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Background: This study aimed to clarify the prognosis of asymptomatic endolymphatic hydrops (EH) in healthy volunteers via five-year follow-ups with inner ear magnetic resonance imaging (MRI)., Methods: Inner ear MRI was performed on 115 participants recruited as controls in a previous study on Meniere's disease. The endolymphatic space was visualized using Naganawa's method of contrast-enhanced MRI with intravenous gadolinium injection and evaluated using Nakashima's method of 2D imaging analysis., Results: Cochlear or vestibular EH was present in 7.0% of participants ( n  = 8), with all cases being unilateral (laterality), moderate (severity), and asymptomatic (onset). Only cochlear-localized EH, only vestibular-localized EH, and both EH were present in 1.7% ( n  = 2) (C group), 4.3% ( n  = 5) (V group), and 0.9% ( n  = 1) (CV group) of participants, respectively. Conducting inner ear MRI after 5 years showed that EH had almost disappeared in two participants in the C and V groups (4/8, 50.0%). EH was still present in three participants in the V group and one in the CV group (4/8, 50.0%). One participant in the V group and another in the CV group presented with residual inner ear EH and developed typical symptomatic Meniere's disease (2/8, 25.0%)., Conclusions: Approximately 7% of healthy participants showed asymptomatic EH. Therefore, EH is not the definitive marker for making a diagnosis of Meniere's disease or the suitable predictor for the development of Meniere's disease. Among these participants, 25% maintained EH and subsequently developed typical Meniere's disease within the next 5 years. Schellong-positive participants maintained persistent EH in the inner ear, and participants with higher scores on the self-rating depression scale developed Meniere's symptoms after 5 years., Level of Evidence: 2a., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Increased fall risk caused by vestibular system impairment is a significant problem associated with aging. A vestibule is composed of linear acceleration-sensing otoliths and rotation-sensing semicircular canals. Otoliths, composed of utricle and saccule, detect linear accelerations. Otolithic organs partially play a role in falls due to aging. Aging possibly changes the morphology and functions of otoliths. However, the specific associations between aging and otolith changes remain unknown. Therefore, this study aimed to clarify these associations in mice., Methods: Young C56BL/6 N (8 week old) and old (108-117 weeks old) mice were used in a micro-computed tomography (μCT) experiment for morphological analysis and a linear acceleration experiment for functional analysis. Young C56BL/6 N (8 week old) and middle-aged (50 week old) mice were used in electron microscopy experiments for morphological analysis., Results: μCT revealed no significant differences in the otolith volume ( p  = 0.11) but significant differences in the otolith density ( p  = 0.001) between young and old mice. μCT and electron microscopy revealed significant differences in the structure of striola at the center of the otolith (μCT; p  = 0.029, electron microscopy; p  = 0.017). Significant differences were also observed in the amplitude of the eye movement during the vestibulo-ocular reflex induced by linear acceleration (maximum amplitude of stimulation = 1.3G [ p  = 0.014]; maximum amplitude of stimulation = 0.7G [ p  = 0.015]), indicating that the otolith function was worse in old mice than in young mice., Discussion: This study demonstrated the decline in otolith function with age caused by age-related morphological changes. Specifically, when otolith density decreased, inertial force acting on the hair cells decreased, and when the structure of striola collapsed, the function of cross-striolar inhibition decreased, thereby causing a decline in the overall otolith function., Competing Interests: The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ueda, Imai, Ito, Okayasu, Harada, Kamakura, Ono, Katsuno, Tanaka, Tatsumi, Hibino, Wanaka and Kitahara.)

Background and Aim: Although no specific sedation recommendations exist in early-stage gastric cancer (ESGC) for endoscopic submucosal dissection (ESD), dexmedetomidine (DEX) is useful along with benzodiazepines and analgesics. Furthermore, DEX is used for endoscopic treatment requiring lengthy sedation. However, it is unclear which patients should be administered DEX. We examined the factors that determine when DEX should be added for sedation during ESD for ESGC., Methods: Of 316 patients undergoing ESD for ESGC at our hospital between January 2017 and December 2020, we examined 310 receiving intravenous anesthesia. Preoperative patient factors and treatment outcomes were retrospectively examined according to the sedation method., Results: Among patients with ESGC undergoing ESD at our hospital, DEX was more frequently used alongside sedation in men, those undergoing gastrectomy, those with a lesion diameter ≥20 mm, and those with preoperative ulcers. In the standard group, patients whose treatment duration exceeded 120 min typically had a lesion diameter ≥20 mm, preoperative ulcers, lesions located outside the L region, and were treated by junior physicians., Conclusion: It is important to evaluate specific preoperative factors (lesion diameter ≥20 mm, preoperative ulcers, lesion located outside the L region, and having a junior physician as the treating physician) in patients undergoing ESD for ESGC to determine whether the combined use of DEX in sedation is necessary., (© 2024 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Kampo medicine, a traditional Japanese herbal medicine, is used for the treatment of otologic and neurotologic diseases in Japan and other Asian countries. However, only Japanese medical doctors can prescribe both Kampo and modern (Western) medicine. Since a medical doctor can perform not only the diagnosis but also Kampo treatment, it is expected that the quality of clinical studies on traditional herbal medicine is higher in Japan than that in other countries. However, there is no Kampo review written in English language for the treatment of otology/neurotology diseases. Herein, we would like to demonstrate evidence of Kampo treatment for otology/neurotology diseases according to previous studies in Japan., Competing Interests: Declaration of Competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier B.V.)

CO 2 enrichment is an essential environmental control technology due to its significantly enhancing effect on crop production capacity. Despite being a key energy consumer in protected agriculture (i.e. greenhouse systems), CO 2 enrichment remains at a low energy use efficiency level, highlighting the need for developing more energy-efficiency strategies for CO 2 enrichment. Therefore, this study employed the computational fluid dynamics (CFD) simulation method to replicate the CO 2 diffusion process resulting from CO 2 enrichment in three commercial strawberry greenhouses with varying geometric characteristics. Based on the CFD-simulated CO 2 concentration distributions, the leaf photosynthetic rate was calculated using a mathematical model group. The CO 2 enrichment efficiency was then analysed by calculating the ratio of increased photosynthesis across the cultivation area to the amount of energy (in CO 2 equivalent) used. The efficiency peaked when the average CO 2 concentration was approximately 500 μmol mol -1 , thereby providing guidance for determining the target concentration of CO 2 enrichment in production. Although this study is limited as the CFD simulation only considered a typical short-period CO 2 enrichment event, future research will provide a broader analysis by considering changes throughout the day., (© 2023. Springer Nature Limited.)

Introduction: Dizziness is a common disease. However, approximately 10-40% of patients were diagnosed unknown dizziness even though general, neurological, and otological examinations were performed. The aim of this otopathological study was to investigate the histopathology of the peripheral vestibular system of patients who suffered from undiagnosed dizziness., Methods: Eighteen temporal bone specimens from 9 patients with undiagnosed dizziness and 20 temporal bone specimens from age-matched 10 normal controls were selected. Cases with a history of dizziness and vertigo caused by particular peripheral vestibular disease and central etiology were excluded. Specimens of the vestibular system were carefully assessed by light microscopy. The basophilic deposits adhered to cupulae of the semicircular canals and the wall of the labyrinth were investigated. Scarpa's ganglion cell counts in the vestibular nerves were performed., Results: Fifteen ears of 9 patients had the findings of vestibular pathology such as a basophilic deposit on cupula (8 ears), on canal wall (7 ears), vestibular nerve loss (8 ears), or vestibular atelectasis (2 ears). Unclear pathological findings such as crista neglecta, subepithelial deposits of the crista ampullaris, and adhesion of the cupula to dark cell area were demonstrated. The mean size of basophilic deposits seen in the patients (mean: 191 µm) was larger than that of latent deposits seen in the normal controls (mean: 101 µm; p = 0.01)., Conclusions: We demonstrated some peripheral vestibular pathological findings such as deposit within the semicircular canal, vestibular nerve loss, and vestibular atelectasis and suggested the possible diagnosis of dizziness (benign paroxysmal positional vertigo, presbyvestibulopathy, vestibular atelectasis). These findings will provide a better insight into the multiple etiologies of the unknown dizziness in the elderly., (© 2022 S. Karger AG, Basel.)

Mononeuritis multiplex is a rare form of cerebral nerve palsy caused by various factors. Coronavirus disease 2019 (COVID-19) vaccination could be an etiology of mononeuritis multiplex, which can affect various nerves. Post-COVID-19 and vaccination-related neurological impairments involve cranial nerves such as the facial, trigeminal, and vagal nerves. We report our experience with a 34-year-old man who developed hypoglossal nerve palsy following COVID-19 vaccination, complicated by progressive mononeuritis multiplex. Hypoglossal nerve palsy may occur following COVID-19 vaccination. The symptoms vary and may progress without treatment. Physicians should consider the possibility of mononeuritis multiplex after COVID-19 vaccination and provide prompt treatment for acute symptom progression., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Okayasu et al.)

Immunoglobulin A (IgA) vasculitis is small-vessel arteritis triggered by autoimmunity and allergies. IgA vasculitis among elderly patients is rare, and there is a lack of evidence regarding the choice of medicine and treatment duration. The main treatment for IgA vasculitis is steroids which can be cured with a small dose of prednisolone without immunosuppressants. Here, we report a case of a 90-year-old patient with the chief complaint of appetite loss and purpura on the legs who was diagnosed with IgA vasculitis based on biopsy results. The patient was initially treated with prednisolone effectively but exacerbated with steroid tapering, eventually requiring the use of an immunosuppressant. This case highlights the importance of monitoring the symptoms of IgA vasculitis while tapering steroids and clarifying the timing of immunosuppressant initiation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Nishikura et al.)

Various prognostic factors for idiopathic sudden sensorineural hearing loss (SSNHL) have been reported. Hearing loss directly derived from idiopathic SSNHL is important for understanding underlying pathogenesis and outcomes. We assessed the usefulness of evaluating hearing loss and recovery of idiopathic SSNHL on the basis of estimated hearing loss. The study included 115 patients whose characteristics and outcomes of hearing loss were investigated. The effects of vertigo/dizziness and age on hearing thresholds before/after treatment, nonaffected ear threshold, estimated hearing loss, improvement of hearing loss, and estimated remaining hearing loss were investigated. Vertigo/dizziness was a significant prognostic factor for hearing. In vertigo/dizziness patients, significantly more severe hearing loss and poorer improvement of hearing loss were observed above 500 Hz and below 1000 Hz, respectively. Severe hearing disorder remained at all frequencies. Conversely, post-treatment thresholds were significantly higher in the older population (≥65 years), although no differences in pretreatment thresholds were observed between the younger (≤64 years) and older populations. However, on the basis of nonaffected ear thresholds, previously existing hearing loss could have influenced the outcome. Thus, comparison of hearing outcomes between affected and nonaffected ears is essential for understanding hearing loss and outcomes in idiopathic SSNHL cases with existing hearing disorder.

Objective: Congenital aural atresia causes severe conductive hearing loss disturbing auditory development. The differences in speech recognition were investigated between bilateral and unilateral aural atresia., Design: The maximum speech recognition scores (SRSs) were compared between patients with bilateral and unilateral aural atresia. In patients with unilateral aural atresia, the maximum SRSs were compared between the atretic and unaffected ears. Furthermore, the correct response rates for test material monosyllables were compared with those of patients with sensorineural hearing loss (SNHL), which had been previously obtained., Study Sample: Twenty-four patients with aural atresia (8 bilateral, and 16 unilateral) participated., Results: The maximum SRS in unilateral atretic ears (median: 72%) was significantly lower than that in unaffected ears (median: 89%) ( p  < 0.05) and in bilateral atretic ears (median: 91%) ( p  < 0.05). Patients with aural atresia had relatively high correct response rates for monosyllables with low correct response rates by patients with SNHL. Conversely, incorrect responses were obtained for several words for which high correct-response rates were attained by patients with SNHL., Conclusions: Poor unilateral atretic-ear development may induce low speech recognition, and the mechanisms underlying speech-recognition reduction differ from those in SNHL.

Giant cell arteritis (GCA) is an autoimmune disease that causes inflammation of the middle and large arteries. Rural areas have many older patients with various symptoms, so large-vessel-type GCA should be managed effectively. Older patients tend to show vague symptoms that cannot be adequately diagnosed and observed. Here, we have encountered a case of a 91-year-old woman with a chief complaint of fatigue diagnosed with large-vessel type GCA in collaboration with a rural clinic. Effective collaboration between physicians in rural hospitals and clinics is necessary for diagnosing and treating large-vessel GCA. In rural areas, without adequate healthcare professionals, physicians should share their abilities and collaborate smoothly to mitigate delays in consultation and treatment. To effectively treat large vessel-type GCA, rural general physicians should be familiar with the clinical course of the disease and treatment for rural comprehensive care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ohta et al.)

COVID-19 causes not only acute but also subacute medical conditions during the clinical course. COVID-19 causes severe inflammatory conditions; therefore, patients may develop long-term complications. Among patients with acute COVID-19, some patients can experience persistent symptoms, such as fatigue, joint pain, and smell and taste abnormalities, known as the long COVID-19 syndrome. The symptoms can be severe and require continuous medical care. Patients with severe clinical courses of COVID-19 may have critical symptoms again after the cure of the acute infections, especially among older patients. We encountered a case of neutropenia and myositis one month after contracting COVID-19. An 89-year-old man presented to our hospital with acute-onset systemic muscle pain and difficulty in movement and speaking. The patient had neutropenia and myositis with an extremely high level of immunoglobulin G caused by COVID-19. A granulocyte colony-stimulating factor could be effective for treating neutropenia. Besides, prednisolone was effective for treating myositis. In community hospitals, after developing COVID-19, appropriate history taking and physical examination should be performed in older patients with ambiguous symptoms, as they might have critical medical conditions such as neutropenia and myositis. The appropriate diagnosis and treatments of older patients with the complications of COVID-19 should be performed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Okayasu et al.)

Many people are affected by tinnitus, a sensation of ringing in the ear despite the absence of external sound. Goshajinkigan (GJG) is one of the formulations of Japanese traditional herbal medicine and is prescribed for the palliative treatment of patients with tinnitus. Although GJG is clinically effective in these patients, its behavioral effects and the underlying neuroanatomical substrate have not been modeled in animals. We modeled tinnitus using salicylate-treated rats, demonstrated the effectiveness of GJG on tinnitus, and examined the underlying neuronal substrate with c-Fos expression. Intraperitoneal injection of sodium salicylate (400 mg/kg) into rats for three consecutive days significantly increased false positive scores, which were used to assess tinnitus behavior. When GJG was orally administered one hour after each salicylate injection, the increase in tinnitus behavior was suppressed. The analysis of c-Fos expression in auditory-related brain areas revealed that GJG significantly reduced the salicylate-induced increase in the number of c-Fos-expressing cells in the auditory cortices, inferior colliculus, and dorsal cochlear nucleus. These results suggest a suppressive effect of GJG on salicylate-induced tinnitus in animal models.