Various non-epithelial masses such as like Kimura’s disease with eosinophilia, MALToma with Sjogren syndrome and schwannoma from the facial nerve, as well as epithelial masses, have been described in around the parotid glands. Some tumors such as pleomorphic adenoma and adenoid cystic carcinoma show atypical findings of recurrence. Diagnostic difficulties still exist, because of limitations of fine needle biopsy, frozen section diagnosis and imaging before and during surgery. Complete resection of the tumor while preserving the nerve function is not possible in some cases. Further improvements of diagnostic measures and surgical procedures are necessary for better treatment of patients with parotid masses.

The phosphodiesterase type 5 (PDE5) inhibitors —sildenafil, vardenafil and tadalafil— are used in the treatment of erectile dysfunction, pulmonary hypertension and benign prostatic hyperplasia (BPH). Recently, hearing loss associated with PDE5 inhibitor use has been reported. We report a patient who developed unilateral sudden hearing loss possibly related to the use of tadalafil. This is the first case report of sudden sensorineural hearing loss related to the use of a PDE5 inhibitor drug in Japan.

A 64-year-old male was started on treatment with tadalafil for BPH. Eight days after the start of treatment, the patient developed sudden right-sided hearing loss. He was referred our hospital, as his hearing did not recover despite oral prednisolone treatment (PSL 40 mg/day for 5 days) prescribed by an ENT specialist. An audiogram revealed sensorineural hearing loss in the right ear, with normal hearing in the other ear. DP-OAE elicited no responses in the right ear. The patient had no tinnitus or disequilibrium, and no nystagmus was observed. The patient was restarted on prednisolone (60 mg/day), which was administered for three days, with the dose tapered over 9 days and discontinuation of tadalafil. An audiogram after the corticosteroid therapy showed complete recovery of the hearing on the right side. The acute sensorineural hearing loss in this patient was probably caused by the ototoxic effects of the PDE5 inhibitor drug.

If the head is tilted fully forward during middle ear (ME) inflation, the tympanic opening of the eustachian tube will be positioned below the ME, and the injected air is expected to be able to drain the intratympanic effusion. To investigate this hypothesis, serial pure-tone audiometries were performed prior to ME inflation, after inflation with the head straight up as usual, and with the head tilted forward. Eight ears (six patients aged between 14 and 87 years) with middle-ear effusion and an air-bone gap of more than 20 dB were included. The mean improvement in air conduction across all seven frequencies was 10.2 dBHL in the upright position of the head, and 18.2 dBHL with the head tilted forward during ME inflation (P<0.001), and in all cases, the air-bone gap almost disappeared. In one case, high-resolution computed tomography was performed, which revealed an effusion-free middle ear after ME inflation with the head tilted forward. We concluded that tympanic effusion can be efficiently drained if ME inflation is performed with the head tilted fully forward.

Penetrating stab wounds of the brain are relatively uncommon in Japan.

We encountered a case of penetrating intracranial injury through the ear canal caused by the temple portion of eyeglasses. The patient was a 58 year-old male, arrested for drunken driving. Policemen found him driving the temple portion of his eyeglasses into his right ear and hitting his head against the wall in the prison. While they tried to remove the implement, they could not pull it out. Therefore, the patient was brought to our emergency room.

Hemorrhage from the ear had stopped by the time the patient was examined. The edge of the implement used to cause the injury could be seen from the right ear. On neurological examination, the patient had right abducens palsy, although he was fully conscious and alert. A head CT and digital subtraction angiography showed the temple portion of the subjects’ eyeglasses passing through the right ear canal and penetrating the skull base, injuring his left frontal lobe. Craniotomy was performed without removing the object blindly. The patient did not develop intracranial infection or cerebral hemorrhage after the operation. However, the right abducens nerve paralysis persisted. Although there are some reports of penetrating intracranial injuries through the orbit, mouth or areas of thin bone within the skull base, this is the first report of trans-canal penetration.

Ganglion is a cystic disease arising from tendon sheaths and synovial tissue in joints. It commonly occurs on the dorsal side of the carpal joint and rarely develops in the temporomandibular joint. In cases of temporomandibular joint ganglion, the cystic mass often occurs in front of the ear, and it is very rare for this condition to manifest as an external auditory canal tumor. We report a case of multilocular temporomandibular joint ganglion which manifested as an external auditory canal mass.

A 66-year-old man was admitted to another hospital with bleeding from a mass in the right external auditory canal. Biopsy revealed the diagnosis of ganglion and the patient was referred to our hospital for curative surgery.

At the first visit to our hospital, examination revealed a swelling in the upper wall of the right ear canal, and the tympanic membrane could not be visualized. CT revealed partial bone defects in the anterior wall of the ear canal.

Surgery was performed by the transcanal approach. A skin incision was made in front of the tumor, and a cystic mass was confirmed subcutaneously. Bone defect of the external auditory canal continued anteriorly from the upper ear canal to the temporomandibular joint. Two small, isolated cysts were found further forward, and all of them were removed. After removal, the bone defect was filled the auricular cartilage, and the cartilage plate was used for reconstruction of the canal wall.

The excised specimen contained three isolated cysts and histopathology confirmed the diagnosis of ganglion. Until now, one year since the surgery, there has been no evidence of recurrence.

Temporomandibular joint ganglion is a relatively rare disease, and cases in which it manifests as a mass in the external auditory canal are very rare. In our case, three isolated cysts were resected by surgery. The bone defect after extraction of the cyst was filled with cartilage pieces and covered with a cartilage plate.

Primary ciliary dyskinesia (PCD) is a hereditary autosomal recessive disorder of ciliary function, causing impairment of ciliary clearance, that is frequently complicated by chronic rhinosinusitis (CRS), otitis media, chronic bronchitis and male infertility. In this study, we report the case of a 13-year-old boy who presented to us with the chief complaints of nasal discharge, productive cough and otorrhea ever since he was 2 years old. At the age of 12 years, he underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis, however, the outcome was unfavorable, with mucous rhinorrhea and mucosal adhesions in the nasal cavity persisting after the surgery. He was then referred to our hospital. CT of the nasal sinuses and chest revealed findings suggestive of CRS and bronchiectasis. There was no visceral inversion. ESS was performed a second time, however, the rhinosinusitis recurred within 3 months after the surgery. Serum levels of the IgG subclasses, IgM, and IgA were normal. The concentration of nasal nitric oxide was 160 ppb, which was very low. Electron-microscopic analysis of the nasal cilia showed abnormal structures of the peripheral and central microtubules in some cilia. Based on these findings, we made the definitive diagnosis of PCD in the patient. His family history was negative for PCD. However, genetic analysis revealed that both he and his father had heterozygous mutations in DNAH11. The diagnosis of PCD is not always easy, partly because of its rarity. We should always keep in mind the possibility of PCD in patients presenting with atypical CRS, chronic otitis media and bronchiectasis.

We report a case of verruca vulgaris of the vocal cord caused by human papilloma virus (HPV), which rarely occurs in the larynx. A 64-year-old man visited our hospital with the chief complaint of hoarseness of voice. A white tumor-like lesion was found in the right vocal cord, which was resected under general anesthesia. Histopathologically, the lesion was diagnosed as verruca vulgaris. Although there has been no recurrence during the outpatient follow-up after surgery, we believe that careful follow-up should be continued taking into consideration the high recurrence rate of this lesion after resection.

Lymphadenopathy is common in young people. However, in most, it is caused by benign or inflammatory diseases, and malignant disease as the cause is rare. We report the case of a 27-year-old man who visited our hospital with the chief complaint of a left neck swelling and was diagnosed as having testicular malignancy with cervical lymphadenopathy. Computed tomography revealed multiple enlarged lymph nodes, with some showing a necrotic component. Lymph node biopsy led to the diagnosis of cervical lymph node metastasis from a carcinoma. On the basis of the age and sex of the patient, and the histopathological findings, we suspected a primary tumor of the testis. We referred the patient to the urology department, where he received prompt treatment. In a patient presenting with multiple lymphadenopathy in the supraclavicular fossa, lymph node biopsy should be considered, even if the patient is young.

There are increasingly diverse thoughts about sex and gender today. It is estimated that there are currently 46,000 patients suffering from gender identity disorder (GID) in Japan.

Herein, we report our experience of hospitalizing and performing an operation in a patient with GID for a postoperative maxillary cyst.

The 50-year-old patient, who appeared to be a female, presented to our hospital with a 1-month history of swelling in the right cheek. CT showed three cysts in the right maxillary sinus. The patient had undergone Caldwell-Luc operation of maxillary sinus on both sides about 30 years earlier. We diagnosed a right postoperative maxillary cyst and suggested operation. At that time, the patient confessed that she had been suffering from GID and was biologically, in fact, a man. She had undergone an orchidectomy 13 years earlier and even changed her name. We decided to treat her as a female patient in our hospital. There were no problems encountered whilst the patient was hospitalized and her postoperative course was uneventful.