The prevalence of moderate or profound hearing loss that may require a hearing aid increases after 80 years of age. The benefits of compensating for hearing impairment are not only to improve communication skills, but also to maintain the interactions between the individual and society. The need to start the elderly over the age of 80 years on hearing aid use is expected to increase from hereon.

This paper provides an overview of the benefits that can be expected from hearing aids and the ways to deal with difficulties faced by older adults with the use of hearing aids, presenting three cases of patients over the age of 80 years who had begun to use hearing aids. The older a person gets, the greater the individual differences in physical and mental functions. A behavioral science approach based on the following (1) to (3) is useful to achieve appropriate patient-centered counseling on optimal hearing aid use. (1) CAPABILITIES: Knowledge and skills; (2) OPPORTUNITIES: External factors enabling hearing aid use; (3) MOTIVATION: Automatic and reflective processes.

We should not hesitate to start patients on the use of hearing aids solely based on their advanced age. As otolaryngologists, we have to provide appropriate testing and evaluation and encourage behavioral changes toward hearing compensation to help patients and their families who are seeking solutions for hearing loss.

There are many causes of pediatric facial nerve palsy, but facial palsy caused by mumps virus is rather rare. Although the prognosis of pediatric facial nerve palsy is better than that of facial palsy in adults, some cases fail to show complete healing or develop pathological synergy, which can significantly reduce the quality of life. In this report, we describe a case of pediatric facial nerve palsy caused by mumps virus.

The patient was a one and a half years old boy. His mother noticed that the child had difficulty moving the right side of his face, and consulted a local doctor. There was no parotid gland swelling, but IgG/IgM antibodies for mumps virus were positive. The ENoG level was 42.5% after 14 days, and the facial palsy had completely resolved when the patient visited us two months later.

It has been reported that mumps virus is the cause in 1.5% of cases of facial paralysis in children and that 18.9% of cases of Bell’s palsy show positive test results for mumps. Furthermore, 1.5% of cases of facial paralysis caused by mumps show parotid gland swelling. Treatment is similar to that for Bell’s palsy.

Although mumps is rarely implicated in pediatric facial nerve palsy, its involvement cannot be ruled out even in the absence of parotid gland swelling, and it is necessary to proactively measure the antibody titers against various viruses, including mumps.

Cases of foreign bodies in the external auditory canal are frequently encountered in the field of otorhinolaryngology. However, there are few case reports of ticks in the external auditory canal. Ticks are known to parasitize humans and feed on blood, sometimes transmitting various infectious diseases, such as severe fever with thrombocytopenia syndrome, and when they are parasitic in the external auditory canal, prompt action is required. We encountered four cases of ticks in the external auditory canal. When removing a tick that has bitten the body, the mouthparts are likely to break off and remain on the skin, so that caution should be exercised. The most reliable method to remove a tick is to remove the tick along with the skin beneath under local anesthesia. Several materials and instruments have been used to remove ticks. Removal of ticks from the external auditory canal is especially difficult because the procedure is painful and the field of view is poor, which limits the use of instruments. It is important to understand the characteristics of ticks occurring as foreign bodies in the external ear and how to deal with them.

Thyroid-like low grade nasopharyngeal papillary adenocarcinoma (TL-LGNPPA) is an extremely rare adenocarcinoma that arises in the posterior nasal septum or the nasopharynx, with histological findings similar to those of papillary thyroid carcinoma; the tumor shows positive immunohistochemistry for thyroid transcription factor-1 (TTF-1) but negative results for thyroglobulin. We performed endoscopic removal of a nasal tumor under general anesthesia in a pregnant woman, and the histopathological diagnosis was TL-LGNPPA.

A 33-year-old woman presented with epistaxis, otorrhea, nasal obstruction, and facial pain during pregnancy. She was referred to our department at 16 weeks of pregnancy for closer examination and treatment of a stalked mass originating from the posterior nasal septum. Biopsy revealed the diagnosis of adenocarcinoma, and we performed endoscopic endonasal surgery while she continued her pregnancy. The tumor showed papillary growth of atypical epithelium, and the tumor cells were positive for TTF-1 and negative for thyroglobulin. Based on the findings, the postoperative histopathological diagnosis was TL-LGNPPA. Both mother and child are healthy, and the patient has shown neither local recurrence nor distant metastasis until now, 8 years since the operation.

This case was extremely rare in the following two respects: endoscopic surgery for a malignant nasal tumor was performed during pregnancy, and the histopathological diagnosis was TL-LGNPPA. By working together with obstetricians and anesthesiologists, we were able to safely accomplish complete removal of the tumor while the patient could continue her pregnancy to term.

IgG4-related disease (IgG4-RD) may also involve the paranasal sinuses, although such cases are rare. In this article, we present a case of IgG4-RD in a 66-year-old man with recurrent paranasal sinus, orbital, and buccal lesions. The patient initially presented with buccal lesions and limited mouth opening two years previously, but did not meet the diagnostic criteria for IgG4-RD at that time. After he was initiated on prednisolone (PSL) treatment, the IgG4 levels increased to 179 mg/dL, but subsequently improved along with the lesions and symptoms. However, while the PSL dose was being tapered, the patient developed worsening of the mouth opening difficulty, ocular motility disorder, and new lesions in the paranasal sinuses and orbit. Rhinosinusitis was suspected and the patient was referred to our department. Conservative treatment with antibiotics and other agents was ineffective, prompting endoscopic sinus surgery for both diagnostic confirmation and lesion control. Postoperative histopathology confirmed IgG4-RD. Postoperatively, treatment with PSL and azathioprine led to temporary improvement, but relapse occurred during PSL tapering. Long-term remission was achieved with PSL and rituximab. This case suggests that IgG4-RD involving the paranasal sinuses may require aggressive management, including steroids and rituximab, due to potential bone destruction and invasion of the surrounding structures. There are limited reports of IgG4-RD with paranasal sinus involvement, particularly those with repeated recurrences, such as this case. Further studies are warranted to establish optimal management strategies.

Serious complications of infectious mononucleosis, including upper airway obstruction, have been reported, although they are rare. Herein, we report the case of a 25-year-old woman who was suspected as having upper airway obstruction on day 5 after the onset of infectious mononucleosis. Tracheostomy was planned to secure the airway, but fortunately, the patient recovered with conservative treatment. There have been several reports in the past of upper airway obstruction developing in patients with infectious mononucleosis, and some cases have had unfortunate outcomes. It is necessary to consider the possibility of progression of upper airway obstruction and take all possible measures to manage the airway in patients with infectious mononucleosis.

Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of Merkel cell origin located at the dermoepidermal junction. It supposedly has a tactile sensory function, generally forming skin masses (face, neck, and extremities) in older patients.

We report a case of MCC suspected initially as a primary hypopharyngeal or unknown-primary hypopharyngeal metastatic carcinoma in a 74-year-old woman. Fine-needle aspiration biopsies of the hypopharyngeal and cervical lymph nodes were suggestive of MCC metastasis. Bronchoscopic lung biopsy revealed small-cell carcinoma of the lung. Approximately half of the MCCs are thought to be primary and develop on the exposed skin of the head and neck region; however, in rare cases, they occur in non-exposed mucosa of the head and neck region (larynx, nasal cavity, and pharynx). Small cell carcinoma and malignant lymphoma are diseases that need to be differentiated from MCC. Immunohistochemistry is useful for differentiating these diseases. In our study, the patient did not have suspicious MCC lesions on the skin of the head, neck, or upper extremities. The patient was considered as having multiple lymph node metastases from MCC, primary in the hypopharynx or unknown primary, overlapping with small cell carcinoma of the lung.

Undifferentiated pleomorphic sarcoma (UPS), formerly known as malignant fibrous histiocytoma, has been re-classified as one of the undifferentiated/unclassified sarcomas, as they lack a tendency towards clear differentiation, in the current WHO classification. UPS arising from the head and neck region accounts for less than 1% of all head and neck tumors.

An 82-year-old woman presented to us with a right cervical mass. MRI showed a tumor measuring 1.3 cm in diameter in her right sternocleidomastoid muscle (SCM). Fine needle aspiration cytology revealed a class 3 result. However, 2 months later, CT revealed that the tumor had grown by up to 2 cm. An incisional biopsy was performed, which revealed the diagnosis of UPS. We performed resection of the SCM, including the region where the biopsy was performed. As there appeared to be a positive margin at the origin of the SCM, we administered adjuvant radiotherapy (66 Gy/33 Fr). No recurrence or metastasis was observed until the end of 5 years after the surgery.

Achieving a safe resection margin at surgery in cases of UPS in the head and neck region often presents a challenge due to the proximity of critical anatomical structures. Intraoperative pathological assessments also entail difficulties in margin evaluation, as it is difficult to distinguish between tumor cells and spindle fibroblastic cells observed in the inflammatory tissue surrounding the tumor. As a result, postoperative assessments often reveal positive surgical margins. Postoperative radiotherapy is believed to contribute to improved local control rates and should be actively considered based on the findings of postoperative pathological examination. However, no standardized pharmacological therapy for recurrent or metastatic UPS has been established yet, and patients with distant metastases generally have a shortened survival period. The development of more effective drug therapies for UPS, including immune checkpoint inhibitors, is eagerly anticipated in the future.

Lemierre syndrome is characterized by pyogenic thrombophlebitis of the internal jugular veins following preceding pharyngitis, causing metastatic infection of multiple organs, including the lungs and joints. The most common causative agent is Fusobacterium necrophorum. We encountered a case of Lemierre syndrome caused by the rare pathogen Prevotella intermedia. In addition to thrombosis of the internal jugular vein, septic pulmonary embolism, hepatic vein thrombosis, and thrombocytopenia were present, which improved with intravenous antibiotic and anticoagulation therapy. However, since the internal jugular vein was closed and a thrombus remained in the bulb, continuation of anticoagulation therapy and continued follow-up should be carefully considered.

Direct training refers to training for oral intake using jelly or thickened water as a preliminary step to resumption of food intake. There is a wide range of patients with swallowing dysfunction, from mild cases who can begin to take food at an early stage, to severely impaired cases who need a long time to resume food intake. In this study, we investigated the relationship between the findings at the time of videoendoscopic evaluation of swallowing (VE) and the changes in the food intake patterns after VE in patients receiving direct training, and statistically analyzed the results.

We performed VE in 319 cases who were under the care of our hospital’s swallowing support team between July and December 2022. Of these cases, after excluding tracheostomy cases, we reviewed the data of 68 cases in which direct training by a speech therapist had been initiated. Statistical analysis was performed to determine the relationships between the findings at the time of VE (Hyodo score, level of consciousness, jelly residual in the epiglottic vallecura, and the serum albumin level) and the following three factors related to changes in the food intake pattern after VE: (1) food intake pattern at 1 week, (2) food intake pattern at discharge, and (3) rate of improvement of the food intake pattern.

The level of consciousness at the time of VE was weakly correlated with the food intake pattern at discharge (correlation r-value = 0.26; p-value = 0.03), the Hyodo score at the time of VE was weakly correlated with the food intake pattern at 1 week (r = 0.28, p = 0.02), and the presence of jelly residual in the epiglottic vallecula at the time of VE was weakly correlated with the food intake pattern at 1 week (r = 0.35. p = 0.003) and the rate of improvement of the food intake pattern (r = 0.39. p < 0.001). Although the serum albumin level at the time of VE was not directly associated with the changes in the food intake pattern following training, multiple regression analysis showed that the serum albumin level exerted a significant influence on the relationships between the other three factors and the changes in the food intake pattern following direct training. Thus, each of the four factors was involved in the changes of the food intake pattern following direct training.