We aimed to conduct interviews on the daily life habits focusing on lightheadedness, sleep-onset disorder associated with recently emerging visual stimuli due to the use of smartphones and games, impairment of sleep quality due to midnight awakening, stress, and migraine in children to explore the causes of the onset of pediatric dizziness. A comparative study was conducted with the subjects of 70 children with pediatric dizziness and 60 control children without dizziness by interviewing them about dizziness and daily life. In the interviews about daily life, the children with pediatric dizziness were found to have experienced sleep disorders significantly more frequently, including sleep-onset disorders and midnight awakening in comparison to those without dizziness. These results suggest that chronic sleep disorders caused autonomic imbalance, which in turn caused dysregulation of circulatory control while standing, leading to orthostatic dysregulation. The children with pediatric dizziness had experienced migraine significantly more frequently in comparison to those without dizziness. In addition, children with pediatric dizziness had experienced significantly more late arrivals at school etc. in comparison to those without dizziness. These results led us to conclude that the improvement of sleep by improving sleep-onset disorder and midnight awakening in daily life, as well as the early detection and treatment of orthostatic dysregulation and migraine, are important for improving pediatric dizziness and reducing social incompatibility, such as late arrival at school.

There are few reports on swallowing rehabilitation in outpatient clinics. At our hospital, we provide outpatient treatment mainly for patients with relatively mild dysphagia and have achieved satisfactory results. In this study, we examined outpatient swallowing rehabilitation for elderly patients. Swallowing disorders in the elderly, ranging from the oral to the pharyngeal stage, were managed with a patient-tailored rehabilitation menu. Improvement was observed in 6 of 15 patients. Among patients with relatively mild dysphagia and whose ADL status allowed them to go to hospital, an outpatient diagnosis and rehabilitation, with the active involvement of an otolaryngologist, was a treatment option.

Kikuchi's disease, also known as histiocytic necrotizing lymphadenitis, is an inflammatory disease. Typically, this disease affects young women, presenting with a fever and painful cervical lymphadenopathy as the main symptoms. We experienced a case of atypical Kikuchi's disease in the parotid gland and superior deep cervical lymph nodes of an elderly man. A 66-year-old man was admitted to our hospital complaining a mass in front of his ear and superior neck pain on the left side. Imaging studies showed a parotid tumor and multiple lymphadenopathy in the upper and middle inner deep cervical region on the left side. In all lesions, the ADC (apparent diffusion coefficient) value was low on magnetic resonance imaging. Malignant disease, such as lymph node metastasis of parotid carcinoma, malignant lymphoma, or a combination of parotid tumor and inflammatory lymphadenopathy, were considered as the differential diagnoses. Parotid gland superficial lobectomy and a cervical lymph node biopsy were performed. The tissue submitted as a parotid tumor was found to be a parotid lymph node on a histopathological examination, and all of the cervical and parotid lymph nodes were diagnosed with Kikuchi's disease. When diagnosing a parotid mass and/or cervical lymphadenopathy, it is important to consider Kikuchi's disease as a differential diagnosis even when the patient does not show the conventional typical features of Kikuchi's disease.

Nodular fasciitis is an inflammatory benign disease mainly composed of proliferating fibroblasts and myofibroblasts. Since this lesion shows rapid growth, it is important to distinguish it from malignant tumors, such as sarcoma. We herein report a case of nodular fasciitis of the left concha of auricle. A 20-year-old man had a habit of touching his ears. His previous doctor detected an easily bleeding mass lesion filling the external auditory canal from the left concha. It was surgically removed but recurred, so he was referred to our department. The pathological diagnosis was nodular fasciitis, but the tumor re-growth was rapid, and infiltration to the surroundings was suspected on imaging, so total excision was performed with a sufficient excision area. The postoperative pathological result was also nodular fasciitis, and the course was good, with no recurrence noted at seven months after surgery.

In order to diagnose Bell's palsy, we need to rule out other diseases that cause peripheral facial nerve palsy, including neoplastic disease. It is important to identify neoplastic paralysis by MRI. A 61-year-old man was admitted to our hospital with a chief complaint of unilateral facial paralysis that had occurred repeatedly for 8 years. Plain MRI was performed multiple times at other hospitals when symptoms appeared in the past, but no obvious tumor was pointed out. This time, in addition to facial nerve paralysis, he was aware of hearing loss, tinnitus, and dizziness, and was first pointed out to have facial schwannoma by contrast-enhanced MRI. He was treated with stereotactic radiotherapy (50Gy/25Fr). When recurrent facial paralysis symptoms appear, neoplastic paralysis should be suspected and contrast-enhanced MRI should be performed. Furthermore, when necessary, it should be confirmed by imaging studies multiple times.

We experienced a case of Bell's palsy with bilateral alternating recurrence at intervals of half a year. We performed decompression of the bilateral facial nerves by a transmastoidal approach in consideration of the surgical indication criteria of our department and the patient's wishes. The patient was completely satisfied with the effect at the one-year follow-up after the surgeries. However, while the Yanagihara grading score on the initially paralyzed side recovered from 8 points to 34 points by 6 months after the first surgery, electroneurography (ENoG) did not reveal any recovery of the compound muscle action potential, so it was difficult to evaluate the surgical effect by ENoG in this case. It is difficult to predict the prognosis of alternating recurrence of Bell's palsy using ENoG by the general method. We therefore intend to adopt the midline method as well in the future.

Respiratory epithelial adenomatoid hamartoma (REAH) is a hamartoma that occurs in the nose and sinuses. We herein report two cases of REAH in which chronic sinusitis and papilloma were suspected based on preoperative clinical findings but REAH was diagnosed by postoperative pathology after endoscopic sinus surgery. It is impossible to differentiate REAH from other sinus diseases by diagnostic imaging, as REAH is only shown as non-specific softtissuedensity areas on computed tomography. However, since the macroscopic findings resemble inflammatory polyps, there may be cases where these lesions are excised by a shaver without a pathological diagnosis. To improve the recognition of REAH, it is necessary to report more cases, We therefore report the details of these two cases along with a literature review.

In this study, we report a case of papillary thyroid cancer (PTC) in which salvage surgery was performed during lenvatinib therapy and in which anaplastic transformation was diagnosed in a postoperative histological examination. The patient was an 80-year-old man who was diagnosed with PTC, with invasion to trachea and cervical esophagus and metastasis of mediastinal lymph node. With the aim of maintaining the patient's quality of life (QOL), we decided not to perform surgery and started lenvatinib therapy. The patient's QOL could be maintained with the continuation of lenvatinib therapy and without severe adverse events for approximately 2 years. However, because of swallowing dysfunction due to the progression of cervical esophagus invasion, total thyroid and laryngo-pharyngo-cervical esophagectomy and free jejunal flap were performed without tracheostomy in the anterior mediastinum. In the postoperative histological examination, one-third of the sample showed anaplastic transformation. At more than 1 year after surgery, no recurrence was observed in the local area, and the mediastinal lesions had continued to shrink.

We encountered six cases with a brain tumor in patients who were diagnosed with glossodynia. All six patients had cerebellopontine angle tumors, including three cases of acoustic neurinoma, and one case each of hemangioma, trigeminal neurinoma and meningioma. Five years had passed in one case since the diagnosis of glossodynia before we noticed the existence of a tumor, while three years had passed in three of these cases. This failure to identify the tumor in a timely manner may have caused the patients to have lost precious time in the treatment process. We therefore investigated how to avoid missing such brain tumors by reviewing the tumor presentation, the data associated with glossogynia cases encountered in our department and other reports. As a result, we noted a pitfall in our blind belief that glossodynia is a kind of psychogenic disease and that tongue pain does not occur when eating. To avoid overlooking such cases in the future, we should avoid promptly diagnosing glossodynia in patients who complain of unilateral tongue edge pain. A total of 57 of 457 cases of glossodynia (12.6%) complained of unilateral tongue edge pain, and we noted brain tumors in 6 of these cases (10.5%). Acoustic meurinoma is found in from 0.5% − 5.7% of cases presenting with sudden hearing loss, so we should bear in mind that the probability of brain tumors among cases with unilateral glossodynia is higher than that. A total of 41.2% cases of glossodynia were associated with spontaneous abnormal taste sensations, while none of the 6 cases with brain tumors reported this symptom. In contrast, 51.9% of glossodynia patients complained of tinnitus, and all 6 cases with a brain tumor also reported this symptom on the affected side. It is important to inquire about the presence of hearing loss or tinnitus, and confirming the laterality of such symptoms can prove extremely important in making a timely diagnosis. We should perform audiometry and electrogustometry at the first visit, and immediately order brain magnetic resonance imaging to be performed in patients with any abnormal signs on those examinations.