Lifestyle habits and examination findings before and during the COVID-19 pandemic: From health checkups in a rural area in Japan.

Aim: Few health checkup studies have reported lifestyle habits and examination results before and during the COVID-19 pandemic. We compared lifestyle habits and examination results surveyed before and during the COVID-19 pandemic. Methods: Five hundred and ten and 396 participants attended the health checkup in 2019 and 2022, respectively. The median age of females was 65 in 2019 and 2022, and that of males was 68 in 2019 and 69 in 2022. We investigated dietary and exercise habits, alcohol consumption, sleeping situation, and examination results, including body mass index (BMI), smell function, and blood examination results before and during the COVID-19 pandemic in a rural area in Japan. Results: An ordinal logistic regression analysis revealed that the intake frequency of vegetables and marine products was significantly less in 2022 than in 2019 after adjusting age and sex; green leafy vegetables (p = .016), fish (p = .002), and other marine products, including squid, shrimp, crabs, and octopus (p = .008). Alcohol consumption amount increased significantly in 2022 than in 2019 in men who drank beer (p = .007) and chuhai (p = .040). Albumin, hematocrit, cholesterols, and uric acid decreased, but serum calcium increased significantly in 2022 than in 2019 after adjusting age and sex. BMI and hemoglobin A1c were not significantly different between 2019 and 2022. A decrease in subjective smell feeling and smell test results was associated with decreased intake frequency of vegetables. Conclusion: Both dietary habits and blood examination results changed significantly during the COVID-19 pandemic in a rural area in Japan.

Significance of an augmented response on cervical vestibular evoked myogenic potential testing in Meniere's disease.

The potential mechanism of augmented response on cervical vestibular evoked myogenic potential (cVEMP) testing and its decrease following treatment in a patient with Meniere's disease (MD) are discussed. Changes of static posturography and cVEMP testing before and after a glycerol drip in a 69-year-old man with unilateral MD, in which significant endolymphatic hydrops (EH) was confirmed on magnetic resonance imaging (MRI) on the diseased side, were evaluated. Values of total locus lengths, areas of postural sway, and their Romberg ratios were decreased after the glycerol drip. On cVEMP testing, the diseased ear demonstrated a 375% larger amplitude than the contralateral ear before treatment, but both ears showed almost the same responses after treatment. An augmented response on cVEMP testing and a decrease following treatment for MD reflect the diversity of clinical findings in MD. Responses on cVEMP testing may relate not only to the degree of EH, but also be due to abnormal acoustic energy absorbance transmitted into the saccule.

Relationship between tinnitus and olfactory dysfunction: audiovisual, olfactory, and medical examinations.

Introduction: Sensory dysfunctions and cognitive impairments are related to each other. Although a relationship between tinnitus and subjective olfactory dysfunction has been reported, there have been no reports investigating the relationship between tinnitus and olfactory test results. Methods: To investigate the relationship between tinnitus and olfactory test results, we conducted sensory tests, including hearing and visual examinations. The subjects included 510 community-dwelling individuals (295 women and 215 men) who attended a health checkup in Yakumo, Japan. The age of the subjects ranged from 40 to 91 years (mean ± standard deviation, 63.8 ± 9.9 years). The participants completed a self-reported questionnaire on subjective tinnitus, olfactory function, and hearing function, as well as their lifestyle. The health checkup included smell, hearing, vision, and blood examinations. Results: After adjusting for age and sex, the presence of tinnitus was significantly associated with subjective olfactory dysfunction, poor olfactory test results, hearing deterioration, vertigo, and headache. Additionally, high serum calcium levels and a low albumin/globulin ratio were significantly associated with low physical activity and nutrition. Women scored higher than men in olfactory and hearing examinations, but there was no gender difference in vision examinations. Conclusion: Subjective smell dysfunction and poor smell test results were significantly associated with tinnitus complaints. Hearing and vision were associated even after adjusting for age and sex. These findings suggest that evaluating the mutual relationships among sensory organs is important when evaluating the influence of sensory dysfunctions on cognitive function.

17O-labeled water distribution in the human inner ear: Insights into lymphatic dynamics and vestibular function.

We evaluated the inner ear distribution of 17O-labeled saline administered to the human tympanic cavity. Magnetic resonance imaging was performed after intratympanic administration in five healthy volunteers and one patient with cochlear endolymphatic hydrops. In all volunteers, 17O-labeled water permeated the cochlear basal turn and vestibule at 30 min and disappeared gradually within 2-4 h. All participants experienced positional vertigo lasting a few hours to a few days. Visualization of 17O-labeled water distribution in the endolymphatic space of the posterior ampulla showed indistinct separation of endolymph and perilymph in the cochlea and most of the vestibule in all participants. Intralabyrinthine distribution of 17O-labeled water differed from that in previous reports of intratympanically administered gadolinium-based contrast agent. 17O-labeled water in the endolymphatic space may cause heavier endolymph and positional vertigo. These results of this study may add new insights for investigating the distribution and the effects of molecules in the inner ear after the intratympanic administration in living humans.

Dietary habits and medical examination findings in Japanese adults middle-aged or older who live alone.

OBJECTIVE: The influence of living alone on multiple food and nutrition behaviors across a range of ages and genders has not been sufficiently investigated. Moreover, to our knowledge, no studies have described both dietary status and medical examination findings in persons living alone. Among individuals who attended a health checkup in a rural town in Japan, we investigated dietary habits and medical examination findings in persons living alone and those living with one or more other persons. METHODS: The participants in this investigation were 501 community-dwelling individuals aged 40 to 91 y (mean, 63.8 ± 9.9 y). Thirty-four (16.4%) of the 207 men and 45 (15.3%) of the 294 women lived alone. Dietary intake frequency of 28 types of foods and drinks, including various vegetables, fruits, meat, seafood, and dairy products, was investigated based on responses to a self-completed questionnaire. During the physical examination, body weight, body mass index, body fat percentage, and blood pressure (systolic and diastolic) were measured. Blood examination included red blood cell count, white blood cell count, platelet count, hemoglobin, hematocrit, total protein, albumin/globulin ratio, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatinine, blood urea nitrogen, uric acid, and serum calcium. RESULTS: Multivariate analysis revealed that living alone independently was associated with a reduced intake frequency of various vegetables and seafood, especially in men. Diastolic blood pressure and triglyceride levels were significantly higher in men living alone than in men living with other persons. The albumin/globulin ratio in women living alone was significantly lower than in women living with other persons. CONCLUSIONS: It was found that living alone was associated not only with a reduced quality of dietary intake but also with an unfavorable trend in some of the medical examination findings.

Dilatation of the Endolymphatic Space in the Ampulla of the Posterior Semicircular Canal: A New Clinical Finding Detected on Magnetic Resonance Imaging.

OBJECTIVES: To investigate the clinical features of ears with dilatation of the endolymphatic space in the ampulla of the posterior semicircular canal on magnetic resonance imaging. STUDY DESIGN: Retrospective study. SETTING: A university hospital. METHODS: This study included 1,842 ears from 934 patients who underwent 3-T magnetic resonance imaging with gadolinium to investigate the presence of endolymphatic hydrops. Age, sex distribution, hearing thresholds on pure-tone audiometry, and vestibular symptoms were compared between cases of unilateral and bilateral dilatation of the endolymphatic space in the ampulla of the posterior semicircular canal. RESULTS: Forty-eight ears (17 men and 14 women; mean age 49.9 yrs) showed dilatation of the endolymphatic space in the ampulla of the posterior semicircular canal. Age and the rate of chronic sensorineural hearing loss were significantly higher in the unilateral group (14 ears) than in the bilateral group (34 ears). The average hearing thresholds and rates of vestibular symptoms reported did not differ between unilateral and bilateral cases, but some patients showed positional nystagmus. CONCLUSIONS: Dilatation of the endolymphatic space in the ampulla was observed selectively in the posterior semicircular canal, though its pathogenesis was not clear. Such dilatation is not usually accompanied by vestibular endolymphatic hydrops, and it may be a cause of vertigo and dizziness.

Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study.

BACKGROUND: Hearing impairment (HI) is associated with dementia. However, the cognitive screening tasks effective in older community dwellers presenting with HI are unclear. METHODS: We retrospectively and cross-sectionally investigated the associations between HI and cognitive function assessed with screening tasks using data from two healthcare check-up programs for community dwellers ≥65 years old in 2018. We examined demographics, risk factors, cognitive function, hearing condition, lifestyles, and self-care levels. Cognitive function was assessed using the clock drawing task and the delayed three words recall task. Hearing condition was assessed using questionnaires on the use of hearing aids and HI during conversation situations. Multivariate analysis was used to identify independent associations between HI and cognitive assessment tasks. RESULTS: We analyzed 1602 eligible participants (61.9% women; 74.3 ± 6.5 years old). Hearing aid users (n = 90) were older (80 vs. 73 years, respectively; p < 0.001) and less likely to draw the clock correctly (71.1% vs. 80.1% years, respectively; p = 0.044) than non-hearing aid users. Multivariate logistic regression analysis showed that HI was associated with inability to draw the clock correctly (odds ratio 1.60, 95% confidence interval 1.12-2.26; p = 0.011), independent of age, living alone, memory impairment, and impaired self-care levels. CONCLUSION: Hearing impairment is independently associated with cognitive decline assessed by the clock drawing task. The clock drawing task may be useful for identifying an increased risk of dementia in older subjects presenting with HI.

Relationship between cognitive impairment and olfactory function among older adults with olfactory impairment.

OBJECTIVE: Understanding the relationships among aging, cognitive function, and olfaction may be useful for diagnosing olfactory decline in older adults. Olfactory function declines in the early stage of neurodegenerative diseases, including Alzheimer's and Parkinson's diseases. Aging and cognitive impairment are associated with olfactory decline. Moreover, the assessment of hyposmia and anosmia is paramount to the diagnosis of neurodegenerative diseases. We aimed to assess the relationships among aging, cognitive function, and olfaction in patients with olfactory impairment. METHODS: This observational study included 141 patients with olfactory deterioration who presented with dementia, mild cognitive impairment (MCI), age-related hyposmia, or postviral olfactory dysfunction (PVOD). The patients underwent T&T olfactometry, a self-administered odor questionnaire (SAOQ), a visual analog scale (VAS), and a Mini-Mental State Examination. RESULTS: T&T odor recognition thresholds decreased with aging (p < 0.01) and cognitive impairment (p < 0.08). The average T&T recognition thresholds were 5.1,4.6,4.2, and 3.7 in dementia, MCI, age-related hyposmia, and PVOD, respectively. Moreover, the average differences between the detection and recognition thresholds were 3.7, 2.8, 2.3, and 2.0 in dementia, MCI, age-related hyposmia, and PVOD, respectively. Hyposmia with dementia presented the highest recognition thresholds (p < 0.05) and the largest differences between the T&T detection and recognition thresholds, compared with age-related hyposmia and PVOD (p < 0.05). Hyposmia with dementia had the highest SAOQ and VAS scores compared with the other groups (p < 0.05). CONCLUSION: The possibility of dementia should be investigated in patients with hyposmia, including those with high T&T recognition thresholds, a large difference between the T&T detection and recognition thresholds, and high SAOQ and VAS scores.

Prevalence of laryngopharyngeal reflux symptoms: comparison between health checkup examinees and patients with otitis media.

OBJECTIVE: To investigate the prevalence of laryngopharyngeal reflux (LPR) symptoms in health checkup examinees and in patients with otitis media with effusion (OME) of undetermined etiology and the significance of age, body mass index (BMI), and pepsinogen (PG) concentration in middle ear effusions (MEEs). STUDY DESIGN: Cross-sectional study. SETTING: Health checkup and private clinics. SUBJECTS AND METHODS: A total of 410 subjects who had undergone a health checkup were asked to respond to the reflux symptom index (RSI) to identify the distribution of the RSI score, and the results were compared with 62 patients with OME by BMI and PG concentration in the MEEs. RESULTS: The RSI-positive (score >13) rate was 7.1% in the health checkup examinees. The highest rate was observed in men in their 40s, who had the highest average BMI. None of the men in their 80s were RSI positive. The RSI-positive rate in patients with OME was 21.0%. None of the male patients ≥ 70 years of age were RSI positive, whereas the average PG concentration was significantly higher in this group. CONCLUSION: The prevalence of LPR symptoms evaluated by the RSI was significantly higher in OME patients than in the health checkup examinees; however, a similar pattern in which LPR symptoms were prominent in middle-aged men with a high BMI and much less in elderly men was observed. Middle-aged men with a high BMI might be diagnosed as having LPR disease based on the relevant symptoms. LPR findings would be more sensitive than symptoms in elderly men.

Audiological signs in pediatric cases with dehiscence of the bony labyrinth caused by a high jugular bulb.

Clinical findings were assessed in three pediatric cases of dehiscence of the bony labyrinth caused by a high jugular bulb (HJB). Two children had two dehiscent lesions, which included posterior semicircular canal dehiscence (PSCD) and vestibular aqueduct dehiscence (VAD). One child had VAD alone. Two subjects with PSCD, but not with VAD alone, had mixed hearing loss and showed wave motion of the baseline on tympanometry and acoustic reflex testing, and a reduced response on otoacoustic emission. These findings may reflect jugular venous pulsations transmitted through the PSC and represent characteristics of cases with PSCD caused by HJB.

Association between endolymphatic hydrops as revealed by magnetic resonance imaging and caloric response.

OBJECTIVE: To investigate the association between the degree of endolymphatic hydrops (EH) revealed by magnetic resonance imaging (MRI) and a caloric response in the ear. STUDY DESIGN: Prospective diagnostic study. SETTING: University hospital. PATIENTS: Twenty-four patients with hearing loss and/or vertigo, who underwent MRI 1 day after an intratympanic gadolinium injection. INTERVENTION: MRI after intratympanic gadolinium injection and caloric testing with cool air stimulation (15°C, 6 l/min, 60 s). MAIN OUTCOME MEASURE: Association between the degree of EH and caloric responses. The degree of EH in the vestibule, in the cochlea, and in the ampulla of the lateral semicircular canal (LSC) was evaluated using MRI. The ratio of the diameter of the endolymphatic space to the diameter of the perilymphatic space was measured in the LSC ampulla. RESULTS: Canal paresis (CP, >25%) was present in 15 patients and absent (CP, <25%) in 9 patients. There was no significant difference between caloric response and the degree of EH in the vestibule, the cochlea, or the LSC ampulla. The period between the onset of clinical symptoms and examination tended to be longer in the group with CP compared with the group without CP. CONCLUSION: There was no significant association between the degree of EH and caloric response.

Relationship between endolymphatic hydrops and vestibular-evoked myogenic potential.

CONCLUSION: Vestibular-evoked myogenic potential (VEMP) can be used to examine endolymphatic hydrops, especially in the vestibule. OBJECTIVE: To investigate the relationship between the degree of endolymphatic hydrops revealed by magnetic resonance imaging (MRI) and VEMP. METHODS: Gadolinium diluted with saline was injected intratympanically in 49 ears (40 patients). One day after the injection, the endolymphatic space in the vestibule and the cochlea was visualized by 3 Tesla MRI. A VEMP test was done, and VEMP was judged as absent when the VEMP was within the noise level. RESULTS: VEMP was present in 21 ears and absent in 28 ears. Endolymphatic hydrops was significantly associated with the disappearance of VEMP. Endolymphatic hydrops in the vestibule had a stronger effect than endolymphatic hydrops in the cochlea. Five patients with extremely large vestibular hydrops showed no response of VEMP.

Changes in endolymphatic hydrops in a patient with Meniere's disease observed using magnetic resonance imaging.

We describe a case report of a patient with Meniere's disease whose changes in endolymphatic hydrops were observed using magnetic resonance imaging (MRI). Gadolinium was injected intratympanically through the tympanic membrane, and MRI scans performed with a 3-T MRI unit revealed endolymphatic hydrops inside the perilymphatic space filled with gadolinium. We evaluated the relationship between the image findings and hearing level. The correlation between the degree of endolymphatic hydrops observed by MRI and hearing level in patients with Meniere's disease offers a promising new method to study the progression of Meniere's disease.

Relationship between the degree of endolymphatic hydrops and electrocochleography.

The purpose of this study was to evaluate the relationship between the endolymphatic space image obtained using magnetic resonance imaging (MRI) and the results of electrocochleography. Electrocochleography recordings were obtained from 25 ears of 24 patients, who underwent MRI 1 day after the intratympanic injection of gadolinium diethylenetriamine pentaacetic acid bismethylamide. The average summating potential to action potential (SP/AP) ratio in patients with significant endolymphatic hydrops in the cochlea was 54 +/- 17%. However, in some patients who had significant endolymphatic hydrops in the cochlea, the SP/AP ratio was not enlarged. This may imply that elevation of the SP/AP ratio is related to not only the degree of endolymphatic hydrops but also to the persistence of hydrops.

Endolymphatic space imaging in patients with delayed endolymphatic hydrops.

CONCLUSION: Magnetic resonance imaging (MRI) after intratympanic gadolinium injection can reveal endolymphatic hydrops (ELH) in patients with delayed ELH (DELH). Patients with contralateral DELH may have bilateral ELH. OBJECTIVE: DELH has previously been diagnosed based on clinical history, hearing and vestibular examinations. DELH is classified into three types: ipsilateral, contralateral and bilateral indicate the side with the longstanding hearing loss. Ipsilateral DELH occurs in the ear with a profound hearing loss, contralateral DELH in the better hearing ear and bilateral DELH in both ears. Imaging diagnosis of the endolymphatic space may add a new dimension to the diagnosis and treatment of DELH. PATIENTS AND METHODS: Gadodiamide hydrate was diluted eightfold with saline. The diluted gadodiamide hydrate was injected intratympanically through the tympanic membrane in two patients with ipsilateral DELH and five patients with contralateral DELH. One day after the injection, 3 Tesla MRI was performed to evaluate the endolymphatic space. RESULTS: ELH was observed in all patients. In three patients who underwent bilateral intratympanic injection of gadolinium and were diagnosed with contralateral DELH, ELH was observed bilaterally. In one of these three patients, ELH was observed in the cochlea on the left and in the vestibule on the right.

Image evaluation of endolymphatic space in fluctuating hearing loss without vertigo.

The objective of the present study was to investigate endolymphatic space images in patients with fluctuating hearing loss without vertigo, and to elucidate its underlying pathophysiology. Eight patients with fluctuating hearing loss without vertigo were included in this study. 3T MRI was taken, 24 h after intratympanic injection of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Electrocochleography and VEMP tests were performed to evaluate cochlear and vestibular functions. Endolymphatic hydrops were observed both in the cochlea and in the vestibule of all eight patients. Three patients out of six whose summating potential/action potential (SP/AP) ratio was recordable showed an elevation of SP/AP ratio. In the two patients with remarkable endolymphatic hydrops in the vestibule, VEMP was absent from the affected ear. In conclusion, 3T MRI after intratympanic injection of Gd-DTPA revealed endolymphatic hydrops both in the cochlea and in the vestibule in the patients with fluctuating hearing loss without vertigo.

Clinical significance of endolymphatic imaging after intratympanic gadolinium injection.

CONCLUSION: Using three-dimensional real inversion recovery (3D-real IR) and three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI), various degrees of endolymphatic hydrops were observed in the basal and upper turns of the cochlea and in the vestibular apparatus after intratympanic gadolinium (Gd) injection. MRI may contribute to our understanding of inner ear diseases and may be a useful addition to intratympanic drug therapy in the management of inner ear diseases. OBJECTIVE: To evaluate 3D-real IR MRI and 3D-FLAIR MRI with clinical symptoms and signs in patients with inner ear disease. PATIENTS AND METHODS: Gd was diluted in saline and injected intratympanically in 73 patients with inner ear disease. The endolymphatic space was evaluated with 3-Tesla MRI at 1 day after the intratympanic Gd injection. RESULTS: 3D-real IR MRI was generally better than 3D-FLAIR MRI in discriminating between the perilymphatic space and endolymphatic space in the cochlear turns and in the vestibular apparatus. However, when Gd concentration was insufficient in the perilymph, it was more difficult to visualize the Gd with 3D-real IR MRI than with 3D-FLAIR MRI. Endolymphatic hydrops was observed using MRI in patients with 'probable' Meniere's disease based on the criteria.

3D computerized model of endolymphatic hydrops from specimens of temporal bone.

CONCLUSION: The 3D models of endolymphatic and perilymphatic spaces enabled us to obtain normal and pathological volumes of each space and helped us to understand the 3D structure of various parts of the inner ear and of endolymphatic hydrops. OBJECTIVE: To make a 3D model of the inner ear using sections of temporal bone with and without hydrops. MATERIALS AND METHODS: Every 10th 20 microm thick section of temporal bone was collected from two ears with endolymphatic hydrops and five ears without hydrops. Using ZedView, 3D Doctor, FreeForm as analytical software, a 3D model of the inner ear was obtained by reconstruction of these sections. The volumes of the endolymphatic (EV) and perilymphatic spaces (PV) were calculated in each part of the cochlea and vestibular apparatus including the semicircular canals, but the endolymphatic duct and sac were not included. RESULTS: In normal ears (controls), the average cochlear EV was 5.1 microl and the PV was 41.9 microl, and the average vestibular EV was 24.0 microl and the PV 75.7 microl. In one hydropic ear, the cochlear EV was 17.5 microl, cochlear PV 30.7 microl, vestibular EV 42.5 microl, and vestibular PV 33.4 microl. In the other hydropic ear, cochlear EV was 31.2 microl, cochlear PV 30.1 microl, vestibular EV 25.6 microl, and vestibular PV 71.8 microl.

Evaluation of the vestibular evoked myogenic potential during parabolic flight in humans.

The purpose of this study was to investigate how gravity affects the vestibular evoked myogenic potential (VEMP). Eight healthy subjects (seven men, one woman; age range 19-45 years) participated in experiments in which three different gravity levels [microgravity (MG), normal gravity (NG), and hypergravity (HG)] were imposed during a parabolic flight procedure. The VEMP was evoked in response to an intense mono-aural click while the subjects kept the sternocleidomastoid (SCM) muscle contracted bilaterally. Background electromyographic activity of the SCM during the test was corrected. The p13-n23 amplitude was significantly greater under MG than under NG or HG. There was no difference in p13 latency between the three gravity levels. Possible mechanisms related to this phenomenon are discussed.