Introduction: Allergic fungal rhinosinusitis (AFRS), the underlying pathophysiology of which is considered to be type I/III allergic reactions to environmental fungi, is recognized as one of the refractory forms of sinusitis. Schizophyllum commune is a basidiomycete that occurs ubiquitously in the environment. Reports of as pathogenic fungal diseases including AFRS and allergic bronchopulmonary mycosis (ABPM), caused by Schizophyllum commune from Japan currently account for 46% of all reports of disease caused by this fungus from around the world, and are increasing. However, since the proof of type I allergy to Schizophyllum commune was not possible until now, definitive diagnosis could not be made in many cases. In this study, we examined whether it might be possible to make a definitive diagnosis of AFRS caused by the basidiomycetes fungus Schizophyllum commune, by PCR analysis and also demonstration of type I allergy to Schizophyllum antigen.
　Method: Among 458 patients with chronic rhinosinusitis who were treated by endoscopic sinus surgery, unknown fungal species were isolated as the cause in 10 patients. PCR analysis was performed on clinical specimens obtained from these 10 patients in an attempt to identify the causative fungal species. Type I allergy (skin test, serumspecific IgE [RAST]) to Schizophyllum commune was examined in 5 of these patients to determine whether the condition was AFRS or a fungal ball. These tests were supported by FACS-JAPAN and Phadia.
　Results: Of the specimens obtained from the 458 patients undergoing surgery, fungi were isolated by culture from 26 specimens; the fungi isolated were Aspergillus sp. in 10 cases, Penicillium sp. in 6 cases, and unknown fungi in the remaining 10 cases. When identification was attempted by PCR analysis, Schizophyllum commune was identified in 5 of these specimens. Therefore, a tentative diagnosis was made based on the clinical findings, imaging (CT, MRI), operative findings, and pathological findings. Three cases were tentatively diagnosed as having AFRS, and the remaining 2 as having a fungal ball. Since skin tests and RAST to Schizophyllum antigen were positive, the three former cases were established as having AFRS caused by Schizophyllum commune. In one of the latter two cases, both the skin test/RAST to Schizophyllum antigen were negative. These type I allergy test findings were consistent with the clinical findings. In the three cases of AFRS, two cases showed postoperative recurrence, with the condition recurring thrice in one of these cases.
　Discussion: Species identification was possible by performing PCR analysis of the specimens from which unknown fungi were isolated on culture. Schizophyllum commune might be the causative fungus in many cases of AFRS showing culture positivity for fungi that, however, cannot be identified. Skin testing and serum fungus-specific IgE levels to Schizophyllum antigen may be expected to enable a definitive diagnosis of AFRS, and thereby, also definitive treatment.

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　The nasal valve region plays a key role in nasal breathing. Although a variety of techniques has been described to treat nasal valve compromise in the international literature, this condition is extremely rare in the Japanese population. This is a case report of a 23-year-old healthy male who presented with external and internal nasal valve obstruction. Both nostrils collapsed completely during forced inspiration due to the weak cartilagenous support. There was no nasal deformity, however, both nostrils were narrowed. Preoperative CT revealed that the nasal septum was straight and the inferior turbinate was not swollen. Preoperative anterior nasomanometry revealed increased nasal resistance in the sitting position. Open septorhinoplasty was performed, leaving a 10-mm wide L strut intact. The internal nasal valve was widened by a pair of spreader grafts measuring 4×25 mm in size. They were first sutured together and placed over the dorsum of the septal cartilage to augment the nasal dorsum. The external nasal valve was reinforced by the techniques of the columella strut and the alar batten graft. All graft pieces were cut from the septal cartilage. The spreader graft was given a roll of the septal extension graft to give support to the tip of the nose. The recorded nasal resistance after surgery was below the standard for an adult, and the nostrils never collapsed under forced inspiration postoperatively. Thus, it must be borne in mind that nasal valve compromise may cause nasal obstruction even in the presence of a straight septum. It can easily be treated by well-known techniques having been used in the field of aesthetic surgery.

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　Laryngeal amyloidosis is a rare disorder. We encountered 5 patients with laryngeal amyloidosis, comprising 2 male patients and 3 female patients; the patients ranged widely in age from 26 to 61 years old. All the five patients were evaluated for evidence of systemic involvement: while 4 of them were finally diagnosed as having localized laryngeal amyloidosis, in the fifth patient, the possibility of a lesion present in the chest could not be excluded. Of the 5 cases, 3 are under follow-up until date, and in each of these cases, the lesion remains stable in size.
　A total of 180 cases of laryngeal amyloidosis were reported in the Japanese literature from 1940 to 2012. The most commonly affected site in the reported cases was the supraglottic region. While many patients present with hoarseness, there may be many patients with small lesions in the supraglottic region with no symptoms. Because of the deposition of amyloid, surgical resection is impossible. Long-term follow up is required to prevent airway stenosis. The main treatment of amyloidosis should be limited to debulking operation by LMS and the surgical invasiveness should be minimized in order not to impair the patient's quality of life.

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　Nasopharyngeal cyst is a rare disease. We report the case of a 5-year-old male child with sleep apnea who was diagnosed as having a nasopharyngeal cyst located in the lateral wall. Apnomonitoring was performed for the patient at the clinic, and the Apnea-Hypoxia Index was 16.3/hr. The cyst was prone to recurrent infections and the snoring persisted, therefore, we performed fiberoptic rhinoscopic-assisted marsupialization of the cyst under general anesthasia. The location of the cyst and histopathological examination of the cyst wall suggested the diagnosis of a branchial cyst. Two years have elapsed since the operation, and there has been no evidence of reccurence. Only 15 cases of nasopharyngeal branchial cyst have been reported in Japan so far, and among these, children with these cysts usualy presented with evidence of sleep apnea. In this report, the diagnosis and treatment of nasopharyngeal branchial cyst are discussed.

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　We present a case of congenital cholesteatoma associated with pars flaccida cholesteatoma. A 53-year-old man presented with a few years' history of left hearing loss. Based on the detection of attic retraction, we made the diagnosis of pars flaccida cholesteatoma. When trans-canal atticotomy was performed, a white mass appeared anterior to the tensor tympani.
　Thus, the patient had congenital cholesteatoma associated with a pars flaccida cholesteatoma, that is, he had two different types of cholesteatomas.
　In most cases, congenital cholesteatoma exists in the anterior or posterior quadrant of the tympanic membrane, whereas in this case, it was found in the attic. Cases with congenital cholesteatoma present only in the attic are unusual. In this case, the congenital cholesteatoma blocked attic aeration, isolating the attic.
　We concluded that this may have resulted in some infection, leading to the formation of acquired pars flaccida cholesteatoma.

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