Hideaki Naganuma

Water May Cure Patients With Meniere Disease

Objectives/Hypothesis: We examined whether sufficient water intake is effective in the long‐term control of vertigo and hearing activity in patients with Meniere disease (MD) for whom conventional therapy has proven unsuccessful.

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.

Cephalometric Analysis in Patients with Obstructive Sleep Apnea Syndrome

Cephalometry is useful as a screening test for anatomical abnormalities in patients having obstructive sleep apnea syndrome. In this study, various conventional parameters in cephalometry, such as the distance and angles determining the oropharyngeal space, and the areas of the soft palate, oral cavity, tongue and pharynx in both posterior-anterior and lateral view X-ray films, were measured before and after surgery in order to evaluate the preoperative predictability and usefulness of uvulopalato-pharyngoplasty and/or midline laser glossectomy (MLG) for the purpose of preoperative assessment and evaluation of surgical treatment. As test subjects, American adult patients with disturbed respiration in sleep observed at Oakland Otology and Apnea Clinic during 1989-1992 and Japanese patients with the same problems observed at Kitasato Univ. Hospital during 1992-1994 were used. The results were as follows: i) cephalometry revealed morphological abnormalities in the skull, and the measurement of soft tissue in the oropharynx provided useful anatomical data to assess the space of the upper airway in each patient before operation; ii) the areas of the soft palate, the whole tongue and the lower half of the tongue were significantly enlarged, and the lengths of MPH, SPL and PNS-H were longer in the apnea group than in the snoring group; iii) in MLG patients, increases in the area of the oral cavity and pharyngeal cavities and a decrease in the area of the upper half of the tongue were observed.

Three-Dimensional Analysis of Morphological Aspects of the Human Saccular Macula

The 3-dimensional shape of the human saccular macula and its orientation in the skull were quantitated in this study. The semicircular canals and saccular maculae were reconstructed 3-dimensionally on a computer from 3 human temporal bones. The 380 to 522 triangles in the entire area of the saccular macula were made by drawing lines between 2 adjacent points every 100-μm width of the saccular macula in each section. The angles between each triangle and each estimated standard axis in the skull obtained were calculated. This information will provide standard data regarding the 3-dimensional morphological aspects of the saccular macula for further investigations of the function of the sacculus. It was determined that the 3-dimensional shape of the saccular macula was not a plane, but was a curved surface like that of an ellipsoid. It is thought that this shape is necessary in order for the saccular macula to detect wide-range linear acceleration.

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.

IQ‐ArfGEF/BRAG1 is associated with synaptic ribbons in the mouse retina

IQ‐ArfGEF/BRAG1 is a guanine nucleotide exchange factor for ADP ribosylation factors (Arfs), which are implicated in membrane trafficking and actin cytoskeleton dynamics. In this study, we examined the immunohistochemical localization of IQ‐ArfGEF/BRAG1 in the adult mouse retina using light and electron microscopy. IQ‐ArfGEF/BRAG1 was distributed in a punctate manner and colocalized well with RIBEYE in both the outer and inner plexiform layers. Immunoelectron microscopic analysis showed that IQ‐ArfGEF/BRAG1 was localized at the synaptic ribbons of photoreceptors. When heterologously expressed in HeLa cells, IQ‐ArfGEF/BRAG1 was recruited to RIBEYE‐containing clusters and formed an immunoprecipitable complex with RIBEYE. Furthermore, immunoprecipitation analysis showed that anti‐IQ‐ArfGEF/BRAG1 antibody efficiently pulled down RIBEYE from retinal lysates. These findings indicate that IQ‐ArfGEF/BRAG1 is a novel component of retinal synaptic ribbons and forms a protein complex with RIBEYE.

Cephalometric and Fiberoptic Evaluation as a Case-selection Technique for Obstructive Sleep Apnea Syndrome (OSAS)*

In order to obtain relatively simple and useful parameters to estimate the severity of obstructive sleep apnea syndrome (OSAS), cephalometric and fiberoptic studies were performed in 64 clinical cases previously diagnosed with either OSAS or snoring. Fourteen cephalometric parameters, 13 parameters derived from physical examination and 18 fiberoptic parameters were compared with the apnea index (AI), the apnea -hypopnea index and lowest SaO 2 values. Statistically significant correlations were found between the AI and the shortest linear distance from the posterior line of the soft palate to the posterior pharyngeal wall measured along a line parallel to the supramentale-Gonion line (PAS-epipharynx distance), the distance from the mandibular plane to the most anterior and superior point on the body of the hyoid bone obtained from cephalometry (MP-H distance) and the degree of redundancy of mucosa in the arytenoid/aryepiglottic fold obtained from videoendoscopy. An increased AI was observed when the PAS-epipharynx distance was <7 mm and there was 100% obstruction in Mullers maneuver at the palate level (supine), the MP-H distance was >27.4 mm and the mucosa of the arytenoid/aryepiglottic fold was markedly redundant. As these three parameters are relatively easy to obtain on an outpatient basis, it is suggested that they could be used in an outpatient setting to provide a good prediction of the severity of OSAS.

Three-Dimensional Reconstruction of the Human Semicircular Canals and Measurement of Each Membranous Canal Plane Defined by Reid's Stereotactic Coordinates

Objectives: Equations for estimating the planar relationships of the human semicircular canals were devised by Blanks et al from a dissected bony labyrinth in a human skull. However, a similar study on the membranous semicircular canal planes has never been published. Methods: In this study, the angle between each membranous canal plane and Reids stereotactic horizontal plane was measured on serial histologic sections of 7 temporal bones from Japanese adults. We reconstructed the 3 semicircular canals by computer-aided 3-dimensional analysis. The angles between each pair of both bony and membranous canal planes were measured. Results: In the bony labyrinth, the angles between the 2 canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.51° ± 2.98° (mean ± SD), 91.70° ± 1.85°, and 94.52° ± 3.32°, respectively. The angles between the 2 membranous canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.05° ± 4.74°, 91.03° ± 2.93°, and 91.92° ± 5.22°, respectively. Conclusions: The data from our study of the membranous labyrinth showed that the angles between each canal plane and the others were much closer to 90° than was found by Blanks et al for the bony labyrinth.

Clinical characteristics of delayed endolymphatic hydrops in Japan: A nationwide survey by the Peripheral Vestibular Disorder Research Committee of Japan

Abstract Conclusion: Similarly to almost all delayed endolymphatic hydrops (DEH) cases with both precedent sudden deafness and mumps deafness, two-thirds of DEH cases with precedent deafness of unknown cause with onset in early childhood developed DEH symptoms within 40 years after the precedent deafness. In spite of the diagnosis of precedent deafness, viral labyrinthitis may build up the late endolymphatic hydrops in most DEH cases up to four decades. Objective: To clarify the characteristics of DEH in Japan. Methods: Clinical information on 198 DEH cases was collected by nationwide, multicenter surveys conducted by the Peripheral Vestibular Disorders Research Committee of Japan. Results: The incidence of the ipsilateral type of DEH was 47.5%, which was almost equal to that of the contralateral type. In both types of DEH, the most common diagnosis of precedent deafness was deafness of unknown cause with onset in early childhood: 43.9% in both types of DEH. Sudden deafness and mumps deafness were the subsequent diagnoses of precedent deafness. The distribution of time delay of the onset between precedent deafness of unknown cause with onset in early childhood and DEH was different from that between precedent sudden and mumps deafness and DEH.

Vestibular Training for Acute Unilateral Vestibular Disturbances: Its Efficacy in Comparison with Antivertigo Drug

We carried out a clinical trial on the treatment of acute unilateral vestibular disturbances (AUVD) without typical Menieres disease and benign paroxysmal positional vertigo. Two therapy groups were selected: vestibular training (VT) with drug therapy and drug administration alone. After the experimental period of 8 weeks, all patients were classified into two groups depending on the methods of treatment, and the clinical courses of the patients were compared statistically. It was confirmed statistically by global judgments of symptoms and signs that improvement rates were higher in the group treated by VT with medication than the improvement rate in the group with medication alone. It is concluded that VT is effective for early relief from vestibular ataxia.