The annual incidence of first surgery for cholesteatoma was 3.2 cases per 100,000 inhabitants/year from 2001 to 2020 in a population in Sakae Ward, Yokohama City, Japan. Sakae Ward has an area of 18.55 square kilometers and 122,000 total inhabitants. This study dealt with the number of first-time surgeries for acquired middle ear cholesteatoma. Congenital cholesteatoma, external auditory canal cholesteatoma, cholesterol granuloma and recurrent middle ear cholesteatoma were excluded, and bilateral cholesteatoma counted as a single case. Almost all cholesteatoma patients in Sakae Ward visit our hospital, so we can calculate the accurate incidence of cholesteatoma requiring surgery in this area.

We herein report the postoperative results of tension-type cholesteatoma performed at Kumamoto University. Successful cases accounted for 70% of the total, which was a comparable rate to that in other facilities. For second-stage surgery, no recurrence of remodeling was observed, but eight cases of residual recurrence were observed. Six of these cases had remnants around the stapes. However, during the observation period (mean two years, nine months), neither residual recurrence nor remodeling recurrence was observed. Tension-type cholesteatoma destroys the area around the stapes at an early stage, and S2 cases with the degree of stapes lesions are more likely to have residual recurrence than X and sufficient cleaning with an endoscope.

Meningioma is a benign tumor that arises from arachnoid cells and is said to easily develop along the distribution area of arachnoid granules. In our patient with a chief complaint of hearing loss, meningioma of the middle cranial fossa was considered to extend to the middle ear via the tympanic canopy. Our multidisciplinary skull base team performed mastoidectomy combined with the middle fossa approach in this case. The tumor in the middle cranial fossa and mastoid sinus was totally removed.

Superficial siderosis is a disease that causes neurological disorders due to iron (hemosiderin) deposition on the brain surface and in the brain parenchyma. Chronic or recurrent hemorrhage in the subarachnoid space is thought to be the cause of this disease. The clinical manifestations of the disease include sensorineural hearing loss, cerebellar ataxia, pyramidal tract signs, and cognitive dysfunction. The clinical manifestations are progressive and irreversible. Some reports suggest that chelating agents and corticosteroids may be effective as treatments; however, at this point, no effective treatment has been clearly identified. We report a case of sensorineural hearing loss due to superficial siderosis that was diagnosed by MRI, which improved after treatment with orally administered corticosteroids.

Patients with blood disease often visit otorhinolaryngologists due to nasal bleeding. In patients with blood disease, nasal bleeding can be difficult to stop and also carry a risk of sudden death. Early diagnoses are this important in cases of nasal bleeding in blood disease patients. Purpura is a well-known physical finding of bleeding tendency, but checking for purpura is not commonly performed by otorhinolaryngologists. We herein report five cases of nasal bleeding in blood disease patients in which checking for purpura was useful for the diagnosis. Case 1. A 71-year-old male with acute myeloid leukemia. Case 2. A 71-year-old male with malignant lymphoma accompanied by idiopathic thrombocytopenic purpura and nasal neurofibroma. He died of bleeding shock and sepsis shortly after admission. Case 3. A 72-year-old male with idiopathic thrombocytopenic purpura. Case 4. A 2-year-and-10-month-old male with idiopathic thrombocytopenic purpura. Case 5. A 2-year-and-9-month-old female with lupus anticoagulant-hypoprothrombinemia syndrome. I recommend checking for purpura when treating patients with nasal bleeding.

Amyloidosis is a disease caused by the accumulation of protein with a specific fiber structure known as amyloid. We herein report a case of localized sinonasal amyloidosis, which is a very rare disease. The patient was a 47-year-old man who complained of nasal obstruction and recurring epistaxis on his right side. Computed tomography and magnetic resonance imaging showed a soft tissue shadow in his right paranasal sinus. Endoscopic sinus surgery was carried out, and the lesion was pathologically found to be amyloidosis. Since he had no disorder in other tissues or organs, he was diagnosed with localized sinonasal amyloidosis. The characteristic calcification of sinonasal amyloidosis has been called “fluffy calcifications” in some reports, which was also seen in this case. “Fluffy calcifications” may be the specific sign of sinonasal amyloidosis.

BCG is a vaccine made by weakening Bacillus Calmette-Guerin, a member of the Mycobacterium tuberculosis group. It is widely used for the prevention of tuberculosis and the treatment of bladder cancer, and is associated with high efficacy and few adverse events. In rare cases, however, serious infections may occur, and the diagnosis and treatment of such infections may be difficult. We herein report a case of deep neck abscess that led to an infected carotid aneurysm after the intracisternal administration of BCG for bladder cancer. The patient, an 84-year-old man, developed BCG lymphadenitis in the left neck approximately one year after intracisternal infusion treatment with BCG. He was treated with antituberculosis drugs for two months; however, debridement was performed because a deep neck abscess developed and the skin gradually self-destructed. The patient continued to receive antituberculosis drugs after debridement, which developed into an infected carotid aneurysm at approximately 2 months after debridement. The rarity of BCG infection makes it difficult to definitively diagnose and treatment is difficult because of a lack of effective treatment methods. In this article, we report our experience with BCG infection and its diagnosis and treatment, and review some of the relevant literature.

We herein report a case of iliopsoas abscess and deep neck abscess. An 85-year-old man with a history of cancer-bearing and uncontrolled diabetes was initially treated for iliopsoas abscess in the Department of Internal Medicine, but his clinical symptoms did not improve. Contrast-enhanced computed tomography during follow-up revealed a deep neck abscess, and we had to perform drainage surgery urgently in our department; thereafter, the situation improved. To our knowledge, no cases of abscess formation in the iliopsoas muscle and neck have been previously reported. Although this is a rare case, we must keep in mind that infection can occur at multiple sites in the aging population.

Langerhans cell histiocytosis (LCH) is a disease of unknown cause in which Langerhans cells proliferate monoclonally, and it has a very low prevalence of 1-2 per million. We herein report a pediatric case of LCH originating from the eye socket. The patient was a five-year-old boy. One month earlier, swelling of the left eye socket had occurred and rapidly enlarged, so he was examined at the ophthalmology department of a local general hospital. A malignant tumor originating from the eye socket was suspected, and the patient was referred for a detailed examination and treatment. At the first visit to our hospital, the destruction of the orbital bone on the outside of the left eye was observed, and the skin covering the outer corner of the left eye was easily crushed, exposing a hemorrhagic mass. Magnetic resonance imaging showed a tumor having an unclear boundary with the lateral rectus muscle and orbital adipose tissue, and positron emission tomography-computed tomography showed hyperaccumulation, consistent with an orbital tumor. A biopsy was performed, and acidophilic atypical cells with a strong tendency to necrotize were found. Immunostaining revealed positive results for CD1a and CD163. Based on the above, a diagnosis of LCH was made. Clinically, the diagnosis was LCH localized to a single organ. Oral predonisolone was started at 60 mg/m²/day and then gradually reduced. A marked regression of the tumor with a favorable disease course was achieved.

The 4K-three-dimensional (3D) exoscope system can observe the surgical field finely and in three dimensions using special glasses for high-precision digital images. In otolaryngology, this approach is suitable for tympanoplasty and laryngoscopic microsurgery, which are performed under a microscope or endoscope. We herein report the features of a 4K-3D exoscope system (OLYMPUS ORBEYE) used for tympanoplasty (Type I), laryngoscopic microsurgery, and hemithyroidectomy. Compared to microscopic surgery, this system allows not only surgical assistants but also visitors (e.g. residents or medical students) to perform surgery while sharing stereoscopic images. It has a number of advantages as well as educational aspects and is very useful as a surgical system in the field of otolaryngology and head and neck surgery.