From January 1983 to June 1988, we treated thirty patients of hypopharyngeal cancer. Among these 30 patients the double and multiple primary cancers were found in five cases (16.7%). All of them were male who had have a history of excessive smoking and drinking. The secondary cancer occurred most frequently in the upper digestive tract, especially esophagus. Since the secondary esophageal cancers were in early stage in 4 cases, we could not detect them by the esophagogram. In those cases, we could detect the lesion under the upper gastro-intestinal endoscopy with Lugol stain. Accordingly, we recommend this examination in the patients of hypopharyngeal cancer.

View full abstract

We examined three important quantitative parameters to evaluate the sleep disturbances in children.
The subjects were 46 children who had sleep disturbances such as sleep apnea, snoring and sternal retraction. They were examined with an all night polysomnography which included mesopharyngeal pressure, arterial oxygen saturation, air flow, thoracic movement, and snoring sound. We obtained Apnea Index, Sleep Oxygen Desaturation Index (SOD Index) which stood for the average percentage of reduction from arterial O2 saturation during sleep and mesopharyngeal pressure amplitude (MPA) which stood for the maximum negative pressure amplitude under the obstructed portion in the upper airway.
In 44 cases of obstructive sleep apnea, the relationship among three parameters was investigated with correlation with chest deformity.
The following results were obtained:
(1) The correlation between Apnea Index and SOD Index (r=0.732, P<0.001) was more (1) The correlation between Apnea Index and SOD Index (r=0.732, P<0.001) was more significant than that between Apnea Index and MPA (r=0.371, P<0.01) and than that between Apnea Index and MPA (r=0.585, P<0.001).
(2) By evaluating Apnea Index and MPA, two types were identified. The one had high values of both Apnea Index and MPA. The other had low values of Apnea Index (below 5 points) and high values of MPA.
(3) MPA had a significant differentiation (P<0.01) between chest deformity cases and no-chest deformity cases. However, neither Apnea Index nor SOD Index had a significant differentiation.
It was considered that MPA was useful for one of the quantitative parameters to evaluate the sleep disturbance in children.

View full abstract

The causative lesion in patients complaining of abnormal sensation in the throat is often obscure because of the difficulty in precise diagnosis. Swallowing function is thought to deteriorate with age from normal to i) a feeling of an abnormal throat sensation, and ii) a frank swallowing disorder. Patients were categorized age-wise, into three main groups, i) 40-50, ii) 50-60 and iii) 60 and above. In the last group were included controls. Pharyngo-larynx was examined by laryngoscopy and contrast barium studies. Compared to the patients in the younger age groups, some patients above 60 years were found to have a higher incidence of inflammatory lesions in the laryngopharynx, barium retention in the piriform sinus, vallecular space and the supra-glottic surface of the cords; a few had slight aspiration of the barium. Patients in the 60-above group showed improvement in their swallowing with drugs which improve cerebral metabolism and circulation. It was found that adding this therapy improves abnormal throat sensation in those senile patients who had swallowing dysfunction. In conclusion, there appear to be a high rate of functional swallowing disturbance among senile patients with abnormal sensation in the throat.

View full abstract

The development of digital radiography (DR) has made it possible to analyze the contour of the laryngeal soft tissue structures in more detail than the conventional screen-film method. The authors first used the DR system for time subtraction of the larynx during inspiration and phonation.
The images are acquired by means of frontal tomography of the larynx using the imaging plate during inspiration and phonation separately, and stored into the memory of the DR system. The thickness of the slices is 5.0 mm. Time subtraction between the mask image during inspiration and the live image during phonation is performed using digital processing on CRT. Superimposing the two images at the upper trachea and the thyroid cartilage of the same depth, makes it possible to measure movement of the vocal cord and false vocal cord quantitatively in three dimensions. The authors named this time subtraction as motion subtraction of the larynx.
This motion subtraction image can be obtained by on-line digital processing without complicated development technique, but has so high spatial resolution. This image processing seems to be useful in functional radiographic analysis of laryngeal diseases.

View full abstract

Non-specific granuloma of the larynx is a relatively uncommon disease, but recurrence is occasionally seen after surgical removal. Most common non-specific granulomas are postintubation granulomas and idiopathic granulomas.
In the past three years, 19 patients with idiopathic granuloma were examined in our clinic. Among 19 patients, 18 were male and one was female. The age ranged from 35 to 64 years with a mean age of 52.1 years. There were no young patients.
All the granulomas were confined to the posterior portion of the unilateral vocal cord. Seven were treated with conservative therapy and 12 were with surgical therapy. Conservative therapy mainly consisted of voice therapy. As a result of voice therapy, the granuloma disappeared in two patients three months later. Surgical therapy such as laryngomicrosurgery was performed, and 10 patients were treated with Nd-YAG laser. After the operation, seven patients required an additional operation because of recurrence. Spontaneous remission was seen in two patients 3 months after recurrence.
The present study indicates that conservative therapy should be chosen initially and repeated operation is not recommended.

View full abstract

The present study indicates that conservative therapy should be chosen initially and repeated operation is not recommended. were adults with the age ranged from 20 to 81 years. The ratio of male to female was 2.6: 1.
The majority of the patients had a sore throat, odynophagia and dysphagia with mild to severe fever. Some patients complained of dyspnea increased in the supine position and decreased in the sitting position, suggesting that a swollen epiglottis dropped down backwards to obstruct the laryngeal orifice in the supine position. This kind of dyspnea is a characteristic symptom in acute epiglottitis.
Tracheotomy was performed in two and tracheal intubation in one, and no death occurred.
Lateral neck roentgenograms were obtained in 16 cases in the course of acute epiglottitis.
The diagnosis of the disease was roentgenographically confirmed in 81 per cent of the cases, but in each case the diagnosis had been made initially by indirect laryngoscopy. The intervals between the onset of symptoms and doctor contact and hospitalization were within 7 days.
Antibiotic therapy was done in most cases. Most signs and symptoms resolved in three to five days, with a dramatic decrease in pain and dysphagia within 24 hours.
Epiglottic swelling resolved in seven to eleven days and 70 per cent of the cases were discharged within that time.

View full abstract

A 42-year-old overweighted man visited our hospital complaining of severe snoring and sleep apnea. The diagnosis of obstructive sleep apnea was established by a sleep study. Uvulopalatopharyngoplasty was performed for relief of airway obstruction, and tracheostomy was added for the postoperative care.
Fourteen days after the operation, a sleep study was performed again with opened as well as closed tracheostoma. Since apnea and snoring were not improved with closed tracheostoma, the stoma was kept open even after the discharge from the hospital. In four months he successfully reduced his weight as much as 10 kg, and the tracheostoma was able to be closed without any trouble.
The number of this kind of patients as obese people is increasing in recent years. Exact diagnosis and adequate treatment for obstructive sleep apnea syndrome are required.

View full abstract

Stenosis of the tracheostoma after laryngectomy is a potentially serious condition. We performed revision surgery of the tracheostomal stenosis after laryngectomy for 10 patients in our clinic between May 1975 and March 1988. Ten patients consisted of 9 males and 1 female with ages ranged from 56 to 74 years. We classified our cases into three types; vertical slit type, concentric type and inferior shelf type. A vertical slit type of stenosis occurred in 9 cases and a concentric type of stenosis in one. We speculated that tracheostomal stenosis was created by an excessive scar tissue formed after postoperative infection, excessive skin around the stoma and supportless tracheal ring. There was one patient who had undergone preoperative radiotherapy. Finally, we reviewed several reconstruction methods of the stenosed tracheostoma and presented our own methods. We recommend a surgical revision for tracheostomal stenosis after laryngectomy when it occurred unfortunately.

View full abstract

We reported a case of early mucoepidermoid carcinoma of the bronchus. A 41-year-old female was admitted to our hospital complaining of hemosputum and slight fever. On fiberoptic bronchoscopy, a tumor mass narrowing the orifice of right middle lobe bronchus was seen. Right middle and lower bilobectomy was performed under the diagnosis of adenocarcinoma, which was suggested by the bronchofiberoptic biopsy. Postoperative histological examination revealed that this tumor was an early mucoepidermoid carcinoma of the bronchus, and that the cellular differentiation was considered as the grade 2 of Conlan's classification. The postoperative course was uneventful. She has been well one year after the operation.

View full abstract