Michihiko Nozue

Neurovascular Compression Syndrome of the Eighth Cranial Nerve. What are the Most Reliable Diagnostic Signs

Summary Forty-three surgical cases were retrospectively analyzed to establish diagnostic criteria and operative indications for vertigo and tinnitus due to neurovascular compression (NVC) of the eighth cranial nerve (8th N). Many NVC syndromes were mistakenly diagnosed as Ménières disease or benign paroxysmal positional vertigo. NVC was confirmed in 31 of the 43 patients. Neurovascular decompression (NVD) resulted in complete recovery or marked improvement of subjective symptoms in all 19 cases with vertigo (100%), and in 19 of 29 patients with tinnitus (65.5%). Multiple factor analysis revealed that abnormal caloric responses have high diagnostic value for vertigo due to NVC. Vertigo due to NVC is of short duration (a few sec to a few min.) in the early phase of the disease, which becomes longer and hearing becomes impaired as the history of NVC lengthens. Low pitch pulsatile and high pitch continuous tinnitus are probably due to NVC and are cured by NVD if hearing is still preserved. Tinnitus associated with hemifacial spasm is strongly indicative of NVD. Decompression of the 8th N should be performed in the early phase of disease, since cochlear and vestibular functions are irreversibly impaired if NVC continues for a long period of time.

Neurovascular compression syndrome of the eighth cranial nerve. Can the site of compression explain the symptoms

Summary Considerable skepticism still exists concerning the concept of neurovascular compression (NVC) syndromes of the eighth cranial nerve (8th N). If such syndromes exist, the sites of compression of the nerve must explain the symptoms encountered. We recorded compound action potentials of the cochlear nerve (CCAPs) during neurovascular decompression (NVD) to examine the topography of the three components of the 8th N. The sites of compression of the 8th N in cases of NVC syndrome confirmed at surgery were superimposed on the topography of the CN and vestibular nerve (VN) in order to determine the relationship between the sites of compression and the symptoms. CCAPs were clearly and consistently recorded on the caudal surface of the 8th N along the midline. In patients with vertigo and tinnitus there was vascular compression of the rostro-ventral (VN) and caudal surface (CN) of the nerve, respectively. In patients with both vertigo and tinnitus, there was compression of both VN and CN. Our findings clearly demonstrate that the symptoms of NVC of the 8th N depend on the part of the nerve that is compressed by blood vessels, and they support the concept of NVC syndrome of the 8th N.

Personality Factors in Pathogenesis of Polyps And Nodules of Vocal Cords

Patients who were diagnosed as polyps or nodules of vocal cords (PN group), and two control groups were tested with Japanese version of Maudsley Personality Inventory to evaluate the personality characteristics of patients with these behavior-induced vocal cord diseases. PN group showed significantly higher E (extraversion-introversion) scores than each control group. This extraversive tendency had no relation to their age, sex, polyp or nodule, and occupation. N (neuroticism) scores were not significantly different between PN group, and each control group. L (lying) scores of PN group were significantly lower than a control group. It was suggested that extraversive personality was one of the important factors relating to the pathogenesis of vocal cord polyp and nodule.

Chronic myringitis and chronic suppurative otitis media

ZusammenfassungVierunddreißig Patienten mit chronischer Myringitis wurden untersucht mittels Otoskopie, Tonaudiometrie, Tympanometrie, Röntgenaufnahmen des Ohres und bakteriologische Untersuchungen des Otorrhöes. Fünf atypische Fälle wurden ausführlich vorgestellt. Drei von diesen Fällen erlebten eine Trommelfellperforation vor dem Ausbruch der typischen, chronischen Myringitis. Die übrigen Fälle zeigten eine kleine, vorübergehende Trommelfellperforation während des langen Verlaufs der chronischen Myringitis. Diese Krankheitsfälle zeigen an, daß die chronische Myringitis während chronischer Mittelohrentzündung vorkommen und auch eine Trommelfellperforation verursachen kann.SummaryThirty-four chronic myringitis cases were examined by otoscopy, pure tone audiometry, tympanometry, skull X-rays, and bacteriologic study of otorrhea. Five atypical cases are presented in detail. Three of these five cases had a perforation of the tympanic membrane preceding the appearance of typical chronic myringitis. The remaining two cases showed a transient small tympanic membrane perforation during the long course of chronic myringitis. These cases suggest that chronic myringitis could occur in some chronic suppurative otitis media and that myringitis could cause tympanic membrane perforation.

Bilateral primary malignant neoplasms of the maxillary sinus: Report of a case and statistical analysis of the reports in japan

Although double primary malignant neoplasms of bilateral maxillary sinuses were regarded as extremely rare, there have been 50 patients described in Japan since 1937. Among them only eight cases showed the histologic distinction between both sides.

Preoperative Diagnosis of Intratemporal Facial Nerve Tumor: High-Resolution CT and Otoscopic Findings in 4 Cases

Four cases of facial nerve tumor were treated in our clinic during the past 16 years, one of which was a recurrence 12 years after the resection. Another case presented with relapsing facial palsy of sudden onset. The others presented with slowly progressive facial palsy. In each of the four cases, the horizontal and vertical portions were included in the tumor extension, and a mass was revealed in the posterior tympanic cavity by use of otoscopy. High-resolution CT, performed in all but the earliest case, proved to be the most valuable diagnostic tool, indicating the anatomical correlation of the tumor with the facial canal. With the diagnosis preoperatively established, facial reanimation procedure could be applied immediately after the tumor resection except in the recurrent case.

Acoustic Tumor with Hearing Loss of Sudden Onset and Recovery

In many cases of acoustic tumor the hearing loss is gradually progressive, but some cases of acoustic tumor show a sudden onset of hearing loss. In this paper we report two interesting cases of acoustic tumors which were diagnosed as sudden deafness at the first examination. Being treated with steroid hormones, their hearing was partially recovered. But the hearing loss recurred in both cases. At the second examination, CT showed the cerebellopontine angle tumors. So it was emphasized that careful questioning as well as the caloric test and the auditory brainstem response (ABR) was important. If one of these tests shows abnormality, the patient should be examined by the CT scan. The same may be said of patients who show recovery due to steroid hormone therapy.

Total Laryngeal Stenosis in Cicatricial Pemphigoid

Cicatricial pemphigoid in the aerodigestive system is rare, but can be life-threatening. We report a case of total laryngeal stenosis. During an exacerbation, the airway of the patient was obliterated with a cicatrix and necessitated an emergency tracheostomy. Six years later when no recurrence of pemphigoid was confirmed, laryngofissure operations were performed with a satisfactory restoration of laryngeal function. Though otolaryngological treatment in the active phases is symptomatic including tracheostomy, surgical procedures should be encouraged once the disease has reached a remission.

Intraoperative Facial Nerve Monitoring by Monopolar Low Constant Current Stimulation and Postoperative Facial Function in Acoustic Tumor Surgery

Among the several methods of intraoperative facial nerve monitoring in acoustic neurinoma surgery, the evoked facial muscle responses (EFMR) by electrical stimulation of the nerve have been most commonly and effectively used [2, 4]. However, the most effective stimulus parameters during surgery have not yet been defined. In the past 9 years, monopolar low constant current stimulation (0.5–0.6 nA) was applied in 52 cases. We report intraoperative findings of the EFMR and their relations to postoperative facial functions.

Hearing Loss and Social Life

Hearing loss is caused by many diseases like congenital deafness, middle ear inflammation, sudden deafness, Meniere’s disease, acoustic neurinoma, neurovascular compression and others. If sensorineural hearing loss occurs, patients get much trouble and stress in their social life.