著者

姜 静愛 田中 恒彦 八木 千裕 堀井 新

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.82, no.1, pp.16-25, 2023-02-28 (Released:2023-04-11)

参考文献数

17

被引用文献数

2

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We report two patients with Persistent Postural- Perceptual Dizziness (PPPD) who were successfully treated by Cognitive Behavioral Therapy (CBT) after initially showing limited responses to vestibular rehabilitation and pharmacotherapy. The vestibular symptoms and psychiatric status were evaluated by the Dizziness Handicap Inventory (DHI) and Hospital Anxiety and Depression Scale (HADS), respectively, before and after six sessions of biweekly CBT intervention. The difficulties and abilities in handling activities of daily living as assessed by medical interviews improved in both patients, suggesting the effectiveness of CBT for PPPD. However, the results of assessment by the DHI/HADS differed between the two patients. Patient 1 showed improvement in the score on the DHI, but not in that on the HADS, whereas Patient 2 showed improvement in the score on the HADS, but not on that in the DHI. Given that both the patients reported improvements in the difficulties and abilities in handling the activities of daily living, we consider that the different results of assessment by the DHI may suggest the need for use of more appropriate measures to evaluate the quality of life after CBT than the DHI. These results might also suggest that CBT may not always exert equal effects on the psychiatric status and vestibular symptom status.

著者

八木 千裕 松山 洋 山本 裕 髙橋 姿

出版者

特定非営利活動法人 日本頭頸部外科学会

雑誌

頭頸部外科 (ISSN:1349581X)

巻号頁・発行日

vol.25, no.3, pp.303-309, 2016-02-28 (Released:2016-04-06)

参考文献数

17

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症例は,先天性下肢複雑奇形に対し頻回の手術が必要と診断され,麻酔科からの依頼により生後8か月時に気管切開術を施行した男児である。計7回の整形外科手術を終了し,4歳3か月時に気管支鏡にて声門下を確認したところ,カニューレ直上に気管内腔をほぼ閉塞する瘢痕組織を認めた。4歳7か月時に瘢痕除去術を施行したが,術後癒着による気管狭窄を認めたため,5歳4か月時に気管拡大術およびTチューブ留置術を施行した。2か月間Tチューブを留置後抜去し,5歳9か月時に気管孔閉鎖術を施行,その後の経過は良好であった。本症例を通して,気管カニューレ抜去困難症に至った反省点や同疾患への治療における工夫などを報告した。

著者

八木 千裕 堀井 新

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.2, pp.62-70, 2020-04-30 (Released:2020-06-02)

参考文献数

34

被引用文献数

2 1

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Persistent postural-perceptual dizziness (PPPD) is a newly defined diagnostic syndrome that was included in the 11th edition of the World Health Organization's International Classification of Diseases (ICD-11) in 2018. PPPD is characterized by persistent chronic vestibular syndrome, typically preceded by acute vestibular disorders, lasting for >3 months. The core vestibular symptoms of PPPD are dizziness, unsteadiness, and/or non-spinning vertigo and are exacerbated by upright posture/walking, active or passive movements, and exposure to moving or complex visual stimuli. PPPD is classified as a functional disorder, and not as a structural or psychiatric condition. No specific laboratory tests for the diagnosis of PPPD are available, and an assessment of the symptoms, exacerbating factors, and medical history is important for the precise diagnosis of PPPD. Although the exact pathophysiology of PPPD remains to be elucidated, data from physiological investigations and rapidly emerging advanced structural and functional neuroimaging studies have revealed some key mechanisms underlying the development of this disorder, including stiffened postural control, a shift in processing spatial orientation information to favor visual or somatosensory over vestibular inputs, and failure of higher cortical mechanisms to modulate the first two processes. Although PPPD is a relatively new diagnosis and will therefore be unfamiliar to many health professionals, undiagnosed or untreated dizzy patients who have been suffering for many years can be saved. Once recognized, PPPD can be managed by effective communication and individually tailored treatment strategies, including serotonergic medications, vestibular rehabilitation and cognitive behavioral therapy.