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We report a case of Costen's syndrome that showed chewing-induced nystagmus and vertigo. A 31-year-old woman visited our hospital complaining of chewing-induced vertigo 5 days after dental therapy. During chewing a stick of gum, she complained of vertigo and showed nystagmus beating to the right, the direction of which changed to the left thereafter. No spontaneous and positional nystagmus or any abnormalities in the neurological examination could, however, be found. The chewing-induced nystagmus and vertigo gradually disappeared within 2 weeks. Costen's syndrome is associated with various symptoms due to temporomandibular dysfunction. In the case, it is suggested that malinterdigitation after dental therapy caused temporomandibular dysfunction, resulting in the chewing-induced nystagmus, therefore, Costen's syndrome was diagnosed.Eustachian tube hypothesis, Tensor tympani hypothesis and otomandibular ligament hypothesis that accounted for temporomandibular dysfunction-induced aural symptoms in patient with Costen's syndrome had been proposed, but recently were withdrew. On the other hand, it is reported that reciprocal connections between trigeminal and vestibular nuclei. The trigeminal somatosensory input associated with temporomandibular dysfunction after dental therapy may cause chewing-induced nystagmus via the trigemino-vestibular connection in the brainstem in the case.

The clinical efficacy of clarithromycin was investigated in 34 children with chronic sinusitis, and 36 children with secretory otitis media accompanied by chronic sinusitis.1) Rhinoscopy showed reduced nasal mucosal swelling in 74.2%, decreased nasal discharge in 78.5%, decreased postnasal drip in 89.3% and improved quality of nasal discharge in 88.6%. Follow up X-ray films showed improved opacity of maxillary sinuses in 81.6%.2) There was improvement in 71.4% in the appearance of the tympanic membrane and in 66.7% in that of the tympanogram.3) The rate of clinical efficacy was 88.6% (marked improvement, 54.3%; some improvement, 34.3%) for chronic sinusitis and 79.6% (marked improvement, 38.8%; some improvement, 40.8%) for secretory otitis media.4) No side effects were observed.On the basis of these results, clarithromycin was judged to be useful in the treatment of children with chronic sinusitis and with secretory otitis media accompanied by chronic sinusitis.