セネストパチーへ移行しためまい・耳鳴症例

Abstract

A 51-year-old male was referred to our outpatient clinic complaining of dizziness and tinnitus associated with stiffness of his right hand on January 17, 1989. He had been treated for seven months after the sudden onset of bilateral ear fullness.The equilibrium function test revealed no evidence of neither peripheral or central vestibular abnormalities except for a positive Schellong test. The pure tone audiogram showed slight bilateral high tone loss. The neurological examination was otherwise within normal limits. A CT scan showed no intracranial abnormalities.On March 27, 1990, he visited to our clinic again complaining of bilateral tinnitus. At the same time his family members reported that he became so nervous that he had to return from his office and that he suffered from insomnia. A minor-tranquilizer, adenosine triphosphate, vitamin B and Chinese-Oriental herb medicine (Boufuu-Tsuushousan, reputed to be a remedy for tinnitus) were administered. As tinnitus and dizziness were relieved, he experienced a cenesthopathic sensation that something was ringing near both ears, around his head, in his left shoulder, under his left axilla, in his left hand, under both feet. This sensation varied with time, emotion, mental and physical stress. After treatment with anti-anxiety medicines, this sensation was relieved to some degree.There have been few reports on cenesthopathy in the head and neck region. This disease is characterized by peculiar sensations that are localized or disseminated, and is difficult to describe. Schizophrenia could be ruled out as he showed no personality changes.This experience points out that when treating patients, we should take into account possible pshychiatric problems.