Studies on the functional status of the autonomic nerve in patients of Ménière's disease

Abstract

The author studied statically and dynamically, the general functional status of the autonomic nerve in patients of Ménière's disease in the intermittent period of the attacks of vertigo and further the etiopathogensis of the disease.
(A) The functional status of the automonic nerve in the statical condition of patients of Ménière's disease when they are not stressed.
1) The psychosomatic studies on Ménière's disease.
The functional status of the autonomic nerve has a close relation to the individual character and mental condition, and further the existence of the autonomic center in the lymbic system of the cerebral cortex has been made clear in recent years. The author investigated the psychosomatic aspects of Ménière's disease in 214 items, and compared them with the controls using the Cornell Medical Index Health Questionnare (CMI) which was made by K. Brodman and the clinical reliability of which was ensured by K. Fukamachi (Table 2, 3. Fig. 2, 3).
i) Significant differences between the Ménière and the control groups were revealed by the following questions. In Ménière's disease, the following complaints due to the autonomic imbalance were observed: pressure or pain in the head, stiffness in the shoulders or the neck, thumping of the heart, cold hands or feet even in hot weather, stubborn coughs following colds, liability to severe colds. From this it is conseivable that these might become one of the etiologic factors of Ménière's disease in the middle ear. Besides, the patients of Ménière's disease have suffered from liver or gall bladder trouble oftener than the controls. This confirmed the report of K. Kubo that the functional disorder of the liver would become one of the predispositions of the nerve deafness.
ii) The discriminative chart by Fukamachi (Fig. 1) made by the statistical method was used to classify patients of Ménière's disease into four groups; normal, provisionally normal, provisionally neurotic and neurotic. The percentage of each type showed the similar ratio to the other psychosomatic diseases such as bronchial asthma and essential hypertension. Ménière's disease lay between neurosis and the normal.(Table 3. Fig. 3)
iii) From above facts, it was made clear that Ménière's disease was a psychosomatic disease, and the author concluded that the therapy of Ménière's disease required not only the somatic but psychic consideration with reference to the judgment of the discriminative chart.
2) The measurement of the activity of serum cholinesterase.
In five cases out of twelve, the fall of the activity of serum cholinesterase was observed, and it showed that it would mean parasympathetic predominance.
3) The measurement of electrolytes in the serum (Na, K, Ca).
The results with 18 patients of Ménière's disease in the intermittent period of the attacks of vertigo were in the normal range.
4) The measurement of 17-Ketosteroid (17-KS) in the urine was made considering the part played by the adrenocortical hormones in the defense mechanism of the living body.
The fall of 17-Ketosteroid in the urine was observed in five cases out of ten, and one feature of Ménière's disease as an adaptation disease was confirmed and an intimate interrelation of the neuro-hormones was suggested. The fact that the fall of 17-KS was rare in males as compared with females seems to be due to the possibility of 17-KS secreted from the testicles in males having masked the deficiency of the 17-KS from the adrenal glands.
5) The measurement of the functional status of the autonomic nerve by Wenger's method.
The measurement was undertaken about the following seven articles.