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Aims/objectives: To examine the effects of surgery for unilateral sinonasal lesions on sleep-disordered breathing (SDB).Material and methods: Oxygen desaturation index (3%ODI) as a marker o...

Background: Regarding the relationship between psychiatric disorders and dizziness, anxiety is the most frequently seen psychiatric disorder in dizzy patients.Objective: We compared the effects of ...

Syphilis is a systemic infection caused by Treponema pallidum, and acquired syphilis is a well-known sexually transmitted infection with a variety of symptoms that hinder accurate diagnosis...

Contrast-enhanced magnetic resonance imaging (MRI) reveals variations in the endolymphatic morphology of the cystic lateral semicircular canal (CLSC) that correlate with inner ear function. This report is the first to suggest a relationship between the morphology and function of this common inner ear malformation in clinical cases.This study investigated the radiological and functional findings of a common inner ear malformation using computed tomography (CT), gadolinium contrast-enhanced magnetic resonance imaging (MRI), caloric testing, and cervical and ocular vestibular evoked myogenic potential (VEMP) testing.Four ears in three patients who were radiologically diagnosed with a CLSC and a normal cochlea on high-resolution CT and contrast-enhanced MRI were included. Semicircular canal and vestibular functions were analyzed using the caloric test and cervical and ocular VEMP testing.Unilateral and bilateral cystic canals were found in two and one patients, respectively. In the first patient, the malformed vestibule and cystic space were separate on imaging, and perilymph filled the cystic space. The functional test results were normal. In the second patient, endolymph filled both cystic spaces, and the functional responses were poor. In the third patient, endolymph filled the cystic space, and the ear did not respond during functional testing.

Postural control is dependent on the visual system in normal conditions. Shift from visual to somatosensory dependence in dizzy patients suggests that utilizing the stable visual references is recommended for the rehabilitation of dizzy patients.To investigate which of the visual or somatosensory system is mainly used for substitution of the impaired spatial orientation in dizzy patients.We recruited 189 consecutive patients with or without dizziness and vestibular dysfunction. Dizzy patients were divided into three groups: acute, episodic, and chronic dizziness. Vestibular function was assessed by caloric test, traditional head impulse test, and head shaking nystagmus. Visual or somatosensory dependence of spatial orientation was assessed by posturography on a solid surface or on foam in eyes open or closed condition. The foam ratio (posturography with/without foam) when eyes were closed was indicative of somatosensory dependence of postural control, whereas the Romberg ratio on foam showed visual dependence. (Romberg ratio on foam)/(foam ratio with eyes closed) was calculated and used as an index of the visual/somatosensory dependence of postural control.The visual/somatosensory ratio of postural control was significantly lower in dizzy patients as well as patients with vestibular dysfunction, however, no differences were found between acute, episodic, and chronic dizziness.

Hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) or gastrointestinal loss of sodium is sometimes seen during chemotherapy. However, hyponatremia due to renal salt wasting syndrome (RSWS) can rarely occur during cisplatin-containing chemotherapy. We report a case of a 65-year-old man with recurrent oropharynx cancer treated with cisplatin, docetaxel and 5-fluorouracil-containing chemotherapy who suffered from acute-onset consciousness disturbance due to hyponatremia just after administration of cisplatin. His serum sodium level was 109 mmol/L, urinary sodium was 132 mmol/L, and the urinary output in 6 h was 3700 mL. In other words, he had hyponatremia, hypernatriuria and the excessive urinary excretion of sodium; the diagnosis of RSWS was made. The patient was treated with supplement of sodium and isotonic solution with careful monitoring of serum sodium level. He responded to the treatment well and recovered from the hyponatremia episode in a few days without an...

We describe a case of recurrent hypopharyngeal pyriform sinus fistula after an open neck surgery, which was successfully treated with transoral surgical closure. The patient was a 7-year-old boy who had previously undergone neck surgery for removal of a fistula. The fistula recurred one month later, and transoral closure was selected as a treatment. Under general anesthesia, the fistula was identified in the left pyriform sinus, and cotton balls soaked with trichloroacetic acid were inserted in the fistula opening, after which an electrocautery scalpel was used to close the fistula. At 18 months postoperatively, there has been no recurrence or complications. This is the first report to describe a transoral surgical closure of a recurrent fistula. Transoral surgical closure was successful and resulted in no complications; it thus appears to be an effective treatment option, even for patients who have previously undergone open neck surgery.

The finding of deteriorated hearing loss at the initial visit at middle to high frequencies is a factor of poor hearing prognosis in Ménière's disease. Early intervention with instructions for lifestyle changes may lead to good outcomes in hearing.An attempt was made to examine long-term changes in hearing loss in unilateral Ménière's disease and factors associated with prognosis of hearing loss retrospectively.Based on their last hearing level of the affected ear, 36 patients were subdivided into two groups: the poor prognosis of hearing (PPH) group and the good prognosis of hearing (GPH) group.In the PPH group, the hearing levels at the initial visit at middle and high frequencies were significantly worse than those in the GPH group. Moreover, the hearing loss progressed during the first 2 years of the disease, and stayed flat to approximately 50 dB at the later stage. Conversely, the hearing loss at the onset in the GPH group showed no further progression over the first 2 years, and remained constant to approximately 35 dB at the later stage. In addition, the mean intervals from the onset to the initial visit in the PPH group were significantly longer than those in the GPH group.

The present findings suggest that complete control of vertigo after endolymphatic sac decompression surgery (ESDS) does not always depend on improved vestibular function or reduced endolymphatic hydrops. Vertigo control is, however, associated with hearing stability.Among surgical treatments for intractable Meniere's disease, ESDS is performed to preserve and improve inner ear function. We examined the correlation between changes in vertigo frequency and neuro-otologic function to understand the condition of the inner ear in patients whose vertigo was completely controlled after undergoing ESDS.This was a retrospective cross-tabulation study. Between 1997 and 2001, we treated 52 patients with intractable vertigo using ESDS and followed the patients regularly for 2 years. Postoperatively we evaluated and recorded changes in vertigo attack frequency, maximum slow phase eye velocity, worst hearing level, and glycerol test results according to modified American Academy of Otolaryngology-Head and Neck Surgery 1995 criteria.We found no correlation between vertigo control and vestibular function. There was also no correlation between vertigo control and negative conversion of the glycerol test. There was a significant correlation between vertigo control and hearing control .

Physicians should consider additional treatment strategies for Meniere's disease patients with a long history of disease and hearing loss in the secondary affected ear and also provide psychological support regarding future progressive bilateral hearing loss.To treat intractable Meniere's disease patients effectively, we need to understand the psychological condition of each patient. We examined the state of neurosis and depression in patients and correlated this with demographic and background information.Between 1998 and 2009, we enrolled 207 patients with intractable Meniere's disease in this prospective study. We used the Cornell Medical Index and the Self-rating Depression Scale to evaluate their psychological condition. We also obtained demographic and background information relating to sex, age, duration of disease, vertigo frequency, hearing level in bilateral sides, and plasma vasopressin level.Neurosis and depression was diagnosed in 40.1% and 60.4%, respectively, of patients with intractable Meniere's disease. Our results showed that surgical treatment significantly improved vertigo and hearing ability in patients with no psychological symptoms compared with those exhibiting psychological symptoms. Patients with a longer duration and worse hearing level in the secondary affected ear had a significantly higher incidence of mental illness than those with a shorter duration and better level of hearing.

This study showed that patients with acoustic tumor (AT) with hearing loss in the contralateral side had severe mood disturbances. It is important for physicians to provide patients who have better hearing in the tumor side with adequate information regarding the possibility of profound bilateral hearing loss and how to communicate with others in such situations.We examined the pretreatment status as regards neurosis and/or depression of patients with an AT using the Cornell Medical Index (CMI) and Self-rating Depression Scale (SDS) and clarified the relationship with the patients' background.We enrolled 30 patients with unilateral AT between 1997 and 2010. At the time of diagnosis, we examined each patient's psychological condition, sex, age, laterality, tumor size, hearing level on bilateral side, facial paresis, headache, and canal paresis.In all, 20.0% of AT patients were diagnosed with neurosis using the CMI and 26.7% had depression according to the SDS. χ(2) analysis showed that patients with AT with hearing deterioration on the contralateral side had mental illness significantly more often than those with normal hearing on the contralateral side. Multivariable regression analysis revealed that the pretreatment status of hearing level on the contralateral side significantly affected the patients' psychological condition.

Conclusion: The prediction of subtype and the affected ear of benign paroxysmal positional vertigo (BPPV) derived from the answers to our questionnaire can support the definitive diagnosis of BPPV. Objectives: We examined to what extent the diagnosis of subtype and the affected ear of BPPV judged from answers to a questionnaire agreed with the diagnosis decided by the results of the positional nystagmus test. Methods: We asked the following questions: ‘What kind of head movements induce vertigo?’ and ‘How long does the vertigo continue?’. As for the affected ear, we asked which ear was lower during stronger vertigo when induced in a supine position or during sleep. Results: The percentages of correct diagnosis speculated by the combined answers were 69% in posterior canal-type BPPV, 48% in BPPV with geotropic nystagmus, and 39% in BPPV with apogeotropic nystagmus. The percentage of correct diagnoses of the affected ear was more than 80%.

Bipolar scissors tonsillectomy followed by cooling down the pharyngeal mucosa has advantages in terms of postoperative pain and intraoperative blood loss compared with cold dissection.The purpose of this study was to compare the postoperative pain between bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa and a traditional cold dissection.A total of 189 patients aged more than 16 years were operated due to habitual tonsillitis, obstructive sleep apnea syndrome, and IgA nephropathy. Of these, 79 patients were operated using bipolar scissors followed by cooling the pharyngeal mucosa with 4°C saline for 10 min just after the removal of tonsils. The other 110 patients underwent cold dissection tonsillectomy. Outcome measures were intraoperative blood loss, operative time, postoperative pain evaluated on a visual analog scale, and postoperative secondary hemorrhage.Significantly lower levels of intraoperative blood loss and less postoperative pain were obtained in bipolar scissors tonsillectomy followed by cooling the pharyngeal mucosa compared with cold dissection. Postoperative hemorrhage needing hemostatic surgery occurred in 2 of 79 patients who underwent bipolar scissors tonsillectomy with cooling, while it occurred in 1 of 110 patients after cold dissection. However, the difference was not statistically significant.

The detection rate of endolymphatic hydrops was significantly higher in patients with Meniere's disease compared with those with sudden deafness, indicating that 3 T magnetic resonance imaging (MRI) with intratympanic gadolinium injection was effective in diagnosing endolymphatic hydrops.To compare the detection rate of endolymphatic hydrops between patients with Meniere's disease and sudden deafness as controls by 3 T MRI after intratympanic gadolinium injection with conventional pulse sequence such as two-dimensional fluid-attenuated inversion recovery.Ten patients with unilateral Meniere's disease and eight with sudden deafness underwent inner ear MRI 24 h after intratympanic gadolinium injection.The endolymphatic space was detected as a low signal intensity area, while the perilymphatic space showed high intensity by gadolinium enhancement. Due to faint enhancement, images could not be evaluated in 1 of 10 patients with Meniere's disease. However, the other nine patients together with two of the eight with sudden deafness were diagnosed as having hydrops. The difference in detection rates between the two diseases was statistically significant. Two hydrops-positive cases with sudden deafness were considered to be of the secondary type of hydrops, because images were taken after partial recovery from hearing loss several months after the onset of the disease.

The 'tinnitus-rare' group had a poorer prognosis for hearing than the 'tinnitus-often' group in all sudden sensorineural hearing loss (SSNHL), although the 'shorter duration' group had better prognosis than the 'longer duration' when restricted to SSNHL accompanied by tinnitus. This indicates that tinnitus itself may not be a sign for poor hearing prognosis but might be an essential sound for the initiation of repair of a damaged auditory system.We examined the hearing improvement rate (HIR) and tinnitus at the onset of SSNHL to elucidate the prognostic value of tinnitus accompanying SSNHL.Fifty patients with SSNHL were treated with systemic administration of steroids. Hearing recovery was determined by comparing the hearing levels before and after treatment. Tinnitus was subjectively evaluated by the tinnitus scoring questionnaire. The score for the five-step evaluation of the subjective tinnitus feelings 'loudness', 'duration' and 'annoyance' was obtained at the onset.In terms of 'duration', when we divided all the cases into 'tinnitus-rare' group and 'tinnitus-often' group, HIR in the 'tinnitus-rare' group was significantly lower than that in 'tinnitus-often' group. When restricted to the 'tinnitus-often' group, HIR for 'shorter duration' was significantly higher than that for 'longer duration'.

Relapsing polychondritis (RP) is characterized by inflammation and subsequent degeneration of cartilage. We report a 61-year-old woman who had RP with audio-vestibular manifestations. She was also diagnosed as having a myelofibrosis with myeloid metaplasia (MMM). Bilateral endolymphatic hydrops (EH) was confirmed by dominant -SP/AP of the electrocochleogram (ECochG). When thalidomide and prednisolone were prescribed for the treatment of MMM, symptoms of RP -- including the inner ear dysfunction -- were ameliorated. Isosorbide, one of the osmotic diuretics commonly used for the treatment of Meniere's disease (MD) in Japan, was also effective in keeping her free from inner ear dysfunction. This is the first report to confirm the existence of EH in a patient with RP with audio-vestibular manifestations. We suppose that an immunological imbalance due to MMM, in conjunction with a specific immunogenetic background, may have played a role in the pathogenesis of RP and the formation of EH in this patient.

When diagnosing and treating patients with acute vertigo, the clinician must differentiate brain lesions from benign peripheral disorders. We here report a rare case of acute vertigo caused by intracranial vertebral artery dissection mimicking peripheral disease. A 67-year-old man presented with spontaneous nystagmus and moderate ataxia preceded by neck pain. No other neurological signs were observed, suggesting acute peripheral vertigo. However, magnetic resonance imaging (MRI) demonstrated a cerebellar infarction. Simultaneous magnetic resonance angiography (MRA) showed no flow void of the left vertebral artery and contrast-enhanced MRA demonstrated a double lumen sign, suggesting that vertebral artery dissection was a cause of infarction. The clinical course was favorable without anticoagulation drugs, which are sometimes contraindicated because of the potential risk of subarachnoid hemorrhage. Vertebral artery dissection can cause cerebellar infarction in patients without vascular risk factors mimicking acute peripheral vertigo. Careful history regarding the neck pain is important and MRA in combination with MRI can replace angiography in diagnosing this disorder.

Vestibular neuritis (VN) rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. We experienced 36 patients with VN treated at our hospital, including cases in our previous preliminary report. To elucidate effects of steroid therapy both on the recovery of peripheral function and on the adaptation of central vestibular compensation, we examined caloric test and several questionnaires with two randomly divided groups, 18 steroid-treated and 18 nonsteroid-treated patients, over two years after the onset. These examinations revealed that steroid-treated patients had a tendency of better canal improvements (13/18, 72%) than nonsteroid-treated ones (10/18, 55.6%). However, there was no significant difference between these two groups. In cases with persistent canal paresis, steroid-treated patients (n = 5) reduced handicaps in their everyday life due to the dizziness induced by head and/or body movements and the disturbance of their mood, more effectively than those with nonsteroid therapy (n = 8). These findings suggest that steroid therapy with VN could be effective on not only vestibular periphery but central vestibular system, to restore the balance.

Using kaolin intake as a behavioral index of emesis in rats, we examined the relationship between susceptibility to motion sickness and to emesis induced by apomorphine or copper sulfate. Rats showed a wide variation in susceptibility to motion sickness. Significant positive correlations were found between susceptibility to motion sickness and to emesis induced by intraperitoneal administration of apomorphine and by oral administration of copper sulfate. Motion, apomorphine and copper sulfate induce emesis through different receptors, so these findings suggest that the sensitivity of a common locus of emesis, presumably the emetic center in the brain stem, is one determinant of individual differences in susceptibility to motion sickness.

The characteristics of linear acceleration to cause motion sickness of rats were examined using pica as a behavioral index of motion sickness. A vestibular sled was used to generate sinusoidal linear acceleration. At 0.4 Hz and with a peak acceleration of 0.15 G, the effectiveness of linear acceleration in inducing motion sickness was X-axis > Y-axis > Z-axis. At 0.4 Hz and along the X-axis, rats suffered from more severe motion sickness with a high peak G load (0.15 G) than with a low one (0.08 G). Along the X-axis and with a peak acceleration of 0.15 G, the severity of motion sickness was not related to frequency (0.4, 0.6 Hz).