Vestibular compensation, the behavioral recovery that takes place following the removal of afferent input from one vestibular organ or nerve, is an attractive behavioral model of lesion-induced plasticity in the central nervous system.

After the left-right difference in the activities of vestibular nucleus neurons induced by unilateral vestibular dysfunction, is corrected, activation of glutamatergic input and attenuation of GABAergic inhibitory input to vestibular neurons on the affected side are thought to be essential for the progression and completion of compensation. When the compensatory mechanisms cease, the resultant sensitivity imbalance leads to prolonged persistence of dynamic symptoms. This condition is called decompensation and manifests as dizziness and unsteadiness induced by vestibular stimuli, such as head movements, persisting for long periods of time. The pathology is thought to be a persistent difference in neural sensitivity between the bilateral vestibular nuclei, and the uneven dependency caused by misleading use of the vestibular nucleus on the unaffected side, vision, and somatosensory sensations after vestibular damage further prolongs the symptoms.

Vestibular symptoms in some uncompensated patients with vestibular hypofunction is found to be intractable to any treatment. We examined whether graded vestibular balance rehabilitation might alleviate the dizziness and balance problems, and increase the safety and independence of patients with chronic balance disorders following unilateral vestibular loss. The stepwise treatment program examined in this study consisted of a vestibular balance rehabilitation program developed at our clinic, including vestibular adaptation training, sensory reweighting training, and vestibular substitution training. This rehabilitation program is aimed at promoting the central vestibular adaptation process, altering the vestibular, visual and somatosensory inputs, and encouraging the use of the sensory substitution system with a human (brain)-machine interface as a substitute for the diminished vestibular input by transmitting information about the patient’s head position to the tongue. This study was performed to investigate the degree to which the stepwise multimodal approach might be effective for chronic balance disorder in subjects with unilateral vestibular loss due to decompensation. Some interventions for rehabilitation were selected and customized for each patient in accordance with the level of their compensation for postural control and their sensory dependence.

Our vestibular rehabilitation treatment strategy, that is, the programmatic stepwise multimodal approach to vestibular rehabilitation, yields beneficial effects in patients with balance disorder secondary to vestibular decompensation.

VZV encephalitis and meningitis developing secondary to varicella zoster are considered to be extremely rare, reportedly occurring at an incidence rate of about 0.5%. On the other hand, it has been reported that even among cases of herpes zoster without symptoms of meningeal irritation, there are many cases of infection of the spinal fluid and in which symptomatic meningitis may develop if the disease progresses. In this report, we describe a case of Ramsay Hunt syndrome associated with multiple cerebral neuropathies, complicated by delayed loss of consciousness and meningitis.

The patient was a 49-year-old man who presented with the complaints of fever, dysphagia, left hearing impairment, left facial palsy, and dizziness. Serology revealed a significant increase in the VZV-IgM and VZV-IgG titers. The patient was diagnosed as having Ramsay Hunt syndrome complicated by lower cranial neuropathy. He was initiated on treatment with a steroid and valaciclovir. Cerebrospinal fluid examination revealed an increased cell count with mononuclear cell predominance, and intravenous aciclovir was administered as treatment for VZV meningitis. About 21 days later, the patient developed impaired consciousness, rigidity of the neck, and fever, all of which improved within 1 to 2 days. In patients with polyneuropathy and an extensive skin rash, the possibility of subclinical VZV meningitis should be kept in mind, and in addition to serological antibody titer testing, aggressive cerebrospinal fluid testing should be performed and intravenous aciclovir administration considered from early in the clinical course.

Tumors of the external auditory canal (EAC) encompass a wide variety of pathologies, including benign and malignant neoplasms. Among benign tumors, osteomas, papillomas, and hemangiomas are commonly reported, whereas the major malignant entities encountered are squamous cell carcinoma and adenoid cystic carcinoma. However, pleomorphic adenomas originating in the EAC are exceedingly rare.

We report a case of a pleomorphic adenoma of the EAC in a 78-year-old female patient who presented with bilateral hearing loss. After earwax removal, her hearing improved, but a mass was detected in the right EAC. Imaging studies, including CT and MRI, revealed a well-demarcated lesion without evidence of bone destruction or continuity with the parotid gland. Fine-needle aspiration cytology suggested malignancy, necessitating further evaluation. The tumor was excised under general anesthesia via a postauricular approach, and histopathological examination confirmed the diagnosis of pleomorphic adenoma. Given the potential risk of malignant transformation and recurrence, regular follow-up of the patient is deemed necessary.

Pleomorphic adenoma of the EAC is a rare entity with diagnostic challenges, as distinguishing it from a malignant tumor based on imaging alone is difficult. Histopathological examination remains the gold standard for diagnosis. Complete surgical excision with an adequate margin is essential to prevent recurrence. Regular long-term follow-up is necessary due to the potential risk of malignant transformation.

Nodular oncocytic hyperplasia (NOH) is classified as a non-neoplastic epithelial lesion in the 2017 World Health Organization (WHO) classification of salivary gland tumors. It is rare, accounting for less than 1% of all salivary gland tumors. The patient, a 63-year-old woman, presented with a slowly increasing swelling of the right cheek. Imaging showed multiple nodular lesions bilaterally in the parotid glands. We performed fine needle aspiration cytology (FNAC), which was inconclusive. Core needle biopsy (CNB) was performed and the findings were consistent with the diagnosis of NOH. As the lesions were benign, we offered the patient several options for managing the condition, including careful follow-up. Due to cosmetic concerns, however, she requested a right parotid tumor resection. The tumor occupied most of the right parotid gland, and the surgery was akin to superficial parotidectomy. A small residual tumor in the right accessory parotid grand and the lesions on the left side are now under observation. We compared the age, sex, presentation, the results of FNAC, and management of 14 cases of NOH reported in the literature, including the present case. In most cases, surgical treatment was undertaken because of the difficulty in preoperative diagnosis of NOH by cytology. There are no previous other reports of the use of CNB for diagnosis, which appears to be useful for preoparative diagnosis of NOH.

IgG4-related disease is a lymphoproliferative disease of unknown etiology that is characterized by increased serum IgG4 concentrations, increased numbers of IgG4-positive plasma cells in the tissues, and enlarged, mass-like, and thickened lesions in various organs throughout the body. A 47-year-old female patient presented with pharyngeal pain and mucosal thickening of the larynx. She was referred to our hospital because of sore throat and mucosal thickening of the larynx. She was admitted to the hospital and started on antibiotic, intravenous steroid and antifungal therapy, and discharged from the hospital following symptomatic relief. Eight months later, she visited our hospital again with sore throat and mucosal thickening of the capsular region of the right tonsil. One and a half months after the second referral, white lesions and swelling of the right tonsil and soft palate were observed in addition to mucosal thickening of the capsule. A portion of the right tonsil was biopsied, including the white lesion, but histopathologic examination was negative for neoplastic lesions. The right tonsil was persistently swollen, and after obtaining consent from the patient, we performed bilateral tonsillectomy. Histopathological examination of the resected tonsils revealed IgG4-related disease. After resection of the palatine tonsils, the mucosal thickening of the larynx also improved. Thus, IgG4-related disease should be considered in patients presenting with recurrent laryngeal and tonsillar swelling of unknown cause.

We present a case of surgical treatment for a subcutaneous hematoma caused by traumatic laceration of a thyroid tumor.

The patient, an octogenarian male, had been under observation for a tumor of the right lobe of the thyroid gland. Following an anterior cervical injury sustained during a bicycle fall, he consulted a local physician. Despite the presence of a cervical hematoma on CT imaging, the absence of subjective symptoms led to the attending physician selecting hospital observation rather than immediate intervention. However, the patient developed hoarseness and dysphagia on the following day, prompting his admission to our facility. Fiberoptic laryngoscopy revealed mild laryngeal edema, and subsequent CT imaging confirmed an enlarging hematoma, necessitating surgical intervention. Postoperative swallowing dysfunction led to an extended hospital stay, and the patient was discharged on the 20th postoperative day.

Hemithyroidectomy or total thyroidectomy is advantageous in cases with thyroid injury for ensuring hemostasis, preventing thyroid storm, and avoiding prolonged intubation.

Lemierre syndrome is a condition characterized by septic thrombophlebitis of the internal jugular vein secondary to an oropharyngeal infection, that can result in systemic septic embolism. We report a case of Lemierre syndrome with thrombophlebitis of the external jugular vein, along with a brief review of the literature.

The patient, a 21-year-old male, presented with fever and pharyngitis. The patient was initially diagnosed as having acute tonsillitis by an otolaryngologist and treated with antibiotics, but his condition failed to improve and he was referred to our department. Chest X-ray on admission revealed abnormal opacities in the left lower lung field, and chest CT showed multiple nodular lesions in both lungs. Suspecting acute tonsillitis complicated by bacterial pneumonia, we initiated the patient on intravenous levofloxacin (LVFX) therapy. On day 3 of hospitalization, an erythematous area appeared on the right side of his neck. Contrast-enhanced CT revealed a 6-cm thrombus in the right external jugular vein and septic pulmonary emboli, confirming the diagnosis of Lemierre syndrome. We started the patient on broad-spectrum antibiotics, and also initiated him on anticoagulant therapy in consultation with the cardiology department. The patient’s condition gradually improved, and he was discharged on the day 15 of hospitalization.

Lemierre syndrome, although relatively rare, can be fatal if not treated appropriately, which underscores the importance of interdisciplinary collaboration in managing this condition. Additionally, anatomical variations in the course of the jugular and facial veins can result in thrombophlebitis affecting superficial veins other than the internal jugular vein.

Myasthenia gravis (MG) is an autoimmune disorder in which receptors at the neuromuscular junctions are destroyed by autoantibodies. The typical autoantibodies associated with MG include acetylcholine receptor (AChR) antibody and muscle-specific receptor (MuSK) antibody. MuSK antibody-positive MG (MuSK-MG) accounts for approximately 5% of all cases of MG and the primary symptom is bulbar palsy. On the other hand, ocular symptoms are rare in the early stage of the disease. In this case, we encountered a patient who complained of pharyngeal dysphoria and diplopia of unknown origin. She was diagnosed as having MuSK-MG after the emergence of dysphagia during follow-up. Because the bulbar palsy in MuSK-MG is often progressive, we believe that the involvement of an otolaryngologist is important for the diagnosis and assessment of patients with MuSK-MG.

Background: Adult T-cell leukemia/lymphoma (ATL) is a peripheral T-cell neoplasm caused by human T-cell leukemia virus type 1 (HTLV-1). While ATL commonly presents with skin lesions, lymphadenopathy, hepatosplenomegaly, and hypercalcemia, laryngeal involvement is extremely rare.

Case Presentation: We report a case of a 77-year-old woman who presented with a history of progressive dyspnea and hoarseness. Imaging and laryngoscopic findings revealed granulomatous lesions in the larynx causing significant airway narrowing. Examination also revealed granulomatous changes in the nasal region and fingers. Blood tests showed elevated white blood cell count and LDH levels. ATL-like cells accounted for 10% of peripheral blood cells, and the test result for HTLV-1 antibodies was positive. Biopsy from the nasal lesion revealed T-cell lymphoma that showed positive immunohistochemical staining for CCR4 and CD30. Based on the findings, the patient was diagnosed as having acute-type ATL with bone marrow infiltration, but no central nervous system involvement.

Management and Outcome: Emergency tracheostomy was performed for airway protection. The patient was started on reduced-dose CHOP chemotherapy, followed by CHOP combined with mogamulizumab (anti-CCR4 antibody) after confirmation of the positive immunohistochemistry for CCR4. She experienced manageable complications, including febrile neutropenia and oral candidiasis. After two courses of treatment, the laryngeal and nasal lesions regressed significantly, allowing for closure of the tracheostomy on day 50. No relapse was observed at the two-month follow-up.

Conclusion: This was a rare case of ATL with laryngeal involvement complicated by airway obstruction. Although ATL primarily affects the blood and lymphatic systems, physicians should be aware of possible head and neck manifestations, especially in HTLV-1 endemic areas. Early recognition and prompt multidisciplinary treatment are essential for airway management and improving the patient outcomes.