The local immune system of human laryngeal tissues was reviewed. Attention was focused to the distribution pattern of the glandular tissue and SIgA production in each structure of the larynx. Glandular acini and ductules were distributed mainly at the level of the false vocal colds and sub-glottis. Glandular buds made their appearance in fetal larynges. IgA and other immunoglobulins were found in adult larynges. In fetal larynges, however, IgA and secretory IgA could not be detected. In adults, diffuse fluorescence for IgA was observed not only in the submucosal or peri-glandular connective tissue but also in the glandular tissue. IgA producing plasma cells were numerous. Secretory component (SC) synthesis was found in the glandular acini and epithelium. SC synthesis was noted also in the glandular tissue of fetuses. These observations indicate that, in human larynges, the local immune function conducted by SIgA starts working shortly after birth.

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The human intrinsic laryngeal muscles (ILMs) are highly specialized for phonation, respiration, and deglutition. Motor endplates (MEPs) and their arrangement in the muscles may be related to the specific function of the larynx. Histochemical techniques were used to determine the distribution of the MEPs in the human ILMs. MEPs of four sets of ILMs obtained from autopsy larynges were clearly visualized using acetylcholinesterase stains (Karnovsky's method & Namba's method). The human ILMs did not show a narrow-band pattern of MEPs which had been observed in the skeletal muscles of the extremities. MEPs were diffusely located throughout the whole length of the thyroarytenoid and lateral cricoarytenoid muscle. A wide-band pattern of MEPs was found in the middle two thirds of the cricothyroid muscle. MEPs in the posterior cricoarytenoid muscle were loosely arranged. In the interarytenoid muscle, MEPs were distributed in an inverted “Y” or fan-shape configuration. Some muscle fibers had more than one MEP, indicating possibilities of multiple innervation. The difference in distribution pattern of MEPs of the laryngeal muscles from that of the skeletal muscles may be attributed to physiological differences between the two muscle groups.

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Noradrenergic nerve fibers contribute to the sympathetic control of blood flow and glandsecretion. Distribution of noradrenergic nerve fibers in and around canine vocal folds was investigated by means of the fluorescence method. In addition, the spatial relationship of noradrenergic nerve fibers to the blood vessels and glands was determined with the use of the peroxidase anti-peroxidase method. Noradrenergic nerve fibers were found around arteries and arterioles whose diameter was 15μm or greater. No noradrenergic fibers, however, were observed around capillaries and veins. In the laryngeal glands, noradrenergic nerve fibers were observed adjacent to the arteries which entered the glands and near the basement membrane of acinous cells. The results suggest that noradrenergic nerve fibers regulate the blood flow in the arteries and arterioles and gland secretion in the larynx.

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Among the intrinsic laryngeal muscles, the arytenoid muscle (AR) displays greatest morphological variations among species. There are two major types : unpaired and paired type. The former has been considered to be more highly evolved than the latter. Dual innervation by the bilateral recurrent laryngeal nerves has been demonstrated in unpaired AR of some species. This study consisted of two portions. The first portion macroscopically confirmed that AR was of a typical unpaired type in man, monkey and guinea pig (Cavia porcellus), of an atypical paired type in dog, and of a typical paired type in cat and rat (Rattus norvegicus). In the second portion, the localization of motor endplates in AR was investigated with the use of acetylcholinesterase staining in three guinea pigs, three rats and four dogs. In the guinea pigs, a broad band of motor endplates was observed in the middle portion of the unpaired AR. In rats, a band of motor endplates was noted in each of the paired AR. The canine AR consisted of two muscles transverse arytenoid and ventricular muscles. The former is paired whereas the latter is partly paired and partly unpaired. Motor endplates of the ventricular muscle were localized in the bilateral muscle bellies and the middle of the unpaired portion. The findings indicate that AR of unpaired type receives dual innervation.

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A case of laryngeal allergy was reported. A 38-year-old female presented to the Department of Otolaryngology, the University Hospital of Tokushima with a two-year history of abnormal sensation in the throat. The abnormal sensation was frequently associated with cough, sneeze, nasal discharge and eye itching. The arytenoid regions were slightly swollen and pale in color. A screening prescription for abnormal sensation in the throat, consisting of Bromazepam (2mg) 3T and Lysozyme chloride (270mg), was administrated for two weeks without any effect. A provocation test revealed allergic reactions of the mucosa of the arytenoid region to mite allergen : Following application of mite allergen, infiltration of mast cells was histologically observed in the mucosa. Azelastine HCl was effective.

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A review was made on the mechanism of control of the fundamental frequency of voice with special reference to the prosodic control of speech articulation. The fundamental frequency of voice (F0) is regulated by changing the vocal fold length, its tension and effective mass of vibration. Physiologically, the intrinsic laryngeal muscles, particularly the cricothyroid and the thyroarytenoid, play a principal role in F0 adjustment, while the contribution of the external laryngeal muscles is also indicated mainly for F0 lowering. In addition, other factors such as subglottal pressure regulation would also be taken into consideration to some extent. In this paper, these factors were discussed based on recent findings in the field of experimental phonetics.

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The influence of changes in the transglottal pressure on the fundamental frequency of phonation (F₀) has been determined by several investigators. In this study, attention was focused on the effect of small transglottal pressure changes, 2cm H₂O or less, upon F₀, which had not closely investigated in previous reports. A 45-year-old male who had no laryngeal, pulmonary and articulatory disorders served as the subject. A nearly linear relationship (-8Hz per cm H₂O) was found between the pressure and F₀ at 138 Hz, 161Hz and 176Hz. At 232Hz and 276Hz, a linear relationship (-11Hz per cm H₂O) was observed when the pressure change was greater than 0.5cm H₂O. For small pressure changes, the relationship was inconsistent. At 190Hz, no consistent relationship was observed between the pressure and F₀. The results suggest that the relationship between the transglottal pressure and F₀ depends on the state of laryngeal adjustment.

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The fundamental frequency (F₀) and sound pressure level (SPL) of voice were measured in 1,563 dysphonia patients of varying etiologic diseases. The measured values were compared with the values obtained from normal control subjects. The results were summarized as follows : (1) In most disease groups, the highest F₀ was low and the F₀ range was decreased. (2) In most disease groups, the SPL for the loudest phonation was reduced and the SPL range was small. (3) The F₀ level for habitual phonation was low in acute laryngitis and Reinke's edema and it was high in sulcus vocalis, carcinoma and mutational dysphonia in males, whereas, in females, the F₀ level for habitual phonation was low in many disease groups. (4) Similar tendencies were noted with the lowest F₀. (5) The SPL for habitual phonation was within the normal range in almost all disease groups. (6) F₀ and SPL presented low but significant correlation to the degree of the lesion in the cases with polyp and carcinoma. (7) The effect of treatment was reflected on F₀ and/or SPL in many disease groups.

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The maximum phonation time (MPT), mean airflow rate during maximum sustained phonation (MFRm), mean airflow rate during comfortable phonation (MFRc) and phonation quotient (PQ) were measured in 60 normal speakers and 1,556 patients with various laryngeal diseases and the clinical significance of the four tests was investigated. The results were as follows : (1) Differences in test value between the normal and pathological groups were most marked for MPT and least significant for MFRc. (2) In the cases of vocal fold polyp and recurrent nerve paralysis, significant correlations were found between the four test values and the normalized size of glottic gap during phonation. (3) Effects of treatments for vocal fold polyp and vocal fold paralysis were manifested in the value of the four test. (4) In normal subjects, MPT, MFRm and PQ were highly correlated to one another but the correlation between MFRc and the other three parameters was low. In the cases of vocal fold paralysis, all four parameters were highly correlated to each other. The correlation among the four parameters varied in the other disease groups. (5) The results led us to the conclusion that MPT and MFRc should be included in the routine test battery.

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The mean airflow rate (MFR) at the habitual vocal pitch and intensity shows great intersubject and intrasubject variations for normal subjects. In other words, the normal range of MFR is wide. Therefore, abnormalities can be determined only when the MFR value is very large.
We thought normal variations might be smaller for the minimum airflow rate at some F₀ and/or SPL levels of phonation than MFR. This paper describes preliminary results obtained from 14 male and 14 female subjects. With the use of flow-F₀ and flow-SPL profiles, the minimum airflow rate was determined for five F₀ levels, 100,140,200,280 and 400Hz, and for four SPL levels, 60, 70, 80 and 90dB. The minimum airflow rate was smaller at middle F₀ than at low and high F₀. The intersubject variation did not differ significantly among different F₀. The minimum airflow rate and its intersubject variations increased with increasing SPL.

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Relationships between tobacco smoking and chronic laryngitis were investigated in 11,809 adults who received physical check-ups for laryngeal cancer at the Yokohama Municipal Cancer Detection Center. The majority of examinees were in their forties or older. The subjects were divided into three groups relative to smoking : non-smokers, smokers with a smoking index (SI) of less than 400 and smokers with SI of 400 or greater. SI was defined as the number of cigaretts per day multiplied by the duration of smoking in year. Of the 11,809 subjects, 5,888 were male and 5921 were female. One thousand five hundred and eleven males and 4,752 females were non-smokers, 1,125 males and 798 females were smokers with SI of less than 400, and 3,252 males and 371 females were smokers with SI of 400 or greater. Attention was focused on the incidence of chronic laryngitis, vocal fold polyp, Reinke's edema, leukoplakia and cancer. The pathologies were observed in 22 percent of the male and 7 percent of the female non-smokers, 37 percent of the male and 34 percent of the female smokers with SI of less than 400, and 51 percent of the male and 54 percent of the female smokers with SI of 400 or greater. The majority of the pathologies was chronic laryngitis in each group.

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A total of 300 patients, 167 males and 133 females, with recurrent laryngeal nerve paralysis examined at the Department of Otolaryngology of Kinki University Hospital during the period from 1975 to 1988 were reviewed retrospectively. The results were as follows : (1) The age ranged from 40 to 79 years in 81 percent of the entire patients. (2) The incidence was higher for males than for females in the age group of 50 years and over. (3) The nerve was affected on the left in 187 (62.3%), on the right in 98 (32.7%) and on both sides in 15 patients (5.0%). (4) The paralysis was post-surgical in 125 patients and non-surgical in 175. The cause of paralysis was chest disease in 67, idiopathic in 48, neck disease (thyroid cancer in the majority) in 45, thyroid surgery in 40, chest surgery in 39 and endotracheal intubation in 36 patients. Chest diseases and surgeries were more frequent in males than in females whereas neck disease and thyroid surgeries were more frequent in females. (5) In 87 patients, paralysis resulted from malignant neoplasms. Forty-six of the 87 patients developed malignancies in the thorax. (6) The initial symptom of eight lung cancer, one mediastinal neoplasm, one esophageal cancer and three aneurysm cases was hoarseness. (7) Chest X-ray, CT and MRI and fluoroscopy of the esophagus were useful in detecting intrathoracic pathologies.

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Metastatic neoplasms of the larynx and hypopharynx are very rare. This paper presents a case report of a 36-year old woman with malignant melanoma. The primary tumor was resected from her back 7 years before, and the first metastatic mass was removed from the right axilla 6 years before. She was refered to us for laryngeal discomfort. Examinations revealed a metastatic melanoma on the left side of the larynx and hypopharynx. Total laryngopharyngectomy, modified neck dissection and primary reconstruction with free jejunum graft were performed. No tumor cells were found at the resected margin. Pre-and postsurgical chemotherapy were employed. The patient has had no further recurrence for 7 months. The incidence, diagnostic evaluation, and management of metastatic melanoma of the head and neck were briefly reviewed and discussed. It was emphasized that a radical surgery followed by radiotherapy, chemotherapy and / or immunotherapy should be indicated, whenever possible, to metastatic melanomas of the head and neck region.

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Fibrin tissue adhesive (Tisseel) was employed in 12 cases of endolaryngeal laser microsurgery for one of the following two purposes : (1) to prevent web formation at the anterior commissure and (2) to close the wound following removal of stenosis or cyst or arytenoidectomy. The former was applied to seven cases and the latter, to five. The follow-up ranged from three days to 15 months. Of the seven cases in which web prevention had been intended, six developed no web and one was lost to follow up. Among the former six, three was followed up for more than one month while the follow-up of the other three was less than three weeks. The use of Tisseel for the purpose of wound closure was successful in all five patients.

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