We devised a method for evaluating the sway of the center of pressure (COP) in stabilometry. Data from 365 healthy adults without dizziness and 2 patients with vestibular disorders were examined. For each subject, the COP was recorded with 100 Hz sampling for 60 seconds under the eyes open and eyes closed conditions while standing upright with the inner sides of both feet in contact. We separated the COP data into the sway of the center of gravity (COG) component and the sway control component. For this purpose, the DFT (discrete Fourier transform) and its inverse transformation were applied to sampled data. Using this method, the COP data were separated into frequency bands up to and including 0.4 Hz and frequencies above 0.4 Hz. Considering the former as the body’s center of gravity sway (COG) component and the latter as the sway control component, we created XY diagrams for each. We calculated the enveloped area, total length, and Romberg’s ratio of the XY diagram, and examined the characteristics and age-related changes in these data. The COP Romberg ratio of patients with vestibular disorders did not necessarily match with the COG component and/or the sway control component. We consider that this finding could be useful to evaluate the state of diseases such as central vestibular compensation.

Among vertigo patients who consulted our department, we noticed that young female patients in their second or third decade of life appeared to show a larger sway when standing upright. The objective of this study was to confirm whether this was statistically significant and to further discuss the cause. A total of 288 patients (160 females, 128 males) who underwent equilibrium examination in 2013 were included. We investigated in detail the locus length per unit area, one of the parameters evaluated in stabilometry, in these patients. Young female patients had a lower average locus length per unit area than female patients of other age groups, both with the eyes open and eyes closed, although the tendency was especially strong with the eyes closed. Young female patients are more likely to suffer from orthostatic dysregulation or psychiatric disorders. Further investigation is necessary to determine whether the large body sway observed in women in their teens or 20s could be attributable to the high prevalence of the aforementioned disorders in these women.

A 1.5-time-scale mockup of the head with a built-in 10-time-scale mockup of the osseous semicircular canals was made based on the CT image of the healthy human temporal bone. When we use this model for the original canalith repositioning procedure (CRP) reported by Epley, the floating otoliths stray into the anterior semicircular canal in the 3rd step of the CRP. Herein, we developed a membranous semicircular model that mimics the human membranous labyrinth, in order and investigated the position of the floating otoliths in the 3rd step of the CRP. Fewer otoliths strayed into the anterior semicircular canal in the third step of the CRP in our new membranous model than in the old osseous model. One reason for this may be that the angles formed by the anterior and posterior semicircular canals differ between the two models.

We examined the data of 76 infants under one-year-old who visited the Toyama University Hospital for hearing examination between April 2017 and March 2022. Unilateral or bilateral hearing loss was found in 35 cases that were referred to us after newborn hearing screening (NHS). In 39 infants who were referred as cases of unilateral hearing loss after NHS, 6 were finally diagnosed as having bilateral hearing loss by ASSR. Not only ABR, but also ASSR is an essential examination for infants with suspected hearing loss.

We conducted a retrospective review of 127 cases of parotid gland tumors that were operated upon at the Toyama Red Cross Hospital Department of Otorhinolaryngology over the past 18 years. There were 108 benign tumors, and pleomorphic adenoma was the most common histological type. Surgery for deep lobe tumors required more operating time and blood loss. The tumors were malignant in 19 cases, 11 of which were parotid epithelial carcinoma, and the most common histological type was carcinoma ex pleomorphic adenoma. Surgical treatment was followed by no recurrence or metastasis in 8 of the 11 cases. In this study, there were 46 pleomorphic adenomas and 5 carcinoma ex pleomorphic adenoma, and the estimated frequency of malignant transformation of pleomorphic adenomas is 9.8%. None of the cases of noninvasive or minimally invasive carcinoma ex pleomorphic adenoma developed recurrence or metastasis, and the prognosis was good. Therefore, it is considered that histological progression is more important than the T-classification. In this study, some cases of parotid gland tumors were diagnosed as being malignant on histopathological examination even in the absence of preoperative clinical symptoms or imaging findings suspicious of malignancy, and cases of parotid epithelial carcinoma had a good local control rate and prognosis. In conclusion, surgical removal might be one of the more effective treatment options for parotid gland tumors.

Neurovascular compression syndrome (NVCS) is a neurological disorder in which the intracranial blood vessels compress the cranial nerves. We report a case of NVCS of the VIII cranial nerve in which nystagmus was confirmed during vertigo attacks by ENG.

The patient was a 32-year-old male who came to our department with the chief complaint of rotatory vertigo. He had no significant past medical history. He had 5–6 attacks of vertigo each year, lasting for about a minute each, without cochlear symptoms. He had been examined by a local neurosurgeon and otorhinolaryngologist, neither of whom found any abnormalities. When a detailed balance function test was performed, he had an accidental attack of vertigo just before the caloric test, and we could record an ENG during the attack. At first, leftward nystagmus appeared, and after it stopped, rightward nystagmus appeared after a change of direction. The nystagmus was approximately 120/30 sec. The maximum slow phase velocity was 100 deg/sec. The attack disappeared in about 2 minutes. Cranial MRI and MRA revealed a meandering left vertebral artery in contact with the base of the left VII and VIII cranial nerves.

Based on the clinical findings, the patient was diagnosed as having NVCS of the VIII cranial nerve. The patient’s symptoms were relieved by carbamazepine.

This is the first case reported in the world, with no report in the literature of ENG findings recorded during a vertigo attack of NVCS in the VIII cranial nerve. The ENG findings in this case complement previous reports and may help to elucidate the pathogenesis of NVCS of the VIII cranial nerve.

Chiari malformation type 1 (CM-1) is characterized by migration of the cerebellar tonsils below the foramen magnum. We report a 53-year-old woman who presented with a history of dizziness and unsteadiness while moving. Neuro-otological and neurological examinations revealed a central balance disorder with down-beating nystagmus. Magnetic resonance imaging of the brain showed descent of the cerebellar tonsils with the formation of a small cavity at the level of C1 of the cervical spinal cord and enlargement of the central canal caudally, based on which we made the diagnosis of CM-1 with early syringomyelia. Thereafter, the patient was successfully treated by a foramen magnum decompression surgery. The presence of CM should be considered in patients who complain of dizziness with down-beating nystagmus.

A 93-year-old man with bilateral mild hearing loss since childhood due to chronic middle ear infections could hear and speak as an adult, but his hearing level had gradually become worse. He started to wear hearing aids when he was 70 years old, but he still found it difficult to hear. Finally, he could not understand the contents of any conversations by 87 years old, even with hearing aids. He accepted to undergo cochlear implantation on the right side at the age of 93 years. The results of the speech recognition test improved after surgery for monosyllables (from 28% to 38%) and single words (from 18% to 38%), but no improvement of sentence recognition was observed. Oldest-old patients have little occasion to speak, and could benefit from special tools, such as an audiobook or DVD, which they can learn by themselves.

A 12-year-old boy with moderate conductive hearing loss from birth due to bilateral atresia of the external auditory canal could hear and speak with bone-conduction hearing aids. However, this type of hearing aid causes skin erosion and irritation in the temporal region. Therefore, we attempted to prescribe cartilage conduction hearing aids for him. At first, we tried to put the transducer of the hearing aids between the tragus and antitragus. But the transducer could not be placed stably in that position and there was acoustic feedback. In such a situation, we usually use an ear mold containing the transducer. But the patient did not want to wear the ear mold because it caused discomfort. Therefore, we used double-faced tape on the sound processor, which successfully led to elimination of the acoustic feedback. The acoustic field hearing test revealed a hearing level of 30 dB.

Objective tinnitus is defined as tinnitus that is audible to others and is caused by myogenic or vascular diseases, etc. We report two cases of objective tinnitus caused by soft palatal myoclonus and dural arteriovenous fistula (DAVF). Case1: A 43-year-old man who presented with objective tinnitus caused by palatal myoclonus after subarachnoid hemorrhage. The objective tinnitus of clicking sounds could be heard through an otoscope His objective tinnitus could be heard synchronously with the soft palatial myoclonus. After conservative treatment with counseling, he tried consciously not to move his larynx, which led to improvement. The objective tinnitus caused by soft palatal myoclonus is considered to arise from the desorption sound between the soft palate and the posterior wall of the pharynx and desorption sound of the lumen of the eustachian tube. Case2: A 68-year-old man who complained of pulsating tinnitus; the tinnitus was synchronized with the cardiac pulsation, and auscultation of the temporal region revealed the pulsating tinnitus. MRI and MRA findings suggested an intracranial vascular lesion.

DAVF in the right transverse-sigmoid sinus was diagnosed from the findings of angiography of reflux into the sinus and not the cortical veins. Based on the above, the patient was diagnosed as having a Cognard type IIa DAVF. Type IIa DAVF is a benign type of DAVF and is not at a high risk for hemorrhage. The patient also had a sleep disorder because of his pulsating tinnitus. Transarterial embolization was performed by the neurosurgeon, which resulted in improvement.

Malignant external otitis is classically described as external otitis caused by Pseudomonas aeruginosa infection in patients with diabetes mellitus.

An 85-year-old man visited our ENT clinic complaining of earache and otorrhea on the right side. Pseudomonas aeruginosa was isolated from the otorrhea fluid, and the patient was referred to our hospital. The external ear was filled with granulomas, and the computed tomographic findings suggested otitis media and mastoiditis. Local antibiotic therapy was not effective, and we performed radical mastoidectomy and removed the infectious granuloma. Two months later, the patient visited our hospital again with severe headache and earache. Examination revealed evidence of facial nerve and abducens nerve paralysis. Computed tomography and magnetic resonance imaging also revealed evidence of skull base osteomyelitis, and MRSA was isolated from the otorrhea fluid. The patient was treated with intravenous antibiotics effective against MRSA for 6 weeks, which led to improvement of the headache and otorrhea. Until 6 months later, there was no relapse of these symptoms, and the facial nerve and abducens nerve palsies improved. Malignant otitis externa and skull base osteomyelitis are often serious. We report a case in which long-term antibiotic therapy was effective.

Hamartomas are benign tumors or non-neoplastic malformations. They occur most often in the lungs and kidneys, and are rarely encountered in the nasal cavity or sinus cavities.

A woman in her 60s with the chief complaints of nasal congestion and rhinorrhea who had been diagnosed and treated as a case of chronic sinusitis with nasal polyps was referred to the otolaryngology department of Toyama Red Cross Hospital. She was found to have a deviated nasal septum and a mass in the right nasal cavity, the base of which was behind the nasal septum. CT showed no soft tissue opacities in the paranasal sinuses. We performed surgery to resect the mass along with the proximal posterior nasal septum and anterior wall of the right sphenoid sinus. Histopathology of the resected specimen revealed a rare respiratory epithelial adenomatoid hamartoma (REAH). The postoperative course was favorable, and the follow-up of the patient was terminated after 8 years without disease recurrence.

It is difficult to judge REAH by visual inspection in a case of chronic sinusitis with nasal polyps or benign tumors. When polypoid lesions are found in daily clinical practice, it is important to always keep in mind the possibility of the complication of REAH.

Rhinolith is a rare disease entity. Herein, we report two patients, one with bilateral rhinoliths and one with a right-sided rhinolith. The first patient, a 64-year-old male, presented with the chief complaint of nasal malodor. He had a history of submucosal insertion of foreign bodies in bilateral nasal cavities 40 years ago for the treatment of atrophic rhinitis. Otorhinolaryngological examination showed bilateral rhinoliths between the bilateral inferior nasal turbinates and the nasal septum. The bilateral rhinoliths were removed piecemeal in two stages, which led to relief from the symptoms. Histopathological examination of the removed rhinoliths revealed evidence of the foreign bodies and calcification. Chemical analysis showed that this rhinolith was composed of calcium phosphate. The bilateral rhinoliths in this case appear to have formed as a result of insertion of foreign bodies for the treatment of atrophic rhinitis.

The second patient was a 15-year-old female who presented with the chief complaints of headache and nasal obstruction on the right side. She gave a past history of a nasal foreign body. Plain head CT showed calcification on the right side of her nasal cavity. Examination revealed a rhinolith between the right inferior nasal turbinate and the septum on the nasal floor. Her symptoms disappeared after the rhinolith was removed en bloc. We found that a duckbill elevator was useful for removal of the rhinolith in both cases.

Olfactory dysfunction is a common symptom encountered by otorhinolaryngologists in our daily clinical practice, often after chronic sinusitis or the common cold. When the cause cannot be identified by otorhinolaryngological examination, central nervous system diseases, drugs, or psychogenic factors would be considered.

We encountered a case of glioblastoma in which the chief presenting complaint was olfactory dysfunction. The patient, a 64-year-old woman, showed no abnormality on otorhinolaryngological examination or sinus CT, and a brain MRI showed a neoplastic lesion in the right temporal lobe. She underwent brain tumor resection, and the histopathological diagnosis was glioblastoma. She received radiation therapy with temozolomide (Stupp regimen). However, she died less than two years after the diagnosis. While glioblastoma might be an infrequent cause of olfactory dysfunction, as in this case reported here, olfactory dysfunction could be the presenting feature of a life-threatening disease and should be approached with caution.

Lacrimal sac carcinoma is a rare disease, and the close similarity of its initial symptoms to those of chronic dacryocystitis makes it rather difficult to differentiate between the two conditions. Herein, we report the case of a 50-year-old man with squamous cell carcinoma of the right lacrimal sac, in whom the diagnosis was made by biopsy after it had extended into the nasal cavity via the nasolacrimal duct. The patient was referred to our ENT department with a 4-month history of a rapidly growing mass in the right neck, and reported having had a swelling around the right inner canthus for more than 6 years. He was diagnosed as having squamous cell carcinoma of the lacrimal sac with right cervical lymph node metastasis. The patient did not wish to have an extended tumor resection, which would have included orbital exenteration, and was therefore initiated on chemoradiotherapy. Both the lacrimal tumor and cervical lymphadenopathy showed significant shrinkage following this treatment. If a patient with lacrimal sac carcinoma is unwilling to undergo, or is not a suitable candidate, for surgery, chemoradiation may be an effective option, depending on the histopathological diagnosis.

The patient was a 27-year-old man who presented with antibiotic-resistant fever, sore throat, cough, and abdominal pain for the past 5 days. During laryngoscopy performed by a local otorhinolaryngologist, he became pale and was brought to our hospital emergency room in a shock state and worsened left upper abdominal pain. Blood examination revealed abnormal results of liver function tests, elevated serum CRP and white blood cell counts, atypical lymphocytes, a positive result of serology for EBV VCA-IgM antibody, and a negative result of serology for EBNA ab. CT showed an enlarged liver and spleen, and splenic laceration and hemorrhage. Based on the findings, we made the diagnosis of splenic injury due to splenomegaly caused by infectious mononucleosis (an infection caused by EBV). Fortunately, the injury was mild, and the patient could be treated conservatively.

Infectious mononucleosis is a disease that is commonly encountered by otorhinolaryngologists. Nevertheless, there have been few reports of cases in Japan, and we considered a case such as ours as being very rare. However, in the MEDLINE and EMBASE databases (1984–2014), we found 81 cases of splenic rupture associated with EBV-infected infectious mononucleosis reported from Europe and the United States, and the fatality rate was reported to be as high as 9%. It is well known that this difference is due to the fact that patients were infected with EBV before their childhood due to the customs that were practiced in Japan. For example, the custom of passing food from parent to child by mouth during childhood. With the disappearance of such customs in recent years, the number of cases of EBV infection in adolescence is increasing, and it is expected that the number of cases of splenic injury will also begin to increase.

We hope that this report will contribute to raising the general awareness about such cases.

Elongated Styloid Process syndrome is caused by an over-elongated styloid process and ossification of the styloid ligament, and manifests with various symptoms such as sore throat, odynophagia, and earache. We present the case of a patient with an elongated styloid process who presented with an intractable sore throat. A 43-year-old woman had been treated conservatively at various hospitals for a sore throat, but her symptoms failed to improve, and she was referred to the Department of Otorhinolaryngology of our hospital for surgical treatment.

At the time of the visit, there was no salivary retention in the pharynx, but examination revealed tenderness around the right tonsil and hyoid bone. 3D-CT showed ossification of the bilateral stylohyoid ligaments, which was determined as being the cause of the symptoms. The patient underwent surgical treatment via the transcervical approach. Thereafter, the sore throat gradually improved, and the pain resolved by one year after the surgery. Elongated styloid process syndrome should be borne in mind in the differential diagnosis of intractable sore throat. Surgical treatment should be considered if the symptoms of elongated styloid process syndrome do not improve with conservative treatment.

The patient was a 57-year-old woman who presented with the chief complain of sore throat and difficulty in swallowing and had consulted an otolaryngologist about 4 months ago. Pharyngeal endoscopy revealed a raised lesion of the nasopharynx and an irregular mucosal lesion in the arytaenoid area; we performed biopsy of these lesions and histopathological examination of the biopsy specimens revealed evidence of inflammation, but no evidence of malignancy. Screening for autoimmune diseases revealed no definitive diagnosis. Since the serological tests for tumor markers as well as IgG4-related diseases were negative, the patient was referred to the Department of Collagen Diseases for further investigation of the possibility of autoimmune disease. An HIV test was performed, and an increase in anti-HIV antibodies and a decrease in CD4-positive T lymphocytes were observed, leading to the diagnosis of HIV infection. Thereafter, the patient was started on treatment at the department of infectious diseases. Serology for HIV-RNA became negative after 3 months. The sore throat improved and the laryngopharyngeal lesions also improved. Early diagnosis of HIV infection is important, because early treatment improves the prognosis and also prevents the spread of infection. The initial symptoms are often in the oropharynx, and it can be said that otolaryngologists play a major role in early diagnosis.

Transesophageal echocardiography (TEE) is performed with an echo probe inserted into the esophagus to evaluate the cardiac status from the esophagus, including searching for intracardiac thrombi and evaluating valvular diseases that cannot be adequately assessed by transthoracic echocardiography. Complications of TEE include lip injury, dental injury, hoarseness of voice, dysphagia, pharyngeal hemorrhage, laryngospasm, upper gastrointestinal bleeding, and perforation of the esophagus. Herein, we report a case of pharyngeal hematoma that developed after TEE. The patient was an 88-year-old woman with aortic stenosis, atrial fibrillation, myocardial infarction, who was under treatment with the anticoagulant drugs clopidogrel and edoxaban. A TEE was performed 1 day prior to the patient’s first visit to our department. The following morning, she developed hemoptysis and hoarseness at the same time, and was brought to the emergency room. Pharyngoscopy revealed a hematoma in the left larynx. Since the hematoma covered most of the vocal cords and there was a risk of asphyxia due to increase in the size of the hematoma, we performed emergency tracheotomy and the patient was urgently admitted to the hospital. After admission, the patient was treated conservatively with hemostatic agents. Since the hematoma shrank gradually in size, the tracheal cannula was removed on the 14th day after the symptom onset. TEE rarely causes serious complications that require the attention of an otorhinolaryngologist.

The submental island flap is an axial-pattern flap with the submental artery and vein, branches of the facial artery/vein, as the feeding and draining blood vessels. The advantages of this flap are that it is a thin and supple flap, has a long vascular stem, the flap donor site can be sewn temporarily, and the operation time is shorter than with a free flap. The disadvantage is that the submandibular region cannot be dissected, and the indication for the use of this flap should be limited to N0 cases.

The patient was an 88-year-old woman in whom excision of T2N0M0 buccal mucosal cancer near the corner of the mouth resulted in a surgical defect measuring 7.5 cm × 5 cm in size, extending from the corner of the mouth to the floor of the oral cavity. An 8 cm × 6 cm submental island flap was harvested, and the defect reconstructed. There was no recurrence after 3 years, and no aesthetic or functional problems were encountered.

A submental island flap appears to be useful for reconstructing cheek defects in the elderly who have difficulty in long time surgery.

Many children with severe motor and intellectual disabilities require surgery to prevent aspiration due to swallowing dysfunction. However, severely mentally and physically handicapped children are at a high risk for the formation of tracheo-innominate artery fistulas, a fatal complication of tracheal cannula placement. Cricoid fenestration and surgical closure of the larynx with partial resection of the cricoid cartilage (Kano’s method), which is based on cricoid fenestration, allow the airway to be secured at the level of the larynx, avoiding proximity of the tracheal cannula to the innominate artery and preventing the development of tracheo-innominate artery fistulas. In this report, we describe a case of surgical closure of the larynx (Kano’s method) in a child with severe motor and intellectual disabilities who had undergone cricoid fenestration approximately 9 months previously. The patient was a 10-year-old girl with respiratory failure due to Fukuyama congenital muscular dystrophy, scoliosis and thoracic deformity. A tracheotomy was requested by the pediatric department for respiratory care, but cricoid fenestration was performed in view of the potentially high risk of formation of tracheo-innominate artery fistula. Thereafter, the patient developed repeated episodes of aspiration pneumonia, and about 9 months later, surgical closure of the larynx (Kano’s method) was performed. There was no granulation tissue or scarring due to the manipulation of the cricoid cartilage, and the surgery was performed without any complications. The procedure was effective for avoiding proximity between the tracheal cannula and innominate artery and preventing the formation of tracheo-innominate artery fistulas. We believe that staged surgical closure of the larynx (Kano’s method) after cricoid fenestration is a useful technique for the treatment of dysphagia in children with severe motor and intellectual disabilities.