[Show abstract][Hide abstract] ABSTRACT: Conclusion:
Contrast-enhanced magnetic resonance imaging (MRI) reveals variations in the endolymphatic morphology of the cystic lateral semicircular canal (CLSC) that correlate with inner ear function. This report is the first to suggest a relationship between the morphology and function of this common inner ear malformation in clinical cases.
This study investigated the radiological and functional findings of a common inner ear malformation using computed tomography (CT), gadolinium contrast-enhanced magnetic resonance imaging (MRI), caloric testing, and cervical and ocular vestibular evoked myogenic potential (VEMP) testing.
Four ears in three patients who were radiologically diagnosed with a CLSC and a normal cochlea on high-resolution CT and contrast-enhanced MRI were included. Semicircular canal and vestibular functions were analyzed using the caloric test and cervical and ocular VEMP testing.
Unilateral and bilateral cystic canals were found in two and one patients, respectively. In the first patient, the malformed vestibule and cystic space were separate on imaging, and perilymph filled the cystic space. The functional test results were normal. In the second patient, endolymph filled both cystic spaces, and the functional responses were poor. In the third patient, endolymph filled the cystic space, and the ear did not respond during functional testing.
Full-text · Article · May 2015 · Acta Oto-Laryngologica
[Show abstract][Hide abstract] ABSTRACT: Bow-tie nystagmus is a rare phenomenon, which is reportedly associated with cerebellar infarction, brain stem anomalies, and so on. We analyzed herein bow-tie nystagmus in a patient with an Arnold-Chiari malformation using a three-dimensional 240 Hz high speed video oculography (VOG) system. The patient's nystagmus consisted of two aspects-slow phases directed upward and quick phases altering the direction obliquely right to left downward in turn (square wave jerks). The dominant frequency of the vertical component was 3.1 Hz, which was exactly twice as fast as that of the horizontal component at 1.55 Hz. Appearance of slow phases of horizontal components suppressed the square wave jerks. Square wave jerks were not only synchronized with quick phases of downbeat nystagmus but also with quick phases of upbeat or torsional nystagmus. Therefore their frequency was not regular but depended on the frequencies of the vertical or torsional component. These data suggest that bow-tie nystagmus is not generated by a common bow-tie nystagmus generator. We propose that bow-tie nystagmus is composed of quick phases of a horizontal component corresponding to the slow phases of the vertical or torsional component which alters its direction left to right in turn in order to avoid lateralization of the position of the eyes.
Full-text · Article · Jan 2015 · Equilibrium Research
[Show abstract][Hide abstract] ABSTRACT: Objectives: The aim in the study was to elucidate whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent unilateral Meniere's disease (MD) from becoming bilateral. Study Design: Prospective case-control study. Setting: Tertiary referral center. Methods: Between 1996 and 2008, we performed a glycerol test (G-test) and electrocochleography (ECoG) on 237 patients with intractable unilateral MD. We performed ESDS on 179 patients (144 with no endolymphatic hydrops and 35 with silent endolymphatic hydrops in the contralateral ear). The other 58 patients (40 without endolymphatic hydrops and 18 with silent endolymphatic hydrops in the contralateral ear) were given available medical treatments. All underwent regular follow-up for at least 5 years. Results: Altogether, 22.4% (53/237) of patients with clinically diagnosed unilateral intractable MD had silent endolymphatic hydrops in the contralateral ear using G-test and ECoG. In the nonsurgical group, 6 of 40 patients with unilateral MD with no endolymphatic hydrops in the contralateral ear developed bilateral disease, whereas in the surgical group 12 of 144 patients did so (p=0.231, Fisher's test). In the nonsurgical group, 9 of 18 patients with unilateral MD and silent endolymphatic hydrops developed the disease in the contralateral ear, whereas in the surgical group 6 of 35 patients developed bilateral disease (p=0.022, Fisher's test). Conclusions: The present findings suggest that ESDS may decrease the incidence of developing MD in silent endolymphatic hydronic contralateral ears diagnosed with G-test and ECoG within the first five postoperative years.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To understand the third mobile window effect of chronic otitis media with cholesteatoma with inner ear fistula on the bone conduction threshold, we examined changes in the bone conduction audiogram after tympanoplasty with mastoidectomy for chronic otitis media with cholesteatoma with canal fistula. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: According to the intraoperative classification of Dornhoffer and Milewski, we focused especially on Type IIa (anatomic bony fistula with no perilymph leak). We checked the bone conduction threshold at least 3 times: just before, just after, and 6 months after surgery in 20 ears with Type IIa lateral semicircular canal fistula. INTERVENTION: Tympanoplasty with mastoidectomy. MAIN OUTCOME MEASURE: Bone conduction thresholds before and after tympanoplasty with mastoidectomy. RESULTS: Compared with the preoperative bone conduction threshold, 6 cases were better, 12 cases were unchanged, and 2 cases were worse within the first postoperative week. Finally, 1 case was better, 15 cases were unchanged, and 4 cases were worse at the sixth postoperative month. Patients with a better bone conduction threshold in the low-tone frequencies immediately after surgery had a tendency to show no preoperative fistula symptoms. Postoperative spontaneous nystagmus had a tendency to be observed in patients with a worse bone conduction threshold in the high-tone frequencies. CONCLUSION: The better bone conduction threshold at low-tone frequencies immediately after tympanoplasty with mastoidectomy and no preoperative fistula symptoms might imply the third mobile window theory. The worse bone conduction threshold in high-tone frequencies with spontaneous nystagmus after surgery might indicate inner ear damage.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The aim of the present study, which involved a 2-year observation period and a nonsurgical control group, was to determine whether endolymphatic sac decompression surgery (ESDS) has the potential to prevent the progression of vertigo and hearing loss in patients with intractable bilateral Ménière's disease (MD). STUDY DESIGN: Prospective case-control study. SETTING: Tertiary referral center. METHODS: Between 1996 and 2008, we subjected 67 patients with intractable bilateral MD to ESDS and local corticosteroid treatment. Another 34 patients with intractable bilateral MD who declined ESDS were treated with the best available medical therapies. All of the patients underwent regular follow-up examinations for at least 2 years. RESULTS: Vertigo was resolved in 22 of 34 patients in the non-ESDS group and 60 of 67 patients in the ESDS group (p = 0.055, Fisher's exact test). Of the 24 patients in the non-ESDS group and 55 patients in the ESDS group in whom the ipsilateral ear (the treated ear) exhibited worse hearing function than the contralateral ear, the hearing level of the former ear was preserved in 13 and 52 patients, respectively (p = 0.007, Fisher's exact test). Of the 10 patients in the nonsurgical group and 12 patients in the surgical group in whom the ipsilateral ear exhibited better hearing function than the contralateral ear, the hearing level of the former ear was preserved in 2 and 11 patients, respectively (p = 0.035, Fisher's exact test). CONCLUSION: The present findings suggest that ESDS combined with local corticosteroid treatment can control progressive hearing loss in both ears in patients with bilateral MD at least during the first 2 postoperative years.
Full-text · Article · Jun 2014 · Otology & Neurotology
[Show abstract][Hide abstract] ABSTRACT: Gadolinium (Gd) contrast-enhanced MRI has recently been introduced to clinical practice to detect endolymphatic hydrops. However, since the image depends on the hardware, pulse sequence or the way of Gd administration, the protocol and the evaluating criteria for hydrops on MRI have not yet been standardized. In this study, we assessed the usefulness of the hydrops detection by MRI following the intratympanic or intravenous Gd administration methods, and compared these findings with the electrocochleography and glycerol test.
MRI was taken in 27 patients with Meniere's disease or delayed endolymphatic hydrops. All patients had frequent episodes of vertigo attacks which were clinically considered as of unilateral ear origin. Two types of Gd administration were used; injection into the tympanic cavity in 17 patients or intravenous injection in 10 patients. Axial 2D-FLAIR images were obtained with a 3.0T MRI unit, 24 and 4 h after intratympanic or intravenous administration, respectively. The endolymphatic space was detected as a low signal intensity area, while the surrounding perilymphatic space showed high intensity with Gd contrast. Those cases in which low signal areas corresponding to the cochlear duct could be clearly noticed, were classified as cochlear hydrops. When the greater part of the vestibule was occupied by a low signal area in more than half of the images, it was classified as vestibular hydrops.
Endolymphatic hydrops was detected in 88% (15/17 cases) by the intratympanic Gd administration method, and 90% (9/10) by the intravenous method. In the contralateral ears, 20% (2/10) showed hydrops, detected by the intravenous method. ECochG and the glycerol test were difficult when the hearing of the patient was severely impaired. Positive results of EcochG and the glycerol test were obtained only in 15 and 6 cases, respectively. However, as far as the waves could be obtained, ECochG showed a high detection rate of 88% (15/17) in the affected ear. In those cases in which both MRI and EcochG could be obtained, including both ears, the results were matched in 78% (21/27ears).
For the qualitative detection of hydrops, intratympanic and intravenous Gd administration methods were equivalent. Inner ear Gd contrast-enhanced MRI had higher efficacy in the detection of hydrops than the conventional tests.
[Show abstract][Hide abstract] ABSTRACT: Conclusion:
Because nystagmus induced by ampullopetal inhibition of the posterior semicircular canal (PSCC) rotates around the axis perpendicular to the plane of the anterior semicircular canal (ASCC) of the other side, when free-floating debris is initially located at the distal portion of the PSCC, a patient showing positional nystagmus appears to have the ASCC type of benign paroxysmal positional nystagmus. We name this 'pseudo-anterior canalolithiasis'.
We report on pseudo-anterior canalolithiasis originating in the PSCC and discuss the differential findings between pseudo-anterior and true anterior canalolithiasis by means of three-dimensional (3D) analysis of the positional nystagmus.
We performed 3D analysis of the positional nystagmus in a patient with true anterior canalolithiasis and in another patient with pseudo-anterior canalolithiasis.
In the patient with true anterior canalolithiasis, the direction of positional nystagmus during reverse Epley maneuver was constant and its axis was perpendicular to the plane of the right ASCC three-dimensionally. In contrast, in the patient with pseudo-anterior canalolithiasis, the first positional nystagmus of which the axis was perpendicular to the plane of the left ASCC became a second positional nystagmus of which the axis was perpendicular to the plane of the right PSCC during the reverse Epley maneuver.
Full-text · Article · Jun 2013 · Acta oto-laryngologica
[Show abstract][Hide abstract] ABSTRACT: Conclusions:
Physicians should consider additional treatment strategies for Meniere's disease patients with a long history of disease and hearing loss in the secondary affected ear and also provide psychological support regarding future progressive bilateral hearing loss.
To treat intractable Meniere's disease patients effectively, we need to understand the psychological condition of each patient. We examined the state of neurosis and depression in patients and correlated this with demographic and background information.
Between 1998 and 2009, we enrolled 207 patients with intractable Meniere's disease in this prospective study. We used the Cornell Medical Index and the Self-rating Depression Scale to evaluate their psychological condition. We also obtained demographic and background information relating to sex, age, duration of disease, vertigo frequency, hearing level in bilateral sides, and plasma vasopressin level.
Neurosis and depression was diagnosed in 40.1% and 60.4%, respectively, of patients with intractable Meniere's disease. Our results showed that surgical treatment significantly improved vertigo and hearing ability in patients with no psychological symptoms compared with those exhibiting psychological symptoms. Patients with a longer duration and worse hearing level in the secondary affected ear had a significantly higher incidence of mental illness than those with a shorter duration and better level of hearing.
Full-text · Article · Jun 2013 · Acta oto-laryngologica
[Show abstract][Hide abstract] ABSTRACT: We report herein on a 6-year-old girl with atlanto-axial rotatory fixation (AARF) which occurred after cochlear implantation under general anesthesia. The cochlear implantation procedure appeared normal, and took 3 hours and 50 minutes. On the 1st postoperative day, the patient complained of neck and shoulder pain but she could rotate her head. On the 4th postoperative day, she had torticollis without any neurologic damage and neither active nor passive rotation of the head could be achieved. She was diagnosed as having AARF on the basis of the computed tomographic findings. She was treated with Glisson's traction for 4 days to correct the deformity. AARF is a rare disorder and its diagnosis is often difficult and delayed. CT scans, especially 3-D reconstruction, are useful to diagnose AARF. It is suggested that AARF can occur after a cervical injury or an upper respiratory tract infection. AARF is also occasionally caused after head and neck surgical procedures such as pharyngeal flap plasty, ear surgery, and plastic surgery for microtia. It is important to be aware of the possible occurrence AARF and to start appropriate treatment as soon as possible.
No preview · Article · Feb 2013 · Practica oto-rhino-laryngologica
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Meniere's disease is a common inner ear disease characterized by vertigo, hearing loss and tinnitus. Since Meniere's disease is thought to be triggered by an immune insult to inner ear hydrops, we examined endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids for intractable Meniere's patients and observed long-term results from 2 years to over a decade until 13 years.
Between 1998 and 2009, we enrolled and assigned 286 intractable Meniere's patients to two groups: group-I (G-I) included patients who underwent endolymphatic sac drainage with steroid instillation and group-II (G-II) included those who declined endolymphatic sac drainage. Definitive spells and hearing improvement in these two groups were determined for 2-13 years after treatment.
According to the established criteria, vertigo was completely controlled in 88% of patients in G-I in the 2nd year, in 73% in the 12th year and in 70% in the 13th year. These results in G-I were significantly better than those in G-II for 13 years after treatment. Hearing was improved in 49% of patients in G-I in the 2nd year, in 27% in the 12th year and in 25% in the 13th year. These results in G-I were significantly better than those in G-II for 12 years after treatment, but this was not significant in the 13th year.
Endolymphatic sac drainage with intra-endolymphatic sac application of large doses of steroids could improve long-term follow-up results of hearing as well as vertigo control. This means that the drainage with local steroids could also improve patients' long-term quality in the prime of life.
Full-text · Article · Dec 2012 · Auris, nasus, larynx
[Show abstract][Hide abstract] ABSTRACT: The prediction of subtype and the affected ear of benign paroxysmal positional vertigo (BPPV) derived from the answers to our questionnaire can support the definitive diagnosis of BPPV.
We examined to what extent the diagnosis of subtype and the affected ear of BPPV judged from answers to a questionnaire agreed with the diagnosis decided by the results of the positional nystagmus test.
We asked the following questions: 'What kind of head movements induce vertigo?' and 'How long does the vertigo continue?'. As for the affected ear, we asked which ear was lower during stronger vertigo when induced in a supine position or during sleep.
The percentages of correct diagnosis speculated by the combined answers were 69% in posterior canal-type BPPV, 48% in BPPV with geotropic nystagmus, and 39% in BPPV with apogeotropic nystagmus. The percentage of correct diagnoses of the affected ear was more than 80%.