著者
藤田 信哉
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.76, no.1, pp.1-7, 2017-02-28 (Released:2017-04-03)
参考文献数
31

Correlations between vertigo, weather fronts, cold temperatures, and low pressures with episodes of Meniere's disease have been previously reported earlier. Such previous reports have indicated that sudden changes in pressure in the inner ear because of weather fronts are a leading causative factor of Meniere's disease. The insertion of a ventilation tube into the eardrum is a recognized method of maintaining a pressure equilibrium in the middle ear. Although the usefulness of this tube has been questioned, it seems to be an acceptable option when choosing between conservative therapy and invasive treatment. Cochlear symptoms and vertigo improve under a relatively positive pressure in the middle ear when patients with Meniere's disease are placed in a decompression chamber. Therefore, a new device that sends micro-pressure pulses into the ear (e.g., the Meniett® device) has become available in western countries. Because this device has not yet been approved in Japan, eardrum massage machines are expected to be used as an alternative method for the treatment of Meniere's disease.
著者
中島 務
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.76, no.4, pp.243-251, 2017-08-31 (Released:2017-10-01)
参考文献数
48

The concept of idiopathic sudden sensorineural hearing loss appeared after the term “Meniere's disease” was widely used. Until around the middle of the 20th century, sudden sensorineural hearing loss had been reported together with Meniere's disease. Moreover, sudden sensorineural hearing loss had been reported collectively regardless of the cause of the hearing loss. In 1944, de Kleyn reported a group of patients with sudden loss of function of the octavus-system in apparently normal persons. This was the first report in the literature which collectively described idiopathic sudden sensorineural hearing loss or idiopathic sudden deafness. From around the middle of the 20th Century, the number of papers regarding idiopathic sudden sensorineural hearing loss gradually increased. Vertigo occurred frequently in patients with severe hearing loss in the high-tone frequencies or with profound hearing loss throughout the whole range of frequencies. Recently magnetic resonance imaging revealed findings not only in the cochlea but also in the vestibule on the affected side in patients with vertigo. Endolymphatic hydrops was revealed in some patients with idiopathic sudden sensorineural hearing loss. These findings may contribute to the understanding of the etiology of sudden hearing loss including the vertigo mechanism. At the present time, however, the border between Meniere's disease and idiopathic sudden sensorineural hearing loss is unclear.
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

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
青木 光広 林 寿光 若岡 敬紀 西堀 丈純 久世 文也 水田 啓介 伊藤 八次
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.76, no.4, pp.270-276, 2017-08-31 (Released:2017-10-01)
参考文献数
18
被引用文献数
1

The superior semicircular canal dehiscence syndrome (SCDS), which presents with comprehensive symptoms such as hyperacusis, autophony, and pressure-induced vertigo, has been recently recognized in Japan. Three patients with SCDS, in whom severe vestibular symptoms were unable to be controlled with conservative treatments, underwent capping surgery through the middle fossa approach. The preoperatively air-bone gap (AB gap) in the audiometry, the decreased threshold of cervical vestibular evoked myogenic potentials (cVEMP) and bone dehiscence of the superior semicircular canal could be observed in all patients on CT imaging. All patients suffered from positional vertigo for about one week after the operation. However, their cochlear and vestibular symptoms associated with the SCDS were relieved within a few months after the operation. The capping procedure decreased the AB gaps and increased the thresholds of cVEMP in all patients. We suggest that capping surgery via the middle fossa approach for the SCDS is an efficient procedure without severe side effects.
著者
角南 貴司子
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.82, no.2, pp.61-67, 2023-04-30 (Released:2023-06-14)
参考文献数
19

Progressive supranuclear palsy (PSP) has been reported as a disorder mainly characterized by a tendency to fall, vertical supranuclear gaze palsy, and constriction of the body axis, akinesia, and cognitive impairment. Patients presenting with these typical clinical features are diagnosed as having the PSP-Richardson syndrome (PSP-RS). Electronystagmography (ENG) is useful for the detection of ocular motility disorder, which is the main feature of PSP. In cases of PSP, ocular motility disorder in the vertical direction occurs from the initial stage of the disease, and is characterized by prolonged latency and reduced velocity of the saccadic eye movement in the vertical direction. Horizontal saccadic eye movement disorder also occurs after the intermediate stage. Square wave jerks (SWJ) are often recognized from the initial stage of the disease. In terms of nystagmus, the quick phase is impaired due to impaired saccadic eye movements, and impairment of optokinetic nystagmus also starts from the quick phase movements. Pursuit (smooth) eye movement may also be impaired as the disease progresses. On the other hand, the vestibulo-ocular reflex is maintained even after disease progression to a late stage.
著者
今井 貴夫
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.2, pp.105-113, 2023-04-30 (Released:2023-06-14)
参考文献数
13

Electrophysiological measurement of the eye rotation axis using stimulation of a single semicircular canal nerve showed that the eye rotated around the axis perpendicular to the plane of the stimulated semicircular canal. Therefore, the affected semicircular canal can be identified by analyzing the eye rotation axis in cases of abnormal nystagmus. When the main component of the abnormal nystagmus is horizontal, the origin of the nystagmus is the lateral semicircular canal. When the main component of the abnormal nystagmus is torsional, the origin of the nystagmus is the anterior and/or posterior semicircular canal. The eye rotation axis in cases of excitatory nystagmus is quite the same as that in cases of inhibitory nystagmus, although the direction of eye rotation is opposite between cases of excitatory and inhibitory nystagmus. Vestibular neuritis mostly involves the superior vestibular nerve. The superior vestibular nerve transmits sensory information transmitted by from the vestibular hair cells located in the anterior and lateral semicircular canals. Therefore, patients with vestibular neuritis exhibit nystagmus with both horizontal and torsional components caused by inhibition of both the anterior and lateral semicircular canals. In patients with Ménière's disease, during a vertigo attack, excitatory nystagmus of anterior and/or posterior and/or lateral semicircular canal origin can be seen. Because the involving ratio of each contributing ratios of the three semicircular canals to nystagmus can vary, the ratio of the torsional component of the nystagmus to the horizontal component also varies. While nystagmus is purely horizontal in some cases, it is purely torsional in others. In the posterior canal type of BPPV, during the Dix-Hallpike maneuver, transient torsional nystagmus with the torsional component directed toward the affected side can be seen. In the lateral canal type of BPPV (canalolithiasis), geotropic positional nystagmus can be seen when the patient is supine. In the lateral canal type of BPPV (cupulolithiasis), apogeotropic positional nystagmus can be seen when the patient is supine.
著者
田村 敦 田所 慎
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.4, pp.242-253, 2019-08-31 (Released:2019-10-02)
参考文献数
66
被引用文献数
1

A major purpose of aeromedicine as a specialty is the prevention of aircraft accidents. Only prevention can save lives. From the earliest days of aviation, almost all aviation accidents have been attributed to the human factor called spatial disorientation. To understand spatial disorientation, one must comprehend how the human body interacts and interprets the environment of flight. This understanding can help to provide control and prevent loss of spatial orientation that can lead to aviation accidents.
著者
関根 和教 今井 貴夫 立花 文寿 松田 和徳 佐藤 豪 武田 憲昭
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.69, no.1, pp.47-51, 2010 (Released:2010-04-01)
参考文献数
15

We report a case of Costen's syndrome that showed chewing-induced nystagmus and vertigo. A 31-year-old woman visited our hospital complaining of chewing-induced vertigo 5 days after dental therapy. During chewing a stick of gum, she complained of vertigo and showed nystagmus beating to the right, the direction of which changed to the left thereafter. No spontaneous and positional nystagmus or any abnormalities in the neurological examination could, however, be found. The chewing-induced nystagmus and vertigo gradually disappeared within 2 weeks. Costen's syndrome is associated with various symptoms due to temporomandibular dysfunction. In the case, it is suggested that malinterdigitation after dental therapy caused temporomandibular dysfunction, resulting in the chewing-induced nystagmus, therefore, Costen's syndrome was diagnosed.Eustachian tube hypothesis, Tensor tympani hypothesis and otomandibular ligament hypothesis that accounted for temporomandibular dysfunction-induced aural symptoms in patient with Costen's syndrome had been proposed, but recently were withdrew. On the other hand, it is reported that reciprocal connections between trigeminal and vestibular nuclei. The trigeminal somatosensory input associated with temporomandibular dysfunction after dental therapy may cause chewing-induced nystagmus via the trigemino-vestibular connection in the brainstem in the case.
著者
塚田 愛 池本 英志 井上 達貴 小島 衣里加 福岡 聖也 砂川 正隆
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.80, no.4, pp.296-302, 2021-08-31 (Released:2021-10-02)
参考文献数
37

Several Japanese herbal medicines (Kampo), including Yokukansan, Yokukansankachimpihange, Shigyakusan, Kososan, Kamishoyosan, Kamikihito, Saikokaryukotsuboreito, Keishikaryukotsuboreito, Hangekobokuto, and Rikkunshito, are clinically used for patients with stress-related symptoms and diseases, according to the patient's constitution and symptoms (`Sho' in Oriental medicine). Kamikihito and Yokukansan are prescribed for the treatment of insomnia and neurosis in Japan. However, the precise mechanisms of actions of these products remain unclear. We investigated their possible antistress effects and involvement of oxytocin in the mechanisms of their actions in an animal model of stress. Oxytocin is a posterior pituitary hormone related to uterine contraction and milking. In recent years, its effects in the central nervous system-including its antistress effect-have been attracting interest. Oxytocin is reported to reduce stress levels via regulation of activities in the hypothalamic-pituitary-adrenal axis. Administration of Kamikihito or Yokukansan significantly increased the secretion of oxytocin in acute stress situations and exerted an antistress effect. Furthermore, the effects of these drugs were partially abrogated by administration of an oxytocin receptor antagonist. These results suggest that Kamikihito and Yokukansan have antistress activity and that increased oxytocin secretion may be involved in the mechanism underlying this effect. In clinical practice, the target candidates for these two drugs are different. Although both are used for irritability, anger and insomnia, Kamikihito is generally prescribed to patients who are physically weak, have weak digestive functions, or complain of mental anxiety. Yokukansan, on the other hand, is prescribed to patients with moderate physical strength, who are sensitive, and easily excited. These Kampo medicines may also be useful for stress-induced symptoms and illnesses.
著者
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.75, no.2, pp.33-40, 2016-04-30 (Released:2016-06-01)
参考文献数
32
被引用文献数
4 1

It is well known that stress induces or aggravates vertigo/dizziness and that dizzy patients have often comorbid psychiatric diseases such as anxiety and depression. Dizziness-associated psychiatric disease is not idiopathic but is usually an adjustment disorder to stressful life events. Stress can be divided into two groups: physical and psychological stress. Psychological stress activates the amygdala, which is a center for emotion discriminating discomfort from comfort, followed by hypothalamic-pituitary-adrenal axis (HPA axis) activation. In dizzy patients, sensory mismatch signals arising from multimodal sensory systems, including the vestibular, visual, and proprioceptive systems, would also activate the amygdala. Together with psychological stress, sensory mismatch signals judged as discomfort signals by the amygdala may drive the HPA axis and bring about dizziness. This scheme can well explain why psychological stress induces or aggravates vertigo and dizziness. In treating dizzy patients with stress-induced anxiety and depression, it is important to take care of comorbid psychiatric diseases and the cause of stress regardless of the existence or absence of organic vestibular diseases.
著者
馬塲 完仁 坂田 英治 飯田 祐起子 半田 由紀 井上 鐵三
出版者
Japan Society for Equilibrium Research
雑誌
Equilibrium Research (ISSN:03855716)
巻号頁・発行日
vol.47, no.4, pp.396-402, 1988 (Released:2009-10-20)
参考文献数
26

Eye movements induced by the I.V. injection of ketamine hydrochloride (Group 1; n=8) and diazepam (Group 2; n=7) were axamined electro-nystagmographically in 15 healthy adults.Complete gaze nystagmus and horizontal rebound nystagmus were observed in all 8 subjects of Group 1, and rebound nystagmus in all 4 directions in 2, but none had positional nystagmus.Primary position downbeat nystagmus was observed in 5 subjects of Group 2, and horizontal gaze nystagmus in all 7, but none had rebound nystagmus, vertical gaze nystagmus or positional nystagmus.
著者
小林 泰輔 岡田 昌浩 寺岡 正人 中村 光士郎
出版者
Japan Society for Equilibrium Research
雑誌
Equilibrium Research (ISSN:03855716)
巻号頁・発行日
vol.65, no.6, pp.453-459, 2006 (Released:2009-06-05)
参考文献数
15
被引用文献数
1

Cogan's syndrome is primarily diagnosed based on subsequent episodes of an inflammatory eye disease and rapidly progressive, usually sequential bilateral loss of audiovestibular function. Since there are still no specific tests for the syndrome, it is difficult to diagnose Cogan's syndrome in the early stage before the emergence of both eye and audiovestiubular symptoms. We present a case of a 34-year-old woman who complained of vertigo and bilateral hearing loss. Magnetic resonance imaging (MRI) of the inner ear was performed before the emergence of keratitis. MRI on the 23rd day after onset of hearing loss revealed a slightly high intensity on TI-weighted images in the right vestibule, which showed profound hearing loss. On the 54th day after onset, high signal intensity was noted in the right cochlea, the vestibule, and lateral semicircular canal on Tl-weighted images, but no enhancement. The high signal intensity disappeared seven months after onset, but there was no defect of inner ear signs on the T2-weighted images. A high signal of the inner ear on T1-weighted images is not a specific sign of MRI in Cogan's syndrome, since it is sometimes encountered in the inner ear of labyrinthitis, bleeding in patients with leukemia, and intralabyrinthine schwanoma. However, MRI could be a possible method for the early diagnosis of Cogan's syndrome because this finding might be recognized before the onset of eye symptoms.
著者
野村 泰之 濱田 敬永 斎藤 雄一郎 吉田 晋也 遠藤 壮平 鴫原 俊太郎 木田 亮紀
出版者
Japan Society for Equilibrium Research
雑誌
Equilibrium Research (ISSN:03855716)
巻号頁・発行日
vol.57, no.6, pp.608-614, 1998 (Released:2009-10-13)
参考文献数
17
被引用文献数
2 2

Recently, because of the development of MRI, it is becoming apparent that there are some cases of cerebellar vascular disorder in the posterior cranial fossa among cases of sudden onset of rotatory vertigo. We reported two cases of sudden onset of rotatory vertigo caused by cerebellar infarction in the territory of the posterior inferior cerebellar artery (PICA) due to cervical occlusive injuries.Case 1. A 48-year-old male sustained a slight whip lash injury and after ten hours, experienced rotatory vertigo and hoarseness. When he came to our hospital, we could only detect hoarseness. However, vascular disorder in the posterior cranial fossa was suggested by the interview. MRI revealed left cerebellar and medulla oblongata infarction.Case 2. A 29-year-old male felt rotatory vertigo and vomited after clicking his neck. Upon closer examination, pure rotatory spontaneous nystagmus, sensory disorder accompanied by sensory dissociation in his face and disability in standing and walking were found, suggesting vascular disorder in the posterior cranial fossa. MRI showed infarction in the left inferior cerebellar region, vermis and left lateral-dorsal medulla oblongata. A dissecting aneurysm in the vertebral artery was found on subsequent angiography.In the Japanese literature, we could find only nine reported cases of cerebellar vascular disorder in the posterior cranial fossa due to the cervical occlusive injuries, in addition to our two cases.The severity of injuries and the period until onset of diagnostic symptoms varied. Therefore, tracing cerebellar vascular disorders due to cervical occlusive injury required not only neurological and neuro-otological findings, but also attention to the history of the original injury and the development of subsequent symptoms. Without a careful interview, it is very difficult to correctly establish the cause of the disorder.
著者
山中 敏彰
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.75, no.4, pp.219-227, 2016-08-31 (Released:2016-10-01)
参考文献数
26
被引用文献数
1 1

Some patients with uncompensated vestibular hypofunction present with a long history of persistent severe problems in posture and mobility that are intractable to any treatment. We examined whether graded vestibular balance rehabilitation would alleviate the dizziness and balance problems, and increase the safety and independence of patients with chronic balance disorders following unilateral vestibular loss. The stepwise treatment program for vestibular balance rehabilitation developed at our clinic consists of vestibular adaptation training (Step 1), sensory reweighing training (Step 2), and vestibular substitution training (Step 3). This rehabilitation program is intended at promoting the central vestibular adaptation process, altering the vestibular, visual and somatosensory inputs, and encouraging the use of the sensory substitution system with a human (brain)-machine interface as a substitute for the diminished vestibular input, for transmitting information about the patient's head position to the tongue. Clinical trials were performed to investigate the degree to which the stepwise multimodal approach might be effective for chronic balance disorder in subjects with unilateral decompensated vestibular loss. Some interventions for rehabilitation were selected and customized for each patient in accordance with the level of their compensation for postural control and sensory dependence. Improvements in the balance performance were noted in 64.4% of all the subjects after the Step 1 training. Of the 31 subjects (35.6%) who failed to improve with the step 1 program, 14 (45.2%) showed improvements after the Step 2 training. All of the subjects who failed to show improvement after the Step 1 and 2 training programs showed pronounced improvements after the Step 3 training. These results suggest that programmatic stepwise multimodal approach to vestibular rehabilitation yields beneficial effect in patients with balance disorder secondary to vestibular decompensation.
著者
増村 千佐子 今井 貴夫 真貝 佳代子 滝本 泰光 奥村 朋子 太田 有美 森鼻 哲生 佐藤 崇 岡崎 鈴代 鎌倉 武史 猪原 秀典
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.76, no.2, pp.72-78, 2017-04-30 (Released:2017-06-01)
参考文献数
15

The differential diagnosis for positional dizziness/vertigo, such as vertigo upon waking up or standing up, includes benign paroxysmal positional vertigo (BPPV), orthostatic hypotension (OH), autonomic dysfunction, and so on. A correct and efficient diagnosis of this condition is important. The purposes of this study were to clarify in which cases is a Schellong test the optimal means of diagnosing OH among patients with positional vertigo and to obtain specific answers to our original questionnaire on dizziness/vertigo among OH patients. All the patients who visited our office complaining of dizziness/vertigo between 2012 and 2015 were asked to perform the Schellong test and to complete our questionnaire. We used a conventional BPPV diagnostic maneuver to diagnosis BPPV. The results were analyzed statistically. A total of 309 cases returned analyzable questionnaire results. Overall, 38 cases were finally diagnosed as having certain BPPV based on the observation of positional nystagmus; 104 cases tested positive using the Schellong test. None of the items in the questionnaire were correlated with either a positive or negative Schellong test result. When 13 Schellong test-positive cases were excluded from the certain BPPV group, three answers to the questions in the questionnaire differed significantly between the certain BPPV group and the Schellong test-positive group. These answers were as follows: a waking up/lying down movement or rolling over in a supine position triggers vertigo, and a specific head position exacerbates vertigo. In conclusion, when a patient complains of vertigo upon waking up or standing up, the following two specific questions should be asked: “Is your vertigo triggered by waking up/lying down or by rolling over in a supine position?” and “Does a specific head position exacerbate your vertigo?” If a patient answers ‘yes’ to either of these questions and positional nystagmus is not observed, a Schellong test should be performed to diagnose OH.
著者
中村 節子
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.71, no.3, pp.182-184, 2012 (Released:2012-08-01)
参考文献数
24