Tetsuo Morihana

Effects of Probiotics on Allergic Rhinitis Induced by Japanese Cedar Pollen: Randomized Double-Blind, Placebo-Controlled Clinical Trial

Background:Lactobacillus casei strain Shirota (LcS) has been found to exert antiallergic effects in animal experiments, but there is little information about its clinical effects in human patients with allergy. Methods: We performed a randomized double-blind, placebo-controlled study to investigate the effects of LcS in patients with allergic rhinitis triggered by Japanese cedar pollen (JCP). Participants were asked to drink fermented milk containing LcS (LcS group) or placebo (control group) for 8 weeks. Clinical symptoms and immunological parameters were compared between the two groups. Results: Symptom-medication scores (SMS) worsened in accordance with the increase in the amount of scattered JCP. In terms of the nasal and ocular SMS, there was no significant difference between the LcS group and the placebo group during the ingestion period. In the subgroup of patients with moderate-to-severe nasal symptom scores before starting the ingestion of test samples, supplementation with LcS tended to reduce nasal SMS. Conclusion: These results indicate that fermented milk containing LcS does not prevent allergic symptoms in patients sensitive to JCP, but may delay the occurrence of allergic symptoms in patients with moderate-to-severe nasal symptom scores.

Steroid effects on vestibular compensation in human

Abstract Vestibular neuritis (VN) rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. We experienced 36 patients with VN treated at our hospital, including cases in our previous preliminary report. To elucidate effects of steroid therapy both on the recovery of peripheral function and on the adaptation of central vestibular compensation, we examined caloric test and several questionnaires with two randomly divided groups, 18 steroid-treated and 18 nonsteroid-treated patients, over two years after the onset. These examinations revealed that steroid-treated patients had a tendency of better canal improvements (13/18, 72%) than nonsteroid-treated ones (10/18, 55.6%). However, there was no significant difference between these two groups. In cases with persistent canal paresis, steroid-treated patients (n = 5) reduced handicaps in their everyday life due to the dizziness induced by head and/or body movements and the disturbance of their mood, more effectively than those with nonsteroid therapy (n = 8). These findings suggest that steroid therapy with VN could be effective on not only vestibular periphery but central vestibular system, to restore the balance.

Long-term results of endolymphatic sac drainage with local steroids for intractable Meniere's disease

OBJECTIVESnMenieres disease is a common inner ear disease characterized by vertigo, hearing loss and tinnitus. Since Menieres disease is thought to be triggered by an immune insult to inner ear hydrops, we examined endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids for intractable Menieres patients and observed long-term results from 2 years to over a decade until 13 years.nnnMETHODSnBetween 1998 and 2009, we enrolled and assigned 286 intractable Menieres patients to two groups: group-I (G-I) included patients who underwent endolymphatic sac drainage with steroid instillation and group-II (G-II) included those who declined endolymphatic sac drainage. Definitive spells and hearing improvement in these two groups were determined for 2-13 years after treatment.nnnRESULTSnAccording to the established criteria, vertigo was completely controlled in 88% of patients in G-I in the 2nd year, in 73% in the 12th year and in 70% in the 13th year. These results in G-I were significantly better than those in G-II for 13 years after treatment. Hearing was improved in 49% of patients in G-I in the 2nd year, in 27% in the 12th year and in 25% in the 13th year. These results in G-I were significantly better than those in G-II for 12 years after treatment, but this was not significant in the 13th year.nnnCONCLUSIONSnEndolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids could improve long-term follow-up results of hearing as well as vertigo control. This means that the drainage with local steroids could also improve patients long-term quality in the prime of life.

An Inhibitory Role for Sema4A in Antigen-Specific Allergic Asthma

PurposeThe class IV semaphorin Sema4A is critical for efficient TH1 differentiation and Sema4a−/− mice exhibit impaired TH1 immune responses. However, the role of Sema4A in TH2 cell-mediated allergic diseases has not been fully studied. The aim of this study was to clarify the regulatory role possessed by Sema4A in mouse models of allergic diseases, particularly allergic asthma.MethodsSema4a−/− mice on a BALB/c background were examined for the development of allergic diseases. To induce experimental asthma, mice were sensitized with ovalbumin (OVA) followed by intranasal challenges with OVA. After challenge, airway hyperreactivity (AHR) and airway inflammation were evaluated. The role of Sema4A in asthma was examined using Sema4a−/− mice and Sema4A-Fc fusion proteins. The direct effects of Sema4A-Fc on antigen-specific effector CD4+ T cells were also examined.ResultsA fraction of Sema4a−/− BALB/c mice spontaneously developed skin lesions that resembled atopic dermatitis (AD) in humans. Furthermore, AHR, airway inflammation, and TH2-type immune responses were enhanced in Sema4a−/− mice compared to wild type (WT) mice when immunized and challenged with OVA. In vivo systemic administration of Sema4A-Fc during the challenge period ameliorated AHR and lung inflammation and reduced the production of TH2-type cytokines in WT mice. The inhibitory effects of Sema4A on airway inflammation were also observed in mice deficient in Tim-2, a Sema4A receptor. Finally, we showed that Sema4A-Fc directly inhibited IL-4-producing OVA-specific CD4+ T cells.ConclusionThese results demonstrate that Sema4A plays an inhibitory role in TH2-type allergic diseases, such as allergic asthma.

Surgical Management of Special Cases of Intractable Meniere's Disease: Unilateral Cases with Intact Canals and Bilateral Cases

If a clinician seeks to allow patients with vertigo to return to work as soon as possible, it is very important to determine the appearance of vestibular symptoms during convalescence just after treatment, as well as the long-term results. Apprehensive patients with vertigo may undergo severe psychological torment if treatment requires long-term rest in bed before they can return to daily life. In this paper, we observed postoperative vestibular symptoms (subjective sensation and objective nystagmus) in 50 patients with intractable Menieres disease, including cases from our previous preliminary report, during the period of convalescence just after endolymphatic sac drainage and steroid instillation surgery (EDSS). All symptoms were eliminated within 8 days after EDSS. There was no significant difference in the duration of any vestibular symptoms between bilateral (n = 8) and unilateral cases (n = 42). This result indicates that EDSS could be as safe a treatment for bilateral Menieres disease as for unilateral disease. In unilateral cases with intact semicircular canal function (n = 17), postoperative evoked vestibular sensation, positional, and positioning (Dix-Hallpike) nystagmus disappeared significantly earlier than in those with canal paresis (n = 25). This result indicates that EDSS could keep the vestibular peripheral function of patients with unilateral Menieres disease with intact canals quite stable after surgery. Therefore, EDSS could be recommended as an initial, less-invasive surgical treatment for intractable Menieres disease, especially in unilateral cases with intact canals and in bilateral cases.

Psychological condition in patients with intractable Meniere's disease

Abstract Conclusions: Physicians should consider additional treatment strategies for Menieres disease patients with a long history of disease and hearing loss in the secondary affected ear and also provide psychological support regarding future progressive bilateral hearing loss. Objectives: To treat intractable Menieres disease patients effectively, we need to understand the psychological condition of each patient. We examined the state of neurosis and depression in patients and correlated this with demographic and background information. Methods: Between 1998 and 2009, we enrolled 207 patients with intractable Menieres disease in this prospective study. We used the Cornell Medical Index and the Self-rating Depression Scale to evaluate their psychological condition. We also obtained demographic and background information relating to sex, age, duration of disease, vertigo frequency, hearing level in bilateral sides, and plasma vasopressin level. Results: Neurosis and depression was diagnosed in 40.1% and 60.4%, respectively, of patients with intractable Menieres disease. Our results showed that surgical treatment significantly improved vertigo and hearing ability in patients with no psychological symptoms compared with those exhibiting psychological symptoms. Patients with a longer duration and worse hearing level in the secondary affected ear had a significantly higher incidence of mental illness than those with a shorter duration and better level of hearing.

Vestibular function and vasopressin.

OBJECTIVEnTo investigate the relation between the vestibular system and vasopressin (AVP).nnnMATERIAL AND METHODSnWe examined the effects of electrical and caloric vestibular stimulation on plasma AVP levels in anesthetized rats. Plasma AVP levels of patients with intractable Ménières disease who were subjected to endolymphatic drainage and steroid instillation surgery (EDSS) or intratympanic gentamicin (GM) injection were measured before and after these interventions.nnnRESULTSnElectrical vestibular stimulation increased plasma AVP levels in a current intensity-dependent manner. Plasma AVP levels were also increased by caloric stimulation with cold water. Plasma AVP levels decreased rapidly after EDSS, and were maintained at a low level even 6-12 months following EDSS or intratympanic GM injection.nnnCONCLUSIONSnVestibular activation or inhibition-induced imbalance of intervestibular activities increased plasma AVP levels in rats. Therefore, vestibular disorder would seem to increase plasma AVP and thus worsen endolymphatic hydrops. EDSS rapidly decreased plasma AVP and would seem to reduce hydrops. Inhibition of vertigo spells by EDSS or intratympanic GM injection would reduce a possible stress response, resulting in a decrease in plasma AVP levels a long time after the treatments. This resultant decrease in AVP would beneficially inhibit the formation and/or maintenance of hydrops and thus prevent vertigo spells.

Changes in caloric responses after temporal bone surgery with posterior tympanotomy

OBJECTIVEnTo elucidate the role of facial recess bony plate in the thermal transmission route from external auditory canal to lateral semicircular canal during caloric stimulation test, we performed the test on patients before and after removal of the plate, i.e. posterior tympanotomy. In the present study, we adopted facial nerve decompression (FND) as posterior tympanotomy without surgery-induced inner ear damages and cochlear implantation (CI) as posterior tympanotomy with surgery-induced inner ear damages.nnnMETHODSnBetween 1999 and 2003, we performed FND on 19 patients with unilateral facial nerve paresis due to Bells palsy (n=7), Ramsay-Hunt syndrome (n=7) or facial nerve trauma (n=5) at Osaka Rosai Hospital. We also performed CI on 34 patients with bilateral deafness at Osaka University Hospital. To examine effects of FND or CI on caloric responses in vestibular periphery, caloric stimulation (30 degrees C cold water and 44 degrees C hot water) with ENG was performed twice, just before and 6 months after surgery in each subject. The caloric-induced nystagmus was recorded by using ENG under dark and open-eyes situation to calculate the maximum slow phase eye velocity.nnnRESULTSnIn cases of FND (n=19), there were significant decreases between pre- and post-operative 30 degrees C responses (t-test: p=0.049<0.05). There were no significant differences between pre- and post-operative 44 degrees C responses (t-test: p=0.467>0.05). In cases of CI (n=34), there were significant changes between pre and post-operative responses in both temperatures (t-test: p<0.0001 in 30 degrees C; p=0.011<0.05 in 44 degrees C).nnnCONCLUSIONnThe insertion of electrodes during CI did some damages to vestibular peripheral function and reduced both hot and cold caloric responses according to the results of CI. However, the procedure during posterior tympanotomy could also decrease caloric responses especially in cold stimulation according to the results of FND. Therefore, we should consider the effect of structural change in temporal bone on the thermal transmission in case of evaluation of vestibular peripheral function by using caloric stimulation test.

Chronic otitis media with cholesteatoma with canal fistula and bone conduction threshold after tympanoplasty with mastoidectomy.

Objective To understand the third mobile window effect of chronic otitis media with cholesteatoma with inner ear fistula on the bone conduction threshold, we examined changes in the bone conduction audiogram after tympanoplasty with mastoidectomy for chronic otitis media with cholesteatoma with canal fistula. Study Design Retrospective case review. Setting Tertiary referral center. Patients According to the intraoperative classification of Dornhoffer and Milewski, we focused especially on Type IIa (anatomic bony fistula with no perilymph leak). We checked the bone conduction threshold at least 3 times: just before, just after, and 6 months after surgery in 20 ears with Type IIa lateral semicircular canal fistula. Intervention Tympanoplasty with mastoidectomy. Main Outcome Measure Bone conduction thresholds before and after tympanoplasty with mastoidectomy. Results Compared with the preoperative bone conduction threshold, 6 cases were better, 12 cases were unchanged, and 2 cases were worse within the first postoperative week. Finally, 1 case was better, 15 cases were unchanged, and 4 cases were worse at the sixth postoperative month. Patients with a better bone conduction threshold in the low-tone frequencies immediately after surgery had a tendency to show no preoperative fistula symptoms. Postoperative spontaneous nystagmus had a tendency to be observed in patients with a worse bone conduction threshold in the high-tone frequencies. Conclusion The better bone conduction threshold at low-tone frequencies immediately after tympanoplasty with mastoidectomy and no preoperative fistula symptoms might imply the third mobile window theory. The worse bone conduction threshold in high-tone frequencies with spontaneous nystagmus after surgery might indicate inner ear damage.

Does endolymphatic sac decompression surgery prevent bilateral development of unilateral Ménière disease

The aim of the study was to elucidate whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent unilateral Ménière disease (MD) from becoming bilateral.