Acta oto-laryngologica. Supplementum最新文献

Conclusions: The symptoms and signs in patients with very small (border zone) cerebellar infarcts (VSCIs) may mimic those in benign peripheral vestibular disorders, except that smooth pursuit eye movement is disturbed in patients with VSCI.

Objectives: VSCIs are located at the boundary territories between well-defined cerebellar arteries and are frequently manifested by dizziness or vertigo. The aim of the current study was to clarify the clinical characteristics of vestibular symptoms and signs associated with VSCI.

Patients and methods: We studied the neuro-otological findings in five vertiginous patients, who were diagnosed as having VSCI based on magnetic resonance imaging (MRI).

Results: Four patients complained of only dizziness or only vertigo, and one complained of dizziness with dysarthria. Horizontal spontaneous nystagmus and saccadic eye movement on eye tracking test were observed in all patients, but there were no abnormalities on examinations for saccade, optokinetic pattern, or visual suppression. Canal paresis was present in three patients.

Conclusions: No definite sign was found of central oculomotor system disorders being independent of saccadic slowing because (1) diminished maximum slow phase velocity of the optokinetic nystagmus (OKNspv) was closely related to saccadic slowing (p<0.01, r=0.59), (2) maximum frequency of optokinetic nystagmus (OKNfq) was normal, (3) visual suppression (VS) change was mild, and (4) the diminished maximum slow phase velocity of the caloric nystagmus (CNspv) seen in some patients is explained by both peripheral and central vestibular involvement. These findings support the extraocular muscle hypothesis.

Objective: To assess whether eye movement disorders seen in patients with myotonic dystrophy type 1 (DM1) are caused by central oculomotor system involvement or extraocular muscle damage.

Patients and methods: Oculomotor functions and their correlation with (CTG)n length were studied in 29 DM1 patients and 12 age-matched controls.

Results: Values for saccadic velocity (p<0.005), maximum OKNspv (p<0.005), and maximum CNspv (p<0.01) in the patient group were markedly lower than in the control group. VS of caloric nystagmus in the patient group was slightly lower than that in the controls. No significant difference was found between the two groups in the maximum OKNfq. Patients with greater (CTG)n lengths had lower saccadic velocities (p<0.01, r=0.71).

Conclusion: The T7511C mutation is considered responsible for maternally inherited, isolated sensorineural hearing loss of cochlear origin. This mutation should be screened for in cases of nonsyndromic, familial sensorineural hearing loss compatible with maternal transmission.

Objectives: To clarify the audiovestibular phenotype characteristics associated with a T7511C mutation in mitochondrial DNA and determine whether it causes isolated sensorineural hearing loss unaccompanied by other neuromuscular symptoms or signs.

Subjects and methods: A proband and affected members of a Japanese family harboring a T7511C mutation in the mitochondrial tRNA(Ser(UCN)) gene were enrolled. Mutation analysis was done on genomic DNA extracted from blood samples. Auditory pathways involved were investigated in examinations that included pure-tone audiograms, acoustic reflexes, speech discrimination testing, distortion-product otoacoustic emissions, and auditory brainstem responses. The presence of other signs and symptoms, including vestibular ones, was investigated.

Results: We identified a homoplasmic T7511C mutation in the mitochondrial tRNA(Ser(UCN)) gene in this family. No other pathogenic mutations associated with hearing loss or common mitochondrial diseases were found. Hearing loss of cochlear origin mainly developed at mid to high frequencies. Vestibular systems were well preserved. No symptoms or signs characteristic of mitochondrial diseases were present in any family members.

Conclusion: This study suggested that nitric oxide (NO) takes part in the parasympathetic nerve control functions mainly through m3 receptors and subsequently through m1 receptors.

Objectives: The regulation of glandular secretions and vasomotor tone in human nasal mucosa implicates muscarinic receptors. There are five recognized classes (m1-m5) of muscarinic receptor subtypes. NO is a free radical gas that has been found to be produced in neuronal cells by the action of enzyme neural nitric oxide synthase (nNOS). The aim of this study was to identify the colocalization of muscarinic receptor subtypes (m1-m5) and nNOS in the human inferior turbinate mucosa.

Materials and methods: Human inferior turbinate mucosa was stained by using the antibody of muscarine receptor subtypes and nNOS in an immunohistochemical double-staining method.

Results: The colocalization of m3 receptors and nNOS-immunoreactive nerve fibers was most extensively distributed on glands, vessels, and epithelium in all muscarinic receptor subtypes. These findings lead us to propose that NO also acts as a neurotransmitter in glands, vessels, and epithelium of the human nasal mucosa and can be assigned to parasympathetic nerve structures through m3 receptors mainly and m1 receptors subsequently.

Conclusions: The proportion of drug-resistant bacteria was lower than previous reports. In children with acute otitis media (AOM), lower age, presence of multiple bacteria, and otitis media with effusion (OME) represented significant factors for recurrent AOM and the presence of drug-resistant bacteria.

Objective: Recently, the proportion of drug-resistant bacteria has been increasing in children with AOM. We studied the proportion of drug-resistant bacteria and background factors for detection of drug-resistant bacteria and recurrent AOM in a private clinic.

Subjects and methods: Subjects comprised 170 patients <12 years old with AOM. Middle ear fluid was collected and pathogenic bacteria were identified. The following factors were considered: age, sex, use of antibiotics in the past 1 month, past history of recurrent AOM, presence of OME, and multiple bacteria of the three main strains (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis).

Results: A total of 169 strains were detected in 77% of children with AOM. Drug-resistant bacteria comprised 44 of the 169 strains (26%). Lower age (p=0.001) and presence of multiple bacteria (p<0.001) represented significant factors for the presence of drug-resistant bacteria. OME was a significant factor for recurrent AOM (p<0.001).

Conclusion: Questionnaire and brief interview played an important complementary role in the mass hearing screening.

Objectives: To evaluate the efficacy of mass screening for hearing loss.

Subjects and methods: Review of a 9-year prospective screening (n=31 902) in a university. The screening comprised pure tone hearing screening at two frequencies (1000 Hz and 4000 Hz) and a questionnaire. Brief interview was introduced during the later 4-year period. The final diagnosis was made in the university hospital.

Results: In hearing screening tests, approximate sensitivity was 89% for 1000 Hz and 91% for 4000 Hz. Approximate specificity was 89% and 88% for 1000 Hz and 4000 Hz, respectively. Brief interview with the subjects on the spot improved the accuracy, especially in specificity. Low tone sensorineural hearing loss, exudative otitis media and chronic otitis media could be overlooked without questionnaires.

A case of parathyroid adenoma causing a spontaneous cervical hematoma is reported. A 55-year-old woman presented with painful swallowing, dysphagia, and dyspnea. Primary hyperparathyroidism and a parathyroid tumor on the left side of the neck had been found 2 years earlier. Fiberoptic laryngoscopy and computed tomography (CT) showed a narrowing of the airway as a result of a retropharyngeal hematoma, and tracheostomy was carried out. Parathyroidectomy was performed 5 months after the absorption of the hematoma, with no complications. A pathological diagnosis revealed a parathyroid adenoma with hemosiderin deposition and fibrosis. Serum calcium and intact parathormone levels normalized postoperatively. Although a spontaneous cervical hematoma resulting from parathyroid tumors rarely occurs, it may lead to an airway compromise. Physicians should be aware of this if such tumors are managed conservatively without surgery.

Multiple system atrophy (MSA) is a progressive neurodegenerative disease that is characterized by varying degrees of parkinsonism and cerebellar, corticospinal, and autonomic dysfunction. Vocal cord abductor paralysis (VCAP) is considered a sign of a poor prognosis in MSA, because it is a life-threatening complication that may cause nocturnal sudden death. This case report presents a patient who was treated for Parkinson's disease, and complained of dizziness and sleep apnea. We examined VCAP using fiberoptic laryngoscopy as the possible cause of sleep apnea. VCAP usually occurs in the advanced stages of MSA and is accompanied by a worsening of other symptoms. Optokinetic nystagmus was severely impaired and the caloric test response was bilaterally absent. Objective findings such as VCAP and abnormal neuro-otological results led to the diagnosis of MSA.