Reiko Beppu

Soluble ICAM‐1 as a regulator of nasal allergic reaction under natural allergen provocation

Background: Intercellular adhesion molecule‐1 (ICAM‐1) plays a key role in the early stage of the signal cascade leading to cellular extravasation and the development of an inflammatory response. Recently, it has been reported that the soluble form of this adhesion molecule is present in human sera, possibly mediating biological actions.

Detection of Herpesvirus DNAs in Perilymph Obtained from Patients with Sensorineural Hearing Loss by Real‐Time Polymerase Chain Reaction

Objectives/Hypothesis: Perilymph and peripheral blood mononuclear cells (PBMCs) from patients with bilateral severe sensorineural hearing loss (SNHL) were evaluated for the presence of DNA from cytomegalovirus (CMV), herpes simplex virus (HSV), and human herpesvirus (HHV)6.

Large vestibular aqueduct syndrome treated by hyperbaric oxygen

We report the case of a 14-year-old girl with a large vestibular aqueduct (LVA) in whom hyperbaric oxygen (HBO) therapy was effective for the treatment of sensorineural hearing loss. The patient was referred to Nagoya University Hospital for the treatment of hearing loss on 14 September, 1998, because her right hearing level had declined abruptly on 22 August, 1998, and had not changed for 3 weeks since then in spite of steroid and prostaglandin therapy. Her audiogram revealed bilateral profound deafness of more than 110 dB. She had had profound hearing loss on the left side since she was 9 years old. HBO therapy was performed on 22 occasions from 17 September until 19 October, 1998. During the HBO therapy, her right hearing ability returned almost to the level determined prior to the abrupt loss, 60 dB. We therefore recommend HBO therapy for the treatment of sensorineural hearing loss associated with large vestibular aqueduct syndrome if the hearing ability does not recover following conventional treatment.

Major Basic Protein and Topical Administration of Ketotifen in Pollinosis under Natural Allergen Provocation

In this study we investigated the potential relation among subjective symptoms, blood eosinophil counts and the levels of major basic protein (MBP) in serum throughout the pre- to postpollen season. In addition, we compared the effects of topical administration of ketotifen on these parameters between the prophylactic treatment group (n = 10) and the postsymptomatic treatment group (n = 10). We found that (1) the levels of MBP in serum during the season were significantly higher than those before the season and (2) the levels of the above three parameters in the prophylactic treatment group were significantly lower than those in the postsymptomatic treatment group during the season. It was concluded from these results that the action of MBP may be involved in the pathogenesis of allergic rhinitis. Furthermore, for the first time we provided evidence that topical ketotifen administration could suppress the systemic upregulation of the blood eosinophil count and MBP level in subjects with pollinosis.

Comparison of TEOAE with Play audiometry for screening hearing problems in children.

To evaluate the usefulness of transiently evoked otoacoustic emissions (TEOAEs) for hearing screening of children at around 3 years of age, measurements were done together with Peep show test in a group of 47 children (n = 93 ears). A stimulus sound of 30 dB nHL was used as the screening intensity for the TEOAE measurement. All measurements were done with awake subjects. Twenty seven ears, all of which were revealed to have normal hearing (within 20 dB HL, assessed by Peep show test) and tympanograms, showed positive TEOAE results. Furthermore, TEOAEs were sensitive to the presence of middle ear conductive impairment, showing negative results. We conclude that, compared with Play audiometry, TEOAE measurements can not yield quantitative results, but can yield qualitative results for determining the presence of hearing impairment without sedative induced sleeping in this critical age of children.

Psychogenic Hearing Loss Combined with Dissociated Amnesia

心因性難聴に健忘を伴った2症例を経験した。 健忘は精神医学的には意識の障害を呈する解離性障害の一症状である。 症例1は年齢16歳, 症例2は15歳と, 思春期の女性であり, 難聴, 健忘以外にも多彩な症状を示した。 症例1は精神科において全生活史健忘との合併と診断された。 症例2は, 幼少時より両側高度感音難聴のため経過観察をしており, 既存の難聴が高度で, 他覚的聴力検査で閾値が確認できないので, 精神医学的状況から心因性難聴と推定した。 心因性難聴の場合は, 十分な心理的ケアが必要であり, 特に他の重篤な精神症状を合併している場合は精神科のカウンセリングを要すると考えられた。

Adenotomy in Cases with Velopharyngeal Incompetence.

We encountered two cases with transnasal leakage of fluid and hypernasality after adenotomy. One case was diagnosed as paralysis of the soft palate and the other as submucosal cleft palate. It was thought that adenotomy exacerbated the velopharyngeal incompetence in these two cases. In order to determine the preoperative status of velopharyngeal incompetence more precisely, we studied retrospectively 35 cases of submucosal cleft palate and congenital velopharyngeal incompetence.It was found that the correct diagnosis was not immediately determined in these cases. Moreover, it became clear that otitis media with effusion coexisted in about 60% of the cases. We concluded that it is important to perform a comprehensive diagnosis including a detailed history of birth and development, visual inspection and palpation of the palate, blowing examination and XP study.

Sensorineural Hearing Loss in Congenital Cytomegalovirus Infection.

Cytomegalovirus (CMV) in the most frequent cause of congenital infections in humans. The neurodevelopmental outcome of infected neonates is well documented and includes a significant risk of sensorineural hearing loss (SNHL).We studied five SNHL subjects with congenital CMV infection. All 5 infected subjects were found to have bilateral progressive SNHL and the deterionation to profound occurred during the first two years of life.Transient evoked otoacoustic emissions (TEOAEs) were recorded in 2 subjects and the TEOAEs of all 4 ears were abnormal. These effects confirmed that hearing loss associated with congenital CMV infection was due to cochlear dysfunction at least, as literature on the histopathology had indicated.One of the five subjects was asymptomatic. The etiology of hearing loss in children often is not identified and we concluded that SNHL in some children was caused by congenital CMV infection.Because the majority of infants with congenital CMV infection are asymptomatic at birth, routine screening of all newborns for congenital CMV infection should be carried out and the management of infected children should include periodic assessments. As the therapy for congenital CMV infection is not effective, CMV vaccination for women of child bearing age should be considered. In the future, vaccination will significantly reduce the prevalence of hearing loss in children.

Objective Evaluation of Prophylactic Treatment for Pollinosis.

In this objective evaluation of the efficacy of prophylactic treatment for Japanese cedar pollinosis during natural allergen exposure, topical ketotifen (0.3-0.4mg/day) was administered during the spring of 1992. Ten patients received prophylactic treatment, and others were treated after the onset of symptoms. Subjective symptom scores, blood eosinophil counts and serum MBP values were examined and compared.The total subjective symptom scores, blood eosinophil counts and serum MBP values in the prophylactic treatment group were significantly lower than in the group treated after the onset of symptoms. Thus, the effect of prophylactic treatment can be evaluated objectively.