We conducted a questionnaire survey of all training facilities (TF) for Board-Certified Otorhinolaryngologists to clarify the clinical practice status of surgery for improving the function of swallowing (SIS) and preventive surgery against aspiration (PSA).
According to the survey conducted in 2017, total laryngectomy to prevent aspiration (TL) was performed 217.1 times a year, and PSA other than total laryngectomy (PS) were performed 759.8 times, cricopharyngeal myotomy (CPM) was performed 412.1 times, and surgery other than cricopharyngeal myotomy (SO) for improving the function of swallowing was performed 483.6 times. We investigated how many TF performed SIS and PSA. TL was estimated to be performed by 58.3%-67.1% of TF, PS by 42.7%-51.9%, CPM by 27.1%-35.6%, and SO by 26.0%-34.5%, respectively as 95% confidence interval for population rate. We also investigated how many TF could perform SIS and PSA. It was estimated that TL could be performed by 79.6%-86.5% of TF, PS by 72.2%-80.0%, CPM by 69.0%-77.1%, and SO by 62.7%-71.4%, respectively as 95% confidence interval for population rate. In comparison with the survey conducted in 2012, we found a significant increase in the number of TF which could, but did not actually perform SIS and PSA, however, there was no significant increase in the number of TF which actually performed SIS and PSA or the case number of SIS and PSA per single TF.
Patients with dysphagia need special treatment and care. Therefore, accumulation of patients who need SIS and PSA at hospitals with sufficient medical infrastructure where the possibility of cooperation with many other specialists who could help dysphagic patients may be effective to cultivate the skill of otolaryngologists in managing dysphagic patients. However, other solutions must be considered in areas with a smaller number of FT in larger medical district.
On the other hand, physicians attending on dysphagic patients may not be aware of the indications for surgery and/or surgeons performing the surgeries. Therefore, it is important for not only individual otolaryngologists, but also their society, to inform the physicians of the possible avenues for surgery and the local surgeons available.
Cyanoacrylate-based adhesives known as instant glue have been used over the last 50 years in medical practice for various purposes such as achieving skin adhesion, hemostasis, vascular anastomosis, fistula closure, etc. The adhesive hardens within a few minutes, and has a strong adhesive effect. However, there is no report of the use of a cyanoacrylate-based adhesive in endoscopic sinus surgery. The advantage of ethyl 2-cyanoacrylate (ECA) is that it has a low viscosity, so that it can dropped into deep target areas in the nasal cavity and paranasal sinuses. Furthermore, the cost of ECA is lower than that of any other cyanoacrylate-based adhesives, and it is not necessary to obtain written consent for the use of blood products.
We present our initial experience of the use of ECA adhesive using a syringe equipped with a fine needle for closure of the mucosal incision in submucous resection of the inferior nasal concha, immobilization of the batten graft in nasal septal surgery and fixation of oxycell cotton in cases of intractable hemorrhage.
The adhesion rate of the mucosal flap in submucous resection of the inferior nasal concha was 92.9% (367/393 sides in 234 cases). On the other hand, the rate of closure by suture with 4-0 PDS® was 92.9% (269/326 sides in 165 cases). Thus, there was a significant difference in the success rate between the ECA-adhesive group and the 4-0 PDS®-suture group (P<0.05).
In nasal septal surgery for cases with caudal end deviation, fixing of the batten graft to the anterior nasal spine is difficult with the currently available techniques. We adopted the hemitransfixion approach and in order to correct the deviation of the caudal end, we rebuilt the caudal end with a batten graft and reinforced it by dropping ECA in 31 cases. The correction was accomplished well and there were no cases of recurrence of deviation.
For 18 sides in 14 cases with intractable hemorrhage, we dropped ECA in the oxycellulose cotton which was placed at bleeding sites for the purpose of fixation, and good hemostasis was obtained, with no cases of re-bleeding.
No serious cases of infection or foreign body reaction were observed.
We concluded that ethyl 2-cyanoacrylate is useful for various purposes in nasal surgery.
In Japan hearing aids (HAs) are categorized as medical devices, while personal listening devices (PLDs) are categorized as home appliances. The aim of this study was to compare the frequency characteristics and perform, objective and subjective evaluations of 2 HAs and 2 PLDs. Monosyllable intelligibility scores under noise was used as the objective parameter for evaluation and impression of sentences under noise was used as the subjective parameter. A total of 35, 15younger individuals (20 to 22 years old) with normal hearing and 20older individuals (41 to 55 years old) with normal hearing were enrolled in the study.
The study revealed that the frequency characteristics of the PLDs did not allow sufficient amplification of speech and showed an output of more than 100 dB SPL, indicating that use of PLDs may be associated with the risk of noise-induced hearing-loss. As for the HAs, sufficient amplification of speech was confirmed. In addition, it was considered that use of HAs would be associated with a low risk of noise-induced hearing-loss due to the output suppression control system.
The objective evaluation revealed significantly better result for the HAs than for the PLDs, whereas subjective evaluation yielded better results for the PLDs than for the HAs. HAs allowed better speech perception, although the hearing impression was poor. On the other hand, the hearing impression was better for the PLDs, even though monosyllable intelligibility was poorer.