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HypothesisDysbiosis of the intestinal microflora has been reported in stress-induced depression and irritable colitis, a similar abnormality may also occur in stress-triggered Meniere’s disease.BackgroundMeniere’s disease is an intractable disease characterized by paroxysms of intense rotatory dizziness, hearing loss, and other auditory symptoms. It is believed to be caused by endolymphatic hydrops of the vestibule and cochlea. The diagnosis of Meniere’s disease is based on the diagnostic criteria established by the Barany Society and AAO-HNS and Journal of Vestibular Research as definite or probable cases. Endolymphatic hydrops identification using cochlear contrast-enhanced MRI (hybrid of reversed image of positive endolymph signal and native image of positive perilymph signal [HYDROPS]) is an objective test for Meniere’s disease, enabling reliable diagnosis of this disease.MethodsWe investigated the gut microbiota of 10 patients (6 males and 4 females, mean age 49.6 ± 8.1 years) who met the diagnostic criteria for a unilateral definite case of Meniere’s disease using the diagnostic criteria of the Journal of Vestibular Research, and who also had significant endolymphatic hydrops on the affected side on HYDROPS. Intestinal microbiota tests were performed on these 10 patients and the results were evaluated in relation to the duration of disease, results of audiometry of the affected side, and DHI (Dizziness Handicap Inventory) score.ResultsA significant negative correlation was found between the disease duration and Shannon diversity index and Faith’s phylogenetic diversity, which indicated dysbiosis of the intestinal microflora. No correlation was found between the indicators of microbial diversity and the results of audiometry or the DHI on the affected side. Dysbiosis of the intestinal microbiota worsened with increasing duration of Meniere’s disease. Moreover,Akkermansia muciniphilawas not detected in any patient with Meniere’s disease.Conclusions.Despite the small number of cases in this study (n = 10), the findings indicate the possibility of abnormalities of the intestinal microflora in Meniere’s disease.

Propylthiouracil (PTU)-induced otitis media with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is an extremely rare adverse event associated with anti-thyroid drugs and is not well recognized. A 42-year-old woman with Graves' disease undergoing PTU therapy for 8 years visited our hospital because of earache and congested feeling in her left ear. Blood tests, a computed tomography scan and pure tone audiometry revealed otitis media and moderate mixed hearing impairment. Antibiotics, ear drops with antibiotics and painkillers were administered. However, her earache and hearing loss gradually got worse and symptoms of facial nerve palsy appeared. At several weeks after initiation of the treatment, a high serum level of myeloperoxidase (MPO)-ANCA, 75.6 U/mL, was revealed. After excluding other causes, she was diagnosed with OMAAV. PTU was suspected as the cause of her OMAAV and was immediately discontinued, and prednisolone was started. Hearing impairment in her left ear gradually got better and showed substantial improvement. Facial nerve palsy disappeared. Although PTU-induced OMAAV is an extremely rare disease, it is important to recognize the disease, as delayed treatment can lead to irreversible hearing loss, hypertrophic pachymeningitis, and subarachnoid hemorrhage. When patients taking anti-thyroid drugs, especially PTU, are diagnosed with refractory otitis media or hearing loss, it is possible that OMAAV might be the cause and thus serum ANCA levels should be evaluated.

Objective Adults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder. Methods : Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane. Results A total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4–53.7 cm) to 52.0 cm (95% CI, 48.9–55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6–53.2 cm) to 52.0 cm (95% CI, 48.9–55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7–98.4 cm/s) to 96.1 cm/s (95% CI, 88.3–103.9 cm/s) (p = 0.005). Conclusions Walking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.

Key Clinical Message Puncture drainage is usually needed to treat peritonsillar abscess. However, inadvertent carotid artery puncture may result in devastating complications. Preoperative transoral carotid ultrasonography (TOCU) is useful to delineate the anatomical relationship between the abscess and carotid artery. We present a case of peritonsillar abscess illustrating the utility of TOPU for safe drainage.