We herein report a case series of 18 cochlear implant users who underwent magnet resonance imaging (MRI). The loci of imaging were head/neck (9 cases), thoracic vertebrae (2 cases), shoulder (1 case), liver (1 case), lower vertebrae (2 cases), whole vertebrae (1 case), and pelvis (2 cases). Nine cases had MRI images that contains artifacts caused by the implanted device. Four cases experienced device-related, MRI-derived complications, and one of them underwent magnet replacement surgery. Among the different MRI sequences, diffusion-weighted images and apparent diffusion coefficient (ADC) maps were more negatively influenced by the magnet than T1- or T2-weighted or MR angiography images. Understanding the artifact size and affected structures when MRI is performed on cochlear implant users is useful for determining the indications of MRI and magnet removal surgery, not merely for otolaryngologists but for any healthcare professionals.

In most cases of pars tensa cholesteatoma, transcanal endoscopic ear surgery (TEES) can be performed with a clear view. Since September 2015, we have selected TEES as the basic procedure for pars tensa cholesteatoma. We classified 115 ears treated with initial surgery for pars tensa cholesteatoma between January 2010 and March 2020 at the Department of Otolaryngology, Kurume University Hospital, based on Japanese Otological Society staging system for middle ear cholesteatoma (2015). The selection of the surgical method, hearing outcomes, and the rate of recurrence due to residual cholesteatoma and reformation of cholesteatoma were determined. The surgical outcomes of the pre-TEES (n=61) and post-TEES (n=54) groups were compared. In the post-TEES group, 74% of the patients underwent surgery with TEES alone. There was a trend toward improved hearing success after the introduction of TEES. The rates of residual recurrence and reformation were similar in the pre-TEES and post-TEES groups.

Nitric oxide (NO) plays many roles in the human body, and the transoral exhaled NO concentration is considered a biomarker of lower airway inflammation. Although a high dose of NO is released from the nasal/paranasal sinuses, the number of reports focusing on this finding are limited. This study aimed to measure the transnasal exhaled NO concentration and investigate whether transnasal and transoral exhaled NO concentrations differ depending on the presence of nasal disease or its type. We succeeded in measuring the transnasal NO concentration, even in cases of severe nasal obstruction, by combining an NO concentration measuring device with part of a nebulizer device. The transoral NO concentration was higher in the following order: the sinusitis group, the allergic rhinitis group, and the control group. In contrast, the transnasal NO concentration was higher in the following order: the allergic rhinitis group, the sinusitis group, and the control group. The transnasal NO concentration is a useful biomarker for nasal diseases.

Tracheostomy, the most common way of creating a surgical airway, is sometimes difficult to perform and manage in high-risk cases, such as in patients with severe obesity, short neck, and long-term cannula management Several concerns regarding intraoperative and postoperative complications have been raised in such cases. In 2007, Kano et al. reported a new technique called cricoid cartilage fenestration (CCFn), and it has been confirmed to be a useful option for high-risk cases of tracheostomy. In our department, CCFn was performed in 13 patients between December 2020 and December 2021. Regarding these cases, post-resuscitation encephalopathy was observed in 7/13 (54%), cerebral hemorrhaging (including brainstem hemorrhaging) in 2/13 (15%), spinal cord infarction in 2/13 (15%), and other issues in 2/13 (15%). Obesity with a body mass index greater than 30 was observed in 4/13 (31%), and 5/13 (38%) were on anticoagulants. No patients had any complications or difficulties of insertion or had the tube fall out. Ventilator withdrawal was possible in 8/13 (62%). One of the two patients with spinal cord infarction was conscious and able to speak; however, they had upper limb motor dysfunction and difficulty speaking due to manual closure of the stoma. While CCFn is a safe technique in a difficult airway setting, it should be performed with caution in patients with upper limb motor dysfunction.

Angioleiomyoma is a benign tumor arising from subcutaneous tissue and is extremely rare in the external auditory canal. We herein report a case of angioleiomyoma arising from the external auditory canal resected with the canal wall down and reconstruction. A 47-year-old man visited an outpatient clinic with a complaint of ear fullness and was then examined for a tumor in the external auditory canal at our hospital. The preoperative diagnosis could not be determined by computed tomography, magnetic resonance imaging or cytology. Surgical resection was performed for a tumor of the external auditory canal, and the canal wall resected along with the tumor was reconstructed using cartilage. The removed tumor was histologically diagnosed as angioleiomyoma. The patient has been free from recurrence during 10 months of follow-up with no retraction of the canal wall. An adequate surgical margin should be recommended, as angioleiomyoma has the potential for malignant transformation or recurrence. We intend to observe the status of the tumor and the canal wall structure going forward.

Complete resection of glomus jugulare tumor (GJT) may result in postoperative inferior cranial nerve palsy. Therefore, a wait-and-scan policy is often chosen in elderly patients. Patients may suffer from pulsatile tinnitus for a long period of time. We performed intentional lateralization of the tympanic membrane for a GJT with pulsatile tinnitus. Case: A 67-year-old woman had had pulsatile tinnitus for 3 years. A reddish pulsatile mass was detected in the lower quadrant of the right tympanic membrane. The diagnosis of GJT (Fisch classification: Class C2) was made based on an imaging examination. Since there was no evidence of inferior cranial nerve palsy, a wait-and-scan approach was selected. However, pulsatile tinnitus caused insomnia and worsening depression. After obtaining her informed consent, we performed intentional lateralization of the tympanic membrane via transcanal endoscopic ear surgery. Immediately after the surgery, the pulsatile tinnitus disappeared. Intentional lateralization of the tympanic membrane may be a treatment option for GJT with pulsatile tinnitus.

The bone-anchored hearing aid (Baha; Cochlear, Sydney, Australia) implant system is based on the principle of osseointegration, which is fundamental to the survival of the implant. However, a history of exposure to irradiation compromises osseointegration, and there is a dearth of data regarding the outcomes of Baha implantation in patients who have undergone radiation therapy. We herein report the clinical results of Baha implantation in a patient who had a history of chemoradiotherapy. A 53-year-old Japanese man presented to our hospital because of suppurative otorrhea and hearing loss after undergoing chemoradiotherapy for nasopharyngeal cancer at 50 years old. He had been deaf in his right ear from 38 years old due to subtotal temporal bone resection for carcinoma of the middle ear. Based on a preoperative implant simulation using computed tomography, the implant site was set at the parietal bone, which was considered outside the irradiation area due to the radiation protocols conventionally used. The Baha implant was placed in his left parietal bone. Aided thresholds using the Baha implant indicated a benefit, with an improvement to 28dB. He was freed from the need for a conventional hearing aid, which helped stop the suppurative otorrhea. No adverse skin reaction was identified in the follow-up period for two years after Baha implantation. Implant stability was assessed by a resonance frequency analysis, which revealed an implant stability quotient of 52.

We report a case of carcinoma ex pleomorphic adenoma in the accessory parotid gland. The patient was a 48-year-old man who presented with a hard mass in his left cheek. We suspected an accessory parotid gland tumor based on an imaging examination. Fine needle aspiration biopsy revealed possibly pleomorphic adenoma. We performed surgical resection with an incision above the tumor, and the pathology results showed carcinoma ex pleomorphic adenoma. After the diagnosis, we performed postoperative chemoradiotherapy using cisplatin. There was no recurrence or metastasis during 27 months of follow-up. In this case, we chose to make a skin incision above the tumor, but after a postoperative review, we found that surgeons should consider an approach where neck dissection and parotidectomy can be connected by the same incision line.

A 56-year-old man presented with hoarseness, and laryngeal endoscopy revealed left vocal cord paralysis. Ultrasonography and contrast-enhanced CT revealed a tumor with an unclear boundary at the lower pole of the left thyroid lobe. Fine needle aspiration cytology showed malignant cells with strong nuclear atypia without the characteristics of papillary carcinoma. Thyroid cancer or other malignant tumors were suspected, and we performed resection of the left thyroid lobe, the tumor-infiltrated recurrent nerve, sternothyroid muscle, parathyroid gland, and surrounding adipose tissue. Immunohistochemical staining was positive for CD5, and negative for thyroglobulin and TTF-1 negative, leading to a diagnosis of intrathyroid thymic carcinoma: ITTC. Since the resection stump was negative and there was no distant metastasis, the patient was followed. Although ITTC has a strong tendency to infiltrate, the course is slower and the prognosis is better in comparison to anaplastic thyroid carcinoma and thyroid squamous cell carcinoma, and radical resection is the first choice of treatment. If a tumor with an unclear boundary is found at the lower thyroid pole and malignant cells different from papillary carcinoma cells are found on cytology, it is important to differentiate this disease and to perform radical resection with a negative margin.

We herein report 13 suggestive cases of spontaneous dysgeusia (SD), including an examination of the features of SD. Our study revealed that SD resembles glossodynia regarding the symptoms and background characteristics, to the extent that it is often difficult to distinguish between the two. The oral sensation is affected by the surrounding atmosphere. SD is one of the known oral sensations. In our study, 62.7% of SD patients reported having some degree of stress in their family life. The number of SD patients has shown an increasing trend in recent years; for example, while 14 SD patients visited our clinic from 2007 to 2009, this number increased to 65 from 2019 to 2021. We suspect this increase is due to aging or caring for a family member. The second taste area is known to be activated when people see an angry expression. Indeed, a few patients reported noticing SD when they witnessed a family member do an angry expression. Unpleasant tastes and disgust are memorialized in the amygdala. Unpleasant information stimulates the amygdala, and unpleasant tastes are generated in the brain, which patients realize on the tongue. We conclude that this is the mechanism underlying the development of SD.

Ectopic thyroid gland is an embryological abnormality in which thyroid tissue is present outside the appropriate location of the thyroid gland, often occurring in the midline of the neck. We report a case of suspected ectopic thyroid cancer originating from the lateral thyroid primordium and arising in the lateral neck. The patient was a man in his 60s who was aware of a right neck tumor that had been gradually enlarging for half a year. At the first visit to our hospital, he had a cystic mass in his right neck. Fine-needle aspiration cytology raised the suspicion of metastasis of adenocarcinoma of unknown primary. However, we subsequently performed lumpectomy and diagnosed papillary thyroid carcinoma. This mass was cystic; however, although it was huge for lymph node metastasis, it was single a single mass of unknown origin because no lymph node structure was seen. Since the patient was at high risk of postoperative recurrence, we judged that internal radioactive iodine therapy was appropriate and performed total thyroidectomy and D1 dissection. Postoperative pathological examination revealed papillary carcinoma in both lobes and no lymph node metastasis. Postoperatively, he received radioactive iodine therapy and is currently under observation.

In recent years, immune checkpoint inhibitors (ICIs) have been widely used in cancer treatment, but various types of immune-related adverse events (irAEs) can be caused by ICIs, so it is necessary to be alert for such side effects. Among potential irAEs, neuromuscular-related adverse events are characterized by a range of symptoms and can be difficult to diagnose. We herein report a case of irAE myositis with dysphagia as the initial symptom. Although steroid treatment was started, the patient was referred due to symptoms such as no improvement in mild aspiration, and a dysphagia evaluation and multidisciplinary dysphagia rehabilitation were continued under the leadership of an otolaryngologist. The dysphagia gradually improved, and the patient was eventually able to advance to the next chemotherapy line. An early evaluation of the swallowing function and its rehabilitation are considered important for improving the general condition and prognosis of patients with irAE myositis caused by ICIs.

We experienced a case of idiopathic superficial temporal artery aneurysm. As the case was suspected of being a mass lesion, puncture aspiration cytology was performed. There was a previous report of a case in which hemostasis took a long time, so it is important to differentiate between the two by the presence of trauma, beating and Terrier's sign, as well as imaging studies using ultrasonography and computed tomography/computed tomography angiography.

Patients with dizziness have frequent autonomic nerve symptoms, such as nausea and vomiting. In the present study, I focused on nausea associated with dizziness in patients who were prone to develop motion sickness compared with those lacking any such tendency. Among the patients who visited my department and complained of dizziness during the 5-year period from August 2016, 198 males and 603 females whose medical records mentioned motion sickness and nausea tendencies were included in this study. Thirty-three male patients were prone to develop motion sickness, and 21 of them (63.6%) also had nausea. One hundred and sixty-five male patients were not prone to develop motion sickness, and 92 of them (55.8%) also had nausea. Two hundred and twelve female patients were prone to develop motion sickness, and 161 of them (75.9%) also had nausea. Three hundred and ninety-one female patients were not were prone to develop motion sickness, and 223 of them (57.0%) also had nausea. Although there was no statistically significant difference among males, a significant difference was observed among females. These results show that individuals prone to develop motion sickness developed dizziness more frequently than those without such a tendency. A relationship between motion sickness and dizziness has been suggested. Equilibrium dysfunction is considered to be associated with dizziness and nausea, causing autonomic nerve symptoms to appear via central neural pathways.