Takaki Inui

Background/Objective: Eosinophilic chronic rhinosinusitis (ECRS) is a subtype of chronic rhinosinusitis with nasal polyps that is characterized by abundant eosinophilic infiltration within nasal polyps. Tuft cells are epithelial chemosensory cells that are present in the normal respiratory tract and activate group-2 innate lymphoid cells through their secretion of interleukin-25 and prostaglandin (PG) D₂. ECRS is also characterized by the activation of group-2 innate lymphoid cells; however, the involvement of tuft cell-derived PGD₂ in this process remains unclear. Methods: We selected consecutive patients with and without ECRS who underwent biopsy or surgical resection. Dual immunohistochemical analyses were performed to determine the presence of tuft cells producing PGD₂, using POU class 2 transcription factor (POU2F3), a specific tuft cell marker, and hematopoietic prostaglandin D synthase (H-PGDS). Results: The cohort included 52 and 14 patients with and without ECRS, respectively. The number of total POU2F3-positive tuft cells (POU2F3⁺/H-PGDS⁺ and POU2F3⁺/H-PGDS⁻) was significantly higher in the ECRS group vs. the non-ECRS one (p < 0.0001). Moreover, the ratio of POU2F3-positive tuft cells expressing H-PGDS [POU2F3⁺/H-PGDS⁺/(POU2F3⁺/H-PGDS⁺ + POU2F3⁺/H-PGDS⁻)] was also significantly higher in the ECRS group vs. the non-ECRS one (p = 0.0084). Conclusions: These results suggest that tuft cells present in the context of ECRS may serve as a potential source of PGD₂, thus involving to the amplification of type 2 inflammation.

Objectives: To describe the prevalence and clinical characteristics of headache or facial pain/pressure among patients presenting with rhinosinusitis in otolaryngology practice and to identify associated clinical findings. Methods: We retrospectively reviewed 304 patients with rhinosinusitis at a tertiary otolaryngology center. Among these patients, headache or facial pain/pressure was assessed in 202 cases with available documentation and analyzed in relation to symptom severity, sinus computed tomography, and nasal endoscopic findings. Multivariable analysis identified factors independently associated with headache or facial pain/pressure. Results: Among the 202 patients, 42.1% reported headache or facial pain/pressure considered related to sinonasal inflammation. High‐intensity facial pain/pressure was uncommon, with 6.5% reporting high SNOT‐22 scores. Active migraine at presentation was rare (1.0%), and a history of migraine (10.4%) was comparable to the general population. In multivariable analysis with false discovery rate adjustment, middle meatal polyps were associated with lower odds of headache or facial pain/pressure (OR: 0.41; 95% CI: 0.19–0.92; adjusted p = 0.032). A maxillary sinus Lund–Mackay score of 2 showed a positive association in unadjusted analysis (OR: 1.49; 95% CI: 1.08–2.04; p = 0.007) but was not significant after correction (adjusted p = 0.056). Headache or facial pain/pressure was not assessed in 102 of the 304 patients. Conclusion: Headache or facial pain/pressure is common but often mild in patients with rhinosinusitis in otolaryngology practice. Variability in symptom assessment may contribute to differences in reported prevalence, highlighting the importance of systematic inquiry combined with endoscopic and radiologic evaluation. Level of Evidence: 3.

Background: Falls along with gait‐balance disturbances are important symptoms of idiopathic normal pressure hydrocephalus (iNPH).Objectives: This study aimed to validate the Functional Gait Assessment (FGA) item‐difficulty hierarchy, determine its optimal fall cutoff value, and identify key items for assessing fall risk in iNPH.Methods: One hundred eighty‐eight iNPH patients underwent pre‐intervention assessments using the FGA, timed up‐and‐go (TUG), 10‐Meter Gait Speed (10MGS) tests, and their falls history in the past 6 months. Rasch analysis confirmed the validity of the FGA item‐difficulty hierarchy and established the relationship between total scores and logit estimates. Logistic regression identified the optimal FGA cutoff value and key fall‐related items.Results: The FGA's item‐difficulty hierarchy was confirmed to range from item 5 (“gait and pivot turn”) at −2.58 logits (easiest) to item 7 (“gait with narrow base of support”) at 5.35 logits (most difficult). Total scores corresponded to logits from −10.39 (score 0) to 11.64 (score 30). The fall rate was 63.3%. The optimal FGA cutoff value was ≤15 points (area under curve [AUC]: 0.901, P < 0.001), outperforming TUG (AUC: 0.712) and 10MGS (AUC: 0.742). Key fall‐related items (R²: 0.545, P < 0.001) were item 2 (“change in gait speed”), item 7 (“gait with narrow base of support”), item 1 (“gait on level surface”), item 10 (“stair steps”), and item 5 (“gait and pivot turn”).Conclusions: Our findings may facilitate early diagnosis and timely interventions, including tailored rehabilitation and fall prevention strategies, by leveraging the item difficulty and characteristics of the FGA for iNPH patients.

This is the first report of vestibular examinations before and after the successful treatment of vestibular migraine (VM), a common cause of recurrent vertigo, with calcitonin gene-related peptide (CGRP) receptor inhibitor. We evaluated a 42-year-old female with VM and concomitant probable Meniere’s disease, whose headache and dizziness have improved promptly with the administration of erenumab, a CGRP receptor inhibitor. The sensorineural hearing loss in pure-tone audiometry, dysfunctions shown in vestibular examinations (cervical and ocular vestibular evoked myogenic potentials), and mild endolymphatic hydrops shown in gadolinium-enhanced inner ear magnetic resonance imaging, all in the right ear, revealed no change compared with those observed before treatment. This case suggests that VM may be treated by blocking CGRP in the trigeminal ganglion, which suppresses the effects on the vestibular nucleus; herein, no effects were observed in the inner ear despite the clear amelioration of dizziness.

Objectives: To elucidate the differences between the cases of Meniere’s disease (MD) with and without coexisting headaches, especially migraine. The clinical characteristics and vestibular functions are compared.Subjects: Fifteen patients with definite unilateral MD without headaches (MD/H−; 10 males and 5 females; mean age of 55.8 years), and 20 patients with definite unilateral MD with headaches (MD/H+; 3 males and 17 females; mean age of 54.4 years; 15 cases of migraine without aura and 5 cases of suspected migraine or tension-type headache) were enrolled.Methods: The medical records, caloric test results, and cervical vestibular evoked myogenic potential (cVEMP) of the patients were reviewed. A monothermal caloric test by injection of cold water was performed, and canal paresis was assessed. cVEMP was recorded using 500 Hz short tone bursts, and the asymmetry ratio using the corrected amplitude of p13–n23 was determined.Results: The patients in the MD/H− group were predominantly male, whereas more female patients were seen in MD/H+ group (p = 0.004). In the MD/H+ group, the frequency of vertigo and the dizziness handicap inventory (DHI) values were significantly higher than those in the MD/H− group (p = 0.045, p = 0.018). Multivariate analysis of sex, frequency of vertigo, DHI, and cVEMP results showed significant differences only in the cVEMP results (p = 0.049).Conclusion: The present study revealed differences in patients with MD depending on the presence or absence of headaches. MD without headaches showed a significant male preponderance. MD with coexisting headaches was more associated with severe saccular dysfunctions than MD without headaches. Concomitant headache may affect the manifestations of the vestibular function, especially in the sacculus, in MD cases.

The condition of vestibular dysfunction and blood flow in the vertebral artery (VA) in transient vascular vertigo/dizziness (TVV) is not well established. To clarify the pathophysiology of TVV, especially the difference between the isolation of vestibular symptoms. Ten TVV patients with central nervous system symptoms (TVVw) and 12 TVV patients without central nervous system symptoms (TVVo) underwent duplex color-coded ultrasonographic evaluation of VAs, caloric test, and cervical vestibular-evoked myogenic potential (cVEMP). The mean flow velocity (MV) ratio (peak MV of contralateral VA divided by target VA) was significantly higher in TVVw than in TVVo. There was no difference in the occurrence of canal paresis between TVVw and TVVo. Abnormal asymmetry ratios (ARs) of cVEMP were observed only in TVVo cases (6 of 12 cases), revealing a statistically significant difference in the number of cases between TVVw and TVVo. Measuring VAs using duplex color-coded ultrasonography and cVEMP may help evaluate TVV. Different results of MV ratio and cVEMP between TVV cases with or without central nervous system symptoms may indicate differences in the pathophysiology between TVVw and TVVo.

オスラー病は遺伝性出血性毛細血管拡張症（Hereditary hemorrhagic telangiectasia: HHT）とも呼ばれ，常染色体顕性遺伝，皮膚や多臓器の多発性毛細血管拡張，反復する鼻出血を3主徴とする多臓器疾患である。当科で鼻出血の制御を目的として入院加療を要したHHT患者3例を経験したため，その治療内容や経過をまとめ報告する。 症例1は30歳女性で，数か月おきにレーザー凝固術を繰り返すことで鼻出血のコントロールを行った。症例2は74歳女性で，肝臓と肺に動静脈奇形の合併に加えて，原因不明とされる脳出血の後遺症を伴っていた。意思疎通ができず，安静が保てないために止血に難渋し，選択的動脈塞栓術を行った。症例3は64歳男性で，多量の鼻出血を繰り返すため鼻粘膜皮膚置換術を行った。術後も鼻出血は反復するものの，頻度や量の改善が見られた。 HHTはほとんどの症例で反復する鼻出血を生じるため，耳鼻咽喉科医が果たす役割は幅広く，鼻出血のコントロールによるQOLの向上だけでなく，診断や合併する疾患に対する専門科受診の橋渡しもしなければならない。しかし，耳鼻咽喉科で見逃されていることも多い疾患であるという認識も必要である。今回の3例も初発症状から診断まで時間が経っており，うち2例は当科で鼻出血の治療歴もあったがHHTの診断に至らなかった。反復する鼻出血を来す疾患としてHHTがあることを念頭におき，HHTを疑う場合は鼻内局所の所見だけではなく，口腔粘膜・手指の観察と家族歴の詳細な問診を忘れてはならない。