Although methods for recording laryngeal images have changed from analog (videotape) to digital (hard disk), nothing has changed in terms of the recording content, which continues to consist of images and sound. Voice analysis is usually carried out separately and filed separately from the laryngeal recording, and for this reason additional information on the relation between the analyzed data and a section of the recorded voice is needed. We developed a new technique to analyze the voice and input the results in a video file simultaneously. Those results include musical scale, fundamental frequency and its standard deviation, PPQ (period perturbation quotient), APQ (amplitude perturbation quotient), NNE (normalized noise energy) and HNR (harmonics-to-noise ratio). As analyzed data is also saved in text format, follow-up usage is facilitated.

Introduction : Construction of a gastric tube that is well perfused with blood during esophagectomy is the most important factor in avoiding anastomotic leakage. Objective : The aim of this study was to examine the correlation between blood flow in the reconstructed gastric tube and the state of the gastric tube after surgery. Patients : A total of 21 patients with esophageal carcinoma undergoing gastric tube reconstruction during esophagectomy between January 2014 and June 2015 were enrolled in this study. Methods : During surgery, we measured the time until the tip of the gastric tube appeared in contrast by ICG fluorescence imaging. On the sixth day after surgery, we observed the gastric tube by endoscope and evaluated the state of the anastomosis in three stages. Results : The median of the time until contrast appearance by ICG fluorescence imaging was 20 seconds. In the observation of anastomosis, white moss was observed in the entire circumference in 4 cases (type A), in less than the entire circumference but more than half in 6 cases (type B), and in less than half the circumference in 11 cases (type C). The median of time until contrast appearance by ICG fluorescence imaging was 29 seconds in type A, 19 seconds in type B, and 16 seconds in type C, i.e. no significant difference among the three types was observed. We divided the patients into three groups according to the quality of the color of the mucosa : “good” (n=15), “slightly poor” (n=6), and “poor” (n=0). The median of the time until contrast appearance by ICG fluorescence imaging was 16 seconds in the “good” group and 42 seconds in the “slightly poor” group, i.e. there was a significant difference between the “good” and “slightly poor” groups (p=0.003). Conclusions : The findings suggest a correlation between the contrast time of the gastric tube by ICG fluorescence imaging and the state of the gastric tube after surgery.

Fiberoptic endoscopy is applied first to evaluate dysphagia. The increasing adoption of Hyodo's score enables us to evaluate dysphagia objectively and to observe the chronological changes of a patient's dysphasia. However, there are no criteria as to when general otolaryngologists should consult with specialists concerning dysphagia. The purpose of this study is to establish additional criteria for further examinations.

A total of 166 patients were examined and analyzed by fiberoptic endoscopic evaluation of swallowing. Patients with the following criteria were not able to eat an ordinary diet (p<0.01;sensitivity=0.97, specificity=0.92) : 1)Hyodo's score above 4;2)residue of colored liquid on the posterior pharyngeal wall or backward flow of colored liquid from the hypopharynx to the oropharynx;and/or 3)saliva penetrating to the laryngeal space. We believe these additional criteria could serve as suggestions for screening to judge when a general otolaryngologist should consult with a specialist concerning dysphagia.

Surgical intervention aiming to restore oral feeding is an effective treatment option for patients with severe swallowing disorder. In this article, we retrospectively analyzed the postoperative courses of 15 patients who underwent surgical interventions to improve swallowing function between 2008 and 2014, and discussed their indications and limitations. The patients ranged in age from 43 to 87 years, and they consisted of 12 males and 3 females. The causes of swallowing disorder were cerebrovascular disorder in 10 patients, increasing age in 3, and other causes in 2. Swallowing function was evaluated by the Food Intake Level Scale (FILS) devised by Fujishima et al. and the flexible endoscopic evaluation score of swallowing (FEESS) devised by Hyodo et al. The evaluation data was collected from pre- and postoperative examinations. FILS scores improved significantly after the operations (on discharge from hospital, best swallow, last visit). However, in aged patients, FILS scores worsened during the follow-up period. FEESS also improved significantly after the operations (on discharge from hospital, best swallow). In 7 cases, FEESS worsened during the follow-up period;however, 6 among these cases maintained oral feeding. In patients over 75 years of age, surgical outcomes were unfavorable due to decreased activities in daily living and poor cognitive function. A postoperative rehabilitation and care support plan should be arranged in advance.

The incidence rate of idiopathic bilateral vocal cord abductor paralysis is quite low in newborns. Here we report the clinical course of a female infant with congenital bilateral vocal cord abductor paralysis. The infant presented with acute cyanosis at birth and tracheal intubation was indicated. Fiber endoscopic examination revealed her vocal cords to be fixed in the midline position. With the exception of Nail-Patella syndrome, no other underlying comorbidity was detected.

Tracheotomy was performed 4 months after birth. Although there were no signs of any spontaneous recovery of vocal cord mobility over a long course of observation, no surgical procedures to lateralize the vocal cords were undertaken. After evaluation of the respiratory data and all of the related conditions, the tracheostoma was closed when the patient attained the age of 18 years. After the closure, she enjoys a quality of life that is better than that when the tracheostoma was present.

Hypopharyngeal tumor growth can cause sudden dyspnea and dysphagia. We performed trans-oral surgery on 3 cases of pedunculated tumor arising from the hypopharynx. In every case, we were unable to grasp the shape of the tumor during the first medical examination because they were impacted in the esophagus. The extracted tumors were shaped like a sausage having mobility, and if they were to become stuck in the larynx, there would be danger of sudden suffocation. In addition, after extraction we found that one of the three cases was liposarcoma. Even if a tumor is suspected to be benign, we should extract it in order to avoid the risk of suffocation and make a definite diagnosis.

An 85-year-old male accidentally ingested a denture. CT image of the cervical area taken at a previous hospital showed the denture was located between the cervical esophagus and the hypopharynx. Extirpation by upper gastrointestinal endoscopy was attempted but failed, and the patient was admitted to our hospital for emergency treatment. Part of the denture was located in the right pyriform fossa, and CT image of the cervical area indicated that the denture had reached close to the cervical esophagus. As visual examination revealed edema in the right bifida, exacerbation of the problem could easily be anticipated. Tracheotomy was performed under local anesthesia, followed by general anesthesia, and the denture was removed using a curved laryngo-pharyngoscope in combination with an electronic endoscope. In postoperative review, some mucosal damage was observed in the hypopharynx, but there was no other obvious finding of postoperative perforation.

The most important prognostic factor in patients undergoing salvage esophagectomy is curative resection. Various reports have indicated better treatment outcomes following cT1-T2 compared with cT3-T4 salvage esophagectomy. We report a case of salvage esophagectomy after aortic stent insertion. A 68-year-old male with esophageal cancer underwent chemoradiotherapy. After completion of therapy, we diagnosed residual carcinoma and aortic invasion. We therefore inserted an aortic stent and performed curative salvage esophagectomy, without major bleeding as a result of the stent insertion. Stent insertion should thus be considered during curative resection in patients undergoing cT4 salvage esophagectomy.

We successfully treated a 32-year-old man with repeated post-tracheotomy tracheal stenosis. The patient was obese, had micrognathia, and had undergone a tonsillectomy and pharyngoplasty for severe sleep apnea syndrome. A tracheotomy was performed in case pharyngeal edema developed. The tracheostomy tube was removed on postoperative day (POD) 8. Subsequently, dyspnea gradually developed, and computed tomography showed tracheal stenosis in the tracheostomy region. Bronchoscopy revealed a saber-shaped deformation of the trachea without granulation or mucosal change. Following introduction of an Ultraflex^® stent, we performed a sleeve resection of the trachea (three tracheal cartilage rings) with end-to-end suture, using 21 stitches of 3-0 absorbable monofilament. Pathologically, the surgical specimen showed severe erosive inflammation. The patient was discharged on POD 16 and subsequently complained of dyspnea on POD 40. Bronchoscopy showed granulation tissue in the anastomosis region, so transbronchoscopic laser ablation was performed twice. The patient has been normal for more than 8 years after the treatment.