耳鼻咽喉科・頭頸部外科84巻8号

2012年07月発行

Current Article

クプラの構造とめまい発症への関与

著者： 鈴木衞¹

所属機関： ¹東京医科大学耳鼻咽喉科学教室

ページ範囲：P.515 - P.523

Ⅰ　はじめに

　クプラは半規管感覚上皮を帽子状に覆うゼラチン様物質である。その表面は索状であるが，下腔面は網目状を呈しており，感覚毛が網目内に入り込んでいる。このような特殊な構造と運動様式が多くの研究者の興味を引きつけてきたが，形態が脆弱で観察困難なため，その本態については不明な点が多い。しかしながら，クプラに何らかの異常があれば半規管受容器の反応性が低下したり，めまいやふらつきの原因になったりすることは容易に想像できる。本稿ではクプラの基礎的事項とそれがどのようにめまい発症に関与するかを述べてみたい。

参考文献

1）Anniko M, et al：Formation of the cupula cristae ampullaris：development in vivo and in vitro. Am J Otol 3：31-40, 1982

2）Mbiene J-P, et al：The pattern of ciliary development in fetal mouse vestibular receptors. A qualitative and quantitative SEM study. Anat Embryol 170：229-238, 1984

3）Takumida M, et al：Development of crista ampullaris in the mouse. J Laryngol Otol 100：759-763, 1986

4）Yamashita H, et al：Histochemical localization of glycoconjugates in the developing endolymphatic sac and vestibular endorgans of the mouse. ORL 54：124-129, 1992

5）中井義明・他：半規管膨大部クプラの発生．耳鼻臨床 75：2427-2435，1982

6）Harada Y：Surface structure of semicircular ampullae. Equilibrium Res 4：53-58, 1972

7）Lim DJ：Vestibular sensory organs. Arch Otolaryngol 94：69-76, 1971

8）佐藤修治：クプラ，クプラ下腔に関する形態学的，電気生理学的および組織化学的研究．耳鼻臨床 81：433-452，1988

9）Dohlman G, et al：The selection and absorption of endolymph. Acta Otolaryngol 51：435-438, 1960

10）Hunter-Duvar IM：An electron microscopic study of the vestibular sensory epithelium. Acta Otolaryngol 95：494-507, 1983

11）Barber VC, et al：Cupula-receptor cell relationships with evidence provided by SEM microdissection. Scanning Electron Microscopy 3：939-948, 1979

12）Tauber R, et al：Complex carbohydrates-Structure and function with respect to the glycoconjugate composition of the cupula of the semicircular canals. Biol Sci Space 15：362-366, 2001

13）Takumida M：Functional morphology of the crista ampullaris with special interests in sensory hairs and cupula：a review. Biol Sci Space 15：356-358, 2001

. J Comp Neurol 402：48-61, 1998

15）Rüsch A, et al：Cupula displacement, hair bundle deflection, and physiological responses in the transparent semicircular canal of young eel. Pflügers Arch 413：533-545, 1989

16）Dohlman GF：The attachment of the cupulae, otolith and tectorial membranes to the sensory cell areas. Acta Otolaryngol 71：89-105, 1971

17）Igarashi M, et al：Cupula, copular zone of otolith membrane, and tectorial membrane in the squirrel monkey. Arch Otorhinolaryngol 68：420-426, 1969

. An experimental investigation. Acta Otolaryngol 87：528-538, 1979

19）Konomi U, et al：Morphological change of the cupula due to an ototoxic agent：A comparison with semicircular canal pathology. Acta Otolaryngol 130：652-658, 2010

20）Kondo T, et al：Changes in the cupula after disruption of the membranous labyrinth. Acta Otolaryngol 132：228-233, 2012

21）Suzuki M, et al：An experimental study on a function of the cupula. Effect of cupula removal on the ampullary nerve action potential. Eur Arch Otorhinolaryngol 241：75-81, 1984

22）Suzuki M, et al：An experimental study on the physiological properties of the cupula. Effect of cupular sectioning on the ampullary nerve action potential. Eur Arch Otorhinolaryngol 241：309-316, 1985

23）Goodyear RJ, et al：Extracellular matrices associated with the apical surfaces of sensory epithelia in the inner ear：molecular and structural diversity. J Neurobiol 52：212-227, 2002

24）Simmler M-C, et al：Targeted disruption of Otog results in deafness and severe imbalance. Nature Genet 24：139-143, 2000

25）El-Amraoui A, et al：Spatiotemporal expression of otogelin in the developing and adult mouse inner ear. Hear Res 158：151-159, 2001

26）Steinhausen W：Über den Nachweis der Bewegung der Cupula in der intakten Bogengangsampulle des Labyrinthes bei der natürlichen rotatorischen and calorischen Reizung. Pflügers Arch Physiol 228：322-328, 1931

27）Dohlman GF：The attachment of the cupulae, otolith and tectorial membranes to the sensory cell areas. Acta Otolaryngol 71：89-105, 1971

28）McLaren JW, et al：Configuration of the cupula during endolymph pressure changes. Soc Neuroscience Abs 2：1060, 1976

29）Hillman DE, et al：Displacement configuration of semicircular canal cupulae. Neuroscience 4：1989-2000, 1979

. Acta Otolaryngol 87：528-538, 1979

31）Suzuki M, et al：Exposure and direct stimulation of the semicircular canal cupula. Eur Arch Otorhinolaryngol 241：141-147, 1985

32）Suzuki M, et al：An experimental study on cupular function：mapping of the cupula by direct stimulation. Eur Arch Otorhinolaryngol 241：237-242, 1985

33）大塚康司・他：微細刺激によるクプラの偏移の観察．Equilibrium Res 64：100-105，2005

34）Otsuka K, et al：A model experiment of BPPV mechanism using the whole membranous labyrinth. Acta Otolaryngol 123：515-518, 2003

35）Baloh RW, et al：Benign positional vertigo：clinical and oculographic features in 240 cases. Neurology 37：371-378, 1987

36）Korres SG, et al：Electronystagmographic findings in benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 113：313-318, 2004

37）Sekine K, et al：Dynamics of the vestibulo-ocular reflex in patients with the horizontal semicircular canal variant of benign paroxysmal positional vertigo. Acta Otolaryngol 124：587-594, 2004

38）Baloh RW, et al：Benign positional vertigo：Clinical and oculographic features in 240 cases. Neurology 37：371-378, 1987

39）Pagnini P, et al：Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec 51：161-170, 1989

40）Baloh RW, et al：Horizontal semicircular canal variant of benign positional vertigo. Neurology 43：2542-2549, 1993

41）藤田信哉・他：HC-BPPV（外側半規管型良性発作性頭位めまい症）の患側と半規管機能について．日耳鼻 108：202-206，2005

42）Moriarty B, et al：The incidence and distribution of copular deposits in the labyrinth. Laryngoscope 102：56-59, 1992

43）Katsarkas A：Electronystagmographic（ENG）findings in paroxysmal positional vertigo（PPV）as a sign of vestibular dysfunction. Acta Otolaryngol 111：193-200, 1991

44）Strupp M, et al：Horizontal canal benign paroxysmal positional vertigo：Reversible ipsilateral caloric hypoexcitability caused by canalolithiasis. Neurology 45：2072-2076, 1995

45）Wada M, et al：Inner-ear function test in cases of posterior canal-type benign paroxysmal positional vertigo. Int Tinnitus J 15：91-93, 2009

46）Iida M, et al：Vertical semicircular canal function：A study in patients with benign paroxysmal positional vertigo. Acta Otolaryngol 545（Suppl）：35-37, 2001

47）Sekine K, et al：Vertical canal function in normal subjects and patients with benign paroxysmal positional vertigo. Acta Otolaryngol 124：1046-1052, 2004

48）Lopez-Escamez JA, et al：Dynamics of canal response to head-shaking test in benign paroxysmal positional vertigo. Acta Otolaryngol 127：1246-1254, 2007

49）Halmagyi GM, et al：A clinical sign of canal paresis. Arch Neurol 45：737-739, 1988

50）Heidenreich KD, et al：Can active lateral canal benign paroxysmal positional vertigo mimic a false-positive head thrust test? Am J Otol 30：353-355, 2009

51）Epley JM：Positional vertigo related to semicircular canalolithiasis. Otolaryngol Head Neck Surg 112：154-161, 1995

52）Smolders JW：Functional recovery in the avian ear after hair cell regeneration. Audiol Neurootol 4：286-302, 1999

53）Jun AI, et al：Temporal bone histopathology in connexin 26-related hearing loss. Laryngoscope 110：269-75, 2000

54）Plantinga RF, et al：Audiological evaluation of affected members from a Dutch DFNA8/12（TECTA）family. J Assoc Res Otolaryngol 8：1-7, 2007

55）Igarashi M, et al：Cupula, copular zone of otolith membrane, and tectorial membrane in the squirrel monkey. Arch Otorhinolaryngol 68：420-426, 1969

56）Suzuki M, et al：An experimental study on the physical properties of the cupula. Effect of cupular sectioning on the ampullary nerve action potential. Eur Arch Otorhinolaryngol 241：309-316, 1985

57）Suzuki M：Surgery. Basic and clinical approach to BPPV based on model experiment results. ed by Suzuki M. Spio, Tokyo, 2012, pp119-124

58）Pohl DV：Posterior semicircular canal occlusion for intractable BPPV. J Vest Res 6：s-48, 1996

59）Kadir A, et al：Effect of streptomycin intoxication on vestibular nerve regeneration and posture recovery. Acta Otolaryngol 117：376-381, 1997

60）Suzuki M, et al：Recovery mechanism of postural disturbance after vestibular neurectomy. ORL 53：290-293, 1991