Regional branches of the Japan Medical Association take the initiative to establish the comprehensive system of care which provides medical and nursing care recently. Otolaryngologists are expected to join in this system to exercise their expertise because of the burgeoning of needs for evaluation and rehabilitation of deglutition disorders.

Without the system, practicing otolaryngologists who are interested in the care of deglutition disorders may be faced with difficulties of medical collaboration.

Also, if the collaboration itself requires considerable effort, some medical providers would avoid the clinical practice of dysphagia.

It is therefore imperative to build an easy-to-join system for otolaryngologists to exert their expertise in the regional community.

Division of Hiroshima Prefecture, The Oto-Rhino-Laryngological Society of Japan has set up the committee of home care in November 2015. We describe regarding the launch of the committee, activities such as “dysphagia case conference” for the members and actions against public administration and the Japan Medical Association in this article.

Introduction: Japan is now a high-aging society, and the numbers of dysphagic patients are increasing. Given this background, we wonder if otolaryngologists have played a prominent enough role in treating swallowing disorders. We therefore examined the current status and issues associated with treatments for swallowing disorders in our region.

Method: We surveyed the medical records of three hospitals in Kochi Prefecture. These hospitals have rehabilitation wards and lack full-time otolaryngologists. We also administered a questionnaire survey to otolaryngologists and speech therapists in Kochi Prefecture.

Results: While there were many dysphagic patients in those hospitals, the evaluation of the swallowing function was not routinely performed. Many ear-nose-and-throat clinic otolaryngologists had difficulty performing active correspondence to treat dysphagic patients. In addition, only a few speech therapists cooperated with otolaryngologist and were confident in their treatment skills.

Conclusion: Otolaryngologists have sufficient knowledge and skills to treat swallowing disorders. Therefore, we stress that it is essential to organize regional medical networks and that otolaryngologists should collaborate with associated doctors and medical staffs, especially speech therapists.

Transoral laser microsurgery (TLM) has made great progress since first being developed in the 1970s, and now it has become an alternative treatment for early laryngeal cancer. Although TLM has some advantages in the duration of the treatment and avoidance of radiation exposure, radiation therapy is still chosen at many institutions instead of TLM. However, some previous studies have revealed that the voice outcome of TLM is not worse than that for radiotherapy and TLM has therefor recently been gaining popularity as a the treatment for early laryngeal cancer.

On the other hand, laryngomicrosurgery with cold instrument dissection was also introduced for the treatment of laryngeal cancer treatment in the 1990s, and this modality reduces the degree of heat damage that is often caused to the normal vocal fold mucosa.

In this article, we describe the indications and the methodology for performing laryngomicrosurgery for the treatment of early laryngeal cancer including, both TLM and cold-instrument dissection. The voice outcomes for TLM and dissection with cold-instruments are also described and statistically analyzed.

The three most important concerns of patients with laryngeal cancer are achieving a cure, saving their voice, and ensuring their daily life without tracheal stoma. Vertical partial laryngectomy is not suitable as a primary option in the treatment of early glottis cancer due to postoperative hoarseness, although it is superior to other treatments in the local control rate. We herein report the utility of vertical partial laryngectomy as salvage surgery after radiation therapy. A total of 264 patients with early glottis cancer were treated in our institute from 2005 to 2014, including 178 cases of stage T1 and 86 T2. Of these, 234 patients were irradiated with or without chemotherapy. Vertical partial laryngectomy was performed in 29 patients and total laryngectomy in 1, due to having received radiation therapy in another hospitals previously. Local recurrence occurred in 31 patients who received radiation therapy, and 18 of them were treated with vertical partial laryngectomy. A total of 47 patients received vertical partial laryngectomy as salvage surgery. All except two patients survived with a functional larynx. The local control rate of partial laryngectomy as a salvage surgery was 95.7%.

The origin of partial laryngectomy dates back more than two centuries. The first laryngeal surgical approach was median thyrotomy by Pelletan. In 1834 , initial tumor resection with laryngofissure was performed by Brauers. In 1851, Gurdon Buck left his name in history as the first to perform a laryngeal carcinoma operation. Following total laryngectomy, the first partial laryngectomy was performed by Heine in 1874. The first hemilaryngectomy was performed by Billroth in 1878 . These procedures can be said to have been born around the same time. Supraglottic partial laryngectomy was put into practical use in the 20th century. However, this variant was ultimately described by Alonso as functional preservation surgery in 1947. In the 1960s and 1970s, a number of partial resection procedures as functional preservation surgery were performed, and modern laryngeal surgery has prominently developed since then. In addition, as functional preservation surgery, a new operation called reconstructive laryngectomy or subtotal laryngectomy (supracricoid partial laryngectomy) was developed. However, reconstructive laryngectomy was a technique that gradually fell out of used due to complications associated with aspiration. Safely establishing and performing these surgical methods will require improving the treatment outcomes and stabilizing the postoperative function. To this end, it seems necessary to recognize the indications and limitations of these procedures.

Chemoradiotherapy is the standard treatment of choice is chemoradiotherapy for locally advanced laryngeal cancer in cases in which the organ function needs to be conserved. Surgical treatment with larynx preservation is only conducted in a limited number of cases. There seems to be no standard organ-preserving surgery for locally advanced laryngeal cancers in cases involving conditions such as vocal cord fixation and/or cricoid cartilage destruction.

We devised a novel operation that preserves the swallowing function and the airway. The operation is performed in two stages. In the first stage, the tumor is resected with the aim of preserving the swallowing function. In the second stage, the airway is reconstructed. This operation was performed for patients with T4a disease and vocal cord paralysis who expressed a strong desire for their laryngeal function to be preserved.

The main surgical procedures for aspiration prevention surgery are total laryngectomy, separation of the larynx from the trachea, and laryngeal closure. Laryngeal closure has the benefit of being minimally invasive and has thus far been reported many times. However, a tracheal cannula needs to be placed after this surgery. In 2008, we reported on the surgical closure of the larynx by removing the cricoid cartilage. The plasty of tracheostoma in this procedure involves the removal of the cricoid cartilage arch and the subsequent formation of a tracheal hole using the residual “lamina” and tracheal ring as a frame. The tracheal hole becomes triangular in shape with the posterior wall of the glottis at its apex. The rigid “lamina” forming the posterior wall allows this large hole to be maintained as-is without constricting. Furthermore, this “lamina” of the cricoid cartilage constitutes an important structure that reduces the risk of stenosis and prevents obstruction of the tracheal hole due to twisting or bending the neck. This procedure is one method of minimally invasive surgical closure of the larynx, and in addition to preventing aspiration from closure of the glottis, it is a useful surgery emphasized by its ability to meet the expectation of performing unique plasty of tracheostoma without a tracheal cannula.

Recent advances in ultrasonography, especially improvements in close-range spatial resolution that have been achieved in the last two decades, have made it possible to gain much more information by allowing the visualization of tissue construction, organ movement, and fine blood flow, even through the cartilage. These improvements could contribute to the rapid improvement of laryngeal ultrasonography.

Ultrasonography has many advantages over other diagnostic imaging modalities: it is non-invasive and radiation-free, it does not require troublesome pre-treatment preparations, it allows for real-time dynamic assessment, and the equipment is portable. And it is cost-effective for both of patients and medical economy. The ultrasonographic assessment of vocal cord movement is performed using two procedures: the middle transverse procedure, and the trans-thyroid cartilage transverse procedure.

We focused on the usefulness of ultrasonography in the primary care of patients presenting with laryngeal symptoms, especially regarding the importance of ultrasonography in the evaluation of the airway condition and vocal cord movement, and the diagnosis of laryngeal tumors.

Introduction: Although the incidence of tuberculosis (TB) in Japan has been decreasing yearly, Japan remains ranked as an intermediate-burden country for TB.

Objective: This study aims to investigate the current situation of laryngeal TB diagnosed in our department. Methods: We retrospectively reviewed the clinical records of 12 patients diagnosed with laryngeal TB in our department between January 2005 and December 2014. The extracted data included sex and age distribution, chief complaint, presence or absence of concomitant active pulmonary TB (PTB) or a history of TB, interferongamma release assay (IGRA) results, and duration from the first visit to the ultimate diagnosis of laryngeal TB. Results: The subjects included 5 men and 7 women with ages ranging from 39 to 79 years. A histopathological examination was performed on five patients. The IGRA was positive in three out of three patients. We observed concomitant PTB in 12 out of 12 patients. The median duration from the first visit to the ultimate diagnosis of laryngeal TB was 16 days.

Conclusion: The clinical symptoms of TB, especially those observed in the larynx, vary among patients. Otolaryngologists should be alert for extrapulmonary manifestations of TB to ensure an early diagnosis and treatment from a public health perspective.

Purpose : We investigated the clinical features according to the subsites of supraglottic carcinoma. Patients and Methods : We investigated 123 cases of supraglottic carcinoma treated that were at Osaka Medical College from 1999 to 2015. The cases involved five subsites: the arytenoid, false vocal cord, infrahyoid epiglottis, epiglottis, and the aryepiglottic fold. We investigated the associations between the subsites and characteristics of the patients, including age, primary symptoms, tumor stage and disease-specific survival.

Results : The subsites of the patients were as follows: the arytenoid, n=42; false vocal cord, n=34; infrahyoid epiglottis, n=20; epiglottis, n=16; and the aryepiglottic fold, n=11. The primary symptoms of the whole study population were as follows, hoarseness, n=56 (46 %); sore throat, n=40 (33%); cervical tumor, n=27 (22%); foreign body sensation, n=26 (21%). There were differences according to the subsites. The prevalence of T3-4 advanced carcinoma was approximately 61% in all subsites, while the prevalence of cervical lymph node metastasis was ranged from 53% to 82%. The disease-specific survival rates according to the subsites were as follows: arytenoid, 68.6%; false vocal cord, 74.5%; infrahyoid epiglottis, 87.5%; epiglottis, 60.0%, and aryepiglottic fold, 43.6%.

Conclusion : The different subsites of supraglottic carcinoma were associated with considerably different clinical features. An understanding of the clinical features of supraglottic carcinoma is important for early detection and appropriate treatment.

The vagus nerve is one of the 12 cranial nerves, which is considered as the 10^th nerve. The vagus nerve extended from the medulla oblongata to the second segment of the transverse colon. This nerve innervates the majority of the muscle of the pharynx, soft palate and larynx. In cases of vagus nerve paralysis, palatal arch movement is restricted. The arches cannot move up and back in order to close off the nasopharynx. This causes hoarseness, nasal speech, aspiration and regurgitation of liquid through the nose. In this article, we report 10 cases of the vagus nerve paralysis.

The patient’ mean age is 59.4 (range 34-83). There were 5 male and 5 female patients, among which there were 6 cases of right and 4 cases of left side paralysis. In six cases the chief complaint was vocal disorders. The causes included 5 cases of Varicella-Zoster virus infection (all confirmed) and 4 cases of central paralysis. In 9 cases of the 10 patients, nasopharyngeal incompetence, elevation or constriction of the paralyzed side and saliva pooling in the pyriform sinus were observed. In 4 cases of the 10 cases, the vagus nerve paralysis improved after treatment within 6 months.

In cases of vagus nerve paralysis immediate and accurate diagnosis and treatment are crucial. It is important to observe the palatal arches as they contract and the soft palatal as it swings up and back in order to close off the nasopharynx.

Background : With regard to the vascular anatomy, it is well known that a non-recurrent inferior laryngeal nerve (NRILN) is always associated with the aberrant subclavian artery (ASCA). As we previously reported in 2001, preoperative CT scans of the neck allowed us to recognize the ASCA and predict an NRILN. In 2016, we also reported in 2016 that approaching the vagal nerve first before dissecting the paratracheal region is essential for the preservation of the NRILN. As we have practiced these methods, we would like to review our clinical results in NRILN cases retrospectively and to verify the efficacy of this approach in avoiding vocal cord paralysis.

Materials and Results: Between May 1995 and June 2016, 2739 patients underwent thyroid or esophageal cancer surgery, in which the right inferior laryngeal nerve was confirmed visually during the surgery. Furthermore, 16 of these patients were diagnosed as having an NRILN. For them, the vagal nerve was approached first in order to preserve the NRILN. Postoperative laryngeal fiberscopy revealed no temporary, incomplete or complete vocal cord paralysis in any of the cases involving patients with the NRILN.

Conclusions: The preoperative diagnosis of ASCA, the prediction of an NRILN, and the procedure of approaching the vagal nerve first, were effective for avoiding vocal cord paralysis in the patients with an NRILN. Vocal cord paralysis is an important factor that is associated with the deterioration of a patient’s QOL.

Patients with voice tremor present with shaking voice which has a frequency of 4-5 Hz in their vocal tract. In most of cases, voice tremor is refractory to conservative treatment such as medication or voice therapy and the symptoms may affect a patient’s quality of life. We experienced a case of voice tremor accompanied by essential tremor of the upper extremities who was treated with bilateral thalamic deep brain stimulation (DBS). The results of an acoustic analysis and laryngeal endoscopic findings showed a partial improvement following unilateral DBS and complete improvement following bilateral DBS. FTRI, Fatr, ATRI, Jitter, Shimmer, vF0, vAm, NHR, sPPQ and sAPQ seemed to be useful parameters of voice tremor. The results suggest that the indication of DBS should be discussed for patients severely affected by voice tremor after considering the patient’s age, accompanying symptoms, backgrounds, occupation and needs.