著者

國弘 幸伸 相馬 啓子

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.73, no.3, pp.174-186, 2014-06-30 (Released:2014-08-01)

参考文献数

10

被引用文献数

3

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Postural, tension-type headache is the most prominent symptom of cerebrospinal fluid leakage. However, in otoneurological practice, dizziness and not headache is the most frequent presenting symptom in patients with this disorder. Affected patients usually describe their dizziness as a floating sensation. Rotatory vertigo occurs quite rarely. Their complaint is substantiated by high degrees of postural unsteadiness. Some patients cannot stand still even with their eyes open. They stumble and totter while walking. In contrast to such high degrees of postural ataxia, oculomotor disorders such as nystagmus, saccadic pursuit, and decrease of oculomotor nystagmus are not seen. As with other symptoms, dizziness and postural unsteadiness are influenced by the weather, and get worse when the weather is bad. The authors speculate that unsteadiness in both peripheral and central nervous systems involved in spatial orientation (integration of visual, vestibular, and proprioceptive input) underlies the dizziness, postural unsteadiness, and a variety of other symptoms of cerebrospinal fluid leakage.

著者

國弘 幸伸 相馬 啓子

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.70, no.3, pp.176-188, 2011 (Released:2011-08-01)

参考文献数

11

被引用文献数

3 1 3

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The most prominent symptom of spinal cerebrospinal fluid (CSF) leakage is an orthostatic, tension-type headache. Other well-known symptoms include nausea, vomiting, photophobia, diplopia, depression, and amnesia. The authors address other commonly encountered symptoms such as dizziness, hearing disturbances, cerebrospinal fluid rhinorrhea, and gustatory and olfactory disturbances.The dizziness experienced in this disorder is essentially characterized as a kind of “floating sensation” or “walking on the clouds” and is associated with a high degree of unsteadiness. A considerable percentage of patients cannot remain standing even when their eyes are open; to-and-fro perturbations are particularly prominent in these patients. Rotatory vertigo attacks can occur in a small portion of patients, but usually only during the early stages of the disease. As with the headache, dizziness is aggravated by an upright or standing position. The weather also influences the intensity of both the headaches and dizziness: both are exacerbated when the atmospheric pressure is low or is falling rapidly. Water intake and/or the drip infusion of a physiological salt solution may temporarily improve dizziness and other symptoms.The usefulness of MRI for diagnosing spinal cerebrospinal fluid leakage is limited. MRI findings are equivocal in most cases; therefore, the authors perform 111In-DTPA scintigraphy for each patient in whom this disorder is suspected.The first choice of treatment for this disorder is bed rest and water intake and/or drip infusion. When these treatments are ineffective, an epidural autologous blood patch is attempted. However, not all patients are cured by this procedure, and dizziness, hearing, and/or tinnitus may worsen after treatment. In some patients, an exploratory tympanotomy is required to rule out associated or treatment-induced perilymphatic fistula.In conclusion, spinal CSF leakage is not a rare disorder, and because this disorder presents with an extremely wide spectrum of symptoms, all physicians in any field of specialization may encounter a patient with this disorder. All physicians should keep this disorder in mind.

著者

大野 芳裕 國弘 幸伸

出版者

耳鼻咽喉科展望会

雑誌

耳鼻咽喉科展望 (ISSN:03869687)

巻号頁・発行日

vol.42, no.1, pp.50-56, 1999-02-15 (Released:2011-03-18)

参考文献数

8

被引用文献数

1

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上咽頭炎68例に対する局所治療 (上咽頭処置およびネブライザー療法) の治療効果につき検討した。治療前後における局所の炎症の程度の判定は, 硬性内視鏡を用いて撮影したビデオ画像により行つた。また自覚症状の変化は, 治療前後に行つたアンケート調査の結果を基に評価した。主訴としては, 咽頭痛 (22.1%) が最も多く, 次いでめまい (19.1%), 咽頭異物感 (14.7%) の順であつた。これらの症状の他にも, 後鼻漏, 肩こり, 頭痛, 耳鳴, 咳嗽, 発熱 (不明熱), 頸部痛, 耳閉感, 咽頭乾燥感, 全身倦怠感など, さまざまな症状がみられた。主訴となつた症状は, 治療後に86.8%の症例で改善がみられた。主訴以外の症状に関しても, それらのすべてにおいて有意な改善が得られた。局所所見の改善率は60.3%であつた。自覚症状と局所所見の改善の有無の間には有意な相関が認められた。以上の結果から, 上咽頭炎に対しては局所治療がきわめて有効であると考えられた。日常臨床においては, 常に本疾患を念頭に置き, 診断と積極的な治療が行われるべきであると思われる。

著者

矢部 はる奈 五島 史行 林 賢 國弘 幸伸 小川 郁

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.100, no.6, pp.491-495, 2007-06-01 (Released:2011-10-07)

参考文献数

15

被引用文献数

1 1

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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.

著者

神崎 仁 浅野 恭子 田副 真美 國弘 幸伸

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.60, no.2, pp.93-104, 2001-04-01

参考文献数

33

被引用文献数

19 6

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In collaboration with otologists and psychotherapists, psychotherapy was performed together with the administration of drugs for patients with Meniere's disease in whom medical treatment, surgical treatment, or intratympanic streptomycin therapy had been ineffective and for a patient with intractable tinnitus. We report in detail 7 patients for whom psychotherapy was effective for vertigo, stabilization of hearing fluctuation, or the acceptance of tinnitus.<BR>It is important to consider psychosomatic aspects in the treatment of patients with Meniere's disease, and it was possible to avoid unnecessary surgery in some Meniere's disease patients using a combination of psychotherapy with medication.

著者

國弘 幸伸 大内 利昭 小形 章 増野 博康 井上 泰宏 神崎 仁

出版者

一般社団法人 日本聴覚医学会

雑誌

AUDIOLOGY JAPAN (ISSN:03038106)

巻号頁・発行日

vol.34, no.5, pp.591-592, 1991-10-15 (Released:2010-04-30)

著者

國弘 幸伸

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium Research (ISSN:03855716)

巻号頁・発行日

vol.63, no.6, pp.533-548, 2004 (Released:2009-06-05)

参考文献数

87

被引用文献数

13 6

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The subjective visual vertical (SVV) signifies the visually determined gravitational vertical. The measurement of SVV is clinically used as a method to assess the degree of dysfunction in the otolith, primary vestibular nerves, and central graviceptive pathways.Perception of vertical, however, does not depend solely on the function of those pathways, but is affected by various factors such as visual information, head position relative to gravity, and linear acceleration forces acting on the gravity vector. In addition, it undergoes a kind of 'vestibular compensation', that is, the tilt of SVV decreases within days to weeks even if the function of the organ responsible for the tilt does not restore function. In examining the patient with vertigo or dysequilibrium, the physician must be well acquainted with those factors affecting SVV and its natural course.This article also referred to the difference between SVV tilts and room tilt illusions. The former are usually stable and chronic signs and manifest as a continuum of angle of tilt up to abut 300. In contrast, the latter occur paroxysmally or transiently in 90° steps.In clinical practice, the measurement of SVV is not so commonly carried out as compared to the recordings of nystagmus. It is expected, however, that SVV be more widely taken into account in clinical practice because the tilt of SVV and the occurrence of nystagmus do not share the same anatomical structures, thus SVV can provide a greater understanding of the patient's complaints and underlying pathologies.

著者

安田 知久 相馬 啓子 國弘 幸伸 安田 宏一

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.78, no.1, pp.39-42, 2019-02-28 (Released:2019-04-01)

参考文献数

11

被引用文献数

1

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Ten healthy volunteers were spun passively on a revolving chair (0.5 Hz left-winded 7 rotation), asked to stand up immediately thereafter and take 30 steps with their eyes closed. The observations revealed that subjects having an anteverted posture turned to the right, whereas those with a retroverted posture turned to the left. To ascertain the reason for this directional switch, volunteers carried a 10-kg weight on their front or back while keeping their axis vertical. The front-weighted subjects turned to the right like the subjects with the anteverted posture, while the back-weighted subjects turned to the left like those with the retroverted posture. The results indicated that shifting of the center of gravity, and not the posture, was the reason for the difference. When the subjects kept their arms up forward horizontally and the legs high up as in Fukuda's stepping test, they turned to the right, because their horizontal arms and highly up legs set the weight forward. The neutral pose, with the arms hanging down along the side of the body and stepping low, was scarcely associated with any turning.

著者

國弘 幸伸 中山 明峰

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.70, no.6, pp.465-472, 2011 (Released:2012-02-01)

参考文献数

14

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Along with Epley's canalith repositioning maneuver, the Semont maneuver is also recognized as an effective physical therapy for benign paroxysmal positional vertigo. However, the details of this maneuver are not well known, presumably because of the obscurity of the original description by Semont et al. In Japan, the “Semont liberatory maneuver,” as described by Brandt, is accepted as the “original” Semont maneuver. However, the two maneuvers are not identical. The aim of this paper was to reproduce the original procedure of Semont's as presented by A. Semont himself at the 10th Nagoya Otorhinolaryngological Forum held in Nagoya, Japan, in 2006. This lecture clarified some obscure points in the original paper; however, the procedure described at the forum was not a detailed reproduction of the original Semont maneuver, but was somewhat more complicated. Also of note, Semont decisively denied the cupulolithiasis theory and explained the usefulness of his maneuver according to the canalolithiasis theory.

著者

倉島 一浩 國弘 幸伸 齋藤 晶 上村 隆一郎 小林 宏成 神崎 仁

出版者

Japan Society for Equilibrium Research

雑誌

Equilibrium research (ISSN:03855716)

巻号頁・発行日

vol.56, no.6, pp.560-568, 1997-12-01

被引用文献数

4 1

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We retrospectively determined the efficacy of Semont's liberatory maneuver in 52 patients with benign paroxysmal positional vertigo (BPPV). Vertigo and torsional nystagmus, characteristic of BPPV, had been induced by the Hallpike maneuver at the time of diagnosis.<BR>Thirty of these patients were treated by Semont's maneuver after being informed in detail about the method. If vertigo reoccurred after treatment, they repeated the maneuver at home twice a day (after awaking and before going to bed) until vertigo disappeared. Patients received no medication and were followed until complete remission or for up to 1 year. The other 22 patients received either no treatment or were treated with medication only; they were followed for up to 9 years.<BR>Disappearance of nystagmus was ascertained for the first group only at our dizziness clinic. While most of these patients exhibited nystagmus lasting‹30 seconds (indicating the mechanism of canalolithiasis), two had nystagmus lasting›1 minute, a sign of cupulolithiasis-induced BPPV. Complete remission of BPPV occurred in 28 patients in the first group or 93.3%; 19 (68%) of these patients showed remission within 3 days. In the second group, the vertigo was resolved in only 9 of the 22 patients (40.9%). The difference in the remission rate of the two groups was significant (p<0.0001).<BR>Our results proved the efficacy of Semont's maneuver for treating not only the more common type of BPPV caused by canalolithiasis but also the less common type induced by cupulolithiasis.