Differences in semicircular canal function in the video head impulse test in patients in the chronic stage of sudden sensorineural hearing loss with vertigo and vestibular neuritis.

BACKGROUND: Sudden sensorineural hearing loss with vertigo (SHLV) and vestibular neuritis (VN) can result in prolonged dizziness. OBJECTIVES: This study aimed to compare the video head impulse test (vHIT) of patients with SHLV and VN. METHODS: Fifteen patients with SHLV and 21 patients with VN who visited the Vertigo/Dizziness Center of our hospital between December 2016 and February 2023 were included. vHIT was performed at the time of admission, and the VOR gain and catch up saccade (CUS) in the three types of semicircular canals (SCCs) were analyzed. RESULTS: Pathologic vHIT results were observed most frequently in the posterior SCC (73%), followed by lateral (53%) and anterior (13%) SCCs in the SHLV group. In contrast, pathologic vHIT results were observed most frequently in the lateral SCC (100%), followed by the anterior (43%) and posterior SCC (24%) SCCs in the VN group. Pathological vHIT results in the lateral and posterior SCC showed significant differences between the two groups, but for anterior SCC, no significant differences were found. CONCLUSIONS AND SIGNIFICANCE: Comparison of the two vHIT results revealed differences in the SCC dysfunction patterns. This may be due to the different pathophysiological mechanisms of the two vestibular disorders, which may result in prolonged vertigo.

Evaluation of changes in endolymphatic volume after middle ear pressure therapy for intractable meniere's disease using 3D magnetic resonance imaging.

BACKGROUND: Nowadays, the endolymphatic space size can be evaluated by 3D-analysis of 3 T-MRI after intravenous injection of gadolinium enhancement. AIMS/OBJECTIVES: In the present study, to elucidate the relationships between vertigo and endolymphatic hydrops (EH) volume after middle ear pressure therapy (MEPT), we investigated changes in EH volume after MEPT for intractable Meniere's disease (MD) by means of the inner ear MRI (ieMRI) in relation to clinical results. MATERIALS AND METHODS: We enrolled 202 successive definite MD cases with intractable vertiginous symptoms from 2015 to 2020, assigning Group-I of MEPT, and Group-II of endolymphatic sac drainage (ELSD). Ninety patients completed the planned 2-year-follow-up, which included assessment of vertigo frequency and changes in EH volume using ieMRI (Group-I/MEPT: n = 40; Group-II/ELSD: n = 50). RESULTS: Two years after surgery, vertigo was completely controlled in 77.5% of patients in Group-I and 90.0% in Group-II. Hearing improved by >10 dB in 7.5% of patients in Group-I and 24.0% in Group-II. ELS ratios were significantly reduced after treatments of Group-I and Group-II only in the vestibule. CONCLUSIONS: The obtained results indicate that MEPT as well as ELSD could be a good treatment option for patients with intractable MD.

Evaluation of changes in endolymphatic hydrops volume after medical treatments for Meniere's disease using 3D magnetic resonance imaging.

OBJECTIVE: To elucidate the relationship between vertigo and EH volume after medical treatment, we investigated changes in endolymphatic hydrops (EH) volume using inner ear magnetic resonance imaging (ieMRI) in relation to clinical results for vertigo and hearing after administration of the anti-vertiginous medications betahistine, adenosine triphosphate (ATP), isosorbide (ISO), and saireito (SAI) for Meniere's disease (MD). METHODS: We retrospectively enrolled 202 consecutive patients diagnosed with unilateral MD from 2015 to 2021 and assigned them to four groups: Group I (G-I), symptomatic oral medication with betahistine only (CONT); Group II (G-II), inner ear vasoactive oral medication (ATP); Group III (G-III), osmotic diuretic oral medication (ISO); and Group IV (G-IV), kampo oral medication (SAI). In total, 172 patients completed the planned one-year-follow-up, which included the assessment of vertigo frequency, hearing improvement, and changes in EH using ieMRI (G-I, n=40; G-II, n=42; G-III, n=44; G-IV, n=46). We constructed 3D MRI images semi-automatically and fused the 3D images of the total fluid space (TFS) of the inner ear and endolymphatic space (ELS). After fusing the images, we calculated the volume ratios of the TFS and ELS (ELS ratios). RESULTS: One year after treatment, vertigo was controlled with zero episodes per month in 57.5% (23/40) of patients in G-I, 78.6% (33/42) in G-II, 81.8% (36/44) in G-III, and 82.6% (38/46) in G-IV (statistical significance: G-I 10 dB in 5.0% (2/40) of patients in G-I, 16.7% (7/42) in G-II, 18.2% (8/44) in G-III, and 21.7% (10/46) in G-IV (statistical significance: G-I=G-II=G-III=G-IV). ELS ratios were significantly reduced after treatment only in the vestibule for G-II, G-III, and G-IV when compared with G-I. Especially among patients with complete control of vertigo after treatment, ELS ratios were significantly reduced after treatment in the vestibule and total inner ear for G-II; in the cochlea, vestibule, and total inner ear for G-III; and in the cochlea, vestibule, and total inner ear for G-IV compared with G-I. However, there were no significant findings in the relationship between hearing results and changes in ELS ratios. CONCLUSION: These results indicate that daily administration of anti-vertiginous medications including ATP, ISO, and SAI could be an effective treatment option for patients with MD at an early stage before it becomes intractable. Treatments to reduce EH might offer better control of vertigo rather than improve hearing.

Culture of organoids with vestibular cell-derived factors promotes differentiation of embryonic stem cells into inner ear vestibular hair cells.

Vestibular hair cells (V-HCs) residing in the inner ear have important roles related to balance. Although differentiation of pluripotent stem cells into HCs has been shown, an effective method has yet to be established. We previously reported that use of vestibular cell-derived conditioned medium (V-CM) was helpful to induce embryonic stem (ES) cells to differentiate into V-HC-like cells in two-dimensional (2D) cultures of ES-derived embryoid bodies (EBs). In the present report, V-CM was used with three-dimensional (3D) cultures of EBs, which resulted in augmented expression of V-HC-related markers (Math1, Myosin6, Brn3c, Dnah5), but not of the cochlear HC-related marker Lmod3. Gene expression analyses of both 2D and 3D EBs cultured for two weeks revealed a greater level of augmented induction of HC-related markers in the 3D-cultured EBs. These results indicate that a 3D culture in combination with use of V-CM is an effective method for producing V-HCs.

Association of Stapedotomy Volume and Patient Sex With Better Outcome.

This cross-sectional study evaluates demographic characteristics, surgical characteristics, and audiometric data associated with closure of the air-bone gap to less than 10 dB or 15 dB.

Behavioral and Immunohistochemical Evidence for Suppressive Effects of Goshajinkigan on Salicylate-Induced Tinnitus in Rats.

Many people are affected by tinnitus, a sensation of ringing in the ear despite the absence of external sound. Goshajinkigan (GJG) is one of the formulations of Japanese traditional herbal medicine and is prescribed for the palliative treatment of patients with tinnitus. Although GJG is clinically effective in these patients, its behavioral effects and the underlying neuroanatomical substrate have not been modeled in animals. We modeled tinnitus using salicylate-treated rats, demonstrated the effectiveness of GJG on tinnitus, and examined the underlying neuronal substrate with c-Fos expression. Intraperitoneal injection of sodium salicylate (400 mg/kg) into rats for three consecutive days significantly increased false positive scores, which were used to assess tinnitus behavior. When GJG was orally administered one hour after each salicylate injection, the increase in tinnitus behavior was suppressed. The analysis of c-Fos expression in auditory-related brain areas revealed that GJG significantly reduced the salicylate-induced increase in the number of c-Fos-expressing cells in the auditory cortices, inferior colliculus, and dorsal cochlear nucleus. These results suggest a suppressive effect of GJG on salicylate-induced tinnitus in animal models.

Results of subjective visual vertical tests in patients with vertigo/dizziness.

OBJECTIVE: We previously established the head-tilt subjective visual vertical (HT-SVV) test to evaluate head-tilt perception gain (HTPG) in addition to the original head-upright SVV (HU-SVV) test (Wada-Y et al.: Laryngoscope Investig Otolaryngol, 2020). In this study, we aimed to investigate the HU-SVV and HT-SVV abnormality rates among patients with vertigo/dizziness. METHODS: Between July 2014 and December 2020, 357 patients were hospitalized for examining the HU-SVV and HT-SVV at our vertigo/dizziness center. Among these patients, 120 had Meniere's disease (MD), 99 had unilateral vestibular disease (UVD), 76 had benign paroxysmal positional vertigo (BPPV), 14 had vestibular migraine (VM), 13 had orthostatic dysfunction (OD), 12 had bilateral vestibular disease (BVD), 12 had central dizziness (CD), 7 had vestibular schwannoma (VS), and 4 had psychogenic dizziness (PD). We determined the reference values of the absolute HU-SVV (<2.5°) and HTPG (0.80-1.25) for the sitting position and used these for calculating the HU-SVV and HT-SVV abnormality rates in each type of vertigo/dizziness. RESULTS: Among the 357 patients, 111 had abnormal HU-SVV results (31.1%), 132 had abnormal HT-SVV results (37.0%), and 185 had abnormal HU-SVV and/or HT-SVV results (51.8%). The modified HT-SVV test in combination with the original HU-SVV test could detect gravity perception disturbance in patients with vertigo/dizziness significantly better than the original test alone (chi-square: p=0.00019). The HU-SVV, HT-SVV, and HU-SVV and/or HT-SVV abnormality rates were significantly higher in patients with peripheral vestibular diseases, i.e., MD, UVD, BPPV, and BVD than in those with other types of vertigo/dizziness, i.e., VM, OD, CD, VS, and PD (chi-square: p=0.010, p=0.020, and p=0.0025, respectively). CONCLUSION: These findings suggest that the combined HT-SVV and HU-SVV test could be a powerful neuro-otologic examination for detecting pathologies in the vestibular otolithic pathway.

The Third Mobile Window Effects in Otology/Neurotology.

It has been revealed that the pure-tone audiometry demonstrates large air-bone gaps at low pitches due to the presence of inner ear fistulae. When a third mobile window resulting from an inner ear fistula is present, in addition to the 2 normally present windows consisting of the oval window and the round window, a portion of the air-conducted waves escape from the scala vestibuli through the inner ear fistula. On the other hand, bone-conducted waves traveling to the scala vestibuli are reduced by an inner ear fistula; however, bone-conducted waves traveling to the scala tympani are not affected by an inner ear fistula. This results in a larger gap than usual in compliance between both perilymphatic spaces and leads to a decrease in the bone conduction threshold. This phenomenon, so-called the third mobile window effects, sometimes may lead otology/neuro-otology surgeons to misunderstand the reason why large air-bone gaps still exist after ossicular reconstruction in tympanoplasty. This review article gives good examples regarding the third mobile window effects in otology/neuro-otology diseases and surgeries.

What diagnosis should we make for long-lasting vertiginous sensation after acute peripheral vertigo?

BACKGROUND: Differential diagnosis of persistent vertigo/dizziness in patients with a past history of vestibular neuritis (VN) and sudden deafness with vertigo (SDV) could sometimes be difficult for physicians due to variable vertiginous symptoms from rotatory to floating sensation. OBJECTIVES: The main purpose of the present study was to examine the associations between the findings of otology/neurotology examinations in patients at the chronic stage after VN and SDV. MATERIAL AND METHODS: We encountered 1789 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University between 2014 and 2018. Eighty-five patients were diagnosed as showing VN and 60 showed SDV according to the diagnostic guideline . The VN and SDV patients included 75 and 45 patients with chronic-stage of persistent vertigo/dizziness, of which 55 and 40 were enrolled into the present study. RESULTS: Persistent vertigo/dizziness after VN was attributable to delayed vestibular compensation (dVC: 33/55; 60.0%), secondary benign paroxysmal positional vertigo (sBPPV: 20/55; 36.4%), and secondary endolymphatic hydrops (sEH: 2/55; 3.6%), while that after SDV was attributable to sBPPV (20/40; 50.0%), sEH (16/40; 40.0%), and dVC (4/40; 10.0%). CONCLUSION AND SIGNIFICANCE: The present results could allow to simplify differential diagnosis of persistent vertigo/dizziness after VN and SDV such diseases as dVC, sBPPV, or sEH.

Isolation and culture of pleural mesothelial cells.

Purpose: Although the isolation of rat and mouse mesothelial cells has previously been reported, most mesothelial cells used for experimental studies are obtained from peritoneal cells. Here, we describe an optimized method for the isolation and in vitro propagation of rodent pleural mesothelial cells without the requirement for specialized surgical techniques. Materials and Methods: To harvest pleural mesothelial cells, the pleural space of 8-9-week-old rats or older mice was filled with 0.25% trypsin in ethylenediaminetetraacetic acid (EDTA) buffer for 20 min at 37 °C. Cells were then harvested, and incubated at 37 °C in a humidified atmosphere with 5% CO2. Immunofluorescence analysis of plated pleural mesothelial cells was performed using Alexa 546 (calretinin). To investigate optimal proliferation conditions, medium enriched with various concentrations of fetal calf serum (FCS) was used for pleural mesothelial cell proliferation. Results: By day 10, confluent cell cultures were established, and the cells displayed an obvious cobblestone morphology. Immunofluorescence analysis of the cells demonstrated that all stained positive for Alexa 546 (calretinin) expression. Mesothelial cells grew better in medium containing 20% FCS than with 10% FCS. Conclusions: This is a simple procedure for the efficient collection of primary pleural mesothelial cells, which were obtained in defined culture conditions from the euthanized rodent thoracic cavity using trypsin-EDTA treatment. The ability to easily culture and maintain identifiable pleural mesothelial cells from rodents will be helpful for future experiments using these cells.

Differentiation of embryonic stem cells into inner ear vestibular hair cells using vestibular cell derived-conditioned medium.

Vestibular hair cells (V-HCs) in the inner ear have important roles and various functions. When V-HCs are damaged, crippling symptoms, such as vertigo, visual field oscillation, and imbalance, are often seen. Recently, several studies have reported differentiation of embryonic stem (ES) cells, as pluripotent stem cells, to HCs, though a method for producing V-HCs has yet to be established. In the present study, we used vestibular cell conditioned medium (V-CM) and effectively induced ES cells to differentiate into V-HCs. Expressions of V-HC-related markers (Math1, Myosin6, Brn3c, Dnah5) were significantly increased in ES cells cultured in V-CM for 2 weeks, while those were not observed in ES cells cultured without V-CM. On the other hand, the cochlear HC-related marker Lmod3 was either not detected or detected only faintly in those cells when cultured in V-CM. Our results demonstrate that V-CM has an ability to specifically induce differentiation of ES cells into V-HCs.

Effect of covering with cross-linked gelatin glue on tissue regeneration in a rat lung injury model.

OBJECTIVES: Thoracic reintervention is a common treatment; however, preventing adhesion of the lung to the thoracic cavity wall remains a problem. This study aimed to investigate the effect on pleural adhesion of covering the postoperative pleural injury site with cross-linked gelatin glue (gelatin plus glutaraldehyde, hereafter 'gelatin glue') and to evaluate the proliferation of healing cells on gelatin glue. METHODS: We created a rat incisional lung-wound model and compared the effects of sealing the wound with gelatin glue (group A, n = 5), fibrin glue (group B, n = 5) or fibrin glue with a polyglycolic acid sheet (group C, n = 5). Adhesions were assessed 28 days postoperatively and compared among the groups using the Karacam's scoring method. Lung-wound healing was studied histologically at day 7 postoperatively. Mesothelial cell proliferation was investigated on gelatin and fibrin glues in vitro. RESULTS: There were no or few adhesions of the chest wall in group A. The adhesion scores (mean ± standard deviation) were 1.2 ± 0.4, 2.6 ± 1.4 and 3.2 ± 1.2 in groups A, B and C, respectively (A vs C, P = 0.0496). During the healing process, the gelatin glue surface was covered by mesothelial-like cells. Proliferation of cultured mesothelial cells was promoted on the gelatin glue compared with the fibrin glue. CONCLUSIONS: Covering lung wounds with the gelatin glue reduced adhesions and promoted the growth of healing cells compared with the fibrin glue. These findings suggest that the gelatin glue may help prevent adhesions and thus be a therapeutically effective biomaterial in lung surgery.

Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis.

OBJECTIVE: The aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients. METHODS: We experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015. Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n=30), horizontal type canal (hBPPVca; n=10), posterior type (n=20), and probable and/or atypical BPPV (n=6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range. RESULTS: The ratio (+) data were as follows: C-test=21.2% (14/66), cVEMP=24.2% (16/66), SVV=48.5% (32/66), G-test=18.2% (12/66), ECoG=18.2% (12/66), ieMRI=12.1% (8/66), ADH=9.1% (6/66), BAP=13.6% (9/66), and SDS=37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings. CONCLUSION: Although patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments.

Ménière's disease with unremitting floating sensation is associated with canal paresis, gravity-sensitive dysfunction, mental illness, and bilaterality.

OBJECTIVE: The aim of the present study was to evaluate the association of neuro-otological examination, blood tests, and scoring questionnaire data with treatment-resistant intractability of persistent dizziness in Ménière's disease. METHODS: We managed 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University from May 2014 to April 2018. Five hundred and twenty-two patients were diagnosed with Ménière's disease (522/1520; 34.3%) according to the 2015 diagnostic guideline of the International Classification of Vestibular Disorders. Among the patients with Ménière's disease there were 102 with intractable rotatory vertigo attacks for more than 3-6 months (102/522; 19.5%), including 20 bilateral cases (20/102; 19.6%), and 88 with intractable unremitting floating sensation rather than rotatory vertigo attacks for more than 3-6 months (88/522; 16.9%), including 28 bilateral cases (28/88; 31.8%). Sixty out of 88 cases with intractable unremitting floating sensation were unilateral and were enrolled for hospitalization to undergo neuro-otological examinations including pure-tone audiometry (PTA), the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV) test, glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Data are presented as positive (+) ratios of the number of patients with examination and questionnaire data outside of the normal range. RESULTS: The ratios (+) were as follows: C-test=33.3% (20/60), cVEMP=25.0% (15/60), SVV=50.0% (30/60), G-test=55.0% (33/60), ECoG=63.3% (38/60), ieMRI=86.7% (52/60), ADH=35.0% (21/60), BAP=11.7% (7/60), and SDS=40.0% (24/60). Multivariate regression analysis revealed that the periods of persistent dizziness were significantly longer in unilateral Ménière's patients with C-test(+), SVV(+), and SDS(+) compared with those with negative findings. Additionally, the periods in bilateral cases were significantly longer than those in unilateral ones. CONCLUSIONS: Although approximately 70% of patients with Ménière's disease are usually treatable through the appropriate conservative medical therapy, the presence of canal paresis, gravity-sensitive dysfunction, neurosis/depression, and bilaterality may make the persistent dizziness intractable and may thus require additional treatments.

Induction of lung-like cells from mouse embryonic stem cells by decellularized lung matrix.

Decellularization of tissues is a recently developed technique mostly used to provide a 3-dimensional matrix structure of the original organ, including decellularized lung tissues for lung transplantation. Based on the results of the present study, we propose new utilization of decellularized tissues as inducers of stem cell differentiation. Decellularized lung matrix (L-Mat) samples were prepared from mouse lungs by SDS treatment, then the effects of L-Mat on differentiation of ES cells into lung cells were investigated. ES cell derived-embryoid bodies (EBs) were transplanted into L-Mat samples and cultured for 2 weeks. At the end of the culture, expressions of lung cell-related markers, such as TTF-1 and SP-C (alveolar type II cells), AQP5 (alveolar type I cells), and CC10 (club cells), were detected in EB outgrowths in L-Mat, while those were not found in EB outgrowths attached to the dish. Our results demonstrated that L-Mat has an ability to induce differentiation of ES cells into lung-like cells.

Efficient induction of inner ear hair cell-like cells from mouse ES cells using combination of Math1 transfection and conditioned medium from ST2 stromal cells.

We sought to establish a more efficient technique for induction of inner ear hair cell-like cells (HC-like cells) from embryonic stem cells (ES cells) by using a combination of two previously reported methods; ST2 stromal cell-conditioned medium, known to be favorable for HC-like cell induction (HIST2 method), and ES cells with transfer of the Math1 gene (Math1-ES cells). Math1-ES cells carrying Tet-inducible Math1 were cultured for 14days with doxycycline in conditioned medium from cultures of ST2 stromal cells following formation of 4-day embryoid bodies (EBs). Although each of the previously introduced methods have been reported to induce approximately 20% HC-like cells and 10% HC-like cells in their respective populations in EB outgrowths at the end of the culture periods, the present combined method was able to generate approximately 30% HC-like cells expressing HC-related markers (myosin6, myosin7a, calretinin, α9AchR, Brn3c), which showed remarkable formation of stereocilia-like structures. Analysis of expressions of marker genes specific for cochlear (Lmod3, Emcn) and vestibular (Dnah5, Ptgds) cells indicated that our HIST2 method may lead to induction of cochlear- and vestibular-type cells. In addition, continuous Math1 induction by doxycycline without use of the HIST2 method preferentially induced cochlear markers with negligible effects on vestibular marker induction.

A Two-Year Randomized Trial of Interventions to Decrease Stress Hormone Vasopressin Production in Patients with Meniere's Disease-A Pilot Study.

UNLABELLED: Meniere's disease, a common inner ear condition, has an incidence of 15-50 per 100,000. Because mental/physical stress and subsequent increase in the stress hormone vasopressin supposedly trigger Meniere's disease, we set a pilot study to seek new therapeutic interventions, namely management of vasopressin secretion, to treat this disease. We enrolled 297 definite Meniere's patients from 2010 to 2012 in a randomized-controlled and open-label trial, assigning Group-I (control) traditional oral medication, Group-II abundant water intake, Group-III tympanic ventilation tubes and Group-IV sleeping in darkness. Two hundred sixty-three patients completed the planned 2-year-follow-up, which included assessment of vertigo, hearing, plasma vasopressin concentrations and changes in stress/psychological factors. At 2 years, vertigo was completely controlled in 54.3% of patients in Group-I, 81.4% in Group-II, 84.1% in Group-III, and 80.0% in Group-IV (statistically I < II = III = IV). Hearing was improved in 7.1% of patients in Group-I, 35.7% in Group-II, 34.9% in Group-III, and 31.7% in Group-IV (statistically I < II = III = IV). Plasma vasopressin concentrations decreased more in Groups-II, -III, and -IV than in Groups-I (statistically I < II = III = IV), although patients' stress/psychological factors had not changed. Physicians have focused on stress management for Meniere's disease. However, avoidance of stress is unrealistic for patients who live in demanding social environments. Our findings in this pilot study suggest that interventions to decrease vasopressin secretion by abundant water intake, tympanic ventilation tubes and sleeping in darkness is feasible in treating Meniere's disease, even though these therapies did not alter reported mental/physical stress levels. TRIAL REGISTRATION: ClinicalTrials.gov NCT01099046.

Negative prognostic factors for psychological conditions in patients with audiovestibular diseases.

OBJECTIVE: To examine the backgrounds of patients with audiovestibular disease regarding what influences their psychological state. METHODS: During a 12-year period, 375 successive patients with audiovestibular diseases were enrolled in this study. Diseases included unilateral (n=174) and bilateral (n=51) Menière's disease, sudden deafness with vertigo (n=70), and vestibular neuritis (n=80). Diagnosis, sex, age, duration of disease, vertigo frequency, persistent nystagmus, and ipsilateral/contralateral hearing levels were recorded. Cornell Medical Index (domains III-IV=neurosis) and Self-Rating Depression Scale (score>40=depression) were applied during acute vertigo remissions in all patients. RESULTS: Neurosis and depression, respectively, were diagnosed in 62.7% and 82.4% of bilateral Menière's, 32.7% and 48.9% of unilateral Menière's, 15.7% and 38.6% of sudden deafness/vertigo, and 12.7% and 31.3% of vestibular neuritis patients. Multivariable logistic regression analysis showed that Menière's disease with longer disease duration (Oz 1.212; P=0.021) and worse hearing in the secondary affected ear (Oz 1.131; P=0.042); sudden deafness/vertigo with persistent nystagmus (Oz 1.895; P=0.005); and vestibular neuritis with longer disease duration (Oz 1.422; P=0.019) and persistent nystagmus (Oz 1.950; P=0.0003) had mental illness significantly more often than those with shorter-duration disease, better hearing and no persistent nystagmus. CONCLUSION: Mental disorder increased in accordance with solo vertigo, vertigo/hearing loss, repeated symptoms, and bilateral lesions. Treatment strategies should be carefully constructed for patients with persistent nystagmus, long disease duration, and hearing loss in the secondary affected ear to avoid psychological disorders.

Effects of posterior tympanotomy with steroids at round window on hearing recovery after revision surgery for intractable Meniere's disease.

CONCLUSIONS: At the second postoperative year, there were no significant differences between results for vertigo and hearing after endolymphatic sac drainage with steroid instillation surgery (EDSS) and EDSS with posterior tympanotomy with steroids at the round window (EDRW). In particular, as regards hearing recovery to the preoperative level, the periods after EDRW were shorter than those after the second EDSS. OBJECTIVES: Patients sometimes faces recurrent problems years after EDSS due to endolymphatic sac closure and/or disease progression. In the present study, we examined the effects of EDRW on vertigo and hearing after revision surgery for intractable relapsed Meniere's disease. METHODS: Sixteen patients with Meniere's disease had revision surgery due to intractable recurrence of disease, and were followed up regularly at least for 2 years. As revision surgery, EDSS was performed repeated in eight cases and EDRW was performed in the other eight. There were no significant differences between the patients' backgrounds in the two groups. RESULTS: Periods of hearing recovery to the preoperative level were 11.5 ± 4.4 months after the first EDSS, although it took 16.4 ± 2.6 months longer after revision surgery with the second EDSS (p = 0.038 < 0.05: first EDSS vs second EDSS) and was 10.0 ± 3.3 months shorter after revision surgery with EDRW (p = 0.010 < 0.05: second EDSS vs EDRW).