Eosinophilic otitis media (EOM) and eosinophilic chronic rhinosinusitis (ECRS) are both intractable upper airway diseases characterized by infiltration of numerous eosinophils. Both EOM and ECRS show high rates of comorbidity with asthma, and are considered to have a “one airway, one disease” relationship with asthma. Here, we summarize our current knowledge regarding the characteristics of EOM/ECRS, their relationships with asthma, and the efficacy of treatments for EOM/ECRS. The greater the severity of asthma, the more severe the EOM/ECRS. Appropriate strengthening of asthma inhalational therapy leads to improvement of comorbid EOM/ECRS. In addition, mild EOM responds to intratympanic infusion of a topical steroid, such as triamcinolone acetonide (TA), whereas moderate EOM requires a systemic steroid together with TA; severe EOM is associated with the formation of granulation tissue that requires surgical removal. Endoscopic sinus surgery is effective for the treatment of ECRS. To prevent recurrence of ECRS, medications such as montelukast, an anti-leukotriene agent, in addition to steroid treatment are necessary in many cases. Recently, the effectiveness of molecular-targeted drugs has been reported, but more data need to be accumulated.

Herein, we report a case of Bezold’s abscess in a 55-year-old man with no underlying disease. The patient gave a history of having noticed a swelling behind the left ear about 3 months earlier, but had not sought treatment. He consulted our hospital a few days after the swelling suddenly began to increase in size and became painful. The left postauricular area was red and swollen, with some areas of necrotic skin. The left pinna was seen protruding conspicuously with purulent discharge filling the ear canal, which impeded examination of the eardrum. On computed tomography (CT), the tympanum and mastoid air cells of the left ear were filled with soft tissue shadows, and a subcutaneous abscess was detected, extending from the side of the head to the neck. The diagnosis was acute mastoiditis of the left ear with Bezold’s abscess, and emergency left mastoidectomy and incision and drainage of the abscess on the left side of the neck were performed. Antibiotic therapy was continued postoperatively. Additional mastoidectomy and closure of the surgical wound following the incision and drainage were performed while the patient was hospitalized. The patient was discharged 23 days after the initial surgery.

Bezold’s abscess of the neck develops as an extracranial complication of otitis media when the pus breaches the mastoid part of the temporal bone via a bone defect. The condition is considered to be common in children and in patients with underlying diseases such as diabetes, but is now rarely encountered. Bezold’s abscess can cause otogenic intracranial complications such as meningitis and brain abscess, if allowed to progress untreated, so that treatment by the appropriate surgical procedure and antibiotic therapy is vital.

A clinical study of 530 patients with epistaxis seen during the past 5 years (2014–2019) is reported. In particular, we report the data of 312 patients who were seen by otorhinolaryngologists. It occurred more frequently in males than in females (male:female ratio, about 2:1). Epistaxis occurred more frequently in the winter, with fewer cases seen in the summer. The most frequently encountered site of bleeding was the Kiesselbach’s area (46.0%). Overall, half of the patients were treated by gauze packing, electrical coagulation successfully controlled the bleeding in 28.9% of the patients, and 11.1% of the patients were treated by balloon tamponade. Re-bleeding was observed in 11.1% of patients. The percentages of patients with hypertension and anticoagulant therapy were significantly lower among patients with re-bleeding who did not require hospitalization than among patients with re-bleeding who required hospitalization. The percentages of patients with bleeding from Kiesselbach’s area was significantly lower in patients with re-bleeding who required hospitalization. The number of patients with re-bleeding requiring no hospitalization was lower as compared to that in 2016. We have been treating patients with suspected bleeding from the posterior area by balloon tamponade since 2016, which, we believe, is the reason for the decrease in the number of patients with re-bleeding who did not require hospitalization. Early treatment is important for the control of nasal bleeding.

Pulmonary cryptococcosis is a fungal infection caused by inhalation of the spores of Cryptococcus neoformans in the soil or pigeon feces. Pulmonary cryptococcosis can be classified as primary pulmonary cryptococcosis, occurring in patients with no underlying disease, or secondary pulmonary cryptococcosis, occurring secondary to some underlying disease. We report a case of secondary pulmonary cryptococcosis complicated by deep neck abscesses.

An 82-year-old woman presenting with the chief complaint of a left neck swelling was admitted to our hospital. She had a history of rheumatoid arthritis for which she was receiving treatment with prednisolone, and also had diabetes mellitus, which was not well-controlled. A neck CT showed deep neck abscesses, and chest CT showed multiple nodules, mass lesions with cavitation, and pleural indentation. We made the diagnosis of deep neck abscesses and performed incision and drainage. We diagnosed the chest lesions as secondary pulmonary cryptococcosis since the serum cryptococcal antigen test was positive, and started the patient on treatment with fluconazole. The serum cryptococcal antigen titer decreased from 64 to 2 after 22 months of treatment, and the chest CT findings also improved.

We consider that in this patient, the pulmonary cryptococcosis lesions, as also the deep neck abscesses, progressed rapidly within a short period of time, because the patient was under long-term steroid therapy for rheumatoid arthritis and also uncontrolled diabetes mellitus; furthermore, she also had lymphocytopenia and hypoalbuminemia due to undernutrition.

In immunocompromised patients presenting with pulmonary symptoms/sign/findings, it is important to consider pulmonary mycosis, including cryptococcosis, in the differential diagnosis.

In this study, we attempted to retrospectively analyze the differences in the therapeutic efficacy of chemotherapy with 5-fluorouracil plus carboplatin according to the number of treatment cycles administered during definitive concurrent chemoradiotherapy (CCRT) in a total of 36 cases of advanced hypopharyngeal and laryngeal squamous cell carcinomas previously untreated at our hospital between 2007 and 2017.

The results were as follows: the 3-year overall survival rate (OS) and 3-year disease-specific survival rate (DSS) were 50% and 57%, respectively, in subjects who had received one cycle of chemotherapy administered during CCRT, and 76% and 83%, respectively, in subjects who had received 2 cycles of chemotherapy. However, no significant difference in the 3-year laryngeal preservation rate was observed between people who had received one and two cycles of chemotherapy. Furthermore, no statistically significant difference in the modified Glasgow Prognostic Score (mGPS), used to estimate cancer cachexia and malnutrition occurring in association with CCRT, was observed either between the two groups.

Based on the results, it was concluded that 2 cycles of chemotherapy administered during definitive CCRT contributed to improve the therapeutic outcomes, such as better survival rates, as compared to one cycle of treatment, especially in patients with stage IVA advanced head and neck squamous cell carcinomas. Furthermore, cancer cachexia and malnutrition were not any worse after 2 cycles of chemotherapies than after one cycle of chemotherapy.

Herein, we report a case of juvenile papillary thyroid cancer (PTC) associated with neurofibromatosis type 1 (NF1). The patient was diagnosed as having NF1 by skin biopsy at 12 years of age. She was admitted to a local ENT clinic with a gradually enlarging neck mass. PTC was suspected, and she was transferred to our university hospital for further treatment. The patient was confirmed to have juvenile PTC with neck metastasis (cT3, cN1b), and was treated by surgical resection of the pyramidal lobe of the thyroid and hyoid bone (Sistrunk operation), together with lateral neck dissection, to preserve the thyroid function. Patients with NF1 are well known to be predisposed to the development of various malignancies. According to our experience, we believe that attention should be paid to the risk of occurrence of PTC in patients with NF1. In patients with NF1, dynamic CT prior to surgery would be very useful to distinguish metastatic lymph nodes from the neurofibromas.

Rubella is an important infection, especially in women who are pregnant; a pregnant woman with rubella may give birth to a child with congenital rubella syndrome. Rubella has recently shown signs of having become an epidemic.

Herein, we report the case of a 34-year-old male patient who visited our otorhinolaryngology outpatient department with the chief complaint of swelling in the neck, and was diagnosed as having rubella. He had been seen at several medical institutions but had not yet been correctly diagnosed, and was then referred to our hospital. Examination at our outpatient department revealed a palpable 15-mm lymph node in the post-auricular region. He had bilateral bulbar conjunctival hyperemia and Forchheimer spots on the hard palate. Pale disseminated small erythematous lesions were scattered on his chest, back and both legs. We made the diagnosis of rubella based on the clinical symptoms/signs and blood results.

We must also consider the diagnosis of rubella in patients who present with fever, rash, and cervical lymphadenopathy. In particular, when significant lymphadenopathy is noted in the posterior cervical region or post-auricular region, it is necessary to perform careful examination of the patient for rashes and Forchheimer spots in the oral cavity.

A venous aneurysm, defined as a focal dilatation in a vein, is an uncommon vascular abnormality. It is to be distinguished from varicose veins, which are characterized by continuously dilated meandering and bending veins. A venous aneurysm can develop in all major veins, but multiple cervical venous aneurysms have rarely been reported, if ever. Herein, we report a case of venous aneurysms in the left external jugular vein and left subclavian vein.

A 64-year-old man was referred to our department from a general physician with a left supraclavicular mass. The mass was soft and painless, and increased in size when the patient performed the Valsalva maneuver. There was no prior history of trauma to that area. Doppler ultrasonography, dynamic computed tomography and magnetic resonance imaging revealed two aneurysms of the left external jugular vein and an aneurysm of the subclavian vein, and suggested the presence of a thrombus in one of the external jugular vein aneurysms. We resected the external jugular lesions with the aim of preventing pulmonary embolism, as well as for esthetic reasons. The resection was performed successfully, with no postoperative complications. Following the surgery, the patient has remained asymptomatic for 4 months. Histopathologically, one of the aneurysms contained a thrombus.

Venous aneurysm of the neck is usually asymptomatic, and is most frequently treated only for esthetic reasons. However, there are a few reports of pulmonary embolism arising from thrombus formation in the jugular and subclavian veins. We consider that surgery should be performed if the patient is deemed to be at the risk of developing pulmonary embolism from the thrombus. In the present patient, we did not resect the subclavian lesion because it was asymptomatic. Careful follow up is important considering the possibility of thrombus formation and rupture.

Background: Based on the background factors and results of blood tests in patients with peritonsillar abscess, we investigated the factors involved in the prolongation of hospitalization and progression to deep neck abscess of these patients.

Objective and Methods: We studied the data of 113 patients with peritonsillar abscesses (including those in whom the condition progressed to deep neck abscesses) who were hospitalized at our department during the 3-year period from August 2014 to July 2017. Data of patients who needed hospitalized treatment for 7 days or more, including the age, BMI, sickness period, white blood cell count, serum CRP, serum total protein, serum albumin, blood glucose, blood HbA1c, and eGFR at the first examination, and the neck factors in the cases that progressed to deep cervical abscess were examined using t-tests.

Results: The blood test items and background factors at the first visit were compared according to the length of hospitalization. The results revealed that prolonged hospitalization was associated with higher values of age, peripheral blood white blood cell count, serum CRP value and blood glucose, and lower values of the serum total protein, serum albumin, and eGFR.

Conclusions: Factors that were associated with a longer hospital stay in this study were relatively high values of age, peripheral blood white blood cell count, blood glucose and serum CRP, and relatively low values of the serum total protein, serum albumin, and eGFR. The disease duration, BMI and HbA1c were not identified as significant factors. Stepwise multiple regression analysis to identify factors associated with prolonged hospitalization identified the blood glucose and serum albumin levels measured at the first visit as significant predictors of a prolonged hospital stay and higher severity of the illness. Our findings suggested the importance of measuring these factors for predicting the progression to deep cervical abscess.