研究者詳細 - 小川　郁

論文 - 小川　郁

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Neuronal re-juvenilization in the nucleus ambiguus after vagal nerve injury

Takaoka Takuji, Shiotani Akihiro, Saito Koichiro, Tomifuji Masayuki, Mori Yuko, Fujimine Takekatsu, Okano Hideyuki, Ogawa Kaoru

Neuroscience Research 65 （ 4 ） 353 - 359 2009年12月

ISSN 0168-0102

Nestin is an intermediate filament expressed in immature cells in the CNS including neural stem/progenitor cells, reactive astrocytes and immature neurons in lesser amounts after injury. Nestin expression in the nucleus ambiguus following vagal nerve injury was studied using nestin-EGFP transgenic rats. We confirmed that EGFP immunoreactivity was evident at 6 h to 8 days in ipsilateral nucleus ambiguus after nerve transection. Properties of these cells were examined immunohistochemically. These EGFP-immunoreactive cells were immunoreactive for Tuj1 and Hu, and exhibited ChAT activity. However, no immunoreactivity for GFAP or CNPase was observed. In normal development, the level of KCC2 expression is known to increase with maturation of neurons. In our study, decreased KCC2 expression was observed in nestin-EGFP-positive cells within the nucleus ambiguus on the lesioned side compared with the contralateral side. These EGFP-immunoreactive cells were immunonegative for BrdU. This is the first study to demonstrate the expression of a neural stem/progenitor cell-enriched marker, Nestin, in the nucleus ambiguus after vagal nerve injury. The present findings suggest that mature motoneurons are an origin of these Nestin-positive cells, which are induced after injury. Mature neurons in the nucleus ambiguus may thus have the potential to juvenilize after vagal/recurrent laryngeal nerve injury.

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Electrocautery snare efficacy in head and neck lesion treatment

Saito Koichiro, Inagaki Koji, Naganishi Hideki, Takaoka Takuji, Isogai Yutaka, Ogawa Kaoru

Journal of Otolaryngology of Japan 112 （ 11 ） 739 - 746 2009年11月

ISSN 0030-6622

The electrocautery snare has been widely used in gastroenterology and to remove bronchial and urinary bladder lesions, but rarely in head and lesion electrocautery. Since October 2006, we have used this instrument to treat 17 head and neck granuloma, papilloma, cyst, and cancer lesions under local or general anesthesia. Lesions were localized in the larynx, oropharynx, hypopharynx, or tracheostoma. The snare was used through a rhinolaryngovideoscope in most cases with a current of 15-30 watts produced by an electrosurgical generator. All procedures were easy, quick and successful, with minimal bleeding. No severe adverse effects were seen in any of our cases. The electrocautery snare was extremely useful in treating pedunculated lesions and in removing epiglottic cysts with a clear margin after excision of the mass without bleeding. Our results indicate the electrocautery snare to be useful and safe in treating selected head and neck lesion cases.

Acute-onset unilateral psychogenic hearing loss in adults

Oishi Naoki, Kanzaki Sho, Kataoka Chinatsu, Tazoe Mami, Takei Yasuhiko, Nagai Keiichi, Kohno Naoyuki, Ogawa Kaoru

ORL 71 （ 5 ） 279 - 283 2009年11月

ISSN 0301-1569

We encountered 6 rare cases of acute-onset unilateral psychogenic hearing loss in adults. All were women in their 20s and 30s. Three cases had severe hearing impairment characterized by hearing loss at every frequency; 2 cases had profound hearing impairment, and 1 case had low-frequency hearing impairment. Of the 6 cases, 3 had a history of hearing loss, and 1 had a history of psychogenic visual disturbance. All 6 cases were initially diagnosed as having idiopathic sudden sensorineural hearing loss; all subsequently received steroid therapy. Three cases were not diagnosed as being psychogenic in origin until otoacoustic emissions and auditory brain responses were performed. Although the presence of distinctive clinical features (age, gender, and past history) is important for suspecting psychogenic hearing loss, objective audiological tests such as otoacoustic emissions are essential for diagnosing some cases. Compared to the existing reports of similar cases, our cases had a poorer prognosis (only 2 cases were cured).

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Inferior meatal antrostomy impairs dynamic stability of the orbital walls

Nagasao Tomohisa, Miyamoto Junpei, Tamaki Tamotsu, Kanazaki Sho, Ogawa Kaoru

Auris Nasus Larynx 36 （ 4 ） 431 - 437 2009年08月

ISSN 0385-8146

Objectives: The medial wall of the maxillary sinus, or the bony buttress, plays an important role in supporting the orbital floor. Since part of the bony buttress is removed in the inferior meatal antrostomy (IMA), it is expected that the IMA makes the orbital floor likely to develop serious fractures in traumatic situations. We conducted the present study to elucidate the effect of the IMA on the vulnerability of the orbital floor. Methods: After producing CAD (Computer Assisted Design) models simulating twelve skulls, we performed simulation antrostomy for each of the twelve CAD models in both the middle meatus and the inferior meatus. According to the site of the antrostomy, the models were categorized as the MMA (middle meatal antrostomy) or IMA groups. We then applied an impact on the orbital region of each model. Using the finite element method, we calculated the area of the orbital wall fracture induced by the impact. Then we compared the area of the orbital wall fractures between the MMA and IMA groups. Results: The orbital wall fracture areas were significantly greater in the IMA group than in the MMA group. Conclusions: The patients who underwent IMA are likely to develop serious orbital fractures if their orbits receive traumatic impacts. Hence, surgeons should be prudent in their indications for IMA.

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Promoted cell proliferation by connexin 30 gene transfection to head-and-neck cancer cell line

Ozawa Hiroyuki, Mutai Hideki, Matsunaga Tatsuo, Tokumaru Yutaka, Fujii Masato, Sakamoto Kouji, Tomita Toshiki, Ogawa Kaoru

Anticancer Research 29 （ 6 ） 1981 - 1985 2009年06月

ISSN 0250-7005

Background: There have been inconsistent results regarding the contribution of the connexin family of genes to tumor cell proliferation. Materials and Methods: We aimed to clarify the role of connexin 30 (Cx30), by transfecting three kinds of vectors that express either full length Cx30 (Cx30-Full), Cx30 devoid of C-terminal region (Cx30-DelC) or Cx30 C-terminal region (Cx30-CT), in HSC-4, a head-and-neck cancer cell line. Results: Transfected Cx30-Full was localized on the plasma membrane, while Cx30-DelC and Cx30-CT was expressed in the cytoplasm or circumnuclear sites. We studied the effect on the growth rate followed by immunostaining with anti-Ki-67 (MIB-1). The MIB indices of HSC-4 cells transfected with Cx30-Full and Cx30-DelC, but not Cx30-CT were shown to be significantly higher than that of the controls. Conclusion: Our results demonstrated that Cx30 enhanced the proliferation of HSC-4 cells and the proliferating activity was considered to be achieved without the transport of the protein onto the plasma membrane.

Heme oxygenase-1 expression in the guinea pig cochlea induced by intense noise stimulation.

Matsunobu Takeshi, Satoh Yasushi, Ogawa Kaoru, Shiotani Akihiro

Acta oto-laryngologica. Supplementum （ 562 ） 18 - 23 2009年06月

ISSN 0365-5237

CONCLUSION: These results suggest that noise induces free radical formation in the cochlea and that, in the guinea pig, heme oxygenase-1 (HO-1) may play an important role in the recovery from noise trauma in the organ of Corti. OBJECTIVE: Free radicals are involved in noise-induced hearing loss. It has been demonstrated that the induction of HO-1 may protect cells exposed to oxidative challenge. The present study was designed to investigate the effect of intense noise exposure on HO-1 induction. MATERIALS AND METHODS: A total of 25 adult guinea pigs (body weight 200-300 g) with a normal Preyers's reflex were used as subjects. Based on preliminary tests, the appropriate intensities and durations of noise were determined that were adequate to induce apparent threshold shifts and lead to various recovery patterns to initial thresholds. The sound was routed through a power amplifier to a speaker, which was positioned directly over the animals in a sound chamber. Auditory brainstem response (ABR) testing, Western blot analysis for HO-1, and immunohistochemical testing were done. RESULTS: Exposure of the guinea pigs to 115 dB SPL octave band noise for 5 h induced HO-1 expression in the organ of Corti. In the organ of Corti, HO-1 expression increased mainly in the outer hair cells. Some expression of HO-1 was observed before and after noise exposure in the supporting cells. HO-1 expression in the organ of Corti was definitely increased in guinea pigs with an intense noise exposure which causes a temporary threshold shift.

Laryngeal function after supracricoid laryngectomy

Saito Koichiro, Araki Koji, Ogawa Kaoru, Shiotani Akihiro

Otolaryngology - Head and Neck Surgery 140 （ 4 ） 487 - 492 2009年04月

ISSN 0194-5998

Objective: The purpose of this study was to assess laryngeal function after supracricoid laryngectomy. Study Design: Case series. Subjects and Methods: Supracricoid laryngectomy (SCL) has been performed in our institution for 24 selected patients with laryngeal cancer since December 2000. Reconstruction was performed through cricohyoidoepiglottopexy for 23 patients and cricohyoidopexy for 1 patient. Seven patients had ipsilateral arytenoid removal, and 15 patients underwent SCL as salvage surgery. A retrospective chart review was performed to assess postoperative speech and swallowing function. Stroboscopy and/or fiberscopy of the neoglottis were used to assess postoperative speech kinetics. Acoustic parameters were measured to evaluate vocal function, and several questionnaires were used to evaluate postoperative quality of life (QOL). Results: In the absence of postoperative complications, stoma closure and normal diet intake were achieved 1 month after surgery. The neoglottis comprises the arytenoid(s), epiglottis, and pyriform sinus mucosa. Several different combinations of vibrating regions were observed among patients during phonation. Although vocalization sounded rough and breathy, vocal communication was possible with little inconvenience. Conclusion: Acceptable functional recovery and tolerable QOL can be achieved after SCL.

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Survey of feeding and swallowing functions in patients recruited by the nutrition support team

Fujimine Takekatsu, Shiotani Akihiro, Saito Koichiro, Tomifuji Masayuki, Tsunoda Koichi, Fujii Masato, Ogawa Kaoru

Japan Journal of Logopedics and Phoniatrics 50 （ 2 ） 109 - 115 2009年04月

ISSN 0030-2813

In order to evaluate feeding and swallowing functions in patients recruited by the Nutrition Support Team (NST), we investigated their underlying diseases, primary departments, age distribution, nutrition administration routes, and feeding and swallowing, The survey was conducted on 66 cases determined to be suffering from malnutrition based on screening of all hospitalized patients. The elderly aged 65 or over accounted for 86 percent of all cases. Neurological disorders were the most prevalent type of disease, affecting 29 percent of all cases. Oral feeding accounted for 40 percent, and supplemental nutrition for 60 percent of all cases. The incidence of aspiration was 66 percent. Forty-two percent of all cases did not involve oral administration. Feeding and swallowing functions were more seriously affected in cases of respiratory and neuromuscular diseases as compared with other diseases. Our findings suggest that in order to carry out safe oral nutrition, medical staff must evaluate the individual patient's feeding and swallowing functions.

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Experimental evaluation of relapse-risks in operated zygoma fractures

Nagasao Maki, Nagasao Tomohisa, Imanishi Yorihisa, Tomita Toshiki, Tamaki Tamotsu, Ogawa Kaoru

Auris Nasus Larynx 36 （ 2 ） 168 - 175 2009年04月

ISSN 0385-8146

Objectives: Prevention of relapse, or postoperative dislocation, of the fixed zygoma is necessary to achieve optimal results in the treatment of zygoma fractures. Assuming that the occurrence of intensified stresses on mastication at the screw-bone interface (SBI) constitutes the essential cause of the relapse, we evaluated the stresses for three different fixation methods-fixation at the frontal process (FP), inferior orbital rim (IOR), and zygomatico-maxillary buttress (ZMB). Methods: We used 10 computer-aided design (CAD) models simulating zygoma fractures in the experiment. For each CAD model, we fixed the fractured zygoma with four screws and one mini-plate at the FP, IOR, or ZMB. After applying a 5.5 kg force simulating mastication, we calculated the intensity and distribution patterns of the stresses occurring at the SBIs of the fixation screws using the finite element method. Thereby, we evaluated dynamic stability of the fixed zygoma for each of the three fixation methods. Results: Greater stresses occur at the SBIs with IOR fixation than at those with FP and ZMB fixation. Although the stresses occurring at the SBIs on mastication demonstrated evenly distributed patterns with the FP and ZMB fixation, the stresses demonstrated concentration on one screw with the IOR fixation. Conclusions: The fixed zygoma is more likely to cause relapse with the IOR fixation than with the FP or ZMB fixation. Hence, in performing zygoma fixation at the IOR, care should be taken to minimize the likelihood of postoperative relapse that is caused by skewed distribution of the stresses on the fixation screws.

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Diagnosis and management of cervical sympathetic chain schwannoma

Tomita Toshiki, Ozawa Hiroyuki, Sakamoto Koji, Ogawa Kaoru, Kameyama Kaori, Fujii Masato

Acta Oto-Laryngologica 129 （ 3 ） 324 - 329 2009年03月

ISSN 0001-6489

Conclusions. Cervical sympathetic chain schwannoma (CSCS) sometimes mimics carotid body tumor (CBT). Differential diagnosis between these tumors is sometimes difficult using MRI alone. MRA, color Doppler ultrasonography, and fine needle aspiration (FNA) after imaging may be helpful to rule out CBT. Surgical resection of CSCS is relatively effortless, and Horner's syndrome is an expected but acceptable postoperative complication. Intratumoral hemorrhage and vasodilation may be the main reasons for significant enhancement on MRI. Objectives. CSCSs are rare and known to mimic carotid body tumors. We report 9 cases of CSCS with an emphasis on imaging, surgical management, and pathological findings. Moreover, we describe the differential diagnosis of CSCS and CBT, and speculate the reasons behind significant enhancement on MRI. Patients and methods. Nine cases of CSCS treated at a tertiary referral center between 1996 and 2008 were reviewed. Results. MRI revealed 3 of 9 cases (33%) splayed the carotid bifurcation and displayed marked contrast enhancement with gadolinium. All patients underwent surgical excision of the mass with minimal blood loss. Postoperative Horner's syndrome was encountered in all patients, which required no treatment. Marked gadolinium enhancement tended to be associated with histological findings such as intratumoral hemorrhage and vasodilation.

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Oxidative stress and Ménière's disease and benign paroxysmal positional vertigo

Goto Fumiyuki, Ide Rika, Yabe Haruna, Kunihiro Takanobu, Ogawa Kaoru

Equilibrium Research 68 （ 1 ） 9 - 13 2009年02月

ISSN 0385-5716

It is known that oxidative stress plays some role in inner ear diseases, such as sensorineural hearing loss due to aging. Free radicals are produced as a result of oxidative stress, such as reactive oxygen species (ROS) and nitric oxide. Radical scavengers and antioxidants play a role in the protection against oxidative stress. Although some basic data have indicated a relationship between oxidative stress and endolymphatic hydrops, no clinical data have been published from patients. Diacron reactive oxygen metabolites (d-ROM) were measured by the Free Radical Analytical system 4 (FRAS 4) from the blood of 39 patients. The subjects consisted of 16 controls, 13 patients with Ménière's disease, and 10 patients with benign paroxysmal positional vertigo. The d-ROM value of the controls was 307.3 ± 42.5 U Carr, compared with 350.1 ± 50.5 U Carr in BPPV and 352.2 ± 71.5 U Carr in Meniere's disease subjects. Although no statistically significant differences were seen among the groups, patients with BPPV and Ménière's disease had slightly higher values than the controls, suggesting that free radicals were being produced in patients with both Ménière's disease and benign paroxysmal positional vertigo. It may be useful to control dizziness or vertigo by reducing free radicals as a product of oxidative stress, and controlling oxidative stress may be a valuable approach in the treatment of patients with dizziness due to Méniè re's disease or benign paroxysmal positional vertigo.

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Bisphosphonate therapy ameliorates hearing loss in mice lacking osteoprotegerin

Kanzaki Sho, Takada Yasunari, Ogawa Kaoru, Matsuo Koichi

Journal of Bone and Mineral Research 24 （ 1 ） 43 - 49 2009年01月

ISSN 0884-0431

Three auditory ossicles including the malleus, incus, and stapes conduct sound in the middle ear from the tympanic membrane to the inner ear. Auditory ossicles are massively resorbed by osteoclasts in Opg^-/- mice, which lack osteoprotegerin (OPG), a soluble decoy receptor for the osteoclastogenic cytokine RANKL. Opg^-/- mice exhibit progressive hearing loss and are a model for juvenile Paget's disease. However, effects of antiresorptive treatment on auditory ossicles and on hearing function in Opg^-/- mice are unknown. We intraperitoneally injected Opg^-/- mice with bisphosphonate risedronate 5 d/wk for 9 wk. Morphology of auditory ossicles was examined microscopically, radiographically, and histologically. Hearing function was monitored by measuring the auditory brain stem response (ABR). Control Opg^-/- mice exhibited thinning of all three ossicles and tibia. In contrast, risedronate treatment significantly inhibited bone loss in auditory ossicles as well as in long bones of Opg^-/- mice. Bony fusion of the junction between the stapes and the otic capsule was reduced after treatment. Moreover, ABR measurement showed that hearing in Opg^-/- mice was significantly improved by risedronate treatment. These data suggest that hearing loss in pathologies characterized, by excessive resorption of the auditory ossicles may be prevented by bisphosphonates.

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Management of deep neck infection by a transnasal approach

Baba Yuh, Kato Yasumasa, Saito Hideyuki, Ogawa Kaoru

Journal of Medical Case Reports 3 2009年

ISSN 1752-1947

Introduction. Deep neck infection is a life-threatening condition, and intravenous antibiotic therapy is preferable in the early stages of the disease. However, in the advanced stages, surgical drainage should be performed. Although several surgical treatment strategies are available, it is necessary to standardize treatment according to the patient's general condition and history. Case presentation. We report the case of a 68-year-old man with a deep neck abscess and with severe diabetes mellitus and inflammation. Computed tomography identified a deep neck infection extending from the level of the epipharynx to that of the hyoid bone. We performed surgical drainage by transnasal endoscopy. The patient exhibited no evidence of either recurrent disease or post-surgical complications within 30 months of follow-up. Conclusions. This case report provides evidence that transnasal endoscopic drainage should be recommended as a standard approach in patients with a deep neck abscess and with a severe general condition, diabetes mellitus, and inflammation.

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Otosclerosis update (1) - Pathophysiology and diagnosis

Ogawa Kaoru, Inoue Yasuhiro, Saito Hideyuki, Kanzaki Sho, Okamoto Yasuhide, Mizutari Kunio, Suzuki Takashi, Oishi Naoki

Practica Oto-Rhino-Laryngologica 102 （ 3 ） 169 - 175 2009年

ISSN 0032-6313

Intractable depression successfully treated with a combination of autogenic training and high-dose antidepressant in department of otorhinolaryngology

Goto Fumiyuki, Nakai Kimiko, Murakami Masato, Ogawa Kaoru

Cases Journal 2 （ 8 ） 2009年

ISSN 1757-1626

Introduction: Patients suffering from ear discomfort are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. Psychotherapy is recommended in some cases. This paper describes the successful administration of autogenic training in a patient suffering from ear discomfort due to major depression. Case presentation: We present a case of intractable depression that was successfully treated with a combination of psychotherapy, administered by a clinical psychologist, and high-dose antidepressant. The patient was a 36-year-old female with hearing discomfort in her left ear. In 2003, she experienced insomnia and an appetite loss, and her condition was diagnosed as major depression along with an avoidant personality disorder. Her depression has not been improved with antidepressant treatment for 3 years in department of psychosomatic medicine. She was referred to our department because of ear discomfort in her left ear. There was no abnormality in her physical examinations. She wanted to be treated in department of otorhinolaryngology. We increased the dose of fluvoxamine maleate up to 200 mg/day, and introduced cognitive therapy and autogenic training by a clinical psychologist. Eventually, her depressive state as well as the hearing complaint was markedly alleviated. Conclusions: Autogenic training can be a viable and acceptable treatment option for patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control physical symptom of depression.

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Pharmacological treatment for acute peripheral vertigo

Goto Fumiyuki, Yabe Haruna, Ogawa Kaoru

Practica Oto-Rhino-Laryngologica 102 （ 4 ） 315 - 320 2009年

ISSN 0032-6313

Introduction: Treatments for acute peripheral vertigo have not been well investigated. The most suitable drug for controlling acute vertigo should suppress both vertigo and accompanying nausea. The purpose of this study was to evaluate the effect of four different drugs on acute peripheral vertigo: (A) hydroxyzine hydrochloride (25 mg, i.v.); (B) 0. 5% metoclopramide (2 ml, i.v.); (C) sodium bicarbonate (40 ml, i.v.); and (D) a cocktail of diphenhydramine hydrochloride (30 mg) and dyprophylline (26 mg) (both i.m.). Methods: Forty-two patients with acute peripheral vertigo (average age: 59. 5 ±18.1 years) with spontaneous nystagmus were assigned to four treatment groups (A-D, above). Patients with central vertigo and vestibular neuritis were excluded. The number of patients in each group was as follows: A, n= 11; B, n=ll; C, n=ll; and D, n=9. Patients were instructed to evaluate their subjective symptoms of nausea and vertigo before and 30 minutes after drug treatment. They rated the severity of their symptoms on a 0-to-10 scale, with 10 representing the most severe symptoms and 0 a lack of symptoms. Results: Group A patients (hydroxyzine hydrochloride; 25 mg, i.v.) reported the highest level of relief from vertigo and nausea after drug treatment, whereas group C (sodium bicarbonate; 40 ml, i.v.) and D (diphenhydramine hydrochloride (30 mg)-dyprophylline (26 mg) cocktail; i.m.) patients reported only the slight relief of these symptoms. Group B patients (0. 5% metoclopramide; 2 ml, i.v.) experienced partial symptom relief; their vertigo remained unchanged. Thus, hydroxyzine hydrochloride (A) was the most effective in controlling both nausea and vertigo, whereas sodium bicarbonate (C) and diphenhydramine hydrochloride and dyprophylline (D) only slightly suppressed vertigo and nausea. Metoclopramide (B) only suppressed nausea. Conclusions: Hydroxyzine hydrochloride (A) was the most suitable for treating acute peripheral vertigo. Doctors should be familiar with the contraindications of these drugs. Some of these drugs may potentially be used in combination to control the symptoms of acute vertigo more effectively.

Heme oxygenase-1 expression in the guinea pig cochlea induced by intense noise stimulation

Matsunobu Takeshi, Satoh Yasushi, Ogawa Kaoru, Shiotani Akihiro

Acta Oto-Laryngologica 129 （ SUPPL. 562 ） 18 - 23 2009年

ISSN 0001-6489

Conclusion: These results suggest that noise induces free radical formation in the cochlea and that, in the guinea pig, heme oxygenase-1 (HO-1) may play an important role in the recovery from noise trauma in the organ of Corti. Objective: Free radicals are involved in noise-induced hearing loss. It has been demonstrated that the induction of HO-1 may protect cells exposed to oxidative challenge. The present study was designed to investigate the effect of intense noise exposure on HO-1 induction. Materials and methods: A total of 25 adult guinea pigs (body weight 200-300 g) with a normal Preyers's reflex were used as subjects. Based on preliminary tests, the appropriate intensities and durations of noise were determined that were adequate to induce apparent threshold shifts and lead to various recovery patterns to initial thresholds. The sound was routed through a power amplifier to a speaker, which was positioned directly over the animals in a sound chamber. Auditory brainstem response (ABR) testing, Western blot analysis for HO-1, and immunohistochemical testing were done. Results: Exposure of the guinea pigs to 115 dB SPL octave band noise for 5 h induced HO-1 expression in the organ of Corti. In the organ of Corti, HO-1 expression increased mainly in the outer hair cells. Some expression of HO-1 was observed before and after noise exposure in the supporting cells. HO-1 expression in the organ of Corti was definitely increased in guinea pigs with an intense noise exposure which causes a temporary threshold shift.

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Meniere's disease in the elderly in Japan

Goto Fumiyuki, Yabe Haruna, Kunihiro Takanobu, Ogawa Kaoru

Equilibrium Research 67 （ 6 ） 500 - 505 2008年12月

ISSN 0385-5716

Introduction: Meniere's disease is generally observed in persons aged between 30 and 50 years old. However, with the aging of the population, one may expect an increase in the number of elderly patients with the disease. The current study was aimed at clarifying the prevalence and clinical characteristics of Meniere's disease in the elderly, especially in patients aged >65 years old at the onset of the disease. Methods: Statistical analysis was performed on the recorded data of patients with Meniere's disease who visited Hino Municipal Hospital from 2004 to 2007. Results: Our sample comprised 47 patients with Meniere's disease, with an average age of 54.9 ± 14.2 years. Patients who developed Meniere's disease at the age of ≥65 years were classified as de novo patients; the remaining patients were classified as non-de novo patients. There were 13 (27.7%) de novo patients (3 males and 9 females; average age: 73.4 ± 4.9 years). The observations showed that the worst hearing level exhibited by the de novo patients was significantly different from that exhibited by the non-de novo patients. As treatment for Meniere's disease, 6 (46.2%) of the de novo patients underwent tympanic tube insertion, while 4 of the 6 patients underwent middle ear pressure treatment with a Meniett device. Conclusion: De-novo patients were more frequently admitted, but there was no difference in the duration of hospitalization between the de novo and non-de novo patients. It can be quite stressful for elderly patients with Meniere's disease to call an ambulance to transport them to the hospital during a vertigo attack. Tympanic tube insertion was undertaken as treatment in many of the patients, but none of the patients received intratympanic gentamicin. It is important that physicians who care for elderly patients with Meniere's disease take special care of those experiencing vertigo. Early diagnosis of Meniere's disease should be made in the elderly.

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Long-term prognosis of steroid-dependent sensorineural hearing loss

Kanzaki Jin, Kanzaki Sho, Ogawa Kaoru

Audiology and Neurotology 14 （ 1 ） 26 - 34 2008年12月

ISSN 1420-3030

We report on the long-term follow-up of 15 patients with steroid-dependent sensorineural hearing loss (SDSNHL), which was steroid dose dependent. We classified the patients into 2 groups: group A consisted of 6 patients with systemic SDSNHL, and group B consisted of 9 patients with inner-ear-specific SDSNHL without systemic disease. Group B patients were further classified as patients with slowly or rapidly progressive hearing loss. The yearly rate of hearing deterioration was greater in group B than in group A. Thus, the long-term hearing prognosis of patients in group B was worse than those in group A. Although SDSNHL may have immune-related origins, we hypothesize that hearing deterioration may be caused by proinflammatory cytokines because many of our cases exhibited abnormal immunological laboratory values and because many of these cases responded favorably to steroid treatment.

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A case of delayed endolymphatic hydrops due to mumps viral infection treated with the Meniett device

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

Equilibrium Research 67 （ 6 ） 496 - 499 2008年12月

ISSN 0385-5716

Objective: We report a case of delayed endolymphatic hydrops due to complicating mumps virus infection that was treated with the Meniett device. Method: Case reports and a review of the world literature on delayed development of endolymphatic hydrops after mumps virus infection are presented. Results: The case of a woman who presented with unilateral, reversible sensorineural hearing loss following mumps infection and was successfully treated with the Meniett device is presented. This woman developed profound sensorineural hearing loss and intractable vertigo spells a few months after contracting mumps. In this case, the incubation period interval between the development of mumps infection and the diagnosis of DEH was only one year. DEH (Delayed endolymphatic hydrops) is a clinical entity characterized by profound sensorineural hearing loss in one ear during its early phase; after a prolonged period of time, DEH enters the late phase, which is characterized by different otologic symptoms. Although the most common causes of DEH are inflammation, trauma and other unidentified events during childhood, viral infections, including mumps, represent one of the known causes of DEH. Mumps infection sometimes represents a confirmed etiology of DEH Sometimes DEH can definitively be diagnosed as being caused by mumps infection. Conclusion: This is the first case report to demonstrate the efficacy of the Meniett device in the treatment of DEH due to complicating mumps infection.

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