Hitome Kobayashi

Effect of single-drug treatment on idiopathic sudden sensorineural hearing loss

OBJECTIVES In order to evaluate the effect of a medical administration for the sudden deafness patients, single-drug treatment for idiopathic sudden sensorineural hearing loss (ISSHL) was assessed at multi-centers participating in the Acute Severe Hearing Loss Study Group sponsored by the Ministry of Health, Labor and Welfare of Japan. METHODS The subjects consisted of ISSHL patients who were (1) 20 years of age or older, (2) diagnosed within 2 weeks after the onset of hearing loss, (3) showing a mean hearing level of 40-90 dB at five frequencies from 250 to 4000 Hz, (4) previously untreated, and (5) with normal for age in hearing of the opposite ear. The drugs used in this study were ATP, alprostadil, hydrocortisone and amidotrizoate, which were administered intravenously, and beraprost sodium and betamethasone, which were given orally. Two drugs were assigned to each center, one of which was selected according to the code hidden in envelopes and administered for 1 week. The treatment after the single-drug administration was conducted at the discretion of each center. The hearing gain and recovery rate at 1 week after the initiation of single-drug treatment and at 1 month or over when the hearing level was fixed, were evaluated based on the criteria for hearing recovery prepared by the Acute Severe Hearing Loss Study Group. RESULTS There was no statistically significant difference in the recovery rate among drugs either at 1 week after the initiation of single-drug treatment or at the time of fixed hearing level. At the time when the hearing level was fixed, a statistically significant difference in the complete recovery rate was detected only between amidotrizoate and beraprost sodium. CONCLUSION From these results, we could not find any specific drugs recommended for ISSNHL. In evaluating the effect of the drugs, however, several problems in the clinical trial for ISSHL should be considered.

Clinical outcomes of ventilation tube placement in children with cleft palate

OBJECTIVE The purpose of this study was to investigate the long-term clinical outcomes in children with cleft palate. METHODS One hundred eight patients with cleft palate (CP) were investigated. Microscopic observation of the middle ears was performed periodically. If chronic otitis media with effusion (OME) was diagnosed at 1 year of age or later, ventilation tube (VT) placement was performed. The air-filled area of the mastoid air cells was checked on X-rays obtained at 1 and 5 years. The data from each measurement were tested statistically by the bootstrap method and Wilcoxons rank-sum test. The clinical course from age 6 to the final examination (average 9.42 years) and the language development at 5 years were analyzed using data from the medical records of individual patients. RESULTS VT placements were performed at 5 years of age or younger in 41 CP patients (82 ears, 38%). About 30% of patients treated by VT placement at 5 years of age or younger required myringotomy and/or VT re-placement at 6 years of age or over. Ninety-five percent of patients who had not been treated by VT insertion at 5 years of age or younger showed a favorable subsequent clinical course. Patients treated by VT insertion at 5 years of age or younger had significantly smaller mastoid air cell areas as measured at 5 years of age and also at 1 year of age. No significant difference in language development was observed between the CP patients that underwent /did not undergo VT placement. CONCLUSIONS VT placement should be positively undertaken in CP children who have small mastoid air cell areas as measured at 1 year of age, because an unfavorable prognosis of OME is expected in such patients. It is considered that patients treated by VT placement at 5 years of age or younger should be carefully followed up for the development of OME even after 6 years of age. Thus, measurement of the mastoid air cell area at the age of 1 year is useful for determining the therapeutic program.

Unilateral hearing loss following rubella infection in an adult.

A 36-year-old man was admitted to our university hospital, complaining of acute hearing loss of the right ear, which was his only hearing ear. He had developed complete deafness due to mumps in the left ear at the age of 26. Before admission, he had been diagnosed as having rubella infection. He noticed hearing loss in the right ear two days after disappearance of macular rash. Headache, nausea and vertigo were not present. Three weeks after the onset of hearing loss, he was admitted to our university hospital. Pure tone audiometry revealed sensorineural hearing loss; a mild ascending audiometric curve with a marked loss at 4,000 Hz and 8,000 Hz. SISI test was positive. Caloric stimulation (ice water 10 ml/10 s) to the right ear demonstrated a normal response. Rubella hemagglutination antibody titer was 512. Specific IgG antibody was over 3,200. Specific IgM antibody was positive (7.01 Enzyme Immunoassay). The data indicated recent infection with rubella. He was given betamethasone for 14 days. Pure tone audiometry showed hearing improvement.

Changes in Cerebrospinal Fluid Pressure in Daily Life

The purpose of the present study was to measure changes in cerebrospinal fluid pressure (CSF-P) during actions of daily life. A spinal tap was performed on 23 inpatients. During the procedure, the patients were requested to perform the following four actions: nose blowing with one side closed, nose blowing with both sides closed, breath holding, and sniffing. The CSF-P was recorded before and during these actions. Of these, nose blowing with both sides closed resulted in the greatest elevation of pressure. Three patients with perilymph fistula showed larger changes than the other 20 patients. Conversely, sniffing lowered the CSF-P in all cases. The present study suggests that daily physical actions cause significant elevations of CSF-P. Such changes may be responsible for the development of perilymph fistula.

Changes in middle ear pressure in daily life

The present study was performed to estimate changes of middle ear pressure (ME‐P) during actions of daily life such as nose blowing and sniffing. ME‐P was measured in 18 patients with perforation of the eardrum. They were asked to perform actions which included nose blowing and sniffing. Eustachian catheterization and politzerization were also applied. Change of ME‐P before and after these actions was recorded using a pressure monitor. Results showed that changes of ME‐P after nose blowing with both nostrils closed were large and rapid. The mean value of ME‐P after nose blowing was 252 mmH2O. In our previous study, the mean value of cerebrospinal fluid pressure (CSF‐P) after nose blowing was 388 mmH2O.1 Therefore, the pressure gradient across the cochlear windows is about 130 mmH2O during nose blowing. The cochlear windows may have been pressed toward the middle ear side. After sniffing, ME‐P was unchanged. These results suggest that nose blowing may be an important cause of perilymphatic fistula (PLF) via the “explosive route,”2 while sniffing is not likely to cause PLF.

Suppressive Activity of Vitamin D3 on Matrix Metalloproteinase Production From Cholesteatoma Keratinocytes In Vitro

There is much evidence that degradation of the extracellular matrix is essential for the development of cholesteatomas and that this is induced by activation of matrix metalloproteinases (MMPs). Vitamin D3 (VD3) has several well-recognised biological activities, including suppression of MMP production. The present study, therefore, was undertaken to examine whether VD3 could suppress MMP production from cholesteatoma keratinocytes in vitro. Keratinocytes (2.5 × 105 cells/mL) induced from cholesteatoma tissue specimens were cultured with various concentrations of VD3. After one hour, lipopolysaccharide was added to the cell cultures at 100 μg/mL. The culture supernatants were then collected and assayed for MMP-1 and MMP-3 by ELISA. We also used ELISA to measure the levels of both TIMP (tissue inhibitor of metalloproteinase)-1 and TIMP-2 in culture supernatants. Addition of VD3 into keratinocyte cultures caused the suppression of MMP and TIMP production, which was increased by LPS stimulation. This was dose-dependent. The present results showing the suppressive activity of VD3 on the production of MMPs, which are responsible for tissue remodeling, strongly suggest that VD3 would be a good candidate for an agent in the medical treatment of, or prophylaxis for, cholesteatomas.

Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan, 2015

OBJECTIVE To (1) indicate the definition, the disease state, methods of diagnosis, and testing for otitis media with effusion (OME) in childhood (<12 years); and (2) recommend methods of treatment in accordance with the evidence-based consensus reached by the Subcommittee of Clinical Practice Guideline for Diagnosis and Management of OME in Children. METHODS We produced Clinical Questions (CQs) concerning the treatment of OME and searched the literature published until April 2014 according to each theme including CQ, the definition, the disease state, the method of diagnosis, and examination. The recommendations are based on the results of the literature review and the expert opinion of the Subcommittee. RESULTS Because children with Downs syndrome and cleft palate are susceptible to OME, we categorized OME into low-risk and high-risk groups (e.g., Downs syndrome and cleft palate), and recommended the appropriate treatment for each group. CONCLUSION In the clinical management of OME in children, Japanese Clinical Practice Guidelines recommend management not only of OME itself, such as effusion in the middle ear and pathological changes in the tympanic membrane, but also pathological abnormality in surrounding organs, such as infectious or inflammatory diseases.

Palatoplasty and Growth of the Temporal Bone Mastoid Air Cells

Objectives The present study was undertaken to analyze the relationship between the method used for manipulation of the levator veli palatini muscle and the area of the mastoid air cells in patients with cleft palate. Design Retrospective study. Patients The subjects were 50 patients seen for surgical treatment of cleft palate. Interventions Palatoplasty was carried out using the mucosal flap method in 25 patients and the mucoperiosteal flap method in 25 patients. In the mucosal flap method, the levator veli palatini muscle was overlapped and sutured, followed by posterior movement of the muscle bundle (the posterior relocation group). In the mucoperiosteal flap method (the control group), the mucoperiosteal flap was pushed back, followed by end-to-end suturing of the muscle. The area of the mastoid air cells was measured on X-rays when patients were 5 years old. Results The mastoid air cell area did not differ significantly between the posterior relocation group (mean, 5.00 cm2; range, 1.66 to 19.7 cm2) and the control group (mean, 5.3 cm2; range, 2.29 to 15.9 cm2). Conclusion No significant growth of mastoid air cells was noted following posterior relocation of the levator veli palatini muscle. Thus, in cases of cleft palate in which significant growth of mastoid air cells is not expected following reconstruction of the levator veli palatini muscle, the results confirm the view that tympanic ventilation tube insertion is the most suitable method for the treatment of otitis media.

Laser irradiation of the semicircular canal: Occlusion of the canal or duct

Abstract The aim of this study was to evaluate the effects of argon laser irradiation of the semicircular canals using computed tomography (CT) images and to examine the basis for laser treatment for benign paroxysmal positional vertigo (BPPV). CT images of the posterior canal were evaluated postoperatively in a patient with intractable BPPV, in whom the unilateral posterior and lateral semicircular canals were irradiated with an argon laser. In addition, bootstrap analysis of 20 patients with normal CT findings of the temporal bone was performed and previous experimentally obtained histologic findings were compared. Cross-sections of the posterior canals of 20 patients were found to show no difference in size between the right and left sides. The laser-irradiated posterior canal became narrower than that on the non-irradiated healthy side in our patient. There was a discrepancy between the CT images and experimentally obtained histologic findings that showed complete occlusion of the canal. CT images of a patient with severe vertigo demonstrated that argon laser irradiation to the blue-lined semicircular canals did not occlude the canal of the corresponding areas, while the canal of the guinea pig histologically showed complete obstruction with new bone after irradiation with the same energy (1.5 W, 0.5 s, spot size: around 200 μm in diameter). The patient has been free from vertigo for 16 years. Marked constriction of the semicircular duct corresponding to the irradiated area appeared to be effective in treating intractable BPPV.

Measurements of internal auditory meatus by polytomography. 1. Normal subjects

Polytomography permits clear visualisation of the internal auditory meatus (IAM), the normal range of measurements of which is important for radiograph interpretation. Previous reports indicate wide variation in vertical diameter and in the length of the posterior canal wall although in any one individual there is usually little variation between the two sides. We studied the relationship of both the vertical diameter and the length of the posterior walls of the IAM to the growth of the skull and pneumatisation of the temporal bone in 300 patients with no evidence of a lesion of the VIII nerve. No statistically significant correlation was observed between these factors.