Motoyuki Hashiba

A study of the relationship between the T&T olfactometer and the University of Pennsylvania Smell Identification Test in a Japanese population

The University of Pennsylvania Smell Identification Test (UPSIT) and a smell ability questionnaire were administered to 167 Japanese volunteers ranging in age from 20 to 59 years. Of these subjects, 80 also received the T&T olfactometer threshold test. Of the latter subjects, 36 were patients tested before endoscopic nasal surgery for sinusitis and polyposis. The patients exhibited decreased smell function, as measured by the T&T olfactometer, the UPSIT, and a 30-item version of the UPSIT in which the 10 least familiar items were removed (ps < 0.001). Spearman correlations ranging from 0.53 to 0.70 were found between (i) scores on the 30- and 40-item UPSITs and (ii) the T&T detection and recognition threshold values. Significant correlations were found between scores on the smell ability questionnaire and the olfactory test measures (UPSIT30 r = 0.56; UPSIT40 r = 0.58; T&T detection r = 0.56; T&T recognition r = 0.69, p < 0.001), indicating that subjects are relatively accurate in assessing their olfactory ability. This study suggests that the 30 and 40-item UPSITs correlate well with measures derived from the T&T olfactometer, and that all three tests are sensitive to the smell loss of Japanese sinusitis/polyposis patients.

Postoperative Olfaction in Chronic Sinusitis: Smokers versus Nonsmokers

In order to study the efficacy of surgical intervention, as well as the influence of cigarette smoking on olfaction in clinical states, we examined olfactory ability by means of the University of Pennsylvania Smell Identification Test (UPSIT). We enrolled 37 patients 21 to 60 years of age who underwent surgery for chronic sinusitis. Normosmia was defined as an UPSIT score of 30 or more. Among these patients, 31 had a disturbance in their smelling ability in the preoperative stage, and the improvement rate, defined as a rise in score of 4 or more points after surgery, was 64.5%; 11 were well healed. However, all 7 patients who were more than 40 years old at the time of surgery, and currently smoking cigarettes, had a significant deficit in olfaction in the preoperative stage and even in the postoperative stage. This study demonstrated that cigarette smoking has adverse effects on olfactory ability, especially for older patients.

Optimal duration of macrolide treatment for chronic sinusitis after endoscopic sinus surgery

OBJECTIVE The objective is to determine the appropriate duration of postoperative macrolide therapy for chronic rhinosinusitis to obtain a favourable outcome with endoscopic sinus surgery (ESS). METHODS The effectiveness of postoperative macrolide treatment was examined in patients with chronic rhinosinusitis who underwent ESS, by comparing 3-month (44 patients) and 6-month administration (66 patients) of clarithromycin (CAM) (200mg/day). Evaluation was made based on subjective symptoms and endoscopic findings at 3, 6 and 12 months after surgery. RESULTS Seventeen (3-month CAM group) and 22 (6-month CAM group) subjects were able to be followed up to 12 months after surgery. No difference in effectiveness was observed between the groups until 6 months after surgery, but the 6-month treatment group showed significantly higher disappearance rates and significantly lower visual analogue scale (VAS) scores in the subjective symptoms of rhinorrhea and postnasal drip at 12 months after surgery. The positive finding rate of postnasal drip by endoscopic examination was also significantly lower in the 6-month treatment group at 12 months after surgery. These changes over time indicated gradual deterioration after discontinuation of CAM treatment in the 3-month treatment group, whereas a small improvement was observed after discontinuation in the 6-month treatment group. CONCLUSION The results indicate that chronic sinusitis patients with rhinorrhea or postnasal drip should be treated with macrolides for 6 months after surgery in order to improve the long-term outcome of endoscopic sinus surgery.

Auditory and vestibular defects induced by experimental labyrinthitis following herpes simplex virus in mice

Abstract Conclusion. Our herpes simplex virus (HSV) labyrinthitis mouse model suggests that HSV infection induces vestibular neuritis and sudden deafness. Objective: Viral labyrinthitis has been postulated to play a role in vestibular neuritis and sudden deafness. We established a mouse model to investigate the pathogenesis of HSV-induced labyrinthitis. The relationship between HSV infection and apoptosis in the labyrinth was assessed. Methods: HSV types 1 and 2 were inoculated into the middle ear of mice, and the function of the cochlear and vestibular nerves was assessed. Histopathological changes were examined with hematoxylin and eosin staining. Anti-HSV immunohistochemistry staining and TUNEL staining were done to investigate the relationship between HSV-infected cells and apoptotic cells. Results: Hearing loss and vestibular dysfunction were observed in all mice after inoculation of HSV type 1 or 2. In the cochlear duct, columnar epithelial cells in the stria vascularis were infected with HSV, but only a portion of the infected cells underwent apoptosis. In contrast, many uninfected cells in the spiral organ of Corti were apoptotic. Vestibular dysfunction was observed when vestibular ganglion cells were largely infected, but not apoptotic. These findings recapitulate sudden deafness and vestibular neuritis described in patients.

Imaginary Gaze Effects on Eye Movements Induced by Linear Acceleration: Involvement of Vestibular Induced Smooth Pursuit Eye Movement

We investigated smooth eye movements elicited i) by linear acceleration in a space-fixed imaginary gaze condition (smooth component of eye movement induced by linear motion: LSEM) and ii) during acoustic pursuit of a moving sound source (smooth component of eye movement induced by acoustic pursuit of a sound source: SSPEM). The two conditions were examined using the same test subjects. LSEM and SSPEM performance was found to be positively correlated across the subject population. From the comparison of LSEM and SSPEM we propose the following hypothesis: LSEM consists not only of a pure translational vestibular-ocular reflex (tVOR) component but also of a component based on the perception of otolithic information. Accordingly, this second component is instrumental in the pursuit of an imaginary visual target during linear self-motion.

Influence of gravity vector on eye movement elicited by linear acceleration.

When the body/head motion is sensed by otolith organs, they respond not only to the resultant acceleration of the motion but also to the gravitational force. We investigated the influence of the gravity vector on the otolithic-ocular reflex caused by motion in normal subjects. The sled type linear accelerator, moving back and forth with a frequency of 0.25 Hz and an amplitude of 2 m, generated right-left linear acceleration with a maximum magnitude of 0.5 g. We tested every subject under seven different postures: 1) 135 degrees forward tilted (F.T.), 2) 90 degrees F.T., 3) 45 degrees F.T., 4) upright sitting, 5) 45 degrees backward tilted (B.T.), 6) 90 degrees B.T., and 7) 135 degrees B.T. Horizontal eye movements with nystagmic pattern were elicited by these stimulations and were recorded by EOG. The eye movement data were analyzed by using a computer with the following procedure. After extraction of saccadic components from the data, the remaining parts were connected smoothly. The waves reconstructed in this manner, considered to be primary otolithic-ocular responses, were processed with the FFT method for calculating the amplitude of the component at 0.25 Hz. As a result, the responses were larger in the forward tilted postures than in the backward tilted postures.

Clarithromycin suppresses proliferation of rat nasal epithelium exposed to endotoxin.

A study was performed to elucidate the action of long-term macrolide therapy in chronic sinusitis. Clarithromycin (CAM) was administered orally once daily for 14 days. On the last 3 days, an endotoxin, lipopolysaccharide (LPS) was instilled intranasally. The extent of DNA synthesis acceleration was studied in both controls and pretreated animals by counting the number of 5-bromo-2′-deoxyuridine (BrdU)-labeled cells in the nasal transitional epithelium. Six hours after the final intranasal instillation of LPS, the number of BrdU-positive cells was significantly higher than control. Pretreatment with CAM for 2 weeks significantly inhibited this increase. Because similar results were obtained in neutrophil-depleted rats, LPS apparently promotes proliferation of the nasal epithelium in the absence of neutrophils; CAM-suppressed epithelial proliferation independently of the neutrophil count. Our results suggest that CAM inhibits LPS-induced increased rates of DNA synthesis by directly affecting the nasal epithelium. The mechanism by which macrolide therapy alleviates the signs and symptoms of chronic sinusitis might therefore involve suppression of inflammatory processes in the nasal and paranasal sinus epithelium.

Does the endolymph pass through the base of the cupula

Whether the endolymph of the semicircular canal passes the cupular partition or not was examined using the lateral semicircular canal system of adult pigeons (Columba livia). By applying various pressures by means of injection of a dye solution through the membranous canal, it was found that the dye solution, was seen to pass the cupula even under very low pressures when the pressure was increased gradually. When pulled by a magnet, the ultrafine particles of the dextran magnetite contained in the injected fluid were found to pass through the subcupular space without evident increase of the ampullary pressure.

Jugular Foramen Neurinoma; A Case Report.

We report a case of jugular foramen neurinoma, a rare tumor of the skull base. A 45-year-old female complained of dysphagia and hoarseness. The patient presented with Co11et-Sicard syndrome, that is, cranial nerve palsies of the IX, X, XI and XII nerves. CT scan and MRI showed a tumor arising from the jugular foramen, which extended to both the parapharyngial space and intracranial region. We succeeded in totally removing the tumor using a combined lateral suboccipital-infralabyrinthine approach.

Enterued as an Elemental Diet for Patients with Head and Neck Cancers.

Twenty eight patients were given an elemental diet (Enterued®) containing small peptides through a nasal feeding tube. Oral alimentation was difficult for these patients because of head and neck cancer itself or the therapy, surgery and/or irradiation. In 23 of the patients (82.1%) the nutritional status was improved. Diarrhea occurred as a side effect in 5 of them (17.9%), 3 of whom stopped using Enterued®. The speed of administration should be carefully controlled to prevent diarrehea.