Somatic cough syndrome (psychogenic cough) is one of the causes of persistent cough. The clinical features of 19 patients diagnosed as having somatic cough syndrome were examined by analysis of the data entered in their medical records.

　The subjects ranged in age from 4 to 50 years, and 18 patients were under 18 years old. Eight patients were male and 11 were female. Eight patients had visited more than one clinic or hospital prior to visiting our hospital. Two children had been hospitalized with a diagnosis of acute subglottic laryngitis. At our hospital, 14 patients had visited multiple departments, and 15 patients had been examined by otorhinolaryngologists. Five patients had comorbid bronchial asthma, and three had comorbid developmental disorders/retardation. The cough had lasted for more than 2 months in 12 patients. Seven patients had suffered from cough for more than 2 years, and the patient with the longest duration of cough had suffered from cough for 15 years. The type of cough was dry cough in 12 patients, barking cough in 6 patients, and the throat-clearing type in 4 patients. Some of the patients also had complaints of throat discomfort/pain, dyspnea, hyperventilation, and weakness of the lower limbs. Nighttime cough was recorded in 17 cases. There was no nighttime cough in 15 patients, however, the two patients with asthma had nighttime cough. A total of 14 patients had undergone laryngoscopic examination. While some patients coughed throughout the time they spent in the consultation room, 9 patients had no cough during their laryngoscopic examination. Some psychosocial problems at school and/or at home had been reported for 6 patients. After the correct diagnosis was made, 8 patients were referred to experts in psychology or psychiatry. Three patients were cured and three patients discontinued their visits on their own.

　The diagnosis of and intervention for somatic cough syndrome take time and effort. A multidimensional approach is important to treat patients with dry or barking cough, which are often persistent and resistant to commonly used medications.

　The following background factors have been identified as being associated with an increased frequency of detection of drug-resistant Streptococcus pneumoniae (DRSP) in pediatric patients with upper and lower respiratory tract infections: attending group care and/or having a sibling attending group care (group care factor) and age below 2 years (age factor). Following the introduction of the pneumococcal conjugate vaccine (PCV), there have been changes in the association of these two factors with the identification of DRSP. In other words, studies have reported that following the introduction of PCV, the frequency of detection of DRSP has decreased in pediatric patients, and that attending group care and age below 2 years were no longer associated with an increased frequency of detection of DRSP. However, there has been limited research of this issue in the field of otorhinolaryngology. Therefore, this study was conducted to retrospectively examine the changes in the frequency of detection of DRSP in relation to background factors in pediatric patients with acute rhinosinusitis after the introduction of PCV. This study included pediatric patients with acute rhinosinusitis in whom S. pneumoniae was isolated. The study population comprised of 547 patients recruited from 2005 to 2009 (period I, before the introduction of PCV) and 495 patients recruited from 2016 to 2020 (period II, 3 years following the introduction of PCV13). Our results showed that the frequency detection of DRSP was significantly lower in period II than in period I, and that attending group care and age below 2 years were no longer factors associated with an increased frequency of detection of DRSP in period II. Furthermore, these results suggest the effectiveness of PCV in reducing the frequency of detection of DRSP.

　Although an emergency medical system for otorhinolaryngology has already been established in each prefecture or each medical care zone in Japan, the actual status of functioning of the system differs depending on the prefecture. In the present study, the regional medical committee of the Oto-Rhino-Laryngological Society of Japan conducted a questionnaire survey of members of the prefectural district subcommittees to determine the status of this emergency otorhinolaryngology system. Respondents from 40 prefectures indicated that their prefectures did have an emergency regional otorhinolaryngology system, whereas respondents from seven prefectures indicated that they did not have such a system. Some of the issues with the emergency otorhinolaryngology system that were highlighted in the survey responses were the considerable burden of work on the otorhinolaryngologists and the uneven distribution of otorhinolaryngologists. Among the most frequently suggested solutions for these issues are an increase in the number of otorhinolaryngologists, as well as improved benefits and greater financial compensation for otorhinolaryngolists. In order to establish and maintain an emergency otorhinolaryngology system within Japan's prefectures, there is a need not only for greater coordination between regional physicians' groups and local governments, but also for consolidation of the existing emergency otorhinolaryngology frameworks, while promoting reforms in the working style of otorhinolaryngologists.

　Recently, syphilis has become a major public health problem in Japan. We report seven cases of syphilis that were encountered in the otorhinolaryngology department at the Osaka Police Hospital over a period of one year and five months. Five of the seven patients were diagnosed as having pharyngeal syphilis. The butterfly appearance, one of the characteristic findings of pharyngeal syphilis, was found in two patients. Four patients had cervical lymphadenopathy, and three of them did not have any cervical tenderness. One of these four patients presented with only cervical lymphadenopathy, with no associated pharyngeal findings, and was diagnosed as a case of syphilitic cervical lymphadenopathy. Evidence of neurosyphilis was found in four of the seven patients. Vestibular dysfunction was found in two patients, and facial palsy in one. The findings of pharyngeal syphilis disappeared rapidly after treatment. Thus, as the condition is eminently treatable, otolaryngologists should make an early and appropriate diagnosis of syphilis. Proactive cerebrospinal fluid examination and neurological examinations may be needed to rule out the possibility of asymptomatic neurosyphilis.

　We present the case of a 25-year-old female patient who presented with recurrent episodes of bleeding (5 times in total until presentation) after undergoing bilateral tonsillectomy for the treatment of recurrent tonsillitis. The preoperative blood examinations, including of the coagulation profile, did not reveal any particular abnormalities, and the tonsillectomy was typically performed without any problems. Subsequently, the patient presented with a history of recurrent hemorrhage after the surgery; of 5 episodes, surgical hemostasis under general anesthesia was required for 3. Serum tests for individual coagulation factors showed a decrease in the activity of factor XIII and, the patient was treated with factor XIII concentrate administered by intravenous injection. Following injection of factor XIII concentrate, the serum factor XIII activity increased markedly, and there has been no recurrence of the bleeding episodes. Therefore, in cases with recurrent postoperative bleeding in whom the preoperative coagulation function tests have failed to reveal any abnormalities, the possibility of factor XIII deficiency should be borne in mind, and where indicated, the bleeding should be controlled by administration of factor XIII concentrate.

　We report a case of thyroid carcinoma with pericardial metastasis who was treated with lenvatinib and showed a good prognosis. The patient, a 59-year-old man diagnosed as having thyroid carcinoma, had undergone subtotal thyroidectomy and radioactive iodine therapy with multiple resections for cervical and mediastinal recurrences and pulmonary metastases. Treatment with lenvatinib was initiated because of disease progression after the above treatments, and was found to be effective to reduce the number of metastatic tumors. However, the patient developed acute myocardial infarction, and lenvatinib was discontinued. He developed neoplastic pericarditis and cardiac tamponade after the discontinuation of lenvatinib. Therefore, lenvatinib administration at a reduced dose was resumed after pericardiocentesis, which led to successful control of the pericarditis and cardiac tamponade. The dose of lenvatinib is usually modified according to the status of the disease as well as profile of side effects. In our patient, the dose of lenvatinib was maintained within the range that produced acceptable side effects, which contributed to favorable disease control and prolonged survival.