耳鼻と臨床
Online ISSN : 2185-1034
Print ISSN : 0447-7227
ISSN-L : 0447-7227
13 巻, Supplement3 号
選択された号の論文の3件中1~3を表示しています
  • 調 重昭
    1967 年 13 巻 Supplement3 号 p. 271-295
    発行日: 1967年
    公開日: 2013/05/10
    ジャーナル フリー
    Functional tests of vestibular apparatus, which have recently been able to provide delicate and exact stimulus to labyrinths, have acquired a deeper significance in diagnosis. Electrophysiological or electron microscopic studies have been making clear the physiology and anatomy of labyrinths. And the study of equilibrial system of eye muscles, chiefly nystagmus, has begun to be revalued in order to view the whole equilibrial function containing the mechanism of central nerve with oculomotor system of brainstem. However, compared with the progress in the experimental or clinical studies of cochlea and semicircular canals, those of otolith organs are lagging far behind ; a lot of problems are still left to be solved, and the function of otolith organs in equilibrial physiology has not yet satisfactorily understood.
    This study is to make clear the otolithic function in position changing. First, with 10 normal persons the author observed their eye movement, their nystagmus, in their position changing under weak centrifugal force by using electronystagmograph. The position changing was done by the subjects themselves keeping their eyes open and wearing Frenzel's glasses in a dark room. The apparatus based upon the positional table system, is capable of changing the tilt of the table sagittally and bitemporally and of rotating the table. On the table the subjects can be easily moved on any axis. When the subject lies in a supine position on the table, both of his labyrinths are apart from the pivot of the apparatus by about 60 cm, so that the lateral semicircular canals are kept almost vertical. Each subject is asked not only to turn both his head and body on his axis but change the position sagittally and bitemporally. In this study the acceleration of rotation is 0.5° per second per second and the rotation is suddenly stopped after the equiangular rotation at the maximal velocity of 30° per second for one minute. Care was taken to prevent the appearance of the response decline phenomenon ; in the test 5 to 10 minutes' pause was given between each rotation.
    Second, the author examined the clinical cases who had lasting and directionfixed positional nystagmus under the same conditions as mentioned above, and observed how the positional nystagmus went on under centrifugal force. Then the author investigated the relation of the change in the nystagmus with the otolithic function.
    The results are as follows:
    1) The perrotary nystagmus in a supine position under centrifugal force during constant velocity showed the same recurrence as, or greater than, the nystagmus in acceleration. This, the author thinks, means that, besides the factor in semicircular canals, some other factor is partaking in causing the nystagmus.
    2) The postrotary nystagmus in a supine position was short in duration and small in frequency. It was deduced from this that in this case the endolymph flow was very much restrained in lateral semicircular canals.
    3) In a supine position the nystagmus and the sensation caused by the stimulus was almost at the threshold or below it, but the nystagmus in most cases in a lateral position during or after the rotation was comparatively distinguishable.
    4) There was not found any relation between the direction in a lateral position and that of the nystagmus in position changing while the rotation continued, but there was some relation between position changing nystagmus and the direction of lateral position after the rotation was stopped. Accordingly it is considered that the slight functional difference in both otoliths is represented by the nystagmus resulting from the stimulation caused by centrifugal force to otolith organs and vestibular center of brainstem during the equiangular rotation.
  • 中島 雅子
    1967 年 13 巻 Supplement3 号 p. 296-332
    発行日: 1967年
    公開日: 2013/05/10
    ジャーナル フリー
    In the study of vestibule, certain authors recently said in their reports that the findings gained through caloric test were less valuable than those obtained from the examination of spontaneous or positional nystagmus. But I think caloric test can st ill be considered to be most reliable and important, when we determine whether there is any unilateral disorder of labyrinth. Various methods of irrigation in caloric test have been performed, but no method has been regarded as the stan-dard. HALLPIKE'S method is fairly popular, but the volume of the water irrigated differs from one researcher to another. It was recommended at the conference of Japan Medical Society in 1960 to supply an ear with 20 cc. of water in the present test and subsequently many otologists have followed this suggestion.
    I doubted the accuracy of the result gained in caloric test in which 20 cc. of water is used for irrigation. In order to prove my doubt I compared the method using 20 cc. of water with HALLPIKE'S 40 sec. irrigation in normals and in patients. Duration, total amplitude and latency were employed as the indicators of caloric reaction. Abnormalities in electronystagmographic findings were also discussed. The followings are the conclusion.
    1) Mean value of duration, total amplitude and latency of 20 cc. irrigation and for 40 sec. irrigation in normal subjects are as follows._??_
    2) In three indicators, the minimal variation is statistically found in the duration of nystagmus, while greatest variation in total amplitude. The value of total amplitude increases more according as the intensity of stimulation such as water volume and temperature of irrigated water than the duration does. Therefore the latter should not be regard as only indicator.
    3) Comparing the variation of the data in 20 cc. irrigation with that in 40 sec. irrigation, I find the former is significantly greater so long as total amplitude and duration concern. The variation of latency is little greater in the 40 sec. irrigation than in 20 cc., but it is not so statistically significant. In view of these findings, it is evident that the method of 40 sec. irrigation is better than that of 20 cc. irrigation.
    4) The mean value of canal paresis % (CP%) is got by dividing the value of the difference of duration between the reactions of the left labyrinth and the right by the value of total duration and in the present case it is 4 %, while directional preponderance % (13P451)), which can be similarly figured out from the variation of the difference of duration between the left-beating and the right-beating nystagmus, is 7 %. The greatest value is 15% in CP% and 20% in DP%.
    5) By the 20 cc. irrigation method no nystagmic response from the irrigation in one or both of the ears was found in 28% of the patients who show response in the 40 sec. irrigation, and 19% of those patients show the response which lies within the normal range of duration when 40 sec. irrigation method is applied to them. From this it is reasonable to presume that hyporeaction found in the 20 cc. irrigation method does not indicate the hypofunction of the labyrinth but is due to some technical and thermotransmissional insufficiency in the irrigation. So the 20 cc. irrigation cannot be considered satisfactory as a regular method of testing nystagmus.
    6) Latency of induced nystagmus in the patients was a little longer than that in the normals, but this fact is negligible except in the case of 40 sec, irrigation of 44°C water. Latency is not influenced by the quantity of water and usually shows a constant value, but does not have any correlation with the duration. Latency is not suitable for an indicator of nystagmus.
  • 牧島 和見
    1967 年 13 巻 Supplement3 号 p. 333-364
    発行日: 1967年
    公開日: 2013/05/10
    ジャーナル フリー
    Presbycusis is one of the most interesting problems in gerontology. Many pathological, physiological and audiological works have been reported, but the exact nature of presbycusis is still obscure.
    Pure tone audiometric tests were performed on 239 patients using the same audiometer.
    On 105 autopsy cases of which 35 cases were examined audiometrically before death, temporal bones and brains were served for pathological studies. The sections of the temporal bones were graphically reconstructed, and the audiometrical and morphological data were compared on parallel coordinate.
    Severity of encephalomalacia and spongy change in the central auditory pathway and atrophy of the general organs were watched carefully. Furthermore arteriosclerosis of the aorta, cerebral artery, internal' auditory artery and renal artery were examined. The significance of those findings on the development of hearing loss were observed.
    Periods from audiometric examination to autopsy were less than 11 months, and the functional and morphological data could be compared with reasonable accuracy.
    The conclusions were as follows:
    1) Type of hearing in presbycusis was classified into seven kinds, i. e., type A (normal audiometric curve), type B (flat curve), type C (abrupt curve), type D (descending curve), type E (convex upwards curve), type Dip and type F (ascending curve). Type D, B and C together occupied the greater part of the examined cases.
    2) The most conspicuous change in the temporal bones of old people was the atrophy of spiral ganglion. Besides, there were observed atrophy of stria vascularis and destruction of hair cells.
    3) Atrophy, spongy change and encephalomalacia were observed in central auditory pathway especially in the central part of eighth cranial nerve, cochlear nuclei and transverse temporal gyri.
    4) Lumen narrowing of internal auditory artery with varing degree was observed in almost all cases of old people, which was conspicuous in the cases with severe arteriosclerosis of cerebral artery.
    5) Lumen narrowing of internal auditory artery was supposed to have positive correlation with atrophy of spiral ganglion and hearing loss.
    6) Hearing loss was supposed to have positive correlation with atrophy of brain and spongy change of transverse temporal gyri. Many cases of encephalomalacia showed high degree of hearing loss.
    7) The development of the above mentioned types of hearing was based on the atrophy of spiral ganglion and the so-called “type factors” and “level down” of auditory acuity was supposed to be due to the effect of cerebral degeneration.
    8) Type B (flat curve) was supposed to be an audiometric image influenced by the cerebral degeneration, type C (abrupt curve) was that affected by the acoustic trauma, and type D (descending curve) was that influenced by the atrophy of spiral ganglion and degeneration of eighth cranial nerve.
    9) Changes in temporal bones and central auditory pathway was considered to be caused by senile atrophy and arteriosclerosis.
    10) Internal auditory artery branched most frequently off from inferior anterior cerebellar artery except for some cases where it directly diverged from basilar artery.
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