著者

土井 勝美

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.1, pp.8-15, 2014-02-28 (Released:2014-04-01)

参考文献数

23

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Meniere's disease is characterized by intermittent episodes of vertigo lasting from minutes to hours, with fluctuating sensorineural hearing loss, tinnitus, and aural pressure. The primary histopathological correlate is endolymphatic hydrops. Several medical and surgical treatments have been offered to patients with Meniere's disease. It has been confirmed that no one effective treatment is available for these patients. According to the severity of the patients' symptoms, appropriate therapeutic strategies should be selected. If medical therapies including lifestyle change, diuretics, and local/systemic steroids have failed, then surgical approaches such as intratympanic gentamicin perfusion (GM), pressure pulse treatment with Meniett®, endolymphatic sac surgery (ESS) and vestibular neurectomy (VN) should be considered. Most reviews have reported relative good (80-100%) vertigo control rates with either GM, Meniett®, ESS, or VN, however, recurrence of vertigo has been noticed in certain cases. A combination of medical and surgical strategies should be recommended and the treatment algorithm for Meniere's disease indicated in “2011 Clinical practice guidelines for Meniere's disease” must be adopted.

著者

小林 泰輔 岡田 昌浩

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.68, no.3, pp.131-137, 2009 (Released:2009-08-01)

参考文献数

15

被引用文献数

3 1

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We report on two cases of cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA) mimicking acute peripheral vertigo. Case 1 was a 54-year-old man with WPW syndrome presenting with sudden vertigo. When he was admitted to our hospital, he had direction fixed horizontal nystagmus towards the left. His symptom disappeared in several days, however, MRI revealed a haemorrhagic infarct in the territory of the right mPICA. Case 2 was a 47-year-old man who was admitted with sudden rotatory vertigo. Direction fixed horizontal nystagmus towards the right was noted and head CT was normal. The nystagmus disappeared on the 5th day of the illness and caloric testing did not show canal paresis. Because of prolonged gate ataxia, a CT scan was performed again. It showed a cerebellar infarction and MRI revealed a cerebellar infarction of the left medial hemisphere and vermis. Infarcts of mPICA sometimes cause acute vertigo presenting horizontal direction fixed nystagmus mimicking peripheral vertigo. In a patient presenting with acute vertigo, head MRI should be performed when he or she has history of risk factor for cerebellar infarction such as diabetes mellitus, ischemic heart disease, and so on. The patients with prolonged ataxia and headache should also undergo MRI.

著者

岡田 智幸

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.77, no.4, pp.201-219, 2018-08-31 (Released:2018-10-02)

参考文献数

83

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Congenital nystagmus (CN) is known as an involuntary to-and-fro movement of the eyes characterized by a wide variation in waveforms ranging from jerk to pendular types. CN is presumed to be present at birth. In antiquity, midwives or shaman occasionally noticed CN. The first description of CN, popularly known in china as “shiji,” was made around 2000 years ago. Despite its various waveforms, people with CN do not develop visual symptoms and rarely complain of oscillopsia. CN can be idiopathic but is most likely caused by gaze stability, although some reports have suggested familial cases. No detailed mechanisms have been proposed to explain the generation of CN waveforms in people with CN in whom the vestibulo-ocular reflex (VOR) cannot be established. The vestibular time constant showed a good correlation between VOR and perception in normal subjects when assessed using perceptual measures. The time constant (TC) of decay of vestibular sensation in individuals with CN was half the duration of the TC found in normal subjects. Thus, individuals with CN have short vestibular time constants, probably due to changes induced in velocity storage processing by the persistent retinal image motion present in individuals with CN. There is a fascinating paper showing that FRMD7, also known as the CN gene, is necessary for optokinetic nystagmus (OKN) in humans and mice. In the retina of FRMD7-mutant mice, horizontal direction selectivity and asymmetry of inhibitory inputs to horizontal direction-selective retinal ganglion cells (HDSCs) are both lost. This could be a hidden essential characteristic of CN. HDSCs are responsible for horizontal OKN and project to the nucleus of the optic tract (NOT), and NOT, in turn, is related to the velocity storage mechanism, vestibular adaptation, and habituation. Inversion of OKN and suppression of nystagmus with eye closure are characteristics of CN. Both of these features can be explained by abnormalities in HDSCs. So, HDSCs can only play the role in the light. In the future, innovative ideas could help to elucidate the nature of CN.

著者

岸田 杏子 野村 泰之 地家 真紀 御子柴 郁夫 岸野 明洋 木村 優介 三浦 正稔 戸井 輝夫 増田 毅 鴫原 俊太郎 大島 猛史

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.157-163, 2019-06-30 (Released:2019-08-02)

参考文献数

15

被引用文献数

1 1

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Purpose: This present study was aimed at evaluating the effects of our original teaching method called “Bang Bang, Hu, Kacha” on the learning efficiency. Methods: We invented this method, which involves hand modulation and vocalization of words, for medical students to enable them to easily understand and memorize the anatomy of the inner ear and vestibular organs. We evaluated its effectiveness based on self-completed questionnaires by the students. Results: The results suggested that the comprehension level of the 30 medical students of the anatomy of the inner ear organs, especially the positional relationships of the semicircular canals and cochlea improved dramatically after they underwent training using this methodology. The medical students assigned high scores to this relational hand modulation method. Conclusion: This “Bang Bang, Hu, Kacha” method seemed to be a very useful for medical education, and allowed easy comprehension and memorization of the inner ear and vestibular anatomical structures.

著者

佐藤 豪

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.3, pp.210-215, 2021-06-30 (Released:2021-08-04)

参考文献数

19

被引用文献数

2

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Bilateral vestibulopathy is characterized by bilateral functional impairment of the peripheral vestibular system. The usual symptoms are persistent unsteadiness and oscillopsia during head and body movements. It has been reported that sensory substitution therapy, that is, vestibular rehabilitation using a sensory substitution device, which transmits other sensory information to a stimulator as a substitute for defective vestibular information, might be effective in patients with bilateral and unilateral vestibulopathy. Recently, we developed a new wearable device, TPAD (tilt perception adjustment device), that transmits vibratory input containing head-tilt information to the mandible as a substitute for defective vestibular information. We assessed the patient using the dizziness handicaps inventory (DHI), gait analysis, and visual/somatosensory dependence of postural control in the patients with unilateral vestibulopathy. Three months after therapy in patients with unilateral vestibulopathy, the DHI and walking speed improved even when the subjects were not wearing the TPAD. Moreover, the index of the visual dependence of posture control that was evaluated by posturography with/without foam rubber in the eyes open or closed condition decreased. The findings suggested that the sensory vibratory substitution with a TPAD for defective vestibular information induced brain plasticity related to sensory re-weighting to reduce the visual dependence of posture control, resulting in the improvement of dizziness and imbalance even while not wearing the TPAD in vestibulopathy patients. We then investigated the effects of sensory substitution therapy using a TPAD in patients with bilateral vestibulopathy and normal subjects. Three months after sensory substitution therapy in patients with bilateral vestibulopathy, the DHI and area with eyes closed measured by posturography improved even when the subjects did not wear a TPAD. However, the gait parameters improved only under the condition of wearing a TPAD. These findings suggest that sensory vibratory substitution with a TPAD might serve as temporary replacement for defective vestibular information in patients with bilateral vestibulopathy. Moreover, wearing of the TPAD improved posture control under the eyes-closed condition with foam rubber measured by posturography in normal subjects. TPAD might be applicable as a wearable device for improving posture control, not only in patients with bilateral vestibulopathy, but also in those with presbyvestibulopathy.

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.57, no.suppl-13, pp.1-103, 1998 (Released:2009-06-05)

著者

小宮山 純

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.6, pp.566-568, 2020-12-31 (Released:2021-02-02)

参考文献数

5

被引用文献数

1 1

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.81, no.5, pp.289-469, 2022-10-31 (Released:2023-01-11)

著者

田岡 俊昭

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.68, no.3, pp.113-118, 2009 (Released:2009-08-01)

参考文献数

9

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CT and MRI are indispensable for routine medical examination of neurovascular disorders. This article describes the imaging findings in acute infarction and carotid plaques, knowledge of which is essential for clinics of equilibrium disorders. Diffusion-weighted images are indispensable for detecting acute infarction, and perfusion MRI also yields important information about the ischemic status. Carotid bifurcation is one of the frequent sites of involvement in atheromatous diseases. A variety of imaging modalities are available for the evaluation of carotid plaques, including conventional contrast angiography, CT, ultrasound, and MRI. MRI is a non-invasive imaging method that reflects the chemical composition, concentration, water content or physical status of the tissues examined.

著者

道祖尾 弦 隈上 秀高 髙橋 晴雄

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.6, pp.528-532, 2014-12-31 (Released:2015-02-01)

参考文献数

18

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We hereby report on our experience regarding a case of rotatory vertigo exhibiting vestibular disorder-like findings accompanying normal pressure hydrocephalus (NPH). The case pertains to a 60-year-old man. Gait disturbance, dysuria, and so on, appeared from around 2007, and he was diagnosed as having NPH by the Department of Neurology of our hospital?. Rotatory vertigo suddenly appeared in October 2011, and he was admitted to the Department of Neurology and subsequently referred to our department on the 2nd sick day. Third degree of horizontal rotatory nystagmus to the left was observed, with no difference between the left and right observed upon a hearing test, and although he was observed with an increased threshold in the high sound area appropriate to his age, no other neurologic symptoms were observed. An equilibrium test was carried out at a later date under the suspicion of right vestibular neuronitis, however, no decline in semicircular canal function was observed upon caloric testing, with no difference between the left and right observed as well upon vestibule-ocular reflex (VOR), and so a follow-up was carried out with a diagnosis of vertebrobasilar insufficiency. The symptoms subsequently rapidly improved, however, nystagmus to the left at III° appeared again one week later, with the same nystagmus appearing again two months later. Lightheadedness was prolonged when rotatory vertigo attacks were not observed and so the patient consulted the Department of Neurology and underwent a tap test taking into consideration his dizziness caused by NPH, as a result of which his dizziness rapidly disappeared compared to the day prior, along with the other symptoms including improved gait disturbance and dysuria, which all continued to improve further. Subsequently, all dizziness disappeared after undergoing an endoscopic third ventriculostomy.

著者

重野 浩一郎

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.6, pp.661-673, 2017-12-31 (Released:2018-02-03)

参考文献数

51

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Benign Paroxysmal Positional Vertigo (BPPV) is the most common and representative vestibular disease of peripheral origin. The three original monographs of BPPV are introduced and commented upon. In addition, a series of essential up-to-date papers are described, focusing particularly on the pathophysiology of BPPV: cupulolithiasis and canalolithiasis, the treatment of posterior canal BPPV, the characteristics of lateral canal BPPV and anterior canal BPPV.

著者

池園 哲郎

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.302-309, 2017-08-31 (Released:2017-10-01)

参考文献数

19

被引用文献数

5 6

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In this symposium, we have discussed the diagnostic criteria of Ménière's disease including the newly published one from the Japan Society for Equilibrium Research (JSER) in 2016. The diagnosis of Ménière's disease is primarily based on the clinical symptoms of vertigo attacks and hearing loss, which usually fluctuates. Historically, several different diagnostic criteria have been published by: 1) The Japanese Ménière's disease study group in 1974 and 2008; 2) The JSER in 1987 and 2016; and 3) The American Academy of Otolaryngology-Head and Neck Surgery in 1995. 4) The Bárány Society also proposed diagnostic criteria for Ménière's disease in 2015. In order to address the future direction for the diagnosis, treatment and research of Ménière's disease, it is crucial to comprehensively understand how these criteria describe the symptoms and background etiology of Ménière's disease. For example, the exact definitions of the term “vertigo” differ among these criteria. In the Japanese criteria, “vertigo” is not restricted to a rotating sensation of the body, whereas the American criteria define “vertigo” as a spinning sensation. In the Japanese criteria, hearing loss temporally coincides with the vertigo attacks, whereas the American and Bárány Society's criteria do not have such restrictions. Along with the current advances in diagnostic tests for otologic diseases, the Bárány Society's criteria include an updated list of the differential diagnosis for Ménière's disease. Most importantly, the Japanese criteria and the American criteria strongly support the hypothesis that the etiology of Ménière's disease is endolymphatic hydrops, and the Japan Society's 2016 criteria include MRI identification of hydrops. In the Bárány Society's criteria, the pathogenesis includes not only endolymphatic hydrops but other conditions as well. It is important to understand the concordance and differences of these criteria for the diagnosis of Ménière's disease.

著者

野村 泰之

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.68, no.3, pp.149-153, 2009 (Released:2009-08-01)

参考文献数

28

被引用文献数

1

著者

杉内 友理子

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.80, no.4, pp.303-310, 2021-08-31 (Released:2021-10-02)

参考文献数

31

被引用文献数

1

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Descending information from the labyrinth to the spinal motoneurons is mainly conveyed through the vestibulospinal system, which consists of the lateral and medial vestibulospinal tracts. The lateral vestibulospinal tract (LVST) arises mainly from the lateral vestibular nucleus and descends ipsilaterally in the ventrolateral funiculus. It mainly receives input from the otolith organs, extends throughout the length of the spinal cord, and exerts excitation on the extensor muscles of the lower leg. Single LVST axons have multiple axon collaterals at different segments along the entire length of the spinal cord, thus playing an important role in maintaining the posture. In contrast, the medial vestibulospinal tract (MVST) originates in the descending, medial and lateral vestibular nuclei, and descends bilaterally in the ventromedial funiculus of the cervical cord. It conveys mainly semicircular canal inputs to the neck motoneurons, and single MVST axons have multiple axon collaterals terminating on neck motoneurons in different segments of the cervical spinal cord, thus playing an important role in the vestibulocollic reflex.

著者

真鍋 恭弘 伏木 宏彰

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.79, no.3, pp.141-147, 2020-06-30 (Released:2020-08-05)

参考文献数

9

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Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo. It can be caused by debris in the semicircular canal of the ear. In regard to the location of the debris in the affected semicircular canal, sequential movement of the patient's head in the canalith repositioning procedure can cause the debris to move from the semicircular canal to the utricle. There is evidence that the canalith repositioning procedure is a safe, effective treatment for BPPV, but busy doctors are not always capable of performing of this procedure for all applicable cases. Therefore, we examined whether performance of the canalith repositioning procedure by well-trained nurses under the supervision of a doctor might be effective. We chose the Epley manoeuver as the canalith repositioning procedure. The results revealed that the period until resolution of dizziness was significantly shortened and the cure rate improved significantly. Therefore, we concluded that the outcomes of nurses' assistance in the Epley manoeuver are favorable. Transferring some of the duties of doctors to nurses would reduce the burden on doctors and allow them to focus on diagnosis and treatment that only doctors can handle. Consequently, task shifting of doctor's work to nurses under the supervision of a doctor can be considered in many aspects of health care.

著者

塚田 景大 宇佐美 真一

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.77, no.3, pp.180-187, 2018-06-30 (Released:2018-08-01)

参考文献数

32

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We summarize the similarities and differences between the cochlea and vestibular endorgans in relation to mutations of genes causing hereditary hearing loss. In regard to the gene expressions associated with hereditary hearing loss in the inner ear, most of the genes expressed in the cochlea are also expressed in the vestibular end-organs. This implies that the genes associated with hereditary hearing loss also function in the vestibular endorgans, and mutations in these genes leading to hearing loss phenotypes may be associated with vestibular dysfunction phenotypes and/or symptoms. We searched the literature for the frequency of vestibular symptoms in patients with mutations in the causative genes for hearing loss. Although 67.3% of the patients with SLC26A4 mutations complained of vestibular symptoms, few patients with other mutations of genes known to cause hereditary hearing loss complained of vestibular symptoms. SLC26A4 and COCH mutations have been reported to be the most frequently associated with vestibular dysfunction and/or symptoms. Characteristically, in patients with SLC26A4 mutations, vertigo episodes are associated with acute hearing deterioration, and in patients with COCH mutations, progressive vestibular dysfunction is associated with progressive hearing loss. Although 4% of patients with GJB2 mutations complained of vestibular symptoms, saccular dysfunction was more frequent. It is difficult to explain the absence of vestibular symptoms in most patients with mutations of the causative genes for hearing loss?. Possible explanations for this inconsistency are the presence and functioning of other molecules to compensate for the functional loss of sensory activity in the vestibular end-organs; congenital or slowly progressive vestibular dysfunction could be compensated by visual and somatosensory input. Furthermore, the vestibular sensory system may have a lower sensitivity than the auditory system. Further studies are required to elucidate the effects of mutations linked to deafness on the vestibular functions.

著者

北島 明美

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.2, pp.85-87, 2011 (Released:2011-06-01)

参考文献数

10

被引用文献数

1 1

著者

近藤 貴仁 小川 恭生 大塚 康司 北島 尚治 稲垣 太郎 清水 重敬 小林 賀子 鈴木 衞

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.4, pp.213-217, 2010 (Released:2010-10-01)

参考文献数

14

被引用文献数

5

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When examining patients with vertigo, it is essential to differentiate between central and peripheral lesions. It has been reported that some infarctions associated with the posterior inferior cerebellar artery (PICA) can mimic peripheral vertigo, such as benign paroxysmal positional vertigo (BPPV). We report on a case that had been treated as BPPV at another institution and eventually turned out to be cerebellar infarction in the PICA legion. Two infarction lesions were observed in the cerebellum. Obstruction of the left vertebral artery was found on MRA. Six months from the first consultation, the BPPV decreased. We should be aware of cases of cerebellar infarction in which nystagmus mimics BPPV.

著者

三輪 徹 蓑田 涼生

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.2, pp.93-101, 2019

被引用文献数

3

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<p> Past major earthquakes have been associated with an increase in the prevalence of vertigo or dizziness; the 2016 Kumamoto earthquakes on April 14 and 16 (JST, moment magnitude=7.0, Shindo 7 [Japanese seismic scale]) and the large numbers of aftershocks were no exception. Several months after the initial earthquake, significant outbreaks of vertigo or dizziness occurred over a large area surrounding the epicenter of the earthquake. However, it is unclear why major earthquakes cause these symptoms. After the major earthquake in Kumamoto, we conducted a questionnaire and medical records survey to investigate post-earthquake dizziness (PED). This survey covered a total of 575 subjects who complained of exacerbation of vertigo or dizziness after the earthquake and visited the hospital for follow-up before the scheduled dates. Our results showed that the number of patients with vertigo or dizziness who visited the hospital increased after the earthquake, and peaked between 2 and 4 weeks after the earthquake. The timing of onset of vestibular disorders varied according to the underlying disease. This study also suggested that earthquake-related psychological stress or stress resulting from earthquake evacuation could cause the onset of some vestibular disorders. We speculated that PED could be caused by stimulation of the vestibular and visual systems and bathyesthesia, psychological stress, potential effects of autonomic stress on the equilibrium function, and/or sensory mismatch. Our study could contribute to establishing PED as a new concept in the area of vestibular disorders.</p>

著者

青柳 優

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.3, pp.113-126, 2010 (Released:2010-08-01)

参考文献数

16

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This article describes the basic elements of auditory evoked potentials, including stimulus tone and recording condition, and clinical applications of auditory evoked potentials, such as ECochG, ABR and ASSR. The clinical applications of auditory evoked potentials are roughly classified into (1) objective audiometry and (2) neurological examination. ECochG is applied to the diagnosis of endolymphatic hydrops and inner ear hearing loss. ABR is still an important examination in the diagnosis of acoustic neurinoma, though the prevalence of MRI has reduced its importance. The elongation of the I-V inter-peak latency (I-V IPL) of ABR in lower brainstem lesion is mainly due to I-III IPL elongation, whereas I-V IPL elongation is mainly due to III-V IPL elongation in upper brainstem lesions. Recruitment and conductive hearing loss can be estimated by the finding of the latency-intensity curve of wave V. Although ABR is the most popular device in objective audiometry, the prediction of hearing levels in the lower frequency range using ABR evoked by clicks is less accurate. The most important benefit of ASSR is to provide an accurate assessment of hearing at different frequencies in a frequency specific manner, if stimulation consists of a sinusoidally amplitude-modulated tone. However, ASSR is not appropriate to use as a diagnostic tool in neurological examinations, because the waveforms of ASSR consist of the interference of different wave components. Power spectrum analysis and phase coherence using fast Fourier transformation are useful for the automatic detection of ASSR, because of its sinusoidal waveform configuration. Because the detectability of ASSR changes under different arousal states, 40-Hz ASSR is suitable for waking adults and 80-Hz ASSR for sleeping children in the assessment of hearing. Its advantage is that the thresholds at 4 different frequencies in both ears can be predicted more rapidly than ABR using the multiple simultaneous stimulation technique.