Tamio Kamei

Hyperbaric oxygen and stellate ganglion blocks for idiopathic sudden hearing loss.

Ninety-one patients suffering from idiopathic sudden hearing loss are presented. Twenty-two patients were given medical treatment (vasodilators, steroid hormones and vitamins) alone (group 1). Forty-nine patients were treated with stellate ganglion block (SGB) plus oxygen hyperbaric therapy (OHP) (group 2) and 20 patients were treated with SGB plus OHP along with medical treatment (group 3). The SGB plus OHP treated patients were given bupivacaine, which induced Moors anterior approach of SGB and then exposed to oxygen at a pressure of 2.4 ATA for 90 min. In group 1, 69% of the patients treated within one week after onset exhibited over 10 dB pure tone average improvement, with only 33% patients treated one to two weeks after onset experiencing over 10 dB. However, 74% of the patients in group 2 and 100% of the patients in group 3 who were treated within two weeks after onset exhibited over 10 dB improvement. More significantly, of the patients which experienced complete loss of hearing, 83% in group 2 and 100% in group 3, exhibited over 10 dB improvement, compared to only 33% in group 1. Moreover, 8 (40%) patients in group 3 recovered to within 20 dB of their normal hearing levels. In group 2, 17 patients were treated two to six weeks after onset and 12 (71%) patients had over 10 dB improvement. SGB plus OHP therapy was shown effective in the treatment of sudden idiopathic hearing loss even when patients were treated more than two weeks after onset.

The effect of overall treatment time of radiation therapy on local control of T1-stage squamous call carcinoma of the glottis

From 1975 to 1990, 72 patients with T1 glottic cancer, excluding a verrucous type of carcinoma, were treated with radiation therapy (RT). All treatments were given with a standard fractionation of 2 Gy per day. The total dose to the tumor ranged from 60 to 70 Gy. Six patients received a split‐course RT. The overall local control rate was 87% at 5 years. Forty‐one patients who completed RT in 45 days or less had a 5‐year local control rate of 95%. Sixteen patients who completed a treatment course in 46 to 49 days had a local control rate of 81%. Fifteen patients with a treatment course of more than 50 days had a local control rate of 73%. There was a statistically significant difference in local control rates among the three groups (P<.05). The split‐course RT group had a 5‐year local control rate of 50%; that rate was statistically significantly inferior to that of the continuous course group (P<.001). Multivariate analysis also showed that an interruption of the treatment course was an important parameter in relation to the local control. The prolongation of standard RT schedules adversely affected local control of T1 glottic carcinoma and, therefore, should be avoided whenever possible.

Familial unilateral deafness and delayed endolymphatic hydrops.

Delayed endolymphatic hydrops (DEH) is a unique disorder characterized by fluctuating otologic symptoms in the setting of preexisting unilateral deafness. The symptoms include aural fullness, fluctuating hearing, and/or episodes of vertigo similar to those observed in Meniere disease and may occur ipsilateral or contralateral to the previously deafened ear. In most reported cases, the unilateral deafness has been a profound sensorineural hearing loss with a sudden onset that has been variously attributed to bacterial or viral labyrinthitis, acoustic or cranial trauma, otosclerosis, and congenital CMV infection. Familial occurrence of the syndrome has not previously been reported in the literature. In this report, we describe two possible familial instances of delayed DEH. These patients raise the possibility that genetic factors may sometimes be the cause of this unusual syndrome.

Stage-Assessment of the Progress of Continuous Vertigo of Peripheral Origin by Means of Spontaneous and Head-shaking Nystagmus Findings

The stages of continuous vertigo of peripheral origin were classified into nine categories according to the findings of spontaneous nystagmus (SPN) and head-shaking nystagmus (HSN). The patients analysed were 18 with vestibular neuronitis, 6 with sudden deafness and 6 with unilateral inner ear disorders. 1) Irritative SPN (Stage I) was rarely encountered. 2) SPN of the paralytic type (Stage II) was usually observed in the period less than one month after the onset of diseases. 3) HSN directed toward the intact side with or without a reversal phase (Stages III-2 and III-1, respectively) were the common types of central compensation. 4) The progress of recovery to complete cure (Stage V) was usually rapid once it had actually begun. 5) During the process of recovery, HSN could disappear transitorily (Stage III-3), or be directed toward the affected side without a reversal phase (Stage III-5). Spontaneous recovery nystagmus (Stage IV) could also occur. 6) About 40% of patients recovered to Stage V within about 4 months after the onset of vertigo, but about 30% of patients remained in Stage III-1 or III-2 even after 4 months.

Two Types of Head-Shaking Tests in Vestibular Examination

In clinical vestibular examination, there are two types of head-shaking tests, in each of which the patients head is shaken in a similar way. One is the head-shaking test for the detection of latent spontaneous vestibular nystagmus. In this test, the patients eyes are observed for nystagmus immediately after a passive rapid head-shaking around a vertical axis, using Frenzels glasses in a dark room. The nystagmus is induced frequently in patients with peripheral and central vestibular disturbances. In peripheral vestibular disturbances, the induced nystagmus can be classified into deficiency-type nystagmus, recovery-type nystagmus and biphasic nystagmus which is usually a mixture of the two. A second head-shaking test is the head-shaking test for the evaluation of jumbling. In this test binocular visual acuity is measured while the patient shakes his head two or three times per second, ten to twenty degrees horizontally or vertically, and compared with that when his head is still. A diagnosis of jumbling is made when the visual acuity during head-shaking is less than half the visual acuity when the head is motionless.

A Quantitative Analysis of Head-shaking Nystagmus of Peripheral Vestibular Origin

A quantitative analysis of horizontal head-shaking nystagmus (HSN) was made on 48 patients with unilateral peripheral vestibular lesions in conjunction with stimulus intensity. Each patient underwent three head-shaking tests with 10, 30 and 50 horizontal head-excursions at a frequency of approximately 2 Hz, and HSN was recorded on ENG with eyes open in total darkness. i) HSN appeared in a biphasic or monophasic pattern. ii) The maximal slow-phase eye velocity (MSV) of the 1st phase (PI) of biphasic HSN increased significantly in proportion to stimulus intensity, and was significantly greater than that of monophasic HSN. iii) The duration of HSN was greater in the 2nd phase (PII) of biphasic HSN than in PI and increased markedly in proportion to stimulus intensity. iv) As the stimulus intensity rose to a high level, the interval between PI and PII (2nd phase latency) shortened, and the PII tended to appear more quickly after head-shaking. It was especially noteworthy that in response to an increase in stimulus intensity, both the MSV in PI and the duration of PII of biphasic HSN increased, but the duration of PI was reversely suppressed by the PII.

Malignant mesenchymoma of the larynx.

A case report of a primary laryngeal malignant mesenchymoma, a very rare head and neck and even rarer laryngeal lesion, is reported. In this case, an 85-year-old man, who had undergone several panendoscopies and biopsies that were non-diagnostic, subsequently succumbed to pulmonary metastases and died from respiratory failure. At autopsy, tumour cells were demonstrated to constitute both bone and striated muscle cell types. As the tumour cells differentiated into two types of specialized cells from one type of embryonal tissue, the diagnosis of malignant mesenchymoma was established.

Clinical Investigation Of Vestibular Damage by Antituberculous Drugs

Vestibular function testing was done regularly on the cases given streptomycin, kanamycin, or enviomycin and a method to detect the cases of vestibular dysfunction at an early stage was discussed, as well as the time these drugs should be discontinued. Subjects were 85 cases of tuberculosis treated with streptomycin, kanamycin, or enviomycin who were admitted to our hospital from December 1984 to May 1986. The method of equilibrium examination performed at regular intervals is as follows: standing test (Romberg test), stepping test, and Meyer zum Gottesberges head-shaking test were done once a week for a month after starting antituberculous injections and they were re-examined once every 2 weeks for at least 3 months after beginning the injections. After the 3 months these tests were done once a month. Eight cases of vestibular damage due to streptomycin or enviomycin could be easily detected at an early stage by performing Meyer zum Gottesberges head-shaking test, together with the standing test and the stepping test. Vestibular dysfunction is apt to occur after about 1 month or within a month from the start of daily injections especially with streptomycin. Therefore, the method of equilibrium examination, we suggest, is that the Meyer zum Gottesberges head-shaking test, the standing test (Romberg test), and the stepping test should be performed once a week during the first month after the start of this drug. When the result of the Meyer zum Gottesberges head-shaking test is less than 50% and swaying and/or rotation occur in the stepping test, the drugs being given should be discontinued.

Investigation of Vestibular Damage by Antituberculous Drugs

Vestibular function testing was performed regularly on patients who were administered streptomycin, kanamycin, or enviomycin, and vestibular damage was detected at an early stage, and quantitatively. We investigated the point in time at which the therapy should be discontinued. Subjects consisted of 204 cases of tuberculosis treated with streptomycin, kanamycin, enviomycin. They were admitted to the hospital between December 1984 and August 1989. Twenty-eight cases of vestibular dysfunction due to streptomycin, kanamycin, and enviomycin could easily be detected at an early stage by performing Meyer zum Gottesberges head-shaking test for the evaluation of jumbling, together with Rombergs test and the stepping test. All cases who had vestibular dysfunction completely recovered because of early detection. In addition, 7 cases recovered afterwards from temporary vestibular damage shown only in Meyer zum Gottesberges head-shaking test (abnormality of vestibulo-ocular reflex was only detected and vestibulo-spinal reflex remained intact), despite continuation of streptomycin injection. When the results of the head-shaking test are less than 50% and when a sway and/or rotation in the stepping test occurs, the injections should be discontinued.

Meyer zum Gottesberge's Head-shaking Test for the Evaluation of Jumbling

Jumbling consists of loss of vestibular eye movement reflexes and resultant oscillopsia during movement of the head. This results in a failure of clear vision during head movement. The head-shaking test for evaluation of the jumbling phenomenon was initially suggested by Meyer zum Gottesberge in 1952. In this test, binocular visual acuity is measured while the patient shakes his head at a rate of 2 or 3 movements per second, 10 to 20 degrees horizontally or vertically, and compared head still position. In normal subjects, only a slight decrease in visual acuity is noted due to this head-shaking. A diagnosis of jumbling is made when the visual acuity during head-shaking is less than half the visual acuity when the head is held motionless. When the visual acuity during head movement is expressed as a percentage of the value obtained while the head is motionless, a quantitative evaluation of jumbling is possible. This test should be done at regular intervals especially on patients who receive parenteral administration of ototoxic aminoglycosides for an early detection of jumbling and an appropriate discontinuation of the drugs, along with repeated auditory testing. The test is also useful in monitoring recovery from jumbling.