Akito Fujino

Initial Symptoms and Retrospective Evaluation of Prognosis in Meniere's Disease

Clinical studies on an initial symptom and a long-term course of vertigo and hearing impairment and retrospective evaluation of the prognosis were performed in Menières disease. One hundred and fifty-one patients (67 males and 84 females) with Menieres disease were treated in the Neuro-otological clinic, Kitasato University Hospital from 1990 to 1995. Ages ranged from 17 to 77 years (mean 47.3 years) at the onset of the disease when the first vertigo attack occurred. There were 106 (70.1%) in their 30s, 40s and 50s, and 28 (18.5%) aged 60 years or over. Seventy-eight patients visited the clinic within one year of the onset of the disease, but the mean interval was 4 years and 5 months (the longest was 25 years). The mean duration time for the follow-up studies from the time of their first visit to the hospital was 2 years and 5 months. The bilateral ears were invaded in 19 patients (12.6%) and the mean length of their time course was 9 years and 10 months which is longer than the length in unilateral cases. Several important key points for diagnosis of Menières disease were investigated in 28 of the 151 cases who had been followed up successfully over a relatively long time course (the mean follow-up time was 7 years and 3 months). Fluctuated or stational cochlear signs, such as tinnitus, hearing impairment and/or fullness in the ear, had started prior to the onset of the first vertigo attack in 17 (61%) of 28 cases. Vertigo without cochlear sign appearing at the onset and cochlear signs were combined later in six (21%) of the 28 cases. Only five (18%) of the 28 cases had vertigo combined with a cochlear sign simultaneously at the onset of the disease. The affected ear was on the left in 15 cases and on the right in seven of 22 unilateral cases. In six bilateral cases the left ear was the first to be invaded in four out of six cases. The interval between the first and second attacks was over 1 year in six of the 28 cases and over 6 months in 10 of the 28 cases. Nine out of the 28 patients had recurrence of vertigo attacks during the first month and five of the nine had a cluster of attacks in the first month. Our study of 28 patients over a long time course revealed eight patients (28.6%) free from the disease. These patients had no recurrence of vertigo for more than 2 years after their last attack, and sixteen (57.1%) of the 28 patients had no recurrence of vertigo for more than 1 year. However, a long period of relief time of more than 2 years in 11 of the 28 patients and a period of more than 1 year was noticed in 16 of the 28 patients. Hearing levels at the middle and low frequencies in the first hearing test were compared with the last test. The mean of hearing levels changed from 38.1 to 36.2 dB after 2 years and 1 month in six cases with the right ear affected and from 34.1 to 45.3 dB after 5 years and 3 months in 15 cases with the left ear affected, but in seven cases with bilateral diseased ears the hearing in both ears became worse, from 25.5 to 57.1 dB in the right ear and from 30.5 to 53.6 dB in the left ear during a period of more than 10 years. These clinical findings should be utilized for diagnosis at the onset of Menières disease to determine the interval for observation in order to evaluate the efficacy of treatment.

Basophilic Deposits on the Cupula: Preliminary Findings Describing the Problems Involved in Studies Regarding the Incidence of Basophilic Deposits on the Cupula

In this study, the possibility of whether basophilic deposits adhered to the cupulas in the semicircular canals was investigated histologically. Results indicated that basophilic deposits were present in all three cupulas of the semicircular canals. The overall incidence of basophilic deposits in the superior, lateral and posterior semicircular canal cupulas was 26%, 41% and 37%, respectively. The incidence of basophilic deposits bound to the cupulas increased with age. The possible origin of these basophilic deposits on the cupulas and the increased incidence of basophilic deposits with increasing age are discussed.

Prognosis of Meniere's Disease by Conservative Treatment: Retrospective Study on the Time Course of the Disease

The incidence of Menières disease was investigated in a total of 3222 patients with vertigo or dizziness who had visited Kitasato University Hospital during 1985-1991. Two hundred and fifty-one of the cases (7.8%) were found to suffer from Menières disease and the male:female ratio was 1:1. Seventy cases of Menières disease with complete records were classified into five groups, depending on the duration of the illness since its onset. Both ears were affected in 12 (17.1%) of the patients but in 4 (33.3%) of prolonged 12 patients having more than 15 years after the onset. All 70 patients had been treated conservatively, except for 3 who had undergone surgery. Frequency of vertiginous attacks and hearing impairment during the last year in each group were retrospectively compared with those of the other groups. No vertiginous attacks were experienced in 13 (24.1%) cases. The average number of vertigo attacks during the last year was 4.5 per year in 49 cases. Adequate therapy is desirable within one year after the onset of Menières disease: the results showed the frequency of vertiginous attacks to be lowest and hearing levels to be best in the first group who were treated less than one year after the onset, in comparison with the other prolonged cases.

A case of cavernous hemangioma in the internal auditory canal.

A case of cavernous hemangioma in the internal auditory canal was reported. The chronology of this case was similar as one of Ménières disease. The neurotological findings in this case were no specific findings to differentiate cavernous hemangioma from acoustic neurinoma. The high-resolution computed tomography (HRCT) revealed calcium stippling in the lesions, whereas magnetic resonance imaging (MRI) demonstrated a low signal intensity on both T1- and T2-weighted images. Comparison of HRCT and MRI findings is most useful for differential diagnosis of intracanalicular tumors.

Prolonged Dysequilibrium in Three Cases with Vestibular Neuronitis: Efficacy of Vestibular Rehabilitation

The clinical course of acute unilateral vestibular disturbance in 3 cases with vestibular neuronitis and a case with labyrinthine destruction was surveyed for a long-term period. Vestibular training with a modified Cawthorne-Cookseys exercise was done in 2 of 3 cases with vestibular neuronitis and a case of labyrinthine destruction. All had no severe troubles in activities of their daily lives over one year after the onset of the disease, but the central compensation was not completed, even in a young patient, in a case of labyrinthine destruction and in a well trained case. Spontaneous nystagmus to the affected side and increase of body sway with eyes closed were revealed by examinations in all cases. Physical exercise was found to be effective for relief from vestibular ataxia, but it was difficult to keep the effect even after training.

Study on vomiting related to the vestibulo-autonomic reflex.

The purpose of this study was to investigate the neural pathway from the vestibular labyrinth to the medullary vomiting center in the cat, using electrophysiological techniques. During electrical stimulation of the canal nerve, we found conflicting results: the pressure in the stomach sometimes increased, and sometimes decreased. There might be several neural structures between the semicircular canal nerve and the vomiting center in the dorsolateral portion of the reticular formation of medulla oblongata. Retching or vomiting-like behavior during both respiration and movement of the stomach was recorded during stimulation at several sites in the lateral medullary reticular formation. However, the evoked unit activities were not always induced by stimulation of the canal nerve.

Effectiveness of Fibronectin in Myringoplasty Using Temporal Fascia

A study of myringoplasty with temporal fascia homograft employing fibronectin was conducted in 14 ears in which the same myringoplasty procedure without fibronectin (1-5 times) had failed to afford closure of tympanic membrane perforation. Closure was obtained in eight ears. These results suggest that fibronectin is effective in myringoplasty using treated temporal fascia homograft.

Origin of positional nystagmus with direction changing towards the upper ear. A case report of head trauma.

Nystagmus towards the upper ear in both lateral head positions is usually considered to appear in patients with central nervous system lesions, especially those in the brain stem or cerebellar posterior vermis. However, its pathogenesis is still obscure, since several reports have suggested that such positional nystagmus may occur in patients with peripheral vestibular disturbances.This report describes a patient with positional nystagmus of this type after head trauma. X-ray examination revealed temporal bone fracture. The origin of positional nystagmus in this case was thought to be a peripheral vestibular lesion because the nystagmus was transient and there was no clinical evidence of any disturbance of the central nervous system. Seven cases of such positional nystagmus seen during the last 3 years in Kitasato University Hospital are summarized. Positional nystagmus towards the upper ear is assumed to be an important sign of central nervous system disturbance, but it may occur with peripheral vestibular lesions. It is necessary in the latter case for the positional nystagmus to disappear in the course of time, and other vestibular and neurological findings may indicate the character of the peripheral vestibular disturbance.