Tracheostomy is commonly performed on patients who require long-term ventilator support. As with all other airway managements, tracheostomy comes with risks: tracheal scarring, tracheal rupture, pneumothorax, and tracheoesophageal fistula. Although rare, free air leakage into the surrounding tissues of the tracheostomy site and consequent pneumomediastinum can also occur due to various reasons, such as tracheal rupture and mispositioning of the tracheal tube. Such conditions may require treatments including high flow oxygen, ventilator management, and occasionally surgical intervention. In our case of a 61-year-old female, emergent tracheostomy was performed and subsequent complications of massive pneumomediastinum and subcutaneous emphysema were treated with negative pressure wound therapy. The follow-up radiograph after negative pressure wound therapy showed resolution of pneumomediastinum and subcutaneous emphysema, and there were no additional complications. Negative pressure wound therapy is an effective treatment option for massive pneumomediastinum and subcutaneous emphysema after tracheostomy.

Nasal valve collapse is one of the causes of nasal obstruction and must be considered in patients with nasal obstruction. There are several surgical procedures available to treat nasal valve collapse. Spreader grafts can be used in the treatment of nasal valve collapse by widening the internal nasal valve angle and maintaining the widened angle. However, this procedure requires sufficient amount of cartilage harvested from the nasal septum. Especially, in cases of secondary rhinoplasty or some primary nasal surgery with thin septal cartilage, it is difficult to harvest an appropriate amount of cartilage from the septum. Here, we describe an effective technique for using septal cartilage and TnR Nasal Mesh^® (T&R Biofab Co., Ltd) for spreader grafts with appropriate thickness in nasal valve collapse.

Cystic tumors arising from cystic dilatation of the excretory duct of the eccrine sweat glands or eccrine hidrocystoma are extremely rare in the external auditory canal. We describe a rare case of an eccrine hidrocystoma, confined to the external auditory canal in an adult patient. The lesion was completely excised via transcanal endoscopic approach. The diagnosis of eccrine hidrocystoma was made based on pathologic findings. Eccrine hidrocystoma should be considered as possible differential diagnoses of mass lesions in the external auditory canal.

Sebaceomas of the external auditory canal (EAC) are extremely rare. The recognition of sebaceoma is important as this benign tumor can be be part of the spectrum of the Muir-Torre syndrome (MTS), which is associated with visceral malignancy and multiple adenomatous polyps. Proper histological identification is thus important for further investigation. We describe a rare case of a sebaceoma that was confined to the EAC. Subsequent immunohistochemical (IHC) staining analysis of the mismatch repair genes (MLH1, MSH2, MSH6, and PMS2) was needed to investigate MTS. Even though the patient has had the history of colon cancer, the result was negative. Otorhinolaryngologists should be aware of rare sebaceoma and its potential association with the internal malignancy, besides the limitation of IHC screening test.

A perilymphatic fistula (PLF) is an abnormal leakage of the perilymph from the inner ear into the middle ear. A PLF may be trauma-induced or may occur with unknown causes. PLF repair should be considered when patients present with sudden or progressive sensorineural hearing loss with positional nystagmus. Although the leakage of perilymph is not always found during the exploration surgery, both hearing loss and dizziness tend to improve immediately after PLF repair. However, about 24% of patients who underwent PLF repair reportedly have experienced recurrent vestibular symptoms, suggesting the possibility of PLF recurrence or other vertigo causes. In this PLF patient, dizziness completely subsided after the PLF repair. However, several months later, the disabling paroxysmal positional vertigo developed, which was diagnosed as benign paroxysmal positional vertigo. Reported herein, with a review of the relevant literature, is a case of paroxysmal positional vertigo several months after PLF repair, where successful vertigo subsidence was finally achieved.