Eiji Chida

Reactivation of herpes simplex virus type 1 in patients with Bell's palsy

Reactivation of herpes simplex virus type 1 (HSV‐1) has been implicated in the pathogenesis of idiopathic peripheral facial palsy (Bells palsy). The present study used the polymerase chain reaction (PCR) to analyze the saliva of patients with Bells palsy for the presence of shed HSV‐1. The study involved 47 patients with Bells palsy, 24 patients with Ramsay Hunt syndrome, and 16 healthy HSV‐seropositive volunteers. HSV‐1 DNA was not detected in the saliva samples from HSV‐seronegative patients. The prevalence of shed HSV‐1 in patients with Bells palsy (50%) was significantly higher than that in healthy volunteers (19%, p<0.05). When saliva samples were tested within 7 days after the onset of palsy, the prevalence of shed HSV‐1 in patients with Bells palsy (40%) was significantly higher than that in patients with Ramsay Hunt syndrome (7%, p<0.05). Furthermore, HSV‐1 usually became undetectable by the second week after the onset of Bells palsy when HSV‐1 was detected during the acute phase of the disease. These findings strongly suggest that reactivation of HSV‐1 is involved in the pathogenesis Bells palsy, and indicate that PCR is a useful tool for early diagnosis of HSV‐1 reactivation in patients with Bells palsy. J. Med. Virol. 54:162–166, 1998.

The efficacy of Burow's solution as an ear preparation for the treatment of chronic ear infections.

Objective To determine the efficacy of Burows solution as an otologic preparation for the treatment of chronic ear infection. Study Design Two studies were included: 1) a prospective clinical study and 2) a laboratory study on antibacterial and antifungal effects. Setting A private otology practice and a laboratory study. Patients Fifty-eight patients with refractory otorrhea. Intervention Diagnosis by otoscopy, audiometry, and bacteriology. Methods Burows solution was mixed in solutions with four organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Candida albicans, and Aspergillus. Soon after Burows solution was mixed in the solutions with organisms, and 5, 10, and 20 minutes thereafter, the mixtures were cultured on agars. The numbers of the bacterial or fungal colonies were counted to evaluate the effect of Burows solution. Main Outcome Measures Changes in the clinical findings of the ears, the symptom of otorrhea, and side effects were assessed. Results Thirty-five (70%) of the 50 ears assessed were “cured” and 10 (20%) ears assessed were “improved.” No significant side effect was observed. Regarding the laboratory study, the four organisms disappeared within 20 minutes after Burows solution was mixed. Conclusion Burows solution was considered to be an effective otologic preparation.

Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy

OBJECTIVE Recent studies provide compelling data for the hypothesis that herpes simplex virus type I (HSV-1) is implicated in the pathogenesis of idiopathic peripheral facial palsy (Bells palsy). The present study analyzed the severity of facial palsy in patients with HSV-1 reactivation and sought to determine the efficacy of acyclovir-prednisone therapy for these patients. MATERIALS AND METHODS In total, 176 patients, clinically diagnosed with Bells palsy. were divided into three groups by polymerase chain reaction (PCR) and serological tests--31 patients with HSV-1 reactivation, 45 patients with VZV reactivation (zoster sine herpete) and 100 patients without HSV-1 or VZV reactivation (Bells palsy). RESULTS The difference in the worst grade of facial palsy between patients with zoster sine herpete and Bells palsy was significant (P = 0.01 10, Mann-Whitney U-test). In contrast, no difference in the severity of palsy was observed between patients with HSV-1 reactivation and Bells palsy. Twelve patients received acyclovir-prednisone treatment within 7 days of onset based on positive PCR results and ten of the 12 (83%) recovered completely. In contrast, 14 patients with HSV-1 reactivation received prednisone treatment because their PCR tests were performed at a later date; ten of these 14 (71%) recovered completely. The difference in the cure rate between the two treatment groups was not significant (P > 0.05, Fisher exact test). CONCLUSIONS The results indicate that the severity of palsy in patients with HSV-1 reactivation is similar to that in patients with Bells palsy and suggest that early diagnosis of HSV-1 reactivation by PCR and subsequent acyclovir-prednisone therapy do not improve recovery from facial palsy.

An anti-mumps IgM antibody level in the serum of idiopathic sudden sensorineural hearing loss

PURPOSE Measurement of anti-IgM antibody for mumps enables us to diagnose silent mumps infection. From the viewpoint of prophylactic medicine, we examined the incidence of silent mumps infection in idiopathic sudden sensorineural hearing loss (ISSNHL) by measurement of anti-mumps IgM antibody. MATERIALS AND METHODS Serum level of anti-mumps IgM antibody was evaluated by EIA method in 69 ISSNHL cases. RESULTS Of the 69 serum samples examined, five samples were positive, two samples were regarded as quasi-positive and other samples were negative for anti-mumps IgM antibody. The positive rate was 7.2% (5/69). The relationship of anti-mumps IgM and IgG antibody was also described. CONCLUSIONS From the measurement of anti-IgM antibody for mumps, it was possible to diagnose silent mumps infection in ISSNHL. The positive rate of anti-IgM antibody in ISSNHL was 7.2% suggesting that the silent mumps infection could be considered as one of the causative factors of ISSNHL even though its incidence is not so high. Since mumps often occurs without clinical symptoms, it is still considered to be one of the important causes of profound hearing loss. From the viewpoint of prophylaxis of profound hearing loss and deafness, we should understand the situation of virus epidemiology and vaccination.

Myeloperoxidase-antineutrophil cytoplasmic antibody-associated sensorineural hearing loss

A 36-year-old female with hyperthyroidism that had been treated with propilthiouracil (PTU) complained of tinnitus and hearing loss in both ears. She was treated with steroid administration by an otolaryngologist; however, hearing continued to fluctuate when the steroids were tapered. Laboratory evaluation revealed a decreased complement level and elevated levels of immunoglobulin M (IgM) and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). With the withdrawal of PTU and high-dose methylprednisolone, she had excellent return of right-sided hearing. In recent years, there have been many reports about MPO-ANCA-associated small vessel vasculitis. Although any organ may be affected by this disease, there are no reports about MPO-ANCA-associated progressive hearing loss without any other organ involvement. The present case suggests the possibility that inner ear blood flow impairment due to ANCA-associated small vessel vasculitis induces the so-called autoimmune sensorineural hearing loss.

A family affected by branchio-oto syndrome with EYA1 mutations

Branchio-oto (BO) syndrome is complicated with congenital preauricular fistulae, branchial fistulae (cysts), and hearing loss (sensorineural, conductive or mixed). As well as branchio-oto-renal (BOR) syndrome. it is known to be an autosomal dominant hereditary disorder. Since mutations in the EYA1 gene have been identified in both BO and BOR syndromes, mutation screening of this gene has been drawing attention as a genetic test to diagnose BOR/BO syndromes. In this study, we genetically investigated the presence of EYA1 mutations in a BO syndrome family in which we observed congenital preauricular fistulae, branchial fistulae (cysts) and hearing loss in four generations. Whereas there was a variety of phenotype expressions in this family, all subjects tested had a nonsense mutation (R264X) in exon 8 of the EYA1 gene. The present report adds further examples to support the usefulness of molecular genetic testing for the diagnosis of patients with BO syndrome.

A rare aneurysmal bone cyst of the maxillary sinus: a case report

Aneurysmal bone cyst (ABC) is a non-neoplastic expansile bone lesion that is common in the long bones; only 2% occurs in the head and neck. We present a case of ABC in a 23-year-old male and describe the clinical and radiological features, histopathology and treatment. Magnetic resonance imaging (MRI) demonstrated multiple internal septations, cysts with fluid-fluid levels of varying intensity, and an intact rim of low-intensity signal completely surrounding the lesion. The tumor was removed by enucleation with resection of the lateral nasal cavity. Histopathologic diagnosis was ABC and fibrous dysplasia. We suggest that MRI is very useful for the diagnosis of ABC. ABC is thought to follow other lesions, and thus when treating ABC, it is important to determine whether any pre-existing lesion has preceded or not; in particular, if the lesion site is in the head and neck region.

Effects of spontaneous otoacoustic emissions on distortion product otoacoustic emission

OBJECTIVE It has been reported that spontaneous otoacoustic emission (SOAE) can prolong the responses or increase the echo power of transiently evoked otoacoustic emission (TEOAE), yet the effects of SOAE on distortion product otoacoustic emission (DPOAE) have been studied less thoroughly. As most of the previous studies have not paid attention to the patients age, sex and hearing level, they have not reflected possible effects of those factors. We studied the effects of SOAE specifically on DPOAE in the following subjects. SUBJECTS AND METHODS The subjects were all females ranging in age from 19 to 24 (average: 21.4) and the 78 ears had a hearing threshold under 15 dB for 1.2, and 4 kHz on pure-tone hearing test. IL088 (Otodynamics) was used for measurement of SOAE and IL092 (Otodynamics) for DPOAE. SOAEs were measured by time-averaging over 100 of the responses, of which those showing a clear peak 3 dB above the noise floor and being reproducible were considered as SOAE-positive. In all the ears. DPOAE responses were measured at L1 = L2 = 70 dB, and in 42 ears also at L1 = L2 = 60 dB and L1/L2 = 60/50 dB. The subjected ears were grouped into two by the presence or the absence of SOAE, and DPOAE amplitudes of 1, 2, and 4 kHz were compared. respectively. RESULTS Of the total, 39 ears were SOAE-positive and 39 SOAE-negative. Statistically no significant difference was observed in the average hearing level between the SOAE-positive and SOAE-negative groups. The hearing levels did not significantly differ in the frequencies of 1, 2. and 4 kHz, respectively, indicating that influence of the hearing level on DPOAE could be excludable. DPOAE amplitudes at L1 = L2 = 70 dB in the frequencies of 1, 2, and 4 kHz were higher in the SOAE-positive group than in the SOAE-negative group. And DPOAE amplitudes were also higher in SOAE-positive group at L1 = L2 = 60 dB and L1/L2 = 60/50 dB in the frequency of 1.2, and 4 kHz, but significant differences were observed only in the frequencies of 4 kHz. By grouping the ears by the number of SOAE. we revealed the tendency that the larger the number of SOAE, the higher the DPOAE amplitudes. CONCLUSIONS We evidenced that SOAE has significant effects on DPOAE responses. In clinical application of DPOAE measurement, therefore, the effects should be seriously taken into account.

Preserved otoacoustic emission in a child with a profound unilateral sensorineural hearing loss

We report a case of profound unilateral sensorineural hearing loss with good response of otoacoustic emission. The patient was a 5-year-old boy. who was diagnosed to have unilateral hearing impairment on pure tone audiometry at the first visit. The affected ear showed the absence of auditory brainstem response; however, its transiently evoked otoacoutic emission and distortion product otoacoustic emission were considered to be normal. These findings indicated that the outer hair cell of cochlea was not impaired and that the impairment should be localized between inner hair cells, primary afferent fiber or its synapses, spiral ganglion of the cochlea and acoustic fiber, or at a combination of these areas. That is, evaluation of otoacoustic emission was useful in determining the region of impairment in sensorineural hearing loss. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.

Sensorineural hearing loss induced by radiation as a late effect: five cases followed by audiogram.

OBJECTIVE We studied the progression of the late radiation-induced sensorineural hearing loss (SNHL) to discuss the pathological mechanism responsible for the progression with referring to past reports. METHODS Five cases were selected among the SNHL cases diagnosed at the Department of Otolaryngology. Hokkaido University. All the cases were followed up with audiograms. RESULTS All of the five cases showed gradual progression of SNHL, which developed mostly 1 2 years after irradiation for brain tumors. Two of them showed rapid progression from time to time with sudden onset in their clinical courses. All the patients were resistant to any medication such as steroid, vitamin B12 or cerebral circulation activators. CONCLUSION Two patterns of progressions of radiation-induced hearing loss were observed. Both of them were considered to be explainable by ischemic changes of the vessels as reported earlier. Since there is no effective treatment for radiation-induced SNHL, it is most important to enlighten clinicians in general on this disease.