[A MULTICENTER CLINICAL SURVEY ABOUT THE PREVALENCE OF JAPANESE CYPRESS POLLINOSIS AND THE EFFICACY OF SUBLINGUAL IMMUNOTHERAPY WITH JAPANESE CEDAR POLLEN EXTRACT DURING JAPANESE CYPRESS POLLEN DISPERSAL PERIOD].

BACKGROUND: Little is known whether sublingual immunotherapy using Japanese cedar pollen extract (cedar SLIT) is effective for not only Japanese cedar pollinosis but also Japanese cypress pollinosis. We investigated the prevalence rate of Japanese cypress pollinosis, efficacy of cedar SLIT on cypress pollinosis and patients' wish to receive cypress SLIT. METHODS: We investigated a multi-center (31 institutions), cross-sectional survey using a self-administrated questionnaire with four questions for patients received cedar SLIT aged from 5 to 69 years old. RESULTS: 2523 subjects were enrolled for analysis. 83.4% of them had pollinosis symptoms during cypress season before cedar SLIT. In such patients, 37.4% experienced lessened efficacy of cedar SLIT during cypress season. Both the prevalence of cypress pollinosis and the lessened efficacy of cedar SLIT on cypress pollinosis were significantly seen in western Japan as compared to eastern Japan. 76.1% of the subject having cypress pollinosis before SLIT wished to receive cypress SLIT if it is available. CONCLUSION: A lessened efficacy of cedar SLIT during cypress season was broadly seen in Japan, and further showed a regional difference. Together with the finding of high wish by patients, these results suggest a development of cypress SLIT is desirable.

Facial nerve paralysis caused by middle ear cholesteatoma and effects of surgical intervention.

CONCLUSIONS: The clinical and surgical findings of this study indicated advanced cholesteatoma in many patients with facial paralysis. The outcome of facial paralysis was good. Poor outcomes were observed in cases with petrosal cholesteatoma and in those who underwent surgery > or = 2 months after the onset of paralysis. OBJECTIVE: To investigate clinical features of cholesteatoma associated with facial paralysis. MATERIAL AND METHODS: Sixteen patients with facial paralysis due to middle ear cholesteatoma were reviewed. After removal of the cholesteatoma lesion, a limited area of the fallopian canal, that in which facial nerve edema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed. RESULTS: Initial paralysis was incomplete in 11 patients (69%). The onset of paralysis was sudden in 12 patients (75%). Labyrinthine fistulae (n = 9; 56%) and bone destruction in the cranial fossa (n = 10; 63%) were frequently observed. Six patients (38%) were totally deaf due to labyrinthitis. The outcome of facial paralysis was good in 13 patients (81%). Patients who underwent surgery > or = 2 months after the onset of paralysis frequently had a poor outcome. Paralysis was not improved in two cases with petrosal cholesteatoma.

Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence.

OBJECTIVE: To show the significance of various factors when predicting the outcome of facial nerve paralysis. DESIGN: Retrospective chart review. SETTING: Nihon University Itabashi Hospital in Tokyo. SUBJECTS: Four hundred sixty-seven patients with facial paralysis who visited the hospital within 14 days of disease onset. METHODS: The failure rate of complete recovery was studied for each of these nine factors: sex, age, varicella-zoster virus (VZV) infection as the cause of paralysis, initial severity of paralysis, number of days from onset of paralysis to the beginning of medical treatment, nerve excitability test (NET), stapedial reflex, lacrimal secretion, and severity of facial paralysis 1 month after onset. These factors were analyzed by logistic regression. RESULTS: Logistic regression clarified that age, VZV infection, NET response, loss of stapedial reflex, and the state of paralysis 1 month after the onset had statistical significance for the prognosis of facial paralysis. The poor recovery rate was greater than 50% in the patients who exhibited abnormal responses on NET or failed to attain recovery to grade III or better during the 1-month period after the onset of paralysis. These findings were therefore considered as high risk factors for the prognosis. The poor recovery rate was between 25% and 50% in patients who were 50 years or older or whose initial grading of paralysis was V or worse. These findings were classified as moderate risk factors. Patients with VZV-caused paralysis and loss of stapedial reflex had poor recovery rates of below 25%, and these were classified as low risk factors. CONCLUSION: It is possible to predict the prognosis of facial paralysis on the basis of several clinical findings. NET response, severe initial paralysis, age 50 years or older, and, as a second-stage factor, severity of facial paralysis 1 month after the onset were found to be especially important factors for predicting the prognosis of facial paralysis.

To what extent do evaluations of facial paralysis by physicians coincide with self-evaluations by patients: comparison of the Yanagihara method, the House-Brackmann method, and self-evaluation by patients.

OBJECTIVES: To understand to what extent evaluations of facial paralysis by physicians coincide with self-evaluations by patients. STUDY DESIGN: Prospective clinical study. PATIENTS: One hundred thirty-one patients (68 male patients and 63 female patients) with facial paralysis were included in the study. INTERVENTIONS: The relationship between the evaluation of facial paralysis using the Yanagihara system, the House-Brackmann grading system, and self-evaluation by patients was studied. MAIN OUTCOME MEASURES: The paralysis scores and grade determined by physicians using the above two systems were well correlated with the self-evaluations by patients. RESULTS The evaluation of subjective symptoms differed among individuals. Even patients who were evaluated as either completely paralyzed or cured according to the Yanagihara and House-Brackmann methods did not always rate their subjective symptoms as being consistent with these scores. CONCLUSION: Evaluations with the two systems correlated significantly with self-evaluations by patients on the whole. These two methods of evaluation are considered appropriate not only for physicians but also for patients. In contrast, some discrepancies were observed. This point should be taken into account in routine patient care.

[An assessment of psychological stress in patients with facial palsy].

OBJECTIVES: Facial palsy may cause excessive stress due to the obviousness of its manifestations. We evaluated psychological stress in patients with facial palsy. SUBJECTS AND METHODS: Subjects were 57 patients with Bell's palsy, 12 with Ramsay Hunt syndrome, and 11 with zoster sine herpete. Eighteen of 50 questions from the Psychological Stress Response Scale (PSRS) were selected and used to in a questionnaire completed by each patient on 2 separate occasions the first hospital visit and after recovery from facial palsy. They also completed a second bodily condition questionnaire before and after treatment. RESULTS: The psychological stress response score of patients with facial palsy was high on the first visit. Intermediate and high psychological stress were observed in 35% on the first visit. These psychological stress response score decreased after recovery from facial palsy. The psychological stress response of patients under 65 years of age in those over 65 years. No gender difference was seen in psychological stress response. Those with herpes zoster showed a higher psychological stress response than others and this decreased after recovery from facial palsy. CONCLUSIONS: Psychological stress response score of patients with facial palsy was high on the first hospital visit, suggesting that we must treat the psychological aspects of this manifestation by adequately explaining prognosis and pathology, in addition to physical therapy.