Vestibular paroxysmia (VP), a neurovascular compression (NVC) syndrome of the eighth cranial nerve, is a rare episodic peripheral vestibular disorder that leads to acute short attacks of vertigo or disequilibrium with or without auditory and vegetative symptoms. Arteries or rarely veins in the cerebellopontine angle are the pathophysiological cause of a segmental, pressure-induced dysfunction of the eighth nerve. The proposed mechanism underlying the acute attacks is ephaptic discharge. Repetitive pathological pressure applied to the nerve by a blood vessel is thought to induce demyelination and subsequently hyperexcitability, enabling the ephaptic discharge. The symptoms of VP are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last <1 minute and occur in a series of up to ≥30 episodes daily. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages. Due to the moderate specificity of MRI, it is not recommended for NVC diagnosis.

Differential diagnoses of short attacks of vertigo to consider are vestibular migraine, Meniere’s disease, Tumarkin’s otolithic crisis, paroxysmal brainstem attacks, perilymph fistula, and epilepsy with vestibular aura. This paper outlines the diagnostic criteria, diagnostic methods, and treatment methods for VP.

The Japan Otological Society Committee proposed the 2016 diagnostic criteria for patulous Eustachian tube, enabling objective diagnosis of this disease. However, in some cases, the underlying cause is difficult to identify and the condition becomes intractable. Endocrine disorders, autoimmune diseases, and malignant tumors are possible causes of persistent patulous Eustachian tube.

A 37-year-old woman was referred to our hospital complaining of aural fullness. The symptoms worsened with time despite some conservative treatments, such as medication or saline-based nasal drops. As the otological symptom became severe, the patient also developed psychiatric symptoms. As clinical examination revealed exophthalmos and tachycardia, we suspected hyperthyroidism, and the findings of blood examination were consistent with the diagnosis of Graves’ disease. The patient was immediately started on an oral thiamazole (Mercazole^®), which led to prompt improvement of the symptoms. Patulous Eustachian tube, improvement of Graves’ disease, or both, could have led to the improvement of the psychiatric symptoms.

Recently, the usefulness of epipharyngeal abrasive therapy (EAT) as an effective treatment method for chronic nasopharyngitis, long COVID, etc., has been reported by otolaryngologists. We employed EAT for tubal stenosis caused by scuba diving-related accidents in scuba divers. We divided the patients enrolled in this study into the following two groups: 1) the EAT group, consisting of patients who received EAT: n = 83; 34 men and 49 women; mean ± SD: 43.2 ± 14.0 years; and 2) the non-EAT group, consisting of patients who did not receive EAT: n = 85; 32 men and 53 women; mean ± SD: 40.5 ± 12.5 years. These included the patients who had been under follow-up at our clinic for 2 years prior to this study, or the ones who refused undergoing ENT. At the first visit, both patient groups received treatment with the same antiallergic agents for 1 month, and the EAT group patients received EAT in addition. All patients underwent Eustachian tube function tests (impedance tests) at the first visit and at the 1-month follow-up examination. Significant improvement of the opening pressure was observed in the EAT group as compared with the non-EAT group. However, the improvements in the compliance curve were not adequate, and we speculated the low number of treatments as the possible reason. We propose the following as the mechanisms underlying the efficacy of EAT for tubal stenosis: 1) improvement of cerebral metabolite excretion tract function by local bloodletting at the epipharyngeal mucosa; 2) anti-inflammatory effects; and 3) the therapeutic effect of EAT on epipharyngeal allergies.

Patients receiving immune checkpoint inhibitor (ICI) therapy should be carefully monitored for the occurrence of immune-related adverse events (irAEs). We report the case of an 87-year-old woman with primary mucosal malignant melanoma (T4aN0M0) of the nasal cavity who developed bullous pemphigoid (BP), a rare irAE, after treatment with pembrolizumab. The patient received definitive heavy ion therapy followed by monotherapy with pembrolizumab. After 6 courses of pembrolizumab, she developed grade 2 oral mucositis, and pembrolizumab was discontinued. Since the oral mucositis improved with a topical steroid spray, and computed tomography revealed shrinkage of the nasal tumor, we followed up the patient after discontinuation of pembrolizumab. However, on day 237 after the first dose of pembrolizumab, she developed bullous dermatitis on the skin of the hands and face. A dermatologist was consulted and biopsy led to the diagnosis of BP. Accordingly, we initiated the patient on oral steroid therapy, which led to resolution of the BP, and the condition has not relapsed since. Meanwhile, the nasal tumor continues to remain shrunk, and the patient has been followed up without treatment, including pembrolizumab administration. Prompt diagnosis and treatment are necessary in patients developing irAEs during/after ICI therapy, and collaboration with specialist physicians could be important.

We report a case of isolated oculomotor nerve paralysis caused by a sphenoid sinus cyst.

The patient, a 70-year-old woman visited her local ophthalmologist with left-sided ptosis and diplopia. She also had signs of left oculomotor nerve paralysis and headache, and further clinical workup led to the diagnosis of a sphenoid sinus cyst; she was referred to our department for further treatment. The patient was unable to open her left eye because of severe ptosis, and the left pupil was dilated. There was also external strabismus, and ocular motility disturbance was observed with elevation, depression, and adduction. CT showed a soft tissue density filling the sphenoid sinus. Bone defects were observed in the oblique plate behind the sphenoid sinus, and the lesion extended to the posterior aspect of the oblique plate. The lesion was observed as a high signal intensity on T1-weighted MRI, and as a low signal intensity on T2-weighted MRI. The mass was 46 × 33 mm in size and was suspected as a mucous cyst. Temporary left endoscopic sinus surgery was performed. Thereafter, the ocular symptoms gradually improved and the patient was discharged without any apparent ophthalmologic signs on the 25th postoperative day.

Since oculomotor nerve paralysis caused by a sphenoid sinus cysts is expected to be cured by surgery, aggressive attempts should be made to motivate patients for surgical treatment.

Syphilis is a systemic bacterial infection caused by Treponema pallidum that is exclusively transmitted through direct contact with contagious mucocutaneous lesions, with the exception of vertical transmission. The laryngeal mucosa serves as a vital portal of entry and manifests various signs and symptoms as the disease progresses through chronic stages.

A 26-year-old female was referred to our hospital with progressively enlarging neck swelling and sore throat that had persisted for a month. Palpable and painful neck masses were observable at levels II, III, and IV, and contrast-enhanced CT imaging confirmed pronounced bilateral cervical lymphadenopathy. Laryngoscopy revealed bulky lingual tonsils and an epiglottis covered in pus, as well as edematous changes in the arytenoids. We diagnosed laryngeal syphilis due to positive results from syphilis blood tests and her occupation as a commercial sex worker for several years. Laboratory tests for other possible venereal infections were all negative, and no genital lesions were found during the gynecological examination. We initiated treatment with intravenous ampicillin/sulbactam and adjuvant steroids. However, on the third day of admission, her respiratory status deteriorated due to airway obstruction. An emergency tracheostomy was required to alleviate the obstruction caused by supraglottic edema. She continued to receive ceftriaxone plus clindamycin and gradually recovered, ultimately being decannulated on the 20th day of admission.

Impaired neck lymph drainage, elicited by the swelling of pharyngeal lesions along with bilateral cervical lymphadenopathy, may have been the underlying etiology for the acute supraglottic edema in this case. Clinicians should be aware of the atypical presentation of early syphilis characterized by prominent swelling of neck lymph nodes and the absence of typical mucosal lesions.

Laryngeal amyloidosis is a rare disease, however, some cases who present with local recurrence or progression to systemic amyloidosis have been reported. Therefore, careful and long-term follow-up is required. We have treated three cases of laryngeal amyloidosis in the last 13 years. Of these, one was an extremely rare case in which transthyretin amyloid (ATTR) protein was deposited in both the larynx and the tongue.

Case 1: A 69-year-old female patient with hoarseness of the voice was referred to us. Laryngeal endoscopic examination showed swelling of the bilateral false vocal folds and a left subglottic mass. A tumor was also identified in the middle of the tongue. The lesions were surgically resected, and histopathological examination revealed ATTR-type amyloidosis in the tongue and subglottis. The patient has remained free of recurrence until her visit at 2 years 6 months after the surgery.

Case 2: A 62-year-old male patient presented to us complaining of persistent hoarseness of the voice for 2 months. Swelling of the right vocal fold was identified at a prior ENT clinic, and biopsy revealed the diagnosis of AL-type amyloidosis. Laryngoscopic partial resection of the right vocal fold was performed, and the hoarseness improved postoperatively. The patient did not have recurrence until his last visit to us at 4 months after the surgery.

Case 3: A 61-year-old female patient with hoarseness of the voice was referred to us for swelling of the left false vocal fold detected at a previous ENT clinic. Biopsy revealed the diagnosis of AL-type amyloidosis. Resection of the left false vocal fold mass was performed, with improvement the hoarseness. Eight years later, swelling of the right false vocal fold was detected and reoperation was performed. Thereafter, the lesion has remained stable.

When a laryngeal submucosal mass of unknown origin is seen, laryngeal amyloidosis should be included in the differential diagnosis.

Lipomas are benign, slow-growing tumors of the head and neck that usually cause few symptoms. When lipomas gradually increase in size, it is sometimes difficult to distinguish them from liposarcomas, which are malignant tumors.

We report the case of a 72-year-old female patient with a giant lipoma arising from the anterior neck. Computed tomography (CT) showed a 13.9 × 4.6 × 10.3 cm giant mass in the anterior neck. Fine-needle aspiration performed under ultrasound guidance, showed no evidence of malignancy, suggesting that the tumor was a benign lipoma. Preoperative CT images were transferred to the Synapse Vincent volume analyzer to measure the tumor volume and CT values: the tumor volume was 496 mL and the mean radiodensity of the tumor was －58 HU (standard deviation, 27 HU); these values lent support to the diagnosis of a benign lipoma. The tumor was surgically removed without any intraoperative complications and the tumor weight was 481 g. After extubation in the operating room, the patient was admitted to the intensive care unit for safe airway management. The postoperative course was uneventful, and the final pathological diagnosis was lipoma. There was no evidence of recurrence at the 3-month follow-up. Herein, we present a case of a giant lipoma of the anterior neck in which measurement of the tumor radiodensity in Hounsfield units (HU) on CT was useful for the diagnosis.

Bacteria of the genus Actinomyces are resident in the oral cavity (interdental spaces, plaques, tonsils, etc.) and these organisms become pathogenic when their environment becomes anaerobic. The predominant site of actinomycosis is the head and neck region, but cases of necrotizing fasciitis and septic shock are extremely rare. In addition, while in most cases, actinomycosis is caused by Actinomyces israelii, actinomycetes are difficult to identify by bacteriological culture.

We report the case of an 84-year-old woman who visited our hospital complaining of anterior cervical swelling and difficulty in breathing. Blood examination showed elevated levels of inflammatory markers, and CT showed a deep neck abscess and emphysema. Surgery was performed, and intraoperative examination revealed necrotizing fasciitis.

The patient went into transient cardiopulmonary arrest and a repeat CT showed worsening of the emphysema and abscess. The final diagnosis was necrotizing fasciitis and septic shock caused by some gas-producing bacteria. The surgery allowed diagnosis of the extensive necrotizing fasciitis in the neck. The condition was thought to be caused by Actinomyces naeslundii, which was detected on blood culture.

Actinomyces naeslundii has been identified in the head and neck region in only four cases in all, including one case in Japan and three cases overseas; thus, it is extremely rare, and ours may be the first case in which it was identified by blood culture.

Fine needle aspiration (FNA) cytology of the thyroid is a test in which cells are aspirated from thyroid tumors by puncture under ultrasound guidance and the tumors are diagnosed as benign or malignant based on the shape and properties of the cells. It is a simple test and is routinely performed on an outpatient basis, but in rare cases serious complications may occur. Some patients develop transient diffuse thyroid swelling after fine needle aspiration (dTSaFNA) cytology of the thyroid, and present with symptoms of anterior neck swelling, neck pain, neck pressure, and dyspnea. We encountered one such case that required hospitalization. The patient was a 29-year-old man with no significant past medical history. He was referred to our department because of a thyroid tumor that happened to be incidentally detected by MRI. He had no palpable mass in the anterior neck. Ultrasound examination showed a well-circumscribed tumor measuring 22 × 14 × 13 mm in size in the upper pole of the right lobe of the thyroid. Ultrasound-guided FNA cytology was performed. After the puncture, there was no swelling in the neck and the patient was sent home. However, bilateral anterior neck swelling and tenderness were observed, and ultrasound examination and computed tomography (CT) revealed diffuse swelling and crack-like gaps in both lobes of the thyroid, as well as edema in the anterior neck muscles. There was no laryngeal edema. The patient was admitted and started on hydrocortisone sodium succinate 300 mg to reduce the edema. By 15 hours after the puncture, the swelling of the anterior neck had improved markedly, and no laryngeal edema was observed, and the patient was discharged. By the 8th day after the thyroid puncture, the anterior neck swelling had completely resolved. The cytology result was Class II.

In patients developing dTSaFNA after FNA, the possibility of occurrence of airway emergencies must also be borne in mind and careful follow-up is necessary. Patients should be fully informed of the possible risks prior to undergoing FNA.

Background: Malignancies of the nasolacrimal apparatus are rare and usually originate from the lacrimal sac. To the best of our knowledge, malignant tumors arising from the nasolacrimal duct are extremely rare. We encountered a patient with squamous cell carcinoma arising from the nasolacrimal duct. Herein, we report this case of nasolacrimal duct carcinoma.

Case: A 65-year-old man presented with a 3-month history of blood-stained lacrimation on the right side. Nasal endoscopy revealed an exophytic lesion occupying the right inferior meatus. Imaging studies showed an expansible lesion involving the nasolacrimal duct and the inferior meatus, but not invading the orbit or adjacent soft tissues. A biopsy was suggestive of squamous cell carcinoma. We performed radical resection through Denker’s approach under endoscopic guidance. Due to the close margins, we also administered postoperative radiation therapy (PORT) for the local lesion. Four months later, we performed conservative neck dissection (I–V) for cervical lymph node metastases. Due to multiple lymph node metastasis, PORT was also administered for the neck lesion. Until now, 2 years after completion of PORT, there has been no evidence of disease recurrence.

Conclusion: We encountered a case of squamous cell carcinoma originating from the nasolacrimal duct, which was controlled while preserving the visual function. CT/MRI imaging and intraoperative endoscopic findings were useful to determine the appropriate extent of resection.

Introduction: There are two types of thyroid cysts: true cysts and secondary cysts; true cysts are rare, and the majority are secondary cysts. In this report, we describe two cases of true epithelial cysts of the thyroid gland.

Case 1: A 70-year-old man was referred to us with an abnormal mediastinal shadow on the chest X-ray detected during a physical checkup. Chest CT revealed a cystic lesion measuring 6 cm in diameter, extending from the lower pole of the right lobe of the thyroid gland to the mediastinum. The lesion was excised through a combined approach of external cervical incision and thoracoscopic surgery. It was found to be strongly adherent to the right recurrent laryngeal nerve, which could not be dissected thoracoscopically. The recurrent laryngeal nerve was transected under the collarbone. The histopathological diagnosis was an epithelial cyst.

Case 2: A 71-year-old man presented with the complaint of a cervical mass. Ultrasonography revealed a cystic lesion measuring 4 cm in diameter in the right lobe and a hypoechoic nodule measuring 7 mm in the left lobe of the thyroid gland. Total thyroidectomy was performed. The histopathological diagnosis of the lesion in the right lobe was epithelial cyst, while that of the nodule in the left lobe was papillary thyroid carcinoma.

Discussion: The two cases were considered as possible cases of thyroglossal duct cysts. Epithelial cysts are rarely found in the thyroid gland, and it is difficult to distinguish them from secondary cysts prior to surgery. Epithelial cysts may have fibrous connective tissue or lymphoid tissue under the epithelium.

Conclusion: We encountered two cases of epithelial cysts in the thyroid gland. Epithelial cysts may adhere to the surrounding tissues, and care must be taken not to damage surrounding tissues, such as nerves, during surgery.

For this study, we defined the Adolescent and Young Adult (AYA) generation as people aged 15 to 39 years old. Otorhinolaryngologists, who often have the opportunity to treat cancer patients of the AYA generation, need to recognize the influence of cancer treatment on the fertility of patients of this generation. Therefore, we conducted a retrospective review of the data of 60 cases of the AYA diagnosed as having head and neck cancer at our department. When the risk of gonadal toxicity associated with head and neck cancer treatment was examined according to the guidelines for fertility preservation, 1 patient was found to be at a high risk and 3 were found to be at intermediate risk. Nevertheless, the risk of gonadal toxicity was not explained in the document, and it is considered that revision of the document would be necessary. In order to secure the fertility of head and neck cancer patients of the AYA generation before the start of cancer treatment, it is necessary to promptly share information about the patients with doctors of the department of obstetrics and gynecology and department of urology. It is necessary to build a reproductive medicine network to ensure prompt cooperation.