Toshiyuki Nomura

A clinical observation of benign paroxysmal positional vertigo (BPPV) after vestibular neuronitis (VN)

We observed 9 cases of BPPV developed after vestibular neuronitis. The interval between the onset of BPPV and vestibular neuronitis ranged from 2 weeks to 20 years. All cases were examined for critical head position which provoked vertigo, non-gaze nystagmus, positional and positioning nystagmus and caloric nystagmus. No characteristic signs and symptoms could be observed. The function of the posterior canal is thought to be necessary to provoke positional vertigo. Thus in BPPV after vestibular neuronitis the function of the posterior canal would presumably have been preserved to some degree. The first possibility is that the function of the posterior canal was not impaired in spite of the damage of the lateral canal. The fact that each canal differs in involvement in vestibular neuronitis may be explained by the difference in the blood supply or the innervation between lateral and posterior canals. If only the artery or nerve which is related to the lateral canal is damaged and the artery or nerve to the posterior canal is not involved, then the function of the posterior canal is preserved. So BPPV may occur soon after the disappearance of severe vertigo. The second possibility is that if the posterior canal had been damaged together with the lateral canal and the functions are recovering, BPPV may occur some time after the onset of vestibular neuronitis. The locus of vestibular neuronitis is in the peripheral vestibular system and the extent and degree of the lesion vary, which may explain why there can be time difference of the recovery between the two canals.

Lateral medullary infarction presenting as isolated vertigo and unilateral loss of visual suppression

Isolated vertigo is rare in lateral medullary infarction. We described early diagnostic challenges in such cases by a neuro-otological approach. We report a 56-year-old man who developed a lateral medullary infarction that presented as isolated vertigo. Before the day 4 from disease onset when diffusion-weighted magnetic resonance imaging (MRI) became positive, this patient showed unilateral loss of visual suppression, a central type of vestibular dysfunction. Since MRI abnormalities may not appear in the early few days from disease onset, unilateral loss of visual suppression might become an important diagnostic option for isolated vertigo due to a lateral medullary infarction. This finding is presumably relevant to the inferior olive lesion.

A Case Report of Facial Nerve Palsy in Childhood Associated with Chickenpox

Chickenpox is one of the most frequent infectious diseases during childhood. However, instances of this disorder being complicated by facial paralysis alone are rare. In a 4-year-old girl, chickenpox-related exanthema appeared. Thereafter, right facial movements became impaired, and the girl was diagnosed with facial paralysis. There were no other neurological abnormalities. After 6 weeks of steroid therapy, a complete response was achieved.

Effect of adenoidectomy and tonsilectomy on serous otitis media.

The efficacy of adenoidectomy in the treatment of serous otitis media was evaluated by tympanograms of 54 patients (107 ears) recorded before and after adenoidectomy and adeno-tonsilectomy.1) About half the B-type and most of the C-type tympanograms improved to A-type after surgery.2) Clinical progress was more favorable when myringotomy preceded surgery.3) The results were less favorable in children under 5 years of age.4) Better results were noted in patients treated with tonsilectomy in addition to adenoidectomy.5) A favorable clinical course was noted in patients with (+)-(++) cloudiness on X-rays of the para-nasal sinuses.6) Improvement of the tympanogram was observed frequently 1-2 months after operatlon.