The immune system of the inner ear has been highlighted as a novel candidate therapeutic target for sensorineural hearing loss. Macrophages are thought to play an important role in inner ear immunity, because the majority of leukocytes in the inner ear exhibit macrophage phenotypes and reside within the inner ear even under the steady state condition. Recent progress in the field of basic research has demonstrated that tissue macrophages have diverse functions, including pattern recognition with nonspecific receptors to be activated the initial process of innate immunity, antigen presentation, and cytokine secretion.

In this review, we discuss the distribution of immunocompetent cells in the inner ear and their currently known roles, as well as the clinical concepts and diagnostic criteria of autoimmune inner ear disease (AIED), and the newly developed therapeutic approaches for AIED, including utilization of biologicals. Given that macrophages are the major immunocompetent cells in the inner ear, clarification of their roles in AIED should lead to development of macrophage-targeted therapies for AIED. Future studies should be performed to elucidate the pathogenesis of immune-mediated sensorineural hearing loss and develop novel therapies for AIED.

Numerous previous studies have suggested that introduction of pneumococcal conjugate vaccines (PCVs) has led to a reduction in the incidence of myringotomy with tympanostomy tube insertion (MTTI), although few reports mention the efficacy in relation to the patient age or the underlaying reason. Herein, we report the results of a post-hoc analysis conducted based on data collected over a 10-year period, including periods before and after the introduction of PCVs in the national vaccine program, registered in the JMDC Claims Database, a nationwide database; the results include those for ages subdivided into 3-month age groups and a comparison of the MTTI incidence between the PCV7 era and PCV13 era. In addition, the change in the incidence of simple myringotomy (sMyr) for otitis media with effusion (OME) is also reported. We analyzed total of the 7,600 cases of MTTI without adenoidectomy and 13,700 cases of sMyr with OME registered from 2008 to 2017, comparing the incidence by calendar year and age (in years) by the chi-square test. Analysis of the 10-year data revealed a two-humped peak in the frequency of MTTI: in the age groups of 1–2 years and age group of 4–6 years. Comparison of the overall incidence of MTTI by age divided into 3-month age groups between the PCV and pre-PCV eras revealed a reduced incidence in the PCV era in the 12–14 months and 24–26 months age groups. The overall incidence of MTTI in 1-year olds was significantly lower (P < 0.01) in the PCV era as compared with that in the pre-PCV. Comparison of the incidence of MTTI between the PCV7 and PCV13 era revealed no consistent trends. Comparison of the total incidence of sMyr between the PCV and pre-PCV eras showed a significant decrease in the incidence of sMyr in 1-year olds in the PCV era (P < 0.001). Our results indicate that the frequency of MTTI showed a peak in 1- to 2-year-olds, and that PCVs were effective for reducing the frequency of MTTI in the age group of 1 to 2 years 2 months, and significantly decreasing the incidence of sMyr for OME in 1-year olds. These results suggest that bacterial infection might play a significant role in the pathogenesis for OME requiring surgical treatment in 1-year olds.

Pleomorphic adenoma of the external auditory canal is a rare disease. Herein, we report a case of pleomorphic adenoma of the external auditory canal that was removed through a transcanal approach by combined use of an endoscope and 3D exoscope. The patient was a 54-year-old man who presented with a history of a mass in the left ear canal. Tissue biopsy led to the suspicion of a ceruminous adenoma in the external auditory canal, and surgery was performed. Under general anesthesia, the tumor was removed through a transcanal approach, with combined use of an endoscope and a 3D exoscope. The tumor was resected with a sufficient safety margin, and the patient has not shown any evidence of recurrence for 1 year 8 months postoperatively. Surgical resection of pleomorphic adenoma of the external auditory canal with a sufficient safety margin is necessary, and combined use of an endoscope and 3D exoscope seems to be useful.

A condition in which blood or serous fluid accumulates in the auricle is known as otohematoma, but the precise definition of this disease is not clear. Treatment has been widely tried with aspiration, incision and drainage, pressure dressing, mattress suture and OK-432 injection is widely used, but there are few reports yet of intralesional steroid injection for treating this condition. In the present study, we performed intralesional injection of triamcinolone acetonide in 9 patients with otohematoma. After needle aspiration, a volume of triamcinolone acetonide equivalent to the aspirated fluid volume was injected. The volume at each injection not allowed to exceed 1.5 mL and the number of injections was kept to 3 or under. The condition improved in all nine patients, with no apparent complications. Intralesional steroid injection is a treatment method that poses a relatively low burden on the patient and should be considered as the first treatment than other treatments.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited autosomal dominant disorder characterized by recurrent epistaxis (most common manifestation), dilated capillaries in the skin and mucous membranes, arteriovenous malformations in other organs, and/or a positive family history. Septodermoplasty or nostril closure has been reported as an effective measure for the control of severe recurrent epistaxis, although the risk of rebleeding and visual problems make it a controversial modality. We encountered two cases of severe HHT who presented with severe recurrent epistaxis and severe anemia, and were urgently hospitalized and treated by endoscopic posterior nasal septum resection. One of these patients has remained free of rebleeding until the present, 2 years after the surgery, while the other developed rebleeding 10 months after surgery, although the bleeding was not severe. The quality of life of both patients was well maintained after the treatment.

Endoscopic posterior nasal septum resection may contribute to the quality of life in HHT patients, at least in terms of leading to reduced nasal bleeding.

Frontal sinus cyst is one of the complications of sinus surgery, that can sometimes lead to further complications such as meningitis and visual dysfunction.

We report the case of a patient with a large frontal sinus cyst that was suspected as being the cause of frontal lobe impairment in the patient. A 54-year-old man presented with exophthalmos, diplopia, and apathy. He gave a history of having undergone endoscopic sinus surgery (ESS) for chronic sinusitis 17 years ago. Magnetic resonance imaging and computed tomography showed a large frontal sinus cyst that compressed the frontal lobe and invaded the orbit. The score on the Japanese version of Montreal Cognitive Assessment (MoCA-J) was 25. The symptoms improved with drainage by ESS. The patient had an uneventful clinical course for 9 months during follow-up after discharge at our outpatient department; however, 9 months after the surgery, he developed epilepsy with the focus in the left frontal lobe, even though the drainage route had remained open. Single photon emission computed tomography revealed blood flow decrease in the left frontal lobe. Head CT and MRI revealed evidence of damage in the left frontal lobe.

Frontal sinus cyst may contribute to cranial nerve symptoms even in the absence of inflammatory findings. Strict follow-up of patients with frontal sinus cysts after operation in preparation for late onset intracranial complication is recommended, especially in patients with giant cysts, for early identification of late-onset intracranial complications.

Lipomatous tumors of the salivary glands are very uncommon and there are few reports in the literature. Histologically, they can be classified into “monophasic” (lipoma component only) or “biphasic” (lipoma component plus epithelial component) tumors. Oncocytic lipoadenoma is a very rare benign biphasic lipomatous tumor of the salivary glands consisting of a fatty component and oncocytic glandular epithelium component. While difficult to diagnose, this tumor is histologically benign and good outcomes have been reported with surgical resection. We report a case of a 69-year-old woman who presented with left submandibular gland swelling. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a biphasic lesion. Fine needle aspiration cytology (FNAC) of the lesion was performed, which revealed the presence of oncocytic glandular cells. Due to the suspicion of malignancy based on the radiological findings, we performed left submandibular sialadenectomy with neck dissection. Histopathologic examination of the resected submandibular gland revealed a focally biphasic tumor composed of an oncocytic epithelial component along with a mature adipose tissue component, and we made the final diagnosis of oncocytic lipoadenoma. Oncocytic lipoadenoma is a benign tumor composed of fatty components and oncocytic glandular epithelial cells, and preoperative diagnosis based on these histopathological features alone is rather difficult. There have been only a few reports of this disease, and further accumulation of cases is desirable.

The prognosis of differentiated thyroid cancers is good, however, there are no established treatment options for patients with radioactive iodine-refractory and unresectable differentiated thyroid cancers. Lenvatinib was approved by the Japan Pharmaceuticals and Medical Devices Agency for the treatment of differentiated thyroid cancers in 2015. However, drug withdrawal or dose reduction is often necessary due to the emergence of adverse effects of these drugs. During the drug discontinuation period, disease progression was frequently observed, and the timing of TKI administration and the management of the adverse events have been discussed.

In this study, we analyzed the data of 12 patients of differentiated thyroid cancer who were treated with lenvatinib at our hospital between 2015 and 2020. Lenvatinib was started at the dose of 24 mg, and the dose was reduced as needed. The response rate was 75.0%, and the median progression free survival was 19.1 months. The results were compatible with those of the SELECT trial. Long-term administration of TKIs was possible with prophylactic treatment used for adverse events, adjustment of the administration schedule of lenvatinib, and timely switch to sorafenib.

Hyalinizing trabecular tumor (HTT) is a rare thyroid tumor, and differentiation of this tumor from papillary thyroid carcinoma by fine needle aspiration (FNA) cytology is often difficult. We report a case of HTT in a 45-year-old female patient. FNA cytology revealed evidence of malignancy and we performed total thyroidectomy under the suspicion of papillary thyroid carcinoma (PTC). Histopathology of the thyroidectomy specimen showed features of HTT. HTT is considered as being a benign tumor of follicular cell origin showing a trabecular growth pattern and hyalinized stroma. HTT contains thyrocytes with numerous intranuclear pseudoinclusions similar to PTC, and the possibility of a false-positive result of FNA cytology needs to be considered.

Malignant lymphomas represented approximately 12.4% of all malignant neoplasms of the head and neck in 2009. The clinical presentation of patients with malignant lymphoma of the head and neck region resemble those of patients with head and neck cancer. These tumors are more common in men over 60 years of age, and they most frequently arise in the mid-pharynx and cervical lymph nodes. Histopathologically, about 80% of causes are B-cell lymphomas. Herein, we report three cases of diffuse large B-cell lymphoma.

Case1

The patient, an 86-year-old woman, presented with a history of right nasal obstruction and right nasal hemorrhage. Findings of CT, MRI and PET led to the suspicion of right nasal sinus malignancy.

Case2

The patient, an 84-year-old woman, presented with a history of hoarseness and dysphagia, and CT showed an enlarged root of the tongue and bilateral cervical lymphadenopathy. The patient was admitted to the hospital urgently due to airway stenosis.

Case3

The patient, an 84-year-old woman, presented with the complaint of pain during swallowing. Findings of CT led to the suspicion of a malignant tumor in the mid-pharynx. PET/CT showed excessive accumulation in multiple lymph nodes and in multiple subcutaneous tumors.

Cases 2 and 3 required airway management at the otorhinolaryngology department.

Malignant lymphomas of the head and neck region often require airway management, and early diagnosis is of importance.

We herein report the case of a male patient with an impalement injury caused by a metallic door handle that penetrated from under the angle of the mandible to the infraorbital area following a fall; the patient was treated by surgery. The patient was a 63-year-old man who fell on a closed door at home after drinking alcohol, and the door handle, which was facing upward at the time, pierced his neck under the left mandible. His family found him lying on the ground with the door handle yanked off from the door, and took him to a local clinic. Tetanus toxoid and cefazolin (CEZ) infusions were administered, but the patient was transferred to our hospital because of the potentially difficult surgery involved.

When the patient presented to our hospital, his vital signs were stable, and imaging examinations revealed no evidence of intracranial injury or large vessel injury. Because of limited mouth opening, a tracheotomy was performed under local anesthesia, and the foreign body was removed under general anesthesia. Subsequently, the patient underwent suborbital wall fracture repair at the Department of Oculoplastic and Orbital Surgery. The postoperative course was uneventful, and the patient was discharged from the hospital on day 14 after the surgery. Postoperative complications included trismus, ocular motility disorder, and sensory disturbance in the area of the skin supplied by the maxillary division of the trigeminal nerve. Rehabilitation improved the trismus and ocular motility disorder, but the sensory disturbance in the affected skin area persisted. In this case, no serious symptoms such as airway stenosis or bleeding was observed at the time of consultation. We performed CT and angiography to examine the puncture track and sites of injury, and removed the door handle by surgery.

Relapsing polychondritis is a rare, refractory disease characterized by chronic inflammation of the cartilage; involvement of the airways is often a poor prognostic factor.

In this report, we describe a case of relapsing polychondritis that was diagnosed by the presence of intractable subglottic stenosis. The patient, a 67-year-old woman, presented to our department with dyspnea. She was diagnosed as having subglottic laryngitis based on the presence of subglottic stenosis and laryngeal swelling, and was admitted to the hospital. The subglottic stenosis improved slightly after treatment with intravenous antibiotics and high doses of a steroid, and the patient was discharged from the hospital. However, after discharge, the subglottic stenosis worsened. The inflammatory response markers remained mildly elevated. The patient was initiated on treatment with an oral steroid on an outpatient basis, and this treatment led to a marked improvement of her symptoms. Thus, the subglottic stenosis was steroid-responsive. The patient also had a tender saddle nose. Based on the above, and the presence of inflammatory findings in the nasal cartilage and laryngeal tracheal cartilage, we made the diagnosis of recurrent polychondritis according to the diagnostic criteria of Michet et al. Subsequent steroid treatment resulted in improvement of both the nasal cartilage tenderness and tinnitus, fulfilling the diagnostic criteria proposed by Damiani et al.

Because of the diverse clinical manifestations of recurrent polychondritis, a definitive diagnosis often takes time. Another reason is the lack of a highly specific laboratory test. Patients with airway involvement often require early intervention, but in this case, we were able to make the diagnosis based on the clinical findings and steroid responsiveness of the lesions, in the absence of a pathological diagnosis. We hope that this case report contributes to increasing awareness about this disease and timely therapeutic intervention in the future.

Skin defects sometimes occur during head and neck surgery, necessitating flap reconstruction in individual cases. The local flap technique is required for closure of small defects. Since the rotation flap is collected around the skin defect, it is necessary to design the size taking into consideration the blood supply and need for reduced tension at the defect site. In this study, we report two cases of skin defects treated with local flaps: a case of parotid squamous cell carcinoma and a case of tracheostoma. For preoperative simulation, we used shelf lining paper to confirm the size of the defect and type of rotation. This allowed the members of the surgical team to share the image, making it useful for preoperative simulation.