Laryngeal granulomas are considered to be caused by general anesthesia, emergency airway management, endotracheal intubation for the purpose of respiratory management of chronic illness, trauma, and infection. In particular, subglottic granuloma is a relatively rare disease that tends to recur and is often difficult to treat. Herein, we report a case of subglottic granuloma that developed after long-term intubation and was successfully treated surgically. The patient, a 32-year-old Indian male, had COVID-19 pneumonia and was treated with long-term tracheal intubation at another hospital. At the initial visit, wheezing on inhalation was observed, and bilateral vocal cord immobility was observed on the laryngeal fibers, which led to the suspicion of bilateral vocal cord paralysis. An emergency tracheotomy was performed on the same day, and when the subglottis was checked through the tracheostomy, a huge subglottic granuloma was found in the posterior part of the glottis. The subglottic granuloma was in contact with the back surface of the bilateral vocal cords and was considered to be the cause of the glottal opening defect. After tracheotomy and conservative treatment for 2 weeks, the size of the subglottic granuloma did not change. Therefore, we planned to remove the subglottic granuloma through an external cervical incision. Under general anesthesia, the subglottic granuloma was removed through a cricothyrotomy with a rigid endoscope. The glottis was opened postoperatively, and the tracheal cannula was removed 2 months after surgery. Nine months have passed since surgery, and laryngeal fiberoptic findings have not revealed any recurrence.

Tuberculosis is an infectious disease that has been identified in Japan and may progress to severe conditions. The middle ear is one of the extrapulmonary sites of tuberculosis, and early detection and treatment are considered important to prevent complications and outbreaks. However, with the development of medical care in developed countries, the number of cases reported in the past few years has been decreasing, and the opportunities to examine such patients have been rare. In addition, because tuberculosis of the middle ear lacks characteristic findings, it is difficult to distinguish it from otitis externa, chronic otitis media, or cholesteatoma, which may lead to a delay in diagnosis. We experienced a rare case of tuberculosis of the middle ear in a pediatric patient. We report the characteristics and recent trends of tuberculosis of the middle ear. We consider that otolaryngologists, who routinely deal with pediatric ear diseases, will have a significant impact on the prevention of mass infections and complications by reaffirming the characteristics and clinical picture of these diseases. A thorough examination should be performed until the possibility of tuberculosis is ruled out. After diagnosis, it is important to carry out surgical treatment, if necessary, in addition to conventional drug treatments.

Navigation systems (Navis) are quite useful for performing safe and precise endoscopic sinus surgery (ESS). Optical-type Navis are available for ESS at our hospital. Thus far, no guidelines have been established on the use of Navis for ESS. To accumulate information that could facilitate discussion about the appropriate use of Navis for ESS, we investigated the practical use of Navis for ESS in our hospital and compared it with that at other hospitals in Japan. Among 147 ESS cases from June 2018 to April 2020, 24 (16.3%) were performed using Navis. These 24 cases were classified into 4 groups: ① sinonasal tumors, ② non-eosinophilic rhinosinusitis (NECRS), ③ eosinophilic rhinosinusitis (ECRS), and ④ cystic disease. Navis for ESS was performed more often in revision cases (16/24, 66.7%) than in fresh ones (8/24, 33.3%). It was utilized at especially high rates for cystic disease and sinonasal tumors, in 83.3% (10/12) and 62.5% (5/8) of cases, respectively. It was not performed as often for NECRS or ECRS, at rates of 6.3% (5/79) and 8.3% (4/48), respectively. Our hospital employed Navis for ESS more often than other hospitals, on average, for cases of sinonasal tumor and chronic rhinosinusitis, whereas its use was equally common among hospitals for cases of cystic disease.

Eosinophilic chronic rhinosinusitis (ECRS) is an intractable form of sinusitis that is resistant to conservative treatment and often recurs after surgery. In recent years, the human anti-human IL-4/13 receptor monoclonal antibody (Dupilumab), which inhibits IL-4/13 signaling and suppresses various inflammatory responses to reduce nasal polyps and improve olfactory dysfunction, has been attracting attention as a new therapeutic agent for patients with inadequate control of sinusitis by existing treatments. In this case, a patient developed recurrent polyps and olfactory dysfunction about 6 months after undergoing a second endoscopic sinus surgery and was then started on Dupilumab. However, 3 months after the start of treatment, the patient developed EGPA, leading to discontinuation of treatment. Eosinophilic granulomatosis with polyangiitis (EGPA) developed during treatment of recurrent ECRS with Dupilumab. EGPA and ECRS are both characterized by increased eosinophil counts and bronchial asthma, and since both concepts overlap, it is often difficult to diagnose EGPA in the early stages of the disease, while ECRS is being observed. Although Dupilmab is basically a safe drug among the biological drugs, we believe it is important to fully explain the risks before treatment, and carefully follow up with blood tests, interviews, and physical findings to determine if there are any subjective symptoms, such as a sudden rise in peripheral eosinophil counts or numbness in the extremities, as part of the evaluation for the occurrence of EGPA during treatment.