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Objective: Gait initiation is a transient procedure between orthostatic posture and steady-state locomotion and includes anticipatory anteroposterior (AP) and lateral movements. Commands for this task are located in some levels of brain stem, which modulates activity of central pattern generator in the spinal cord. The purpose of this work was to explore the role of the vestibular system in this voluntary stepping. Methods: Six patients with chronic bilateral vestibular loss (BVL) were measured by means of a large force plate (70 cm×120 cm ) and the displacement of the center of pressure (COP) during gait initiation was calculated. Measurement parameters comprised maximum distance (MD), velocity (MV) in the AP and lateral direction as well as for pre-, first- and second-step stages, and the angle of the COP trajectory. Results: For all stages, BVL patients registered lower values for both MD and MV in the AP direction than did normal subjects. In the lateral direction, however, neither MD nor MV in BVL patients showed any difference from those of normals. The step angle of the COP trajectory was obviously reduced. Conclusion: These results suggest that in the AP direction, the vestibulospinal pathway can influence the locomotor related neural circuits, including the central pattern generator and supraspinal levels, by means of modifying the velocity and step length in order to stabilize the trunk. On the other hand, the control mechanism in the lateral direction may be different from that in the AP direction.

A 9-year-old boy with inner ear malformation complained of slight deafness and unsteadiness. CT revealed a normal cochlea despite enlargement of the lateral semicircular canals. The vertical semicircular canals developed more or less normally. The caloric test showed complete canal paresis bilaterally; however, a horizontal rotational stimulus elicited a vestibulo-ocular response, which showed only rightward and downward nystagmus, and their maximal slow-phase velocities were low. In addition, the examination of the vertical semicircular canal function using the head-tilted rotation test revealed a more active response, and the maximal slow-phase velocities were higher than those of a standard horizontal rotational test. These results suggest that the function of the vertical semicircular canal was well preserved and that it may have perceived the horizontal acceleration instead of the lateral semicircular canal.

Vestibular compesation in 3 patients with vestibular neuronitis was examined with static posturography (SPG) and kinetic posturography (KPG). SPG was recorded by a stabilometer during quiet standing and KPG was recorded by POLGON so that angular change of the shoulder on the frontal plane was measured during stepping in the same position. Our study showed earlier improvement of SPG than KPG. By vestibular training, the initial high levels of SPG and KPG decreased precipitously and in the case of sequela, the remarkably high level of KPG gradually decreased. The stepping test by POLGON combined with a stabilometry was useful for estimation vestibular dysfunction.

Olfactory neuroblastoma is a rare malignant tumor of neural crest origin, arising in the nasal cavity. We encountered three cases of olfactory neuroblastoma : Case 1, in which the tumor had invaded to the ethmoidal sinus, Case 2, in which the tumor was limited to the nasal cavity, and Case 3, in which the tumor had invaded the anterior cranial fossa.All 3 patients were treated with a combination of surgery, radiotherapy, and chemotherapy. All of the patients are still alive without any evidence of recurrence.

We report 3 cases of Kimura's disease. All patients were male and ranged in age from 15 to 62 years. All cases showed eosinophilic granuloma in the salivary glands and regional lymphadenopathy. Case 1 was initially diagnosed with a malignant tumor by imaging findings (MRI, CT). This patient was treated with steroids only, showing a remarkable improvement. Case 2 with relapsing nephrotic syndrome has been kept free of granuloma by surgery and steroid hormone therapy. Case 3, who underwent surgical excision, experienced recurrence in spite of the continuous application of NSAID (nonsteroid anti- inflammatory drugs).

Pleomorphic adenoma originating from the external auditory canal (EAC) is reportedly very rare. Only six cases were found in the Japanese literature.A 31-year-old female visited us with a four-year history of hearing loss and otorrhea of the left ear. The left EAC was occupied by a firm elastic tumor. On January 7, 1994, the tumor was excised under general anesthesia through an incision of the posterior auricular sulcus.The excised tumor was grayish-whited, 1.2×1.4×1.5cm in size. The histopathological diagnosis was pleomorphic adenoma. The tumor has not recurred during the year since the operation.

We investigated the correlation between body sway and head sway in 64 healthy subjects who stood on a force-measuring platform. Each subject wore a helmet attached to a cephalograph and was asked to stand as still as possible on a platform with his feet close together for 60 sec. Subjects were asked to do this three times with their eyes closed and three times with their eyes open. We selected the test with the minimum sway for computer analysis of the sway path, sway area, ratio of anteroposterior/lateral components, sway velocity in each direction, averaged divisional frequency, and Romberg quotient. The movement of the head was significantly correlated with the center of foot pressure (COF) for the sway path, sway area, sway velocity, averaged divisional frequency, and the Romberg quotient. Our findings suggest that COF sway can be used instead of head sway to assess those five parameters.

Analyses of environmental and biological specimens were carried out by PIXE. The yield of potassium (Kα line) is used as a standard for other elements. Environmental and biological samples studied here are standard polished glass beads (30/60 mesh), soil dust generated by studded tires. materials accumulated in a water supplying pipe, perfumes of China and Japan, ash. asbestos-dark, briquettes, synovial fluids, sex skin of a chimpanzee and so on. Concentrations of K, Ca, Fe and Zn in these biological samples are noticeable.

To quantitate the development of equilibrium in children, we investigated movements of the head and of the center of foot pressure (COF) in standing subjects, using a cephalograph, a force measuring platform, and a technical computer. We studied 126 subjects, 105 healthy children, aged 4-18 years, and 21 adults, aged 20-28 years. Each subject stood with their feet together on a platform for 60 s each with eyes open or closed. The area and total length of head and COF movements decreased with increasing age, and were significantly greater in children under 12 years than in adults. The ratio of the lengths of head to COF movements was significantly larger in children under 9 years than in adults. The ratio of the anteroposterior to lateral movement of COF was also larger in children under 9 years. These observations suggested that body sway in children was not only larger than that in adults, but different in nature.

A 47-year-old man complained of dyspnea after a traffic accident. He was found to have a retropharyngeal abscess.We review 35 case of retropharyngeal abscess reported in Japan between 1986 and 1992, 9 patients were below 3 years of age, and 16 were over 20 years of age.The causes were infection in 7, tuberculosis in 4 and presumably related to diabetes in 4. However, there was no report of post-traumatic origin.

A case of multiple sclerosis with acute deafness and dizziness as initial symptoms was reported. The pure-tone audiometry showed a high-frequency sensorineural hearing loss; in the auditory evoked brain stem response (ABR), the left side had a normal peak I with an absence of subsequent peaks. In the equilibrium test, Bruns' nystagmus was present, and the caloric test demonstrated CP on the left side. MRI disclosed a high-intensity lesion in the cerebellar peduncle (T2-weighted image). With steroid therapy, the deafness and dizziness improved within 10 days, although, after 20 days, the findings of the ABR and caloric test remained unchanged.

Vestibular compensation in patients with bilateral vestibular dysfunction was examined with the use of static posturography (SPG) and kinetic posturography (KPG). SPG was recorded by a stabilometer during quiet stance and KPG was recorded by POLGON so that angular changes of the shoulder in the frontal plane were measured during stepping in the same position. In addition, we recorded movements of daily life. The subjects were 3 patients with bilateral vestibular loss. The values of SPG decreased gradually. However, abnormalities of KPG with eyes closed tended to persist, and the effect of vestibular training was transient. In regard to movements of daily life, the jumbling phenomenon during walking disappeared within 6 to 8 months, but jumbling with quick head motion persisted. Unsteadiness while standing on a sofa, or putting on socks while standing on one leg, or walking in a dark room persisted.

Unicylce riding is a sport and exercise in Japanese elementary schools. Our concern is the possibility of its effect on vestibular training. In the present experiment we examined the effects of unicycle riding on several aspects of posture-maintaining, using a stabilometer and calculating the duration of the posture-maintaining period.Twelve pupils in a Prefectural School for Deaf were selected as subjects of vestibular training with unicycles. Those subjects suffered from severe hearing impairment, and some of them also had other sensory or physical problems. Unicycle riding was taught by two physical education teachers for about two hours every day except holidays.The subjects were tested with a stabilometer while standing straight with toes and heels together, with eyes open and eyes closed. Then they were asked to keep standing with three foot positions with eyes open and eyes closed to estimate the duration of stable posture-maintaining. The 3 foot positions were 1) standing straight on one leg (one-leg standing), 2) standing with tandem Romberg's foot position (tandem-Romberg standing), and 3) standing on one leg while maintaining airplane-like posture of horizontally outstretched hands and 45 degrees forward-tilted body trunk (airplane standing).The subjects were classified into 3 groups according to the effect of train-ing: well-trained group (Group A), moderately-trained group (Group B) and poorly-trained group (Group C). Stabilometry and measurements of posture-maintaining time were performed, followed by the same tests every 3 months for 9 months.Group A and Group B obtained a significant effect of unicycle training in posture-maintaining, while Group C showed no effect in all the methods used in the present study throughout the 9 months. Vestibular training with the unicycle is very useful for the development and rehabilitation of equilibrium function.

The course of recovery in 4 patients with Meniere's disease was examined with static posturography (SPG) and kinetic posturography (KPG). SPG was recorded by a stabilometer during quiet stance and KPG was recorded by PO LGON so that the angular change of the shoulder in the frontal plane was measured during stepping in the same position. The process of SPG improve-ment was concordant with that of KPG, and the abnormally high levels of SPG and KPG be came normal within 8 days. Those results differ from those of vestibular neuronitis. We consider that the mechanism of recovery from Meniere's attacks is different from vestibular compensation and is due to fluctuation of inner ear function.

POLGON (Polarized light goniometer) was used to evaluate ataxia during stepping movements in patients with spinocerebellar degeneration (SCD) and Parkinson's disease. The measurements included mean angular change of shoulders (M.A.C.S.) and its coefficient of variation (C.V.). In patients with SCD, the values of M.A.C.S. were significantly larger at 1.0 step/s than those at other stepping rhythms. This results suggests that the stepping rhythm of 1.0 step/s is useful for the detection of cerebellar ataxia. The values of C.V. correlated with the degree of advancement of SCD. In patients with Parkinson's disease, the values of M.A.C.S. tended to decrease because of the restricted elevation of the knee, while those of C.V. were increased. The results showed that the stepping test using the POLGON was useful for estimation of the characteristic disequilibrium of SCD and Parkinson's disease.

身体障害者福祉法の定めるところにより身体障害者手帳を交付された者は, 数々の利益を受けることができる。 しかし, 同法の意義は更生医療と更生への援助であり, 同法15条指定医は正確な聴力検査に基づく等級判定を行う義務がある。 難聴を有する身体障害者が一旦手帳を手にすると, 後日障害等級の改善が確認されても手帳の返還ないし書き換えを求めることが困難となる傾向がある。 このような問題に関する実情は必ずしも解明されているとは限らない。 筆者は県から補装具装用判定の委嘱を受け, 聴力障害者の聴力を再検する機会に恵まれているので, 手帳を所有している障害者の聴力を精検し, 初回検査との関係を調べ, 問題点の解明を試みた。 結果として, 特に高齢者の聴力検査に問題点があることを強調した。

The changes in angulation of the shoulders while stepping in patients with unilateral peripheral vestibular disorders were mesured by POLGON and relationship between them and deviations in the Fukuda's stepping test were analyzed.The ratio of average angular change of the shoulder on the affected side to that of the contralateral shoulder was increased in patients with marked deviations in Fukuda's test. There were a significant correlation between the abovementioned ratio and the angle of rotation in Fukuda's stepping test.The coefficient of variation (C.V.) of the changes of shoulder angulation tended to be increased on the affected side, while no correlation was obtained between the ratio of the C.V. on the affected side to that on the intact side one and the angle of deviation.These results suggest that the differences bet-ween the angulation of the shoulders while stepping are closely related to the results of Fukuda's test.

The standing body sway of normal subjects and of patients with unilateral vestibular disorders was measured. The patients were not able to stand with toes and heels together, so the upright position with toes and heels apart was applied. Visual stimulation consisted of clockwise and counter-clockwise concentrically-moving spotlights at constant velocities of 60 and 90 deg/sec. The body sway of the patients was significantly larger during contralateral stimulation by moving spotlights than during ipsilateral moving stimulation, while the sway of normal subjects was symmetrical, increasing with increasing velocity.

Vestibular evoked myogenic potentials (VEMP) occurring after click stimulation in cervical muscles are thought to be a polysynaptic response of otolith-vestibular nerve origin. In optokinetic after-nystagmus (OKAN) the direction of after-nystagmus changes and slow-phase velocity decreases with head tilt. This phenomenon may be an otolith response to the direction of gravity. We assumed that intense clicks might have some influence on OKAN via the otolith-vestibular nerve. Twelve normal subjects who showed VEMP at 75 dB normal hearing level (nHL) clicks were examined. The OKAN was recorded under four conditions: right monaural, left monaural and binaural stimulation by 75 dB nHL clicks, and absence of click stimulation. Horizontal optokinetic stimulation was applied using stepwise increasing speeds from 30 deg/s to 90 deg/s. Two seconds before the stimulus ended, clicks were sounded. The slow-phase velocity of the recorded electro-nystagmography was manually measured. There was no effect on OKAN with unilateral stimulation but binaural stimulation suppressed it. These results suggest that a velocity storage integrator is influenced by intense clicks via the otolithic area.

A 12-year-old female had iritis, episcleritis, papilledema and vestibuloauditory dysfunction. The diagnosis was atypical Cogan's syndrome as described by Cody and Haynes.The initial symptoms were high fever and injected bulbar conjunctiva.Attack of vertigo, as in Meniere's disease, appeared 2 months after the onset. The results of equilibrium and glycerol tests, and electrocochleography suggested endolymphatic hydrops in the inner ear.Within 4 weeks after the initiation of steroid therapy, hearing improved and ocular symptoms disappeared without papilledema. At the time of discharge, she had no ataxia, but bilateral CP was present in the caloric test.We considered that the disorder of the inner ear in Cogan's syndrome is hydrops due to vascular insufficiency.