Changes in the position of the larynx with aging are reported to influence swallowing. Here, we examined lateral X-ray images of the neck to identify age-related changes in larynx position at rest. Subjects: In total, 258 men and 268 women were examined. Methods: The distance between the highest point of the anterior edge of the third cervical vertebra and the lowest point of the anterior edge of the fifth cervical vertebra, set as a base distance (a), was measured as well as the distances from the level of the highest point of the anterior edge of the third cervical vertebra to the lowest point of the hyoid bone (b), to the anterior commissure (c), and to the lowest point of the thyroid cartilage (d). Ratios of the distances (b), (c), and (d) to distance (a) were compared by sex and age group using Student's T-test. Results: The (c/a) ratio and the (d/a) ratio were significantly lower in men than in women. All three ratios, (b/a), (c/a), and (d/a), increased with age in both men and women. The position of the larynx was significantly lower in men in their forties than in men in their fifties, and similarly, in women in their forties than in women in their sixties. Conclusion: The position of the larynx gradually becomes lower with aging, with notable progression in the forties and beyond.
Intramural metastasis (IM) from esophageal squamous cell carcinoma (ESCC) is sometimes found. The aim of this study was to clarify the specific characteristics and survival impact of IM in patients with ESCC. Among 840 patients who underwent surgery for ESCC, 44 (5.2%) had IM. Patients with IM had significantly more advanced tumors compared with those without. In addition, the curative resection rate was lower in patients with IM (p<0.01). Overall survival (OS) and disease-specific survival (DSS) of patients with IM were significantly worse than those without IM (both p<0.01). In multivariate analysis, the presence of IM was one of the independent risk factors for poor OS and DSS (both p<0.01). To improve outcomes in such cases, multimodal treatment with strong antitumor activity should be considered.
We conducted a questionnaire survey to clarify the current state of dysphagia treatment in Osaka prefecture. The survey results revealed the following challenges. 1) Adoption of videoendoscopic evaluation of swallowing (VE) and scoring systems: Only a limited proportion of private practitioners conducted VE (22%), and scoring systems remain inadequate, with adoption rates at 57% for hospital physicians and 14% for private practitioners. This finding highlights the need for dynamic awareness activities. 2) Collaboration with speech therapists (ST): Only 1% of private practitioners had designated STs, making ST-led dysphagia rehabilitation difficult. It is important to perceive the larger community as a team ─ such as liaising with STs from visiting nurse stations ─ and to establish a structure that allows for collaborative dysphagia treatment. 3) Information dissemination: When asked whether any facilities or departments within the community offer dysphagia evaluations, the majority of responses were either “none” or “unclear.” These highlight difficulties in identifying facilities that offer evaluations. Dysphagia is a functional disorder that can occur from various diseases, so information about the various facilities and types of evaluations on offer should be made available, especially to facilitate liaisons between patient consultation, other relevant departments, and STs. To achieve this, active dissemination of information is imperative. 4) Engaging in and promoting home medical care: Despite the promotion of home medical care, this service is not offered by hospital physicians and only 5.2% of private practitioners offer swallowing function evaluation through house visits. Ear, nose, and throat physicians should also actively engage in home medical care.
The subject was an 83-year-old male who had suffered repeated dyspnea attacks with inspiratory stridor starting 8 years earlier. He had a previous history of two tracheotomies. Because his glottic opening width had gradually decreased, a “Retina” with one-way speech valve had been inserted after the second tracheotomy one year ago. The patient consulted a hospital to have the tracheal stoma closed. Laryngoscopic findings demonstrated that the vocal cords were drawn into the trachea after abduction during inspiration, and the glottic opening narrowed. Electromyography of the posterior cricoarytenoid muscle using hooked wire electrode showed a clear myogenic change. We confirmed clear denaturation confined to the posterior cricoarytenoid muscle and performed the Woodman method of vocal lateralization. Pathological findings revealed non-inflammatory myopathy of the posterior cricoarytenoid muscle. We closed the tracheal stoma to keep the widened airway in good condition. Recurrence of tracheal stenosis has not occurred after one and a half years post-surgery.
Post-tracheostomy infection control is a major issue in patients with severe dysphagia, because the tracheostoma is easily infected by aspirated saliva. It is of even greater concern in patients infected with multidrug-resistant bacteria, owing to the limited number of available antibiotics. Herein, we report 2 cases in which aspiration prevention surgery was performed following posttracheostomy infection caused by multidrug-resistant bacteria. Case 1: A 64-year-old male who was diagnosed with amyotrophic lateral sclerosis underwent a tracheostomy due to respiratory problems. He was a methicillin-resistant Staphylococcus aureus carrier, and hence, aspiration prevention surgery was performed post-tracheostomy. During the surgery, stomal infection by methicillin-resistant Staphylococcus aureus was detected and was controlled by debridement around the tracheal stoma, aspiration prevention, and effective antibiotic use. Case 2: A 64-year-old male who was diagnosed with multiple system atrophy underwent a tracheostomy for treatment of aspiration pneumonia caused by multidrug-resistant Pseudomonas aeruginosa. Despite the administration of antibiotics before the tracheostomy, tracheal-stoma infection developed about a week after the procedure. As saliva aspiration was considered to be the main cause of infection, aspiration prevention surgery was performed in addition to frequent debridement and wound washes for infection control. The results in these cases suggest that when severely dysphagic patients with multidrug-resistant bacterial infection need a tracheostomy, a concurrent aspiration prevention surgery may be recommended over tracheostomy alone. In such cases, the treatment strategy should be determined considering post-surgery infection control.
Surgery is the treatment of choice for thyroid papillary carcinoma. However, we need to be careful when making a decision on a treatment strategy in cases of thyroid carcinoma during pregnancy. Here we reported our treatment experience with an aggressive thyroid cancer case during the second half of pregnancy. A 33-year-old female presented with median cervical mass at the 37th week of pregnancy. Fine needle aspiration cytology showed malignancy but not specified. She underwent a Caesarean operation two days after her first visit. Subsequently, she had a total thyroidectomy with right-sided neck dissection on the 25th day after the first visit, followed by RI therapy due to lung metastasis. The post-operative course was favorable, without severe complications. We concluded that surgery should be considered even during pregnancy in cases of a clinically aggressive thyroid cancer with cytologically indeterminate nodule.