In this paper, several kinds of anesthesias are described from the viewpoint of application for phonosurgery. And their merits or demerits are discussed for the benefit of choosing one of anesthesic methods. Authors concluded as follows; 1) Topical anesthesias should be used for correction or resection of simple laryngeal lesions like pedinculated polyp, and should be performed especially when easy exposure of the larynx is possible. 2) Anesthesia of percutaneous jet ventilation is very useful for resection of lesions like granulomas which frequenently occurrs in posterior portion of the larynx. More precise surgery is necessary for laryngeal granulomas because of their common recurrence. As entire surgical field including posterior portion of the larynx cannot be obtained with a tracheal tube, jet anesthesia in which a tracheal tube is not necessary is the most suitable for laryngeal granulomas in the posteirior wall of the larynx. 3) General anesthesia with an endotracheal tube is most commonly used for every part of surgery. Even for phonosurgery, this method is still useful for precise correction of the shape of the vocal cord. However, this method has tow demerits. First, observing of surgical field is not always complete because of the endotrachal tube itself. Second, the surgeon cannot hear the patient's voice while performing the operation. 4) Neuroleptanalgesia (NLA) might play a very important role in phonosurgery. Phonosurgery is not only for cure of lesions but also for improving phonatory function. With NLA, the patient can phonate. Hence, the surgeon can hear the voice and observe the vibratory pattern of the vocal cord under stroboscopic light during the operation. The surgeon easily knows where in vocal cords and how surgical procedures should be carried out. However, every surgeon should recognize that more sophisticated technique is required when performing phonosurgical procedures under NLA.
Nobody can deny that phoniatric examinations including aenodynamics analyzing vibratory patterns of the vocal folds' or the like may play a very important role for diagnosis of the lesions and, in addition, for evaluation of their post-operative results. In this paper, aerodynamic aspects in laryngeal diseases were described and discussed mainly from the viewpoint of clinical application of flow rate measurements for evaluating the laryngeal function of the phonation.
Utterance behavior varies by person or by place. Few papers have been published on its nature of those who are heavily using their voice, including teachers, singers, telephone operators and salesmen, or even people in general. It is often found that many of patients complaining of voice disturbance use theirvoice excessively. Quantitative data on total of speeking time in a day, speeking time ratio per hour and distribution of sound pressure level and frequency during speech will help us to comprehend speeking behavior of each case and to evaluate the relations between cause of voice disturbance and utterance behavior. A portable device to record uttering time for 24 hours was invented for those purposes. Its usefulness was described.
In this paper, various methods of surgical treatment for voice disorder due to unilateral recurrent nerve palsy were briefly reviewed. The author emphasized the necessity of the choice of different approaches depending on the width of the glottal chink; injection or insertion method for the narrow glottal chink (paramedian fixation) and arytenoid adduction for the wide glottal chink (intermediate fixation) and for the difference in the level of the both vocal folds.