Yasuhiro Miyamoto

Pediatric bilateral facial nerve palsy secondary to acute otitis media.

Bilateral facial palsy after the onset of acute otitis media is presented in a 19-month-old patient. Facial nerve palsy disappeared gradually after myringotomy. The mechanisms underlying the facial nerve palsy with otitis media are discussed.

Horizontal eye response to an abrupt lateral head drop in normal subjects and patients with Meniere's disease

OBJECTIVE To detect the endolymphatic hydrops by using the otolithic nature in patients with Menieres disease and delayed hydrops. METHODS We developed a new technique for measuring horizontal eye movements, corresponding to lateral head drop in total darkness, approximately 1g environment. Normal subjects (n=16, mean age: 27.3 years old) and patients (seven for pre-operative state, four for furosemide test at pre-operative state; two for post-operative state) were employed in the test. The principle of the test is to drop the head in a lateral position separately from the body with a rapid release exposing the head. Bitemporal EOG, accelometric and trigger signals for the releaser were recorded for processing at 1 KHz sampling time. RESULTS The drop was performed five times in succession. The latency of horizontal eye response was of 40 ms order in normal subjects on both sides and were never beyond 60 ms. Eye response of the patients was in different patterns from normal subjects and the latencies delayed either to normal side or to the affected side. Following furosemide intravenous injection, more certain information was obtained. Three of four patients were recovered to normal range as to the latency. CONCLUSIONS We emphasize that this test may provide a new measure sensitive to the hydrops and can underline this test to detect the hydrops in Menieres disease.

Severe tracheal stenosis with tracheopathia osteoplastica‐like changes due to traumatic blunt injury

A 17‐year‐old man was injured in a motorcycle accident, leading to a complex cerebral contusion and hepatic injury. Approximately one month after being discharged from the hospital, the patient experienced gradually progressive dyspnea on exertion. Chest computed tomography revealed severe upper tracheal stenosis; thus, emergency tracheotomy and subsequent tracheoplasty were performed. Microscopically, the deformation of tracheal cartilage and extensive interstitial ossification/fibro‐elastic changes were observed. To our knowledge, this is the first report documenting the ossification of the trachea that rapidly progressed after injury, which was confirmed by surgical resection of the upper trachea.

Examination of the Relationship between OSA and Obesity

Obesity is one of most important risk factors for obstructive sleep apnea syndrome (OSA). In this studys, we examined the importance of a rapid and considerable increase in body weight in OSA using a weight changing index (WCI). We investigated 39 patients (35 males and 4 females) that were referred to our hospital complaining of snoring and sleeping disturbance, and we employed body mass index (BMI) to evaluate obesity. The BMI was estimated as body weight divided by height to the second power: BMI (kg/m2)=body weight/(height * height). WCI was estimated as the previous BMI around the time the patients noticed sleeping disturbance, minus the present BMI. We evaluated degrees of OSA using the apnea-hypopnea index (AHI) as measured by polysomnography. We found a significant correlation between AHI and BMI, confirming that obesity greatly influences OSA. In younger subjects, the correlation between OSA and increases in WCI was more prominent than that in older subjects, whereas the BMI values did not differ significantly with age. Since WCI appeared to reflect the accumulation of visceral fat, we suggest that visceral-fat obesity most strongly influences OSA. The increasing prevalence of obesity is likely to produce social problems associated with a higher incidence of OSA. It is therefore important to develop suitable methods for the detection and treatment of OSA.

Head Shaking Nystagmus in the Patient with Idiopathic Unilateral Peripheral Facial Palsy.

A case of idiopathic unilateral peripheral facial palsy showing unique findings and time course of the head shaking nystagmus was reported.A 15 year-old woman complained of right facial paralysis. She was admitted to our hospital for treatment using a drip infusion of steroids. Three days after onset of the paralysis, she complained of vertigo. At that time she showed no spontaneous or positional nystagmus but manifested right beating nystagmus 5 seconds after the cessation of head shaking stimulation. Six days after onset of the vertigo, right beating nystagmus was also observed but it appeared 40 seconds after the cessation of head shaking. It is assumed that she showed only the 2nd phase of head shaking nystagmus without the 1st phase because of the long latency period. She showed a mild increase in complement fixing antibody titer to the varicella-zoster virus.The head shaking test is well known to be quite sensitive in the detection of unilateral vestibular disorders. Since the 1st phase of head shaking nystagmus is due to velocity storage, any process that interferes with velocity storage can alter the pattern of nystagmus. When velocity storage is very poor, the 1st phase of head shaking nystagmus may be brief or absent. Thus, it is assumed that the patient in the present report had a lesion in the central vestibular system, presumably in the velocity storage mechanism due to varicella-zoster virus infection.