Hiromi Naramura

Urinary and Fecal Incontinence in a Community‐Residing Older Population in Japan

OBJECTIVE: To estimate the prevalence and risk factors of urinary and fecal incontinence among a community‐residing older population in Japan.

Physical and Mental Correlates of Hearing Impairment in the Elderly in Japan

Seven hundred and forty seven elderly people aged from 65 to 98 (209 male and 538 female) admitted to the Geriatric Health Service Facility were evaluated with pure-tone audiometry, Office of Population Censuses and Surveys (OPCS) personal care severity score, OPCS hearing severity score, Mini-mental State Examination (MMSE) and Self-rating Depression Scale (SDS). A single correlation study indicated that the hearing level significantly correlated with age, OPCS hearing severity score, MMSE total score and SDS total score. A multiple regression analysis showed that age, OPCS hearing severity score, and MMSE total score were significantly associated with the hearing level. We demonstrated here that the objective auditory function strongly correlated with the cognitive function measured by MMSE total score, suggesting that a regular audiological check-up and the early detection of the hearing impairment could contribute to the maintenance of the quality of life in the elderly.

Hearing Recovery in Sudden Deafness Patients Using a Modified Defibrinogenation Therapy

Ninety-eight patients with idiopathic sudden deafness were treated with a modified defibrinogenation (DF) therapy including batroxobin, low molecular dextran, vasodilators and vitamins. Hearing improvement was evaluated with two methods: categorical judgement and improvement rate (%). By categorical judgement, 60 patients (61% of the total) were classified into recovery or good improvement categories. The improvement rate was calculated for each of the 93 patients, and the average value was 64%. Modified DF therapy was effective especially for patients with severe hearing loss of 70-90 dB with flat audiogram. Although serum fibrinogen significantly decreased after batroxobin administration there was no correlation between the concentration of fibrinogen and hearing recovery. When prognostic factors were studied, the interval between the onset of hearing loss and start of treatment, initial hearing level, and the existence of vertigo all had significant correlation with the degree of hearing recovery.

Hearing Recovery Following Large and Small Fenestra Stapes Surgery for Otosclerosis

Fifty-five ear of 49 patients with otosclerosis were operated on with either large fenestra stapes (stapedectomy; SDE) or small fenestra stapes (stapedectomy; STO) surgery. Pre-operative average hearing levels for the speech frequency ranges (0.5, 1, 2 kHz) were 56.1 dBHL for SDE and 61.0 dBHL for STO. These improved to 39.0 dBHL and 35.0 dBHL. Statistically, significant hearing recovery was obtained for a frequency range from 0.125 to 2 kHz for SDE and from 0.125 to 4 kHz for STO (p < 0.05, Dunnetts multiple variance test). The degree of post-operative hearing improvement for STO was significantly higher at 0.5, 2 and 8 kHz than that for SDE (p < 0.05, Students t-test). A pre-operative speech discrimination score of 80% was obtained at 68.9 dB for SDE and at 76.0 dB for STO. These values improved to 56.1 dB and 49.5 dB post-operatively. Thus, it was proved that STO results in better hearing than SDE does.

Clinical characteristics and hearing recovery in perilymphatic fistulas of different etiologies

Clinical features and hearing recovery were compared between three types of perilymphatic fistula groups; surgically confirmed (PLF-conf, n = 16), suspected (PLF-susp, n = 24) and traumatic (trauma-PLF, n = 11). Initial average hearing level was best in the PLF-susp group (50.9 dBHL), followed by the trauma-PLF (55.7 dBHL) and PLF-conf (59.7 dBHL) groups, though the difference was not significant (ANOVA, p > 0.05). Of 51 patients, 27 cases were operated on and fistula was confirmed in 19 ears (70.4%). Conservative treatment, including bed rest and medication, was given to all patients. After the treatment, meaningful hearing recovery was obtained only at 1 kHz in the PLF-conf group (paired t-test, p < 0.05). However, significant recovery was seen at all frequency ranges (0.125-8 kHz) in the PLF-susp group (average, 16.8 dB; p < 0.01), while hearing improvement was intermediate for the trauma-PLF group. The initial hearing level and the period until the start of treatment strongly correlated with the final hearing level. Although 27 patients (47%) complained of dizziness, the prognosis for vertigo is excellent as noted by other authors. It was concluded that if conservative treatment is started early for PLF patients with mild hearing loss, hearing recovery can be ensured.

Time Course of Vestibular Function in Patients with Meniere's Disease Following Vestibular Nerve Section

Harmonic acceleration rotational test and vestibular autorotation test (VAT) were performed on 8 patients with Menières disease before and after vestibular nerve section. Sinusoidal rotations of 0.01-0.64 Hz were used in the HA rotational test. VAT was performed at frequencies between 0.5 and 6 Hz. Two weeks after operation, almost all the patients consistently showed response asymmetry toward the healthy ear at all stimulus frequencies and a reduction in sensitivity to rotational stimuli at 0.01 Hz in the HA rotational test. Prior to surgery, the time constant of the vestibulo-ocular reflex (VOR) varied according to the residual vestibular function of each patient. The time constant then dropped to a mean of 4.2 s after the operation. In the VAT, almost all the patients showed a gain reduction at all frequency ranges on the seventh postoperative day. These findings suggest that response asymmetry and gain at 0.01 Hz in the HA rotational test are valuable for evaluating the time course of the compensation of the vestibular function after surgery and that the VOR time constant is useful in detecting whether the vestibular nerve has been sectioned correctly.

Results of Stapes Surgery, 1980-1990.

Fifty five stapes operations performed during the past 11 years were studied. The average air conduction level of 0.5-2kHz was 58.5dBHL pre-operatively. This was improved to 31.6dBHL in audiograms recorded 3-6 months after operation. During the first 5 years of this survey, stapedectomy (SDE) was performed in 76.0% of the patients. Stapedotomy (STO) was more frequently done during the next 6 years (53.3%). A comparison of the two operations showed that hearing was better at all frequencies (0.125-8kHz) after STO than after SDE. The difference was greatest at 8kHz. It was confirmed that STO resulted in better hearing than SDE in patients with otosclerosis.