Transoral pharyngeal ultrasonography (TOPU) is a new ultrasound technique for otorhinolaryngology. TOPU is applicated from transoral carotid ultrasonography, and useful for delineation of pharyngeal lesions. Peritonsillar abscesses is well known as common disease in otorhinolaryngology, and often needed a puncture drainage of abscesses. This procedure usually is performed blindly into the inside of pharynx, thus, it has a risk of fatal complications and low success rate. TOPU-guided needle aspiration appears to be useful for safe drainage of peritonsillar abscesses. We report a case of peritonsillar abscess whom we performed puncture drainage with TOPU guiding.

Background/Objectives: Migraine is frequently comorbid with Meniere’s disease, which may complicate interpretation of inner ear imaging and clinical diagnosis. While endolymphatic hydrops has been studied in Meniere’s disease and vestibular migraine separately, comparative imaging data for Meniere’s disease patients with and without migraine remain limited. Methods: We retrospectively analyzed 78 patients with definite Meniere’s disease who underwent endolymphatic contrast-enhanced MRI (HYbriD of Reversed image of Positive endolymph signal and native image of positive perilymph signal; or “HYDROPS”). Patients were classified as Meniere’s disease only group (n = 56), or Meniere’s disease with migraine (n = 22). The degree of endolymphatic hydrops (negative, mild, or significant) was assessed separately in the inner ear, the cochlea, and the vestibule. Results: In Meniere’s disease group, the affected ear consistently showed higher rates of significant endolymphatic hydrops compared to the healthy ear across the inner ear, cochlea, and vestibule (p < 0.01). In contrast, Meniere’s disease with migraine group showed no significant interaural differences. Meniere’s disease with migraine group showed a significantly higher frequency of significant endolymphatic hydrops in the healthy cochlea (p < 0.01). Similar patterns were observed in the inner ear (p < 0.025) and vestibule (p = 0.05), although these differences did not reach statistical significance. Bilateral hydrops was significantly more frequent in Meniere’s disease with migraine group than in Meniere’s disease group among all regions investigated (p < 0.05). Conclusions: Meniere’s disease patients with migraine exhibit a distinct endolymphatic hydrops pattern, characterized by bilateral or symmetrical hydrops and involvement of the healthy ear. These findings suggest migraine-related mechanisms may contribute to endolymphatic hydrops, and bilateral endolymphatic hydrops on endolymphatic contrast-enhanced MRI in suspected Meniere’s disease cases should prompt consideration of comorbid migraine, in addition to bilateral Meniere’s disease or asymptomatic hydrops.

The persistent stapedial artery (PSA) is an exceedingly vascular anomaly that can lead to hearing loss or pulsatile tinnitus, yet its preoperative diagnosis is often challenging. We report the case of a 24-year-old woman with bilateral PSA and stapes ankylosis who presented with progressive bilateral mixed hearing loss. The patient was initially diagnosed with bilateral congenital stapes ankylosis and stapes surgery was performed on the left side using transcanal endoscopic ear surgery (TEES). Intraoperative observation of the tympanic cavity revealed the presence of a persistent stapedial artery. The stapes surgery was completed successfully while preserving the stapedial artery, resulting in postoperative hearing improvement. Subsequently, surgery was planned for the right ear. Suspecting the possibility of PSA, we performed a contrast CT scan; additionally, we prepared subtraction images and CT angiography. These images strongly suggested the presence of the PSA on the right side as well. This case highlights the superior surgical visualization provided by TEES and underscores the effectiveness of advanced imaging techniques in diagnosing PSA.

Background Powered intracapsular tonsillectomy (PIT) is considered a less invasive alternative to conventional extracapsular tonsillectomy (cTE), potentially reducing postoperative pain and complications. However, most prior studies have been retrospective. Objective This study aimed to assess the clinical utility of PIT in comparison to cTE through a single-blind, randomized controlled trial. Methods In this prospective trial (registered with the WHO International Clinical Trials Registry Platform, ID: JPRN-UMIN000043776), patients undergoing PIT (n = 6) or cTE (n = 5) were evaluated. The primary outcome was postoperative pain measured by the FACES Pain Rating Scale (FRS). Secondary outcomes included analgesic use, dietary intake, and postoperative bleeding. Results The PIT group showed a trend toward lower FRS scores on postoperative days two to four (p = 0.053) and significantly reduced analgesic consumption (p < 0.001). No significant differences were found in dietary intake. No postoperative bleeding occurred in either group. Conclusion PIT was associated with significantly lower analgesic use and a trend toward reduced postoperative pain, with no increased risk of bleeding. PIT may be a safe and minimally invasive alternative to cTE, potentially facilitating earlier postoperative dietary advancement.

Cogan’s syndrome is characterized by ocular symptoms and auditory vestibular dysfunction. Auditory vestibular dysfunction in Cogan’s syndrome is believed to be similar to Ménière’s disease, but the cause is not known in detail. We present the case of a 10-year-old boy with Cogan’s syndrome. The patient had panuveitis, bilateral hearing loss, and bilateral vestibular dysfunction. MRI revealed no evidence of endolymphatic hydrops, which is a cause of Ménière’s disease, and enhanced contrast effects on the bilateral cochlear and vestibular apparatus. The caloric test, the video-head impulse test, and the vestibular evoked muscle potential test also showed severe vestibular dysfunction. Based on the above, the auditory vestibular dysfunction in this patient was considered to be caused by internal otitis. The patient’s vision recovered after treatment with steroids and immunosuppressive drugs, but his hearing did not recover. He underwent bilateral cochlear implantation and had a good postoperative course but we encountered difficulty in deciding when to perform cochlear implantation. This case demonstrates the importance of determining the timing of surgery in consideration of the ossification and fibrosis of the inner ear and the drug administration status.