Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 76, Issue 9special
Displaying 1-31 of 31 articles from this issue
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  • The State of Vertiginous Lesions in Tsushima Island
    Shigeaki Shirabe
    1983 Volume 76 Issue 9special Pages 2211-2214
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2211
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    The population of six towns located on Tsushima, a remote, isolated island is about 52, 000 and clinical consultation and medical examination were made in the summers from 1977 to 1982 by a medical team from Fukuoka University. Sensory deafness including presbyacusis, chronic middle ear infection, chronic sinusitis and laryngopharygeal neurosis were the most frequent symptoms in the E N T patients. Three patients suffering from tumors of the cerebellopontine angle, esophagus and middle ear (glomus jugular tumor) were found and treated in the Fukuoka University Hospital.
    Twenty-four patients with vertiginous attacks were examined and 15 were diagnosed as having Meniere's disease and nine, benign paroxysmal positional vertigo. Most of the 24 individuals who complained of vertigo, were considered to require further, continued medical care. The morbidity here was higher than other areas of this country. The urgent necessity of establishing a better means of care for the islanders is strongly emphasized by the author.
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  • An Epidemiological Study of Meniere's Disease in Toyama Prefecture
    Kanemasa Mizukoshi, Hideo Shojaku, Masatsugu Asai, Hideya Ohi, Yukio W ...
    1983 Volume 76 Issue 9special Pages 2215-2220
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2215
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    Three hundred and twenty-three patients with Meniere's disease were registered to have an intractable disease from 779 members or clinics of the Toyama Medical Association in Toyama Prefecture in 1974 and 1979. Of the 1, 044 patients who had visited the Neuro-Otological Clinic of the Toyama Medical and Pharmaceutical University Hospital during the three years from October 1979 to December 1982, 102 patients were diagnosed to have Meniere's disease including atypical cases. An epidemiological study of these patients were made and the following characteristic epidemiological features were obtained.
    1) The incidence of Meniere's disease in Toyama Prefecture was estimated to be 14.7 per 100, 000 population on the basis of the registration of this intractable disease made by the members of the Toyama Medical Association.
    2) Sex-ratio: The incidence was higher in males than females in Toyama Prefecture.
    3) Age-distribution: The age distribution of the 102 patients with Meniere's disease peaks at the age group of 40-49 years for males and females.
    4) There was an increasing number of patients in the cities of Toyama Prefecture compared with the countryside. This tendancy was seen in the patients collected by the Toyama Medical Association.
    5) Season of onset: There was an apparent high incidence of initial vertiginous attack in March and in October. This tendency was seen in patients from Toyama Medical and Pharmacutical University Hospital.
    6) The incidence of bilateral Meniere's disease: Of the 102 patients with Meniere's disease (including atypical cases), 9 were bilateral (8.9%).
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  • Clinical Survey of Peripheral Vestibular Disorders (1980-1982)
    Kohji Tokumasu, Akihiro Ikegami, Akira Saito, Naoki Tashiro, Kazuyoshi ...
    1983 Volume 76 Issue 9special Pages 2221-2227
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2221
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    Eight hundred and seventy-seven patients were diagnosed to have peripheral vestibular diseases among 3, 602 patients who had visited the Neurootological Clinic of the Kitasato University Hospital from 1980 to 1982. The percentage of peripheral vestibular diseases was as follows: sensorineural deafness, 20.8%; vertigo and dizziness in chronic middle ear inflammation, 19.3%; Meniere's disease, 16.4%; sudden deafness, 14.9%; postional vertigo of benign paroxysmal type, 11.1%; and vestibular neuritis, 3.4%.
    Several clues for the diagnosis of peripheral vestibular diseases and the importance of neurological examination were discussed.
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  • Clinical and Statistical Observation of Patients Receiving the Vestibular Function Test
    Yutaka Yoshimoto, Ikuo Ohno, Hidehiko Maeda
    1983 Volume 76 Issue 9special Pages 2228-2233
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2228
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    In order to clarify the aspect of vertigo, statistical observation was performed on 2, 107 patients who were subjected to the vestibular function test. The patients in their forties were predominant in number in the whole population, males in their forties and females in their fifties being the largest in number. Patients with peripheral vestibular disorders accounted for about 50 percent of the population, and those with central vestibular disorders, about 20 percent. Of peripheral vestibular disorders, sudden deafness, positional vertigo of the benign paroxysmal type, and Ménière's disease constituted about 5 percent of the population, and vestibular neuronitis accounted for only 1 percent. The proportion of patients with Ménière's disease and positional vertigo of the benign paroxysmal type tended to increase from year to year. Vertigo was abolished or decreased in about 80 percent of the patients in 8 years after the first visit. In a long term follow-up the prognosis of vertigo was considered to be generally favorable.
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  • Vestibulo-cochlear Disorders and Occupational Reinstatement
    Comparison of Various Vertiginous Diseases
    Shoji Takayasu, Sanae Katori
    1983 Volume 76 Issue 9special Pages 2234-2241
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2234
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    The correlation between the symptoms remaining after treatment for five years and occupational reinstatement of the patients with vertigo or dizziness which arose from functional otogenic disorders or intracranial organic diseases was evaluated. The result was discussed clinically and sociologically in comparison with that of the previously reported organic inner ear disorders such as Meniere's disease.
    1). The failure of reinstatement due to vertiginous disease was found at a significantly lower percentage in the group with functional inner ear disorders than in the other two groups.
    2). The most influential factor on the failure differed among the three groups as follows: tinnitus and hearing disturbance in the organic inner ear disease group; nausea and workshop circumstance (human relation) in the intracranial organic disease group; and head heaviness, lack of selfconfidence and iatrogenic neurosis in the functional inner ear disorder group.
    3). It was, therefore, confirmed that organic inner ear diseases had the same sociological seriousness as intracranial organic diseases and must be treated with sociological considerations.
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  • A Comparative Study with Vestibular Tests of Patients with Ménière's Disease in Uppsala University and Osaka City University
    Yoshiaki Nakai, Toshio Imoto, Hideo Yamane, Yasuhiro Minowa, Kazuo Kon ...
    1983 Volume 76 Issue 9special Pages 2242-2247
    Published: September 15, 1983
    Released on J-STAGE: December 12, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2242
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    Forty-seven and 34 patients with Meniere's disease who, respectively, visited the Uppsala University from December 1980 to July 1981 and the Osaka City University from October 1981 to December 1982 were investigated using a battery of vestibular tests performed in the same manner, and the test results from the two universities were compared.
    1) No significant difference in age, duration of illness and the duration of time from the last vertigo attack till the tests were found.
    2) In the pure tone hearing test, both average of hearing loss and type of hearing loss in there was no significant difference.
    3) No significant differences in spontaneous nystagmus and positional nystagmus were found.
    4) In the caloric test both CP and DP showed no significant difference (and in OKN, DP had no significant difference. We concluded that our vestibular investigation revealed no difference between Swedish and Japanese patients with respect to sex, age, duration of illness and the time period from the last attack.
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  • Observation of the Microvascular Structure of the Vestibular Organ by Scanning Electron Microscope
    Yoshiaki Nakai, Haruhiko Masutani, Kazuhiro Ohashi, Kuan-cheng Chang, ...
    1983 Volume 76 Issue 9special Pages 2248-2263
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2248
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    Under a scanning electron microscope, microcirculation of the vestibular organ was observed with the corrosion casting technique. The following results were obtained. The anterior vestibular artery (AVA) was distributed to the utriculus, lateral ampulla, superior ampulla and semicircular canal. The dense capillary network was only found below the hair cells areas. The coiling artery or arteriole was found at the central part of the hair cell areas. The blood vessels of the planum semilunatum formed a loop structure like renal tubules. A secretory or absorptive function of the endolymph was suspected in this portion. One or two arterioles run to the semicircular canal without communicating with the crista ampullaris. The blood vessels of this portion run straightfoward in the canal and never make a dense capillary network.
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  • A Morphological Study of the Endolymphatic Sac Function
    Yoshiaki Nakai, Hideo Yamane, Toshio Imoto
    1983 Volume 76 Issue 9special Pages 2264-2272
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2264
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    The maintenance of homeostasis of the inner ear which is one of the functions of the endolymphatic sac was studied. Streptomycin (SM) was administered to a guinea pig to disturb its vestibular epithelium. The degenerated cell debris was then investigated. In addition, morphological changes were compared between the vestibular epithelium and the endolymphatic sac. The mechanism of foreign body handling by the endolymphatic sac was studied. The following results were obtained.
    (1) Disturbance in the vestibular epithelium was found after administration of SM. As reported by many authors, the epithelium of the ampullar was more severely disturbed than the macula.
    (2) In the macula otoconia which were in the process of fusing were observed at many sites. It was presumed that the otoconial membrane played an important role in forming otoconia.
    (3) There was much cell debris present in the cavity of the endolymphatic sac, and macrophages were phagocyting these foreign bodies.
    (4) The epithelium of the endolymphatic sac, especially microvilli of light cells were decreased or swollen and apocrine-like protrusions were observed.
    From the above results, it was considered that the endolymphatic sac has a function of maintaining homeostasis of the inner ear.
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  • An Ultrastructural Study of the Permeability of Blood Vessels in the Inner Ear (Part II)
    Effect of Experimental Acute Hypertension
    Masafumi Sakagami, Mitsuhito Sano, Toru Matsunaga
    1983 Volume 76 Issue 9special Pages 2273-2282
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2273
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    The effects of the acute hypertension induced in rats by intravenous injection of methoxamine chloride (Mexan) on the stria vascularis and spiral ligament were studied electronmicroscopically with the tracer method of horseradish peroxidase (HRP). A large amount of extravasation of HRP occurred in the stria vascularis, which was due to increased vesicular transport. The leaked HRP spread into intercellular spaces, but spreading towards the endolymph was prevented by the zonulae occludentes existing between marginal cells and towards the perilymph by the zonulae occludentes between basal cells. A reaction product was occasionally found between basal cells. No leakage of HRP from capillaries was observed in the spiral ligament although some labelled micropinocytotic vesicles were present in the endothelium. It is suggested that, under the acute hypertensive condition, areas of zonulae occludentes bordering the stria vascularis play an important role as a barrier to HRP, whereas in the spiral ligament capillaries themselves act as a barrier.
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  • A Quantitative Analysis of Protein in the Fluid of the Human Endolymphatic Sac
    Masaaki Yamane, Takashi Futaki, Akira Shirahata, Masanori Yoshioka
    1983 Volume 76 Issue 9special Pages 2283-2287
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2283
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    A quantitative analysis was made of protein in three fluid samples obtained from the endolymphatic sacs of patients with Meniere's disease during epidural shunt operation utilizing the single radial immunodiffusion method. Prior to th protein analysis, the percentage of whole-blood contamination in the sample was determined using test strips for urinalysis. The concentrations of transferrin, C3, C4 in the samples could be measured quantitatively. These procedures were thought to be very useful for the analysis of inner ear fluids.
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  • Effect of Glycerol on Cochlear Potentials in the Guinea Pig
    Shuichi Okada, Shinichiro Asakuma, Yukio Muratsuka, Takuya Uemura
    1983 Volume 76 Issue 9special Pages 2288-2292
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2288
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    To study the rationale of the glycerol test, cochlear potentials were measured in albino guinea pigs after intravenous administration of 50% glycerol solution. The endocochlear dc potential was reduced slightly within a few minutes after glycerol injection and the negative summating potential also decreased simultaneously. However, these changes were merely transient and almost disappeared within ten minutes. Several investigators have pointed out that the reduction of inner ear pressure caused by glycerol injection takes place after about ten minutes. Therefore, it may be that the changes observed in this study are not due to dehydration by glycerol in the cochlea and, in turn, that the osmotic force of glycerol does not affect directly cochlear potentials, at least in normal guinea pigs.
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  • Experimental Vestibular Disorder Induced by Tympanic Cavity Drug Infusion
    Koichiro Shigeno, Tetsuya Egami, Shigeto Nakajima, Hidehaku Kumagami
    1983 Volume 76 Issue 9special Pages 2293-2299
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2293
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    Experimental vestibular disorders of the peripheral type were induced using transtympanic infusion of several drugs. Drugs with high specific gravity such as saturated sodium chroride and pottasium chroride, heavy water, ethylene glycol, glycerine, isosorbid and urea induced direction-changing, positional nystagmus. The nystagmus was directed upward when the head was held with the right or left side down, to the injected side with the nose-up, to the non-injected side with the nose-down position, respectively. Ethyl-alcohol and aceton which have low specific gravities also induced direction-changing, positional nystagmus, although the direction was opposite to that of those drugs with high gravities.
    Most of these positional nystagmus developed to paralytic nystagmus which directing toward the non-injected side in all head positions or disappeared in three hours. Some animals had a second phase of positional nystagmus before it disappeared. Only pottasium chroride produced irritative nystagmus which directing towared the injected side in all positions and changed to paralytic nystagmus.
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  • Effects of Experimental Acute Hypertension on the Blood-Labyrinthine Barrier
    Hiroaki Miyamoto, Toru Matsunaga
    1983 Volume 76 Issue 9special Pages 2300-2307
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2300
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    With intraperitoneal injection of 0.16mg/kg methoxamine hydrochloride, experimental acute hypertension was made in guinea pig. Blood pressure was measured with a physiological pressure transducer. The initial mean blood pressure was 50-60mmHg and methoxamine caused a rapid increase of 50-60mmHg in about 15-20 minutes.
    For the first experiment, Kanamycin was used as a tracer. Four hundred mg/kg Kanamycin was injected intraperitoneally, and 20min. after injection, acute hypertension was created.
    Inner ear fluids were collected with micro-glass capillaries 10min., 40min., and 3 hours 40min. after inducing acute hypertension. Kanamycin concentrations in the inner ear fluids were measured with the bioassay technique.
    The results showed that Kanamycin went into the inner ear fluids rapidly at a higher dose with acute hypertension, and excretion from inner ear fluids were rapid compared with the normal group. This result indicates that the permiability of Kanamycin through the blood-labyrinthine barrier seems to be increased by acute hypertension.
    The ion concentrations of the inner ear fluids under the effect of acute hypertension were measured with an atomic absorption spectro photometer (Japan Jarrell Ash AA 855). Fifteen minutes after injection of methoxamine, the inner ear fluids were taken and K+ and Na+ ion concentrations were analysed. The results show that in the case of perilymph, the K+ ion concentration in the scala tympani was increased; the Na+ ion in the scala vestibuli was decreased; and in the endolymph, K+ was decreased and Na+ was increased.
    From these two experiments, we concluded that the function of the blood-labyrinthine barrier was affected by acute hypertension and the ion concentrations in the inner ear fluids were also changed.
    Because of the relationship between the perilymph and endolymph, which changes of ion concentrations are primary is not known and the meaning of these changes is not clear.
    The osmotic pressure between the endolymph and perilymph may be changed and if these unbalances in the ion concentrations are continued, histological and functional disturbances of the inner ear can occur.
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  • Effects of Noradrenaline Infusion on the Whole Blood Viscosity and Viscosity's Regulatory Factors
    Noriaki Takeda, Takeshi Kubo, Toru Matsunaga, Etsuko Tanaka, Shoziro S ...
    1983 Volume 76 Issue 9special Pages 2308-2316
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2308
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    It is well known that microcirculation is influenced by blood viscosity. We investigated the effects of noradrenaline (NA) infusion on the whole blood viscosity and viscosity's regulatory factors in order to elucidate the role of the sympatho-adrenal activity in microcirculation.
    The results are as follows.
    1. The whole-blood viscosity measured at five different shear rates proportionally increased as the plasma NA concentrations increased.
    2. The increments of the whole-blood viscosity after NA infusion (ΔCP) were greater at low shear rates than that at high shear rates.
    3. The mean ΔCP in sympathicotonic persons, who are so classified by autonomic nervous function tests, tended to be greater than that in nonsympathicotonic persons.
    4. The platelet aggregability, hematocrit, and contents of some plasma lipids and lipoproteins, which can influence the whole blood viscosity, also increased after NA infusion.
    Present data pointed out the possibility that the sympatho-adrenal hyperactivity may cause “the brain-inner ear circulatory insufficiency” due to impaired microcirculations being induced by the increased whole blood viscosity.
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  • Effects of Cervical Sympathetic Stimulation on Vestibulo-Ocular Reflex of Rabbits with Normal, Low and High Blood Pressure
    Koichi Yamamoto, Toru Matsunaga, Takeshi Kubo
    1983 Volume 76 Issue 9special Pages 2317-2323
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2317
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    The effect of an unilateral cervical sympathetic stimulation on per-rotational nystagmus was investigated in alert rabbits with low, normal and high blood pressure. The cervical sympathetic chain and vagus nerve on one side were cut and the distal part of the cervical sympathetic ganglion (CSG) was stimulated electrically. When a CSG was stimulated, nystagmus towards the stimulated side was suppressed predominantly. As a result, directional preponderance which was directed away from the stimulated side appeared. This effect became obvious when the animal's blood pressure was low. Oxygen partial pressure was recorded in the perilymph of inner ear and cerebellum. Unilateral CSG stimulation predominantly suppressed oxygen tension of stimulated side. This results suggested that the influence of CSG stimulation on the vestibuloocular reflex is considered to be due to aregional ischemia induced by vasoconstriction.
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  • Measurement of the Pressure in the Endolymphatic Sac During the Surgical Procedure of Patients with Ménière's Disease
    Takashi Futaki, Masaaki Yamane, Takesumi Doi
    1983 Volume 76 Issue 9special Pages 2324-2328
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2324
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    In order to confirm the rationale of Portmann's operation, i. e. epidural shunting leads the pressure of the endolymphatic sac to the mastoid cavity where the pressure is one atmospheric pressure, a new microtransducer with transistors was applied to measure the intra-sac pressure during the operation of Meniere's patients.
    The values obtained from 10 patients ranged from 13mmH2O to 34mmH2O, averaging 19mmH2O. The paper includes a bibliographical discussion on the technical problem and the meaning of this value
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  • Considerations on Endolymphatic Sac Operation for Meniere's Diesease
    Is it necessary to open the sac?
    Jiro Hozawa
    1983 Volume 76 Issue 9special Pages 2329-2338
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2329
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    Endolymphatic sac operations were performed in 23 patients with Meniere's disease. Nine of them were free of attacks for more than 10 years after Portmann's operation. However, it is hard to believe that the endolymphatic sac fistula can be kept for more than 10 years. Although the endolymphatic shunt operation could form a semi-permanent fistula, postoperative exacerbations of hearing impairment were oftenly experienced. Shambough's operation had a so-called decompressive effect without opening the endolymphatic sac. In order to prevent a recurrence, adequate managements after the decompression operation are important rather than opening the endolymphatic sac.
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  • Clinical Observation of Benign Paroxysmal Positional Vertigo
    Masaru Shirato, Tokuji Unno, Satoru Onodera
    1983 Volume 76 Issue 9special Pages 2339-2342
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2339
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    Sixty patients with benign paroxysmal positional vertigo (BPPV) were clinically investigated. No sex differences were observed. Twenty-seven of the 60 cases (75%) were in middle- or old age. Head and neck trauma and heart disorder including hypertension were more remarkable as causative factors. In 70% of BPPV, symptoms disappeared in a month. Recurrences of the attack were observed in 38%.
    A benign course is one of the characteristic features of BPPV. However, cases of recurrent attacks are not uncommon.
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  • Clinical Study of Acute Peripheral Vestibular Palsy
    Hideo Miyata
    1983 Volume 76 Issue 9special Pages 2343-2353
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2343
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    Clinical studies were performed on 51 patients with acute peripheral vestibular palsy (similar to vestibular neuronitis) diagnosed, according to the criteria of Gifu University, from January 1980 to December 1982, in the Department of Otolaryngology Gifu University School of Medicine.
    1) The patients, 36 males and 15 females, ranged in age from 19 to 69 years.
    2) No seasonal differences were noted. In 23 patients the onset was in the morning.
    3) Seven of the patients had a history of common cold, and 23 were fatigued from overwork.
    4) Physical and laboratory examinations were carried out to determine any predisposition to acute peripheral vestibular palsy. Disorders of the circulatory system and of the metabolic system were found more frequently in patients with acute peripheral vestibular palsy with no recent history of common cold than in control subjects.
    5) Elevation of the rubella antibody titer (1:256) was noted one of the 11 patients tested.
    6) Abnormal caloric responses were present in all 51 patients. All were unilateral with canal paresis or directional preponderance. Eight patients (15.7%) showed no response to caloric stimulation at 30°C and 44°C. After medication, four showed some recovery of response to caloric stimulation.
    7) On the Gifu University galvanic nystagmus test, four patients who had been ill for more than three months showed normal thresholds, indicating that the function of the vestibular nerve endings and ganglion was normal or recovering.
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  • Vestibulo-Cochlear Dysfunction in Migrating Disseminated Multiple Cranial Neuropathy
    Akira Takahashi
    1983 Volume 76 Issue 9special Pages 2354-2362
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2354
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    Multiple cranial nerve palsy can occur in various intracranial or juxtacranial diseases including neoplasm, granuloma, angiopathy and meningeal diseases, or in acute or chronic relapsing polyneuropathy of demyelinating nature. The latter condition is characterized by symmetrical or bilateral, and predominantly motor nerve involvement.
    In 1967, the author described a peculiar, multiple, cranial nerve palsy and proposed the descriptive designation of migrating, disseminated, multiple, cranial neuropathy. Since then, 9 cases have been reported from Japan and 3 case series have been known from Thailand, Sri-Lanka and Finland.
    The cranial nerve palsy in this disease is acute in onset, usually self-limited in course, and migrates with latent interval. All of the sensori-motor cranial nerves II-XII may be involved. Repeated and careful examination and long-term follow-up study failed to disclose any evidence of systemic or local underlying disease processes.
    In this report, 10 of our own cases are described. Paralysis of the vestibulo-Cochlear nerve was found in 5 patients. Neurological and neuro-otological studies disclosed that hearing loss was of sensori-neural type and the vestibular dysfunction was due to peripheral origin. One of these was found to have benign paroxysmal positional vertigo.
    Attention should be given to those presenting with vestibulo-cochlear symptoms and signs, especially with a tendency to relapse, in relation to migrating, disseminated, multiple, cranial neuropathy.
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  • Clinical Observation of Vestibular Neuronitis
    Michihiko Nozue, Hiroyuki Mineta, Hajime Nakagawa, Yasuhiro Serizawa, ...
    1983 Volume 76 Issue 9special Pages 2363-2367
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2363
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    The etiology and true characteristics of vestibular neuronitis are still obscure, and some people do not use the name of vestibular neuronitis. We investigated the problems of our patients with vestibular neuronitis. The incidence of vestibular neuronitis was less than that of Meniere's disease or other vertiginous diseases. Usually, the etiology of vestibular neuronitis is considered to be common cold or upper respiratory inflammation. However, such episodes as common cold were very rare in our cases. The number of vertiginous attacks in vestibular neuronitis is said to be once, but in several of patients, few vestiginous attacks were seen.
    As mentioned above, the etiology of vestibular neuronitis is not yet clear. Some regard vascular disorder as a cause, or consider it the same as the Guillaine-Barré syndrome. These should be investigated in the future.
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  • A Clinical Observations Vestibular Neuronitis
    Neurotological Findings and Progress
    Takaaki Matsuo, Toru Sekitani, Tetsuyasu Hirata, Keiko Kado, Takaaki N ...
    1983 Volume 76 Issue 9special Pages 2368-2375
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2368
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    Follow-up observation of patients with vestibular neuronitis was made neurotologically and their progress was evaluated. The observation period of the 30 patients (1972-1983) was one year and 5 months in average ranging from 5 days to 9 years 6 months. Eleven patients have been followed for over one year. The tests which were used to evaluate this series consisted of: examination of spontaneous nystagmus, head positional nystagmus, caloric nystagmus and computed galvanic body sway test (Yamaguchi University). Changes in subjective symptoms were described.
    1. Many patients complained of vertigo (whirling) (93%). Others had a floating sensation and unsteadiness of gait. Fifty per cent of the patients were relieved of vertigo in 3 months, whereas 5 patients suffered from an intractable dizzy sensation for over one year. Even after 3 years, 3 of these patients were troubled with the dizzy sensation. Other causative disease including central lesions were excluded in these patients.
    2. Spontaneous nystagmus, which was usually horizontal and with a fixed direction, remaineds in 50% of the patients after one year.
    3. All of those tested showed reduced caloric responses. Five of the 30 patients showed the null response in cold caloric (including ice water) stimulation. Four of them did not improve in the caloric test when tested approximately 2 years and 5 months in average after onset.
    4. The computed galvanic body sway test (Yamaguchi University) revealed a reduced response in the body sway induced by galvanic stimulation; slow response in body sway is peculiar to vestibular neuronitis. This slow response returned to a normal range in 68.4% of the patients in 2 years and 9 months.
    These findings suggested that the prognosis of vestibular neuronitis is poorer than generally expected.
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  • Vestibular Neuronitis
    A Follow-up Measurement of Serum Viral Antibody Titer
    Tetsuyasu Hirata, Toru Sekitani, Takaaki Matsuo, Masaaki Hiyoshi, Taka ...
    1983 Volume 76 Issue 9special Pages 2376-2382
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2376
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    A follow-up measurement of the titer of serum virus antibodies against various kinds of the so-called neurotropic viruses in 19 patients with vestibular neuronitis was made to investigate the pathogenesis of this desease. Viruses evaluated were as follows: herpes simplex virus (CF), varicella-zoster virus (CF), adenovirus (CF), influenza virus A (CF) and B (CF), parainfluenza virus 3 (HI), mumps virus (HI), rubella virus (HI) and measles virus (HI).
    The following findings have so far been.
    1. Highly rising titer in herpes simplex virus and variation of 4 x in titer ranger range during observation period are seen in 3 of the 14 cases.
    2. An extremely high titer (256) of adenovirus was observed in a 4-year-old boy with vestibular neuronitis, showing variation of 4 x in titer.
    3. A high titer and variation (4 x) of parainfluenza virus 3 were observed in one patient whose antibody titer was first measured serologically 3 years after the onset of vertigo due to vestibular neuronitis.
    These data in vestibular neuronitis are compared with other disease groups, i. e. the Hunt syndrome, sudden deafness, Bell's palsy, vertigo (excluding vestibular neuronitis) and other noninfectious and non-vertigo diseases as control. As far as the present results and comparison are concerned, no definite explanation or speculation was made about the pathogenesis of this disease or its relationship to virus infection. Further follow-up survey is needed.
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  • Equilibrium Function of Patients treated with Streptomycin
    Mamoru Suzuki, Takeshi Ariki, Makoto Shirane, Shuji Sato, Midoriko Ish ...
    1983 Volume 76 Issue 9special Pages 2383-2387
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2383
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    Vestibular function tests were performed in 42 patients who had received streptomycin (SM) injections. The results of the vestibular function tests were analyzed together with symptoms, results of audiometry and SM dosage.
    Mann's test was positive in only 28.6% of the patients, although the one-leg standing test and stepping test yielded 61.9% and 54.8% positive rates, respectively. Since all the patients with abnormal Mann's test also showed poor results in the standing test, the standing test should be given top priority for screening vestibular dysfunction. In Mann's test, the average dosage of SM in the positive patients tended to be greater than that of the negative patients, whereas in both standing and stepping tests, the averaged SM dosage were not different among the positive and negative patients. Among the parameters of the stepping test, abnormal values were far more frequently found in the distance of shift, rather than the angle of rotation. This may indicate a low chance of unilateral damage to the vestibular system in SM patients.
    Spontaneous nystagmus was observed in 11.9% of the total patients.
    The caloric test revealed either CP or DP in 7 patients (18.5%). All of these patients showed almost the same hearing threshold bilaterally, indicating that the laterality of the vestibular function was not related to the threshold of hearing.
    The averaged audiometry thresholds were 11.5dB in the middle and low frequency range and 37.7dB at 8kHz. The thresholds of hearing were not parallel to the average dosage of SM.
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  • A Study of Vestibular Disorders Using a Tilt Apparatus
    Nystagmus in Benign Paroxysmal Positional Vertigo Induced by Tilting
    Shigeaki Shirabe, Kimio Shiraishi, Masashi Kawano, Toyoji Soda
    1983 Volume 76 Issue 9special Pages 2388-2392
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2388
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    Over the past 5 years we observed ocular reflexes produced by tilting stimulation with a subject sitting in an orthocephalic posture on a chair apparatus with a continuous tilt. The vector acceleration separate from the gravity force gives a stimulus to the two otolithic organs, while the tilt apparatus moves slowly at a speed of 0.5 degrees or 1 degree per second. At that point vector acceleration upon each maculas changes continuoisly. We made use of a tilt chair apparatus which was electrically driven as far as 25 degrees at a speed of 1 degree per second. Eye movement was observed using a nystagmograph and through an infrared TV-camera in front of the eyes.
    Even in healthy persons nystagmoid eye movement (weak nystagmus) is observed, though only slightly, and patients with vertigo clearly develop nystagmus. Thus this eye movement can be used as an index for the study. Two hundred and four patients who complained of vertigo or dizziness were examined by means of our new method. Classification of the nystagmus response is as follows: Type I is of fixed direction, Type II is of changed direction and Type III is a combination of the two. Most healthy persons show no clear nystagmus. Patients with Meniere's disease, sudden deafness and vestibular neuronitis show direction-fixed nystagmus (Type I). In patients with otolithic disorders such as positional vertigo of benign paroxysmal type, when their head and limbs were tilted to the right the nystagmus beat to the left. Similary, when the head was tilted to the left the nystagmus was directed to the opposite side (Type II).
    Healthy persons were studied by dividing them into three groups by age, namely 20-35 years old (A group), 36-55 years old (B), and over 56 years old (C). Each group consisted of 20 persons or more. One of the 20 in the A group showed nystagmoid eye movements at a minor amplitude and a small beat number. The incidence of eye movements was minimal but it tended to increase by age, which is considered to be due to geriatric degeneration of static organs including the otolithic organ. Motion sickness in healthy persons was also studied with tilting stimulation. The intensity of nystagmus in persons with motion sickness tended to increase as symptoms became severer. A survey was made referring to motion sickness in relation to vestibular disorders. There were many patients with a history of motion sickness. The incidence was statistically high in benign paroxysmal positional vertigo compared with Meniere's disease and sudden deafness.
    In the future, in addition to basic study to endorse these findings, study should be made of whether this tilting stimulation is really related to the otolithic organ only, and whether there is any influence on the semicircular canals and the proprioceptive receptor system as well as on the control of the central nervous systems.
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  • Quantitative Analysis of the Visual Vestibulo-Ocular Reflex Induced by Sinusoidal Rotation in Patients with Peripheral Vestibular Disorders
    Kanemasa Mizukoshi, Hideto Kobayashi, Yukio Watanabe, Naoki Ohahi, Hid ...
    1983 Volume 76 Issue 9special Pages 2393-2400
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2393
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    In order to investigate the interaction between the vestibular and optokinetic systems in patients with peripheral vestibular disorders, the visual vestibulo-ocular reflex (V-VOR) gain in thirty-seven patients with peripheral vestibular disorders was measured using pendular harmonic sinusoidal rotation with optokinetic stationary stimuli. The patients were rotated sinusoidally at an amplitude of 240° and at a frequency of 0.1Hz (maximum velocity 75.4°/s), both with eyes closed and open.
    Comparing the vestibulo-ocular reflex (VOR) and V-VOR gains in the patients with definite Meniere's disease (17 cases), benign paroxismal positional vertigo (BPPV, 10 cases) and sudden deafness with vertigo or dizziness (10 cases), VOR-DP and a normal V-VOR gain were more frequently observed in patients with Meniere's disease (17 cases) and sudden deafness (7 cases) than in those with the BPPV (3 cases). In two patients with bilateral Meniere's disease, an abnormally decreased VOR-gain (under 0.5) in the bilateral directions with normal V-VOR gain was measured when tested independently. However, an abnormal V-VOR gain was observed in only one patient of sudden deafness due to a retro-cochlear lesion.
    From our VOR and V-VOR gain observation and that of caloric responses, we have concluded that VOR and V-VOR gains provided additional information for the evaluation of peripheral vestibular disorders as well as central nervous system disorders.
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  • Clinical Findings with the Galvanic Body Sway Tests in Patients with Vestibular Disorder
    Yukio Watanabe, Hideya Ohi, Masayo Sawa, Naoki Ohashi, Hideto Kobayash ...
    1983 Volume 76 Issue 9special Pages 2401-2406
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2401
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    The galvanic body sway test (GBST) was performed in 15 normal subjects and patients with vertigo or disequilibrium indicative of canal paresis and of bilaterally depressed responses to the caloric test. In normal subjects, galvanic body sway responses appeared at stimulations of 0.2mA or less. The average threshold intensity for galvanic body sway responses of normal subjects was 0.09±0.1mA. Uni- or bilaterally depressed responses to GBST were found in 19 patients (37.2%) as follows: vascular disorder of the brain in 4, cerebello pontine angle tumor in 3, head trauma in 3, unilateral deafness in 3, sudden deafness with vertigo in 2 and others in 4. Patients with inner ear disorders such as Meniere's disease showed normal responses to the test.
    In 13 patients with abnormal GBST, central equilibrium disorders such as abnormal OKN or ETT, down beat nystagmus, caloric perversion and/or positional nystagmus (direction-changing type) were observed. In those with abnormal responses to GBST, the number of central equilibrium disorders was significantly more than that of those with normal GBST responses.
    Our clinical study seemed to indicate that GBST may provide information different from the caloric test for the diagnosis of vestibular disorders and may be useful not only for the diagnosis of vestibular neuronitis but also for the diagnosis of some central disorder of the vestibular system.
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  • Quantitative Frequency Analysis of Movement of the Body's Center of Gravity
    Kiichiro Taguchi, Masato Kikukawa, Kiyotaka Higaki
    1983 Volume 76 Issue 9special Pages 2407-2410
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2407
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    Two techniques of frequency analysis were performed to find pathognomonic characteristics of body sway in patients with equilibrium disorders or ataxia.
    A stabilometer using the straingauge technique was used to obtain, from a subject standing normally on the platform, a continuous record of the movement in the horizontal plane. The data was at the same time supplied to a data recorder, which separately stored the data of lateral and antero-posterior movements on the tape. The recorded data on the tape was fed into a digital computer for the spectral analysis and the calculation of averaged divisional frequencies.
    Careful investigation proved that the peak frequencies and the calculated averaged divisional frequencies are reliable indicators of frequency characteristics of the body sway, suggesting the possibility of their clinical application.
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  • Observation of the Velocity of Body Sway Ménière's Disease
    Isamu Watanabe, Jin Okubo, Shuji Kodaka, Kazuhiko Mashima, Hiroyoshi I ...
    1983 Volume 76 Issue 9special Pages 2411-2417
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2411
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    Vestibulo-spinal reflexes in Ménière's disease were analyzed using gravigrams and velocitygrams.
    Studies of vestibular disturbance have so far been centered around nystagmus. With the development of the gravicorder, however, a new approach to the testing of vestibulospinal reflexes began to be tried, which is based on the analysis of the center of gravity.
    A characteristic of gravigrams is that they are positional graphs and provide no information about time-course changes in the velocity with which the center of gravity moves. To clarify time-course changes in the velocity of the sway of the center of gravity while recording its movement, we processed data of the change in the time-course velocity, a component of dynamic control system, with a computer and obtained velocity-grams.
    On gravigrams, body movements differing in frequency are represented by the same area change as long as their amplitudes are the same. These same body movements, however, produce completely different velocitygrams, which are constructed on the basis of differentials of the above recordings.
    Eleven patients with Ménière's disease were then tested during a non-attack period with their eyes open and closed. It became clear from the above test that, even among patients who exhibited the same pattern of area change on gravigrams, velocitygrams were different from each other. This means that the velocity is controlled by a different recovery conditions.
    That the velocitygrams of patients in a non-attack period varied greatly suggests that each patient responded differently to treatment.
    The above findings indicate that the velocity of body sway, which is a parameter of the dynamic control functions, plays an important role in the clinical diagnosis of equilibrium disturbance.
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  • Clinical Significance of Head Movement while Stepping
    Kiichiro Taguchi, Chiharu Hirabayashi, Masato Kikukawa
    1983 Volume 76 Issue 9special Pages 2418-2425
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2418
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    A newly devised system was employed to measure head movement while stepping. The system consisted of three accelerometers, a multi-channel telemeter and a microcomputer.
    The data calculated by the computer were expressed in cm and plotted on the 3-dimensional coordinates.
    A total of ten normal adults and twenty-two patients with peripheral vestibular disorders were examined. The results obtained from the normal subjects were stable at the stepping speeds of 1.2 and 1.4 steps/sec. The patients with peripheral vestibular disorders, except those with benign paroxysmal positional vertigo, showed large values of head movement in all three dimensions. However, the most important clinical characteristic was confirmed to be the increased horizontal head movement with abnormal ratios of anteroposterior components to lateral components in the head movement.
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  • Epidemiological Survey of Vestibular Disorders
    Isamu Watanabe, Jin Ohkubo, Motohisa Ikeda, Kanemasa Mizukoshi, Yukio ...
    1983 Volume 76 Issue 9special Pages 2426-2457
    Published: September 15, 1983
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.76.9special_2426
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    In 1980, the Vestibular Disorders Research Committee of Japan, which is supported by the Ministry of Health and Welfare, was founded by 24 doctors, who come from various districts or areas of Japan. First of all, the Committee drafted the diagnostic criteria of several peripheral vestibular disorders, such as benign paroxysmal vertigo, vestibular neuronitis, bilateral loss of labyrinthine function, inner ear syphilis. In the epidemiological survey, 783 cases of vestibular disorders were collected from the Committee members. The proportion of vestibular disorders in the total number of patient treated during the same period was 3.2-3.8% for new patients. The male: female ratio was 3.6:4.7. Among these cases, the proportion of definite casses of Ménière's disease in the total number of new patients was 0.79%, and this figure is very close to the proportion obtained from the epidemiological survey by the Ménière's disease Research Committee of Japan in 1977, and the prevalence of Ménière's disease estimated from the survey was 160 per million. The prevalence of each type of vestibular disorders estimated from the data of Ménière's disease were as follows: benign paroxysmal positional vertigo 107, sudden deafness with vestibular disturbance 85, vestibular neuronitis 35, traumatic vestibular disorders 18, bilateral loss of vestibular function 16, inner ear syphilis 11 (per million). However, as these estimations are based on the second hand data, further investigation will be necessary.
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