The number of patients with allergic rhinitis (AR) has increased globally. In Japan, more than 40% of the people are affected with AR. Although it is not a life-threatening illness, it is important to control AR because it directly correlates with the patient’s quality of life. Surgical treatment is considered for managing severe cases and those with ineffective conservative therapy. According to the Japanese Guidelines for AR, surgical treatment is recommended for patients with severe AR and nasal obstruction caused by thickening of the inferior turbinate and a deviated nasal septum. There are many methods and equipment for measuring nasal airflow; however, there is no consensus regarding the results of previous clinical studies on nasal obstruction. In this review, we described the relationship between the anatomical and physiological factors of the nasal cavity that affect nasal obstruction, and the implementation of the two major evaluation methods and examinations in Japan. Rhinomanometry is the physiological examination of nasal airway breathing, whereas acoustic rhinometry is the anatomical examination. In addition, we introduced several clinical studies on AR and evaluation methods for patients with nasal valve stenosis.

Cervical tuberculosis (TB) is an important disease for otolaryngologists as a differential diagnosis for cervical lymphadenopathy. In the present study, we investigated nine cases of cervical TB diagnosed in our department in the past 10 years. The patients were three males and six females, and their ages ranged from 28 to 77 years (mean 64.6 years). One patient in her 20s was a visitor from Southeast Asia.

T-SPOT and QuantiFERON, called IGRAs (Interferon-Gamma Release Assays), are used for diagnosis and are well known for their high sensitivity and specificity. However, during the window period within 8–10 weeks of TB infection, T-SPOT is false negative. Therefore, when cervical TB is strongly suspected, repeated IGRAs should be performed, or early Mycobacterium tuberculosis culture should be considered to distinguish non-tuberculous Mycobacterium tuberculosis.

We encountered two rare cases of actinomycosis that occurred in the nasal sinus and external ear, respectively.

Case 1: A 55-year-old woman presented to our hospital complaining of left temporal headache. A hard rhinolith was found in her left common nasal meatus and was removed with forceps. Based on the pathological examination, we diagnosed it as a rhinolith caused by actinomyces. After the removal of the nasal foreign body, her left temporal headache improved immediately.

Case 2: A 63-year-old woman presented with hearing loss and pain in the right ear. Her right auditory canal was filled with granulation, and surgery was performed to remove the granulation and an infectious foreign body. Upon pathological examination, a plant-derived foreign body and an actinomycete mass were found to accompany the inflammatory granulation. Postoperatively, her right tympanic membrane perforation remained; however, the conductive hearing loss was relieved.

Orbital sinusitis complications may cause serious sequelae. Hence, appropriate diagnosis and treatment are necessary. In this report, we described a case of orbital apex syndrome caused by Pseudomonas aeruginosa, which spread from sinusitis. An 82-year-old man, with left buccal pain and temporal headaches, was referred to our hospital for examination and treatment. Medical history included diabetes mellitus, myocardial infarction (he received anticoagulant therapy), and bilateral maxillary sinus surgery. Based on nasal findings and sinus computed tomography (CT), maxillary neuralgia caused by sinusitis was diagnosed, and neuropathic pain medication was prescribed. One month after the initial visit, left vision loss, limited eye movement, and blepharoptosis occurred. Sinus CT showed mucosal swelling, bony destruction of the left sphenoid sinus, and increased soft tissue contrast density from the orbital apex to the optic nerve canal and cavernous sinus. Based on our examinations, a diagnosis of orbital apex syndrome was made. Antibiotics were administered and the patient underwent endoscopic sinus surgery. The mucosa of the sphenoid sinus and optic nerve canal was necrotic. On postoperative day 5, the patient complained of contralateral vision loss. The following day, light perception returned. No blepharoptosis or eye movement disorder was observed. Pathological and bacteriological examinations revealed optic neuritis caused by P. aeruginosa. Inflammation associated with left optic neuritis spread to the optic chiasm and caused right optic neuritis. Although reports of orbital apex syndrome caused by P. aeruginosa are rare, it can cause severe functional impairment because of necrosis of tissues. Although the imaging findings appeared mild, these should be interpreted with caution in cases with severe symptoms, immunocompromised states, and postoperatively.