The patient was a 72-year-old woman who had eosinophilic otitis media that was intractable. The general treatment for this condition includes infusion of steroids into the tympanic cavity. However, since this case was complicated by aspirin-induced asthma, the patient experienced anaphylaxis (dyspnea) immediately after Kenacort-A^® was injected into the tympanic cavity. I have performed this treatment for intractable otitis media in outpatient departments for 10 years, but I have not encountered such a case. Along with the case report, I present a review of the literature and report the mechanism of the anaphylactic onset.

External auditory canal tumor is a relatively rare disease. There are many kinds of skin tumors in the external auditory canal; arising from cerumical gland, sweat gland, sebaceous gland, bone under the skin and so on. We reported 3 cases of external auditory canal mass having similar appearance. All 3 patients were pointed out the mass by chance when they visited the hospital. The appearance of 3 masses showed very similar, smooth surface and dark reddish-brown color, but each postoperative pathological diagnosis were different; cholesterin glanuloma, ceruminous adenocarcinoma and hemangioma. The diagnosis of external auditory canal tumor is often difficult before postoperative pathological examination. Therefore it is necessary to make a treatment plan with consideration for the possibility of a malignant tumor.

Since the first endolymphatic sac surgery (ELS) performed by Portmann in 1926, it has been widely performed to preserve hearing and vestibular function in Ménière’s disease (MD). However, in 1981, Thomsen reported that there was no significant difference between ELS and mastoidectomy performed as placebo suggesting that ELS merely had a placebo effect. Since his report, ELS has been criticized and its use put into question. If the surgery is still to be performed, what factors should be taken into account? In this paper, we discuss the current and future status of ELS that deals with analyzing anatomy as well as the function of the endolymphatic sac (ES); secondly, we cover findings of the ES obtained from patients with MD, and lastly go over ELS outcome based on our own experience, or in published literatures. Compared with cases where no surgery was performed, vertiginous attacks decreased significantly with ELS, and hearing could be preserved in cases with steroid instillation during ELS. In our experience, cases where ELS failed had psychiatric characteristics and in cases where the nystagmus could not be confirmed during a vertiginous attack. Thus, in order to improve ELS results, correct diagnosis of definite cases with MD, and administrating a test that can detect the potential presence of endolymphatic hydrops (EH) are both important. Observation of the presence of EH by MRI should also be considered as an important indicator in the future. For a neurotologist, ELS is a useful alternative for treating refractive cases with MD and is still valuable as a first choice in surgical treatment of MD.

Vertiginous symptoms in patients with benign paroxysmal positional vertigo (BPPV) usually disappear within a month after onset. However, these symptoms sometimes keep longer and/or have a recurrence to do damages to their daily life. Singular neurectomy and canal occlusion/plugging are situated in the center of surgical strategies for patients with intractable BPPV. The latter one, canal occlusion/plugging, is the most common surgery all over the world, because it is an absolutely safe and widely useful surgery. During the convalescence period, patients transiently show motion-evoked dizziness and low-tone air-bone gaps. More than one month after surgery, both findings disappear according to fixation of the plugged area (i.e. the third mobile window theory).

Hemifacial spasm (HFS) is an involuntary contraction of muscles on one side of the face. In Japan, this clinical entity is usually treated by the neurologists or neurosurgeons. However, we otolaryngologists sometimes have an occasion to see HFS patients at the initial consultation, so it is important for otolaryngologists to deepen the knowledge for the management of HFS. In some overseas hospitals, oto-neurosurgeons manage all kinds of HFS treatments, from initial diagnosis to surgery. Fortunately, we had an opportunity to learn these skills when studying abroad at such hospitals, and after coming back to Japan, we had an occasion to use that experience for the treatment of an HFS patient. Here we report the case of an HFS patient treated with oto-neurologic microvascular decompression in our department.