Practica Oto-Rhino-Laryngologica

Epidemiological Survey of Vestibular Disorders (Second report)

with special reference to the incidence of various types of vestibular disorders in outpatients at their initial visit

Isamu Watanabe, Jin Ohkubo, Motohisa Ikeda, Kanemasa Mizukoshi, Ikuo W ...

1984 Volume 77 Issue 10special Pages 2079-2085
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2079

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In 1980, the Vestibular Disorders Research Committee of Japan, which is supported by the Minitsry of Health and Welfare, was founded by 24 doctors, from several districts of Japan. First, the Committee drated the diagnostic criteria for several peripheral vestibular disorders, such as benign paroxysmal vertigo, vestibular neuronitis, bilateral loss of labyrinthine function, inner ear syphilis. In an epidemiological survey, 783, cases of vestibular disorders were collected by the Committee members.
This second report describes a comparative survey of the monthly incidence of vertigo, equilibrium disturbance, and vestibular disorders (including pathological types and classification of symptoms) among outpatients visiting the same clinics for the first time in 1982 and 1983.
There was no appraciable difference between the two surverys in terms of the total number of outpatients affected by vestibular disturbances, but these were some insignificant variations in some of the factors examined.
When we have stabilized the incidense of the various pathological types of diseases by further surveys, we will perform an epidemiological survey which includes the contemporary incidence and compares it with the results of previous surveys.

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Epidemiological Studies of Meniere's Disease in Toyama Prefecture

in Comparison with the Findings of 2nd Nation-wide Survey

Hideo Shojaku, Kanemasa Mizukoshi, Yukio Watanabe, Naoki Ohashi, Hajim ...

1984 Volume 77 Issue 10special Pages 2086-2096
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2086

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After the last Survey of Meniere's disease in Toyama Prefecture, 169 new cases of Meniere's disease were diagnosed in 1982 by the same 779 members or clinics of the Toyama Medical Association and listed in the intractable disease category.
Questionnaires were sent to these patients, and the replies received from 70 of them analyzed epidemiologically and clinically and the results were compared with those of 520 cases of Meniere's disease, registered as definite Meniere's disease in the 2nd nation-wide survey by the Meniere's Disease Research Committee of Japan from 1974-1976.
The following characteristic epidemiological and clinical features of Meniere's disease were noted in Toyama Prefecture:
1) The incidence of Meniere's disease was 17.4 per 100, 000 population as registered by the Members of the Toyama Medical Association in 1974/1979 and in 1982.
2) Sex-ratio: There were 107 males and 385 females.
3) Age distribution: The age distribution peaked 50-59 years for males and 60-69 years for females.
4) There were more patients in the cities of east Toyama prefecture than in the rural areas of west Toyama.
5) Season and time onset: There was no high incidence of vertiginous attacks in the seasons. and a high incidence with peaks 4:00-8:00 and 12:00-16:00.
6) Family history: Six (9.2%) of the 70 patients had a close relative with Meniere's disease.
7) Dizzy attacks of Meniere's disease were more common in Toyama Prefecture characteristic than in the 2nd nation-wide survey.

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Mode of Termination of Vestibular Primary Afferent Fibers from the Horizontal Semicircular Canals in the Cat Vestibular Nucleus

Sei-ichi Sasaki, Norio Ishizuka

1984 Volume 77 Issue 10special Pages 2097-2102
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2097

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Physiologically identified single vestibular primary fibers originating from the horizontal semicircular canal were stained by intraaxonal injection of horseradish peroxidase and three-dimensionally reconstructed under the light microscope.
In the vestibular root bundle, each fiber had one collateral and distributed terminals in the vestibular interstitial nucleus. The stem axon bifurcated into ascending and descending branches in the lateral vestibular nucleus. The ascending branch distributed terminals in the superior vestibular nucleus. The descending branch sent several collaterals to the ventrolateral region of the lateral and inferior vestibular nucleus.
These collaterals ran medially and reached the medial vestibular nucleus. Terminals were observed mainly in the boundaries between the medial nucleus and the lateral or inferior nucleus. Few terminals could be observed in the dorsal part of the lateral vestibular nucleus.

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Influence of Aminoglycosides on the Ampullar Receptors of the Isolated Posterior Semicircular Canal of the Frog

Midoriko Ishida

1984 Volume 77 Issue 10special Pages 2103-2106
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2103

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The posterior semicircular canal of the frog was isolated in Ringers' solution. An apparatus for constant aspiration was devised which was attached to the end of the posterior canal isolated to make the ampullofugal deviation of the cupula in the posterior canal, and the action potential in the ampullar branch of the vestibular nerve was led off by a micro-suction electrode. From the ampullar branch of the vestibular nerve almost identical responses were recorded by an electronic counter: about 1000 spikes above 50V for 7 seconds.
Next, the influence of aminoglycosides on the ampullar receptors of the isolated posterior semicircular canal was studied. Gentamycin and Panimycin inhibited the response to the stimulation of ampullar receptor at 140r/ml, and reduced the electrical activity to 50% at 210/ml.
Sagamicin inhibited the response at 210/ml and reduced the activity to 40% at 350/ml.

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Morphological Changes in Vestibular Sensory Epithelia Caused by Ototoxic Drugs

SEM study

Kouji Sera

1984 Volume 77 Issue 10special Pages 2107-2119
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2107

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4mg (0.1ml) of gentamicin (GM) or tobramycin (TOB) was injected into the tympanic cavity of guinea pigs. Changes in the sensory epithelia of the crista ampullaris, macula sacculi and macula utriculi were examined by SEM.
1) Four days after injection, some degenerative changes were already noticed in the sensory epithelia.
2) Damage tended to progress, and changes were observed in the GM group even 1 month after injection.
3) In the crista, more damage was observed in the central portion, and less in the periphery. In the macula, the striola showed the most change.
4) There were no significant differences in susceptibility to GM and TOB between the crista and the maculae.
5) Early changes observed in the sensory cilia were fusion and ballooning. This developed further to disappearance of the cilia.
6) One month after injection, damaged hair cells were replaced by supporting cells, suggesting that the change is irreversible.

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The Effect of Carbonic Anhydrase Inhibitor on the Otoconia and the Otoconial Membrane

A Scanning Electronmicroscopic Study

Yasuo Harada, Yuzuru Murakami, Toshitada Sakai, Masaya Takumida, Nobuh ...

1984 Volume 77 Issue 10special Pages 2120-2128
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2120

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Acetazolamide, in a daily dose of 100mg/kg; was injected intraperitoneally for 21 days in 5 guinea pigs and 5 mice. Changes on the otoconia and the otoconial membrane were investigated by SEM. In most of the animals the number of otoconia in both the utricle and the saccule was decreased.
In some animals with a marked reduction in otoconia, the entire mesh-work structure of the macular membrane was even visualized. Sensory cilia were sometimes seen through the otoconial membrane.
Otoconia were more markedly decreased in the saccule than in the utricle. The remaining otoconia showed some changes: giant, dumbell-shaped or spongy surfaced otoconia. Acetazolamide seems to inhibit the crystalization of the calcium bicarbonate contained in the otoconial precursor. Carbonic anhydrase may contribute to the formation and maintenancc of the otocoinal membrane.

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Free Floating Cell in the Endolymphatic Sac of Squirrel Monkeys after Section of the Utricular Nerve

Hideo Yamane, Yoshiaki Nakai, Makoto Igarashi

1984 Volume 77 Issue 10special Pages 2129-2135
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2129

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Free floating cells (FFCs) in the endolymphatic sac (ES) were examined microscopically, counted, and studied statistically in squirrel monkeys after unilateral utricular nerve section (UNS). After the operation these monkeys were kept for 17-38 days until the acquisition of functional (locomotor balance) compensation was completed.
There were twice more FFCs in the ES on the operated side than on the non-operated side. A significant increase (P<0.05) of FFCs was seen in the ES under pathological conditions with autogenous debris in the endolymphatic space. The ES thus appears to react to labyrinthine insults.

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Saccular and Cochlear EP in Animals with Hydrops

Eiichi Arakawa, Jun Kusakari, Masaaki Rokugo, Kenji Ohyama, Naoki Inam ...

1984 Volume 77 Issue 10special Pages 2136-2142
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2136

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It is well known that the saccular endolymphatic potential (SEP) in normal animals is not produced in the saccule per se but by a leak from the cochlear endolymphatic potential (CEP). The present study examines the relationship between CEP and SEP in animals with hydrops. Endolympahtic hydrops was induced by obliterating the endolymphatic sac in 33 animals and the potential was measured 2 weeks, 1 month and 3 months postoperatively.
CEP was already slightly reduced at 2 weeks and was 56.0±15.1mV and 54.8±13.1mV (normal value 87.2±5.3mV) at 1 and 3 months, respectively. SEP was also reduced to -0.2±3.5mV and -1.0±1.9mV (normal value 5.0±3.5mV) at 1 and 3 months, respectively. As the magnitudes of the potentials were reduced, the response to ischemia was decreased, namely a delayed decline and slow rate of decline, indicating a reduced metabolic rate in the stria vasculalis. In the early stage of hydrops, the magnitude of SEP reduction in asphyxia was about 10% that of CEP, as in normal animals. Later, however, the reduction of SEP became much less and finally it was slightly increased during asphyxia even though CEP was reduced. It was concluded that CEP was not transmitted to the saccule in case of ears with advanced hyrdrops.

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Radio-immunological Determination of IgG in Endolymph Obtained from the Endolymphatic Sac of Two Patients with Ménière's Disease and One Control

Takashi Futaki, Kosuke Ishii, Masaaki Yamane, Tsuyoshi Ohta, Koichi Hi ...

1984 Volume 77 Issue 10special Pages 2143-2147
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2143

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During endolymphatic sac surgery in two patients with Meniere's disease, very samll amounts of intra-sac endolymph were obtained along with a tiny specimen of the outer wall of the sac.
From a deaf patient with temporal bone fracture, the same specimens were obtained during labyrinthectomy.
The homogenated sac wall and human serum albumin, were placed in wells, and the γ-counts were compared after a radio-immunological procedure utilizing the endolymph and ¹²⁵I-anti Human IgG (Goat). A significantly higher concentration of IgG was found in the endolymph of the patients with Meniere's disease than in the control endolymph.
Genetic factors, such as autoimmunity, are discussed as a possible cause of endolymphatic hydrops.

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Endolymphatic Hydrops and Complement

Tamotsu Harada, Toru Matsunaga, Kozo Inoue, Kyongsu Hong

1984 Volume 77 Issue 10special Pages 2148-2154
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2148

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Previously, we demonstrated the existence of IgG antibody in the endolymphatic fluid. In the present study, for the determination of endolymphatic complement, we established a new system using 1.5×10⁸ cells/ml sheep erythrocytes made up to a total volume of 50μl. The value of endolymphatic CH50 determined by this system was 3.70u/ml. Endolymphatic hydrops was induced experimentally in guinea pigs using rabbit's stria vascularis as the antigen, as previously described. In the present study, the activation system of the complement involved in endolymphatic hydrops was assessed in C4 deficient guinea pigs (C4D guinea pigs). Under anesthesia with nembutal, these animals were perfused with 10% neutral formalin and immobilized.
Observations were made after HE staining. In normal guinea pigs (Hartley strain) endolymphatic hydrops was induced in 40% (4/10), but in none of the 18 C4D guinea pigs. These results suggest that the main activation system for the complement involved in the development of endolymphatic hydrops is the classical pathway.

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Evaluation of Drug Effects in Medical Treatment of Peripheral Vestibular Disorders

With Special Reference to the Double-Blind Test for Adenosine Triphosphate (ATP)

Kanemasa Mizukoshi, Isamu Watanabe, Toru Matsunaga, Manabi Hinoki, Ats ...

1984 Volume 77 Issue 10special Pages 2155-2163
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2155

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Subjective and objective signs and symptoms of 128 patients with Meniere's disease and of 98 with other peripheral vestibular disorders were analyzed in a double-blind controlled study comparing ATP (300mg) and β-histine (36mg) each given daily for four weeks. The clinical subjective and objective evaluations were recorded by doctor and patients at the neurotological examination before treatment started, after two weeks, and after four weeks. The method of giving medicine was the matched-pair-group-method for this double-blind controlled trial.
The attending doctors all concluded that ATP was significantly more effective than β-histine in the treatment of peripheral vestibular disorders.
Currently, there are great variations in the clinical evaluations of the effectiveness of antivertiginous drugs. Our studies included both subjective and objective evaluations. This was helpful. Indeed, what is needed is the establishment of a fuller and more uniform set of criteria for evaluating the effectiveness of antivertiginous drugs. Such strict criteria must include subjective as well as objective evaluation if we are to judge drug effects accurately.

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Clinical Observations on Bilateral Vestibular Neuronitis

Shigeaki Shirabe

1984 Volume 77 Issue 10special Pages 2164-2170
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2164

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Three patients with bilateral vestibular neuronitis, among the 71 with vestibular neuronitis who visited the Fukuoka University Hospital during the past 10 years, are described. A 58 year old woman was found to have hypofunction of the right vestibular organ in 1975 and became unresponsive bilaterally to caloric and rotational stimuli after a recurrent attack of vertigo in 1982, after 6 months of persistent ataxia. A 68 year old man had vertigo for 10 days in 1978 and a recurrence in August 1983, with bilateral dead labyrinths. A 62 year old woman experienced ataxia in August 1982 and rotational vertigo in August 1983. Her bilateral caloric nystagmus responses are much damaged with persistent ataxia even after 6 months. All three patients have jumbling phenomenon, which in second case is so slight that there are no subjective symptoms. The tilted chair test revealed direction changing type in cases 1 and 2, and case 3 changed from deficient type to direction fixed type.
An analysis of the process by which vestibular neuronitis with bilateral changes is damaged or recovers and the results of the tilted chair test suggest that vestibular neuronitis involves not only the vestibular nervous and semicircular canal systems but also the otolith organ system. The author plans further studies of partial loss of the peripheral vestibular system.

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Immunological Examination of Cerebrospinal Fluid in Patients with Vestibular Neuronitis

Takaaki Matsuo, Toru Sekitani, Keiko Kado, Takaaki Noguchi, Yoshiko Ma ...

1984 Volume 77 Issue 10special Pages 2171-2182
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2171

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The cerebrospinal fluid (CSF) and serum of four patients with vestibular neuronitis were studied immunologically. Our patients were one male and three females aged 28 to 55 years. They had no caloric response at the initial test, 2 to 18 days after the onset, and were observed for over one month. All CSF samples, obtained by lumbar puncture, were examined for total protein, albumin, IgG, cell count and several virus antibodies (herpes simplex 1, 2, varicella-zoster, cytomegalo, EB, rubeola, parainfluenza types 1-4, influenza A, B, rubella and Japanese encephalitis viruses).
1) In all four cases, CSF total protein was slightly increased without rise of cell counts during the clinical course.
2) The CSF/serum albumin Index (CSF×10³/serum albumin concentration ratio) and IgG Index [(CSF/serum IgG)/(CSF/serum albumin)] were within the normal range and there was no specific change in their relationship during the clinical course.
3) Herpes simplex virus type 1 IgG antibody titer in paired sera rose in one of the four, but in the CSF there was no change.
4) Herpes simplex virus type 1 IgG antibody titer in the CSF rose in another case starting 26 days after the onset and remained elevated even after three months. At the same time, the serum titer was also elevated, but there was no specific change.
5) These results support the view that vestibular neuronitis is closely related to herpes simplex viral infection.

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Vestibular Neuronitis

A Follow-up Measurement of Serum Viral Antibody Titers (2nd report)

Tetsuyasu Hirata, Toru Sekitani, Masaaki Hiyoshi, Yoshihiko Okinaka, T ...

1984 Volume 77 Issue 10special Pages 2183-2190
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2183

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Twenty-six cases of vestibular neuronitis were tested serologically for nine viruses: herpes simplex (CF), varicella-zoster (CF), adenovirus (CF), influenza A and B (CF), parainfluenza 3 (HI), mumps (HI), rubella (HI) and measles (HI). Mycoplasma (PHA) was also tested.
In nine patients who had four-fold or greater rises in serum antibody titer, mainly in paired sera, the onset of vertigo was assumed to be related to virus infections, herpes simplex in 2 cases, adenovirus in 2 cases and influenza B in 3 cases.

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A Case of Bilateral Vestibular Neuronitis with Blurred Vision during Head and/or Body Movements (Jumbling Phenomenon)

Taisuke Kurokawa, Kanemasa Mizukoshi, Yukio Watanabe, Hideto Kobayashi ...

1984 Volume 77 Issue 10special Pages 2191-2198
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2191

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In Japan there have been few case reports of bilateral vestibular neuronitis fulfilling the diagnostic criteria of vestibular neuronitis drafted by the Vestibular Disorders Research Committee of Japan in 1980. We examined a 43-year-old female with bilateral vestibular neuronitis who had blurred vision during head and/or body movements. Severe loss of bilateral vestibular functions was noted on caloric and visual vestibulo-ocular reflex (V-VOR) tests.
Moreover, complete bilateral loss galvanic body-sway was recognized on 0.5mA galvanic stimulation. However, there was no hearing impairment and no central nervous system disorder. On subsequent neurotological examinations, we found that her caloric responses and VOR-gains recovered as her dizziness disappeared. However, her blurred vision and loss of galvanic body-sway persisted. These findings suggest that the battery of V-VOR-gain, caloric and galvanic body-sway tests are of great value in follow-up studies of vestibular neuronitis.

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Equilibrium Function Test in Patients Treated with Streptomycin

Toshie Sakurai, Yoshiaki Nakai, Toshio Imoto

1984 Volume 77 Issue 10special Pages 2199-2205
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2199

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Vestibular function tests were performed in 20 patients receiving streptomycin (SM) injections.
(1) Three patients complained of the so-called “jumbling phenomenon” and 7 patients had a floating sensation when head or body positions were changed.
(2) Manns test, one-leg standing test and stabilometry were sensitive tests in patients with subjective symptoms.
(3) Stabilometry was the most sensitive of the vestibular function tests for patients receiving SM injections.
(4) The typical jumbling phenomenon was sometimes observed in patients injected with less than 10g of SM and appeared within 2 weeks of the first SM injection.
(5) The onset of the jumbling phenomenon was not related to the dose or duration of SM therapy.

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Analysis of Velocity Component by Direction of Body Sway

Its relation to nystagmus

Masahiko Yamamoto, Atsushi Komatsuzaki

1984 Volume 77 Issue 10special Pages 2206-2216
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2206

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The extent and pattern of body sway vary greatly with the severity of ataxia in patients with nystagmus.
The changes in the direction of body sway in response to imposed motions were studied by recording the center of gravity. For this purpose, a matrix with velocity as the parameter was postulated, which showed the sway of the center of gravity in eight directions each covering a 45/field. This method was tentatively named the swaying velocity analysis in eight directions. Data on the body equilibrium were recorded for 60sec, and analyses were performed with sampling times of 100msec.
The velocity in eight directions and velocity differences between movements in opposite directions were first determined for 55 normal subjects. Those for patients with nystagmus were then determined and checked against the normal values. A positive correlation was clear in swaying with the eyes closed. Lateral swaying was faster in the direction of the fast component of nystagmus and slower in that of the slow component. There was no correlation between the direction of nystagmus and that of anterposterior or oblique swaying.
The above findings indicate that lateral sway in the presence of nystagmus is, like nystagmus, diphasic, and has fast and slow components. Presumably, the fast component is associated with righting, and the slow component with deviation. The present method of analysis allows simultaneous observation of deviation and righting. While the intensity of swaying reflects the severity of ataxia in general, the velocity difference between opposite directions of sway provides a more difinite index of the severity of ataxia, particularly that concerned with the righting reflex.

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Jumbling Phenomenon and Aminoglycosides

Otoneurological study and prognosis in 14 cases

Keiko Kado, Toru Sekitani, Takaaki Noguchi, Yuji Imate, Atsuo Ueki, Mi ...

1984 Volume 77 Issue 10special Pages 2217-2225
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2217

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Fourteen patients with the jumbling phenomenon which occurred after the administration of aminoglycoside antibiotics were examined in the Department of Otorhinolaryngology, Yamaguchi University Hospital, from January 1975 to December 1983.
1. Thirteen patients were treated with streptomycin sulfate (SM) and one with gentamycin.
2. The accumulated dose of SM at the onset of ataxia or at the time of otoneurological consultation varied from 6 to 55 grams. There was no relationship between the onset of the jumbling phenomenon and the dose of SM.
3. Disturbances of visual fixation due to probable bilateral dysfunction of the labyrinths and cerebellum, and of the cerebrum in some cases, might cause the jumbling phenomenon, in which the visible object in front of the patient moves up and down during walking.
4. Equilibrium examinations revealed definite abnormality of the righting reflex. In contrast, various results were obtained in response to caloric stimulation ranging from no response to lowered excitability.
5. Eleven patients were suspected of having some involvement of the lower brain stem and cerebellum, also.
6. Four patients showed some improvement in the follow-up examinations, but no change in their responses to caloric stimulation.

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Jumbling Phenomenon in a Case of Unilateral Peripheral Vestibular Disease

Kohji Tokumasu, Akito Fujino, Akihiro Ikegami, Shinichi Nishihata

1984 Volume 77 Issue 10special Pages 2226-2233
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2226

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One kind of oscillopsia of vestibular origin consists of disorders in visual perception when a patient with loss of vestibular function moves rapidly. It is called “jumbling” and may be induced by insufficiency of compensatory vestibular eye movement.
Usually “jumbling phenomenon” appears in cases of loss of bilateral vestibular function, since an intact unilateral labyrinth may completely cover the absence of unilateral vestibular function. However, it appeared in our three patients with unilateral vestibular disease: vestibular neuritis or unilateral labyrinthine disease due to meningitis. All three complained of difficulty in walking in dim light and sensed apparent move ments of a still target when they moved their head towards the side of the diseased ear either actively or passively.
They had normal clear vision during movement of the head to the side of the intact ear. This may be called “unilateral jumbling” as opposed to “bilateral jumbling”, which is oscillopsia caused by moving the head to either. Unilateral jumbling, which seems to be provoked by strong DP (directional preponderance of nystagmus) due to acute vestibular asymmetry, may disappear as soon as vestibular symmetry disappears. However, unilateral jumbling in older patients or in those with unilateral vestibular disease combined with some central nervous system disorder may persist for a long time.

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Visually Elicited Body Sway and Jumbling of Objects

Kiichiro Taguchi, Masato Kikukawa, Chiharu Hirabayashi, Kazuya Ito

1984 Volume 77 Issue 10special Pages 2234-2239
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2234

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A new technique to objectify the Jumbling of objects (Dandy's symptom) with visual stimulation and posturography was devised and used to test a patient with severe bilateral vestibular disorder who complained of blurred vision while walking. He showed abnormal irregular body movement while standing on the platform of a stabilometer and looking at the spotlights moving on the screen. At the same time he felt a sensation of jumbling and the recorded of his eye movement showed abnormal tracking which meant that he could not pursue the moving spotlights correctly.

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Clinical and Pathologic Aural Findings in a Case of Diffuse Metastatic Leptomeningeal Carcinomatosis

Hideo Miyata, Eiji Asai, Michiko Yoshimura, Masataka Kato

1984 Volume 77 Issue 10special Pages 2240-2250
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2240

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The otological symptoms and temporal bone findings in a 56-year old female with deafness due to subarachnoid metastases of adenocarcinoma of the lung are described.
Hearing in the left ear was almost totally lost in about 3 days, and after 18 days the right ear became involved. She denied vertigo except for some unsteadiness on walking. There was slight left facial weakness and left IX th & X th nerve paralysis and severe bilateral deafness. However, hearing in the right ear improved about 35 dB during treatment (⁶⁰Co radiation and chemotherapy). The caloric response to ice water was absent in the left ear. The galvanic nystagmus test revealed that the site of damage was the left superior vestibular nerve and ganglion.
She died about 15 months after the onset of otologic symptoms. The temporal bones were removed approximately four hours after death, fixed, and processed in the usual manner.
The left ear: The internal auditory canal was not filled with tumor cells, but the VIII th nerve was severely degenerated. There was marked loss of cochlear neurons and severe degeneration of the superior vestibular nerve and ganglion. The organ of Corti and the sensory elements in all the vestibular organs appeared to be intact. There was slight partial degeneration of the facial nerve. The middle ear and mastoid were normal.
The right ear: The internal auditory canal was free of tumor. Part of the VIII th nerve was still intact, but the cochlear neurons were decreased. The organ of Corti and the sensory & neural elements of vestibular end organs appeared intact.

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Psychological Factors in Peripherallabyrinthine Vertigo

from the Results of the Cornell Medical Index

Kanae Nakamura, Hisako Ito, Hiroyuki Mineta, Michihiko Nozue

1984 Volume 77 Issue 10special Pages 2251-2255
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2251

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The CMI test was administered to 42 patients with peripheral labyrinthine disorders to evaluate the influence of psychological factors on their vertigo: 15 with Ménière's disease, 13 with benign paroxysmal positional vertigo (BPPV), 11 with otogenic vertigo and 3 with sudden deafness.
1) CMI III and IV types were noted in 40% of those with Ménière's disease, in 31% of those with benign paroxysmal positional vertigo (BPPV) and in 18% of those with otogenic vertigo.
2) CMI II type patients with Ménière's disease and BPPV had physical symptoms simmultaneously with psychologic symptoms.
3) CMI III and IV type patients had mild recurrent vertigo without objective findings.
These results indicate that the patients personalities had some influence on the clinical course of their vertigo.

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Psychological Factors in Patients with Vestibular Dysfunction

(1) Meniere's diseas

Shoji Takayasu, Sanae Katori

1984 Volume 77 Issue 10special Pages 2256-2263
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2256

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As a first step in analysing the psychological factors in the onset and recovery of various vestibular dusfunctions, two Cornell Medical Index tests were given to 37 patients with Meniere's disease before and after conservative therapy for more than two years. The results were correlated with the Profile of Complaints and the Psychosomatic Index to evaluate quantitatively the influence psychological factors on vertigo or dizziness.
The Profile before Meniere's disease showed definitely higher than average scores for Hypersensitivity and Tension.
In patients with this Profile psychological factors may be maximum in the aggravation of and minimum in the treatment process, so the best recovery may be expected. If the Hypersensitivity score is extremely low, the psychological factors have a moderate effect on both the onset and the later course of Meniere's disease, and conservative treatment has good results in these cases.
Psychological factors, however, are minimal in patients with cardiovascular, skeletal or skin problems (somatic). Those with Maladjustment, depression and anxiety (psychological probmems) have a high Tension score and an extremely low Hypersensitivity score. Therapy is usually ineffective because there is a high degree of hypochondria in these patients.

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Personality Profile by Y-G Test in Patients with Vestibular Disorders

Kiichiro Taguchi, Kiyotaka Higaki, Masato Kikukawa

1984 Volume 77 Issue 10special Pages 2264-2268
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2264

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Patients with vestibular disorders were interviewed and their personalities classified into Schneider's psychopathologic categories. About half the patients had asthenic type personalities.
Another study, using the Y-G Personality Test, showed a prevalence of psychosomatic type personality profiles among patients with equilibrium disorders, characterized by lack of agreeableness, thinking introversion and general inactivity.

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Vestibular Function in Alcoholics

Hiroe Takano, Yoshiaki Nakai, Toshio Imoto, Keiko Taenaka, Hirofumi Ok ...

1984 Volume 77 Issue 10special Pages 2269-2274
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2269

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Stabilometry and stepping tests were performed in 41 chronic alcoholics. Ataxia or other neurological symptoms were not revealed for these patients. In 22 out of the 41 patients, vestibular function test were perfomed. Spontaneous nystagmus in 3 patients and positional nystagmus in 9 patients and positional nystagmus in 9 patients and positional nystagmus in 9 patients were recognized.
Unilateral or bilateral canal paresis (CP) was observed in 45%. OKN and ETT patterns were abnormal in 5 patients. Since these abnormal findings were especially prevalent in patients who had stopped drinking less than 6 months earlier, they appeared to be related to abstinence.

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Trapezoid Rotation Test by Computerized Rotary Chair System

Comparison with positional nystagmus test in patients with Meniere's disease

Jiro Hozawa, Fumiaki Fujiwara, Shuji Ota, Mikio Miyakura

1984 Volume 77 Issue 10special Pages 2275-2284
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2275

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The trapezoid rotation test by the Contraves Rotary Chair System was carried out in 14 patients with several stages of Meniere's disease. Directional preponderance (DP) was detected in 47 of 51 tests. Positional nystagmus was present in only 45% of the patients showing DP in the rotation test.
The changing process of DP detected by the trapezoid rotation test reflected labyrinthine pathology more accurately than did the positional nystagmus test.

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Influence of Aging on Optokinetic Nystagmus

Keiko Taenaka, Yoshiaki Nakai, Toshio Imoto, Hideo Yamane

1984 Volume 77 Issue 10special Pages 2285-2291
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2285

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The number, speed and width of targets are known to be factors which influence the results of the optokinetic nystagmus test, which is widely performed as one of the vestibular function tests. Thinking that the age of the examinee might also be a factor, we used three different target speeds of 60°/sec, 90°/sec and 120°/sec, to inducestare type OKN in normal subjects aged 10 to 70 to exclude the influeuce of vestibul ar lesions. The eye speed of the slow phase decreased conspicuously at 120°/sec over age 40. However, there are some problems with OKN testing at low target speeds of 20°/sec or 40°/sec in the diagnosis of central lesions, including those in the cerebellum, and peripheral lesions. The present data suggest that the effect of aging must be considered in the clinical use of the OKN test and that the speed for provocation of stare type OKN should be about 60°/sec.

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An Investigation of Laterotorsion after Caloric Stimulation in Normal Subjects and Patients with Dead Labyrinth by a New Device

“three-dimentional head rest” with a microcomputor

Takashi Futaki, Masaaki Yamane, Takesumi Dohi

1984 Volume 77 Issue 10special Pages 2292-2302
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2292

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The criptospinal reflex or laterotorsion, an expression of the vestibulo-spinal reflex after caloric stimulation, can be demonstrated easily in any clinic. However, a few attempts have been made to use this reflex clinically for vestibular testing (Henriksson et al, Spector).
The authors developed a new device, a “Encorders”, i. e. a rolling photosensor, connected to a micro-computor and a printer. Three parameters, i. e. axis rotation, wipeing action and sliding side to side are yielded online by this device.
After cold irrigation (30°C), almost all normal subjects showed laterotorsion toward the slow phase of caloric nystagmus, but, only one third showed laterotorsion toward the slow phase of “Heisswasser-Nystagmus” (Bárány).
The patients with bilateral dead labyrinths, however, showed laterotorsion after irrigation with 30°C, 44°C and ice water.

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Computer Analysis of Spontaneous Nystagmus

Masaru Shirato, Tokuji Unno

1984 Volume 77 Issue 10special Pages 2303-2308
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2303

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The diagnosis of spontaneous nystagmus is aided by principal component analysis with a microcomputer. In addition to the basic parameters of nystagmus (duration, amplitude and eyespeed), smoothness and kurtosis of nystagmus are calculated, and size factor and shape factor in the principal components can be clearly separated. Moreover, by plotting diagrams of factor scores one can demonstrated several kinds of nystagmus. In the near furture objective diagnosis of spontaneous nystagmus will be possible.

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An Algorithm for Detecting the Quick Phases of Nystagmus

Kenichiro Nogami, Takuya Uemura, Masahiro Iwamoto, Kiyotoshi Matsuoka

1984 Volume 77 Issue 10special Pages 2309-2315
Published: 1984
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.77.10special_2309

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A new computer algorithm has been developed to detect and remove the quick phases of nystagmus induced by the pendular rotation test. It consists of two procedures. First, an index representing the probability that the eye movement at an arbitrary time can be identified as a quick phase of nystagmus is calculated. Second, the true quick phase is determined from the apparent one thus obtained by considering the latency time for the appearance of the quick phase. This algorithm makes it possible to produce the tracing of cumulative slow-phase eye position by interpolating across the quick phases.

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