We analyzed the isolated bacteria in the otorrhea fluid specimens and selection of appropriate antibiotics for patients with chronic purulent otitis media who visited the Department of Ageo Central General Hospital Otolaryngology-Head and Neck Surgery from April 2015 to March 2020.

　A total of 269 strains were identified in 235 of the 281 subjects. The most frequently detected strain was Staphylococcus aureus (115 strains), accounting for 42.7% of all the isolates. This was followed by fungi (37 strains; 13.8%), Pseudomonas aeruginosa (32 strains, 11.9%). Methicillin-resistant Staphylococcus aureus (28 strains; 10.4%). Mixed infections with resistant bacteria and fungi may necessitate prolonged treatment. Patients over the age of 60 years accounted for 75.3%, or 177, of the 235 cases with positive isolates.

　In terms of the drug susceptibility, methicillin-resistant Staphylococcus aureus was highly sensitive to arbekacin, vancomycin, and sulfamethoxazole-trimethoprim. Pseudomonas aeruginosa was highly sensitive to meropenem, cefepime, and levofloxacin.

　Chronic eardrum perforation leads to repeated infections and resistance to antibiotics. It is considered necessary to ensure that appropriate antibiotics are selected to reduce the detection of refractory bacteria.

　Delayed surgery for blowout orbital fracture is challenging. Although the most important purpose of the surgery is to reduce the adhesions between the orbital contents and the sinonasal mucosa or the fractured bone fragments, it is more difficult to identify the adhesions in delayed surgeries than in fresh cases. Recently, cine MRI has been reported as a useful modality for identifying the adhesions. In this report, we describe delayed surgery for a case of blowout orbital fracture that was successfully performed with the help of preoperative cine MRI.

　A 54-year-old man who presented to us with diplopia, had undergone reconstructive surgery for the facial bones, except for the orbit as he had not recognized diplopia at that time, at our department a year earlier. Preoperative cine MRI showed adhesions in the medial wall of the orbit, so that the reduction surgery was performed successfully. The postoperative eye movements improved immediately and the improvement has been maintained.

　Cine MRI provided effective information to identify the adhesions. Delayed reduction surgery should be performed in cases of blowout orbital fracture if the adhesions can be identified, since it is strongly expected to improve the eye movements.

　The sphenoid sinus is close to the optic canal and cavernous sinus, and direct extension of inflammation from the sphenoid sinus to the cavernous sinus causes severe headache and nausea, and sometimes meningitis and epidural abscess. We report a case of acute sphenoid sinusitis in which the inflammation spread to the cavernous sinus.

　A 47-year-old woman was admitted to a neighborhood otolaryngology clinic with the chief complaints of headache and nausea. Cranial CT and MRI showed left sphenoid sinusitis, and the patient was referred to our department for further examination and medical treatment. Imaging examinations revealed spread of acute inflammation from the sphenoid sinus to the left cavernous sinus; the patient was urgently admitted to our department on the same day and started on treatment with the appropriate antibiotics. On the day after hospitalization, the patient complained of severe headache and nausea, and endoscopic sinus surgery was performed for drainage of the sphenoid sinus. After the operation, the patient recovered without any sequelae, such as diplopia or meningitis, and was discharged on the 17th hospital day.

　Since early diagnosis and treatment influence the prognosis after the spread of inflammation to the cavernous sinus, it is very important to identify the causative bacteria and administer the appropriate antibacterial drugs, in addition to surgical drainage.

　We report a case of endoscopic-assisted complete removal of a dermoid cyst in the floor of the mouth.

　A 56-year-old woman presented to our otorhinolaryngology clinic with a history of recurrent infection of the floor of the mouth. She had been treated for an oral floor abscess at a previous hospital. However, in view of recurrent infection of the same area of the mouth she was referred to our department for further examination and treatment. Imaging examination showed a mass in the central floor of the mouth, which was suspected as a dermoid cyst. We successfully performed complete resection of the tumor in the oral floor via an intraoral approach. Because the poor macroscopic view limits proper visualization of the lesion near the mental spine, we used an endoscope-assisted intraoral approach. The endoscope-assisted intraoral approach provided a good view of the lesion, and we succeeded in complete removal of the cyst without causing cyst rupture.

　The patient was a 49-year-old man who was transported to a general hospital with breathing difficulty of acute onset. Laryngoscopic examination showed spasmic movements of pharynx and limitation of the glottic opening. We suspected central neurological disorder,and referred the patient to the Department of Neurology. Examination at this department revealed fasciculation of the chin, gynecomastia, and atrophy of the tongue and plantar muscles. These findings led to the suspicion of Spinal and Bulbar Muscular Atrophy (SBMA), and subsequent physiological and genetic tests confirmed the definitive diagnosis of SBMA.

　We report the case of a patent with Spinal and Bulbar Muscular Atrophy who presented with laryngospasm, with a review of the literature.

　Various cutaneous flaps have been utilized for tissue reconstruction in patients undergoing operations in the head and neck region, and a few cases of carcinoma developing from the reconstructed flap itself have been reported. Herein, we report a rare case of carcinoma arising from a pectoralis major musculocutaneous flap 30 years after the patient underwent operation for oropharyngeal squamous cell carcinoma.

　A 78-year-old male patient consulted our department with a history of gradually worsening dysphagia and weight loss. Upper gastrointestinal endoscopy revealed a whitish papillary tumor on the surface of the reconstructed flap. Biopsy was performed and the histological diagnosis was benign squamous papilloma. Although endoscopic tumor resection was attempted three times, no improvement in the dysphagia was noted. Therefore, complete flap resection and reconstruction using a vascularized free jejunal autograft was performed. To our surprise, the final histological diagnosis obtained from examination of the resected specimen was verrucous carcinoma. We wish to emphasize the importance of long-term follow-up of patients undergoing reconstructive surgery is vital, in view of the small, but definite risk of secondary carcinoma arising from the reconstructed cutaneous flap itself.