Equilibrium Research
Online ISSN : 1882-577X
Print ISSN : 0385-5716
ISSN-L : 0385-5716
77 巻, 1 号
FEBRUARY
選択された号の論文の7件中1~7を表示しています
シリーズ教育講座 「原著から今日まで ―代表的疾患の変遷―」
  • 喜多村 健
    2018 年 77 巻 1 号 p. 3-10
    発行日: 2018/02/28
    公開日: 2018/04/04
    ジャーナル フリー

     The aim of the present paper was to provide a comprehensive review of vestibular neuritis. This disorder was described for the first time by Ruttin in 1909 and Nylen coined the term vestibular neuritis in 1924. Dix and Hallpike reported 100 cases with vestibular neuritis including cases with either single or multiple attacks of vertigo. A more restricted diagnostic criterion limited to a single severe attack of vertigo with a subsequent unilateral deficit in caloric response was adopted by the Japan Society For Equilibrium Research and Research Group for Vestibular Disorder of the Ministry of Health, Labour and Welfare of Japan. A human temporal bone histopathological study demonstrated severe atrophic changes of one or more nerve trunks of the superior vestibular nerve, with or without their associated sense organs. The above histological findings suggested viral infection rather than vascular occlusion. However, the cause of vestibular neuritis remains uncertain. Previous histopathological studies exhibited atrophic changes limited to the superior division of the vestibular nerve. In addition, recent studies revealed that some patients demonstrated vestibular dysfunction limited to the inferior division or superior/inferior division of the vestibular nerve. Antiviral agents (valacyclovir) have failed to demonstrate any improvement in vestibular neuritis-related vestibular function. Furthermore, the effectiveness of corticosteroids in the management of patients with vestibular neuritis has not been established. A Cochrane Database Systematic Review reported insufficient evidence to support the administration of corticosteroids to patients with vestibular neuritis in 2011.

原著
  • 岩澤 敬, 野本 剛輝, 小川 恭生, 近藤 貴仁, 矢富 正徳, 勝部 泰彰, 武田 淳雄, 井上 文, 塚原 清彰
    2018 年 77 巻 1 号 p. 11-16
    発行日: 2018/02/28
    公開日: 2018/04/04
    ジャーナル フリー

     Miller Fisher syndrome (MFS) was first described in 1956 by Miller Fisher as an unusual variant of acute idiopathic polyneuritis. It is a variant of Guillain-Barre syndrome that is characterized by ophthalmoplegia, ataxia, and areflexia. High titers of serum IgG reactivity to GQ1b ganglioside are detected in patients with MFS. Here, we report the case of a patient who exhibited horizontal nystagmus on the lateral gaze position early in the onset and was diagnosed with MFS.

     A 45-year-old woman was admitted to our hospital with rotatory vertigo 12 days after being diagnosed with an influenza A infection. Two days after hospitalization, she showed bilateral horizontal gaze nystagmus in the abducent direction. At the same time, a central nerve system disorder was suspected as a result of neurotological findings; she was diagnosed with MFS. The vertigo improved after the administration of intravenous immunoglobulin therapy and she was discharged 11 days after hospitalization. This is a rare case of MFS after influenza A infection. There may be an association between anti-GQ1b antibodies and peripheral or brainstem disorders.

  • ―DHI を併用した疾患群別活用法についての検討―
    西村 信子, 伏木 宏彰, 角田 玲子
    2018 年 77 巻 1 号 p. 17-21
    発行日: 2018/02/28
    公開日: 2018/04/04
    ジャーナル フリー

     This study compared the scores on each scale of the Japanese version of the Dizziness Handicap Inventory (DHI) consisting of the three subscales, used conveniently at a dizziness outpatient department, and psychological tests, such as the new version of the State Trait Anxiety Inventory (STAI) and Self-Rating Depression Scale (SDS) by a disease group. The participants included 126 patients (38 men and 88 women; mean age=55.10 years, SD 15.66) who visited the dizziness outpatient department for the first time during January 2014 to December 2015 and were categorized into three disease groups: psychogenic, central, and peripheral vestibular disease. A retrospective cohort investigation method was employed.

     The participants generally had high scores in the DHI evaluating the level of disabilities in daily life caused by dizziness symptoms, indicating that they had moderate dizziness subject to possible drug therapy and/or rehabilitation. Interestingly, the results of the psychological tests (STAI and SDS) as well as the DHI subscales varied among the disease groups. Patients with psychogenic dizziness tended to have emotional and functional difficulties due to their dizziness symptoms and to be more susceptible to a state of anxiety. Peripheral dizziness patients had a state of anxiety in the normal range and depressive symptoms were mild, but there was a correlation with DHI.

  • ―電極挿入法による比較―
    中村 雅子, 加我 君孝
    2018 年 77 巻 1 号 p. 22-29
    発行日: 2018/02/28
    公開日: 2018/04/04
    ジャーナル フリー

     There are two techniques for cochlear implant placement. This study aimed at comparing spontaneous nystagmus and postoperative hearing change one day and 7days after surgery between the cochleostomy and the round window approach.

     Twenty-two patients who underwent cochlear implantation by the cochleostomy approach and 36 patients by the round window approach were studied. Spontaneous nystagmus was recorded one day and 7days after cochlear implant using VNG and subjective vertiginous sensation was investigated by interviewing. Long-term postoperative hearing was compared with preoperative hearing.

     The incidence of spontaneous nystagmus in the round window approach patients at one day and 7days was higher than in the cochleostomy patients, although mo significant difference was seen in the slow phase velocity between the round window or cochleostomy approach. One day and 7days after the cochlear implantation, a vertiginous sensation was subjectively perceived in patients who underwent the cochleostomy rather than the round window approach. It was found that temporary vestibular irritation was associated with both the cochleostomy and round window approach.

  • 阿部 靖, 伏木 宏彰, 角田 玲子, 前田 佑輔, 木下 修, 遠藤 まゆみ, 西村 信子
    2018 年 77 巻 1 号 p. 30-37
    発行日: 2018/02/28
    公開日: 2018/04/04
    ジャーナル フリー

     As the aging population increases, the number of patients with complaints of dizziness is increasing. Vestibular rehabilitation (VR) therapy (VRT) is reported to be helpful for these patients, especially those with unilateral vestibular dysfunction. In Japan, VRTs are usually performed by physicians. In order to investigate the effectiveness of VRT, we used a team approach that included physicians, PTs, and laboratory technicians who cooperated to deliver VRT.

     Six patients with refractory dizziness due to a unilateral vestibular disorder were treated with customized VRT for approximately three months. The typical procedure for VR in the clinic consisted of medical examinations, self-reporting of symptoms using a questionnaire (Dizziness Handicap Inventory, [DHI]), a balance test using posturography, walking test (Timed Up and Go Test, [TUG]), and VRT sessions. The tests included a head and eye movement test, caloric test, and head impulse test (HIT). The range of motion in the legs, muscle strength, foot deformity, and wear on the patient's shoes were also investigated by the PT. For VR at home, customized rehabilitation programs for individual patients were created. The program was revised by the PT at the monthly follow-up visits.

     After three months of VRT, the indexes of the posturography balance test showed improvements on average. In particular, there were significant improvements in the balance test on the rubber foam that was performed with the eyes closed. Most of the DHI scores improved with time, but they were not statistically significant.

     VRT using the team approach may improve vestibular function and quality of life in patients with intractable dizziness.

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