Allergen immunotherapy is a curative treatment for type I allergic diseases. It is said that when treatment is continued for several years, allergen immunotherapy can induce long-term remission and cure, with effects lasting even after the treatment is discontinued. Allergen immunotherapy has also been reported as having the effect of preventing new allergen sensitization and also preventing the onset of other allergic diseases (such as asthma). While the traditional subcutaneous injection method carries the risk of side effects such as anaphylactic shock and is not widely adopted in Japan, sublingual immunotherapy allows for safe and convenient immunotherapy. In Japan, allergen immunotherapy had historically been overlooked as an option for allergy treatment, but with the availability of sublingual immunotherapy in clinical practice, it has become an important treatment option at present.

The most commonly used treatment for allergic diseases is symptomatic drug therapy, which provides relief during treatment, but the symptoms reappear once the medication is stopped. Regardless of the cause, the drugs used for treatment are selected based on the symptoms. Surgical therapy differs from drug therapy in that its effects last slightly longer, but it has no effect on the underlying allergy mechanism either and is therefore also classified as symptomatic therapy. Allergen immunotherapy is the only treatment modality available at present that can induce long-term remission or cure and can be classified as curative therapy. Currently, treatment is available for dust mites and cedar pollen allergies, but there are high expectations in the field that treatment will soon become available also for grass and birch pollen allergies. Considering the significance of sublingual immunotherapy as a curative treatment rather than just symptomatic treatment, we otorhinolaryngologists should also consider it as an important treatment option.

The incidence rate of patients with life-threatening dizziness seen at vertigo/dizziness outpatient clinics has been reported to be approximately 1%. Of the remaining cases, in 70%–80%, the dizziness is considered as being of inner ear origin. We, as neuro-otologists, have an important role in making the appropriate diagnosis in each case of peripheral vestibular disease. Especially in city hospitals and town outpatient clinics with insufficient equipment for examining equilibrium, neuro-otologists need to adopt rational history-taking techniques for diagnosing the cause of vertigo/dizziness.

In this study, we reviewed the data of 464 patients with vertigo/dizziness in whom a definitive diagnosis had been made at the vertigo/dizziness outpatient clinic between April 2023 and March 2024. We hypothesized that if a patient’s dizziness was motion-evoked, they would have difficulty in answering questions about the frequency and duration of their symptoms. To assess this hypothesis, we analyzed the relationship between the patients’ responses regarding the duration and frequency of vertigo episodes and the final confirmed diagnosis.

The results showed a significant correlation, indicating that patients who could provide information about the monthly frequency and duration of their vertigo episodes were more likely to have diseases causing spontaneous vertigo, whereas those who could not were more likely to have diseases causing motion-evoked dizziness. Through structured medical interviews based on this approach, clinicians should first roughly list several possible causes of vertigo and then select specific examinations to establish a definitive diagnosis.

Nasal intraorbital complications refer to conditions in which inflammation extends from the nasal sinuses to the orbit, potentially causing visual defects. Left untreated long, these visual defects could result in irreversible visual impairment. Therefore, early diagnosis and treatment are important.

In this report, we describe two cases of nasal intraorbital complications that were diagnosed and treated at an early stage and showed a good visual prognosis.

Case 1: A 79-year-old woman visited an ophthalmology clinic with the chief complaint of left eyelid swelling. Five days later, she reported a decrease in visual acuity on the left side and was referred to our department as the findings of CT and MRI led to the suspicion of nasal intraorbital complications secondary to acute sinusitis. We performed endoscopic rhinosinus surgery and extra-nasal drainage on day 2 after the patient reported visual impairment, in an attempt to restore the visual acuity. The patient’s visual acuity improved postoperatively. Case 2: A 60-year-old woman presented to our department with right upper eyelid swelling that had developed a few days after she suffered from an upper respiratory infection. We performed endoscopic rhinosinus surgery and drainage through an external nasal incision. Her visual function was preserved postoperatively.

Early treatment is important in patients presenting with nasal intraorbital complications. Many articles have reported that visual impairment due to naso-orbital complications may fail to resolve if not treated within 48 hours. Case 1 suggests that ophthalmologists should consider the possibility of nasal intraorbital complications in patients presenting with vision problems after an upper respiratory infection. Fortunately, the patient was treated within 48 hours and her vision improved. Case 2 could be treated before the onset of vision loss. Early treatment was considered important to preserve vision.

Hypopharyngeal stricture can occur from several causes, including tumor invasion and post-treatment changes, but case reports of the condition caused by adhesions are rare. In patients with difficulty in oral intake, nasogastric tube insertion is the initially selected means to provide nutrition. Although hypopharyngeal adhesions are not a commonly reported complication of nasogastric tube insertion, we encountered a case of hypopharyngeal stenosis that we attributed to adhesions caused by the nasogastric tube insertion.

A 76-year-old man was urgently admitted to our hospital due to worsening respiratory condition. We diagnosed the patient as having aspiration pneumonia and started him on antibiotic therapy; we also inserted a nasogastric tube for providing nutrition and initiated rehabilitation. However, the patient’s respiratory condition continued to worsen because of aspiration of saliva. Therefore, we performed a tracheotomy to improve the respiratory condition, but the symptoms still failed to improve. Finally, we resorted to laryngectomy to prevent aspiration. Intraoperative examination revealed adhesions in the midline portion, from the post-cricoid region to the pharyngoesophageal junction. We considered that mechanical stimulation by the gastric tube had induced ischemia, ulceration, and infection, and that the adhesions were a result of the wound healing process occurring in the setting of a poor nutritional status.

Dysphagia in older persons can be of diverse causation. Herein, we report the case of a 71-year-old man who presented with severe dysphagia.

The patient’s swallowing function had begun to deteriorate 2 years before his first visit to our hospital. Videoendoscopic and video-fluorographic examinations of swallowing revealed absent dilatation of the esophageal orifice during swallowing. We treated the patient surgically, by cricopharyngeal myotomy. Histopathologic examination revealed atrophic changes of the cricopharyngeal muscle. However, no improvement of the swallowing function was observed after the surgery.

We made a note of the forward leaning posture and cervical extension of the patient, and advised him to engage in regular Pilates exercise. A physical therapist provided instructions at the hospital once in a week and the patient practiced the exercises daily at home. By the end of two months, the forward leaning posture and cervical extension of the patient had improved. In addition, he also showed improvement of the swallowing function and eventually resumed oral intake. Indeed, video-fluorography after 2 months of regular Pilates revealed that the anterior movement distance of the hyoid had increased. This result indicated that the anterior movement of the hyoid plays an important role in the dilatation of the esophageal orifice during swallowing.

We believe that the posture exerts a very important influence on swallowing and that Pilates exercises are very useful to improve the posture. In the patient reported herein, both cricopharyngeal myotomy and Pilates exercises contributed significantly to the improvement in the swallowing function.

Chondrosarcoma of the larynx is a very rare disease, accounting for only 0.2% of all primary malignancies of the larynx. Surgery is often the treatment of first choice in resectable cases, but adequate evidence for treatment of this tumor has not yet been established.

We report our experience with a case of laryngeal chondrosarcoma in a patient in his 60s. The patient was incidentally diagnosed as having a tumor in the larynx during a health checkup and was referred to his previous hospital. A detailed examination at that hospital revealed the tumor as a low-grade laryngeal chondrosarcoma, and total laryngectomy was recommended as treatment. However, as the patient was asymptomatic and he could not accept the loss of his larynx, he refused surgery.

He was then referred to our hospital in the hope for some treatment that could preserve his speech and swallowing functions. The head and neck surgeon, radiation oncologist, and bone and soft tissue oncologist discussed the patient’s treatment plan and offered the patient carbon-ion radiotherapy and larynx-preserving surgery as treatment options, and the patient chose surgery. The tumor was resected with a margin of a few millimeters. After the surgery, the patient’s speech and swallowing function have been preserved, and at present, one year four months after the surgery, there is no evidence of tumor recurrence.

Our experience suggests that larynx-preserving surgery may be an effective treatment option for patients with a strong desire for laryngeal preservation.

Lemierre’s syndrome is a rare, but potentially life-threatening condition characterized by internal jugular vein thrombophlebitis following an oropharyngeal infection, often caused by Fusobacterium species. We report the case of a 22-year-old female patient who presented with fever and pharyngitis, which progressed to left cervical pain. Imaging revealed thrombosis of the left internal jugular vein and multiple septic emboli in the lungs. Contrast-enhanced CT suggested possible venous wall rupture, complicating differentiation between an abscess and hematoma. Initial empirical antibiotic therapy with meropenem and vancomycin proved ineffective, necessitating surgical drainage on day 4, which confirmed both a purulent discharge and venous wall rupture. The affected vein was ligated and excised. Postoperatively, anticoagulant drug therapy was initiated and the antibiotic therapy was de-escalated. The patient showed steady improvement and was discharged on an additional four-week oral antibiotic regimen. This case highlights the diagnostic and therapeutic challenges of Lemierre’s syndrome, particularly in relation to distinguishing between an abscess and hematoma and managing venous wall rupture. Negative blood cultures do not rule out the diagnosis, and tailored antibiotic therapy remains crucial. Early imaging and ultrasound-guided aspiration may facilitate earlier intervention and improve outcomes.

Objective: To develop a LINE bot system that automatically summarizes and distributes recent otolaryngology research papers, and to evaluate its effectiveness in supporting continuing medical education for otolaryngologists.

Methods: We developed a LINE bot system using Google Apps Script that searches PubMed for recent otolaryngology papers, summarizes them using ChatGPT-4, and distributes the summaries daily. Twelve otolaryngologists (6 specialists and 6 residents) used the system for two weeks. Because the system delivered content directly to their smartphones, the participants could access the latest summaries during their downtime, potentially contributing to more efficient time utilization and supporting workstyle reforms. We then conducted a survey to assess the changes in the paper reading habits of the participants and the system’s usefulness.

Results: Of all the participants, 91.7% reported an increase in the number of English papers that they read (average increase of 7.2 papers/week), 83.3% reported improved learning motivation, and 91.7% found the system helpful for quickly obtaining the latest information.

Conclusion: The LINE bot system showed promise for supporting continuing medical education for otolaryngologists, facilitating learning during otherwise idle moments, which could be expected to contribute to improving the quality of daily clinical practice.

There are three established treatment options for Graves’ disease: antithyroid drugs (ATD), radioiodine therapy (RAI), and surgery. While ATDs are often selected as the first-line treatment, the optimal approach when ATDs cannot be used or when transitioning from ATDs to other treatment options remains unclear. In this study, we attempted to analyze the factors influencing the choice between RAI and surgery for the aforementioned patients referred to our department. During the study period, 141 patients (56.4%) were treated with RAI and 109 (43.6%) by surgery; 96% of patients had received prior treatment with ATDs. Among those undergoing surgery, in 38.5% of patients, surgery was unavoidable as RAI was contraindicated for reasons such as pregnancy, breastfeeding, ophthalmopathy, adolescence, comorbid thyroid cancer, or strong desire of the patient to avoid RAI. The remaining 61.5% opted for surgery based on several factors, including younger age, severe adverse reactions to ATDs, history of thyroid crisis, and greater thyroid weight. While these factors independently contributed to the decision to select surgery, they did not entirely exclude the possibility of RAI treatment. The final decision was influenced by both clinical factors and the preferences of the patients and clinicians, indicating that the treatment choice can vary across different medical facilities. This study highlights the importance of a personalized approach in selecting between RAI and surgery for patients with Graves’ disease.