Patients with dysphagia visit various kinds of medical institutions, such as private clinics, general hospitals, or university hospitals. Treatments for dysphagia vary greatly depending on these institutions' respective roles. Among them, university hospitals are called on to make precise diagnoses of the etiology and pathophysiology of swallowing disorders. We proposed a simple scoring system for endoscopic swallowing evaluation, and presented its usefulness as a tool for evaluating dysphagia features and severity and deciding oral food intake. In rehabilitation for dysphagic patients, simple maneuvers which can be performed by the patient or a family member are mainly applied. We perform surgical interventions for severe dysphagia aiming to restore oral food intake and prevent aspiration pneumonia. Pharmacological therapy is a promising new therapeutic strategy, and we are pursuing its clinical applications. Education and training for young doctors, co-medical staff, and medical students are important in the university hospital setting. We are also trying to organize a local medical network system and enlighten citizens on treatments for dysphagia.
Injection laryngoplasty is one of the typical remedies used in the treatment of glottal insufficiency. In Japan, silicone, collagen, autologous fat, and calcium phosphate cement have been used as injectable materials. No material, however, has been able to fully satisfy all ideal conditions with respect to biocompatibility, non-absorbency, non-migration, and ready formulation for easy injection. Hyaluronic acid (HA) is one component of the extracellular matrix that plays a key role in tissue viscosity, shock absorption, wound healing, and space filling. Research into the role of HA in laryngology indicates that it has profound effects on the structure and viscoelasticity of vocal folds. Injection laryngoplasty using HA was performed on 13 patients with glottal insufficiency. The indications and limitations of injection laryngoplasty using HA were discussed. 1) For augmentation of the vibrating part of the vocal fold, injection laryngoplasty using HA was indicated to be effective. 2) Injection laryngoplasty using HA was indicated to be effective for patients who underwent injection laryngoplasty using other materials and had bad outcomes. 3) Another operative procedure is indicated for medialization of vocal folds.
Professional singers were interviewed to learn what voice disorders mean to them. Nine singers who specialize in opera, musical theater, jazz, or pops were asked to verbally describe the physical conditions and kinesthetic sensations that they feel during successful singing. They also reported their experiences of voice disorders as well as treatments by otolaryngologists. The singers' verbal descriptions indicated that successful singing requires appropriate control of respiration, which coordinates the entire system of singing, i.e., respiration, phonation, and articulation (resonance), and that relaxed laryngeal conditions are also important. Professional singers are "athletes" who utilize various muscles for singing. Malcoordination of various muscles for singing, therefore, may lead to vocal disorders. Understanding of their "working situation", i.e., the difficulty of canceling their concerts, and of their anxiety and stress are important when treating professional singers.
The central auditory pathway plays an important role in auditory processing, and disturbance of the pathway causes various symptoms; e.g., speech recognition disorder and auditory agnosia. Investigation of the auditory pathway in live humans is difficult, however, because of its complexity compared to other modalities such as the visual or somatosensory pathway. MRaxonography (MRX) is a new technique to investigate the auditory pathway non-invasively, which has been impossible with classical methods. It is based on a diffusion-weighted MRI technique and offers the ability to visualize the human neuronal tract. We successfully visualized the central auditory pathway in normal subjects using MRX. MRX is also useful as a diagnostic tool for central auditory disturbance. For further investigation, measurement of diffusion coefficient and diffusion tensor analysis are promising methods for quantification of auditory function. MRX is a useful technique for investigating the central auditory system.
Calcium phosphate bone paste (BIOPEX®) is a material for medical use to cover bone defects. It changes from a paste form to hydroxyapatite solid form with time and offers many advantages as a material for vocal fold injection. Preparation and injection procedures are easy because the material is provided in a kit and is a paste form when injected. As material absorption is minimal over a long period, therapeutic effect is stable for long duration. In addition, its solidity after injection enables this material to be used in patients with large posterior glottal gap. The technique we established calls for injection of the material into the lateral side of the vocal process to the adduct arytenoid cartilage using an expandable laryngoscope (FK or Weerda type) and video laryngo-pharyngoscope system. Holding with forceps after injection, to keep the cartilage in good position for a few minutes until the material solidifies, makes this procedure more successful. We also invented a novel trans-oral vocal fold closing method by injecting BIOPEX into both vocal folds taking advantage of arytenoid adduction. Vocal fold injection with BIOPEX in this trans-oral technique has effect similar to thyroplasty type I and arytenoid adduction.
There are few studies on the linguistic knowledge of Japanese children with specific language impairment (SLI). The purpose of this study was to investigate the characteristics of case-marker errors in the utterances of 2 Japanese children with SLI, focusing on the structural ("ga", "o" and "ni") and inherent (case-makers except "ga", "o" and "ni") cases. The participants were 2 children with SLI. Child A was 10 years old and Child B was 9 years old. Case-marker errors in spontaneous speech were identified and analyzed. The results were as follows. In both Child A and B, the number of errors was significantly higher in structural cases than in inherent cases. These results were consistent with those in hearing-impaired children reported previously. However, in both Child A and B, the number of errors in structural cases showed no difference between those mistakenly taken for other structural cases and those taken for inherent cases. These results were not in accordance with those which were reported for hearing-impaired children. In children with hearing impairments, few errors in structural cases mistakenly taken for inherent cases were observed. These results suggest that in children with SLI, knowledge of the difference between structural and inherent cases is not so acquired as in hearing-impaired children.
There are few reported cases of mitigation or improvement in developmental stuttering that has progressed to the fourth of the developmental phases. Tsuzuki (2002) reported that phase four stutterers could also improve, but the process of mitigation or improvement has yet to be clarified. This study examined the effects of treatment and the mitigation/improvement process when mental rehearsal built in systematic desensitization was applied during the commencement of treatment. The treatment was performed on 21 cases 8 to 50 years old suffering from developmental stuttering phase four. According to subjective evaluation results of patients who received treatment, indicated on a seven-point (or four-point) scale concerning "state of fear and action" and "state of dialogue," 10 cases reached the normal range. There was one case -a school child- that reached phase one, five cases that reached phase two, one case of phase three, and four cases that remained in phase four. The improvement process of the school child traced the progression process. However, with adult cases, the patients went from phase two to the normal level without exhibiting the phase one state. In phase two, there emerged the action of talking without caring about speech disorders, despite the appearance of blocks. Furthermore, there were examples of cases where the behavior of paying attention to one's own speech remained after regressing to a phase two state, as well as one case where it disappeared. This indicates that even in phase two during development, there is a stage where one pays attention to one's speech and a stage where one does not do so.
We report a case of associated laryngeal paralysis from slight head injury. A 67-year-old woman who had fallen to the ground suffered from dysphagia. We did not detect any abnormal findings by high-resolution computed tomography (CT) or magnetic resonance imaging (MRI). No remarkable change was detected by blood test or cerebrospinal fluid examination. Slight head injury can cause associated laryngeal paralysis.
The subjects were 117 typically developing children from ages 3: 01 to 6: 01. They were divided into six groups of half-year age-sets and an object naming task involving 40 picture cards was conducted. Their performances were analyzed and comparisons were made among the six groups from the aspects of lexical form and semantic structure. The error types were semantic relation, functional factor and irrelevant answer. The results indicated that percentages of correct answers correlated closely and increased with age. The groups from 3: 01 to 4: 05 got low scores compared with the 4: 06 and older groups. The group from 3: 01 to 3: 05 also got significantly higher scores for irrelevant answers. The groups from 3: 01 to 4: 05 used a large number of baby words and onomatopoeia. Errors were reduced in the groups from 4: 06 to 6: 01, but there were slight semantic and functional errors in all groups. In the groups 4: 06 and above, errors showed a steep decline and became consistent among all subjects. These results suggest that typically developing children grow out of their perceptual effect and at 4: 06 reach relatively stable levels in both their quantitative and qualitative aspects in the acquisition of words.
The questions at the focus of the present study were as follows: 1. What are the cognitive perceptions of children of deaf adults (CODA) and their parents concerning interpretation? 2. How do their perceptions progress with the child's developmental stage? These points were analyzed by applying the Modified Grounded Theory Approach (M-GTA). Interview respondents consisted of 25 CODAs and 19 deaf parents, including 15 pairs of real parent and child. The M-GTA results indicated that 27 concepts, 6 categories and 6 sub-categories were obtained from utterance records running to 320,849 letters. The results of semi-structured interviews with CODAs revealed no conscious perception of supporting their parent during childhood; but in adolescence internal conflict emerged, and in adulthood the CODAs understood and accepted the disabilities of their parents. The deaf parents depended on interpretation performed by the CODA in childhood and adolescence, but in adulthood their own independence resulted from nondependency on the CODA. These results suggest that conscious awareness is shared between CODAs and their parents during the CODA's childhood, then this mutual awareness is lost, but ultimately it becomes consistent again. However, there are differences among individuals with respect to this progression.
Vocal fold scarring and sulcus vocalis significantly increase stiffness of the mucosal wave of the vocal folds. The dysphonia caused by vocal fold scarring and sulcus vocalis is often severe and difficult to treat. We report here three cases with vocal fold scarring and sulcus vocalis that were successfully treated by voice therapy. Two cases had been initially treated by local injection of basic fibroblast growth factor (bFGF) into the vocal folds. The other case had no history of prior treatment. Stroboscopic examination showed reduction of the mucosal wave of amplitude, a spindle-shaped glottal gap and hyperfunction in all patients. They underwent voice therapy consisting of exercises designed to modify vocal misuse and increase vocal fold flexibility, such as trill exercises and Vocal Function Exercise (VFE). Examination at the end of voice therapy showed remarkable improvement of voice. Stroboscopy showed mobile, less stiff vocal folds with excellent amplitude and mucosal wave. These results indicate that voice therapy can help improve vocal function in cases with vocal fold scarring and sulcus vocalis.
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