Shigemitsu Yoshihara

A comparison and conversion table of ‘the House–Brackmann facial nerve grading system’ and ‘the Yanagihara grading system’

A comparison between the House-Brackmann facial nerve grading system (the HB-system) and the Yanagihara grading system (the Y-system) was studied with 199 evaluations of 62 cases of postoperative unilateral acoustic neuroma. In the beginning, an original draft of the conversion table was formulated according to the 199 evaluations, in which, 0-6, 8-14, 16-20, 22-28, 30-38, and 40 points in the Y-system were matched with grade VI, V, IV, III, II, and I in the HB-system respectively. The result of the present study for prediction of sequelae showed that it was not necessary to consider the sequelae in a conversion table. And more, the study of an inter-observer variation showed that the lower and upper limits of the scores in the Y-system may shift within about a 2-point range in the draft table. From these aspects, a newly revised conversion table was proposed as a revised conversion table, in which, 0-6, 8-14, 16-22, 24-30, 32-38, and 40 points in the Y-system were matched with grade VI, V, IV, III, II, and I in the HB-system. This revised conversion table is much easier to remember for clinical use, because the score of the lower limit of each grade is simply in multiples of 8, that is, 0, 8, 16, 24, 32 and 40.

Age-related changes in transiently evoked otoacoustic emissions and distortion product otoacoustic emissions in normal-hearing ears

Age-related changes in transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were evaluated in normal-hearing ears. The TEOAE was elicited by a non-linear click with a stimulus level of 82 +/- 1 dB SPL using ILO 88 in 251 normal-hearing ears. The DPOAE at the frequency of 2f1-f2 was measured with stimulus levels of 70 dB SPL (f1) and 60 dB SPL (f2) and with an f2/f1 ratio of 1.2 using ILO 92 in 64 normal-hearing ears. The results obtained showed that TEOAE and DPOAE were decreased with increasing age. Moreover, the same pattern of gradual decrease in TEOAE and in DPOAE suggests the possibility of the same generating mechanism associated with outer hair cells (OHCs).

Age-related changes in evoked otoacoustic emission in normal-hearing ears.

The evoked otoacoustic emissions (e-OAEs) elicited by both tone-bursts and clicks were investigated in normal-hearing ears of three age groups: young age group (approximately 30 years), middle age group (31-50 years) and old age group (51 years approximately). The pseudothreshold of tone-burst e-OAE at stimulus frequencies between 500 Hz and 2 kHz was significantly elevated in the middle and old age groups compared with that in the young age group. When the relationship between averaged emission cochleograms drawn from the mean pseudothresholds of tone-burst e-OAEs at 6 stimulus frequencies between 500 Hz and 4 kHz and averaged pure-tone audiograms was analyzed, a clear difference was found among the three age groups in a frequency range between 500 Hz and 2 kHz. Total echo power, reproducibility, highest peak power and frequency area peak power up to 4 kHz in click e-OAE significantly decreased in the middle and old age groups compared with those in the young age group. These results indicate the possibility that the function of cochlear micromechanics deteriorates in all cochlear partitions with increasing age, even in normal-hearing ears.

Pathophysiology of hearing impairment in acoustic neuroma with profound deafness: analysis by evoked otoacoustic emission and promontory stimulation test.

Evoked otoacoustic emissions (e-OAEs) were examined and promontory stimulus test (PST) done prior to tumor removal in 15 cases of surgically proven unilateral acoustic neuroma (AN) with more than 80 dB in pure-tone hearing level. The e-OAEs were elicited by tone-bursts at 1 kHz and 2 kHz, and an interaural difference in pseudothreshold of more than 10 dB was defined as a significant impairment of the cochlear function. In PST, electrical stimulation was applied by a burst mode at 6 stimulus frequencies between 50 Hz and 1600 Hz. The number of stimulus frequencies with a positive response was defined as the PST score. The results obtained were as follows; i) Mean interaural difference in e-OAE pseudothreshold was 16.0 dB at 1 kHz and 8.0 dB at 2 kHz, ii) Positive PST was found in only 40% of the subjects and the mean PST score was 0.93, iii). When the pathophysiology of hearing impairment was inferred from the combination of the findings in e-OAEs and PST, it was found that 33.3% of the subjects had pure cochlear impairment, 13.3% pure retrocochlear impairment and 46.7% cochlear-retrocochlear impairment. It is concluded that analysis of both e-OAEs and PST could clarify the pathophysiology of hearing impairment in AN with profound deafness, which cannot be determined by conventional psychoacoustic tests.

Electromyographic analysis of profound facial nerve paralysis following acoustic neuroma resection.

The aim of our retrospective study was to determine whether electromyographic findings (motor unit action potentials, MUAPs) can be used in long-term prognosis for profound facial nerve paralysis in patients whose nerve continuity is preserved during surgery for acoustic neuroma. The orbicularis oris, frontal, and orbicularis oculi muscles were examined for the occurrence of MUAPs in 48 such patients. In 30 patients who recovered from complete paralysis within 10 months after surgery, MUAPs in the first two muscles tended to precede the first sign of facial movement. MUAPs appeared in the orbicularis muscle in 80% of these patients at 1 month and in all at 5 months. In the frontal and orbicularis oculi muscles, MUAPs occurred in only 0-20% of these patients in the first month; within 3-5 months the number increased rapidly, and MUAPs were present in 95% of these patients at 10 months. In the remaining 18 patients with long-term complete paralysis (at least 1 year), MUAPs appeared solely in the orbicularis oris muscle: in 20% of these patients in the first month after surgery. While this number slowly rose, there was no period of rapid increase later. We conclude that the occurrence of MUAPs in the orbicularis oris and frontal muscles within 3 months of surgery indicates a good prognosis for reversal of facial nerve paralysis.