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Objective To determine if the COVID-19 vaccine can cause vestibular neuritis (VN). Design Retrospective study. Setting Vertigo outpatient clinic of the Department of Otolaryngology JR Tokyo General Hospital. Participants: 378 patients who presented at the Vertigo clinic between July 2018 and March 2022 Results 23 out of 378 cases were diagnosed with vestibular neuritis. There was a significant seasonal bias of the onset of VN in 2021-3Q compared to other seasons. All 7 patients diagnosed with VN whose onset was 2021-3Q and 2021-4Q had received the BNT162b2 (Pfizer-BioNTech) vaccine within the previous 3 months and one patient diagnosed with VN whose onset was 2022-1Q had a history of COVID-19 infection six months earlier. Conclusions VN should be recognized as one of the side-effects of the BNT162b2 COVID-19 vaccination.

Background/Objectives: The line bisection task (LBT) is a well-known test in which a horizontal line is presented in front of the subject and the subject is asked to draw a mark vertically bisecting the line. We developed the new LBT using three-dimensionally transformed rectangles to enhance the sense of depth and evaluated the influence of vestibular dysfunction on the deviation. Methods: One hundred participants were recruited from patients referred to the vertigo outpatient clinic. The average deviation in the LBT was the leftward deviation in the figures viewed from the right side and the rightward deviation in the figures viewed from the left side, indicating that the figures were perceived three-dimensionally, with the division point deviating to the far side. Results: In multivariate analysis of variance (MANOVA) analyses, the significant leftward deviation was observed in the group with vestibular dysfunction in caloric testing, and the significant rightward deviation dependent on increasing age was also observed. In univariate analyses, the significant leftward deviation in the figure viewed from the left side (135 degrees) was observed in the group with vestibular dysfunction in caloric testing, and the significant leftward deviation was also observed in figures viewed from the center, left or right side (0, 15 and 165 degrees) in the group with vestibular dysfunction in vHIT evaluation. Conclusions: Vestibular dysfunction can alter the deviation in the new LBT, suggesting the potential of the new LBT as an assessment of vestibular dysfunction.

Background/Objectives: This study aimed to examine the associations between diet-related quality of life (DRQOL) and psychological distress, autonomic dysfunction, and migraine in patients with dizziness and balance disorders. Methods: In this retrospective cross-sectional study, 122 patients (56 men, 66 women; mean age 40.4 ± 12.8 years, minimum 14, maximum 65) from the vertigo outpatient clinic at JR Tokyo General Hospital completed self-reported questionnaires. These included the DRQOL scale, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Self-rating Depression Scale (SDS), Orthostatic Dysregulation (OD) checklist, and migraine assessments (POUNDing [Pulsating, duration of 4–72 h, Unilateral, Nausea, Disabling], MIDAS, migraine screener). Correlational analyses, group comparisons, and receiver operating characteristic (ROC) analyses were conducted. Results: Higher DRQOL scores indicate poorer DRQOL. DRQOL scores showed positive correlations with psychological distress (SDS: ρ = 0.57; HADS-A: ρ = 0.50; HADS-D: ρ = 0.53; all p < 0.001) and OD severity (ρ = 0.50, p < 0.001) but not with age, DHI, or individual migraine indices. Migraine screener-positive patients had significantly higher DRQOL scores (p < 0.01). DRQOL alone showed modest ability to discriminate migraine screener-positive from migraine screener-negative patients (AUC = 0.65); discrimination improved to an AUC of 0.77 in a multivariable model that also included age and sex. Conclusions: DRQOL appears to capture psychological and autonomic symptom burden rather than vestibular or headache severity, suggesting that it may serve as a complementary, patient-centered metric that adds a multidimensional perspective to conventional vestibular and headache assessments.

This case report presents bilateral hearing loss after vestibular‐evoked myogenic potential (VEMP) testing. The loud acoustic stimulus used in VEMP testing can cause noise‐induced hearing loss in some cases with high sensitivity to noise exposure or by exceeding individual cochlear safety thresholds. This case report presents bilateral hearing loss after vestibular‐evoked myogenic potential (VEMP) testing. The loud acoustic stimulus used in VEMP testing can cause noise‐induced hearing loss in some cases with high sensitivity to noise exposure or by exceeding individual cochlear safety thresholds.

Background/Objectives: The objective of this study is to determine whether the strong acoustic stimuli used in vestibular evoked myogenic potential (VEMP) testing contribute to distortion product otoacoustic emission (DPOAE) level reduction due to noise-induced hearing loss. Methods: The DPOAE levels were measured routinely to evaluate vestibular balance disorders with sensorineural hearing loss and to monitor changes in cochlear function before and after VEMP. The changes in DPOAE levels after VEMP testing in 174 patients (80 males and 94 females; median age, 53 years [interquartile range, 39–67 years; range, 15–85 years]) who were examined in the vertigo outpatient clinic between June 2021 and December 2024 were retrospectively analyzed. Results: The DPOAE levels decreased significantly after VEMP testing at 1.4 kHz, 2 kHz, 2.8 kHz, sum all 1/2 octave, and average 1/2 octave (1–6 kHz). The decrease in DPOAE levels at 6 kHz exhibited a significant negative linear correlation with age (the coefficient of determination: 0.0189, p = 0.01), but not sex or side. Conclusions: The strong sound stimulation used in VEMP testing can decrease DPOAE levels. The frequencies at which DPOAE levels decreased significantly were overtones of the stimulus frequency, suggesting a possible effect of acoustic stimulation. VEMP testing can be an invasive test method and should be performed with detailed consideration of the risks and benefits. The age factor can influence the decrease in DPOAE levels in VEMP testing.

Background Acetazolamide, a carbonic anhydrase inhibitor, is used in the treatment of several otolaryngological conditions, including Meniere's disease (MD). Despite its efficacy in reducing vertigo attacks, it is associated with a high rate of adverse events such as sensory disturbances, electrolyte imbalances, and liver dysfunction. The primary objective of this study is to evaluate the efficacy of acetazolamide in reducing vertigo attacks in MD patients. The secondary objective is to determine the incidence and severity of adverse drug events associated with acetazolamide treatment in this patient population. Methodology The study subjects were 70 patients who visited the vertigo outpatient clinic of our department from March 2019 to July 2024 and were diagnosed with definite or probable MD. Results A total of 15 cases had a history of acetazolamide prescription, with doses ranging from 125 to 750 mg/day. In total, 12 (80%) patients had symptoms of numbness in hands, feet, or other parts of the body, which caused discontinuation of medication after the initial prescription in five cases. Hypokalemia with liver dysfunction and hypokalemia with an open fracture of the distal end of the right radius due to staggering were observed in one patient each. In both cases of hypokalemia, Chinese herbal medicines containing licorice were prescribed in combination. Overall, 11 (73%) cases had a decrease in vertigo attacks. Hearing thresholds did not recover significantly after the prescription. Conclusions Although acetazolamide is effective in preventing vertigo attacks of MD, the rate of adverse events is high. Detailed instructions, careful dosage adjustment, periodic assessment of symptoms, and blood examinations for electrolyte and liver function are required.

Introduction Tumor lysis syndrome (TLS) arises from the rapid breakdown of tumor cells during oncological treatment. Although TLS is rarely observed in solid tumors, few studies have documented instances of TLS associated with pembrolizumab. This report presents a case involving pembrolizumab‐induced TLS. Case Presentation A 76‐year‐old male patient with advanced renal pelvis cancer (T3N2M1) was treated with pembrolizumab as second‐line therapy. Four days after the initiation of therapy, the patient developed TLS. Despite intensive therapeutic interventions, he succumbed to the condition on the 10th day. Conclusion This case highlights a fatal TLS episode after pembrolizumab. Given its poor prognosis, blood monitoring and prophylaxis are warranted in intermediate‐risk patients, particularly when multiple non‐renal risk factors are present.

Although EGFR tyrosine kinase inhibitors (EGFR-TKIs) are effective for EGFR -mutant lung adenocarcinoma (LUAD), resistance inevitably develops through diverse mechanisms, including secondary genetic mutations, amplifications and as-yet undefined processes. To comprehensively unravel the mechanisms of EGFR-TKI resistance, we establish a biobank of patient-derived EGFR -mutant lung cancer organoids, encompassing cases previously treated with EGFR-TKIs. Through comprehensive molecular profiling including single-cell analysis, here we identify a subgroup of EGFR-TKI-resistant LUAD organoids that lacks known resistance-related genetic lesions and instead exhibits a basal-shift phenotype characterized by the hybrid expression of LUAD- and squamous cell carcinoma-related genes. Prospective gene engineering demonstrates that NKX2-1 knockout induces the basal-shift transformation along with EGFR-target therapy resistance. Basal-shift LUADs frequently harbor CDKN2A/B loss and are sensitive to CDK4/6 inhibitors. Our EGFR -mutant lung cancer organoid library not only offers a valuable resource for lung cancer research but also provides insights into molecular underpinnings of EGFR-TKI resistance, facilitating the development of therapeutic strategies. Resistance to EGFR tyrosine kinase inhibitors (EGFR-TKIs) is prevalent. Here the authors establish a biobank of patient-derived EGFR-mutant lung cancer organoids and identify a subgroup of EGFR-TKI-resistant lung adenocarcinoma organoids, which exhibit a basal-shift phenotype and vulnerability to CDK4/6 inhibitors.

Introduction The long‐term prognosis of endovascular stenting for ureteroarterial fistulas is not always favorable. We present a case in which endovascular repair of a ureteroarterial fistula led to the development of an infectious iliac artery pseudoaneurysm that required open vascular graft replacement 1 year later. Case presentation A 38‐year‐old woman with radiation‐induced vesicovaginal fistula and bilateral ureteral stenosis underwent urinary diversion using an ileal conduit. During left ureteral stent exchange, a ureteroarterial fistula occurred on the left side and was successfully treated with vascular stent grafting. One year later, gross hematuria recurred, requiring open surgical intervention because of the formation of an infectious pseudoaneurysm near the aortic bifurcation. Conclusion Several patients treated with stent grafting for ureteroarterial fistulas require subsequent reintervention. Urologists managing patients with ureteroarterial fistulas should collaborate closely with interventional radiologists and vascular surgeons to ensure comprehensive care.

Comprehensive genomic profiling (CGP) is useful for optimizing targeted therapy and immunotherapy strategies for thoracic malignancies. This study aimed to evaluate the clinical utility and diagnostic complementarity of the in‐house sequencing platform Rapid‐Neo. We retrospectively analyzed 110 patients with thoracic malignancies who underwent Rapid‐Neo testing. The baseline characteristics, sequencing results, concordance with companion diagnostics (CDx), and clinical outcomes were assessed. Of 110 patients, 100 (90.9%) had primary lung cancer. Rapid‐Neo identified at least one genomic alteration in 99.1% of cases and well‐established driver alterations in 66.0% of lung cancer cases. TMB‐high and MSI‐high statuses were observed in 9.0% and 2.0% of cases, respectively. Among the 90 cases with prior CDx, Rapid‐Neo identified driver alterations in 10.0% of the cases, including EGFR, KRAS, MET, RET, and ERBB2, suggesting its potential to overcome the limitations of conventional CDx tests. High concordance (96.8%) was observed between the Rapid‐Neo and CDx results, finally. In EGFR‐mutant lung adenocarcinoma, high tumor mutation burden (TMB) was associated with a significantly shorter progression‐free survival (PFS) after EGFR‐TKI therapy (HR = 2.58, p = 0.018) and remained an independent prognostic factor in multivariate analysis. Furthermore, among patients receiving immune checkpoint inhibitors (ICIs), favorable genomic markers such as TMB‐high or MSI‐high were associated with prolonged PFS. Rapid‐Neo demonstrated high sensitivity and concordance with CDx, while also identifying actionable driver alterations missed by the initial CDx. Moreover, the genomic markers identified by Rapid‐Neo may provide predictive values for both targeted therapy and immunotherapy responses, supporting their integration into routine clinical decision‐making. We clarified the utility and challenges of in‐house comprehensive genomic profiling (CGP) testing in lung cancer care.