Takayoshi Itaya

Comparison of Effectiveness of Maneuvers and Medication in the Treatment of Benign Paroxysmal Positional Vertigo

In this paper, the treatment by medication together with two maneuvers-the particle repositioning maneuver (PRM) reported by Parnes and Price-Jones and the liberatory maneuver (LM) reported by Semont et al.-were compared with treatment by medication alone. Fourteen of 15 cases (93.3%) treated with the PRM and 11 of 14 cases (78.6%) treated with the LM showed improvement after 2 weeks. These results were better than that obtained by medication alone, in which 8 of 26 cases (30.8%) showed improvement after 2 weeks. The most important benefit of these maneuvers seemed to be the speedier recovery than with medication alone, as there was no significant difference in the late success rate after 3 months between the maneuvers and medication alone.

Air caloric test with continuous thermal change.

A new technique was designed for vestibular testing with an air caloric stimulator. With this technique, the temperature threshold necessary to induce caloric nystagmus was measured as air temperature decreased at a constant rate (from 37 degrees C). As a pilot study, an air caloric test with continuous thermal change was done at 6 different rates of decrease: 0.01, 0.03, 0.05, 0.1, 0.15 and 0.2 degrees C/s. The rate of 0.05 degrees C/s gave the smallest standard deviation for temperature threshold in normal subjects. This deviation had the narrowest normal limits of all ordinary caloric tests when the coefficient of variation was compared (standard deviation/mean x 100). No discomfort was observed during or after the air caloric test with continuous thermal change at this rate.

Air Caloric Test with Continuous Thermal Change in Patients with Vestibular Disorders

In a previous report (1) the author described a new air caloric test with continuous thermal change. In this study, 19 patients with vestibular disorders were examined with this technique, and the results were compared with the results of the water caloric test (30 degrees C, 50 ml, 20 s) in the same subjects. A difference in interaural response to the air caloric test was noted in 9 of the 19 patients (47.4%), greater than with the water caloric test, 5 of 19 (26.3%). The detectability of vestibular disorders with the air caloric test (28 of 38 ears; 73.7%) was significantly higher than that with the water caloric test (8 of 38 ears; 21.1%) (p < 0.01). The air test appeared to estimate vestibular function more precisely, as stimulation by this method is too weak to cause vestibular recruitment.

A Case of a True Malignant Mixed Tumor of the Parotid Gland.

True malignant mixed tumor (carcinosarcoma) of salivary glands, with carcinomatous and sarcomatous components, is aggressive and extremely rare. We report a case of a true malignant mixed tumor in a parotid lesion.A 58-year-old man had a painless right inf raauricular mass that had been present for about 30 years. A 6×4cm elastic hard nodule existed from the tragus to the angle of the mandible. The patient underwent total parotidectomy with facial nerve preservation. The entire tumor was resected with the surrounding tissues except along the main trunk of the facial nerve. Histologically, the tumor showed a biphasic pattern composed of both carcinomatous and sarcomatous elements. The carcinomatous component was adenocarcinoma with ductal structure and the sarcomatous components varied from unclassified sarcoma to unequivocal chondrosarcoma. Two months later, the patient suddenly complained of right facial paralysis. Magnetic resonance imaging revealed a irregular mass extending to the parapharyngeal space. A radical operation, combined with chemotherapy and radiotherapy, was performed with neck dissection, partial mandibulectomy and facial nerve sacrifice. Despite these intensive therapies, an X ray study showed multiple pulmonary coin lesions three months after the second operation.We emphasize the necessity for radicality in initial operations when dealing with this type of tumor.

Two Cases Showing Dizziness during Recovery from Puffer Fish Poisoning.

Symptoms and neuro-otological test results in two patients with puffer fish poisoning (one severe case and the other mild) were reported. Both patients complained of dizziness one day after revival. The eye-tracking test showed a saccadic pattern in the severe case. The optokinetic pattern test showed overall poor pursuit in the severe case, while poor pursuit was only evident at high speeds in the mild case. The caloric test showed bilateral hypofunction in both cases. Tests results uniformly improved when dizziness disappeared. These observations suggest that tetrodotoxin may affect both the peripheral and central nervous systems.

A Case of Multiple Schwannomas with the Initial Symptoms of a Parotid Tumor.

In 1984, Shishiba et al described 4 cases with multiple cutaneous neurilemmomas as “neurilemmomatosis” which is a systemic disease distinct from neurofibromatosis. Since then, some reports have been published on multiple schwannomas as a systemic disease. In this paper, we report a case of multiple schwannomas with the initial symptoms of a parotid tumor.A 64-year-old man visited our hospital complaining of swelling in the right inf raauricular region. Preoperative CT and MRI examinations revealed a 25×25 mm round tumor in the deep portion of the right parotid gland and two other tumors in the deep right upper neck. A malignant tumor in the parotid gland with lymph node metastasis was suspected. An operation revealed that these tumors originated from the facial nerve, a branch of the accessory nerve and the brachial plexus. There were two independent tumors in the facial nerve. The tumor in the accessory nerve was totally removed, but the others were treated conservatively in consideration of his quality of life. The tumors in the accesory and the facial nerves were examined histologically, and were diagnosed as a mixed type schwannoma.The present case could not be considered to be neurofibromatosis, because the patient did not have dermatological findings, cafe au lait spots, neurofibromas, nor a familial history of neurofibromatosis.