野田 昌生

BACKGROUND: Reduction of spontaneous nystagmus by fixation, a characteristic feature of peripheral nystagmus, is important for differentiating between peripheral and central vestibular disorders. In the emergency room, Frenzel goggles are recommended to observe spontaneous nystagmus for the differential diagnosis of acute vestibular syndrome. We developed a portable loupe with a Fresnel lens to observe nystagmus. The loupe does not require power supply and can be used under ceiling lights. The aim of this study was to quantitatively and objectively compare the abilities of the loupe and conventional Frenzel goggles to observe spontaneous nystagmus and to verify that the loupe can detect peripheral nystagmus that cannot be observed with the naked eye. METHODS: Visual impact susceptibility was compared between the loupe and Frenzel goggles using the slow-phase velocity of nystagmus induced by the caloric test in 15 participants. Subsequently, under lighting, the nystagmus observations under the naked eye condition and with the use of the loupe were compared. Furthermore, the visibility of nystagmus was evaluated from recorded videographic images. RESULTS: In observations of nystagmus induced by the caloric test, the visual impact of the loupe was not inferior to that of Frenzel goggles. The mean slow-phase velocity of nystagmus recorded with the loupe was significantly higher than that observed with the naked eye. Nystagmus weakened under bright lighting could be recovered by the loupe as fixation was blocked and the direction of the nystagmus could be defined. CONCLUSIONS: The results showed that the loupe is helpful in observing nystagmus, which is weakly observed with the naked eye under bright light. This portable, low-cost loupe, which yields superior results, can serve as an alternative to conventional Frenzel goggles in emergency medical settings where rapid assessment is required.

Lifestyle-related diseases, such as diabetes, are mostly caused by poor lifestyle habits; therefore, modifying these habits is important. In Japan, a system of specific health checkups (SHC) and specific health guidance (SHG) was introduced in 2008. The challenges faced include low retention rates and difficulty in maintaining results. Digital technologies can support self-management and increase patient convenience, although evidence of the usefulness of this technology for SHG is limited. This study evaluated the usefulness of nutritional guidance using a smartphone application (app) added to conventional SHG. We recruited eligible participants for SHG in Japan from November 2018 to March 2020. We assigned them to "Intervention Group: Application-Supported Nutrition Therapy" or "Control Group: Human Nutrition Therapy" based on their desire to use the app. The primary outcome was a change in non-high-density lipoprotein cholesterol (non-HDL-C) levels post-intervention. The secondary outcomes were a change in lipid profile, metabolic indices, and frequency of logins to the app. We assessed 109 participants in two cohorts: 3-month (short-term) and 6-month (long-term). The short-term cohort had 23 intervention and 29 control participants, while the long-term cohort had 35 and 22, respectively. There was a significant improvement in non-HDL-C levels in the short-term intervention group compared to the control group. There was no significant difference in non-HDL-C levels in the long-term groups or at 1 year. There were significant improvements in body weight (BW) in the short-term cohort until 1 year compared within the groups. The retention rate remained high in the short-term cohort (92%) but decreased to 57.8% at 6 months in the long-term cohort. Using an app system to facilitate dietary recordings and guidance for patients at risk of lifestyle-related diseases led to improved lipid levels and BW. These benefits persisted to some extent after 1 year. This app may partially supplement conventional SHG.

The intricate distribution of the facial nerve within the temporal bone is crucial in otological surgery. Anomalous facial nerve pathways are occasionally observed in middle ear malformations, although intra-tympanic bifurcation of the facial nerve is rare. When managing ossicular malformations with atypical facial nerve trajectories, hearing reconstruction should be prioritized based on the trajectory pattern and presence of the oval window. In this case, stapes surgery was performed due to facial nerve bifurcation within the tympanic cavity. In this case report, a 15-year-old female underwent stapes surgery due to gradually worsening conductive hearing loss. She was monitored at another hospital because of left-sided hearing loss at birth screening using automated auditory brainstem response. Her left ear initially had mild hearing loss, while her right ear remained within normal limits. However, her hearing deteriorated progressively, leading to significant daily challenges by age seven, prompting referral to our hospital. Intraoperatively, findings included defects in the incus-long process and stapes head, along with facial nerve bifurcation around the oval window, and the stapes footplate had poor flexibility. Stapedotomy was performed cautiously to preserve the facial nerve, utilizing a Teflon piston wire for sound transmission reconstruction. Postoperatively, the patient experienced no complications or facial nerve palsy, with hearing improving to 28.8 dB. Understanding the precise pathophysiology of middle ear anomalies is crucial for selecting appropriate surgical approaches. Even though the anomalies could not be evaluated prior to surgery, surgeons must carefully consider the risk of facial nerve injury and choose the optimal technique and reconstruction method tailored to each case, as predicting outcomes solely from preoperative evaluations can be challenging.