Satsuki Yasumura

Epidemiologic characteristics of definite Ménière's disease in Japan : A long-term survey of toyama and niigata prefectures

To identify epidemiologic characteristics of definite cases of Ménière’s disease (DMD), we conducted retrospective surveys of the period 1990–2004 of the Nishikubiki district and of the period 1980–2004 of Toyama Medical and Pharmaceutical University. Three hundred and seventy-five patients (50 from Nishikubiki, 325 from Toyama) were diagnosed with DMD according to the diagnostic criteria proposed by the Japanese Society for Equilibrium Research. There was a slight increase in the prevalence of DMD during the period 1990–2004. However, incidence did not change significantly over time. The average annual prevalence and incidence were 34.5 and 5.0, respectively, per 100,000 population. Incidence and prevalence predominated in females. With respect to age at disease, the incidence in elderly patients was increased when we corrected for age distribution in the overall population.

Positron emission tomography for predicting malignancy of sinonasal inverted papilloma.

Background: Sinonasal inverted papilloma (IP) is an uncommon nasal tumor. It is known for being locally invasive and recurrent, with a high probability of malignant transformation. Accurate initial staging and close surveillance are critical in the management of the disease. Methods and Results: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) was performed in 5 patients with IP. High FDG uptake (maximum standardized uptake (SUVmax) value >3.0) was observed in all patients, and 2 patients with IP associated with squamous cell carcinoma (SCC) exhibited higher SUVmax values. Conclusion: The SUVmax value of a sinonasal tumor can warn the surgeon of the probability of an associated malignancy, even when preoperative biopsy demonstrates a purely benign papilloma.

Vascular cross-compression of the Vllth and VIIIth cranial nerves

A 53-year-old male patient had been suffering from severe aural symptoms (pulsatile right-sided tinnitus and paroxysmal dizziness attacks with nausea) and right hemifacial spasm. Treatment had involved stellate ganglion block with lignocaine and the injection of intravenous sodium bicarbonate solution for attacks of Menières syndrome and facial nerve block with lidocaine for hemi-facial spasm. Despite these treatments, the dizzy attacks became more frequent, developing into the clustering state. Air CT cisternography and vertebral angiography demonstrated an enlarged and curved vertebral artery. Vascular cross-compression of the VIIth and VIIIth cranial nerves was therefore suspected. Microvascular decompression was performed. After operation, the pulsatile tinnitus, dizziness and hemifacial spasm disappeared. From the present case and a review of the literature, we conclude that vascular cross-compression of the VIIIth cranial nerve should be an indication for microvascular decompression only when symptoms of vascular cross-compression of the VIIth cranial nerve are also seen.

Cerebral Autoregulation in Patients with Orthostatic Hypotension

The present study was conducted to determine the relationship between autonomic nervous function and cerebral autoregulation in 17 patients with vertigo or dizziness. Autonomic nervous function was examined by measuring systolic blood pressure response and dynamic electrocardiogram R-peak to R-peak response upon standing up. Regional cerebral autoregulation was examined by comparing cerebral blood flow in both supine and standing positions with single photon emission computed tomography. Moreover, the relationship of each of these three measures to postural provocation of symptoms was studied. The findings indicated that autonomic nervous dysfunction does not influence cerebral autoregulation, but autonomic nervous dysfunction was related to postural provocation of symptoms. This might indicate that impaired autoregulation in the brain stem or the peripheral vestibule, which could not be detected by the single photon emission computed tomography, played a role in inducing vertigo or dizziness in patients with orthostatic hypotension.

Intermittent pressure therapy of intractable Meniere's disease and delayed endolymphatic hydrops using the transtympanic membrane massage device: a preliminary report.

Abstract Conclusion. Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Menieres disease (MD) and delayed endolymphatic hydrops (DEH). Objective: The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device. Methods: Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device. Results: With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p > 0.05). No complications were directly attributable to treatment with the TMM device.

Cochlear Implantation in a Patient with Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like Episodes Syndrome

Objective - The aim of this study was to investigate the usefulness of a Nucleus® CI24M cochlear implant in a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome. Material and methods - A 29-year-old woman with MELAS syndrome presented with sensorineural hearing loss and diabetes mellitus and underwent multichannel cochlear implantation. The follow-up period was 10 months. The case history, assessment of mitochondrial disease, indications for the cochlear implant and the benefits of cochlear implantation were evaluated. Results - Nine months after the surgery the patient could use the telephone and was quite satisfied with the improvement in communication due to the cochlear implant. Conclusion - Cochlear implantation can be recommended for patients with MELAS syndrome if they have residual retrocochlear function. Single photon emission computerized tomography was found to be very useful for evaluating retrocochlear function.

Involvement of the VIIIth cranial nerve and the brainstem in patients with hemifacial spasm.

Twenty-seven patients with hemifacial spasm underwent neurotological (auditory and equilibrium) examinations to evaluate the VIIIth cranial nerve and/or brainstem involvement. Radiological examinations were performed to evaluate the underlying abnormalities. Twenty patients had abnormal neurotological findings, with the VIIIth cranial nerve involvement being suggested in 10 and brainstem involvement in the other 10. Radiological examinations indicated that vascular abnormalities could be detected more often in the patients with brainstem involvement than in those with VIIIth cranial nerve involvement.

Prediction of vestibulo-autonomic symptoms during the caloric test: Evaluation of autonomic activity by spectral analysis of the electrocardiographic R–R interval

Conclusion. If the high-frequency (HF) component of the R–R interval spectrum of the electrocardiogram (ECG) increases after the first stimulation during a bithermal caloric test, subsequent repeated stimulations may be likely to induce autonomic symptoms such as nausea. Objective. Nausea often occurs as a vestibulo-autonomic symptom during the caloric test. However, there have been only a few clinical studies of autonomic activity during this test. To determine whether certain factors can predict the development of nausea, we performed an autonomic function test by means of R–R interval spectral analysis of the ECG during caloric testing. Material and methods. The study subjects were 53 healthy volunteers aged 22–39 years (41 males, 12 females; mean age 25.3 years) and a 35-year-old male patient with a labyrinthine defect. The caloric test was performed in 43 subjects using an air caloric apparatus with bithermal stimulation of alternate ears. After each stimulation, the subjects were asked about autonomic symptoms. Serial ECG records were obtained and R–R interval spectral analysis was performed. Results. Severe nausea was observed in 12 subjects (28%). In the group with severe nausea, the HF component of the R–R interval spectrum increased after the first caloric stimulation when autonomic symptoms had not yet become marked.

Retro—labyrinthine Disorder in Cases with Peripheral Facial Palsy

In some previously reported cases, facial palsy, even in Bells palsy, involved vestibular dysfunction. Vestibular dysfunction in facial palsy is considered to be due to a retro-labyrinthine disorder such as vestibular neuronitis or acoustic neuromas. For the past 9 years we have been using the galvanic body sway test (GBST) routinely for differential diagnosis of the vestibular system. This paper reports GBST detected, retro-labyrinthine disorders in facial palsy. From 1981 to 1989, equilibrium examinations were performed in 33 cases with Bells palsy and in 12 cases with Hunts syndrome within 2 weeks after the onset. GBST was tested in 10 out of the 17 cases showing canal paresis (CP) in the caloric test. Abnormal GBST responses were detected in 9 cases (90%), 4 (80%) with Bells palsy and 5 (100%) with Hunts syndrome. The incidence of abnormal GBST was very high not only in Hunts syndrome but also in Bells palsy. The results indicate that vestibular dysfunction combined with facial palsy is mainly due to a retro-labyrinthine disorder and suggest that what is called vestibular neuronitis might be caused by a pathogenesis similar to that of facial palsy.

A Case of Cerebellopontine Angle Metastasis of Renal Cell Carcinoma with Hearing Impairment.

We experienced a rare case of metastatic cerebellopontine (CP) angle tumor, originating from a renal cell carcinoma with hearing impairment. A 61-year-old male was admitted to our hospital complaining of sudden hearing impairment of the left ear. He had been well for six years, after a diagnosis of left renal cell carcinoma two years previously, with lung metastasis and brain metastases in the frontal lobe. Brain tumors had been removed twice. Magnetic resonance imaging (MRI) of the head showed a new lesion at the CP angle with recurrence of the left metastatic tumors.Hearing impairment was achieved by the administration of corticosteroid. The patient showed loss of II -V waves on left ABR, and optokinetic nystagmus test depression on the counterclockwise. Hearing impairment and dizziness progressively worsened during the subsequent two year period, but he was managed as an out-patient until March in 1998.