研究者詳細 - 小川　郁

論文 - 小川　郁

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Phobic postural vertigo in Japan

Goto Fumiyuki, Yabe Haruna, Nakai Kimiko, Kunihiro Takanobu, Ogawa Kaoru

Equilibrium Research 66 （ 3 ） 123 - 129 2007年06月

ISSN 0385-5716

Introduction: Dizziness and vertigo are symptoms of various psychiatric conditions like major depression, somatoform disorder, anxiety disorders, and so on. Phobic postural vertigo (PPV) was first reported by Brandt T et al. in 1994. PPV occurs chiefly in patients with an obsessive-compulsive or narcissistic personality. The diagnosis is based on six characteristics proposed by Brandt et al. The key for a correct diagnosis is spontaneous (sometimes stimulus-induced) postural vertigo and unsteadiness in maintaining an upright position and walking. Methods: The characteristics of patients with PPV were reviewed in 16 patients from June 2002 to November 2006 in our hospital. Some psychological evaluations were preformed by a self-rating questionnaire. MAS (Manifest Anxiety Scale) was used to evaluate the level of anxiety, and the Japanese version of MOCI (Maudsley's Obsessional Compulsive Inventory) was employed to evaluate the obsessive-compulsive personality. Results: We encountered 16 PPV patients. Fourteen were female and 2 were male. The average age was 55±15.5 years old. Many of the patients showed depression and a high level of anxiety. The average MOCI score was 10.8, and this indicated an obsessive-compulsive or narcissistic personality. Treatment involved drug therapy with SSRI (Selective serotonin reuptake inhibitors), antidepressants, anxiolytics like benzodiazepine (BZD), and psychotherapy including cognitive behavior therapy and autogenic training. Conclusion: The diagnosis of PPV was important to improve the prognosis. The key for a correct diagnosis is not anxiety but the subjective dizziness itself. An obsessional personality is often observed.

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Temporal changes of subjective visual vertical in patients with vestibular neuritis

Goto Fumiyuki, Higashino Kazutaka, Kunihiro Takanobu, Hayashi Yujiro, Saito Akira, Masuda Kanako, Kanzaki Jin, Ogawa Kaoru

Equilibrium Research 66 （ 3 ） 116 - 122 2007年06月

ISSN 0385-5716

Introduction: During the acute phase, patients with vestibular neuritis suffer from severe vertigo. With time, the intensity of vertigo gradually decreases. The aims of the present study were: (1) to determine whether changes in the subjective visual vertical (SVV) system reflect how patients subjectively experience vertigo, and (2) to determine the relationship between changes in SVV and canal paralysis (CP). Methods: Our subjects comprised 23 patients with vestibular neuritis. We measured the SVV of each patient several times to evaluate the recovery of SVV and CP over time. The intensity of vertigo was graded numerically as follows: (1) 5 - very intense (patient cannot stand with eyes open), (2) 4 - intense (patient cannot stand with eyes closed), (3) 3 - moderate (patient can stand with eyes closed), (4) 2 - slight vertigo, and (5) 1 - no vertigo. We also evaluated CP in 10 patients using the thermal caloric test. Results: The temporal process of SVV recovery was grouped into three categories: (1) small fluctuation/rapid recovery (N=7); (2) small fluctuation/delayed recovery (N=8); and (3) large fluctuation (N=8). For CP recovery, we observed cases that failed to recover (N=4) and others that did recover (N=6). When tested 30 days and 1 year after the initial examination, the CP recovery group displayed larger SVV fluctuations accompanied by intense subjective vertigo, whereas the group that did not recover exhibited fewer fluctuations accompanied by weak vertigo. Conclusions: SVV represents the subjective perception of the direction of gravity. Fluctuations in SVV, rather than absolute SVV, correlate well with the subjective intensity of vertigo. This suggests that, during the recovery process, fluctuations in SVV, rather than the dysfunction itself, causes dizziness. Measuring SVV is very straightforward and quantifying SVV fluctuations is an effective measure of the intensity of vertigo.

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Laryngeal carcinoma presenting as a large anterior neck abscess

Nakagawa Hideki, Shiotani Akihiro, Araki Koji, Kusuyama Toshiyuki, Fukuda Hiroyuki, Ogawa Kaoru

Auris Nasus Larynx 34 （ 2 ） 249 - 251 2007年06月

ISSN 0385-8146

Laryngeal carcinoma presenting as a cervical abscess is rare, so that its diagnosis is not easy. We described a case of laryngeal squamous cell carcinoma presenting as a prelaryngeal large abscess. Markedly swollen false vocal fold inhibited fiberscopic examination of the vocal folds. CT scan indicated destruction of the thyroid cartilage. Although biopsies from the abscess did not reveal malignancy, laryngeal squamous cell carcinoma was confirmed by laryngomicrosurgery with laryngeal vestibulectomy. The patient was treated by total laryngectomy with neck dissection followed by radiotherapy. The abscess was thought to be formed not by direct extension and necrosis of the tumor, but by the leakage of air and mucus through the fistula on the destroyed thyroid cartilage. Precise observation and biopsy under directscopic vestibulectomy played an important role in diagnosis of malignancy inherent in severe inflammatory tissues.

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Appropriate diameter for screws to fix the maxilla following Le Fort I osteotomy

Nagasao Tomohisa, Miyamoto Junpei, Hikosaka Makoto, Nagasao Maki, Tokumaru Yutaka, Ogawa Kaoru, Nakajima Tatsuo

Journal of Cranio-Maxillofacial Surgery 35 （ 4-5 ） 227 - 233 2007年06月

ISSN 1010-5182

Background: After Le Fort I osteotomy, there is sometimes a secondary deformity (relapse), with the lower segment deviating from the intraoperatively fixed position. It is hyopothesized that the structural stability of the reconstructed maxilla is affected by the diameter of the fixation screws. The present study aims to elucidate the relationship between the diameters of the screws and the structural stability of the maxilla after Le Fort I osteotomy. Methods: 3D models were produced on a workstation from 20 dry skulls and a Le Fort I operation was simulated on them. The upper and lower segments of the divided maxilla in each of the 20 models were connected using four plates and 16 screws. Five different diameters of the fixation screws were tested. Thus altogether 100 models were produced. A 180 N load was applied to the molar region for each model. Using finite element analysis, the resultant stresses and deviations of the lower segments were calculated. Finally, referring to these values, the relationships between screw diameters and stability of the lower segment were evaluated. Result: The stability of the lower segment was greatest when the diameter of the fixation screws was equal to the thickness of the bone at each fixation site. Conclusion: In performing Le Fort I osteotomy, it is recommended that bone thickness is measured at each fixation site in advance, and the diameter of the fixation screws matched accordingly; thereby optimum stability of the reconstructed maxilla can be anticipated.

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Creatine and tempol attenuate noise-induced hearing loss

Minami Shujiro B., Yamashita Daisuke, Ogawa Kaoru, Schacht Jochen, Miller Josef M.

Brain Research 1148 （ 1 ） 83 - 89 2007年05月

ISSN 0006-8993

To define the role of free radical formation and potential energy depletion in noise induced hearing loss (NIHL), we measured the effectiveness of tempol (free radical scavenger) and creatine (enhances cellular energy storage) alone and in combination to attenuate NIHL. Guinea pigs were divided into four treatment groups: controls, 3% creatine diet (2 weeks prior to noise exposure), tempol (3 mM in drinking water 2 weeks prior to exposure), and creatine plus tempol and exposed to 120 dB SPL one-octave band noise centered at 4 kHz for 5 h. The noise-only control group showed frequency-dependent auditory threshold shifts (measured by auditory brainstem response, ABR) of up to 73 dB (16 kHz) on day 1, and up to 50 dB (8 kHz) on day 10. Creatine-treated subjects had significantly smaller ABR threshold shifts on day 1 and on day 10. Tempol alone significantly reduced ABR threshold shifts on day 10 but not on day 1. ABR shifts after combination treatment were similar to those in the creatine group. Hair cell loss on day 10 was equally attenuated by creatine and tempol alone or in combination. Our results indicate that the maintenance of ATP levels is important in attenuating both temporary and permanent NIHL, while the scavenging of free radicals provides protection from permanent NIHL.

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Role of salivary gland scintigraphy with Tc-99m pertechnetate in determining treatment of solitary parotid gland tumors

Nakahara Tadaki, Suzuki Takayuki, Hashimoto Jun, Shigematsu Naoyuki, Tomita Toshiki, Ogawa Kaoru, Kubo Atsushi

Clinical Nuclear Medicine 32 （ 5 ） 363 - 366 2007年05月

ISSN 0363-9762

PURPOSE OF THE REPORT: Although salivary gland scintigraphy has been useful for the diagnosis of Warthin's tumor (WT), there are no reports concerning the clinical impact of this scintigraphy. MATERIALS AND METHODS: We retrospectively investigated 127 patients with solitary parotid tumors who had undergone salivary gland scintigraphy. RESULTS: For patients who had surgery, the sensitivity, specificity, and accuracy of differentiating WT from non-WTs were 95%, 91%, and 92%, respectively. There was a significant correlation between scintigraphic results and the treatment decisions made for the 127 patients (χ = 16.5, P = 0.00026). The proportion of WT patients among those who underwent surgery was 19%, whereas 42% of those who were suspected to have WT from scintigraphy were followed without surgical intervention. The main reasons for clinical observation in these patients were comorbidity, refusal of surgery, and age. CONCLUSIONS: The high percentage of nonsurgical patients suspected to have WT can be explained by the high diagnostic accuracy of salivary gland scintigraphy, which is useful for determining further management when surgery is contraindicated or is refused by the patient.

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Evaluation of postural cerebral hemodynamics by near-infrared spectroscopy in patients with dizziness with or without orthostatic dysfunction

Goto Fumiyuki, Asama Youji, Ogawa Kaoru

Equilibrium Research 66 （ 2 ） 52 - 58 2007年04月

ISSN 0385-5716

Introduction: Using the near-infrared spectroscopy (NIRS), we evaluated the central circulation of patients with either dizziness and orthostatic dysfunction or dizziness alone. Methods: We used the NIRO-200 NIRS instrument to monitor bilateral oxygenation changes in cerebellar hemoglobin levels in 57 subjects during an orthostatic exam. Of the 46 patients with dizziness, 8 had orthostatic dysfunction. To determine whether NIRS is useful for evaluating patients with dizziness, we compared blood pressure changes with orthostatic dysfunction test scores. Diagnostic criteria for orthostatic dysfunction were as follows: (1) a greater than 21 mmHg reduction in systemic blood pressure, (2) a greater than 16 mmHg reduction in pulse pressure, and (3) a greater than 21 beats per minute increase in pulse rate. Results: We observed four different types of changes in oxy-hemoglobin during the orthostatic test. In type I, a rapid temporal decline of oxy-hemoglobin was followed by rapid recovery. In type II, the decline of oxy-hemoglobin was followed by recovery of oxy-hemoglobin levels above the initial levels. In type III, the decline of oxy-hemoglobin was followed by recovery of oxy-hemoglobin levels below the initial levels. In type IV, the decline of oxy-hemoglobin persisted without recovery. Most of the control patients displayed type I changes. Patients with orthostatic hypertension more frequently displayed type II and IV changes. Nine of the dizzy patients had a positive orthostatic test. Of these patients, 3 displayed type II changes and 6 displayed type IV changes. Conclusions: In normal subjects, cerebellar circulation remains stable, at least if orthostatically induced changes in blood pressure remain within normal ranges due to autoregulation. We suspect that dysfunctional autoregulation was responsible for the reduced cerebellar circulation in patients with orthostatic dysfunction. We propose that NIRS is an excellent, non-invasive tool for evaluating patients with dizziness that present with orthostatic dysfunction.

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Analysis of the orbital floor morphology

Nagasao Tomohisa, Hikosaka Makoto, Morotomi Tadaaki, Nagasao Maki, Ogawa Kaoru, Nakajima Tatsuo

Journal of Cranio-Maxillofacial Surgery 35 （ 2 ） 112 - 119 2007年03月

ISSN 1010-5182

Introduction: For the repair of large orbital floor defects due to blow-out fractures or those involved by tumours, it is necessary to understand the detailed morphology. The purpose of the present study was to elucidate how age and gender affect its three-dimensional morphology. Methods: The 3-D computer tomography data of 305 orbits of 182 patients were included in the study. Using the CT data, the orbital floor angle (the angle between the orbital floor and the horizontal plane) and the location of the most inferior point of the orbital floor were measured. Patients were classified into subgroups according to their gender and age. Data were compared among the subgroups. Results: The orbital floor angle was greater in males than in females, and in children than in adults. The location of the lowest point of the orbital floor moves postero-inferiorly with increasing age. Conclusion: The present study demonstrated that gender and age affects morphology of the orbital floor. These findings should be useful for reconstruction of the orbital floor.

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Planned neck dissection after weekly docetaxel and concurrent radiotherapy for advanced oropharyngeal cancer

Tomita Toshiki, Ozawa Hiroyuki, Sakamoto Koji, Fujii Ryoichi, Ogawa Kaoru, Fujii Masato, Yamashita Taku, Shinden Seiichi

Journal of Otolaryngology of Japan 110 （ 3 ） 95 - 102 2007年03月

ISSN 0030-6622

Small oropharyngeal carcinomas with advanced neck metastases (stage N2 or greater) are common. Patients with small T with large N oropharyngeal carcinoma have high rates of local control but lower rates of regional control when treated with chemoradiotherapy. Clinical assessment after chemoradiotherapy cannot ensure the absence of neck disease. In the last 5 years, we have treated patients with T1-2 with N2-3 oropharyngeal carcinoma with weekly docetaxel radiotherapy followed by planned neck dissection (PND). Our objectives were to clarify the pathologically complete response (CR) rate of neck metastasis after weekly docetaxel radiotherapy, to identify the clinical predictor of residual neck disease, and to determine the mobidity of planned neck dissection. After chemoradiotherapy, all 12 patients had a complete response at the primary site. We conducted 15 neck dissections. Of these, 6 (40%) had positive nodes. The pathological CR rate of neck metastasis was 58.3%, whereas overall 2-year neck control rate was 91.7%. These findings lend support to the role of PND after chemoradiotherapy in N2-3 neck disease. After chemoradiotherapy, clinical parameters including TN status, feasibility of chemoradiotherapy, largest lymph node size or size reduction in MRI, did not identify patients with residual neck disease. We conducted selective neck dissection (SND) in 80% of patients. SND as PND appears to be appropriate in this group of patients because of the low incidence of complications. A further cohort study including the comparison of PND nonenforcement group is necessary to clarify the validity of the addition of PND in weekly docetaxel radiotherapy.

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Cholesterol granuloma surrounding the endolymphatic sac

Kanzaki Sho, Araki Yasutomo, Okamoto Yasuhide, Kurita Akihiro, Ogawa Kaoru

Auris Nasus Larynx 34 （ 1 ） 95 - 100 2007年03月

ISSN 0385-8146

We report a unique case of cholesterol granuloma (CG) surrounding the endolymphatic sac (ES). A 49-year-old man presented with the left side of sensorineural hearing loss, tinnitus, and vertigo. Magnetic resonance and computed tomography imaging revealed a CG surrounding the left ES. The patient initially underwent left transmastoid surgical resection of the tumor. At the time of surgery, brown fluid was aspirated from the tumor, but no other tumors were found. Histopathological examination revealed that the tumor contained cholesterol crystals, confirming the diagnosis of CG. At his 12-month postoperative follow-up, there was no evidence of recurrence. We discuss the radiology, pathology, and surgical removal of CGs surrounding ES.

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Sendai virus vector-mediated transgene expression in the cochlea in vivo

Kanzaki Sho, Shiotani Akihiro, Inoue Makoto, Hasegawa Mamoru, Ogawa Kaoru

Audiology and Neurotology 12 （ 2 ） 119 - 126 2007年02月

ISSN 1420-3030

We injected a recombinant Sendai virus (SeV) vector into the guinea pig cochlea using two different approaches - the scala media and scala tympani - and investigated which cell types took up the vector. The hearing threshold shift and distribution of transfected cells in animals using the scala media approach were different compared to those using the scala tympani approach. SeV can transfect very different types of cells, including stria vascularis, spiral ganglion neurons, and sensory epithelia of the organ of Corti, and fibrocytes of the scala tympani. Because SeV vectors can potentially deliver stimuli to the cochlea to induce hair cell regeneration, it may be a powerful tool for repairing the organ of Corti.

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A case of glossopharyngeal zoster diagnosed by detecting viral specific antigen in the pharyngeal mucous membrane

Nakagawa Hideki, Nagasao M., Kusuyama T., Fukuda H., Ogawa K.

Journal of Laryngology and Otology 121 （ 2 ） 163 - 165 2007年02月

ISSN 0022-2151

Glossopharyngeal nerve paralysis caused by varicella zoster virus reactivation is rare. We present a case of glossopharyngeal zoster confirmed by direct immunofluorescence staining for virus antigens. A 35-year-old man presented with right-sided, severe swallowing pain and dysgeusia. Physical examination showed a loss of ipsilateral gag reflex. White spots on the posterior wall of the right pyriform sinus were seen by laryngofibroscopy, and a loss of taste on the right posterior part of the tongue was confirmed by gustometry using the filter paper disc method. The varicella zoster virus antigen was revealed by direct immunofluorescence staining by fluorescein isothiocyanate labelled mouse monoclonal antibody specific for varicella zoster virus glycoprotein, using samples obtained from the mucosal lesion by abrasion with a cotton swab. The patient was treated by intravenous administration of acyclovir. His throat pain and dysgeusia completely resolved. We discuss the advantages of direct immunofluorescence staining for varicella zoster virus antigen for the diagnosis of glossopharyngeal zoster.

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Pulse-oximetery is useful in determining the indications for adeno-tonsillectomy in pediatric sleep-disordered breathing

Saito Hideyuki, Araki Kouji, Ozawa Hiroyuki, Mizutari Kunio, Inagaki Kouji, Habu Noboru, Yamashita Taku, Fujii Ryouichi, Miyazaki Soichiro, Ogawa Kaoru

International Journal of Pediatric Otorhinolaryngology 71 （ 1 ） 1 - 6 2007年01月

ISSN 0165-5876

Objective: Although first line therapy of sleep-disordered breathing (SDB) in children is adeno-tonsillectomy, the indications for this operation have not yet been clearly established. We investigated whether pulse-oximetry is useful for determining the optional treatment modality for pediatric SDB. Method: Two hundred and thirty-two children presenting with snoring and gasping had their oxygen saturation levels examined during sleep. Among them, 86 underwent on adeno-tonsillectomy and were evaluated pre- and post-surgery. We also examined 25 healthy children as controls. Results: Little desaturation was observed in healthy children. The difference in oxygen saturation levels of the patients between pre- and post-surgery was closely correlated with the pre-surgery levels. We examined the reaction operation characteristics and concluded that children with an oxygen desaturation index of 4% or more (ODI4) of more than 1.5 and/or ODI3 of more than 3.5 should undergo surgery. Conclusion: Pulse-oximetry is useful in determining the indications for adeno-tonsillectomy.

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Hypothyroidism after radiotherapy for patients with head and neck cancer

Ozawa Hiroyuki, Saitou Hideyuki, Mizutari Kunio, Takata Yasunori, Ogawa Kaoru

American Journal of Otolaryngology - Head and Neck Medicine and Surgery 28 （ 1 ） 46 - 49 2007年01月

ISSN 0196-0709

We report on 2 cases of hypothyroidism presenting clinical symptoms that occurred after radiotherapy for cancer of the head and neck and on the results of estimating thyroid function in patients with head and neck cancer who received radiotherapy. The first patient underwent total laryngectomy for laryngeal cancer without sacrificing the thyroid gland and partial gastrectomy for gastric cancer. Radiotherapy of the neck was carried out postoperatively. Two years later, the patient developed chest pain; pericardial effusion was detected, leading to a diagnosis of myxedema caused by hypothyroidism. The second patient received radiotherapy alone for laryngeal cancer. Two months later, low serum sodium concentration and anemia were detected in this patient. The cause of these changes was subsequently found to be hypothyroidism. Based on our experience with these 2 cases, we measured thyroid function in 35 patients who had undergone neck radiation for head and neck cancer at our hospital over the past 10 years. Hypothyroidism was observed in 13 of the 35 patients (37%). The prevalence of hypothyroidism was 46% (6/13) for patients treated with both radiation and surgery, as compared with 32% (7/22) for those who received radiation alone. The risk factors responsible for hypothyroidism were not evident from the statistical analysis of these cases. We believe that thyroid function should be evaluated periodically in patients who have undergone neck radiation because it is often difficult to diagnose hypothyroidism only from clinical symptoms.

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Malignant tumors of the parapharyngeal space

Tomita Toshiki, Sakamoto Koji, Fujii Ryoichi, Ozawa Hiroyuki, Ogawa Kaoru, Fujii Masato

Toukeibu Gan 33 （ 4 ） 493 - 498 2007年

ISSN 1349-5747

Most parapharyngeal space tumors are benign, and malignancies are rare. We report the results of a retrospective review of patients with primary parapharyngeal space malignant tumors treated at our institution from 1994 to 2007. During this period, 42 patients seen at our institution were found to have parapharyngeal space tumors. Six tumors (14.3%) were malignant and 36 (85.7%) were benign. Six of 21 (28.6%) prestyloid tumors were malignant, and malignant tumors were all found in the prestyloid region in MRI. There were three carcinoma ex pleomorphic adenomas and one each of salivary duct carcinoma and liposarcoma and chordoma. Four of the six tumors were diagnosed as benign preoperatively. Prestyloid parapharyngeal space tumors should be indicated for surgery even if they are asymptomatic, because preoperative diagnosis is difficult. It was difficult to deal with tumors that were revealed to be malignant postoperatively. Postoperative adjuvant therapy should be considered case by case by referring to the histology and surgical margin, because malignant parapharyngeal space tumors are heterogeneous. If tumors recur, it is important to follow up strictly to salvage them.

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Survey of patients wearing hearing aids applied with and without financial support from the hearing-handicapped approval law

Goto Fumiyuki, Yabe Haruna, Ogino Tamotsu, Ogawa Kaoru

Practica Oto-Rhino-Laryngologica 100 （ 8 ） 623 - 628 2007年

ISSN 0032-6313

In Japan, there is a government-mandated financial support system to help hearing-handicapped patients. In this welfare law, patients with severe hearing loss are categorized into three grades according to severity of hearing disturbance. Patients in each grade have the right to obtain financial support. Obtaining financial aid is a two-step process. First, the patient must apply for a certificate or license indicating that he/she is indeed hearing handicapped. It usually takes a few weeks to receive this license. Second, the patient must complete a financial support application form, which takes about one month for government approval. A doctor must sign both of these application forms. Between January 2005 and April 2006, we surveyed patients consulting our office for hearing aid counseling to assess the current situation and satisfaction of patients who bought hearing aids using governmental financial support. The patients graded their experience on a 5-point satisfaction scale. Among the eighty-nine patients who consulted our office, 22 (24.7%) patients applied for support; all 22 of these patients qualified as having a severe hearing-handicap. The average ages of patients certified as hearing handicapped and patients not certified as hearing handicapped were 80.9±7.7 years and 75.1±23.3 years, respectively. It took, on average, another 49 days to obtain financial support. Patients receiving governmental financial support rated their satisfaction significantly higher than did patients who did not receive support. The average amount of financial support was 40,736 yen ($340). A small amount of financial support can increase patient satisfaction. To promote the government-mandated financial support system for the hearing handicapped, doctors should show more interest in this law. Doctors should also actively guide and encourage certified patients in applying for governmental financial support for hearing aids, all with long-term goal of helping these patients achieve a better quality of life.

Treatment of four cases of intractable Meniere's disease with a new middle ear pressure device, Meniett®

Yabe Haruna, Goto Fumiyuki, Hayashi Ken, Kunihiro Takanobu, Ogawa Kaoru

Practica Oto-Rhino-Laryngologica 100 （ 6 ） 491 - 495 2007年

ISSN 0032-6313

It is not easy to treat patients with intractable Meniere's disease. Intratympanic injection of gentamicin or steroid is one option. The other is a surgical procedure like endolymphatic shunt surgery. Middle ear pressure treatment using the Meniett device, which has not been approved by the Japanese government is widely accepted in foreign countries. We had a chance to use this Meniett device under approval of the ethic's committee of Hino Municipal Hospital since September 2004. (Methods) Four patients with intractable Meniere's disease who suffered intensive vertigo attack for more than 5 months with conservative medical treatment were employed in the study. Ages ranged from 67 to 72, with 3 females and 1 male. After a ventilation tube was inserted under local anesthesia, treatment with the Meniett was performed 3 times a day at home. (Results) Two patients improved and 2 slightly improved concerning vertigo attacks. One showed no change, 1 experienced a worsening, and 2 showed slight improvement concerning the hearing level. (Conclusion) The Meniett device is less invasive and may be suitable for elderly patients who prefer conservative treatment. The mechanism involved in the reduction of vertigo attacks is not clear so far, but we speculate that middle ear pressure may suppress serum vasopressin (antidiuretic hormone) secretion and thereby reduce endolymphatic hydrops. It is necessary to accumulate treatment data with the Meniett in Japan to obtain official approval by the government.

Resorption of auditory ossicles and hearing loss in mice lacking osteoprotegerin

Kanzaki Sho, Ito Masako, Takada Yasunari, Ogawa Kaoru, Matsuo Koichi

Bone 39 （ 2 ） 414 - 419 2006年08月

ISSN 8756-3282

Bones conduct sound in the middle ear. The three ossicles-the malleus, incus, and stapes-form a chain that transmits vibrations from the tympanic membrane to the oval window of the inner ear. Little is known about bone remodeling events in these ossicles and about potential effects of osteoporosis on hearing loss. Osteoclastic bone resorption is enhanced in Opg^-/- mice lacking osteoprotegerin, which is a soluble decoy receptor for the osteoclastogenic cytokine RANKL. We asked whether auditory ossicles are resorbed in Opg^-/- mice, and whether these mice suffer from impaired auditory function. All three ossicles in Opg^-/- mice showed thinning, especially at the malleal manubrium and incus body. Most notably, unlike in the case in wild-type mice, the junction between the stapes and the otic capsule was fixed in Opg^-/- mice, and the stapedial footplate was thinner and broader. Radiological analyses revealed that malleal cortical thickness was positively correlated with tibial bone mineral density in Opg^-/- and control littermate mice. Furthermore, progressive hearing loss was detected in Opg^-/- mice starting at 6 to 15 weeks of age. These data suggest that osteoprotegerin plays a crucial role in hearing by protecting the auditory ossicles and otic capsule from osteoclastic bone resorption.

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Clinical experience with silicon pharyngeal tube for pharyngocutaneous fistula and cervical esophagus stenosis

Tomifuji Masayuki, Shiotani Akihiro, Takaoka Takuji, Mori Yuko, Fujimine Takekatsu, Ogawa Kaoru

Nippon Jibiinkoka Gakkai kaiho. 109 （ 6 ） 530 - 534 2006年06月

ISSN 0030-6622

Total laryngectomy or laryngopharyngectomy are commonly performed for the treatment of laryngeal cancer or hypopharyngeal cancer. However pharyngocutaneous fistula and cervical esophageal stenosis have been reported as postoperative complications of these procedures. We used a silicon pharyngeal tube in cases that developed pharyngocutaneous fistula and cervical esophageal stenosis. The pharyngeal tube was useful for controlling aspiration pneumonia and for starting oral feeding in a case of pharyngocutaneous fistula after a total laryngectomy. It was also helpful for starting oral feeding in a case with cervical esophageal stenosis after total laryngopharyngectomy and free jejunum interposition. This patient was able to maintain a good quality of life until re-operation. Adverse effects from the insertion of the tube included a foreign body sensation and pharyngeal pain that was tolerable with the use of NSAIDs for a short time. Silicon pharyngeal tubes are useful for the treatment of pharyngocutaneous fistula and cervical esophageal stenosis.

Adenoviral gene transfer of BDNF and GDNF synergistically prevent motoneuron loss in the nucleus ambiguus

Moro Kazuhisa, Shiotani Akihiro, Watabe Kazuhiko, Takeda Yasuo, Saito Koichiro, Mori Yuko, Ogawa Kaoru

Brain Research 1076 （ 1 ） 1 - 8 2006年03月

ISSN 0006-8993

We have previously shown that neuroprotective effects of an adenoviral glial cell line-derived neurotrophic factor (GDNF) gene transfer on the lesioned adult rat motoneurons in the nucleus ambiguus. In the present study, we examined neuroprotective effects of adenoviral gene transfer of brain-derived neurotrophic factor (BDNF) or/and GDNF to motoneurons in nucleus ambiguus using an adult rat vagal nerve avulsion model. The animals avulsed and inoculated with adenoviral vectors encoding BDNF (AxCAmBDNFME) or/and GDNF (AxCAhGDNF) showed immunolabeling for BDNF or/and GDNF in the nucleus ambiguus on the treated side, respectively, and expression of virus-induced BDNF or/and GDNF mRNA transcripts in the brainstem tissue that contained the nucleus ambiguus of the treated side. The treatment with AxCAhGDNF or AxCAmBDNFME significantly prevented the loss of vagal motoneurons in comparison to the control; the protective effect of AxCAmBDNFME was greater than that of AxCAhGDNF. The combined treatment with AxCAmBDNFME and AxCAhGDNF acted synergistically and significantly larger number of vagal motoneurons was preserved as compared to either AxCAmBDNFME treatment or AxCAhGDNF treatment. The treatment with AxCAmBDNFME or/and AxCAhGDNF after avulsion also suppressed the activity of nitric oxide synthase in lesioned motoneurons in the nucleus ambiguus. These results indicate that adenovirus-mediated BDNF and GDNF gene transfer may prevent the degeneration of motoneurons in humans after either vagal nerve injury or recurrent laryngeal nerve injury.

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