Meiho Nakayama

BPPV and Variants: Improved Treatment Results with Automated, Nystagmus-Based Repositioning

OBJECTIVE: Although classical benign paroxysmal positional vertigo has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variants remain a significant problem. We investigated the efficacy of analyzing and treating positional vertigo with a system that provides unlimited, automated maneuverability of the patient while maintaining constant electronic monitoring of nystagmus. STUDY DESIGN AND SETTING: A power-driven, multi-axial positioning chair combined with ongoing infrared video-oculography was used to manage 986 subjects in a tertiary clinical setting with complaints of positional vertigo. A nystagmus-based strategy and condition-specific protocols were used. RESULTS: Significantly enhanced treatment outcomes were achieved, especially regarding intransigent and variant forms. Pertinent correlations were noted. CONCLUSION: This multi-axial positioning chair combination provided enhanced diagnostic and treatment capabilities for managing positional vertigo, apparently due to improved analytical capability, precision repeatability, and unlimited 360-degree maneuverability. SIGNIFICANCE: This advancement should be considered for tertiary management of complicated labyrinthine lithiasis.

Aging Effects on Vestibulo-Ocular Responses in C57BL/6 Mice: Comparison with Alteration in Auditory Function

Age-related changes in auditory function are well documented in animal models; however, this is not the case as regards vestibular function. In this study, we evaluated age-related changes in vestibulo-ocular responses in C57BL/6 mice that are considered as a model of presbycusis. The functional data were substantiated by the findings of histological analysis of vestibular and auditory peripherals. The gain in vestibulo-ocular reflex, which reflects functionality of the vestibular system, increased in an age-dependent manner until 12 weeks and exhibited limited functional loss due to aging after 24 weeks. By contrast, no alteration in the thresholds of the auditory brainstem response (ABR) was observed from 3 to 12 weeks of age; however, ABR thresholds were significantly elevated from age 24 weeks and onwards. Histological analysis demonstrated that the degeneration of auditory peripherals was closely related with functional loss due to aging. Vestibular peripherals also exhibited age-related degeneration morphologically, although age-related dysfunction was not apparent. Age-related changes in the vestibular function of C57BL/6 mice followed a different time course when compared to changes in auditory function. These findings indicate that mechanisms for age-related changes in vestibular function differ from those of auditory function.

Differential diagnosis of obstructive sleep apnea syndrome patients and snorers using cephalograms

Abstract Severe snoring is thought by many to be an early stage of obstructive sleep apnea syndrome (OSAS), but the anatomical relation between snoring and OSAS, if any, has remained unclear. To compare the morphology of the airway between snorers and OSAS patients for possible similarities, we conducted a cephalometric analysis of Japanese OSAS patients (n = 10), habitual snorers (n = 10), and non‐snoring controls (n = 50). There was no significant difference in SNB (the angle formed by the sella, nasion and point B) between OSAS patients and the control subjects. Obstructive sleep apnea syndrome patients tended to have an anteriorly positioned maxilla, and an anteroposterior misalignment between the maxilla and mandible. There was also a tendency toward skeletal openbite. Both OSAS patients and snorers had large tongues and large soft palates, thus causing constriction of the airway with resultant smaller airway diameter and smaller airway surface area. Significant differences between OSAS patients and snorers were found in thickness and length of soft palate surface area, and thickness, length, and position of the hyoid bone. These results suggest that cephalographic measurements may be of considerable use in determining the seriousness of a patients condition.

Use of trafermin to treat a skin ulcer after repair of a deep auricular laceration: A case report

We used trafermin (recombinant human basic fibroblast growth factor) to treat a skin ulcer (diameter, 1u2005cm; depth, 2u2005mm) that developed after an extremely deep auricular laceration was sutured. Excellent results were obtained after use of trafermin for 2 weeks. To our knowledge, we report the first clinical use of trafermin in a patient with a skin ulcer resulting from auricular trauma. Trafermin may promise to be an effective treatment for skin ulcers.

Five cases of chondroma involving the external auditory canal

A cartilaginous tumor located in the external auditory canal is a rare finding. Only 48 cases of chondromas of the external auditory canal have been documented in the literature. The natural course of these tumors as well as the diagnosis and management has not been well established. We have encountered five cases of external auditory canal chondroma. The patients consisted of three males, ages 12, 14, and 29, and two females, ages 2 and 3, respectively. Otoscopic examination demonstrated a tiny firm tumor protruding from the anterior wall of the bony external auditory canal. Surgery was performed all cases, and the tumor proved to be a chondroma histologically. All cases could be approached through the ear canal. The postoperative courses were uneventful and no recurrences were found during the follow-up periods. From our experiences, it is important to recognize that chondromas are in the differential of small exophytic tumors on the anterior or superior wall of the external auditory canal and can be removed safely and effectively through the transcanal approach.

A preliminary study on the influence of obstructive sleep apnea upon cumulative parasympathetic system activity

OBJECTIVEnAlthough the autonomic nervous system plays a key role in mediating cardiovascular changes during obstructive sleep apnea (OSA), parasympathetic nervous system (PNS) activity during sleep apnea has not yet been sufficiently investigated. This study is to discuss the relationship between PNS activity and OSA.nnnMETHODSnPolysomnography recording was carried out in 76 patients (71 male and 5 female) with OSA. Cumulative PNS activity during sleep for each patient was derived from time series data of electrocardiogram (ECG) and analyzed by coarse graining spectral analysis of heart rate variability. The correlation between cumulative PNS activity and apnea-hypopnea index (AHI) was then discussed.nnnRESULTSnCumulative PNS activity and PNS peaks during sleep were lowly but significantly correlated with OSA severity (r=-0.344, p<0.005; and r=-0.266, p<0.05 respectively), and a linear regression equation could be established. Furthermore, significant correlation was also observed in the adult groups and in the moderate and severe groups, but not in the juvenile and the elderly and mild groups.nnnCONCLUSIONnThese findings indicated that PNS function was obviously influenced by OSA during sleep. Cumulative PNS activity level might also serve as a useful parameter for the evaluation of OSA.

Hearing Loss Associated with Vertigo

Some diseases that produce hearing loss can also produce disorders of vertigo. In this chapter, relation and diseases between hearing loss and vertigo were explained.

A Case of Cerebello-Pontine Angle Infarction Found by Vertebral Angiography

A patient was admitted complaining of sudden vertigo. Otoneurological examinations, electronystagmography (ENG), and vertebral angiography (VAG) showed constriction of vertebral artery and anterior inferior cerebellar artery, and basilar artery obstruction. Based on these findings, we diagnosed the case as posterior cranial fossa infarction. Computed tomography (CT) and magnetic resonance imaging (MRI) findings were negative. The authors conclude that VAG should be performed in certain cases of vertigo thought to be of central nervous origin when CT and MRI findings are both negative.