A total of 147 patients with the main complaint of tinnitus consulted our hospital between November 12, 2013 and August 4, 2022, the target period of our study. The patients included 84 men, 63 women (male:female ratio, 57%: 43%). The patients ranged in age from 19 to 91 years (average age, 62.2 years).

We prescribed on Methylcobalamin, Adenosine Triphosphate Disodium Hydrate, and Nicotinamide Papaverine Hydrochloride or Chinese medicine for tinnitus (99 cases). The Chinese medicine was Chotosan in most cases, followed in prescription frequency by Yokukansan and Goshajinkigan, in that order. In addition, we prescribed a sleep-inducing drug.

In all cases overall, the THI scores after treatment were significantly decreased as compared with the scores before treatment.

In all the cases treated with Chinese medicines, the THI scores after treatment were significantly decreased as compared with the scores before treatment.

I believe that Chinese medicines are effective against tinnitus.

Continued treatment with Chinese medicines for half a year to several years, along with psychotherapy and sound therapy appears to be effective.

Trauma to the ear sometimes causes tympanic membrane perforation, and there are some cases of secondary cholesteatoma. However, traumatic cholesteatoma without tympanic membrane perforation is extremely rare. In this study, we report a case of traumatic middle ear cholesteatoma without tympanic membrane perforation.

A 19-year-old male patient presented to out hospital with hearing loss on the right side after a tree branch injured his right ear six years ago. No perforation of the tympanic membrane was found. Pure tone audiometry showed right-sided conductive hearing loss, and tympanometry showed a type B result. Temporal bone CT showed a soft-tissue density from the epitympanum to the mastoid, with a high-density area of calcification within the mastoid. MRI diffusion-weighted imaging showed a high-intensity area in the mastoid, suggestive of cholesteatoma. We performed tympanoplasty and mastoidectomy. The cholesteatoma was found in the mastoid, extending into the epitympanic space, and a calcified lesion was also identified within the cholesteatoma. The cholesteatoma was not contiguous with the tympanic membrane. The long process of the incus and superstructure of the stapes were eroded. In this case, a foreign body had penetrated the tympanic membrane and entered the mastoid cavity, causing a calcified lesion. Also, a piece of the epithelium of the tympanic membrane had strayed into the mastoid with the foreign body. Alternatively, inflammation of the mastoid mucosa caused squamous metaplasia resulting in cholesteatoma formation, but the tympanic membrane perforation had closed, leaving a scar lesion.

In this case, although the tympanic membrane findings were atypical for secondary cholesteatoma, we suspected a cholesteatoma lesion from the findings of CT, with MRI confirming the diagnosis.

Lipomas are the most commonly encountered benign mesenchymal soft tissue neoplasms.

They originate from mature adipose tissue and could arise at any location containing fat tissue. Nasopharyngeal lipomas are however extremely rare, with only a few reports in the literature. Only three cases of nasopharyngeal lipoma have been reported in Japan from 1968 to 2020.

We describe the case of a 69-year-old male patient with a nasopharyngeal lipoma. The mass, arising from the lateral nasopharyngeal wall, measured 35 mm in diameter. The tumor was removed en bloc, via the oral approach. If possible, surgical resection should be considered in cases of symptomatic lipoma.

Background: Japanese cedar pollinosis (JCP) could lead to impaired quality of life through causing rhinitis-related sleep problems. In this study, we investigated, using both subjective and objective methods, the efficacy of treatment initiation with fluticasone nasal spray (NS), as compared to oral loratadine in ameliorating the nasal symptoms and sleep disturbance in patients presenting with symptoms of JCP.

Methods: A total of 48 patients with JCP were randomly assigned to treatment initiation with fluticasone NS, using oral loratadine tablets as the add-on drug, or the converse treatment, namely, treatment initiation with oral loratadine, using fluticasone NS as the add-on drug. The study outcomes were the average apnea-hypopnea index (AHI), Japanese version of the Pittsburgh sleep quality index (PSQI-J) Global score, total nasal symptom score (TNSS), score on the Epworth sleepiness scale (ESS), score on the Japanese rhinoconjunctivitis quality of life questionnaire (JRQJQ), and score in the Japanese version of the rhinoconjunctivitis quality of life questionnaire (RQLQJ). The clinical trial registration number is UMIN000003374.

Results: There were no significant differences in the AHI and PSQI-J scores between the groups. However, significantly greater improvements in the TNSS (p = 0.007) and nasal blockage (p = 0.009) scores during the peak pollen season, and in the JRQLQ (p = 0.00144), RQLQJ (p = 0.0107), and ESS (p = 0.026) scores after the peak pollen season were observed in the group initiated on treatment with fluticasone NS as compared to the group initiated on treatment with oral loratadine.

Conclusion: In patients with JCP, initiation of treatment with fluticasone NS was associated with improvement of all of the nasal symptoms, excessive daytime sleepiness, and impaired activities of daily living.

The prognosis of metastatic malignant melanoma remains poor and it is sometimes difficult to stop bleeding from a hemorrhagic metastatic lesion. Herein, we report a case of gastrectomy performed for uncontrolled bleeding from a stomach metastasis arising from malignant melanoma of the nasal cavity.

The patient was a 55-year-old man with malignant melanoma of the nasal cavity. Complete resection of the primary lesion a transnasal approach and postoperative radiation were performed, however, one year after the treatment, the patient was diagnosed as having metastasis to the Rouviere node. Moreover, upper gastrointestinal endoscopy also showed some elevated submucosal lesions in the stomach. Histologic examination showed metastatic malignant melanoma in the stomach, and PET-CT revealed multiple bone metastases and cervical lymph node metastases. Despite treatment with nivolumab, ipilimumab and pembrolizumab, the gastric metastatic lesion only enlarged.

About 58 months after his first visit to us, the patient was hospitalized because of severe anemia, and upper gastrointestinal endoscopy showed bleeding from the gastric metastatic lesion. As endoscopic hemostasis was difficult to accomplish, we performed proximal gastrectomy as palliative surgery. Following the surgery, the anemia improved and there were no postoperative complications. Pembrolizumab therapy was continued postoperatively, but the patient died 5 months after the surgery.

Immune checkpoint inhibitors and molecular-targeted agents are known to improve the outcomes of patients with malignant melanoma, however, it is sometimes difficult to control the bleeding metastatic lesions.

We think that gastrectomy is effective in patients with uncontrollable gastrointestinal hemorrhage, even if it is only with palliative intent.

Paranasal sinus osteoma is the most frequently encountered benign tumor in the nasal and sinus areas. Frontal sinus osteoma is the most common sinus osteoma (80%), and is usually asymptomatic. A 35-year-old woman was admitted to our hospital complaining of right forehead prominence and pain, and was diagnosed as having a right frontal sinus osteoma and frontal sinusitis. Extranasal frontal sinusectomy was performed. There was no recurrence of the lesion after surgery. Surgery is indicated in cases of frontal sinus osteoma when the condition is symptomatic. The surgical methods include extra-nasal frontal sinus surgery and endoscopic sinus surgery. Endoscopic sinus surgery is superior in terms of yielding better aesthetic outcomes, being minimally invasive, and allowing a shortened hospital stay. The indications for endoscopic sinus surgery have been expanding with the development of endoscopic surgery techniques, however, the precise indications have not been clearly defined until date. In regard to reconstruction of the frontal bone following extranasal frontal sinusectomy, it is necessary to select the most appropriate material for individual patients based on an understanding of the characteristics of different materials available.

Patients with maxillary sinus foreign bodies are frequently encountered in the fields of otolaryngology and dental and oral surgery. In the majority of cases, the cause is iatrogenic in relation to dental care, or a result of trauma. We report a case of long-term retention of a foreign body (an arrow nock) in the maxillary sinus. A 50-year-old man was referred to our hospital by a local practitioner with suspected mycosis of the left maxillary sinus. Computed tomography showed an opacity in the maxillary sinus suggestive of a foreign body, but we misidentified it as a fungus ball. However, presence of a foreign body (an arrow nock) in the maxillary sinus was confirmed during endoscopic sinus surgery and the foreign body was removed. The patient gave a history of having sustained facial trauma during archery practice 30 years ago. We speculate that the foreign body had entered the maxillary sinus at the time of that accident. Maxillary sinus foreign bodies are usually associated with dental treatment, and finding of an arrow nock in the sinus is quite rare. Since a plastic foreign body does not elicit much antigen tissue reaction, the arrow nock had remained lodged in the sinus for a long time. This case underscores the need to bear in mind that foreign bodies can enter the sinuses at the time of facial trauma and remain lodged there for long periods of time.

We treated a 66-year-old female patient with a tracheostoma who suffered from aphonia even when the tracheostoma was manually closed. The patient had undergone tracheostomy and reduction of an amyloid mass via laryngo-micro surgery twice at another hospital. Thereafter, she was unable to produce sounds due to scarring and adhesion of the vocal folds. One year later, she was referred to our hospital. We performed staged operations. In the first step, the mobility of the vocal folds was restored by incision of the glottal adhesions, and the amyloid mass and scar tissue in the laryngotracheal region were removed via a laryngofissure approach. A free mucosal flap harvested from the lower lip was grafted on to the raw surface. A core mold was placed between the glottis and above the tracheostoma. A laryngotracheal fistula was created to keep the lumen open. In the second operation, which was performed 24 days after the first operation, the core mold was removed and the laryngotracheal fistula was closed. The tracheostoma was closed about 4 months after the initial operation. The postoperative course was uneventful, with no exertional dyspnea, and the patient’s normal voice was restored, with no complaints for at least three years thereafter. The goal of treatment of laryngeal amyloidosis is to remove the amyloid mass while preserving the respiratory and phonatory functions of the larynx, because these functions are essential to maintain the quality of daily life, and also because recurrent growth of an amyloid mass in the head and neck region, even if it occurs, is usually extremely slow.

Hyalinizing trabecular tumor (HTT) has rarely been encountered in clinical practice in recent years. This report is about a case of a 56-year-old woman who was diagnosed as having an HTT. The patient presented with a one-week history of episodic pain in the pharynx to the emergency room. She had a left deep neck abscess with an abscess or a tumor in the left thyroid on enhanced CT. We performed emergency surgery, namely, drainage with left hemithyroidectomy. A tumor was isolated within the dissected thyroid. Since a trabecular arrangement was observed within the tumor, we made the diagnosis of HTT. Immunohistochemistry showed negative staining for MIB-1 (Ki-67). Video fluorography did not reveal a pyriform sinus fistula.

Although HTT has histological features close to papillary thyroid carcinoma, most reported cases were benign. However, there are also a few reports of malignant HTT with lymph node metastasis or gene rearrangement. Therefore, HTT classified as ‘other tumor’ in the General Rules for the Description of Thyroid Cancer.

We treated a patient with a deep neck abscess, and found HTT within the resected thyroid. In view of the reports of malignant HTT, careful observation is necessary.

Recently, there have been reports of the use of percutaneous cardiopulmonary support (PCPS) to guarantee safe airway management in thyroid tumor patients with tracheal infiltration. We report a case of anaplastic thyroid cancer in which we performed tracheostomy in preparation for PCPS. A 64-year-old woman visited our hospital with the chief complaint of anterior cervical swelling and had been diagnosed as having a thyroid tumor with tracheal infiltration. She needed urgent tracheostomy, but as surgical airway management was considered difficult in an emergency, we performed tracheostomy in preparation for PCPS. Although our case presented herein needed preparation alone without actual performance of PCPS, it is suggested that preparation for PCPS needs to be considered for 1) those in whom the most narrowed part of the trachea is 5 mm or less, 2) those with intratracheal infiltration of the tumor, and 3) those with potential need for surgical airway management in an emergency.

Introduction: ENKL (extranodal NK/T-cell lymphoma, nasal type) is an NK cell-derived lymphoma that develops in the nasal cavity and pharynx, and is characterized by progressive necrotic and destructive granulomatous lesions. Tumor features in ENKL are often difficult to diagnose because of the strong tendency towards granulation tissue formation and necrosis. However, early diagnosis is important because the prognosis differs markedly depending on the stage of the disease. In this study, we report two cases of ENKL that were difficult to diagnose even six months after the initial appearance of symptoms.

Case 1: A 34-year-old Vietnamese man was referred to our department for investigation of the cause of recurrent nasopharyngitis with unknown fever persisting for over 6 months.

Case 2: A 42-year-old man with symptoms of sinusitis for about 2 years and 3 months had necrotic-like tissue of inferior turbinate that gradually expanded into the nasal cavity, but the diagnosis could not be made even after several biopsies. The patient developed nasal hemorrhage that was difficult to control. He was transferred to our hospital for control of the bleeding.

Summary: We encountered two cases of ENKL that were difficult to diagnose even 6 months after the onset of symptoms. In cases presenting with persistent fever and nasopharyngeal symptoms, it is important to keep in mind the possible diagnosis of ENKL. It is important to consider biopsy under general anesthesia, if possible. It is important for the clinician and pathologist to work closely together to obtain an early diagnosis.

We encountered a patient with psychogenic dysphonia who was successfully treated with kambakutaisoto. The patient was a 35-year-old woman. About 2 months before she visited us, she had been stressed by her boss frequently yelling at her at work. She then visited our department with a day’s history of loss of voice. Fiberoptic laryngoscopy showed no organic abnormalities in the vocal cords. While glottic insufficiency was observed at the time of vocalization, glottal closure was good at the time of coughing. Therefore, we diagnosed the patient as having psychogenic dysphonia associated with stress. We recommended that she see a psychiatrist or psychosomatic physician, but she was reluctant. Therefore, we started her on treatment with kambakutaisoto (7.5 g/day), and her voice was restored on day 3 of treatment with this drug. When the patient was seen again on day 7, the dose of kambakutaisoto was reduced to 2.5 g/day. Eventually, she became to deal with the stress, and kambakutaisoto was discontinued at her visit to us on day 42 of treatment. Thereafter, the symptom has never recurred.

Thus, treatment with kambakutaisoto could be tried in patients with psychogenic dysphonia caused by stress.

It is well known that chemotherapy in adolescent and young adult (AYA) patients with cancer can reduce fertility, regardless of the regimen used. A decline in fertility greatly affects the quality of life of cancer survivors in the AYA age group; however, it is thought that few patients receive fertility preservation advice.

A questionnaire survey was conducted to assess the current understanding and consideration of fertility among otorhinolaryngologists/head and neck surgeons who treat AYA patients with cancer, and to inform them of the guidelines for fertility preservation. A total of 275 otorhinolaryngologists/head and neck surgeons working at our hospital in Ehime, Japan, six neighboring universities, and their affiliated facilities were included in this study. The questionnaire was mailed and the respondents were requested to return them by fax. Twenty questions were asked, including the respondents’ length (in years) of experience as physicians, their specialties, their experience in medical care and chemotherapy for AYA patients with cancer, and their knowledge and experience pertaining to fertility reduction measures. Although 58.7% of the physicians were aware of the recommendation of cryopreservation of eggs/sperm prior to chemotherapy was recommended, only 7 out of 40 physicians (17.5%) had referred AYA patients with cancer to an appropriate medical facility (department) after obtaining informed consent for chemotherapy. Although fertility preservation has been discussed at professional conferences and seminars, consideration and actions in the field of otorhinolaryngology/head and neck surgery have not been sufficient. We hope that the results of this survey will help raise awareness of fertility preservation among otorhinolaryngologists/head and neck surgeons.