Exercise-induced laryngeal obstruction (EILO) refers to airway dysfunction that develops during high-intensity exercise in young athletes, manifesting as inspiratory dyspnea and stridor. The symptoms of EILO mimic those of asthma and hyperventilation, which sometimes co-exist with EILO.

The clinical feature of EILO has been revealed a laryngeal collapse caused by a high inspiratory airflow velocity observed using continuous laryngoscopy during exercise (CLE), as the gold standard test for the diagnosis. Resting laryngoscopy in these subjects usually reveals no abnormalities. During CLE, the laryngeal obstruction arises from a supraglottic lesion, followed by glottic fold adduction. EILO has been classified into two subtypes: the supraglottic type and the glottic type. In the supraglottic type, the obstruction is caused by medial rotation of the ary-epiglottic folds, while in the glottic type, it is caused by adduction of the vocal folds. Biofeedback for respiratory education, abdominal/diaphragmatic breathing, and surgical procedures have been used as therapeutic interventions for EILO. Surgery is indicated in cases with moderate or severe supraglottic type of EILO.

In this review, we describe the prevalence of EILO, the diagnostic approaches, and the current therapeutic interventions, including in our cases.

Superficial siderosis is a progressive disease of the central nervous system associated with chronic subarachnoid hemorrhage, that could result in complications such as progressive sensorineural hearing loss, cerebellar ataxia, pyramidal signs, and dementia. Most patients (95%) experience progressive sensorineural hearing loss that begins early in the disease. Despite the retrocochlear component of the hearing loss, the hearing outcomes following cochlear implantation (CI) for the severe sensorineural hearing loss were variable.

We report the case of a 58-year-old female patient with superficial siderosis who underwent CI for severe sensorineural hearing loss. At 2 years after the CI, the postoperative average hearing level was 42 dB. In the speech audiometric test, the monosyllabic discrimination ability without lip reading was 0%, but the correct response rate became 60% when lip reading was added. In this case, the effect of CI was not good, but she received subjective benefit from the CI in terms of both communication and awareness of environmental sounds. However, the performance of the CI may decline due to progression of the disease in the future. Therefore, it is important to explain the possibility of limited benefit accruing from the CI and the risk of progressive performance decline to patients prior to the CI.

Herein, we report two cases of otogenic brain abscess caused by suppurative otitis media and cholesteatoma. The first case was 20-year-old male patient who had a brain abscess in the temporal lobe measuring about 30 mm in diameter. He was successfully managed by brain abscess drainage followed by surgery by a combined otorhinolaryngologic and neurosurgical approach. The second case was 73-year-old female patient who had a brain abscess in the temporal lobe measuring about 17 mm in diameter. She was successfully managed by canal wall-down mastoidectomy removing the membrane of the cholesteatoma in the area of the bone defect. It is important in the treatment of otogenic brain abscess for otorhinolaryngologists and neurosurgeons to work together as a team.

Due to the increasing popularity of dental implant treatment, cases of maxillary sinusitis developing after dental implant treatment have also been increasing. We examined the effectiveness of endoscopic sinus surgery (ESS) in controlling maxillary sinusitis developing after dental implant treatment.

Between January 2015 and June 2021, we examined 11 patients who underwent ESS for maxillary sinusitis that had developed after dental implant treatment. The patients consisted of 4 men and 7 women, with a median age of 53 years (23–75 years); the median observation period after ESS was 18 months (3–36 months). We examined the changes in the symptoms, degree of opacification of the maxillary sinus, and results of culture of the discharge fluid from the maxillary sinus.

Of the 11 patients, 8 responded to pre- and postoperative questionnaires. The scores on the nasal symptoms questionnaire (NSQ) improved after the surgery. Results of culture of the discharge fluid from the maxillary sinus could be obtained for 4 patients, and Staphylococcus sp. was the predominantly detected bacterial species. Presence of several anaerobic bacteria was also detected in the discharge fluid, similar to the case in odontogenic maxillary sinusitis. None of the patients required removal of the dental implants after the ESS.

These data suggest that ESS is effective for the treatment of maxillary sinusitis developing after dental implant treatment. Since maxillary sinusitis may not heal even after the removal of dental implants, ESS should be proactively considered for the control of maxillary sinusitis developing after dental implant treatment.

We report a case of adenoid cystic carcinoma of the oral floor that was diagnosed nearly 3 years after the patient’s first visit to our institution. A 43-year-old woman presented with a 4-month history of pain in the tongue and left submandibular region. Clinical examination revealed palpable induration in the left sublingual and submandibular regions. Ultrasonography showed heterogeneous echoes in the left submandibular gland; however, computed tomography (CT) and serological examination revealed no abnormalities. Fine-needle aspiration cytology (FNAC) did not reveal any atypical cells. Ultrasonography performed after 6 months showed no changes, and the patient was discharged from the clinic. Subsequently, the patient experienced numbness of the tongue and difficulty in moving it and was examined again. Repeat FNAC of the sublingual region revealed a class III result, and CT/positron emission tomography-CT indicated oral cancer with lung metastasis (T4aN2bM1). Rapid pathological analysis of the cervical lymph nodes also led to the diagnosis of cervical lymph node metastasis from the adenoid cystic carcinoma. We performed resection of the left side of the oral floor, left hemiglossectomy, marginal resection of the mandible, bilateral neck dissection, and reconstruction using a pectoralis major myocutaneous flap. Histological examination of the surgical margin was positive for cancer cells microscopically, and the patient was initiated on postoperative chemoradiotherapy. Since then, there has been no evidence of local recurrence; however, the patient was initiated on pembrolizumab treatment due to an increase in the size of the lung metastasis. The probability of malignancy in sublingual tumors is high, and regular follow-up should be continued even when no definitive diagnosis has been made.

We report the results of a retrospective review of the data of 52 patients over the age of 75 years with hypopharyngeal carcinoma who were treated at our institution between January 2012 and December 2021, to determine their current status, including the age, disease stage, performance status, presence/absence of double cancer, number of comorbidities, treatment method, treatment rate, postoperative complications, and prognosis. Among the cases of radical cure achieved by treatment, the performance status became worse in 61%. Of the 52 patients, 44 (85%) selected treatment to achieve radical cure, and 8 selected non-radical cure treatments.

Complications involving the site of injury occurred most frequently after surgery, and dysphagia and aspiration pneumonia were the most frequently encountered complications after radiotherapy.

There were significant differences in the 5-year diseases-specific survival rates between patients with different disease stages (I and II vs. IV), number of comorbidities (Charlson Comorbidity Index: 0–4 vs. over 5), and treatments (radical treatment vs. non-radical treatment).

Treatment of patients with hypopharyngeal carcinoma should be individualized based on their age, disease stage, performance status, presence/absence of double cancer, number of comorbidities, comprehension ability, family cooperation, etc.

As the performance status deteriorates more easily in older people, it is desirable to decide on a treatment policy based not only on the age, but also the number of comorbidities and expected comprehension ability of the patients. In conclusion, we think that patients would prefer deciding the way of treatment based on the potential for radical cure regardless of their age.

Malignant melanomas are rarely occurring tumors, and mucosal melanoma accounts for 9% of all malignant melanomas in Japan. Primary sinonasal mucosal melanoma is an aggressive tumor with a high metastatic potential and poor outcomes. Spontaneous regression of primary cutaneous melanoma has been reported in 10%–35% of cases, but regression of a mucosal melanoma is rather rare. We report the case of an 86-year-old woman with a black tumor in the right nasal cavity. A diagnosis of malignant melanoma was made based on biopsy, but while her biopsy results were awaited, her tumor spontaneously regressed. We initially considered the use of immune checkpoint inhibitor therapy with the involvement of the oncology department of our hospital, but then decided to only follow up the patient closely. The black tumor reappeared at the same site 91 days after the first biopsy. Based on the second biopsy, the lesion was diagnosed as a malignant melanoma (T3N0M0). Endoscopic nasal tumorectomy was performed, followed by the start of immunotherapy (nivolumab) on day 26 after the surgery. Subsequently, while no local recurrence was observed, metastases were detected in the right submandibular lymph node, right lung, liver, and retroperitoneum. We switched the treatment to a two-drug regimen (ipilimumab/nivolumab), but the immunotherapy proved ineffective and the treatment was discontinued on day 404 after surgery due to progression of systemic metastases.

Spontaneous regression of malignant melanoma is thought to occur via the host immune response to the tumor. Although spontaneous regression of some primary cutaneous malignant melanomas has been reported, there is no consensus on whether the transient spontaneous regression affects the prognosis of these patients. Spontaneous regression of mucosal malignant melanomas is so rare that in our patient, we could not determine whether or when the tumor might reappear and what the patient prognosis might be. It is necessary to follow up these patients closely so that there is no delay in the treatment.

Ossifying fibromyxoid tumor (OFMT) is a soft tissue tumor of mesenchymal origin, usually with an indolent course. It was first reported by Enzinger et al in 1989, and nearly 300 cases have been reported so far. Most of them arise in the subcutaneous tissue and trunk; it is said to arise in the head and neck area in about 10%–15% of cases, but involvement of the parapharyngeal space is very rare, and only 2 cases have been reported so far. We report a case of malignant OFMT that arose in the parapharyngeal space.

A 39-year-old man with a several years’ history of snoring, which he had been neglecting even though it had gradually worsened, presented to our department with a few days’ history of sore throat and difficulty in breathing. We considered a possibility of airway stenosis and performed tumor resection for obtaining a definitive diagnosis. We tried to resect tumor via the transoral approach using a rigid endoscope with a flexible tip. However, the tumor had invaded the surrounding tissues, so that we had to adopt the transcervical approach for the resection.

The histopathologic diagnosis was malignant OFMT and the patient has been under close observation for 12 months, and remains disease-free.

OFMTs are reported to have a high propensity for recurrence and distant metastasis, so that long-term follow-up of these patients is important.

Neuroendocrine carcinoma (NEC) is a rare malignant tumor arising from the neuroendocrine cells. These tumors most often occur in the lung and pancreas. Among the NECs, large cell neuroendocrine carcinoma (LCNEC) carries a particularly poor prognosis and its occurrence in the nasal cavity is extremely rare. The survival prognosis of patients with laryngeal LCNEC is reported to be extremely poor, that is, less than 2 years. Herein, we report a case of LCNEC of the nasal septum who showed long-term survival after treatment at our hospital. This patient was a 37-year-old man who presented with the chief complaint of epistaxis and nasal pain. The clinical stage was determined as cT3N0M0, Stage III. We performed partial maxillectomy and total nasal septectomy, and started the patient on postoperative chemotherapy with cisplatin and VP-16, as well as postoperative radiotherapy to the surgical bed at the primary site. Before the start of the postoperative treatments, right subclavian lymph node metastasis was found, and subclavian dissection was performed. Eight months after the primary surgery, the patient was diagnosed as having a late cervical lymph node metastasis, and we performed neck dissection. The patient has since remained alive without recurrence for 4 years after the primary surgery. LCNEC is a rare disease known to carry a very poor prognosis, and we will continue to carefully follow up the patient.

Synovial sarcoma is a malignant soft-tissue tumor that arises predominantly in the limbs in young adults, and rarely originates in the paranasal sinuses. Herein, we report a case of synovial sarcoma of the maxillary sinus seen at our department. A 31-year-old man was referred to our department with a neoplastic lesion in the left nasal cavity. Since histological examination could not confirm the diagnosis, endoscopic-assisted maxillary tumor resection was performed, in addition to gingival incision. Postoperative histopathological examination confirmed the diagnosis of synovial sarcoma. Since the resected margin in the infraorbital wall was microscopically positive for tumor cells, we administered radiation therapy and chemotherapy to preserve the eyeball and facial morphology. One year and 3 months after the initial surgery, the patient was diagnosed as having a tumor recurrence, and we performed total left maxillary resection, left upper neck dissection, and reconstruction with an anterolateral thigh flap. Subsequently, due to repeated tumor recurrences, the patient needed CyberKnife palliative irradiation and chemotherapy, but the regional invasion worsened, and the patient died 2 years and 7 months after the initial surgery. Primary synovial sarcoma of the paranasal sinuses is a very rare disease, and radical surgical resection with multidisciplinary involvement, including of doctors of the departments of oncology, orthopedic surgery, and radiology, is necessary. Further case reports are needed to establish evidence for treatment.

Graves’ disease is rarely encountered in children, and pediatric cases of Graves’ disease are often difficult to treat with antithyroid drugs, owing to the nature of the adverse reactions to these drugs. Thyroidectomy may be indicated in children with Graves’ disease who cannot be continued on pharmacotherapy. However, as compared with adults, pediatric cases of Graves’ disease treated by surgery show a higher frequency of recurrence and also a higher frequency of complications, especially recurrent laryngeal nerve paralysis and hypocalcemia. We report a case of Graves’ disease in a 5-year-old girl, in whom antithyroid pharmacotherapy had to be discontinued because of the occurrence of neutropenia. Consequently, we treated the child by thyroidectomy without complications or recurrence, in collaboration with a multidisciplinary team that included pediatricians, anesthesiologists, and cardiovascular surgeons.

A 70-year-old female patient complaining of persistent pain in the left temporal region was referred to our university hospital by her physician. Audiometry and examination of the tympanic membrane yielded no unremarkable findings. Further diagnostic evaluation by computed tomography of the temporal bone revealed an infiltrative opacity and irregularity in the temporal bone, and on magnetic resonance imaging, both T1- and T2-weighted images revealed low signal intensity signals in the same area. Based on the presence of an infiltrative opacity in the left middle ear, elevated conductive thresholds in the temporal bone, and left facial nerve paresis, we scheduled a biopsy of the temporal bone lesion. A preoperative workup uncovered evidence of a primary lung neoplasm located in the middle lobe of the left lung. Histopathological examination confirmed the primary lung cancer, and consistent histological features in the temporal bone lesions. While the temporal bone is a relatively uncommon site of metastasis from malignant tumors, the most common primary sites are the lung, breast, and prostate. It is therefore recommended to conduct a systematic investigation of temporal bone lesions, including a search for primary tumors, given the possibility of malignant tumor metastasis in patients presenting with temporal bone lesions.

Background and Objectives: Cervical lymph node enlargement is a manifestation of various diseases, including malignant lymphoma. Open biopsy of the enlarged lymph node is frequently required for disease diagnosis, especially when malignant lymphoma is suspected. Serum levels of soluble interleukin 2 receptor (sIL-2R) may also be considered as a biomarker for malignant lymphoma. This study was aimed at determining whether measurement of serum sIL-2R levels might be useful in the diagnosis of malignant lymphoma.

Material and Methods: We conducted a retrospective review of the data of 281 patients who had undergone open cervical lymph node biopsy at our institution between 2015 and 2019. The patients included 157 men and 124 women, ranging in age from 5–90 years. Data on the age, diagnosis, and serum sIL-2R levels of the patients were obtained from their medical records.

Results: Overall, there were 184 cases of malignant lymphoma (MLs) and 97 cases of other diseases (NMLs). The mean age was significantly higher and mean serum level of sIL-2R were significantly higher in the ML group as compared with the NML group. Among the patients with ML, the serum sIL-2R levels were significantly higher in patients with T-cell lymphoma than in patients with B-cell lymphoma. The area under the receiver operating characteristic curve of the serum level of sIL-2R for predicting ML was 0.711, and a serum sIL-2R level of 1246 U/ml was associated with the maximum value of the sensitivity + specificity for the diagnosis of ML. Multivariate analysis revealed that the area under the receiver operating characteristic curve increased to 0.758 for patients aged over 61 years old and patients with serum sIL-2R levels of more than 1246 U/ml.

Conclusions: Among patients presenting with cervical lymphadenopathy, measurement of the serum sIL-2R level could be useful for distinguishing between patients with and without ML, with a cutoff level for the diagnosis of ML of 1246 U/ml.