This retrospective study was conducted to determine whether or not treatment-specific antihistamine treatments would improve satisfaction and symptoms in patients with cedar pollinosis in a clinic. A total of 280 cases were examined among patients ≥ 12 years old. Satisfaction with treatment was increased in the year the questionnaire was used (87.7%) compared to the previous year, when the questionnaire had not been used (78.4). In both the peak pollen period and the late pollen period, the nasal symptom score and daily quality of life were better in the treatment group than in the non-treatment group (p < 0.001). This study showed that the patient satisfaction was improved using the specific questionnaire, and treatment efficiency was also achieved. At the second clinic visit, the percentage of patients wanting to continue taking the same medication was 89.4%. These results suggest that adequate information sharing with patients using a specific questionnaire may facilitate remote healthcare in the context of the COVID-19 pandemic.

The main objective of this study was to determine whether or not conservative treatment with steroids is effective for eosinophilic sinusitis. We studied 37 cases of eosinophilic sinusitis with a definitive diagnosis. Patients were divided into 2 groups: a conservative steroid therapy group (n=15) and an endoscopic sinus surgery (ESS) group (n=22). After retrospectively examining the degree of improvement in the nasal polyp score, nasal congestion score, and olfactory dysfunction in the conservative therapy group, these treatment results were compared between the two groups. In the conservative therapy group, nasal drops or steroid sprays were administered to all patients, and prednisolone (orally) was administered to 12 of the 15 patients (80%). In addition, 8 cases (53%) received inhaled corticosteroids for asthma in combination with exhalation through the nose. The pre- and posttreatment nasal polyp scores were compared in the conservative treatment group, and a significant improvement was noted on both the left and right sides (p < 0.001). There was also a significant improvement in the nasal congestion score (p < 0.001). Conservative steroid therapy alone for olfactory dysfunction led to complete remission in 6 of 15 cases (40%) and condition improvement in 8 cases (53%). There was a significant difference between the conservative therapy group and the ESS group in the pre-and posttreatment nasal polyp and nasal congestion scores but not in the degree of improvement in the sense of smell. This study showed that the combination of steroid nasal drops, nasal inhalation of steroid inhalers, and oral steroids can exert therapeutic effects on nasal congestion and olfactory dysfunction for eosinophilic sinusitis. However, a decrease in cortisol levels was observed in 5 of 9 cases (56%) receiving oral steroids as well as in 3 of 4 cases receiving long-term oral administration of Celestamine^®. When oral steroids, including Celestamine^®, are taken, careful treatment is recommended, and cortisol levels need to be monitored regularly.

Coagulation factor XIII is activated by thrombin at the final stage of the coagulation reaction and has the effect of cross-linking fibrins to each other. The fibrins form a thrombus, which provides mechanical resistance. When coagulation factor XIII is deficient, the fibrin thrombus dissolves before tissue repair progresses, causing bleeding at the same site half a day after hemostasis. A large amount of coagulation factor XIII is said to be consumed by highly invasive surgery. In this study, we retrospectively analyzed the characteristics of 16 patients whose factor XIII levels were measured after head and neck surgery between 2012 and 2020. Ten of the 16 patients (62.5%) had decreased factor XIII levels. Factor XIII tended to decrease in patients with frequent bleeding, and wound complications occurred more frequently in the XIII-deficient group than in the normal-range group. Knowledge of coagulation factor XIII is essential for otolaryngologists/head and neck surgeons to prevent and control wound complications.

A 42-year-old male patient presented to our hospital due to a huge nasopalatine duct cyst that was associated with eosinophilic sinusitis. The patient complained of bilateral nasal obstruction. Computed tomography and magnetic resonance imaging showed a nasopalatine duct cyst that elevated the floor of the bilateral nasal cavity, and a nasal polyp in the left nasal cavity. We performed mucosal resection, to the extent that was possible, in the floor of the nasal cavity, and endoscopic sinus surgery. Nasal polyps in the left nasal cavity were resected and the left ethmoid sinus was opened. The nasal obstruction was resolved after surgery, and the patient had a good clinical course.

We herein report a 14-year-old female with a huge choanal polyp that originated from the sphenoid sinus. This patient was admitted to our hospital with symptoms of nasal congestion, mild respiratory distress and dysphagia. Computed tomography showed a huge choanal polyp originating from an ostium of the left sphenoid sinus and extending to the oropharynx. Endoscopic sinus surgery was performed, and the choanal polyp was successfully removed. After surgery, nasal congestion, mild respiratory distress and dysphagia improved promptly. We consider this case of a huge choanal polyp originating from the sphenoid sinus to be extremely rare.

Ramsay Hunt syndrome is characterized by facial nerve palsy, VIIIth cranial nerve symptoms (vertigo, tinnitus, hearing loss), and herpes zoster of the auricle. In addition to the three main features, multiple neurological disorders, such as glossopharyngeal nerve palsy and vagus nerve palsy, are also seen in daily practice, although less frequently. At her previous doctor's office, a 76-year-old woman was diagnosed with left Ramsay Hunt syndrome and was treated with antibiotics and intravenous steroids. She was referred to our department about four months after her initial visit to the previous physician because of residual dysphagia despite rehabilitation. We performed surgery to improve her voice and swallowing due to left high vagus nerve palsy, and the patient had a good outcome. Although the diagnosis of Ramsay Hunt syndrome is relatively easy in daily practice, it is necessary to observe the pharynx thoroughly, as the findings may be overlooked. In addition, the present case suggests that surgery can be a good treatment for patients with residual high vagus nerve palsy and insufficient improvement by rehabilitation.

In 2021, we experienced a case of bilateral acute sensorineural hearing loss diagnosed as otosyphilis based on blood tests on admission. The hearing loss was successfully treated by the simultaneous administration of a tapering dose of corticosteroids and antipyretic therapy. A simple MRI scan (3D-FLAIR image) showed that the inner ear had a high signal before treatment, which normalized after treatment. Due to the widespread use of penicillin, the number of cases of syphilis in Japan has decreased dramatically since the end of World War II, and the disease is rarely encountered in daily clinical practice. However, the number of patients has increased in recent years, and it has become a social problem. The diagnosis is not easy due to the variety of symptoms and because multiple organs are involved. Furthermore, patients may hesitate to be interviewed because it is a sexually transmitted disease. Since otosyphilis is not uncommon, it should be included in the list of differential diagnoses in the daily clinical practice of otolaryngology. We herein report a case and review the relevant literature.

A 71-year-old man presented with diplopia and ptosis of the right eyelid, and a serious of examinations resulted in a diagnosis of right peripheral oculomotor nerve paralysis. He had sinusitis only on the paralyzed side, so we considered opening the maxillary sinus by endoscopic sinus surgery. However, a preoperative evaluation revealed complete occlusion of the internal carotid artery, so we decided against aggressive surgical treatment, considering the risk of complications associated with the introduction of general anesthesia. After consulting with the Department of Neurology at our hospital, we suggested decompression and drainage by puncturing the natural foramen of the maxillary sinus under local anesthesia, followed by infection control and anti-inflammatory treatment centered on steroids for acute neuropathy. Thanks to additional efforts to control the blood glucose level and improve the microcirculation with antiplatelet drugs, the patient was able to open his eyes after about one month, and his diplopia gradually improved with a subsequently relatively good course. It was thus considered important to consider the optimal treatment policy on a case-by-case basis, taking into consideration the underlying disease and complications.

Madelung's disease (benign symmetrical lipomatosis) is characterized by symmetrical fat accumulation at multiple sites in the neck, trunk and limbs. We experienced a case of Madelung's disease in which tracheostomy and lipectomy were required to treat airway stenosis. The patient was a 64-year-old man with a long history of heavy alcohol consumption. He presented with complaints of hoarseness, neck swelling, and shortness of breath on exertion. CT and endoscopy revealed airway narrowing due to fatty deposits in the subcutaneous tissue and within the larynx. We therefore performed lipectomy and tracheostomy. To achieve a better long-term outcome, abstinence from alcohol is essential; however, he could only abstain during hospitalization and started drinking after discharge. Since he had no intention to continue to abstinence and indicated that he did not wish to receive additional treatment, we decided not to close the tracheostomy, and a tracheal cannula was placed. When treating patients with Madelung's disease, it is crucial to consider surgical treatment (lipectomy and tracheostomy) when functional abnormalities, such as airway obstruction, are observed.

Large-cell neuroendocrine carcinoma (LCNEC) was first reported as a neuroendocrine carcinoma of the lung, and a small number of cases have been reported in the pharyngeal region. In this study, we experienced a rare case of primary LCNEC of the hypopharynx. The patient was an 86-year-old man. He presented with a chief complaint of dysphagia, with laryngeal fiber scans showing a neoplastic lesion extending from the right pyriform sinus to the laryngeal cavity. A biopsy was performed during a tracheostomy for airway obstruction, resulting in the diagnosis of LCNEC. We performed total laryngectomy, partial hypopharyngectomy, and right neck dissection. Four years have passed since the surgery, and no recurrence has been observed. Although the classification of head and neck LCNEC was not established until the third edition of the WHO classification, the disease has a poor prognosis and was revised to a high-grade classification in the fourth edition of the WHO classification. The addition of postoperative adjuvant chemotherapy to radical resection surgery is expected to improve the prognosis of head and neck LCNEC.

We experienced a rare case of acute throat ulcers that was thought to be caused by gastric acid reflux. The case was a 27-year-old man who became aware of a sore throat on the day after experiencing frequent vomiting episodes and impaired consciousness due to heavy drinking, and developed pharyngeal mucositis and white mucosal lesions. He was treated with antibiotics and steroids for acute epiglottitis, and his subjective symptoms and local findings improved. However, this case showed findings that did not match the typical cases of acute inflammation caused by bacterial infection. Based on the medical history, characteristic mucositis, and histopathological examination after discharge, we determined that the cause of acute inflammation was mucosal injury due to gastric acid reflux. Gastric acid reflux is considered to be one of the causes of multiple throat ulcers.