Long-term changes in serum squamous cell carcinoma antigen levels after surgery in patients with sinonasal inverted papilloma

鼻副鼻腔内反性乳頭腫の術後再発に対する血中 SCC 抗原の長期経過の検討

Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho

日本耳鼻咽喉科頭頸部外科学会会報


Vestibular compensation: Neural mechanisms and clinical implications for the treatment of vertigo.

receptor antagonist, has been shown to accelerate the late process in rats. Accordingly, long-term administration of betahistine is recommended for the treatment of subacute vertigo in patients who were not compensated for unilateral vestibular dysfunction. In the process of dynamic vestibular compensation after UL, the sensitivity of ipsi-MVe neurons to head velocity and acceleration is restored due to synaptic changes such as long-term potentiation and sprouting of commissures, resulting in the restoration of the dynamic vestibulo-ocular and vestibulo-spinal reflexes. To facilitate dynamic vestibular compensation, early ambulation and subsequent vestibular rehabilitation exercise are recommended for the treatment of chronic vertigo in patients with uncompensated unilateral vestibular dysfunction. Although vestibular compensation after bilateral vestibular loss is not expected, vestibular rehabilitation with a sensory-substitution strategy can improve imbalance in patients with bilateral vestibular lesions.


鼻中隔後端に生じたThyroid-like low-grade nasopharyngeal papillary adenocarcinoma例


特集 達人にきく! 厄介なめまいへの対応法 フレイル症例のめまいへの対応

特集 達人にきく! 厄介なめまいへの対応法 フレイル症例のめまいへの対応

Otolaryngology-Head and Neck Surgery (Tokyo)


特集 めまいを起こす薬·治す薬 原因·症状のおさらい&薬剤性めまいを見逃さない 軽視しない! めまいの薬物治療-めまいを治す薬の薬学的フォロー② めまい治療薬の特徴と使い分け


Effects of high-dose betahistine on intractable dizziness in patients with uncompensated unilateral vestibulopathy.

Short-term administration with the standard dose and dosing period of betahistine did not improve DHI scores in the enrolled patients, indicating that they were not compensated for unilateral vestibulopathy with intractable dizziness. The present findings suggest that long-term administration with high-dose betahistine facilitates vestibular compensation to improve intractable dizziness in some, but not all patients with uncompensated unilateral vestibulopathy.


The effects of continuous administration of diazepam on the recovery of lesion-induced nystagmus in unilaterally labyrinthectomised rats.

These findings suggested that continuous administration of diazepam accelerates the initial process of VC; however, it does not suppress the nystagmus-driving mechanisms in rats.


A Case of Cervical Gas Gangrene with Intractable Residual Pharyngeal Fistula That Was Closed Using a PGA Sheet

難治性咽頭瘻孔に対してPGAシートを併用した閉鎖術が有効であった頸部ガス壊疽例


Management of Peripheral Vestibular Dysfunction in Older Adults and Sensory Substitution Therapy Using TPAD for Intractable Dizziness

高齢者の末梢前庭障害への対応と難治例に対する TPAD による感覚代行治療


A Case of Downbeat Nystagmus Induced by Carbamazepine Intoxication

カルバマゼピン中毒により下眼瞼向き眼振を認めた薬剤性めまい症例


Comparison of the efficacy of the Epley maneuver and repeated Dix-Hallpike tests for eliminating positional nystagmus: A multicenter randomized study.


Risk factors of first bite syndrome after surgical resection of parapharyngeal space tumors.

The present findings suggest that concomitant surgical settings of 1) sympathetic denervation of the parotid gland with ligation of the external carotid artery or injury of the sympathetic nerve plexus around the external carotid artery during its mobilization, and 2) residual parotid gland tissue are risk factors for the development of first bite syndrome after surgical resection of parapharyngeal space tumors. J. Med. Invest. 70 : 150-153, February, 2023.

The Journal of Medical Investigation : JMI


Effect of Surgical Training Using a Virtual Reality Sinus Simulator in Medical Education

バーチャルリアリティーを用いた内視鏡下鼻副鼻腔手術シミュレーターによる医学教育実習の効果


Clinical Statistics of Patients with Dizziness and Vertigo at Tokushima University Hospital

当科のめまい外来の臨床統計 (武田憲昭教授退任記念総説集)


Clinical Outcomes of Treatment for Tongue Cancer at Tokushima University Hospital

当科における舌癌の治療成績 (武田憲昭教授退任記念総説集)


Hearing Outcomes After Tympanoplasty for Cholesteatoma at Tokushima University Hospital

当科における真珠腫性中耳炎の手術成績 (武田憲昭教授退任記念総説集)


Clinical Outcomes of Treatment for Laryngeal Cancer at Tokushima University Hospital

当科における喉頭癌の治療成績 (武田憲昭教授退任記念総説集)


New method to evaluate sequelae of static facial asymmetry in patients with facial palsy using three-dimensional scanning analysis.

The present findings suggest that affected-unaffected side differences in the depth of the nasolabial fold of the measured using three-dimensional scanning analysis can be used as an index of sequelae of static facial asymmetry. It is also suggested that the index can evaluate whether interventions are effective for the treatment of sequelae.


Long-term changes in serum squamous cell carcinoma antigen levels after surgery in patients with sinonasal inverted papilloma.

These findings suggest that SCCA can be a tumor marker of IP. It is also suggested that postoperative elevation of SCCA levels is a clinical marker for monitoring the recurrence of IP during the follow-up period. A SCCA cut-off value of 1.85 ng/ml postoperatively may predict the subsequent recurrence of IP with high sensitivity and specificity.


Development of receptive vocabulary and verbal intelligence in Japanese children with unilateral hearing loss.

These findings suggest that the development of receptive vocabulary and verbal intelligence was delayed in preschool-age children with UHL and that most of them caught up to exhibit normal language ability after school admission.


Aural stimulation with capsaicin prevented pneumonia in dementia patients

カプサイシン軟膏による外耳道刺激は高齢認知症患者の肺炎を予防する

Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho

日本耳鼻咽喉科頭頸部外科学会会報


Dietary Supplementation with Monosodium Glutamate Suppresses Chemotherapy-Induced Downregulation of the T1R3 Taste Receptor Subunit in Head and Neck Cancer Patients.

(Background) We investigated the effect of dietary supplementation with monosodium glutamate (MSG) on chemotherapy-induced downregulation of the T1R3 taste receptor subunit expression in the tongue of patients with advanced head and neck cancer. (Methods) Patients undergoing two rounds of chemoradiotherapy were randomly allocated to a control or intervention group (dietary supplementation with MSG at 2.7 g/day during the second round of chemotherapy). The relative expression of T1R3, a subunit of both umami and sweet taste receptors, in the tongue was assessed by quantitative polymerase chain reaction analysis. Dysgeusia was assessed with a visual analog scale and daily energy intake was evaluated. (Results) T1R3 expression levels in the tongue, taste sensitivity, and daily energy intake were significantly reduced after the first round of chemotherapy compared with before treatment. Furthermore, these parameters significantly decreased after the second round of chemotherapy, but the extent of decrease was significantly attenuated in the MSG group compared with the control group. (Conclusions) MSG supplementation suppresses chemotherapy-induced dysgeusia, possibly due to the inhibition of the T1R3-containing taste receptor downregulation in the tongue, thereby increasing energy intake in patients with advanced head and neck cancer.


Effects of vocal nodules on acoustic characteristics of voice in children : an acoustic analysis of voice.

Objective : In the present study, an attempt was made to evaluate the acoustic characteristics of voice in pediatric patients with vocal nodules using acoustic analysis of voice. Methods : Thirty-five pediatric patients with vocal nodules and 32 control children without dysphonia were enrolled in this study. Their voice samples were analyzed using the Multi-Dimensional Voice Program. Acoustic parameters of voice, such as pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR), were measured. Results : In phonation at a loudness of over 80 dBA, the PPQ, APQ, and NHR values of the voice significantly increased in children with vocal nodules than in the control children without dysphonia. The sensitivities and specificities of PPQ, APQ, and NHR for prediction of vocal nodules in children were 62.86% and 84.38%, 74.29% and 75.00%, and 31.43% and 93.75%, respectively. Discussion : The present findings suggest that vocal nodules affect vocal fold vibration, resulting in impaired control of pitch and loudness leading to increased noise components. NHR could be used to evaluate the efficacy of treatment, such as voice rehabilitation, in pediatric patients with vocal nodules because of its high specificity for prediction of vocal nodules in children. J. Med. Invest. 68 : 276-279, August, 2021.

The Journal of Medical Investigation : JMI


Vestibular and cochlear nerve enhancement on MRI and its correlation with vestibulocochlear functional deficits in patients with Ramsay Hunt syndrome.

In patients with RHS, the origin of vertigo may be superior vestibular neuritis, which is affected by reactive varicella-zoster virus from the geniculate ganglion of the facial nerve through the faciovestibular anastomosis. The results also suggested that in some RHS patients, inferior vestibular neuritis contributes to the development of vertigo and that the origin of refractory sensorineural hearing loss is cochlear neuritis.

Among RHS patients, 79%, 53%, 17% and 26% showed CP in the caloric test, abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, respectively. SIinc rates of the SVN were significantly increased in RHS patients with CP in the caloric test, and with abnormal responses to oVEMP and cVEMP. SIinc rates of the SVN tended to increase in RHS patients with refractory sensorineural hearing loss (p = 0.052). SIinc rates of the IVN were significantly increased in RHS patients with abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, but not in those with CP in the caloric test. SIinc rates of the CN were significantly increased in RHS patients with CP in the caloric test, abnormal response to oVEMP and refractory sensorineural hearing loss, but not in those with abnormal response to cVEMP.


Effects of Betahistine on the Development of Vestibular Compensation after Unilateral Labyrinthectomy in Rats.

These findings suggest that betahistine facilitated the late, but not the initial, process of VC in UL rats.


Stratification of hippocampal electrophysiological activation evoked by selective electrical stimulation of different angular and linear acceleration sensors in the rat peripheral vestibular system.

It has become well established that vestibular information is important for hippocampal function and spatial memory. However, as yet, relatively little is known about how different kinds of vestibular information are 'represented' in different parts of the hippocampus. This study used selective electrical stimulation of each of the 5 vestibular sensors (the horizontal (HC), anterior (AC) and posterior (PC) semi-circular canals, and the utricle and saccule) in the rat and recorded local field potentials (LFPs) across the hippocampus, using a 16 electrode microarray. We found that stimulation of any vestibular sensor in the left labyrinth evoked triphasic LFPs in both hippocampi, although it was clear that, in general, the amplitudes were greater for the right, contralateral side. This was particularly true for Phase 1 for the HC, AC, utricle and saccule, Phase 2 for the HC, PC, utricle and saccule, and Phase 3 for the AC, PC and saccule. Overall, our results suggest that vestibular input to the hippocampus is bilateral, preferentially contralateral, but highly stratified in that stimulation of the same vestibular sensor results in activation of different specific areas of the hippocampus, with different LFP amplitudes and latencies. This suggests the possibility that different regions of the hippocampus use different kinds of vestibular information for different purposes and that there may be a high degree of redundancy in the representation of vestibular input, perhaps ensuring that the hippocampus is more robust to the partial loss of vestibular information.


Differential cytokine profiles in pediatric patients with PFAPA syndrome and recurrent tonsillitis.

Objective : An attempt was made to identify characteristic cytokine profiles to distinguish periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPAS) from recurrent tonsillitis, of which clinical manifestations are similar to those of PFAPAS in children. Methods : Serum concentrations of IL-6, IL-4 and IFN-γ were measured during febrile episodes in pediatric patients. Results : The levels of IL-6 during febrile episodes were markedly increased above the upper limit of normal ranges in patients with both PFAPAS and recurrent tonsillitis, but there were no significant differences between groups. The levels of IL-4 during febrile episodes in PFAPAS patients were significantly lower than those in recurrent tonsillitis patients. The levels of IFN-γ during febrile episodes in PFAPAS patients were significantly higher than those in recurrent tonsillitis patients. Conclusion : In pediatric patients with PFAPAS, despite an increase of IL-6, IL-4 was suppressed with a marked increase of IFN-γ during febrile episodes. On the contrary, in febrile pediatric patients with recurrent tonsillitis, both IL-6 and IL-4, but not IFN-γ were increased. The characteristic cytokine profiles of IL-6, IL-4 and IFN-γ can be used for differential diagnosis of PFAPAS from recurrent tonsillitis in children in clinical ear, nose and throat (ENT) settings. J. Med. Invest. 68 : 38-41, February, 2021.

The Journal of Medical Investigation : JMI


A Case of Extramedullary Relapse of APL on the Tympanic Membrane

鼓膜に髄外再発した急性前骨髄球性白血病例

Temporal bone lesions are rarely seen in patients with acute promyelocytic leukemia (APL) during the remission phase. We report a case of APL who showed extramedullary relapse on the tympanic membrane while in the complete remission phase. A 48-year-old male patient with APL in complete remission after the initial therapy presented with left ear fullness. Endoscopic examination revealed a mass on the left tympanic membrane, and temporal bone CT showed a mass localized on the left tympanic membrane. He was diagnosed as having extramedullary relapse of APL based on the histopathological findings of the lesion on the tympanic membrane. There were no APL cells in the blood or bone marrow. However, PCR analysis revealed the presence of PML-RARα in the bone marrow. Based on these findings, we diagnosed the patient as having molecular recurrence of APL, and administered chemotherapy. During the treatment, the ear lesion decreased steadily in size, and finally disappeared. Absence of PML-RARα in the bone marrow specimen after the treatment indicated that the patient had entered the second remission phase. Subsequently, hematopoietic stem-cell transplantation was performed, and the patient remains in remission. In a patient with a history of leukemia presenting with temporal bone lesions, extramedullary relapse should be considered in the differential diagnosis even if the patient is in the remission phase.


Effects of corticosteroid on mRNA levels of histamine H1 receptor in nasal mucosa of healthy participants and HeLa cells.

The purpose of this study is to examine the effect of intranasal corticosteroid (INCS) administration on histamine H1 receptor (H1R) gene expression in the nasal mucosa of healthy participants and the effects of dexamethasone on basal and histamine-induced H1R mRNA expression, and histamine-induced phosphorylation of extracellular signal-regulated kinase (ERK) in HeLa cells. Sixteen healthy participants were given INCS once daily for a week. After pretreatment of dexamethasone, HeLa cells were treated with histamine. Levels of H1R mRNA and phosphorylation of ERK were measured using real time PCR and immunoblot analysis, respectively. Levels of H1R mRNA in the nasal mucosa of healthy participants receiving INCS was significantly decreased. Dexamethasone suppressed basal levels of H1R mRNA, and histamine-induced up-regulation of H1R mRNA and ERK phosphorylation in HeLa cells. These data suggested that corticosteroid inhibited both basal transcription and histamine-induced transcriptional activation of H1R through its suppression of ERK phosphorylation in the signaling pathway involved in H1R gene transcription. It is further suggested that pre-seasonal prophylactic administration of INCS suppresses both basal and pollen-induced upregulation of H1R gene expression in the nasal mucosa of patients with pollinosis, leading to prevention of the exacerbation of nasal symptoms during peak pollen season. J. Med. Invest. 67 : 311-314, August, 2020.


The effects of selective electrical stimulation of the rat cochlea on hippocampal field potentials.

The hippocampus is a brain structure well known for its importance to spatial learning and memory. As such it is assumed to use multisensory integration in order to generate mathematical maps of the spatial environment. Auditory inputs to the hippocampus have been described to a limited extent. Although it has been demonstrated that natural auditory stimulation can evoke local field potentials (LFPs) and single neuron responses in the hippocampus, and that noise trauma and tinnitus can cause maladaptive hippocampal plasticity, to the best of our knowledge no one has selectively, electrically stimulated the cochlea and recorded electrophysiological responses in the hippocampus. Here, we used unilateral electrical cochlear stimulation in rats while recording LFPs in the hippocampus bilaterally, with a multi-electrode array. We observed triphasic LFP responses bilaterally from unilateral stimulation, but with larger amplitudes on the contralateral side, especially for Phase 1 and 3 of the LFP, for which the latencies were also longer. The latencies under urethane anaesthesia were consistent with auditory information from the cochlea travelling across approximately 6-7 synapses. These data demonstrate that the cochlea contributes a powerful auditory input to the hippocampus, which is also lateralized, and may have implications for spatial cognition in cochlear implant patients.


ベタヒスチンが一側内耳破壊ラットの前庭代償過程に与える影響

ベタヒスチンが一側内耳破壊ラットの前庭代償過程に与える影響

耳鼻咽喉科ニューロサイエンス

耳鼻咽喉科ニューロサイエンス


上眼瞼向き自発眼振，方向交代性背地性頭位眼振と低音障害型感音難聴を呈した第四脳室毛様細胞性星細胞腫例


Daily auricular stimulation with capsaicin ointment improved cough reflex sensitivity in elderly patients with dysphagia: a pilot study.

Daily auricular stimulation with capsaicin ointment would be a safe and effective intervention to prevent pneumonia in elderly with a risk of aspiration.


Electroneurography cannot predict when facial synkinesis develops in patients with facial palsy.

The objective of this study is to clarify when facial palsy patients with lower value of Electroneurography (ENoG) should begin the rehabilitation to prevent the development of facial synkinesis. For this purpose, we examined the relationship between the value of ENoG measured 10-14 days after facial palsy onset and the onset day of the development of oral-ocular synkinesis. Sixteen patients with facial palsy including 11 with Bell's palsy and 5 with Ramsay Hunt syndrome (7 men and 9 women ; 15-73 years old ; mean age, 41.6 years) were enrolled in this study. There was no correlation between ENoG value and the onset day of the development of oral-ocular synkinesis (ρ = .09, p = .73). Oral-ocular synkinesis began to develop in 4.0 ± 0.7 months (mean ± SD ; range : 3.1-5.0 months) after facial palsy onset regardless of ENoG value. In conclusion, ENoG value cannot predict when facial synkinesis develops in patients with facial palsy. We recommend that facial palsy patients with a high risk for the development of synkinesis begin the biofeedback rehabilitation with mirror to prevent the development of facial synkinesis 3 months after facial palsy onset. J. Med. Invest. 67 : 87-89, February, 2020.

The Journal of Medical Investigation : JMI


Aural stimulation with capsaicin prevented pneumonia in dementia patients.

These findings suggest that daily long-term aural stimulation with capsaicin ointment enhanced the cough reflex via Arnold's ear-cough reflex as a glottis protective measure, resulting in the reduction of incidence of pneumonia in elderly dementia patients at high risk of aspiration. The daily aural stimulation with capsaicin ointment may be a safe and promising intervention to prevent aspiration pneumonia in elderly people, especially those who cannot undergo swallowing exercise.


Comparative study of anti-vertiginous and anti-anxious drugs for the treatment of chronic vestibular patients with secondary anxiety.

Targeting for comorbid anxiety was beneficial for subjective symptoms of chronic dizziness with secondary anxiety.

Forty-three patients who had chronic dizziness lasting more than three months due to organic vestibular diseases with secondary anxiety. Anxiety was evaluated by the State-Trait Anxiety Inventory (STAI). Subjective handicaps due to dizziness were assessed by the validated questionnaire consisted of 14 questions that were categorized into two physical and three emotional factors. During the initial six months of the study, 21 patients were treated by anti-anxious benzodiazepines (loflazepate, 2 mg/day) for four weeks, whereas anti-vertiginous cholinergic antagonist (diphenidol, 75 mg/day) was used for four weeks for other 22 patients during the later six months-period. Subjective handicaps and STAI were compared between pre- and post-treatment.


動物モデルを用いた免疫組織化学的手法により前庭代償の新しい評価法

動物モデルを用いた免疫組織化学的手法により前庭代償の新しい評価法

耳鼻咽喉科ニューロサイエンス

耳鼻咽喉科ニューロサイエンス


A new immunohistochemical method to evaluate the development of vestibular compensation after unilateral labyrinthectomy in rats.

These findings suggested that the number of MK801-induced Fos-LIR neurons in contra-MVe was decreased in concordance with the restoration of ipsi-MVe-activity during the late process of VC after UL and that thioperamide accelerated the late, but not the initial process of VC.


Effect of Surgical Training Using a Virtual Reality Temporal Bone Simulator in Medical Education

医学教育におけるバーチャルリアリティーを用いた側頭骨手術シミュレーション実習の効果

 To estimate the effects of a virtual reality temporal bone simulator in medical education.

 Two hundred and thirty-five medical students undergoing bedside learning were recruited in this study for two years. The same instructor provided the training during the first year, while several instructors provided the training, based on a guidance manual, during the second year. We examined the students' knowledge of anatomy of the temporal bone and administered a questionnaire to determine their comprehension of surgical procedures involving the temporal bone after the training as compared to the level of understanding before the training.

 The percentage of correct answers in the examination of anatomical knowledge about the temporal bone after the simulation in the first and second year improved from 51.8% to 83.9% and 49.4% to 80.0%, respectively. The percentages of medical students who responded with "well understood" or "I think I understood" to questions in the questionnaire on comprehension of surgical procedures involving the temporal bone in the first and second year were 84.3% and 76.4% for mastoidectomy, 74.8% and 66.4% for tympanotomy and 67.8% and 52.3% for cochleostomy, respectively. The anatomical and surgical comprehension levels, except for the case of cochleostomy, did not differ between students who received instructions from several instructors and those who received from the same instructor in this study. The training using a virtual reality temporal bone simulator was useful to improve the students' anatomical knowledge about the temporal bone and their comprehension of surgical procedures involving the temporal bone, and to unify the training content, regardless of the instructor because of standardization and customization of the surgical procedure. Thus, the training using a virtual reality temporal bone simulator is one of the most effective tools of medical education for both medical students and instructors.


Vestibular-related eye movements in the rat following selective electrical stimulation of the vestibular sensors.

Rats are the most commonly used species in the neurosciences; however, little is known about the effects of selective electrical stimulation of individual vestibular sensors, on their eye movements. This limits their use to study the effects of vestibular stimulation on the brain, and their use in further exploring novel technologies such as artificial vestibular implants. We describe the effects of electrical stimulation of each vestibular sensor on vestibular-related eye movement in rats and compared the results to other species. We demonstrated that each sensor is responsible for specific bilateral eye movements. We found that the eye movements in rats differed from other species. Although the results were similar when stimulating the horizontal canal ampulla, differences appeared when stimulating the vertical canal sensors. During utricular stimulation, the ipsilateral eye moved dorsally in most cases, while the contralateral eye usually moved either caudally, or in extorsion. Saccular stimulation usually moved the ipsilateral eye dorsally or ventrally, while the contralateral eye usually moved ventrally or caudally. This study provides the first data on the application of selective electrical vestibular stimulation in the rat to the study of vestibular-related eye movements.

Journal of Comparative Physiology. A, Neuroethology, Sensory, Neural, and Behavioral Physiology


Effects of electrical stimulation of the rat vestibular labyrinth on c-Fos expression in the hippocampus.

Several studies have demonstrated that electrical activation of the peripheral vestibular system can evoke field potential, multi-unit neuronal activity and acetylcholine release in the hippocampus (HPC). However, no study to date has employed the immediate early gene protein, c-Fos, to investigate the distribution of activation of cells in the HPC following electrical stimulation of the vestibular system. We found that vestibular stimulation increased the number of animals expressing c-Fos in the dorsal HPC compared to sham control rats (P ≤ 0.02), but not in the ventral HPC. c-Fos was also expressed in an increased number of animals in the dorsal dentate gyrus (DG) compared to sham control rats (P ≤ 0.0001), and to a lesser extent in the ventral DG (P ≤ 0.006). The results of this study show that activation of the vestibular system results in a differential increase in the expression of c-Fos across different regions of the HPC.


Effects of repeated snowboard exercise in virtual reality with time lags of visual scene behind body rotation on head stability and subjective slalom run performance in healthy young subjects

After repeated snowboard exercises in the virtual reality (VR) world with increasing time lags in trials 3-8, it is suggested that the adaptation to repeated visual-vestibulosomatosensory conflict in the VR world improved dynamic posture control and motor performance in the real world without the development of motion sickness. The VR technology was used and the effects of repeated snowboard exercise examined in the VR world with time lags between visual scene and body rotation on the head stability and slalom run performance during exercise in healthy subjects. Forty-two healthy young subjects participated in the study. After trials 1 and 2 of snowboard exercise in the VR world without time lag, trials 3-8 were conducted with 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6 s time lags of the visual scene that the computer creates behind board rotation, respectively. Finally, trial 9 was conducted without time lag. Head linear accelerations and subjective slalom run performance were evaluated. The standard deviations of head linear accelerations in inter-aural direction were significantly increased in trial 8, with a time lag of 0.6 s, but significantly decreased in trial 9 without a time lag, compared with those in trial 2 without a time lag. The subjective scores of slalom run performance were significantly decreased in trial 8, with a time lag of 0.6 s, but significantly increased in trial 9 without a time lag, compared with those in trial 2 without a time lag. Motion sickness was not induced in any subjects.


Anatomy and surgical approach of rat's vestibular sensors and nerves

The rat is one of the most used species in the neurosciences, but how to selectively reach each of its 5 vestibular sensors has never been described. Besides, new functions of the vestibular system have been recently discovered in the rat involving vegetative, circadian and cognitive functions. But the central pathways sustaining these functions and the role of each of the vestibular sensors are not clear. Here we want to describe the anatomy and look for a direct surgical approach to the 5 vestibular sensors in rats, as an indispensable technique to further study the central vestibular pathways. To do so we studied 10 rats either by microtomography with osmium tetroxide staining, histology with hematoxilyn-eosine staining or microsurgical dissection. The microtomography allows a 3D representation of the 5 vestibular sensors and their nerves, with precise landmarks confirmed by the histological analysis. Each of the landmarks are illustrated and a selective surgical approach to each sensor and their nerves, is described step by step. Selective approaches to the vestibular sensors have been used in other species such as cats, monkeys and recently humans but the current study is the first allowing this technique in rats. Each vestibular sensor of the rat can be reached by a selective surgical approach. This allows further techniques such as electrophysiology or neurotracing of the central vestibular pathways. This also indicates the rat as a potential model for vestibular prostheses.


The temperature of aural air stimulation equivalent to aural stimulation with water at 20<SUP>°</SUP>C in the caloric test.

少量注水法に対応するエアーカロリック検査の刺激条件の検討

In the present study, we examined the temperature of aural air stimulation that was equivalent to aural stimulation with water at 20°C in the caloric test. In 10 ears of 5 healthy volunteers, the maximum slow phase eye velocities (MSPEVs) of nystagmus induced by aural stimulation with air at 22°C, 46°C and 16°C were the same as those with water at 30°C, 44°C and 20°C, respectively. These findings suggest that caloric stimulation with air at 16°C is equivalent to that with water at 20°C that is commonly used in the caloric test in Japan. The MSPEVs of nystagmus induced by aural stimulation with air at 16°C were over 20°/sec in all ears except one, in which the MSPEV was 19.7°/sec. The criteria of canal paresis where the MSPEV of caloric nystagmus induced by aural stimulation with water at 20°C is less than 20°/sec can be used in the caloric test with aural air stimulation at 16°C.


Long-term prognosis of hearing loss in patients with unilateral Ménière's disease.

Abstract Conclusion: The finding of deteriorated hearing loss at the initial visit at middle to high frequencies is a factor of poor hearing prognosis in Ménière's disease. Early intervention with instructions for lifestyle changes may lead to good outcomes in hearing. Objective: An attempt was made to examine long-term changes in hearing loss in unilateral Ménière's disease and factors associated with prognosis of hearing loss retrospectively. Methods: Based on their last hearing level of the affected ear, 36 patients were subdivided into two groups: the poor prognosis of hearing (PPH) group and the good prognosis of hearing (GPH) group. Results: In the PPH group, the hearing levels at the initial visit at middle and high frequencies were significantly worse than those in the GPH group. Moreover, the hearing loss progressed during the first 2 years of the disease, and stayed flat to approximately 50 dB at the later stage. Conversely, the hearing loss at the onset in the GPH group showed no further progression over the first 2 years, and remained constant to approximately 35 dB at the later stage. In addition, the mean intervals from the onset to the initial visit in the PPH group were significantly longer than those in the GPH group.


Galvanic vestibular stimulation impairs cell proliferation and neurogenesis in the rat hippocampus but not spatial memory.

Galvanic vestibular stimulation (GVS) is a method of activating the peripheral vestibular system using direct current that is widely employed in clinical neurological testing. Since movement is recognized to stimulate hippocampal neurogenesis and movement is impossible without activation of the vestibular system, we speculated that activating the vestibular system in rats while minimizing movement, by delivering GVS under anesthesia, would affect hippocampal cell proliferation and neurogenesis, and spatial memory. Compared with the sham control group, the number of cells incorporating the DNA replication marker, bromodeoxyuridine (BrdU), was significantly reduced in the bilateral hippocampi in both the cathode left-anode right and cathode right-anode left stimulation groups (P ≤ 0.0001). The majority of the BrdU(+ve) cells co-expressed Ki-67, a marker for the S phase of the cell cycle, suggesting that these BrdU(+ve) cells were still in the cell cycle; however, there was no significant difference in the degree of co-labeling between the two stimulation groups. Single labeling for doublecortin (DCX), a marker of immature neurons, showed that while there was no significant difference between the different groups in the number of DCX(+ve) cells in the right dentate gryus, in the left dentate gyrus there was a significant decrease in the cathode left-anode right group compared with the sham controls (P ≤ 0.03). Nonetheless, when animals were tested in place recognition, object exploration and Morris water maze tasks, there were no significant differences between the GVS groups and the sham controls. These results suggest that GVS can have striking effects on cell proliferation and possibly neurogenesis in the hippocampus, without affecting spatial memory.


Risk factors for poor outcome of a single Epley maneuver and residual positional vertigo in patients with benign paroxysmal positional vertigo.

The findings suggest that in patients with posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (P-BPPV), head trauma and prolonged bedrest, but not inner ear disease, are risk factors for poor outcome of a single Epley maneuver and persistent residual positional vertigo. We first examined the efficacy of a single Epley maneuver and then assessed the time course in remission of residual positional vertigo in patients with idiopathic P-BPPV and secondary P-BPPV. A total of 157 patients with idiopathic P-BPPV and 40 patients with secondary P-BPPV (secondary to head trauma in 8 patients, to prolonged bedrest in 14 patients, and to inner ear disease in 18 patients) were treated with a single Epley maneuver. The negative rates of the Dix-Hallpike test on day 7 after a single Epley maneuver in both patients with P-BPPV secondary to head trauma (25%) and those with prolonged bedrest (36%) were significantly lower than that (73%) in patients with idiopathic P-BPPV. Additionally, the remission of residual positional vertigo in the former groups of patients was significantly delayed in comparison with that of the latter group. However, there were no significant differences in the efficacy of a single Epley maneuver and persistent residual positional vertigo between idiopathic P-BPPV and P-BPPV secondary to inner ear disease.


Therapeutic effects of diphenidol and betahistine on acute vertigo as determined by the self-assessment of handicap in daily life due to vertigo

急性期のめまいに対するジフェニドールとベタヒスチンの治療効果 患者による日常生活の障害の改善から評価した治療効果の比較

Diphenidol and betahistine are anti-vertigo medications used for the treatment of vertiginous disorders. In the present study, we compared the therapeutic effects of diphenidol and betahistine on the handicap in daily life due to vertigo in patients with acute vertigo. The administration of diphenidol for four weeks significantly decreased the scores for factor 1: handicap in social activities, factor 2: handicap in head movements, factor 3: handicap in body movements, factor 4: handicap in emotion, factor 5: handicap in human interactions and factor 6: handicap due to discomfort. Because diphenidol has both anti-vertigo and anti-emetic actions, these findings suggested that its administration for four weeks recovered the functional handicap associated with factors 2 and 3 and the discomfort handicap of factor 6, resulting in recovery of the social handicap in factors 1 and 5 and emotional handicap (factor 4) in patients with vertigo. On the other hand, the administration of betahistine for four weeks only significantly decreased the scores of factors 1 and 5. This finding suggested that long-term administration of betahistine may be necessary to recover the other factors associated with handicap in patients with vertigo, because betahistine is reported to gradually accelerate the process of vestibular compensation after the development of vestibular asymmetry.

今回，われわれはめまいによりもたらされる日常生活の障害の程度を客観的に評価できるアンケートを用い，ジフェニドールとベタヒスチンの治療効果を比較検討した．ジフェニドールは 4 週間投与で，めまいによる社会活動性の障害，めまいを増悪させる身体の動き(頭位，視覚)，めまいによる身体行動の制限(全般的，体動)，めまいによる感情障害，めまいによる対人関係の障害，めまいによる不快感のすべての因子を有意に改善させた．ジフェニドールは抗めまい作用に加えて制吐作用を持つことから，めまいによる機能障害およびめまいに伴う不快感を改善させ，その結果，めまいによる社会的障害およびめまいによる感情障害を改善させたものと考えられた．ベタヒスチンは 4 週間投与で，めまいによる社会活動性の障害，めまいによる対人関係の障害を有意に改善させたが，その他の因子には有意な改善を認めなかった．薬理作用の点から，ベタヒスチンは 2 カ月以上の長期投与を推奨している報告もあり，めまいにより引き起こされる日常生活の障害に対するベタヒスチンによる効果を明らかにするためには，さらに長期間の投与による検討が必要であると考えられた．


Effects of sleep position on time course in remission of positional vertigo in patients with benign paroxysmal positional vertigo.

The side of the affected ear was significantly associated with the head-lying side during sleep in patients with P-BPPV and was closely but not significantly associated with it in patients with H-BPPV. However, the head-lying side during sleep did not affect the remission rate of their positional vertigo.


We report a case of infantile middle-ear teratoma. A 6-month-old girl was first seen and reported to have a history of refractory left-ear otitis media. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor occupying the tympanic cavity and eustachian tube. The tumor, was biopsied twice transaural, under general anesthesia, contained squamous epithelium, striated muscle, and adipose tissue, suggesting middle-ear teratoma. The tumor was resected completely in canal wall tympanoplasty with mastoidectomy under general anesthesia. Histologically, the heterogeneous tumor consisted of tissues including squamous epithelium, sebaceous gland and hair follicle, skin appendages, adipose tissue, striated muscle, cartilage, minor salivary-gland-like tissue, and bone. Mature middle-ear teratoma was diagnosed due to the absence of immaturity and malignancy. The girl remains recurrence-free in the 3 years since surgery.


急性期のめまいに対するジフェニドールとベタヒスチンの効果:日常生活障害度の改善の評価

厚生労働省 難治性疾患克服研究事業 前庭機能異常に関する調査研究班 平成21年度報告書


アルコール性頭位眼振の3次元主軸解析

アルコール性頭位眼振の3次元主軸解析

厚生労働省 難治性疾患克服事業 前庭機能異常に関する調査研究班 平成21年度報告書


A case of Costen's syndrome with chewing-induced vertigo

咀嚼によりめまいが誘発されたCosten症候群症例

症例は31歳女性で，歯科で下顎の左第1第2大臼歯の治療を受け，治療5日後，朝より咀嚼時の発作性回転性めまいが出現した．めまいは2~3分持続し，頭痛を伴い，その後，浮動感が持続した．夜になっても症状が持続するため救急外来を受診した．当初，注視眼振検査およびフレンツェル眼鏡を用いた座位の頭位眼振検査，頭振後眼振検査で眼振を認めなかった．また標準純音聴力検査も正常であった．冷温交互法による温度刺激検査は左右差なく，視標追跡検査および視運動性眼振検査も異常を認めなかった．めまいを誘発するためにガムを咀嚼させると回転性のめまい発作を誘発できた．赤外線CCDカメラで記録したところ，ガムの咀嚼時に右向きの眼振が出現し，次第に眼振の方向が左向きへと変化する水平性の眼振を認めた．Costen症候群と診断し，開発した三次元主軸解析法により眼振を解析した．原因を歯科治療に伴う咬合不全である可能性を考え，口腔外科を紹介したが，2週間後には症状が軽快したため無治療で経過観察したが，症状の再発は認めなかった．


3D analysis of benign positional nystagmus due to cupulolithiasis in posterior semicircular canal

The characteristic of both the vertical-torsional positional nystagmus with long time constant and its disappearance at the neutral head position could diagnose cupulolithiasis in posterior semicircular canal (PSCC) in the eight patients with the PSCC type of benign paroxysmal positional vertigo (P-BPPV). The aim of the study was to diagnose cupulolithiasis in patients with P-BPPV. We used three-dimensional rotation axis analysis of nystagmus of the vertical-torsional positional nystagmus in 111 patients with P-BPPV and evaluated its time constant. We then examined whether the vertical-torsional positional nystagmus with long time constant disappeared at the neutral head position where the axis of the heavy cupula of the affected PSCC is aligned with gravity. The first parameter showed a wide variation that could be divided into two groups: one lasting more than 40 s in 8 patients and another below 20 s in 103 patients. Since the time constant of the positional nystagmus induced by cupulolithiasis was much longer than that induced by canalolithiasis, this finding suggests that cupulolithiasis in the PSCC induced the vertical-torsional positional nystagmus with a long time constant in the group of eight patients. The vertical-torsional positional nystagmus disappeared in these patients at the neutral head position, where the axis of the cupula of affected PSCC aligned with gravity.


A Case of Solitary Plasmacytoma of Bone in the Clivus

頭蓋底骨斜台部に発生した骨の孤発性形質細胞腫例

Most patients with plasmacytoma demonstrate a generalized disease at diagnosis such as multiple myeloma (MM). However, 3-5 percents of patients with plasmacytoma present with either a single bone lesion, or less commonly, a soft tissue mass, of monoclonal plasma cells: solitary plasmacytoma of bone (SPB) or extramedullary plasmacytoma (EMP). Moreover, SPB has a high risk of progression to MM. We report a 65-year-old female with SPB that only involved the skull base bone. She complained of discomfort of the throat for one month and endoscopic examinations showed a submucosal tumor of the nasopharynx. The tumor was biopsied by an endoscopic transnasal approach with the navigation system under general anesthesia. Resected tumor tissue showed monoclonal proliferation of CD138-positive plasma cells with lambda light chain expression in the cytoplasm. Although a small M protein was present in serum, CT, MRI and FDG-PET demonstrated that the osteolytic lesion arising from the clivus of the skull base bone gave rise to a submucosal tumor of the nasopharynx without skeletal lesions and other related organ or tissue impairment. Bone marrow did not contain monoclonal plasma cells, which is not consistent with MM. Finally, we diagnosed the patient as having SPB, but not EMP, without complication of MM.


Effects of hypergravity on histamine H1 receptor mRNA expression in hypothalamus and brainstem of rats: implications for development of motion sickness

The study findings suggest that histamine was released from the axon terminals in the hypothalamus and brainstem and the released histamine activated post-synaptic H1 receptors there, resulting in the development of motion sickness. We first examined which subtype of post-synaptic histaminergic receptor was responsible for the development of motion sickness. We then examined whether H1 receptors were up-regulated in various areas of the rat brain after 2 G hypergravity load, because the stimulation of H1 receptor was reported to up-regulate the level of H1 receptor protein expression through augmentation of H1 receptor mRNA expression. For this purpose, we used an animal model of motion sickness, using pica (eating non-nutritive substances such as kaolin), as a behavioral index in rats. After 2 G hypergravity load, rats ate a significant amount of kaolin, indicating that they suffered from motion sickness. The hypergravity-induced kaolin intake was suppressed by mepyramine, but not by terfinadine or zolantizine. This finding indicates that cerebral post-synaptic H1 but not H2 or peripheral H1 receptors play an important role in the development of motion sickness. The expression of H1 receptor mRNA was up-regulated in the hypothalamus and brainstem, but not in the cerebral cortex after 2 G hypergravity load in rats.


We report a case of Bow hunters stroke with the complaint of cervical vertigo. A 48-year-old man complained of cervical vertigo following head rotation to the left. He showed positional nystagmus when his head was rotated to the left in the supine position and, if the head rotation was maintained, he felt a gradual drop into unconsciousness. The positional nystagmus and fainting were not, however, induced in the patient in the left lateral decubitus position without head rotation. Three-dimensional analysis of his positional nystagmus showed its inconsistent rotational axis, which is different from the single rotational axis in patients with peripheral positional nystagmus. These findings suggested the central cervical positional vertigo/nystagmus in the patients. MRI showed an old infarction of the left cerebellum and MRA showed severe hypoplasia of the left vertebral artery. Vertebral angiography showed severe stenosis of the left vertebral artery and the mechanical occlusion of the right vertebral artery by the atlas-axis joint at C1-C2 when the patients head was rotated to the left. Therefore, it is demonstrated that his positional vertigo/nystagmus with fainting caused by head rotation to the left was induced by the vertebrobasilar insufficiency due to mechanical occlusion of the vertebral artery associated with head rotation, resulting in the diagnosis of Bow hunters stroke in this patient.


We report two young patients of Wallenberg syndrome who presented with acute vertigo as the initial symptom. Neither Case 1, an 8-year-old girl, nor Case 2, a 29-year-old man, showed any abnormal findings on the initial magnetic resonance imaging (MRI) on day 1. In addition to nystagmus, several neurological signs became positive during the clinical course. Finally, the diagnosis of Wallenberg syndrome was made in both cases based on the detection of a lateral medullary infarction in a follow-up MRI conducted on day 4. Stroke should be considered in the differential diagnosis of acute vertigo, even in young patients without risk factors for cerebrovascular disorders, such as hypertension, diabetes and/or hyperlipidemia. Since MRI may show no abnormalities in the very early stages of stroke, neurological examinations are useful to establish the diagnosis in cases presenting with vertigo induced by brain stem or cerebellar infarction.


Differential diagnosis of true and pseudo-bilateral benign positional nystagmus

Two patients showing two rotational axes of their positional nystagmus had canalolithiasis in bilateral posterior semicircular canals (PSCCs), leading to the diagnosis of true bilateral benign paroxysmal positional nystagmus (P-BPPN). Another 18 patients had a single rotation axis of their positional nystagmus with short time constant (TC) on one side and long TC on the other. Since canalolithiasis in the uppermost PSCC may be transient cupulolithiasis, evoking positional nystagmus with long TC, the diagnosis of the latter patients should be pseudo-bilateral P-BPPN. To differentiate the true bilateral posterior canal type of P-BPPN from pseudo-bilateral P-BPPN. The rotational axis and TC of positional nystagmus were three-dimensionally analyzed in 20 patients showing geotropic torsional nystagmus on the left and right Dix-Hallpike (D-H) maneuvers. Two patients showed two rotational axes of their positional nystagmus, which were perpendicular to the plane of the PSCCs. There were no differences in TCs of their positional nystagmus between bilateral D-Hs. Another 18 patients showed a single rotational axis of their positional nystagmus, which was perpendicular to the plane of either the left or right PSCC. TCs of their positional nystagmus were short on one side and long on the other.


Changes in slow phase eye velocity and time constant of positional nystagmus at transform from cupulolithiasis to canalolithiasis

Changes in slow phase eye velocity (SPEV) and time constant (TC) of benign paroxysmal positional nystagmus in horizontal canal type were examined at transitional period from cupulolithiasis (apogeotropic nystagmus) into canalolithiasis (geotropic nystagmus) in two patients. SPEV and TC of positional nystagmus were tri-dimensionally analyzed. The first patient showed an apogeotropic nystagmus. Head rotation to the left in supine position induced a right-beating nystagmus with an initial SPEVof 15.3 degrees/s and a TC of 133 s. The nystagmus then gradually declined with a TC of 31.3 s after reaching a maximum SPEV of 28.8 degrees/s. After the nystagmus disappeared, he showed a geotropic nystagmus. The second patient showed a left-beating nystagmus with an initial SPEV of 2.5 degrees/s and a TC of 141 s when his head was rotated to the right in supine position. The nystagmus then gradually declined with a TC of 8.05 s after reaching a maximum SPEV of 16.7 degrees/s. After the nystagmus disappeared, he showed a geotropic nystagmus. The present findings suggested that in both patients, at the period of an increase of SPEV of the positional nystagmus with the shortening of its TC, cupulolithiasis transformed into canalolithiasis.


眼振の3次元主軸解析による両側性後半規管BPPVの病態解明

眼振の3次元主軸解析による両側性後半規管BPPVの病態解明

厚生労働省科学研究費補助金 特定疾患対策研究事業 前庭機能異常に関する調査研究 平成18年度報告書


前庭型メニエール病の臨床的検討

前庭型メニエール病の臨床的検討


当科における真珠腫性中耳炎の術式と術後聴力成績

当科における真珠腫性中耳炎の術式と術後聴力成績


Natural history of benign paroxysmal positional vertigo and efficacy of Epley and Lemtert maneuvers

We assessed the efficacy of Epley maneuver in patients with posterior canal benign paroxysmal positional vertigo (P-BPPV) and Lempert maneuver in patients with horizontal canal BPPV (H-BPPV). In patients with P-BPPV, positional vertigo in patients treated by Epley maneuver was significantly resolved more quickly than that in untreated patients. But in patients with H-BPPV, there were no significant differences of time course in remission of positional vertigo between untreated patients and patients treated by Lempert maneuver. Among the untreated patients, the positional vertigo in patients with H-BPPV was significantly resolved more quickly than that in patients with P-BPPV. Epley maneuver was effective for the treatment of patients with P-BPPV, whereas the efficacy of Lempert maneuver for the treatment of patients with H-BPPV was limited. The natural courses in remission of positional vertigo in untreated patients with H-BPPV showed significantly faster resolution than that in patients with P-BPPV.


メニエール病患者におけるストレス関連遺伝子発現変化のDNAマイクロアレイ解析

メニエール病患者におけるストレス関連遺伝子発現変化のDNAマイクロアレイ解析

厚生労働省科学研究補助金，特定疾患対策研究事業，前庭機能異常に関する調査研究，平成17年度報告書


良性発作性頭位めまい症における眼振の性状と治癒期間

良性発作性頭位めまい症における眼振の性状と治癒期間

平成16年度厚生労働省科学研究補助金 特定疾患対策研究事業 前庭機能異常に関する調査研究報告書


メニエール病の難聴の長期予後

メニエール病の難聴の長期予後


Clinical practice guideline of Meniere's disease

メニエール病診療ガイドライン

Otolaryngology-Head and Neck Surgery (Tokyo)


Jugular bulb abnormalities in patients with Ménière's disease using high-resolution computed tomography

European Archives of Oto-Rhino-Laryngology