Invasion and metastasis are hallmarks of cancer and reflect the grade of malignancy. For oral tongue cancer, the depth of invasion has been incorporated in the T classification since the 8th edition of the UICC TNM classification. The invasive potential, namely, the pattern of invasion at the invasive front has been shown to be a prognostic factor in cases of tongue cancer. Several methods of evaluation of the tumor invasive potential, such as determination of the expression pattern of the laminin γ2 chain, assessment by the Yamamoto-Kohama classification, measurement of the tumor budding score, and determining the worst pattern of invasion, have been reported. High invasion potential as evaluated by these methods is recognized as a poor prognostic factor for late cervical metastasis of N0 tongue cancer, as well as for survival in patients with tongue cancer. After the initial surgery, evaluation of the tumor invasive potential at the invasive front of the primary tumor should be performed, in addition to measuring the depth of invasion and evaluating adverse features in the surgically resected specimens. Selection of the treatment strategy depending on the invasive potential might be useful to overcome the poor prognosis of highly invasive tongue cancers and establishment a better treatment policy, e.g., neck dissection, in cases of tongue cancer.

Neurofibromatosis type 2 (NF2) is a rare autosomal-dominant hereditary disease characterized by the presence of bilateral acoustic tumors. Some patients with NF2 suffer from bilateral profound hearing loss. An auditory brainstem implant (ABI) directly stimulating the cochlear nucleus is a traditional option for hearing rehabilitation in NF2 patients with profound hearing loss. Recently, cases of NF2 in whom hearing was successfully restored by cochlear implants (CIs) have been reported.

We report the case of a 61-year-old female patient with NF2, who presented with bilateral hearing loss, in whom excellent hearing function was successfully restored by CI surgery. When the patient was 34 years old, she underwent resection of an acoustic tumor on the right side, which resulted in complete hearing loss on the right side. At the age of 55, an acoustic tumor was detected on the left side, however, since it was small, it was managed conservatively and showed no increase in size during the course of follow-up. Six years later, while the tumor size on the left side remained stable, the hearing loss on the same side had progressed to become severe. As a promontory stimulation test showed remaining neural function in the cochlear nerve, we suspected that the cochlear nerve function may be intact. Therefore, CI surgery was performed on the left side, with excellent recovery of the hearing function for daily communications; the hearing ability remains intact at present, 2 years since the CI surgery. The promontory stimulation test may be useful for predicting the effectiveness of CIs in NF2 patients with bilateral profound hearing loss. CIs may be a useful for some cases of NF2 with bilateral profound hearing loss.

Acyclovir and valacyclovir are effective therapeutic agents for viral infections caused by viruses such as herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV). These viruses are also known to be the causative viruses of peripheral facial palsies, such as Bell’s palsy and Ramsay Hunt syndrome. While acyclovir and valacyclovir are commonly used in the field of otolaryngology, they may cause renal dysfunction or encephalopathy as a side effect in rare cases. The patient reported herein was an 83-year-old man who developed left peripheral facial palsy and was prescribed a steroid and valacyclovir (3000 mg/day) to be taken at home. The patient was uncomfortable drinking fluids due to spillage from the mouth as a result of the paralysis, and reduced his fluid intake. Four days after visiting our department, he developed consciousness disorder and visited our hospital again. Dialysis and fluid management were initiated to treat the dehydration, drug-induced acute renal injury, and acyclovir encephalopathy. In the elderly, even if renal function appears to be normal in pre-medication tests, it may deteriorate during treatment with acyclovir or valacyclovir, due to environmental changes, decreased reserve capacity, dehydration, etc., and furthermore, may be complicated by acyclovir encephalopathy. Therefore, when administering acyclovir or valacyclovir to the elderly, it is necessary to provide sufficient guidance to the patients regarding adequate fluid intake; it may also be advisable to consider the use of alternative drugs.

We report a case of extension of a hearing aid mold material into the middle ear, with ossicular fracture and disarticulation. The patient was a 70-year-old man, in whom the hearing aid impression material extended into the tympanic cavity during ear mold fitting. We performed removal of the foreign body from the middle ear under general anesthesia, followed by tympanoplasty IIIc using the fractured incus as columella. We selected the retroauricular approach for the operation, and the thickened posterior wall skin of the external auditory canal was incised and everted to obtain a wider access; these procedures led to complete removal of the impression material lodged in the tympanic cavity. Prior consultation with an otorhinolaryngologist is desirable for hearing-impaired patients desiring to purchase hearing aids, and it is necessary for ear mold impressions to be made by an otorhinolaryngologists, especially for postoperative ears or ears with a history of otitis media. Sufficient communication between the otorhinolaryngologist and the hearing aid dealer is important, as is communication between the otorhinolaryngologist and the family physician. Persons with hearing impairment wishing to use a hearing aid should seek an otorhinolaryngologist’s opinion before it is fitted. The otorhinolaryngologist is required to work closely, not only with certified hearing aid specialists, but also with hearing aid dealers not working with any certified hearing aid technicians.

Cases with foreign bodies in the ear canal are often encountered in otorhinolaryngology outpatient clinics. The nature of the foreign bodies may not become immediately apparent at first glance. We report the case of a 65-year-old man with foreign bodies in both ears, who showed characteristic otoscopic findings. He presented with a history of recurrent episodes of remission and exacerbation of an abnormal sensation in both ears. Otoscopy revealed multiple pearl-like bodies in both ear canals. Close examination revealed that these bodies were composed of scrubs contained in facial soaps. We found that the patient put the foreign bodies himself into his ear canals, from the history of repeated remission and exacerbation of the abnormal sensation in the ears.

For safe treatment of foreign bodies in the ear canal, it is important to identify the foreign body. In addition, to avoid recurrence, it may be important to investigate how the foreign body found its way into the ear canal.

Congealed scrub material as a foreign body has been observed in the conjunctiva but has never previously been reported in the ear canal. When encountering patients with characteristic otoscopic findings, otologists should be aware of the possibility of congealed scrub material being present in the ear canals as foreign bodies characteristic otoscopic findings.

Epistaxis is a commonly encountered ENT emergency. While epistaxis can be easily controlled in most cases by simple techniques such as compression, it can sometimes prove difficult to arrest the bleeding. Such intractable epistaxis can be caused by various diseases, including idiopathic thrombocytopenic purpura (ITP). We report the case of a patient with refractory epistaxis who was diagnosed as having ITP, along with a discussion of the rates of patients with ITP and other blood disorders in Japanese patients with epistaxis.

A 70-year-old man presented to our hospital with refractory nose bleed. Blood tests showed no abnormalities of the blood clotting capacity, while the platelet count was markedly reduced to 8000/μl. Bone marrow examination revealed no abnormalities and the patient was diagnosed as having ITP. Treatment with oral prednisolone was started immediately, and the platelet count gradually improved.

Nose bleed is a common symptom in patients with ITP, especially in the early stages of the disease, although the diagnosis is often missed at the first visit of the patient to the ENT department. However, ITP may account only for a limited proportion of patients with epistaxis. To estimate the situation in Japan, we reviewed papers that included more than 100 cases of epistaxis that had been published during the 30-year period from 1990 to 2019. We found that 0%–6.0% of cases of nasal hemorrhage had blood disorders, and more than 0%–0.49% had ITP. Thus, patients with ITP do not represent a large percentage of patients with epistaxis, but the absolute number is not small. ITP can have serious outcomes, and otorhinolaryngologists should be well aware of this condition.

We report the case of a 26-year-old male patient who presented with repeated hemorrhages from the bilateral tonsillar fossae in the initial days after tonsillectomy. Despite trans-oral hemostasis surgery undertaken twice under general anesthesia, the bleeding recurred. Angiography following endotracheal intubation revealed bleeding from the tonsillar branch of the left facial artery, and the bleeding was arrested by an endovascular embolization procedure. Bleeding from the right side ceased during this procedure. Sedation with general anesthesia was maintained for 3 days to give complete rest to the wound, and successful hemostasis was achieved. Subsequent examinations revealed a reduced level of blood coagulation factor VIII, and the patient was diagnosed as having hemophilia A.

The coagulation dysfunction in patients with hemophilia A can vary, and mild or even moderate dysfunction in an adult case may remain latent. During preoperative evaluation in patients scheduled to undergo surgery, careful attention should be paid to even the slightest prolongation of the activated prothrombin time or a minor bleeding tendency. In the present case, transcatheter arterial embolization and prolonged sedation with general anesthesia to provide rest to the surgical wound were effective for controlling intractable hemorrhage after tonsillectomy.

The standard treatment for locally advanced head and neck squamous cell carcinoma includes surgery, chemoradiotherapy (CRT), or bio-radiation therapy (BRT). BRT is recommended for elderly and patients with renal failure. However, acute mucositis, dermatitis, and dysphagia occur more frequently following BRT than after CRT. The incidence of esophageal stricture was significantly higher in patients who underwent percutaneous endoscopic gastrostomy (PEG) before treatment than in those who did not undergo PEG. We report a case of severe stenosis of the esophageal junction developing after BRT in a patient with hypopharyngeal cancer.

A 66-year-old man with cT2N2bM0 hypopharyngeal cancer was initially treated with neck dissection and concurrent BRT. PEG had been performed before the treatment. He completed the full course of BRT, but he complained of dysphagia, which was diagnosed as being caused by severe stenosis of the esophageal junction. Therefore, he was treated by total pharyngolaryngoesophagectomy for resection of the esophageal cancer and to permit oral intake.

We should consider not only whether the treatment can be completed, but also how side effects need to be managed, for example, by reducing the cetuximab dose or suspending BRT, before severe mucositis develops. From our experience of this case, we learned that it is important to prevent severe mucositis. Consequently, it is necessary to ensure oral care and pain control, so that oral intake remains possible.

Dysphagia in older persons can be of diverse causation. Herein, we report the case of a 74-year-old man with severe dysphagia caused by myopathy of the cricopharyngeal muscle.

His swallowing function had begun to deteriorate 6 years before his first visit to our hospital. Videoendoscopic and video-fluorographic examinations of swallowing revealed no dilatation of the esophageal orifice. The patient was treated by cricopharyngeal myotomy. Histopathologic examination revealed myopathy of the cricopharyngeal muscle. However, no improvement of the swallowing function was observed after the surgery. This finding, along with his weight loss of 10 kg during the 6-year period suggested that the patient had sarcopenia with a loss of general muscle strength, including of the muscles related to swallowing, due to malnutrition. After nutritional management by tube feeding and swallowing rehabilitation for 3 months, he showed improvement in the swallowing function, and finally resumed oral intake. Indeed, video-fluorography after 5 months of rehabilitation revealed that the anterior movement distance of the hyoid had increased. This result indicated that anterior movement of the hyoid plays an important role in the dilatation of the esophageal orifice during swallowing.

Introduction: The carotid sinus is an organ that regulates the blood pressure and heart rate, but spread of head and neck cancer to the neck lymph nodes can cause carotid sinus syndrome, with syncopal attacks. We report a case of hypopharyngeal carcinoma with neck lymph node metastasis who was suspected as having carotid sinus syndrome.

Case presentation: The patient was a man in his 70s. While hospitalized for hypopharyngeal carcinoma, he suffered syncopal attacks. Since there was no evidence of a cardiac origin for the fainting attack, we suspected vasosuppressive carotid sinus syndrome, which is relatively rare.

Conclusion: Head and neck cancers are often associated with lymph node metastasis, which may cause carotid sinus syndrome. Head and neck surgeons and otolaryngologists should be made aware of possible cause of syncopal attacks.

We conducted a retrospective analysis of 497 patients who underwent tonsillectomy at Kamio Memorial Hospital from September 2015 to August 2018. A total of 35 cases (7.0%) developed postoperative bleeding and 3 cases (0.6%) needed a second operation under general anesthesia to stop the bleeding. Postoperative bleeding most frequently occurred between 24 hours and 6 days after the operation. The incidence of postoperative bleeding was significantly higher in males and in patients aged 20–39 years old. The operation time, body mass index, smoking habit, and history of hypertension were not identified as clinical risk factors for bleeding after tonsillectomy in this study.