Vestibular evoked myogenic potentials (VEMPs) are vestibular-dependent, short-latency muscle reflexes evoked by large air-conducted sound or bone-conducted vibrations. There are two kinds of VEMPs: ocular VEMPs (oVEMPs) recorded from extraocular muscles and cervical VEMPs (cVEMPs) recorded from the sternocleidmastoid muscles. The oVEMPs reflect the function of the utricle in the contralateral ear whereas the cVEMPs reflect the function of the saccule in the ipsilateral ear. Combinational use of the VEMPs with tests of semicircular canals such as the caloric test and the video head impulse test enables elaborate evaluation of the peripheral vestibular function. This review outlines the mechanism, methods, and clinical applications of the VEMPs.

　IgG4-related disease is a systemic chronic inflammatory disease characterized by elevated serum levels of IgG4, massive infiltration of tissues by IgG4-positive plasma cells, and tissue fibrosis. Mikulicz's disease, Küttner's tumor and Riedel's thyroiditis are considered to be examples of IgG4-related disease involving the head and neck region. In recent years, reports of nasal manifestations associated with IgG4-related diseases have been increasing. We report four cases of IgG4-related disease who presented with chronic rhinosinusitis. Case 1 (47-year-old man) and Case 2 (49-year-old man) had undergone surgery for chronic sinusitis, but presented with other organ symptoms several years later. IgG4-positive plasma cell infiltration was observed in the nasal biopsy specimens. Case 3 (64-year-old male) and Case 4 (65-year-old male) visited us with the chief complaint of nasal symptoms, accompanied by symptoms pertaining to other organ systems. All four cases had rhinosinusitis accompanied by symptoms pertaining to several other organ systems and were definitively diagnosed as cases of IgG4-related disease by nasal biopsy. Biopsy of nasal polyps is relatively easy to perform as compared to biopsy of other organs, such as the pancreas or pituitary gland. Therefore, otorhinolaryngologists can play an important role in diagnosis of IgG4-related diseases. In patients with rhinosinusitis who present with symptoms pertaining to other organ symptoms, IgG4-related disease must be considered in the differential diagnosis.

　Kimura's disease is a relatively rare disease characterized by the presence of indolent masses in the soft tissues subcutaneous swellings throughout the body, with an increase in the peripheral blood eosinophil counts and raised serum IgE levels. Surgical treatment, drug therapy, and radiation therapy have been used as treatments, but the disease often recurs. We encountered a case of Giant Kimura's disease and present the case herein, with some review of the literature. Although no reliably effective treatment has been established yet for Kimura's disease, it seems that combined treatment with oral steroids, radiation, and surgery may represent an appropriate approach.

　Gradenigo syndrome was first reported by Giuseppe Gradenigo in 1904. The three characteristic features of the syndrome are otitis media, trigeminal neuralgia, and abducens nerve paralysis. Inflammation spreads from the middle ear (otitis media) to the apex of the petrous bone, affecting the trigeminal nerve and abducens nerve. The patient reported herein was a 10-year-old girl. She presented with the complaints of temporal and postauricular, but examination at a pediatric otorhinolaryngology clinic failed to reveal any abnormal findings. Therefore, the patient was prescribed only analgesics and followed up, but presented with abducens nerve palsy about a month later. Examination at our hospital revealed findings suggestive of otitis media, and the patient was diagnosed as a case of Gradenigo syndrome, based on the presence of the three main features. Conservative treatment with antibiotics was successful, with marked improvement of the symptoms and clinical findings, and she was discharged 10 days after the start of treatment. Based on the CT and MRI findings, and also the clinical response to treatment, we determined that primary petrositis was the underlying cause. At 6 months after discharge, there is no evidence of recurrence and the patient is doing well.

　In recent years, the onset of this syndrome has become rare due to the widespread use of antibiotics. It is important to conduct a detailed examination with imaging studies, even if the eardrum is normal, in patients presenting with persistent ear pain for more than a week.

　Pleomorphic adenomas are benign tumors that arise from the salivary glands, predominantly the major salivary glands, and rarely in the nasal cavity. Surgical resection is the mainstay of treatment, however, as there is a certain probability of malignant transformation and recurrence, it is important to ensure en bloc resection of the tumor.

　We encountered a 54-year-old male patient with pleomorphic adenoma arising from the nasal septum. He presented with the complaint of nasal obstruction and was diagnosed as having a tumor in the right nose and referred to our hospital for further examination and treatment. CT revealed a tumor localized to the nasal cavity, and endoscopic nasal tumor resection was performed. The tumor was neither adherent to the nasal septal cartilage nor to the nasal bone, and it was possible to remove it with a sufficient surgical margin. Histopathological examination confirmed the diagnosis of pleomorphic adenoma, and complete resection was confirmed.

　To date, 157 cases of nasal pleomorphic adenoma have been reported in Japan. A review of the surgical procedures adopted in previous cases, especially in recent years, revealed that with the advancements in endoscopic techniques, the intranasal approach has been increasingly selected for the resection of these nasal tumors. Depending on the size and location of the tumor, it is difficult to perform intraoperative manipulation because the base is unclear. Therefore, it is important to confirm the indication for surgery and develop an optimal approach to achieve complete en bloc resection.

　In our report, we introduce the surgical procedures and strategies adopted by us, and discuss the new surgical procedures described recently.

　We report the case of a 62-year-old male patient with parathyroid carcinoma and chronic renal failure. The patient presented with hypercalcemia and evidence of chronic renal disease. Elevation of the serum level of Intact-PTH, along with the findings of ultrasonography, CT and MRI suggested the diagnosis of parathyroid adenoma with primary hyperparathyroidism. Since conservative therapy did not resolve the hypercalcemia, surgery was performed, with extirpation of the left parathyroid gland. The tumor was located under the lower aspect of the left lobe of the thyroid gland, and was slightly hard in consistency. There was no evidence of infiltration of the left lobe of the thyroid gland or other adjacent organs. Histopathological examination revealed carcinoma of the parathyroid gland. Furthermore, histopathological examination also showed extracapsular extension of the tumor and we considered this finding as corresponding to a positive surgical margin. Therefore, three months after the operation, we performed left lobectomy of the thyroid gland with bifurcational lymphadenectomy. The postoperative course was uneventful, and there has been no evidence of local recurrence or distant metastasis until now, one year after the operation.

　Based on these clinical and laboratory findings, the patient was suspected as having parathyroid adenoma, not parathyroid cancer. From the findings in this case and other previously reported cases, we wish to underscore the points that need to?? considered in respect of the preoperative examinations, precautions during the postoperative follow-up period, and treatments for recurrence and distant metastasis.