Postoperative bleeding in tonsillectomy is one of the most serious complications, as it can cause airway obstruction and is sometimes fatal. In 176 patients who underwent bilateral tonsillectomy at our department, we investigated the rate and timing of postoperative bleeding and risk factors. Risk factors included the primary disease, age, sex, smoking history, history of hypertension or diabetes, use of anticoagulant/ antiplatelet drugs, peripheral blood platelet count, history of peritonsillar abscess, ligation, adhesion, and operative time. Postoperative bleeding occurred in 53 patients (30.1％). Among them, 5 cases (2.8％) required hemostasis under general anesthesia. Regarding the risk factors for postoperative bleeding, only the operation time was found to be significantly related, and postoperative bleeding was found to be particularly frequent when the operation time was ≥90 minutes.

A 40-year-old woman had bilateral mixed hearing loss with air-bone gap and no stapedial muscle reflex. She had blue sclera and a history of bone fracture with osteogenesis imperfecta. We made the diagnosis of van der Hoeve syndrome based on these clinical symptoms, signs, and examination findings. In the left ear, stapedotomy was attempted, but the footplate was fractured. Partial stapedectomy was thus performed with removal of the posterior half of the footplate. In the right ear, stapedotomy was performed successfully. After the surgery, her bilateral hearing loss improved. Hearing loss in cases of van der Hoeve syndrome is conductive loss and resembles that found in cases of otosclerosis. The present findings suggest that stapes surgery for van der Hoeve syndrome is valid, and stapedectomy is useful if carefully performed.

Cysts of different embryological etiologies may occur in the head and neck region, including congenital cysts, such as thyroglossal duct cysts, branchial cleft cysts, and lymphangiomas; and acquired cysts, such as plunging ranulas. The treatment of these cysts can be divided into two main categories: excision and sclerotherapy, such as OK-432. We herein report two cases in which OK-432 was effective in treating cysts in the pharynx that were refractory to repeated surgical removal and multiple puncture drainage. Case 1 was a woman in her 30s who had a cyst at the root of the tongue that had been resected twice but had recured within a few months. Case 2 was a woman in her 60s who had undergone repeated surgical procedures for a cyst on the root of the tongue over 30 years ago both cases were treated with OK-432, which allowed the cyst to shrink and remain in a reduced size. Some cysts in the head and neck region are rare, but they recur repeatedly and are refractory, making them difficult to treat. Sclerotherapy with OK-432 may be an effective outpatient treatment option for these cases that are difficult to treat surgically.

A 41-year-old woman was referred to our department for a fever and neck swelling. Her soluble IL-2R level was elevated at 3,619 U/㎖, and her platelet count was decreased at 59 × 10³/μℓ. Because of the high soluble IL-2 level, we strongly suspected malignant lymphoma and performed positron emission tomography. The presence of highly increased multiple aggregations in the right cervical lymph node and splenomegaly supported our suspicions of malignant lymphoma. On the day after the initial examination, her white blood cell count decreased to 3,000/μℓ, and the next day, a right cervical lymph node biopsy was performed under general anesthesia. Given the possibility of subacute necrotizing lymphadenitis, the patient was started on a steroid-tapering regimen. Postoperatively, liver enzymes were elevated, and we suspected hemophagocytic syndrome, but the patient's symptoms improved steadily, and a histological examination revealed subacute necrotizing lymphadenitis.

The concept of chronic rhinosinusitis (CRS) has shifted from the traditional clinical classification of phenotypes, which are largely based on the presence or absence of nasal polyps, to three inflammatory endotypes (Types 1, 2, and 3), based on specific mechanisms and molecular biomarkers. Treatment based on their pathological mechanisms has also changed significantly. The typical disease of Type 2 inflammatory CRS is eosinophilic CRS (ECRS), which has a characteristic clinical presentation different from that of previous bacterial CRS. Type 2 CRS and non-Type 2 CRS differ greatly, not only in their primary site of involvement but also in the cytokines and inflammatory cells involved in their pathogenesis. Therefore, even the conservative treatment methods and ESS (Endoscopic sinus surgery) techniques differ substantially between Type 2 and non-Type 2 CRS. Previous reports indicate that approximately half of all CRS cases involve Type 2 inflammation. When other endotypes are combined, 72％ of CRS cases are associated with Type 2 inflammation, and 87％ of CRS with nasal polyps are associated with Type 2 inflammation. The number of cases of eosinophilic sinusitis is increasing in Japan, and the number of uncontrolled CRS patients is also increasing under conventional classical treatment. This paper describes the pathogenesis of Type 2 inflammatory CRS, represented by ECRS, and discusses approaches to its diagnosis and treatment. In addition, steroid therapy, including the results of treatment in our institution, ESS methods, and biologic agents for Type 2 CRS, are also discussed.