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Objective The maxillofacial characteristics of patients with obstructive sleep apnea syndrome (OSAS) have previously been analyzed using standard cephalometric analysis. Malocclusion influences the occurrence of sleep apnea, but the pathology of malocclusion in OSAS has not yet been fully investigated. Therefore, we investigated malocclusion in patients with OSAS using cephalometric and dental analysis. Methods Cephalometric and dental analyses were performed to evaluate malocclusion in 97 male patients with OSAS (49.7±11.7 years). The number of apnea and hypopnea episodes per hour (apnea-hypopnea index: AHI) was determined by standard polysomnography. Results The overall prevalence of severe overjet (the horizontal distance between the upper and lower incisors of ≥6 mm) was 43.3%. AHI was significantly correlated with body mass index (BMI) in obese OSAS patients (r=0.385, p=0.010), whereas it was significantly correlated with overjet in non-obese OSAS patients (BMI

A 40-year-old male patient had a vertigo attack with vomiting; however, there was no hearing loss, headache, or palsy of arms or legs. On admission, the CT examination did not show any tumors, or infarctions of the brain, brain stem or cerebrum. Neurotological findings of an electro-nystagmography and caloric test did not show any abnormalities, except a platform test showed positive. Two days after admission, MRI examination showed a small mass (15 mm) in the left cerebellar peduncle. Previously, cavernous anginoma was considered rare, but the increasing use of MRI has demonstrated numerous cases. Typically, epileptic or other convulsive symptoms appear initially, but in our case, pathology was indicated by vertigo without other cranial nerve symptoms.

Down-beat nystagmus is often observed in dizzy patients with a central lesion focus; however, up-beat nystagmus has rarely been noted. A 57-year-old man who com-plained of dizziness was diagnosed as having Wernicke encephalopathy on the basis of neurological findings, an MRI and the past history given at first visit to Aichi Medical University. Up-beat nystagmus was observed under an infrared camera and recorded by electronystagmography (ENG). An eye-tracking test for optokinetic nystagmus showed saccades and ataxia. Vitamin B1 50 mg per day was administered immediately. Although symptoms such as cerebellar ataxia had improved by the third day after administration and were almost absent by the 19th day, saccades and ataxia, recorded by ENG, and up-beating nystagmus remained for more than 4 months.

現代医学的治接療が難渋した老人性耳鳴の四症例に対して, 中医学的鍼治療を施行した結果, 興味深い臨床知見が得られたので報告する。初診時, 純音オージオグラムでは全症例とも高音漸傾型の感音難聴を呈し, また標準耳鳴検査法においては, 各症例それぞれに最高14dBから6dBまでの耳鳴ラウドネスが検出されていた。さらに語音聴力検査やSISIテストにて, 症例1と症例2はいわゆる迷路型, 症例3は混合型, そして症例4は後迷路型の聴覚障害であると判明した。その一方で, 中医学的弁証論では, 全症例の病因病機はいずれも, 耳や脳の基本栄養物質である腎精気の加齢による衰退, すなわち「腎精虚損証」に深く関与しているものと診断された。これより, いわゆる「補腎益気・養耳健脳」という治療原則を導き出し, それに基づいて週1回, 連続10週間, 合計10回の鍼治療を行った。その結果, 明らかな迷路性障害が存在した症例1・2・3は, ほぼ毎回鍼治療後, 約半日から数日間に亘って, 程度差があるものの確実な耳鳴の軽減効果が見られた。特に3回目の治療以降は, それぞれの症例における自覚的耳鳴の大きさや耳鳴のラウドネスは, 常時治療前の1/2～1/3のレベルにまで低下するとほぼ満足の行く臨床効果が示された。しかしながら, 症例4に関しては今回の鍼治療の期間中には, 耳鳴ラウドネスの多少の変動が見られたものの, 全般的に病状の明らかな緩解までには至らなかった。結論として, 中医学的鍼治療は老人性耳鳴に対して一定の軽減作用を有するものであろうが, その中でも後迷路性のものに比べ, とりわけ迷路性または混合性の耳鳴には, より適した治療方法ではないかと考えられる。今後, そのさらなる臨床応用が期待される。

Although the interrelations between dizziness and various psychological factors have been well reported, the effectiveness of various therapies in reducing dizziness has received much less attention. In a previous study, we reported that group psychotherapy was effective in improving the condition of patients suffering from dizziness. In this study, we investigated the environmental factors which may have caused the dizziness of eighty-six patients. Probable causes for their dizziness included a dysfunctional family (30%), work- or job-related stress (31%), and mental illness (23%). Difficulty with human relations and anxiety were the most common factors exacerbating symptoms of dizziness. Group psychotherapy was found to be effective in helping these patients reduce their dizziness.

A 67-year-old female was admitted for treatment of vertigo and bilateral hearing loss. Although ATP and vitamin were administered immediately, left upper facial nerve paralysis appeared three days later. CT and MRI revealed old cerebral infarctions without any abnormality in the brain stem or cerebellum. Left anterior inferior cerebellar artery syndrome was detected by vertebral angiography (VAG) with defects in the left anterior inferior cerebellar artery (AICA) and left posterior inferior cerebellar artery (PICA).The observations of spontaneous nystagmus were important for the diagnosis in this case. Early diagnosis is necessary for the prevention of progressive pathology.

For 48 months since 1986, a male patient in his early 60 s has been treated for Wallenberg's syndrome, we report our otoneurological and roentgenological findings.Rotatory nystagmus is often found in medullary disturbances. In this case pure rotatory nystagmus to the affected left side was observed in the early stage, which then gradually moved up and down diagonally to different positions. In Wallenberg's syndrome, it is indeed difficult to predict the exact type of nystagmus because of variable symptoms in different types of disturbances.Electronic nystagmography (ENG) improved at 8 months and angiography confirmed by-pass circulation to the affected side at 24 months. It seemed that the by-pass had been completed at 8 months, at the time of the improvement in ENG.Urokinase administration proved helpful in this case, but it must be applied with great care because of the danger of bleeding cerebral disease.ENG examinations and otoneurological finding were decisive in establishing an early diagnosis.

Although congenital vertical nystagmus is very rare, we treated on 6-year-old girl who had spontaneous eye movements and myopia. Down beat nystagmus was noted on forward gaze, and it increased in amplitude and frequency on downward gaze. The nystagmus disappeared when her eyes were closed in a lighted room and when her eyes were open in a dark room.Eye tracking tests for slow and quick components in the horizontal plane were normal. Optokinetic nystagmus in the horizontal plane was within normal limits. Normal caloric responses were observed. No vertical optokinetic nystagmus was induced. The patient had complete loss of the slow pursuit function in the vertical plane. Therefore, we considered this to be a case of congenital vertical nystagmus due to a disturbance of the slow pursuit system of vertical eye movements.

Two patients complaining of hearing loss with vertigo were examined radiologically and neurotologically. Electronystagmography and positional nystagmus testing showed central disturbances. Vertebral angiography (VAG) showed narrowings in the vertebral artery (VA) concomitant with defects in the anterior inferior cerebellar artery (AICA) diagonally opposite to the respective impaired VA branch. We demonstrate in this study that the AICA syndrome resulted from vertebral basilar insufficiency (VBI).Today, due to improvements in CT, MRI and angiography, the AICA syndrome is much better understood. Since VBI will futher complicate AICA syndromes and other secondary disturbances, we conclude that VAG should be performed with care certain cases of vertigo thought to be caused by VBI.

We used trafermin (recombinant human basic fibroblast growth factor) to treat a skin ulcer (diameter, 1 cm; depth, 2 mm) that developed after an extremely deep auricular laceration was sutured. Excellent results were obtained after use of trafermin for 2 weeks. To our knowledge, we report the first clinical use of trafermin in a patient with a skin ulcer resulting from auricular trauma. Trafermin may promise to be an effective treatment for skin ulcers.

Objective To compare megadose steroid therapy (n = 17; group S) and lipoprostaglandin E1(lipo-PGE1) therapy (n = 14; group L) in patients with recent-onset Bell palsy complicated by diabetes. Design A nonrandomized controlled trial was performed. The 2 groups were almost identical in age, sex distribution, and laterality, and there was no difference in the average palsy scores in the 2 groups either at the time of the first visit or when the palsy was at its worst. Results There was no statistically significant difference in the cumulative rates of improvement in the 2 groups 4 weeks, 2 months, or 6 months after the first visit, revealing no difference in the therapeutic effects of the 2 agents. During the therapy, fasting blood glucose concentrations were increased in all patients in group S, whereas they were not increased in group L. Complicated diabetes was aggravated in group S, while it was not aggravated in group L. Conclusions Lipo-PGE1therapy may have improved vascular flow in the facial nerves and accelerated recovery, resulting in a rate of improvement comparable with that obtained through megadose steroid therapy. Lipo-PGE1is a useful treatment method for patients with Bell palsy complicated by diabetes.

Abscess of the nasal septum is rare, but immediate diagnosis and surgical drainage are necessary to prevent significant complications.A 1.5-month-old girl was admitted to our hospital with fever, mouth breathing and feeding difficulty. Both nasal cavities were occluded by septum swelling with serous rhinorrhea. In spite of immediate puncture, drainage and administration of antibiotics, she developed meningitis and saddle nose, but she improved gradually and was discharged 19 days after admission.Ninety cases (including our case) of nasal septal abscess reported in the Japanese literature from 1914 to 1982 are reviewed.

Histological examination of 36 samples of spontaneous otitis media in mice showed cholesterol granulomas in the middle ear cleft of 7. The cholesterol granuloma was found inside the round window niche and the oval window niche in almost closed ear cleft, but cholesteatomatic otitis media was not found, and the samples showed changes in the organ of Corti.In the clinical study of middle ear surgery, granuloma was found not in the oval or round window niche but in the mastoid cells, or inside closed cleft apart from the middle ear cleft.The authors conclude that cholesterol granulomas develop where ventilation is insufficient and that inflammation promotes such a process secondarily. Cholesterol granuloma does not develop into cholesteatomatic otitis media.

From Jan. 1977 to Sept. 1984, 71 patients 73 ears with sudden deafness who were admitted to the hospital of Aichi Medical University were classified into 4 groups: Group A, 16 patients with both nystagmus and vertigo; Group B, 4 with nystagmus but no vertigo; Group C, 9 with vertigo but no nystagmus; Group D, 40 with neither nystagmus nor vertigo. Of the 73 ears, 2 did not fit into any of groups.The course of hearing improvement and vestibular function were examined in each group. Hearing acuity did not improve much in Group A. In all cases in which nystagmus worsened during treatment, hearing did not improve.

Harada's disease is well known as a systemic disorder of pigment cells especially in the uveal tract, retina and meninges. Signs of integumentary (vitiligo, poliosis and alopecia) and auditory involvement (dysacousia, tinnitus and vertigo) are common.The authors report a case of Harada's disease with equilibrium disorder.The patient was a 36-year-old man, who complained of hyperemia of his eye balls and deterioration of his visual acuity and was admitted to the department of ophthalmology of our hospital. A diagnosis of Harada's disease was made, and he was treated with steroid therapy. His visual acuity improved, but he suffered from a sudden onset of vertigo 13 days after admission.Several neuro-otological findings and some therapeutic features are discussed.

A case of acute polyradiculoneuritis accompanied by rare complications of the VII, VIII and IX cranial nerve disorder was described. There was an elevation of the rubella virus antibody titer, which suggested the case had been infected before. Thirty-eight year-old woman complained of bilateral tinnitus and was proven audiometrically to have sensori-neural hearing loss. Electroacoustical examination disclosed that all the waves were suppressed and that wave I and V were barely detected, while wave II, III and IV were absent. The neurological and audiological disorders were successfully treated with corticosteroid, and the patient had neither sequelae nor recurrence.

From Jan. 1981 to Dec. 1983, 307 outpatients complained of abnormal sensations in the throat. No significant sex difference was noted. Most of them were in the fourth to seventh decades.Their complaints were varied, most of them feeling a lump or foreign body sensation. Further examinations revealed paranasal sinusitis in 62 cases, abnormal esophageal roentogenological findings in 22 and serum iron deficiency in 34.Of the 307 patients 175 responded to questionnaries: 50 were asymptomatic. The others had some symptoms but tried to ignore them and live with their disease.

A case of Wolfram syndrome associated with dysphagia is described hereinafter. In 1938, Wolfram reported four patients with diabetes mellitus and optic atrophy. Since then, this syndrome has been recorded over 100 cases, often in association with diabetes insipidus and deafness. Various symptoms are shown in this syndrome, dysphagia or vertigo is however rarely seen. Atrophy of hypothalamic nuclei that progresses gradually, degeneration of the optic nerve, its chiasm and tract, and totally unexpected degeneration of the pons and cerebellum are considered as the pathogenesis of this syndrome.The patient, twenty-seven year-old female, has been suffering from optic atrophy since the age of fourteen and diabetes mellitus since the age of twenty-three. Dysphagia has developed since the age of seventeen. Dysphagia and dysequilibrium revealed brain stem lesion. As the treatment for dysphagia, cricopharyngeal myotomy was fairly effective. The specimen of the muscle obtained in the operation revealed neurogenic atrophy of muscle.

Several reports have drawn attention to the presence of rheumatoid arthritis in the larynx. Although dyspnea induced by cricoarytenoid arthritic ankylosis has received attention as a medical emergency, some patients with slightly more severe disease complained of sore throat.We treated two patients with cricoarytenoid rheumatoid arthritis who complained of sore throat.Case 1. A 51-year-old female who had suffered from rheumatoid arthritis for 12 years complained of severe sore throat and pain on swallowing for several years. Laryngeal examination showed edematous swelling of the right arytenoid region.Case 2. A 53-year-old female who had had rheumatoid arthritis for 21 years was referred because of recent vertigo and hearing impairment. During her admission she complained of sore throat. Laryngeal examination showed edematous white-coated swelling of the arytenoids.