In order to study distribution of the melanin and melanocytes in the inner ear, we used 10 crucians (fresh-water fish),10 frogs,5 guinea pigs and human. Melanin and melanocytes were distributed mostly in the crus com m une and ampulla of frog, and in the ampulla and utricle of guinea pig. The shape of melanocyte was dendritic in crusian and frog, whereas it was rod shape in the guinea pig which was similar to melanocyte in pia mater of human. Histologically, we observed these species by H-E staining, melanocytes in guinea pig and human were localized adjacent to the epithelium of ampulla, while these in crucian and frog were localized in the surroundings of ampulla in some distance from the epithelium. We, using microanalysis by Ito, measured the contents of PTCA (indicator of eumelanin) and AHP (indicator of pheomelanin) in membranous labyrinth of utricules and posterior ampullae from 8 colored and 5 albino guinea pigs. The mean content of PTCA and AHP membranous labyr i n th were 10.1 ng per ear and 1.8 ng per ear respectively in colored guinea pigs, while 0.3 ng per ear and 4.6 ng per ear in albino guinea pigs. Eumelanin content of inner ear in the colored guinea pig was dominantly higher than that of the black hair in colored guinea pig or Japanese.
The vertebral and basilar arteries, the eighth cranial nerve roots, the vestibular and cochlear nuclei were observed macroscopically and/or with a light microscope in 9 aged cadavers,7 with and 2 without “vertigo” while they were alive. The cadavers, received from nursing homes for aged in Shimane p refecture, were selected by a questionare to nurses with regard to the clinical informations of the cadaver3 about vestibulocochlear disturbances during their lifetime. The cadavers were fixed by perfusion with 10% formalin. After the brains were dissected out, the bodies and brains were immersed in the same fixative separately for more than a half year. The diameters of some regions of the vertebral and basilar arteries were measured by slide calipers. The histology of the 8th cranial nerve roots was examined by the Luxol fast blue stained method. The three vestibular and two cochlear nuclei were stained with Klaver- Barrera's method and then degenerating nerve cells were numbered at the level of the abducens nerve nuclei, in each nucleus. Finally, stenosisof arteries, degenerating nerve cell ratios in the nuclei, demyelination of the nerves, were analized statistically. 9 cases,5 men and 4 women, were ranged from 73 to 88 years old. Clinically 7 cases complained nonrotational “vertigo” of various associated conditions and 2 did not. On the past history, they frequently had arteriosclerosis, hypertension and heart diseases. In the vertebral and basilar arteries, all cases had atherosclerosis of various degree and stenosis more than 50% were noted in half of the cases. The 8th cranial nerve roots exhibited demyelination in some cases. The severity could be classified into 3 groups, that is severe, almost intact and intermediate. Qualitatively in all of the vestibular and cochlear nuclei, non specific degenerative findings in nerve cells were observed such as chromatolysis or ghost cell with the accumulation of lipofuscin. Quantitatively 2 cases showed very high degenerating nerve cell ratios. Statistically there were significant differences in degenerating nerve cell ratio in the right medial vestibular nuclei concerning to the existence of “vertigo”, and also in the degree of the 8th cranial nerve demyelination to stenosis of the right vertebral artery. High corelations were noted in degenerating cell ratio between right and left sides of the superior and lateral vestibular nuclei.
Light microscopic and scanning and transmission electron microscopic findings from a patient with Mondini type at right ear and Michel type at left ear genetic aplastic deafness are described. The round window of each ear was absent. The medial surface of stapedial foot plate of right ear was depressed roundly at central part and it was covered by thick membrane to make a partition of the middle and the inner ear. The course of the internal auditory meatus of left ear was deviated ventrally. The cochlea was presented by only three forths of turn at right ear and total aplasia at left ear. Three lows of spherical buldging thought to be outer hair cell were found between outer pillar cells and Hensen's cells. The other superstructures of cochlear duct were not present. Round dome shaped modiolus of the left ear contained some nerve fibers and spiral ganglions sparsely. In the spiral ganglion cell, a small number of neurofibril and a few Nissle Bodies were present in the cytoplasm of it. The saccule, utricle and semicircular canals of each ear were missing to make a common cavity of vestibular system. There were several otolith under the surface of membrane covered the common cavity. The sensory cells and its related tissues were not found in the both ear.
The morphological changes of the vestibular organ of the guinea pig following extracochlear electrical stimulation were investigated using scanning electron microscope. Positive and negative square wave pulse stimulation were given through the silver ball electrode placed on the round window membrane. The current intensities used in this experiment were 100,200 and 300μA. Direct current stimulation at the intensity of 300μA caused severe damage to the utricular macula and the ampullar crista of the lateral semicircular canal. The degenerative changes such as fusion of sensory hairs, protrusion of the cuticular plate and loss of sensory cells were found on both the utricle and the semicircular canal. In the most severely damaged area, the basement membrane of the macula was destroyed. In the clinical application of direct current stimulation to the inner ear for relieving tirihitus, special attention should be payed to the vestibular organ.
The morphological and functional disorders of the vestibular organs were investigated in mice injected with Mycobacterium fortuitum (M. fortuitum). M. fortuitum induced severe morphological damages no t only in the vestibular sensory cells but also in the vestibular ganglion cells and nerves. These morphological changes were observed 2 weeks after inoculation of M. fortuitum. The degeneration of vestibular ganglion cells and nerves seemed to be caused by a direct action of M. fortuitum. The disorders of the vestibular functions also became apparent 2 weeks after inoculation. These findings indicated certain correlation between the morphological and the functional disorders.
In a patient whose severe vertigo with accompanying head movement during treatment with gentamicin was relieved after discontinuance of the treatment, objective findings and histology of the temporal bone were investigated. Although maculae were normal, many sensory cells at the crist of ampulla were atrophied and a lot of vacuoles were observed in the sensory epithelium. An eosinophilic substance existed on dark cells starting at the lateral side of crista of ampulla. In this report, the relationship between histological pictures and clinical symptoms in this patient was discussed. The so-far publicly reported histological findings on human vestibule and semicircular canal after administration of aminoglycoside drugs were reviewed. Histological pictures of the temporal bone obtained in a patient with M eniere's disease who had suffered from cyclic attacks of vertigo for 30 years and exhibited endolymphatic hydrops were presented and discussion was made on these histological pictures and the onset mechanism of vertigo attack.
Effects of the intratympanic and intralabyrinthine injections of Gentamicin on the posterior semicircular canal were studied using bull frog. After intratympanic injection of Gentamicin (20 mg), only mild changes of the sensory cells were observed. They were slight loss of the sensory cells and bulging of the cell surface. The posterior ampullary nerve action potentials reduced to approximately 68% of the noninjection ear. When Gentamicin (4 mg) was injected into the labyrinth, more pronounced damage was observed. The action potentials likewise reduced markedly.
The lateral wall of the endolymphatic sac of nine patients of Meniere and one of acoustic tumor as control was undergone in a immunohistochemical procedure using FITC labeled antihuman IgA, IgG, IgM, IgE, C1q, C3, C4, and Fibrinogen into the freesed specimen and the luminescent-microscopy. The highest rate of p o sitive luminescense was yielded in IgG (83%) comparing other immunoglobulin, i. e. IgA (63%), IgM (38%). In a control, there was none. This result might be understood as an expression of an immunological disorder in the endolymphatic space including the sac itself.
We investigated the location of immunogloblin G (IgG) in the endolymphatic sac (ES) of guinea pigs to prove the one of evidences that ES will be the involved organ in immuno-reaction of the inner ear. By using immunohistological technique we could recognize IgG mainly in the subepithelial layer of ES and partially in some ES epithelium. Free floating cells also have IgG. Plasma cells that will exist in the subepithelial layer could not clearly recognized as having IgG. These results might indicate that ES can be an immunor e active organ of the inner ear under some pathlogical conditions and that the origin of IgG in the ES will be mainly derived from the systemic source.
Effects of glycerol, urea and mannitol on hydrostatic pressure of labyrinthine fluids and DC potential were studied in the guinea pig cochlea with a servo-controlled micropipet system. Each osmotic agent produced substantial pressure reduction in both endo- and perilymph with a maximum reduction during 20-30 min after the administration. Difference in pattern of the pressure changes between the inner ear fluids and CSF indicates a possible dehydration effect in the labyrinth for glyceral and urea, but an ambiguous effect for mannitol. These three agents diminished the endocochlear DC potential with a maximum diminution at five minutes. Difference in time course between the pressure and the DC potential reduction suggests the DC potential may not be diminished by the osmotic dehydration effect. Metabolic effect of these osmotic agents on the stria vascularis is considered to be a possible cause of the DC potential change.
It is known that the introduction of the high K solution into the perilymphatic space produces the nystagmus initially towards the treated side (irritative nystagmus)lasting for several minutes and towards the opposite side (paralytic nystagmus) thereafter. In order to examine the changes of the vestibular neuron during these period, the single unit action potential was recorded from the superior vestibular nerve of the guinea pig anesthetized with Nembutal and the effect of high K in perilymph upon the interspike interval was examined. Several minutes after the introduction of the saturated K solution in the scala tympani from the middle ear by iontophresis, the interspike interval started to decrease, reached to the about half of the control value in 10 to 15 minutes and suddenly disappeared. It was concluded that the initial irritative nystagmus was induced by the excitation of the primary vestibular nerve and the following paralytic one was due to the abolishment of the nerve activity.
Pathogenesis of widened AP-SP complex in cases with cerebellopontine angle tumors remains unclear. As acoustic neuromas usually originate from the vestibular nerve, this nerve might take part of the origin of the broad waveform. Effects of Lidocain injection through a micropipette into the root exit zone of the vestibular nerve, where the cochlear efferent fibers run together, on AP-SP complex were investigated in guinea pigs. The AP-SP complex in response to clicks and tone bursts was recorded from the bony wall of the scala vestibuli in the basal turn of the cochlear. Inactivation of the efferent cochlear fibers resulted in marked widening of the waveform, independent of the interstimulus intervals. This broad wave was composed of DC-shift which was quite similar to the envelope curve of the acoustic stimuli. Participation of the efferent cochlear fiber activity on the negative summating potential has not been reported in detail. The authors concluded that the broad waveform of EcochG in cases with cerebellopontine angle tumors was enhanced negative SP due to inactivated efferent cochlear nerve activity.
It is well known that administration of some substances whose specific gravity and density are different from those of body fluid causes positional nystagmus. In this study, we investigated the effects of administration of D20 as a negative geotropic nystagmus inducer and alcohol as a positive nystagmus inducer on the quantitative assay of positional nystagmus as well as on the gain and phase of vestiburoocular reflex of the rabbits. In addition, based on the results obtained in this experiment, we have made some studies about the mechanism of phase lag of VOR observed in patients of Meniere's disease.
Registered cases of Ménière's Disease collected by the Committee members were studied and classified according to the age of onset and the duration of the disease. The influence of each factors on the vestibular symptoms and hearing impairment was analyzed. Next, the influence of these two factors on the hearing loss of the affected side was studied in 120 cases of definite Ménière's Disease. The results of this study were as follows: 1) The hearing impairment of the affected side increased gradually with the age of onset and the duration of the disease. 2) The vestibular symptoms of Ménière's disease were not significantly affected by these two factors.
After the last Survey of Meniere's disease and sudden deafness in Toyama Prefecture,187 new cases of Meniere's disease and 131 new cases of sudden deafness were diagnosed by the same 779 members or clinics of the Toyama Medical Association in 1985 and listed in the intractable disease category. The following characteristics on epidem i ological and clinical features of Meniere's disease and sudden deafness were noted in Toyama Prefecture: 1) Prevalence: The prevalence of Meniere's disease was 17.5 per 100,000 population as registered by the Members of Toyama Medical Association in 1974,1 979,1982and in 1985. The prevalence of sudden deafness was 7.2 per 100,000 popula t ion as registered by Members of Toyama Medical Association in 1973,1978 an d in 1985. 2) Sex-ratio: The male/female ratio in patients with Meniere's disease was 213/560. There were 117 males and 121 females in sudden deafness. 3) Age distribution: The peak of age distribution was located in 50-59 years for males and 60-69 years for females in Meniere's disease. The peak of sudden dea fness for males was in the fourth decade, while for females in the fifth decade. 4) Geographical distribution: The number of patients with Meniere's disease was higher in Toyama city and the neighboring areas where urbanization is in progress. There were more patients in Toyama city, Takaoka city and Ohsawano area in sudden deafness. This study shows that certain epidemiological characteristics of Meniere's disease are different from those of sudden deafness.
The population of six towns located on Tsushima, a remote, isolated island about 51000. The ENT-examination and clinical consultation for patients with vertigo and/or dizziness were made from March 1984 to December 1985 in National Tsushima Hospital. Within about 1600 outpatients,72 patients with vertiginous attacks were examined and 7 were diagnosed as having Meniere's disease and 24 paroxysmal positional vertigo, benign paroxysmal type of 6, head injury of 6 and unknown causes of 12. Seventy five years old man suffering from tumor of cerebropontine angle were found and 2 women suffering from bilateral vestibular hypofunction were treated in the Hospital. Four patients with unilateral vestibular hypofunction were considered to old vestibular neuronitis.
Thirty-nine cases (including the recent 7 cases) of vestibular neuronitis were investigated serologically. Among them,32 cases were already reported in the previous papers. Recent 7 cases were examined for various viral antibody titers (herpes simplex type 1, varicella-zoster, cytomegalo, EB, rubeola and rubella virus) by means of indirect fluorescent antibody technique (FA) and enzyme-linked immunosorbent assay (ELISA). Three cases among 7 cases showed a fourfold or higher rise in antib ody titers in paired sera: herpes simplex type 1 in one and EB virus in two cases. It was assumed that viral infections would play some contributory role in the onset of vertigo in these patients (10 cases in 39). In the late period of their cou r se, some cases showed significant rise in the viral antibody titers but none of them had recurrent attack of vertigo in that period in this series.
Follow-up observation of caloric test and galvanic body sway test (GBST) of patients with vestibular neuronitis was performed. All of patients showed uni- or bilateral reduced responses of caloric test and GBST. Although reduced caloric responses remained on the period of observation in all patients, the duration up to recovery of GBST was very various. The shortest term for recovery was 13 days after onset and it was extremely short than previous reports. On the other hand there was a case whose reduced GBST responses still remained after one year. It was suggested that degree of vestibular neuronitis was very various and if a term from an onset to an equilibrium examination was long, slight disorders of retro-labyrinthine lesions by vestibular neuronitis might not be detectable. The number of retro-labyrinthine disorders including vestibular neuronitis might be more than that has been considered.
Prognosis of the eighteen cases of benign paroxysmal positional vertigo, which were exmined for a long time, was evaluated on the base of the recurrence of vertiginous attack, the period of the continuity of the vertiginous attack and the continuity of the symptoms (slight floating sensation, headache, etc) without vertigo. 1) Four cases (22%) had the recurrence of the vertiginous attack ( =Group IV). 1. Clinical findings (including equiliblium function test, audiogram, and s o on)revealed no difference between Group IV and others (Group I III). 2. Two cases out of three cases with history of head trauma had the r ecurrence of vertiginous attack. 2) Seven cases had the continuity of the symptoms (slight floating sensation, headache, etc) without vertigo ( =Group III). 1. Accompanying symptoms on the vertiginous attack were noted in four cases (57%) of Group III. 2. Unsociable or ner v ous character was noted in five cases (71%) of Group III. 3. Hearing impairment was noted in five cases (71%) of Group III. In Group III it is necessary to consider about the factor of the neurosis or psychosomatic disease.
Survey of the literature on the vestibular neuronitis was done mainly on the data source from the world-spread medical journals and on the domestically but publicly issued journals, and this list was made as the second issue. (First issue: Sekitani,1982). The period of collection of the related paper written in Japanese was from January 1982 to January 1986. Meanwhile, the period of collection and list of the papers written in the foreign languages was from the most beginning of the issued paper, i. e., Ruttin in 1909 to January 1986.
Twenty-eight cases with severe vestibular impairment who visited the Department of Otorhinolaryngology, Yamaguchi University School of Medicine from 1975to 1985 were studied otoneurologically. Cases of vestibular impairment were as follows: 22 cases due to drug intoxication (Streptomycin sulfate 16, combined Streptomycin 3, Gentamicin 1, Sisomicin 1 and Amikacin 1),1 of Harada's disease (uveomeningitic syndrome),1 of bilateral vestibular neuronitis,1 of bilateral acoustic neurinoma,1 of suppurative meningitis and 2 due to unknown cause. Of 22 cases due to drug intoxication, only one case show ed marked recovery of caloric response by 6 months. Subjective prognosis was fairly good in 8 out of 15 cases due to Streptomycin sulfate intoxication. Caloric response at the early period after the manifestation of dysequiliblium is considered as an important indicator determining the prognosis in case with severe vestibular impairment.
On 27 patients treated with streptomycin sulfate, we examined whether or not vestibular reaction and especially caloric nystagmus response would be significant for the detection of their disequilibrium. These patients were 22 males and 5 females averaging 51 years old, and average dose was 20 gr. In individual cases, repeated caloric test not necessarily made it easy to detect early disequilibrium. Using a method of irrigation at 30 degrees and 40 se c. according to Hallpike's method, caloric response was compared between 32 patients (averaging 50 years old)with dizziness of unknown origin who were judged to have normal vestibular peripheral function and 20 streptomycin group. Strepomycin group showed reduction in duration, frequency and maximum eye speed of slow phase, of 10%,25% and 40%. Two cases of bilateral vestibular hypofunction with Jumbling phenomenon w ere reported. A case with some right-left difference in vestibular function was intractable. And another case with recovered subjective symptoms showed a slight recovery of bilateral caloric response, as well.
We performed the tilt chair test with 14 healthy volunteers after giving each two single dosis of whisky (42%,70 ml). We then determined their responses after 30min.,90 min. and 12 hours. After 90 min. alcohol intake,12 persons developed a divergent type of positional nystagmus in the first phase, as described by Aschan. However, only two showed any nystagmus with tilt chair. Positional nystagmus induced by alcohol also proved to suppress the onset of nystagmus due to tilt stimulation in the opposite direction. After 12 hours alcohol intake, all of volunteers showing convergent pos i t ional nystagmus had nystagmus as a result of tilting stimulation.
The depression inventory was administered to 58 patients with dizziness (including rotational sensation and unsteady sensation) to evaluate the relation between their dizziness and their propensities of depression. In this study, we scored the de p ression inventory and decided that its normal limit was less than 14 marks in the depression score. More than 15 marks in it was abnormal, and we interpreted it had the propensity of depression. The following characteristic features of dizziness were noted: 1) The propensity of depression was noted in 58.6% of patients with dizziness. 2) The propensity of depression was higher in female, in the patients with rotational sensation, in the patients with abnormal views on ENG. 3) In the patients suffering from dizziness for more than 3 months, the propensity of depression was high. 4) In the patients with dizziness that the parts of disorder were not clear, the distribution of the score had two peaks. So we analogy that the relation between dizziness and the propensity of depression has two cases. One case, in the patients with dizziness that the parts of disorder are clear, dizziness gives rise to the propensity of depression. Another case, in those with dizziness that the parts of disorder are not clear, the propensity of depression gives rise to dizziness.
In order to investigate the imbalance of autonomic nervous system in vertiginous patients, ice water immersion test was carried out in 33 healthy subjects and 110vertiginous patients. This test was a convenient method of measuring autonomic nervous function. Side difference was evaluated as autonomic nervous asynmetry by comparing bilateral palm skin temperature after ice water immersion. In vertiginous patients, incidence of side difference were signi ficantly higher than those in healthy subjects. Especially in Meniere's disease, incidence was 80% at attack stage. This incidence was significant high compared with 19.2% at interval stage and 18.2% in healthy subjects. Side difference was not found in patients of labyrinthitis and vestibular neuronitis and frequently observed in cases of side differense of vertebrarterial flow. So we assumed that autonomic nervous asynmetry was cause of vertigo attack and autonomic asynmetry and side difference of vertebrarterial flow were correlated each other.
Evaluating the function of autonomic nervous system with the CV% value for R-R interval on ECG involves some problems. To resolve these problems, we have devised a method whereby variations in R-R intervals with time are treated by a computer and shown in diagram. The subjects were 29 cases of orthostatic dysregulation (OD) due entirely to the autonomic dysfunction. The R-R interval of 100 beats was measured at 4 points in time, namely, at 20 minutes bed rest, immediately after orthostatism,5 and 10 minutes after orthostatism. And the diagrammatic description was compared with evaluation on the CV% value for study. The pathological findings obtained on OD could be classified by the diagrammatic description into 4 groups as follows. 1) Flat without rhythm both at rest and after erect standing. 2) Rhythmical variations both at rest and after orthostatism. 3) Flat at rest but getting gradually rhythmical after erect standing. 4) Rhythmical at rest but becoming flat simultaneously with erect standing. These findings cannot be analyzed by the conventional evaluation on the CV%value which was varying without any clinical significance through the test. We have shown the diagrammatic description method to be excellent in that the evaluation is hardly affected by arrhythmia and noise.
Delayed endolymphatic hydrops (DEH), a clinical entity which can be differentiated from Meniere's disease, was first reported simultaneously by Nadol et al. and Wolfson et al. in 1975, and was specified by Schuknecht in 1978. In the past 6 years and 8 months, we encountered 30 cases of DEH,28 ipsilateral and 2 contralateral, in our clinic (Univ. of Tokyo Hospital). In 14 cases, the genesis of the hearing loss was juvenile unilateral deafness of unknown etiology. Other causes were mumps in 8 cases, sudden deafness in 5, head trauma, measles and progressive sensorineural hearing loss in 1 respectively. The latency between hearing loss and vertigo ranged from 3 to 49years. In the ipsilateral cases the result of the Furosemide Test was 86% positive in the deafened ear. This test seems to be very useful for the diagnosis of DEH. It is very difficult to determine which ear is responsible for the vertigo. Added to the cochlear symptoms and other clinical signs, the furosemide test is often of great advantage in the determination of the responsible ear. On the basis of the furosemide test we have been able to choose the method of treatment, conservatively or surgically. In many patients conservative treatment with diuretics and steroids yielded good results. Eleven cases were treated by epidural shunt operation on the endolymphatic sac. Ten of these are free from violent vertigo and doing very well after an average postoperative period of 18 months, and 3of them have no complaint 3 years after the operation.
By principal component analysis, the difference between irritative nystagmus and paralytic nystagmus was clarified. In irritative nystagmus, slow phase factors together with fast phase factors were highly extracted at the first principal component. In paralytic nystagmus, slow phase factors were mainly extracted at the third and the fourth principal component. As a result, determination of the affected side in peripheral vestibular disorders is possible.
Trapezoid rotation test (±2,4,6,8, and 10°/sec2,10”) using the Contraves'Computerized rotary chair system were repeated for the same subjects (kept their eyes open in the dark) under the various conditions, and each results were compared to investigate the influence of various factors. By this investigation, the follow i n g results were noticeable: 1) A false sign of “labyrinthine preponderance” in the normal subjects was provoked by “only dim illumination” inside of the testing room, and the influence of subjects'lateral gazing eye-position. 2) VOR gain was enhanced slightly by the subjects' voluntary control, and was decreased by non-optimal head position and non-arousal condition of the subject. 3) Frequent calibrations of ENG were available to avoid the fluctuation of the testresult induced by the intraelectrode resistance. 4) The authers' trapezoid. rotation test could show the exact reproducibility of the test-result by taking care of the above mentioned various factors. So-called “response decline phenomenon” was not observed by repeating this test.
Vertiginous attacks associated with hearing disturbance, such as tinnitus, hearing impairment and fullness in the ear were investigated on their simultaneous graphic displays of the time course in each patient suffering from Ménière's disease by using a microcomputer. The mean interval time of successive two vertiginous attacks and the mean value of air-conduction hearing level at 250 Hz,500 Hz,1000 Hz and 2000Hz were dislpayed continuously on a graph. By observation the clinical course of each patient for long duration, it was concluded that following five sorts of vestibulocochlear symptom may be classified by interrelation between vertigo and hearing disturbance. They are “T” type; recurrence of vertigo associated with hearing disturbance, “SD” type; recurrence of vertigo with sudden severe deafness without ma rked fluctuation of it, “L” type; improvement of hearing associated with vertiginous attacks, “V” type; recurrent vertigo without marked hearing di sturbance and “C” type; fluctuated hearing disturbances without vertigo. Those symptomatic types may appear in a single case and the mechanism caused such a various type was discussed.
Mechanical difference of both positive findings between transtympanic electrocochleography and the glycerol dehydration test was discussed in sixty-three patients with Meniere's disease. The pure tone audiometry was measured before and after intravenous drip infusion of 50 g glycerol in forty-five ears. Transtympanic electrocochleography was recorded in sixty-five ears. Both measurements were carried out at ten days to twenty years from onset of the first episodic attack. The results were as follow: 1) Electrocochleographic positive findings, significant enlargement of -SP/AP ratio, was recorded in 63% of sixty-five ears. This incidence increased in cases with pure tone average of 40 dB or more and two or more years from onset (p < 0.10). 2) Significant improvement of hearing threshold following infusion of glycerol was showed in 56% of forty-five ears. This incidence increased in cases with pure to ne average of less than 40 dB and less than two years from onset (p<0.10). 3) Those who showed negative findings of both measurements was 7% of all. This results indicate that electrocochleography and the glycerol dehydr a tion test should be measured together in clinical practice. Because the former was more useful in relative advanced Ménière's disease, and in the early stage of Meniere's disease the latter was more effective.
Coenzyme Q10 (Co Q10) is a quinone of the mitochondrial electron-transfer system that plays an important role in energy-producing process of the tissue metabolism. Therefore, the deficiency of Co Q10 is likely to cause serious dysfunction for the vestibular system that is in action continuously as is the myocardium. On the viewpoint, the serum Co Q10 assayed quantita t i vely by High Performance Liquid Chromatography (HPLC) in 30 cases of Meniere's disease. In spite of the Co Q10 level is said to be extremely hig h in cases of hyperlipemia, it remained at the upper limit of the normal range (0.84±0.2 μg/ml) in 5 out of 8 cases of Meniere's disease complicated with hyperlipemia, evidently low at 0.65±0.16 in 22 cases without hyperlipemia and extremely low at 0.40±0.04 in 5 cases having an orthostatic decrease in the hight of the T11 wave in ECG. Findings above have led us to conclude that the Co Q10 levels in patients with Meniere's disease are low and have something to do with development of the disease and to confirm the value of follow-up investigations.
The body sway of the patients with unilateral and bilateral Meniere's disease was recorded by using a cephalograph and a stabilometer, and analyzed with a microcomputer. The results show that the locus type, locus area and locus length traced by the head's center and the body's center of gravity (abbreviated to CG) are useful parameters of the body sway, representing the characteristics of peripheral vestibular disorders. The noteworthy characteristics are shown in the left and right type in statokinesigram, the significant differences of locus area and/or locus length between the head movement and the CG movement, high degree of cross-correlation between the head movement and the CG movement, and the change of the averaged divisional frequencies of the body sway with eye-closing.
Dysequilibrium associated with vertigo is usually improved rapidly by a compensatory function of the nervous system and the restoration of equilibrium is considered. to be largely influenced by patient's ability of adjustment to deranged vestibular functions. Thus, when the sequence of events during the recovery is analysed by certain parameters; the changes of bodily sway velocity during a short period of time (90 sec period from the starting of examination by blind-folding) it would be possible to estimate or predict one's ability to restore from dysequilibrium. For this purpose, the bodily sway analysis with 8 directional velocities was utilized; for a 90 sec study period right after the eyes closure on the platform, the velocity and the velocity difference were computer-analyzed. This study disclosed that a normal individual shows a convergence of velocity, that is, the velocity gets faster as soon as the eyes closed. and then gradually slowed down. This appears to be a phenomenon of physiological convergence. This phenomenon is elicited most distinctly when the velocity difference is utilized as a parameter. The compensatory function for dysequilibrium appears to correlate well with the duration and characteristics of convergence phenomenon and thus the recovery from the vestibular dysfunction may be predicted when the convergence process is evaluated.
We analysed the direction of 21 normal adults' body sway and changes of the direction of body sway in 12 patients with peripheral labyrinthine vertigo during their recovery course, by using Vector Statokinesigram. The results were as follows: 1) We used Vector Statokinesigram in order to obtain the direction of human body sway. As the result, it was confirmed that the direction of body sway was cle arer than the analysis of the velocity. 2) Vector Statokinesigram were classified into the following 4 types: right anteriorleft posterior type, no directional type, right-left type and anterior-posterio r type. 3) Vector Statokinesiigram of normal adults, in short period, showed little change of pattern during eyes open. 4) The left anterior-right posterior type was observed only in patients with peripheral labyrinthine vertigo. It seemed to be unstable state. 5) Most patients with peripheral labyrinthine vertigo finally showed right anteriorleft posterior type in the course of recovery. 6) The right anterior-left posterior type seemed to be one of the stable type.
The relationship between visual field and body sway was investigated by using a concentrically moving multi-spotlights stimulator, a body sway recording system and a minicomputer in the following four groups: the normal subject group, the patient group with peripheral vestibular disorders, the patient group with central vestibular disorders and the patient group with cervical disorders. The patient group with peripheral vestibular disor d ers showed such characteristics of body sway as more predominant head movement than that of the center of gravity, an irregular increase of the body sway with stimulation velocity in the composite and peripheral visual fields, reduced dispersion in the distribution of body sway velocity with foveal stimulation, and an increase of averaged divisional frequencies, sometimes accompanying peak formation on the frequency spectrum of the body sway. The body sway test with the newly devised visual stimulation seems to have a possibility to differentiate the peripheral vestibular lesions from the other vertiginous or ataxic disorders of unknown origins, and to make topographic diagnosis.
To clarify the influence of the vestibular stimulation upon the upright standing, we tried to analyse the postural change by the caloric stimulation with warm and cold water systematically. The subjects were 8 healthy males. They were asked to stand on the platform with their eyes closed. In 4 subjects unilateral (right side) caloric stimulation was performed and in another 4 subjects simultaneous bilateral caloric stimulation was performed. The postural change was analysed using the output of the X axis component (left-right direction of body sway) and Y axis component (anterior-posterior direction of body sway) from the platform. As special attention was paid to the postural deviation evoked by the caloric stimulation, we picked out a slow wave (less than 0.15 Hz) from the X and Y axis components by the digital filter with the aid of a microcomputer. In the linear stabilometry, left and anterior postural deviation occurred by the caloric stimulation to the right side with warm water. Right and anterior postural deviation occurred by the caloric stimulation to the right side with cold water. Simultaneous bilateral caloric stimulation evoked only anterior or posterior postural deviation. The posterior deviation was evoked by warm water and anterior deviation was evoked by cold water. In the spot stabilometry, left-right and anterior-, posterior body sway was occurred by the unilateral caloric stimulation and anteriorposterior body sway was occurred by the bilateral caloric stimulation. We considered that this study would be a model of the vertigo evoked by unilateral or bilateral inner ear disorders and further investigation of this study would lead us to clarify the role of the vestibular function during upright standing.