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原著
  • 井門 謙太郎, 平川 勝洋, 渡部 浩
    29 巻 (2017) 1 号 p. 1-7
    公開日: 2017/10/27
    ジャーナル フリー

    The clinical symptoms of perennial laryngeal allergy include a persistent cough, itching and irritation of the throat. We endeavored to shed some light on the features of antigens and laryngeal findings of perennial laryngeal allergy. A clinical study focusing on the diagnosis of laryngeal allergy was carried out in 53 patients exhibiting a persistent cough, itching and irritation of the throat. A diagnosis of laryngeal allergy was confirmed based on the effectiveness of H1-blockers and the presence of specific IgE antibodies by RAST testing. Laryngeal allergy was diagnosed according to the criteria proposed by the Society of Study for Laryngeal Allergy in Japan(2011).

    Seventeen of the 53 patients were diagnosed with perennial laryngeal allergy. A major positive perennial antigen in laryngeal allergy is the house dust mite. In comparison to nasal allergy, moth and cockroach antigens have a higher positive frequency with perennial laryngeal allergy.

    The sensitivity and specificity of nasopharyngeal smears for laryngeal allergy were 59% and 73%, respectively. H1-blockers were significantly effective with positive nasopharyngeal smears.

    A pale laryngeal mucosa was typical laryngeal feature in perennial laryngeal allergy cases, and patients whom antihistamines were effective tended to exhibit a pale laryngeal mucosa.

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  • 宇野 敦彦, 長井 美樹, 山本 佳史, 坂田 義治, 宮原 裕
    29 巻 (2017) 1 号 p. 8-13
    公開日: 2017/10/27
    ジャーナル フリー

    We reviewed 51 patients that underwent surgery to prevent respiratory aspiration. Neurodegenerative disease(48%)and encephalopathy(22%)were frequent underlying pathologies. All cases had episodes of aspiration pneumonia. Seventy percent of the cases were bedridden and required total assistance in daily life. Despite the significance of the decision to undergo surgery, as the laryngeal function, including phonation, would be permanently lost following surgery, the medical stuff was not unable to directly confirm the will of the patient in 35% of cases. A tracheal cannula was used pre-operatively in 76% of cases and post-operatively in 53%. Pre-operatively, 94% of patients received total alimentation through a catheter without any oral ingestion, but this proportion decreased to 37% post-operatively.

    In addition to preventing aspiration, surgery allowed for relief from a tracheal cannula(29% of cases)and the recovery of oral ingestion, albeit only to a slight degree in some instances(57% of cases). In some of cases, oral ingestion successfully recovered even after years without phonation or oral intake. In these cases, earlier surgery would have helped improve the quality of life even further.

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症例
  • 石田 愛 , 永井 世里, 小山 新一郎, 江崎 伸一, 濱島 有喜, 村上 信五
    29 巻 (2017) 1 号 p. 14-16
    公開日: 2017/10/27
    ジャーナル フリー

    Vocal cord paralysis often occurs due to unknown reasons. Since bilateral paralysis can cause dyspnea,we have to carefully watch the state of the patient while investigating the causes of paralysis. We herein report a case of bilateral vocal cord paralysis in a patient who was a vegetarian. The patient’ paralysis was improved by the administration of mecobalamin.

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  • 斎藤 真貴子, 倉富 勇一郎, 佐藤 慎太郎
    29 巻 (2017) 1 号 p. 17-20
    公開日: 2017/10/27
    ジャーナル フリー

    Soft tissue tumors of the larynx are extremely rare. Our patient was a 41-year-old Japanese male with a chief complaint of hoarseness. In the larynx, a slightly reddish tumor was observed on the anterior third portion of the right vocal cord. Laryngeal laser microsurgery(LMS)was performed to remove part of the tumor. The pathological diagnosis was suspected to be malignant fibrous histiocytoma, and the differential diagnosis was angiomatoid fibrous histiocytoma or undifferentiated pleomorphic adenoma; the tumor was reportedly not a high-grade malignant lesion. After surgery, the residual tumor showed rapid regrowth, so a second round of LMS was performed to completely remove the residual tumor. After this second surgery, mucosal injection and swelling was observed on the subglottic region of anterior commissure and anterior region of the right arytenoid. A third round of LMS was performed, but no residual tumor was identified. After this third procedure, the patient showed no recurrence. – The final pathological diagnosis was “unusual atypical spindle cell tumor, unclassified” with low-grade malignancy. The pathological classification of soft tissue tumors has been changed. Physicians should keep in mind that rare soft tissue tumors of the larynx include low-grade malignant spindle cell tumors, which can be cured by LMS, as shown in this case report.

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