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In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR).The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction.One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr.Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used.The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

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

Background: The clinical usefulness of concurrent chemoradiotherapy before surgery in the treatment of primary, locally advanced sinonasal low-grade, non-intestinal type adenocarcinoma (LG non-ITAC) is unclear.Methods: We present the first case report of the efficacy of super-selective intra-arterial cisplatin (CDDP) infusion concurrent with conventional fractionated radiotherapy (RT) for LG non-ITAC in a Japanese patient.Results: A white, rugged-marginal mass that was histopathologically diagnosed as LG non-ITAC occupied the right nasal cavity. Based on the imaging findings, including computed tomography, magnetic resonance imaging, and positron emission tomography, the tumor was diagnosed as T4aN0M0, stage IVa. After treatment, the nasal tumor disappeared leaving only a small bulge in the medial wall of the middle turbinate. The patient also underwent right transnasal ethmoidectomy performed as salvage surgery. A histopathological examination revealed that the lesion was replaced by granulation tissue with lymphocytic infiltration and hemosiderin-laden macrophages, and no viable tumor cells remained. In the seven years after treatment, the patient has not experienced any local recurrence or regional or distant metastasis.Conclusions: Super-selective intra-arterial CDDP infusion concurrent with conventional fractionated RT followed by salvage surgery might be useful for the management of sinonasal LG non-ITAC.

Sensory conflict among visual, vestibular, and somatosensory information induces vertiginous sensation and postural instability. To elucidate the cognitive mechanisms of the integration between the visual and vestibular cues in humans, we analyzed the cortical hemodynamic responses during sensory conflict between visual and horizontal rotatory vestibular stimulation using a multichannel near-infrared spectroscopy (NIRS) system. The subjects sat on a rotatory chair that was accelerated at 3°/s2 for 20 s to the right or left, kept rotating at 60°/s for 80 s, and then decelerated at 3°/s2 for 20 s. The subjects were instructed to watch white stripes projected on a screen surrounding the chair during the acceleration and deceleration periods. The white stripes moved in two ways; in the “congruent” condition, the stripes moved in the opposite direction of chair rotation at 3°/s2 (i.e., natural visual stimulation), whereas in the “incongruent” condition, the stripes moved in the same direction of chair rotation at 3°/s2 (i.e., conflicted visual stimulation). The cortical hemodynamic activity was recorded from the bilateral temporoparietal regions. Statistical analyses using NIRS-SPM software indicated that hemodynamic activity increased in the bilateral temporoparietal junctions (TPJs) and human MT+ complex, including the medial temporal (MT) area and medial superior temporal (MST) area in the incongruent condition. Furthermore, the subjective strength of the vertiginous sensation was negatively correlated with hemodynamic activity in the dorsal part of the supramarginal gyrus (SMG) in and around the intraparietal sulcus (IPS). These results suggest that sensory conflict between the visual and vestibular stimuli promotes cortical cognitive processes in the cortical network consisting of the TPJ, the medial temporal gyrus (MTG), and IPS, which might contribute to self-motion perception to maintain a sense of balance or equilibrioception during sensory conflict.

Rationale: Most cases of lymphoepithelial carcinoma (LEC) occur in the nasopharynx, and LEC in the sinonasal tract is extremely rare; thus, the clinical characteristics of sinonasal LEC are not well known. Patient concerns: A 63-year-old Japanese man presented with a three-week history of left cheek pain, nasal obstruction and cheek swelling. Diagnoses: Enhanced CT and MRI revealed a tumor of the left maxillary sinus that invaded the left orbit and hard palate, with multiple swollen left cervical lymph nodes. Open biopsy was performed, and the specimen was diagnosed as LEC. Interventions: Alternating chemoradiotherapy (ALCRT) followed by salvage surgery was performed. Outcomes: Our patient has been disease free for 5 years. Lessons: A literature review of the epidemiology, etiology, clinical course and management of sinonasal LEC is highlighted. We believe ALCRT followed by salvage surgery to be a highly optimal treatment for sinonasal LEC from the viewpoint of a balance between quality of life and a high curative effect.

Conclusions: It was shown that practicing with a tangible head model with semicircular canals is a useful educational tool for learning the physical treatment for BPPV. Objectives: To assess the efficacy of using a tangible head model with semicircular canals to teach the physical treatment for BPPV. Methods: This study compared the number of canalith particles in the posterior semicircular canal that 20 participants could move from the ampulla to the utricle, before and after practicing with the tangible model. Results: Before practicing with the model, they could move 2.5 (mean value) of 10 canalith particles. However, after practicing, they could move 6.6 (mean value) of 10 canalith particles. There was a statistical difference (p < 0.01) between the two trials.

Fibrin glue might be an inessential bioadhesive for attachment of hyperdry amniotic membrane (AM) patches in canal wall down (CWD) tympanoplasty.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.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.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 (p0.05) and was not significantly different between the two AM groups (p0.05).

Background The prognosis for patients with mucosal malignant melanoma (MMM) of the nasal cavity is very poor because of the radioresistance of melanoma cells. Methods We present the first case report of the efficacy of superselective intra-arterial cisplatin (CDDP) infusion concurrent with hypofractionated radiotherapy (RT) for MMM of the nasal cavity. Results A pink, polypoid mass, histopathologically diagnosed as an amelanostic melanoma, occupied the right nasal cavity. After the treatment, a nasal tumor disappeared, leaving only a small bulge in the medial wall of the middle turbinate. Histopathologic examination revealed scattered degenerated melanoma cells, remaining only in the small restricted area in the medial surface of the excised middle turbinate. Twelve months after the treatment, the patient has not experienced any local recurrence or regional and distant metastasis. Conclusions The superselective intra-arterial CDDP infusion concurrent with hypofractionated RT might be useful for the management of nasal MMM. © 2011 Wiley Periodicals, Inc. Head Neck, 2013

Objectives: To overcome the lack of the autografts in revision ear surgery, the usefulness of human amniotic membrane (AM) patches as a dressing substitute for fascia grafts of the temporal muscle (temporalis fascia graft) was investigated in canal wall down tympanoplasty. Study Design: Retrospective chart review. Methods: In 11 ears of 11 patients, the AM was attached over the bony surface of the mastoid cavity (AM group). In 11 ears of nine patients, the temporalis fascia graft was attached over the bony surface of the mastoid cavity (fascia group). The times for graft epithelization were compared in both groups. Results: In both groups, complete epithelization of the mastoid cavity took place in all patients. The time of epithelization in the AM group was 32 days, whereas in the fascia group it was 45 days. Complete epithelization of the AM graft was significantly faster than the fascia graft (P < .05). Conclusions: Hyperdry AM might be a new useful dressing substitute for temporalis fascia graft due to the reduction in the epithlializing time offered by the AM in revision ear surgery.

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).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.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.With both devices, the frequency of vertigo after treatment was significantly lower than before treatment (p0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device (p0.05). No complications were directly attributable to treatment with the TMM device.

Intense brief sound evokes short-latency myogenic potentials around the eyes in humans. These potentials are named ocular vestibular-evoked myogenic potentials (OVEMP), but the origin and pathway of these responses remain unclear. To establish an animal model for OVEMP, we recorded sound-evoked potentials around the eyes using awake monkeys. Two macaque monkeys were used in the research. A pair of electrodes was attached under an eye, and each animal was made to gaze at the monitor with their eyes in a fixed position while sitting in a primate chair. When a 135-dB SPL air-conducted 500-Hz tone burst was applied, the peak latencies of the first negative and second positive waves were 10.4 msec and 13.7 msec. The peak latency of the first negative wave did not change when the frequency was changed. The threshold of the myogenic potentials at a frequency of 500 Hz was lowest among the 4 tested frequencies (500Hz, 1kHz, 2kHz and 4kHz). The contralateral amplitude to the sound stimulation was greater than the ipsilateral amplitude. Furthermore, the amplitude for an upward-gazing position was greater than that for a downward-gazing position. The characteristics of these potentials were similar to those of OVEMP in humans, suggesting that the sound-evoked myogenic potentials around the eyes in monkeys may be utilized as an animal model of OVEMP.

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.

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.Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) was performed in 5 patients with IP. High FDG uptake (maximum standardized uptake (SUVmax) value3.0) was observed in all patients, and 2 patients with IP associated with squamous cell carcinoma (SCC) exhibited higher SUVmax values.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.

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

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.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.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.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 (p0.01) in all these parameters between the two groups.

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.

低音部に感音難聴を来す疾患には種々の報告があり, その病態は必ずしも内リンパ水腫だけではないと考えられる。 本研究ではALHLの検査所見や臨床的な特徴を明らかにすることを目的に, 91名の患者を反復型と単発型の2グループに分類して分析した。 91名のうち54名が反復型, 37名が単発型であった。 反復型のうち13名は後にメニエール病と診断され, 12名は一側性, 1名は両側性であった。 この14耳に対して蝸電図検査を行い, 12耳で100dBpeSPLクリック音に対する-SP/AP比の異常増大を認めた。 ALHLの発症からめまい発症までの期間は, 2週から68ヵ月であった。 このうち6名ではALHLから1年以上経過後にめまいを起こした。 低音域の聴力の予後は比較的良好でメニエール病に移行後の前庭症状も重症例は少ないという特徴があった。 ALHL患者は必ずしも内リンパ水腫を有するとは言えず, 予後を予測するために蝸電図は有用であった。 病初期には内リンパ水腫以外の病態もあり得ることを考慮に入れながら, 診断, 治療にあたる必要がある。

We experienced 2 cases of a brain abscess secondary to middle ear cholesteatoma. Case 1 was a 73-year-old male. When visiting a local hospital for treatment of a common cold, he suddenly fell into convulsions and was hospitalized. CT and MRI revealed a right temporal lobe abscess and middle ear cholesteatoma. Case 2 was an 18-year-old male. He visited a local neurosurgeon for headache and low grade fever. CT and MRI revealed a left cerebellar abscess and middle ear cholesteatoma.In both cases, there were no aural symptoms such as otorrhea or otalgia before the brain abscess diagnosis. We want to stress that it is necessary to properly treat middle ear cholesteatoma because of the possible sudden occurrence of brain abscesses.

Objectives:In this study, we developed a tangible head model for the physical treatment of benign paroxysmal positional vertigo (BPPV) and assessed the educational efficacy of this model for people. This model has a 10-time-scale mockup of the semicircular canal, which contains 10 canalith particles, located in a 1.5-time-scale mockup of the head.Methods:This was a prospective study involving 20 medical students just starting to study otolaryngology. At first, they learned the canalith repositioning procedure (CRP) from an article. After reading the article, they tried to move 10 canalith particles from the ampulla to the utricle using the model, during which they were not able to see inside. Second, they practiced the CRP using the model, and they could see the inside. Third, they tried to move 10 canalith particles from the ampulla to the utricle using the model, during which they could not see the inside. Compare the number of canalith particles, which students can move from the ampulla to the utricle,...

Clinical features of mycosis in paranasal sinuses are investigated in this study. Seven patients who were pathologically diagnosed with paranasal mycosis after surgery between 1976 and 1995 are presented. Four of the 7 patients had mycosis in the maxillary sinus, 1 in the ethmoidal sinus and nasal cavity and 2 in the sphenoidal sinus. All of the cases were unilateral. Candida was pathologically confirmed only in 1 patient and aspergillus was found in the remaining 6 patients. Surgical treatment was performed on all patients and additional antifungal medicines were administered in two cases. The prognosis was good in general and only one patient who had severe diabetes mellitus died due to intracranial invasion of fungal granuloma.We concluded that the prognosis of mycosis in paranasal sinuses depends on a nearly diagnosis regardless of the invasiveness of the mycosis and that surgical treatment should be performed as soon as possible to avoid intracranial invasion. Care must be taken if the aspergillosis originates from a sphenoidal sinus, because sphenoidal mycosis seems to be more aggressive than mycosis originating from other sinuses.

The prevalence of definitively diagnosed cases of Meniere's disease (M.D.) in eastern Toyama prefecture and the Hida district of Gifu prefecture were examined. Questionnaires were sent to all ENT clinic (general practitioners) and hospitals in both areas. Prevalence was estimated as 18.3 per 100, 000 in eastern Toyama prefecture and 36.6 in the Hida. Prevalence in Hida was higher than that reported in Japan over all. There is a tendency for patients with M.D. to go to an ENT clinic not a general hospital, because M.D. does not cause death. The reasons for the high rate were suspected to be because Hida district is a relatively isolated area of medical care, and the response rate was 100%, and because we surveyed both ENT clinics and general hospitals. Few definitively diagnosed cases of M.D. were reported except in ENT departments. The results showed that a good method of evaluating the prevalence of definitively diagnosed cases of M.D. was to survey ENT departments only.

To evaluate the prevalence of definitively diagnosed cases of Meniere's disease (MD) in the West Kubiki District of Niigata Prefecture in Japan, the diagnostic data files and record-linkage system at Itoigawa General Hospital were screened to identify the local residents who were definitively diagnosed with MD between 1991 and 1994. Reevaluation of the patient's data were established according to diagnostic criteria proposed by Meniere's Disease Research Committee of Japan supported by the Ministry of Health and Welfare. Seventeen definite and 55 suspected cases were re-evaluated among 130 patients. All definitively diagnosed patients were evaluated by the ENT department. The prevalence in 1994 was estimated at 21 per 100000 population.

The present study investigated the efficacy and safety of using a lower dose of cisplatin (CDDP) in super-selective intra-arterial concurrent chemoradiotherapy (SSIACRT) to treat maxillary squamous cell carcinoma. 10 patients with maxillary squamous cell carcinoma (T3 n = 6, T4a n = 4) without regional or distant metastasis were treated by SSIACRT. The CDDP dose per course was 100 mg/body, i.e. 50-80 mg/m(2). 6-9 weeks after SSIACRT, partial maxillectomy was performed on all patients. Clinical and histological responses, survival rates, and adverse events were investigated. 10 (100%) of 10 patients achieved both clinical and pathological complete or partial remission. The 3-year overall and disease-free survival rates were 100 and 90%, respectively. Grade 3 toxicity was experienced by two patients. In conclusion, the SSIACRT regimen with a lower dose of CDDP (100 mg/body) had an equivalent therapeutic outcome and lower toxic outcome compared to a higher dose of CDDP. This regimen could be an effective and safe therapeutic modality for maxillary squamous cell carcinoma except T4b and N1/2 disease.

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.

To overcome the lack of the autografts in revision ear surgery, the usefulness of human amniotic membrane (AM) patches as a dressing substitute for fascia grafts of the temporal muscle (temporalis fascia graft) was investigated in canal wall down tympanoplasty.Retrospective chart review.In 11 ears of 11 patients, the AM was attached over the bony surface of the mastoid cavity (AM group). In 11 ears of nine patients, the temporalis fascia graft was attached over the bony surface of the mastoid cavity (fascia group). The times for graft epithelization were compared in both groups.In both groups, complete epithelization of the mastoid cavity took place in all patients. The time of epithelization in the AM group was 32 days, whereas in the fascia group it was 45 days. Complete epithelization of the AM graft was significantly faster than the fascia graft (P.05).Hyperdry AM might be a new useful dressing substitute for temporalis fascia graft due to the reduction in the epithlializing time offered by the AM in revision ear surgery.

We conclude that not all low-tone sudden deafness (SD) patients suffered from endolymphatic hydrops even if they had vertigo attack at the onset and that electrocochleography (ECochG) was a useful prognostic tool.To investigate whether low-tone SD was a precursor of Meniere's disease and whether patients with low-tone SD suffered from endolymphatic hydrops.This was a retrospective case review in the university hospital. A total of 184 patients with low-tone SD were divided into two groups with single and recurrent episodes. The progress, follow-up audiograms, and ECochG results of the patients were reviewed and compared with those of patients with high-tone SD and Meniere's disease.In all, 83 of 177 patients with low-tone SD unaccompanied by vertigo had recurrent hearing loss; 15 of the 83 developed vertiginous attacks. The remaining 94 patients had a single episode. Three of the seven patients with low-tone SD accompanied by vertigo had recurrent hearing loss; two of the three were subsequently confirmed to have Meniere's disease. The other four had a single episode. No difference in rate of progress from SD to Meniere's disease was observed among the low-tone and the high-tone SD groups. The average -SP/AP of each group with a single episode is smaller than that of other groups with recurrent episodes and Meniere's disease.

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.

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.

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.

Objective - The aim of this study was to investigate the usefulness of a Nucleus® CI24M cochlear implant in a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome. Material and methods - A 29-year-old woman with MELAS syndrome presented with sensorineural hearing loss and diabetes mellitus and underwent multichannel cochlear implantation. The follow-up period was 10 months. The case history, assessment of mitochondrial disease, indications for the cochlear implant and the benefits of cochlear implantation were evaluated. Results - Nine months after the surgery the patient could use the telephone and was quite satisfied with the improvement in communication due to the cochlear implant. Conclusion - Cochlear implantation can be recommended for patients with MELAS syndrome if they have residual retrocochlear function. Single photon emission computerized tomography was found to be very useful for evaluating retrocochlear function.