We experienced 15 surgical cases of petrous apex-11 cholesteatomas and 4 cholesterin granulomas-between January 2013 and July 2021. Among the four cases of cholesterin granuloma, one underwent transmastoid surgery, while the others received intranasal endoscopic surgery to create drainage routes. Among the 11 cases of cholesteatoma, 5 received initial surgery, and 6 were reoperations. The extent of the lesion based on Sanna's classification was supralabyrinthine in seven patients, massive in two, and infralabyrinthine in two. In the supralabyrinthine type, the middle fossa approach or combined approach of the middle cranial fossa and translabyrinthine approach was necessary in cases with severe extensions or those receiving reoperation. The minimally invasive procedure through the superior semicircular canal approach was performed in cases with a small extension. In the massive type, the transcochlear and middle fossa combined approach was used, while in the infralabyrinthine type, the infracochlear or infralabyrinthine approach was performed, depending on the localization and degree of the extension. The hearing was preserved in all cases of cholesterin granuloma and three cases of cholesteatomas. Since the petrous apex is located in the deepest part of the temporal bone, it is crucial to have a thorough understanding of the anatomy and select a surgical approach that considers the lesion and hearing.

Vestibular rehabilitation was performed for 22 in-patients with acute unilateral vestibular dysfunction from June 2019 to February 2022. Individual vestibular rehabilitation by a physical therapist was started as soon as possible after admission, and the motor function was evaluated using the Timed Up and Go Test (TUG) and Five-Times-Sit-to-Stand Test (FTSST). The median time from the onset of the disease to the start of vestibular rehabilitation was five days. There were no adverse events. Both the TUG and FTSST time decreased significantly after vestibular rehabilitation. The patients were divided into two groups − those 40 to 69 years old and those 70 to 89 years old − but no significant differences were observed between the groups. In five patients, the Dizziness Handicap Inventory and total trajectory length with eyes closed on posturography were examined. Both values improved with no significant differences. Individual vestibular rehabilitation by a physical therapist improved the motor function of patients with acute unilateral peripheral vestibular disorders.

We have already reported that low-dose SSRI therapy for PPPD is associated with an efficacy rate of 75.9%. The treatment outcomes of SSRI therapy for each subtype of PPPD have not yet been reported, and this is the first report. Low-dose SSRI therapy was effective for all subtypes of PPPD (visual-dominant type, active motion-dominant type, and mixed type). In particular, the visual-dominant type was considered refractory given its high Dizziness Handicap Inventory (DHI) score, although the degree of improvement of the Niigata PPPD Questionnaire (NPQ) with low-dose SSRI therapy was significantly higher than that of the active motion-dominant type. This suggests that low-dose SSRI therapy may be effective for visual-dominant type PPPD, despite its higher severity prior to the initiation of treatment. Low-dose SSRI therapy is also expected to be effective for OD as a preceding dizziness disorder.

Most cases of dental implant displacement into the maxillary sinus have historically been removed via the canine fossa approach, but in recent years, there have been some reports of endoscopic endonasal sinus surgery (ESS) performed by otorhinolaryngologists. In this study, we reviewed cases in which ESS was performed in our department for maxillary sinus implants. In all cases, we were able to remove the dental implants by opening the natural opening of the maxillary sinus of the middle nasal passage. The combination with other sinus operations and nasal cavity improvement procedures resulted in a good outcome. The prognosis was good, and ESS was deemed an effective treatment for dental implant displacement into the maxillary sinus and associated sinusitis. However, the optimal approach should be selected after careful consideration of the size and location of the stray foreign body.

Stuttering is a disorder of speech fluency. It occurs primarily in early childhood but may persist beyond elementary school age, resulting in negative consequences in academic and professional activities that require conversation. We started a stuttering clinic for all age groups in September 2017, with 239 new visits through August 2021. We examined changes over time with respect to the route of visit and place of residence. The results showed that more than half of the patients came via the Internet when the stuttering outpatient clinic first started, and referrals from other institutions and from family members and acquaintances have increased. In addition, although our clinic is located in Kurume City, we found that the number of patients coming from outside Kurume City and Fukuoka Prefecture has also increased. In conclusion, we found that there are many patients who have problems with stuttering with few places that accept them, so many patients travelled from locations far away from the clinic. We need to continue to cooperate with doctors and speech-language pathologists to support patients who stutter.

The early diagnosis of tuberculous otitis media, the number of cases of which has been decreasing in recent years, is desirable, as tubercle bacilli are transmitted via air; however, an accurate diagnosis can often be time-consuming. We herein report a case of tuberculous otitis media that was difficult to diagnose. The case was a 76-year-old man who started conservative treatment for chronic otitis media, but his improvement was poor, so his intractable otitis media was investigated closely; however, a definitive diagnosis was not reached. Tubercle bacillus was detected in the white moss-like lesion that appeared in the nasopharynx, leading to the diagnosis of tuberculous otitis media. By examining the factors that made the diagnosis difficult in this case, it was considered that an earlier diagnosis would have been possible.

Early-stage oropharyngeal and hypopharyngeal cancer is often found by upper gastrointestinal endoscopy in the field of gastroenterology. Compared to upper gastrointestinal endoscopy, laryngeal fibers have a lower resolution and therefore it is sometimes difficult to observe these lesions. Using a nasal endoscope to facilitate the evaluation of lesions that are difficult to diagnose with laryngeal fibers, I was successfully able to make a diagnosis. Making accurate observations with an endoscope, especially NBI (narrow and imaging), is important for diagnosing early cancer and determining the extent of a lesion. Especially in cancer-based hospitals, endoscopy may be indispensable for the diagnosis and observation of early-stage cancer.

Oral candidiasis is one of the most common oral opportunistic infections seen in association with human immunodeficiency virus (HIV) infection and is considered the initial manifestation of HIV. We herein report two patients with non-pseudomembranous candidiasis that proved to be the first indicator of HIV infection. Case 1 was a 69-year-old male. An oral examination revealed erythematous mucosa and atrophy of the lingual papillae of the tongue, which was diagnosed as mycosis. He had frequently traveled to Thailand. An HIV antibody test was positive. Case 2 was a 44-year-old male. An oral examination revealed atrophic findings on the tongue and a small ulcerative lesion at the midline of the tongue. A biopsy revealed oral candidiasis, and a diagnosis of midline rhomboid glossitis due to Candida was made. An interview revealed that he was a homosexual, and an HIV antibody test was positive. Oral candidiasis can be the initial indicator of underlying HIV infection. An early diagnosis/intervention with HIV treatment is important for improving the prognosis and preventing spread of the infection. Thus, otolaryngologists, who make many oral observations, should be aware of the characteristics and presentation of erythematous and hyperplastic candidiasis as early marker for HIV infection, especially in patients with no other immunosuppressive status.

An ectopic thymoma occurring in the neck is rare. We herein report a case of ectopic cervical thymoma. The patient was a 53-year-old woman who visited our hospital with a complaint of an anterior cervical mass found during a medical examination. Cervical ultrasonography, computed tomography and magnetic resonance imaging revealed a 40 × 30 × 50 mm anterior cervical mass located caudal to the left lobe of the thyroid. Malignant lymphoma or Castleman's disease was suspected according to the fine-needle aspiration cytology findings. The patient underwent wedge resection of the tumor, resulting in a histopathological diagnosis of thymoma. Subsequently, we performed total resection of the thymoma. Thymoma sometimes behaves as a malignant tumor by invading the surrounding stroma or disseminating to distant organs. Ectopic cervical thymoma should be treated as a potentially malignant tumor. Complete resection of the tumor is required for the curative treatment of ectopic cervical thymoma. Because a preoperative diagnosis of ectopic cervical thymoma is difficult, it should be borne in mind that thymomas can occur in the neck.

1. We conducted a questionnaire survey to investigate the impact of mask-wearing, a preventive measure against COVID-19 infection, on children and adults with hearing loss in Japan and received responses from 135 participants. 2. Children and adults with hearing loss rely not only on their hearing but also on facial expressions, especially mouth movements, of their conversational partners to extract information. When a mask covers the mouth of the conversational partner, understanding conversations becomes very difficult for people with hearing loss. This finding was confirmed by our questionnaire survey. 3. Advances in hearing aids are expected to improve the ability to obtain auditory information. 4. However, the real problem is that people with normal hearing cannot detect the disability of people with hearing loss based on their appearance. 5. To solve this issue, people with hearing loss as well as otolaryngologists should make efforts to promote awareness regarding the hearing loss symbol among the general population.