Kazuhiro Teramoto

BEHANDLUNG DER MENIERESCHEN KRANKHEIT. PAUKENHOHLENINFUSION VON LIDOCAIN­ UND STEROIDLOSUNG

Before considering the surgical treatment on patients with Meniere disease who would resist to various conservative therapies, including oral drug therapy, the author experimented the inner ear anesthetic therapy or the middle ear infusion therapy with a steroid solution, and each therapeutic result was compared. The results were as follows: 1) The effectiveness of the inner ear anesthetic therapy for vertigo was noted in 42 ears out of the total 47, while the effectiveness of the middle ear steroid infusion therapy for vertigo was found in all treated 21 ears. 2) Although both therapies proved non-effective for hearing disturbance, excluding special cases, the former therapy was found effective for tinnitus in 36 ears out of the total of 57, whereas the latter proved effective for it in 26 ears among 42. 3) For other concomitant symptoms such as the full sensation of ear obturation, head heaviness, and stiff shoulders, both therapies were considerably effective. It was concluded from these results that the first choice of therapy for patients with Meniere disease who should resist to all conservative therapies should be the middle ear steroid infusion therapy at the outpatient clinic, and the second choice would be the inner ear anesthetic therapy, and that both therapies were worth while experimenting before considering surgical treatment.

Use of the visual suppression test using post-rotatory nystagmus to determine skill in ballet dancers

Twelve ballet dancers with various levels of dancing experience and skill were examined with the visual suppression test using post-rotatory nystagmus (PRVST) and caloric stimulation (CVST). The PRVST results showed a suppression rate that was higher than in untrained subjects. The CVST results showed a suppression rate similar to that in untrained subjects. A correlation between the PRVST and CVST suppression rates and the length of dancing experience showed that the suppression rate increased as the level of experience and skill rose. These results indicate that the PRVST and CVST can aid in the clinical and quantitative assessment of the function of the central nervous system in visual-vestibular interactions in ballet dancers. Additionally, testing may have determined function of vestibulo-cerebellar pathways through habituation of visual-vestibular interactions. Findings indicate that it may be possible to use suppression rates of PRVST and CVST to determine the approximate level of a dancers experience and skill.

Visual Suppression Test Using Post-Rotatory Nystagmus: Clinical Course in Patients with Motion Sickness

With the results of VS test (%) we were able to classify patients into three groups as follows: Group I, hyper range of visual suppression, VS (%) = 100-90; Group II, normal range of VS (%) = 89-45; Group III, reduced or abolished range of VS (%) = less than 44. The results with VS test using post-rotatory nystagmus (PRN) were in Group I 58 cases, in Group II 28 cases and in Group III 1 case, and using caloric nystagmus (CN) the results in Group I were 39 cases, Group II 29 cases, and Group III 1 case. With the correlation of VS test between PRN and CN we were able to classify patients into four types as follows: Type I, hyper range of VS in both PRN and CN; Type II, hyper range of VS in PRN; however, normal range of VS in CN; Type III, normal range of VS in both PRN and CN; Type IV reduced or abolished range of VS in both PRN and CN. It was very interesting in the clinical course of motion sickness that patients under 11 years of age (18 cases) of Type I (31 cases) showed marked improvement to Type III (11 cases) at the time of disappearance of symptoms; however, patients over 12 years of age (13 cases) of Type I remained stationary Type I (9 cases) at the time of disappearance of symptoms.

A visual suppression test using post-rotatory nystagmus.

The visual suppression test is one method for examining the function of visual fixation and visual influence on vestibular nystagmus. In this study the visual suppression test using post-rotatory nystagmus was investigated in 65 normal subjects and 142 clinical cases with cerebellar lesions. In 65 normal subjects the mean +/- standard deviation of visual suppression of the slow phase velocity on post-rotatory nystagmus was 69 +/- 11%. As to the stimulation for visual suppression test, the post-rotatory method using rotatory stimulation is milder than caloric stimulation. This method is far simpler to analyze than the visual suppression test using pendular rotatory nystagmus and other vestibulo-ocular reflex tests. In the 142 patients with cerebellar lesions, reduced or abolished visual suppression on post-rotatory nystagmus was seen in 89 patients with radiologically confirmed disturbances in the vestibulo-cerebellum. And this method could identify the lesion side in the cerebellum. These results showed a correlation between the visual suppression test using post-rotatory nystagmus and one using caloric nystagmus in 65 normal subjects and 142 clinical cases with cerebellar lesions.

Die Klassifizierung Des Optokinetischen Nachnystagmus (Optokinetic After Nystagmus, Okan) Und Seine Topischdiagnostische Bedeutung Beim Menschen

The existence of optokinetic after-nystagmus (OKAN) has long been known, as far back as the age of Barany. The term OKAN means nystagmus appearing after first inducing optokinetic nystagmus, and then the optokinetic stimulation is removed. It appears easily with the eyes open in a dark place. There have been various theories about the mechanism of the onset of OKAN. Sakata et al. Previously classified the types of okan into the following 7 types: 1) the normal type, 2) the directional preponderance type, 3) the disinhibitory type, 4) the inversive type, 5) the inhibitory type, 6) the dysmetric type, 7) the clonic type. In the present study, the authors performed a vestibular equilibrium function inspection, including an OKAN inspection, on about 10,000 patients who visited the Department of Neuro-Otology with complaints of vertigo and equilibrial disturbance. The results of the inspection were classified in acordance with sakatas method, and the diagnostic contribution of the OKAN inspection was examined. The diagnostic significance of the okan inspection is considered as follows: 1) This inspection can detect a very small difference between the left and the right of nystagmus in the vestibular-optokinetic system, which difference cannot be detected with OKP inspection giving a rather strong stimulation or with the caloric test giving a non-physiological strong stimulation. 2) This can be a focal localization diagnostic method by the classification by type.

Clinical values in inversive type of optokinetic after-nystagmus(OKAN).

1) We examined patients with bilateral lesions in the otolith-semicircular canals, vertebro-basilar artery insufficiency and cerebellar atrophy who showed the inversive type of OKAN, and we discuss the clinical value of the inversive type of OKAN.2) As in animal experiments, patients with bilateral lesions in the otolith-semicircular canals also show the inversive type of OKAN.3) Unlike the animal experiments however, patients with cerebellar disturbances also show the inversive type of OKAN.In these patients, there is an imbalance between the brainstem and the eye movement system which leads to a decomposition of the cerebellar eye movement integration system causing the inversive type of OKAN.4) The inversive type of OKAN points to disturbances of integration and compensation when bilateral lesions in the otolith-semicircular canals or lesions in the central vestibular system affect visual-vestibular interaction.