【Aim】 The goal of the study was to evaluate the advantages of image-guided navigation system (IGS)-assisted endoscopic endonasal dacryocystorhinostomy (EN-DCR) in patients with the primary nasolacrimal duct obstruction (NLDO) and the primary common canalicular obstruction (CCO).

【Methods】 A retrospective review was performed for 32 cases (32 eyes) treated with EN-DCR without IGS (non-IGS group) and 60 cases (63 eyes) treated with IGS-assisted EN-DCR (IGS group) from October 2012 to March 2017. All surgeries were performed by the same surgeons (ST and KT). The success rate, the surgical complications, and the drilling time in osteotomy were investigated in the patients with NLDO and CCO. The criteria for anatomical success were patency with syringing and a 70-degree endoscopic view of the ostium. The criteria for functional success were visualization of fluorescein dye at the ostium and relief from epiphora. Evaluation was performed at 6 months postoperatively. The surgical complications and the drilling time were obtained from surgical records and intraoperative endoscopic video findings. Furthermore, we developed a new sutured mucosal flap technique for fixing the anterior flap of the lacrimal sac and the agger nasi mucosa. The postoperative ostium size in NLDO cases was compared among the three surgical techniques: IGS with a sutured mucosal flap (14 cases, September 2016 ~ March 2017), IGS without a sutured mucosal flap (46 cases, November 2014 ~ August 2016) and non-IGS without a sutured mucosal flap (32 cases, October 2012 ~ October 2014).

【Results】 The mean drilling time for osteotomy was significantly shorter in the IGS group compared to the non-IGS group. There was no significant difference in the success rate and the surgical complications of these groups. The ostium size using an IGS with a sutured mucosal flap was significantly larger than those in the cases treated without a sutured mucosal flap with or without an IGS.

【Conclusion】 An IGS may provide precise anatomical information that assists in wide exposure of the lacrimal sac. This is an advantage of IGS-assisted EN-DCR. Our new sutured mucosal flap technique significantly improved the postoperative ostium size.

Vascular malformations in the paranasal sinuses are rarely reported, except in the case of hereditary hemorrhagic telangiectasia. Generally, surgical treatment is performed for the head and neck arteriovenous malformations (AVM) that can be resected with low risk. This study describes the case of a patient with vascular malformations located in both the orbit and adjacent paranasal sinuses that were treated with interventional radiology (IVR). We also present a review of the relevant literature.

The case involved a 26-year-old man who had blurred vision, proptosis, and conjunctival congestion in his right eye. By evaluating his computed tomography, magnetic resonance imaging, and magnetic resonance angiography scans, we found that he had an orbital arteriovenous fistula (AVF). However, it was difficult to determine whether the paranasal lesion was connected to the orbital AVF. An angiograph revealed that the lesions were an orbital AVF and an AVM from orbit to ethmoid sinus. IVR was performed by a neurosurgeon, and both lesions were embolized.

In our case, the orbital AVF and the AVM from orbit to ethmoid sinus were combined. Besides this case, there are only a few reports of orbital AVF and paranasal vascular malformations are extremely rare.

We recommend that after consultation with neurosurgeons, radiologists, and/or other specialists, treatment should be planned based on a case by case basis. At our institute, we have organized the Osaka University Vascular Anomaly Conference where radiologists, neurosurgeons, orthopedic surgeons, plastic surgeons, otolaryngologists, pathologists, internists, and pediatricians discuss the treatment of each patient with vascular anomalies.

A 51-year-old male who worked as a brewer of miso (fermented soybean paste) presented with a chief complaint of vertigo and was diagnosed with perilymphatic fistula. Head computed tomography (CT) revealed no significant findings in the cerebellum and brainstem, but there was soft tissue density with calcification in the right maxillary sinus. Although there were no nasal symptoms, non-invasive chronic fungal rhinosinusitis was suspected. After resolution of the perilymphatic fistula, endoscopic sinus surgery (ESS) was performed. The pathology of the specimen from the right maxillary sinus revealed only crystal deposition, but the fungus was not identified. Thirteen months after ESS, the patient visited our hospital again with a complaint of pain in the right cheek and rhinorrhea. Endoscopy revealed hyphae in the right nasal cavity. A culture of white pus from the right maxillary sinus revealed Aspergillus, not otherwise specified. Polymerase chain reaction (PCR) of the culture product was positive for Aspergillus oryzae, and this was considered to be the causative organism of rhinosinusitis.

We describe a patient who presented with a frontal sinus osteoma accompanied by a pneumocephalus causing aphasia. A 45-year old woman with a chief complaint of headache was referred to our outpatient ear, nose, and throat (ENT) clinic. A CT scan showed a large frontal sinus osteoma and pneumocephalus. Based on the standard language test for aphasia, she presented with aphasia including verbal paraphasia, and difficulty in word finding, reading, and auditory comprehension. She had no agrammatism, or apraxia of speech, and had no difficulties in word fluency or repetition. Kohs block-design test demonstrated that her IQ score was relatively low. After an endoscopic biopsy of her frontal sinus, a craniotomy with resection of the osteoma was performed. Her postoperative CT scan showed a remarkable reduction in the size of the pneumocephalus, and her linguistic and intelligence evaluation showed complete recovery. Her frontal sinus osteoma and linguistic and intelligent function have remained in the normal range for the last 4 years. It is possible that transient aphasia due to pressure and ischemia might have occurred in the center of the orbital pars of the left inferior frontal gyrus, and in the networks between the cortical regions of language function.

This is the first case report describing a frontal sinus osteoma accompanied by a pneumocephalus resulting in aphasia without other neurological symptoms.

Introduction: Olfactory dysfunction has been shown to be an early sign of neurodegenerative disease, but the incidence of neurodegenerative disease in patients with olfactory dysfunction in Japan is unknown. Moreover, olfactory dysfunction has been suggested to be a predictor of mortality. The goal of the present study was to investigate the long term olfactory prognosis, incidence of neurodegenerative disease and mortality in patients with olfactory dysfunction.

Methods: A cross-sectional study was performed in patients with olfactory dysfunction who presented at the Department of Otorhinolaryngology of The Jikei University Hospital from April 2009 to March 2012. Of 228 patients, 167 with known street addresses were mailed questionnaires from December 2016 to March 2017. The survey asked about death, newly diagnosed diseases, and the current visual analogue scale of olfactory symptoms since the patient had been treated at our hospital. If the patient could not answer due to death or other factors, family members were permitted to answer. Information on age, sex, duration of symptoms, visual analogue scale, and the results of the initial olfactory examination was obtained from hospital records. The patient was enrolled in the study if their completed questionnaire was returned by May 2017 and consent was provided.

Results: Completed questionnaires were returned and consent to the study was given for 86 patients (34 males, 52 females; mean age, 58.3 years). In these patients, olfactory dysfunction was idiopathic in 11 cases, and was due to chronic sinusitis in 37 and viral infection in 19. A neurodegenerative disease (Parkinson’s disease) had been diagnosed in 2 of the patients with idiopathic olfactory dysfunction. Two patients had died prior to return of the questionnaires. The causes of death were unclear, but both patients had been diagnosed with cancer.

Conclusion: Parkinson’s disease reportedly occurs in 2 of the patients with idiopathic olfactory dysfunction. Therefore, if idiopathic olfactory dysfunction is diagnosed, symptoms of other neurodegenerative disorders, such as autonomic dysfunction, and other cognitive disorders should be assessed to rule out a neurodegenerative disease. Neurologists should also be consulted in such cases. The mortality rate in the present study was 2.3%. The relevance of olfactory dysfunction to death was not confirmed; however, if symptoms are chronic and cancer has been diagnosed, quality of life and activities of daily living of the patient require careful attention.

Inverted papilloma (IP) is most frequently encountered in sinonasal benign tumors. The first choice of treatment for sinonasal IP is surgical excision because of the high rate of recurrence and the potential of malignant transformation. IP originating in the sphenoid sinus is rare. Here, we report two cases of IP of the sphenoid sinus resected with endoscopic sinus surgery. The first case was a 41 year-old man who had a history of treatment for a pituitary adenoma. Due to left visual disturbance, the patient visited our hospital. An MRI indicated an intracranial tumor extending to both the bilateral sphenoid sinuses and nasal cavities. Although recurrence of his pituitary adenoma was considered likely, histopathological examination indicated an IP of the sphenoid sinus. Endoscopic sinus surgery (ESS) was performed, and the tumor in the sphenoid sinus was completely resected. The second case was a 77 year-old man. His IP of the sphenoid sinus was found serendipidously in an ENT clinic. This IP occupied both bilateral sphenoid sinuses and posterior parts of the nasal cavity. The tumor was completely resected with ESS. There are some vital tissues, such as the optic nerve and carotid artery, in the sphenoid sinus that require careful and safe procedures for tumor resection. A wider opening of the anterior wall of the sphenoid sinus, piecemeal resection of the tumor, exact identification of the IP location, use of various angle endoscopes, and an intraoperative navigation system are important for the safety and efficacy in ESS for IP of the sphenoid sinus.

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Rendu-Weber disease, is an autosomal dominant disorder. Epistaxis is the most common symptom and presents in more than 95% of the HHT patients. However, the occurrence and frequency of epistaxis in HHT patients are not well understood in Japan. We administered an anonymous questionnaire and obtained information regarding the degree, history, and treatment of epistaxis. Thirty-six valid responders were analyzed, 34 (94%) of whom suffered from epistaxis more than once a week. Epistaxis appeared before the age of 19 years in 17 (47%) of the responders, but the median age of the HHT diagnosis was 40 years. Thirty (83%) of the responders underwent otorhinolaryngological examination. About half of the responders underwent either gauze-packing or coagulation treatment. However, these patients recorded low levels of satisfaction with the otorhinolaryngological examination. About 60% of the responders preferred to visit an otorhinolaryngologist who was familiar with both the symptoms and diagnosis of HHT. Thus, otorhinolaryngologists are now recommended in Japan for the diagnosis and treatment of HHT.

The Japanese Rhinologic Society has held a yearly “Hands-on Seminar on Basic Research for Clinicians” since 2014. These seminars are planned with the aim of increasing the motivation toward and research skills of clinical otorhinolaryngologists for basic research, and in turn to encourage inter-disciplinary collaboration through research with universities. Fortunately, there has been a high level of anticipation for these seminars, and many participants said in post-seminar questionnaires that they would like the seminars to continue in the future. The fourth seminar was held at the 56th Annual Meeting of the Japanese Rhinologic Society (Kofu). Similar to the previous seminars, there were three different themes, each of which had dedicated booths with demonstrations and information. After the most recent seminar, participants completed a questionnaire survey. The seminar content was well-received, with all of the responses rating it as “Good” or “Very good”. About 10% of the participants said they would like the demonstration time to be longer. Meanwhile, responses on whether the participants would like the seminars to continue in the future fell to below 90% for the first time.