Kimiko Nakai

Case report: a case of intractable Meniere's disease treated with autogenic training

BackgroundPsychological stress plays an important role in the onset and course of Menieres disease. Surgical therapy and intratympanic gentamicin treatment are options for cases that are intractable to conventional medical therapy. Psychotherapy, however, including autogenic training (AT), which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of AT in a subject suffering from intractable Menieres disease.Case presentationA 51-year-old male patient has suffered from fluctuating right sensorineural hearing loss with vertigo since 1994. In May 2002, he was first admitted to our hospital due to a severe vertigo attack accompanied by right sensorineural hearing loss. Spontaneous nystagmus toward the right side was observed. Since April 2004, he has experienced vertigo spells with right-sided tinnitus a few times per month that are intractable to conventional medical therapy. After four months, tympanic tube insertion was preformed in the right tympanic membrane. Intratympanic injection of dexamethasone was ineffective. He refused Meniett therapy and intratympanic gentamicin injection. In addition to his vertigo spells, he suffered from insomnia, tinnitus, and anxiety. Tranquilizers such as benzodiazepines and antidepressants such as serotonin selective re-uptake inhibitors (SSRIs) failed to stop the vertigo and only slightly improved his insomnia. In December 2006, the patient began psychological counseling with a psychotherapist. After brief psychological counseling along with cognitive behavior therapy (CBT), he began AT. He diligently and regularly continued his AT training in his home according to a written timetable. His insomnia, tinnitus, and vertigo spells disappeared within a few weeks after only four psychotherapy sessions. In order to master the six standard formulas of AT, he underwent two more sessions. Thereafter, he underwent follow-up for 9 months with no additional treatment. He is now free from drugs, including tranquilizers, and has continued AT. No additional treatment was performed. When we examined him six and nine months later for follow-up, he was free of vertigo and insomnia.ConclusionAT together with CBT can be a viable and palatable treatment option for Menieres disease patients who are not responsive to other therapies.

Phobic postural vertigo treated with autogenic training: a case report

BackgroundPatients suffering from dizziness due to vertigo are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. In many cases, the diagnosis is psychological dizziness. Phobic postural vertigo, which was first reported by Brandt T et al in 1994, is supposed to be a type of psychological dizziness. The diagnosis is based on 6 characteristics proposed by Brandt et al. Patients are usually treated with conventional medical therapy, but some cases may be refractory to such a therapy. Psychotherapy is recommended in some cases; however, psychotherapy including autogenic training, which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of autogenic training in a patient suffering from phobic postural vertigo.Case presentationWe present a case of a patient who suffered from phobic postural vertigo. A 37-year-old female complained of dizziness. She had started experiencing dizziness almost 3 years She was intractable to many sort of conventional therapy. In the end, her symptom disappeared after introduction of autogenic training.ConclusionAutogenic training can be a viable and acceptable treatment option for phobic postural vertigo patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control symptom of phobic postural vertigo.

Intractable depression successfully treated with a combination of autogenic training and high-dose antidepressant in department of otorhinolaryngology: a case report

IntroductionPatients suffering from ear discomfort are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. Psychotherapy is recommended in some cases. This paper describes the successful administration of autogenic training in a patient suffering from ear discomfort due to major depression.Case presentationWe present a case of intractable depression that was successfully treated with a combination of psychotherapy, administered by a clinical psychologist, and high-dose antidepressant. The patient was a 36-year-old female with hearing discomfort in her left ear. In 2003, she experienced insomnia and an appetite loss, and her condition was diagnosed as major depression along with an avoidant personality disorder. Her depression has not been improved with antidepressant treatment for 3 years in department of psychosomatic medicine. She was referred to our department because of ear discomfort in her left ear. There was no abnormality in her physical examinations. She wanted to be treated in department of otorhinolaryngology. We increased the dose of fluvoxamine maleate up to 200 mg/day, and introduced cognitive therapy and autogenic training by a clinical psychologist. Eventually, her depressive state as well as the hearing complaint was markedly alleviated.ConclusionAutogenic training can be a viable and acceptable treatment option for patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control physical symptom of depression.

P107: Obsessive-Compulsive Personality in Phobic Postural Vertigo

Objectives:It is known that about 10% of patients with dizziness is psychological origin. However the detailed investigation concerning psychological aspects is missing. Phobic postural vertigo (PPV) is clinical entity, which is proposed by Brandt et al. He first described this somatoform disorder, manifested by dizziness and unsteadiness. The purpose of this study is to present clinical and psychological characteristics including obsessive-compulsive personality and anxiety of PPV. Methods and Measures:The record of 29 consecutive patients with PPV who attended our department during 2004-2006 was reviewed. Most of the patients receive neurootological evaluation and psychological examinations by self-rating questionnaire including MAS (Manifest Anxiety Scale) and Japanese version of MOCI (Maudsley Obcessional Compulsive Inventory) to evaluate anxiety and obsessive-compulsive personality. Results: 24 are female and 5 were male. Average age was 54.7±16.6 years old. Many of the patients have depression and high level of anxiety. The average score of MOCI was 10.1 and indicated obsessive-compulsive personality. The treatment was drug therapy with SSRI (Serotonine selective reuptake inhibitor), antidepressant, anxiolytics like benzodiazepine (BZD), and psychotherapy including cognitive behavior therapy and autogenic training. During the follow up symptoms disappeared in 6 (20.7%) patients and improved in 21 (72.3%) patients. Conclusion: The obcessional personality is often observed in PPV patients.The psychological assessment of dizzy patients is necessary to support correct diagnosis of PPV and obtain better prognosis. In addition to the conventional drug therapy ,psychotherapy was required to some of these patients.

R067: Objective Measurement of Stress in Autogenic Training:

tor (BDNF) and TRPV1 were examined by using real-time PCR according to the previous paper. RESULTS: In SG, TRPV1 mRNA expression was significantly up-regulated 2h and decreased 12h after salicylate injection. BDNF mRNA expression was also significantly increased 2h and returned to the control level 12h after the injection. In DCN, TRPV1 or BDNF mRNA expression was not significantly changed. CONCLUSION: In previous studies, high doses of salicylate increased spontaneous firing rates in SG but not in DCN. Together with the present results, it is suggested that salicylateinduced TRPV1 up-regulation in SG could be a marker of salicylate-induced tinnitus. Balaban et al. recently proposed that lipoxygenase activation during cyclo-oxygenase inhibition by salicylate could be a potential intrinsic source of TRPV1 activation in inner ear ganglia. They also demonstrated that inner ear perfusion of capsaicin, a ligand of TRPV1, increased cochlear ensemble background activity, possibly tinnitus. All these findings suggest that salicylate could activate TRPV1 in SG, resulting in tinnitus generation. SIGNIFICANCE: The goal of the present tinnitus study is to elucidate basic molecular mechanisms of tinnitus generation and to find safe and effective treatments for intractable tinnitus patients.