From March 2023 to December 2023, 1,500 cases with dizziness visited our clinic. Among these, 369 were migraine cases, representing 24.6% of all dizziness cases. Of these, 57 were confirmed to be vestibular migraine (VM). This accounted for 3.8% of all dizziness cases. We studied the effectiveness of Migsis^® + Merislon^® + Adetphos^® in 37 VM patients who were followed for 4 weeks. The headache improvement rate with Migsis alone was 28.6%, while that with combination therapy was 43.2%. However, the efficacy was deemed insufficient, suggesting the need for additional medications and long-term treatment. Dizziness was evaluated using the Dizziness Handicap Inventory (DHI) score: initial visit, 45.4 ± 19.8 points；2 weeks, 32.1 ± 24.4；4 weeks, 22.1 ± 22.1 points. Significant improvements in comparison to baseline were observed at 2 and 4 weeks. This combination resulted in an early improvement in dizziness, with a 62.2% improvement rate. In contrast, the improvement rate with Migsis^® alone was 46.4%. Combining prophylactic migraine medication with anti-dizziness medication for endolymphatic hydrops was associated with some improvement in both headache and dizziness; however, further research is needed. To prevent VM, it is important to consider multiple prophylactic medications, as well as medications to reduce intracranial pressure and treat endolymphatic hydrops. Educating patients on self-management strategies is crucial for the effective treatment of VM.

Cervical abscesses, also known as Bezold's abscesses, are an extracranial complication of otitis media. With the development and widespread use of antimicrobial agents, this condition is now rare. Cases of congenital aural atresia with external auditory canal cholesteatoma and cervical abscess are extremely rare. We report the case of a 25-year-old male patient with congenital aural atresia who developed an external auditory canal cholesteatoma leading to a cervical abscess. He had been diagnosed with left microtia and left hearing loss since childhood, but he had not visited a medical institution. Ten days before his first visit to our hospital, he experienced left ear pain and difficulty opening his mouth. The left external auditory canal was closed, and a temporal bone contrast computed tomography (CT) scan showed abscess formation around the left mastoid process. Based on the suspicion of left external auditory canal cholesteatoma and Bezold's abscess with congenital aural atresia, the patient was treated with antimicrobial therapy and underwent surgery. The cholesteatoma filled the tympanic and mastoid cavities, and the inferior wall of the ear canal was destroyed, forming a bony fistula. The cholesteatoma, which had extended into the parotid abscess cavity, was completely removed. At 1 year and 3 months postoperatively, there was no evidence of infection or recurrence.

A sinonasal fungus ball is extremely rare in the frontal sinus (FS), as the FS is located on the anterior cranial floor and closely proximal to the orbit. The anatomical location and morphology of the FS make it difficult to remove the fungal mass, and surgery is required to remove the fungal mass and open the FS ostium. Given that fungal infections may recur due to postoperative stenosis of the FS ostium, the surgical approach should be thoroughly reviewed preoperatively. We herein report a rare case of a sinonasal fungus ball of the right FS in a 71-year-old man treated with Draf type IIb surgery. For FS fungus balls, the surgical approach to the FS should be considered based on a preoperative imaging diagnosis. In the present case, removal of the fungal mass by shaving enough bone from the FS floor seemed to be able to cure the disease without recurrence.

Small cell carcinoma of the head and neck is rare and has a poor prognosis due to early distant metastases. There are no established standard therapies for this disease, so it is treated in the same manner as small cell lung carcinoma. We herein report a case of maxillary sinus small-cell carcinoma with multiple metastases that was successfully treated with pembrolizumab. An 85-year-old man presented with proptosis, poor vision, and diplopia. A detailed examination led to a diagnosis of small cell carcinoma spreading from the right maxillary sinus to the orbit, zygoma, and ethmoid sinus, and multiple liver and bone metastases. Due to his advanced age, the patient received palliative radiotherapy for the right maxillary sinus and immunotherapy with pembrolizumab. The maxillary sinus tumors and hepatic metastases showed a complete response after 6 months of immunotherapy. Pembrolizumab may be a new option for the treatment of small cell carcinomas of the head and neck with metastasis.

Inverted papilloma arising from the sphenoid sinus is rare. The first choice of treatment for inverted papillomas of the nasal and paranasal sinuses is complete surgical excision of the tumor. The sphenoid sinus is anatomically surrounded by important structures, such as cranial nerves II-VI, the internal carotid artery, and the cavernous sinus. Excising tumors without damaging these structures during surgery is crucial. Furthermore, very few reports have described the procedure for excising tumors that extend into the lateral fossa of the sphenoid sinus. We herein report a 53-year-old woman with inverted papillomas occurring simultaneously in the right maxillary and left sphenoid sinuses who underwent endoscopic sinus surgery (ESS). One year and four months after the initial surgery, the papilloma that extended to the lateral fossa of the left sphenoid sinus was excised by ESS via the left pterygopalatine fossa. If possible, an inverted papilloma extending to the lateral fossa of the sphenoid sinus should be excised using ESS. However, depending on the nature of the tumor, removal via the pterygopalatine fossa should also be considered.

Atypical parathyroid adenoma (APA) is a rare condition that is considered to be a borderline condition between adenoma and cancer. We herein report a case of APA. A 61-year-old man was referred to our department for a preoperative evaluation of lung cancer. Positron emission tomography-computed tomography showed an abnormal accumulation in the dorsal right lobe of the thyroid gland. Based on various examinations, the patient was suspected to have primary hyperparathyroidism due to the presence of adenoma and therefore underwent adenoma resection. The mass was resected, although it adhered to the surrounding tissues, such as the thyroid gland and the right recurrent nerve. The postoperative pathological diagnosis was APA, and the tumor cells were exposed on the resected surface, thus resulting in a positive surgical margin. The postoperative serum calcium levels thereafter normalized. The intact PTH level initially normalized one month after surgery, however, it later rose again, and remained above the upper limit of normal. A careful follow-up is needed, although no recurrence has been reported to date. When a parathyroid tumor adheres to the surrounding tissues during resection, the possibility of APA is suspected, and the surrounding tissue should therefore be removed a far as possible.

Acceleration is applied to humans during their postural retention and movement. The equilibrium center receives input from the visual, vestibular, and somatosensory systems, while the vomiting center receives input from the gastrointestinal tract. An input that cannot be regulated by the equilibrium center results in an equilibrium disorder, and an input that cannot be controlled by the vomiting center results in vomiting. Because the vomiting center has greater regulatory capacity than the equilibrium center, a sustained and large input is required to induce vomiting. In the vomiting center, the magnitude of the input from the gastrointestinal tract affects the input from the equilibrium center. During childhood, individuals with a greater gastrointestinal input are thought to develop complex and large neural networks around the two centers, which inhibit vomiting. Individuals with stronger inhibitory functions are more likely to experience vomiting when equilibrium dysfunction occurs. Individuals with stronger inhibitory functions are more likely to experience vomiting when equilibrium dysfunction occurs. Vomiting that occurs in association with vestibular disorders involves equilibrium disorders, afferent input from the gastrointestinal tract to the vomiting center, the neural network around the equilibrium and vomiting centers, and the individual characteristics of the vomiting center.

We investigated the psychological background and mechanism of onset of juvenile hypersalivation in patients under 29 years of age who chiefly complained of hypersalivation. A psychological test and questionnaire revealed that most participants had some social anxiety in their background. A comparison study of juvenile hypersalivation and juvenile dry mouth, along with the analysis of 1,517 cases of dry mouth, showed that the amount of saliva depends on the affected period. Psychological obsession or fixed attention sometimes cause functional disorders and organic changes. When these individuals have social anxiety, they concentrate and obsess on saliva for a long time, even over trivial things. Juvenile hypersalivation is first caused by social anxiety, and thereafter hypersalivation tends to occur continuously. The amygdala is activated when these individuals experience social anxiety. The central nucleus of the amygdala (CeA) directly or indirectly leads to the superior salivary nucleus and is also related to plasticity diseases, such as the learning of fear conditioning. Juvenile hypersalivation is a type of plasticity disease caused by a long obsession with saliva. The CeA also controls social behavior or individual distance, and is related to social anxiety. Juvenile hypersalivation associated with social anxiety is closely related to the amygdala. Although treating the disease is challenging, we should focus on reducing the patient's excessive consciousness of hypersalivation rather than improving it. We conclude that preceding psychological obsession or fixed attention causes hypersalivation；therefore, relaxation of the individual could normalize the volume of saliva.