The pharyngeal phase of swallowing is a stereotyped motor activity controlled by the swallowing central pattern generator (CPG) within the medulla. The swallowing CPG consists of dorsal and ventral swallowing groups (DSG and VSG, respectively), where the DSG triggers the swallowing reflex by receiving monosynaptic or paucisynaptic input from the superior laryngeal nerve, and the VSG distributes motor commands to the swallowing-related muscles. Neurons in the medullary intermediate reticular nucleus are involved in laryngeal adduction during post-inspiration and swallowing and thus are members of both respiratory and swallowing CPGs. Laryngeal adduction during swallowing is important not only for ensuring airway protection but also for creating a positive subglottic pressure that facilitates efficient swallowing. The Kölliker–Fuse nucleus (KF) in the pons regulates the postinspiratory activity during breathing and swallowing. Expiratory decrementing neurons of the Bötzinger complex may play a role in the arrest of respiratory activity during swallowing. Swallowing preferentially occurs during the postinspiratory or expiratory phases. The swallowing reflex is suppressed during inspiration centrally by the KF and peripherally by the pulmonary stretch receptor, and swallowing strongly resets the respiratory rhythm. The interval between the onset of swallow and the subsequent inspiration is shortest for swallows initiated near the expiratory-to-inspiratory phase transition and may represent a period of vulnerability to aspiration.

Improving the pharyngeal stage of swallowing while preserving the laryngeal function is usually the most important goal of surgical treatment for the patients with severe dysphagia. To date, many surgical procedures have been introduced to allow patients to resume oral intake and thereby improve the patient’s quality of life. Typical surgical procedures include cricopharyngeal myotomy, laryngeal suspension, type I thyroplasty, arytenoid adduction, injection laryngoplasty, and pharyngeal flap surgery, etc. Considering the increasing number of patients with dysphagia in an aging society in recent years, otolaryngologists should therefore be knowledgeable of as many surgical procedures as possible. However, since surgery is not indicated for all patients with pharyngeal stage dysphagia, the pathological conditions of dysphagia should be properly understood based on the patient’s physical, mental and social backgrounds. According to each surgical principle and indication, it is necessary to perform one or more appropriate surgical procedures.

In a super-aging society, dysphagia has become a major problem. Dysphagia is caused by primary diseases, such as cerebrovascular diseases and neurodegenerative diseases, as well as head and neck tumors. In addition, disuse muscle atrophy and sarcopenia may cause swallowing disturbances. Rehabilitation is an important treatment for dysphagia. However, rehabilitation deals with disorders, thus, it needs to performed comprehensively in context with the patient’s ability, activity, and environment. In consideration of the general condition, safe oral intake needs to be ensured via prevention of aspiration by respiratory rehabilitation combined with risk management. Attempts have been made to objectively evaluate and provide feedback on the intensity, amount, and effect of rehabilitation. Several treatment methods, including neurorehabilitation, have been established. However, limited information is available about evidence-based treatment for rehabilitation. As per the current recommendations, rehabilitation should be performed according to the type of dysphagia. To date, reports verifying the effectiveness of training have been scant, and further research on this subject is warranted.

Objective: To assess the efficacy of laparoscopic anti-reflux surgery (LARS) for treating Japanese patients with laryngopharyngeal reflux disease (LPRD) refractory to proton pump inhibitor (PPI) therapy.

Methods: The outcomes of LARS were retrospectively assessed using validated questionnaires, such as the reflux symptom index (RSI), in Japanese LPRD patients with abnormal proximal exposure (APE) as measured by hypopharyngeal multichannel intraluminal impedance-pH (HMII).

Results: Twenty-eight patients with LPR symptoms and documented APE underwent LARS. Of these patients, 26 (93%) saw significant symptomatic improvement, and their RSI values significantly improved postoperatively (19.8 ± 10.8 vs. 7.3 ± 8.1, p<0.001). A mild retrosternal food-sticking sensation was reported in 5 patients (18%) postoperatively.

Conclusion: LARS is an effective treatment for patients with LPR symptoms and documented APE as measured by HMII. HMII is essential for the evaluation of patients with LPR symptoms.

We successfully developed the Taguchi method as the short version of Vocal Function Exercise (VFE). The Taguchi method involves only the following training contents included in VFE: Extension of phonation time, and phonation exercise with a certain voice pitch. We applied this method to a series of voice disorder cases. Patients treated with the short version of VFE were typically in their 60s and 70s, often with vocal cord atrophy and sulcus. The number of training sessions and the training period duration were ≤6 times and ≤3 months, respectively, so treatment was completed in a shorter period of time than with the original VFE method. We also noted an improvement in the auditory impression, maximum phonation time, and Voice Handicap Index (VHI) in most cases with the short version of VFE compared to before therapy. The short version of VFE can be accomplished with a simple procedure and is expected to shorten the treatment period.

Endoscopic laryngo-pharyngeal surgery(ELPS) was developed for superficial cancers of the pharynx or larynx in Japan. This method requires some special instruments, including a malleable electrocautery and curved forceps. The existing curved forceps come fall short in achieving some of our needs with regard to grip force and other requirements. Thus, we developed a curved forceps prototype for ELPS. The forceps is bent at the tip to allow the operator to reach any part of the field of view exposed with a curved direct laryngoscope. Furthermore, they have improved grip force in comparison to existing forceps models. They seemed to be more feasible for ELPS than existing forceps models.

We herein report the results of voice restoration with a voice prosthesis in 37 laryngectomized patients who were treated in our department between June 2011 and December 2015. A Provox^® voice prosthesis was used in all cases. Tracheoesophageal (TE) puncture was performed at the time of total laryngectomy (Primary puncture) in 21 patients, while 16 patients underwent TE puncture at a later stage (Secondary puncture). Ninety-seven percent of the patients developed good and intelligible speech using the voice prosthesis. We have also obtained financial support for laryngectomized patients in cooperation with the government of Yamanashi Prefecture, and have obtained subsidies from several municipalities, to provide assistance in the form of daily life equipment (an HME cassette and adhesive). As a result, we have attained 100% assistance for TE shunt speech patients in these for residential areas. We hope that options for voice restoration will increase with the spread of subsidies through the entire country.

Medialization procedures, such as type I thyroplasty, arytenoid adduction, and vocal fold injection, are currently popular treatments for hoarseness due to unilateral vocal fold paralysis. However, hoarseness occasionally remains after medialization procedures due to tension imbalance. This tension imbalance causes diplophonia, asymmetry and aperiodic vibrational flutter in travelling wave motion. This is mostly due to incomplete glottic closure, imbalance in muscular tension, and increased air flow through an incompetent glottis. There is no established treatment for tension imbalance. We herein report two cases with remaining hoarseness post-medialization for chronic unilateral vocal fold paralysis. These patients underwent voice therapy using flow phonation to establish respiratory support and a resonant voice to facilitate vocal fold vibration. As a result, the functional vocal fold vibration, aerodynamic assessments, acoustic analysis findings and self-rated condition improved in both cases after therapy. These results suggest that voice therapy involving flow phonation and resonant voice may help improve the vocal function in cases of tension imbalance with dysphonia. Further studies with a larger number of participants or a prospective randomized controlled trial are warranted.

We experienced a case in which laryngeal deployment was difficult due to an unexpected opening disorder during laryngeal microsurgery for laryngeal tumors. The patient was a 39-year-old man, and the jaws were preoperatively examined. After intravenous anesthesia with no history of arthropathy and no dental damage, opening obstruction was noted, but we were still able to perform intubation using a McGRATH^® tube．Although the opening was about 15 mm in size, it was difficult to deploy a laryngeal microscope. The tissue was collected transnasal using a biopsy and nasal fiberscope with forceps. After the removal of the intubation tube, the opening improved to 25 mm. Characteristic square mandible face was noted, and the cause of the opening disorder was thought to be masticatory muscle tendon aponeurosis hyperplasia. We herein report this case，including some considerations from the literatures.

Laryngeal mycosis usually develops in immunocompromised patients and occurs superficially. It is generally treated by systemic antifungal drugs. We herein report a case of laryngeal mycosis in the subcutaneous tissue in a supposedly immunocompetent patient that was treated successfully with surgical resection. A 66-year-old female without any obvious risk factors presented with an 18-month history of hoarseness. An elevated lesion was detected on the right vocal cord. The lesion had been caused by two white submucosal masses and was removed via a direct laryngoscopic examination under general anesthesia. Based on a histopathological examination, the masses were diagnosed as a fungal infection. Additional examinations to identify risk factors, including a systemic computed tomography scan, gastrointestinal endoscopy, serologic tests for mycosis and collagen diseases, and tumor marker assessments, revealed no significant findings. No recurrence was seen for eight months without any additional systemic antifungal drug administration. We experienced a case of submucosal mycosis in the vocal cord. Surgical resection seems to be effective, especially in immunocompetent patients, when the lesion is localized.

Laryngeal chondrosarcoma is a rare tumor, accounting for 0.2% of all malignant laryngeal tumors. Since grade 1 laryngeal chondrosarcoma is associated with a good prognosis, larynx-preserving surgery is desirable. This report describes a case of cricoid chondrosarcoma in which a cricoid cartilage defect was reconstructed with muscle-pedicled thyroid cartilage after tumor resection. A 62-year old man was referred to our hospital due to a subglottal tumor that was incidentally detected on cervical spine MRI. CT images revealed a tumor that had developed from the cricoid cartilage, and the diagnosis of chondrosarcoma, grade 1 was confirmed based on the findings of a histological examination. The patient underwent partial cricoidectomy with reconstruction using muscle-pedicled thyroid cartilage. Although tracheostomy was performed intraoperatively, he was decannulated 2 months later. At 1 year after surgery, the patient is currently alive with no evidence of recurrence and normal oral feeding.

We herein report the case of a patient with adult T-cell leukemia of the larynx.Adult T cell Leukemia was first described by Takatsuki in 1975. ATL is associated with human T cell lymphotropic virus typeⅠ(HTLV-1). Patients with this condition usually show lymphadenopathy and skin rash. The association of local laryngeal mass lesions is rare.

The patient, a 67-year-old woman, complained of throat pain that persisted for two weeks. She had a tumor of the epiglottis as well as cervical lymphadenopathy, and ulceration of a finger. To obtain a definite diagnosis, we obtained a biopsy specimen from the laryngeal tumor; however, the lesion was necrotic. Thus, we then obtained a biopsy specimen of the right cervical lymph node. The pathological findings suggested malignant lymphoma originating from the T cells. HTLV-1 was found in her serum, and a provirus was identified in ATL cells. The patient was treated with chemotherapy and the epiglottal mass gradually disappeared.

Otolaryngologists should consider ATL in the differential diagnosis of laryngeal carcinoma.