Investigation of Stress Levels before the Onset of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVES: We hypothesized that patients with idiopathic sudden sensorineural hearing loss (ISSHL) would have experienced more stress prior to the onset than they typically did. This study investigated stress levels in patients before the onset of ISSHL. MATERIALS AND METHODS: Forty-two patients with ISSHL were investigated. We used an original questionnaire to evaluate subjective stress levels in 1 week before onset. Serum hemoglobin A1c (HbA1c) and total cholesterol were examined to evaluate biochemical stress markers reflecting the preceding 1 to 2 months. The results on admission were compared with those at the follow-up visit. RESULTS: Significantly more patients reported greater physical exhaustion, greater mental exhaustion, or a worse physical condition on admission than at follow-up (p<0.01, for each variable). On admission, 81% of patients reported greater than normal stress with regard to at least 1 of 3 items. The mean serum HbA1c was slightly but nonsignificantly lower at the follow-up visit (p=0.10), while the mean serum total cholesterol was significantly lower at follow-up than on admission (p<0.01). CONCLUSION: The results indicate that patients were under a greater degree of stress before the onset of ISSHL, suggesting that stress plays a role in inducing ISSHL.

[A Pediatric Case of Retropharyngeal Abscess Causing Multiple Instances of Cranial Nerve Palsy].

Deep neck abscesses are relatively rare in children compared with adults. Diagnosis can be difficult in pediatric patients because of the various clinical symptoms, therefore, it is important to correctly understand the pathology. We report herein on a rare pediatric case of a deep neck abscess that caused multiple instances of cranial nerve palsy. The patient was a 7-year-old boy who, despite treatment by a local physician for fever, swelling of the left neck and neck pain, developed torticollis, dysarthria, dysphagia and hoarseness and consequently consulted our department. We observed palsy associated with the IX, X, and XII left cranial nerves and a retropharyngeal abscess was diagnosed based on the computed tomography findings. The patient was hospitalized and underwent conservative treatment, and on day 21 of hospitalization, the patient was discharged after his symptoms had eased and the size of the abscess had reduced. We believe that palsy of the cranial nerves in the present case occurred as a result of pressure being applied to the cranial nerves in the carotid space due to an abscess in the retropharyngeal space.

Recurrent chondro-osseous respiratory epithelial adenomatoid hamartoma of the nasal cavity in a child.

Chondro-osseous respiratory epithelial adenomatoid hamartoma (COREAH) is an extremely rare type of hamartoma. To the best of our knowledge, only 1 case has been previously reported. A 7-year-old girl presented with a case of COREAH of the bilateral nasal cavities. Polypous masses in both nasal cavities were resected endoscopically, and they were histologically diagnosed as COREAH. A large polypous mass recurred 1 year postsurgically on the right side only. A second endoscopic surgery was performed, and the lesion was confirmed to be recurrent COREAH. Hamartoma of the nasal cavity is rare and is generally considered to be self-limiting. This case suggests that nasal hamartomas may have neoplastic characteristics, and therefore require complete resection.

Frequency characteristics of contralateral sound suppression of 40-Hz auditory steady-state response.

Sound presented to the contralateral ear suppresses the amplitude of the 40-Hz auditory steady-state response (ASSR). The frequency characteristics of this suppression of the 40-Hz ASSR for amplitude modulated (AM) tones at 1,000 Hz (79-dB SPL) were examined in 12 healthy volunteers (10 males and 2 females, mean age 32.3 years) using contralateral AM tones (500, 1,000, 2,000, and 4,000 Hz) and 1/3 octave-band noise (500, 1,000, 2,000, and 4,000 Hz). The 40-Hz ASSR at 1,000 Hz was suppressed by a relatively wide frequency range of contralateral sound than expected from the known characteristics of psychophysical central masking by contralateral sound: the greatest suppression was obtained with 500- and 1,000-Hz sounds, but considerable suppression was also obtained with 2,000- and 4,000-Hz sounds. Substantial differences in the suppression pattern were not observed between two types of contra-suppressors; i.e., AM tones and 1/3 octave-band noise. Therefore, any sound presented to the contralateral ear, regardless of the frequency, can suppress the 40-Hz ASSR. Moreover, the different frequency characteristics of the contralateral sound effects between the psychophysical central masking and the 40-Hz ASSR would support the idea that the 40-Hz ASSR has an additive role in the processing of auditory signals to simple threshold judgment. Investigation of the type of psychophysical measurement using the AM signal showing similar suppression patterns by the presentation of contralateral sound would be helpful to reveal the functional relevance of ASSRs.

Contralateral white noise attenuates 40-Hz auditory steady-state fields but not N100m in auditory evoked fields.

The different response characteristics of the different auditory cortical responses under conventional central masking conditions were examined by comparing the effects of contralateral white noise on the cortical component of 40-Hz auditory steady state fields (ASSFs) and the N100 m component in auditory evoked fields (AEFs) for tone bursts using a helmet-shaped magnetoencephalography system in 8 healthy volunteers (7 males, mean age 32.6 years). The ASSFs were elicited by monaural 1000 Hz amplitude modulation tones at 80 dB SPL, with the amplitude modulated at 39 Hz. The AEFs were elicited by monaural 1000 Hz tone bursts of 60 ms duration (rise and fall times of 10 ms, plateau time of 40 ms) at 80 dB SPL. The results indicated that continuous white noise at 70 dB SPL presented to the contralateral ear did not suppress the N100 m response in either hemisphere, but significantly reduced the amplitude of the 40-Hz ASSF in both hemispheres with asymmetry in that suppression of the 40-Hz ASSF was greater in the right hemisphere. Different effects of contralateral white noise on these two responses may reflect different functional auditory processes in the cortices.

Toll-like receptor 9-dependent activation of bone marrow-derived dendritic cells by URA5 DNA from Cryptococcus neoformans.

Cryptococcus neoformans is an opportunistic fungal pathogen that causes meningoencephalitis in immunocompromised patients. Recently, we reported that Toll-like receptor 9 (TLR9) is involved in host defense against C. neoformans: specifically, it detects the pathogen's DNA. In the present study, we aimed to elucidate the mechanisms underlying TLR9-mediated activation of innate immune responses by using the URA5 gene, which encodes a virulent component of this fungal pathogen. A PCR-amplified 345-bp URA5 gene fragment induced interleukin-12 p40 (IL-12p40) production by bone marrow-derived dendritic cells (BM-DCs) in a TLR9-dependent manner. Similar activity was detected in the 5' 129-bp DNA fragment of URA5 and in a synthesized oligodeoxynucleotide (ODN) with the same sequence. Shorter ODN fragments, which contained GTCGGT or GACGAT but had only 24 or 21 bases, induced IL-12p40 production and CD40 expression by BM-DCs, but this activity vanished when the CG sequence was replaced by GC or when a phosphorothioate modification was introduced. IL-12p40 production caused by active ODN was strikingly enhanced by treatment with DOTAP, a cationic lipid that increases the uptake of DNA by BM-DCs, though DOTAP failed to induce IL-12p40 production by inactive ODN and did not affect the activity of an ODN-containing canonical CpG motif. There was no apparent difference in intracellular trafficking between active and inactive ODNs. Finally, an extremely high dose of inactive ODN suppressed IL-12p40 production by BM-DCs that had been stimulated with active ODN. These results suggest that the C. neoformans URA5 gene activates BM-DCs through a TLR9-mediated signaling pathway, using a mechanism possibly independent of the canonical CpG motif.

Effects of neck muscle vibration on subjective visual vertical: comparative analysis with effects on nystagmus.

In patients with unilateral vestibular dysfunction, vibratory stimulation to the neck muscles not only induces shift of the subjective visual vertical (SVV), but also enhances the generation of nystagmus. In the present study, the effects of neck vibration on the SVV were compared with those on nystagmus in patients with unilateral vestibular schwannoma (14 patients; 6 males and 8 females, mean age 54.2 years). The results indicated that the presence of nystagmus and magnitude of the SVV were generally correlated, neck vibration significantly increased the abnormal shift of the SVV and the presence of nystagmus, and the effects of vibration to the ipsilateral dorsal neck were significantly larger than those to the contralateral dorsal neck on the SVV, whereas no significant difference was observed in slow phase velocity of nystagmus. The present study suggests that both SVV and nystagmus induced by vibration have many similar clinical features and may be important in assessing the unilateral vestibular dysfunction.

Concomitant chemoradiotherapy as a standard treatment for squamous cell carcinoma of the temporal bone.

We sought to characterize the effectiveness of concomitant chemoradiotherapy (CCRT) for patients with squamous cell carcinoma of the temporal bone. We performed a retrospective chart review of 14 patients with cancer of the temporal bone who were provided initial treatment in our hospital from December 2001 to November 2008. Four patients with stage I tumors were treated by radiation therapy alone or with oral administration of S1. One patient with a stage II tumor was treated by radiation therapy concomitant with low dose docetaxel. Nine patients with stage IV tumors were treated by CCRT using the TPF regimen (docetaxel, cisplatin, and 5-fluorouracil). As an initial treatment, all patients but one were treated by radiation therapy with or without chemotherapy. Grade 4 adverse events of patients who received CCRT using the TPF regimen involved the leukopenia in one patient and the neutropenia in two patients. Local recurrences were observed in three patients including two patients with T4 tumors. Five-year disease-specific survival rates for all patients and for patients with T4 tumors were 78% and 67%, respectively. CCRT using the TPF regimen is safe and effective as the first treatment for patients with cancer of the temporal bone.

Bimodal audio-visual training enhances auditory adaptation process.

Effects of auditory training with bimodal audio-visual stimuli on monomodal aural speech intelligibility were examined in individuals with normal hearing using highly degraded noise-vocoded speech sound. Visual cue simultaneously presented with auditory stimuli during the training session significantly improved auditory speech intelligibility not only for words used in the training session, but also untrained words, when compared with the auditory training using only auditory stimuli. Visual information is generally considered to complement insufficient speech information conveyed by the auditory system during audio-visual speech perception. However, the present results showed another beneficial effect of audio-visual training that the visual cue enhances the auditory adaptation process to the degraded new speech sound, which is different from those given during bimodal training.

Effects of contralateral noise on 40-Hz and 80-Hz auditory steady-state responses.

OBJECTIVES: The amplitude of 40-Hz auditory steady-state response (ASSR) in response to repeated click or tone pips at levels of 45 to 60 dB SL is reduced by up to 50% by the central masking mechanism if white noise at levels of 40 to 60 dB SL is applied contralaterally. However, the effect of contralateral noise on the elevation of the threshold of ASSR is unknown. The present study investigated the effects of contralateral noise on the threshold measurements of ASSR for 40- and 80-Hz amplitude modulated tones that are widely used in clinical examinations. DESIGN: The effects of contralateral noise on the 40- and 80-Hz ASSRs for amplitude modulated tones at 500 Hz and 2000 Hz were examined in 11 healthy volunteers (10 men and 1 woman, mean age 26.1 years). Contralateral noise consisted of white noise low-pass filtered at 700 and 4000 Hz in the measurements of ASSR at a carrier frequency of 500 and 2000 Hz, respectively. RESULTS: Contralateral noise at a level of 40 dB SL caused no significant psychophysical threshold elevation, caused significant threshold elevation of the 40-Hz ASSR (average 10 to 15 dB), and caused no significant threshold elevation of the 80-Hz ASSR. CONCLUSIONS: The different effects on the 40- and 80-Hz ASSRs were probably related to the differences in sources because the 40-Hz ASSR contains more components from the upper auditory pathway that are affected by contralateral masking, whereas the 80-Hz ASSR contains more components from the brain stem. The present results suggest that threshold elevation of the 40-Hz ASSR may occur during clinical measurements using binaural presentation of sounds and cause a possible discrepancy between psychophysical threshold and 40-Hz ASSR measurements.