Temporal bone high-resolution CT (HRCT) is a commonly performed imaging examination before the ear surgery. HRCT offers good-quality images, however, there has been a little improvement in the HRCT imaging techniques over the last 30 years. In this paper, we introduce different types of CT other than HRCT that are applicable to the temporal bone imaging. Cone-beam CT (CBCT) is another popular CT technique that provides images with a high spatial resolution, with low radiation dose exposure; the trade-off is the high rate of artifacts and low signal-to-noise ratio. Ultra-high resolution CT (U-HRCT) is a successor technique to HRCT. Now clinically available, U-HRCT provides precise images with high signal-to-noise ratios. Intra-operative images can be obtained using mobile CBCT equipment (m-CBCT) and a multi-axis C-arm with robotic technology. m-CBCT is a truly mobile CT equipment that provides satisfactory image quality. The multi-axis robotic C-arm equipment is mandatory for conducting transcatheter aortic valve implantation, and many hospitals are equipped with this device. CT-like images using this device can be an effective option for challenging cases. Photon counting CT (PCCT) is a next-generation CT that offers images with high spatial resolution and high contrast resolution at low radiation doses. Clinical application of PCCT in the field of ear surgery is expected in the near future.

Psychogenic hearing loss is described as hearing loss without anatomic or physiologic abnormalities. Current treatment options include psychotherapy and pharmacotherapy, but there are many cases in which neither treatment is effective. Herein, we reported a case of pediatric psychogenic hearing loss in which use of a hearing aid led to hearing recovery. As the patient requested to wear the hearing aid, one explanation for the hearing improvement could be the psychological comfort. An alternate explanation could be his belief that the treatment made his hearing better. Taken together, we think that hearing aids should be included as one of the treatment options for children with psychogenic hearing loss.

Meningeal carcinomatosis develops when a malignant tumor spreads to the arachnoid or subarachnoid space of the brain and spinal cord, causing a variety of neurological symptoms, and in general, is known to carry an extremely poor prognosis. In this report, we present the case of a 48-year-old woman who developed acute sensorineural hearing loss during treatment for breast cancer, and was diagnosed as having meningeal carcinomatosis based on a history of spinal metastasis and head imaging findings. This case report serves to highlight the possibility that chemoradiotherapy might be useful even in patients with advanced breast cancer with meningeal carcinomatosis, not only to obtain improved hearing, but also prolong the life expectancy.

Cochlear implantation (CI) is currently the standard therapeutic option for patients with severe-to-profound sensorineural hearing loss. Although CI yields a good outcome in the majority of cases, individual differences in the outcomes are known to exist. Among the various factors affecting the outcomes of CI, genetic factors are known to be amongst the most important. Genetic disorders are known to be the most common causes of congenital/early-onset sensorineural hearing loss and are encountered in a considerable proportion of cases of late-onset hearing loss. When the etiology is located within the cochlea, there is potential for a good outcome of CI. Therefore, it is essential to determine which region of the cochlea is affected, by identification of the responsible genes.

In this study, we performed genetic testing in 87 patients who were scheduled for CI. The patients were screened for 63 known deafness genes, with gene mutations that cause hearing loss identified in about 25% of the cases (22/87).

In general, the outcomes in patients in whom the causative gene was identified were found to be good. Particularly in the prelingual group, the development of auditory behavior (evaluated by IT-MAIS) was better in patients in whom the causative gene was identified.

Genetic testing can be useful for deciding the treatment strategy for hearing loss. In addition, relatively rare genes were also identified, suggesting that comprehensive analysis may be useful for diagnosing the cause of hearing loss.

In recent years, there has been an increasing demand among the elderly for reacquisition of their ability for hearing. We report two super-elderly persons aged 85 years who underwent cochlear implant surgery. Case 1 was an 85-year-old man who presented with severe sensorineural hearing loss of 102 dB on the right and 105 dB on the left. We performed cochlear implant surgery. At 3 months after the surgery, the 67-S was 50%, the CI-2004 was 90%, and sentence hearing was 100%. Case 2 was an 85-year-old woman with severe sensorineural hearing loss in both ears. We performed cochlear implant surgery. At 3 months after the surgery, the 67-S was 30%, CI-2004 was 68%, and sentence hearing was 80%. Both patients were receiving anticoagulants, but their cognitive functions and general condition were good. There were no complications in either case, and a questionnaire survey showed an increase in communication opportunities, with both patients saying that “conversations with other people increased,” and “phones became audible.” In addition, we noticed more positive behaviors and improvement in the level of activities of the patients such as “more going out,” “feeling like participating in alumni association meets,” “increased participation in events,” etc. Unlike young people, cochlear implant surgery in the elderly entails various additional problems. However, the desire for reacquisition of the hearing ability plays a major role. Our findings suggest that cochlear implant surgery may be considered for super-elderly persons if there are no problems with their general condition or cognitive functions.

Auricular reconstruction surgery in cases of microtia is a two-step procedure performed by plastic surgeons in Japan. We performed active middle ear implant (Vibrant Soundbridge^®: VSB) surgery for congenital aural atresia prior to auricular reconstruction, and a new surgical procedure is proposed for skin incision and temporal muscle flap preparation. The surgical procedure is to make a 10-cm skin incision at 5 cm from the posterior edge of the temporomandibular joint capsule, then make an incision from the skin to the deep temporal fascia at once, and peel off the skin flap to the posterior edge of the temporomandibular joint on the temporal fascia. Furthermore, this is a method in which the temporalis muscle is incised 1 cm anterior to the skin incision site to create a temporalis muscle flap with upper and lower stalks. This procedure is associated with a scarce possibility of interfering with future auricular reconstruction, and we propose a further study to establish it as a standard procedure.

Nasal septal cyst often occurs as a complication after septoplasty or rhinoplasty, and has also been reported as a phenotype of pleomorphic adenoma, dermoid cyst, tuberculosis, or aneurysmal bone cyst in the final pathological diagnosis. Among these, a primary simple cyst of the nasal septum is extremely rare. Although no treatment strategy has been established for a nasal septal cyst, several surgical methods, such as cyst fenestration, open septorhinoplasty, or and total excision have been reported. Total excision is recommended in cases with no history of septal surgery to prevent recurrence of the lesion; however, careful handling is necessary to avoid damage to the L-strut and keystone area during the surgery, to prevent postoperative nasal deformity.

We present the case of a 71-year-old woman with a septal cyst who was referred to our hospital with a 3-month history of bilateral nasal congestion and nose pain. Physical examination revealed a septal mass that protruded into both sides of the nasal cavity. Based on the findings of computed tomography and magnetic resonance imaging, the patient was diagnosed as having a primary simple cyst of the nasal septum. We performed complete excision of the cyst from the nasal mucosa and of the deformed nasal septal cartilage via transnasal endoscopy. The postoperative course was uneventful. No complications, such as saddle-nose deformity and nasal septal perforation were encountered, and the subjective symptoms were alleviated.

In this case, we were able to perform total cystectomy without complications by applying the septoplasty approach. By mastering basic surgery, it will be possible to safely approach rare cases such as this one.

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that is sometimes encountered in the field of otolaryngology. SFT is classified as an ‘intermediate’ (rarely metastasizing) in the 2020 WHO classification of FIBROBLASTIC/MYOFIBROBLASTIC TUMOURS. It has been reported that embolization is required prior to surgery because of the high blood flow in these tumors. In addition, postoperative recurrence has also been reported in cases of pleural primary tumors, underscoring the importance of preoperative diagnosis and careful postoperative observation. In the case reported herein, the patient presented with the chief complaint of a nasal blockage. Examination revealed a mass filling the left nasal cavity, and biopsy revealed an inflammatory polyp. Thus, we encountered a case in which a SFT was diagnosed by histopathological examination after endoscopic removal of the mass without preoperative vascular embolization. The histological image of irregularly arranged spindle-shaped cells are also known to be present in other mesenchymal tumors such as fibrosarcoma, fibroma, and malignant histiocytoma. Positive immunohistochemistry for CD34 is not a specific finding of SFT, but it is a useful marker for differentiation from the above tumors, since CD34 immunostaining is usually negative in these tumors. The Ki67 index was less than 1%, indicating that the tumor was not malignant. The reason why the preoperative diagnosis was unsuccessful was that the histopathological diagnosis of the tumor showed edematous growth, and an adequate specimen containing the neoplastic lesion could not be obtained by outpatient biopsy. Contrast-enhanced MRI showed a poorly enhancing area in the anterior nasal cavity, and the specimen should have been taken from the posterior lesion, which showed more uniform contrast enhancement. We report this case along with a literature review, including cautions needed for biopsy in preoperative diagnosis.

Eosinophilic chronic rhinosinusitis (ECRS) is a refractory rhinosinusitis characterized by elevated peripheral blood eosinophil counts, nasal polyps, and bronchial asthma. In recent years, anti-human IL-4/13 receptor monoclonal antibody (dupilumab) has become available as a new treatment option for patients with ECRS who are poorly controlled by existing treatments, such as surgery and steroid treatment. On the other hand, eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis syndrome characterized by peripheral blood eosinophilia, peripheral neuritis, purpura, muscle and joint pain, heart disorder, gastrointestinal disorder, etc. Since patients with EGPA often exhibit symptoms of bronchial asthma and rhinosinusitis prior to manifesting vasculitis symptoms, it is difficult to distinguish patients with the early phase of EGPA from those with ECRS. We encountered a patient of ECRS who developed EGPA after the initial administration of dupilumab. The patient was a 55-year-old woman who presented with the chief complaints of nasal obstruction and olfactory disturbance. She was diagnosed as having severe ECRS with asthma and endoscopic sinus surgery was performed, but the nasal symptoms and polyps recurred. The nasal polyps shrank with the administration of oral steroids, but quickly enlarged upon discontinuation of the steroids. Because the manifestations of ECRS were poorly controlled with the existing treatments, we started the patient on treatment with dupilumab. However, the day after the first administration of dupilumab, the patient developed weakness and numbness in both legs. Blood tests showed an increase in the percentage of eosinophils in the peripheral blood from 28% to 55%, and serology for MPO-ANCA was positive. A nerve conduction study revealed evidence of mononeuritis multiplex, and the patient was diagnosed as having EGPA. Dupilumab was discontinued and steroid pulse therapy was administered, which led to improvement of the weakness and numbness in both legs, although both the symptoms persisted. Since serology for MPO-ANCA was also positive in stored blood prior to the dupilumab administration, it is suggested that dupilumab administration induced peripheral blood eosinophilia, leading to the onset of mononeuritis multiplex in the patient with EGPA.

Anterior cervical plate fixation is a common surgical procedure for cervical spinal disease. However, it sometimes causes serious complications. Pharyngo-esophageal perforation following anterior cervical plate fixation is a rare complication, but associated with severe morbidity. Pharyngo-esophageal perforation often occurs in the acute phase during surgery or within a few months after surgery. However, we encountered 4 cases of delayed perforation developing more than 3 years after the surgery. The chief complaint was dysphagia in two cases, and one case was asymptomatic. There are as yet no clear guidelines for the treatment of pharyngo-esophageal perforation following anterior cervical plate fixation. We performed primary closure in two of the patients and flap reconstruction in the remaining patient. Flap reconstruction was considered in the case with large perforation and anterolateral thigh free flaps were used. In all cases, the perforation was closed and oral intake became possible. Pharyngo-esophageal perforations that occur long after anterior cervical plate fixation may be associated with fewer symptoms, and it is therefore important to bear the possibility in mind, especially in patients who present with dysphagia.

Mucosal malignant melanoma is a fast-growing and difficult-to-control disease. New treatments, for example, carbon-ion radiotherapy and immune checkpoint inhibitors have been developed and appropriate treatment strategies including these treatments may need to be considered.

Herein, we report a case of oral mucosal melanoma with multiple cervical lymph node metastases treated with an immune checkpoint inhibitor and carbon ion radiotherapy.

The patient was a 50-year-old woman diagnosed as having malignant melanoma of the mandibular gingiva with left cervical lymph node metastasis. She received four courses of nivolumab therapy before carbon-ion radiotherapy. The metastatic lymph node enlarged until immediately after the second course of nivolumab, however, thereafter, a tendency towards shrinkage was observed. However, the lymphadenopathy persisted even after carbon-ion radiotherapy, therefore, the patient received two courses of combined nivolumab and ipilimumab therapy. However, the treatment had to be discontinued before the third course because of the development of Grade 4 liver dysfunction. The liver damage improved with steroid pulse therapy and the metastatic lymph nodes continued to shrink.

In this report, we also review the data of 23 cases of mucosal malignant melanoma who received carbon-ion radiotherapy from 2017 to 2020 at the Kanagawa Cancer Center and discuss their outcomes. Of the 23, 19 cases (87%) developed metastasis after carbon-ion radiotherapy, including distant metastasis in 12 cases (60%). For cases of advanced mucosal malignant melanoma, we believe that an effective and safe combination of topical and systemic treatment is needed.

Postoperative chylorrhea in the head and neck region is mainly encountered as a complication of lateral neck dissection. Conservative treatment includes clamping or removal of the drain, local compression, fat-restricted diet, fasting, systemic administration of somatostatin analogues, and local minocycline infusion therapy. If conservative treatment proves ineffective, lymph duct ligation is indicated. When performing lymph duct ligation, having the patient ingest fat before surgery is effective for identifying the site of the lymphatic leak. We report a case of refractory chylorrhea after thyroid cancer surgery, which was successfully controlled by preoperative ice cream ingestion by the patient. Based on this case, we concluded that preoperative ingestion of high-fat ice cream is useful for identifying the site of chylorrhea and confirming stoppage of chylorrhea.

Introduction: Patients under mechanical ventilation are not able to communicate using their voice, which reduces their quality of life. The Blom^® tracheostomy tube with a speech inner cannula allows voice to be produced even in patients receiving mechanical ventilation. Therefore, we attempted to use the Blom^® tracheostomy tube in two patients who were receiving mechanical ventilation.

Cases: Two patients in whom a cuffed tracheostomy cannula had been inserted were included in this study. One patient (60-year-old woman) had multiple systemic atrophy, and the other (52-year-old woman) had been admitted in a shock state and had cardiopulmonary insufficiency. We changed the tracheostomy tube to the Blom^® tracheostomy tube in both patients.

The Blom^® tracheostomy tube with a speech inner cannula allowed an audible voice to be produced, which enabled verbal communication and the QOL of the patients improved.

Conclusion: The Blom^® tracheostomy tube with a speech inner cannula provided one option for verbal communication in ventilator-dependent patients with a tracheostomy with a fully inflated cuff. We needed to change the ventilation modes. One patient developed aspiration pneumonia, but desired to continue to use the Blom^® tracheostomy tube with a speech inner cannula. Use of this device permitted verbal communication in two patients who were receiving mechanical ventilation.

Duplication cysts are rare congenital anomalies that result from foregut budding errors during embryonic development, and are extremely rare in the cervical esophagus. Furthermore, only a few cases of cervical esophageal cysts have been published in the literature to date. Most cases in adults are discovered incidentally, and there are no published reports of cases of duplication cysts of the cervical esophagus presenting with neck swelling or fever.

We report the case of a 21-year-old woman who presented to our hospital with a history of persistent neck swelling and recurrent fever, and was diagnosed as having a duplication cyst of the cervical esophagus. CT and MRI revealed a cystic mass in the left neck. The cervical esophagus showed a bird’s beak sign, suggesting that the cyst arose from the muscular layer of the esophagus. Additional blood tests, fine needle aspiration of the cyst, and esophagogastroduodenoscopy also failed to yield a definitive diagnosis. Therefore, we resected the mass via cervical esophagotomy, and the lesion was diagnosed postoperatively as a duplication cyst of the cervical esophagus. Thus, the possibility of a duplication cyst of the cervical esophagus should be borne in mind in patients presenting with a neck swelling.