After acute unilateral loss of peripheral vestibular function, numerous oculomotor and postural deficits appear; these deficits can be subdivided into static and dynamic categories. Static signs include paralytic spontaneous nystagmus and postural symptoms such as falling to the affected side. These symptoms usually diminish or disappear entirely even medical intervention. This recovery of normal function is due to the plasticity inherent in the central vestibular system, even in the absence of recovery of the vestibular function on the affected side (static vestibular compensation). Dynamic signs include depressed and asymmetrical vestibulo-ocular reflex (VOR). Vestibular rehabilitation is known to be useful for the improvement of dynamic signs after unilateral vestibular loss. The aim of vestibular rehabilitation is to promote dynamic vestibular compensation and sensory substitution by visual and somatosensory input. Moderate to strong evidence from several high-quality randomized controlled trials exists to support the efficacy and safety of vestibular rehabilitation in managing unilateral peripheral vestibular dysfunction. Moderate evidence also exists supporting the ability of vestibular rehabilitation to resolve symptoms and improve function within the mid-term. In this article, evidence for vestibular rehabilitation and the mechanisms underlying static and dynamic vestibular compensation will be introduced.

We report a case of granulomas within the middle ear accompanying small yellow lumps within the granulation tissue in the epitympanum found during an operation.

The patient, a 74-year-old woman, was referred to our hospital because of suspected middle ear cholesteatoma. When tympanoplasty was performed, the epitympanum was filled with granulation tissue containing many yellow nodules. On histopathological examination, the yellow nodules were found to be yeast-like fungal masses with granulomas around them. The granulomas were rich in histiocytes and multinucleated giant cells. The postoperative course was good; however, fluconazole was administered for 4 weeks according to the guidelines for the management of deep mycosis.

The most common fungal disease in the ear, nose and throat area is fungal infection of the external auditory canal, and the causative fungus is often Aspergillus or Candida. In this case, the small nodules present in the epitympanum were considered to be caused by Candida parapsilosis detected before the surgery, and it is possible that yellow pigment was produced by Candida parapsilosis.

Pulmonary aspergillosis, pulmonary cryptococcosis, and histoplasmosis are well-known to cause fungal granulomas; however, in this case, the granuloma was considered to be caused by Candida parapsilosis.

We cannot find reports in the literature of middle ear granuloma caused by a fungus, and we consider this to be a very rare case.

Dacryocystorhinostomy is now a well established surgery for chronic dacryocystitis and nasolacrimal duct obstruction with high success rate. However, when the refractory purulent discharge continues after a dacryocystorhinostomy, a dacryocystectomy can be one of the therapeutic options to stop the discharge. We herein report on a case of successful management with antibiotic ointment injection into the lacrimal sac for refractory chronic dacryocystitis with methicillin-resistant Staphylococcus aureus after a primary dacryocystorhinostomy.

A seventy-four year-old woman was referred to our hospital with purulent discharge from the right eye, ophthalmalgia, and visual disturbance. Computed tomography-dacryocystography showed a right nasolacrimal duct obstruction. She was diagnosed as having right chronic dacryocystitis with a corneal ulcer by an ophthalmologist. The bacterial culture of the discharge revealed methicillin-resistant Staphylococcus aureus. The endoscopic dacryocystorhinostomy was performed by an otorhinolaryngologist with the assistance of the ophthalmologist. One month after the operation, the purulent discharge recurred from the operated side and it was refractory regardless of removal of the lacrimal stent and conservative treatment with antibiotic eye drops and an iodine eye drop. To stop the discharge, which continued at one week after the administration of vancomycin ophthalmic ointment, we tried vancomycin ophthalmic ointment injection therapy into the lacrimal sac from inferior lacrimal punctum. The injection was done once a day, and continued for six days. After the therapy, the purulent discharge stopped and the rhinostomy could be seen clearly.

We presume that either the long retention of vancomycin ophthalmic ointment or the high local concentration of vancomycin in the lacrimal sac were the reasons for the success of this injection therapy.

Warthin’s tumor is the second most commonly occurring benign parotid tumor. As compared to malignant transformation of a pleomorphic adenoma, carcinoma arising from a Warthin’s tumor is extremely rare. A 77-year-old man presented with a slow-growing left upper neck mass. Enhanced CT showed that the mass consisted of 4 tumors, including 2 low-density tumors with capsules on the anterior aspect, 1 heterogeneously enhancing tumor with a capsule, also on the posterior aspect, and 1 irregularly shaped tumor at the center of the other 3 tumors. The diagnosis could not be established preoperatively, because fine needle aspiration cytology suggested a benign tumor, and FDG-PET/CT revealed accumulation in the tumor. We performed partial parotidectomy and neck dissection of level I, II and III lymph nodes, including the tumors. Histopathology revealed the diagnosis of intermediate-grade mucoepidermoid carcinoma in the 2 low-density tumors on the anterior aspect, and the heterogeneously enhancing tumor with a capsule on the posterior aspect was found to be a Warthin’s tumor. A transitional zone between the mucoepidermoid carcinoma and the Warthin’s tumor was observed in the irregularly shaped tumor at the center. FDG-PET/CT excluded the presence of malignancy in any other tumor other than the tumor we treated. Therefore, we concluded that the mucoepidermoid carcinoma arose from the Warthin’s tumor (pT3N0M0, Stage III). Without any additional treatment, the patient has shown no recurrence and been alive for a year now. Thus, it appears that we performed the appropriate surgery for the intermediate-grade mucoepidermoid carcinoma. To date, only 21 cases of mucoepidermoid carcinoma arising in a Warthin’s tumor have been reported in the literature. All the cases were treated with surgery and showed a favorable prognosis.

Fish bone foreign bodies are commonly found in clinical practice. Fish bones impacted in the palatine or lingual tonsils can be removed endoscopically. However, in cases of extrapharyngeal fish bone foreign bodies, intervention with direct laryngoscopy or surgical removal might be necessary. We report herein on a case of a fish bone foreign body impacted in the larynx which was removed with a lateral thyrotomy.

A 75-year-old man presented with throat pain after eating sea bream. An endoscopic examination revealed erythema of the right arytenoid with mild swelling. Computed tomographic examination showed a foreign body in the larynx which suggested laryngeal fish bone impaction. The patient underwent WEERDA-type direct laryngoscopy under general anesthesia but no foreign body was visualized. We performed a lateral thyrotomy and the fish bone was extracted from the patient without any major complications.

There are different approaches to removing fish bone foreign bodies depending on the site of the impaction. If foreign bodies cannot be removed endoscopically, we consider a lateral thyrotomy could be the next treatment option for patients with laryngeal fish bone impactions.

Inflammatory myofibroblastic tumors (IMTs) are a rare neoplasm in the head and neck region. In this report, we describe a case of IMT in the supraclavicular area.

A 44-year-old male presented to our department with right supraclavicular area swelling. Computed tomography and magnetic resonance imaging revealed a mass of 42×26×42 mm. We could not perform diagnosis via fine-needle aspiration cytology (FNAC) or core-needle biopsy (CNB). Therefore, open biopsy was performed. Based on histopathological and immunohistochemical analyses, the tumor was diagnosed as an IMT. Subsequently, the patient exhibited hoarseness, and tumor growth caused laryngeal paralysis. Therefore, the tumor was treated with total surgical excision. After the surgery, neither right laryngeal atrophy, nor dysphagia or dysphonia were encountered.

IMTs are rare; however, they can occur in any portion of the body; thus, it must be considered as a differential diagnosis for head and neck tumors. If diagnosis is difficult via FNAC and CNB, open biopsy of the tumor is warranted.

Basaloid squamous cell carcinomas (BSCCs) are a cancerous lesion consisting of proliferation of basal cell-like cells and are considered to be highly malignant tumors showing extensive invasion and lymph node metastases in the early stage. Three cases of BSCC in the hypopharynx are reported along with a review of the relevant literature.

Case 1

A 74-year-old man with feeling of discomfort in the pharynx visited a local doctor and a tumor was found in the hypopharynx. He was referred to our hospital because it was diagnosed as a squamous call carcinoma (SCC) by biopsy. Endoscopic laryngopharyngeal surgery was performed for hypopharyngeal cancer (postcricoid, cT2N0M0). BSCC was diagnosed based on the pathological examination. Radiation therapy was performed because of suspicion for carcinoma in situ at the resection stump. There has been no recurrence 5 years and 6 months after radiotherapy.

Case 2

A 71-year-old man visited a local doctor with hoarseness and was diagnosed as having hypopharyngeal carcinoma (left pyriform sinus cT4aN2bM0). He was referred to our hospital for surgical treatment. Pharyngolaryngectomy, neck dissection, thyroid lobectomy, and free jejunal transfer were performed. BSCC was diagnosed based on the pathological examination. Because the tumor was classed as pT4aN2b, radiation therapy was performed. Local recurrence has not been observed for 2 years and 5 months after radiotherapy. However, hilar lymph node metastasis appeared, so chemotherapy was started as for the treatment of SCC. Currently, a partial response has been obtained, and treatment is ongoing.

Case 3

A 69-year-old man was referred to our hospital because he was found to have a hypopharyngeal tumor on periodic endoscopy after laryngeal cancer treatment. Hypopharyngeal carcinoma (posterior wall cT3N0M0) was diagnosed. The biopsy showed poorly differentiated SCC or undifferentiated carcinoma. Pharyngolaryngectomy, neck dissection, thyroidectomy, and free jejunal transfer were performed. BSCC was diagnosed based on the pathological examination. Although there has been no recurrence of the hypopharyngeal carcinoma, the patient died of primary lung cancer 1 year and 6 months after surgery.

We encountered a patient who visited our hospital with facial edema as the chief initial complaint, who showed repeated remission and aggravation after steroid administration, who subsequently developed symptoms of polyneuropathy and lower limb purpura, and who was finally diagnosed as having eosinophilic granulomatosis with polyangiitis (EGPA), a condition difficult to diagnose early. In the future, with population aging, the numbers of EGPA patients are expected to increase. Clarification of the pathology of EGPA and early diagnosis/treatment may be important for patients’ QOL.

Syphilis is a systemic infectious disease caused by Treponema pallidum, resulting in specific symptoms. We experienced a case of syphilis in a 57-year-old woman whose complaint was cervical lymphadenopathy. Both the syphilis qualitative blood tests (TPLA and RPR) were positive and the serum soluble IL-2R level was 1,300 U/L. A cervical lymph node biopsy was performed, the results of which demonstrated a granulomatous lesion consistent with syphilis lymphadenitis.

The number of syphilis patients in Japan has been rapidly increasing since 2010, mainly in the metropolitan area and a warning announcement was issued from the Japanese Society for Sexually Transmitted Infections in 2016. Both mucosal plaque and angular cheilitis are typical, but not specific findings. In any case, with lymphadenopathy as the sole symptom, detailed medical history inquiry sometimes leads to the diagnosis.