Nihon Kikan Shokudoka Gakkai Kaiho
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
Volume 61, Issue 4
Displaying 1-10 of 10 articles from this issue
Original
  • Makoto Miyamoto, Yuko Mori, Hideki Nakagawa, Etsuyo Tamura, Seiji Niim ...
    2010 Volume 61 Issue 4 Pages 345-352
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    We performed a clinical, statistical review of 458 cases of recurrent laryngeal nerve paralysis (RLNP) referred to TOKYO VOICE CENTER between January 2001 and December 2008. There were 229 males and 229 females. Their age range was from 4 to 90 years (average age : 54.6 years). The affected nerve was unilateral in 433 patients (right in 138 cases, left in 295) and bilateral in 25. The causes of paralysis were postoperative RLNP in 262 cases (57.2%), non-surgical in 196 (42.8%), ideopathic in 75 (16.4%), and combined nerve paralysis in 29 (6.3%) ; a natural recovery was seen in 28 causes (6.1%). In each cases, therapy started with voice therapy and was followed by an operation, according to each patient's will.
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  • Haruhito Saida, Kazuo Ohashi, Katsutoshi Hara
    2010 Volume 61 Issue 4 Pages 353-360
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    Hyperthermotherapy using steam has been long known, over since the age of Hippocrates. Because it involves no medicines and does not have side effects, it has become a popular health-promoting method. Although this method has shown effective results for nasal diseases, analysis for pharyngeal and laryngeal diseases has not been adequate. Recently handy steam inhalers requiring no water nor electricity have been developed. This method involves high temperature and humidity without use of drugs. It uses the heat produced by oxidization of iron oxide. Singers, actors and teachers sometimes need vocal care immediately before their performances. For voice care in these cases, analysis of voice and EGG (electroglottography), and images (2000 frames/sec) of vocal cord vibration and the state of air tract fluid by high-speed color camera (Memrecam GX-1 Plus : Nac) were carried out pre- and post-inhalation in 4 cases. The following results were revealed. In the cases of normal vocal cords, APQ, PPQ and NHR decreased between pre- and post-inhalation, so the voice improved. New color images by high-speed camera have enabled observation of vocal cord vibration and the state of air tract fluid. The fluid exists at two positions of the vocal cords during phonation. The first is on the surface of the supraglottis. This fluid comes from the subglottic space at the onset of phonation. It mixes with the fluid on the supraglottis, and is shaped like a spindle rotating on the surface of the glottis. At the moment of breathing, this spindle-shaped fluid descends to the subglottis. As a result the fluid added by inhalation is useful as lubrication of the vocal cord. Dr. Kawaida reported a dynamic study on air tract fluid in lubrication of the larynx during phonation using an excised canine larynx. We agree with his theory based our observations using high-speed color photography. The second fluid exists at the anterior surface of the vocal cords. It appears like a web. During the opening phase of vocal cord vibration this fluid is stretched thin, while during the closing phase it thickly covers the anterior glottis. This suggests the web causes the EGGOQ to decrease. In the case of vocal cord swelling, the fluid exists near the tip of the swollen vocal cords, not at the anterior glottis. We hypothesized that the fluid on the surface of the supraglottis makes the tips of the swollen vocal cords heavy and accelerates the velocity of the closing phase, making the EGGOQ high. A handy steam inhaler can be successfully used for lubricating the larynx and for care of some professional voices.
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  • Akihito Yamauchi, Masafumi Ohki, Hiromu Kato, Sakurako Kishida, Mutsuk ...
    2010 Volume 61 Issue 4 Pages 361-367
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    To reveal the characteristics of viral associated laryngeal palsy, we performed a clinical study through a chart review of patients visiting our department between June 2003 and December 2007. A total of 8 cases (7 men, 1 woman;age range, 21-86) with viral associated laryngeal paralysis were assessed for causes, severity, prognosis and treatments. The most frequent chief complaints were dysphagia (6 cases), hoarseness (5 cases), otalgia (3 cases), hearing loss (3 cases) and facial rash (2 cases). In all cases, VZV reactivation was considered to be the causative agent through serological study. Vocal cord paralysis was complete in 7 cases and incomplete in 1 case. The affected side was right in 4 cases, left in 3 cases and bilateral in 1 case. Aside from vocal cord palsy, the vagus nerve (8 cases), glossopharyngeal nerve (8 cases) and cochleovestibular nerve (2 cases) were frequently involved. Treatment included acyclovir (6 cases), steroid (6 cases), rehabilitation (5 cases) and operation (2 cases). Vocal cord palsy improved in 7 cases within 5.3 months on average (fully recovered in 2 cases;partially recovered in 5 cases). The affected cranial nerves revealed improvement in all cases within 3.6 months (fully recovered in 6 cases;partially recovered in 2 cases). Swallowing function was evaluated in 7 cases by videofluoroscopy : 1 case was within the normal limits;1 case revealed oral swallowing dysfunction;5 cases revealed oral and pharyngeal swallowing dysfunction;and aspiration was observed in 4 out of 7 cases. Swallowing dysfunction revealed various degrees of improvement during follow-up, and aspiration disappeared in all cases followed. Although viral involvement is a good prognostic indicator in associated laryngeal palsy, functional improvement usually takes several months. A high level of attention is needed at the time of diagnosis, and early administration of acyclovir and steroid is considered favorable.
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  • Kazuhiro Nakamura, Kiyoaki Tsukahara, Tomoyuki Yoshida, Taro Inagaki, ...
    2010 Volume 61 Issue 4 Pages 368-374
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    Arytenoid adduction (AA) is a moderately difficult operation, and for the reason it is difficult for an operator to perform the operation alone. By contrast, an operator can perform vocal fold injection surgery under general anesthesia without assistance. However, for cases with a wide glottal slit, there is a limit to the voice improvement that can be achieved by injection surgery. Therefore, AA should be the procedure of choice when an assistant is available for the surgery. We devised a surgical procedure that would allow an operator to perform AA without assistance, and we compared the results between single-operator and multiple-operator groups.
    From January 2001 to June 2009, 23 patients underwent AA at our department. Of the 23, 16 underwent type I thyroplasty (TPI) and/or type IV thyroplasty (TPIV) combined with AA. The average age of the patients was 60.4 years. Of the 16 patients, 13 underwent AA+TPI, 2 underwent AA+TPI+TPIV, and 1 underwent AA+TPIV. There were 6 cases in the single-operator group and 10 cases in the multiple-operator group. Total intravenous anesthesia was selected for 14 cases, and local anesthesia for 2 cases. Skin hooks and an ecarteur were used to secure the operation field, and the vessel sealing system and ultrasonically activated scalpel were used in the single-operator group. Under voice monitoring, the position of the vocal fold was determined with a laryngeal video-endoscope by the operator working alone. In the multiple-operator group, the first assistant held the laryngeal video-endoscope. We comparatively evaluated the operation time in the two groups.
    The operation time was 130.7 minutes, on average, in the multiple-operator group and 138.0 minutes, on average, in the single-operator group ; i.e., there was no significant difference between the two groups.
    AA can be performed by a single operator without any extension of the operation time using special devices.
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  • Hajime Ishinaga, Kazuya Otsu, Atsushi Yuta, Kazuhiko Takeuchi
    2010 Volume 61 Issue 4 Pages 375-380
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    We experienced four cases of supracricoid partial laryngectomy with cricohyoido-epiglotto-pexy (SCL-CHEP) or Cricohyoido-pexy (SCL-CHP) for laryngeal carcinoma in our department from 2007 to 2009. Three patients had SCL-CHEP after radiation failure and one patient had SCL-CHP without pre-treatment. The complication with SCL was a subglottic granuloma in one patient leading to re-operation. All of the patients retained normal deglutition and had successful tracheostomy tube decannulation. We concluded SCL-CHEP and SCL-CHP are safe surgical approaches allowing conservation of laryngeal function especially in selected recurrences after irradiation failures of a glottis carcinoma.
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  • Mioko Fukahori, Shun-ichi Chitose, Akiteru Maeda, Hirohito Umeno, Tada ...
    2010 Volume 61 Issue 4 Pages 381-387
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    Fourteen patients who had oropharyngeal carcinoma were treated with intra-arterial chemoradiotherapy between December 2002 and December 2008. The patients were classified as 3 stage II, 3 stage III and 8 stage IV cases. According to the subsite of the oropharynx, the patients were classified as 6 lateral wall (LW), 5 anterior wall (AW) and 3 superior wall (SW) cases. Intra-arterial infusion chemotherapy by cisplatin was given weekly with concurrent radiotherapy for approximately four weeks, and the total number of infusions was decided according to intermediate judgments of effectiveness. The total dose of radiation was 60-81.4 Gy (average 65.3 Gy). As a result of this treatment, there were 12 CR (85.7%) and 2 PR (14.3%) for primary tumor and 4 CR (57.1%), 2 PR (28.6%), and 1 NC (14.3%) for lymph node. Regarding survival, 7 were alive and cancer-free (50%), 2 were alive with cervical lymph node metastasis (14.3%), 4 died of the primary tumor (28.6%) and 1 died of other disease (7.1%). The local control rates by subsite were 75%in LW, 66.7%in AW and 33.3%in SW. These results indicate in terms of both local control rate and functional preservation, that advanced AW cancer seems to be a good indication for intra-arterial chemoradiotherapy, but the therapy should be determined cautiously with respect to indications for LW and SW oropharyngeal carcinoma.
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Case Report
  • Kiyohito Hosokawa
    2010 Volume 61 Issue 4 Pages 388-394
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    The case of an internal type of laryngocele in a 77-year-old woman is reported. Laryngoscopic examination showed a swelling of the right false cord, aryepiglottic fold and ventricle. CT imaging adjusted for lung examination revealed an air-filled mass in the paraglottic space. These findings led to a diagnosis of internal laryngocele. The mass had grown slightly by the next visit and the patient was admitted on the seventh day of disease. Tracheotomy was performed on the twelfth day under local anesthesia and the laryngocele was continuously marsupialized by laryngomicrosurgery under general anesthesia. On post-operative day 1, a comparatively high degree of edema of the right piriform sinus and false cord was observed. No recurrence of laryngocele has been indicated by laryngoscopic examination 18 months later, and CT imaging about 2 year after the operation showed only a small nodule in the right paraglottic space. Marsupialization of internal laryngocele by laryngomicrosurgery appears to be a low invasional and acceptable mode of treatment.
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  • Koji Ebisumoto, Koichiro Nishiyama, Ryosuke Sugimoto, Taku Atsumi, Hik ...
    2010 Volume 61 Issue 4 Pages 395-401
    Published: August 10, 2010
    Released on J-STAGE: August 25, 2010
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    Balloon dilatation is a rehabilitation method for cricopharyngeal dysfunction. We applied the method to two cases with persistent dysphagia after various rehabilitations at another hospital. Both cases showed immediate improvements up to resumption of a regular diet.
    The balloon dilatation method can be adapted safely and securely under laryngeal fiberscope because the cricopharyngeal area is visualized clearly. We confirmed the advantages to otolaryngologists of this treatment for cricopharyngeal dysfunction.
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