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The incidence of Meniere's disease was investigated in patients with vertigo or dizziness who visited Kitasato University Hospital from 1985 to 1991. Of a total of 3, 222, Meniere's disease was diagnosed in 251 patients (7.8%). The male female ration was 1 : 1.73.Seventy patients with Meniere's disease were classified into 5 groups, depending on the duration of the disease. Both ears were affected in 12 (17.1 %) of the 70, but in 4 (33.3%) of the 12 patients with more than 15 years of disease.Of the 70 patients 67 were treated conservatively, and 3 surgically. The frequency of vertigo attacks and the degree of hearing impairment during the past year in each group were compared. No vertigo attack was experienced in 13 (24.1 %) of the 70. In 49 patients the average number of vertigo attack was 4.5 in the past year.Adequate therapy is most desirable within one year after the onset of Meniere's disease, because the frequency of vertigo attacks and the hearing level can be best controlled when therapy is started less than one year after the onset.

The origin of nystagmus, and the neurological symptoms and signs in 5 patients with Wallenberg's syndrome were related to the site and extension of lesions revealed by MRI. The relationship between nystagmus and a lesion in the neural structure, especially in the vestibular nucleus, was studied.1. Pure rotatory nystagmus was observed in 3 of the 5 patients, rotatory nystagmus with dissociated vertical movements like a see-saw in one, and no nystagmus in one.2. Nystagmus towards the side of the lesion was observed in one patient and nystagmus towards the contralateral side in 3.3. MRI did not reveal any lesions at the level of the lateral vestibular nucleus in any of the patients.4. Two patients, who had lesions in the medial and or inferior vestibular nucleus, did not complain of vertigo. On the contrary, 3, who had no lesions in the vestibular nuclei, complained of vertigo or dizziness. Therefore, it was supposed that a lesion adjacent to the vestibular nuclei associated with preservation of the vestibular nuclei might cause vertigo.5. Both skew deviation of the eyes and head tilt phenomenon were observed only in patients with no preservation of the medial and or inferior vestibular nucleus.6. Recording of eye movements with a CCD camera was very helpful in the analysis of nystagmus and in the follow-up studies of these patients.

We compared the effectiveness of 2 different therapies in elderly patients with benign paroxysmal positional vertigo.Eighteen patients were treated with an anti-vertigo drug and 18 with vestibular training (VT) and the same drug. They were classified into Group "B" and "VT + B", respectively.The background factors, such as age, severity in symptoms, degree of disturbance in examinations, et, were similar in the 2 groups.Vertigo, dizziness, unsteadiness in Mann's test and positional nystagmus improved significantly more in Group "VT+B" than in Group "B". The global judgment in each group revealed that both marked and moderate improvement was significantly higher in Group "VT+B" than in Group "B" (P

In order to evaluate the effectiveness of various therapies for vertigo at-tacks associated with tinnitus and hearing loss in Meniere's disease, the standard of both AAOO in 1972 and AAO-HNS in 1985 for the evaluation have been used in the United States and in Japan. The efficacy of treatment to prevent or decrease vertigo attacks and the duration of observation to evaluate it are the two main points discussed because the recurrence of attacks causes great suffering and it may make a hearing loss irreversible.There is often need to evaluate conservative treatment even soon after the start of therapy in order to judge whether the treatment is suitable for the patient. The modified evaluation method of AAO-HNS, which compares the mean numbers of attacks during the same intervals before and after the start of treatment is proposed in this study. This method can be useful both for short observation times less than 2.5 years and for long times of 3 or 5 years or more.

Positional nystagmus of the direction changing type, especially nystagmus towards the side of the upper ear in the lateral head position, is considered to appear in patients with disorders of the central nervous system. However, it might also occur in patients with peripheral vestibular disturbances.The pathogenesis of nystagmus directed towards the upper ear side remains obscure because controversial results have been reported in several papers.This paper discribes two patients with positional nystagmus directed towards the upper ear side, which was provoked after a short latency in both lateral head positions and disppeared within a few days. In both patients neurological and neurootological examinations indicated the presence of peripheral vestibular disorders.A fragment of statoconia adhering temporarily to the cupula of the lateral semicircular canal might be the cause of the nystagmus in our two patients.

Vestibular neuronitis is a peripheral vestibular disease of unknown etiology, in which severe vertigo attacks associated with disequilibrium usually start without any cochlear signs such as tinnitus or deafness after acute upper respiratory inflammation. It is generally accepted that the disease has a good prognosis beacause both subjective sensation and objective disequilibrium gradually improve and no recurrence of attacks is noticed.However, some patients complain of a transient dizzy sensation induced by quick body motion and disequilibrium during standing or walking, especially in darkness, a long time after the onset.Follow-up studies were carried out in six patients with vestibular neuronitis for 1 to 2 years after the beginning of the disease. Canal paresis was revealed by caloric tests in all six, it was bilateral in one. Five had transient diz-ziness and or unsteadiness during quick body movements 1 to 2 years after the onset of the disease. ENG studies revealed spontaneous nys-tagmus with eyes closed in two patients more than 2 years after the onset. The residual symptoms of dizziness and disequilibrium during body motion in vestibular neuronitis were assumed to be caused by prolonged failure in the acquisition of central vestibular compensation. Physical exercises were ordered in 2 patients, but complete recovery was not achieved.Disturvance of activities of daily living (ADL) are also discussed.

Opsoclonus was analyzed in two patients with acute encephalitis in the initial, extreme and recovery stages and the ENG and VTR findings were compared.In the initial stage ocular oscillation was mainly in the horizontal direction, with an amplitude of 5-30 degrees and a frequency of 7-8 Hz. It started suddenly several days after the patients developed fatigue and fever. A series of 1-10 beats of eye movements with some pause of various durations was repeated.Head rolling from side to side with a small amplitude was sometimes accompanied by eye oscillations. The patients had oscillopsia and an unsteady and staggering gait.The extreme stage started a few days after the initial stage. There was typical opsoclonus, consisting of multidirected but mainly vertical or diagonal oscillations of the eyes. The amplitude was large and reached 80 degrees. The frequency varied from 3-9 Hz. There were almost no pauses. The patients were unable to sit up, and their heads trembled in the same direction as the eye movements. Myoclonic jerks and ataxia of the trunk and extremities were maximum.In the recovery stage, the eye oscillations gradually decreased, and flutter-like oscillations (FLO) appeared. They were mainly horizontal, 5-20 degrees in amplitude, and their frequencies were 7-8 Hz. Pauses of various durations followed each series of 1-10 beats. The patients were able to stand and walk.Opsoclonus was triggered in all three stages by visual fixation, intention to move the eyes, mental excitation and sound stimulation.

The maculo-ocular reflex related to horizontal sinusoidal linear accelerations was studied in 7 patients with labyrinthine disorders, 4 with unilateral and 3 with bilateral disturbances.1. The responses of the patients with unilateral labyrinthine disorders were the same as those of normal human subjects.2. Reduced responses and increased phase differences were observed in the patients with bilateral labyrinthine disorders.3. Differences in functional vulnerability between the semicircular canals and the otolith organs were demonstrated in patients with ototoxic disorders by comparing the results of the pendural rotation test with those of the sinusoidal linear acceleration test.