著者

塩崎 智之 和田 佳郎 伊藤 妙子 山中 敏彰 北原 糺

出版者

一般社団法人 日本めまい平衡医学会

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.79, no.4, pp.274-280, 2020-08-31 (Released:2020-10-01)

参考文献数

12

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There are patients with floating dizziness who do not show abnormalities in current vertigo balance tests. We developed a clinical examination to quantify gravity perception as a first step to test our hypothesis that a gravity perception disturbance is the cause of floating dizziness. The gravity sensitivity can be measured accurately by adding the head tilting condition to the original subjective visual vertical (SVV) test. We named this test the Head Tilt SVV (HT-SVV). The most important measurement item in HT-SVV is head tilt perception gain (HTPG). HT-SVV measurements in 329 healthy subjects yielded an average value and standard deviation of 1.02±0.12 and a reference value of 0.80-1.25 for HTPG, and a difference between the left and right HTPG of 4.7±3.7%, i.e.,<10.0%. We could not detect age-related changes in gravitational sensitivity by the original SVV, but found that HTPG, determined by HT-SVV, increased with age. A significantly higher rate of subjective dizziness was noted in patients who tested positive in the HT-SVV than in those who tested negative among patients who developed floating dizziness after BPPV. We would like to clarify the clinical significance of the test method and establish the concept of gravitational susceptibility disorder, although a number of relevant issues still remain to be clarified.

著者

藤田 裕人 小泉 敏三 乾 洋史 伊藤 妙子 北原 糺

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.116, no.9, pp.851-857, 2023 (Released:2023-09-01)

参考文献数

21

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There have been many reports of endolymphatic hydrops (EH) in patients with Meniere’s disease (MD) since the first report by Hallpike and Yamakawa in 1938. Mental/physical stress and subsequent increase in release of the stress hormone arginine vasopressin (AVP) supposedly triggers MD. Recently, many lines of evidence have suggested the possibility that AVP is closely linked to the formation of EH in cases of MD. In the present study, we attempted to investigate the relationship between stress and EH in patients with unilateral Meniere’s disease (uMD).We enrolled 113 definite uMD patients from July 2014 to October 2019. All patients underwent 3-T magnetic resonance imaging (MRI) 4 hours after intravenous gadolinium injection. We adopted the criteria for evaluation of EH proposed by Nakashima et al. Stress was evaluated using the depressive self-rating scale (SDS), the psychological stress response scale (SRS), and the dizziness handicap inventory (DHI) modified by Nishiike et al. These stress scores and the blood AVP levels were compared in patients with EH.There was no significant correlation between EH and the stress scores on the affected side, but the anxiety score showed a significant correlation with EH on the sound side (p = 0.04). There was no significant correlation between the EH and AVP in either the affected side or the sound side. We suppose that the formation of EH involves a complex process of stresses.

著者

乾 洋史 伊藤 妙子 北原 糺

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.113, no.10, pp.667-678, 2020 (Released:2020-10-01)

参考文献数

44

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Magnetic resonance (MR)-based volumetric measurement of the endolymphatic space (ELS) was conducted in patients with acute low-tone sensorineural hearing loss (ALHL), sudden deafness (SD), cochlear Meniere’s disease (cMD), and unilateral MD (uMD), and the results were compared with those in control subjects (CS). Seventy-nine patients with ALHL, 99 with SD, 65 with cMD, 77 with uMD, and 47 CS participated in this study. With the exception of the patients with uMD, none of the subjects had vertigo. Images of the inner ear fluid space, positive perilymph and positive endolymph signal were acquired using a 3-T MR imaging scanner. Three-dimensional images were reconstructed semi-automatically by using anatomical and tissue information to fuse the inner ear fluid space images with the ELS images. The cochlear and vestibular ELS/total fluid space (TFS) volume ratios were 10.2%±6.8% and 17.7%±10.2%, respectively. The cochlear ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS, and patients with ALHL, SD, and cMD (CS=ALHL<SD<cMD<uMD). The vestibular ELS/TFS volume ratio in patients with uMD was significantly higher than that in the CS and other patients groups (CS=ALHL=SD<cMD<uMD). The cochlear and vestibular ELS volume ratio in patients with uMD and other endolymphatic hydrops-related diseases differed from that in the CS. These results suggest that assessment of the prognosis is possible by MR evaluation in patients with endolymphatic hydrops-related inner ear diseases.