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Malignant otitis externa (skull base osteomyelitis) can be fatal and long-term antibiotic therapy is recommended. Despite being potentially fatal, this infection causes minor changes in inflammatory biomarkers (white blood cell count and C-reactive protein levels) upon blood testing. Computed tomography and magnetic resonance imaging changes persist over a long period. Therefore, it is difficult to determine the optimal time for the discontinuation of antibiotics. We present a 77-year-old male whose medical history included type 2 diabetes mellitus who suffered from chronic otitis media with Pseudomonas aeruginosa infection. His condition did not improve with proper treatment, and imaging revealed malignant otitis media. Intravenous cefepime treatment was administered. Antibiotic treatment was de-escalated to oral levofloxacin treatment after Gallium-67 scintigraphy showed less accumulation after 6 weeks of Cefepime administration; accumulation almost disappeared after 1 year. In this report, we describe the usefulness of gallium scintigraphy in the evaluation of malignant otitis externa.

Sternotomy is indicated when a goiter cannot be resected via a cervical incision, such as in the case of a substernal goiter extending beyond the aortic arch. In this article, we report a case of a large substernal goiter that was successfully removed using the cervical approach only. This is a case of a 68-year-old woman, diagnosed with goiter 20 years ago, who complained of a neck mass enlargement with associated cough. Pathological examination revealed no malignancy. Computed tomography (CT) scan showed an 11-cm thyroid mass reaching the level of the aortic arch. Preoperatively, we evaluated the substernal extent of the goiter via CT in the extended neck position to decide whether sternotomy was necessary. With the patient’s neck extended, the goiter withdraws cranially above the aortic arch. The mass was then removed via the cervical approach without sternotomy. Preoperative CT in the extended neck position was thus deemed helpful in deciding whether or not sternotomy was required.

Amyloidosis rarely occurs in the head and neck region and is extremely rare in the nasopharynx (3%). We encountered a case of nasopharyngeal amyloidosis discovered because of exudative otitis media. The patient presented to a local otolaryngology department with complaints of hearing loss, right exudative otitis media, and a nasopharyngeal mass. She was referred to our department for consultation. A diagnosis of AA type amyloidosis was made based on a biopsy of the mass. In a detailed systemic examination in internal medicine, there were no findings suggestive of systemic amyloidosis or the presence of a primary disease, leading to a diagnosis of localized nasopharyngeal amyloidosis. Surgical resection was difficult. However, in outpatient follow-up, no signs of a change to the systemic type were observed. If amyloid deposition is discovered in a particular organ, the prognosis is good if it is localized. It is however imperative to check whether it has a systemic nature through a detailed systemic examination. In addition, as the AA type may be secondary to rheumatoid arthritis or collagen disease, it is important to determine if there is a primary disease through a detailed examination. Since the transformation of localized amyloidosis to the systemic type has been reported, stringent follow-up is important.

Acquired ear canal stenosis can be caused by trauma, inflammation, postoperative scar formation, or tumors. There is a risk of cholesteatoma formation because of keratinized deposits in the closed space, with a reduction in quality of life because of conductive hearing loss. A cholesteatoma that has grown in a closed external auditory canal is difficult to find because of its location and the original hearing loss because of ear canal stenosis. Regarding imaging for cholesteatoma, CT absorption values are nonspecific, but MRIs are said to be effective. In an MRI, diffusion-weighted images are useful for distinguishing cholesteatoma. In surgery for ear canal stenosis, it is important to adopt strategies that will prevent post-operative restenosis and re-closure. If a cholesteatoma is also present, besides excising it, the ear canal should be enlarged. It is also important to follow-up patients with traumatic ear canal stenosis. We present a case of cholesteatoma associated with traumatic ear canal stenosis discovered 50 years after injury. Here, the cholesteatoma was diagnosed by MRI, and the external ear canal was enlarged during surgery. No postoperative recurrence was observed during follow-up.

Active learning refers to the settings in which a machine learning algorithm (learner) is able to select data from which it learns (selecting points and then obtaining their labels), and by doing so aims to achieve better accuracy (e.g., by avoiding obtaining training data that is redundant or unimportant). Active learning is particularly useful in cases where the labeling cost is high. A common assumption is that an active learning algorithm is aware of the details of the underlying learning algorithm for which it obtains the data. However, in many practical settings, obtaining precise details of the learning algorithm may not be feasible, making the underlying algorithm in essence a black box – no knowledge of the internal workings of the algorithm is available, and only the inputs and corresponding output estimates are accessible. This makes many of the traditional approaches not applicable, or at the least not effective. Hence our motivation is to use the only data that is accessible in black box settings – output estimates. We note that accuracy will improve only if the learner’s output estimates change. Therefore we propose active learning criterion that utilizes the information contained within the changes of output estimates.

Background/Aim: Nuclear protein in testis (NUT) carcinoma is extremely rare, occurs in the midline of the body, progresses rapidly and is refractory to treatment; most patients die within a year. Here, we describe a case of maxillary sinus NUT carcinoma presenting with epistaxis and nasal obstruction that was treated as a standard head and neck carcinoma. Case Report: The patient was a 41-year-old male with a left buccal swelling; the diagnosis was made of primary NUT carcinoma of the left maxillary sinus and bone metastasis in the cervical spine. After induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil, the tumor decreased in size, and the patient was further treated with cisplatin and radiation therapy. One month after that, the tumor remained small, however, lung metastasis was observed. Therefore, nivolumab was administered. Cetuximab and paclitaxel were administered after the lung metastasis worsened, but the patient developed progressive disease and died 11 months after diagnosis. Conclusion: Effective treatments for NUT carcinoma have not yet been established. However, early testing to establish the diagnosis may provide useful insights to guide clinical decisions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background/Aim: A pharyngeal fistula is the most common complication of total laryngectomy; thus, accurate diagnosis and treatment are important. Diagnosis is usually made by the finding of leakage of the contrast agent outside the pharynx during swallowing contrast examination. Herein, we encountered a case in which fine leaks not detected on contrast examination during swallowing were visualized and diagnosed by computed tomography (CT) imaging with oral contrast media with the patient in a prone position. Case Report: During imaging in a prone position, the contrast agent entered the sutures on the cephalocaudal and ventral sides of the surgical site, which were particularly prone to leaks due to gravity, and it was possible to diagnose minute leaks. When there is a high risk of postoperative pharyngeal fistula, such as in reconstructive cases with a pedunculated flap or with overlapping risk factors such as preoperative irradiation, CT imaging with contrast medium in a prone position is considered useful when swallowing contrast examination does not provide a clear diagnosis. However, suture failure is possible, and this should be evaluated. Conclusion: This case suggests that routine prone CT may lead to the early detection of postoperative pharyngeal fistula in high-risk cases. Further accumulation of cases is required to confirm our findings. [ABSTRACT FROM AUTHOR]