著者

野村 俊之 山本 昌彦 鈴木 光也 吉田 友英 大和田 聡子 重田 芙由子 池宮城 慶寛 田村 裕也

出版者

一般社団法人 日本耳鼻咽喉科頭頸部外科学会

雑誌

日本耳鼻咽喉科学会会報 (ISSN:00306622)

巻号頁・発行日

vol.114, no.11, pp.869-874, 2011 (Released:2011-12-02)

参考文献数

10

被引用文献数

1

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2007年8月より2009年7月までの2年間に, 東邦大学医療センター佐倉病院耳鼻咽喉科において良性発作性頭位めまい症と診断した1,145名を対象とし, われわれが考案した運動療法で治療を行った. われわれの方法は患側が特定できなくても整形外科疾患など頸椎・脊椎に問題のある症例でも, 患者が自宅で自分のペースで治療を行えるという特徴を有している. その結果1カ月以内に80.7%, そして3カ月以内では91.7%のめまい消失をみた. その中でも発症より1週間以内に受診した症例では2週間以内に80%の症例がめまいの消失をみている. めまい発症より受診時期が遅くなるにしたがって治癒期間も長くなる傾向があった.

著者

渡邊 千尋 大和田 聡子 伊藤 吏 村上 信五 欠畑 誠治

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.3, pp.178-184, 2019-06-30 (Released:2019-08-02)

参考文献数

15

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Herein, we present a patient with superior semicircular canal dehiscence syndrome (SCDS) manifesting as convergence spasms, which were alleviated by canal plugging surgery. SCDS is described in the literature by Minor as “a condition characterized by vertigo and oscillopsia induced by loud sounds or changes in the pressure of the external auditory canal or middle ear due to the dehiscence of the bone overlying the superior semicircular canal.” Convergence spasms are characterized by intermittent sustained convergence, accommodative spasms and miosis, and are likely to be caused by a functional disease, although in some cases, it is a manifestation of an organic disease. A 49-year-old male patient visited our department with a 2-year history of intermittent sudden vertigo and cloudy vision. The vertigo attacks had gradually increased in frequency and could last all day. Pure-tone audiometry showed bilateral conductive hearing impairment with air-bone gap at low frequencies from 125Hz to 500Hz. A head CT showed bone dehiscence above the bilateral superior semicircular canals and tegmen of the epitympani. Initial equilibrium testing did not reveal any abnormal findings. Initial sono-ocular testing of the right ear indicated upbeat nystagmus. However, after multiple outpatient visits, the upbeat nystagmus disappeared during the sono-ocular test and was replaced by paradoxical convergence. The eye tracking test also revealed paradoxical convergence, which became frequent and was accompanied by pupillary miosis. This paradoxical convergence was ultimately diagnosed as convergence spasms. No improvement of symptoms was achieved through non-surgical treatments over an extended period of time, therefore, canal plugging surgery was recommended. The surgery was performed through a middle fossa approach, and it completely eliminated the cochlear and vestibular symptoms associated with SCDS and the convergence spasms. Finally, we suspected that the convergence spasms were caused by ocular dysfunction as well as neurological factors related to the SCDS.