The rate of tubercular disease in Japan has been decreasing for the past several years. However, in comparison to European and American advanced nations, the rate is still relatively high. About 70% of all cases presenting with lymph node tuberculosis tend to demonstrate cervical lesions. We diagnosed six patients to have cervical tuberculous lymphadenitis at our institution from April 2009 to April 2014. Five patients had been referred to our hospital after complaining of swelling of the neck lymph node and one patient presented with no symptoms. Their ages ranged from 36 to 83 years old. All patients underwent fine needle aspiration cytology and bacteriological examinations from the cervical lymph node, and two patients underwent an open biopsy of the cervical lymph node. When examining patients who demonstrate swelling of the cervical lymph node, it is important to take the possibility of lymph node tuberculous into consideration.

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Background/Objective：The quality of life (QOL) of patients suffering from Japanese cedar (JC) pollinosis is significantly reduced. Due to time restraints, it is challenging to investigate the QOL during clinic visits in the high pollen season. In contrast, online surveys may be performed easily；however, it is difficult to confirm whether the participants have JC pollinosis. We therefore developed a new system for investigating the QOL of patients with JC pollinosis in order to overcome these issues. The present study was conducted to assess the usefulness of this system for evaluating JC pollinosis patients. Methods：Patients with JC pollinosis were screened at ENT clinics. Each patient registered themselves online, and QOL surveillance was performed on the website among registered patients three times during the pollen season. Results：A total of 236 patients registered for the study, 133 (56.4%) of whom took part in the survey during the high pollen season. The QOL scores significantly increased in the patients with JC pollinosis as the pollen levels in the air increased. The correlation between the severity of JC pollinosis and the number of clinic visits was found to be significant. Conclusions：Our newly developed system is useful for investigating the QOL and behavioral preferences of patients with JC pollinosis.

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Recently, refractory acute rhinosinusitis caused by drug-resistant Streptcoccus pneumoniae (DRSP) and ampicillin (ABPC)-resistant Haemophilus influenzae has been reported. Drug-resistant bacterial transmission through infants attending nursery school is considered to be a probable cause of such infection. I investigated the relationship between living with infants attending a day nursery and the frequency of detecting drug-resistant bacteria, and also evaluated the drug sensitivity of the detected bacteria in adult patients with acute rhinosinusitis. The subjects consisted of 670 adult patients who presented to my clinic with acute rhinosinusitis between July 2010 and June 2013. DRSP and ABPC-resistant H. influenzae was detected at a significantly higher frequency in the patients living with infants who attend nursery schools than in those not living with such infants. The identified bacteria tended to have poor drug sensitivity. To treat acute rhinosinusitis in adult patients with infants who attend nursery schools, antibacterial drugs should be carefully selected while considering the possibility of potential drug resistance and the severity of infection should also be evaluated.

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Although tracheoesophageal fistula is primarily attributed to congenital factors, it may occasionally be caused by acquired factors, such as malignant tumors, infection, and trauma caused by poorly performed medical procedures. Patients with tracheoesophageal fistula should be evaluated to determine its precise location, and the management of nutrition and body conditions should be immediately initiated. We herein present the case of a foreign patient with tracheoesophageal fistula who came from a developing country and presented with unexplained coughing while drinking water. Her medical history indicated dialysis for chronic renal failure. She had undergone several medical procedures with prolonged tracheal intubation and the use of gastric tubes in her country. Although laryngoscopy did not identify any abnormalities, VF clearly showed a tracheoesophageal fistula. Although such cases are not frequently encountered in patients from developed countries such as Japan, patients from developing countries who present with cough of an unknown etiology should be screened for tracheoesophageal fistula.

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Cholesteatoma usually recurs and therefore requires a long follow-up period after surgical treatment. However, the optimal period for follow-up is still debatable. Here, we report on two cases in which the patients had each undergone an operation for treating middle ear cholesteatoma several decades earlier in different hospitals, but had been lost to follow-up after the operation. The first patient presented with ear discharge and dizziness, and the second had no symptoms. However, computed tomography and magnetic resonance imaging findings indicated a recurrence of cholesteatoma. During the first patient's surgery, the tympanic cavity was found to be filled with the cholesteatoma. The surrounding granulation tissue extended to the anterior and lateral semicircular canal ampullae. In the second patient, the mastoid cavity was filled with the cholesteatoma, and a fistula was observed on the lateral semicircular canal. Care should be taken to monitor possible recurrences even in asymptomatic patients who have a history of surgery for cholesteatoma. Patient education and access to clinical records are considered necessary for optimal follow-up care. If recurrent cholesteatoma is strongly suspected, revision surgery should be considered.

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