Glottic squamous cell carcinoma is a disease with good life prognosis, but local recurrence of 30% has been reported in cases of treatment with radiotherapy alone. For the purpose of enhancing local control and the preservation rate of the larynx, oral anticancer drug S-1 has been administered in addition to radiotherapy. Twenty-seven patients who received concurrent radiotherapy with S-1 at our hospital between April 2004 and July 2010 were examined. The dose of S-1 was calculated based on the body surface area and reduced by one level from the initial reference amount (80-100 mg/day), and it was administered for 2 weeks followed by a 1-week rest period during the radiotherapy. The 5-year disease-specific survival rate and larynx preservation rate were 100% and 88.2%, respectively. Adverse events of Grade 3 or higher included 10 cases of dermatitis, 7 cases of mucositis, and 1 case each of leukopenia, infection and diarrhea. There was no termination or discontinuation of radiotherapy. Concurrent radiotherapy with S-1 for T2N0 glottic cancer was considered to be a manageable and useful treatment.

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After tracheostomy, the tracheostomy tube is removed when not needed. In cases when the tracheo-cutaneous fistula does not close automatically, it must be closed by surgery. Fundamentally, we close the tracheo-cutaneous fistula by a hinge flap (hinge group) ; but when using this procedure is difficult, we add an anterior chest skin flap (anterior chest skin flap group). Here, we examined the results for a total of 70 cases (41 male, 29 female) of tracheo-cutaneous fistula closure performed over a 10-year period from 2004 to 2013. The average age was 63 years old (13 to 83). The primary diseases for tracheostomy included 26 thyroid tumors, 13 oral cancers, and 9 oropharyngeal cancers. The tracheo-cutaneous fistula closure types were 62 hinge group (89%) and 8 anterior chest skin flap group (11%). The maximum diameter of the stoma before operation was significantly larger with the anterior chest skin flap group than with the hinge group. There was no significant difference in time from tracheostomy to closure of trachea-cutaneous fistula between the 2 groups. Postoperative complications arose in 18 cases (29%) in the hinge group and in 4 cases (50%) in the anterior chest skin flap group. The 18 cases presenting postoperative failure of the sutures or infection had a significant history of radiotherapy. A total of 16 cases automatically closed between 2 weeks and 6 months (median 1.5 months), but 2 cases remain unclosed to date.

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We recorded swallowing sounds, including characteristic sharp click-like sounds, through the ear (intra-aural swallowing sounds) using a small lavalier microphone in 10 normal adults with no swallowing disorders or ear diseases. Simultaneous recordings of the intra-aural swallowing sounds and nasopharyngeal endoscopic findings revealed that the characteristic click-like sounds with high-frequency spectra came at the beginning of the pharyngeal phase of swallowing. This finding strongly suggested the click-like sounds coincide with the Eustachian tube's quick open-close movements. Intra-aural swallowing sounds are easy to record using low cost and relatively uncomplicated equipment. Also, among intra-aural swallowing sounds, the characteristic click sound is relatively easy to identify both by sound spectrographic processing and with repeated listening. Moreover, by using this click sound as an indicator of a certain point of swallowing (opening of the Eustachian tube), analyses of swallowing activity can be performed with considerable precision in time-domain. Although much additional study remains to be carried out, such as investigating the influences of aging, tubal function and dysphagia, our findings suggest that recording of intra-aural swallowing sounds can be one of the most useful and non-invasive methods for screening of dysphagia and precise analysis of dynamics of swallowing.

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Croup syndrome is a condition characterized by upper respiratory tract stenosis triggered by various kinds of viral infection. Although the syndrome is common in children, adult croup is very rare. A 24-years-old female complained of productive cough and sore throat for three days, for which she had taken over-the-counter medication. She visited an emergency outpatient department after developing severe dyspnea. She presented with inspiratory stridor, hoarseness and barking cough. Multidetector computed tomography (MDCT) revealed severe subglottic stenosis, and she was diagnosed as having croup. Laryngoscopy showed mucosal swelling and edema in the subglottic space. The patient was immediately admitted, and adrenalin inhalation and venous injection of steroids were started. Her complaints disappeared within a few days and she was discharged on day 6.

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Hypopharyngeal schwannoma is a very rare disease. Here we report a hypopharyngeal tumor in a 43-year-old male. His chief complaint was hoarseness and he had a past history of testis carcinoma. CT scan taken during a follow-up of the testis carcinoma accidentally revealed a tumorous lesion in the right pyriform sinus. Otolaryngological examination at a hospital revealed a submucosal tumor in the hypopharynx, and the patient was referred to our university hospital for further examination. Fiberscopic examination revealed a whitish submucosal mass in the postcricoid area, posterior to the right arytenoid. His right vocal cord was fixed in the submedian position. By MRI, the mass showed low signal in T1 and high in T2 and it was enhanced by gadolinium. With a preoperative diagnosis of hypopharyngeal submucosal tumor, total extirpation of the tumor was performed under laryngomicrosurgery. A mucosal incision was made immediately above the tumor and the tumor was dissected. The size of the tumor was 15×10×5mm. The histopathological diagnosis was schwannoma. The postoperative course was good and the patient was discharged eight days after surgery. Until now, there have been no signs of recurrent tumor, but the fixed right vocal cord has remained unchanged. Peroral approach with laryngomicroscopy was used for the present case. The peroral approach is advantageous over open surgery in that the former is less invasive and patients can have meals immediately after the operation.

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Anastomotic leakage and formation of a pharyngocutaneous fistula can occur following total laryngectomy, but this result is the complication that one most wants to avoid. In cases when fistula closure is difficult, oral ingestion becomes impossible for the remainder of the patient's life, and quality of life (QOL) is greatly compromised. Here, we report a case in which oral ingestion became possible with use of a Har-El Pharyngeal Tube. The patient was a 77-year-old male diagnosed with T2N0M0 stage II laryngeal cancer. He had a history of radiotherapy to the neck at age 60 years, and a total laryngectomy and bilateral neck dissection were performed for his laryngeal cancer. Infection occurred due to anastomotic leakage, and an extensive pharyngocutaneous fistula formed. Fistula closure surgery was performed using a free forearm flap and a pectoralis major flap, but fistula closure was unsuccessful. The patient's cardiovascular status deteriorated after the second surgery, making further surgery under general anesthesia difficult. The patient had a strong desire to ingest food and drink orally, and a Har-El Pharyngeal Tube was privately imported and used as a pharyngeal and esophageal bypass tube. With placement of the tube, the patient was able to ingest fluids and thin porridge (porridge and water in equal proportions). However, pain limited feeding to once a day for about 15 minutes. The pharyngocutaneous fistula expanded with use of the tube, and leakage occurred during oral ingestion. The patient's general condition, including cardiac function, deteriorated further, and he died 8 months after starting use of the pharyngeal tube. The pharyngeal tube was used until one month before the patient's death. The Har-El Pharyngeal Tube may be considered one method for use in patients with intractable pharyngocutaneous fistula.

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A left thyroid lobe resection and left lateral neck dissection were performed on a 57-year-old male as treatment for papillary thyroid cancer (T2N1M0). On the second day after surgery, the patient presented with left neck swelling about 10cm in diameter. A needle puncture showed milky discharge. Placing the patient on a low-fat diet had no positive effect. Magnetic resonance imaging (MRI) showed the thoracic duct and fluid collection in the left neck. We performed a second surgery on the twelfth day after thyroidectomy. Chyle leakage was detected at the left subclavian-jugular junction. The leakage point was mattress-sutured with the patient's fat tissue and covered with a tissue sealing sheet and fibrin glue. The patient had no postoperative complications. The drainage tube was removed on the fifth day after the second surgery, and the patient was discharged on the eighth day.

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A 66-year-old male presented progressive pharyngalgia, odynophagia, and lockjaw with swelling around the palatine tonsil and upper and lateral cervical lesions on the left side. CT scan revealed a peritonsillar abscess on the left side that extended to the parapharyngeal, retropharyngeal and anterior cervical spaces with phlegmone of the anterior neck and chest. Fiberscopic findings indicated that the lateral pharyngeal wall, epiglottis and ary-epiglottic fold were edematous with redness of a degree near to obstructing the supraglottic space. After emergent tracheotomy, surgical drainage was performed under local anesthesia. His conditions were improved gradually by cleaning the drained spaces with saline and intravenous administrations of antibiotics. However, on the 29th post-operative day, severe pharyngalgia reoccurred with abscess formation only in the posteroinferior lesion of the peritonsillar space. In response, surgical drainage of the abscess and tonsillectomy on the left side were then performed. After the tonsillectomy, a branchial fistula through the superior pharyngeal constrictor muscle was detected in the tonsillar fossa, and the branchial fistula was removed. Pathological study revealed that the inner structure of the branchial fistula was lined with stratified squamous epithelium. After the surgery, his symptoms have not recurred for six years.

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