[Introduction]
　In general, the longer the duration of a disease, the greater the likelihood of disease progression and poorer the prognosis. We investigated the hypothesis that the prognosis of olfactory dysfunction (OD) due to chronic rhinosinusitis (CRS) becomes worse as the duration of the OD becomes longer.
[Patients and Methods]
　A total of 113 patients (70 males, 43 females; age range: 21-74 years; mean age: 50.9±12.7 years) with OD due to CRS who underwent appropriate surgery and postoperative treatment were followed up for at least 3 months. A visual analog scale (VAS) was used to evaluate the pre- and post-treatment symptoms of OD. The data of 19 patients who had persistent severe OD (VAS ≥ 1.0) even after appropriate treatment were analyzed by multiple logistic regression analysis using SPSS ver. 16.0.
[Results and Discussion]
　The multiple logistic regression analysis identified the following poor prognostic factors (OR): 1) male gender (18.996); 2) OD duration ≥ 5 years (10.023); 3)age ≥ 60 years (9.349); 4) peripheral eosinophil count ≥ 800/μL (8.234) (predictive rate: 89.4%). A significant negative correlation was observed between the OD duration and the post-treatment VAS (r= -.399, n=113). This negative correlation was particularly strong in male patients aged ≥ 60 years (r= -.632, n=27), in subgroups with aspirin-intolerant asthma (r= -.624, n=11), in patients with serum total IgE ≥ 300 IU/ml (r= -.679, n=24), and in current smokers (r= -.731, n=11). These results indicate that the prognosis of OD due to CRS becomes poorer as the duration of the disease becomes longer. In particular, patients with the aforementioned risk factors should be started on treatment as soon as possible and should be appropriately educated.

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　Cerebral palsy may be caused by birth asphyxia or neonatal hyperbilirubinemia, and is classified by the degree of paralysis and the parts affected by the paralysis. The spasticity type is often associated with hearing loss. Before the introduction of ABR, the hearing loss in cases of cerebral palsy was considered to be central (in the brain) in origin. In newborn infants, the blood-labyrinth barrier is immature. The high bilirubin levels are thus easily transferred to the inner ear, damaging the cochlea. The hypoxia caused by asphyxia can also damage the cochlea.
　There are few reports about the hearing ability in cerebral palsy patients in adulthood. We encountered some such cases with hearing loss. All of the patients had sensorineural hearing loss, although the degree of hearing loss varied. Even in cases with moderate hearing loss, the hearing loss was often not noticed until adulthood. In some cases, the hearing improved with hearing aids, which brought much satisfaction. Although there are many cases of patients with cerebral palsy that have never consulted an otolaryngologist, evaluation and treatment of hearing loss are very important in these patients.

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　A clinical study was performed of 63 patients with parotid gland tumors who underwent parotidectomy, in whom the tumors were diagnosed as benign tumors on preoperative examinations between August 2003 and March 2013. The numbers of benign and malignant tumors were 58 and 5, respectively. The most frequently encountered tumor was pleomorphic adenoma (35 cases), followed in frequency by warthin's tumor (14 cases). All of the 5 malignant tumors were carcinomas, including 4 cases of low-grade malignant carcinomas, and pain was observed in 2 of these cases. The mean age of the patients with pleomorphic adenoma and warthin's tumor was 46.6 and 59.7 years old, respectively, with the age of the patients with the warthin's tumor being significantly higher than that of the patients with pleomorphic adenoma. There were 50 tumors involving the superficial lobe and 13 involving the deep lobe. Postoperative facial nerve paralysis was observed in 16 cases, and there was a tendency towards the incidence of the paralysis being higher in the cases with tumors in the deep lobe than in those with tumors in the superficial lobe.
　It is difficult to differentiate between benign and malignant tumors among low-grade malignant tumors preoperatively, however, it would seem that pain is an important sign indicating the diagnosis of a malignant tumor.

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　Herein, we report a rare case of hypopharyngeal cancer metastasizing to the kidney. A 46-year-old female patient presented to us with the chief complaint of right lumbar pain 5 months after she had undergone surgery and chemoradiation therapy for hypopharyngeal squamous cell carcinoma. CT and MRI revealed a solid and irregularly enhancing mass lesion in the right kidney. Abnormal accumulation was observed on positron emission tomography. Based on the findings, primary or metastatic tumor was strongly suspected, and renal biopsy was performed. The pathological findings showed squamous cell carcinoma of the kidney, and a diagnosis of renal metastasis from hypopharyngeal cancer was confirmed. Treatment by nephrectomy was not indicated because of the poor performance status of the patient. Proton beam therapy was undertaken as palliative treatment to avoid abdominal complications. While we administered this therapy with palliative intent, the renal metastatic tumor disappeared after the treatment.

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　We report, herein, a case of immunoglobulin (Ig)G4-related disease affecting the orbital foramen and paranasal sinuses. A 54-year-old man was diagnosed as having chronic sinusitis and underwent four rounds sessions? of endoscopic sinus surgery at a local otolaryngological clinic. Lack of improvement in the nasal symptoms and onset of left ocular proptosis following this treatment led to a diagnosis of recurrent chronic sinusitis and orbital cellulitis, and the patient was referred to our hospital. Contrast-enhanced computed tomography of the paranasal sinuses revealed dense soft tissues in the ethmoid sinuses on both sides, osseous defects in the orbital lamina papyracea, dense soft tissue in the region of the medial rectus muscle, and enlargement of the lacrimal gland and infraorbital groove ..side..?. Immunoglobulin analysis of the peripheral blood showed elevated serum IgG (3062 mg/dl) and IgG4 (1060 mg/dl) levels. IgG4-related disease was suspected, and endoscopic sinus surgery was conducted using a navigation system to obtain a definitive diagnosis. Histopathological examination of specimens of the affected paranasal sinus mucosa and orbital tissue obtained intraoperatively revealed extensive infiltration by IgG4-positive plasma cells, confirming the diagnosis of IgG4-related disease. Postoperative systemic steroid therapy was administered at the Department of Rheumatology, which resulted in marked improvement of the nasal symptoms and left ocular proptosis. The patient remained well at least until the 12-month follow-up postoperatively. In patients with periorbital swelling accompanied by paranasal sinus lesions, IgG4-related disease should be considered in the differential diagnosis, in addition to conditions such as malignant lymphoma and sinusitis with orbital complications.

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[in Japanese]

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