Laryngeal stroboscopy is an extremely useful method to observe lesion of the larynx. By using a VTR system, we can easily observe the opening and closing movements of the vocal cords frame by frame.
Endoscopic videostroboscopy was performed in 50 patients, and their dysphonia was assessed according to the GRBAS scale.
Breathy hoarseness was found in 30 patients, in 26 of whom incomplete closure of the glottis was observed.
In addition, the area of the glottis on phonation was measured in 19 patiens.
The grade of breathy hoarseness (B0-B3) was highly consistent with the grade of incomplete glottic closure (the rate of the area of the closing phase per the area of the opening phase).

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To clarify the etiological role of human papillomavirus (HPV) on the laryngeal papilloma and cancer, we examined 5 cases of laryngeal papillomas and 28 cases of laryngeal cancers (squamous cell carcinoma) by means of dot blot (Vira Pap^TM) hybridization, Southern blot hybridization as well as another new method, polymerase chain reaction (PCR). HPV type 6 or 11 DNA was detected in all cases of multiple papillomatosis both in adult and children. In one case of solitary papilloma, no HPV genome was detected. On the other hand, HPV type 16 and/or 18 DNA were found in 3 specimens of 28 laryngeal cancers (10.7%). This is the first report of the HPV 18 DNA detection from the head and neck cancer. From these result, it has been strongly supported that HPV type 6 and 11 play a key role at least in benign multiple papillomatosis, and HPV type 16 and 18 play a role in some malignant laryngeal tumors.

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An Abnormal sensation in the throat can be caused by various different diseases. In this study, we divided the patients who showed an asthmatic pattern on flow-volume curve testing into two groups;
1) 106 patients with no other abnormalities detected by otolaryngological examinations and other tests. -Asthmatic pattern group.
2) 67 patients with local inflamation diagnosed otolaryngologically. -Local inflammation group.
We then evaluated the effectiveness of selected medications for abnormal sensation in the throat in these two groups of patients. In the asthmatic pattern group, 83 patients were treated with medications and no drugs were used in 23 patients. In the local inflammation group, 60 patients were treated with medications and no drugs were used in 6 patients. The improvement of abnormal sensation was higher in the treated patients in both groups. In the asthmatic pattern group, high efficacy rates were shown for bronchodilators (70.4%) and antiallergic agents (63.8%). On the other hand, in the local inflammation group, antiallergic agents (63.6%) and anti-inflammatory agents showed a high effectiveness (60.9%). The efficacy rate with minor-tranquilizers was similar in both groups (62.5%).

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The cricopharyngeal muscle works as the upper esophageal sphincter in deglutition. In the intraluminal manometric study, high resting pressure at the pharyngo-esophageal junction (PEJ) falls to the atmospheric pressure on swallowing, but the mechanism of this pressure change is not fully clarified. Using three mongrel dogs, the authors investigated that me-chanism by the simultaneous recordings of the laryngeal movement, the intraluminal pressure and the electromyograms of the thyrohyoid, thyropharyngeal and cricopharyngeal muscles.
As a result, the resting pressure at the PEJ fell before the onset of the elevation of the larynx in every swallowing and the relaxation of the cricopharyngeal muscle started prior to the falling of the resting pressure at the PEJ. On the basis of the results, the authors concluded that the drop in pressure at the PEJ during swallowing was mainly caused by the relaxation of the cricopharyngeal muscle.

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While following the course of patients with Wegener's granulomatosis in which it had been possible to achieve a remission, we encountered a patient in whom we observed granuloma formation in the subglottis. A tracheostomy was performed because of the risk of respiratory distress, and after that there was a recrudescence of the patient's Wegener's granulomatosis. During the course of the above, the patient remained ANCA (Anti-neutrophil cytoplasm antibody) -negative. When these facts were considered, it appeared that when the lesions are localized and progressing gradually, ANCA positivity dose not develop. Moreover, when we take into consideration the fact that the initial onset was after surgery, the surgery may also have been an etiologic facter.

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We encountered a very rare case of adult laryngeal anomaly accompanied by positional and morphological abnormalities of the hyoid bone and dysplasia of the strap muscle.
The case was a 35-year-old female, and the major complaint was slight hoarseness. At the time of the first examination, a belt-like eminence, which was more elevated and harder to the touch at the proximal end, was noted visually near the sternal region of attachment of the left strap muscle. Upon palpation, the hyoid bone was found to be located lower than its normal position, and moreover, the left greater horn of the hyoid bone was unclear to the touch. As the laryngopharyngeal findings, the anterior commissure showed right lateral displacement. The left plica ventricularis looked swollen, and the left vocal cord was difficult to see. However, movement of the left arytenoid region was limited in comparison with the right region and the left piriform fossa was shallow and narrow.
Soft-tissue radiography of the neck, hypopharyngo-esophagography, CT scan, etc., revealed abnormalities of the hyoid bone. That is, the right greater horn was thin and slanted sharply from the right posterosuperior region to the left anteroinferior region, the body of the hyoid bone was thick and in contact with the thyroid cartilage, and the left greater horn was in an almost horizontal position from that point of contact. In addition, dysplasia of belt-like hyperplasia was seen in the left strap muscle. This case was diagnosed as laryngeal deviation to the right due to the above anomalies.
The etiology of laryngeal anomalies in this case were considered from the embryological viewpoint. On the basis of our experience with the reported case, we learned that morphological abnormalities, such as laryngeal anomalies, can be a cause of idiopathic laryngeal deviation.

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A 70-year-old female visited our clinic with a complaint of a lump in the throat feeling for over 10 years. And she coughed up a large polyp projected from her mouth. Fiberscopic examination revealed the pedunculated polypoid mass which attached to the right side of the epiglottis and the vallecula.
We feared imminent mechanical obstruction of her larynx with consequent asphyxiation. After admission, the polyp was resected with forceps and an electric knife using laryngomicroscopic procedure under general anesthesia.
On microscopic examination, the polyp was lined by a normal squamous epithelium. The stroma consisted of rich collagen fiber, fatty tissue and some capillary vessels. A chronic inflammation including plasma cells and mast cells was present, but there was no evidence of malignancy.
A case of fibromatous polyp of the oropharynx was discussed on incidence, the histologic findings and clinical features together with review of literatures.

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Neurinoma of the vocal fold is not common. A 43-year-old female with neurinoma of the left vocal fold was treated by microlaryngeal surgery. Clinical observation using laryngostrobovideography and CT revealed a smooth mass localized in the left vocal fold. The tumor was successfully removed under general anesthesia by microlaryngeal surgery. We applied the fibrin-glue (Tisseel®) on the surgical wound of the vocal fold to avoid post-operative scar. Postoperative wound healing of the vocal fold was excellent in this case. Her phonatory function was satisfactory and no tumor recurrence have been noted after surgery. In this case, the fibrin glue might have good effect on the wound healing of the vocal fold.

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A 26-year-old male was admitted to our hospital complaining of dyspnea. Laryngoscopic examination showed circumscribed stenosis in the subglottis. He had fallen into respiratory failure after surgical operation in the hospital which had been treated with intubation of a cuffed tube and intermitent, positive pressure ventilation.
At an operative findings, lower half of the posterior cricoid plate missed and diaphragm was recognized between the cricoid and first tracheal ring, showing only match-head-sized hole in the center. End-to-end anastomosis after resection of 3 tracheal rings were successfully performed.
Five months later, however, slight stridor on exertion wasoticed. Fiberscopic findings showed a posteriorly based web in the suture ends, which was treated with a silicone T-tube for a period of 2 months. After extubation, he has not shown any sign of dyspnea for 2 years.
Operative procedures and possible causes of a tracheal stenosis were discussed in detail based on previous papers.

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A case of Juvenile achalasia in a 13-year-old boy was reported. Dysphagia, vomiting and a failure to thrive have been troubling him for five years. Plain chest roentgenograms showed (1) air-fluid levels by air esophagogram, (2) esophageal line beside vertebrae, and (3) no stomach gas. Barium-filled esophagogram showed achalasia of the esophagus, spindle type, Grade II. LESP (Lower Esophageal Sphincter Pressure) was high.
Sublingual administration of nifedipine was started 30 min before meals. Nifedipine improved symptoms of achalasia and decreased LESP. No side effects were observed. Although long term nifedipine therapy may cause side effects, nifedipine therapy is useful and reasonable for partients with achalasia to improve of failure to thrive and symptoms before radical surgery methods.

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A 54-year-old female complained of anterior neck mass. An elastic hard mass, 4×3cm in size, was noted on the left lobe of the thyroid gland. As the thyroid functional test, scintigram revealed Plummer's disease, surgical removal was carried out. In this study the vascular architecture of Plummer's disease were reproduced with methacrylate casting medium andobserved under a scanning electron microscope. The vascular architecture of Plummer's disease is not composed of distinct basket-like capillary networks but dense capillary networks. The dilatation of the capillaries may indicate the hyperfunctional condition of the thyroid gland, and the small protrusions may represent the initial stages of the neogenesis of the capillaries, that is, these findings suggest that this thyroid nodule is still growing. The rich vascular bed and the sinusoidal capillaries of Plummer's disease could make it advantageous to absorb the thyroid hormones.

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