To investigate the usefulness of hearing assessment tools for early determination of hearing in infants, we evaluated the functional use of sound by fifteen infants fitted with hearing aids or cochlear implants for various degrees of hearing impairment (profound, severe and moderate) including several developmental retardations. Evaluations were performed longitudinally making use of two assessment tools: ”Tanaka’s Developmental Test of Auditory Function” and the ”Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS).” In the profound group, scores were low before implantation but improved sharply after cochlear implantation. In the severe group, shifts in scores were thought to be attributable to rapid auditory development, aggravated hearing loss, adverse living situations, and developmental delays. In the moderate group, all scores were higher than those of the other two groups. The above trends were closely similar using both scales: the more severe the hearing loss, the lower were the scores. This study indicated the usefulness of hearing assessment tools for very early determination of hearing in infants with hearing loss.
Arytenoid cartilage dislocation has traditionally been relatively rare; however, recently cases caused by endotracheal intubation appear to be increasing. Arytenoid cartilage dislocation can occur anteriorly or posteriorly during the process of intubation. Here, we dealt with two cases of arytenoid dislocation occurring anteriorly and posteriorly after general anesthesia. Case 1: A 47-year-old woman underwent an operation for breast cancer under general anesthesia. She suffered hoarseness immediately following intubation and it continued for two months. Videolaryngoscopic examination revealed fixation of the right vocal fold and electromyography revealed electrical activity in the right thyroarytenoid muscle during phonation. We diagnosed right anterior arytenoid cartilage dislocation and undertook manual reduction by laryngomicrosurgery. Postoperatively the patient’s hoarseness began to improve gradually and ultimately resulted in improvement of the right anterior arytenoid cartilage dislocation after a period of six months. Case 2: A 35-year-old male underwent an operation for hepatic hematoma under general anesthesia. Hoarseness was noted immediately after intubation and it continued for one week. Videolaryngoscopic examination revealed posterior fixation of the right vocal fold. We diagnosed right posterior arytenoid cartilage dislocation and planned manual reduction by laryngomicrosurgery. However, his child’s hand accidentally hit his neck and his hoarseness disappeared; improvement of the right posterior arytenoid cartilage dislocation was also noted.
Purpose of the review: The purpose of this review is to describe the surgical approach to benign superficial lesions of the larynx. It will discuss the microanatomy of the layered vocal fold structure and how this impacts decisions as to how to approach such lesions and the appropriate surgical instrumentation that helps to facilitate safe and effective surgery. A number of common lesions will be presented along with the various surgical techniques that allow for maximizing the surgical results, preventing recurrence and minimizing risks.
Vocal fold scarring is a fibroplastically acquired anomaly of the pliable vocal fold cover resulting from surgery, trauma or repetitive inflammation which causes vocal impairment due to abnormal vocal fold vibration. For diagnosis of vocal fold scarring, vocal fold vibration should be examined by stroboscopic videolaryngoscopy or high-speed videolaryngoscopy. In these procedures, reduced amplitude and traveling wave, phase shift between the vocal folds, and glottal closure insufficiency are observed. Imaging analysis methods include multi-line videokymography showing the time-series change of vocal fold vibration and laryngotopography showing differences in vibration at various points of the vocal fold. In cases where endoscopic diagnosis does not correspond with the dysphonic symptoms, further examination is important, keeping the possibility of vocal fold scarring in mind.
Laryngeal scar cases are often difficult to treat due to complicated pathogenesis. There is a possibility that anomalies in deep structures that cannot be observed by endoscopy may cause impairments in vocal fold motion or mucosal waves. Therefore, it is necessary to understand not only vocal fold lesions, but also the presence or absence of scars in deep regions, changes in the shape of the laryngeal framework, displacement and movement disorders of arytenoid cartilage. Using 3DCT, we examined autologous fat injection laryngoplasty cases, laryngeal trauma cases, and cases in which laryngofissure was performed after laryngeal trauma in order to determine the influence that structural anomalies in deep regions have on vocal fold motion or mucosal waves. All cases involved impairments in vocal fold motion or mucosal waves, and the presence of a scarring lesion was suspected. In the autologous fat injection laryngoplasty cases, vocal fold mucosal waves were impaired as a result of both vocal folds being tense due to overinjection. In the laryngeal trauma cases, fractured cricoid cartilage and dislocated arytenoid cartilage were confirmed at the cricoarytenoid joint. In the post-laryngofissure cases, vocal fold level differences due to unilateral arytenoid dislocation and vertical misalignment of the bilateral thyroid cartilage lamina were confirmed. These anomalies accounted for the impairments in vocal fold motion and mucosal waves. For treating voice disorders that result from laryngeal scar, it is important to consider structural anomalies in deep regions in addition to regions that can be observed with an endoscope. 3DCT allows visualization of the complex configuration of the larynx, and is thus suited for the evaluation of laryngeal scar cases.
The purpose of intracordal injection of steroids is to reduce scar volume and soften scar tissue. Repeated injections are also effective against scarring in the maturation phase. This therapy alone cannot induce scarless healing, however, and treatment should be multidisciplinary. This therapy is useful by virtue of its being the most convenient.
Vocal fold scarring is characterized by histological alteration of the lamina propria of the vocal fold. Tissue engineering and regenerative medicine is a strong strategy for regenerating the scarred vocal fold. We applied an atelocollagen sheet implant to provide an appropriate scaffold for regeneration of the lamina propria. Clinical results were encouraging, showing improvement of the tissue property of the scarred vocal folds.
Laryngomicrosurgery (LMS) is often adopted for resection of unnecessary masses such as polyps. However, LMS is relatively poor at compensating for defective tissue and is not completely useful for improving the physical condition, thus making it unsuited to dealing with scar formation on the vocal folds. A surgical method for scars has been performed at the Tokyo Voice Center whereby the hard mass, i.e. the scar, is removed. After this surgery, improved tissue in the vocal folds can be expected. In this paper, we report on this surgical technique and indicate the clinical results.
In a survey conducted by the Japanese Ministry of Education (2002) it was reported that 6.3% of all elementary and middle school students have difficulties qualifying as developmental disabilities. Research on deaf children with developmental disabilities has been inadequate, however, and therefore I investigated the number of deaf children with developmental disabilities. I sent out questionnaires to all schools for the deaf in Japan. The results revealed that 30.0% of students had difficulties in learning, 9.1% had attention deficit, and 4.6% had obsessive-compulsive behavior and interpersonal relationship problems. These percentages were higher than those for normal-hearing students. All questions were grouped based on factor analysis, and the children were cluster-analyzed according to their factor scores. As a result, 6 distinct groups were found in elementary schools for the deaf. Here I introduced educational support for two typical cases in each cluster. The task that lies ahead is to develop effective methods to aid each group type determined by this study.
Herein we report the hearing acquisition support undertaken for multiply handicapped children with hearing impairments at Fukushima Medical University Hospital and Fukushima Rehabilitation Center for Children. In addition, we discuss indications for the use of hearing aids or cochlear implants for these children. Cochlear implants can be useful tools for hearing acquisition in multiply handicapped children; however, adequate consideration of indications is necessary. Also, in multiply handicapped children, hearing compensation through the use of hearing aids and cochlear implants provides benefits in terms of improved communication, including non-verbal and emotional communication.
The effectiveness of cochlear implantation in hearing-impaired children with additional disability is still controversial. In this study, we report the effect of pre-operative developmental delay on post-operative speech performance and the effectiveness of cochlear implantation in profound hearing-impaired patients with pervasive developmental disorders. The cognitive-adaptive developmental quotient evaluated using the Kyoto Scale for Psychological Development showed significant correlation with the post-operative language-social developmental quotient. Although it showed a positive correlation with intelligibility of consonant-vowel syllables and phrases, the correlation coefficient was small. The speech intelligibility test showed diverse results in cochlear implant recipients with pervasive developmental disorders. On average, they showed slightly lower scores on the speech intelligibility tests. In most cases, patients showed improved response to sounds in daily life, and the families of the patients were satisfied with the cochlear implant. The attitude of patients to their surroundings did not change so much as their response to sounds did.
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