It is a clinical routine to observe the wave motion of the vocal fold, at present, with a laryngeal stroboscope and to evaluate the flexibility of vocal fold. However, a laryngeal stroboscope can not be used unless the patient's vocal pitches are obtained. Fukuda has developed a method that enables to observe membranous vibrations (pseudo-wave motion) produced by giving externally forced vibrations to the vocal fold with a laryngeal vibrator. We currently applied this method to observe the stiff vocal fold lesions such as vocal fold leukoplakia and cancer, and evaluated the deviation of respective regions of the vocal fold induced by their stiffness. Laryngomicrosurgical biopsy was performed from stiff vocal fold lesions under general anesthesia. Stiff lesions were determined during vibratory motion of the vocal fold produced with a vibrator which was placed to an anterocervical region in the neighborhood of the thyroid cartilage. The membranous vibrations of the vocal fold were videotaped with the aid of strobolight. When the strobolight and ordinary light of xenon were simultaneously used, a static image of the vocal fold by a phenomenon of remaining images and membranous vibrations of the vocal fold were concurrently recorded on the same screen. A cycle of vocal fold vibrations at a site of biopsy was traced for the measurement whose deviations were graphically shown.

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A clinical review was made on 408 cases of unilateral recurrent laryngeal nerve paralysis from 1977 through 1984.
Among those, 223 were male patients and 185 females, and as for age distribution, most cases were seen in patients of their 6th decades of life.
As the causes of paralysis, it is revealed that 153 cases (37.5%) were caused by surgery involving the recurrent laryngeal nerve or vagal nerve, 59 cases (14.6%) by tumorous lesions in head and neck and thorax and 130 cases (32.0%) by unknown cause.
Comparing with 602 cases from 1965 through 1976, which have been already reported as a clinical survey from Keio University, the unknown causes were less and causes of surgery and tumorous lesions were more frequently clarified.
We have sent out a questionnaire to the patients with unknown causes and made a research for their afterwards diseases.

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The postnatal development of substance P (SP) in the larynx of mice was immunohistochemically investigated. The appearance of weak SP positive fibers in the epithelial layer was detected at an early embryonic stage of 17th days. The development of these fibers was enhanced gradually after birth, especially within the first 3 weeks. At the age of 21 days just corresponding to the age of the weaning of mice, a histologically particular finding appeared to be obvious that a part of strongly SP-positive nerves extend their fibers ends to the surface of the laryngeal mucosa. Nerve fibers which distributed in close association with the epithelial vessels and glands were also detected in this stage. Then by the age of 35th days fully matured histological findings were obtained.
The above evidence suggests that SP-fibers abundantly present in larynx, physiologically involved in the sensory system of the external stimuli from the air tract.

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Continuous rales heard during spontaneous attacks of bronchial asthma (natural attacks) and those of exercise-induced asthma (EIA) in children were analyzed sonographically using a sound spectrograph. We analyzed rales simultaneously recorded at three different locations, i. e. on the left and right sides of the chest and on the neck. Natural attacks were found in 68 patients and EIA in 31.
The number and the duration of rales per respiratory cycle significantly increased in patients with natural attacks and in those with EIA according to the severity of the attack and the degree of decrease of FEV1. 0. In both natural attacks and EIA, the number of sites of rales were found to increase in a correlation with the degree of attacks and a decrease in pulmonary function.
When comparing rales of natural attacks and EIA the fundamental frequency of the rales was significantly higher in EIA. This suggests that the location of bronchial contraction in EIA is more central than in natural attacks.
The highest prevelence of rales among the three different pick-up points was on the neck. About 90% of rales were recorded on the neck, and about 90% of rales recorded on the chest were also simultaneously detected on the neck. We conclude that the neck is a important location for auscultating rales and rales are strongly transmitted to the neck than over the other side of the chest.
Rales of short duration occurring in children with natural attacks and EIA were different from the squawks that were classified as discontinuous rales in adults with interstitial pneumonitis. The duration, number of overtones and timing of onset were all different in those two groups. We conclude that the mechanism of production may be nearly equal to that of continuous rales.

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A case of 56-year-old woman who was strangled by an agricultural machine, was reported. She had been complaining of dysphagia and dyspnea since one month after the accident. Clinical examinations revealed that there had been laryngopharyngeal stenosis and fractures of both the hyoid bone and the thyroid cartilage. Reconstruction of the lumen had been performed. However, the tendency of cicatricial stenosis was observed for two years. The scar tissue was vapolized with CO2 laser irradiation finally.

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The patient was a 40-year-old woman who complained of hoarseness for the past one year. Laryngoscopic examination revealed diffuse swelling in the right false vocal cord and the ventricle.
Laryngeal CT-scanning showed a round high-density mass suggesting a submucosal tumor in the paraglottic area. The tumor was removed through laryngofissure.
Reconstruction of the larynx was performed by use of a pedicled thyrohyoid muscle flap inserted into the defect after removal of the tumor.
As histopathological findings showed a malignant oxyphilic adenoma, total of 40 Gy in linac was radiated to the larynx in 2 Gy doses per day.
In order to evaluate phonatory function of the patient, aerodynamic studies and sound spectrographic analysis were performed pre and post operatively. Her voice returned to normal after the operation. During sustained vowel /a/ phonation, air flow rate became stable and reduced from 257 ml/sec to 125 ml/sec.
After the operation, sound spectrographic findings revealed clear and stable formants, regularity of fundamental frequencies and normal pitch levels in her voice.
There has been no evidence of recurrence for 5 years.

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Formation of an intratracheal granuloma is one of the sequelae in tracheotomy. We reported a man of intratracheal granuloma. The patient underwent an emergency tracheotomy in another hospital to secure his air way for unconsciousness caused by the traffic accident. Six weeks later, his tracheostoma was closed. After the closure of the tracheostoma, shortness of breath increased gradually. After six months, as his dyspnea became severe, he visited our hospital urgently. We removed the intratracheal granuloma through the new tracheostoma which was made by us. We cited a few factors as the cause of the intratracheal granuloma, that is, infection around the tracheostoma, mechanical irritation of the cannula and unskillful technique in the tracheotomy. It is concluded that we must pay much attention to surgical managements in tracheotomy in order to avoid complications and sequelae, even though the tracheotomy is in emergency.

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A mass radiographic examination of the chest disclosed an asymptomatic abnormal mediastinal shadow protruding to the right thoracic cavity in a 41-year-old house wife. At the time of evaluation of the tumor shadow, a radiopaque shadow in the trachea was incidentally discovered. Bronchoscopic examination revealed a smooth-surfaced, yellowish white, round tumor originating from the anterior wall at the level of lower third of the trachea and occluding two thirds of the lumen. But a definite diagnosis was not established. Transthoracic needle aspiration biopsy of the mediastinal tumor was of no diagnostic value. Although she was quite asymptomatic at the time, surgical treatment was thought to be reasonable because the trachea was threatened eventually to be occluded completely by the tumor. Removal of the anterior mediastinal tumor was followed by tracheal sleeve resection with end-to-end anastomosis. The mediastinal tumor was a thymic cyst and the tracheal tumor was a neurilemmona.
Tracheal neurilemmomas are rare and only 19 documented cases in the world literature were found.

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Case: A 30-year-old man of epilepsy intentionally swallowed a stapling machine, tweezers, and two felt pens. In the X-ray examinations of chest and abdomen, the stapling machine had lodged in his esophagus. The other items were found in his stomach. By gastrotomy the felt pens and tweezers were removed. After that we inserted 22 Fr Nelaton's catheter into his esophagus from E-C junction. His esophagus was enlarged by inflating the catheter with air. Drawing the inflated catheter downwards gradually, we put a bougie into his esophagus transorally to push the stapling machine down to E-C junction. In this way, the stapling machine was pushed into his stomach and removed.

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