Sinonasal squamous cell carcinoma (SCC) is a rare tumor arising either de novo or in association with inverted papillomas (IPs). IPs are rare benign tumors of the sinonasal tract with high recurrence rates and potential for malignant transformation, although the specific mechanisms underlying the association of SCC with IP and the clinical features of SCC associated with IP versus those of de novo SCC remain unclear, with substantial debate continuing on these issues.

Human papilloma virus (HPV) has attracted much attention as a cause of sinonasal SCC. HPV-related multiphenotypic sinonasal carcinoma (HMSC) is also a sinonasal tract tumor with features of both surface-derived and salivary gland carcinoma, such as adenoid cystic carcinoma, and has been newly classified as an HPV-positive sinonasal carcinoma. A deeper understanding of the overall incidence and clinicopathological profile is required for the management of patients with HPV-related sinonasal carcinoma.

In the current review, we discuss and compare the oncological features and prognosis of patients with sinonasal SCCs based on their etiology. We also review the roles of high-risk human papilloma viruses (HPVs) in the pathogenesis of SCCs associated with IPs.

Acute hearing loss can arise from a variety of disorders, with many cases treated as deafness of sudden onset. We report the case of a patient who presented with hearing loss, vertigo, facial palsy and brain abscess due to masked mastoiditis.

The patient, a 54-year-old man was referred to us with acute hearing loss on the right side and vertigo. He was started on treatment with an oral steroid, as a case of sudden-onset deafness. He developed right facial nerve palsy 10 days later, and a headache and right abducens nerve palsy 28 days later. Imaging examinations revealed pathological changes in the mastoid with the posterior tympanum and a cerebral abscess. The cerebral abscess failed to respond to antibiotic therapy, and mastoidectomy and tympanoplasty were carried out. A review of the past medical history of the patient revealed that he had been diagnosed as having otitis media 2 months earlier, which was still persistent. Enterococcus gallinarum, a rare anaerobic bacterium, was isolated from the middle ear fluid by bacterial culture. Masked mastoiditis without obvious inflammatory findings is difficult to diagnose, and careful observation is required.

Otogenic intracranial complications are rare, but could be life-threatening. Because of the great advances in antibiotic therapy and imaging techniques, the mortality rate and prevalence are on the decrease, but cases still do occur. Middle ear infection, for example chronic otitis media, acute otitis media, and cholesteatoma do rarely spread into the intracranial space to cause central nervous system complications, such as meningitis, brain abscess, lateral sinus thrombosis, etc. Sometimes, surgery is needed in addition to adequate antibiotic therapy for the treatment. We encountered 3 patients with meningitis complicating middle ear infection in the last 5 years. The 2 patients with cholesteatoma showed good outcomes after undergoing radical mastoidectomy, while the third patient with fungal malignant external otitis media died. Early surgical treatment possibly contributed to the better outcomes in the cholesteatoma cases. The patient with fungal malignant external otitis media showed bone erosion, which could have led to the meningitis. Resistance to antibiotics suggested the possibility of fungal infection, and cerebrospinal fluid examination helped in the diagnosis.

Tolosa-Hunt syndrome (THS) is characterized by intense unilateral orbital pain and ophthalmoplegia associated with third, fourth, and sixth cranial nerve neuropathies. It is presumed to be caused by granulomatous inflammation in the cavernous sinus or orbital fissure. We report the case of an 18-year-old man, who presented with severe left orbital pain and diplopia. He was diagnosed as having facial nerve paralysis at a neighborhood clinic and referred to Fujisawa City Hospital. At the hospital, he complained of diplopia and examination revealed ptosis due to left third cranial nerve palsy, but no signs of facial nerve palsy. MRI revealed high-intensity changes in the left cavernous sinus, and based on the findings, the patient was diagnosed as having THS. The sings of third cranial nerve neuropathy improved with steroid therapy for 3 months. No recurrence has been observed. It is important for otolaryngologists encountering patients with severe orbital pain and the third nerve palsy to be aware of THS.

Intraparotid facial nerve schwannoma is rare. During the process of resection of the parotid gland tumor with sacrifice or intracapsular enucleation of the facial nerve, the postoperative facial nerve function is expected to become worse, and it is difficult to reconstruct the facial nerve to obtain better than Grade III function on the House Brackman Scale. Herein, we report the case of a patient who developed facial nerve injury during parotidectomy for an intraparotid facial nerve schwannoma, in whom we performed neurorrhaphy with the great auricular nerve, with satisfactory results. The patient achieved better facial mobility. The patient, a 36-year-old woman, presented with a 1-year history of a painful mass over the right parotid region. The findings of fine needle aspiration biopsy was classified as IVB, suggesting a salivary gland neoplasm of uncertain malignant potential. Magnetic resonance imaging showed a tumor measuring 5.3 cm in diameter, which was suspected as being malignant. We performed parotidectomy, during which the facial nerve had to be sacrificed almost entirely assuming intracapsular enucleation of the facial nerve tissue. Facial stimulation yielded no response. Therefore, we performed end-to-end facial nerve reconstruction and additional end-to-side anastomosis with the facial with the greater auricular nerve. Postoperative electroneurography of the facial nerve elicited 0% response. However, by 6 months after the surgery, the facial nerve function had recovered up to House Brackman grade II with mild synkinesis, and electroneurography showed 28% response. In addition to end-to-end anastomosis for facial nerve injury, anastomosis with the greater auricular nerve might be an effective procedure to obtain better postoperative facial nerve function.

Hematoma in the receiver area is one of the minor complications after cochlear implant (CI) surgery. While hematomas occurring several years after CI surgery are quite rare, they can cause infection and thickening of the subcutaneous tissue around the receiver area, interfering with proper functioning of the device. Therefore, prompt diagnosis and appropriate treatment are necessary.

Herein, we report the case of a 74-year-old man who was diagnosed as having delayed onset hematoma in the receiver area 5 years after CI. The patient presented to our hospital complaining of a swelling around the receiver area and increasing difficulty in using the cochlear implant. He was receiving antithrombotic drug therapy for atrial fibrillation. CT revealed a fluid collection between the subcutaneous tissue and the receiver. Needle aspiration revealed that the fluid collection was a hematoma. Although aspiration resulted in transient resolution, the hematoma recurred. Then, the antithrombotic drug was discontinued to improve the prolonged PT-INR, surgery was performed to drain the hematoma. We made a minimal skin incision just above the receiver, fearing that a large skin incision around the receiver could damage the array from the receiver and cause much bleeding during surgery leading to regrowth of the hematoma. After the treatment, the hematoma was reduced to a significantly resorbed state, enabling the patient to use the CI again.

In the future, the incidence of delayed onset hematoma after CI may increase as the number of long-term/elder CI users receiving antithrombotic therapy for other underlying conditions increases. Hence, it is crucial to resolve predisposing factors and try minimally invasive intervention at first to drain the hematoma and allow the functioning of the CI to be maintained.

Hairy polyps are rare, benign tumors. They are frequently located in the nasopharynx and oropharynx, and are composed of ectodermal and mesodermal germ layers. The clinical symptoms of hairy polyps depend on their size and location. Breathing disorders are the main features of hairy polyps located in the respiratory tract. We evaluated a patient with a hairy polyp in the nasopharynx. The mother of a 10-month-old girl noted a tumor in the infant’s mouth and called the ambulance. On physical examination, a soft polypoid mass was found extending from the girl’s mouth. The mass was on the tongue and had a smooth, skin-like surface. Computed tomography (CT) was performed, which demonstrated a 20×13 mm mass attached to the left side of the nasopharynx. During the examination, the girl was crying and developed transient temporary respiratory distress due to aspiration of the tumor. Because of the risk of upper airway obstruction by the tumor, emergency surgery was performed under general anesthesia. The mass was found to arise from the left wall of the nasopharynx and was completely excised via an oral approach. On histopathologic examination, the polyp measured 62×25×20 mm in size, and was covered by keratinizing stratified squamous epithelium consisting of skeletal muscle, cartilage, bone, fat, nerves, blood vessels, and skin appendages. There were no endodermal components, and no evidence of malignancy. The histopathologic diagnosis was a hairy polyp.

Background: We reported the clinical course of a rare case with eosinophilic granulomatosis with polyangiitis (EGPA) after surgery for eosinophilic sinusitis (ECRS).

Case presentation: The patient, diaganosed as a case of ECRS (JESREC score 17 points) 7 years after the operation for chronic sinusitis, was re-operated. Four months after the surgery for ECRS, the patient developed fever, cough, and sensory impairment in the lower limbs. Clinical and laboratory examinations at this time confirmed the diagnosis of EGPA. Postoperative histopathology revealed findings of chronic sinusitis at the first surgery and ECRS at the second surgery, with no evidence of vasculitis detected at either examination. It is noteworthy that the patient developed bronchial asthma during the interval between the initial surgery and the onset of ECRS.

Conclusion: ECRS and asthma frequently co-exist, and EGPA is extremely rare. It is difficult to distinguish the prodromal phase of EGPA from ECRS in the absence of systemic symptoms caused by vasculitits, with the patient manifesting only nasal sympoms, asthma, and eosionphilia. In our patient reported herein, the eosinophil count was found to be significantly increased to 22.2% prior to the the second surgery. In patients with ECRS with a differential eosinophil count exceeding 20%, even in the absence of systemic symptoms, it might be necessary to bear in mind the possibility of EGPA.

Amyloidosis is a rare disease characterized by the accumulation of an abnormal protein called “amyloid” in various organs, interfering with their functioning. The condition has been classified into systemic amyloidosis, in which amyloid is deposited in multiple organs, and localized amyloidosis, in which amyloid is deposited in limited organs and tissues. Systemic amyloidosis carries an extremely poor prognosis due to the damage of multiple organs; on the other hand, localized amyloidosis develops slowly, and, in general, carries a good prognosis. Therefore, it is of clinical importance to distinguish between the two types. Herein, we report a relatively rare case of localized amyloidosis of the pharynx.

The patient was a 30-year-old woman who presented to us with a few days’ history of discomfort in the left side of the throat. Examination revealed a yellow elastic hard mass on the left side of the uvula and the histopathological diagnosis was amyloidosis. We excluded systemic amyloidosis by thorough clinical examinations, and made the final diagnosis of localized amyloidosis. The patient is under follow-up, with no active treatment, considering that she has no subjective symptoms and is not at risk of developing airway narrowing. At present, about two years later, the course of the patient remains satisfactory, with neither increase in the size of the pharyngeal mass, nor evidence of transition to systemic amyloidosis.

Localized amyloidosis usually carries a good prognosis, while systemic amyloidosis often carries a poor prognosis, and a thorough whole-body examination is required to distinguish between the two. In rare cases, localized amyloidosis can transform into systemic amyloidosis, so that careful follow-up of the patients is necessary.

While obesity is one of the most important risk factors for obstructive sleep apnea (OSA), patients who are not obese can also develop OSA. This study was conducted to explore which factors might have the greatest effect in reducing the apnea hypopnea index (AHI) in patients with OSA. We investigated the body mass index (BMI), visceral fat area, tonsillar size, soft palate position, and cephalometric parameters in patients with OSA.

A total of 179 adult male Japanese OSA patients were recruited. The average age of the patiens was 56.7±12.7 years, the mean AHI was 47.7± 21.1 events/hr, and the mean BMI was 27.1±4.8 kg/m².

The OSA patients were divided into three groups according to their BMI (BMI < 25 kg/m², 25 kg/m² < BMI < 30 kg/m², BMI > 30 kg/m²). The MP-H and PNS-P were statistically significantly lower in the group with BMI < 25 kg/m². The BMI and tonsillar size were statistically significantly greater in the group with BMI > 30 kg/m². After controlling for BMI, only MP-H and tonsillar size were identified as statistically significant factors (P < 0.05).

This study revealed relationships between the OSA severity and some parameters. The AHI could be improved by weight loss in OSA patients with obesity, but not in OSA patients without severe obesity (including pre-obesity) can not improve AHI by losing weight.

We report two cases of hypopharyngeal cancer that developed purulent spondylitis after radiation therapy (RT). Case 1 was a 77-year-old woman who presented with neck pain and restricted backbending ability. She had undergone RT (70 Gy, combined with cetuximab) for cT3N0M0 hypopharyngeal cancer. Nine months after RT, she was diagnosed as having purulent spondylitis from the findings on MRI. The purulent spondylitis rapidly improved with conservative antibiotic (ceftriaxone) therapy for 7 days. Case 2 was a 57-year-old man who presented with dysphagia. He had undergone RT (70 Gy, combined with docetaxel) for cT2N0M0 hypopharyngeal cancer. Seven months after the RT, he was diagnosed as having purulent spondylitis based on the radiological (MRI) and histopathological findings. We performed surgical debridement and reconstruction of the lesions, as the purulent spondylitis proved refractory to antibiotic (tazobactam/piperacillin) therapy for 14 days. At four years 6 months after the surgery, the lesions remained controlled and no recurrence was observed. Although purulent spondylitis occurring after RT is rare, it is important to consider this potentially fatal disease as one of the serious late complications after RT.

Extracapsular hemorrhage of parathyroid gland is a less frequent cause of spontaneous neck hematoma than iatrogenic or traumatic causes, and a careful diagnosis is necessary in suspected cases. Since the first report by Capps in 1934, several reports have described primary hyperparathyroidism due to parathyroid adenoma as the underlying disease. We encountered a case of deep neck hematoma caused by hemorrhage from a hypertrophic parathyroid gland in a patient with secondary hyperparathyroidism.

A 40-year-old man with a medical history of chronic kidney disease who was on maintenance hemodialysis and was taking aspirin and calcimimetics, presented with a tender swelling on his neck and mild dyspnea. Computed tomography performed at his primary care hospital revealed an abnormal opacity with a small mass on the right dorsal side of the thyroid, suggestive of a hematoma and the right inferior parathyroid gland as the source of bleeding. The following day, exacerbated symptoms and blood test results suggested worsening of the hematoma, and we performed emergent surgery to remove the hematoma and the parathyroid gland, along with tracheotomy. The surgical findings exhibited hematoma, and the right inferior parathyroid gland as a small, yellow mass dorsal and caudal to the right lobe of the thyroid. Histopathological examination revealed hyperplastic parathyroid tissue with hemorrhage. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. Previous reports of hematoma originating from parathyroid indicate that the most commonly observed symptoms are ecchymosis, swelling, and pain of the anterior cervical region, accompanied by hypercalcemia and increased intact PTH (iPTH) levels. Our patient, while he had symptoms consistent with the diagnosis, showed normal serum iPTH and calcium levels, likely because of the background pathology of parathyroid hyperplasia and use of a calcimimetic. While surgery remains the definitive treatment to prevent/control recurrent hemorrhage, the optimum timing still needs to be determined.

Many adverse events occur during treatment with molecular-targeted agents for unresectable differentiated thyroid cancer, necessitating dose reduction or withdrawal of treatment. However, dose reduction or withdrawal after the appearance of adverse events may decrease a patient’s motivation for treatment, while excessive dose reduction may reduce the treatment efficacy. With the objective of avoiding the occurrence adverse events, we attempted a “weekends-off” administration schedule (five days-on and two days-off administration) of lenvatinib. Five consenting patients with thyroid cancer who were started on lenvatinib treatment at our hospital between September 2020 and May 2021 developed grade 2 or grade 3 adverse events. Four patients showed a partial response or no change during the observation period, and the incidence of adverse events decreased to 20%. This result suggests that the weekends-off administration of lenvatinib is a useful scheduled drug withdrawal method to control adverse events, while maintaining the therapeutic effects of treatment.