Gastroesophageal reflux disease (GERD) is caused by the pathological reflux of gastric contents into the esophagus and pharyngo-laryngeal regions. The long-lasting presence of the refluxed gastric contents stimulates the mucosal sensory nerves and causes inflammation of the mucosal surface. In the gastric contents, hydrochloric acid and pepsin are the most powerful agents causing mucosal damage. For the development of GERD, the following three factors are required: Firstly, the gastric mucosal secretion of hydrochloric acid and pepsin should be normally maintained. Secondly, the normal function of the lower esophageal sphincter to prevent gastroesophageal reflux should be damaged. Thirdly, acid clearance by the peristaltic esophageal motor function and salivary secretion should be damaged. Although the symptoms of GERD-related disease are various, acid suppression by potent proton pump inhibitors is always useful for system control as well as for disease resolution. The possible role of GERD may be considered when treating of cases of resistant pulmonary, nasal, paranasal and pharyngo-laryngo-esophageal diseases.

View full abstract

The term gastroesophageal disease (GERD) is used for patients with typical or/and atypical symptoms with physical complications which result from the reflux of stomach and duodenal contents, mainly gastric acid, into the esophagus. It is easy to diagnose obvious esophagitis by endoscopy. On the other hand, skillful medical interviews and other examinations, such as pH monitoring and esophageal manometry are required to diagnose patients with endoscopic negative GERD and atypical symptoms, such as noncardiac chest pain and chronic cough. PPI test is a clinically useful tool in the therapeutic diagnosis for atypical GERD.
The goal of medications for GERD is an improvement in the QOL from primary therapy and no recurrence with maintenance therapy. The use of PPI is superior to H₂RA both for primary and maintenance therapies. PPI therapy is also more cost effective than H₂RA therapy.

View full abstract

Treatment for GERD is generally based on a conservative approach mainly of PPI along with a correction of bad habits as already reported worldwide. However, surgery still remains a treatment for resistant cases, such as cases accompanied by a large hiatal hernia or respiratory complications. However, the concept of surgery for GERD is different from ordinary one, of which purpose is to remove legions. The surgery for GERD is to improve function not to remove. This concept makes surgeon feel difficult to perform the surgery. The same standard operation cannot be easily applied to every case, but every case must obtain an improved result after the repair of the reflux inhibitory function. The indications for the operations, as well as the choice of the appropriate operative procedure judging from the general condition of each patient, are the key points for surgical treatment. At the same time an effort to improve one's technical skill as a surgeon is also required.

View full abstract

It is a well-known fact that a typical symptom, such as “heartburn,” can result from stomach acid reflux. Recently the manifestations of otolaryngology have also attracted attention as an atypical symptoms. The condition of an otolaryngology symptom in GERD has been called LPRD (Laryngo Pharyngeal Reflux Disease) in Europe and America. Such cases have been reported for 35 years in Europe and America, and there have also been many recent reports. However, the pathology of such cases contains many unknown points. Although pH monitoring, endoscopy, larynx mirror inspection etc. are carried out at diagnosis.

View full abstract

Gastroesophageal reflux (GER) is a term that describes the intermittent regurgitation of stomach material into the esophagus and has been applied to a variety of clinical disorders (GERD) frequently encountered in the care of pediatric patients. The main clinical symptom of GER is usually vomiting. Patients with GERD manifest signs and symptoms that reflect between compromise respiratory function, esophageal barrier function, and nutriton. As a result, recurrent pneumonia, esophagitis, or failure to thrive occur frequently. From previous studies and our results, respiratory diseases are obviously related to GER. Airway obstruction is considered a factor in the deterioration of GER patients. It is very important that respiratory function should be evaluated in the care of GERD.

View full abstract

Sulcus vocalis is a disease characterized by furrows in the mucosa of the vocal folds and which causes “hoarseness.” The symptoms of sulcus vocalis are caused by a disturbance in the mucosal waves on the vocal folds, by incomplete glottis closure with the “sulcus,” and a “bowing” change in the vocal cord. To treat the symptoms, we have to remove the “sulcus” and the “bowing,” but we do not yet have a technique to remove the “sulcus” completely or a method that can reset the mucous membrane to its normal state. A retrospective review of 105 patients with sulcus vocalis seen at the Department of Otolaryngology, University of Tokyo Hospital in the 10 years from 1992 to 2001 was carried out in order to gain the etiology, clinical aspects, treatments and results. The results were as follows.
1) There were 81 males and 24 females, and the male to female ratio was approximately 4:1. The age range was from 11 to 78 years, with a mean of 49.0 years.
2) The age of onset had two peaks: between 10 and 15 years and between 55 and 60 years. Regarding the average contraction period, the group of patients whose onset age was over 50 years was shorter than that of the other group.
3) The majority of the patients had a mild to severe degree of hoarseness with a breathy quality. The mean maximum phonation time at the first visit was 14.3 s for males and 12.6 s for females. The mean airflow rate with loud phonation was 412.8 ml/s for males and 274.9 ml/s for females. At high pitched phonation, it was 351.4 ml/s for males and 249.8 ml/s for females.
4) 28 patients of the total (27%) were treated by phonosurgery. The total cases of phonosurgeries were 63.23 patients had intra-cordal injection of collagen. The average no. of injections was 2.3 times per a patient. The average interval between injections was approximately 3 months.
5) The surgically treated patients showed improvements on the GRABS scale, especially in terms of “breathy” and “roughness.” The average MPT after treatment became 1 s longer, but this was not a significant improvement statistically.

View full abstract

A 66-year-old female who had been followed by internists for systemic sarcoidosis visited our clinic chiefly complaining of proloned hoarseness for 8 years. Laryngoscopic examination revealed a submucous mass on the right vocal fold extending to the false vocal fold. Under general anesthesia, the mass was removed microlaryngoscopically, and the wound was sutured. Histological examination revealed a noncaseous granuloma with Langhans-type giant cells, some of which contained visible asteroid bodies. Postoperatively, the patient's hoarseness improved and normal vocal fold vibration was observed under stroboscopy.

View full abstract

Everson defined spontaneous regression in 1966. We reported a 81-year-old man with laryngeal cancer which falls under this definition of spontaneous regression. He visited our hospital complaining of hoarseness, dysphagia and pharyngeal paresthesia. Endoscopic examination showed a tumor extending from the false cord to the laryngeal vestible. The surface of the tumor was mostly white with dark red parts. CT scan showed that the circumference of the tumor was enhanced. At the same time, stomach cancer was found. The patient rejected all treatment, and we could only observe him carefully. The laryngeal cancer gradually reduced and disappeared. Afterward, it recurred and radiation therapy was performed. As to the stomach cancer, the regression of the tumor was not seen.
In past reports, there have been few cases about spontaneous regression of the laryngeal cancer. Thus, this case is very rare. Further investigations are needed from various viewpoints.

View full abstract

Liposarcoma is commonly a soft tissue sarcoma. The lower extremities, retroperitoneum and inguinal region are the most common locations of liposarcoma. We report a case of liposarcoma of the hypopharynx. Primary liposarcomas of the hypopharynx are extremely rare, with only 17 cases identified in the world literature.
A-57-year old man came to our hospital complaining of a foreign-body sensation on swallowing. On fiberscopic examination, we found a mass in the left side of the hypopharynx. The tumor was resected along its capsule using a diode laser via direct laryngoscopy. Histopathological examination showed a lipoma. However, one month after the surgery, the tumor recurred. The recurrent tumor was resected using a diode laser, and the resected tumor was histopathologically diagnosed as a well-differentiated liposarcoma. The patient subsequently underwent pharyngolaryngotomy and bilateral neck dissection. The postoperative course was uneventful. No recurrence was seen 32 months after the operation.

View full abstract