2021/06/24 更新

写真a

モリタ ユカ
森田 由香
MORITA Yuka
所属
医歯学総合病院 耳鼻咽喉・頭頸部外科 講師
職名
講師
外部リンク

学位

  • 医学博士 ( 2007年3月   新潟大学 )

研究キーワード

  • 加齢性難聴

  • 難治性中耳炎

  • 中耳真珠腫

  • 側頭骨手術

研究分野

  • ライフサイエンス / 耳鼻咽喉科学  / 難治性中耳炎 側頭骨手術 加齢性難聴

経歴

  • 新潟大学   医歯学総合病院 耳鼻咽喉・頭頸部外科   講師

    2016年1月 - 現在

  • 新潟大学   医歯学総合病院 耳鼻咽喉・頭頸部外科   助教

    2012年11月 - 2015年12月

  • 新潟大学   耳鼻咽喉科   助教

    2011年4月 - 2012年11月

学歴

  • 新潟大学大学院医歯学総合研究科   生体機能調節医学専攻感覚統合医学大講座耳鼻咽喉科・頭頸部外科学

    2003年4月 - 2007年3月

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  • 新潟大学   医学部

    1992年4月 - 1998年3月

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所属学協会

  • 日本耳科学会

    2001年5月 - 現在

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  • 日本耳鼻咽喉科学会

    1998年5月 - 現在

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  • 日本頭頸部外科学会

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  • 日本めまい平衡医学会

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論文

  • Nationwide survey of middle ear cholesteatoma surgery cases in Japan: Results from the Japan Otological society registry using the JOS staging and classification system. 国際誌

    Manabu Komori, Yuka Morita, Tetsuya Tono, Keiji Matsuda, Yutaka Yamamoto, Masafumi Sakagami, Naohito Hato, Hiromi Kojima, Haruo Takahashi

    Auris, nasus, larynx48 ( 4 ) 555 - 564   2021年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: This study was aimed to determine the characteristics of middle ear cholesteatoma and to investigate short-term outcomes regarding the rates of residual and recurrent cholesteatoma and the postoperative hearing results in Japan, via a nationwide survey using staging and classification criteria for middle ear cholesteatoma, as proposed by the Japan Otological Society (JOS). METHODS: The first-round survey was conducted in 2016. The target was patients with middle ear cholesteatoma who were surgically treated in Japan between January and December 2015. Medical information on the patients was anonymized. The questionnaire entries were age, sex, cholesteatoma classification and stage, preoperative hearing level, mastoid development, status of the stapes, and surgical method. There were a total of 1,787 registered patients from 74 facilities from all over Japan. The second survey was conducted in January 2018 and received 1,456 responses from 49 facilities in Japan. Of the 1,456 cases, 1,060 were conducted in the postoperative hearing survey and 1,084 in the residual recurrence survey. RESULTS: The most common cholesteatoma type was pars flaccida cholesteatoma (63.3%), followed by pars tensa cholesteatoma (13.0%), congenital cholesteatoma (12.9%), and cholesteatoma secondary to chronic tensa perforation (5.6%). Cholesteatoma of uncertain origin accounted for 5.0% (90 cases). Stage II was predominant in pars flaccida and pars tensa cholesteatoma, which frequently involves the mastoid, whereas about half of cases of cholesteatoma secondary to chronic tensa perforation and congenital cholesteatoma were classified as stage I. One hundred fifty-two of 1,084 cases (14.0%) had recurrent cholesteatoma, residual cholesteatoma, or both following first surgeries. The postoperative rates of hearing success rate was 63.3%. CONCLUSION: We were able to clarify not only the current epidemiological status of middle ear cholesteatoma but also the current trends of cholesteatoma surgery in Japan. The development of a staging system by the JOS Committee serving an epidemiological database for international or time-dependent comparison. It is possible to use this staging system with reasonable reliability.

    DOI: 10.1016/j.anl.2020.09.011

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  • Prediction of effectiveness of potassium-competitive acid blocker and serotonin noradrenaline reuptake inhibitor on abnormal sensation in the throat: use of patient-reported outcome measures (PROMs). 国際誌

    Nao Takahashi, Kaori Ikeda, Genki Iwai, Kaori Shinbori, Hironori Baba, Takanobu Sasaki, Kuniyuki Takahashi, Yuka Morita, Arata Horii

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery278 ( 5 ) 1483 - 1489   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: To determine patients with abnormal sensation in the throat (AST) who would respond to potassium-competitive acid blocker (P-CAB) or serotonin noradrenaline reuptake inhibitor (SNRI) treatment. METHODS: AST patients were randomly divided into two groups. Thirty-one and 21 patients received P-CAB and SNRI treatment, respectively. GETS-J, the Japanese version of Glasgow Edinburgh Throat Scales (GETS), consisted of three subscales of throat symptoms (globus sensation, pain/swelling of the throat, and dysphagia) and somatic distress due to the disease, Frequency Scale for the Symptoms of Gastro-esophageal reflux disease (FSSG), and Hospital Anxiety and Depression Scale (HADS) were used before and after treatments. Responders to treatments were defined as those who showed 50% or more decrease in symptom scores or somatic distress. RESULTS: Pre-treatment GETS-J pain/swelling scores and FSSG acid reflux scores were higher in P-CAB responders and decreased after treatment. Receiver operating characteristic curve for pain/swelling subscale had an area under the curve (AUC) of 0.792 to predict P-CAB responders and a score of 11 provided the best combination of sensitivity (62.5%) and specificity (80%). Somatic distress and HADS anxiety scores, but no other GETS-J symptom scores, decreased after SNRI treatment. Pre-treatment globus scores were lower in SNRI responders. AUC value for globus subscale to predict SNRI responders was 0.741 and a score of 6.5 provided the best combination of sensitivity (70%) and specificity (73%). CONCLUSIONS: Pain/swelling is a characteristic symptom in AST patients who respond to P-CAB treatment. SNRI treatment would be effective for somatic distress in cases with mild symptoms.

    DOI: 10.1007/s00405-020-06544-0

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  • Clinical characteristics, the diagnostic criteria and management recommendation of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) proposed by Japan Otological Society. 国際誌

    Yasuaki Harabuchi, Kan Kishibe, Kaori Tateyama, Yuka Morita, Naohiro Yoshida, Masahiro Okada, Yasuomi Kunimoto, Takeshi Watanabe, Akira Inagaki, Tadao Yoshida, Mitsuyoshi Imaizumi, Takeshi Nakamura, Takeshi Matsunobu, Shigeto Kobayashi, Yukiko Iino, Shingo Murakami, Haruo Takahashi, Tetsuya Tono

    Auris, nasus, larynx48 ( 1 ) 2 - 14   2021年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a form of necrotizing vasculitis with few or no immune deposits. It primarily affects small and medium blood vessels. AAV is classified into three categories, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangitis (EGPA), and two major ANCAs, proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA are involved in their pathogenesis. Intractable otitis media frequently occurs in patients with GPA, MPA or EGPA, although all patients show similar clinical features, regardless of the type of AAV. Furthermore, approximately 15% patients with otitis media caused by AAV do not show ANCA positivity, histopathological evidence, or any other AAV-related lesions at the initial visit; therefore, these patients do not fulfill the ordinary diagnostic criteria for systemic AAV. Thus, we first proposed that this condition could be categorized as "otitis media with AAV (OMAAV)". Subsequently, the Japanese Otological Society (JOS) conducted a nationwide survey between December 2013 and February 2014 and identified 297 patients with OMAAV. The survey revealed that OMAAV is a disease that initially occurs in the middle ear and subsequently spreads to other organs such as the lungs and kidneys, with eventual involvement of all body organs. Severe sequelae such as facial palsy, hypertrophic pachymeningitis, complete deafness, and subarachnoid hemorrhage resulting in death can also occur. In this review, we introduce the clinical features, diagnostic criteria, and treatment strategies recommended by JOS for early diagnosis and treatment of OMAAV.

    DOI: 10.1016/j.anl.2020.07.004

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  • Subtypes of Persistent Postural-Perceptual Dizziness. 国際誌

    Chihiro Yagi, Yuka Morita, Meiko Kitazawa, Tatsuya Yamagishi, Shinsuke Ohshima, Shuji Izumi, Kuniyuki Takahashi, Arata Horii

    Frontiers in neurology12   652366 - 652366   2021年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Persistent postural-perceptual dizziness (PPPD) is a persistent chronic vestibular syndrome exacerbated by upright posture/walking, active or passive motion, and exposure to moving or complex visual stimuli. PPPD has four precursors: phobic postural vertigo, space-motion discomfort, visual vertigo, and chronic subjective dizziness. These four diseases share clinical features that form the basis of the diagnostic criteria for PPPD. Semiological similarities do not necessarily mean that PPPD is a single entity. However, if PPPD is not a single disorder but just a composite of four precursors, it may be subdivided according to the characteristics of each precursor. Objective: To test whether PPPD is a single disorder, we attempted a subtyping of PPPD. Methods: One-hundred-eight untreated patients with PPPD were enrolled in the study, who filled out the Niigata PPPD Questionnaire (NPQ) that consists of 12 questions on exacerbating factors for PPPD. A factor analysis of the patients' answers to the NPQ and a subsequent cluster analysis of the patients with PPPD using factors revealed by the factor analysis were performed. To validate our cluster classification, cluster differences were assessed using analysis of variance. Multiple comparison analyses were performed on demographical data, precipitating diseases, the Dizziness Handicap Inventory, the Hospital Anxiety and Depression Scale, and several vestibular tests to characterize each cluster. Results: Factor analysis revealed three underlying factors among the exacerbating factors in the NPQ. Exacerbation by visual stimuli (visual factor) accounted for 47.4% of total variance in the questionnaire. Exacerbation by walking/active motion (active-motion factor) and by passive motion/standing (passive-motion/standing factor) accounted for 12.0 and 7.67% of variance, respectively. Cluster analysis revealed three clusters: the visual-dominant subtype (n = 49); the active motion-dominant subtype (n = 20); and the mixed subtype (n = 39). The patients in the active motion-dominant subtype were significantly older than those in the visual-dominant subtype. There were no significant differences among the subtypes in other demographical data or conventional vestibular tests. Conclusions: The most common main exacerbating factor of PPPD was the visual factor. PPPD may be categorized into three subtypes. Conventional vestibular tests failed to point the characteristics of each subtype.

    DOI: 10.3389/fneur.2021.652366

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  • Tympanic membrane findings of otitis media with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV). 国際誌

    Yuka Morita, Meiko Kitazawa, Chihiro Yagi, Yoriko Nonomura, Kuniyuki Takahashi, Tatsuya Yamagishi, Shinsuke Ohshima, Shuji Izumi, Arata Horii

    Auris, nasus, larynx47 ( 5 ) 740 - 746   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Otitis media with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is characterized by adult otitis media refractory to conventional treatments. OMAAV is either an aural manifestation of existing ANCA-associated vasculitis (AAV) or an initial aural manifestation of AAV. OMAAV occasionally causes an irreversible profound sensorineural hearing loss that may require a cochlear implant even in the latter case. In such a case, prompt diagnosis of OMAAV is important but sometimes difficult. When diagnosing OMAAV, repetitive otitis media with effusion (OME) in adults is the most difficult differential diagnosis. Precise evaluation of tympanic membrane (TM) findings would help to achieve a prompt diagnosis. The objective of this study was to discriminate OMAAV from adult OME based on tympanic TM findings. METHODS: 10 with OMAAV and 10 with adult OME were included. We established a scoring system of OMAAV tympanic membrane (SCOT) to evaluate TM findings of OMAAV consisted of following three characteristic findings: thickening of pars tensa, vasodilation of pars tensa, and posterior wall swelling. Each TM finding in OMAAV and OME was scored from 0 to 3 by 20 otolaryngologists who never knew the diagnosis. Reliability of the scoring system in terms of consistency between examiners was evaluated by intraclass correlation coefficients (ICC). Validity was tested by comparing the TM scores between OMAAV and OME and by the area under the curve (AUC) of receiver operating characteristic (ROC) curve to discriminate OMAAV from OME. Correlations between the TM scores and various systemic markers of OMAAV including white blood cell count, C-reactive protein, myeloperoxidase-anti-neutrophil cytoplasmic antibody, and Birmingham Vasculitis Activity Score were examined. RESULTS: The ICC of each score was over 0.95. Each of and the total TM scores were significantly higher in OMAAV than in OME. AUC of ROC curve was 0.9134. The cut-off value set at 2 points had the best combination of sensitivity (93.0%) and specificity (74.0%) to distinguish OMAAV from OME. No significant correlations were found between the total score of SCOT and systemic markers. However, the total score of SCOT significantly correlated with the average hearing level of both air (p = 0.021) and bone conductions (p = 0.032). CONCLUSION: Reliability and validity of SCOT in discriminating OMAAV from adult OME, the most difficult differential diagnosis, were demonstrated, suggesting that SCOT would be useful to make an early diagnosis of OMAAV. Correlation of SCOT with hearing level suggests that SCOT is also useful to evaluate disease status of OMAAV.

    DOI: 10.1016/j.anl.2020.02.017

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  • Patient-specific 3D-printed Model-assisted Supracochlear Approach to the Petrous Apex. 国際誌

    Kuniyuki Takahashi, Yuka Morita, Naotaka Aizawa, Manabu Ogi, Yoriko Nonomura, Meiko Kitazawa, Chihiro Yagi, Shinsuke Ohshima, Shuji Izumi, Tatsuya Yamagishi, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology41 ( 8 ) e1041-e1045   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To present a case of pediatric cholesteatoma that invaded the petrous apex (PA) and discuss the usefulness of preoperative three-dimensional (3D) surgical simulation on a personal computer (PC) and patient-specific 3D printed model-assisted surgery. PATIENT: A 5-year-old boy with congenital cholesteatoma underwent a planned two-stage canal wall up mastoidectomy. The cholesteatoma had invaded the PA from a small space anterior to the superior semicircular canal (SSCC). During the removal of this lesion in the first surgery, the tip of a 1-mm round knife broke off and fell into the PA. The surgeon could not remove it, as it was thought that opening the space might damage the SSCC and the facial nerve (FN). INTERVENTION: Before the second surgery, a preoperative 3D surgical simulation on a PC was performed, and an approach to the PA via the triangle surrounded by the SSCC, FN, and middle cranial fossa, namely, the supracochlear approach, was discovered. A patient-specific 3D-printed model, which had been drilled to make each surface of the triangle including the SSCC, FN, and middle cranial fossa visible in the PC simulation surgery, was then created and a 3D-printed model-assisted surgery was planned. RESULTS: By placing the sterilized patient-specific 3D model close to the surgical field, the cholesteatoma and iatrogenic foreign body could be successfully removed from the PA without damaging the important surrounding structures. CONCLUSIONS: Preoperative 3D surgical simulations and intraoperative patient-specific 3D-printed model-assisted surgeries are new, powerful tools that aid in performing challenging surgeries on temporal bones.

    DOI: 10.1097/MAO.0000000000002720

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  • IN RESPONSE TO THE LETTER TO THE EDITOR: AGE-RELATED HEARING LOSS IS STRONGLY ASSOCIATED WITH COGNITIVE DECLINE REGARDLESS OF THE APOE4 POLYMORPHISM. 国際誌

    Yuka Morita, Takanobu Sasaki, Kuniyuki Takahashi, Meiko Kitazawa, Yoriko Nonomura, Chihiro Yagi, Tatsuya Yamagishi, Shinsuke Ohshima, Shuji Izumi, Arata Horii, Minako Wakasugi, Akio Yokoseki, Ichiei Narita, Naoto Endo

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology41 ( 5 ) 718 - 719   2020年6月

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  • Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes. 国際誌

    Tatsuya Yamagishi, Shinsuke Ohshima, Chihiro Yagi, Meiko Kitazawa, Yoriko Nonomura, Shuji Izumi, Yuka Morita, Kuniyuki Takahashi, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology41 ( 5 ) 704 - 708   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome. STUDY DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery. INTERVENTION: During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen. MAIN OUTCOME MEASURES: Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared. RESULTS: No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders. CONCLUSION: NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.

    DOI: 10.1097/MAO.0000000000002594

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  • Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops? 国際誌

    Yuka Morita, Kuniyuki Takahashi, Shinsuke Ohshima, Chihiro Yagi, Meiko Kitazawa, Tatsuya Yamagishi, Shuji Izumi, Arata Horii

    Frontiers in surgery7   601692 - 601692   2020年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Vestibular Meniere's disease (American Academy of Ophthalmology and Otolaryngology, 1972) also known as possible Meniere's disease (American Academy of Otolaryngology Head and Neck Surgery, 1995) or vestibular type of atypical Meniere's disease (V-AMD) (Japan Society for Equilibrium Research, 2017) is characterized by an episodic vertigo without hearing loss. Though named as Meniere's disease (MD), this entity may not be caused solely by endolymphatic hydrops (EH). Objective: To estimate the role of EH in vestibular Meniere's disease in comparison with definite Meniere's disease. Methods: Thirty patients with unilateral definite MD and 16 patients with vestibular Meniere's disease were included. Those who met the criteria for definite or probable vestibular migraine were excluded. All patients underwent vestibular assessments including inner ear MRI 4 h after intravenous gadolinium injection, bithermal caloric testing, directional preponderance of vestibulo-ocular reflex in rotatory chair test, cervical- and ocular-vestibular evoked myogenic potential, stepping test, dizziness handicap inventory (DHI), and hospital anxiety and depression scale (HADS). All above tests and frequency/duration of vertigo spells were compared between vestibular Meniere's disease and MD. Results: Even in unilateral MD, cochlear and vestibular endolymphatic hydrops (c-, v-EH) were demonstrated not only in the affected side but also in the healthy side in more than half of patients. Positive rate of v-EH in vestibular Meniere's disease (68.8%) was as high as that of MD (80%). In vestibular Meniere's disease, the number of bilateral EH was higher in the vestibule (56.3%) than that in the cochlea (25.0%). There were no differences in vestibular tests and DHI between vestibular Meniere's disease and MD; however, the frequency of vertigo spells was lower in vestibular Meniere's disease (p = 0.001). The total HADS score in the MD group was significantly higher than that in the vestibular Meniere's disease group. Conclusions: MD is a systemic disease with bilateral involvement of inner ears. V-EH is a major pathophysiology of vestibular Meniere's disease, which would precede c-EH in the development of vestibular Meniere's disease, a milder subtype of MD. MRI is useful for differentiating MD from other vertigo attacks caused by different pathologies in bringing EH into evidence.

    DOI: 10.3389/fsurg.2020.601692

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  • Age-related Hearing Loss Is Strongly Associated With Cognitive Decline Regardless of the APOE4 Polymorphism. 国際誌

    Yuka Morita, Takanobu Sasaki, Kuniyuki Takahashi, Meiko Kitazawa, Yoriko Nonomura, Chihiro Yagi, Tatsuya Yamagishi, Shinsuke Ohshima, Shuji Izumi, Minako Wakasugi, Akio Yokoseki, Ichiei Narita, Naoto Endo, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology40 ( 10 ) 1263 - 1267   2019年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To examine the association between hearing impairment and cognitive decline and to identify possible risk factors for presbycusis. STUDY DESIGN: Cross-sectional survey in prospective cohort study. SETTING: University hospital. PATIENTS: A total of 322 participants aged >60 years, for whom all the below data were available, were enrolled in the study. There were 168 females and 154 males with a median age of 71 years (range: 60-89 yrs). INTERVENTIONS: PROST (Project in Sado for Total Health), a medical database in Sado island Japan, was analyzed. MAIN OUTCOME MEASURES: Data on pure-tone audiometry, mini-mental state examination (MMSE), polymorphism of apolipoprotein E4 (ApoE4), diabetes mellitus, hypertension, smoking, and alcohol consumption were extracted. Hearing impairment was defined as an average frequency between 0.25 and 8 kHz that exceeded 30 dB. Multivariate analysis was used to identify which of the above factors could predict the hearing impairment. Hearing threshold of each Hz was compared between the ApoE4 (+/+), (+/-), and (-/-) groups. RESULTS: Among various factors, only low MMSE scores (<24) showed significant association with hearing impairment. There were no differences in the hearing threshold of all frequencies between ApoE status groups. CONCLUSIONS: Hearing impairment was associated with low MMSE sores, regardless of the ApoE4 status. If ApoE4 status would be a common upstream predictor for both the hearing and cognitive impairment, hearing threshold would be related to ApoE4 status. However, these results may suggest that hearing impairment may be causally related to the cognitive dysfunction, perhaps via the cognitive load mechanisms.

    DOI: 10.1097/MAO.0000000000002415

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  • Corrigendum to "Reliability and validity of the Japanese version of the Glasgow Edinburgh Throat Scale (GETS-J): use for a symptom scale of globus sensation" [Auris Nasus Lar7708170ynx 45 (2018) 1041-1046]. 国際誌

    Nao Takahashi, Kaori Mori, Hironori Baba, Takanobu Sasaki, Masaaki Ohno, Fumio Ikarashi, Naotaka Aizawa, Kunihiro Sato, Akio Tsuchiya, Hideyuki Hanazawa, Masahiko Tomita, Yamato Kubota, Yuka Morita, Kuniyuki Takahashi, Arata Horii

    Auris, nasus, larynx46 ( 4 ) 651 - 652   2019年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.anl.2019.01.012

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  • A Validated Questionnaire to Assess the Severity of Persistent Postural-Perceptual Dizziness (PPPD): The Niigata PPPD Questionnaire (NPQ). 国際誌

    Chihiro Yagi, Yuka Morita, Meiko Kitazawa, Yoriko Nonomura, Tatsuya Yamagishi, Shinsuke Ohshima, Shuji Izumi, Kuniyuki Takahashi, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology40 ( 7 ) e747-e752   2019年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To establish a questionnaire to diagnose and assess the severity of persistent postural-perceptual dizziness (PPPD). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Fifty PPPD patients and 50 consecutive control patients with other vestibular disorders. INTERVENTIONS: Patients answered questions on three exacerbating factors of PPPD (upright posture/walking, movement, and visual stimulation), and each factor was evaluated using four questions scoring the severity from 0 (none) to 6 (unbearable). Somatic and psychological distress was evaluated by the Visual Analog Scale (VAS) and the Hospital Anxiety and Depression Scale (HADS), respectively. MAIN OUTCOME MEASURES: The questionnaire's reliability was tested by Cronbach's alpha, and it was validated by examining the differences in the questionnaire's scores between PPPD patients and controls. The area under the curve (AUC) of the receiver operating characteristic curve for each factor was calculated. RESULTS: Cronbach's alpha coefficient was >0.8 for all factors, except the movement factor. There were no significant differences in the VAS and HADS scores between the two groups. However, the combined and individual questionnaire scores for each factor were higher in PPPD patients than in controls, indicating the questionnaire's high validity. The AUC was widest for the visual stimulation factor (0.830), and a score of 9 (full score 24) had the best sensitivity (82%) and specificity (74%) for discriminating PPPD patients from controls. CONCLUSIONS: We developed a questionnaire that exhibited high reliability and validity in evaluating PPPD severity. The visual stimulation factor may be the most characteristic among the three exacerbating factors.

    DOI: 10.1097/MAO.0000000000002325

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  • Comparative study of anti-vertiginous and anti-anxious drugs for the treatment of chronic vestibular patients with secondary anxiety. 国際誌

    Go Sato, Kazunori Matsuda, Momoyo Matsuoka, Junya Fukuda, Yuka Morita, Kuniyuki Takahashi, Arata Horii, Noriaki Takeda

    Acta oto-laryngologica139 ( 7 ) 593 - 597   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background: Regarding the relationship between psychiatric disorders and dizziness, anxiety is the most frequently seen psychiatric disorder in dizzy patients. Objective: We compared the effects of anti-anxious benzodiazepines (loflazepate) and anti-vertiginous cholinergic antagonist (diphenidol) on the subjective symptoms in chronic vestibular patients with secondary anxiety. Methods: Forty-three patients who had chronic dizziness lasting more than three months due to organic vestibular diseases with secondary anxiety. Anxiety was evaluated by the State-Trait Anxiety Inventory (STAI). Subjective handicaps due to dizziness were assessed by the validated questionnaire consisted of 14 questions that were categorized into two physical and three emotional factors. During the initial six months of the study, 21 patients were treated by anti-anxious benzodiazepines (loflazepate, 2 mg/day) for four weeks, whereas anti-vertiginous cholinergic antagonist (diphenidol, 75 mg/day) was used for four weeks for other 22 patients during the later six months-period. Subjective handicaps and STAI were compared between pre- and post-treatment. Results: Loflazepate improved not only three emotional factors and state anxiety but also one of the physical factors. Diphenidol improved two physical factors but no emotional factors nor state and trait anxiety. Conclusions: Targeting for comorbid anxiety was beneficial for subjective symptoms of chronic dizziness with secondary anxiety.

    DOI: 10.1080/00016489.2019.1612531

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  • Nationwide survey of congenital cholesteatoma using staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society. 国際誌

    Yuka Morita, Tetsuya Tono, Masafumi Sakagami, Yutaka Yamamoto, Keiji Matsuda, Manabu Komori, Naohito Hato, Sho Hashimoto, Haruo Takahashi, Hiromi Kojima

    Auris, nasus, larynx46 ( 3 ) 346 - 352   2019年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: This study was undertaken to determine the characteristics of congenital cholesteatoma (CC) in Japan, via a nationwide survey using staging and classification criteria for middle ear cholesteatoma, as proposed by the Japan Otological Society (JOS). METHODS: A nationwide survey regarding middle ear cholesteatoma treated in 2015 was performed. There were 1787 registrations from 74 facilities, among which, CC accounted for 12.9% (231 cases) of all middle ear cholesteatoma cases. The extent of the disease was classified according to the classification and staging of cholesteatoma proposed by JOS in 2015. RESULTS: The age of the patients ranged from 1 to 55 years (mean, 8.2 years; median, 6 years; 149 ears of males; 82 ears of females). Among these cases, 105 (45.5%) were classified as stage I, 121 (52.4%) as stage II, and 5 (2.1%) as stage III, with no cases in stage IV. In the sub classification of stage I, 35 (33%), 43 (41%) and 27 (26%) ears were classified as stages I-a, I-b and I-c, respectively. Stage I-b (cholesteatoma confined to the posterior half of the tympanic cavity) was more frequent than stage I-a (the anterior half of tympanic cavity). Pre-operative hearing level of air-conduction was 20.5dB for stage I-a, 34.5dB for stage I-b, 30.5dB for stage I-c, 38.6dB for stage II, and 59.0dB for stage III. The rate of missing stapes superstructure increased as the disease progressed. In the same way, the mastoid development lowered as the stage of the disease progressed. There were significant differences in the age at operation, pre-operative hearing level, status of stapes, and major ossiculoplasty, between stage l-a and l-b. CONCLUSIONS: The current condition of CC in Japan was been evaluated; in particular, it was observed that the cases limited to the posterior part of tympanic cavity were not rare. The JOS stage classification based on the progression of the disease seemed simple and efficient.

    DOI: 10.1016/j.anl.2018.10.015

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  • International Collaborative Assessment of the Validity of the EAONO-JOS Cholesteatoma Staging System. 国際誌

    Adrian L James, Tetsuya Tono, Michael S Cohen, Arunachalam Iyer, Lynn Cooke, Yuka Morita, Keiji Matsuda, Yutaka Yamamoto, Masafumi Sakagami, Matthew Yung

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology40 ( 5 ) 630 - 637   2019年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Assessment of validity of the Japanese Otological Society and the European Academy of Otology and Neurotology (EAONO-JOS) cholesteatoma staging system (EJS) through international collaboration to investigate: (a) feasibility of retrospectively staging previously acquired data, (b) strengths and weaknesses of the staging system. METHOD: Nine centers with prospective cholesteatoma databases were recruited. Cases were allocated to EJS Stage at each center using details from time of initial surgery. An independent rater also staged the cases and noted any discrepancies. At one center results from database staging were compared with staging based on contemporaneous operative records. Inter and intrarater reliabilities were calculated, and recidivism rates calculated according to Stage. RESULTS: Of 1482 cases of cholesteatoma, 320 (22%) were Stage 1, 977 (67%) Stage 2, 153 (11%) Stage 3 and 4 (0.3%) Stage 4. No database contained details of all parameters required for accurate staging. Staging discrepancies occurred in >10% cases but inter and intrarater reliability of staging were high (Kappa 0.8; 95% confidence interval between 0.7-0.9). At 5 years, 11% had residual and 8% had recurrent cholesteatoma: rates increased with Stage but generally not significantly (Kaplan-Meier Log Rank analysis). CONCLUSION: The EJS Staging system provides an internationally agreed standard for collecting data to classify cholesteatoma severity. Although data can be applied retrospectively with reasonable reliability, prospective data collection would prevent inaccuracies that arise from missing data fields. To enhance validity of the EJS system, we propose clearer definitions of some categories. Refinements to definitions of stage may improve prognostic utility of the EJS but should be made using evidence powered by large-scale collaboration.

    DOI: 10.1097/MAO.0000000000002168

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  • Otosclerosis: anatomical distribution of otosclerotic loci analyzed by high-resolution computed tomography. 国際誌

    Chihiro Yagi, Yuka Morita, Kuniyuki Takahashi, Manabu Ogi, Shinsuke Oshima, Yutaka Yamamoto, Arata Horii

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery276 ( 5 ) 1335 - 1340   2019年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    PURPOSE: To clarify the anatomical distribution of otosclerotic loci in otosclerosis. METHODS: Ninety-five patients with surgically confirmed uni- or bilateral otosclerosis were enrolled into the study. Hypodense areas observed in the otic capsule by high-resolution computed tomography (HRCT) were defined as otosclerotic loci. The location and number of lesions were examined, and the probability of lesion overlap and correlation with age/hearing parameters (air and bone conduction threshold, air-bone gaps) were tested. RESULTS: Otosclerotic loci were confirmed by HRCT in 77 out of 115 operated ears. The three commonly affected sites were the anterior part of the oval window (ant-OW), anterior part of the internal auditory canal (ant-IAC), and pericochlear area (PCochA), with lesions detected in 96.1%, 46.8%, and 26.0% of ears, respectively. Only the ant-OW area was affected in 48.1% of the ears; the ant-IAC in 3.9%; and PCochA in none with significant differences (p < 0.01). The ant-OW lesions preferentially overlapped with ant-IAC (44.6%) than PCochA lesions (27.0%) (p < 0.05). Among double sites diseases, triple sites diseases occurred more commonly in the ant-OW + PCochA group (80%) than ant-OW + ant-IAC group (48.5%) (p < 0.05). There was no correlation between a number of lesions and age/hearing parameters. CONCLUSIONS: Based on the probability of lesion overlap, otosclerotic lesions may initiate at ant-OW followed by ant-IAC and later PCochA. Although the number of lesions showed no immediate correlation with hearing level or age, anatomical stage of the disease estimated by the location and the number of otosclerotic loci could be useful in predicting the future hearing status.

    DOI: 10.1007/s00405-019-05385-w

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  • Cochlear implantation in patients with bilateral deafness caused by otitis media with ANCA-associated vasculitis (OMAAV): A report of four cases. 国際誌

    Takeshi Watanabe, Haruo Yoshida, Kan Kishibe, Yuka Morita, Naohiro Yoshida, Haruo Takahashi, Yasuaki Harabuchi

    Auris, nasus, larynx45 ( 5 ) 922 - 928   2018年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) without systemic symptoms but with initial symptoms related to the ear, such as hearing loss, otalgia, and dizziness, has recently been reported. We have categorized this condition as otitis media with AAV (OMAAV), and have recently proposed its diagnostic criteria. METHODS: To determine the effectiveness of cochlear implantation (CI) in patients with profound hearing loss due to OMAAV. We examined the language understanding ability of four patients with bilateral profound or total deafness due to OMAAV, who underwent CI. RESULTS: In three of the four patients, the language understanding ability with CI was poor. These three patients with poor performance had characteristic features, including a short interval from the onset of ear symptoms to total deafness and clear enhancement of the cochlea on magnetic resonance imaging (MRI). CONCLUSION: The poor results observed in patients with a rapidly progressive history of hearing loss were attributed to possible severe and profuse intracochlear bleeding and/or destruction of structures, including the spiral ganglion. All the three patients showed contrast enhancement in the inner ear on MRI. We believe that preoperative evaluation of the history of hearing loss as well as the findings of contrast-enhanced MRI is important for predicting the prognosis after CI.

    DOI: 10.1016/j.anl.2017.12.007

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  • Reliability and validity of the Japanese version of the Glasgow Edinburgh Throat Scale (GETS-J): Use for a symptom scale of globus sensation. 国際誌

    Nao Takahashi, Kaori Mori, Hironori Baba, Takanobu Sasaki, Masaaki Ohno, Fumio Ikarashi, Naotaka Aizawa, Kunihiro Sato, Akio Tsuchiya, Hideyuki Hanazawa, Masahiko Tomita, Yamato Kubota, Yuka Morita, Kuniyuki Takahashi, Arata Horii

    Auris, nasus, larynx45 ( 5 ) 1041 - 1046   2018年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Globus sensation, a feeling of lump or something stuck in the throat, could be caused by structural, functional, and psychogenic diseases. Due to a possible multifactorial nature of the disease, neither diagnosing test battery nor standard treatment for globus sensation has been established. Therefore, a questionnaire to accurately identify globus patients and evaluate the severity of the disease is desired. Glasgow Edinburgh Throat Scale (GETS) is a 10-item questionnaire about the throat symptoms consisting of three subscales relating to dysphagia, globus sensation, and pain/swelling in the throat. It was reported that globus patients marked high scores specifically for the globus scale among three scales, indicating that GETS can be used as a valid symptom scale for globus sensation. Aims of this study were to translate GETS into Japanese and to test its reliability and validity. METHODS: Fifty-five patients complaining of globus sensation without abnormal endoscopic and CT findings were enrolled into the study. They were asked to answer the questions of GETS translated into Japanese (GETS-J). Reliability (internal consistency) of the questionnaire was tested using Cronbach's coefficient alpha. To test the validity, principal components analysis was used to identify the factorial structure of the questionnaire and GETS-J data were compared with those reported in the original GETS. Contribution of psychiatric comorbidities to globus sensation was also investigated by examining the correlation between Hospital Anxiety and Depression Scale (HADS) and GETS-J. RESULTS: Reliability of the questionnaire examined by the Cronbach's coefficient alpha was satisfactory and all higher than 0.75. Principal components analysis identified following three questions as the globus scale: Q1, Feeling something stuck in the throat; Q5, Throat closing off; Q9, Want to swallow all the time. Somatic distress, i.e., patients' reaction to throat symptoms, was significantly correlated with globus scale (r=0.680). Anxiety component of HADS was significantly correlated with somatic distress but not with globus scale. These results were consistent with those of the original GETS except for the replacement of Q3 (discomfort/irritation in the throat) to Q5 (throat closing off) for globus scale in GETS-J. CONCLUSION: Translation of GETS into Japanese showed high reliability and validity, suggesting that translation and cross-cultural adaptation were not problematic. High correlation of globus scale of GETS-J with somatic distress indicated that GETS-J could be a useful questionnaire to identify the globus patients and evaluate the severity of the disease. Anxiety may complicate the somatic distress in patients with globus sensation.

    DOI: 10.1016/j.anl.2018.02.001

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  • Risk Factors of Recurrence in Pediatric Congenital Cholesteatoma. 国際誌

    Yuka Morita, Kuniyuki Takahashi, Shuji Izumi, Yamato Kubota, Shinsuke Ohshima, Yutaka Yamamoto, Sugata Takahashi, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology38 ( 10 ) 1463 - 1469   2017年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To examine the risk factors of recurrence in pediatric congenital cholesteatoma. STUDY DESIGN: Retrospective chart review. SETTING: University hospital. PATIENTS: Sixty-seven patients having tympanic type of congenital cholesteatoma under 15-years old at surgery. INTERVENTIONS: Canal wall-up tympanomastoidectomy (n = 30) or transcanal atticotomy/tympanoplasty (n = 37) was performed depending on cholesteatoma extension, 16 of which were followed by second-look surgery. Preoperative computed tomography (CT) before second-look surgery or follow-up CT was performed to detect residual recurrence 1 year after the surgery. Cholesteatoma found at the second surgery was also included in the recurrence. All patients had no recurrent cholesteatoma at the last follow-up (median, 61 mo after surgery). MAIN OUTCOME MEASURES: Possible predictive factors were compared between the groups. RESULTS: Residual cholesteatoma and retraction cholesteatoma occurred in 21 and 6%, respectively. There was no significant difference in age, sex, and type of cholesteatoma (open or closed) between the groups; however, Potsic stage and status of stapes involvement were more advanced in the residual cholesteatoma group. All residual lesions could be detected by follow-up CT or by second-look surgery. All of four retraction cholesteatoma patients were male, young at the surgery and in stage IV. CONCLUSION: Recurrence mostly occurred as residual cholesteatoma, suggesting that CT is recommended as a follow-up tool for congenital cholesteatoma. Advanced lesions had the risk of residual cholesteatoma, suggesting that complete removal of epithelium is important. Although rare, young advanced-stage patients had risk of retraction cholesteatoma and therefore normal mucosa should be preserved as much as possible for these patients.

    DOI: 10.1097/MAO.0000000000001587

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  • Bone Density Development of the Temporal Bone Assessed by Computed Tomography. 国際誌

    Kuniyuki Takahashi, Yuka Morita, Shinsuke Ohshima, Shuji Izumi, Yamato Kubota, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology38 ( 10 ) 1445 - 1449   2017年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    HYPOTHESIS: The temporal bone shows regional differences in bone development. BACKGROUND: The spreading pattern of acute mastoiditis shows age-related differences. In infants, it spreads laterally and causes retroauricular swelling, whereas in older children, it tends to spread medially and causes intracranial complications. We hypothesized that bone maturation may influence the spreading pattern of acute mastoiditis. METHODS: Eighty participants with normal hearing, aged 3 months to 42 years, participated in this study. Computed tomography (CT) values (Hounsfield unit [HU]) in various regions of the temporal bone, such as the otic capsule (OC), lateral surface of the mastoid cavity (LS), posterior cranial fossa (PCF), and middle cranial fossa (MCF), were measured as markers of bone density. Bone density development curves, wherein CT values were plotted against age, were created for each region. The age at which the CT value exceeded 1000 HU, which is used as an indicator of bone maturation, was calculated from the development curves and compared between the regions. RESULTS: The OC showed mature bone at birth, whereas the LS, PCF, and MCF showed rapid maturation in early childhood. However, there were significant regional differences in the ages of maturation: 1.7, 3.9, and 10.8 years for the LS, PCF, and MCF, respectively. CONCLUSION: To our knowledge, this is the first report to show regional differences in the maturation of temporal bone, which could partly account for the differences in the spreading pattern of acute mastoiditis in individuals of different ages.

    DOI: 10.1097/MAO.0000000000001566

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  • Creating an Optimal 3D Printed Model for Temporal Bone Dissection Training. 国際誌

    Kuniyuki Takahashi, Yuka Morita, Shinsuke Ohshima, Shuji Izumi, Yamato Kubota, Yutaka Yamamoto, Sugata Takahashi, Arata Horii

    The Annals of otology, rhinology, and laryngology126 ( 7 ) 530 - 536   2017年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Making a 3-dimensional (3D) temporal bone model is simple using a plaster powder bed and an inkjet printer. However, it is difficult to reproduce air-containing spaces and precise middle ear structures. The objective of this study was to overcome these problems and create a temporal bone model that would be useful both as a training tool and for preoperative simulation. METHODS: Drainage holes were made to remove excess materials from air-containing spaces, ossicle ligaments were manually changed to bony structures, and small and/or soft tissue structures were colored differently while designing the 3D models. The outcomes were evaluated by 3 procedures: macroscopic and endoscopic inspection of the model, comparison of computed tomography (CT) images of the model to the original CT, and assessment of tactile sensation and reproducibility by 20 surgeons performing surgery on the model. RESULTS: Macroscopic and endoscopic inspection, CT images, and assessment by surgeons were in agreement in terms of reproducibility of model structures. Most structures could be reproduced, but the stapes, tympanic sinus, and mastoid air cells were unsatisfactory. Perioperative tactile sensation of the model was excellent. CONCLUSIONS: Although this model still does not embody perfect reproducibility, it proved sufficiently practical for use in surgical training.

    DOI: 10.1177/0003489417705395

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  • Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society. 国際誌

    Tetsuya Tono, Masafumi Sakagami, Hiromi Kojima, Yutaka Yamamoto, Keiji Matsuda, Manabu Komori, Naohito Hato, Yuka Morita, Sho Hashimoto

    Auris, nasus, larynx44 ( 2 ) 135 - 140   2017年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    In order to provide a basis for meaningful exchange of information among those treating cholesteatoma, the Committee on Nomenclature of the Japan Otological Society (JOS) was appointed in 2004 to create a cholesteatoma staging system as simple as possible to use in clinical practice in Japan. Following the announcement of preliminary criteria for the staging of pars flaccida (attic) cholesteatoma in 2008, we proposed the 2010 JOS staging system for two major types of retraction pocket cholesteatoma, pars flaccida and pars tensa cholesteatoma. Since then, the JOS staging system has been widely used in clinical studies of cholesteatoma in Japan, allowing standardization in reporting of surgical outcomes based on the respective stages of cholesteatoma. We have recently expanded the range of cholesteatoma by adding cholesteatoma secondary to a tensa perforation and congenital cholesteatoma as the 2015 JOS staging system for middle ear cholesteatoma. Although further revisions may be required for universal acceptance of these criteria, we hope our staging system will open the way for international consensus on staging and classification of middle ear cholesteatoma in the near future.

    DOI: 10.1016/j.anl.2016.06.012

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  • Clinical features and treatment outcomes of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV): A retrospective analysis of 235 patients from a nationwide survey in Japan. 国際誌

    Yasuaki Harabuchi, Kan Kishibe, Kaori Tateyama, Yuka Morita, Naohiro Yoshida, Yasuomi Kunimoto, Takamichi Matsui, Hiroshi Sakaguchi, Masahiro Okada, Takeshi Watanabe, Akira Inagaki, Shigeto Kobayashi, Yukiko Iino, Shingo Murakami, Haruo Takahashi, Tetsuya Tono

    Modern rheumatology27 ( 1 ) 87 - 94   2017年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: We aimed to analyze clinical features and treatment outcomes of otitis media caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), i.e. otitis media with AAV (OMAAV). METHODS: This survey was performed between December 2013 and February 2014. The study began with a preliminary survey to 123 otolaryngology institutions in Japan to inquire about their experiences with OMAAV patients during the past 10 years, and was followed by a questionnaire survey to investigate clinical and laboratory findings. OMAAV was defined using the criteria described in the text. RESULTS: Two hundred and thirty-five patients classified as OMAAV were enrolled in this study. They were characterized as follows: (1) disease onset with initial signs/symptoms due to intractable otitis media with effusion or granulation, which did not respond to ordinary treatments such as antibiotics and insertion of tympanic ventilation tubes, followed by progressive hearing loss; (2) predominantly female (73%) and older (median age: 68 years); (3) predominantly myeloperoxidase (MPO)-ANCA-positive (60%), followed by proteinase 3 (PR3)-ANCA-positive (19%) and both ANCAs-negative (16%); (4) frequently observed accompanying facial palsy (36%) and hypertrophic pachymeningitis (28%); and (5) disease often involving lung (35%) and kidney (26%) lesions. Four factors associated with OMAAV were found to be related to an unfavorable clinical course threatening the patient's hearing and/or lives, namely facial palsy, hypertrophic pachymeningitis, both ANCAs-negative phenotype, and disease relapse. The occurrence of hypertrophic pachymeningitis was associated with facial palsy (p < 0.05), both ANCAs-negative phenotype (p < 0.001), and headache (p < 0.001). The administration of corticosteroid together with an immunosuppressant was an independent predicting factor for lack of disease relapse (odds ratio [OR] = 1.90, p = 0.03) and an improvement in hearing loss (OR =2.58, p = 0.0002). CONCLUSION: Since OMAAV has novel clinical features, the disease may be categorized as a subentity for the classification of AAV.

    DOI: 10.1080/14397595.2016.1177926

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  • Vestibular Involvement in Patients With Otitis Media With Antineutrophil Cytoplasmic Antibody-associated Vasculitis. 国際誌

    Yuka Morita, Kuniyuki Takahashi, Shuji Izumi, Yamato Kubota, Shinsuke Ohshima, Arata Horii

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology38 ( 1 ) 97 - 101   2017年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Otitis media (OM) with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is a novel concept of ear disease that is characterized by progressive mixed or sensorineural hearing loss with occasional systemic involvement. Considering the accumulating knowledge about the characteristics of and treatment for auditory dysfunction in OMAAV, the objective of this study was to investigate the vestibular function and symptoms of patients with OMAAV. STUDY DESIGN: Retrospective chart review. SETTING: University hospital. PATIENTS: Thirty-one OMAAV patients met criteria proposed by the OMAAV study group in Japan. MAIN OUTCOME MEASURES: Clinical characteristics and vestibular tests. RESULTS: Eleven of 31 OMAAV patients had vestibular symptoms; 3 patients had acute vertigo attack with sudden hearing loss and 8 patients had chronic dizziness. Episodic vertigo was not seen in any of the patients. Three patients who received a less intensive therapy without immunosuppressive agents developed intractable persistent dizziness. All symptomatic patients and six of the nine OMAAV patients without vestibular symptoms showed unilateral or bilateral caloric weakness; therefore, vestibular involvement was present in 84% of OMAAV patients. Gain of vestibulo-ocular reflex was reduced in symptomatic patients. The eye-tracking test and optokinetic nystagmus revealed no evidence of central dysfunction. CONCLUSION: Vestibular dysfunction was seen in 84% of OMAAV patients. One-third of OMAAV patients showed vestibular symptoms such as acute vertigo attack or chronic dizziness, which are of peripheral origin. One-third of the symptomatic patients developed intractable dizziness. Initial intensive treatment by combination therapy with steroid and immunosuppressive agents may be essential for preventing the development of intractable dizziness.

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  • Hippocampal gene expression, serum cortisol level, and spatial memory in rats exposed to hypergravity. 国際誌

    Arata Horii, Kenji Mitani, Chisako Masumura, Atsuhiko Uno, Takao Imai, Yuka Morita, Kuniyuki Takahashi, Tadashi Kitahara, Hidenori Inohara

    Journal of vestibular research : equilibrium & orientation27 ( 4 ) 209 - 215   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Due to spatial disorientation reported in space, spatial memory and navigation performances could be more largely impaired by gravity changes. Hippocampus, a key structure for spatial memory, receives inputs from gravity-sensing otolith organs. OBJECTIVE: To determine the key molecules in the rat hippocampus that contribute to an adaptation to altered gravity in terms of spatial memory performance. METHODS: Gene expression of hippocampus and spatial memory after continuous two-weeks exposure to 2 G hypergravity (HG) were examined using a microarray analysis followed by real-time PCR methods and radial arm maze testing, respectively. Serum cortisol levels during HG load were measured as a stress marker. RESULTS: Accuracy to enter the correct arms in HG rats was significantly lower than that of controls, indicating an impaired spatial memory due to gravity changes. Microarray analysis followed by real-time PCR confirmed an upregulation of insulin like growth factor binding protein 2 (IGFBP2) gene. Serum cortisol level was the same level as controls at the last day of hypergravity, suggesting the adaptation to HG-induced stress. CONCLUSIONS: Given that the IGF systems are involved in neurotrophic and synaptic plasticity mechanisms, IGF system might contribute to the adaptation to altered gravity in terms of spatial memory.

    DOI: 10.3233/VES-170521

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  • Psychiatric comorbidities and use of milnacipran in patients with chronic dizziness. 国際誌

    Arata Horii, Takao Imai, Tadashi Kitahara, Atsuhiko Uno, Yuka Morita, Kuniyuki Takahashi, Hidenori Inohara

    Journal of vestibular research : equilibrium & orientation26 ( 3 ) 335 - 40   2016年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Psychiatric comorbidities are an important issue in the treatment of chronic dizziness patients. OBJECTIVE: To test the correlation between psychiatric status and subjective handicaps and to examine the effects of milnacipran on handicaps. METHODS: Hospital anxiety and depression scale (HADS) and handicaps were assessed by a questionnaire before and eight weeks after milnacipran treatment (50 mg/day) in 29 consecutive patients with chronic dizziness. Effects of milnaciplan were compared with fluvoxamine (200 mg/day). RESULTS: A significant correlation was found between anxious and depressive scale scores and also between HADS and handicaps. Duration of symptoms was longer in the anxious/depressive group (HADS≧13) than in the non-anxious/depressive group. Handicaps and HADS were significantly decreased after treatment only in the anxious/depressive group. There were no overall differences in drug effects between milnaciplan and fluvoxamine. However, the rate of patients with a post/pre ratio of handicaps <80% was higher in milnaciplan group compared with the fluvoxamine group. CONCLUSIONS: Not only anxiety disorders but also depression should be considered as comorbid psychiatric disorders in patients with chronic dizziness. Dizzy patients with psychiatric comorbidities have a longer duration of symptoms and more handicaps than those without psychiatric disorders. Milnacipran may be chosen as a treatment for patients with chronic dizziness with comorbid psychiatric disorders in case of and insufficient response to SSRIs.

    DOI: 10.3233/VES-160582

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  • Pediatric middle ear cholesteatoma: the comparative study of congenital cholesteatoma and acquired cholesteatoma. 国際誌

    Yuka Morita, Yutaka Yamamoto, Shinsuke Oshima, Kuniyuki Takahashi, Sugata Takahashi

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery273 ( 5 ) 1155 - 60   2016年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    This study examined the differences between congenital cholesteatoma (CC) and acquired cholesteatomas (AC) in children by comparing clinical features and treatment courses. This was a retrospective study which retrospectively evaluated 127 children with middle ear cholesteatomas using medical records from January 1999 to December 2012 in the Department of Otolaryngology, Niigata University Hospital. The study comprised 69 and 58 cases of CC and AC, respectively. The main outcome measures include patient backgrounds, the opportunities for consultations, mastoid cell development, intraoperative finding of stapes, surgical procedure and number of surgeries. The average age at operation was 6.4 and 9.8 years in CC and AC, respectively. AC was more prevalent in boys. Mastoid development was better in CC than in AC. We adopted a two-stage operation in 17 cases (25 %) of CC and in 22 cases (38 %) of AC. The repeat surgery rate was 11.6 % in CC and 27.6 % in AC. Three times as many operations were required for three cases (4.3 %) of CC and 10 cases (17.2 %) of AC. The lesions in AC were more difficult to control. In the treatment of pediatric middle ear cholesteatoma, we had to keep the outcome in mind.

    DOI: 10.1007/s00405-015-3679-5

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  • A case of lateral sinus insufficiency with acute otitis media: Early surgical intervention for prevention of lateral sinus thrombosis. 国際誌

    Kuniyuki Takahashi, Yutaka Yamamoto, Manabu Ogi, Shinsuke Ohshima, Yuka Morita, Sugata Takahashi

    Auris, nasus, larynx42 ( 6 ) 492 - 5   2015年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To describe a case of lateral sinus insufficiency, presumably occurring just prior to lateral sinus thrombosis (LST), and to discuss the importance of early surgical intervention and the pathophysiology of full-blown LST. CASE REPORT: A 4-year-old boy developed headaches and vomiting after exhibiting typical symptoms of acute otitis media. Contrast-enhanced CT revealed narrowing of the sigmoid sinus medially by gas and low-density material. We diagnosed the patient with suspected LST and consequently performed mastoidectomy. A large amount of bloody pus was found in the mastoid cavity and below the bony sinus plate. Sigmoid sinus blood flow was completely restored after drainage of the hemorrhagic and purulent material, and the patient recovered fully. CONCLUSION: Because of the anatomical features of the dural venous sinus, hemorrhage per diapedesis may be strongly associated with the development of LST. In the patient with suspected LST, early diagnosis and surgery prior to the development of intravenous thrombus are key for full recovery from this condition.

    DOI: 10.1016/j.anl.2015.04.007

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  • Acquired cholesteatoma in children: clinical features and surgical outcome. 国際誌

    Yuka Morita, Yutaka Yamamoto, Shinsuke Oshima, Kuniyuki Takahashi, Sugata Takahashi

    Auris, nasus, larynx41 ( 5 ) 417 - 21   2014年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: In general, cholesteatoma tends to recur more frequently in children than in adults. This has been suggested to be due to immature Eustachian tube function, underdeveloped mastoid air cells, and subsequent repetitive otitis media in children. This study was undertaken to determine the characteristics of acquired cholesteatoma in children by comparison with that in adults. METHODS: We retrospectively evaluated 42 children with acquired cholesteatoma (males, 38; females, 4; age range, 3-15 years) using medical records from January 1999 to December 2009 at the Department of Otolaryngology, Niigata University Hospital. The extent of disease was classified according to the Classification and Staging of cholesteatoma proposed by the Japan Otological Society in 2010. RESULTS: No major differences in stage classification were observed between children and adults. In children with pars flaccida-type cholesteatoma, the epithelium tended to invade from the attic to the mastoid cavity and mesotympanum. In contrast, adult patients with invasion to the mesotympanum were fewer. The rate of disappearance of the stapes superstructure was almost the same in children and in adults. The destruction of the superstructure of the stapes was more common in pars tensa type than pars flaccida type; so it was dependent on the pathology. Postoperative hearing levels were better in children, even in those with widespread lesions. However, the recurrence rate was significantly higher in children. CONCLUSIONS: Acquired cholesteatoma in children showed a wider invasion, and the recurrence rates were higher than that in adults. For patients with a widespread lesion and severe destruction of the ossicles, a two-stage surgery is recommended.

    DOI: 10.1016/j.anl.2014.05.002

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  • Long-term follow-up results of canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction in cholesteatoma surgery. 国際誌

    Yutaka Yamamoto, Kuniyuki Takahashi, Yuka Morita, Shinsuke Ohshima, Sugata Takahashi

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology35 ( 6 ) 961 - 5   2014年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The pathogenesis of recurrent cholesteatoma can be roughly divided into residual lesions and re-retraction of the epithelium. To prevent both residual and re-retraction cholesteatoma, we performed canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction as a fundamental surgical treatment for patients with acquired cholesteatoma. We attempted to achieve the complete extirpation of cholesteatoma in the wide surgical field made by the canal wall down procedure and simultaneously prevent recurrent retraction cholesteatoma and regain the physiologic canal wall, in which patients can have a "maintenance-free ear." OBJECTIVE: The surgical method used in the present study was described, and the long-term postoperative results of this method were evaluated. STUDY DESIGN: Retrospective study. PATIENTS: Participants were 118 patients with acquired cholesteatoma who underwent canal wall down tympanoplasty with mastoid obliteration and could be followed-up for more than 5 years. MAIN OUTCOME MEASURES: Postoperative changes in the reconstructed canal wall, the rate of otorrhea, and exposure of the material were examined using endoscopic images, medical charts, and CT scans. RESULTS: A total of 113 ears (95.8 %) achieved the nearly physiologic appearance of the external auditory canal, and these conditions were maintained throughout the follow-up periods. However, recurrent cholesteatoma was not observed during the follow-up periods. Postoperative otorrhea was observed in 2.5% of ears. Exposure of the bone pate was only noted in 1 patient (0.8 %). Postoperative CT scans confirmed that ossification developed in the bone pate used in the reconstructed canal wall and mastoid surface. CONCLUSION: Canal wall down tympanoplasty with mastoid obliteration using the bone pate plate for canal wall reconstruction prevents both recurrent and residual cholesteatoma and contributes to a good quality of life for the patient.

    DOI: 10.1097/MAO.0000000000000414

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  • Can the pathogenesis of auditory ossicular malformations be explained by the branchial-based theory?--Evaluation by the consecutive distribution of embryologic foci in 87 cases. 国際誌

    Yutaka Yamamoto, Kuniyuki Takahashi, Yuka Morita, Shinsuke Ohshima, Sugata Takahashi

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology35 ( 3 ) 449 - 53   2014年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Development of the auditory ossicles is initiated by induction of the cartilage primordium of each ossicle between the fifth and seventh fetal week. It is well known that primordium of the upper part of the ossicular chain is derived from the first branchial arch and that of the lower part develops from the second branchial arch. Previous studies have suggested that auditory ossicular malformations are caused by deficiencies in the early period of induction of the cartilage primordium. However, auditory ossicular malformations can occur at any developing stage, and their clinical features are very complicated. OBJECTIVE: The precise embryologic foci of auditory ossicular malformations were estimated by evaluating the consecutive distribution of these anomalies, and the pathogenesis of these malformations was discussed using new aspects. STUDY DESIGN: Retrospective study. PATIENTS: Eighty-seven ears of 78 patients that underwent surgical treatment after the diagnosis of an auditory ossicular malformation in Niigata University Hospital between 1998 and 2012. MAIN OUTCOME MEASURES: The types of malformations were roughly divided into 4 groups based on intraoperative findings: Type A--ankylosis of the malleus head or short process of the incus; type B--defect in the connection between the incus and stapes; type C--fixation of the footplate; and type D--a complex lesion combining types B and C. Additionally, the consecutive points of the malformation were precisely evaluated, and a distribution map of the malformation was made. Foci of the malformations of each type were then estimated. RESULTS: Type A malformations were observed in 8 ears, type B in 33 ears, type C in 32 ears, type D in 6 ears, and unclassified anomalies in 8 ears. A deformity was observed in the malleus handle, which is located in the lower part of the ossicle, in 5 of 7 ears with type A malformations, which suggests that the pathogenesis of ankylosis of the malleus head or short process of the incus could not simply be explained by the branchial-based theory. The focus of the type B malformation was located on the long process of the incus and not onthe I-S joint. We suggest that pathogenesis of the defect inthe connection between the incus and stapes could not be explained by a conjugation deficiency in the cartilage primordium but could be explained by an ossification deficiency after the conjugation period. The focus of the location of the defect was shifted more medially in type D malformations than in type B malformations, and this was significantly different, which suggests that this type of malformation is not caused by 2 independent anomalies but is inducted by a monogenic abnormality. CONCLUSION: The foci of auditory ossicular malformations were highly variable, which suggests that the pathogenesis of these malformations could not be simply explained by a branchial-based theory. Auditory ossicular malformations occur at various developmental stages of the auditory ossicles.

    DOI: 10.1097/MAO.0000000000000176

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  • Primary paraganglioma in the facial nerve canal. 国際誌

    Kuniyuki Takahashi, Yutaka Yamamoto, Shinsuke Ohshima, Yuka Morita, Sugata Takahashi

    Auris, nasus, larynx41 ( 1 ) 93 - 6   2014年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: To describe primary paraganglioma in the facial nerve canal and discuss the characteristics of facial nerve paraganglioma in contrast with other tumors. CASE REPORT: A 23-year-old man developed gradually progressive right facial palsy as the initial symptom. One year later, he exhibited hearing loss without tinnitus in his right ear. CT demonstrated an enlarged facial nerve canal with irregular bony erosion of the circumference. MRI showed a well-enhanced heterogeneous mass with hypo-intensity spots inside it. During surgery, a blood-rich tumor was observed along the facial nerve: however, extensive bleeding interfered with tumor removal. The surgical specimen demonstrated paraganglioma. The tumor was completely removed in the second surgery in combination with arterial embolization. Facial nerve function was reconstructed with a free muscle flap more than one year following resection. CONCLUSION: Because paraganglioma is a blood-rich tumor, it is important to perform angiography and embolization. If preoperative facial nerve palsy is demonstrated, careful management of facial nerve function is needed. Paraganglioma must be considered in the differential diagnosis of a facial nerve tumor.

    DOI: 10.1016/j.anl.2013.04.007

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  • Clinical behavior and pathogenesis of secondary acquired cholesteatoma with a tympanic membrane perforation. 国際誌

    Yutaka Yamamoto, Kuniyuki Takahashi, Yuka Morita, Sugata Takahashi

    Acta oto-laryngologica133 ( 10 ) 1035 - 9   2013年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    CONCLUSION: The pathogenesis of secondary acquired cholesteatoma with a tympanic membrane (TM) perforation is very different from that of other types of cholesteatoma. This disease should be clearly categorized as a different type of cholesteatoma. OBJECTIVE: Primary cholesteatoma generally arises from retraction of the squamous epithelium of the TM. However, in rare cases, epithelial invasion occurs from the edge of the TM perforation and migrates to the medial surface of the TM and middle ear cavity. The aim of this study was to evaluate the clinical features of secondary acquired cholesteatoma with a TM perforation. METHODS: We investigated 13 ears that underwent surgical treatment after the diagnosis of secondary acquired cholesteatoma with a TM perforation. Patient backgrounds, the preoperative appearances of TM, intraoperative findings, and histopathological findings were investigated. RESULTS: The average age was much higher than that of patients with other types of cholesteatoma, suggesting that it must require long periods of time to establish the disease. The common area of the epithelial invasion was on the superior part of the TM perforation around the tip of the malleus handle. The tendon of the tensor tympani muscle plays an important role as an extension route for this disease.

    DOI: 10.3109/00016489.2013.814924

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  • Bcl11b heterozygosity leads to age-related hearing loss and degeneration of outer hair cells of the mouse cochlea.

    Hitoshi Okumura, Yuki Miyasaka, Yuka Morita, Tomoyuki Nomura, Yukio Mishima, Sugata Takahashi, Ryo Kominami

    Experimental animals60 ( 4 ) 355 - 61   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BCL11B/CTIP2 zinc-finger transcription factor is expressed in various types of cells in many different tissues. This study showed that BCL11B is expressed in the nucleus of the outer hair cells of the mouse cochlea, degeneration of which is known to cause deafness and presbycusis or age-related hearing loss (AHL). We tested whether or not Bcl11b heterozygosity would affect AHL in mice. Analysis of auditory brainstem responses revealed AHL in Bcl11b (+/-) heterozygous, but not wild-type, mice, which was evident as early as 3 months after birth. Histological abnormalities were observed in the outer hair cells of the Bcl11b (+/-) mice at 6 months of age with hearing loss. These results suggest that the AHL observed in Bcl11b (+/-) mice is the result of impairment of the outer hair cells and that BCL11B activity is required for the maintenance of outer hair cells and normal hearing.

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  • [A case of difficult-to-diagnose hereditary angioedema].

    Yuka Morita, Hideyuki Hanazawa, Ushi Ueki, Sugata Takahashi

    Nihon Jibiinkoka Gakkai kaiho112 ( 11 ) 747 - 51   2009年11月

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)  

    Hereditary angioedema (HAE) due to an inherited C1-inhibitor (C1-INH) deficiency causes localized swelling of the oral cavity, pharynx, larynx, and face, that may be life-threatening when the larynx is involved. A 26-year-old woman seen 3 times previously for pharyngeal or laryngeal edema while in her teens, and seen this time for dyspnea was found in computed tomography (CT) to have esophageal edema and pleural effusion. Her C1-INH activity was low, yielding a definitive diagnosis of HAE for her 10-year-plus-disease history. n mind in th e f idiopathicedema. should be kept i While it is comparatively rare, HAE differential diagnosis o

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  • Fine mapping of Ahl3 affecting both age-related and noise-induced hearing loss. 国際誌

    Yuka Morita, Sachiko Hirokawa, Yoshiaki Kikkawa, Tomoyuki Nomura, Hiromichi Yonekawa, Toshihiko Shiroishi, Sugata Takahashi, Ryo Kominami

    Biochemical and biophysical research communications355 ( 1 ) 117 - 21   2007年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    A region in the vicinity of D17Mit119 on mouse chromosome 17 harbors a susceptibility gene, designated as Ahl3, to age-related hearing loss (AHL). We produced congenic lines of C57BL/6 background that substituted regions around D17Mit119 with MSM-derived ones, and examined auditory brainstem response (ABR) thresholds for their hearing capacity at 6 and 12months of age. Three congenic lines carrying the approximately 14-Mb region between D17Mit274 and D17Mit183 retained normal hearing at 12months of age whereas two congenic lines not carrying this region tended to lose hearing at that age. We also investigated noise-induced hearing loss (NIHL) in congenic lines at 1, 7 and 14days after exposure to the noise of 100dB for 1h. Most congenic mice carrying the 14-Mb region did not exhibit permanent threshold shift (PTS) whereas mice not carrying this region exhibited a strong tendency of PTS, indicating the role of Ahl3 in susceptibility to NIHL. These results indicate that Ahl3 exists within the 14-Mb region and affects not only AHL but also NIHL.

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  • Treatment of ranula--excision of the sublingual gland versus marsupialization. 国際誌

    Yuka Morita, Katsuro Sato, Masahiro Kawana, Sugata Takahasi, Fumio Ikarashi

    Auris, nasus, larynx30 ( 3 ) 311 - 4   2003年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.

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受賞

  • 第20回日本耳科学会奨励賞

    2013年10月   日本耳科学会   ANCA関連血管炎による難治性中耳炎の検討 -骨導聴力閾値の上昇を呈した9例16耳-

    森田 由香

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共同研究・競争的資金等の研究

  • 加齢性難聴が認知機能障害に与える影響に関する研究

    研究課題/領域番号:17K11318  2017年04月 - 2021年03月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    森田 由香

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    担当区分:研究代表者 

    配分額:4550000円 ( 直接経費:3500000円 、 間接経費:1050000円 )

    加齢性難聴はコミュニケーション障害をきたすのみならず、認知機能にも影響するといわれている。超高齢社会を向かえた我が国にとって、認知症対策は避けて通れない喫緊の課題である。認知症は一旦発症すると有効な治療法がなく、早期発見、早期介入による発症予防が重要である。我々は、加齢性疾患を対象とした佐渡市の疫学研究(PROST 研究)において、加齢性難聴と脳血管障害、糖尿病、腎障害など他の加齢性疾患との間にその発症や程度に有意な相関のあることを発表してきた。本研究では加齢性難聴と認知症の関係に注目し、PROST に登録されたビッグデータを用いて難聴の程度と認知機能、難聴への介入(補聴器)の認知機能への影響、加齢性難聴に関する遺伝子変異に関して検討している。現在まで、3300例の登録があり、そのうち793例の純音聴力検査が利用可能であり、周波数別の聴力検査結果の入力を終了した。
    高齢者における難聴についての解析を行うため、対象を60歳以上の322例に限定して解析した。認知機能の指標であるMinimental state examination(MMSE)の結果について、23点以下が認知機能低下とし、0.25~8kHzの周波数平均聴力が30dB以上を難聴ありと定義した。難聴発症と、認知機能低下、糖尿病、高血圧、飲酒、喫煙のリスクファクターを多変量解析したところ、難聴と認知機能低下は、オッズ比2.847(95%CI 1.605-5.050、p<0.001)と強い相関をみとめた。一方で、アルツハイマ-病の原因遺伝子のひとつとされるApoE4遺伝子多形との関連について検討したが、難聴とApoE4多形の関連はなかった。2者の関係性の方向として、ApoEは認知機能低下と関連することから、ApoEを介さず、難聴と関連していると考えられ、加齢性難聴発症が認知機能低下に影響すると考えられた。

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  • 加齢性難聴発症の病態解明―脳血管障害との関係についての研究

    研究課題/領域番号:26462552  2014年04月 - 2018年03月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    森田 由香

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    担当区分:研究代表者 

    配分額:4810000円 ( 直接経費:3700000円 、 間接経費:1110000円 )

    加齢性難聴は加齢により発症し徐々に進行する難聴で、人類でもっとも多い慢性疾患のひとつである。加齢に伴い脳血管障害も増加するが、これらの関係が明らかになれば、血管障害障害の予防が、難聴の予防、進行の抑制する可能性が考えられる。さらに高次機能である認知症との関係が明らかになれば、超高齢化社会の日本において果たす役割は大きい。
    今回の検討で、モデルマウスとヒト疫学研究から、加齢性難聴と脳血管障害に明らかな関係は認められなかった。さらにアルツハイマー病の危険因子とされるApoE4の存在も聴力には影響はなかった。しかし、認知機能の低下については強い相関をみとめ、今後の解析の糸口になったと考えられる。

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  • 加齢性難聴発症のメカニズム-骨代謝シグナル分子の解析

    研究課題/領域番号:24791757  2012年04月 - 2014年03月

    日本学術振興会  科学研究費助成事業 若手研究(B)  若手研究(B)

    森田 由香

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    担当区分:研究代表者 

    配分額:1950000円 ( 直接経費:1500000円 、 間接経費:450000円 )

    加齢性難聴の増悪因子についての検討を行った。高齢化のすすんだ離島におけるヒト疫学研究において、加齢性難聴例410耳について、70歳未満の若年群と70歳以上の高齢群に分けて、加齢性難聴に影響する因子を調査した。その結果、糖尿病に関しては、若年群において糖尿病がある群で難聴が有意に高度であった。また、喫煙と飲酒の有無に関しては、両群において、有意に難聴の増悪が認められ、糖尿病、喫煙、飲酒は加齢性難聴増悪因子のひとつと考えられた。一方、高血圧の有無は加齢性難聴増悪には関与しなかった。

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