Prevalence of Tongue Cleaning Using a Toothbrush: A Questionnaire Survey in Fukui Prefecture, Japan.

OBJECTIVE: The aim of this study was to investigate the tongue cleaning habits using toothbrushes among outpatients of the University of Fukui Hospital and a private hospital in Fukui Prefecture. METHODS: We administered a questionnaire survey to volunteers detailing tongue cleaning habits using toothbrushes. The content of the questions in this survey were as follows: gender, age, frequency of tongue cleaning, portion of tongue cleaning, and purposes of tongue cleaning. RESULTS: We had 1,014 volunteers of various ages participating in this study. Regarding the frequency of tongue cleaning, 187 (18.4%) of all participants replied, "Every day", and 346 (34.1%) replied, "Sometimes". Regarding tongue cleaning of the 533 participants with active tongue cleaning habits, 242 (45.4%) participants replied, "The center of the dorsum of the tongue", and 274 (51.4%) replied, "The entire tongue". When analyzing the purpose of tongue cleaning, 346 (64.9%) participants replied, "To remove the tongue stain", 192 (36.0%) participants replied, "To remove the tongue coating", and 240 (45.0%) participants replied, "To manage halitosis". CONCLUSIONS: This study clarified that a wide range of age groups in the nonhospitalized general public practiced tongue cleaning habits using a toothbrush for various purposes.

Association of tongue brushing with the number of fungiform taste buds and taste perception: A preliminary study using confocal laser scanning microscopy in combination with a filter-paper disc method.

OBJECTIVE: The aim of this study was to investigate the association of tongue brushing with the number of fungiform taste buds and taste perception using a confocal laser scanning microscopy in combination with a filter-paper disc method (FPDM). METHODS: Twenty-four subjects with or without a habit of tongue brushing (11 males and 13 females, 20-46 years old) participated in this study. Nine of the 24 subjects had no habit of tongue brushing (Group 1, n=9). Fifteen subjects had a habit of tongue brushing, and the brushing regions of the tongue were as follows: central region (Group 2, n=7), or entire region (Group 3, n=8) of the tongue dorsum. Using confocal laser scanning microscopy, the average number of taste buds per fungiform papilla (FP) was counted. Taste perception was evaluated using an FPDM. These observations were performed in the midlateral region of the tongue since the distribution of fungiform papillae is large in the midlateral region compared to that in the central region. RESULTS: The subjects in Group 3 showed a significantly decreased number of fungiform taste buds compared to Group 1 and Group 2. Group 3 also showed significantly higher FPDM scores than the other two groups. CONCLUSIONS: Excessive tongue brushing of the entire tongue dorsum, including the midlateral region, may have an association with the decreased number of FP and taste buds and decreased taste sensation. To avoid these conditions, instituting proper tongue brushing methods, such as limiting it to the central region of the tongue and using a light touch, is suggested and is important for the subjects who are eager to participate in tongue brushing.

Relationship between gustatory function and average number of taste buds per fungiform papilla measured by confocal laser scanning microscopy in humans.

The aim of this study was to elucidate the relationship between the gustatory function and average number of taste buds per fungiform papilla (FP) in humans. Systemically healthy volunteers (n = 211), pre-operative patients with chronic otitis media (n = 79), and postoperative patients, with or without a chorda tympani nerve (CTN) severed during middle ear surgery (n = 63), were included. Confocal laser scanning microscopy was employed to observe fungiform taste buds because it allows many FP to be observed non-invasively in a short period of time. Taste buds in an average of 10 FP in the midlateral region of the tongue were counted. In total, 3,849 FP were observed in 353 subjects. The gustatory function was measured by electrogustometry (EGM). An inverse relationship was found between the gustatory function and average number of fungiform taste buds per papilla. The healthy volunteers showed a lower EGM threshold (better gustatory function) and had more taste buds than did the patients with otitis media, and the patients with otitis media showed a lower EGM threshold and had more taste buds than did postoperative patients, reflecting the severity of damage to the CTN. It was concluded that the confocal laser scanning microscope is a very useful tool for using to observe a large number of taste buds non-invasively.

Gustatory Dysfunction and Decreased Number of Fungiform Taste Buds in Patients With Chronic Otitis Media With Cholesteatoma.

OBJECTIVE: To compare the number of fungiform taste buds among patients with chronic otitis media (COM), those with pars flaccida retraction type cholesteatoma, and those with pars tensa retraction type cholesteatoma in combination with gustatory function. METHODS: Thirty-seven patients with COM, 22 patients with pars flaccida retraction type cholesteatoma, and 17 patients with pars tensa retraction type cholesteatoma were included. An average of 10 fungiform papillae (FP) per patient in the midlateral region of the tongue were observed by confocal laser scanning microscopy in vivo, and the average number of taste buds were counted. Just before the observation of FP, electrogustometry (EGM) was performed to evaluate gustatory function. RESULTS: A significant decrease of the average number of fungiform taste buds and significant elevation of EGM thresholds were clarified in the pars tensa retraction type cholesteatoma group but not in the COM or pars flaccida type cholesteatoma group. CONCLUSION: It was suggested that some neurotoxic cytokines produced by cholesteatoma tissue might affect the CTN morphology, resulting in a decreased number of fungiform taste buds and elevation of EGM threshold in patients with pars tensa retraction type cholesteatoma.

Comparison of fungiform taste-bud distribution among age groups using confocal laser scanning microscopy in vivo in combination with gustatory function.

The aim of this study was to compare the distribution of taste buds in fungiform papillae (FP) and gustatory function between young and elderly age groups. Confocal laser scanning microscopy was used because it allows many FP to be observed non-invasively in a short period of time. The age of participants (n = 211) varied from 20 to 83 yr. The tip and midlateral region of the tongue were observed. Taste buds in an average of 10 FP in each area were counted. A total of 2,350 FP at the tongue tip and 2,592 FP in the midlateral region could be observed. The average number of taste buds was similar among all age groups both at the tongue tip and in the midlateral region. The taste function, measured by electrogustometry, among participants 20-29 yr of age was significantly lower than that in the other age groups; however, there was no difference among any other age groups in taste function. These results indicate that the peripheral gustatory system is well maintained anatomically and functionally in elderly people.

Long-term Follow-up Results of Regeneration Process of Fungiform Taste Buds After Severing the Chorda Tympani Nerve During Middle Ear Surgery.

OBJECTIVE: To elucidate the regeneration process of fungiform taste buds after severing the chorda tympani nerve (CTN) by confocal laser scanning microscopy in vivo. METHODS: In 7 consecutive patients whose CTN was severed during tympanoplasty, an average of 10 fungiform papillae in the midlateral region of the tongue were periodically observed, and the number of taste buds was counted until 12 to 24 months after surgery. Gustatory function was assessed by EGM. RESULTS: EGM thresholds showed no response within 1 month after surgery in any patient. All taste buds had disappeared until 13 to 71 days after surgery. Regenerated taste buds were first detected 5 to 8 months after surgery in 5 of the 7 patients. EGM thresholds recovered to their preoperative values in 2 patients. In these 2 patients, the number of regenerated taste buds gradually increased in combination with a recovered taste function. However, a time lag existed between taste bud regeneration and taste function recovery. EGM thresholds did not recover in the other 3 patients with regenerated taste buds, suggesting that these taste buds were immature without gustatory function. CONCLUSION: The long-term regeneration process of fungiform taste buds could be clarified using confocal laser scanning microscopy.

Degeneration process of fungiform taste buds after severing the human chorda tympani nerve--observation by confocal laser scanning microscopy.

OBJECTIVE: To elucidate the degeneration process of fungiform taste buds after severing the chorda tympani nerve (CTN) by confocal laser scanning microscopy in vivo. STUDY DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Seven consecutive patients whose CTN was severed during tympanoplasty for middle ear cholesteatoma. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Preoperative and postoperative gustatory functions were assessed by electrogustometry (EGM). An average of 10 fungiform papillae (FP) in the midlateral region of the tongue were periodically observed, and the number of taste buds was counted using a confocal laser microscope. Among them, 2 to 3 reference FPs were selected based on the typical form of the FP or characteristic arrangements of taste pores. Observation was performed before surgery, 1 or 2 days after surgery, 2 or 3 times a week until 2 weeks after surgery, once a week between 2 and 4 weeks, and every 2 to 4 weeks thereafter until all taste buds had disappeared. RESULTS: EGM thresholds showed no response within 1 month after surgery in all patients. The initial change in the degeneration process was the disappearance of taste pores. The surface of taste buds became covered with epithelium. Finally, taste buds themselves atrofied and disappeared. The time course of degeneration differed depending upon individuals, each FP, and each taste bud. By employing the generalized linear mixed model under the Poisson distribution, it was calculated that all taste buds would disappear at around 50 days after surgery. CONCLUSION: Confocal laser scanning microscopy was useful for clarifying the degeneration process of fungiform taste buds.

Observation of regenerated fungiform taste buds after severing the chorda tympani nerve using confocal laser scanning microscopy in vivo.

OBJECTIVE: To evaluate whether regenerated fungiform taste buds after severing the chorda tympani nerve can be detected by confocal laser scanning microscopy in vivo. STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Six patients with a normal gustatory function (Group 1), 9 patients with taste function recovery after severing the CTN (Group 2), and 5 patients without taste function recovery (Group 3) were included. In Groups 2 and 3, canal wall up (closed) tympanoplasty or canal wall down with canal reconstruction tympanoplasty was performed in all patients. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: The severed nerves were readapted or approximated on the temporalis muscle fascia used to reconstruct the eardrum during surgery. Preoperative and postoperative gustatory functions were assessed using electrogustometry. Twelve to 260 months after severing the CTN, the surface of the midlateral region of the tongue was observed with a confocal laser microscope. RESULTS: EGM thresholds showed no response 1 month after surgery in all patients of Groups 2 and 3. In Group 2, EGM thresholds showed recovery 1 to 2 years after surgery and before confocal microscopy (-1.3 ± 6.5 dB). There was a significant difference between Group 1 (-5.7 ± 2.0 dB; p < 0.01) and Group 2. In Group 3, EGM thresholds showed no response for more than 2 years. In the control group (Group 1), 0 to 16 taste buds were observed in each FP, and 55 (79.7%) of 69 FP contained at least 1 taste bud. The mean number of taste bud per papilla was 3.7 ± 3.6. In patients with a recovered taste function (Group 2), 0 to 8 taste buds were observed in each FP. In this group, 54 (56.2%) of 94 FP contained at least 1 taste bud. The mean number of taste bud per papilla was 2.0 ± 2.2 (p < 0.01). In Group 3, without recovery, the FP was atrophied, and no taste bud was observed. CONCLUSION: Regenerated fungiform taste bud could be observed in vivo using confocal laser scanning microscopy, indicating that regenerated taste bud can be detected without biopsy.

Comparison of regeneration of the chorda tympani nerve and gustatory function recovery after severing the nerve between pediatric and adult patients.

OBJECTIVE: To compare the incidence of regeneration of the chorda tympani nerve (CTN) and taste function recovery between pediatric and adult patients after severing the CTN. STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Consecutive 31 pediatric patients and 61 adult patients who underwent staged tympanoplasty (86 patients) or reoperation (6 patients) because of chronic otitis media with (89 patients) or without cholesteatoma (3 patients) and whose CTN was severed during primary surgery were included. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURES: The severed nerves were readapted or approximated on the temporalis muscle fascia used to reconstruct the eardrum. During secondary surgery, we tried to detect regenerated CTN. Preoperative and postoperative gustatory function was assessed using electrogustometry. RESULTS: Regenerated CTN was detected during secondary surgery in 58.1% (18/31) of pediatric patients and 31.1% (19/61) of adults (p < 0.05). However, the number of patients with preoperatively elevated electrogustometry threshold was greater in adult patients. When the subjects were limited to those with preoperatively normal taste function, there was no significant difference between the 2 groups. Among patients with CTN regeneration, the incidence of taste function recovery was higher (12/18; 66.7%) in children than that (6/19; 31.6%) in adults (p < 0.05). However, there was no significant difference when the subjects were limited to those with preoperatively normal taste function. CONCLUSION: Chronic inflammation may not severely affect the CTN in pediatric patients, resulting in higher incidences of CTN regeneration and gustatory function recovery after severing the nerve, compared with those in adult patients.

Length of nerve gap defects correlates with incidence of nerve regeneration but not with recovery of taste function in patients with severed chorda tympani nerve.

OBJECTIVE: To evaluate the relationship between the length of nerve gap defects, incidence of nerve regeneration, and recovery of gustatory function after severing the chorda tympani nerve (CTN). STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Eighty-eight consecutive patients whose CTNs were severed during primary surgery and who underwent secondary surgery were included. Proximal and distal stumps of severed nerves were readapted or approximated during surgery. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURES: Before and after surgery, the taste function was periodically evaluated using electrogustometry. Nerve gaps were classified into 4 groups: readaptation (Group 1), 1 to 3 mm (Group 2), 4 to 6 mm (Group 3), and more than 7 mm (Group 4). RESULTS: Regenerated nerves in the tympanic segment were detected in 36 (41%) of the 88 patients during secondary surgery. The incidence of nerve regeneration was 100% (10/10) in Group 1, 45% (10/22) in Group 2, 47% (9/19) in Group 3, and 19% (7/37) in Group 4. There was a significant difference between the length of nerve gap defects and incidence of nerve regeneration (p < 0.001). In the 36 patients with a regenerated CTN, the incidence of gustatory function recovery was 60% (6/10) in Group 1, 50% (5/10) in Group 2, 56% (5/9) in Group 3, and 43% (3/7) in Group 4. There was no significant difference between the length of nerve gap defects and incidence of taste function recovery. CONCLUSION: Reconstruction of a severed CTN is very important for regeneration. However, the regenerated CTN in the tympanic segment does not always reinnervate the fungiform papillae.

Morphology of human fungiform papillae after severing chorda tympani nerve.

OBJECTIVES: We aimed to clarify the postoperative morphology of the fungiform papillae (FP) of the tongue in patients who recovered gustatory function after the chorda tympani nerve was severed during middle ear surgery. METHODS: Fifty-four patients with normal preoperative gustatory function measured by electrogustometry (EGM) were included. The proximal and distal stumps of the severed nerves were re-adapted or re-approximated during surgery to promote regeneration of the nerve. The EGM thresholds over 2 years after surgery were compared with preoperative values. At the same time, the morphological characteristics of the FP in the midlateral region of the tongue were recorded with a digital microscope. RESULTS: One month after surgery, EGM showed no response in any patients. At a time point of more than 2 years, the FP showed complete atrophy and no response to EGM on the surgical side in 21 of the 54 patients. In 16 patients who showed complete recovery of the EGM threshold (below 20 microA), the FP showed an almost normal appearance, and the mean number of FP was 77.5% (10 +/- 4.1 papillae per square centimeter) of that on the contralateral side (12.9 +/- 4.9 papillae per square centimeter; p > 0.05). CONCLUSIONS: The morphology of the FP was maintained in patients who recovered gustatory function after the chorda tympani nerve was severed. Because the results indicate regeneration of the taste buds, further observation is needed to detect regenerated taste buds in the FP.

Light and electron microscopic observation of regenerated fungiform taste buds in patients with recovered taste function after severing chorda tympani nerve.

OBJECTIVES: The aim of this study was to evaluate the mean number of regenerated fungiform taste buds per papilla and perform light and electron microscopic observation of taste buds in patients with recovered taste function after severing the chorda tympani nerve during middle ear surgery. METHODS: We performed a biopsy on the fungiform papillae (FP) in the midlateral region of the dorsal surface of the tongue from 5 control volunteers (33 total FP) and from 7 and 5 patients with and without taste recovery (34 and 29 FP, respectively) 3 years 6 months to 18 years after surgery. The specimens were observed by light and transmission electron microscopy. The taste function was evaluated by electrogustometry. RESULTS: The mean number of taste buds in the FP of patients with completely recovered taste function was significantly smaller (1.9 +/- 1.4 per papilla; p < 0.01) than that of the control subjects (3.8 +/- 2.2 per papilla). By transmission electron microscopy, 4 distinct types of cell (type I, II, III, and basal cells) were identified in the regenerated taste buds. Nerve fibers and nerve terminals were also found in the taste buds. CONCLUSIONS: It was clarified that taste buds containing taste cells and nerve endings do regenerate in the FP of patients with recovered taste function.

The terminal of the sympathetic nerve fibers in the facial nerve.

OBJECTIVE: The terminal of the sympathetic nerve fibers of the rat facial nerve in the temporal bone region was investigated. MATERIAL AND METHODS: We used tyrosine hydroxylase (TH) and the synaptophysin antibody as markers of the sympathetic nerve fiber and the membrane of the synaptic vesicle, respectively. Using immunohistochemistry, we determined whether and where the synapse exists in the facial nerve of the Sprague-Dawley rat. RESULTS: TH-immunoreactive fibers were confirmed as being present in both the epineurium and the nerve fascicle of the facial nerve. A synaptophysin immunoreaction was found in the facial nerve in a region of the temporal bone. These reaction products looked like varicosities. Most TH-positive fibers in the facial nerve disappeared after superior cervical ganglionectomy. CONCLUSIONS: As the synaptophysin immunoreaction indicates the existence of a synapse, we speculate that the sympathetic fibers affect the facial nerve in the region of the temporal bone. Further studies may be needed to elucidate the function of the sympathetic system in the facial nerve.

Inhibitory effect of cyclosporin A on p-glycoprotein function in peripheral nerves of mice treated with doxorubicin and vinblastine.

OBJECTIVE: To investigate the inhibitory effect of cyclosporin A on p-glycoprotein function in peripheral nerves (VIIth, VIIIth and sciatic nerves). MATERIAL AND METHODS: Male mdr1a(-/-) and mdr1a(+/+) FVB mice were used. Doxorubicin (30 mg/kg) was administered intravenously with or without i.p. administration of cyclosporin A (200 mg/kg). Vinblastine (5 mg/kg) was also administered intravenously with or without i.p. administration of cyclosporin A (200 mg/kg). RESULTS: Tissue concentrations of doxorubicin and vinblastine in peripheral nerves of the mdr1a(+/+) mice pretreated with 200 mg/kg cyclosporin A were significantly higher than those in the mdr1a(+/+) mice administered doxorubicin or vinblastine alone, suggesting that cyclosporin A inhibited the efflux pump function of p-glycoprotein in the peripheral nerves. In the mdr1a(-/-) mice, tissue concentrations of doxorubicin and vinblastine in peripheral nerves were also significantly higher than those in the mdr1a(+/+) mice administered doxorubicin or vinblastine alone. Based on these results, it is suggested that p-glycoprotein plays an important role in blood-nerve barrier function by preventing side-effects induced by neurotoxic drugs. CONCLUSION: When doxorubicin and vinblastine are co-administered with cyclosporin A, the patient should be carefully monitored because peripheral nerve disorders may be induced.

Cochlear nerve demyelination causes prolongation of wave I latency in ABR of the myelin deficient (md) rat.

In this study, we examined the auditory brainstem responses (ABRs), distortion product of otoacoustic emissions (DPOAEs) and cochlear morphology of the myelin deficient (md) rat, which completely lacks central myelin but not peripheral myelin. ABRs showed a marked prolongation not only wave II-IV latencies but also wave I latency. Cochlear nerve fibers near the modiolus lost their myelin halfway into the internal auditory canal. DPOAEs also decreased at a lower frequency of the combined tone. Since nerve fibers ending at the apical turn of the cochlea passed through central portion of the cochlear nerve, wave I prolongation of ABRs and decrease of DPOAEs at a lower frequency might originate mainly from the demyelinated CNS part of the cochlear nerve and efferent olivocochlear bundle in the internal auditory canal.

Gene expression analysis of human middle ear cholesteatoma using complementary DNA arrays.

OBJECTIVE: To identify genes regulated in human cholesteatoma compared with normal skin tissue using complementary DNA arrays. STUDY DESIGN: In vitro analysis. METHODS: Eight cholesteatoma and retroauricular skin samples were obtained from the same patients during surgery. Upregulated and downregulated genes were highlighted using complementary DNA arrays for screening. Reverse transcriptase-polymerase chain reaction and immunohistochemical staining were performed to confirm the results of the complementary DNA array. RESULTS: Twelve genes were found to be induced or upregulated in cholesteatoma compared with skin samples. These included genes involved in cell proliferation and differentiation (eg, calgranulin A, calgranulin B, psoriasin, thymosin beta-10) and cell invasion (eg, cathepsin C, cathepsin D, cathepsin H). Analyses by means of reverse transcription-polymerase chain reaction showed enhanced expression of several genes including calgranulin A, calgranulin B, psoriasin, thymosin beta-10, cathepsin C, cathepsin D, and cathepsin H in cholesteatoma, supporting the findings from the gene array. In addition, it was verified by immunohistochemical analysis that the expressions of Calgranulin A, Calgranulin B, and Cathepsin D were mainly located in cholesteatoma epithelium. CONCLUSION: The observed alteration in gene expression may play a role in various mechanisms of pathogenesis in cholesteatoma.

Tracheoesophageal shunt method with omohyoid muscle loop for voice restoration.

OBJECTIVE: To decrease the aspiration rate of the previously reported simple mucodermal tracheoesophageal (TE) shunt method for voice restoration after total laryngectomy with the use of omohyoid muscle loop. DESIGN: Retrospective clinical analysis. SETTING: Department of Otorhinolaryngology, Fukui Medical University, Fukui, Japan. PATIENTS: Ten male patients underwent total laryngectomy and received TE shunt by the omohyoid muscle loop method for voice restoration. There were 5 patients with glottic laryngeal cancer, 2 with supraglottic laryngeal cancer, and 3 with hypopharyngeal cancer. Patients' age ranged from 46 to 66 years. INTERVENTION: The dermal incision on the neck was U-shaped with a superiorly pedicled, small U-shaped dermal flap. This small flap was used to form the anterior wall of the shunt. Bilateral omohyoid muscles were preserved at the total laryngectomy site with or without neck dissection. After creating a TE shunt directly on the posterior wall of the tracheal stump, the bilateral omohyoid muscles were looped through each other beneath the TE shunt. MAIN OUTCOME MEASUREMENTS: Maximum phonation time, maximum phonation intensity, and rating scales of shunt voice, aspiration rate, and survival time. RESULTS: Mean maximum phonation time was 20 seconds, while mean maximum phonation intensity was 83 dB. The first voice was obtained on postoperative day 29 on average. Of the 10 patients, 9 could phonate, with 1 case (10%) of slight aspiration 3 months after the surgery. CONCLUSIONS: Although this omohyoid muscle loop method needs to preserve the hyoid bone with those muscles, aspiration was prevented more effectively compared with the former, direct mucodermal TE shunt method. The indication for this method is preferably glottic laryngeal cancer.

Incidence of regeneration of the chorda tympani nerve after middle ear surgery.

We retrospectively reviewed 52 patients who underwent middle ear surgery during which the chorda tympani nerves were severed and who then underwent secondary surgery 1 to 5 years later. In 22 patients (42.3%), regenerated chorda tympani nerves (entire length of the tympanic segment) were detected in the submucosal layer of the reconstructed eardrum during the secondary surgery. Before the secondary surgery, 16 patients (30.8%) showed threshold recovery on electrogustometry. When 5 regenerated nerves were observed by transmission electron microscopy, myelinated nerve fibers were detected in a small fascicle or connective tissue, but the number of myelinated axons was significantly decreased (7.4% to 84.6%; p = .01) compared with that in normal subjects (1,911 +/- 324; n = 4). There was a significant difference in the incidence of regeneration between the group with end-to-end anastomosis (5/5 or 100%) and that with nerve gap defects (17/47 or 36.2%; p <.05); this finding suggests that repair of the sectioned nerve produces a better incidence of regeneration than leaving the nerve unrepaired.

Analysis of heat-shock related gene expression in head-and-neck cancer using cDNA arrays.

PURPOSE: The aim of the present study was to identify genes regulated in the early response to heat-shock in human head-and-neck cancer cells using a cDNA array. METHODS AND MATERIALS: IMC-3 cells were heat-shocked at 44 degrees C for 30 min, then incubated for 6 h. After 6 h incubation, mRNAs were extracted. Early gene expressions in IMC-3 cells were analyzed using a cDNA array after heat-shock. In addition, reverse transcription-polymerase chain reaction (RT-PCR) was performed to identify the expressions of mRNA for confirming features by cDNA array analysis in several other cell lines (KB, T3M-1, SCC-TF) as well as in IMC-3 cells. RESULTS: Twenty-eight genes were found to be induced or upregulated by heat-shock in IMC-3 cells. These included genes involved in the apoptosis (e.g., CC3, caspase10), tumor invasion (e.g., CC3, TIMP-3), cell cycle checkpoint control (e.g., DP-1, CDC25A), signal transduction (e.g., MEK1) as well as genes associated with heat stress (e.g., Hsp70B', Hsp40). Gene expressions of CC3 and MEK1 were recognized to be induced by heat-shock in pharyngeal cancer cells (KB, T3M-1) and lingual cancer cells (SCC-TF). CONCLUSION: The observed alteration in gene expression may play a role in various biochemical pathways of cancer cells exposed to heat-shock.

Psychogenic hearing loss with panic anxiety attack after the onset of acute inner ear disorder.

A very rare case of a 50-year-old female showing psychogenic hearing loss with a panic anxiety attack that complicated an acute organic sensorineural hearing loss is reported. At the first visit to our clinic, the patient showed left sensorineural hearing loss with an inner ear disorder pattern. Five days after the onset, her left hearing threshold markedly increased without any subjective signs. On the next day, she suddenly experienced a severe panic attack with anxiety. After the attack, she felt mildly anxious and depressed. A combined therapy using primary corticosteroid therapy for the acute inner ear disorder, psychiatric counseling based on cognitive therapy and the administration of a minor tranquilizer was performed. Her left hearing threshold recovered to within normal ranges except in the high-frequency ranges immediately after the treatment. This case was considered very rare because: (1) the panic anxiety attack occurred in the conversion disorder as psychogenic hearing loss and (2) the psychogenic hearing loss complicated the primary sudden deafness. We suggest that otorhinolaryngologists should have psychiatric knowledge and be able to treat psychogenic hearing loss as a primary care.