In this review, the author reviewed the change of diagnosis of vestibular diseases from the appearance of VEMP (vestibular evoked myogenic potential) and vHIT (video head-impulse test). VEMP is a clinical test for disorders of the otolith organ, while vHIT is a clinical test for disorders of the semicircular canals. Using VEMP and vHIT, it is possible to assess all parts of the vestibular labyrinth at a clinic. VEMP enables clinicians to diagnose “otolithic vertigo/dizziness” and “inferior vestibular neuritis”. Furthermore, VEMP provides valuable information for the diagnosis of endolymphatic hydrops, superior canal dehiscence syndrome, and impairments of the vestibulo-spinal tract and medial longitudinal fasciculus. In addition to the diagnosis of bilateral vestibulopathy and vestibular neuritis, vHIT also enables clinicians to diagnose impairments of the vertical semicircular canals, especially isolated posterior semicircular canal dysfunction. Finally, the author wishes to emphasize that combined use of VEMP and vHIT is very important because combinations of abnormal findings in these tests could provide us with clues to clarifying the etiology and pathophysiology.

We report the case of a 31-year-old woman with a supralabyrinthine petrous bone cholesteatoma who presented with acute facial paralysis, without other symptoms; she had first noticed the symptoms 2 months earlier. She was prescribed oral steroid therapy at a previous clinic, which had proved ineffective. Examination revealed a normal appearance of the tympanic membrane, and pure tone audiometry showed no evidence of hearing loss. Computed tomography (CT) revealed a spindle-shaped soft-tissue lesion occupying the labyrinthine segment of the facial nerve coursing to the epitympanum. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed a non-enhancing mass in the same region. A provisional diagnosis of facial nerve schwannoma was made on clinical and radiological grounds, and surgical resection was performed via a middle fossa approach. Keratin debris was found along the labyrinthine segment of the facial nerve coursing to the ossicles, which led us to make the diagnosis of cholesteatoma. The lesion was completely resected along with the head of the malleus and incus by mastoidectomy, and ossiculoplasty was performed. Histological examination confirmed the diagnosis of cholesteatoma. The patient’s facial paralysis failed to recover. In patients with a small lesion in the petrous bone who present with isolated facial palsy as the only clinical manifestation, it is often difficult to differentiate between a cholesteatoma and facial nerve schwannoma, and gadolinium-enhanced MRI is a useful imaging examination to differentiate between the two diseases. In the present case, facial nerve schwannoma was suspected as the most likely diagnosis based on the clinical presentation and CT findings; however, the lack of enhancement on gadolinium MRI pointed to the diagnosis of cholesteatoma. Physicians should be aware of these clinical aspects for appropriate treatment planning.

Eosinophilic otitis media (EOM) is characterized by the presence of highly viscous middle ear effusion containing eosinophils, and is usually associated with bronchial asthma. Intratympanic corticosteroid administration and/or systemic steroid administration are effective treatments. However, the middle ear effusion and progressive hearing loss are difficult to control, significantly affecting the patient’s quality of life. Therefore, appropriate care is important not only for controlling the middle ear effusion and otorrhea, but also for preventing the progression of hearing loss.

A 46-year-old woman was referred to our hospital with suspected eosinophilic otitis media. She had a history of asthma and aspirin sensitivity. In addition, she had recurrent nasal polyps despite having undergone nasal polypectomy on two occasions. She was diagnosed as having bilateral EOM according to the diagnostic criteria. She was started on steroid treatment, but after showing initial response, the middle ear effusion recurred immediately after withdrawal of steroid treatment. Although the patient also had difficulty in communication because of bilateral hearing loss, she could not wear hearing aids because of the middle ear effusion. Hearing aids sometimes aggravate middle ear infection by blocking aeration, increasing the risk of sensorineural hearing loss. Therefore, we implanted a bone-anchored hearing aid (Baha^®) in her right ear. Average hearing threshold of 500, 1000 and 2000 was 35 dB using Baha^®. Although audiometry revealed deterioration of the bone-conduction threshold in the right ear at five years after the Baha^® implantation, she still had sufficient bone conduction hearing using Baha^® because of the preserved bone-conduction in the contralateral ear. The Baha^® hearing system is a clinically effective and good hearing rehabilitative device for patients with EOM.

Soft tissue eosinophilic granulomatosis (Kimura’s disease) is a benign disease with a chronic course that manifests as painless soft tissue masses or enlarged lymph nodes. These masses frequently occur in the head and neck region, especially around the parotid gland, while there are few reports of involvement of the ear canal.

We encountered a case of soft tissue eosinophilic granulomatosis of the ear canal. Surgical resection and oral administration of suplatast tosilate proved effective and no recurrence was observed. Soft tissue eosinophilic granulomas have a propensity to recur after single-modality treatment. In this case, combined surgical and drug treatment proved effective and no recurrence was observed.

The superior orbital fissure syndrome (SOFS) is caused by impaired functions of the cranial nerves (III, IV, V₁, VI) that enter the orbit through the superior orbital fissure. SOFS associated with malignant lymphoma is rare.

We present the case of an 88-year-old female patient who presented with left-sided ptosis and total ophthalmoplegia, with pain in the left eye. Examination revealed small tumors in the left lower eyelid and a nodule in the left leg. CT of the orbits and the nasal sinus area showed mass lesions in the ethmoid sinuses of both sides and the left sphenoid sinus. We suspected infection or autoimmune disorder and performed endoscopic sinus surgery for the purpose of histopathologic diagnosis and treatment.

Both frozen-section and permanent section diagnosis of the resected specimen revealed features consistent with malignant lymphoma (diffuse large B-cell lymphoma (DLBCL)). Biopsy of the skin nodule in the left leg performed at the same time also revealed features consistent with the diagnosis of DLBCL.

Although the standard treatment for DLBCL is combination chemotherapy (R-CHOP), this patient and her family decided against aggressive chemotherapy in favor of best supportive care, in view of her age and performance status.

A large variety of disease processes are known to underlie the etiopathogenesis of SOFS, such as infections and autoimmune diseases. When the onset of symptoms is slow, a neoplastic cause should be considered.

The greater the degree of disease progression, the higher the risk of vision loss from optic neuropathy. Therefore, the condition should be diagnosed early and treated promptly to avoid blindness.

Laryngeal amyloidosis is a relatively rare disease, and usually carries a good prognosis. However, if a patient with laryngeal amyloidosis develops inflammation of the larynx, airway narrowing and dyspnea may occur. In this article, we report the case of a patient with laryngeal amyloidosis who had a long clinical course and required two tracheostomies and microlaryngeal surgeries.

The patient was a woman in her 30s at the time of her initial visit, who visited our hospital with the complaint of hoarseness. Laryngoscopy revealed a yellow lesion around the vocal cords. A tracheostomy and microlaryngeal surgery were performed for biopsy and reduction of the lesion. Histopathological examination of the resected lesion revealed the diagnosis of laryngeal amyloidosis, and after closure of the tracheotomy, the patient was followed up as an outpatient. Nineteen years later, the patient visited our hospital again with the chief complaint of dyspnea, and was hospitalized. She was diagnosed as having airway narrowing caused by recurrent laryngeal amyloidosis and laryngeal edema, and treated with antimicrobial agents. The laryngeal inflammation and edema subsided, however, the dyspnea due to airway narrowing caused by laryngeal amyloidosis failed to improve, so that a second tracheostomy and microlaryngeal surgery were performed.

Although laryngeal amyloidosis is said to carry a good prognosis, dyspnea caused by edema of the larynx and recurrence of amyloidosis could be fatal, as in this case. Unlike in the case of other types of localized amyloidosis, otolaryngologists/head and neck surgeons should be aware that early amyloidosis reduction surgery under local anesthesia or microlaryngeal surgery is important for patients presenting with even mild clinical symptoms, such as hoarseness, to prevent the risk of development of airway obstruction due to infection.

A 54-year-old woman presented to us with the chief complaint of hoarseness. Laryngoscopy showed a submucosal mass in each of the ventricular bands on either side. Computed tomography showed a cystic lesion and laryngoscopic resection was planned. Intraoperative findings showed a cystic lesion in the bilateral ventricular bands, both of which were removed. The symptoms improved after the surgery, but 40 months later, the patient visited us again complaining of hoarseness. Laryngoscopy revealed a cystic lesion in the left ventricular band and oral laryngoscopic removal was performed again, and based on the microscopic and pathological findings, a diagnosis of laryngeal saccular cyst was made. A laryngeal saccular cyst is a type of laryngeal cyst that occurs when the opening to the laryngeal cavity is obstructed.

We encountered a case of bilateral multiple laryngeal saccular cysts and report the case herein, with a review of the literature. It is important to completely remove such cyst in order to prevent recurrence.

Objectives: Laryngeal trauma caused by external factors is rare. The treatment strategies for laryngeal trauma, including the optimal surgical approaches, airway management methods, and fixation materials to be used still remain under debate.

Methods: We retrospectively analyzed the details of the management and clinical course of 16 patients with fresh laryngeal trauma treated between April 2000 and March 2020 at the Hiroshima University Hospital.

Results: The causes of the laryngeal trauma included sports accident (n = 6), fall (n = 3), suicidal behavior (n = 2), labor accident (n = 2), and other (n = 3). Categorization of the severity and the treatment policy, including the surgical indications, were in accordance with the classification proposed by Umeno et al. We performed surgical repositioning of the fractured thyroid cartilage in 7 cases and repositioning or correction of arytenoid cartilage dislocation in 2 cases under general anesthesia. The fixation materials used varied depending on the need.

Conclusion: The clinical features of laryngeal trauma were examined. Further studies on fixation methods, methods to restore the phonation ability, and appropriate surgical timing are required.

Pleomorphic adenoma is the most common benign tumor of the salivary glands, accounting for about 60% of all salivary gland tumors. Patients with pleomorphic adenoma usually present with a painless mass of the salivary glands, and the condition is rarely associated with a painful mass.

Pleomorphic adenoma presents with a variety of histological features within the tumor, with myxoma-like tissue and cartilage components admixed with epithelial cell proliferation, which may be accompanied by cystic degeneration. Necrosis of these salivary gland tumors following fine-needle aspiration biopsy has been documented. However, spontaneous necrosis of pleomorphic adenomas is extremely rare. We report a case of a 32-year-old woman who presented with a rapidly growing painful swelling under the mandible. Ultrasonography revealed a tumor in the right submandibular gland. Fine-needle biopsy of the right submandibular gland led to suspicion of a malignant tumor. We performed surgical resection of the submandibular gland. The histopathological diagnosis was pleomorphic adenoma with extensive internal necrosis.

An ectopic thyroid gland is often associated with a thyroglossal duct, as it is caused by impaired descent of the thyroid gland during development. However, in some cases, it is thyroglossal after the thyroid gland has settled in place and before the thyroid gland is formed in capsular. In some cases, an ectopic thyroid gland is said to form by invasion of the proximal tissue without a thyroglossal duct. In addition, in most cases, the ectopic thyroid tissue is seen near the midline. Herein, we report a case of papillary carcinoma arising from ectopic thyroid tissue not associated with a thyroglossal duct in the right lateral neck. The patient was a 64-year-old man who visited our department with the complaint of a mass in the right lateral neck. Ultrasonography and contrast-enhanced CT revealed a cystic lesion with a major axis diameter of about 40 mm, while no defects or neoplastic lesions were found in the intrinsic thyroid gland. Assuming a benign diagnosis, such as a lateral neck cyst or neck lymphangioma, we performed right lateral neck cystectomy. However, postoperative histopathology revealed the diagnosis of papillary carcinoma arising from ectopic thyroid tissue. There are rare reports in the literature of a lateral neck ectopic thyroid existing with the normal thyroid gland, with no thyroglossal duct, as in this case.

Thyroid carcinoma showing thymus-like differentiation (CASTLE) is a rare histological type of malignant tumor of the thyroid gland and similar to thymic epithelial tumors. Thyroid CASTLE accounts for 0.075% of all malignant thyroid tumors, and preoperative diagnosis is difficult. We report the case of a 64-year-old woman with thyroid CASTLE. An elastic hard nodule was palpated on the right anterior neck. Blood tests showed no abnormalities, and thyroid function and parathyroid function were normal. Computed tomography showed an iso-absorbing nodular shadow measuring 16 mm located caudal to the right lobe of the thyroid gland. Neck echography showed a nodule with indistinct borders and slightly irregular margins on the caudal aspect of the right lobe of the thyroid gland. It was impossible to make a diagnosis, but since malignancy could not be ruled out, we decided to perform diagnostic and therapeutic surgery consisting of resection of the right lobe of the thyroid gland and ipsilateral lymph node dissection in the central region of the neck. A poorly differentiated 16-mm carcinoma was found at the inferior pole of the thyroid gland. Immunostaining was positive for CD5, and a diagnosis of thyroid CASTLE was made. If a tumor of the thyroid gland lacks the features of more common thyroid tumors such as papillary carcinoma or follicular tumor and is localized caudally to the inferior pole of the thyroid gland, thyroid CASTLE should be included in the differential diagnosis.

Neurilemmoma of the hypoglossal nerve is rare. We report a case of neurilemmoma that originated in the hypoglossal nerve.

A 59-year-old female was admitted to our hospital because of a submandibular swelling, and the clinical diagnosis was salivary gland tumor of the submandibular region. The tumor was removed together with the submandibular gland. Paralysis of the tongue was observed postoperatively. Histopathological analysis of the tumor revealed a neurilemmoma.

Although this case was rare, neurilemmoma should be considered in the differential diagnosis of a submandibular mass.

Palatine tonsillectomy is a surgical procedure that novice otolaryngologists should master early and is taught at many medical institutions. Unfortunately, however, the transoral procedure cannot provide a large enough field-of-view to doctors other than the one performing the operation. Therefore, it is difficult to share the surgical field and provide real-time teaching. Dissection of the wrong layer can cause postoperative bleeding and pain. Our department uses a 70°, 4-mm rigid endoscope for palatine tonsillectomy, which makes it possible for preceptors to teach tonsillectomy in real time and to evaluate the condition of the postoperative wound in detail. We classified the postoperative state after tonsillectomy into three stages, based on the degree of residual subcapsular connective tissue. We assessed the association between the amount of residual subcapsular connective tissue and the underlying indication for tonsillectomy, the postoperative course, and the operation time in 33 patients who had undergone palatine tonsillectomy at our institution between May 2017 and November 2020. We found that the more the subcapsular connective tissue that remained, the less the postoperative pain and bleeding. This association suggests that conserving the subcapsular connective tissue is important. Bringing the endoscope closer to the surgical field to observe the field without blind areas enables adequate hemostasis and easy sharing of the surgical field; therefore, this method is also effective for teaching tonsillectomy to surgical trainees.