Thirty-year trends in sudden deafness from four nationwide epidemiological surveys in Japan.

CONCLUSIONS: The estimated annual number of patients with sudden deafness treated in Japan has increased during the last 30 years, especially in the elderly population. Hypertension and diabetes mellitus could contribute to the etiology of this disorder. OBJECTIVES: To investigate the epidemiological trends of sudden deafness in Japan over the past 30 years by analyzing data from national surveys. MATERIALS AND METHODS: Nationwide epidemiological surveys on sudden deafness were conducted four times by the Research Committee of the Ministry of Health and Welfare in Japan. The first, second, third, and fourth surveys were performed in 1972, 1987, 1993, and 2001, respectively. RESULTS: The estimated annual numbers of patients with sudden deafness treated in Japan were 4000 in 1972; 16,700 in 1987; 24,000 in 1993, and 35,000 in 2001. The average ages of patients at onset were 39.1, 45.4, 49.3, and 51.3 years, respectively. Thus, both the number of patients and the average age of patients with sudden deafness have increased during the past 30 years. Patients with sudden deafness in the fourth survey exhibited hypertension and diabetes mellitus more frequently than did patients in the first survey; this trend was particularly noticeable among elderly patients.

Response of cochlear blood flow to prostaglandin E1 applied topically to the round window.

CONCLUSIONS: The increase in cochlear blood flow (CBF) after administration of prostaglandin E1 (PGE1) to the round window depends on increased blood flow through the anterior inferior cerebellar artery (AICA). OBJECTIVES: To evaluate the response of CBF to PGE1 applied topically to the round window, and to investigate the origin of blood flow changes after this topical application. MATERIAL AND METHODS: The response of CBF to topically applied PGE1 was measured by placing the tip of a laser Doppler probe on the bony wall of the basal turn of the cochlea after the middle ear mucosa over the cochlea had been removed in guinea pigs and rats. In rats, the CBF response to PGE1 administration was investigated after occlusion of the AICA or stapedial artery. RESULTS: CBF increased following PGE1 administration in both guinea pigs and rats. In rats, CBF increased from 100% to 132%+/-10% (mean+/-SD) after the topical application of 0.5 microl of a 0.014% PGE1 solution. CBF decreased after occlusion of the AICA or stapedial artery but did not increase after PGE1 administration during occlusion of the AICA. The CBF response to PGE1 administration was similar before and after occlusion of the stapedial artery.

Small cell carcinoma of the larynx treated with irinotecan and cisplatin.

We report a case of advanced small cell carcinoma in the larynx, which was treated with Irinotecan hydrochloride (CPT-11) chemotherapy. The patient was free of disease for 4 years after treatment. Several chemotherapeutic agents for small cell carcinoma have been proposed; however, median survival time has been miserable, especially in advanced cases. For the cure of the aggressive lethal behavior of this disease, chemotherapy with CPT-11 might be effective to improve median survival of patients with small cell carcinomas of the larynx.

Blood flow in the ears of patients receiving cochlear implants.

We measured cochlear blood flow (CBF) in 55 patients who received cochlear implants, using a laser-Doppler probe placed over the site of drilling in the cochlear bony wall. The subjects included 29 patients with congenital deafness of unknown cause, 8 with idiopathic progressive sensorineural hearing loss, 4 with postmeningitic deafness, 3 with Waardenburg's syndrome, 3 with congenital cytomegalovirus infection, and 8 whose deafness had other causes. There was a wide range of CBF values in patients with congenital deafness of unknown cause. In the patients with idiopathic progressive sensorineural hearing loss, the CBF was significantly lower in patients more than 40 years old. Intracochlear calcification following meningitis appears to be associated with a reduced CBF.

Changes in cochlear blood flow due to endotoxin-induced otitis media.

The purpose of this study was to elucidate the influence of otitis media on blood flow in the lateral wall of the cochlea by means of a model of endotoxin-induced otitis media. The cochlear blood flow (CBF) following lipopolysaccharide inoculation into the middle ear cavities of rats was measured by laser-Doppler flowmetry and compared with that of untreated ears. After this evaluation, the influence on CBF of concomitant use of a nitric oxide synthase inhibitor was also investigated. The first day after inoculation, the CBF of treated ears decreased significantly. This decrease recovered gradually between the 7th and 14th days. With concomitant use of a nitric oxide synthase inhibitor, the decrease in CBF was prevented to some extent. The results showed a functional influence upon CBF by endotoxin-induced otitis media. The significance of prophylactic use of the drug is also discussed in regard to the effect on CBF following otitis media.

Contribution of stapedial artery to blood flow in the cochlea and its surrounding bone.

This study was performed to elucidate the contribution of the stapedial artery (SA)--which has been considered to be independent of the vertebrobasilar system--to blood flow in the ear by observing ear blood flow in Sprague-Dawley rats. A laser-Doppler (LD) probe was positioned on the bony wall of the cochlear basal turn after removal of the middle ear mucosa. The LD output was measured while either or both the SA and the anterior inferior cerebellar artery (AICA) were occluded. The LD output decreased to 70.6+/-2.5% (mean+/-S.D.) of the baseline value following SA occlusion, and to 58.0+/-7.8% following AICA occlusion in 12 animals. The rebound phenomenon of blood flow, which is a type of autoregulation, was only observed after releasing AICA occlusion. Simultaneous occlusion of the SA and AICA decreased the LD output to 27.0+/-5.5% of the baseline value. The role of the contribution of the SA and AICA to the LD output is discussed.

A comparative study of intratympanic steroid and NO synthase inhibitor for treatment of cochlear lateral wall damage due to acute otitis media.

We studied the damage to the cochlear lateral wall induced by otitis media and the therapeutic effects of intratympanic administration of steroid and nitric oxide (NO) synthase inhibitor. In Sprague-Dawley rats, right middle ear cavities were inoculated with lipopolysaccharide, followed after 30 min by intratympanic administration of dexamethasone, NOS-inhibitor or PBS. Twenty-four hours after lipopolysaccharide inoculation, cochlear blood flow was measured by laser-Doppler flowmetry. Prostaglandin E(1) was topically applied to the round window membrane of the right ear and changes in cochlear blood flow were calculated. Changes of cochlear blood flow were significantly different among the three groups. Increases in cochlear blood flow following PGE(1) application were higher in the group that received NOS-inhibitor. Electron microscopic examination revealed that changes in the stria vascularis were less severe in rats treated with dexamethasone or NOS-inhibitor. Our results show the effectiveness of intratympanic dexamethasone or NOS-inhibitor in treating cochlear lateral wall damage caused by otitis media.

Disorders of cochlear blood flow.

The cochlea is principally supplied from the inner ear artery (labyrinthine artery), which is usually a branch of the anterior inferior cerebellar artery. Cochlear blood flow is a function of cochlear perfusion pressure, which is calculated as the difference between mean arterial blood pressure and inner ear fluid pressure. Many otologic disorders such as noise-induced hearing loss, endolymphatic hydrops and presbycusis are suspected of being related to alterations in cochlear blood flow. However, the human cochlea is not easily accessible for investigation because this delicate sensory organ is hidden deep in the temporal bone. In patients with sensorineural hearing loss, magnetic resonance imaging, laser-Doppler flowmetry and ultrasonography have been used to investigate the status of cochlear blood flow. There have been many reports of hearing loss that were considered to be caused by blood flow disturbance in the cochlea. However, direct evidence of blood flow disturbance in the cochlea is still lacking in most of the cases.

[Effects of round window membrane rupture on cochlear blood flow and endocochlear potential].

The degree of hearing loss and audiogram shape vary in patients with perilymphatic fistula. The cause of variability is not well known. To determine the effect of perilymphatic fistula on cochlear function, we studied the effect of round window membrane rupture on cochlear blood flow (CBF) by placing a laser-Doppler probe to the basal turn in 20 guinea pigs. In 10, endocochlear potential (EP) was measured by inserting a glass microelectrode through the stria vascularis of the basal turn. During 60 minutes following round window membrane rupture, CBF decrease of more than 15% was observed in 9 of 20 animals, and EP decrease of more than 15% was observed in 5 of 10. A significant correlation was observed between the degree of CBF reduction and EP reduction. In 3 animals in which CBF decreased after round window membrane rupture, temporal bones were studied histologically. One cochlea showed endolymphatic hydrops and another cochlea showed significant hemorrhage in the scala tympani after rupture. These results suggested that CBF impairment is associated with cochlear dysfunction in perilymphatic fistula.

Imaging of a congenital perilymphatic fistula.

A 7-year-old boy with a history of purulent meningitis and watery rhinorrhea was studied using computed tomography (CT) and magnetic resonance imaging (MRI). He had a common cavity in the left inner ear. With high-resolution heavily T2-weighted MRI, leakage of the inner ear fluid into the middle ear at the oval window area through a congenital perilymphatic fistula could be visualized. Surgery to close the fistula showed a perforation in the stapes footplate.

Blood flow measurements in the ears of patients receiving cochlear implants.

We measured cochlear blood flow in 12 patients who received cochlear implants, using a laser-Doppler probe with an outer diameter of 0.8 mm. The subjects had congenital deafness, idiopathic progressive sensorineural hearing loss, Waardenburg's syndrome, narrow internal auditory canal, or sudden deafness. Putting the probe tip to the site of drilling for cochlear implantation, we measured blood flow before, during, and after the cochlear bony wall was opened. The laser-Doppler output was confirmed even after the tip of the probe was inserted into the perilymphatic space in all cases. Our results revealed that blood flow was maintained in all cochleas, although there was a probability of reduction in blood flow volume. We conclude that laser-Doppler flowmetry is both relatively safe and useful for measuring blood flow in the ears during cochlear implantation procedures.

Transmeatal low-power laser irradiation for tinnitus.

OBJECTIVE: To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus. STUDY DESIGN: Prospective, randomized double-blind study. METHODS: This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined. RESULTS: No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. CONCLUSION: Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.