsillectomy and adenoidectomy during the COVID-19 pandemic in Japan was age-dependent and to examine trends in postoperative hemostasis activity using nationwide claims data. METHODS: We conducted a nationwide longitudinal descriptive study using National Database Open Data from fiscal years (FY) 2015-2023. Annual procedure counts were extracted for tonsillectomy (K377-1), adenoidectomy (K370), and postoperative hemostasis after tonsil surgery (K367-a). Pandemic phases were defined as pre-COVID (FY2015-FY2019), COVID onset (FY2020), COVID ongoing (FY2021-FY2022), and recovery (FY2023). Age-stratified analyses were performed for tonsillectomy. The postoperative hemostasis rate was calculated per 1000 tonsillectomies. RESULTS: Tonsillectomy and adenoidectomy volumes increased through FY2019, reaching 73,577 and 14,910 cases, respectively, before declining sharply in FY2020 to 47,097 and 7018. The reduction in tonsillectomy was strongly age-dependent and greatest among children aged 0-14 years, with a 48.9% decrease from FY2019 to FY2020 (29,340-14,992), whereas the decline among adults aged ≥ 60 years was smaller at 12.5% (5433-4752). Surgical volumes remained suppressed during FY2021-FY2022 and partially recovered in FY2023 but did not return to prepandemic peak levels. The absolute number of postoperative hemostasis procedures remained relatively stable over time; however, the hemostasis rate increased during the pandemic period because tonsillectomy volume declined. CONCLUSION: The pandemic-associated reduction in tonsillectomy and adenoidectomy in Japan was disproportionately concentrated in pediatric patients. Despite reduced surgical volume, the absolute postoperative hemostasis activity was relatively preserved. These findings provide nationwide evidence of age-dependent disruption in elective otolaryngologic procedures during the COVID-19 pandemic. LEVEL OF EVIDENCE: 4.

Auricular rhabdomyosarcoma is an extremely rare malignancy in the pediatric population, and its management presents unique challenges due to both oncologic and reconstructive considerations. Chemotherapy remains the cornerstone of treatment, but surgical intervention is indicated when the tumor demonstrates limited response to induction therapy or when durable local control is required. We report the case of a 16-year-old boy with rhabdomyosarcoma originating in the auricle and extending into the external auditory canal (EAC). He underwent wide local excision of part of the auricle, lateral EAC, and superficial parotid gland after a limited response to induction chemotherapy. Immediate reconstruction of the EAC was performed using a tubularized anterolateral thigh (ALT) flap, with the epithelial surface oriented outward to preserve canal patency and auditory function. Despite the inherent thickness of the ALT flap, this method achieved favorable outcomes, including successful postoperative radiation therapy, preserved hearing, and negative surgical margins. The patient remained disease-free with preserved auditory function and only minimal canal narrowing at the 5-year follow-up visit. This case demonstrates that ALT flap tubularization is a viable reconstructive technique, even for complex pediatric sarcoma cases. It provides a balance between oncologic safety, functional preservation, and long-term durability.