Treatment of recurrent respiratory papillomatosis (RRP) has historically been, and still remains, a difficult challenge. Although there is no evidence-based treatment to date, surgery is generally performed and is considered as the standard treatment modality. Recent trends in respect of surgical instruments in the management of RRP in Europe, United States as well as Japan include the microdebrider and carbon dioxide (CO₂) laser. However, adjuvant pharmacological treatment is increasingly being used due to the high tendency towards recurrence of the disease.

Among the various adjuvant pharmacotherapies that have been employed, intralesional cidofovir injection remains the leading option in Europe and the United States, even though its use for this indication remains off-label. Herein, we introduce our experience of the treatment for the first time in Asia; we found that the treatment showed acceptable efficacy, without obvious adverse events. However, as there is no consensus as yet in regard to the optimal treatment regimen, uncontrolled spread of this treatment should be avoided. To guide current practice of adjuvant intralesional cidofovir for RRP in adults and children, the RRP Task Force of the United States approved 18 consensus statements, which should be referred to while planning the treatment.

Numerous other pharmacotherapies are expected in the future. Based on the histological characteristics of RRP, there have been some reports of promising results achieved with relatively high doses of bevacizumab, a monoclonal antibody against vascular endothelial growth factor. In addition, based on the results of basic research showing increased expression of cyclooxygenase-2 (COX-2) in RRP, a study of the long-term safety and effectiveness of the selective COX-2 inhibitor is currently ongoing in the United States. Furthermore, vaccination against human papillomavirus (HPV) could be expected to play a role in both prophylaxis and treatment of RRP.

Cochlear implant is an established auditory prosthesis for children and adults with severe to profound sensorineural hearing loss. With the expansion of the use of cochlear implants, the number of cochlear implant users needing magnetic resonance imaging (MRI) is also increasing.

We report a case of magnet displacement after 1.5 T MRI in a 68-year-old female patient who was using the Hi-Res 90K^TM cochlear implant. The patient complained of severe pain during the MRI. On physical examination, the skin over the internal magnet was found to be swollen. Because of severe tenderness in the region, the patient could not wear the receiver-stimulator. A CT scan showed that the lower end of the internal magnet in the implant had become dislodged from the silicone sheath. In this case, the magnet was repositioned by a non-invasive approach via a percutaneous closed reduction maneuver. Immediately after the repositioning procedure, the tenderness and the bulging of the skin disappeared. At present, 6 months since the procedure, the cochlear implant continues to function well.

We report a rare case of a patient with a cholesterol granuloma located in the infratemporal fossa. A 65-year-old male patient was referred to our department because of the findings on CT at another hospital of right ear opacification and bone defect of the anterior wall of the tympanum. He had undergone right ear surgery at the age of 33 years. He had suffered from hearing loss on the right side for many years and experienced right-sided otorrhea since two months before presentation. In addition, a lesion in the anterior wall of the right maxillary sinus associated with a bone defect was also recognized on the CT. MRI demonstrated a large cystic lesion extending to the infratemporal fossa and tympanum. Cholesterol granuloma, cholesteatoma, and tumor invasion from the maxillary sinus were considered in the differential diagnosis; OMAAV, or Otitis Media with Anti-neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis, was also suspected because blood examination revealed an elevated myeloperoxidase-ANCA titer. Tympanoplasty was planned for biopsy and drainage of the cyst, followed by endoscopic sinus surgery for biopsy. Canal wall-down mastoidectomy was performed, the granulation tissue occupying the tympanum and attic was removed, and the bone defect was found above the orifice of the right Eustachian tube. After fenestration, abundant brown fluid flowed out of the cavity in the infratemporal fossa. A drainage tube was then inserted into the tympanic membrane and a silicone sheet into the cavity of the infratemporal fossa. Histological examination demonstrated no evidence of malignant tumor or OMAAV, whereas the finding of a granuloma containing cholesterol crystals in the middle ear mucosa indicated the diagnosis of cholesterol granuloma. After the surgery, the otorrhea resolved. The patient is under follow-up at our hospital and has shown no evidence of recurrence since the surgery.

We propose a novel nasal symptom questionnaire (NSQ) for easy evaluation of patients suffering from sinonasal diseases. Between June 2015 and April 2016, the NSQ was completed by 70 healthy people without any nasal diseases, 79 patients who had undergone sinonasal surgery, and 44 patients with olfactory disorder who were treated at the Department of Otolaryngology, Hyogo College of Medicine. The NSQ is a self-administered survey questionnaire consisting of a total of 10 items divided into two parts (I–II): (I) nasal symptom-related items (8 items): 1) sneezing and/or itching of nose, 2) nasal discharge, 3) nasal obstruction, 4) post nasal drip and/or sputum, 5) olfactory loss, 6) pain (buccal, tooth, facial pain and/or headache), 7) eye itching and/or epiphora, and 8) cough; and (II) quality of life (QOL)-related items (2 items): 1) reduced productivity at school/work, limitation of outdoor life and/or social functioning, and 2) sleep problem, general physical problems and/or emotional problems. The subjects are asked to score their responses to each item of the NSQ on a 4-grade scale, as follows: no symptoms at all (0 points); mild symptoms (1 point); severe symptoms (2 points), and extremely severe symptoms (3 points). The total (0–30 points) score on the NSQ and also the scores for individual (0–3 points) items of the NSQ were analyzed. In addition, a visual analogue scale (VAS) for determining the severity of the nasal symptoms was also applied in the third part (III) of the NSQ. The mean total score on the NSQ (9.97 points, n=79) was significantly higher in the patients with sinonasal diseases (3.14 points, n=70) than in the healthy subjects (p<0.001). The scores for nasal discharge, obstruction, postnasal drip, and QOL-related items were also significantly higher in the patient group higher than in the group of healthy subjects. In particular, patients with eosinophilic chronic rhinosinusitis (ECRS) showed high scores on the items of olfaction loss and cough. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of 0.847 could be considered as “good”. According to these statistical data, the cutoff value of the NSQ score for patients with sinonasal diseases was clinically determined to be 4 or more. The NSQ score showed a statistically significant correlation with the scores on other previously reported questionnaires for nasal symptoms. Our results suggested the NSQ as a useful questionnaire for easy evaluation of the condition of patients suffering from nasal symptoms.

Nasal foreign bodies are commonly encountered in ENT outpatient clinics. They are more frequently seen in young children, therefore, they tend to be long-standing, unless the children themselves confess or the families happen to catch sight during the insertion. Inorganic foreign bodies such as metal are associated with few symptoms. Multiple magnetic foreign bodies are unique in nature because of their attractive forces. We report a case with long-standing bilateral intranasal foreign bodies which had been inserted more than 15 years earlier. A 23-year-old female presented to us with the complaint of slight pain in the left cheek. Nasal endoscopy and CT revealed a small part of a metallic foreign body on the nasal septum on the right side. We removed the foreign body endoscopically from inside the nasal septum under general anesthesia. The foreign body consisted of two small magnets attracted to each other. They sandwiched the nasal septum and had been buried in the nasal septum for a long time without any infection. Nasal septal perforation had not occurred, presumably because one side of the foreign bodies was covered by mucosa. Some cases of multiple magnetic foreign bodies in the nasal septum have been reported with the complication of perforation of the nasal septum. It is also dangerous to perform MRI in cases with magnetic foreign bodies. Such foreign bodies must be removed without delay.

Oral Allergy Syndrome (OAS) is caused by ingestion of trigger foods, including several fruits and vegetables. Many patients with OAS also suffer from hay fever, a condition that is called Pollen-Associated Food Allergy Syndrome (PFS).

In this study, we focused on patients who tested positive for antibodies against the antigen of the genus Alnus of the birch family, which is one of the causative pollen antigens.

Among the subjects who visited our department between May 2012 and October 2015 with nasal symptoms and underwent determination of antigen-specific IgE antibody (Immuno CAP), we investigated the antigen-positive rate, the age-specific sensitization rate for the antigen of the genus Alnus, and the age, sex and the presence OAS in patients showing a positive reaction to the antigen of the genus Alnus.

Positive reaction to the antigen of the genus Alnus was found in 19% of the patients with nasal symptoms, which represented one in about five people tested. The total IgE was high in many of the Alnus-positive cases, and there were no cases that showed sensitization to the Alnus antigen alone.

The patients with OAS had a tendency to show significantly elevated levels of Alnus-specific IgE.

The pollen scattering season, namely, early spring, of the genus Alnus overlaps with that of Japanese cedar and cypress, therefore, Alnus hay fever hardly attracts attention.

However, sensitization to the genus Alunus may cause OAS and may even leads to anaphylaxis. Therefore, the antigen of the genus Alnus should also be tested for to determine the causative antigens for hay fever in the early spring.

We report a case of dumbbell-shaped Warthin’s tumor extending from the parotid gland to the parapharyngeal space. A 64-year-old man was referred because of a left neck tumor and a feeling of dysphagia. CT scanning and an MRI examination revealed a tumor with clear boundaries extending from the deep lobe of the parotid gland into the parapharyngeal space. Warthin’s tumor was diagnosed based on a biopsy from the oral cavity, and a transcervical-parotid approach was chosen. The tumor size was approximately 9 cm, but the tumor was relatively soft with minimal adhesion; thus, we were able to remove it en bloc without any major complications. The patient exhibited first bite syndrome on the eighth day after surgery, but the pain gradually disappeared.

We examined four patients who underwent reoperations for recurrent parotid pleomorphic adenoma in our department. All four patients had multi-focal recurrent nodules following one or three prior surgical procedures. The surgical procedures included a total parotidectomy in two patients and a superficial parotidectomy in two patients; an antegrade technique was used for two patients and a retrograde technique was used for the other two patients. There were two incidents of transient facial nerve palsy after the operations, but both patients recovered within six months. None of the patients experienced further recurrence after the reoperations. Retrograde nerve dissection is useful, and possibly essential, for the treatment of recurrent pleomorphic adenoma of the parotid gland. However, long-term follow up for these tumors is needed because of the high rate of recurrence for recurrent parotid pleomorphic adenoma.

The TPF protocol composed of docetaxel, cisplatine and 5-fluorouracil, is the most commonly used chemotherapy regimen for the treatment of head and neck cancer. Recently, the importance of maintaining a relative dose-intensity (RDI) has been shown. Therefore, the treatment and prevention of febrile neutropenia, which can reduce the RDI of the TPF protocol, are important. Here, we compare patient outcomes before and after the introduction of pegfilgrastim for primary prophylaxis. The first group is consisted of 60 patients (88 chemotherapy courses) treated between January 2011 and October 2014 who did not receive prophylaxis. The second group consisted of 14 patients (20 chemotherapy courses) treated between November 2014 and July 2016 using pegfilgrastim. We examined the frequency of neutropenia (grade 3 and 4), febrile neutropenia (FN) and treatment-related death, the amount of granulocyte-colony stimulating factor (G-CSF) used, the cost for FN treatment and the hospitalization period. In the first group, there were 74 neutropenia events, 34 cases of FN and 2 treatment-related deaths; the average hospitalization period was 18.5 days. In the second group, there were 7 neutropenia events, 1 case of FN, and 0 treatment-related death; the average hospitalization period was 12.6 days. The frequency of adverse events, the amount of G-CSF used, the cost for FN and the hospitalization period were all significantly reduced by the introduction of pegfilgrastim. In conclusion, the administration of pegfilgrastim for the primary prophylaxis of FN was effective when included in the TPF protocol for the treatment of head and neck cancer.

We reviewed 78 cases of parotid gland tumors treated at our hospital over the past 2 years and 5 months. Benign tumors were observed in 65 patients (36 males and 29 females), and malignant tumors were observed in 13 patients (4 males and 9 females). The average patient age was 50 years old for the cases with benign tumors and 65 years old for the cases with malignant tumors. The most common benign tumor was pleomorphic adenoma, followed by Warthin’s tumor. The most common malignant tumor was mucoepidermoid carcinoma. The sensitivity/specificity/accuracy of preoperative fine-needle aspiration cytology (FNA) were 27.3%, 96.8%, and 86.5%, respectively, while those of MRI were 84.6%, 86.2%, and 85.9% when an unsharp margin or a low signal intensity on T2-weighed MRI were regarded as malignant findings. As surgical treatments, extirpation or a partial lobectomy were mainly applied for benign tumors. On the other hand, a partial lobectomy or total parotidectomy with facial nerve resection were selected for malignant tumors, except in 3 cases that only underwent an open biopsy. Postoperative facial nerve palsy was observed in 6 (9.2%) out of 65 benign tumor cases and 5 (50%) out of 10 malignant tumor cases treated with radical surgery, but all the patients except for one case with parotid cancer recovered in 1 to 5 months. Postoperative first bite syndrome was seen in 3 cases requiring deep lobe tumor removal. When the patient group with Warthin’s tumor was compared with that of pleomorphic adenoma, a significantly higher age, a male predominance, and a higher smoking rate were observed, similar to the findings of previous reports. Not only imaging findings and FNA results, but also patient age, sex, and smoking habits are thought to be important for discriminating between Warthin’s tumor and pleomorphic adenoma.