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Some patients with acute or chronic vestibular disorders continue to complain of dizziness and disequilibrium. Although treated with medication, their activities of daily living (ADL) and occupational activities are restricted. Equilibrium training is applied to reduce the disability of the patients.Methods: Before training is started, the degree of impairment, disability and handicaps of the patients were evaluated. To evaluate subjective and objective disabilities, the ADL were investigated by questionnaire and equilibrium function tests were performed.Three times a day at home, patients performed several somewhat difficult exercises selected from their defective movements. Training continued until their disabilities were reduced.The effects of training were assessed by ADL, equilibrium function tests, stabilometry and gait test.Subjects: The subjects were 8 patients with unilateral vestibular disorders, 4 with postoperative acoustic neurinoma, and 8 with bilateral vestibular disorders.Results: Equilibrium training was effective in all 8 patients with unilateral vestibular dysfunction, in all 4 patients with postoperative acoustic neurinoma, and in 7 of the 8 with bilateral vestibular dysfunction. It was difficult to evaluate the effect of the training in a case of bilateral Meniere's disease.Conclusion: We found many differences in disability among patients with similar impairments, and were able to plan an individual training program suitable for each patient. ADL and equilibrium function tests were useful for evaluating disability and the effect of training.We considered equilibrium training effective for patients with unilateral vestibular disorders who showed chronic disability persisting for more than several weeks after onset, for patients with postoperative acoustic neurinoma who had persistent disability 4 weeks after surgery and for patients with bilateral vestibular disorders with disability persisting for more than 8 weeks.

To assess the efficacy of Ibudilast in Meniere's desease, we randomly selected 15 patients with this desease seven males and eight females aged 30 - 73 years.We administered three capsules of Ketas® every day to these patients and investigated the following : 1) effect of treatment on vertigo, 2) effect of treatment on damage to the inner ear, 3) effect of treatment on recurrent attacks of vertigo. The effect of treatment on recurrent attacks of vertigo was evaluated by comparing the number of attacks a months after the start of treatment with the number before treatment.Treatment reduced recurrent attacks of vertigo in 11 patients (73%).No side effects were reported in this study.We conclude that Ketas® may be an effective drug for Meniere's disease.

To clarify the role of vestibular and proprioceptive reflexes in the regulation of the upright standing posture, we analysed with feedback models sways of the head and of the body's center of gravity (BCG) and the activity of the nuchal and soleus muscles.Seven healthy adults were asked to stand upright with eyes closed and feet together on a stabilometer. The forward-backward sways of the head and BCG and the activity of the nuchal and soleus muscles were recorded polygraphically. The head sway and the nuchal muscle activity (head-nuchal muscle system) were analysed with a 2-dimensional feedback model to study vestibulo-spinal postural regulation. The sway of BCG and the soleus muscle activity (BCG-soleus muscle system) were analysed with a 2-dimensional feedback model to study proprio-spinal postural regulation.1. The determinants of the noise correlation matrix in the head-nuchal muscle system and in the BCG-soleus muscle system were close to 1, indicating good feedback.2. The order. of the autoregressive process, i. e. the length of the past sway forming the present sway, was greater in the head-nuchal muscle system than in the BCG-soleus muscle system.3. The power spectrum showed a higher power in the frequency range in the BCG sway than in the head sway. The correlogram showed that the correlation ratio decreased more rapidly to the base line in the BCG sway than in the head sway. These results indicate that regulation of the standing posture by proprioceptive reflexes is more minute than that by labyrinthine reflexes.4. The impulse responses calculated with the head sway as output and the nuchal muscle activity as input were divergent in 4 subjects. The impulse responses calculated with the head sway as input and the nuchal muscle activity as output were convergent in all 7. On the other hand, the impulse responses calculated with the BCG sway as output and the soleus muscle activity as input and with the BCG sway as input and the soleus muscle activity as output were convergent in all 7. These results suggest that the BCG-soleus muscle system provides greater stability than the head-nuchal muscle system.

Vertigo in vestibular Meniere's disease is similar to that in Meniere's disease, but in the former there are no cochlear symptoms.A 58-year-old woman visited Gifu University Hospital on August 31, 1987, complaining of recurrent attacks of vertigo. She had no cochlear symptoms. Caloric tests indicated left canal paresis, but no abnormalities were detected on CT scan. We diagnosed vestibular Meniere's disease. She later complained of positional vertigo with severe nausea and visited our hospital again on February 15, 1990.Neurological findings : Lateral gaze directional nystagmus and down beat head shaking nystagmus were seen. In voluntary OKN, smooth pursuit was abnormal but saccadic eye movement was not. We speculated that disorders of eye movements were caused by a lesion of the flocculus or its connection to the vestibular nuclei.MRI findings : MRI showed a tumor of the fourth ventricle, compressing the right cerebellar peduncle.Neurological findings corresponded with MRI findings.We conclude that the vertigo was due to vertebrobasilar insufficiency or endolymphatic hydrops caused by disturbance of CSF flow.

A case of fluctuating hearing loss related to contralateral delayed endolymphatic hydrops (DEH) was first described Schuknecht in 1978. Our patient was a 63-year-old male with diabetes mellitus who developed fluctuating hearing loss and was found to have contralateral DEH. He had had severe hearing loss in the left ear following otitis media when he was six years old. Since the age of 53, he had occasionally noticed fluctuating hearing loss in the right ear along with episodic vertigo of Meniere's type.After admission to our hospital, the audiograms of his right ear revealed periodically-fluctuating hearing loss without vertigo. His hearing in the right ear fluctuated diurnally ; his hearing depression was severe in the morning, improved at noon and became severe again in the evening. Because he had diabetes mellitus, his blood glucose levels were serially determined. It was interesting that the fluctuations of his blood glucose levels preceded those of his hearing in the right ear by approximately three hours.

For examination of horizontal optokinetic nystagmus a large cylinder (2m in diameter and 2m in height) was rotated electrically both right and left with an angular acceleration of 2°/sec2 for 90 seconds. Tests were carried out by binocular and monocular vision.Results are as follows : (1) In a patient with strabismus convergens et sursum vergens, nystagmus was well evoked by optokinetic stimuli to both right and left in the case of binocular vision. In monocular vision, when the cylinder was rotated from the side of open eye to that of the covered, nystagmus was induced; on the other hand, while the cylinder was rotated from the side of covered eye to that of the open, provocation of nystagmus was disturbed. Namely, monocular unidirectionality of optokinetic reflex was observed. Taking into account the work of Tokita (1956) and Guillery (1969), this abnormality may suggest the disorder of uncrossed fibers in the optic tract.(2) In a patient with strabismus convergens et alternans, on the occasion of monocular vision, when the right eye was stimulated, movement of the left was disturbed; on the other hand, when left eye was stimulated, that of the right was disturbed. This abnormality suggests a disorder of association between the right and left eye system.(3) In a patient with strabismus divergens, movement of the right eye did not occur in the same manner as that of the left. Accordingly, conjugate eye-movement was disturbed.(4) In a patient with strabismus convergens, smooth pursuit of a moving object was disturbed. This abnormality suggests a disorder in the occipital lobe.Various optokinetic abnormalities are observed in patients with strabismus and include : Optokinetic monocular unidirectionality, disorder of association between the right and left eye system, disturbance of conjugate eye-movement and disorder of smooth pursuit of a moving object.

There are many patients with central vertigo and/or equilibrium disturbance in whom neurootological examination fail to explain the site of lesion or the etiology of disturbance.In this paper the results of computed tomography (CT) performed in these patients are reported.SubjectsTwenty-eight patients who complained of vertigo and/or equilibrium disturbance were evaluated in this study. These patients received neurootological examinations and it was inferred that their complaints were due to disorders of the contral nervous system.MethedThe EMI 1, 000 system or 1, 010 system were utilized for the study.ResultsThe following results were obtained.1) Two of the 5 patients with severe standing disturbance were shown to have cerebrocerebellar atrophy.2) Two of the 5 patients with cerebellar signs had cerebellar and brain stem atrophy.3) All of the 5 patients with congenital nystagmus did not show any abnormal findings on CT.4) Nine of the 13 patients with other neurootological signs showed cerebral, cerebellar and brain stem atrophy.These results lead to the following conclusions.1) Computed tomography is of value in the diagnosis of central vertigo and equilibrium disturbance.2) Brain atrophy is significant in the development of central vertigo and equilibrium disturbances.3) Diagnosis of vertigo and equilibrium disturbance can be suggested by functional neurootological examination and confirmed morphologically by computed tomography.

It has been described that optokinetic disturbances are diminutions of nystagmus. However, the present authors noted that there was an abnormality showing hypernystagmus in optokinetic nystagmus of clinical cases.A cylinder was used in order to produce optokinetic stimuli. The cylinder was rotated electrically with angular acceleration of 2°/sec for 90 seconds. The resultant nystagmus was recorded by using an electronystagmograph. The ENG record during 90 seconds was divided every 10 seconds into 9 equal parts. A number of nystagmus beats and a mean slow phase eye-speed during each 10 seconds was measured. When the measured values of the number of nystagmus beats or the eye-speed exceeded the normal values, the optokinetic nystagmus was judged to be hypernystagmus.The lesion in the cases showing the optokinetic hypernystagmus were located in the visual apparatus, the cerebral cortex, the basal ganglia, the brain-stem and the labyrinth.Furthermore, it was stated that this optokinetic hypernystagmus was different from the optokinetic hypernystagmus associated with the development of optokinetic function.