Allergic rhinitis (AR) is a type I allergic disease of the nasal mucosa characterized by sneezing, watery rhinorrhea, and nasal congestion. A recent epidemiological survey revealed that nearly half of the population develops AR. Until recently, Th2 cells, which produce IL-4, IL-5, and IL-13 in an antigen-dependent manner and induce type 2 immune responses, were thought to play a major role in the pathogenesis. However, since the recent discovery of group 2 innate lymphoid cells (ILC2s), which also produce type 2 cytokines in response to IL-25, IL-33, TSLP released from epithelial cells, involvement of ILC2s also in the development of AR has been proven. Histamine is a major chemical mediator that induces AR symptoms through binding to the histamine H₁ receptor (H1R). We found that histamine-mediated stimulation of H1R induced upregulation of the H1R gene expression and that the elevated receptor expression levels in the nasal mucosa increased histamine signaling to exacerbate the symptoms of AR. Antihistamines block histamine signaling triggered via the H1R, suppress histamine-induced upregulation of transcriptional activation, and suppress basal transcription of H1R in the absence of histamine, which may reflect the inverse agonist action of antihistamines. Allergen immunotherapy can provide long-term benefits in patients with AR by modulating the immune responses. Sublingual immunotherapy (SLIT) with a standardized Japanese cedar (JC) pollen significantly improved the nasal symptoms and AR-related sleep disturbance in patients with JC pollinosis. Dual SLIT with JC pollen and house dust mite (HDM) suppressed both JC pollen-induced seasonal and HDM-induced perennial nasal symptoms in bisensitized patients with AR. Dual SLIT was more effective in suppressing nasal obstruction at the peak of JC pollen dispersal period than mono SLIT with JC pollen. In this paper, we describe the recent advances in the management of allergic rhinitis, along with our own research findings.

There have been many reports of endolymphatic hydrops (EH) in patients with Meniere’s disease (MD) since the first report by Hallpike and Yamakawa in 1938. Mental/physical stress and subsequent increase in release of the stress hormone arginine vasopressin (AVP) supposedly triggers MD. Recently, many lines of evidence have suggested the possibility that AVP is closely linked to the formation of EH in cases of MD. In the present study, we attempted to investigate the relationship between stress and EH in patients with unilateral Meniere’s disease (uMD).

We enrolled 113 definite uMD patients from July 2014 to October 2019. All patients underwent 3-T magnetic resonance imaging (MRI) 4 hours after intravenous gadolinium injection. We adopted the criteria for evaluation of EH proposed by Nakashima et al. Stress was evaluated using the depressive self-rating scale (SDS), the psychological stress response scale (SRS), and the dizziness handicap inventory (DHI) modified by Nishiike et al. These stress scores and the blood AVP levels were compared in patients with EH.

There was no significant correlation between EH and the stress scores on the affected side, but the anxiety score showed a significant correlation with EH on the sound side (p = 0.04). There was no significant correlation between the EH and AVP in either the affected side or the sound side. We suppose that the formation of EH involves a complex process of stresses.

Cholesteatoma is relatively rare with congenital aural atresia. Infected cholesteatomas sometimes cause intracranial complications, for example, meningitis, brain abscess, and lateral sinus thrombosis. We report a case of a 68-year-old female with congenital aural atresia who was diagnosed as having an otogenic brain abscess. She presented with otalgia, headache, nausea, and disturbance of consciousness. The findings on CT and MRI led to the diagnosis of brain abscess and infected cholesteatoma. The brain abscess was present around the brainstem. Complete removal of the cholesteatoma and brain abscess drainage were performed in addition to antibiotic administration. By day 80 after the surgery, brain abscess was found to have diminished in size and the patient had regained normal consciousness. Intracranial complications of infected cholesteatomas, including brain abscess, have a high mortality. Treatment of otogenic brain abscess involves complete removal of the cholesteatoma, abscess drainage, and antibiotic therapy. However, the optimal timing for the surgery is not yet established. For safe and effective treatment of otogenic brain abscess, cooperation between otolaryngologists and neurosurgeons/neurologists is desirable.

We retrospectively investigated the prognostic factors for recovery by multivariate analyses in patients with peripheral facial nerve palsy who had undergone transmastoid facial nerve decompression at our department.

Forty-four patients with Bell’s palsy or Ramsay Hunt syndrome were enrolled in the study. They were 26 men and 18 women, aged 17 to 80 years with an average of 55.4 years. Twenty-seven patients had Bell’s palsy and 17 patients had Hunt syndrome. We performed multiple regression analysis and binary logistic regression analysis with the final palsy score (Score_final) or increase in the palsy score (ΔScore) as the outcome variables. Six explanatory variables were set; preoperative palsy score (Score_pre), days from onset to surgery, patient age, gender (male = 1, female = 0), causative disease (Bell = 1, Hunt = 0), and percent electroneurographic response.

Eleven patients (25.0%) completely recovered (Score_final ≥36), the Score_final was restored to ≥20 in 40 patients (90.9%), and there was no patient with Score_final <10. In multivariate analyses, the partial regression coefficient was negative for days from onset, age and gender, and positive for causative disease and electroneurographic response. On the other hand, the sign of the partial regression coefficient for Score_pre changed with the outcome variable; positive with Score_final and negative with ΔScore. The probability of ΔScore ≥30, calculated by the binary logistic regression equation, was larger in patients with ΔScore ≥30 than in those with ΔScore <30 (0.442 ± 0.230 vs. 0.260 ± 0.151, P = 0.003). The positive and negative predictive values for ΔScore ≥30 by this analysis were 0.750 and 0.778, respectively.

These results suggest that early surgery, young age, female gender, Bell’s palsy, and high electroneurographic response may be favorable for recovery from palsy after facial nerve decompression, and that binary logistic regression analysis is useful for practical prediction of recovery.

I present my own case here: I, a 49-year-old man, a doctor who has been practicing as an otorhinolaryngologist for 25 years and was previously healthy, developed pulsatile tinnitus. I developed sudden-onset pulsatile tinnitus, with a pulsating feeling and very slight swelling in my neck, without pain. For early diagnosis, palpation and auscultation of the neck are considered useful in the general outpatient clinic, and color Doppler ultrasound imaging has also been reported as being potentially beneficial in ENT practice. In my case, cerebral angiography for definitive diagnosis showed a dural arteriovenous fistula in the left sigmoid sinus fed by dural branches of the occipital artery. I underwent endovascular treatment for the involved left sigmoid sinus at admission. The pulsatile tinnitus disappeared immediately after the treatment and has not recurred for four years after the treatment. My case emphasizes the importance of early diagnosis of dural arteriovenous fistula in the ENT clinic to obtain good outcomes. I recommend palpation, auscultation of the neck, and color Doppler ultrasound imaging for all patients with pulsatile tinnitus, followed by MRI, MRA, and preoperative angiography at an advanced medical institution for the diagnosis of critical conditions such as a dural arteriovenous fistula. My experience serves as evidence to support the use of endovascular treatment as a safe and effective treatment for dural arteriovenous fistula. Dural arteriovenous fistula is a potentially curable entity that we should bear in mind in the differential diagnosis of patients presenting with pulsatile tinnitus.

Dysthyroid orbitopathy is an autoimmune inflammatory disease of the orbital tissues associated with Graves’ disease, and rarely, Hashimoto’s disease. Symptoms include diplopia, rabbit eyes, decreased visual acuity, and cosmetic problems, such as protruding eyeballs. Our department has been performing endoscopic transnasal orbital decompression for dysthyroid orbitopathy since 2015. Orbital decompression is performed to relieve pressure on the optic nerve in severe cases, and also to resolve cosmetic problems such as protrusion of the eyes in mild to moderate cases. Surgery is usually performed bilaterally, and there are very few reports of unilateral orbital decompression. Herein, we report performing an endoscopic transnasal orbital decompression procedure to improve eye closure difficulties and improve the appearance in an inactive, mild case with unilateral thyroid ophthalmopathy. The patient was an 18-year-old woman who was diagnosed as having Graves’ disease 6 years before her first visit to our department. She developed dysthyroid orbitopathy 3 years before her first visit to our department and was treated with steroid pulses and botox injections at the neuro-ophthalmology department. She had undergone total thyroidectomy 1 year before her first visit to our department. She was referred to our department and underwent right orbital decompression surgery. After the surgery, the protrusion of the eyeballs decreased by 3 mm, and the subjective symptom of difficulty in closing the eye also improved. Also, diplopia is the main postoperative complication of endoscopic transnasal orbital decompression. In this case, however, there was no diplopia.

Endoscopic transnasal orbital decompression is useful for the treatment of unilateral ocular protrusion due to dysthyroid orbitopathy, because it is minimally invasive and yields excellent cosmetic outcomes. For inactive cases such as this case, it is necessary to carefully balance the operation with the contralateral side after explaining the risk of postoperative diplopia to the patient. The patient should be carefully monitored for the appearance of symptoms of postoperative diplopia and worsening of activities in the future.

We present the case of a 63-year-old woman with cerebrospinal fluid (CSF) rhinorrhea of the clivus. She presented with a 6-week history of left-sided watery nasal discharge. RI cisternography showed evidence of a CSF leak in the sphenoid sinus at the previous institution, so the patient was referred to our hospital for further examination. CT and MR imaging revealed fluid collection in the left-sided sphenoid sinus and a clival bone defect. Transnasal endoscopic repair was performed using autologous grafts of her abdominal fat and fascia, and a mucosal flap from the nasal septum. Histological examination showed no evidence of tumor. We made the final diagnosis of idiopathic CSF rhinorrhea. There were no signs of a CFS leak or any new lesion at the clivus at the 2-year follow-up. Reconstruction with a mucosal flap from the nasal septum is considered as being useful for CSF rhinorrhea in the clivus.

Introduction: There is no definitive treatment for glossodynia, however, there are scattered reports of treatment success with Kampo medicines. We examined the effects of Kampo treatment for glossodynia and report the results herein.

Methods: We conducted a retrospective survey of 19 patients with glossodynia who received Kampo medicines from 2017 to 2021. We prescribed the Kampo medicines for 2 to 4 weeks initially, and then depending on the condition of the patient, either continued the medicine or changed the type of Kampo medicine.

Results: The patients ranged in age from 29 to 82 years, with an average of 59.1 years; there were 2 males and 17 females. Of the 19 patients, 5 patients (26%) were cured, 10 (53%) improved, 2 (11%) improved slightly, and 2 (11%) showed no change of condition. Kampo medicines that were effective were as diverse as thirteen different types. The most frequently prescribed Kampo medicine was jiinshihoto, which was effective in 5 cases. Byakkokaninjinto and kamishoyosan were effective in 3 cases each.

Conclusion: Since 15 patients (79%) were cured or improved or more and 17 (89%), Kampo medicines might be useful treatment agents for glossodynia. Jiinshihoto, byakkokaninjinto, and kamishoyosan are often effective, and Kampo medicines that improve liver depression and yin deficiency are often effective.

Metastatic carcinomas in the head and neck region are relatively rare, with hypopharyngeal metastasis being exceptionally rare. Herein, we report a case of hypopharyngeal metastasis from a uterine leiomyosarcoma.

A 61-year-old woman undergoing systemic chemotherapy for a uterine leiomyosarcoma was referred to our department from the Department of Oncology for sore throat and dysphagia. Fiberoptic laryngoscopy revealed a smooth and raised lesion in the right piriform sinus of the hypopharynx. As an inflammatory cause was suspected, biopsy was not performed. After some months, the lesion became ulcerated, prompting the need for a biopsy. The biopsy results indicated metastatic leiomyosarcoma, and the patient was diagnosed as having a hypopharyngeal metastasis from uterine leiomyosarcoma. The patient was initiated on systemic chemotherapy, however, her condition continued to deteriorate and she eventually died of disease progression.

Primary kidney and lung cancers may metastasize to the nasal sinuses and pharynx, with the tonsils being the most frequently affected pharyngeal structure. However, hypopharyngeal metastasis is exceptionally rare.

A hematogenous route of spread was considered for the hypopharyngeal metastasis in this case. However, whether the hematogenous metastasis occurred through the pulmonary circulation or vertebral venous plexus remains debatable.

Initial manifestations of metastases to the head and neck include minor symptoms such as pharyngeal discomfort. Thus, it is necessary to pay attention to even minor symptoms in patients with cancer.

The life expectancy in patients with metastasis to the head and neck region is usually less than 1 year. Therefore, it is necessary to thoroughly consider treatments according to the patient’s condition.

We encountered a rare case of schwannoma of the larynx. A 42-year-old man who had suffered from hoarseness for 13 years had been found by laryngoscopy 7 years ago as having a submucosal tumor in the left arytenoid region of the larynx. The tumor was removed transorally via laryngoscopy. The histopathological diagnosis was schwannoma. Two years later, the patient complained of a foreign body sensation in the larynx and pharynx, and laryngoscopy revealed a smooth mass in the left arytenoid region, suggesting recurrence of the schwannoma. CT and T1-weighted MRI showed a well-defined enhancing lesion measuring 32 × 23 × 20 mm in size without invasion in the left arytenoid region of the larynx. For the treatment, since it was a recurrent case, we selected an external approach to ensure complete removal of the tumor. The left laryngeal schwannoma excision was performed via a suprahyoid approach and tracheostomy were performed under general anesthesia. The histopathological diagnosis was schwannoma Antoni type A and B. With this surgery, the hoarseness improved without dysphonia, although the dysphagia was prolonged. The results of fiberoptic endoscopic evaluation of swallowing and the clinical course of dysphagia suggested that the dysphagia, it was derived from the inner branch of the superior laryngeal nerve. The dysphagia improved 2 months after the surgery. No recurrence has been observed for 4 years since the surgery.

Loeys-Dietz syndrome is an autosomal dominant, systemic connective tissue disorder with vascular and skeletal symptoms similar to Marfan syndrome. Clinical findings vary from case to case, but almost all patients present with some vascular symptoms. The vascular symptoms of Loeys-Dietz syndrome are more frequent and more severe than those in Marfan syndrome. In particular, macrovascular lesions tend to cause aneurysm formation and dissection at an early stage, and there are many case reports of systemic vascular tortuosity and complications of small and medium-sized aneurysms and arterial dissection.

We encountered a case of Loeys-Diez syndrome with left vocal cord paralysis after acute aortic dissection. The patient was a 31-year-old man who was taking warfarin potassium and had vascular tortuosity in the left superior thyroid artery and other arteries. For left vocal cord paralysis, left arytenoid adduction with nerve-muscle pedicle flap transfer was performed. The patient was discharged without any problems during or after the surgery. However, on the 17^th day after the surgery, he came to the emergency room due to delayed postoperative bleeding and laryngeal edema. On the same day, hemostasis and tracheostomy were performed.

Postoperative bleeding is one of the complications that should be considered in voice improvement surgery. We thought that it was necessary to make a surgical plan with a thorough understanding that cases of hereditary aortic diseases such as Marfan syndrome and Loeys-Dietz syndrome have vascular tortuosity and fragility. Even when performing surgery, it is necessary to perform protective perivascular operations and be aware of the possibility of wound healing failure after surgery.

Multiple symmetrical lipomatosis is a slowly progressive disease characterized by multiple accumulations of nonencapsulated lipomas with a symmetrical distribution in the neck, shoulders, trunk, and limbs. It is most common in middle-aged men with a history of heavy alcohol intake. Cases have been accumulating in recent years, mainly in southern Europe, whereas reports from Japan are still limited. The pathogenesis of the disease has not yet been completely elucidated. While no standard treatment has been established, lipectomy has been reported to be effective for neck lesions. In this article, we report our experience of surgical resection of a neck lesion in a case of multiple symmetrical lipomatosis, with a brief review of the literature. The patient was a 60-year-old man who presented to our outpatient clinic with the chief complaint of neck swelling. We decided to perform surgery for cosmetic purposes. Lipectomy of the neck was performed by dissecting the fat tissue in both the shallow and deep layers of the platysma. Postoperatively, a hematoma formed, and hemostasis was performed under general anesthesia. The patient was discharged on postoperative day 10, and good cosmetic results were achieved with no obvious recurrence on MRI at six months after the surgery. Patients with multiple symmetrical lipomatosis often have hepatic damage due to a history of heavy alcohol consumption; thus, postoperative bleeding is frequent and careful attention must be paid. Although the pathogenesis of the disease is still unknown and no standard management methods have been established, it should be noted that there is a long-term risk of postoperative recurrence and sudden death due to autonomic disorder.

Metastatic tumors of the larynx are rare. Among these, the particularly rare metastatic colorectal cancer often carries a poor prognosis. In this study, we report a case of laryngeal metastasis from transverse colon cancer, with a review of the relevant literature.

A 77-year-old man who had undergone surgery for transverse colon cancer was diagnosed as having a recurrence of the colon cancer 2 years after the surgery. PET-CT revealed strong accumulation in the larynx, with an SUVmax of 9.46.

The patient visited our department, and was noted to have hoarseness of the voice; however, the vocal cord movements were maintained, and there was no obvious neoplastic lesion.

However, a contrast-enhanced CT performed one month after the first visit revealed a neoplastic lesion in front of the thyroid cartilage, and the patient returned to our department.

A submucosal laryngeal tumor was suspected before the surgery for the recurrent transverse colon cancer; therefore, considering the risk of airway obstruction and dissemination along the biopsy track, we proceeded with elective surgery for the recurrent transverse colon cancer.

Subsequently, fine-needle aspiration cytology (FNAC) performed from the anterior neck, revealed class V, SCC, or suspected adenocarcinoma.

No cervical lymph node metastasis was observed, and total laryngectomy was performed.

Three months after the patient’s first visit, histopathology confirmed adenocarcinoma and metastasis from transverse colon cancer. At seven months after the operation, while no local recurrence was observed, brain metastasis was found, and the patient was transferred to another hospital.

In conclusion, if a metastatic submucosal laryngeal tumor is suspected, it is important to carefully select the biopsy method.

In recent years, the number of cases of noninvasive fungal sinusitis diagnosed in asymptomatic and elderly patients has increased. The elderly are more likely to have comorbidities, and it is often difficult to determine a treatment plan, especially in asymptomatic patients. Surgery is the treatment modality of first choice, but there are no clear guidelines yet. In this study, we investigated factors predictive of pain in patients with noninvasive fungal sinusitis.

Of 554 patients who underwent endoscopic sinus surgery between April 2010 and March 2020 at Yokohama City University Medical Center, 59 patients were diagnosed as cases of fungal sinusitis by identification of fungi in the resected surgical specimens. For this study, 19 patients with preoperative symptoms such as headache and facial pain were classified into the Pain group, and the remaining 40 patients were classified into the Control group. A total of 18 items were extracted for the analysis, including patient background factors, preoperative CT findings, blood test findings, localization of the fungal mass, and the isolated fungal species.

Univariate analysis revealed significant differences in the age and amount of alcohol consumption, frequency of ethmoid sinus and frontal sinus lesions, the Lund-Mackay score, and the white blood cell count between the Pain and Control groups. Multivariate analysis identified only the Lund-Mackay score and white blood cell count as independent predictors of pain; in the ROC curve analysis, the AUC for the Lund-Mackay score was 0.76, and the sensitivity and specificity were maximal at a cutoff score of 5 points.

The results of this study suggest that noninvasive fungal sinusitis patients with a high Lund-Mackay score or high white blood cell count should be considered for surgery.