Patients in patulous eustachian tube complain of various discomforts, such as aural fullness, autophony and hearing their own breathing sound. These symptoms are caused by persistent opening of the normally closed eustachian tube. The most annoying symptom is autophony. Actually, patients with patulous eustachian tube often complain that external sounds cannot be clearly heard during vocalization. The symptoms are modified by the postural change, which helps us diagnose the illness patulous eustachian tube. We can confirm the diagnosis by the objective findings such as eardrum movement synchronized with respiration.

　We have tried a variety of treatments for patulous eustachian tube, including conservative therapy and surgical procedures. Prior to the treatments, a rational explanation for the symptoms should be performed, which often relieves the patient's anxiety. Most patients can be controlled by nasal instillation of physiological saline, so this therapy is first-line for patulous eustachian tube. Although symptoms usually respond to such conservative treatment or even subside spontaneously, there are some chronic cases that are resistant to all conservative treatments. We have introduced a unique surgery, in which a silicon plug is inserted into the eustachian tube trans-tympanically. This plugging method is very effective and less-invasive. An appropriate size of plug can also keep the tubal function normal.
　Some patients usually sniff their nose in order to relieve the aural symptoms. The sniffing habit is risking middle ear diseases such as cholesteatoma, so it should be prohibited.

　Preoperative estimation of the extent of tumor attachment to allow selection of the appropriate surgical procedure for complete resection of the tumor is recommended in cases of sinonasal papilloma. Conventional CT and MRI are useful to estimate the extent of attachment for tumors showing narrow attachment, but not for those showing broad attachment. We estimated the extent of tumor attachment using dynamic MRI to enhance the over-time contrast effect. The results revealed different contrast effects between slices including the attachment and slices not including the attachment, which may be expected to allow accurate estimation of the extent of attachment even for tumors showing wide. attachment. Although dynamic MRI is not easy to perform, it appears to be advantageous for estimating the extent of attachment even for tumors showing broad attachment.

　We report the cases of two patients who underwent endoscopic sinus surgery for sinonasal papilloma of the sphenoid sinus. The histopathological diagnosis was invated papilloma of the sphenoid sinus. Until date, since the surgery, there has been no evidence of recurrence.

　Because of the structural complexity of the sphenoid sinus, we needed a 70-degree rigid endoscope for the observation. We used curved forceps, a micro debrider and a diamond bar to resect the sinonasal papilloma from the tumor base. With control of bleeding by electrocautery, we were able to visualize the operative area better. There were some vital organs (internal carotid artery, optic nerve, etc.) around the tumor. Therefore for safe surgery, we needed to fix the dangerous site using a navigation system.
　Because of the potential for damage to the internal carotid artery during the surgery, ESS for sinonasal papillomas arising from the sphenoid sinus is preferable to be undertaken in adequately equipped facilities and by skilled surgeons for dealing with any complications.

　A 65-year-old woman visited our ENT hospital with the complaint of subjective left tinnitus, which felt like air escaping from the ear.

　Magnetic resonance angiography revealed stenosis of the left internal carotid artery, and the patient was referred to the neuroendovascular surgeon at our hospital. Cerebral angiography carried out by this surgeon revealed stenosis (NASCET 75%) of the left carotid cavernous sinus. The patient strongly desired treatment, and endovascular treatment was performed. The left internal carotid artery obstruction was relieved by inflation of a balloon catheter, and the pulsatile tinnitus disappeared immediately. An endovascular stent (Tsunami^®) was inserted to prevent re-stenosis and dissociation, completing the surgery. After 6 months of follow-up, there has been no re-stenosis or recurrence of the vascular tinnitus.
　We should be aware of the possibility of vascular disease in patients presenting with pulsatile tinnitus and should perform thorough imaging studies to establish the cause.

　We encountered a case of postoperative infection of the u-HA / PLLA composite plate (SUPER FIXSORB-MX^®) that had been inserted for repair of a medial orbital wall fracture 1 year ago, following an event of common cold.

　The patient was a 40-year-old male who had sustained injury to the medial orbital wall during a boxing game 2 years earlier. Surgery was performed using a silicone plate for repair of the medial orbital wall fracture. The patient developed postoperative enophthalmos and diplopia, which persisted even at 1 year after the operation. Therefore, a second operation was performed by a plastic surgeon for rigid reconstruction using SUPER FIXSORB-MX^®. While the patient showed all-round improvement after the second operation, he was found to have exophthalmos, diplopia and orbital pain at 1 year after the surgery. Physical examination and CT revealed findings suggestive of infection around the SUPER FIXSORB-MX^®, therefore, emergency surgery was performed to remove the plate, followed by antibiotic therapy for 2 weeks. Postoperative infection of SUPER FIXSORB-MX^® is rather rare, and our patient needs close follow-up.