In 2018, the new TNM classification (AJCC 8th edition) was introduced. We investigated the prognosis of nasopharyngeal cancer in 45 nasopharyngeal cancer patients who underwent first-line therapy at the Department of Otolaryngology, Head and Neck Surgery, Kyushu University between January 2010 and January 2020. There were 31 male and 14 female patients, ranging in age from 12 to 88 years old, with a median age of 59 years old. Of these, 40 patients with nasopharyngeal squamous cell carcinoma were evaluated for their five-year overall survival (OS) and progression-free survival (PFS) as well as prognostic factors. The 5-year OS rate was 75.5%, and the 5-year PFS rate was 64.3%. As prognostic factors, there were no significant differences in outcome by stage, histological type, and Epstein-Barr virus positivity. In addition, it was considered necessary to further investigate the optimal dose of cisplatin for chemoradiotherapy combined with cisplatin, which is the main treatment for nasopharyngeal cancer.

Recently, there have been reports of the supplementary effects of interference current (IFC) stimulation on swallowing dynamics and improvement of delayed swallowing reflexes, and the use of IFC in the treatment of dysphagia is desired. We investigated the effects of IFC combined swallowing training at our clinic in 14 patients who were evaluated with VF, and examined the results of the swallowing questionnaire and changes in the delay time of laryngeal elevation (LEDT) before and after training. Results showed that the number of A items in the questionnaire decreased in 8 (57.1%) cases (no significant difference; p=0.109 > 0.05). In addition, the mean LEDT was shortened from 0.46 ± 0.19 s before training to 0.33 ± 0.09 s after training, showing a significant difference (p=0.016 < 0.05). In conclusion, swallowing training with IFC was found to be effective in improving subjective symptoms and improving the delayed induction of pharyngeal phase swallowing, which was considered difficult to improve with conventional swallowing training.

We herein report four operative cases of temporal bone glomus tumors encountered between 2016 and 2021. Two of the cases were glomus jugulare, and the other two were glomus tympanicum. Characteristic symptoms included pulsatile tinnitus in the two patients with glomus tympanicum. Preoperative audiometry revealed conductive hearing loss on the affected side and air-bone gap in three patients. One of the glomus jugulare cases required three surgeries: a biopsy, resection, and reoperation. Vascular embolization was performed in all four cases. There was no evidence of pre- or postoperative neurologic deficit in any cases. No postoperative recurrence or regrowth was observed in any cases, and the patients are under follow-up. Because glomus tumors are rich in blood vessels, preoperative embolization and the use of a high-frequency bipolar coagulator may aid in performing safe surgery.

We performed surgical treatment for a case of aberrant carotid artery in the middle ear with pulsatile tinnitus. Case：The patient was a 19-year-old woman. For several years, pulsatile tinnitus gradually increased and hearing loss appeared. A red pulsatile mass was found in the anterior lower quadrant of the tympanic membrane. Temporal bone CT and contrast-enhanced MRI revealed that the cause of the pulsatile tinnitus was an aberrant carotid artery in the middle ear. We performed surgical treatment. Intentional lateralization of the tympanic membrane was performed using sliced cartilage. Type IIIc tympanoplasty was performed using a long columella. After surgery, the pulsatile tinnitus disappeared and the conductive hearing loss improved. Intraoperative bleeding was minimal. There are controversial opinions regarding the surgical treatment of this disease. However, there is no significant risk when surgery is performed after an adequate preoperative evaluation. Intentional lateralizing of the tympanic membrane and reconstruction of the ossicles using a long columella may be effective for eliminating pulsatile tinnitus and improving conductive hearing loss.

Although temporal bone fractures are known to be able to cause perilymphatic fistulas (PLFs), the diagnosis of PLFs is difficult. Therefore, PLFs due to temporal bone fractures may be missed. We herein report a case of bilateral PLFs due to bilateral temporal fractures. Case: After receiving intensive treatment for acute subdural hematoma caused by a traffic accident, an 18-year-old girl showed bilateral facial nerve palsy. Her neurosurgeon consulted us for a clinical examination. The patient was able to walk and did not complain of vertigo. Therefore, vestibular disorder was not suspected. In addition to bilateral facial paralysis and bilateral hearing loss, the patient had difficulty standing up while blindfolded. Vestibular function tests revealed spontaneous nystagmus and positional nystagmus. PLF was suspected, so bilateral exploratory tympanotomy was performed. Lymphatic leakage from the bilateral inner ear windows was observed, and bilateral inner ear window closure was performed. The day after surgery, she was able to walk with a blindfold. PLF may be suspected in cases of temporal bone fractures, even without complaints of vertigo. Therefore, a careful examination by an otorhinolaryngologist should be requested.

Skull-base metastasis of malignant tumor shows various clinical symptoms, including cranial nerve palsy symptoms (e.g., headache, diplopia, dysarthria, and dysphagia), which depend on the position of metastasis. We report a case in which acute deafness and dizziness revealed skull-base metastasis of renal cell carcinoma. As in this case, symptoms like deafness, dizziness, dysphagia, and dysarthria, which are the first symptoms of otolaryngology, may appear as the initial clinical symptoms. Nerve palsy reduced the patient's quality of life. If such symptoms are observed in cancer patients, it is desirable to distinguish skull base metastasis using imaging tests, and to refer the patient for radiation therapy.

An 18-year-old male patient had developed epileptic seizures with loss of consciousness 3 years earlier, and despite subsequent drug treatment, he still had recurrent epileptic seizures. Imaging studies revealed a meningoencephalocele with protrusion of the temporal lobe from the middle cranial fossa to the lateral fossa of the sphenoid sinus. Since this was thought to be the focus of the temporal lobe epilepsy, he was admitted to our hospital for resection of the meningoencephalocele. The patient underwent transnasal endoscopic resection of the meningoencephalocele in the lateral fossa of the sphenoid bone, followed by multilayer skull base reconstruction using a pedicled middle turbinate mucosal (MT) flap. Postoperatively, the epileptic seizures disappeared, and the patient has recovered without cerebrospinal fluid leakage or wound complications. If the area is localized near the sphenopalatine foramen, such as the lateral fossa of the sphenoid sinus, an MT flap can be used instead of a nasal septal mucosal flap. Furthermore, by using a minimal transpterygoid approach and preserving the sphenopalatine artery and its branch, the middle turbinate artery, it was possible to use the MT flap during skull base reconstruction.

We herein report a case of inflammation of a pendulous tonsil that was initially suspected of being malignant. A teenage girl had been experiencing discomfort when swallowing for several years and visited a local doctor because of sudden dysphagia and hemoptysis. The pharyngeal cavity was narrowed by a dark-red mass about 3cm in diameter with a base near the right inferior tonsillar pole, and the patient was referred to our department the next day under suspicion of a hemangioma of the oropharynx. At the initial visit, the mass was erythematous and swollen with white moss. Blood tests showed a mild inflammatory reaction, but the coagulation function was normal. Contrast-enhanced magnetic resonance imaging suggested malignant lymphoma or a malignant solid tumor as possible differential diagnoses. One week later, the inflammation of the mass had subsided, and the appearance resembled the right palatine tonsil. A biopsy showed inflammation of the tonsil tissue. Three weeks after the initial visit, tonsillectomy was performed. A histopathologic examination revealed that the mass was hyperplasia of the tonsil and was not malignant.

Laryngeal leiomyosarcoma is a rare malignant tumor of the larynx. Its symptoms are nonspecific and difficult to diagnose, and no treatment has been established. We report a case of laryngeal leiomyosarcoma. The patient, a 57-year-old man, presented to our hospital with a polyp on the left vocal fold that was unresponsive to conservative treatment. Flexible fiberscopy showed a submucosal tumor in the anterior third of the left vocal fold, which was suspected to be a left vocal fold cyst, and direct laryngoscopy was performed. One month after surgery, the tumor recurred, and laryngeal stroboscope showed loss of mucocutaneous wave motion over the entire left vocal fold, leading us to suspect a submucosal malignant tumor. Based on a second examination by direct laryngoscopy, the case was diagnosed as laryngeal leiomyosarcoma. Vertical partial laryngectomy was selected for curative resection. Six months have passed since the surgery, and the patient has progressed without local recurrence. Although total laryngectomy was often selected in the relevant literature, vertical partial laryngectomy should be considered as a treatment option from the viewpoint of the extent of the tumor and the preservation of postoperative phonation.

Actinomycosis is an inflammatory disease caused by infection with Actinomyces spp. In recent years, the prevalence of the acute form, which is characterized by local inflammation and pain, has decreased, while that of the chronic form, which causes mass formation, has increased. Actinomycosis is most common in the head and neck region, and laryngeal lesions are extremely rare. We herein report a case of laryngeal actinomycosis that had to be distinguished from malignancy. A 71-year-old woman was referred to our hospital with a chief complaint of hoarseness for the past two months. Laryngoscopy revealed a necrotic white mass in the glottis and paralysis of the left vocal cord, which were clinical findings that required a differential diagnosis from malignancy. A tissue biopsy was performed for the same area, and a diagnosis of laryngeal actinomycosis was made. Paralysis of the left vocal cord was considered an inflammatory change. The patient was treated with amoxicillin for eight weeks and has had no recurrence since then. The diagnosis of this disease is often difficult because of its rarity. An early diagnosis can be made by keeping this disease in mind when a mass lesion is identified.

A 73-year-old male with hoarseness caused by leukoplakia of the left vocal cord was been referred to our department. A polyp-like mass in the anterior part of the right vocal cord has developed 13 months after the first visit, which was diagnosed as spindle cell carcinoma (T1aN0M0) by excisional biopsy under general anesthesia and postoperative imaging. Since the surgical margin was negative, adjuvant therapy was not performed, and the patient is alive without recurrence at 18 months postoperatively. Spindle cell carcinoma is categorized as a subtype of squamous cell carcinoma, and consists of biphasic squamous cell carcinoma and spindle cells. Although the larynx is the most frequent site of spindle cell carcinoma of the head and neck, it accounts for only 1% of laryngeal tumors. Laryngeal spindle cell carcinoma is often characterized by a polyp-like appearance and exophytic growth, and should be carefully distinguished from benign lesions. While surgery is widely performed as a definitive treatment,the roles of radiation therapy and medical therapy are not proven due to the rarity of the disease. Thus, further molecular biological research to identify the targetable alternations is warranted.