The ultimate purpose of cancer treatment is to improve the quality of life (QOL) of the patient besides prolonging the survival. As the prognosis of patients with head and neck cancers improves, attention has been directed at the QOL of the cancer survivors, that is, the quality of survival (QOS). The concept of cancer survivorship refers to the patient showing no signs of cancer after treatment completion, that is, living with, through, and beyond cancer with the family, caregivers, and other survivors. In this editorial, the authors describe the current status and future perspectives, including efforts at our hospital for evaluation of the QOS of head and neck cancer patients, rehabilitation of the shoulder joint after neck dissection, management of radiation-associated dysphagia (RAD) by providing swallowing training, supportive care, early detection for minimally invasive surgery, and the de-escalation treatment strategy for Human Papilloma Virus-related oropharyngeal cancers. We must pay attention to offering head and neck cancer patients not only simple cure, but a better cure.

Involvement of endolymphatic hydrops has been reported in both Ménière’s disease (MD) and acute low-tone sensorineural hearing loss (ALHL). However, only a few studies have been conducted to compare the two conditions in respect of the involvement of endolymphatic hydrops. For this research, I extracted the medical records of patients who fulfilled the diagnostic criteria for MD and ALHL among patients who visited my clinic for dizziness or hearing loss over the past seven years. I then conducted a retrospective analysis of the patient data, including the age at the time of the initial visit, gender, affected side, hearing level, subjective symptoms, presence/absence of nystagmus, tendency to develop MD, etc. There were 108 cases with 110 ears diagnosed as having MD (definite), including 29 cases in men (26.9%) and 79 cases in women (73.1%), 163 cases with ALHL, including 41 cases in men (25.2%) and 122 cases in women (74.8%), and 31 cases with cochlear MD, including 5 cases in men (16.1%) and 26 cases in women (83.9%). The male-female ratio was 1:5.2 for patients with cochlear MD, 1:3.0 for patients with ALHL, and 1:2.7 for patients with MD (definite). The average ages of the above patient groups were as follows: MD (definite), 45.1±14.1 years; cochlear MD, 38.8±14.2 years; ALHL, 46.9±15.5 years. There was no significant age difference between the patients with MD (definite) and those with ALHL. There were 31 cases (15.3%) in which the diagnosis changed from ALHL to cochlear MD and 8 cases (4.0%) in which the diagnosis changed from ALHL to MD (definite). The diagnosis changed from ALHL to cochlear MD or MD (definite) more frequently in women than in men; in particular, all of the patients in whom the diagnosis changed from ALHL to MD (definite) were woman. There were no significant differences among the three patient groups in the total hearing levels for three low frequencies (125 Hz, 250 Hz, 500 Hz) at the initial visit. The average age of the patients in whom the diagnosis changed from ALHL to MD (definite) tended to be higher (53.7±18.3), whereas those of the patients in whom the diagnosis changed to cochlear MD tended to be lower (38.8±14.2). Of the patients with MD (definite), 77.8% already had hearing loss at the time of their clinic visit. On the other hand, only 20.4% of patients had nystagmus or dizziness at the first visit. The results of this study revealed that most patients with ALHL and MD were already aware of hearing loss or the sensation of clogged ears.

Temporal bone encephalocele is an abnormal condition in which the meninges protrude into the pneumatized cranial base. It can result in intracranial complications, including meningitis, intracranial abscess, and epilepsy, so that surgical repair is recommended to decrease the risk of these complications. Herein, we report a case of temporal bone encephalocele in which the transmastoid approach was used for surgical repair. A 64-year-old female patient admitted to our hospital had a history of diagnosed as having meningitis and intracranial abscess in the right lateral lobe. Otoscopic examination revealed a normal tympanic membrane with an inserted ventilation tube. Pure-tone audiometry showed slight conductive hearing loss in the right ear. High-resolution computed tomography of the temporal bone revealed a bone defect behind the tegmen tympani and the mastoid filled with soft tissue. We performed mastoidectomy to perform biopsy. Frozen section diagnosis of the specimen revealed that the soft tissue was brain tissue. On the basis of these findings, we diagnosed the patient as having temporal bone encephalocele. The herniating tissue was resected, and the defect in the bone was covered with fascia, and then with the cartilage of the pinna and temporal bone plate. A year after the surgery, the patient remains free of any complications of encephalocele. Otolaryngologists should bear in mind the possibility of encephalocele in subjects with defects of the temporal bone, since patients with temporal bone encephalocele usually present with otologic symptoms, including hearing loss and otorrhea.

Orbital wall fractures are frequently encountered in clinical practice, however, the indications for surgical treatment still remain controversial. The appropriate treatment strategy is determined taking into consideration the age and general condition of the patient, the severity of diplopia, and the degree of strangulation of the extraocular muscles in individual cases. Herein, we report a case of medial orbital wall fracture which improved with conservative treatment, however, the patient presented with recurrent diplopia about 5 months later.

A 51-year-old woman presented to our hospital with diplopia after sustaining injury in a bicycle accident the previous day. Computed tomography (CT) showed a left medial orbital wall fracture. Magnetic resonance imaging (MRI) showed no strangulation of the extraocular muscles, therefore, the patient was managed by conservative treatment. The symptoms improved by day 3, and ophthalmological examination showed that the restricted movements of the left eye had recovered. However, approximately 5 months after the injury, the patient became aware of diplopia again and visited our hospital. Ophthalmologic examination revealed that the restricted movements of the left eye again, but CT and MRI showed no remarkable changes as compared to the previous imaging findings. Since conservative treatment appeared to be ineffective, endoscopic reduction of the medial orbital wall fracture was performed, with prompt resolusion of the diplopia immediately after the operation.

The present case was a rare case of late relapse of diplopia after initial improvement with conservative treatment, in which it was difficult to judge the surgical indication and the appropriate timing of surgery.

Eosinophilic granulomatosis with polyangiitis (EGPA) is an anti-neutrophil cytoplasmic autoantibody-related vasculitis, that is characterized by systemic vasculitis with marked eosinophilia. Rhinosinusitis is a major manifestation of EGPA, and otorhinolaryngologists treating patients with chronic eosinophilic rhinosinusitis (ECRS) should be aware of the risk of development of EGPA in these patients; however, few reports have addressed the disease characteristics and essential patient guidance. Herein, we present the case of a patient with EGPA who developed postoperative cerebral infarction after surgical treatment for ECRS.

A 60-year-old male patient was evaluated for nasal obstruction and smell disturbance. Physical examination showed bilateral polyps in the nasal cavities. Computed tomography revealed bilateral pansinusitis, predominantly in the ethmoid sinus. Nasal polyp biopsy revealed eosinophilic infiltration. Based on the diagnosis of ECRS, the patient was scheduled for bilateral endoscopic sinus surgery. In addition, preoperative evaluation revealed bronchial asthma, and the patient was started on inhaled bronchodilator/steroid therapy.

During the postoperative course, the patient frequently experienced exacerbation of sinus mucosal edema, and received multiple short courses of oral steroids. The patient sought medical consultation 25 months after the surgery, complaining of a sensation of coldness in both the lower limbs and a four-day history of numbness in both hands and weakness in all limbs. High-resolution magnetic resonance imaging of the brain showed infarction in both the putamen and the thalamus. Blood examination showed a markedly increased eosinophil count (48%), and the patient was diagnosed as having EGPA. Remission was achieved with pulse steroid therapy and immunosuppressants, but the patient was unfortunately left with the sequelae of hemiplegia and dysarthria.

Patients with ECRS should be informed of the risk of development of EGPA and be educated about specific vasculitis symptoms, so as to facilitate early diagnosis. The risk of development of EGPA is higher in patients with peripheral blood differential eosinophil counts in excess of 10% on preoperative examination for ECRS and those showing recurrent inflammation of the sinus mucosa postoperatively. In such cases, close monitoring of the peripheral blood eosinophil counts is critical throughout the follow-up period.

Synovial sarcoma is a malignant tumor that is said to account for about 10% of all malignant soft tissue tumors. It occurs predominantly in young adults and most frequently arises from the joints of the extremities; it is relatively rare in the head and neck region.

We report a case of synovial sarcoma of the larynx in an elderly woman. The patient was a 77-year-old woman who visited a previous hospital with a 2-month history of sore throat and cough, and examination revealed a neoplastic lesion extending from the left vocal cord to the false vocal cord. On biopsy, the lesion was suspected as being a synovial sarcoma or sarcomatoid carcinoma, and the patient was referred to our department for further examination and treatment.

Since the patient had airway obstruction, a tracheotomy was performed under general anesthesia on the day after the initial examination. In addition, tumor biopsy was performed again for a definitive diagnosis and a specimen was also submitted for genetic testing. The genetic testing revealed SS18-SSX2 mRNA, which led to the definite diagnosis of synovial sarcoma. Total laryngectomy with left neck dissection was performed as curative treatment. Permanent histopathology of the resected specimen showed curative resection and no lymph node metastasis. Since the effectiveness of radiotherapy and chemotherapy for synovial sarcoma has not yet been established, no postoperative treatment was planned. Synovial sarcoma is generally considered as carrying a poor prognosis, and careful follow-up of the patient is required.

Carcinoma of the external auditory canal is among the rarer forms of head and neck cancer. We retrospectively analyzed the data of 15 cases of carcinoma of the external auditory canal treated at our hospital between January 2009 and December 2018.

The patients consisted of 7 male and 8 female patients, aged 38 to 85 years, with a median age of 66 years. The histopathological type was squamous cell carcinoma in all cases, and the mean follow-up period was 36.2 months (range, 3 to 102 months).

The tumor stage was T1 in 5 cases, T2 in 1 case, T3 in 6 cases, and T4 in 3 cases. There were no cases with lymph node or distant metastasis. According to the Pittsburgh staging classification, 5 patients had Stage I disease, 1 patient had Stage II disease, 6 patients had Stage III disease, and 3 patients had Stage IV disease.

Ten patients underwent surgery as the initial treatment, and 5 patients with positive margins received postoperative chemoradiotherapy. Three patients received super-selective intra-arterial rapid infusion chemotherapy as the initial treatment. Two patients received radiotherapy alone.

The 5-year overall survival and 5-year disease-specific survival rates as evaluated by the Kaplan-Meier method were 57.7% and 72.5%, respectively. The 5-year disease-specific survival rate was 100% in patients with Stage I/II disease, 40.0% in those with Stage III disease, and 50.0% in those with Stage IV disease. Six patients with early-stage disease showed good outcomes with surgery or radiotherapy, but the outcomes became poorer as the disease became more advanced. It is necessary to accumulate a larger number of advanced cases and consider effective treatment methods to improve the treatment outcomes.

There are several treatment modalities for Graves’ disease (Basedow’s disease), including antithyroid drugs (ATDs), radioactive iodine (RAI), and thyroidectomy. In cases with adverse reactions to ATDs and documented/suspected thyroid malignancies, thyroidectomy is considered. The American Thyroid Association (ATA) guideline recommends that patients be rendered euthyroid with ATDs prior to thyroidectomy. However, thyroidectomy performed under the condition of severe hyperthyroidism is sometimes necessary in cases that are refractory to ATDs or RAI.

A 20-year-old male patient visited a neighborhood clinic for palpitation and dyspnea. He was diagnosed as having Graves’ disease and started on treatment with methimazole (MMI). However, 5 months later, as no remission was achieved, the patient was referred to the thyroidology department of our hospital. RAI was administered, but no remission was achieved. Three months later, they referred him to our department for surgery.

On the day before the surgery, the serum free T3 was 184.2 pg/ml, and serum free T4 was 41.5 ng/ml. We performed total thyroidectomy despite the clinical evidence of severe hyperthyroidism. Intraoperatively, the thyroid was found to be diffusely enlarged and hypervascular. Hyperthermia, hypertension, and tachycardia, symptoms of thyrotoxicosis, were observed during the surgery, so that the anesthesiologist administered beta-adrenergic blocker and performed systemic cooling. The blood loss was 155 ml, and the operative time was 260 minutes. Hypertension and tachycardia persisted postoperatively, and the patient was administered systemic corticosteroid, beta-adrenergic blocker, and calcium channel blocker therapy. There were no major postoperative complications, except for right recurrent laryngeal nerve injury. The patient developed no evidence of thyrotoxic crisis, such as coma or heart failure. He was discharged from our hospital on day 10 after the surgery.

When thyroidectomy for Graves’ disease is performed under the condition of severe hyperthyroidism, perioperative care, including systemic cooling and appropriate drug therapy are required to avoid fatal complications derived from thyrotoxic crisis.

Killian-Jamieson diverticulum is an outpouching of the esophagus on the anterior aspect through the Killian-Jamieson space, between the most lateral aspect of the transverse part of the inferior margin of the cricopharyngeus muscle and the cricoid cartilage attachment of the esophageal longitudinal muscle. There has long been diagnostic confusion between Zenker diverticulum and Killian-Jamieson diverticulum, and it is important to differentiate between the two. Herein, we report a case of Killian-Jamieson diverticulum.

The patient was a 55-year-old woman in whom neck ultrasonography during a medical examination revealed a tumor in the left thyroid lobe. While we initially suspected Zenker diverticulum, measurement of the swallowing pressure showed a flat-pressured UES, which is not the usual finding in cases of Zenker diverticulum, and we suspected Killian-Jamieson diverticulum. Finally, the surgical findings confirmed the diagnosis of Killian-Jamieson diverticulum. Her clinical course was good, with no hoarseness nor evidence of obstruction. A Zenker diverticulum often protrudes on the median line. In this case, the surgical findings confirmed the final diagnosis, but to the best of our knowledge, there are no reports of measurement of the swallowing pressure in cases of Killian-Jamieson diverticulum. Based on our findings, we suggest that preoperative measurement of the swallowing pressure may help in differentiating Killian-Jamieson diverticulum from Zenker diverticulum.

Hereditary angioedema (HAE) is an inherited disease characterized by angioedema, that is caused by a genetic abnormality of C1-inhibitor (C1-INH). Decrease or functional abnormality of the C1-INH protein leads to excessive production of bradykinin, which causes increased vascular permeability. Patients with HAE present with edema of the face, arms and legs, as also of the larynx and gastrointestinal tract. Notably, airway stenosis caused by laryngeal edema can be fatal. Upper airway surgery under general anesthesia in patients with HAE carries the risk of airway stenosis caused by surgical site edema and by laryngeal edema due to tracheal intubation. In one guideline for the management of HAE, administration of C1-INH (Berinert^®P) prior to surgery is recommended as prophylaxis against the development of angioedema.

A 68-year-old female patient with HAE (type 1) was referred to our department with the chief complaint of pain in the right maxilla. She had undergone Caldwell-Luc surgery for sinusitis as a 13-year-old. CT showed two cysts in the right maxilla, and she was diagnosed as having maxillary cysts and scheduled for surgery. As she suffered from frequent attacks of HAE, we administered C1-INH to the patient prior to surgery, according to a guideline for the management of HAE, and the patient underwent endoscopic sinus surgery (ESS) under general anesthesia without HAE attacks during the perioperative period.

ESS under general anesthesia in a patient with HAE carries the risk of angioedema developing at the surgical site and laryngeal edema developing as a result of tracheal intubation. We could safely perform ESS without angioedema developing in the perioperative period, by prophylactic administration of C1-INH according to a guideline for the management of HAE.

We encountered a case of diffuse thyroid swelling after fine needle aspiration (dTSaFNA) cytology, and monitored the swelling by thyroid ultrasonography. The scan findings are reported. A 57-year-old female visited our hospital complaining of swelling in her anterior neck. She had a history of metal allergy and was not taking any medications. Because a solid cystic tumor was detected in the left thyroid lobe, we decided to perform fine-needle aspiration cytology (FNAC). When the second aspiration was performed with a 22-gauge needle inserted into the nodule in the left lobe, the patient immediately complained of pain in her neck. Within 2 minutes, her anterior neck swelled up and ultrasonography showed vascular dilatation in the left thyroid lobe. Neck cooling with steroid injection was undertaken. However, over the next 5 minutes, the vascular dilatation also spread to the right lobe. About 15 minutes later, the vessels gradually became unclear, and the neck pain and swelling persisted, and the patient was hospitalized for observation. By the following day, all the symptoms and signs had resolved and the patient was discharged. FNA is associated with the risk of neck swelling caused by hemorrhage or dTSaFNA. To make a prompt diagnosis and provide appropriate treatment for this complication, ultrasonography could be useful.