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Papers - Ogawa, Kaoru

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Sudden onset hearing loss and vertigo just before posterior inferior cerebellar artery infarction (lateral medulla syndrome)

Kanzaki Sho, Suzuki Takafumi, Suzuki Shigeaki, Suzuki Norihiro, Ogawa Kaoru

Otology and Neurotology 34 ( 2 ) 2013.02

ISSN 1531-7129

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Quality of life reported by patients with idiopathic sudden sensorineural hearing loss

Sano Hajime, Okamoto Makito, Ohhashi Kentaro, Iwasaki Satoshi, Ogawa Kaoru

Otology and Neurotology 34 ( 1 ) 36 - 40 2013.01

ISSN 1531-7129

OBJECTIVE: This study evaluated quality of life (QOL) in the patients with idiopathic sudden sensorineural hearing loss (ISSHL). STUDY DESIGN: Cross-sectional study. SETTING: Multicenter clinical investigation in ten university hospitals. PATIENTS: In total, 167 patients with ISSHL and 134 patients with bilateral sensorineural hearing loss (BSHL; control) were included. MAIN OUTCOME MEASURES: The Short Form Health Survey Version 2 was used to assess the health-related QOL. RESULTS: The average scores of 8 domains and 2 summary components were similar between the 2 groups. All scores except those for bodily pain (BP) in ISSHL patients and BP and vitality in BSHL patients were significantly lower than the Japanese average. Scores for the mental component summary (MCS) were especially low in ISSHL patients. MCS scores of ISSHL patients aged 40 to 49, 50 to 59, 60 to 69, and 70 years or older were significantly lower than the Japanese average for each age group. MCS scores of BSHL patients 70 years or older were significantly lower than the Japanese average. Two-way analysis of variance revealed no significant association of disease (ISSHL and BSHL) and age with MCS score. Interactions were also not significant. The effects of sex, age, hearing level, and time interval from the onset on MCS scores of ISSHL patients were evaluated using multiple regression analysis. Age and time interval from the onset were observed to be significant confounders. CONCLUSION: The QOL of patients with ISSHL deteriorated especially in terms of mental functioning. Similar deterioration was observed in BSHL patients.

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Treating pediatric psychogenic dizziness with a japanese herbal medicine

Goto Fumiyuki, Morimoto Noriko, Taiji Hidenobu, Tsutumi Tomoko, Ogawa Kaoru

Explore: The Journal of Science and Healing 9 ( 1 ) 41 - 43 2013.01

ISSN 1550-8307

Objective: No conventional pharmacotherapy is available for the treatment of psychogenic dizziness in pediatric patients. Adults with psychogenic dizziness are treated with psychiatric medicines as the standard treatment. In children, this treatment is not widely accepted because of the potential for adverse reactions. Instead, Kampo, an alternative medicine, is probably the best choice of treatment. Design: We report herein three of four cases of pediatric psychogenic dizziness successfully treated with Yoku-kan-san-ka-chimpi-hange (YKCH), a traditional Japanese Kampo medicine known to ameliorate psychiatric symptoms. Subjects: YKCH was prescribed to four patients (two boys and two girls) with psychiatric dizziness whose ages ranged from 11 to 15 years. Four weeks after the initiation of treatment, clinical improvement was assessed by the Clinical Global impression-Improvement scale. Results: In three of the four patients, the drug showed some significant effects. The remaining patient could not continue the medication. It is reasonable to assume that YKCH was effective because of its serotonergic mechanism and the improvement of sleep in our patients. Conclusions: This report is the first to describe the beneficial effects of YKCH in the treatment of pediatric psychogenic dizziness. We conclude that administration of YKCH may be a suitable complementary therapy for pediatric psychogenic dizziness.

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Novel In Vivo Imaging Analysis of an Inner Ear Drug Delivery System in Mice

Kanzaki Sho, Fujioka Masato, Yasuda Akimasa, Shibata Shinsuke, Nakamura Masaya, Okano Hirotaka James, Ogawa Kaoru, Okano Hideyuki

PLoS One 7 ( 12 ) 2012.12

Objective: Systemic steroid injections are used to treat idiopathic sudden-onset sensorineural hearing loss (ISSHL) and some inner ear disorders. Recent studies show that transtympanic (TT) steroid injections are effective for treating ISSHL. As in vivo monitoring of drug delivery dynamics for inner ear is lacking, its time course and dispersion of drugs is unknown. Here, we used a new in vivo imaging system to monitor drug delivery in live mice and to compare drug concentrations over time after TT and systemic injections. Methods: Luciferin delivered into the inner ears of GFAP-Luc transgenic mice reacted with luciferase in GFAP-expressing cells in the cochlear spiral ganglion, resulting in photon bioluminescence. We used the Xenogen IVIS® imaging system to measure how long photons continued to be emitted in the inner ear after TT or systemic injections of luciferin, and then compared the associated drug dynamics. Results: The response to TT and IP injections differed significantly. Photons were detected five minutes after TT injection, peaking at ~20 minutes. By contrast, photons were first detected 30 minutes after i.p. injection. TT and i.p. drug delivery time differed considerably. With TT injections, photons were detected earlier than with IP injections. Photon bioluminescence also disappeared sooner. Delivery time varied with TT injections. Conclusions: We speculate that the drug might enter the Eustachian tube from the middle ear. We conclude that inner-ear drug concentration can be maintained longer if the two injection routes are combined. As the size of luciferin differs from that of therapeutics like dexamethasone, combining drugs with luciferin may advance our understanding of in vivo drug delivery dynamics in the inner ear.

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Transoral anterior approach using median mandibular splitting in upper spinal tumor extirpation

Hiromasa Kawana, Shin Kato, Seiji Asoda, Akihiko Koike, Ryotaro Iwasaki, Morio Matsumoto, Kota Watanebe, Yorihisa Imanishi, Kaoru Ogawa, Taneaki Nakagawa

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 114 ( 5 ) 2012.11

ISSN 2212-4403

Objective: Transoral approach from the anterior direction is necessary if an upper spinal tumor is too big to extirpate via the posterior approach alone. To obtain a good anterior view of the surgical field, the mandible, tongue, and soft palate have to be split, and we developed a criterion to select the surgical strategy. Study Design: We indicated a decision-making process of splitting techniques and indications with actual cases and review of literatures. Result: Tumors were located from the level of C1 to the lower part of C3. Computerized tomography and magnetic resonance imaging were important to decide approaches. The orthopedic surgical team invited oral and maxillofacial surgeons team to assist in all transoral anterior approach cases. Conclusions: Vertical splitting of the mandible, incising the skin of the mental region, and splitting the middle of the tongue were combined according to the position of the spinal tumor.

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Objective evaluation of neck muscle tension and static balance in patients with chronic dizziness

Asama Youji, Goto Fumiyuki, Tsutsumi Tomoko, Ogawa Kaoru

Acta Oto-Laryngologica 132 ( 11 ) 1168 - 1171 2012.11

ISSN 0001-6489

Conclusion: Increase in the average value of bilateral neck muscle tension (ANT) indicates the increase in neck muscle tension to stabilize static posture resulting from vestibular compensation. Asymmetry of neck muscle tension was closely related to postural imbalance. Objective: Patients with dizziness often complain of neck symptoms with stiff neck. This study was conducted to clarify the pathophysiological mechanism of neck symptoms in patients with dizziness. Methods: We objectively measured bilateral trapezius muscle tension in patients with chronic dizziness and determined its relationship with static postural perturbation. The study included 26 patients with chronic dizziness caused by unilateral vestibular deficit and 24 healthy controls. The tension of bilateral trapezius muscles was objectively measured using a neck muscle tension meter. ANT and the ratio (right/left) of the bilateral neck muscle tension (RNT) were calculated. Static posturography was performed to measure total length of path (LNG). Results: ANT was negatively correlated to LNG under the eyes closed (EC) condition only in the case of the patients (r 0.44, p < 0.05). In the case of both the controls and the patients with a unilateral vestibular deficit, RNT was positively correlated to LNG under the EC condition.

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Neurally mediated syncope presenting with paroxysmal positional vertigo and tinnitus

Goto Fumiyuki, Tsutsumi Tomoko, Nakamura Iwao, Ogawa Kaoru

Auris Nasus Larynx 39 ( 5 ) 531 - 533 2012.10

ISSN 0385-8146

A 72-year-old man with positional vertigo and tinnitus was referred to us. He did not want to perform provoking test except once due to his fear. No positional nystagmus was provoked. He found that his attacks usually occurred when he lay on his right ear. From his clinical history, benign paroxysmal positional vertigo was suspected. Conventional pharmacotherapy as well as non-specific physical therapy did not have significant effect. His feeling of positional vertigo with pyrosis was actually presyncope. We suspected cardiovascular disorders, and referred him to a cardiologist. Portable cardiogram monitoring revealed paroxysmal bradycardia. He was diagnosed with neurally mediated syncope, and a pacemaker was implanted. His paroxysmal dizziness soon disappeared. It is important to study the clinical history of the patients in detail, as they are not always able to accurately explain their symptoms. We should carefully rule out cardiovascular disorders, especially when we see the patients with suspected BPPV without the characteristic positional nystagmus.

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Correlations of inflammatory biomarkers with the onset and prognosis of idiopathic sudden sensorineural hearing loss

Masuda Masatsugu, Kanzaki Sho, Minami Shujiro, Kikuchi Jun, Kanzaki Jin, Sato Hiroaki, Ogawa Kaoru

Otology and Neurotology 33 ( 7 ) 1142 - 1150 2012.09

ISSN 1531-7129

HYPOTHESIS: We investigated whether inflammatory biomarkers and stress are involved in the pathophysiology of idiopathic sensorineural hearing loss (ISHL). STUDY DESIGN: Individual cohort study. SETTING: Two tertiary centers. PATIENTS: Forty-three ISHL and 10 non-ISHL patients seen in our ENT departments from 2004 to 2010 within a week from the onset of new symptoms and without steroid administration before visiting our departments. INTERVENTION: Multiple audiologic evaluations, blood tests including leukocyte counts, natural killer cell activity (NKCA), interleukin 6 (IL-6), tumor necrosis factor, high-sensitivity CRP (hCRP), and the General Health Questionnaire were used to evaluate the systemic stress and inflammatory response. MAIN OUTCOME MEASURES: Correlations between biomarkers and ISHL severity and prognosis were evaluated by statistical analysis. RESULTS: In the ISHL patients, a neutrophil count above the reference range was associated with severe hearing loss and poor prognosis, and was accompanied by low NKCA and high IL-6. In the non-ISHL patients, these associations were not present. The abnormal neutrophil count was independent of preexisting vascular diseases. The abnormal counts responded to treatment and decreased into the reference range. CONCLUSION: Neutrophil counts above the reference range of a facility will be a useful indicator of poor prognosis of ISHL. Synchronism of different types of NF-κB activation pathways could be required to cause severe ISHL. An NKCA decrease, an acute neutrophil count increase, and an IL-6 increase can induce NF-κB activation in the cochlea and cause severe ISHL. Further epidemiologic surveys should be conducted to evaluate whether stressful life events increase the risk of severe ISHL onset.

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Application of the endoscopic transsphenoidal approach to true type transsellar transsphenoidal meningoencephalocele in an adult

Saito Katsuya, Toda Masahiro, Sano Keisho, Tomita Toshiki, Ogawa Kaoru, Yoshida Kazunari

Acta Neurochirurgica 154 ( 8 ) 1511 - 1515 2012.08

ISSN 0001-6268

Of the transsellar transsphenoidalmeningoencephaloceles (TTSMEs), the true type presents with the hernial sac extending from the intracranium to the epipharynx through the sellar floor. The true type is the most serious and difficult to manage, especially when the hernial sac contains vital structures, such as the anterior cerebral artery, pituitary gland, optic nerve, hypothalamus, and third ventricle. Surgical outcome for true type TTSME is reported to be poor. We describe a successful case of endoscopic repair for a 36-year-old man with true type TTSME. Our success with endoscopic repair for true type TTSME in an adult is the first reported case. We believe that the endoscopic transsphenoidal approach allows less invasive surgery and provides an acceptable operative outcome in comparison with other microsurgical approaches.

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Lateral semicircular canal plugging with endolymphatic sac decompression as new surgical treatment for intractable Meniere's disease

Goto Fumiyyuki, Tsutsumi Tomoko, Ogawa Kaoru

Acta Oto-Laryngologica 132 ( 8 ) 893 - 895 2012.08

ISSN 0001-6489

Conclusion: Lateral canal plugging with endolymphatic sac decompression (LCPESD) is a new therapeutic approach to intractable Meniere's disease. Further clinical data will be required. Objective: The objective of this paper is to present a new surgical procedure, i.e. lateral canal plugging (LCP) with endolymphatic sac decompression (ESD), which we defined as LCPESD. Two cases of intractable Meniere's disease, a 48-year-old male and a 48-year-old female, were successfully treated by this method. Methods: LCPESD was performed under general anesthesia. First ESD was undertaken followed by LCP. The bone was drilled up to the 'blue line' in the central portion of the bony lateral canal; then a 2 mm segment of canal was skeletonized to create a fenestra. A plug comprising temporalis fascia, bone pate, and fibrinogen glue was inserted through the fenestra to compress the endosteum and membranous labyrinth. Results: The attack of Meniere's disease was completely controlled and the hearing threshold did not change after the surgery for 2 years. Obliteration of the horizontal canal was confirmed by MRI.

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Statistical analysis of 32 patients with nasopharyngeal Carcinoma

Fujii Ryoichi, Imanishi Yorihisa, Tomita Toshiki, Sakamoto Koji, Shigetomi Seiji, Habu Noboru, Ootsuka Kuninori, Sato Yoichiro, Ozawa Hiroyuki, Yamashita Taku, Fujii Masato, Shigematsu Naoyuki, Ogawa Kaoru

Journal of Otolaryngology of Japan 115 ( 8 ) 773 - 782 2012.08

ISSN 0030-6622

In order to assess the clinical outcome and prognostic factors of patients with nasopharyngeal carcinoma (NPC) who were initially treated in the Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine between 1997 and 2006, statistical analyses were performed based on the patient medical records. Cause-specific survival (CSS) and disease-free survival (DFS) in all cases (stage I to IV, n = 32) and advanced cases (stage III and IV, n = 22) were estimated using the Kaplan-Meier method. The independent prognostic values of the clinical and therapeutic factors were determined using multivariate Cox proportional hazards models. Results: The 5-year CSS/DFS were 43.4%/34.8% in all cases and 34.596/29.8% in advanced cases. Multivariate analysis revealed that, in all cases, the independent prognostic factors for CSS were age ≥ 61 vs. ≤60, risk ratio (RR) =5.717, p = 0.006), T-stage (3/4 vs. 1/2, RR = 6.957, p = 0.004), and the use of platinum agents (unused vs. used, RR = 3.911, p = 0.012), whereas those for DFS were T-stage (3/4 vs. 1/2, RR=3.499, p = 0.019) and the use of platinum agents (unused vs. used, RR=2.947, p = 0.028). In advanced cases, the use of platinum agents alone was significant for both CSS (RR = 4.503, p = 0.023)and DFS (RR=4.218, p = 0.014). The patients who received neoadjuvant chemotherapy (NAC) showed better CSS and DFS than the patients who did not (p = 0.066 and p = 0.025, respectively) in a univariate analysis (Log-rank test), although no significant difference was seen between these groups in the multivariate analysis. Conclusion: The advantage of the administration of platinum agents in the treatment of NPC was statistically corroborated even in our study with its small sample size. As agents combined with chemoradiotherapy, the efficacy of do-cetaxel alone did not seem comparable to that of platinum agents. The docetaxel-CDDP-5-FU regimen applied as NAC was suggested to be possibly beneficial for advanced cases of NPC.

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Outcomes of autogenic training for patients with chronic subjective dizziness

Goto F., Tsutsumi T., Kabeya M., Ogawa K.

Journal of Psychosomatic Research 72 ( 5 ) 410 - 411 2012.05

ISSN 0022-3999

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Surgical results of an endoscopic endonasal approach for clival chordomas

Saito Katsuya, Toda Masahiro, Tomita Toshiki, Ogawa Kaoru, Yoshida Kazunari

Acta Neurochirurgica 154 ( 5 ) 879 - 886 2012.05

ISSN 0001-6268

Background The surgical approaches for clival chordomas remain controversial, although the extent of resection is one of the most important factors for long survival rates. Recently an endoscopic endonasal approach in good collaboration with otolaryngologists has attracted major attention as a surgical approach for clival chordomas. We describe our experience with the endoscopic endonasal approach and provide a review of the literature. Methods Between 2008 and 2011, six operations were performed via the endoscopic endonasal approach for clivus chordomas. The mean tumor size was 35 mm in diameter. The tumor location was mainly from the upper to middle clivus. The tumor extended into the cavernous sinus in five cases and intradurally in three cases. A binostril approach was performed in four cases, while a one nostril approach was performed in two cases. Results Gross total removal was achieved in three cases. The analysis of cases with incomplete resection suggested that residual tumors were observed epidurally and subdurally. The residual on the epidura was observed from the posterior clinoid to the posterior compartment of the cavernous sinus. On the other hand, the residual on the subdural was observed behind the upper part of the pituitary gland. There was no postoperative cerebrospinal fluid (CSF) leakage using vascularized nasoseptal flaps in any of the cases. Conclusions The endoscopic endonasal transclival approach allows an appropriate extent of resection with acceptable complication rates in comparison with other approaches. In our series, the accomplishment of gross total removal was associated with the relationship between the tumors and surrounding structures, such as the pituitary gland and the cavernous portion of the intracranial carotid artery (ICA).

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A new device for delivering drugs into the inner ear

Kanzaki Sho, Saito Hideyuki, Inoue Yasuhiro, Ogawa Kaoru

Auris Nasus Larynx 39 ( 2 ) 208 - 211 2012.04

ISSN 0385-8146

Objectives: Intratympanic injection (ITI) of drugs into the inner ear is an attractive way to deliver therapy. However, if the round window membrane (RWM) cannot be visualized, adhesions need to be removed first before ITI can be performed. We developed and tested a novel otoendoscopy device that allows visualization of the RWM for the purpose of ITI. Methods: Our otoendoscope consists of a catheter channel for delivering drugs and a suction channel. Results: The novel otoendoscope for inner ear drug delivery has a fine needle with catheter, which can be used to remove or perforate round window niche (RWN) mucosal adhesions. The elliptical shape of the otoendoscope effectively captures the field in the light-guided area, resulting in bright images. Conclusions: Our otoendoscope can be used to apply drugs directly onto the surface of the RWM and to verify the correct placement of an inner ear drug delivery system, ensuring that it is safely in place.

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Various levels of plasma brain-derived neurotrophic factor in patients with tinnitus

Goto Fumiyuki, Saruta Juri, Kanzaki Sho, To Masahiro, Tsutsumi Tomoko, Tsukinoki Keiichi, Ogawa Kaoru

Neuroscience Letters 510 ( 2 ) 73 - 77 2012.02

ISSN 0304-3940

Objective: Thus far, no objective measure has been developed to evaluate tinnitus severity. There is a close relationship between tinnitus and depression, in which brain-derived neurotrophic factor (BDNF) has a pathophysiological role. To determine whether BDNF levels could be used to evaluate tinnitus severity, we evaluated plasma BDNF levels in patients with tinnitus. Methods: Plasma BDNF levels were measured in 43 tinnitus patients and 30 healthy control patients. The severities of tinnitus, depression, and anxiety were measured using the tinnitus handicap inventory (THI) and the hospital anxiety and depression scale (HADS), respectively. Patients with tinnitus were divided into 2 groups depending on their THI scores: mildly handicapped (<36) and severely handicapped (>38). We also divided our subjects into 2 groups depending on the HADS score, which represents patient mood, including depression and anxiety. Results: Plasma BDNF levels were significantly higher in the mildly handicapped group than in the severely handicapped and control groups (P< 0.01). Patients with HADS scores of ≤14 had significantly lower THI scores (P< 0.05) and higher BDNF levels (P< 0.01). Conclusions: Our findings show for the first time that plasma BDNF levels vary with the severity of tinnitus, suggesting that plasma BDNF level is a useful tool for objective evaluation of tinnitus.

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Overexpression of SIP1 and downregulation of e-cadherin predict delayed neck metastasis in stage I/II oral tongue squamous cell carcinoma after partial glossectomy

Sakamoto Koji, Imanishi Yorihisa, Tomita Toshiki, Shimoda Masayuki, Kameyama Kaori, Shibata Katsushi, Sakai Nobuya, Ozawa Hiroyuki, Shigetomi Seiji, Fujii Ryoichi, Fujii Masato, Ogawa Kaoru

Annals of Surgical Oncology 19 ( 2 ) 612 - 619 2012.02

ISSN 1068-9265

Background: Patients with clinical stage I/II (T1-2N0M0) oral tongue squamous cell carcinoma (TSCC) usually undergo partial glossectomy alone. However, 14-48% of them develop delayed neck metastasis (DNM), which may lead to an unfavorable course. Recently epithelial-to-mesenchymal transition (EMT) has been thought to play a crucial role in cancer metastasis. The present study aimed to examine the associations of EMT-involved molecular factors and clinicopathological factors with DNM in stage I/II TSCC. Methods: mRNA expression levels of E-cadherin and its transcriptional repressors (snail, SIP1, and twist) in 7 head and neck squamous cell carcinoma (HNSCC) cell lines were evaluated by quantitative real-time PCR. Clinicopathological parameters and immunohistochemical expressions of E-cadherin and its repressors were examined in surgical specimens of 37 stage I/II TSCC patients who underwent partial glossectomy alone. Results: In HNSCC cells, E-cadherin expression was inversely correlated with SIP1 expression (P = 0.023). Univariate analysis of immunohistochemistry showed that overexpression of SIP1 and loss of E-cadherin were significantly correlated with DNM, although no inverse correlation was found between E-cadherin and its repressors. Multiple logistic regression analysis including clinicopathological and molecular factors revealed that overexpression of SIP1 (P = 0.005), loss of E-cadherin (P = 0.046), and vascular invasion (P = 0.024) were independently correlated with DNM. Conclusions: These results suggest that development of DNM in stage I/II TSCC is closely related to induction of EMT in primary tumor cells. Especially, SIP1 and E-cadherin are considered to be the possible markers for selecting patients at high risk of DNM.

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Effects of a perilymphatic fistula on the passive vibration response of the basilar membrane

Koike Takuji, Sakamoto Chiaki, Sakashita Tasuku, Hayashi Ken, Kanzaki Sho, Ogawa Kaoru

Hearing Research 283 ( 1-2 ) 117 - 125 2012.01

ISSN 0378-5955

In this study, a three-dimensional finite-element model of the passive human cochlea was created. Dynamic behavior of the basilar membrane caused by the vibration of the stapes footplate was analyzed considering a fluid-structure interaction with the cochlear fluid. Next, the effects of a perilymphatic fistula (PLF) on the vibration of the cochlea were examined by making a small hole on the wall of the cochlea model. Even if a PLF existed in the scala vestibuli, a traveling wave was generated on the basilar membrane. When a PLF existed at the basal end of the cochlea, the shape of the traveling wave envelope showed no remarkable change, but the maximum amplitude became smaller at the entire frequency range from 0.5 to 5. kHz and decreased with decreasing frequency. In contrast, when a PLF existed at the second turn of the cochlea, the traveling wave envelope showed a notch at the position of the PLF and the maximum amplitude also became smaller. This model assists in elucidating the mechanisms of hearing loss due to a PLF from the view of dynamics.

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[Application of antidepressant to treat patients in the department of otolaryngology].

Goto Fumiyuki, Tsutsumi Tomoko, Ogawa Kaoru

Nihon rinsho. Japanese journal of clinical medicine 70 ( 1 ) 115 - 121 2012.01

ISSN 0047-1852

There are some patients complaining of somatic symptom who has depression. The use of antidepressant to these patients would be quite useful. Patients with dispersion have a variety sort of physical symptom. The evaluation of depression based on physical complaints may be difficult for otorhinolaryngologists, but it is important to do so where possible to increase the focus on the subject's physical illness. The prevalence of somatic complaints in hospitalized patients whose chief complaint was either dizziness or vertigo was very high. These patients were usually accompanied with depression. Then the effect of paroxetine to the patients with tinnitus was investigated. The paroxetine may be effective in treating distressed tinnitus patients with depression and anxiety by reducing their tinnitus severity as well as their depression and anxiety.

Comparative study between pre-seasonal and intra-seasonal treatment of allergic rhinitis using a new 808nm diode laser system

Sasaki Katsumi, Ohshiro Toshio, Ohshiro Takafumi, Kanzaki Sho, Ogawa Kaoru

Laser Therapy 21 ( 3 ) 209 - 214 2012

ISSN 0898-5901

Background and Aims: Allergic rhinitis annually reaches epidemic proportions in Japan, and represents a major problem. The application of the CO2 laser in the treatment of allergic rhinitis was first successfully reported in 1982, but CO2 laser ablation is associated with side effects. The Ohshiro Clinic started using the conventional Nd: YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd: YAG laser with efficacy and safety at least equal to the others. Even more recently, we have adopted a novel 808 nm diode laser, and the present retrospective study examined the difference in of the efficacy rate between the preseasonal and intra-seasonal treatment of allergic rhinitis with this system. Subjects and methods: One thousand, two hundred and ten patients primarily presented to the Ohshiro Clinic with allergic rhinitis during the period from December 2010 to April 2011, of whom 531 were selected for blood tests to identify 13 kinds of Japanese allergens including cedar pollen. In the 2010-2011 season, huge clouds of cedar pollen appeared from February 26 ^th. The subjects were therefore divided into two groups depending on the treatment period, namely the preseasonal and intra-seasonal groups, December 1 ^st, 2010 to February 25 ^th, 2011 and February 26 ^th to April 6 ^th 2011, respectively. All patients were treated with the new 808 nm diode laser system. Results: A high success rate was achieved in both groups, with no significant difference seen regarding the symptoms of rhinorrhea, obstruction, sneezing, quality of life (QOL) or severity. Conclusions: The 808 nm diode laser offers an excellent solution for the uncomfortable symptoms of allergic rhinitis, and could be equally well applied before or during the Japanese cedar pollen dispersed season.

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Efficacy of a vibrotactile neurofeedback training in stance and gait conditions for the treatment of balance deficits

Basta Dietmar, Rossi-Izquierdo Marcos, Soto-Varela Andrés, Greters Mario Edwin, Bittar Roseli Saraiva, Steinhagen-Thiessen Elisabeth, Eckardt Rahel, Harada Tatsuhiko, Goto Fumiyuki, Ogawa Kaoru, Ernst Arne

Otology and Neurotology 32 ( 9 ) 1492 - 1499 2011.12

ISSN 1531-7129

Objective: Vestibular rehabilitation strategies mostly require a long-lasting training in stance conditions, which is finally not always successful. The individualized training in everyday-life conditions with an intuitive tactile neurofeedback stimulus seems to be a more promising approach. Hence, the present study was aimed at investigating the efficacy of a new vibrotactile neurofeedback system for vestibular rehabilitation. Study Design: Double-blinded trial. Patients: One hundred five patients who experience one of the following balance disorders for more than 12 months were included in the study: canal paresis, otolith disorder, removal of an acoustic neuroma, microvascular compression syndrome, Parkinson's disease, and presbyvertigo. Interventions: Vibrotactile neurofeedback training was performed daily (15 min) over 2 weeks with the Vertiguard system in those 6 tasks of the Standard Balance Deficit Test with the most prominent deviations from the normative values. Main Outcome Measures Trunk and ankle sway, dizziness handicap inventory, and vestibular symptom score were measured in the verum and placebo group before the training, on the last training day and 3 months later. Results: A significant reduction in trunk and ankle sway as well as in the subjective symptom scores were observed in the verum group. Such an effect could not be found in any of the outcome parameters of the placebo group. Conclusion: The vibrotactile neurofeedback training applied in the present study is a highly efficient method for the reduction of body sway in different balance disorders. Because the rehabilitation program is easy to perform, not exhausting, and time saving, elderly patients and those with serious, long-lasting balance problems also can participate successfully.

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