Estimated incidence and characteristics of vestibular neuritis in Japan: A nationwide survey

OBJECTIVE

To assess the annual incidence of vestibular neuritis (VN) in the Japanese population.

METHODS

We conducted a mail-based survey targeting otolaryngologic clinics and hospitals across Japan to estimate the annual number of patients who were newly-diagnosed with VN during the one-year period of 2021. Using a stratified sampling method, we selected 1,107 departments and asked them to report the number of new patients with VN and their demographics. The total number of VN patients was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate.

RESULTS

The overall survey response rate was 40.5 % (448 departments). The estimated number of newly-diagnosed VN patients in 2021 was 8,861 (95 % confidential interval [CI], 2,290-15,432) The annual incidence of VN was 7.05 per 100,000 population in Japan. The male-to-female ratio of VN patients was 0.96, and the mean age was 60.3 ± 16.1 years (range 11-94 years).

CONCLUSIONS

The annual incidence of VN in Japan in 2021 had almost doubled and the mean age had become older compared to the previous study in 1993 (annual incidence; 3.5 per 100,000 per year; mean age: 45 years).

Isolated Otolith Dysfunction in Persistent Postural-Perceptual Dizziness

The aims of this study were to investigate otolith dysfunction, especially isolated otolith dysfunction (with preserved semicircular canal function) in persistent postural-perceptual dizziness (PPPD) patients. Twenty-one patients who had been diagnosed with PPPD were enrolled in this study. The subjects filled out questionnaires [the Dizziness Handicap Inventory (DHI) and the Niigata PPPD Questionnaire (NPQ)] and underwent vestibular evoked myogenic potential (VEMP) tests, video head-impulse tests (vHIT), and stabilometry. Among the 21 subjects with PPPD, 9 showed isolated otolith dysfunction, 4 exhibited both otolith dysfunction and semicircular canal dysfunction, and 2 demonstrated isolated semicircular canal dysfunction. Six subjects exhibited normal VEMP and vHIT results. Concerning the subjects' questionnaire scores and stabilometric parameters, there were no significant differences among subgroups when the subjects were classified according to their VEMP and vHIT results while stabilometric parameters obtained in PPPD subjects were significantly increased than published data of healthy subjects. As precipitating conditions for PPPD, vestibular neuritis was the most frequent and the second most was idiopathic otolithic vertigo. In conclusion, the majority of PPPD patients had otolith dysfunction, and most of them showed isolated otolith dysfunction. Idiopathic otolithic vertigo can be a precipitating factor of PPPD. While otolith dysfunction may be associated with initiation of PPPD symptoms, PPPD symptoms are also considered to be associated with other dysfunctions of the sensory processing system.

Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere's disease and delayed endolymphatic hydrops

BACKGROUND

A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device.

OBJECTIVES

The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months.

MATERIALS AND METHODS

Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device.

RESULTS

In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19-24 months after treatment. The distribution of vertigo at 19-24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission.

CONCLUSIONS AND SIGNIFICANCE

Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.

Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere's disease and delayed endolymphatic hydrops: a prospective study

BACKGROUND

The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device.

OBJECTIVES

The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device.

MATERIALS AND METHODS

23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device.

RESULTS

In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices.

CONCLUSIONS AND SIGNIFICANCE

Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

Estimated prevalence and characteristics of bilateral vestibulopathy diagnosed in Japan: A nationwide survey

OBJECTIVE

To assess the prevalence and annual incidence of bilateral vestibulopathy (BV) diagnosed in the Japanese adult population.

METHODS

We conducted a mail-based survey targeting otolaryngologic clinics and hospitals across Japan to estimate the annual number of patients who were diagnosed as having bilateral vestibulopathy after vestibular function tests during a 12-month period ending March 2019. Using a stratified sampling method, we selected 1,106 departments and asked them to report the number of patients with BV and their demographics. The total number of patients was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate.

RESULTS

The overall survey response rate was 51.4% (568 departments). The estimated number of patients diagnoses with BV in 2018 was 1,063 (95% confidential interval [CI], 127-1,998) which included 407 patients (95% CI: 134-680) newly-diagnosed with BV. The prevalence and annual incidence of BV in Japan were 0.84 and 0.32, respectively per 100,000 population in Japan. The male-to-female ratio of BV patients was 1.29, and the mean age was 63.7 ± 16.4 years (range 18-84 years). The most frequent etiologies of BV were Meniere's disease (11.4%), meningitis (3.4%), and ototoxic agents (3%).

CONCLUSIONS

Patients who were diagnosed as having BV were extremely rare in Japan.

Effects of External Auditory Meatus Occlusion on Ocular Vestibular Evoked Myogenic Potentials Induced by Bone Conducted Sound

To facilitate more reliable recordings of the ocular vestibular evoked myogenic potentials (oVEMP) induced by bone-conducted sound using the B81 bone conduction transducer, we preliminarily studied the effects of external auditory meatus occlusion using an earplug on such oVEMP. Eight healthy volunteers (four males and four females, 26–48 years of age, mean age: 34. 5 years) and 14 patients with vestibular disease (2 males and 12 females, 18–59 years of age, mean age: 41.5 years) were enrolled. oVEMP testing was performed using a B81 placed on the temple. Tone bursts (500 Hz, rise/fall time: 2 ms, plateau time: 2 ms, and 70 dB nHL) were presented at a rate of 5.1 Hz. N1-P1 amplitudes were measured and analyzed. Occlusion resulted in significantly larger N1-P1 amplitudes [mean ± SE (SD): 12.3 ± 1.67 (6.71) μV vs. 9.55 ± 1.55 (6.21) μV; p = 0.020, paired t-test]. While four patients did not exhibit any response on either side in the absence of occlusion, all of them showed unilateral or bilateral responses when occlusion was employed. In any patient occlusion did not result in loss of oVEMP responses. External auditory meatus occlusion using an earplug could allow more reliable recordings of bone conduction transducer-induced oVEMP.

Cervical vestibular evoked myogenic potential with chirp sounds

BACKGROUND

There are only a few reports concerning cervical vestibular evoked myogenic potential (cVEMP) using chirp sound, and clinical indications/advantages of it are still unclear.

OBJECTIVE

To compare cVEMP using CE-chirp LS® with cVEMP using 500 Hz and 1000 Hz tone bursts (TB) and to investigate clinical indications/advantages of CE-chirp LS® for recording cVEMP.

METHODS

Sixteen patients with vestibular disorders (2men and 14 women) (18∼62, mean 42.9 years of age) were enrolled in this study. Participants underwent cVEMP testing using 500 Hz and 1000 Hz tone bursts (TB) and CE-chirp LS®. Response rate of P1-N1, corrected/normalized amplitude of P1-N1, latencies of P1 and N1, asymmetry ratio, and correlation of P1 latency to SLOPE in tuning property test (an index of endolymphatic hydrops) were compared.

RESULTS

Corrected/normalized amplitude of P1-N1 to CE-chirp LS® was smaller than corrected/normalized amplitude of P1-N1 to 500 Hz TB. Peak latencies to CE-chirp LS® were the shortest among the 3 types of stimulation. EH-positive ears according to the tuning property test had tendency of prolonged P1 latencies to CE-chirp LS®.

CONCLUSION

CE-chirp LS® is applicable for recording cVEMP with a similar diagnostic accuracy to TB. Prolongation of P1 latency in CE-chirp LS® might be an indicator of endolymphatic hydrops in the saccule.

Vestibular Migraine Patients Show Lack of Habituation in Auditory Middle Latency Responses to Repetitive Stimuli: Comparison With Meniere's Disease Patients

Objectives: To compare habituation in auditory middle latency response (AMLR) to repetitive stimuli of vestibular migraine (VM) patients with Meniere's disease (MD) patients and healthy controls (HC) and to assess usefulness of AMLR for diagnosis of VM. Subjects: Thirteen unilateral definite MD patients (2 men, 11 women, mean age 50.6), 13 definite VM patients (3 men, 10 women, mean age 45.5), and 8 HC subjects (2 men, 6 women, mean age 37.1) were enrolled. Methods: The electrodes were placed on the vertex and the spinal process of the fifth cervical vertebra. Binaural click stimulation (0.1 ms, 70 dBnHL) was presented. A total of 800 responses were averaged. Averaged responses were divided into four sets (S1 to S4) according to the temporal order. No, Po, Na, and Pa were identified, and amplitudes and latencies were measured. Results: Concerning latencies, HC subjects showed a tendency of shorter latencies. However, there was no clear effect of repetitive stimulation. Concerning No-Po amplitudes, no significant differences were observed. Raw amplitudes of Na-Pa showed statistically significant differences in S1 and S2 among the groups (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM in S1 (smaller in VM) (p < 0.01 Bonferroni's test) and in MD vs. VM in S2 (smaller in VM) (p < 0.01 Bonferroni test). Relative amplitudes of Na-Pa to S1 showed statistically significant differences in S4 (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM (larger in VM) (p < 0.01 Bonferroni's test). Differences of Na-Pa amplitudes in S2 to S4 from Na-Pa amplitude in S1 were significant in S4 of VM patients (Dunnett's test). Conclusions: VM patients showed lack of habituation (potentiation) of Na-Pa amplitude in AMLR to repetitive stimuli while MD patients and HC subjects showed habituation. Observation of lack of habituation has high diagnostic accuracy for differential diagnosis of VM from MD.

Dynamics of the Vortex-Particle Complexes Bound to the Free Surface of Superfluid Helium

We present an experimental and theoretical study of the 2D dynamics of electrically charged nanoparticles trapped under a free surface of superfluid helium in a static vertical electric field. We focus on the dynamics of particles driven by the interaction with quantized vortices terminating at the free surface. We identify two types of particle trajectories and the associated vortex structures: vertical linear vortices pinned at the bottom of the container and half-ring vortices traveling along the free surface of the liquid.

Simultaneous Presentation of Definite Vestibular Migraine and Definite Ménière's Disease: Overlapping Syndrome of Two Diseases

Objectives: To review the clinical records of patients that exhibited the clinical features of both vestibular migraine (VM) and Ménière's disease (MD) during each episodic vertigo attack and to discuss the possible pathophysiology of such combination of symptoms.

Subjects: Ten patients that were selected according to criteria based on a combination of the diagnostic criteria for definite MD and VM (9 females and one male, age: 22–54 years) were enrolled. They were required to show features of both diseases in each vertigo attack.

Methods: The patients' medical histories and pure-tone audiometry, cervical vestibular evoked myogenic potential (cVEMP), video head-impulse test (vHIT), and caloric test results were examined. cVEMP was recorded using 500 and 1,000 Hz short tone bursts (125dBSPL, air-conducted), 500 Hz-1,000 Hz cVEMP slope, an index of endolymphatic hydrops in the saccule was calculated using normalized amplitudes of p13-n23. For performing vHIT, each subject was seated 1.5 m in front of a target and asked to keep watching it as their head was passively rotated by the examiner. Their eye movements were evaluated using video-oculography while their head movements were recorded using inertial sensors.

Results: The patients were predominantly female. On average, the onset of migrainous headaches occurred 9 years earlier than the onset of vertigo attacks. All of the patients but one had migraines with auras. Five of the 10 patients had a family history of vertigo attacks accompanied by both migrainous and auditory symptoms. The patients mainly displayed hearing loss at low frequencies. Nine patients exhibited 500–1,000 Hz cVEMP slope < −19.9, which was suggestive of endolymphatic hydrops. None of the patients who underwent vHIT showed abnormal canal function. One patient showed unilaterally decreased caloric responses.

Conclusions: These patients presented with simultaneous MD and VM signs/symptoms might be referred to “VM/MD overlapping syndrome (VM/MD-OS)” as a new clinical syndrome.

Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière's Disease?

OBJECTIVE

The aim of this study is to show sensitivity and specificity of cervical vestibular-evoked myogenic potential (cVEMP) tuning property test to Ménière's disease (MD) in comparison with healthy controls (HC) and patients with other vestibular diseases.

SUBJECTS

Totally 92 subjects (50 women and 42 men, 20-77 years of age) were enrolled in this study. Subjects were composed of 38 definite unilateral MD patients, 11 unilateral benign paroxysmal positional vertigo patients, 14 vestibular migraine patients, 19 unilateral vestibular neuritis patients, and 10 HC.

METHODS

The subjects underwent cVEMP testing to 500 and 1,000 Hz short tone bursts (125 dBSPL). The corrected amplitudes of the first biphasic responses (p13-n23) (cVEMP) were measured. Then, a tuning property index (the 500-1,000 Hz cVEMP slope) was calculated.

RESULTS

The area of under the ROC curve (AUC) was 0.75 in comparison with other vestibular disease patients, while AUC was 0.77 in comparison with other vestibular disease patients plus HC. The best cutoff point of the 500-1,000 Hz cVEMP slope was -19.9. Sensitivity of the tuning property test to MD was 0.74, while specificity was 0.76 to other vestibular disease patients.

CONCLUSION

The tuning property test of cVEMP is useful as a screening test of MD.

Response measurement of single-crystal chemical vapor deposition diamond radiation detector for intense X-rays aiming at neutron bang-time and neutron burn-history measurement on an inertial confinement fusion with fast ignition

A neutron bang time and burn history monitor in inertial confinement fusion with fast ignition are necessary for plasma diagnostics. In the FIREX project, however, no detector attained those capabilities because high-intensity X-rays accompanied fast electrons used for plasma heating. To solve this problem, single-crystal CVD diamond was grown and fabricated into a radiation detector. The detector, which had excellent charge transportation property, was tested to obtain a response function for intense X-rays. The applicability for neutron bang time and burn history monitor was verified experimentally. Charge collection efficiency of 99.5% ± 0.8% and 97.1% ± 1.4% for holes and electrons were obtained using 5.486 MeV alpha particles. The drift velocity at electric field which saturates charge collection efficiency was 1.1 ± 0.4 × 10(7) cm/s and 1.0 ± 0.3 × 10(7) cm/s for holes and electrons. Fast response of several ns pulse width for intense X-ray was obtained at the GEKKO XII experiment, which is sufficiently fast for ToF measurements to obtain a neutron signal separately from X-rays. Based on these results, we confirmed that the single-crystal CVD diamond detector obtained neutron signal with good S/N under ion temperature 0.5-1 keV and neutron yield of more than 10(9) neutrons/shot.

Endonasal flap suture-dacryocystorhinostomy (eFS-DCR): a new surgical technique for nasolacrimal duct obstruction (NLDO)

CONCLUSION

Endonasal flap suture-dacryocystorhinostomy (eFS- DCR) is a new and valuable technique for the treatment of nasolacrimal duct obstruction (NLDO). This technique could improve the success rate of endonasal DCR in comparison to external DCR.

OBJECTIVE

The standard procedure for NLDO is DCR. DCR can be performed via either an external or endonasal approach. External DCR is now regarded as the gold standard in the treatment of NLDO because of its higher success rate. However, we report a new endonasal surgical technique, eFS-DCR, and assess its efficacy by comparison with the standard endonasal DCR.

METHODS

We prospectively investigated a series of 62 consecutive patients with NLDO undergoing endonasal DCR. There were two surgical intervention groups: group 1 (24 patients, 28 sites) undergoing endonasal DCR without eFS; and group 2 (38 patients, 47 sites) undergoing eFS-DCR. Study end points were success rate, the ostium diameter (OD) of the lacrimal sac after DCR, and the duration of stent placement. We compared the two groups on these three points.

RESULTS

The success rate was 78.6% (22 of 28 sites) for group 1 (DCR without eFS) and 97.9% (46 of 47 sites) for group 2 (eFS-DCR). The ostium size in patients in group 2 was larger than that in group 1. The median time for the duration of stent placement was 42.5 days for group 1 and 31.5 days for group 2. There was a statistical difference (p < 0.01) in all these parameters between the two groups.

Application of hyperdry amniotic membrane patches without fibrin glue over the bony surface of mastoid cavities in canal wall down tympanoplasty

CONCLUSION

Fibrin glue might be an inessential bioadhesive for attachment of hyperdry amniotic membrane (AM) patches in canal wall down (CWD) tympanoplasty.

OBJECTIVE

To clarify the pliability and adherence capability of human hyperdry AM, the feasibility of fixing hyperdry AM without fibrin glue to the bony surface of the mastoid cavity was evaluated in CWD tympanoplasty.

METHODS

This was a retrospective chart review. In seven ears of seven patients, the AM was simply attached over the bony surface of the mastoid cavity without fibrin glue (AMG(-) group). In 22 ears of 20 other patients, hyperdry AM (11 ears of 11 patients, AMG(+) group) or temporal fascia (11 ears of 9 patients, TFG(+) group) was attached over the bony surface of the mastoid cavity with fibrin glue. Times for graft epithelization were compared among the three groups.

RESULTS

Complete epithelization of the mastoid cavity took place in all patients in all three groups. The mean time to complete epithelization of the graft in the AMG(-) and AMG(+) groups was significantly faster than that in the TFG(+) group (p < 0.05) and was not significantly different between the two AM groups (p > 0.05).

Formation of NaCl-type monodeuteride LaD by the disproportionation reaction of LaD2

Previous x-ray diffraction measurements revealed the pressure-induced decomposition of an fcc LaH2.3 into H-rich and H-poor fcc phases around 11 GPa. The present neutron diffraction measurements on LaD2 confirm the formation of NaCl-type LaD as a counterpart of the D-rich LaD2+δ by disproportionation. First-principles enthalpy and lattice dynamic calculations demonstrate that the NaCl-type LaH is stabilized at high pressures and can be recovered at ambient conditions. Finding the NaCl-type LaH will pave the way for investigations on the site-dependent nature of hydrogen-metal interactions.

Intermittent pressure therapy of intractable Meniere's disease and delayed endolymphatic hydrops using the transtympanic membrane massage device: a preliminary report

CONCLUSION

Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH).

OBJECTIVE

The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device.

METHODS

Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device.

RESULTS

With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p > 0.05). No complications were directly attributable to treatment with the TMM device.

[Effect of S-1 in a patient with metastatic eyelid sebaceous carcinoma]

We report a 68-year-old female with a history of repeated right cervical lymph node metastasis secondary to eyelid sebaceous carcinoma. She had undergone right neck dissection due to lymph node metastasis at the department of surgery in an other local hospital. After the orbital exenteration, she underwent multiple operations, including 2 right partial parotidectomy and then total parotidectomy, 4 right cervical lymph node excisions and 1 left upper neck dissection due to lymph node metastasis. Adjuvant chemotherapy with S-1(at a dose of 80 mg per day)alone was applied as tumor dormancy therapy on an outpatient basis. Any adverse events during S-1 medication were observed. New metastatic lesions were not found until 29 months after the beginning of chemotherapy with S-1 alone. Although the effectiveness of S-1 for eyelid sebaceous carcinoma has not been demonstrated, S-1 might be useful in patients with recurrent eyelid sebaceous carcinoma based on our patient's recurrence-free survival.

Long-term effects of the Meniett device in Japanese patients with Meniere's disease and delayed endolymphatic hydrops reported by the Middle Ear Pressure Treatment Research Group of Japan

CONCLUSION

The Meniett device is a minimally invasive and safe treatment that may be used to provide longer-term reduction of vestibular symptoms in patients with delayed endolymphatic hydrops (DEH) as well as those with Meniere's disease (MD).

OBJECTIVE

The effects of the Meniett device were evaluated in patients with a diagnosis of definite MD or DEH according to the 1995 AAO-HNS criteria.

METHODS

Twenty-nine ears of 28 patients with MD and 5 ears of 5 patients with DEH (ipsilateral type 4, contralateral type 1) were treated with the Meniett device by the Middle Ear Pressure Treatment Research Group of Japan. All of the patients had failed to respond to medical treatment including diuretics before the pressure treatment.

RESULTS

Sixteen (57%) patients with MD and all five (100%) patients with DEH remained entirely free from vertigo spells; nine (32%) patients with MD responded with a significant decrease in the frequency of vertigo spells. In regard to hearing, 25 ears (74%: MD, n = 21; ipsilateral DEH, n = 4) had stable hearing levels; only 4 ears (12%: MD, n = 3; contralateral DEH, n = 1) showed a significant hearing improvement. No complications were attributable to the Meniett device.

Prognosis of inner ear function in pneumolabyrinth: case report and literature review

Pneumolabyrinth, the presence of air within the labyrinth, is a rare radiologic finding associated with a well-known perilymphatic fistula (PLF). As there are only 24 published case reports in medical literature, multiple treatment options for the pneumolabyrinth are available. We report a case of a 20-year-old man with a pneumolabyrinth secondary to tympanic membrane and ossicular trauma. Despite conservative treatment, sensorineural hearing loss (SNHL) had progressed rapidly, and his profound deafness had not recovered after surgical exploration with closure of the PLF. Functional prognostic factors of SNHL are revised and compared with this case.

An ultrahigh-vacuum apparatus for resonant diffraction experiments using soft x rays (hnu=300-2000 eV)

We have developed an ultrahigh-vacuum instrument for resonant diffraction experiments using polarized soft x rays in the energy range of hnu=300-2000 eV at beamline BL17SU of SPring-8. The diffractometer consists of modified differentially pumped rotary feedthroughs for theta-2theta stages, a sample manipulator with motor-controlled x-y-z-, tilt (chi)-, and azimuth (phi)-axes, and a liquid helium flow-type cryostat for temperature dependent measurements between 30 and 300 K. Test results indicate that the diffractometer exhibits high reproducibility (better than 0.001 degrees ) for a Bragg reflection of alpha-quartz 100 at a photon energy of hnu=1950 eV. Typical off- and on-resonance Bragg reflections in the energy range of 530-1950 eV could be measured using the apparatus. The results show that x-ray diffraction experiments with energy-, azimuth-, and incident photon polarization-dependence can be reliably measured using soft x rays in the energy range of approximately 300-2000 eV. The facility can be used for resonant diffraction experiments across the L-edge of transition metals, M-edge of lanthanides, and up to the Si K-edge of materials.

Mumps virus may damage the vestibular nerve as well as the inner ear

We report a case of mumps deafness with acute vestibular symptoms secondary to both retrolabyrinthine and inner ear dysfunction. To our knowledge, no such case has been reported elsewhere. The patient was a 6-year-old girl in whom mumps deafness was initially diagnosed. Two days after onset of the hearing impairment, severe vertigo developed. Neurotologic examinations revealed spontaneous right-beating nystagmus, left canal paresis, absence of vestibular-evoked myogenic potentials in the left ear, and absence of responses to a left galvanic body sway test (GBST). The vertigo resolved 7 days after onset. However, the left hearing impairment progressed to complete deafness. Six months later, left canal paresis was still present, but bilateral GBST responses were normal, suggesting that retrolabyrinthine vestibular function had been restored. Mumps virus may affect retrolabyrinthine function as well as the inner ear.

Turbulence in boundary flow of superfluid 4He triggered by free vortex rings

The transition to turbulence in the boundary flow of superfluid 4He is investigated using a vortex-free vibrating wire. At high wire vibration velocities, we found that stable alternating flow around the wire enters a turbulent phase triggered by free vortex rings. Numerical simulations of vortex dynamics demonstrate that vortex rings can attach to the surface of an oscillating obstacle and expand unstably due to the boundary flow of the superfluid, forming turbulence. Experimental investigations indicate that the turbulent phase continues even after stopping the injection of vortex rings, which is also confirmed by the simulations.

Effects of direct cedrol inhalation into the lower airway on autonomic nervous activity in totally laryngectomized subjects

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Relationships between smell sensation and autonomic changes have been studied extensively. However, the possibility that odorants may also act on the lung and lower airway remains unknown.

WHAT THIS STUDY ADDS

The present results provide the first evidence that the lung and lower airway exert an inhibitory influence on the cardiovascular system in response to Cedrol (odorant) in the air under physiological conditions.

AIMS

Previous studies reported that Cedrol (odorant) inhalation (CI) induced changes in autonomic balance and baroreceptor sensitivity (BRS) in both healthy subjects and anosmic patients. This suggests that Cedrol may act on the lower airway, and that the pulmonary system may exert an inhibitory influence on the cardiovascular system.

METHOD

To test the above possibility, vaporized Cedrol (64.0 +/- 7.7 10(-9)m) or blank air was directly inhaled through the lower airway from a hole in the trachea, but not through the upper airway, using totally laryngectomized subjects. During the experiment, ECG, systolic (SBP) and diastolic (DBP) blood pressures were measured. Sympathetic and parasympathetic nervous activity was estimated by spectral analyses of variability in these parameters (heart rate variability (HRV), SBP variability (SBPV) and DBP variability (DBPV)). BRS was computed from transfer gain between SBP and the R-R interval of the ECG.

RESULTS

SBP and DBP significantly decreased during CI, although there were no significant differences in HR and respiratory rate. BRS significantly increased during CI. The low frequency components of SBPV and DBPV (indices for sympathetic activity) significantly decreased during CI, while high frequency components of HRV (an index for parasympathetic activity) significantly increased.

CONCLUSIONS

The present experiment using totally laryngectomized patients replicated the similar results in healthy subjects who inhaled Cedrol through the nose, suppression of sympathetic outflow and increase in parasympathetic outflow. These results demonstrated that Cedrol acts on the lower airway and pulmonary system, and suggest a new target for drug therapy of hypertension.

Terahertz conductivity of localized photoinduced carriers in a Mott insulator YTiO(3) at low excitation density, contrasted with the metallic nature in a band semiconductor Si

We performed optical-pump terahertz-probe measurements of a Mott insulator YTiO(3) and a band semiconductor Si using a laser diode (1.47 eV) and a femtosecond-pulse laser (1.55 eV). Both samples possess long energy-relaxation times (1.5 ms for YTiO(3) and 15 µs for Si); therefore, it is possible to extract terahertz complex conductivities of photoinduced carriers under equilibrium. We observed highly contrasting behaviour-Drude conductivity in Si and localized conductivity possibly obeying the Jonscher law in YTiO(3). The carrier number at the highest carrier-concentration layer in YTiO(3) is estimated to be 0.015 per Ti site. Anisotropic conductivity of YTiO(3) is determined. Our study indicates that localized carriers might play an important role in the incipient formation of photoinduced metallic phases in Mott insulators. In addition, this study shows that the transfer-matrix method is effective for extracting an optical constant of a sample with a spatially inhomogeneous carrier distribution.

Effects of vestibular nerve section on sound-evoked myogenic potentials in the sternocleidomastoid muscle of monkeys

OBJECTIVE

The aim of this study was to elucidate the neural pathway for sound-evoked myogenic potentials (SEMPs) in monkeys with characteristics similar to those of vestibular evoked myogenic potentials in humans.

METHODS

Six macaque monkeys were examined. The effects of total and selective vestibular nerve section on the SEMPs were evaluated in three monkeys.

RESULTS

After total vestibular nerve section, the SEMPs and caloric nystagmus were eliminated, and the auditory brainstem response remained. After selective superior vestibular nerve section, the SEMPs remained, but caloric nystagmus was eliminated.

CONCLUSIONS

The inferior vestibular nerve comprises a neural pathway for SEMPs in monkeys.

SIGNIFICANCE

SEMP in monkeys may provide a model of human VEMPs.

Positron emission tomography for predicting malignancy of sinonasal inverted papilloma

BACKGROUND

Sinonasal inverted papilloma (IP) is an uncommon nasal tumor. It is known for being locally invasive and recurrent, with a high probability of malignant transformation. Accurate initial staging and close surveillance are critical in the management of the disease.

METHODS AND RESULTS

Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) was performed in 5 patients with IP. High FDG uptake (maximum standardized uptake (SUVmax) value >3.0) was observed in all patients, and 2 patients with IP associated with squamous cell carcinoma (SCC) exhibited higher SUVmax values.

CONCLUSION

The SUVmax value of a sinonasal tumor can warn the surgeon of the probability of an associated malignancy, even when preoperative biopsy demonstrates a purely benign papilloma.

Effects of selective cochlear toxicity and vestibular deafferentation on vestibular evoked myogenic potentials in guinea pigs

CONCLUSION

The findings suggest that sound-evoked myogenic potentials on the guinea pig sternocleidomastoid muscle (SM) originate from the vestibular end organ and not from the cochlea of the inner ear.

OBJECTIVE

Studies in animals of the sound evoked vestibular myogenic potentials on the SM should aid in elucidating the pathway of the vestibular-evoked myogenic potential (VEMP). However, details of the pathway of the VEMP remain to be elucidated. This study aimed to clarify aspects of this pathway.

MATERIALS AND METHODS

In the present study, short latency biphasic myogenic potentials on the SM in guinea pigs were induced by an intense brief sound.

RESULTS

The thresholds of the potentials were 67 dB SPL above those of the auditory brainstem response (ABR). The potentials were eliminated by a vestibular deafferentation, but were observed after selective cochlea toxicity using an amikacin injection.

Sound-evoked myogenic potentials on the sternocleidomastoid muscle in monkeys

CONCLUSION

We recorded sound-evoked myogenic potentials of the sternocleidomastoid (SCM) muscle using awake monkeys. The characteristics of these potentials are similar to those of vestibular evoked myogenic potentials (VEMPs) in humans, suggesting that the sound-evoked myogenic potentials of the SCM muscle in monkeys may be utilized as an animal model of VEMPs.

OBJECTIVE

The pathway of the VEMPs remains uncertain as no animal model has yet been used to record sound-evoked myogenic potentials in the SCM muscle. Therefore, the present study aimed to establish an animal model of VEMPs using macaque monkeys.

MATERIALS AND METHODS

Four macaque monkeys were used. A pair of electrodes was attached on the SCM muscle ipsilateral side to the intense sound stimulation.

RESULTS

The sound-evoked myogenic potentials of the SCM muscle exhibited a biphasic waveform. When a click at 125 dBSPL was applied, the peak latency of the first positive wave was 12.5 ms and was not delayed when the stimulating sound intensity was reduced. The thresholds of the myogenic potentials were 103 dBSPL, which were 43 dB higher than those of the auditory brainstem response (ABR). When a short tone burst was applied, the reactive optimal frequency of the myogenic potentials was relatively low (500-1000 Hz).

Anomalous translational velocity of vortex ring with finite-amplitude Kelvin waves

We consider finite-amplitude Kelvin waves on an inviscid vortex assuming that the vortex core has infinitesimal thickness. By numerically solving the governing Biot-Savart equation of motion, we study how the frequency of the Kelvin waves and the velocity of the perturbed ring depend on the Kelvin wave amplitude. In particular, we show that, if the amplitude of the Kelvin waves is sufficiently large, the perturbed vortex ring moves backwards.

Twisted vortex state

We study a twisted vortex bundle where quantized vortices form helices circling around the axis of the bundle in a "force-free" configuration. Such a state is created by injecting vortices into a rotating vortex-free superfluid. Using continuum theory we determine the structure and the relaxation of the twisted state. This is confirmed by numerical calculations. We also present experimental evidence of the twisted vortex state in superfluid 3He-B.

Vortex multiplication in applied flow: A precursor to superfluid turbulence

A surface-mediated process is identified in 3He-B which generates vortices at a roughly constant rate. It precedes a faster form of turbulence where intervortex interactions dominate. This precursor becomes observable when vortex loops are introduced in low-velocity rotating flow at sufficiently low mutual friction dissipation at temperatures below 0.5Tc. Our measurements indicate that the formation of new loops is associated with a single vortex interacting in the applied flow with the sample boundary. Numerical calculations show that the single-vortex instability arises when a helical Kelvin wave expands from a reconnection kink at the wall and then intersects again with the wall.

Epidemiologic Characteristics of Definite Ménière’s Disease in Japan

To identify epidemiologic characteristics of definite cases of Ménière's disease (DMD), we conducted retrospective surveys of the period 1990-2004 of the Nishikubiki district and of the period 1980-2004 of Toyama Medical and Pharmaceutical University. Three hundred and seventy-five patients (50 from Nishikubiki, 325 from Toyama) were diagnosed with DMD according to the diagnostic criteria proposed by the Japanese Society for Equilibrium Research. There was a slight increase in the prevalence of DMD during the period 1990-2004. However, incidence did not change significantly over time. The average annual prevalence and incidence were 34.5 and 5.0, respectively, per 100,000 population. Incidence and prevalence predominated in females. With respect to age at disease, the incidence in elderly patients was increased when we corrected for age distribution in the overall population.

Momentum dependence of charge excitations in the electron-doped superconductor Nd1.85 Ce0.15 CuO4: a resonant inelastic x-ray scattering study

We report a resonant inelastic x-ray scattering (RIXS) study of charge excitations in the electron-doped high-T(c) superconductor Nd1.85 Ce0.15 CuO4. The intraband and interband excitations across the Fermi energy are separated for the first time by tuning the experimental conditions properly to measure charge excitations at low energy. A dispersion relation with q-dependent width emerges clearly in the intraband excitation, while the intensity of the interband excitation is concentrated around 2 eV near the zone center. The experimental results are consistent with theoretical calculation of the RIXS spectra based on the Hubbard model.

Determination of the orbital polarization in YTiO3 by using soft X-ray linear dichroism

We report measurements of linear dichroism in x-ray absorption at Ti L(2,3) edges of a Mott-insulating ferromagnet YTiO3, where orbital ordering occurs in the triply degenerate Ti 3d t(2g) states. Dichroic spectra and their integrated intensities are obtained for the incident electric field with polarizations parallel to a, b, and c axes. The comparison of the spectra with atomic multiplet calculations removes the ambiguity about the orbital polarization, i.e., the relative weights of |xy>, |yz>, and |zx> orbits, which are crucial for the origin of ferromagnetism. The result is consistent with the previous analysis of nuclear magnetic resonance in the Mizokawa-Fujimori scheme.

An intrinsic velocity-independent criterion for superfluid turbulence

Hydrodynamic flow in classical and quantum fluids can be either laminar or turbulent. Vorticity in turbulent flow is often modelled with vortex filaments. While this represents an idealization in classical fluids, vortices are topologically stable quantized objects in superfluids. Superfluid turbulence is therefore thought to be important for the understanding of turbulence more generally. The fermionic 3He superfluids are attractive systems to study because their characteristics vary widely over the experimentally accessible temperature regime. Here we report nuclear magnetic resonance measurements and numerical simulations indicating the existence of sharp transition to turbulence in the B phase of superfluid 3He. Above 0.60T(c) (where T(c) is the transition temperature for superfluidity) the hydrodynamics are regular, while below this temperature we see turbulent behaviour. The transition is insensitive to the fluid velocity, in striking contrast to current textbook knowledge of turbulence. Rather, it is controlled by an intrinsic parameter of the superfluid: the mutual friction between the normal and superfluid components of the flow, which causes damping of the vortex motion.

Expression of MMP-8 and MMP-13 mRNAs in rat periodontium during tooth eruption

The present study was designed to investigate mRNA expression of matrix metalloproteinase-8 (MMP-8) and MMP-13 in forming periodontium during tooth eruption in the rat. RT-PCR for the decalcified paraffin sections indicated expression of MMP-8 and MMP-13 in the periodontal tissues. In situ hydridization demonstrated expression of MMP-8 in osteoblasts, osteocytes, periodontal ligament cells, cementoblasts, and cementocytes along with collagen types I and III. In contrast, transcripts of MMP-13 were confined to a small population of osteoblasts and osteocytes in alveolar bone. The results suggested that MMP-8 may be involved in remodeling the periodontium during tooth eruption, and its expression may be coordinated with that of collagen types I and III, whereas the participation of MMP-13 may be rather limited.

Two cases of off-pump coronary artery bypass grafting combined with abdominal aortic aneurysm repair

Two cases of coronary artery disease coexisting with abdominal aortic aneurysm were treated with off-pump coronary artery bypass grafting combined with repair of the aneurysm. The first patient was a 67-year-old man exhibiting a large pulsating abdominal mass. Abdominal computed tomography demonstrated a 9-cm aneurysm and coronary angiogram revealed a 90% stenosis of the obtuse marginal branch for which percutaneous transluminal angioplasty could not be performed. He underwent simultaneous single coronary artery bypass grafting without cardiopulmonary bypass, and bifurcated graft replacement. The second patient was a 71-year-old man who had acute myocardial infarction, and one month later underwent coronary angiogram which revealed three vessel disease in the coronary artery. Computed tomography revealed a 4-cm aneurysm, and angiography showed a 90% stenosis of the left renal artery. He underwent a single stage operation that involved three coronary artery bypass grafting without cardiopulmonary bypass, straight graft replacement, and reconstruction of the left renal artery using the saphenous vein graft. The postoperative course was uneventful in both cases. We currently recommend a single stage operation involving off-pump coronary artery bypass grafting.

[Malignant cardiac lymphoma]

A 65-year-old male was admitted to the hospital in shock. The transesophageal echocardiography showed cardiac tumor in the right atrium. The tumor was resected under cardiopulmonary bypass. It was diagnosed as malignant lymphoma of B-cell type by histological examination. After operation, his general condition became satisfactory. Then he received chemotherapy. Twenty days after operation, however, a mass appeared in the right side of chin. It was diagnosed as malignant lymphoma of the same cell type as in the heart. We searched his body with CT and Ga-scanning. No other lesions were found. After the chemotherapy (CHOP, 6 cycles), the mass disappeared. No recurrence was been observed for six months.

Significance of percutaneous cardiopulmonary bypass support for volume reduction surgery with severe hypercapnia

In patients with reduced respiratory function, lung resection is associated with high risk because separate ventilation is generally needed for safe management. For patients with end-stage emphysema, intraoperative respiratory management is important and particularly difficult because neither incomplete oxygenation nor selective ventilation can be performed, so the operation may be interrupted. In this study, we assess the effectiveness of the percutaneous cardiopulmonary support (PCPS) system for lung volume reduction surgery in patients with severe hypercapnia (arterial carbon dioxide tension >50 mm Hg) and discuss the significance of PCPS for patients who are beyond the standard criteria for lung volume reduction surgery (LVRS). We studied 3 patients with severe hypercapnia due to emphysema who underwent volume reduction surgery. One patient was previously treated surgically for contralateral pneumothorax. All patients had a severe smoking history and were suspected to have fragile lungs. During the operation. PCPS provided sufficient support flow. Intraoperative management using PCPS was easy, and no severe complications were observed. One patient exhibited severe hemodynamic deterioration on postoperative Day 15. Other patients' PaCO2 improved postoperatively. One had a calcification of a femoral artery, but there was no trouble inserting a cannula. Bilateral or unilateral volume reduction surgery was performed under PCPS in patients with end-stage emphysema. We conclude that PCPS is an adjunct to LVRS, useful for intraoperative management of some patients with severe hypercapnea, and the LVRS indications can be extended.

[Treatment of mediastinal infection by continuous closed irrigation with an antibiotic solution in a new bone baby]

The patient was a three-week-old girl. Four days after thoracic surgery, mild fever developed, and turbid fluid was drained from the incision. Culture of the discharge showed Pseudomonas aeruginosa and Serratia marcescens. Débridement was immediately performed and continuous closed irrigation with an antibiotic solution started and maintained for 17 days. During this period, the upper half of the body was elevated. Ten days after irrigation started culture of the drainage fluid became negative. We emphasize early diagnosis, and the usefulness of continuous closed irrigation with an antibiotic solution in neonates.