Clinical Efficiencies of Stabilometry and Visual Feedback Test for Differentiating the Patients with Psychogenic Vertigo from Healthy Subjects.

The psychogenic vertigo has been diagnosed based on subjective dizzy symptom without abnormal findings of oculomotor tests and vestibular tests. We investigated the characteristics of the postural control system in patients with psychogenic vertigo using stabilometry and Body Tracking Tests with a visual feedback test to assess the dynamic body balance. This study consisted of 14 patients with psychogenic vertigo and 92 aged-match healthy subjects. They were instructed to keep the center of pressure constantly in the target circle displayed on the screen in front of the subjects. The dynamic body balance was evaluated by the proportion of the center of pressure (COP) including in the target circle during the test. The psychogenic vertigo group showed a larger area and a smaller locus length per unit area in comparison with the healthy subject group (p<0.01). In spectral analysis with the maximum entropy method (MEM), the power of the medio-lateral and antero-posterior positional power spectrum under eyes open condition were significantly largest at around 0.125 Hz in the psychogenic vertigo group. No significant difference in the result of Body Tracking Tests with a visual feedback test was found between both groups. Our results suggest that the patients with psychogenic vertigo maintain body balance with extremely slowly and large movements for quiet stance during eyes open condition. The results of Body Tracking Tests with a visual feedback test may indicate that the spontaneous postural control itself in patients with psychogenic vertigo does not differ from that in healthy individuals. We believe that this test could be useful as one of the significant diagnostic tests for psychogenic vertigo.

Age-related morphological changes in the basement membrane in the stria vascularis of C57BL/6 mice.

Basement membrane anionic sites (BMAS) are involved in the selective transport of electrically charged macromolecules in cochlear capillaries. Using cationic polyethyleneimine (PEI), we examined age-related changes in BMAS in the cochleae of C57BL/6 mice. The mice were grouped according to age as follows: 3 days, 4 weeks, 8 weeks, 6 months, and 12 months. In the right bony labyrinths, widths of the stria vascularis were measured in paraffin-embedded sections using light microscopy. The left bony labyrinths were immersed in a 0.5 % cationic PEI solution and embedded in epoxy resin. Ultrathin sections of the left cochlea were examined using transmission electron microscopy. A significant difference in stria vascularis width was observed between the 4-week-old and 12-month-old mice. The PEI distribution in the capillary and epithelial basement membranes (BMs) of the cochlea was observed. In all animals, PEI particles were evenly distributed in the capillary BM of the spiral ligament and in the subepithelial BM of Reissner's membrane. In the stria vascularis, PEI particles were evenly distributed in the capillary BM in 3-day-old mice. In 4- and 8-week-old mice, PEI particle sizes were markedly lower than those observed in 3-day-old mice. In 6- and 12-month-old mice, PEI particles were hardly detected in the strial capillary BM. In the strial capillary BM in these mice, the laminae rarae externa and interna disappeared, but the lamina densa became larger. We speculated that age-related changes of strial capillary BMAS may affect electrically charged macromolecule transport systems in the stria vascularis of C57BL/6 mice.

Measuring local immunoglobulin E in the inferior turbinate nasal mucosa in patients with allergic rhinitis.

BACKGROUND: Studies show that immunoglobulin E (IgE) is produced in the local nasal mucosa in allergic rhinitis patients. However, no study involved the measurement of IgE levels in the local nasal mucosal tissue in allergic rhinitis patients. This study aimed to measure the local IgE levels in the nasal mucosal tissue and to compare the levels of total IgE and specific IgEs in the serum and the inferior turbinate nasal mucosa in allergic rhinitis patients using the AlaSTAT 3gAllergy assay (Siemens Healthcare Diagnostics AG, Erlangen, Germany). METHODS: Total IgE antibodies and allergen-specific IgE antibodies in each sample of nasal mucosal tissue from 11 allergic rhinitis patients were measured with the AlaSTAT 3gAllergy assay. We compared the levels of total IgE and IgEs specific for house dust (HD), mites, and cedar pollen in the serum and the inferior turbinate. RESULTS: The total IgE levels and the cedar pollen-specific IgE levels in the inferior turbinate mucosal tissue correlated significantly with their respective levels in serum. The HD- and mite-specific IgE levels in the inferior turbinate mucosal tissue did not correlate significantly with their respective levels in the serum. CONCLUSIONS: Our results evaluating the correlations between nasal mucosal and serum levels of antigen-specific IgE indicate that IgE produced in the nasal mucosa affects the IgE levels in the serum, especially the cedar pollen-specific IgE.

Prognostic factors for long-term hearing preservation after canal-tympanoplasty for congenital aural atresia.

The present study aimed to determine favorable prognostic factors for long-term postoperative hearing outcome after canal-tympanoplasty for congenital aural atresia (CAA). We retrospectively reviewed pre and postoperative hearing results and image findings of 51 ears with CAA performed by canal-tympanoplasty for primary repair. Averages of the postoperative air and bone-conduction thresholds, and the air-bone gap (ABG) were calculated from the last pure-tone audiometry. Follow-up duration ranged from 16 to 139 months. A successful hearing result was defined as a postoperative ABG of ≤15 dB, or a postoperative pure-tone average of ≤30 dB. The influence of the following factors on the success of surgery was assessed by multivariate logistic regression analysis: total Jahrsdoerfer grading system score, age at surgery, and dimensions of middle ear including incudostapedial joint angulation, mesotympanic height, mesotympanic width, mesotympanic depth, mesotympanic area, mesotympanic volume, reconstructable external auditory canal (EAC) diameter, and reconstructable EAC height. Successful hearing outcomes were achieved in 24 of 51 ears (47.1%). A multivariate logistic regression analysis showed that an EAC area >72.3 mm(2) was the most significant favorable predictive factor (P = 0.006), followed by mesotympanic depth >5.5 mm (P = 0.013), mesotympanic height >4.6 mm (P = 0.016), and EAC diameter >9.5 mm (P = 0.029). In conclusion, the size of the reconstructable EAC and mesotympanum is important for predicting long-term favorable hearing outcome following canal-tympanoplasty for CAA.

Superior canal dehiscence syndrome: A review.

Superior canal dehiscence syndrome (SCDS) is a vestibular disorder in which the presence of a pathological third window in the labyrinth causes several vestibular and cochlear symptoms. Herein, we review the diagnostic criteria and treatment of SCDS. The cause of SCDS is considered to be congenital or acquired; however, its etiology is not well known. Symptoms: Vertigo and/or oscillopsia induced by loud sounds (Tullio phenomenon) or stimuli that change the middle ear or intracranial pressure (fistula symptoms) with vestibular symptoms and hyperacusis and aural fullness with cochlear symptoms are characteristic clinical complaints of this syndrome. Neurological tests: Vertical-torsional eye movements can be observed when the Tullio phenomenon or fistula symptoms are induced. Conductive hearing loss with both a decrease in the bone conduction threshold at lower frequencies and an increase in the air conduction threshold at lower frequencies may be present on audiometry. Cervical and/or ocular vestibular evoked myogenic potentials are effective in strongly suspecting the presence of a pathologic third window in the labyrinth. Computed tomography (CT) imaging: High-resolution CT findings with multiplanar reconstruction in the plane of the superior semicircular canal consistent with dehiscence indicate SCDS. The Pöschl view along the plane of the superior semicircular canal and the Stenvers view perpendicular to it are recommended as CT imaging conditions. Findings from all three major diagnostic categories (symptoms, neurological tests, and/or CT imaging) are needed to diagnose SCDS. The surgical approaches for SCDS are as follows: the 1) middle cranial fossa approach, 2) transmastoid approach, and 3) round window and oval window reinforcement. Each technique has advantages and disadvantages.

[Tracking axis of the body tracking test(BTT)].

We report herein on the use of the body tracking test (BTT), which is a method for quantitatively evaluating dynamic body balancing function, and how the body center moves during tracking by healthy subjects. We investigated 779 healthy subjects with no history of vertigo or balance disorder and a mean age of 37.9 years. Breakdown is as follows. Under 10 years old is 81 (37 boy and 44 girl), 10 years of age is 162 (73 boy and 89 girl), 20 years of age is 110 (43 men and 67 women), 30 years of age is 73 (44 male, 29 female), 40 years of age is 79 (49 men and 30 women), 50 years of age is 77 (40 men and 37 women), 60 years of age is 100 (53 men and 47 women), 70 years of age is 73 (27 men and 46 women), 80 years of age is 24 (15 men and 9 women). For the visual stimulus, we used a constant-speed antero-posterior (A-P) stimulus BTT and a constant-speed lateral BTT. BTT analysis involved principal axis analysis, in which the principal axis was the first principal component according to a principal component analysis technique. The axis tilt in the principal axis direction was assessed by calculating the coordinate Y-axis and X-axis tilt. In the anteroposterior (A-P) BTT, subjects of all ages exhibited an angle of tilt in the clockwise direction (the "plus" direction), together with the position vector and velocity vector. In the lateral BTT, we observed that the subjects tracked with a tilt in the counter-clockwise direction (the "minus" direction), together with the position vector and velocity vector. In terms of the subjects' ages, the angle of tilt from 0 degree in the antero-posterior (A-P) BTT showed the clockwise direction (the "plus" direction). In the lateral BTT, subjects 10 to 30 years of age exhibited tracking along the X-axis, with no observable tilt. Movement of the center of gravity may be a major acquired ability (practice) with respect to the direction of tilt of the tracking axis. Spatial sensory ability primarily involves the right parietal lobe of the brain, and somatosensory information from the left side of the body is believed to be used more for the positional relationships between the legs and the torso. Deviation of the principal axis appears to be related to the relationship between the dominant foot and the pivot foot, as well as to the functions of the parietal lobe that are involved in spatial sensing.

Short-term functional and morphological changes in guinea pig cochlea following intratympanic application of Burow's solution.

OBJECTIVES: Burow's solution, comprising aluminum sulfate and acetic acid, is an otic drug formulation applied to the tympanic cavity. We characterized the relationship between the auditory brain stem response (ABR) thresholds and the area of the capillary basement membrane anionic sites in the stria vascularis after the application of Burow's solution. METHODS: We used cationic polyethylenimine (PEI) to observe changes in the capillary basement membrane anionic sites in the stria vascularis. Burow's solution was dropped directly onto the round window membrane and retained for 2 hours. The ABRs were recorded at 4, 8, and 20 kHz immediately before surgery and before decapitation. The cochlea was extirpated immediately or 2 days after the surgery and immersed in cationic PEI solution. The PEI distribution associated with the capillary basement membrane anionic sites was measured in the basal and third turns. RESULTS: The ABR threshold shifts at 4, 8, and 20 kHz were significantly increased immediately after the surgery, whereas those at 4 and 8 kHz, but not at 20 kHz, had recovered 2 days after the surgery. Further, the PEI distribution was significantly decreased immediately after the surgery and had recovered 2 days after the surgery. CONCLUSIONS: Although Burow's solution may cause an acetic low pH in the stria vascularis and a temporary ABR threshold shift at 4 and 8 kHz, the permanent ABR threshold shift at 20 kHz cannot be attributed to the acetic low pH.

[Clinical evaluation of vertigo in menopausal women].

Vertigo is one of the usual menopausal symptoms. We have often examined some women under the complaint of vertigo related with the menopause. We diagnosed each disease based on neuro-otological examinations and investigated the characteristics of menopausal-associated vertigo. We studied 413 women aged 40-59 years old who complained of vertigo. There were 73 women with menopause symptoms (14 women introduced from the gynecologist in our medical center, 18 women had undergone treatment at another female clinic, and 41 women visited an otorhinolaryngologist first) compared with 340 women without menopause symptoms. In the menopause group, 41 (56.2%) cases were diagnosed as having benign paroxysmal positional vertigo (BPPV), 13 (17.8%) cases had Meniere's disease, sudden deafness with vertigo accounted 2 cases, one was an acoustic tumor, and so on. The percentage of patients with BPPV was almost same ratio between the menopause group (56.2%) and the non-menopause group (52.9%). The percentage of patients with Meniere's disease was higher markedly in the menopausal group (17.8%). than the non-menopause group (9.7%). Menopausal symptoms are caused not only by hot flashes related to a lack of estrogen but also by psychological factors. The onset of Meniere's disease can also be influenced by psychological factors. As for the diagnosis of Meniere's disease, we supposed the reason for the higher percentage in the menopausal group was its relationship with psychological factors. We could diagnose and treat some menopausal women with vertigo. We believe that joint consultation with a gynecologist and otorhinolaryngologist would be necessary to ensure an optimum quality of life for such patients.

Evaluation of the Carhart effect in congenital middle ear malformation with both an intact external ear canal and a mobile stapes footplate.

The medical charts of 41 ears with congenital middle ear malformation with both an intact external ear canal and a mobile stapes footplate were reviewed retrospectively to study the Carhart effect. The operations were categorized as successful or unsuccessful according to the extent of decrease in the average air-bone gap. Statistically significant differences were observed between the 2 groups with respect to the changes in pure-tone average and the changes in the bone conduction (BC) threshold at 1 and 2 kHz. Linear regression analysis revealed weak correlations between the change in the BC threshold and the postoperative BC threshold at an overall level and at the 4 frequencies tested. Stapes ankylosis is a main cause of the Carhart effect. The present study showed that in congenital middle ear malformation, the Carhart effect was caused not only by stapes ankylosis but also by other types of disruption in the ossicular chain.

[Non-specific exercise therapy for benign paroxysmal postural vertigo].

We treated 1145 patients diagnosed as having benign paroxysmal postural vertigo at the Toho University Medical Center Sakura Hospital from August 2007 to July 2009 by the exercise therapy developed by us. The most advantageous characteristic of our method is that patients can perform the exercises themselves at their own pace in their homes, even if the affected side cannot be identified and/or the patients have any orthopedic cervical and/or spinal problems. In 80.7% and 91.7% of the patients in our case series, the vertigo was no longer present at one and three months, respectively. In addition, the vertigo disappeared within two weeks in the patients who were examined within one week of the start of the symptom. The longer the period between the onset of vertigo and the hospital visit, the longer the period needed for control of the symptom.

Effect of Burow's solution on the guinea pig inner ear.

OBJECTIVES: We examined the changes in the inner ear hair cells following intratympanic injection of Burow's solution. METHODS: Thirty-one albino guinea pigs with a normal Preyer's reflex were used. Burow's solution was applied and allowed to remain on the round window membrane for 30 minutes (30-minute group), 1 hour (1-hour group), or 2 hours (2-hour group). Seven days later, the left temporal bone was removed. Auditory brain stem responses were recorded at 4, 8, and 20 kHz before application of Burow's solution and again immediately before decapitation. The cochlea and utricle were dissected, stained with rhodamine-phalloidin, and examined under a fluorescence microscope. RESULTS: The postoperative auditory brain stem response thresholds at 20 kHz in the 1-hour group and those at 8 and 20 kHz in the 2-hour group were increased significantly compared to the baseline thresholds. Surface preparations of the organ of Corti revealed no hair cell loss in the 30-minute group, loss of outer hair cells in the lower half of the basal turn in half of the animals in the 1-hour group, and loss of outer hair cells in the basal turn in almost all animals in the 2-hour group. In the 2-hour group, the microthin sections of the round window membrane showed degeneration of the outer epithelium. CONCLUSIONS: The retention of Burow's solution on the round window membrane for 2 hours induces degeneration of the outer epithelium and damage to the cochlear outer hair cells.

Comparison of hearing improvement and complications after stapes surgery with and without potassium titanyl phosphate laser for manipulation of the foot plate.

OBJECTIVE: The purpose of the current study was to evaluate the differences in hearing results and complications between the conventional technique (CT) and potassium titanyl phosphate laser (KTP) laser-assisted stapes surgery that does not involve the manipulation of the foot plate. METHODS: Ninety-eight ears with conductive or mixed hearing loss due to otosclerosis were operated on by using the CT or KTP laser-assisted manipulation. The results of pure-tone audiometry, the duration of postoperative vestibular symptoms, and the presence of damage to the foot plate were reviewed retrospectively. RESULTS: The extent of hearing improvement and the duration of vestibular symptoms were not significantly different between the two groups. The damage to the foot plate was significantly less frequent in the KTP group compared to the CT group. Profound sensorineural hearing loss occurred in one case in the CT group, whereas no significant sensorineural hearing loss was detected in the KTP group. CONCLUSIONS: According to our present findings, KTP laser-assisted surgery was safer than CT in terms of the damage to the foot plate even when the KTP laser was not used for opening the foot plate. However, both techniques showed similar results in hearing improvement and vestibular symptoms.

Dizziness after an earthquake tilted the house.

Major earthquakes occasionally cause vertiginous attacks or persistent dizziness, which may be related to the effects of autonomic stress on equilibrium function and/or psychological factors. We present the case of a 73-year-old woman who suffered from persistent dizziness for 1 year, during which she lived in a house tilted by the great 2011 Tohoku earthquake. An electronystagmogram demonstrated leftward horizontal and downbeat nystagmus in the sitting and supine positions with eyes closed. Caloric testing and cervical vestibular-evoked myogenic potentials showed normal responses in both ears. Posturography indicated no involvement of psychological factors or autonomic stress. After moving into a new apartment, both the dizziness and nystagmus completely disappeared within 10 weeks. We speculate that the gravity-related linear acceleration with vertical and horizontal components in the tilted house may have chronically stimulated the otoliths, inducing the symptoms and nystagmus via the velocity storage mechanism.

Effect of vitamin C depletion on age-related hearing loss in SMP30/GNL knockout mice.

Using senescence marker protein 30 (SMP30)/gluconolactonase (GNL) knockout (KO) mice, which cannot synthesize vitamin C (VC), we examined whether modulating VC level affects age-related hearing loss (AHL). KO and wild-type (WT) C57BL/6 mice were given water containing 1.5 g/L VC [VC(+)] or 37.5mg/L VC [VC(-)]. At 10 months of age, KO VC(-) mice showed significant reduction in VC level in the inner ear, plasma, and liver, increase in auditory brainstem response (ABR) thresholds, and decrease in the number of spiral ganglion cells compared to WT VC(-), WT VC(+), and KO VC(+) mice. There were no differences in VC level in the inner ear, ABR thresholds, or the number of spiral ganglion cells among WT VC(-), WT VC(+), and KO VC(+) mice. These findings suggest that VC depletion can accelerate AHL but that supplementing VC may not increase VC level in the inner ear or slow AHL in mice.

Two cases of Tullio phenomenon in which oval and round window reinforcement surgery was effective.

AIM: To report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110dB at 2000 or 4000Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear. Leftward horizontal nystagmus was recorded in an electronystagmogram using a pure-tone sound of 110dB at 500 or 1000Hz in the right ear. Surgical findings indicated that the prosthesis was inserted deep into the oval window, which was closed with thin connective tissue. OUTCOMES: After oval and round window reinforcement surgery was performed in the right ear, and loud, pure-tone sounds elicited neither nystagmus nor dizziness in either patient.

Combined effects of vestibular stimulation and gaze direction on orientation of sound lateralization.

Dichotic sound discrimination is influenced by either visual or vestibular stimulation. This study investigated the effect of simultaneous gaze and vestibular inputs on dichotic sound discrimination. The subjects (n=12) closed their eyes or gazed at a red target light placed at a distance of 50cm from their eyes, and the ITD discrimination test was simultaneously performed in either the supine or in the right lateral decubitus position, in which gravitational linear acceleration causes utricular stimulation in the lower ear. In the ITD discrimination tests, the amplitudes of saw-tooth waves in the supine position with straight gaze were significantly different from those in the lateral decubitus position with downward or upward gaze. The saw-tooth waves in the lateral decubitus position with eye closed significantly shifted toward the upper ear compared to that in the supine position with eye closed. The saw-tooth waves in the lateral decubitus position with upward and with downward gaze shifted significantly toward the upper and lower ears, respectively, as compared to that in the supine position with straight gaze. We concluded that a sound image resulting from dichotic stimulation may be more dominantly influenced by the direction of eccentric gaze than by utricular stimulation that occurs due to gravitational linear acceleration.

Time course of apoptotic cell death in guinea pig cochlea following intratympanic gentamicin application.

CONCLUSIONS: The present study showed that the molecular signal that promotes the death of cochlear hair cells (HCs) induced by intratympanic gentamicin application is significant before the manifestation of morphological and functional changes. OBJECTIVES: The effect of agents that protect the HCs from aminoglycoside ototoxicity is influenced by the timing of their administration. However, morphological, functional and molecular changes in the cochlea in the early stage following aminoglycoside application have rarely been studied. Therefore, we examined the chronological changes in the cochlea following intratympanic gentamicin application. MATERIALS AND METHODS: Small pieces of gelatin sponge soaked with gentamicin (40 mg/ml) were placed on the round window membrane of mature guinea pigs, and the tympanic bulla was filled with gentamicin solution. They were euthanized at 6, 12, 18, 24, and 48 h following gentamicin application. Auditory brainstem responses (ABRs) were measured before gentamicin application and immediately before euthanasia, and the extent of missing and TUNEL-positive HCs was evaluated. RESULTS: ABR thresholds significantly increased 18 h or later following gentamicin application, and the loss of HCs was seen at 24 and 48 h. While functional and morphological changes were not evident until 18 h after gentamicin application, substantial amounts of TUNEL-positive HCs appeared at 12 h.

[Adult-onset Still's disease following severe sore throat and fever. Case report].

Adult-onset Still's disease (AOSD) is characterized by fever, rash, and joint pain and may lead to chronic arthritis. The cause of AOSD is unknown, and it is rare. In children, Still's Disease is called systemic juvenile rheumatoid arthritis. We encountered a patient with adult-onset Still's disease following a severe sore throat and fever. The patient was a 17-year-old woman who consulted our hospital because of a sore throat and fever. She was admitted and treated with antibiotics, but the fever persisted. Laboratory parameters of inflammatory activity increased at an accelerated rate, and after ruling out sepsis, EBV-associated disease, and malignant lymphoma, a diagnosis of AOSD was made. Steroid therapy was very effective. When acute pharyngitis is observed in association with significant changes in laboratory parameters despite mild local symptoms, or when pharyngitis is observed in association with joint pain, continuous fever, and a rash, it is important to consider AOSI).