Shigeru Kikuchi

Evaluation of Super-High-Dose Steroid Therapy for Sudden Sensorineural Hearing Loss

OBJECTIVE: To determine the efficacy of a high-dose steroid regimen for patients with sudden sensorineural hearing loss (SSNHL) and to evaluate the relationship between outcome and initial steroid dose. STUDY DESIGN AND SETTING: We conducted a retrospective study of 112 patients presenting to Saitama Medical Center. Patients received tapering courses of hydrocortisone (HC) with an initial dose of either 1200 mg or 600 mg. RESULTS: More than 87% of patients had recovery of hearing. When hearing stabilized, there were no significant differences between the 1200 mg and 600 mg groups in terms of hearing outcome (P > 0.05). However, at completion of treatment, the 1200 mg group exhibited significantly superior complete recovery rate and improvement rate (P < 0.05). CONCLUSION: Application of our treatment protocol of a tapered course of 1200 mg HC significantly and rapidly improves recovery outcomes in patients of SSNHL. EBM rating: C-4

Management of esophageal foreign bodies: experience of 90 cases

BackgroundIn Japan, there have been few recent reports of large-scale studies on the characteristics and optimal treatment of esophageal foreign bodies.MethodsWe analyzed data on 90 patients diagnosed as having esophageal foreign bodies treated between April 2002 and August 2007.ResultsIn children younger than 15 years (n = 13), the types of foreign bodies included coins (n = 9), food (n = 1), and other objects (n = 3), 12 of which were successfully removed without endoscopic procedures; in the remaining 1 case, the object advanced to the lower digestive tract spontaneously. In adults aged 15 years or older (n = 77), the types of foreign bodies included food-bolus impaction (n = 26), press-through packages (n = 18), fish bones (n = 14), dental prostheses (n = 13), and other objects (n = 6). The foreign bodies had advanced to the lower digestive tract in 4 patients at the time of flexible endoscopy performed under topical pharyngeal anesthesia. In 6 of the remaining 73 patients, the first endoscopic extraction was unsuccessful, and 5 of these cases involved dental prostheses. The mean maximal size of the dental prosthesis was significantly greater in patients in whom removal was unsuccessful than in those in which it was successful (5.8 versus 1.6 cm, respectively; P < 0.05). The procedures employed following unsuccessful endoscopy included thoracotomy (n = 1), laparotomy (n = 1), removal by forceps under direct vision (n = 1), and rigid (n = 1), and flexible endoscopy (n = 2) under general anesthesia.ConclusionsThe majority of esophageal foreign bodies were successfully removed nonendoscopically in pediatric patients and endoscopically in adult patients. Endoscopic removal under topical pharyngeal anesthesia may not be indicated for patients who have swallowed large dental prostheses.

Changes in Listing plane thickness caused by vestibular schwannoma: a parameter for evaluating the accuracy of the gravity-oriented internal model.

Objective Three-dimensional analysis of video-oculograms can be used to calculate Listing plane for patients and experimental subjects. Listing plane reflects the head’s orientation with respect to gravity, which suggests that the plane is derived from otolithic vestibular input, itself, or from a gravity-oriented internal model constructed through integration of visual, vestibular, and proprioceptive sensory inputs. The goal of this study was to determine whether the Listing plane can serve as a parameter for evaluating static (peripheral or central) vestibular function. Study Design Prospective study. Setting Tertiary referral center. Patients Healthy subjects and patients with unilateral vestibular schwannoma without any previous treatment. Intervention Diagnostic. Main Outcome Measures Video-oculograms were recorded from healthy subjects (aged 36.8 ± 6.3 yr) and from patients (aged 60.3 ± 7.5 yr) during voluntary gaze with the head in an upright or each-side-down orientation, and the thicknesses of the calculated Listing planes were then compared. Results Results revealed thickening of the Listing plane in patients only when the head was in an impaired-side-down orientation (1.250 ± 0.795 and 1.074 ± 0.759 degrees in the right- and left-side-down head orientations in healthy subjects versus 2.222 ± 1.237 degrees in the impaired-side-down orientation in patients), and this thickening correlated with caloric weakness. By contrast, neither the sensation of postural instability nor postural disturbance in force platform recordings contributed to the thickness of Listing plane. Conclusion The thickness of the Listing plane could be a novel parameter for quantitatively evaluating static vestibular (otolithic) function, although central compensation might exist.

Organised haematoma of the maxillary sinus: pathophysiological differences suggesting a new aetiological hypothesis

BACKGROUND AND OBJECTIVESnOrganised haematomas of the maxillary sinus are rare, non-neoplastic, haemorrhagic lesions which can extend into the nasal cavity and/or the other paranasal sinuses. This study aimed to investigate the pathology of maxillary sinus organised haematoma, and also proposes a new aetiological hypothesis based on the observed pathology.nnnMETHODSnBiopsies, computed tomography, magnetic resonance imaging and post-surgical histopathological examination of resected specimens were carried out.nnnCONCLUSIONnDistinct pathological differences were observed between the basal and peripheral portions of organised haematomas. We propose that an organised haematoma originates from the exudation of blood components between vascular endothelial cells. As a result, the basal portion consists of aggregated, dilated vessels around the natural ostium of the maxillary sinus. In addition, pseudovessels, without endothelial cells, arise from endocapillary vessels within the haematoma. Exudation of additional blood components from the pseudovessels advances the growth of the organised haematoma.

Time course of the recovery of three-dimensional eye position in patients with acute cerebellitis.

Listings plane is a construction derived from eye position and reflects gravitational orientation. The cerebellum plays a key role in orienting and integrating sensory input concerning gravity from visual, vestibular and proprioceptive apparatuses. This suggests that the thickness of Listings plane could serve as a novel parameter for evaluating the accuracy of the constructed gravity-oriented internal model. We report a case with acute cerebellitis along with data on Listings plane, calculated from consecutive infrared video-oculogram recordings. We found thickening of Listings plane at the early stage of the disease, and a gradual reduction of the thickness into normal range in parallel with the recovery of the patients posture and gate. Notably, clinical improvement of the patients posture was delayed relative to the normalization of the thickness of Listings plane. The thickness of Listings plane reflects the stability of the cerebellar-mediated cognitive gravitational reference frame. This thickness value could serve as a parameter to quantitatively evaluate the function of the constructed internal model. Recovery from cerebellar ataxia (manifested as normalization of the thickness of Listings plane) was followed by recovery of muscular strength lost during the period the patient was by his disease forced to assume a lying position.

Effects of nasal septum perforation repair on nasal airflow: An analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models

OBJECTIVEnThe purpose of this research is to examine the changes in nasal airflow dynamics before and after the nasal perforation repair.nnnMETHODSnThree dimensional (3D) models of the nasal cavity before and after septal perforation repair was reconstructed using preoperative and postoperative computed tomography (CT) images of a patient. The numerical simulation was carried out using ANSYS CFX V15.0. Pre- and post-operative models were compared by their velocity, pressure (P), pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy (TKE) in three plains.nnnRESULTSnIn the post-operative state, the cross flows disappeared. In preoperative state, there were areas showing high PG, WS, SSR at the posterior border of the perforation, which exactly correspond to the area showing erosive mucosa on endoscopic inspection of the patient. In postoperative state, such high PG, WS and SSR areas disappeared. High TKEs also disappeared after surgery.nnnCONCLUSIONnThe effects of septal perforation repair on airflow dynamics were evaluated using computer fluid dynamics (CFD). High WS, PG and SSR observed at the edge of the septal perforation may be related to the clinical symptom such as nasal bleeding and pain. TKE was considered to cause nasal symptom.

Optokinetic stimulation can break Listing's law without induction of eye movement

OBJECTIVEnPseudo-images of three-dimensional eye movements captured on an infrared video oculogram can be translated onto a rotational expression around axial vector. This provides a subjects Listings plane, which moves according to the heads orientation relative to gravity. Optokinetically induced changes in the cognitive gravitational reference frame will affect the context of Listings plane. The purpose of this study was to estimate the effect of OKS on Listings plane.nnnMETHODSnIn this study, we presented vertical optokinetic visual stimulation with fixation targets, which are thought to induce pseudo-inclination of the head, and evaluated changes in the subjects Listings plane.nnnRESULTSnWe observed no stimulus-induced movement of Listings plane that corresponded to the assumed pseudo-recognition of a change in verticality. On the other hand, we did observe vergence movement of Listings plane (in the yaw plane), which corresponded to exposure to diminished and increased gravitational circumstance. In addition, the thickness of Listings plane significantly increased with the load of each stimulation.nnnCONCLUSIONnVertical OKS leads to a rotation of Listings plane mainly around a vertical axis. This may represent false exhibition of central compensatory re-weighting with respect to inherent otoconial mass asymmetry resulting from the OKS-mediated loss of the gravity reference. In addition, a OKS-mediated thickening of Listings plane suggests to us that confusing visual input can reduce the stability of the internal model, which would likely manifest itself as a thickening of Listings plane. In other words, fluctuation between the build-up and drop-out of vection induced by optokinetic stimulation will cause a thickening of Listings plane. The thickness of Listings plane could be a novel clinical parameter for quantitatively evaluating static vestibular function and accuracy of the internal model.