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Clinical Study of 1, 228 Cases for 20 Years
Shinzo Tanaka, Yasumasa Tanaka, Machiko Fujita, Keiichi Chijiwa, Minor ...
1993 Volume 1993 Issue Supplement62 Pages
1-8
Published: June 15, 1993
Released on J-STAGE: November 27, 2012
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Six hundred sixty four patients with recurrent laryngeal nerve paralysis (RLNP) who visited Kurume University Hospital between 1981 and 1990 were studied and the results were compared with those from 564 patients with RLNP who visited the same hospital between 1971 and 1980. In the 80's, the number of male patients increased significantly, because the number of patients with RLNP due to lung cancer or radical surgery for esophageal or lung cancer increased. Cases of RLNP from unknown causes decreased in the 80's, probably because CT, MR' and ultrasonic examination were effective in diagnosing the cause of RLNP. Two thirds of the RLNP cases after intubation and a third of those from unknown causes recovered perfectly. In 80% of those cases, recovery was recognized until three months after onset. In the 80's, surgical treatment doubled and transcutaneous intrafold injection was performed for most patients. This surgery resulted in sufficient improvement of phonation in almost all cases.
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Toshihiko Inoue, Shinzo Tanaka, Yasumasa Tanaka, Minoru Hirano
1993 Volume 1993 Issue Supplement62 Pages
9-13
Published: June 15, 1993
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Between 1981 and 1990,202 of 276 patients with sulcus in the vocal fold were diagnosed with sulcus vocalis in our clinic. Seventy four cases were asymptomatic or associated with other organic voice disorders. Eighty one percent of sulcus vocalis were males and 79% were bilateral. Hoarseness occurred between fifty and seventy years of age in 51% of the patients. The onset of hoarseness occurred in patients below 20 years of age in only 5%of cases. Transcutaneous silicon injection to the vocal folds was performed in four patients and improved the voice in three. The improvement, however, lasted more than six months in only one patient. Nineteen patients were treated with voice therapy, and 37% of those improved.
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Retrospective Study of 428 Cases for 10 Years
Hirohito Umeno, Shinzo Tanaka, Ruriko Terasawa, Minoru Hirano
1993 Volume 1993 Issue Supplement62 Pages
14-19
Published: June 15, 1993
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Four hundred twenty eight patients with vocal fold nodules were treated in our clinic between 1981 and 1990. One hundred thirteen cases were children (younger than fifteen years) and 315 cases were adults (older than fifteen years). Among children, males predominated, while 98% of patients were females in the adult cases. Vocal abuse was the most frequent cause. The children tended not to care of vocal abuse. Sixty-one children were treated with voice therapy with improvement in 65%. One hundred eighty five adult patients were treated with voice therapy only and 77% showed improved phonation. Excision of the nodules was performed for 34 adult cases with endolaryngeal microsurgery or laryngeal fiberoscopy. The voice was improved in 93% of the cases treated surgically.
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Retrospective Study of 601 Cases for 10 Years
Hirohito Umeno, Shinzo Tanaka, Ruriko Terasawa, Minoru Hirano
1993 Volume 1993 Issue Supplement62 Pages
20-26
Published: June 15, 1993
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Six hundred one patients with vocal fold polyp were treated in our clinic between 1981and 1990. Only two cases were younger than fifteen years of age. The patient ages were most frequent in the forties or fifties. There was no significant difference between the number of male and female patients. Vocal abuse was supposed to be the most frequent cause. Drinking or smoking was not a significant factor in causing the polyp. Surgery was performed in 348 cases; 251 with endolaryngeal microsurgery,90 with laryngeal fiberoscopy and 7 with indirect laryngoscopy. The voice improved in 98% of surgical cases. Fifty nine patients were treated with voice therapy only, and 59% of the patients showed vocal improvement. Voice therapy was most effective for patients with a unilateral small red polyp.
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A 10-Year Review of 198 Patients
Tomoaki Sanada, Shinzo Tanaka, Kiminori Sato, Minoru Hirano
1993 Volume 1993 Issue Supplement62 Pages
27-32
Published: June 15, 1993
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One hundred ninety eight patients with Reinke's edema who visited our clinic between 1981 and 1990 were retrospectively studied. One hundred twenty four were males and 74were females. Ninety percent of the patients were between 30 and 69 years old. Brinkman's index was 400 or more in 78% of patients. This suggests that smoking was the most important etiological factor. Surgery was performed for 73 cases and the hoarseness improved in 63 cases. Thirty one patients stopped smoking for more than a month without surgery, and 16 cases showed vocal improvement. Surgery was effective regardless of the size of the lesion, while prohibition of smoking was effective only for slight edema. Voice therapy without surgery or prohibition of smoking had no effect on hoarseness.
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Retrospective Study of 75 Cases for 10 Years
Yasumasa Tanaka, Shinzo Tanaka, Tomoaki Sanada, Sumiko Kage, Minoru Hi ...
1993 Volume 1993 Issue Supplement62 Pages
33-38
Published: June 15, 1993
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Seventy-five patients with vocal fold cyst who visited our clinic between 1981 and 1990were studied. Almost half of the cases were male and 83% were between thirty and seventy years of age. Only two cases were younger than twenty years of age. Surgery was performed for 38 patients and 97% of those patients showed vocal improvement after surgery. Vocal function tests and acoustic analyses revealed significant improvements after surgery. There was no difference in results between the complete removal of the cyst with preservation of vocal fold epithelium and removal of the superficial cyst wall covered by vocal fold epithelium. Recurrence occurred in only one case after surgery.
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Kiminori Sato, Shinji Sakaguchi, Tetsuji Yoshida, Yasumasa Tanaka, Hir ...
1993 Volume 1993 Issue Supplement62 Pages
39-46
Published: June 15, 1993
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A total of 217 patients with epithelial hyperplasia of the larynx were treated between 1971 and 1990. The majority of the patients were male smokers. Most patients between 50 and 60 years old. Between 1981 and 1990, conservative treatment was given to 65 patients with non-massive lesions, and 60% showed improvement. Discontinuation of smoking during conservative treatment affected the incidence of improvement. Ninety one patients were treated with endolaryngeal microscopic CO2 laser surgery between 1978 and 1990. Fifteen patients developed recurrence. The recurrent lesion was benign epithelial hyperplasia in eight and invasive carcinoma in seven. Only male and preoperative smokers had recurrence. Discontinuation of smoking following laser surgery did not affect the incidence of recurrence. The incidence of recurrence and cancer development in severe dysplasia cases was lower than that among patients who were not treated by CO2 laser.
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Yasumasa Tanaka, Shinzo Tanaka, Minoru Hirano
1993 Volume 1993 Issue Supplement62 Pages
47-55
Published: June 15, 1993
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Thirty six patients with laryngeal papilloma treated in our clinic between 1971 and 1990 were retrospectively investigated. There were 26 males and 10 females. Ten patients were juveniles (juvenile papilloma) and 26 were adults (adult papilloma). The lesion was frequently multifocal in juvenile cases and frequently monofocal in adult cases. Surgical removal with an electrocoagulator or CO
2 laser was performed for all patients. Repeat surgery was required for recurrence in 9 cases of juvenile papilloma and 16 cases of adult papilloma. Monofocal adult papilloma tended to be controlled well with surgery. Five patients were treated with interferon and 4 patients became disease free after interferon injection.
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A 20-Years Review of 129 Patients
Tatsuya Saito, Shinji Sakaguchi, Kiminori Sato, Shinzo Tanaka, Minoru ...
1993 Volume 1993 Issue Supplement62 Pages
56-61
Published: June 15, 1993
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A retrospective review of 129 patients with non-specific laryngeal granuloma who visited to our clinic between 1971 and 1990 is presented. Eighty-two out of 128 cases were intubation granuloma,25 were contact granuloma and 22 were ideopathic. Females were predominant in intubation granuloma, while males predominated in contact and ideopathic granulama. There was no significant difference in age distribution among intubation, contact and ideopathic granulomas. Almost all cases had granulomas near the posterior glottis, but the granuloma was near the anterior commissure in two cases and below the glottis in one case. Surgical removal was performed for 70 patients; 14 with indirect laryngoscopy, one with laryngeal fiberscopy and 55 with endolaryngeal microsurgery. Recurrence occurred in 20% of intubation granulomas, in 46% of contact granulomas and in 36% of ideopathic granulomas. Thirty two patients were treated with conservative therapy, mainly voice therapy. In 24 of those cases, the granuloma disappeared. Only one case had recurrence of the granuloma after conservative therapy.
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Tatsuya Saito, Shinji Sakaguchi, Kiminori Sato, Shinzo Tanaka, Minoru ...
1993 Volume 1993 Issue Supplement62 Pages
62-66
Published: June 15, 1993
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Nine patients with laryngeal tuberculosis were treated in our clinic between 1981 and 1990. Seven of nine patients had lesions in the vocal fold and complained of hoarseness. Four patients had a past histry of pulmonary tuberculosis. The lesion of the vocal fold was tumor-like or granular, red in color with edema or partial coating. Stroboscopic examination revealed that the vibratory amplitude was small and the wave disappeared in the vocal fold lesion. The vocal fold vibration, however, did not disappear in any patient.
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Kiminori Sato, Shinji Sakaguchi, Yasumasa Tanaka, Yuuichiro Higaki, To ...
1993 Volume 1993 Issue Supplement62 Pages
67-76
Published: June 15, 1993
Released on J-STAGE: November 27, 2012
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A total of 23 patients with acute injury of the larynx and cervical trachea were treated during the period between 1971 and 1990. The majority of the patients were male. The patient ages were predominantly between 10 and 40 years old. Conservative treatment was given to about half of the patients, and primary suture was performed on about half. These cases represent a relative consistency in management principles: (1) Primary care should be maintenance of an adequate airway, (2) Antibiotics and steroids should be given for conservative treatement, (3) Soft tissue should be preserved as much as possible, and intralaryngeal or intratracheal wound(s) should be primarily sutured, (4) The cartilaginous framework should be repositioned and fixed.
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Kiminori Sato, Shinji Sakaguchi, Yasumasa Tanaka, Yuuichiro Higaki, To ...
1993 Volume 1993 Issue Supplement62 Pages
77-85
Published: June 15, 1993
Released on J-STAGE: November 27, 2012
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A total of 42 patients with cicatricious stenosis of the larynx and trachea were treated between 1971 and 1990. One-fourth of the patients were children and three-fourth were adults. The cause was iatrogenic in 57%. These cases represent a relative consistency of management principles. For cicatricious stenosis of the larynx and cervical trachea: (1)The cartilaginous framework should be repositioned and fixed, (2) The stenotic area and granulation tissue should be excised, (3) The raw surface of the mucosa should be covered with skin or mucosal graft, (4) The stent should be left in position for more than 3 months. For cicatricious stenosis of the thoracic trachea: (1) The stenotic area and granulation tissue should be excised by laser, (2) The stent should be left in position.
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Results of Voice Therapy
Osamu Shiromoto, Sadako Shiromoto, Shinzo Tanaka, Minoru Hirano
1993 Volume 1993 Issue Supplement62 Pages
86-90
Published: June 15, 1993
Released on J-STAGE: November 27, 2012
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Voice therapy was given to 51 patients with functional dysphonia between 1981 and 1991. Twenty two patients dropped out before voice therapy was completed. Twenty two of 29 patients who completed the voice therapy obtained improvement in voice and /or phonation. Three cases were psychogenic and improved considerably with therapy. Four cases were mutational. The voice was normalized in three, but unchanged in one. Seven were hypofunctional, nine hyperfunctional, four had a gap in the posterior glottis during phonation and two had normal behavior of the vocal fold during phonation. The rate of improvement was 100% for hypofunctional,67% for hyperfunctional dysphonia,25% for dysphonia with posterior gap and 100% for those with normal vocal fold behavior. Voice therapy was not sufficiently effective in hyperfunctional dysphonia and dysphonia with posterior glottic gap.
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Taketo Kuroki, Shinsuke Ito, Shuichi Odahara, Katsuya Yamaguchi, Motoh ...
1993 Volume 1993 Issue Supplement62 Pages
91-95
Published: June 15, 1993
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The incidence and degree of sensorineural hearing loss were analyzed in 303 patients with monolateral chronic otitis media. The contralateral healthy ear served as a control. A difference greater than 10 dB in average of bone conduction thresholds at 500,1000,2000 and 4000 Hz was found in 30% of the subjects,20 dB in 16% and 30 dB in 5%. Each frequency was equally affected. Patients with prolonged disease were more likely to be affected. Significant relationship was not found between sensorineural hearing loss and the presence of cholesteatoma.
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Shuichi Odahara, Shinsuke Ito, Katsuya Yamaguchi, Masao Taketomi, Muts ...
1993 Volume 1993 Issue Supplement62 Pages
96-99
Published: June 15, 1993
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Twenty nine cases with unilateral labyrinthine fistula due to cholesteatoma were treated surgically and followed for at least one month. The mean preoperative bone conduction thresholds were higher 10 dB or more higher in the ear with the fistula than in the contralateral ears in 48% of the patients. The difference between the pre-and postoperative thresholds was less than 10 dB in 86% of the subjects. Vestibular disorders were found preoperatively in 47%. The symptoms did not worsened after surgery in any case. Normal pre-operative vestibular function was not affected in any case. Disorders in static vestibular function such as spontaneous nystagmus and Romberg's phenomenon showed gradual improvement. However, disequilibrium during active movement persisted for a long period.
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Masao Taketomi, Shinsuke Ito, Hisako Tokumaru, Taketo Kuroki, Motohiro ...
1993 Volume 1993 Issue Supplement62 Pages
100-104
Published: June 15, 1993
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We studied 1870 patients with vertigo between 1981 and 1990. Ten percent demonstrated the symptoms of benign paroxismal positional vertigo. Common etiologic factors were supposed to be a longterm bedridden state, head injury and hypertension. The symptoms disappeared within 3 months in 39.3% of the cases. Treatment using diphenidol, cinnarizine and vitamines was not effective.
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Katsuya Yamaguchi, Shinsuke Ito, Masao Taketomi, Motohiro Hiraki, Muts ...
1993 Volume 1993 Issue Supplement62 Pages
105-109
Published: June 15, 1993
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An endolymphatic sac-mastoid shunt procedure was performed in 37 cases of Meniere's disease. In accordance with AAOO (American Academy of Ophthalmology and Otolaryngology,1972) criteria,19% were class A,54% class B,15% class C,12% class D. Hearing losses of more than 15 dB occurred in 50% of the ears in which silicon film was used, and 23% of those whose sacs were incised and turned over by Kitahara's method. There was a statistically significant difference in the incidence between the two groups.
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Yasumasa Tanaka, Shinsuke Ito, Shinji Sakaguchi, Katsuya Yamaguchi, Mo ...
1993 Volume 1993 Issue Supplement62 Pages
110-115
Published: June 15, 1993
Released on J-STAGE: November 27, 2012
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Five hundred fifty ears with chronic otitis media were treated surgically at our hospital between 1981 and 1990. They consisted of 313 ears with cholesteatoma and 237 ears without cholesteatoma. The former affected men more often than women, especially in children. Tympanoplasty type I was most frequently performed, and type III-C was the second choice. Surgery for recurrence of cholesteatoma was required in 19.8% of all cholesteatoma cases.10.2% of the cholesteatomas were caused by a tympanoplasty. Tympanoplasty type I was successful in 73%, type II in 50%, type III in 44%, Type III -C in 62%, type IV in 18% and type IV-C in 37%.
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