Japan is one of the world's leading countries with a super-aging society among the countries in the world with the fastest rate of super-aging of society, with an aging rate of 28.1%, as estimated in 2018. In the elderly population, dizziness and balance disorders are well-known risk factors for falls. In the present study, we examined the effects of vestibular rehabilitation in patients aged 65 years old or older who had dizziness and an impaired sense of balance, which, as mentioned above, are major risk factors for falls.

　The subjects of this prospective interventional study comprised 21 patients with dizziness aged 65 years old or older (7 men and 14 women). We performed a comparative assessment of the patients using the Dizziness Handicap Inventory (DHI) before the start of vestibular rehabilitation intervention and 2 months after the start of the intervention. As vestibular rehabilitation, the subjects were asked to practice the X1 paradigm proposed by Tusa et al. and the Brandt-Daroff method at home for 2 months.

　The results revealed significant improvement of the average score and scores in the three categories of physical, emotional and functional well-being of the DHI at 2 months after the start of the intervention as compared to before the intervention. Among the vestibular rehabilitation methods, the X1 paradigm is mainly aimed at correcting the left-right difference in the semicircular canal vestibulo-ocular reflex, while the Brandt-Daroff method is aimed at promoting sensory substitution by vision and somatic sensation. In the patients with age-related balance disorder in this study, it appears that the subjective symptoms improved because of sensory substitution, mainly owing to the improvement of vision and somatic sensation by vestibular rehabilitation.

　A 42-year-old man presented to our ENT department with a history of persistent lower ear swelling and pain. Contrast-enhanced CT revealed enlargement and central necrosis of the upper deep cervical lymph nodes, and an abscess in the sternocleidomastoid muscle. We started the patient on antibiotic therapy (ampicillin/sulbactam), and punctured the abscess. The next day, we undertook incision and drainage, because the neck findings had become worse. At the time of the operation, we recognized an abscess cavity in the sternocleidomastoid and fistula formation from the abscess to an upper deep cervical lymph node along the accessory nerve. The patient's condition improved after the surgery, and he was discharged on the 23rd hospital day.

　Commonly, deep neck infections spread to the adjacent tissues, with potential abscess formation, through nearby cervical spaces intramuscular abscesses are more frequently encountered in the muscles of the lower limbs, and are rare in the cervical region. However, in this case, the infection spread into the muscle along the penetrating blood vessels or nerves.

　Based on this case, we wish to highlight the importance of spread of infection via muscles, besides via the cervical spaces, in patients presenting with a deep neck abscess.

　We report a patient who developed a subperiosteal orbital abscess due to acute aggravation of chronic sinusitis, that resulted in vision loss. A 30-year-old female patient who presented with right eyelid swelling and pain was diagnosed as having right orbital cellulitis. CT revealed a right subperiosteal orbital abscess. The visual acuity on the right side was below the light perception level, and the patient also had marked exophthalmos and corneal opacity. Based on the CT and MRI findings, we diagnosed the patient as having rhinogenic orbital complications. We performed endoscopic sinus surgery with external incision for the purpose of drainage of the subperiosteal orbital abscess and creation of a pathway for drainage. After postoperative antibiotic and steroid therapy, the eyelid swelling and pain improved, but the visual impairment persisted. Therefore, optic nerve decompression was performed and a second course of steroid pulse therapy was administered, however, the visual impairment still persisted. Acute aggravation of chronic sinusitis can manifest as various symptoms due to the spread of inflammation to the surrounding tissues. In some patients, irreversible optic nerve damage can occur within a short time, and markedly impair the quality of life of the patient. The interval from onset to surgery, the preoperative visual acuity, the optic disc findings, and the extent of visual field defects are all prognostic factors for the visual acuity. Accurate and rapid diagnosis and treatment are required to avoid permanent visual impairment.

　Airway obstruction due to subglottic granulation, thought to be quite rare, can be caused by infection, trauma, tracheal intubation, etc. We report a patient who presented with recurrent subglottic granulation that required multiple operations within a period of 9 months.

　A 70-year-old man visited our hospital with the chief complaint of dyspnea. He gave a past history of having undergone intubation at another hospital at the onset of myocardial infarction. Therefore, we suspected subglottic stenosis caused by the formation of subglottic granulation. We attempted complete resection of the granulation by microscopic laryngeal surgery via the oral route, but the granulation was located in an area that was difficult to approach. Despite multiple operations, recurrence was suspected due to residual granulation. Then, we approached the granulation through a transtracheal incision using a nasal direct mirror and a 70-degree oblique mirror, which allowed clear visualization of the entire granulation and the base of the granulation was reliably resected.

　Since the postoperative course was good and no recurrence has been observed, we believe that for patients with subglottic granulation who are selected for surgery due to respiratory problems, good surgical planning to identify means that would allow clear visualization of the base of the granulation is necessary.