Objectives. The purpose of the present study is to find out the clinical characteristics which determine candidates for retraining therapy (TRT) with a sound generator (SG) as well as the prognosis of this . Method. This study enrolled 270 serious patients who visited this institute between January 2004 and December 2008 in the TRT program. The relationships among compliance, efficacy, clinical characteristics, and affinity for SG were evaluated retrospectively. Results. The persistence rate at one month was 61.5%. The shorter duration and higher pitch of were significant independent predictors of compliance. Six months after the initiation of TRT, 65.2% subjects demonstrated significant relief from . The Kaplan-Meier method demonstrated that the overall efficacy rate at 18 months was 86.5%. The lower loudness of , recognition of attenuation by a sound generator, and patient’s positive attitude toward TRT were significant variables for predicting favorable results. Conclusion. The patients with lower loudness of were suitable for TRT with a SG.

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Objective: The objective of this study was to evaluate the efficacy of hangekobokuto in chronic .
Study design: This study was a randomized, double-blind, placebo-controlled trial compared hangekobokuto to placebo in chronic patients.
Setting/location: This study was conducted at the Department of Otorhinolaryngology of Kitasato University Hospital/Japan.
Subjects: Participants were adults, with chronic ( ≥ 3 months), mild to severe handicap ( Handicap Inventory [THI] score ≥ 18).
Interventions: Seventy-six patients were randomized to receive either hangekobokuto or placebo.
Outcome measures: Change in THI score from baseline to final follow-up visit was the primary efficacy measure. Changes in Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HADS), and Short-Form 36-Items Health Survey (SF-36) scores were secondary efficacy measures. We also conducted 3 ancillary analyses.
Results: No significant intergroup differences were noted in THI (Total: p = 0.73, Functional: p = 0.99, Emotional: p = 0.78, Catastrophic: p = 0.59), or any secondary endpoints. In patients without apparent anxiety or depression, no significant intergroup differences were noted in THI. In patients with vertigo/dizziness, hangekobokuto tended to improve THI (Total: p = 0.006) as compared to the placebo. In patients with hangekobokuto "sho", no significant intergroup differences were noted in THI.
Conclusion: Although no significant intergroup difference was observed, hangekobokuto tended to improve THI in patients with vertigo/dizziness. Identifying a more definitive indicator for prescribing Kampo medicine and a study design which reflects characteristics of Kampo medicine may lead to a more informative evaluation of its benefit.

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Vibration disease results from the long-term use of vibratory tools such as chain-saws and pneumatic hammers. Vibration, noise, and cold are stressors that impair the human body. Consequently, signs and symptoms can occur, including which can be associated with hearing loss. occurs in approximately 40% of the patients, and is hard to effectively treat. Stellate ganglion block was performed in patients with . The efficacy of the ganglion block was evaluated by the five steps' method of patient self-assessment and by the audiometric method. The effective rates of the ganglion block for was 62.5% by self-assessment and 68.8% by audiometric assessment. The hearing acuity partially recovered and was associated with good or partial relief of . A follow-up study for 18 months revealed that the efficacy of stellate ganglion block for persisted. Thus, stellate ganglion block therapy can be effective for the of in patients with vibration disease.

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Although there are many cases of aurium due to circulatory disorders in the vertebrobasilar arterial system, a basis for diagnosing of circulatory disorders has not yet been found. Twenty seven ears of twenty patients with aurium with no history of middle ear diseases or sensorineural hearing loss but with cerebral infarction and assumed to have circulatory disorders in the vertebrobasilar arterial system were selected for diagnostic therapy in order to elucidate their clinical features.
Curative effects on aurium were good twenty ears (74.1%) markedly improved at the eighth week after the first . Hypacusis hearing in the low-tone region observed on audiograms during the initialexamination showed improvement or tendency toward improvement.
Hypacusis hearing in the low-tone region observed at a similar level in audiograms of both ears possibly suggests the existence of circulatory disorders in the vertebrobasilar arterial system and also was a clinical characteristic of patients with aurium to where circulation improving agents were effective.

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Objective: In medically refractory idiopathic intracranial hypertension (IIH), venous sinus stenosis (VSS) stenting has been an effective

modality. Among patients who experience recurrent symptoms and develop new stenosis, the optimal strategy is unknown. The aim of this study was to investigate the role of rescue re-stenting in patients with recurrence after prior successful stenting.

Methods: This was a single center, retrospective review from a prospectively maintained IIH registry. Between 2012 and 2023, patients who underwent interventions for confirmed IIH and angiographically demonstrable VSS were included. The cohort was divided into those who underwent a single stenting procedure (single stent group) and those who underwent re-stenting due to recurrence of symptoms and new angiographic stenosis (re-stent group).

Results: Ninety seven patients were included: 87 in the single stent group and 10 in the re-stent group, with a median age of 32 (interquartile range 26–38). 94% were female. Both groups had similar baseline demographic and clinical characteristics. There was similar improvement in papilledema and

. Headache improvement was greater in the single stent group at 6 weeks (88.4% vs. 60.0%, p = 0.04, single vs. re-stent group), but similar at 6 months post-procedure. For visual disturbances, there was similar improvement at 6 weeks, but greater improvement in the single stent group at 6 months post-procedure (86.8% vs. 75.0%, p = 0.04, single vs. re-stent group). None of the re-stented patients required rescue ventriculoperitoneal shunt placement.

Conclusion: Re-stenting among IIH patients with recurrent symptoms after initial successful VSS stenting is feasible with similar efficacy in improving symptoms.

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Objective: Selective transvenous embolization (sTVE) is an effective technique for treating dural arteriovenous fistulas (DAVFs); however, selective catheterization into the shunted pouch is often difficult due to the acute angle of the access route between the target pouch and dural sinus. We present our initial experience using a steerable microcatheter (SM) to manually control the tip angle for selective catheterization and sTVE of DAVFs.

Methods: Thirteen consecutive cases of DAVFs and 16 procedures that involved sTVE using SM between October 2016 and October 2018 were reviewed. SMs were used for selective catheterization of shunted venous pouches and/or the affected sinus and coil embolization. We evaluated the maneuverability of the SM, the success of selective catheterization into the target lesions, and the results of endovascular treatments.

Results: Endovascular procedures were performed in a single session in 10 cases and in two staged sessions in 3 cases. There was no difficulty in maneuverability of the SM. Successful selective catheterization was achieved in 26 of 27 target lesions. Immediately after embolization, angiography showed complete occlusion in 10 cases and marked reduction in 3 cases. During 40.9 months of mean follow-up, 12 cases showed complete occlusion and one case showed a small residual shunt on MRI. Procedure-related complications of spontaneous thrombosis of the affected sinus were observed in one case. There were no cases of recurrence or exacerbation during follow-up.

Conclusion: SM is useful for selective catheterization for target lesions during sTVE of DAVFs.

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is a symptom often encountered in daily clinical practice. Objective evaluation, however, is usually difficult, and judgment of the effects of therapy varies. We had patients write a“diary of ”as a means of accurately assessing the therapeutic effects of intravenous injection of xylocaine and stimulation of the stellate ganglion. Immediate effectiveness, and the subjective improvement rating were studied. We judged the magnitude, nature and mental effects of , and therapeutic effects from chronological changes in the magnitude of recorded in the diary. The results of our study show that therapeutic effects on can be predicted somewhat from the underlying disease, the pathology, the character of the patient, and the therapy. Thus, the “diary of ”is considered to be a significant method for judging the therapeutic effects of .

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Objective: Posterior condylar canal dural arteriovenous fistula (PCC DAVF) is extremely rare, with only four previously reported cases in the English literature. Cases may present

and radiculopathy. In cases where the drainer is around the brainstem, subarachnoid and intraventricular hemorrhages (IVHs) may occur. We describe the clinical presentation, angiographic imaging, and endovascular strategy of a PCC DAVF.

Case Presentation: A 30-year-old woman presented to our hospital with

and stiffness of the shoulder. Neuroimaging studies showed DAVF with fistulous points around right PCC consisted of a high-flow shunt, fed mainly by the occipital artery, and drained to the suboccipital cavernous sinus (SCS) and internal jugular vein. The lesion was treated with a combination of transvenous coil embolization and transarterial Onyx injection. The patient recovered immediately after intervention and had no neurological deficits in the follow-up visit.

Conclusion: In this case, endovascular

was performed safely without recurrence so far. A strategy combining transvenous coil embolization and transarterial Onyx injection may be an effective for PCC DAVF with high-flow shunt. Further case accumulation is desired.

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While rare, complications following Le Fort I maxillary osteotomy includes hemorrhage, ischemia, infection, and vascular abnormalities. This study aimed to present an uncommon case of delayed presentation of a middle meningeal pseudoaneurysm formation after Le Fort I osteotomy. The patient initially presented with pulsatile

, and the pseudoaneurysm was subsequently treated successfully with image-guided embolization.

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in 55 ears was treated with a custom made suppressor which was designed to apply an alternative current to the cochlea of patients and the current level was in the range of 200-300μA. A well charge balanced stimulus waveforms, whose stimulus current density around the electrode is 1.25μC·cm^-2·geom/phase, was used and it was shown from our that no problem in patients was observed. Averaged loudness level (difference between level and hearing level) of before was 15.7dB, while 8.4dB after . More than 5dB of level was improved in 30 of 55 ears treated with the device and in 5 ears disappeared.

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Objective: We discuss the details of a case in which iatrogenic vertebral arteriovenous fistula (VAVF) was successfully treated with a covered stent.

Case Presentation: A 62-year-old man presented with

after catheterization via the internal jugular vein and subsequently developed iatrogenic VAVF. Under general anesthesia, stent-assisted coil embolization was attempted via the right femoral artery but was unsuccessful. Therefore, a covered stent (Fluency 8 × 40 mm; C. R. Bard, Inc., Tempe, AZ, USA) was deployed, resulting in a marked decrease in shunt flow. The VAVF was obliterated 3.4 months after the procedure without postoperative complications.

Conclusion: Endovascular

using a covered stent can be an option for iatrogenic VAVF.

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Soshikokito is a Kampo formulation used in the of bronchial asthma, especially in those patients with hot flushes and cold sensation in their feet. But there is also a description in classical textbooks for its usage for the of . We report two typical cases of prolonged treated successfully with soshikokito. Case1was a 70-year-old woman who visited our clinic complaining of , dizziness and insomnia. She had a history of bilateral otitis media in her childhood, and had been suffering from after being operated for it. The had worsened during the three months prior to her first visit to us. After 3 months' with soshikokito with additional shisoyo, her symptoms improved, so much so that after 8 months, she could live her life normally. Case 2 was a 58-year-old man who presented with , hearing disturbance and a sense of irritation. He also complained of insomnia and cold sensation in his limbs. After1month's with soshikokito with additional shisoyo and bushi, most all of his symptoms resolved. In addition, we also evaluated the clinical efficacy of soshikokito for prolonged , retrospectively, and found that it was effective in five out of the ten cases we treated with this formulation. Most of the successfully treated patients presented with hot flushes or cold sensation in their feet. These case reports suggest that soshikokito may be a useful formulation for the of not only bronchial asthma, but also of prolonged .

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The sweep frequency impedance (SFI) meter allows us to measure the dynamic characteristics of the middle ear in adults (Fig. 1). To extend its versatility, it has been redesigned and applied to newborns. The SPL was found to show variations at around 0.26 and 1.13 kHz (Fig. 2). Although the former is probably related to the resonance of the middle ear, the source of the latter is still unclear. Modal analyses of the finite- element models of the newborn auditory system (Fig. 3) revealed that there is a resonance of the external ear canal wall at around 0.3 kHz, suggesting that the first variation of the SPL curve may be related to the resonance of their external ear canal.

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affects 10-20% of the population, and in 5% or more of affected individuals, is severe enough to impair daily life. Much research has been conducted regarding the of , but unfortunately, very few effective treatments have been reported. In this study, we detected and attempted to reduce or eliminate it using a sound source supplemented with phase conversion.
In a previous study, we reported that the preliminary study showed that additional sound used as a neuronal excitation impulse signal may influence brainstem coding and the classification of the degree of impairment in hearing ability, conducted during the subject test. In the present study, we report how we increased the number of subjects, and in addition to classification by degree of hearing impairment, we also classify subjects by degree of severity, and perform additional investigation of its significance.
This study has major potential to be clinically applied as a novel for . Approval for this study was obtained from the Kitasato University Ethics Review Committee.

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Vertigo occurs due to various reasons, therefore an accurate diagnosis is demanded. However, as the rate of occurrence during diagnosis is 40～60%, it is difficult to clearly recognize the disease. Therefore, this study aimed to develop a compact eye movement measurement system that is possible to measure and record the vertigo at home. In this study, the accurate calculation of eye movement was evaluated by the camera that was expected to be mounted. The algorithm of this system analyzes the horizontal and vertical components by tracking the pupil, subsequently extracts and tracks the feature points from the iris pattern in order to analyze the rotation components. As the results of evaluation experiment of images taken by the camera revealed that, the average calculation error of movement amount and rotation amount were 0.04mm and 0.23mm at resolving power of 9.35um/pixel respectively, a strong correlation could be seen. In addition, eye movement is 0.7mm/frame when taken by 30fps, calculation error is the range of 1frame. Based from the results, satisfactory tracking of eye movements is potentially can be performed by the camera.

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Fifty-three patients with hemifacial spasm, six patients with trigeminal neuralgia and five patients with unilateral were treated by a “microvascular decompression” method and follow-up results for more than one year were evaluated. Follow-up operative results of 44 patients with hemifacial spasm were : 1) excellent—24, 2) good—12, 3) fair—7 and 4) poor—1. The operative results of hemifacial spasm were evaluated according to Jannetta's classification¹⁷⁾ combined with the degree of postoperative hearing reduction. Reduction of hearing acuity occurred in nine out of 53 patients. No recurrence of hemifacial spasm was encountered during follow-up period. It was interesting enough that the ipsilateral facial paresis which existed preoperatively gradually improved after decompressive surgery for hemifacial spasm. Eight out of 10 patients who developed facial paresis without having previous traumatizing surgical and six out of 13 patients who had undergone previous peripheral surgical for hemifacial spasm gradually improved after this decompressive surgery. All six patients with trigeminal neuralgia were completely cured and they noticed no sensory changes on the affected side of the face postoperatively. Four out of five patients with were improved by the surgery.
The most characteristic forms of compressing arteries were that the arteries crossdistorted the cranial nerves usually at their exit zones from the brain-stem and the arteries were angled and sclerotic focally at the compressing sites. Vertebral angiographic studies provided a key to solve the problem of why these arteries were sclerotic at the angular part and why hemifacial spasm affected one side of the face. Although the etiology of these hyperactive dysfunctions of the cranial nerves is still controversial, vascular compression-distortion seems very likely to be responsible for these syndromes. The “microvascular decompression” of cranial nerves is a refined and nontraumatic technique which seems to promise a stable and permanent cure of the hyperdysfunction of cranial nerves.

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