The number of elderly dysphagia cases is increasing rapidly. Otorhinolaryngologists cannot avoid the treatment of swallowing. There are many cases of dysphagia during the pharyngeal period, and rehabilitation during the pharyngeal period is essential. Swallowing reflexes, glottic closure, cricopharyngeal muscle relaxation, and laryngeal elevation are required to prevent aspiration. There are many cases of developing pneumonia after eating cooked rice; in such cases, changing to porridge or a mixer avoids pneumonia, while posture and guidance reduce aspiration. Treatment according to the condition can reduce hospitalization and medical expenses.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Transoral resection of early-stage cancer of the hypopharynx is currently practiced, and our department has been performing endoscopic laryngopharyngeal surgery （ELPS） for Tis to some T3 cases. In this study, we examined the cases of cervical lymph node metastasis after ELPS at our department and found two cases among 38 cases from 2016 to 2021. Three cases were cured without metastasis or recurrence over a 5-year period.
The incidence of lymph node metastasis is high in early-stage hypopharyngeal carcinoma with a tumor thickness of over 1,000μm or vascular invasion on pathological examination. In all of the two metastatic cases and the three cured cases, pathological examination revealed a tumor thickness of more than 1,000μm, with no vascular invasion. However, endoscopic findings showed type 0-Ⅰs＋Ⅱc in the two metastatic cases, but type 0-Ⅰs in the three cured cases.
It is thought that endoscopic findings may be able to estimate the prognostic impact.

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It is often difficult to diagnose cases of globus pharyngeus or a foreign body in the pharynx because no abnormal findings are found when observing the pharynx and larynx. In such cases, it is effective to observe the esophagus using a conventional rhinolaryngoscope.
Method: After ordinary laryngoscopy, the tip of the endoscope is inserted into the esophagus. The inside of the esophagus is observed while the esophageal lumen is expanded by swallowing saliva or a small amount of water.
Results: Esophageal cancer, esophageal foreign bodies and steakhouse syndrome are observed.
Discussion: Although this method is uncomplicated, it is an effective examination because it allows immediate diagnosis when abnormal findings are observed. However, observation of the esophagus using a laryngeal endoscope has limitations in range and accuracy, so prudence is required in evaluating and making decisions when no abnormal findings are observed.

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Methotrexate （MTX） is widely used as a treatment for rheumatoid arthritis. It is known to cause stomatitis and bone marrow suppression as side effects, but there have been no reports of myelodysplastic syndrome （MDS）. We report a case of severe oral and pharyngeal mucosal erosions and pancytopenia during oral MTX administration, which led to the diagnosis of myelodysplastic syndrome. The patient was an 87-year-old woman who had been taking MTX for rheumatoid arthritis for 7 years. She came to the hospital because of difficulty eating with stomatitis. She was treated with intravenous drip as an outpatient, but the condition did not improve and she was hospitalized 3 days later. After admission, MTX was stopped, but the erosions of the oral cavity and laryngeal mucosa got worse, and also pancytopenia was observed, so a bone marrow examination was performed. The results showed MDS. We continued symptomatic treatment, the pancytopenia and mucosal erosions gradually improved and the patient was discharged from the hospital. The pancytopenia and mucosal erosions improved after MTX was discontinued in this patient, suggesting that MDS developed due to the cytotoxic effect of MTX. Caution is required when treating an elderly person taking MTX who has stomatitis, as it may be a precursor to serious side effects such as myelosuppression and MDS.

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Metastasis to the oral cavity accounts for about 1％ of all oral malignancies. Among them, tongue metastasis of pancreatic cancer is considered to be extremely rare. We report a case of tongue metastasis of pancreatic cancer. The patient was a 56-year-old man with a chief complaint of tongue pain and a mass on the tongue. In year X, he underwent pancreatectomy for pancreatic cancer cT3N1aM0, Stage ⅡB. In year X＋2, mediastinal lymph node recurrence occurred, and palliative chemotherapy was started. The patient underwent a regimen change due to PD and radiotherapy to the mediastinal lesion, and the disease was stable thereafter. In year X＋4, a painful mass lesion appeared on the tongue. After several appropriate tests, he was diagnosed with tongue metastasis of pancreatic cancer. The tongue tumor tended to grow and worsening pain made oral intake difficult, so a partial tongue resection was performed as palliative treatment. As a result, the patient’s tumor-induced tongue pain and oral intake improved. This surgical treatment contributed to the improvement of QOL in the terminal stage of cancer.

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[in Japanese]

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[in Japanese]

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We have experienced four cases of childhood Sjögren’s syndrome in our department and report their progress. The ages of the patients ranged from 7 to 14 years, and the sexes were two boys and two girls. Three patients had recurrent swelling of the major salivary glands, three had skin rash, and two had fever. None of the patients complained of dryness. All patients were positive for anti-SS-A/Ro antibodies, and one patient was positive for anti-SS-B/La antibodies. All patients underwent tests for salivary secretion by the gum test, sialography, and minor salivary gland biopsy, and had findings suggesting the presence of salivary gland destruction.
We performed salivary gland ultrasonography in all cases, which revealed hypoechoic areas and hyperechoic lines in the salivary glands in some cases. Ultrasonography is a minimally invasive test and is considered suitable for screening.
We have also had cases of aseptic meningitis and systemic lupus erythematosus as complications; collaboration with the Department of Pediatrics is necessary in the treatment of such cases.

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Although primary herpes simplex virus （HSV） infection is usually asymptomatic, it sometimes causes gingivostomatitis or pharyngolaryngitis. Serum viral titer is useful for diagnosis of HSV primary infection. However, even anti-HSV IgM antibody （HSV-IgM） frequently remains negative during the early phase of primary infection. Here, we describe two cases of pharyngitis caused by primary HSV infection, which showed different serological patterns of anti-HSV-IgM antibody and anti-HSV IgG antibody.

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Introduction: Nasogastric tubes are inserted for the purpose of enteral nutrition, gastric decompression, gastric lavage, drug administration, and specimen collection. The most common site of nasogastric tube insertion is into the trachea, but lung injury, pneumothorax, perforation of the gastrointestinal tract, and intracranial insertion have been reported. Here, we report a case of airway stenosis and cervical subcutaneous emphysema caused by pharyngolaryngeal swelling and hematoma after insertion of a nasogastric tube, which resulted in emergency surgery.
The patient was a 75-year-old male with the chief complaint of dyspnea, and a history of dementia and cerebral infarction. The patient was referred to our internal medicine department for a thorough examination of pleural effusion. After returning home, he developed pharyngeal pain and fever, right cervical swelling, epistaxis, and respiratory distress, and was brought to the emergency department of our hospital. He was referred to our department on suspicion of a cervical abscess. A submucosal hematoma and swelling were observed in the pharyngeal region, and the patient had airway stenosis. A contrast-enhanced CT scan of the cervical region showed an image of gas in the cervical region, suggesting infection with gas-producing bacteria, and so an incisional drainage procedure was performed on the same day. The patient’s general condition improved postoperatively, and he was discharged from the hospital.
Conclusion: The patient had a tendency to hemorrhage due to anticoagulant medication, and it was considered that submucosal hemorrhage and emphysema had spread extensively from the nasopharynx to the neck and caused airway narrowing due to mucosal damage of the nasopharyngeal cavity caused by the nasogastric tube.

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