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Yukio Watanabe, Hideo Shoujaku, Kanemasa Mizukoshi, Hans Chrischan Lar ...
1989 Volume 1989 Issue Supplement36 Pages
1-8
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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We have introduced a computer system to control and analyze equilibrium examinations in the clinical routine. An algorithm to analyze caloric responses, the usefulness of this system and parameters to evaluate the responses by computer analysis are reported. Caloric stimulation is given by 24°C cold and 50°C hot air at a 61/min. flow rate for one minute. Nystagmus waves elicited by the calorization are automatically identified, and the amplitude and velocity of nystagmus are calculated by on-line real time process. After all equilibrium examinations of a patient are completed, the caloric responses are computed and the results are printed on an X-Y plotter along with the results of optokinetic nystagmus and rotatory test. The slow phase velocity of each nystagmus are plotted and the values of duration, the number of nystagmus, maximum slow phase velocity and total amplitude in each calorization are indicated on the graph. The percentage of canal paresis (CP) and directional preponderance (DP) of each parameter are also printed on the graph. We can qualitatively observe caloric responses by the graph of the slow phase velocity and quantitatively evaluate disorders of the responses by the indicated values. Computer analysis of caloric nystagmus is very useful to evaluate responses correctly, particularly in cases showing such complicated responses as both CP and DP are combined or those are influenced by spontaneous nystagmus. We concluded that the maximum slow phase velocity is the best parameter to evaluate caloric test in the computer analysis.
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Yukio Watanabe, Jun-ichi Imamura, Seiichi Takeda, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
9-16
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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A new device to observe and record eye movement was developed. This device consisted of two analog amplifiers to record horizontal and vertical eye movements, a small computer (PDP11/34), a laser printer and an X-Y plotter. An analog amplifier was only used to amplify weak signals with a long time constant, i. e. D. C. or longer than 3.0 sec, and with a low pass filter. All other functions of the conventional electronystagmography (ENG)were computerized. Instead of the pen mechanism of ENG, the graphic display, X-Y plotter and laser printer were used to observe and record eye movement. Just sampled eye movements are shown on the graphic display for ten seconds and printed on the X-Y plotter and/or laser printer after disappeared from the graphic display. As eye movement is seen after magnification on the graphic screen, fine nystagmus can be observed without the aid of velocity component in the conventional ENG. The time scale and the magnification of waves can be changed to suite each nystagmus responses. As this system can analyze nystagmus responses such as caloric test, optokinetic nystagmus and rotatory test, the test results are immediately indicated on the output devices after the completion of each examination.
Beside the many merits described so far, this system has two big merits:
The recorded eye movements and the results of analysis are printed out after being summarized, and can be kept on magnetic discs at a low cost. Therefore we can reduce space to keep the clinical records of many patients. We can purchase this device at a lower cost than the conventional ENG.
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Yukio Watanabe, Hideto Kobayashi, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
17-21
Published: December 25, 1989
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Differences between vestibular nystagmus and optokinetic nystagmus in fast phase elicited by the same stimulating velocity in a sinusoidal manner were determined. A rotatory chair was surrounded by a cylinder screen to project stripes for optokinetic stimulation. The test subject was instructed to look at stripes rotating sinusoidally for the pendular optokinetic nystagmus (POKN) testing without rotation of the chair. Then the test subject was sinusoidally rotated with eyes closed for the vestibulo ocular reflex (VOR) testing, and finally requested to open eyes with the chair rotating in the illuminated screen for the visual and vestibulo ocular reflex (VVOR) testing.
The relationship between fast phase amplitude and velocity was approximated by the exponential equation, i. e. Velocity (i)= V (1-exp (-Amplitude (i)/A). The V and A which were calculated by the least square method from fast phase amplitude and velocity of every nystagmus in each testing condition were parameters to evaluate the amplitude and velocity of each response.
Previously, the gain of slow phase velocity of normal subjects was in the order VVOR>POKN>VOR. However, the V and A values of normal subjects were in the order POKN>VVOR>VOR (P<0.005). Moreover, the coefficient of correlation between the gain of slow phase velocity and the V-value in VOR (0.49) was significantly more than that in POKN (0.20) and VVOR (0.19).
In conclusion, although the fast phase of OKN in stripe stimulation is saccadic eye movement look at the next stripe closer to the center of visual field, that of vestibular nystagmus is reflex eye movement for recovery of the eye deviation by vestibulo ocular reflex.
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Yukio Watanabe, Akihiko Ohmura, Muneharu Ito, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
22-32
Published: December 25, 1989
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To investigate the influence of stimulation to the retina in optokinetic nystagmus (OKN), we tested optokinetic stimulation by numerous random dots pattern projected on a half hemispherical screen. As the random dot pattern is very bright in the whole visual field, the peripheral retina of the test subject is stimulated more strongly than that by stripe pattern which is generally used in clinical routine.
The constant acceleration optokinetic stimulations by the random dot pattern and the stripe pattern were given to 30 normal subjects and the results were compared. The responses of OKN were analyzed by a small computer PDP11/34.
In the OKN elicited by the random dot pattern (dot pattern OKN), the number of nystagmus was significantly more, the duration was shorter and amplitude was smaller than those in the OKN elicited by the stripe pattern (stripe pattern OKN). This tendency was especially significant in stimulating velocity less than 70 deg/sec and considered to be the characteristic of retinal OKN.
The slow and fast phase amplitudes of the dot pattern OKN increased with the increase of stimulating velocity, i. e., slow phase velocity of OKN. On the other hand, in the stripe pattern OKN the amplitude of nystagmus was almost constant, and duration and the number of nystagmus was corresponded to those of stripes passing through the center of the stimulating visual field.
These results indicate that the stripe pattern OKN reflects a saccadic eye movement when looking at the next stripe close to the center of visual field. However, the dot pattern OKN is a reflex eye movement for recovery of eye deviation by slow phase of nystagmus as vestibular nystagmus.
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Hideo Shojaku, Muneharu Ito, Katsuichi Akaogi, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
33-37
Published: December 25, 1989
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The change in horizontal optokinetic after-nystagmus (HOKAN) with regard to gravity was evaluated in 5 normal subjects who had not suffered from vertiginous diseases. Following optokinetic stimulation for 30 sec, HOKAN was recorded in total darkness by using electro-nystagmography. Four parameters of HOKAN, such as duration, number, initial slow phase velocity and time constant, were measured upright or two 90° lateral tilted positions (right lateral head position or left lateral head position).
In contrast with duration, number and initial slow phase velocity, time constants of HOKAN during both statically tilted positions were markedly reduced compared with that during upright position. Furthermore, secondary HOKAN was found in only one lateral head position, neither in the other side nor in upright position in 1 out of 5 subjects. These findings suggest that otolith input may modify not only vertical OKAN but also HOKAN in humans.
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Masatsugu Asai, Yukio Watanabe, Naoki Ohashi, Satsuki Yasumura, Katuic ...
1989 Volume 1989 Issue Supplement36 Pages
38-44
Published: December 25, 1989
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EquiTest® system is a new test apparatus to evaluate equilibrium function using complicated stimulations in combination with visual and the somatosensory inputs. The test consists of the sensory organization test and the movement coordination test.
The equilibrium function is supported by three sensory organs: the visual, the vestibulum and the somatosensory. The sensory organization test is to evaluate the function of these sensory organs singularly and in combination in relation to posture control. This test consists of six conditions.
The movement coordination test is given with eyes open and is to evaluate posture responses to external perturbations given by movements of the foot plate. At first the subject is stimulated by a forward and backward movement, and then by the toes being tilted up and down. Each stimulation is repeated five times. The test results are evaluated by the amplitude of body sway, which in normal subjects decreases with repetition as subjects adapt to the stimulations.
Forty two patients (27 peripheral vestibular disorders,6 cerebellar and brain stem infarctions and 9 spino-cerebellar degenerations) were tested by this system.
In conclusions, more than half of the patients in each group showed abnormal results in equilibrium scores during the sensory organization test. Only a few patients with peripheral disorders showed abnormal results in the movement coordination test, while many patients with central nervous system disorders showed abnormal results. Especially in 9 patients with spinocerebellar disorders, there was a high incidence of abnormal results under all conditions. EquiTest® was very useful as an auxiliary examination for differential diagnosis of dynamic equilibrium dysfunction.
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Masatsugu Asai, Yukio Watanabe, Naoki Ohashi, Hajime Nakagawa, Kanemas ...
1989 Volume 1989 Issue Supplement36 Pages
45-50
Published: December 25, 1989
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The body sway test was taken by in 200 patients with dizziness or vertigo (100peripheral vestibular disorders and 100 CNS disorders) to differentiate peripheral disorders from CNS disorders.
The patients were divided into four groups according to the sway length. Of the 19 patients showing more than 700 mm for 30 seconds,16 had CNS disorders and only 3peripheral disorders. We regarded this sway length to be a characteristic difference between peripheral vestibular and CNS disorders.
However, in the range of 300 mm t o 699 mm in sway length, there were not only many patients with peripheral vestibular disorders but also many with CNS disorders. So the frequency analysis in body sway was performed.
The X (lateral) and Y (anterior- p osterior) sway was divided in to six ranges between 0-4 Hz, and the percentage of the sum of the power in each category to the sum of all power was calculated. This parameter was clinically useful. In the forward-backward sway analysis, power percentage in the under 0.125 Hz range were remarkably lower in some CNS disorders than in peripheral vestibular disorders, even when patients in both groups showed almost the same sway length.
In conclusion frequency a n alysis of body sway is useful for differential diagnosis in clinical practice.
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Hideo Shojaku, Yukio Watanabe, Naoki Ohashi, Muneharu Ito, Yoshikazu I ...
1989 Volume 1989 Issue Supplement36 Pages
51-56
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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The effects of transdermally administered scopolamine (Scopoderm TTS) on caloric, rotatory, optokinetic and optokinetic after nystagmus were evaluated in normal subjects. Two Scopoderm TTS or two placebo were applied retro-aurally 24 hours before each test. Three parameters (maximum slow phase velocity, number of nystagmus and duration of nystagmus) of air caloric test in 9 volunteers were used. Each ear was stimulated at 20°C or 50°C air temperature for 60 sec. Gain (= peak slow phase velocity/peak head velocity)of rotatory and optokinetic nystagmus of 12 subjects was examined during the sinusoidallyinduced rotatory and optokinetic stimulation (amplitude 120 deg; frequency 0.1 Hz). After 60°/s optokinetic stimulation for 30 sec, optokinetic after nystagmus of 9 people was measured in the dark. Initial slow phase velocity (=average of first three slow phase velocity), number of nystagmus and duration of nystagmus were calculated. During the experiment, subjects were required to do mental arithmetic while each nystagmus was being recorded.
The drug reduced the maximum slow phase velocity of caloric nystagmus, compared with the placebo. There were no significant differences between treatments in both rotatory and optokinetic tests. Scopolamine had a suppressive effect on both initial slow phase velocity and duration of nystagmus of optokinetic after nystagmus. In a accordance with to Cohen's theory, this drug acts on a velocity storage integrator of the central nervous system.
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Naoki Ohashi, Yukio Watanabe
1989 Volume 1989 Issue Supplement36 Pages
57-62
Published: December 25, 1989
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The power spectra (PS) of eye movement and of target movement was calculated and the power spectra difference (PSD i. e., ‘PS of eye movement’-‘PS of target movement’) was obtained. In normal subjects whose pursuit patterns were smooth, PSD-f0 [PSD at f0(target frequency)] was greater than PSD-f0↑ (PSD average above f0). On the contrary, PSD-f0↑ is greater than PSD-f0 in pathological (saccadic or ataxic) pursuit patterns. Therefore, we conclude that 1) pathological pursuit patterns contain a frequency higher than the basic frequency identical to the target movements, and 2) a greater PSD-f0 sustains smooth pursuit.
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Akihiko Omura, Yukio Watanabe, Naoki Ohashi, Hideto Kobayashi, Akemi K ...
1989 Volume 1989 Issue Supplement36 Pages
63-69
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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Passive head movement was tested in 15 volunteers and four patients with uilateral vestibular dysfunction and compared with the results of pendular rotation test. The head of test subjects, sitting on a rotating chair with eyes closed, was fixed with a helmet which sinusoidally rotated with 30 peak to peak amplitude at 0.1,0.3, and 0.5 Hz.
The gain of slow phase velocity elicited by both stimuli was analyzed by a mini-computer (PDP11/34).
In normal subjects, the gain of passive head movement was slightly higher than that of pendular rotation at every test frequency. However, in the patients the gain of pendular rotation was higher than that of passive head movement rotation at every test frequency.
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Shin Aso, Yoshikazu Igarashi, Shinsuke Ueda, Takatoshi Nagasaki, Hidey ...
1989 Volume 1989 Issue Supplement36 Pages
70-77
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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A hundred and sixteen patients (133 ears) with Meniere's disease were divided into three case groups of ‘always’, ‘sometimes’ and ‘never’ having tinnitus. Spontaneous momentary tinnitus was carefully eliminated before grouping. The group ‘always’ having tinnitus was in a significantly more advanced stage of pure tone average hearing loss and abnormal electrocochleography than the group ‘sometimes’ having tinniuts. However, it was found in the group ‘never’ having tinnitus that a patient who had fluctuant hearing loss from 35 dB to 70 dB and dizziness had never experienced tinnitus.
Pitch matching tests were performed in 23 Meniere's ears and other sensorineural hearing losses. The pitches of tinnitus with Meniere's ears were lower than those of others but not statistically significant.
Nineteen pa t i ents with Meniere's disease were conservatively treated with the osmotic diuretic, Isosorbide. Twenty four weeks after the initial administration the tinnitus was better in 26%, unchanged in 58% and became worse in 16%. Of a series of 21 patients who had undergone endolymphatic sac surgery, eight patients felt there was an improvement in their tinnitus, ten said it was unchanged and three found it to be worse.
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Muneharu Ito, Hideo Shojaku, Hideto Kobayashi, Shin Aso, Yukio Watanab ...
1989 Volume 1989 Issue Supplement36 Pages
78-81
Published: December 25, 1989
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A Furosemide VOR test was performed on 41 patients with typical Meniere's disease,21 with atypical Meniere's disease,13 with delayed endolymphatic hydrops and 6 with syphilitic labyrinthitis.
Twenty-five of the 41 patients (61%) with typical Meniere's disease were evaluated as being abnormal by this test. Even more patients (91%) were judged to be abnormal when results of the furosemide VOR test were combined with those of the glycerol dehydration test or transtympanic electrocochleography, which suggests that a combination of these tests may be useful in diagnosing endolymphatic hydrops of typical Meniere's disease.
Twelve of the 21 patients (57%) with atypical Meniere's disease showed abnormal results in both the furosemide VOR test and caloric test. Eight of 13 patients (62%) with delayed endolymphatic hydrops and 3 of 6 (50%) with syphilitic labyrinthitis also had positive results. These findings suggest that this test may be useful for checking endolymphatic hydrops of the vestibular system of the inner ear not only for typical Meniere's disease but also for dizziness.
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Hideto Kobayashi, Yukio Watanabe, Kanemasa Mizukoshi, Takatoshi Nagasa ...
1989 Volume 1989 Issue Supplement36 Pages
82-89
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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Seventy eight ears in 46 patients with inner ear syphilis were studied and the results of the otoneurological examination were reviewed. In the transtympanic electrocochleography,10 out of 20 ears showed a dominant -SP response. Ten out of 23 ears showed positive findings in the intravenously administered glycerol test. Moreover, three out of six patients showed positive results in the furosemide VOR test. In conclusion, some cases of inner ear syphilis show characteristic findings of endolymphatic hydrops and degeneration of the organ of Corti, spiral ganglion, and nerve fibers in the labyrinth.
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Hajime Nakagawa, Naoki Ohashi, Yukio Watanabe, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
90-97
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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In 28 patients with spinocerebellar degeneration and 3 patients with Shy-Drager syndrome (SDS), who had visited the Toyama Medical and Pharmaceutical University Hospital during the period from 1983 to 1988, the neuro-otological and autonomic nervous system examinations were made in the Department of Neurotology.
According to Hirayama's classification (1982), the patients were classified into three groups, i. e.,15 cases of OPCA and Menzel type (OPCA group),7 of with LCCA and Holmes type (LCCA group), and 6 cases of miscellaneus type from the standpoint of neural functions.
The results obtained were summerized as follows and were evaluated with special references to the comparison of three groups and SDS. The incidence of gaze nystagmus and rebound nystagmus was higher in the group of OPCA than LCCA.
Both horizontal and vertical smooth pursuit eye movement and OKN were disturbed in those groups including SDS.
FFS (failure of fixation suppression) was found more often in the LCCA group than OPCA type. LCCA might affect the Purkinje cell.
In some cases the discrepancy between positive FFS and smooth pursuit deficit was recognized. There may not be a common pathway in these two mechanisms.
Autonomic nerve system disturbances were observed in patient s with not only SDS and OPCA but with LCCA.
The test battery of image analysis and neuro-otological and autonomic nerve examinations are importance to differentiate those disease entities.
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Hideya Ohi, Yukio Watanabe, Shin Aso, Kanemasa Mizukosh
1989 Volume 1989 Issue Supplement36 Pages
98-104
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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Clinical evaluation was made of 27 cases with acoustic tumors i. e.,4 ear tumors,11small tumors,6 medium tumors and 6 large tumors. Many cases had hearing loss and tinnitus. Sudden hearing impairment occurred in 10 cases. ABR was abnormal in almost all cases. Twenty three cases (85%) showed CP in their first caloric test. However two ear tumors showed normal response eventually. Of 23 cases on which galvanic body sway test (GBST) was carried out,21 cases (91%) showed abnormal response, but two with ear tumors (9%) showed a normal response. Moreover, ABR was positive in some cases of CPA syndrome without tumors. Therefore the ABR, caloric test and GBST are valuable in establishing an early diagnosis of acoustic tumors.
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Kenji Yasuda, Yukio Watanabe, Hideya Ohi, Hajime Nakagawa, Hideto Koba ...
1989 Volume 1989 Issue Supplement36 Pages
105-114
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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We reported the otoneurological findings of 5 cerebellopontine angle tumors other than acoustic neuromas, and compared the results with those of 11 cases of acoustic neuroma. The signs and symptoms of other cerebellopontine angle tumors were not uniform, thus, the differential diagnosis between other cerebellopontine angle tumors invasing VIII nerve and acouctic neuroma was very difficult.
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Neuro-Otological and MRI, CT Findings
Yoshikazu Igarashi, Hajime Nakagawa, Naoki Ohashi, Yukio Watanabe, Kan ...
1989 Volume 1989 Issue Supplement36 Pages
115-121
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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We reported a case of pontine glioma with sudden hearing loss. The patient was a 16year-old female with a history of left sudden hearing loss, tinnitus and headache.
Skull X-rays and nonenhanced CT scan were normal. The neuro-otological examination revealed severe functional distubance of the pons. Enhanced CT demonstrated a back shadow on the left cerebello-pontine angle lesion. MRI revealed a fine shadow on the large left pontine lesion.
We reconfirmed that the neuro-otological examination with MRI studies greatly contributes to detailed local diagnosis of brainstem lesions.
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Akihiko Omura, Yukio Watanabe, Hideto Kobayashi, Hideo Shojaku, Masats ...
1989 Volume 1989 Issue Supplement36 Pages
122-132
Published: December 25, 1989
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Neuro-otological studies were made in 84 patients with vertigo or dizziness after head and neck injuries. Patients were classified as traumatic cervical syndrome, simple head injuries, and head injuries with brain stem disorder according to suspected localization.
In patients having head injuries with brain stem lesions, equilibrium examination showed the central nervous system disorders, such as gaze-directional gaze nystagmus, failure of fixation suppression, ataxic or saccadic pursuit, diminution of OKN, and abnormal VVOR gain. Nystagmus provocated by neck torsion was frequently observed in patients with traumatic cervical syndrome. So abnormal results in neuro-otological examinations well reflected the condition of the patients with vertigo or dizziness after head and neck injuries. According to our follow-up studies on patients having head injuries with suspected brain stem disorders, there were dizziness and disequilibrium persisted with poor prognosis. However, in the other patients without brain stem disorder the results of equilibrium examinations improved generally.
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Hideto Kobayashi, Yukio Watanabe, Naoki Ohashi, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
133-140
Published: December 25, 1989
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As a clinical investigations of the interactions between the optokinetic and vestibular system, a pendular optokinetic nystagmus (P-OKN) test was carried out on 57 patients with central nervous system disorders and compared with the pendular rotation tests (VOR and VVOR tests) and OKN test by linear acceleration stimuli. Most cases of central nervous system disorders with decreased P-OKN gain showed diminution of OKN during linear acceleration. However, in several cases, normal P-OKN accompanied by abnormal accelerated OKN findings were observed. We concluded that the difference between the POKN and the accelerated OKN tests may be associated with different alertness during the optokinetic stimuli, especially due to the short stimulation time and also the increased and decreased velocities respectively. The P-OKN test is a simple and useful short test for detecting the abnormal oculomotor system, and may become a good screening test for central nervous system disorders.
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Naoki Ohashi, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
141-144
Published: December 25, 1989
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Previously, we explained the system we developed to examine the predictive function in smooth pursuit and reported that the phase lag is small if the predictive mechanism is functioning normally. We performed the same examination on disequilibrium patients with the central lesions. The qualitative judgment of ETT in these patients was designated as “saccadic pursuit pattern”. The results indicated that the phase lag is significantly greater in these patients. This indicates that the predictive mechanism in smooth pursuit is disordered in disequilibrium patients with the central lesions.
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Naoki Ohashi, Satsuki Yasumura, Hajime Nakagawa, Kanemasa Mizukoshi, S ...
1989 Volume 1989 Issue Supplement36 Pages
145-152
Published: December 25, 1989
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Twenty four patients with hemifacial spasm underwent thorough examinations consisting of 1). taking subjective symptons (tinnitus and/or dizziness),2). the otoneurological examinations (auditory and equilibrium examinations) and 3). checking the serum lipids. X-rays (air CT and/or VAG) were taken in some cases. Abnormal findings were obtained in 6 patients in the auditory and in 17 patients in equilibrium examinations. Moreover, abnormal findings suggesting brain-stem disorders (elongation of I-V latency in bilateral sides, indefinite V peak in the healthy side, abnormal findings in the oculomotor system (saccadic or ataxic pursuit patterns, diminution or inversion in the horizontal OKN) were obtained in 11 patients. In 3 of them, the enlarged vertebral or basilar arteries were found by X-ray examination. In 3 of them, serum lipids (cholesterol or trigyceride) were high. One of them is medicated for hypertension. Therefore, we conclude that the abnormal otoneurological findings suggesting brain-stem disorders came from [1] brain-stem compression by enlarged vertebral or basilar arteries or [2] arteriosclerosis or hypertensive angiopathy in the brainstem.
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Satsuki Yasumura, Naoki Ohashi, Yukio Watanabe, Kanemasa Mizukoshi, Sh ...
1989 Volume 1989 Issue Supplement36 Pages
153-158
Published: December 25, 1989
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A case of neurovascular compression of the /th and 8th cranial nerves was reported. The patient, a 53-year-old male, had a history of pulsating right tinnitus and paroxysmal dizziness with nausea and right facial spasms. For a long time, he was treated with SGB or injection of sodium bicarbonate, having been diagnosed as “Meniere's disease”. In spite of these treatments, the attack of dizziness became more frequent, developing to the clustering state. Neurovascular compression of the 7th and 8th cranial nerves was confirmed when the enlarged and curved vertebral artery was found during air CT and VAG examina. tions. Therefore, Jannetta's operation (microvascular decompression) was performed by the neurosurgeons. During the operation a branch of PICA was found to be compressing both the 7th and 8th cranial nerves. After surgical treatment, pulsating tinnitus, dizziness and facial spasms disappeared, and hearing loss improved.
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Takatoshi Nagasaki, Shin Aso, Yukio Watanabe, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
159-166
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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Osteopetrosis is a rare hereditary disorder of bone development due to a defect in bone resorption (dysfunction of osteoclast). We report a 40-year-old man with autosomal dominant osteopetrosis (radiological type I). All of his siblings died of “bone disease” in the fifth decade of life. His radiological findings and family history agree with those of the autosomal dominant type of osteopetrosis. The otoneurological problems were bilateral combined hearing loss, disequilibrium and right facial paralysis. Sensorineural hearing loss, floating sensation and facial paralysis in this case were suggested to have been caused by nerve compression in the internal auditory canal or traction of the nerves as a result of bone deformity around the internal auditory canal.
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Shin Aso, Yukio Watanabe, Naoki Ohashi, Hideto Kobayashi, Yukio Yoshid ...
1989 Volume 1989 Issue Supplement36 Pages
167-175
Published: December 25, 1989
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In our hospital inner ear anomalies were found radiologically in ten patients with profound sensorineural hearing loss. Of the ten patients,5 had a narrow internal auditory canal,4 showed dilated vestibule, one showed aplasia of the cochlea and in one patient there was tapering of the internal auditory meatus and facial canal because of abnormal proliferation of the petrosal bone. In 3 patients poor responses in caloric test and galvanic body sway test (GBST) were found. This means some retro-labyrinthine disorders. As in cases with severe deafness audiological recruitment tests are impossible to do, but, instead GBST can be used for detecting of retro-labyrinthine disorders. Not only tomography and CT scanning of the temporal bone but also caloric test and GBST are important techniques because they can reveal functional features of any inner ear anomalies.
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Yukio Yoshida, Muneharu Ito, Yoshikazu Igarashi, Yukio Watanabe
1989 Volume 1989 Issue Supplement36 Pages
176-180
Published: December 25, 1989
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There are many cases of labyrinthitis following by chronic otitis media before World War II. However, few cases of labyrinthitis caused by acute otitis media have been reported during the past 30 years. We have encountered a case with labyrinthitis following acute otitis media.
The patient was a man of 37 years old who had initially fever, headache with slight dizziness and later severe dizziness and right temporalgia. He could not walk because of dizziness and immediately hospitalized.
His right hearing represented combined deafness of 21 dB. Galvanic body sway test (GBST) was positive and caloric test indicated CP of right ear. According to the results of GBST, ENG and audiometoric assessments we diagnosed him as having labyrinthitis caused by acute otxitis media.
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Yoshikazu Igarashi, Shin Aso, Hideya Ohi, Shinsuke Ueda, Yukio Watanab ...
1989 Volume 1989 Issue Supplement36 Pages
181-187
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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Compound action potentials (APs) in electrocochleography were recorded after intravenous administration of lidocaine hydrochloride in guinea pigs (10-20 mg/kg) and in patients with tinnitus (2 mg/kg). In other patients with tinnitus, blood samples were collected for measurement of the serum concentration level of lidocaine. Blood pressure and pulse rates were monitored following adminstration (1 mg/kg). Changes in the amplitude of APs were observed.
In guinea pigs, AP amplitudes were significantly reduced just after injection of lidocaine and then increased until 4 minutes after administration, gradually decreased later. In patients with tinnitus no significant changes in AP could be seen. The maximum serum concentration level of lidocaine was 2.26 ± 0.68 pg/m1 at 2 minutes after administration and then it was rapidly decreased. No changes could be seen in blood pressure or pulse rate.
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Jun-ichi Imamura, Yukio Watanabe, Naoki Ohashi, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
188-192
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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We developed a database system for equilibrium examination by personal computer (NEC PC-9801). About 1800 recordings were made over 3 years.
Items registered are identification of the patient, clinical history, diagnosis, results of equilibrium examination, and audiological findings. A summary of each test is also stored for later reference.
In our department, a computer system using PDP-11/34 to analyze equilibrium examination is introduced into the clinical routine. The results of computer analysis were transferred to the database system through the serial line, and all other items were input from the keyboard. The system has such functions as picking up cases satisfying specified conditions, counting cases, making histograms or calculating average and correlation; and is able to exchange data with general application programs on personal computer.
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Seiichi Takeda, Shin Aso, Yukio Watanabe, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
193-197
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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A low cost computer system of sound stimuli was developed for auditory evoked responses. To elicit auditory brainstem responses, APs and SPs in electrocochleography and other parameters of evoked auditory responses could be controlled by simple computer procedures. Our system has a trigger terminal for input and output. All auditory evoked examinations can be performed automatically by using our computer system for processing auditory evoked responses. Simply set such parameters of sound stimuli as inter-stimulus interval, number of stimuli, initial intensity and frequency, before the test. Conditions of the parameters can be stored and changed easily.
With this system, our sound stimuli has been more useful and flexible in performing evoked response audiometry than conventional sound stimulators.
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Morihiro Yamamoto, Satsuki Yasumura, Shin Aso, Yukio Watanabe, Kanemas ...
1989 Volume 1989 Issue Supplement36 Pages
198-202
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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We report otoneurological findings in 2 cases of acute stage hearing loss due to mumps. Patient one was a 12-year-old female, who complained of hearing loss without vertigo two days after parotid swelling. Audiometry showed 110 dB perceptive deafness nine days after onset, but equilibrium test results were almost normal. In Patient 2 who was 35year-old male, hearing loss of almost the same degree as in patient 1 occurred on the same day as parotid swelling, and audiometry showed 110 dB eighteen days after parotid swelling. Vertigo occurred nine days after the onset of hearing loss. A caloric test showed canal paresis (CP) of the affected side and the CP showed retrolabyrinthine disorder by the galvanic body sway test (GBST). The disorder recovered nine days after onset, but hearing loss and CP did not improve. From these findings it is concluded that inner ear and retrolabyrinthine disorders occurred together but only the inner ear disorder did not recover.
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Shinsuke Ueda, Yukio Watanabe, Yukio Yoshida, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
203-207
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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We have operated on 604 cases of nose and paranasal diseases during the last nine years. Twenty-one of them had sinusitises or paranasal cysts with visual disturbance. Subjective or objective symptoms and operating findings and the factors of improved visual acuity were evaluated retrospectively.
Sixteen cases of chronic sinusitises were operated on previously and only five cases were initial operations. A few patients complained of nasal symptoms, but closure of middle nasal meatus was observed in most of the patients.
Visual acuity improved in 14 patients. Preoperative visual acuity and operative findings and past history of operations were not related with prognosis of visual acuity. The factors of improved visual acuity were significantly related with the preoperative normal fundus or early operations.
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Ken-ichi Kanda, Hideya Ohi, Yukio Watanabe, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
208-211
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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A case of frontal sinus mucocele is reported. A 72-year-old man, complained of swelling of the upper eyelid. Examination revealed the presence of a cyst in the frontal sinus. The frontal sinus was opened by Killian's method and the frontal sinus mucocele was removed. The wall of frontal sinus was partially destroyed and the dural surface was widely exposed. Two days after the operation, computed tomography showed evidence of space occupying lesions severely pressing the frontal lobe. However, the patient did not complain of psychiatric symptoms and there was no presence of suspected meningitis. This means that the mucocele grew very slowly. The patient completely recovered and there has been no trouble after the operation.
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Hideto Kobayashi, Yukio Watanabe, Yukio Yoshida, Shin Aso, Naoki Ohash ...
1989 Volume 1989 Issue Supplement36 Pages
212-216
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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In thirteen infants with laryngeal stridor admitted in our hospital, foreign bodies in the bronchi were observed in 7 cases. Three cases of laryngomalacia, one vocal cord nodule, one difficulty in decannulation after tracheostomy, one hypopharyngeal cyst were also revealed. We reported a case of hypopharyngeal cyst causing severe deviation of his larynx. The importance of recognizing the etiology of laryngeal stridor in infants by using direct laryngoscopy under general anesthesia is emphasized.
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Katuichi Akaogi, Masatsugu Asai, Jun-ichi Imamura, Hideto Kobayashi, Y ...
1989 Volume 1989 Issue Supplement36 Pages
217-222
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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A case of adult laryngeal papillomatosis was treated by using endoscopic carbon dioxide laser surgery with interferon injection therapy. There are many treatments of benign laryngeal papillomatosis. It is exceedingly difficult to control because of rapid recurrence after removal. However, in this case complete disappearance of papillomatosis was observed after the therapy. We concluded both laser surgery and systemic administration of alpha-type interferon to be effective therapy for papillomatosis as one of the most frustrating diseases in the field of otolaryngology.
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Hiroshi Inaba, Naoki Ohashi, Yukio Watanabe, Kanemasa Mizukoshi
1989 Volume 1989 Issue Supplement36 Pages
223-227
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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A 69-old-female noticed a non-tender mass in her parotid region. Sialography and CT scanning showed a left parotid tumor. Facial nerve palsy was absent, but left cervical lymphadenopathy was noticed. The patient underwent a superficial parotidectomy with preservation of the facial nerve. The tumor was a grey, soft mass,6×8 cm in size. Histologically, the parenchyma of left parotid gland was replaced by infiltrates of the lymphoma cells. Our case fulfilled the criteria of Hyman and Wolff. The diagnosis of diffuse lymphoma, medium-sized cell type was made according to LSG classification. Postoperatively, the patient received external cobalt irradiation (46.6 Gy) to the parotis and the whole cervical regions, and then was treated with chemotherapy because of a metastasizing disease of the spleen. Literature on malignant lymphoma of the parotid gland was reviewed.
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Hideto Kobayashi, Naoki Ohashi, Ken-ichi Kanda, Hideo Shojaku, Yukio W ...
1989 Volume 1989 Issue Supplement36 Pages
228-231
Published: December 25, 1989
Released on J-STAGE: November 27, 2012
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During otolaryngological treatment, our patients sometimes experienced so-called shock, such as neurogenic shock and psychogenic shock. The autonomic nervous system function of 29 patients who had a history of shock were examined. Twenty-seven patients (93%) had positive Schellong's test results. Five out of 7 patients had abnormal RR intervals on the ECG during the Schellong's test. Therefore the test battery of the Schellong's test and the RR intervals on the ECG before the examinations and treatments may make it possible to predict the occurrence of the so-called shock.
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