Upper respiratory tract infections, sinonasal disease, trauma, inhalation of drugs, and degenerative diseases are among the frequent causes of olfactory dysfunction. Recently, there have also been cases of olfactory dysfunction caused by COVID-19 infection. Patients with olfactory dysfunction often receive checkups with a T&T olfactometer or an Alinamin test. Olfactory training, in which patients actively sniff odors, has been introduced as a new treatment method for olfactory dysfunction. In our hospital, clinical laboratory technicians perform T&T olfactometry, while speech therapists perform olfactory training under a rehabilitation doctor. In this study, patients diagnosed with olfactory dysfunction underwent olfactory training for more than 3 months. The study was approved by the ethics committee of the International University of Health and Welfare. Olfactory training included exposure to odorants (rose, lemon, eucalyptus, and cinnamon) for 10 seconds each, twice per day (morning and evening). After 3 months, the 4 odorants were changed to lavender, orange, cypress, and vanilla. The results in olfactometry before and after olfactory training were compared retrospectively. No significant improvement was seen in T&T olfactometry, but a significant improvement was found in a self-administered Olfactory QOL questionnaire and visual analogue scale (VAS). Here, we introduce this approach for cases of olfactory dysfunction, with the goal of establishing a more effective and uniform protocol for Japanese patients.

Primary ciliary dyskinesia (PCD) is an otorhinolaryngological and respiratory condition characterized by motile ciliary dysfunction, which results in intractable recurrent sinusitis, otitis media, bronchiectasis, and pneumonia. Currently, there is no evidence-based therapeutic strategy for management of chronic sinusitis in patients with PCD. We retrospectively investigated the clinical features of five patients with PCD who underwent endoscopic sinus surgery. These patients included 4 men and 1 woman, and had a mean age of 24 years (range 12–33 years). Recurrent pneumonia and bronchitis occurred in 3 patients, inversion of the internal organs in 2, and male infertility in one. Electron microscopy revealed abnormalities in 4 patients: an inner dynein arm defect in 2, and inner and outer dynein arm defects in 2. Nasal endoscopy revealed polyps in 3 patients, and purulent rhinorrhea in all patients. Three patients had hypoplastic frontal and sphenoid sinuses. All patients received long-term low-dose macrolide therapy, but symptoms persisted and endoscopic sinus surgery was required in all cases. Postoperatively, nasal suction of the posterior nasal cavity and middle nasal meatus was easier, and nasal irrigation with saline reduced the frequency of pneumonia in 2 patients. These findings may suggest that endoscopic sinus surgery followed by nasal irrigation may improve upper airway secretion clearance and reduce the risk of lower respiratory tract infection.

There are no established standards or guidelines for the treatment strategy for odontogenic maxillary sinusitis. Endoscopic sinus surgery (ESS) may be difficult to perform due to the inflammatory nature of the procedure if preoperative dental treatment is inadequate. In addition, postoperative recurrence is also a concern because the etiology remains. In this study, we divided patients into two groups: those who had preoperative extraction of the root cause teeth (6 cases) and those who had dental treatment other than tooth extraction (10 cases), and retrospectively evaluated the operation time, amount of blood loss, and postoperative recurrence. There were no significant differences in operative time, blood loss and postoperative recurrence between the groups. Thus, tooth extraction is not always necessary for safe surgery, and preservation of the causative tooth may be an option. The otolaryngologist should continue to monitor the nasal sinuses after ESS because maxillary sinusitis may recur with or without tooth extraction. It is important for otolaryngology and dentistry to work closely together for appropriate treatment of odontogenic maxillary sinusitis since this disease involves both fields.

It is now widely recognized in Japan that nasal valve obstruction is a cause of symptoms of nasal obstruction. Perforation of the nasal septum can also cause these symptoms and is sometimes treated surgically. We report a case of nasal obstruction with internal nasal valve obstruction and nasal septal perforation, in which nasal septal perforation repair and open septorhinoplasty were performed simultaneously with excellent results. The patient was a 61-year-old male who had undergone nasal septal surgery 30 years previously. He had a history of nasal obstruction symptoms that had worsened over the past several years and he was referred to our department for initial consultation, after visiting an otorhinolaryngology clinic. The patient was found to have a leftward slanting nose, depression of both nasal valves on inhalation, nasal septal perforation of 13 × 8 mm in the anterior nasal septum, and leftward nasal septum deviation with a spur. Simultaneous surgery was performed for external open septorhinoplasty and nasal septal perforation repair. Bilateral marginal incisions joined to an “inverted-v” transcolumellar incision were made to expose the lower lateral cartilage, the upper lateral cartilage, and the nasal septal cartilage. The nasal septal mucosa in the upper part of the perforation was dissected up to the medial aspect of the upper lateral cartilage, while in the lower part, the nasal mucosa was dissected from the bottom of the nasal cavity to the inferior nasal meatus. A U-shaped incision was made in the mucosa of the nasal floor to advance the upper and lower mucosal flaps and suture the perforation. In addition, the right temporal fascia and auricular cartilage were harvested and used as a connective tissue graft for the nasal septal perforation and a spreader graft for the nasal valve obstruction, respectively. Postoperatively, the nasal septal perforation was closed and the symptoms of nasal obstruction disappeared. In recent years, various endoscopic septal perforation repair techniques have been developed; however, our case suggests that simultaneous nasal septal perforation repair and open septorhinoplasty should be considered in patients with nasal obstruction with combined nasal valve obstruction and nasal septal perforation, or with suspected fragility of the external nose.

Recent advances in endoscopic technology and surgical instruments have expanded the indications of endoscopic endonasal surgery to include orbital tumors. Tumors located at the medial orbita, especially at the orbital apex, are considered to be appropriate for an endoscopic endonasal approach, although careful manipulation is required to avoid damage to visual function. Here, we report a case of an orbital tumor treated with novel endoscopic endonasal resection. A 45-year-old woman visited an ophthalmologist with a three-week history of blurred vision in the right eye. A CT scan showed a right orbital tumor located at the medial orbita outside the muscle cone. MRI indicated vascular malformation (cavernous hemangioma), with a diameter of 22 mm. Preoperative corrected visual acuity was (1.0) in the right eye and (1.2) in the left eye with a critical fusion frequency of 15 Hz in the right eye and 32 Hz in the left eye, indicating deterioration of right optic nerve function. The patient underwent radical resection of the tumor with an endoscopic endonasal approach to the orbit via the middle meatus, ethmoid sinus and lamina papyracea using an image-guided system. The tumor was adherent to the medial rectus muscle, but was carefully and successfully removed using fine instruments for otologic surgery and neurosurgery. The final histologic diagnosis was also vascular malformation (cavernous hemangioma). Postoperative corrected visual acuity was bilateral (1.5), and the critical fusion frequency was 35 Hz in the right eye and 39 Hz in the left eye, indicating improvement of right optic nerve function. Preoperative right blurred vision also disappeared with no ocular motility dysfunction. There were no adhesions in the sinonasal cavities and no other adverse events after surgery. Although an endoscopic endonasal approach is suitable for medial orbital resection, it is difficult due to the narrow surgical field and inconvenient operability. Therefore, there is a need to develop novel surgical techniques and instruments for safe and reliable treatment in a good surgical field.

Post-traumatic olfactory dysfunction is known to have a poor prognosis. Traumatic olfactory dysfunction is commonly associated with parosmia, which is an often neglected symptom due to difficulty with its assessment using standard olfactory testing. We report a case of a patient diagnosed with post-traumatic olfactory loss and parosmia. Olfactory loss recovered within one year, but parosmia persisted for five years before disappearing.

The patient was a 41-year-old woman who fell from a 2-meter-high wall and injured her right occipital area. A few days later, she noticed a decreased sense of smell and visited our department. An intravenous olfactory test and T&T olfactometry showed olfactory loss. She was treated with olfactory stimulation and followed up with T&T olfactometry, Open Essence, a Visual Analogue Scale (VAS), and the Self-Administered Odor Questionnaire (SAOQ). Approximately one year after the injury, her sense of smell was rated as cured by T&T olfactometry, but showed no improvement on VAS or SAOQ, and parosmia remained. The patient continued olfactory stimulation at home, and approximately 5 years after the injury parosmia disappeared, with VAS and SAOQ also showing significant improvement.

Qualitative olfactory dysfunction such as parosmia is difficult to assess with standard olfactory tests, but patients with parosmia suffer from a significant loss of quality of life. Olfactory identification tests and subjective symptom-based evaluations such as VAS and SAOQ may better reflect the subjective symptoms of parosmia, in addition to standard olfactory tests. Post-traumatic parosmia should also be approached with the understanding that this condition may undergo long-term changes.

HPV-related multiphenotypic sinonasal carcinoma (HMSC) is a recently classified disease, with only a few case reports in Japan, and the disease concept is not widely recognized. HMSC is characterized by localization to the nasal sinuses, diverse histopathological features such as squamous cell dysplasia and adenoid cystic carcinoma, and the presence of high-risk HPV (mainly type 33) infection. While the disease commonly has high-grade histological features, it also often has a relatively slow course, which makes it important to distinguish HMSC from squamous cell carcinoma, adenoid cystic carcinoma, and other types of carcinoma. In this study, we report a case of HPV-associated nasal sinus cancer in which HPV type 33 was detected. The patient was a 44-year-old woman who visited our hospital with a chief complaint of epistaxis. A hemorrhagic tumor occupying the right middle nasal passage and posterior nostril was noted. Based on histological diversity and positive p16 immunostaining on biopsy, a diagnosis of HMSC was made and the patient underwent surgical treatment. HMSC is similar in histologic morphology to adenoid cystic carcinoma and squamous cell carcinoma. In specimens of nasal sinus carcinoma in which HMSC is suspected, it is important to perform p16 staining, as in mesopharyngeal carcinoma, and if the specimen shows diffuse positive findings, specific tests such as in situ hybridization and PCR should be performed to diagnose HMSC, with the assumption of HPV-related carcinoma.

Necrosis of the nasal cavity can be caused by a wide variety of factors, including nasal natural killer/T-cell lymphoma, granulomatosis with polyangiitis, leukemia, infection, and drugs. We herein report a case of nasal septal necrosis caused by Aspergillus infection. A 78-year-old woman with myelodysplastic syndrome was treated at the Department of Hematology at our hospital. She had a fever, and bone marrow examination showed transition from myelodysplastic syndrome to hypoplastic myelogenous leukemia; thus, chemotherapy was started. At initial presentation, crusts were present on the left side of the nasal septum. A CT scan showed a mass lesion without calcification or bone destruction in the bilateral maxillary sinuses, and MRI T2-weighted images showed low signal intensity in the left maxillary sinus, suggesting the presence of fungi. Decreased platelets were observed and conservative treatment was performed based on the risk of bleeding associated with removal of the crusts. However, crusts started to appear on both sides of the nasal septum, and biopsy revealed Aspergillus in the necrotic tissue. There was no invasion of tumor cells or fungi in the peri-necrotic mucosa. Necrosis of the nasal septum due to Aspergillus infection was suspected, but infiltration of leukemic cells could not be ruled out. Therefore, surgery was performed under general anesthesia for collection of sufficient tissue for biopsy, necrotic tissue removal, and diagnostic treatment of the left maxillary sinus lesion. No tumor cells were detected in the necrotic tissue of the nasal septum, but Aspergillus infiltration was observed, indicating that the necrosis was caused by Aspergillus infection. A caseous matter was present in the maxillary sinus, but pathological examination revealed no fungi.