Surgical injury of the labyrinth had been generally believed to result in complete hearing loss. However, recent clinical experiences and experimental animal studies allowed surgical access to the inner ear with preservation of the cochlear function, thus providing a new gateway for the treatment of Ménière’s disease, benign paroxysmal positional vertigo and cholesteatoma, skull base tumors and acoustic neuromas. Electrophysiological experiments have shown that hearing can be preserved after semicircular canal transection, whereas wide opening of the vestibule results in hearing loss. Our clinical experiences of partial labyrinthectomy for various middle ear diseases, including labyrinthine fistula, petrous bone cholesteatomas and superior semicircular canal dehiscence syndrome are herein presented and pertinent electrophysiological research from our department is also presented and discussed.

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Benign paroxysmal positional vertigo (BPPV) is usually idiopathic and characterized by transient position-induced nystagmus with vertigo. However, it is widely known that BPPV-like symptoms arise during the course of diseases such as Meniere’s disease, sudden deafness, and vestibular neuritis. We report three patients who developed sudden sensorineural hearing loss with BPPV-like symptoms in the same ear. Two patients showed vertigo characterized by the lateral semicircular canal (LSCC), the other patient showed vertigo characterized by a combination of the posterior semicircular canal (PSCC) and the LSCC. Two patients had canal paresis (CP), but did not have otolith dysfunction. The hearing level improved significantly in two patients. BPPV-like symptoms with sudden deafness is thought to be involved in canalithiasis, as physical therapy has been effective in some cases. We suppose that the BPPV-like symptoms arise from the falling of the otolith associated with inner ear dysfunction.

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Mortality in descending necrotizing mediastinitis (DNM), a rare downward spread of deep neck infection, is reported to range from 5% to 10%, requiring immediate treatment. We report a case of DNM following acute epiglottitis. A 64-year-old woman hospitalized to treat acute epiglottitis developed DNM within 48 hours of admission. She had been administered steroids since 4 years earlier for rheumatoid arthritis and insulin since 17 years earlier for diabetes mellitus. Computed tomography (CT) indicated an abscess in the retropharyngeal space extending to the posterior mediastinum, reaching the tracheal bifurcation. Following cervical drainage and thoracoscopic pleural dissective drainage without tracheostomy, a pus culture showed Pseudomonas aeruginosa. Postoperative continuous mediastinal and pleural irrigation with saline were conducted through the drain. The thoracic drain was removed on postoperative day 19 and the cervical drain on day 23. She was discharged on postoperative day 42 without serious complications.

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Postoperative topical ear treatment in infants is often difficult and troublesome. We removed congenital middle-ear cholesteatoma via partial transcanal myringectomy in 3 infants.
Subjects were 2 boys and a girl aged 2–3 years. Two also had bilateral secretory otitis media. Cholesteatoma was closed type and was confined to the mesotympanum in all cases—the anterosuperior quadrant in 2 and the anterosuperior-anteroinferior quadrants in one. Operative procedure was as follows: the tympanic membrane was partially resected in proportion to cholesteatoma size without elevating ear canal skin. Cholesteatoma was removed through the perforation created, followed by immediate underlay myringoplasty using a temporal fascia graft. To eliminate postoperative topical treatment, no packing was placed in the ear canal.
The fascia graft epithelialized satisfactorily in the three cases. The postoperative clinical course of two subjects has been uneventful in 10 to 13 months of follow-up. The third infant developed recurrent cholesteatoma and underwent a second operation 15 months after the first surgery. No re-recurrence has been seen in the 14 months since reoperation.
Our approach involves minimal surgical invasion, requires no postoperative topical treatment, and is thus useful in removing congenital cholesteatoma confined to the mesotympanum, particularly in infants.

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We discuss hearing improvement pathology and mechanism induced in Valsalva experiment.
A 47-year-old man with progressively bilaterally impaired hearing underwent exploratory tympanotomy. On the right side, we found perilymph leakage from the footplate and bilateral ossicular chain abnormality-complete separation of the I-S joint and of the posterior crus and footplate without stapes fixation. On the left, we found incomplete I-S joint separation and complete separation of the posterior crus and footplate without stapes fixation. We conducted partial stapedectomy on the right side and stapedotomy on the left. Histopathologically, the bone structure was normal. Postoperative bilateral hearing improved.

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Intraparotid facial nerve schwannoma is a relatively rare disease. Multiple facial parotid gland schwannomas are especially rare in Japan, where only 8 cases have been reported. We report a case of multiple facial schwannomas in the parotid gland.
A 27-year-old man seen for swelling of the right parotid gland was found in magnetic resonance imaging (MRI) to have two right parotid gland tumors. Facial schwannoma was not diagnosable preoperatively. One tumor, which was not resectable, arose from the main facial nerve trunk. The other, arising from the marginal mandibular facial nerve branch, was completely resected. Histologically, this second tumor was diagnosed as a schwannoma.

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Lingual hematoma is a rare but potentially fatal cause of upper airway obstruction, and is mostly associated with either trauma or hematological disease such as elevated prothrombin time. We report a pregnant woman with lingual hematoma due to traumatic kissing associated with idiopathic thrombocytopenic purpura (ITP). A review of the literature indicated that most previous reports showed trauma and anticoagulants with warfarin, heparin, or tissue plasminogen activators to be the most common causes of lingual hematoma. This is, to the best of our knowledge, the first report of lingual hematoma secondary to traumatic kissing. Otolaryngologists and anesthesia staff must thus be aware of this complication due to the possibility of fatal posttrauma hemorrhage.

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Liposarcoma is the second most common soft-tissue malignancy following malignant fibrous histocytoma. Only 5.6% of liposarcomas are found in the head and neck, and most arise in soft neck tissue. Liposarcoma of the larynx is extremely rare, with only 34 cases reported in the English literature. We report case number 35.
The World Health Organization (WHO) identifies five histological liposarcoma subtypes-well-differentiated, myxoid, round cell, pleomorphic, and dedifferentiated. Our subject was a 38-year-old man with well-differentiated a primary arytenoids liposarcoma. We treated him using wide-excision direct-suspension laryngoscopy, entirely preserving laryngeal structures and function.
Laryngeal liposarcoma is easily mistaken for a benign soft tissue tumor. We diagnosed our subject with well-differentiated liposarcoma based on genetic studies confirming murine double minute 2 (MDM2) and cyclin-dependent kinase 4 (CDK4) amplification having the characteristic giant chromosome derived from the 12q(13-15) region.
Laryngeal liposarcoma recurrence is high, but with no reported cervical lymph node metastasis. Wide surgical excision is the mainstay of treatment, although the usefulness of radiation therapy remains to be determined. Because well-differentiated liposarcoma has low malignancy, we retain larynx function and recommend removing a tumor surgically with sufficient margins and comprehensive long-term follow-up.

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Ectopic thyroid tissue is thought to form when the thyroid primordium fails to descend normally. Such tissue is generally considered extremely rare as a malignant tumor site. We report a case of an ectopic thyroids becoming such a site.
A 57-year-old man had an anterior neck tumor diagnosed in computed tomography (CT) as a thyroglossal duct cyst. The tissue was surgically resected using the Sistrunk’s procedure when ectopic thyroid papillary carcinoma was identified within the cyst. Thyroid gland morphology was normal and no sign of lymph node metastasis was detected, therefore no further resection was done. Examination of the patient 3 year and 8 months postoperatively showed that the man had no evidence of tumor recurrence or lymph node metastasis.
Given ectopic thyroid development within a thyroglossal duct cyst and its susceptibility to malignant tumor formation, we strongly advise that ectopic tissue pathology be closely studied to address this potential malignancy.

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Primary sebaceous carcinoma of the submandibular gland is extremely rare, despite the many sebaceous glands in the parotid and submandibular glands.
We report a case of sebaceous carcinoma of the left submandibular gland in a 47-year-old man. After tumor extirpation, radical neck dissection, and postoperative radiation, there has been no evidence of recurrence.

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Periodic fever with aphthous pharyngitis and adenitis (PFAPA) syndrome, which usually occurs in early childhood, features periodic high fever, aphthous stomatitis, tonsillitis, pharyngitis and cervical adenitis. Recurrent tonsillitis during fever becomes an issue for the otolaryngologist. We think PFAPA syndrome is often misdiagnosed as chronic tonsillitis. Although antibiotics are usually prescribed for acute exacerbated chronic tonsillitis, antibiotics are ineffective in PFAPA syndrome, and steroids should be used instead. Differentiating PFAPA syndrome from chronic tonsillitis is thus a priority. In recent reports on tonsillectomy efficacy, surgery is an option for managing PFAPA syndrome. In our cases of a 4-year-old girl diagnosed clinically with PFAPA syndrome, tonsillectomy proved effective. Unlike chronic tonsillitis, PFAPA syndrome recurs regularly every 3-8 weeks, enabling tonsillectomy to be timed relatively easily. We review the literature and discuss clinical PFAPA syndrome features and management.

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