A 14-year nationwide epidemiological analysis of delayed endolymphatic hydrops in Japan.

BACKGROUND: Delayed endolymphatic hydrops (DEH) is an inner ear disease that causes recurrent vertigo in the ipsilateral ear or fluctuating hearing in the contralateral ear due to endolymphatic hydrops secondary to preceding deafness. There are few reports of large, multicentre studies investigating the clinical-epidemiological characteristics of DEH. OBJECTIVE: This study aimed to clarify the characteristics of DEH in Japan. METHODS: Clinical data on 662 patients with DEH were analysed by nationwide, multicentre surveys conducted by the Peripheral Vestibular Disorders Research Group of Japan. RESULTS: The proportion of ipsilateral DEH (IDEH) was slightly higher than that of contralateral DEH (CDEH) at 55.4%. The time delay between onset of precedent deafness and onset of DEH was significantly longer for CDEH than for IDEH. The most common cause of precedent deafness was a disease of unknown cause with onset in early childhood (33.1%). Epidemiological characteristics were not significantly different between CDEH with and without vertigo. CONCLUSION: DEH appearing to be caused by viral labyrinthitis has a high rate of onset within 40 years of precedent deafness. Clinical and epidemiological characteristics of IDEH, CDEH with vertigo, and CDEH without vertigo were very similar. SIGNIFICANCE: The clinical-epidemiological characteristics of DEH in Japan were clarified.

[A Pediatric Case of Retropharyngeal Abscess Causing Multiple Instances of Cranial Nerve Palsy].

Deep neck abscesses are relatively rare in children compared with adults. Diagnosis can be difficult in pediatric patients because of the various clinical symptoms, therefore, it is important to correctly understand the pathology. We report herein on a rare pediatric case of a deep neck abscess that caused multiple instances of cranial nerve palsy. The patient was a 7-year-old boy who, despite treatment by a local physician for fever, swelling of the left neck and neck pain, developed torticollis, dysarthria, dysphagia and hoarseness and consequently consulted our department. We observed palsy associated with the IX, X, and XII left cranial nerves and a retropharyngeal abscess was diagnosed based on the computed tomography findings. The patient was hospitalized and underwent conservative treatment, and on day 21 of hospitalization, the patient was discharged after his symptoms had eased and the size of the abscess had reduced. We believe that palsy of the cranial nerves in the present case occurred as a result of pressure being applied to the cranial nerves in the carotid space due to an abscess in the retropharyngeal space.

Effects of arginine vasopressin on auditory brainstem response and cochlear morphology in rats.

OBJECTIVE: This study was conducted to evaluate the relationship between hearing and cochlear histopathology after arginine vasopressin administration in rats. METHODS: A total of 30 Wistar rats were injected with either 0.02 unit/g of arginine vasopressin or the same amount of isotonic saline solution. The initial auditory brain stem response threshold was recorded and additional measurements were made at 10, 30, 60, and 90 min after injection of arginine vasopressin or isotonic saline solution. The threshold for each timepoint was compared with the initial threshold. Histological quantitative assessment of endolymphatic hydrops in the cochlea was performed using light microscopy and assessment of the basal, intermediate, and marginal cells of the stria vascularis was performed with electron microscopy. RESULTS: The auditory brain stem threshold 60 min after arginine vasopressin injection increased significantly in comparison with the initial threshold (P<0.05). Although the index for endolymphatic hydrops in rats administered arginine vasopressin was not different from that in controls (P>0.05), vacuoles in the intermediate cells were increased significantly in the treated rats (P<0.01). CONCLUSION: Hearing impairment was detected without endolymphatic hydrops in rats administered arginine vasopressin. An increase of vacuoles in the intermediate cells may account for the hearing impairment induced by arginine vasopressin injection.

Clinical characteristics of delayed endolymphatic hydrops in Japan: A nationwide survey by the Peripheral Vestibular Disorder Research Committee of Japan.

CONCLUSION: Similarly to almost all delayed endolymphatic hydrops (DEH) cases with both precedent sudden deafness and mumps deafness, two-thirds of DEH cases with precedent deafness of unknown cause with onset in early childhood developed DEH symptoms within 40 years after the precedent deafness. In spite of the diagnosis of precedent deafness, viral labyrinthitis may build up the late endolymphatic hydrops in most DEH cases up to four decades. OBJECTIVE: To clarify the characteristics of DEH in Japan. METHODS: Clinical information on 198 DEH cases was collected by nationwide, multicenter surveys conducted by the Peripheral Vestibular Disorders Research Committee of Japan. RESULTS: The incidence of the ipsilateral type of DEH was 47.5%, which was almost equal to that of the contralateral type. In both types of DEH, the most common diagnosis of precedent deafness was deafness of unknown cause with onset in early childhood: 43.9% in both types of DEH. Sudden deafness and mumps deafness were the subsequent diagnoses of precedent deafness. The distribution of time delay of the onset between precedent deafness of unknown cause with onset in early childhood and DEH was different from that between precedent sudden and mumps deafness and DEH.

Inner-ear function test in cases of posterior canal-type benign paroxysmal positional vertigo.

Otolaryngologists typically perform diagnoses and offer medical treatment for vestibular dysfunction. This vestibular dysfunction manifests as benign paroxysmal positional vertigo (BPPV), Ménière's disease, vestibular neuronitis, and so on. The etiology of BPPV is still not clear, so in this article we discuss inner-ear function, etiology, and factors related to BPPV. We examined by pure-tone audiometry and hot and cold caloric tests patients whom we identified as having diagnosed posterior canal-type BPPV. We observed canal paresis at a high rate on the affected side (p < .01). The term of recovery at the first treatment was longer in patients with canal paresis as compared to those without. Deterioration of hearing level was observed more frequently on the affected side (p < .01). The horizontal semicircular canal and cochlea are important potential sites of lesions affecting posterior canal-type BPPV, and the posterior circular canal and otolith are already considered to be sites of affecting lesions.

IQ-ArfGEF/BRAG1 is associated with synaptic ribbons in the mouse retina.

IQ-ArfGEF/BRAG1 is a guanine nucleotide exchange factor for ADP ribosylation factors (Arfs), which are implicated in membrane trafficking and actin cytoskeleton dynamics. In this study, we examined the immunohistochemical localization of IQ-ArfGEF/BRAG1 in the adult mouse retina using light and electron microscopy. IQ-ArfGEF/BRAG1 was distributed in a punctate manner and colocalized well with RIBEYE in both the outer and inner plexiform layers. Immunoelectron microscopic analysis showed that IQ-ArfGEF/BRAG1 was localized at the synaptic ribbons of photoreceptors. When heterologously expressed in HeLa cells, IQ-ArfGEF/BRAG1 was recruited to RIBEYE-containing clusters and formed an immunoprecipitable complex with RIBEYE. Furthermore, immunoprecipitation analysis showed that anti-IQ-ArfGEF/BRAG1 antibody efficiently pulled down RIBEYE from retinal lysates. These findings indicate that IQ-ArfGEF/BRAG1 is a novel component of retinal synaptic ribbons and forms a protein complex with RIBEYE.

Correlation between arteriosclerotic changes and prognosis in patients with peripheral vestibular disorders.

Symptoms such as vertigo and unsteady gait occur in various diseases and are among the relatively common chief complaints. Even at present, the mechanisms underlying these disorders are unclear. We report a significant correlation between a prolonged period of resolution of benign paroxysmal positional vertigo (BPPV) and histories of lifestyle-related illnesses. We consider the possibility of correlating between BPPV prognosis and arteriosclerotic changes. Using carotid ultrasonography, we examined maximum intima-media thickness (IMT), maximum common carotid artery IMT, and biochemical examinations in 105 patients with peripheral vertigo. We divided patients with BPPV into groups with and without abnormal thickness of the IMT. The maximum IMT was 1.35 mm in patients with peripheral vestibular disorders. The proportion of peripheral vestibular disorder patients with a maximum IMT of > or = 1.1 mm (i.e., thickening) was 58%. The rate at which the feeling of positional vertigo remained at the halfway point in the observation period was significantly higher in the group of patients with an IMT of > or =1.1 mm (p = .0007). Our results indicate that cervical ultrasonography is useful for noninvasive examination of arteriosclerotic changes in patients with peripheral vestibular disorders. We saw indications that such patients show progression of arteriosclerotic changes. This study suggested that the arteriosclerotic change was related to prognosis.

Arteriosclerotic changes as background factors in patients with peripheral vestibular disorders.

Symptoms such as vertigo and unsteady gait occur in various diseases and are among the relatively common chief complaints. Even at present, the mechanisms underlying these disorders are unclear. We considered the possibility of peripheral vestibular disorders correlating with lifestyle-related illnesses. Under these circumstances, we assessed correlations of lifestyle-related illness as background factors for peripheral vestibular disorders and associated arteriosclerotic changes. Using carotid ultrasonography, we assessed maximum intima-media thickness (max IMT) and maximum common carotid artery IMT and evaluated biochemical examinations in 85 patients with peripheral vertigo. The patients were divided into two groups: those with benign paroxysmal positional vertigo (BPPV) and those with peripheral vestibular disorders. The frequency of abnormal IMT was significantly higher in those in the BPPV group. Calculating for average age, max IMT was significantly higher in the BPPV group. The correlation coefficient between age and max IMT was 0.343 (p < .001). All other correlation coefficients also reached statistical significance. Our results indicate that cervical ultrasonography is useful for noninvasive examination of arteriosclerotic changes in patients with peripheral vestibular disorders. Our results also indicated that peripheral vestibular disorder patients show progression of arteriosclerotic changes.

Water may cure patients with Meniere disease.

OBJECTIVES/HYPOTHESIS: We examined whether sufficient water intake is effective in the long-term control of vertigo and hearing activity in patients with Meniere disease (MD) for whom conventional therapy has proven unsuccessful. STUDY DESIGN: The authors conducted a time-series study with historical control. METHODS: Eighteen patients with MD in group 1 drank 35 mL/kg per day of water for 2 years. Twenty-nine patients with MD treated with the conventional dietary and diuretic therapy for more than 2 years during 1992 to 1999 at the same hospital were enrolled in a historical control of group 2. RESULTS: Patients in group 1 dramatically relieved vertigo and significantly improved in the hearing of the worst pure-tone average of three frequencies (0.125, 0.25, and 0.5 kHz) (low PTA) during the last 6 months of the study period. In contrast, patients in group 2 became worse in both the four- (0.5, 1, 2, and 4 kHz) frequency PTA and the low PTA, although their vertigo did improve. The number of patients whose hearing were improved, unchanged, and worse were 4, 12, and 2 in group 1 and 2, 11, and 16 in group 2, respectively. CONCLUSION: Deliberate modulation of the intake of water may be the simplest and most cost-effective medical treatment for patients with MD. Larger studies will be needed to confirm these results in a larger patient cohort.

Three-dimensional reconstruction of the human semicircular canals and measurement of each membranous canal plane defined by Reid's stereotactic coordinates.

OBJECTIVES: Equations for estimating the planar relationships of the human semicircular canals were devised by Blanks et al from a dissected bony labyrinth in a human skull. However, a similar study on the membranous semicircular canal planes has never been published. METHODS: In this study, the angle between each membranous canal plane and Reid's stereotactic horizontal plane was measured on serial histologic sections of 7 temporal bones from Japanese adults. We reconstructed the 3 semicircular canals by computer-aided 3-dimensional analysis. The angles between each pair of both bony and membranous canal planes were measured. RESULTS: In the bony labyrinth, the angles between the 2 canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.51 degrees +/- 2.98 degrees (mean +/- SD), 91.70 degrees +/- 1.85 degrees, and 94.52 degrees +/- 3.32 degrees, respectively. The angles between the 2 membranous canal planes of the lateral-anterior, anterior-posterior, and lateral-posterior pairs were 90.05 degrees +/- 4.74 degrees, 91.03 degrees +/- 2.93 degrees, and 91.92 degrees +/- 5.22 degrees, respectively. CONCLUSIONS: The data from our study of the membranous labyrinth showed that the angles between each canal plane and the others were much closer to 90 degrees than was found by Blanks et al for the bony labyrinth.

Three-dimensional analysis of morphological aspects of the human utricular macula.

The 3-dimensional shape of the human utricular macula and its orientation in the skull are quantitated in this report, which is one of a series. The semicircular canals and utricular macula were reconstructed in 3 dimensions on a computer from 3 human temporal bones. The 238 to 279 triangles in the entire area of the utricular macula were made by drawing lines between 2 adjacent points every 200-microm width of the utricular macula in each section. We calculated the angles between each triangle and each estimated standard axis in the skull. This study provides standard data regarding the 3-dimensional morphological aspects of the utricular macula for further investigation of the function of the utriculus. We determined that the 3-dimensional shape of the utricular macula was not a plane, but was a curved surface like that of an ellipsoid. We believe this shape is necessary for the utricular macula to detect wide-range linear acceleration.

Cephalometric and fiberoptic evaluation as a case-selection technique for obstructive sleep apnea syndrome (OSAS).

In order to obtain relatively simple and useful parameters to estimate the severity of obstructive sleep apnea syndrome (OSAS), cephalometric and fiberoptic studies were performed in 64 clinical cases previously diagnosed with either OSAS or snoring. Fourteen cephalometric parameters, 13 parameters derived from physical examination and 18 fiberoptic parameters were compared with the apnea index (AI), the apnea-hypopnea index and lowest SaO2 values. Statistically significant correlations were found between the Al and the shortest linear distance from the posterior line of the soft palate to the posterior pharyngeal wall measured along a line parallel to the supramentale-Gonion line (PAS-epipharynx distance), the distance from the mandibular plane to the most anterior and superior point on the body of the hyoid bone obtained from cephalometry (MP-H distance) and the degree of redundancy of mucosa in the arytenoid/aryepiglottic fold obtained from videoendoscopy. An increased Al was observed when the PAS-epipharynx distance was < 7 mm and there was 100% obstruction in Muller's maneuver at the palate level (supine), the MP-H distance was > 27.4 mm and the mucosa of the arytenoid/aryepiglottic fold was markedly redundant. As these three parameters are relatively easy to obtain on an outpatient basis, it is suggested that they could be used in an outpatient setting to provide a good prediction of the severity of OSAS.