Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.anl.2022.01.009

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES/HYPOTHESIS: To determine the relationship between signal intensity on gadolinium (Gd)-enhanced magnetic resonance images and growth of vestibular schwannomas (VSs). STUDY DESIGN: Cross-sectional study. METHODS: In this cross-sectional study, we retrospectively reviewed the data of 31 patients with VSs who underwent magnetic resonance imaging (MRI). The mean signal intensities within the regions of interest in the tumor, pons, and temporal muscles were measured on Gd-enhanced T1-weighted MRI. Relative intensity ratios were calculated as follows: T/N pons ratio (T/Np) is the tumor signal intensity/pons signal intensity and T/N muscle ratio (T/Nm) is the tumor signal intensity/temporal muscle signal intensity. Volume measurements were used to assess the tumor size. Growth rate was determined by assessing previous imaging studies. Growing VS was defined as a tumor with a growth rate >100 mm3 /year. RESULTS: The mean (standard deviation) T/Np and T/Nm were 1.47 (0.27) and 1.50 (0.24), respectively, in nongrowing tumors and 1.78 (0.17) and 1.90 (0.12), respectively, in growing tumors. The T/Np and T/Nm differed significantly between the two groups (T/Np, P < .001; T/Nm, P < .001). Receiver operating characteristic curve analysis showed that cutoffs of 1.56 and 1.76 for T/Np (93.33% sensitivity, 75.00% specificity) and T/Nm (100.00% sensitivity, 93.75% specificity), respectively, could be used to diagnose a growth rate of >100 mm3 /year. The area under the curve was 0.85 (95% confidence interval, 0.70-1.00) for T/Np and 0.94 (0.82-1.00) for T/Nm. CONCLUSION: Growing VSs show higher signal intensities on Gd-enhanced MRI. Thus, measuring the signal intensity of VS on Gd-enhanced MRI may aid in predicting VS growth. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:198-203, 2022.

DOI： 10.1002/lary.29834

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.archger.2021.104502

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：NLM (Medline)  

HYPOTHESIS: We investigated the treatment effect of intratympanic insulin-like growth factor-1 (IGF-1) on severe facial paralysis in guinea pigs. BACKGROUND: The use of regenerative medicine involving growth factors has been reported in the treatment of peripheral nerve diseases. IGF-1 plays a crucial role in nerve regeneration. METHODS: We performed the following procedures on guinea pigs. In the normal group (n = 7), no procedure was performed. In the saline (n = 7) and IGF-1 (n = 7) groups, facial paralysis was induced by freezing of the facial canal. Subsequently, in the saline and IGF-1 groups, a gelatin hydrogel impregnated with 100 μL saline and 400 μg/100 μL IGF-1, respectively, was placed in the facial canal. Facial nerve functions were evaluated using three test batteries: facial movement observation, electrophysiological testing, and histological assessment. RESULTS: At 10 weeks postoperatively, the facial movement scores for the IGF-1 group were improved compared to those in the saline group. The conductive velocity was significantly faster in the IGF-1 group than in the saline group. There was a significant between-group difference in the nerve fiber number and myelin thickness. CONCLUSION: Intratympanic IGF-1 administration improved facial nerve regeneration. This novel method could provide prompt ambulatory regenerative treatment and reduce the incidence of poor recovery in patients with severe facial paralysis.

DOI： 10.1097/MAO.0000000000003263

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The concept of otitis media with ANCA-associated vasculitis (OMAAV) was recently proposed by the study group of the Japan Otological Society. However, little is known about the effect of ear involvement on the clinical features and prognosis of AAV. We investigate this issue in this study. METHODS: We retrospectively examined 36 patients diagnosed with OMAAV and 44 patients diagnosed with AAV without ear involvement (non-OMAAV) at Ehime University Hospital from 2013 to 2018. We collected serological findings including ANCA type and titer, C-reactive protein (CRP), serum creatinine level, organ involved at initial diagnosis, treatment, remission, disease relapse, and mortality from medical records. We investigated whether clinical features and outcomes differed between the OMAAV and non-OMAAV groups. RESULTS: Age, ANCA titer, and CRP at initial diagnosis were not significantly different between the two groups, and the rate of intravenous cyclophosphamide (IVCY) use also did not differ. The proportions of patients with concurrent eye involvement, facial palsy (FP), and hypertrophic pachymeningitis (HCP) were significantly higher in the OMAAV than in the non-OMAAV group (p = 0.005, 0.005 and 0.049, respectively), while both renal and peripheral nerve involvement were significantly less common in OMAAV patients (p = 0.04). Among the 30 patients with renal involvement, serum creatinine level at diagnosis was significantly lower in the OMAAV group (p = 0.04). The mortality rate was 8.3% in OMAAV and 6.8% in non-OMAAV cases, but this difference was not significant. The rate of relapse was 33.3% in OMAAV and 13.6% in non-OMAAV cases; this difference was significant (p = 0.04). CONCLUSIONS: Serological measurements of disease activity did not differ between the groups. Eye involvement, FP, and HCP, however, were significantly more common in AAV with ear involvement. In addition, renal involvement was less common and renal impairment was milder in AAV with ear involvement. These findings can be considered clinical features. The relapse rate was significantly higher in AAV with ear involvement.

DOI： 10.1016/j.anl.2021.01.023

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ireland Ltd  

Objective: Some cases of peripheral facial paralysis are resistant to treatment, thus, a non-recovery model of facial paralysis is needed to develop new treatment strategies for this condition. The purpose of the current study was to develop an animal model of which facial palsy was severe and prolonged. Methods: Ten 8-week-old female Hartley guinea pigs weighing between 400 and 500 g were used for the animal model. The vertical segment of the facial canal was accessed via the otic bulla, without removing the bony wall of the facial canal. The canal was then frozen for 5 s using freeze spray. Facial movements, electroneurography (ENoG), histology, and changes in temperature were evaluated. Results: All animals exhibited complete facial paralysis immediately after the procedure and recovered gradually, however, not all of them had recovered completely 15 weeks after freezing. The ENoG values one week after freezing for all animals (10/10) were 0%. Histological examination one week after freezing revealed that most of the vertically placed myelinated nerve fibers which had been frozen were remarkably affected and denatured. The number of vertically placed myelinated nerve fibers increased 15 weeks after freezing, but the nerve fibers were smaller than normal nerve fibers and were distorted in shape. Conclusion: Complete facial paralysis was induced in Hartley guinea pigs by freezing the facial canal. The behavioral, ENoG, and histopathological data suggest that the facial paralysis was severe and prolonged. This model may assist in developing novel treatment for severe facial palsy and facilitate basic research on facial nerve regeneration.

DOI： 10.1016/j.anl.2020.03.012

Scopus

PubMed

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.anl.2020.09.004

researchmap

Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1038/s41440-020-0444-y

researchmap

Other Link： http://www.nature.com/articles/s41440-020-0444-y

Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/aud.0000000000000773

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES/HYPOTHESIS: Epidemiological information regarding the relationship between household income and education and hearing impairment (HI) is limited. The present cross-sectional study investigated this issue in Japan. STUDY DESIGN: Cross-sectional investigation. METHODS: Study subjects were 371 men and 639 women aged 36 to 84 years. A self-administered questionnaire was used. Audiological assessment was performed by pure-tone audiometry. HI was defined as present in subjects who did not respond to a pure-tone average of >25 dB HL in the better hearing ear according to the World Health Organization standard. Adjustment was made for age, smoking status, alcohol consumption, hypertension, dyslipidemia, diabetes mellitus, and body mass index. RESULTS: The prevalence of HI was 31.5% in 371 men and 20.8% in 639 women. In men, a slight inverted J-shaped association was observed between household income and HI, compared with a household income of <3 million yen per year. A household income of 3 to 5 million yen, but not of 5 million yen or more, was independently inversely associated with the prevalence of HI; the prevalence ratio for 3 to 5million yen was 0.73 (95% confidence interval: 0.54-0.999). After adjustment for confounding factors, no relationship was found between household income and the prevalence of HI in women. There were no associations between educational level and the prevalence of HI in either men or women in the multivariate model. CONCLUSIONS: Our results suggest that medium, but not high, household income may be associated with a lower prevalence of HI only in men. LEVEL OF EVIDENCE: 2b Laryngoscope, 129:2153-2157, 2019.

DOI： 10.1002/lary.27758

PubMed

researchmap

Language：English  

OBJECTIVE: To investigate treatment outcomes, hearing outcomes, and adverse effects of rituximab (RTX) for intractable otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV). METHODS: Twenty-three patients who met the criteria proposed by the OMAAV study group were included. RTX was used for patients who had difficulty achieving induction of remission using glucocorticoids (GC) and intravenous cyclophosphamide (IVCY). RESULTS: Six patients were treated with RTX (RTX group), while 17 patients did not require RTX for induction of remission (non-RTX group). All six patients in the RTX group achieved remission. Age, sex, and months from onset to diagnosis did not differ significantly between the groups. The air-conduction hearing thresholds at diagnosis and remission were 71.7±6.3dB and 50.1±5.1dB in the RTX group, and 56.8±4.8dB and 35.8±4.8dB in the non-RTX group, respectively. Hearing level at remission was significantly better in the non-RTX group (p<0.05), while hearing gain did not differ significantly between the groups. Infectious complications were similar between the groups. CONCLUSIONS: Our findings suggest that RTX is effective and safe for intractable OMAAV patients who have a poor response to GC and IVCY.

DOI： 10.1016/j.anl.2018.05.011

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Audiological Society  

DOI： 10.4295/audiology.61.423

researchmap

DOI： 10.5152/iao.2018.4746

PubMed

researchmap

DOI： 10.1016/j.exger.2017.12.027

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ireland Ltd  

Objective: In the assessment of chronic otitis media (COM) and its treatment, patient-reported outcomes are becoming increasingly important. The aim of the present study was to translate and validate the Zurich chronic middle ear inventory (ZCMEI-21) in Japanese in order to provide the first Japanese-language instrument for measuring health-related quality of life (HRQoL) in COM. Methods: The ZCMEI-21 was translated into Japanese according to published guidelines. In order to assess validity, the ZCMEI-21-Jap total score was compared to a question directly addressing HRQoL as well as the five-level version of the EQ-5D questionnaire, a generic measure of HRQoL. Results: Demographic data and validity were assessed in a total of 91 COM patients. The ZCMEI-21-Jap total and subscale scores were well comparable to those of the original validation study. Cronbach's α of the ZCMEI-21-Jap was 0.85, indicating an excellent internal consistency. The ZCMEI-21-Jap total score showed a strong correlation (r = 0.68, p &lt
0.0001) to the question directly addressing HRQoL and, as expected, only a moderate correlation to the EQ-5D scores (r = 0.49, p &lt
0.0001 for descriptive system score and r = 0.44, p &lt
0.0001 for VAS score). Conclusion: We successfully translated the ZCMEI-21 into Japanese and were able to obtain sufficient information during the validation process for the use of the ZCMEI-21-Jap to quantify HRQoL in patients with COM. With the current study, we aim to take a step forward towards an international standardization of reporting HRQoL in COM.

DOI： 10.1016/j.anl.2018.05.008

Scopus

PubMed

researchmap

Language：English   Publisher：Lippincott Williams and Wilkins  

Objective: To investigate differences in immune activity based on the presence of multiple organ involvement in patients with antineutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV) and whether hearing outcomes are different between patients with AAV localized to the ear and patients with systemic AAV. Study Design: Retrospective case review. Setting: University hospital. Patients: Twenty patients with otitis media with AAV (OMAAV) who met the criteria proposed by the OMAAV study group in Japan. Main Outcome Measure(s): Serum levels of C-reactive protein, ANCA titer, soluble interleukin-2 receptor levels, and hearing outcome. Results: Thirteen patients had disease involvement of organs other than the ear (systemic OMAAV group)
involvement was localized to the ear in seven patients (localized OMAAV group). Serum levels of C-reactive protein, ANCA titer, and soluble interleukin-2 receptor were not significantly different between the groups. Hearing levels at diagnosis and in remission were significantly worse in the localized OMAAV group compared with the systemic OMAAV group. Hearing gain was not significantly different between groups. Conclusion: It is suggested that immune activity in patients with AAV localized to the ear is equivalent to activity in patients with systemic AAV. Therefore, we may need treatment for OMAAV equal in intensity to that for systemic AAV. As the hearing level at diagnosis was worse in patients with AAV localized to the ear than in patients with systemic AAV, earlier diagnosis may be needed to improve hearing outcome.

DOI： 10.1097/MAO.0000000000001563

Scopus

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：INFORMA HEALTHCARE  

Conclusion: Gene analysis of facial muscle may be a promising way to detect denervation of facial muscle, helping to determine the prognosis of a facial palsy early in its progression. Objectives: In the treatment of intratemporal facial palsy, early diagnosis of neural damage is important in deciding about therapeutic modalities. In this study, we investigated the relationship between the severity of facial palsy and the level of myogenin expressed in the facial muscle. Methods: The animals were divided into two groups, depending on whether the facial nerve was resected or compressed. Expression of myogenin mRNAwas examined using real-time PCR and in situ hybridization of the facial muscle following the nerve damage. Results: Increased expression of myogenin was observed in the nerve resection group, while no such increase was seen in the nerve compression group. In situ hybridization indicated that myogenin was expressed exclusively in satellite cells around the denervated muscle fibers.

DOI： 10.3109/00016489.2011.653671

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE PUBLICATIONS LTD  

Objective. Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. The aim of this study was to evaluate the regeneration-facilitating effects of novel facial nerve decompression surgery using bFGF in a gelatin hydrogel in patients with severe Bell palsy.
Study Design. Prospective clinical study.
Setting. Tertiary referral center.
Subjects and Methods. Twenty patients with Bell palsy after more than 2 weeks following the onset of severe paralysis were treated with the new procedure. The facial nerve was decompressed between tympanic and mastoid segments via the mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated by the House-Brackmann (H-B) grading system. The outcomes were compared with the authors' previous study, which reported outcomes of the patients who underwent conventional decompression surgery (n = 58) or conservative treatment (n = 43).
Results. The complete recovery (H-B grade 1) rate of the novel surgery (75.0%) was significantly better than the rate of conventional surgery (44.8%) and conservative treatment (23.3%). Every patient in the novel decompression surgery group improved to H-B grade 2 or better even when undergone between 31 and 99 days after onset.
Conclusion. Advantages of this decompression surgery are low risk of complications and long effective period after onset of the paralysis. To the authors' knowledge, this is the first clinical report of the efficacy of bFGF using a new drug delivery system in patients with severe Bell palsy.

DOI： 10.1177/0194599811431661

Web of Science

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS AS  

Conclusion. Topical application of basic fibroblast growth factor (bFGF) hydrogel facilitates faster healing from traumatic facial paralysis due to continuous release of bFGF. Objectives. bFGF is considered a potent agent to facilitate recovery from neuronal damage, however, exogenously applied bFGF does not work well because of its short acting time. To enhance the effects in vivo, we developed a new drug delivery system by embedding bFGF in a gelatin hydrogel that degrades slowly. In this study, the effects of bFGF-hydrogel on traumatic facial nerve paralysis were investigated in guinea pigs. Methods. The intratemporal facial nerve was exposed and clamped at the vertical portion using micro needle forceps. The animals were then subjected to one of the following three procedures: group A, no further treatment; group B, one-shot application of bFGF to the nerve; and group C, application of bFGF-hydrogel instead. Six weeks later, facial nerve functions were evaluated by three test batteries: observation of facial movements, electrophysiological testing, and histological study. Results. The results for groups A and B were similar in the three tests, indicating that one-shot application of bFGF did not benefit facial nerve recovery. In contrast, group C achieved better results in all tests.

DOI： 10.3109/00016480902896139

Web of Science

PubMed

researchmap

Language：English   Publisher：INFORMA HEALTHCARE  

Despite recent evidence suggesting that Bell's palsy is associated with reactivation of alfa-herpes viruses, the disease has been treated empirically, and the use of valacyclovir has not been definitively established. In 2007, two prospective, randomised, placebo-controlled trials evaluating valacyclovir were reported in patients with Bell's palsy. One demonstrated that valacyclovir/prednisolone therapy was statistically more effective than placebo/prednisolone therapy in improving the recovery of patients with Bell's palsy, excluding zoster sine herpete. However, considering the cost-benefit ratio of this treatment and the limitations of virological diagnoses, we recommend that valacyclovir should be used in cases of severe palsy within 3 days after the onset of Bell's palsy.

DOI： 10.1517/14656560802365447

Web of Science

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Society of Practical Otolaryngology  

The goal of surgical treatment for benign parotid gland tumors is to remove the mass completely without causing facial nerve palsy. In recent years, limited parotidectomy is becoming a new standard procedure for benign tumors, replacing superficial parotidectomy, and excellent results equal to the old procedure are being reported. This study evaluates the postoperative results of 59 benign parotid tumors treated surgically between 1991 and 2001, then determined whether limited parotidectomy can become the new standard of surgical management for benign parotid tumor. In 39 of the 59 patients, we investigated the frequency of local recurrence, Prey's syndrome and facial palsy. The histopathological diagnosis was pleomorphic adenoma in 17, Warthin's tumor in 15 and miscellaneous tumor including cyst, lymphoepithelial lesion or other lesions in 7, respectively. Twenty-one patients underwent partial parotidectomy, 10 enucleation and 8 superficial parotidectomy, respectively. The postoperative follow-up duration ranged from 3 to 14 years with an average of 7.54 years. According to the results of this follow-up study, there was no recurrence with each surgical procedure. Frey's syndrome did not occur in any patient after partial parotidectomy compared to that in 3 patients (37.5%) after superficial parotidectomy. Four patients (19.0%) temporarily experienced in some degree of facial nerve weakness after partial parotidectomy. From these results, partial parotidectomy is thought to be a new trend in the surgical treatment of benign parotid tumor.

DOI： 10.5631/jibirin.99.445

Scopus

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Equilibrium Research  

Bow hunter's stroke is vertebrobasilar insufficiency caused by stenosis of vertebral artery (VA) at the atlantoaxial level by head rotation. A 52-year-old man complained of dizziness during head rotation towards the right. Downbeat nystagmus was noted when his neck was rotated to the right. MRI demonstrated hypoplasia of the right VA. Angiography revealed the right hypoplastic VA ending at the posterior inferior cerebellar artery. The left VA was dominant and had normal flow with the head in the neutral position. Head turning to the right caused complete occlusion of the right VA at the level of the atlas and the patient felt dizziness. Surgical therapy was not performed because he did not agree to the operation.

DOI： 10.3757/jser.64.233

Scopus

researchmap

Language：Japanese   Publisher：The Society of Practical Otolaryngology  

A 17-year-old female with right deafness developed sudden left hearing loss without vertigo. She admitted to our hospital with an idiopathic fever that persisted for 3 months. Sensory hearing loss on both sides and inflammation shown on immunological blood examination were noted on admission. We pointed out differences in blood pressure between the radial artery and femoral artery. Magnetic resonance imaging and computed tomography showed complete occlusion of the left carotid artery with some calcification. We considered that hearing loss in this case might be associated with aortitis syndrome and continuous steroid therapy was administered. Physical findings and hearing were improved gradually.

DOI： 10.5631/jibirin.96.859

CiNii Books

researchmap

Other Link： https://jlc.jst.go.jp/DN/JALC/00232402764?from=CiNii

Language：Japanese   Publisher：(株)東京医学社  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01814&link_issn=&doc_id=20220318150006&doc_link_id=%2Faq9johne%2F2022%2F003804%2F006%2F0387-0389%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9johne%2F2022%2F003804%2F006%2F0387-0389%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)東京医学社  

researchmap

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01814&link_issn=&doc_id=20211018050012&doc_link_id=%2Faq9johne%2F2021%2F003711%2F012%2F1445-1446%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9johne%2F2021%2F003711%2F012%2F1445-1446%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：Oto-Rhino-Laryngological Society of Japan Inc.  

DOI： 10.3950/jibiinkoka.123.177

Scopus

researchmap

Language：Japanese   Publisher：日本顔面神経学会  

顔面神経麻痺の診断には現在、柳原法やHouse-Brackmann法などが用いられているが、これらの方法は、評価を行う医師の視覚と経験によって判断されているため、同じ所見でも医師によって評価結果に違いが生じてしまう。近年、人工知能の分野で人の脳神経回路を模したNeural Networkを発展させたConvolution Neural Network(CNN)を用いるDeep Learning(DL)が注目されている。著者等はCNNを用いたDLを利用することで医師の視覚や経験に依存しない診断方法を開発することを目的に研究を行った。当科で顔面神経麻痺と診断された患者のうち治療前後に顔表情の動画を撮影できた患者を対象とし、柳原法の点数が8点以下(高度麻痺)、10〜18点(中等度麻痺)、20点以上(軽度麻痺)の3段階に分類した症例の画像をDLに学習させて最適な重みパラメータを求めた。検証のために各段階から1症例を検証用データとして学習から除き、学習によって求められた重みパラメータを用いて、検証用データをDLに診断させ、DLの精度を評価した。その結果、DL型人工知能を用いれば麻痺の重症度評価がある程度可能なことが明らかになった。

researchmap

Language：Japanese   Publisher：(一社)日本聴覚医学会  

researchmap

Language：Japanese   Publisher：(一社)日本耳科学会  

researchmap

Language：Japanese   Publisher：(一社)日本耳科学会  

researchmap

Language：Japanese   Publisher：(一社)日本耳科学会  

researchmap

Language：Japanese   Publisher：(一社)日本聴覚医学会  

researchmap

Language：Japanese   Publisher：(一社)日本聴覚医学会  

researchmap

Language：Japanese   Publisher：日本小児耳鼻咽喉科学会  

researchmap

Language：Japanese   Publisher：愛媛医学会  

目的:乳幼児の聴覚障害は、言語発達、学習、心理面、コミュニケーションなどに大きな影響を及ぼすとされ、早期発見および早期対応が重要とされている。今回、愛媛県における難聴児の早期発見、療育介入の現況を調査したので報告する。方法:2005年4月から2015年3月の10年間に、難聴精査のために愛媛県身体障害者福祉センターを受診した7歳未満の未就学児512例を対象とした。これらの512例に対して、他覚的聴力検査(ABR、ASSR)を中心に精密聴力検査を行い、聴力を推定した。さらに、補聴器による療育開始年齢、新生児聴覚スクリーニング検査陽性児の精密聴力検査結果、愛媛県内の療育機関の状況について後ろ向きに検討した。結果:未就学児512例に対して精密聴力検査を行った結果、両側難聴は174例(34%)、一側性難聴は41例(8%)、健常聴力は281例(55%)、その他16例(3%)であった。補聴器による療育介入に関しては、10年間の集計期間において補聴器装用開始が早くなっており、早期発見、早期対応の傾向がみられた。新生児聴覚スクリーニング検査で要精査となり、受診した児の10年間の年平均は7.4人、受診者全体に対する聴覚スクリーニング陽性児の割合は平均14.2%であった。両者は徐々に増加傾向がみられた。新生児聴覚スクリーニング検査要精査児51例の精密聴力検査結果は重度難聴13例(25.5%)、高度難聴10例(20.0%)、中等度難聴10例(20.0%)、軽度難聴6例(11.8%)、一側性難聴5例(9.8%)、健常聴力7例(13.7%)であった。結論:愛媛県では小児難聴の診療に関して、診断、治療、療育と一連のプロセスが確立している点が評価できた。今後も早期発見、早期対応や充実した支援体制を目指し、新生児聴覚スクリーニング検査のさらなる普及、公的補助の改善が必要と思われた。(著者抄録)

researchmap

Language：Japanese   Publisher：(一社)日本耳科学会  

researchmap

Language：Japanese   Publisher：(株)東京医学社  

researchmap

Language：Japanese   Publisher：市立宇和島病院生活協同組合  

researchmap

Language：Japanese   Publisher：日本顔面神経学会  

高度に変性にした顔面神経麻痺では、通常の治療を行っても十分な神経再生が得られず後遺障害を生じる場合が多い。このような症例の予後改善には、神経障害部位の軸索伸長および再髄鞘化を促すことが重要であり、再生医療のターゲットとなり得る。著者等は、顔面神経に徐放化栄養因子を投与する再生促進治療を行っており、良好な成績が得られているので報告した。この新しい顔面神経減荷手術は、1)神経再生を促進、2)発症2週以降でも適応、3)低侵襲な手術手技、4)合併症の軽減、をコンセプトとしており、普遍的な治療となる可能性を持っている。これまでに高度Bell麻痺20例に施行し、治療成績は、House-Brackmann法におけるグレード1または2への回復率が95%(19例)であり、従来の治療法施行例に比べて有意に高かった。

researchmap

Language：Japanese   Publisher：日本顔面神経学会  

最近Bell麻痺の病態として単純ヘルペスウイルス1型(HSV-1)の関与が明らかにされた。ウイルス同定が左右個々に施行可能な耳介や涙液などの検体からはHSV-1が健側からも検出されており、Bell麻痺患者では両側性にHSV-1の再活性化が生じている可能性が指摘されている。そこで今回、その可能性について、健側電気味覚閾値の観点から検討した。対象は、過去35年間に当科受診したBell麻痺患者のうち初診時に電気味覚検査を施行された595例とし、健常コントロール群として中里らの「健康人の電気味覚検査」のデータを使用した。検討の結果、健常コントロール群と比較してBell麻痺群では患側のみならず健側の味覚閾値も有意に上昇しており、両側性HSV-1再活性化が示唆された。このことから、Bell麻痺患者の電気味覚検査においては従来の左右差に基づく診断基準を見直す必要があると考えられた。

researchmap

Language：Japanese  

CiNii Books

researchmap

Language：Japanese   Publisher：日本顔面神経学会  

顔面表情筋の運動スコア(柳原法)が8/40以下の高度麻痺で、電気生理学的に高度脱神経を認めた20歳以上の21例を対象に、徐放化栄養因子を用いた顔面神経減荷手術を施行した。対象に対し経乳突的顔面神経減荷手術を施行し、露出された顔面神経周囲にbasic fibroblast growth factor(bFGF)添加ゼラチンハイドロゲルを留置して神経再生を誘導した。21例のうち、6ヵ月以上経過観察が可能であった16例について顔面神経麻痺の予後を検討した結果、House-Brackmann法のGrade IとIIへの治癒率は87.5%であった。以前に当科で行った従来法による減荷手術との比較では、徐放化bFGFを用いた減荷手術の方が予後良好であったが有意差はなかった。また、同程度の高度麻痺で保存治療を行った群との比較では、徐放化bFGFを用いた減荷手術群の方が有意に予後良好であった。

researchmap

Language：Japanese   Publisher：日本顔面神経学会  

約30年間に受診した末梢性顔面神経麻痺症例の発症早期の味覚機能について検討した。対象は発症後7日以内に受診し、電気味覚検査を行ったBell麻痺671例、Hunt症候群133例であり、電気味覚検査における健患側の閾値差により重症度分類を行い、味覚機能障害と原因疾患、顔面神経麻痺の程度・予後との関連を調査した。その結果、Bell麻痺では味覚障害の有無と顔面神経麻痺の程度や予後との関連はみられなかったが、Hunt症候群では味覚障害の程度が強いほど、非治癒例の割合が高く、味覚機能高度障害例は味覚機能正常例に比べて有意に予後不良であった。顔面神経麻痺の予後判定は種々の検査法を総合的に判断することが重要であるが、味覚機能検査がHunt症候群の予後診断の一助となる可能性が示唆された。

researchmap

Language：Japanese   Publisher：日本顔面神経学会  

麻痺発症から4ヵ月以上後にリハビリテーションを開始した高度顔面神経麻痺患者5名(平均53.8歳)を対象として、リハビリテーション前後のQOLの変化をFacial Clinimetric Evaluation Scale(FaCE Scale)を用いて評価した。原因疾患はBell麻痺3例、Hunt症候群1例、外傷性1例であり、FaCE Scaleのアンケート項目を各分野別に分けて調査した結果、リハビリテーション後は社会活動や食事摂取の分野で変化がみられ、顔面神経麻痺患者の日常生活動作や心理的側面が改善されていることが示唆された。また、FaCE ScaleでのQOL改善とともに柳原法での機能的回復も認められた。FaCE Scaleは患者の心理的側面を含め多面的に評価でき、簡便なアンケートで後遺症程度を定量的に判定可能であった。

researchmap

Language：Japanese   Publisher：愛媛医学会  

10週齢雄性ウイスター系ラット8匹を用い、神経切断・挫滅の2種類(各4匹)の顔面神経麻痺モデルを作製し、顔面表情筋にみられるRNA発現の変化について検討した。神経切断モデル(切断群)、神経挫滅モデル(挫滅群)の両群とも眼瞼やヒゲの動きが消失し、完全麻痺を呈した。切断群では28日を過ぎても表情運動が回復しなかったのに対し、挫滅群は10日目頃より徐々に表情運動が回復し17.6±2.8日で治癒に至った。処置後1週目のENoG値は切断群で0%、挫滅群で5.8±2.4%であった。臨床的にはENoG値10%以下は高度麻痺と診断されることから両群とも高度麻痺と評価した。切断群ではMyog、Vamp2、Igfbp6という三つのRNAが挫滅群と比べ有意に増加し、神経障害後の早期の病態診断への応用の可能性が示された。

researchmap

Language：Japanese   Publisher：(一社)日本聴覚医学会  

小児のASSR閾値と幼児聴力検査およびABR検査の結果とを比較し、ASSRの他覚的聴力検査としての有用性について検討した。平成17年3月から平成20年8月にASSRを施行した難聴児39例(0〜75ヵ月)を対象とし、1)ASSR閾値と幼児聴力検査閾値との相関、2)ABR両側無反応例のASSR閾値の2項目について検討した。いずれも幼児聴力検査閾値に比べASSR閾値のほうが15〜22dB高く、全周波数で有意な相関がみられた。ABR両側105dB無反応でASSRを施行した10症例では、全例にASSRの反応がみられ、特に500,1kHzでは半数以上で反応がみられた。以上の結果より、ASSRはオージオグラムの推定や重度難聴の評価への有用性であること示唆された。一方、ASSR閾値と幼児聴力検査閾値が乖離する例があり、難聴の診断においては従来の検査法の結果と合わせて総合的に判断することが肝要である。(著者抄録)

DOI： 10.4295/audiology.52.112

researchmap

Language：Japanese   Publisher：Society of Practical Otolaryngology  

Some facial palsy patients develop bilateral and/or recurrent facial palsy. To clarify the characteristic of bilateral and recurrent facial palsy, we retrospectively investigated 193 patients with bilateral and recurrent facial palsy in the 3385 patients who were treated for facial palsy during the past 3 decades. Among the 193 cases, 62 patients had ipsilateral recurrent palsy, 25 patients had bilateral simultaneous palsy, 88 patients had bilateral alternative palsy, and 18 patients had bilateral recurrent palsy. The major cause of palsy was Bell's palsy, and it accounted for 84. 5 % (163/193). Traumatic palsy, Guillain-Barré syndrome and facial schwannoma were rare, with rates below 3%. Therefore, the 163 patients with Bell's palsy were further investigated, and the following characteristic were found. (1) Patients with bilateral alternative palsy were more frequently associated with diabetes mellitus and hypertension, and patients with bilateral recurrent palsy were more frequently associated with diabetes mellitus than patients who had a single ipsilateral palsy. (2) The age at the first episode in patients with bilateral recurrent palsy and ipsilateral recurrent palsy was significantly younger than that in those without recurrent palsy.

DOI： 10.5631/jibirin.102.191

Scopus

researchmap

Language：Japanese  

researchmap

Language：Japanese  

CiNii Books

researchmap

Language：Japanese  

researchmap