Practica Oto-Rhino-Laryngologica

An Epidemiological Study of Meniere's Disease Conducted by the Meniere's Disease Research Committee of Japan from 1977 to 1979

Kanemasa Mizukoshi

1982 Volume 75 Issue 5special Pages 1145-1149
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1145

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After the first and second nation-wide surveys of the Meniere's Disease Research Committee of Japan from 1974 to 1976, the third nation-wide survey was carried out in the 435 departments of otolaryngology, internal medicine and neurology of both general and university hospitals for one week in June 1977 (Watanabe, 1978). In this survey, 747 patients with definite Meniere's disease were collected from 214 departments, that is 0.76% of the total number of out- and in-patients and were statistically evaluated with respect to severely disabled patients.
Nakae and Komatsuzaki (1978) conducted an epidemiological analysis of 512 patients with Meniere's disease by means of questionaires comparing them with the 321 vertiginous patients and 512 ENT out-patients in whom Meniere's disease had been ruled out; the complications of hypotension, preceding presence of fatigue, insufficient sleep and mental stress were frequently observed in the group of Meniere's disease. Yasuda (1978) analysed a correlation between the vertiginous attack of Meniere's disease and the weather at four different districts in Japan.
Between December 1978 and October 1979, a follow-up of the second nation-wide survey of Meniere's disease was made. Among the 180 selected patients who were sick for a shorter period than one year at the second nationwide survey, 120 patients (66%) were collected by the seventeen members of this Committee in 1979, and were evaluated from the epidemiological and clinical points of view (Mizukoshi et al., 1980).
According to these epidemiological and clinical surveys of the period during 1977-1979, the characteristic features of Meniere's disease are as follows.
1) From the nation-wide one-day and one-week surveys, a total number of patients with Meniere's disease in Japan was calculated to be about 4, 000-80, 000, and a prevalence rate was also estimated to be 35-170 per million inhabitants (Nakae et al., 1978).
2) There was an increasing number of patients in the southern area of the Kanto district, compared with the northern area. (Naito, 1973; Watanabe, 1976 and 1979; and Nakae et al., 1978).
3) The rate of patients who were severely disabled to the point of their daily lives being handicapped was estimated to be 54.7% (in the 3rd survey) or 15.2% (in the 4th follow-up study). (Watanabe, 1979; and Mizukoshi et al., 1980).
4) In 67 (60.9%) of the 110 follow-up patients who were sick for 2-4 years, vertigo was of less intensity in the last year and the vertigo tended to change into dizziness as the duration of the illness became longer. (Mizukoshi et al. 1980).
5) The hearing level as expressed by the pure-tone audiogram deteriorated by an average of 10.5dB in the 4th follow-up survey. (Mizukoshi et al., 1980).
6) The incidence of bilateral Meniere's disease increased as the duration of illness became longer. (Mizukoshi et al., 1977 and 1980)

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An Epidemiological and Clinical Follow-up Survey of Early Cases of Meniere's Disease Collected by the Seventeen Members of the Meniere's Disease Research Committee of Japan

Kanemasa Mizukoshi, Yukio Watanabe, Naoki Ohashi, Yoshiaki Ohno, Isamu ...

1982 Volume 75 Issue 5special Pages 1150-1164
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1150

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Between December 1978 and October 1979, a nation-wide follow-up of the second nation-wide survey of the 520 patients with definite Meniere's disease who had been collected by the seventeen members of the Meniere's Disease Research Committee of Japan from 1975 to 1976 was made by the same members. Among the 180 selected patients, who had a shorter duration of illness than one year at the second nation-wide survey, 120 patients (66%) were clinically followed up by the same members.
The following characteristic epidemiological and clinical features were obtained:
1) Sex ratio: The incidence was higher in males than females (71:49).
2) Age distribution at onset: The age distribution of the follow-up patients peaks at the age group of 40-49 years for both males and females, which was shown to be similar to the second survey for males.
3) The rate of patients who were severely disabled to the point of interference with their daily lives, was estimated to be 17.0% in this follow-up survey.
4) In 67 (60.9%) of the 110 follow-up cases, vertigo was of less intensity in the last one year, and it had a general tendency to change into dizziness as the duration of illness became longer.
5) The hearing level as expressed by the pure-tone audiogram deteriorated by an average of 10.5dB in the follow-up survey (2-4 years). Hearing impairments were more marked in the patients who were heavy drinkers and had the first attack at older ages.
6) The incidence of bilateral Meniere's disease increases with time from 2 to 5 cases for about 2-4 years.

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Incidence and Prevalence of Meniere's Disease in Sagamihara City, Kanagawa-ken

Kohji Tokumasu, Naoki Tashiro, [in Japanese], Akira Saito, Rokuro Kawa ...

1982 Volume 75 Issue 5special Pages 1165-1173
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1165

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One-hundred and eighty patients of Ménière's disease have been found from 5, 920 patients who had visited the Neurootological Clinic of Kitasato University Hospital in the seven years from August 1971 to July 1978.
The incidence and prevalence of Ménière's disease in Sagamihara City, Kanagawa-ken, Japan was estimated by a study of the district extended medical cares of Kitasato University Hospital. Thirty-six per cent of the patients of Kitasato University Hospital live in Sagamihara City, the population of which is about 400, 000.
The result showed that the mean incidence of Ménière's disease for one year in Sagamihara City is 2.764 per 100, 000 population and the prevalence, 16.763 per 100, 000 population.

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Results of the Examination of Predisposition to Meniere's Disease

Yatsuji Ito, Takashi Tokita, Hideo Miyata, Masahiko Hashimoto, Tomiyas ...

1982 Volume 75 Issue 5special Pages 1174-1181
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1174

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A Histochemical Study of the Effect of Streptomycin Sulfate on the Inner Ear of the Guinea Pig after Obliteration of the Endolymphatic Duct

Akira Ogawa, Saeko Takahashi, Takashi Yoshizumi, Jin Okubo, Isamu Wata ...

1982 Volume 75 Issue 5special Pages 1182-1188
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1182

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The effect of streptomycin sulfate (SM) on the sensory epithelia of the inner ear of guinea pigs were studied histochemically. The guinea pigs, in which the right endolymphatic duct were obliterated surgically, were injected with SM 250mg/kg ten times in one month. Succinate dehydrogenase staining was used in the histochemical study. The enzymic activity of the sensory cells in the surface specimens from the cristae ampullares, maculae utriculi, maculae sacculi and the organ of Corti were investigated light microscopically.
The study revealed that SM caused more remarkable damage on the vestibular sensory cells of the operated side compared with that of the opposite. The organ of Corti remained intact on both sides.
To explain these findings, we considered that SM might be accumulated in large amounts in the endolymphatic space.

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A Morphological and Histochemical Study of the Effect of Urea on Experimental Endolymphatic Hydrops in Guinea Pigs

Masatoyo Akiyoshi, Saburo Yano, Hozumi Nakada

1982 Volume 75 Issue 5special Pages 1189-1197
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1189

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The present study was performed to elucidate the effect of urea administration on the inner ear lesion in the patient with Meniere's disease. Urea (2g/kg) was given orally to the Hartley guinea pigs which had undergone obliteration operation of the endolymphatic duct on the right side according to Kimura (1967) one and three weeks previously. The animals were sacrificed for staining of the superficial blood vessels of the endolymphatic space by the benzidin reaction and for demonstration of the activity in the energy metabolism of the inner ear hair cells by the supravital reduction reaction with nitro-BT. The following results were obtained.
1. One week after the operation, scattered stenotic or ischemic foci were found in the capillary net-work subjacent to the vestibular sensory organs, such as cristae ampullares and maculae and in that of the stria vascularis of the right ear which received the operation. These capillary changes were more prominent in the basal turn, especially in its lower part rather than in the second turn.
2. Three weeks after the operation, slight decrease in formazan deposition was seen in the outer hair cells, especially severe in the apical turn, resulting in scattered loss of the outer and inner hair cells in the right ear which received the operation.
3. The urea treatment induced repair of the capillary changes of the inner ear and alleviation of the impairment of formazan deposition to the outer hair cells in the right ear.
4. The mechanism of the effect of urea on the endolymphatic hydrops and associated changes of the inner ear was discussed.

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The Experimental Results of Endolymphatic Sac Obliteration at Osaka University with Regard to the Functional Tests in Guinea Pigs after Obliteration of the Endolymphatic Sac

Shin-ichi Okumura, Takashi Matsunaga, Toru Matsunaga, Toshi Naito

1982 Volume 75 Issue 5special Pages 1198-1202
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1198

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Several experiments were reported with regard to the experimental endolymphatic hydrops of guinea pigs after obliteration of the endolymphatic sac.
1. Uno (1969) reported that the cochlear potentials of guinea pigs with endolymphatic hydrops were depressed to a maximum amplitude of CM and the N₁ amplitude of AP was decreased.
2. Tomiyama (1969) and the present authors reported the increase in the directional preponderance differences of C & E DPRT in the guinea pigs after obliteration of the endolymphatic sac.
3. The guinea pigs with experimental endolymphatic hydrops produced positive results to the experimental furosemide test by C & E DPRT, and the histology of the inner ears of guinea pigs with the positive furosemide test revealed either normalizing or collapsing of the endolymphatic hydrops which had once been produced in the affected ear, while the opposite ear was almost normal.

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The Effect of Furosemide on the Concentrations of Electrolytes in Inner Ear Fluids

Naoyuki Kanoh, Kazuo Makimoto

1982 Volume 75 Issue 5special Pages 1203-1209
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1203

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Serum, cerebrospinal fluid (CSF), scala vestibuli perilymph and scala tympani perilymph were collected from 286 normal anesthetized guinea pigs (sodium pentobarbital 20-30mg/kg I. P.) both before and after intravenous administration of furosemide (15mg/kg) and normal saline (1.5ml/kg). One hundred and twelve guinea pigs receiving normal saline were used as a control group. Then, the sodium and potassium concentrations were assessed using a microflame photometer (I. L. 443 Instrumentation Lab.).
Measurement was made of 104 normal guinea pigs to obtain the preinjection values as standards for the subsequent experiments.
Marked increase in the sodium concentration was observed both in the scala vestibule and tympani perilymphs, and slight increase was found in CSF, while there was no significant change in the serum.
The potassium concentration was increased in both scala vestibuli and tympani perilymphs, but there was no significant change in CSF or serum.
The results of the present study revealed that the increase in sodium concentration was a result of dehydration in the above-mentioned fluid spaces.
Changes in potassium concentration was found in both perilymphs, and this may not be attributable to such a simple process as dehydration. The elevation of these potassium concentrations will be understood when concomitant changes in the electrolytes in the endolymph are clarified, or considered the specific effects of Furosemide to these fluid spaces in the point of transport system of electrolytes.
For the elucidation of the effect of furosemide, the above findings of electrolyte concentrations should be further evaluated with respect to their possible significance.

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Immunological Consideration on Recurrent Episodes of Meniere's Disease

Jiro Hozawa, Hisaki Saito, Fumihito Suzuki, Shigeki Kamata, Masaru Hak ...

1982 Volume 75 Issue 5special Pages 1210-1217
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1210

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The reality of allergic endolymphatic hydrops as a cause of recurrent episodes of Meniere's disease was suggested from the results of the following studies: 1) Clinical studies
a) The skin test using 34 sorts of food antigen extracts and the glycerol test were performed on 23 patients with Meniere's disease. The rate of positive glycerol test was higher in the group with the positive skin reaction than in the negative group (p=0.05).
b) In some patients, whose episodes were provoked by the challenge-feeding test, improvement in hearing was produced after Portmann's endolymphatic operation. 2) Experimental studies
a) Labyrinthine reactions were produced when challenged with the antigen through the left foramen stylomastoideum in 4 groups of rabbits as follows: (A) rabbits sensitized by hen's serum, (B) control rabbits, (C) rabbits inoculated with BCG vaccine and (D) control rabbits. Among these 4 groups, the positional nystagmus observed in group A bore a striking resemblance to that of Meniere's attack. The electrocochleograph of group A showed a pattern of cochlear impairment and a histological study revealed endolymphatic hydrops in the ear on the challenged side. This endolymphatic hydrops was not found in the other groups. From these findings, endolymphatic hydrops does not appear to be induced by cell-mediated immunity, but by humoral immunity.
b) To determine the place of antigen-antibody reaction, the labyrinths of guinea pigs sensitized by horseradish peroxidase (HRP) were investigated by electronmicroscopy after challenge with this antigen through the perilymphatic space. Particles of HRP could pass through the Reissner's membrane by intracellular transportation and clung to the surface of dark cells in the stria vascularis. These findings were not observed in the control study and suggest that hyper-permeability of the Reissner's membrane and hypersecretion of the stria vascularis induced by the antigen-antibody reaction are probable causes of endolymphatic hydrops.

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Histopathology of Méenière's Disease with Rupture of Saccular Membrane

Yoshiharu Igarashi, Tetsuo Ishii

1982 Volume 75 Issue 5special Pages 1218-1225
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1218

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Both of the temporal bones of a 52-year-old man who died of a metastatic cancer of the stomach were histologically studied. One year prior to death, he had stayed in bed for 3 days suffering from a severe vertiginous attack. His left temporal bone showed collapse of the cochlear duct and rupture of the saccular wall. The deficit of the saccular membrane affected almost half of the entire membrane. The distension of the Reissner membrane indicated the presence of endolymphatic hydrops before the occurrence of its collapse. The rupture of the saccular membrane was considered to be caused by rapid increase in endolymph within the saccule, resulting in collapse of the cochlear duct. Though these pathological findings resemble those of Meniere's disease, this patient failed to be so diagnosed because of the lack of repetition of vertigo, which may have been due to a persistent endolymphatic fistula in the saccule. The right ear of this patient had a normal cochlear duct and saccule.

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A Report of 3 Cases of Bilateral Ménière's Disease with Reference to Its Diagnostic Criteria

Hitoshi Ogino, Mitsuhito Sano, Takeshi Kubo, Toru Matsunaga, Toshi Nai ...

1982 Volume 75 Issue 5special Pages 1226-1236
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1226

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Three cases of Meniere's disease are reported. Case 1, a 39-year-old man suffered from vertigo with right fluctuant hearing loss and tinnitus. After an interval of about 5 years, he experienced left fluctuant hearing loss and tinnitus with a vertigo attack. Case 2, a 51-year-old woman suffered from left Meniere's disease, and 5 years there-after was troubled with right fluctuant hearing loss and tinnitus with vertigo attack. Case 3, a 22-year-old woman developed sudden deafness on the right side without vertigo in the course of left Meniere's disease. Cases 1 and 2 were diagnosed as bilateral Meniere's disease.
Generally the criteria for Meniere's disease are well-known, but those for bilateral Meniere's disease are not yet clear. We propose the following criteria of bilateral Meniere's disease.
1) Unilateral Meniere's disease with contralateral fluctuant sensorineural hearing loss and tinnitus accompanied by vertigo is definite bilateral Meniere's disease.
2) Unilateral Meniere's disease with contralateral fluctuant sensorineural hearing loss and tinnitus regardless of vertigo is suspected bilateral Meniere's disease.

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A Study of Vestibular Meniere's Disease

Kyoya Takagi, Takashi Tokita, Hideo Miyata, Tatsuo Maki, Tomiyasu Sait ...

1982 Volume 75 Issue 5special Pages 1237-1242
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1237

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I. Introduction
The present paper was designed to study the presence of vestibular Meniere's disease (VMD) and the possibility of VMD transforming into Meniere's Disease (MD).
II. Examinees and Methods
1) According to the diagnosis criteria set by the Department of the Otorhinolaryngology, Gifu University School of Medicine, a comparative study was made of the clinical features of 40 patients diagnosed as VMD and 80 diagnosed as MD.
2) Using the same criteria, a study was made of 50 patients diagnosed as MD, regarding the delay in the appearance of cochlear symptoms against the first attack of vertigo.
III. Results and Consideration
1) Of those diagnosed as VMD, females were predominant and a few had spontaneous nystagmus, CP and CP+DP, compared with those diagnosed as MD. These findings indicate the presence of VMD which differs from MD in the pathological change.
2) In MD, there existed cochlear symptoms developing after vertigo, the delay ranging from 2 months to 6 years. During that period, repeated attacks of vertigo occurred unaccompanied by cochlear symptoms. This shows the presence of VMD which shifts to MD.
3) In other words, it seemed that among patients of VMD there were one type which was similar to MD and another type differing from MD in pathology.

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Classification of the Course of Meniere's Disease

Masami Yanagida, Takashi Tokita, Hideo Miyata, Tatsuo Maki

1982 Volume 75 Issue 5special Pages 1243-1248
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1243

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1. Purpose
From the pattern of the change of patient's hearing in the course of Meniere's disease, the course of Menierés diseae was classified from the pattern of the change of patient's hearing and that of vertigo.
2. Examinees
Examined were 53 proven patients of Meniere's disease according to the diagnostic criteria set by Gifu University. They were 19 males and 32 females, ranging in age from 15 to 71.
The classification of the patterns of the manifestations of vertigo was as follows.
Type 1: Recurrence of definitive spells at long intervals changes to repeated slight spells at short intervals…5 cases
Type 2: A definitive spell appears repeatedly in the same season once or twice every year…16 cases
Type 3: Recurrence of spells gradually decreases with time…7 cases
Type 4: A burst of spells occurs continuously from the onset of the disease…11 cases
Type 5: Repetition of single definitive spells and burst of spells appears with irregular alternation…14 cases
3. Results
(1) According to the change in hearing, 6 types were classifiable.
Type A: Hearing was not aggravated…13 cases
Type B: Hearing was gradually aggravated…14 cases
B1: Difficulty in hearing occurred simultaneously with the fit of the initial spell…9 cases
B2: Difficulty in hearing occurred subsequent the initial spell…5 cases
Type C: Difficulty in hearing appeared suddenly and did not worsen…10 cases
C1: Sudden hearing loss occurred simultaneously with the fit of the initial spell…6 cases
C2: Sudden hearing loss followed the onset of the initial spell…4 cases
Type D: Difficulty in hearing appeared suddenly and then was gradually aggravated with the course of the disease…3 cases
Type E: Difficulty in hearing had existed before the initial spell and was not aggravated…8 cases
Type F: Difficulty in hearing had existed before and was gradually aggravated…5 cases
(2) In the study of association with the classification of course of vertigo, Type A was found to be predominant in Type 2, Type B in Types 2 and 5, Type C in Type 4, Type E in Type 5, and Type F in Type 2.

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Clinical Consideration of Pathogenesis of Lermoyez's Syndrome

Jiro Hozawa, Shigeki Kamata, Akiko Takagi, Kiyozumi Nakamura, Takashi ...

1982 Volume 75 Issue 5special Pages 1249-1253
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1249

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The pathogenesis of Lermoyez's syndrome was discussed on the basis of a patient, who was treated by perivascular sympathectomy at the proximal part of the vertebral artery. After this operation “episodic vertigo” disappeared completely, although cyclic fluctuating hearing loss continued as before. The glycerol test performed preand postoperatively was always negative.
Therefore, the mechanism of cochlear dysfunction was inexplicable in terms of the blood circulatory disturbance theory or the intralabyrinthine hyper-pressure theory.

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Electrocochleography in the Diagnosis of Endolymphatic Hydrops

Nozomu Mori, Takashi Matsunaga, Hideyo Asai, Yuriko Suizu

1982 Volume 75 Issue 5special Pages 1254-1258
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1254

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Extratympanic electrocochleographic findings were compared with the results of the glycerol test and the furosemide test in Meniere's disease. Increased negative summating potentials (SP) were recorded in 25 of the 35 ears (71%), while the glycerol test was positive in 14 of the 25 ears (56%) and the furosemide test was positive in 6 of the 22 ears (27%).
The relationship between the average hearing level at 2 to 8kHz and the increase of negative SP was examined in 35 ears with Meniere's disease. Increased negative SP's were recorded in many patients with mild to moderate deafness. In many of the patients with almost normal hearing and low tone loss with normal hearing above 2kHz, normal SP's were recorded, but no SP appeared in patients with severe deafness.
In the conditions other than Meniere's disease, increased negative SP's were recorded. In some of these, the glycerol test or the furosemide test revealed the existence of endolymphatic hydrops.
The relationship of increased negative SP to endolymphatic hydrops is discussed and the suitability of electrocochleography in the diagnosis of endolymphatic hydrops, compared with the glycerol test and the furosemide test is stressed.

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A Study of Patients with Meniere's Disease with Negative -SP on Elecrrocochleogram

Satoshi Hiraga, Takashi Tokita, Hideo Miyata, Kazuko Usui

1982 Volume 75 Issue 5special Pages 1259-1265
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1259

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It is widely held that the electrocochleogram of the patient with Meniere's disease is characterized by increased -SP. The view that the increased -SP reflects the existence of endolymphatic hydrops is considered vital today. However, there are some typical cases of Meniere's disease in which increased -SP is not noted. We studied 44 patients of Meniere's disease and conducted electrocochleographic examination in order to determine whether there are any differences between those who had increased -SP and those who did not.
The following results were obtained.
1. No difference was noted in the nature of dizziness or in the length of the period from the vertigenous attack to the day of the examination.
2. Many of those whose course of the disease is longer than one year and shorter than five years, had positive -SP.
3. No difference was found in the degree of hearing loss.
4. Both positive and negative -SP's were observed in all types of hearing loss.
5. The equilibrium examination revealed no definite difference between these two groups.
From the above, we concluded that clinically there was no definite difference between the positive and negative -SP cases. This proves that electrocochleographic examination, which is considered to be vitally conductive to the diagnosis of the condition of Meniere's disease, fails to provide definite clue to the diagnosis of Meniere's disease. In our view it is appropriate to diagnose Meniere's disease on the bases of anamnesis, hearing and equilibrium examinations and electrocochleographic examination should be made to evaluate the existence of the endolymphatic hydrops.

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Reliability of Glycerol Test and Furosemide Test

Kiichiro Taguchi, Masato Kikukawa

1982 Volume 75 Issue 5special Pages 1266-1270
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1266

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The glycerol test and the furosemide test have been reported to be useful tools for the diagnosis of endolymphatic hydrops. However, there is little evidence that increased caloric response is produced with the glycerol test or that hearing is improved with the furosemide test.
The present investigation was performed to evaluate whether the glycerol or furosemide test is capable of detecting endolymphatic hydrops in terms of caloric nystagmus or air-conduction threshold.
Ten subjects with unilateral Ménière's disease were analysed in the experiment and the following results were obtained.
1) Glycerol was more effective in improving hearing than furosemide.
2) Test-retest reliability was statistically significant.
3) Intravenous administration of 30mg furosemide showed a significant hearing improvement in 2 patients and a remarkably increased caloric response in one, in whom negative response was obtained with 20mg furosemide.

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Effect of Optokinetic Stimulation on Head Movement in Patients with Ménière's Disease

Kiichiro Taguchi

1982 Volume 75 Issue 5special Pages 1271-1284
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1271

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The effects of horizontal and vertical optokinetic stimulation on the head movement in patients with Ménière's disease were investigated using an optokinetic stimulator of Jung's type, a cephalographic system with an industrial television and a minicomputer.
The following results were obtained.
1. Three types of the locus patterns traced by the head movement were obtained during optokinetic stimulation. The centripetal type was observed in 8 subjects, the left and right type in 5 and the forward and backward type in 7. All of the patients with bilateral Ménière's disease showed the forward and backward type.
2. The total length of the locus during one minute of standing gradually increased up to 30 to 90deg/sec of stimulus speed and then decreased. However, there were some exceptional cases which showed irregular courses of going up and down in the locus length.
3. In the ratio of the anteroposterior component to the lateral component of the locus, most of the tested subjects showed minimum values during horizontal stimulation and maximum values during vertical stimulation.
4. There were several kinds of time courses in the head position during optokinetic stimulation.
5. The frequency spectra and the averaged divisional frequencies were obtained and some characteristic results were shown depending upon the types of the locus.

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A Case of Left-Sided Acoustic Tumor with Normal Caloric Reaction

Tsutomu Yamazaki, Sachie Watanabe, Namie Hayashi, Hideo Kozaki, Takao ...

1982 Volume 75 Issue 5special Pages 1285-1289
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1285

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A 53-year-old woman noted hearing difficulty on telephoning, and her mean pure tone average scores for 2, 000, 4, 000 and 8, 000Hz were 65dB in the left ear. There was no balance disturbance, and the caloric reaction remained within normal ranges. In impedance measurement, the normal uncrossed and crossed reflex thresholds on both ears (Jerger, S. et al., 1977) were observed, and only the reflex decay on left contralateral stimulation was abnormal.
A tumor with a diameter of 2cm was visible to the naked eye away from the internal acoustic meatus in the left-sided cerebellar-pontine angle. From the neurootological signs, the tumor seemed to have originated in the inferior vestibular nerve (Ylikoski, J. et al., 1978)

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Measurement of the Pupil Area-The Results of the Mecholyl Test by Means of Conjunctival Instillation in Patients with Meniere's Disease

Machiko Takeda, Takuya Uemura, Mitsuko Itoh

1982 Volume 75 Issue 5special Pages 1290-1294
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1290

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Patients with Meniere's disease were examined using the mecholyl test by means of conjunctival instillation and the pupil contraction rate was calculated by measuring the pupil area before and after mecholyl application. The rate of appearance of abnormal miosis was significantly higher than that of normal subjects during the interval, quasi-attack, and attack stages of the disease on both the affected and unaffected sides, although the rate of appearance obtained by measuring the pupil diameter was higher on the affected side only than that of normal subjects. When the test was repeated on the same patients, the rate of contraction of the pupil area markedly increased on the affected side in the following order: the interval, quasi-attack and attack stages. This indicates that the deterioration in autonomic function in the affected side is related to the cause of vertiginous attack in Meniere's disease.

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Therapeutic Efficacy of Ifenprodil, Cinnarizine and Low Molecular Weight Dextran in Meniere's Disease (Typical and Atypical Types)

Tsutomu Yamazaki, Sachie Watanabe, Namie Hayashi, Hideo Kozaki, Takao ...

1982 Volume 75 Issue 5special Pages 1295-1300
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1295

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Ifenprodil, cinnarizine, and low molecular weight dextran (250ml) were administered to patients with Meniere's disease (typical and atypical types), and their effectiveness and side effects were evaluated. Ifenprodil was administered to 50 patients, 32 of whom had had diphenidol previously. In all of the 50 patients, who were observed on an average of 161 days, the rate of most effective was 40%.
The antivertiginous effect of cinnarizine was evaluated in a single administration to 38 patients with Meniere's diseas (typical and atypical types), who were observed at a mean of 105 days, the rate of most effective was 42%.
In 30 admitted or readmitted patients with Meniere's disease (typical and atypical types), the effect of low molecular weight dextran (250ml) was evaluated.
The rate of most effective was 40%, which was mainly observed in improvement in hearing difficulty in sudden sensoneural hearing loss or Meniere's disease.
Good effects were seen from all three drugs in patients with vestibular disorder with an apparent dysfunction of the central nervous system as reflected in the eye-tracking test and examination for optokinetic nystagmus.

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The Effectiveness of Anti-vertigo Drugs as Described in Therapeutic Reports in Japan

Takashi Matsunaga, Toru Matsunaga, Toshi Naito, Hideaki Tamura

1982 Volume 75 Issue 5special Pages 1301-1326
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1301

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From the bibliographical investigation of the effectiveness of anti-vertigo drugs as described in the therapeutic reports of the department of Oto-laryngology of Osaka University Medical School from 1959 to 1980 and from other reports in this country from the period of 1967 through 1979, the authors arrived at the following conclusions.
1. There was no consistent pattern of correlation between the type of anti-vertigo drugs and the type of diseases with vertigo.
2. The effectiveness of anti-vertigo drugs for the diseases with vertigo in general had a relatively consistent pattern of 30-50% effectiveness if the categories “effective” and others better than that are included in the statistical study. When the category “relatively effective” was also included, the percentage of effectiveness increased to 45-85%, but the difference was more marked.
3. There was no significant difference in the effectiveness of anti-vertigo drugs for Meniere's disease from that for other diseases with vertigo. By double blind studies, isoproterenol was found to be slightly more effective for Meniere's disease than for other diseases, but diphenidol, ifenprodil, etc. also tended to show similar effects on this disease.

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Clinical Investigation of the Prevention of Ménierè's Disease

Shoji Takayasu, Sanae Katori

1982 Volume 75 Issue 5special Pages 1327-1335
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1327

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Significant somatic conditions under which Ménierè's disease develops were discussed based on clinical observation of seven vertiginous patients (orthostatic disregulation, 4; cervical vertigo, 2; and combination of both, 1) whose onset of Ménière's disease was late in their life, and measures to prevent idiopathic onset or periodic attacks were considered.
It was demonstrated statistically that any of the following conditions have a sure prospect of Ménière's disease: one was the ipsidirectional appearance of both vestibular asymmetry (expressed as direction of the induced horizontal nystagmus on ENG) and vegetative asymmetry (expressed as direction to the side with wider responded amplitude on bi-auricular plethysmography) iduced by keeping the patient erect after resting in the supine position for 20 minutes as in Schellong's test, and the other was the labyrinthine type of the cervical threshold shift appearing on pure tone audiometry by keeping the same head position as in the cervical nystagmus.
The improvement in the above-mentioned significant conditions, the refore, may prevent the onset or expected next attack of Ménierè's disease and appropriate treatment for them may correct orthostatic disregulation and cervical vertigo.

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[title in Japanese]

[in Japanese]

1982 Volume 75 Issue 5special Pages 1336-1340
Published: May 20, 1982
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.75.5special_1336

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