The aim of this study was to evaluate the indications, outcomes and limitations of OK-432 sclerotherapy in various otolaryngological cystic diseases. We analyzed the data of 148 patients with otolaryngological cystic diseases who had undergone OK-432 sclerotherapy. Of these patients, 48 (32%) had a plunging ranula, 14 (9%) had a lymphangioma, 12 (8%) had a branchial cleft cyst, 15 (10%) had a thyroglossal duct cyst, 11 (7%) had a thyroid cyst, 3 (2%) had a cervical lymphocele after neck dissection for head and neck cancer, 23 (16%) had a salivary mucocele, and 22 (15%) had an auricular hematoma. In the cases with a plunging ranula, lymphangioma, branchial cleft cyst, thyroglossal duct cyst, thyroid cyst or cervical lymphocele, we aspirated as much of the fluid content of the cystic lesion as possible, and replaced the aspirated fluid with about half the volume of OK-432 solution. In the cases with a salivary mucocele or auricular hematoma, we prepared a 0.5-Klinische Einheit (KE) of OK-432 diluted with 0.2 ml saline solution and injected this OK-432 solution into the lesion via a 27G needle to prevent leakage of the agent from the lesion. Complete disappearance of the lesion was observed in 119 of the 148 patients (80%). On the other hand, marked reduction was observed in 20 of the 148 patients (14%), partial reduction in 3 patients (2%) and no response was seen in 6 patients (4%). The responses to OK-432 therapy were better in the cases with a plunging ranula, lymphangioma, thyroglossal duct cyst, thyroid cyst, auricular hematoma or salivary mucocele than in those with a branchial cleft cyst. Local discomfort at the injection site and fever were observed as side effects in 68 (46%) and 61 (41%) of the patients, respectively, however, there were no cases of serious complications of OK-432 therapy, and the therapy seemed to have no influence on any future surgery. We undertook OK-432 therapy on an outpatient basis without hospitalization in all cases, except for the few who had the potential risk of airway obstruction. Our results confirmed that OK-432 therapy is a simple, easy, safe and effective therapeutic modality that can be used as a substitute for surgery in the treatment of various otolaryngological cystic diseases.

We retrospectively analyzed the data of 387 patients who had no previous experience of using hearing aids, seen between 2009 and 2013 (164 males and 223 females). The average age of the overall subject population was 77.3 years (range 34 to 96 years); gender-wise, the average age of the males was 76.5 years (range 49 to 96), while that of the females was 77.9 (range 34 to 94). Of the 387 patients, 289 purchased hearing aids, representing a purchase rate of 74.7% during the five-year period, with the rate increasing year on year. The average hearing level of the ear for which the hearing aid was used was 61.5 dBHL ((500 Hz+1000 Hz+1000 Hz+2000 Hz)/4). The average hearing level of the patients who purchased a hearing aid was 64.2 dBHL, while that of the patient who didn’t purchase a hearing aid was 52.9 dBHL, with the hearing level in the former group being significantly higher than that in the latter group (p<0.05). In all, 37 patients wore hearing aids for both ears, representing a rate of use of bilateral hearing aids of 12.8%. We had aimed at providing hearing aids on rent for approximately two months. However, the mean rental period in patients who purchased hearing aids was 88.5 days.

We encountered a case of sudden hearing loss in a 4-year old boy. The patient was brought to the hospital with a history of having developed tinnitus and vertigo simultaneously. He could not walk due to the severe vertigo. We detected acute sensorineural hearing loss of his right ear, and horizontal and rotatory nystagmus. Hematological examination, CT of the temporal bone and MRI of the brain revealed no abnormalities. Consequently, we diagnosed the case as a case of idiopathic sudden hearing loss. We administered prednisolone for seven days, which led to improvement of the vertigo, but not of the hearing loss.

Sudden hearing loss in childhood is often accompanied by vertigo, as compared to sudden hearing loss in adulthood. However, the prognosis of sudden hearing loss is similar in adults and in children.

Angiofibroma is a benign tumor and mostly occurs in the nasopharynx among the otorhinolaryngological region. The tumor has a predilection for adolescent boys. In addition, angiofibromas are highly vascular tumors and surgery for these tumors is associated with a massive risk of hemorrhage.

A 61-year-old male patient presented to us with the chief complaint of epistaxis from the left nostril, and was diagnosed as having an extremely rare type of angiofibroma arising from the nasal septum. The CT and MRI imaging showed an enhancing mass in the nasal septum, with no evidence of infiltration of the surrounding tissues. The tumor was fully resected endoscopically after preoperative vascular embolization.

In this report, we discuss the differences in the clinical features between angiofibroma of the nasal cavity and angiofibroma of the nasal septum, and the significance of preoperative embolization of angiofibromas.

Monotherapy with intranasal corticosteroids results in some improvement of the nasal congestion in patients with allergic rhinitis. However, the improvement after oral administration of the combination tablet of fexofenadine hydrochloride/pseudoephedrine hydrochloride (FH/PH) is more rapid. In this study, we evaluated the possibility of expediting the induction effect of monotherapy with intranasal corticosteroids by using these combination tablets at the start of therapy.

For this evaluation, 29 patients presenting with the chief complaints of nasal allergy and nasal congestion were divided into two groups: one group (n=17) was treated with the FH/PH tablets in combination with intranasal corticosteroids (combination group), while the other (n=12) was treated with an intranasal corticosteroid spray alone (intranasal corticosteroid monotherapy group).

The combination group was treated with the FH/PH tablets for two weeks. One week after the start of treatment, concurrent administration of an intranasal corticosteroid spray (mometasone furoate hydrate) was started to initiate the shift toward intranasal corticosteroid therapy. Two weeks after the first dose, the treatment was switched to intranasal corticosteroid monotherapy, which was then used as the sole regimen for the subsequent two weeks. The overall treatment efficacy was evaluated four weeks after the first dose.

One, two and four weeks after the first dose, the Visual Analogue Scale (VAS) for symptoms showed significant improvement in both groups. The degree of swelling of the inferior nasal turbinate mucosa showed steady improvement each week after the start of treatment in the combination group; on the other hand, no significant improvement of the mucosal swelling was observed at one week after the start of treatment in the intranasal corticosteroid monotherapy group.

Our findings suggest that improvement of nasal congestion with FH/PH is more rapid than that with intranasal corticosteroids, and it is advantageous to administer FH/PH prior to the start of intranasal corticosteroid monotherapy.

Our study further suggests that fast-acting FH/PH may perform a key role as an effective induction agent at the start of monotherapy with intranasal corticosteroids in patients with allergic rhinitis presenting with nasal congestion.

The patient was a 41-year-old man who presented with an approximately 1-month history of sore throat. Examination revealed several ulcers on both sides of the tonsillar bed and root of the tongue. Blood, microbiological and histopathological examinations failed to reveal a clear cause of the ulcers. Viral infection, syphilis and tuberculosis were ruled out. An incomplete type of Behcet’s disease was diagnosed by the internal medicine and connective tissue disorders. Treatment with prednisolone and colchicine led to steady improvement of the pharyngeal ulcers. Approximately five months later, the patient visited our hospital again with a history of exertional dyspnea, and he was diagnosed as having pneumocystis pneumonia. Finally, his pharyngeal ulcers were diagnosed as having been caused by HIV (human immunodeficiency virus) infection. Oral manifestations such as intractable pharyngeal ulcers are sometimes the presenting symptom in patients with HIV infection. Therefore, every otolaryngologist should be aware of the possibility of the diagnosis of HIV infection in patients with oral/pharyngeal ulcers.

There have been reports of cases in which a clicking sound is produced in the neck region upon swallowing. It could occur because of elongation and thickening of the hyoid bone, resulting in its coming in contact with the cervical vertebrae during swallowing, or because of abutting of the thyroid cartilage against the hyoid bone, or even because of ossification of the space between the thyroid cartilage and the greater cornu of the hyoid bone. However, in all of these cases, the causes are different and also very rare. Herein, we report a case that we encountered in which a clicking sound was produced in the neck region because of both the thyroid bone and the hyoid bone coming in contact with the cervical vertebrae. The patient was a 57-year-old man. He visited our clinic, because one-year earlier, he had started to hear a sound when swallowing, which had progressively worsened. The abnormal sound was a click coming from the left neck region, and on CT, we observed elongation and hypertrophy of the left greater cornu of the hyoid bone. It was thought that the overgrowth of the hyoid bone was the principal cause, however, this could not be confirmed prior to the surgery. Surgery was performed under local anesthesia. First, the hypertrophic omohyoid muscle and sternohyoid muscle were cut, but the symptoms did not change. Upon cutting of the left greater cornu of the hyoid bone, which was thickened and slightly elongated, and came in contact the cervical vertebrae upon swallowing, the symptoms resolved somewhat. After cutting the superior cornu of the thyroid cartilage, which interfered with the cervical vertebrae upon swallowing, the symptoms disappeared altogether. This was an extremely rare case where the symptoms were caused by both the thyroid cartilage and the hyoid bone, however, appropriate treatment was given through surgery done under local anesthesia while the symptoms were concurrently assessed.

Advanced maxillary cancer involving the eye or tissues surrounding the orbit necessitates removal of the eyeball or intensive radiotherapy with the radiation field including the eyeball. Thus, the treatment often results in severe visual impairment in the patient. Herein, we report a case of extended total maxillectomy combined with autokeratoplasty performed for a patient with maxillary sinus cancer involving the orbit. A 55-year-old man visited our hospital with a suspected maxillary sinus tumor. Endoscopic nasal biopsy revealed the diagnosis of squamous cell carcinoma and we diagnosed the patient as a case of maxillary sinus carcinoma (T4aN1M0) invading the right orbit on the basis of the MRI findings. The patient also suffered from left corneal opacity because of keratoconus. It was predicted that the treatment of the maxillary sinus cancer would leave the patient with severe left visual impairment and a significant deterioration in the quality of life (QOL). To provide the patient with best possible QOL, we performed extended total maxillectomy combined with autokeratoplasty. At a follow-up examination conducted 3 years 11 months after the surgery, the patient was found to show no signs of recurrence and his eyesight on the right side was maintained.

A 73-year-old male was referred to our hospital complaining of swelling of his right neck, and was diagnosed as having oropharyngeal squamous cell carcinoma, clinical stage T2N2bM0. He had received concurrent radiotherapy with cetuximab treatment and achieved complete remission by the time he had received a total of 70 Gy of radiation to the neck and 7 courses of intravenous cetuximab treatment. However, he developed perforation of the sigmoid colon 1 month after completion of the cetuximab treatment.

Cetuximab is a monoclonal antibody directed against epidermal growth factor receptor (EGFR), which binds to EGFR and inhibits cell proliferation. We searched PubMed and the Japan Medical Abstracts Society for cases of bowel perforation associated with cetuximab treatment, and identified 3 other cases of bowel perforation. All developed bowel perforation a couple of months after the completion of cetuximab treatment and had a history of gastrointestinal diseases like colon cancer, stoma creation and colonic diverticular disease. Only a few cases of severe gastrointestinal complications related to cetuximab treatment for head and neck cancer have been reported until now, and this is the first case of a patient with oropharyngeal carcinoma developing bowel perforation requiring urgent surgery. However, we suspect that EGFR inhibitors could exert toxic effects on the bowel mucosa in the same way as VEGF receptor inhibitors, the toxicity of which to the bowel mucosa came to be widely recognized during the post-marketing surveillance.

Close observation with an index of suspicion for bowel perforation is thought to be necessary when treating head and neck cancer patients with cetuximab, especially in patients with a history of gastrointestinal diseases like diverticular disease.

The mandible is significantly involved in oropharyngeal functions. Dysphagia and dysarthria occur in patients undergoing segmental resection of the mandible for malignant tumors. In some cases, en bloc resection of the skull base and temporomandibular joint is required on account of extensive spread of the tumor and involvement of the joint capsule. In such cases, hard reconstruction of the mandible is difficult and a free flap consisting of soft tissue alone is used for the reconstruction. In this study, we evaluated the deglutition and articulatory functions patients undergoing resection of the middle cranial fossa and segmental resection of the mandible for en bloc resection of the joint capsule, followed by reconstruction using a soft tissue free graft. We examined the data of four of six subjects who underwent the aforementioned surgery between 2010 and 2014 at the Department of Otorhinolaryngology, Head and Neck Surgery, Hachioji Medical Center and answered our questionnaire. There were three males and one female, ranging in age from 14 to 69 years (mean age: 49.2 years). The primary tumor was located in the parotid gland in three cases, and in the ear canal in one case. Referring to the Clinical Practice Guidelines in Oncology, Head and Neck Cancers (2013), articulation was assessed based on the conversational function evaluation criteria, while feeding disorder was evaluated based on the MTF scores, functional oral intake scale (FOIS) and food style at hospital discharge. The mean score on the conversational function evaluation criteria was 9.25. The mean MTF and FOIS scores were 11 and 5.75, respectively, both of which indicate relatively well-conserved function. As for the type of food that the patients could eat at hospital discharge, all of the patients were able to ingest a bite-sized soft foods. Thus, the feeding and articulatory functions were conserved in subjects who underwent mandibular reconstruction using soft tissue alone.