We analyzed the cases of double cancer from 182 hypopharyngeal cancer patients and 596 esophageal cancer patients who were treated in the Surgery of the Otorhinolaryngology Department of Kurume University Hospital between 1989 and 2000. There were 43 double cancer patients (synchronous 32 cases, metachronous 11 cases), and the occurrence rates were 23% for hypopharyngeal cancers and 7% for esophageal cancers. The three-year cumulative survival rates determined by the Kaplan-Meier method for early hypopharyngeal cancers, with or without esophageal cancer, were 81% and 76%, respectively. Similarly, the survival rates for advanced hypopharyngeal cancers were 41% (with double cancer) and 45% (without double cancers). There was no statistically significant difference between the groups. The three-year cumulative survival rates for early esophageal cancers, with or without double cancers, were 60% and 85%, respectively. Similarly, the survival rates for advanced esophageal cancers were 53% (with double cancer) and 40% (without double cancer). There was no statistically significant difference here either. The present study suggests the necessity of early diagnosis and treatment of double cancer in patients with hypopharyngeal cancer and esophageal cancer in close cooperation between Surgery and Otorhinolaryngology departments.

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Subjects were used to swallow a capsule containing barium, and the sensation of the capsule being caught in the throat was examined. Twenty normal persons (18 males, 2 females) with a mean age of 38 years (31-51) were used as subjects. Subjects were asked to swallow a No.0 capsule containing barium powder, and the place where the capsule stopped in the esophagus was compared with the place where the subject felt it. Many subjects felt the capsule had stopped proximally when the capsule stopped between the cricopharyngeal constriction and the bronchial constriction of the esophagus. They felt it had stopped at the level of the 7th cervical. When the capsule was stopped at the level of the aortic arch in the bronchial constriction, some subjects felt it had stopped at the level of the 7th cervical vertebra. When it had stopped below the center of the aortic arch, none of the subjects had the sensation of it being caught in the throat. Thus, of the subjects in whom the capsule stopped between the cricopharyngeal constriction and the bronchial constriction, or in the bronchial constriction, those who felt it was caught in the region of the 7th cervical vertebra reported a feeling of it being caught in the throat.

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Thirty-one patients with Basedow's disease underwent operations, and 40 patients with the same disease were treated by antithyroid drugs at our department. Postoperative results of 31 patients revealed hypothyroid in 16 patients, and recurrent hyperthyroid in 2 patients. Thirteen patients had their therapy discontinued of the patients who were treated by antithyroid drugs at our department, and 10 of these 13 patients were well-controlled without recurrence. Twenty of the 24 patients who continue therapy with antithyroid drugs are well-controlled without recurrence. In general, head and neck surgeons are apt to decide on the indication for surgery for patients with Basedow's disease, however, from this study, it is suggested that head and neck surgeons should rather medicate such patients with antithyroid drugs.

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We reported on three children with laryngeal foreign body: one case of glottic foreign body and two cases of subglottic foreign body. The first case was a 9-month-old boy with a piece of plastic in the glottis. The second case was a 13-month-old girl who had abruptly developed a cough and had been treated as a pseudo croup. Due to an exacerbation of stridor the next day, she was admitted to our hospital. Endoscopic examination revealed a shrimp tale invaginated in the subglottic space. The third case was a 32-month-old girl with a hard nut shell in the subglottic space. Although the foreign body was removed, stridor still remained and she was diagnosed as asthma. It is difficult to find foreign bodies at the larynx in children since their symptoms and signs are not sufficiently collected due to difficulty in communicating with them and their impatience with examination. Therefore, endoscopic examinations and cervical X-rays should be performed on children who abruptly develop stridor, hoarseness, and cough. In addition, when a stridor remains even after the removal of a foreign body, children should be completely examined to determine whether other foreign bodies exist.

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A 69-year-old man relapsed into laryngeal papilloma of the anterior commissure. The papilloma was subjected to laryngeal microsurgery using an oblique-angled solid tele-endoscope combined with direct laryngoscopy. After the operation, some adhesion developed near the anterior commissure, though no recurrent laryngeal papilloma was confirmed. The vocal cord adhesion was, therefore, separated at the adhesive site. After the separated area was irradiated by laser, a mucosal suture was performed in order to produce a margin. This treatment resulted in a relapse of papilloma, as well as improved postoperative voice quality, and allowed early rehabilitation.

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We reported two cases with inflammatory stenosis of the trachea and subglottic region due to a high tracheostomy. In both cases, the defect in the face of cricoid cartilage and inflammatory granulation were observed during the operation. In both patients, a staged operation using a transcient tracheocontenuous fissure was performed. Tracheal stenosis was not observed after first staged operation in either cases, and the tracheocontenuous fissure was closed by a hinge flap in one case. In the other cases, the tracheocontenuous fissure was not closed, because of respiratory dysfunction. We concluded that a staged operation using a tracheocontenuous fissure is a safe and effective method for inflammatory stenosis of the trachea and subglottic region.

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In order to facilitate the suturing procedure during microlaryngosurgery under direct laryngoscopy, we recently devised a specially designed holder and a “bender” for the needles used in this type of surgery. The use of these instruments was tested on both the right and left vocal cords, and the results were technically compared and discussed.

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Videofluorograms using mobile surgical C-ARM fluoroscopic X-ray equipment (C-ARM) equipped with a dual field (9 inch) image intensifier were performed for patients with swallowing disorders.
The advantages of this type of examination were the following. 1) The features of the C-ARM helped achieve a drastically lower radiation dose for the examiner during the procedure compared to conventional fixed fluoroscopic X-ray equipment. 2) The C-ARM offered excellent positioning flexibility, consequently patients could undergo the examination in the compensative position. 3) Patients could also undergo the examination sitting in a wheelchair or lying on a stretcher. 4) The C-ARM captured and showed clear dynamic images on a monitor and provided excellent resolution and video recording, 5) The C-ARM requires less space, consequently it can be set up even at office-based clinics. 6) The cost of C-ARM is cheaper than that of conventional fixed fluoroscopic X-ray equipment.
Videofluorograms using mobile C-ARM fluoroscopic X-ray equipment are a reliable procedure for office-based videofluorography of patients with swallowing disorders.

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The most accurate method for diagnosing Laryngopharyngeal Reflux Disease (LPRD) is to demonstrate a possible gastric acid regurgitation up to the hypopharynx or upper esophagus with a pH monitor. However, a standard method and values for diagnosing LPRD have not yet been established. At our institution, a pH sensor is inserted through the nasal route under endoscopic observation, and a probe is inserted into the cervical esophagus (2 cm below the tip of the piriform sinus during phonation). This procedure can be performed easily for outpatients, thus minimizing treatment time.

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