Some diseases are well known to be provoked by inadequate adaptation to physical and/or psychogenic stress in daily life. Attacks of Ménière's disease characterized by vertigo, fluctuating hearing loss and tinnitus due to inner ear pathology represent a common example. Furthermore, this disease has been proposed to be more prevalent among technologically advanced societies where people live a stressful lifestyle, i. e. “Menierization is civilization”. However, it is very difficult to prove a significant relationship between stress and inner ear pathology, since the definition of stress is too obscure for scientific analysis of these aspects.
Since the oto-pathology in Ménière's disease was first identified as being inner ear endolymphatic hydrops through temporal bone studies in 1938, it has gradually become understood that inner ear endoorgan tissues, including the endolymphatic sac, prepare the fluid homeostatic system via water metabolism-related molecules such as vasopressin and aquaporin. Subsequently, it was proposed that the pathogenesis in Ménière's disease could be inner ear endolymphatic hydrops due to a disorder of water metabolism-related molecules.
In the present paper, we would like to discuss the neuroscientific relationship between stress and inner ear pathology by reviewing plasma vasopressin (an anti-diuretic stress hormone) and its receptor, V2 receptor, in the endolymphatic sac (an inner ear endo-organ for endolymph absorption) in patients with Meniere's disease.

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We reported two cases of neurofibromatosis type 2. Case 1 was a 24-year-old woman with bilateral slight to moderate sensorineural hearing loss. MRI demonstrated a large acoustic tumor (AT) measuring 4.0cm on the right side and another small AT of 1.0cm on the left side. Surgical resection of the right AT resulted in deafness of the right ear. She decided to delay surgery on the left ear until the hearing diminished and/or the tumor grew. However, the remaining hearing of the left ear became further gradually impaired reaching deafness 5 years later without apparent growth of the left AT. Case 2 was a 36-year-old man with moderate sensorineural hearing loss of the left ear and juvenile deafness of the rightear. He showed right peripheral facial palsy and cerebellar ataxia. MRI demonstrated bilateral ATs measuring 2.0cm and 2.5cm, respectively, in addition to several meningiomas in the brain and neurofibromas in the spine. Neurosurgeons estimated that there was no indication for surgical resection or gammaknife treatment.

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Eruption of a tooth into the nasal cavity is a rare clinical entity. We report 3 cases of ectopic inverted tooth in the nasal cavity.
Case 1: An 8-year-old girl presented with cacosmia in the left nasal cavity. A white mass diagnosed as a foreign body was found in the left nasal cavity and was extracted via the left nostril. The mass was a supernumerary tooth.
Case 2: A 7-year-old girl was brought to our outpatient department because of a foreign body in the left nasal cavity. She complained of nasal obstruction, nasal pain, and epistaxis. Panoramic radiography and computed tomography demonstrated that the mass thought to be a foreign body was actually an inverted supernumerary tooth. We removed it by endoscope via an endonasal approach.
Case 3: A 28-year-old man presented with nasal obstruction. Although the diagnosis was hypertrophic rhinitis, a white mass was found in the left nasal cavity. The mass was extracted during submucous turbinectomy and was determined to be an inverted supernumerary tooth.
Although most previous reports have indicated that inverted teeth in the nasal cavity are easily extracted via the nostril, clinicians should be aware that the differential diagnosis of intranasal teeth includes foreign body, rhinolith, and tumor.

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Objective: Treatment of maxillary sinusitis with an indwelling tube is not a common method at present. The study examined the efficacy of treatment by puncture and repetitive irrigation of the maxillary sinus using an indwelling tube.
Subjects: The subjects consisted of 52 cases (sinuses) of maxillary sinusitis in 51 patients (10 to 80 years old, averaged 52.7 years old) that had not responded at all to pharmacotherapy (including clarithromycin) and nebulized aerosol therapy (cefmenoxime hydrochloride) for more than 1 month after the acute stage. Patients of odontogenic sinusitis or nasal polyp were excluded from this study.
Method: The patients were treated by sinus irrigation with normal saline solution (100 to 200ml) and instillation followed by 1% cefmenoxime hydrochloride solution (1ml) in the sinus once daily, using an indwelling tube with SinoJect^® (a special device for puncture and irrigation of the maxillary sinus) inserted in the maxillary sinus via the inferior meatus. And the tube was removed when macroscopic observation confirmed recovery of clear washout products. The effects of treatment were also evaluated on X-ray findings obtained 1 to 2 weeks later.
Results: 1) Complete response (opacity disappeared) was noted in 21 (40.4%) cases, partial response (opacity was reduced) in 17 (32.7%) cases, and no response in 14 (26.9%) cases. Finally, more than half the patients showing no response underwent endoscopic sinus surgery. 2) The frequencies of the irrigation ranged 2 from 19 times and averaged 3.9 times. 3) Puncture and irrigation was performed very easily and safely. There was no significant complication in any patient.
Conclusion: The results suggested that repetitive irrigation with an indwelling tube is a useful treatment method for intractable maxillary sinusitis.

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Myxofibrosarcoma is a soft tissue neoplasm, usually arising in elderly patients especially in the limbs, but very rarely in the head and neck region. We report a rare case of myxofibrosarcoma in the oropharynx. A 48-year-old man visited our department complaining of pharyngeal dysesthesia. A tumor was detected inside the left palatine tonsil. The cervical lymph node was not palpable. MRI showed a 40×25×20mm mass. Resection of the tumor was performed. The tumor was histopathologically and immunohistochemically diagnosed as low-grade myxofibrosarcoma. Myxofibrosarcoma is very rare in the oropharynx. Though the tumor is a low-grade malignancy, complete resection of the tumor must be performed.

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Deep neck infections including cervical abscess are severe and emergent diseases in otolaryngological practice. We encountered a 73-year-old male with a deep cervical and mediastinal abscess complicated by diabetes mellitus. ENT examination showed painful neck swelling with a severe bulge in the retropharyngeal space extending to the hypopharynx on the left side. CT examination indicated abscess formation with gas extending from the neck to the upper mediastium. We performed cervical drainage and administered intravenous antibiotics together with human immunoglobulin. Computed tomography (CT) on the next day showed persistent deep cervical and mediastinal abscess despite those treatments. During the second operation, cervical drainage was performed, but cervical and mediastinal abscess still persisted on CT. During the third operation, both cervical drainage and thoracoscopic drainage were performed in collaboration with thoracic surgeons. Then, the abscess disappeared completely within a few days after surgery.
We confirmed that immediate cervical drainage was essential for the treatment of deep cervical and mediastinal abscess. CT examination was considered the most useful evaluation for estimating the effect of treatment.

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We report a rare case of extranasopharyngeal angiofibroma of the infratemporal fossa. A seventeen-year-old man had been aware of a swelling mass in the oral cavity for three years. A large submucosal mass was identified at the right soft palate, but there was no obvious lesion in the nasal cavity or nasopharyngeal space. Computed tomography and magnetic resonance imaging demonstrated that the infratemporal fossa was occupied by a large spindle-shaped mass showing strong enhancement and the foramen ovale had been expanded by the mass. Under a diagnosis of trigeminal schwannoma, surgery was performed via the facial dismasking approach. The mass was parallel to a trigeminal nerve, which was sacrificed, and the lesion was removed completely with an addition of cervical approach. Having lost considerable blood, he received a blood transfusion intraoperatively, however, his postoperative clinical course was uneventful. The mass presented a smooth, elastic, pale appearance, and its histopathological diagnosis was angiofibroma. The origin of the lesion was considered the pterygoid (vidian) canal, which is an unusual site for the origin of angiofibroma. The patient did not demonstrate dysarthria or dysmasesis, and there was no apparent cosmetic complication. The patient is currently free from disease two years after surgery. The facial dismasking approach offers excellent access for excision of a tumor involving the infratemporal fossa.

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We reviewed 23 cases of parapharyngeal space tumors that were treated at Kurume University Hospital between 1990 and 2006. Histological diagnoses were obtained by excision of tumors (21/23). Seventy-six percent of the parapharyngeal space tumors were benign, and 24% were malignant. Thirty-eight percent (8/21) of these tumors were pleomorphic adenoma, and 24% (5/21) were schwannoma. The trans-parotid approach and the trans-mandible approach were used in 88% (14/16) of benign tumors, the mandibular swing approach was used in one case of malignant tumor. Postoperative complications were identified in 16 of the 21 patients. The most common complication, facial nerve paralysis, was identified in 8 patients and 7 patients were demonstrated first bite syndrome. In consideration of the high incidence of postoperative complication, the surgical approach should be carefully selected when treating parapharyngeal space tumors.

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Neck dissection is a highly important surgical procedure in the treatment of squamous cell carcinoma (SCC) of the head and neck since the control of the nodal disease is highly important in these patients. In this paper, 131 patients (210 necks) treated in our department were analyzed. The most frequent primary lesion site was the oral cavity, followed by larynx, hypopharynx and mesopharynx, and treatment of metastatic nodes was considered important especially in patients with SCC in those regions. As the surgical procedure for neck dissection, (modified) radical neck dissection was chosen for higher N stage cases, although it was also applied to lower N stage cases. Postoperative irradiation was performed for 70% of the patients, and control of the neck was considered good as recurrent neck disease occurred in 8% of the patients, and only 20% of those died of recurrent neck disease. The most common primary site showing cervical recurrence was the oral cavity, and control of neck disease is considered important, especially in patients with SCC of the oral cavity. Patients with ≤ number of pN 1 receiving postoperative irradiation, and patients with pN(-) and ≤ number of pN 1 without postoperative irradiation showed significantly higher survival rates. Postoperative irradiation should be done for patients with ≥ number of pN 2, and follow-up without postoperative treatment should be considered for the cases of ≤ number of pN 1. Further consideration of patient selection with regard to the area of dissection and the indication for postoperative irradiation without decreasing the survival rate is needed to further improve the treatment of head and neck SCCs.

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PFAPA has recently been defined as a non-hereditary autoinflammatory disease characterized by Periodic episodes of high Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis. PFAPA is a benign pediatric syndrome of unknown etiology. It might have been diagnosed as antibiotic-resistant recurrent tonsillitis and indicated for unnecessary tonsillectomy in the otolaryngology clinic. Autoinflammatory diseases are a new and expanding classification of inflammatory diseases characterized by recurrent episodes of systemic inflammation in the absence of pathogens, autoantibodies or antigen-specific T cells. This disease is induced by abnormality of neutrophil-related inflammatory cytokines that regulates inflammation, innate immunity and apoptosis. Up-to-date information on innate immunity is also concisely reviewed.

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