Japan is facing a super-aging society. As of October 2022, 29% of the population was ≥65 years of age, and 15.5% was ≥75 years of age, and this trend is expected to continue. With this demographic shift, opportunities to treat elderly patients (age : ≥75 years) with head and neck cancer have increased. Cancer registry data have revealed an increase in the number of elderly laryngeal and hypopharyngeal cancers, and there is a need to establish safe and effective treatments for these elderly patients.

When considering the surgical treatment of elderly patients with head and neck cancer, many factors, such as tissue fragility, decreased organ reserve, altered pharmacokinetics, and the possibility of postoperative cognitive dysfunction, can make treatment difficult. Despite these difficulties, we have performed surgical treatment for elderly patients with laryngeal or hypopharyngeal cancer as long as their performance status is maintained and the procedure is considered tolerable.

From 2008 to 2022, we performed open surgery and transoral surgery for laryngeal/hypopharyngeal cancer in 18 and 49 elderly patients, respectively. No surgery-related deaths occurred, and 66 patients were eventually able to achieve oral intake. The satisfactory survival rates suggest that physicians should not hesitate to perform surgical treatment for elderly patients when the situation permits.

当院は進行喉頭癌に対して喉頭温存を目的にmodified RADPLATを行ってきた．本検討T3，T4a喉頭癌63例における75歳未満，以上の5年局所制御率はそれぞれ88％，91％，5年喉頭機能温存生存率は77％，73％であった．75歳以上ではGrade3以上の好中球減少とHb低下の頻度が高い傾向にあった．進行下咽頭癌に対してはchemo-selectionとしてTPF導入化学療法を行い手術，あるいは化学放射線治療を行っている．StageⅢ，Ⅳ下咽頭癌100例において，75歳以上では未満と比較して化学放射線治療の3年無増悪生存率，全生存率が不良であった．さらに75歳以上では十分なシスプラチン投与が困難であった．進行喉頭癌に対するm-RADPLATは高齢者にも忍容性があり，その治療成績は非高齢者と同等であった．しかしながら進行下咽頭癌に対するTPF療法後の化学放射線治療において，高齢者の治療成績は不良であり，その治療方針の決定は注意深く行う必要がある．

先行研究で頭頸部癌再建手術症例に対する高齢者機能評価（geriatric assessment : GA）の有用性について検討し，GAは非自宅退院に関連があり，必要な介入も明らかになった．本検討では喉頭下咽頭癌再建手術症例のうち咽喉頭全摘，再建（total pharyngolaryngectomy and reconstruction : TPL）症例の合併症，非自宅退院とGAの関連を確認し，必要なマネジメントを検討した．

対象は2019年9月から2023年3月までにGAをおこなった喉頭・下咽頭癌患者のうちTPLをおこなった49例とした．対照群として非喉頭摘出の再建手術群82例を設定し，GAとの関連を後ろ向きに解析した．

TPLの合併症は7例（14%）で発生し，Charlson Comorbidity Index（CCI）と関連をみとめた（p=0.03）．非自宅退院は2例（4％）のみのため，解析は行わなかった．対照群では合併症は30例（36%）で発生し，認知症と関連を認めた（p=0.04）．非自宅退院は5例（6%）で認め，関連はなかった．

TPLは対照群と比較すると合併症発生率が低く，術後経過が安定しており高齢者でも管理しやすいと考えられる．ただし，CCI陽性症例は合併症の発症率が高く，手術前に意思決定支援を行い，合併症についての理解を得ることが必要と考えられた．

今後，本研究の結果をカンファレンスに反映させて介入を行っていく予定である．

Problems associated with recurrent laryngeal nerve injury include (1) the loss of motoneurons in the nucleus ambiguous, (2) degeneration and poor regeneration of neural fibers, (3) degeneration of the motor neural endplate and atrophy of the laryngeal muscle, and (4) misdirected reinnervation. For (1)-(3), the value of novel therapies, including gene therapies, has been reported. However, even if morphological regeneration is achieved, recovery of the laryngeal motor function is difficult because of (4) misdirected reinnervation. We investigated the value of a neural regeneration tube (a polyglycolic acid [PGA] tube filled with collagen fibers: PGA-C tube) as a scaffold and a novel inhibition therapy for misdirection by inhibiting sensory and autonomic nerve fiber regeneration. We confirmed that the PGA-C tube can be used not only as a scaffold but also as a drug delivery system for nerve regeneration. We also confirmed the effect of TrkA inhibitors, which block the NGF-TrkA pathway and affect the regeneration of sensory/automatic nerves, thus preventing misdirected regeneration of motor and sensory nerves and promoting the regeneration of motor neurons to achieve functional recovery.

The temporary goal of our future strategy is to enhance the glottic adduct movement. As the posterior cricoarytenoid (PCA) muscle is the only abductor muscle of the vocal fold, preventing axon regeneration to the PCA might thus strengthen the adductive function. Novel strategies for overcoming this issue and further investigations are underway.

A 2021 epidemiological study in Japan revealed that iatrogenic causes represent the most prevalent etiology of vocal-fold scarring. Owing to the absence of validated therapeutic modalities, over half of the cases remain untreated. Vocal fold surgery has been identified as a significant factor contributing to the development of scarring, with evidence of scarring being present in all cases. These findings underscore the need for a more comprehensive understanding of the underlying pathology and the advancement of preventive treatments. Research on tissue regeneration and fibrosis in various organs has been ongoing for several years. Single-cell analyses have recently identified numerous cellular players and networks involved in fibrosis, marking a new era in the field of fibrosis research. In particular, interactions between fibroblasts and macrophages play a critical role in both tissue regeneration and fibrosis. In the context of vocal folds, co-culture experiments have demonstrated that these interactions promote fibrosis, thereby underscoring the need for macrophage-targeted therapeutic strategies. Following vocal fold injury, we observed transient infiltration of inflammatory macrophages. We herein report our efforts to enhance wound healing by promoting the transition from inflammatory to reparative macrophage polarization.

In cases of recurrent laryngeal nerve invasion due to thyroid cancer, resection of the recurrent laryngeal nerve is necessary. Immediate reconstruction of the recurrent laryngeal nerve is often performed in such cases. Our hospital has also been proactive in performing immediate reconstruction (e.g., recurrent laryngeal nerve end-to-end anastomosis, and ansa cervicalis-recurrent laryngeal nerve anastomosis). On the other hand, reports from basic research using animals have shown that reconstruction using artificial nerve tubes is more useful for promoting nerve regeneration than existing methods. Furthermore, artificial nerve tubes are used in clinical practice in other fields and their safety is guaranteed. In this study, we encountered a case in which the recurrent laryngeal nerve was reconstructed using an artificial nerve after recurrent laryngeal nerve resection due to thyroid cancer. We present the results of our hospital and consider and report the possibility of recurrent laryngeal nerve regeneration in the future.

Case : We performed recurrent laryngeal nerve reconstruction using an artificial nerve in 9 cases, including 8 cases of recurrent laryngeal nerve resection due to thyroid cancer and 1 case of recurrent laryngeal nerve resection due to cervical esophageal cancer. In the reconstruction method, an artificial nerve was used between the recurrent laryngeal nerve and the recurrent laryngeal nerve, except for the case in which an artificial nerve was used between the recurrent laryngeal nerve and the ansa cervicalis due to thyroid cancer. The postoperative voice was equivalent to the preoperative voice in all cases, except for 2 cases with vocal cord atrophy due to recurrent laryngeal nerve paralysis.

Conclusion : We have experienced cases in which a patient’s postoperative voice improved when an artificial nerve was used for recurrent laryngeal nerve reconstruction. When existing reconstruction methods are not possible, recurrent laryngeal nerve reconstruction using artificial nerves should be considered.

Voice changes due to age, sex, physical characteristics such as weight and height, and mental and physical conditions. People can infer their emotions and physical conditions by simply listening to these changes. The evaluation of voice involves physical factors based on the periodic vibration of the vocal cords and perceptual factors, which makes uniform evaluation difficult. Therefore, various voice diagnostic methods have been developed for this purpose.

Acoustic analysis techniques have improved the accuracy due to advances in recording equipment and pitch extraction methods. Computer improvements have increased calculation speed, even as data volume rises, enabling the real-time display of measurements. In addition, recording levels no longer require adjustment, simplifying the analysis, and enhancing accuracy.

AI-based evaluations provide objective and reproducible voice disorder assessments and can accurately diagnose recurrent nerve palsy and laryngeal lesions. These technologies are expected to contribute to telemedicine and preventive medicine and serve as comprehensive diagnostic tools. Integrating AI and advanced recording technologies, along with voice diagnostics, has great potential for improving healthcare quality.

Flexible endoscopic evaluation of swallowing (FEES) is a standard procedure for diagnosing swallowing impairment. FEES has favorable features as an instrumental examination for swallowing impairment, as it is portable and can be used at the bedside. However, the appropriate evaluation of FEES findings is challenging. Therefore, the interpretation of FEES results may vary among evaluators with different levels of experience and skills. One potential solution for evaluating the findings of FEES is an artificial intelligence (AI)-assisted computer-aided diagnosis (CAD). Recent progress in deep learning has highlighted the use of AI-assisted CADs in medical applications. We investigated the effectiveness of an AI-assisted CAD for FEES.

This section provides an overview of emergency airway management, focusing on the conditions that lead to airway emergencies, necessary equipment, and anesthesia considerations. For otolaryngologists and head and neck surgeons, upper airway obstruction is commonly encountered and is caused by conditions such as acute epiglottitis, anaphylactic shock, laryngeal edema, tumors, hemorrhaging, postoperative complications, airway foreign bodies, and trauma. A rapid assessment and stabilization of the respiratory status are crucial to prevent catastrophic outcomes. Therefore, it is essential to mentally simulate various scenarios during non-emergent times and ensure the readiness of the necessary equipment and anesthesia techniques for actual procedures. The equipment typically includes oxygen systems, bag valve masks, laryngeal masks, endotracheal tubes, cricothyroidotomy kits, and tracheostomy sets. When human resources are available, collaboration between anesthesiologists and emergency physicians is advisable. Special caution is required when performing rapid sequence intubation, particularly in cases involving post-operative bleeding or extensive neck surgery with resultant airway edema, as these situations may lead to a “cannot ventilate, cannot intubate” scenario. Airway emergencies are inseparable from our practices. Maintaining a mindset of preparedness is essential for preventing the loss of lives that could otherwise be saved.

Emergency airway management must be mastered by medical professionals. Methods of airway management include endotracheal intubation, tracheostomy, and cricothyroidotomy. Of these, cricothyroidotomy is the quickest to apply in an emergency. This article describes cricothyroidotomy as a method of managing airway emergencies. The most important aspect to ensure safe and successful cricothyroidotomy is to approach the anatomically correct location of the cricothyroid membrane. Anyone who is not confident should participate in a hands-on emergency airway management session.

There are two pathophysiologies that may cause airway emergencies at ear, nose and throat clinics. One is airway obstruction caused by airway diseases such as acute epiglottitis (upper airway) or asthma (lower airway). The second is securing the airway for emergency resuscitation. In cases of airway emergencies due to upper and lower airway obstruction caused by airway diseases, the pathophysiology of airway emergencies and obstructive lesions is always known. Hence, securing the airway and the optimal timing are the most important factors. It is important to assess and predict airway emergencies and to take the initiative to manage any airway emergencies that may arise. In cases in which the airway must be secured for emergency resuscitation, familiarity with cardiopulmonary resuscitation is essential. Managing airway emergencies entails not only securing the airway, but also providing treatment after cardiopulmonary resuscitation.

Surgery for vocal fold lesions is usually performed under general anesthesia. However, surgery under local anesthesia may be necessary when considering the waiting period before surgery or hospitalization, the condition of the lesion, the need to operate while checking the voice, or the physical and social circumstances of the patient. Office-based voice surgery under local anesthesia allows voice monitoring while checking vocal fold movement and mucosal waves during and immediately after surgery. In addition, the use of an electronic endoscope allows clear observation of the lesion, and multiple physicians can check the lesion on a monitor, which is useful for improving the procedure and safety. There are several methods of accessing the vocal folds under local anesthesia, including percutaneous and oral approaches, depending on the lesion. Pathology findings include vocal fold atrophy, sulcus, recurrent laryngeal nerve palsy, vocal fold polyps, and laryngeal cysts. Possible techniques include excision of lesions using scalpels, shears, and forceps and injection of artificial materials or corticosteroid preparations. Suppression of the pharyngeal reflex is essential for the transoral approach and is key to the success or failure of the procedure. We herein report the selection criteria for transnasal endoscopic microsurgery of the larynx and preoperative procedures, including anesthesia, surgical procedures, and postoperative management.

Surgery and biopsy for laryngeal and hypopharyngeal lesions under surface anesthesia using a flexible endoscope inserted nasally and transoral instruments such as a forceps are minimally invasive procedures that can be performed on an outpatient basis. Based on my experience, these procedures can be performed either by two medical professionals –a surgeon and a scopist– or by a surgeon working alone. This study focused on the key techniques required in procedures performed by a surgeon alone.

Between January 2015 and December 2023, 208 patients underwent these procedures under surface anesthesia, with 136 procedures performed by a single surgeon and 72 performed by two professionals (specifically, a surgeon and a scopist). The primary treatment options were laryngeal and hypopharyngeal diseases, including tumors, unilateral vocal cord paralysis, vocal cord atrophy, vocal cord polyps, and laryngeal granulomas. These procedures included vocal cord injections, mass resections, biopsies, cystotomies, stent removal, and laser vaporization.

The success rates were 95.6% for procedures performed by a single surgeon and 98.6% for those performed two professionals. Complications were minimal, with one case each of mild laryngeal edema and vasovagal reflex. Overall, this surgical method has been proven to be both effective and safe.

Vocal fold surgery has traditionally been performed as microsurgery under general anesthesia due to the intricate surgical field. Recent advancements in endoscopy and instrumentation have enabled minimally invasive outpatient procedures. This article describes a novel approach for vocal fold surgery under topical anesthesia with endoscopic visualization while the patient is conscious. Two primary techniques are used. The first involves injecting various materials into the vocal folds using a curved Cathelin needle inserted above the thyrohyoid notch. The second includes endoscopic excision of vocal fold lesions using wire forceps. Cathelin needles may also be used to incise polyp or cyst bases. Indications for the injection technique include vocal cord paralysis, atrophy, scarring, polypoid changes, and Botulinum toxin injection for spasmodic dysphonia. The excision method is indicated for vocal cord polyps, nodules, and cysts. The primary advantage of this awake procedure is that it allows real-time assessment of vocal cord vibration using stroboscopy during surgery.

In Japan, Type Ⅳ thyroplasty has predominantly been performed as a voice-feminization surgery for transgender women, while anterior glottoplasty has not been widely practiced. In this study, we examined changes in voice before and after anterior glottoplasty at our institution. The results were then compared with those of type Ⅳ thyroplasty performed at the same institution, and the characteristics of each procedure were discussed. Both surgical techniques yielded a postoperative voice frequency of >200 Hz, which is considered a feminine voice. However, each technique has its own advantages and disadvantages, and it was concluded that the choice of procedure should be tailored to individual patients.

General anesthesia under spontaneous respiration without respiratory support or airway instruments is the optimal anesthetic technique for pediatric ENT laryngoscopists. This allows observation of the natural condition of the larynx in children, who are much smaller than adults, as well as identification of lesions and laser surgery. Achieving the appropriate depth of anesthesia requires a trained anesthesiologist and close collaboration between the otolaryngologist and the anesthesiologist. The risks associated with this technique include hypoxia, gastroesophageal reflux, laryngospasm, and intraoperative movement of the child, which must be managed during surgery. We herein report how we performed laryngoscopic surgery in children at our institution under non-intubated general anesthesia with spontaneous respiration.

In Japan, a super-aging society, dysphagia has become a significant social issue, increasing the demand for otolaryngologists to diagnose and treat this condition. However, standardization of dysphagia treatment remains challenging owing to its diverse nature.

Surgical treatment was considered when rehabilitation over a certain period did not lead to improvement. Decisions on surgical indications and techniques are made through multidisciplinary discussions, considering objective evaluations and social background. Surgical treatments are generally categorized into those performed for the prevention of aspiration and those performed to improve the swallowing function. Selecting appropriate surgical techniques requires experience and must account for the patient's overall condition and future rehabilitation prospects, emphasizing minimally invasive options, whenever possible.

Recently, minimally invasive procedures, such as glottic closure surgery under local anesthesia and transoral cricopharyngeal myotomy, have become more prevalent in Japan, with more facilities considering their implementation. This study introduces various surgical techniques for the treatment of dysphagia, categorized by invasiveness, and provides insights into intraoperative precautions and technical tips. Although surgery is a rehabilitation method, it can be crucial for cases in which functional improvement is otherwise difficult. A deeper understanding of these surgical options can expand available treatment options.

This article provides a detailed explanation of the indications, sequence, and planning for type I thyroplasty and arytenoid adduction. Type I thyroplasty is indicated for all cases of vocal fold paralysis, in which the muscles are atrophied due to nerve paralysis. The indications for arytenoid adduction can be determined by a preoperative endoscopic examination. As the vocal fold swells with a short surgical procedure, arytenoid adduction is performed first. A cervical CT scan was used to evaluate and measure the following variables : 1) the shape and ossification state of the thyroid cartilage ; 2) the degree of vocal fold atrophy ; 3) the position of the anterior commissure attached to the thyroid cartilage ; 4) the angle of the vocal fold projected onto the affected thyroid cartilage ; and 5) the position of the arytenoid cartilage. Laryngeal electromyography is used to evaluate 1) based on the action potential during phonation, and 2) based on the difference in action potential between low-pitched and high-pitched phonation.

There were 70 cases autopsied at the Tokyo Metropolitan Coroner’s Office from April 2020 to August 2023 that tested positive for novel coronavirus infection. Of these, pharyngolaryngitis due to new-type coronavirus infection was diagnosed as the cause of death in four cases. We will discuss pharyngolaryngitis caused by new-type coronavirus infection, focusing on these autopsy reports. Three of the four cases had severe disease factors, and hypoadrenalism was noted in one of the others. Three cases were confirmed to have had a fever, but none sought medical attention. In one case, a security camera caught the patient shortly before her death, suggesting that her symptoms may have progressed rapidly and led to her death. A gross examination of the cases revealed mild edema but intense erythema and a high degree of inflammatory cell infiltration histologically. Inflammatory cell infiltration of the mucosal epithelium was present, suggesting that impairment of the barrier function by epithelial damage had led to an increased degree of inflammation. In one case, there was a high degree of inflammatory cell infiltration within the muscles of the larynx, suggesting the possibility of nerve or muscle damage. Although pharyngolaryngitis caused by novel coronavirus infection is often regarded as a mild disease because of its symptoms, it is important to note that it can be fatal and has a rapid onset.

During the COVID-19 pandemic, the number of patients requiring ventilatory management increased owing to severe pneumonia, and the number of cases of laryngotracheal stenosis increased accordingly. We herein report three cases of laryngotracheal stenosis after percutaneous tracheostomy, cricoid cartilage necrosis and subglottic granuloma, and posterior vocal fold adhesion and cricoarytenoid joint fixation. The affinity of SARS-CoV-2 for the upper respiratory tract and the anatomy of cricoid cartilage were thought to contribute to the development of these complications. We discuss the mechanism by which the combined effects of long-term intubation, tracheostomy management, direct effects of the virus, and inflammatory response cause laryngotracheal stenosis. The importance of early detection and appropriate therapeutic intervention are emphasized, while the establishment of future countermeasures are also discussed.

Deep neck abscesses are severe. Emergency airway management is required when laryngeal edema occurs. In this study, a retrospective analysis of clinical data from patients with deep neck abscesses was performed to investigate the risk factors for laryngeal edema. A total of 47 patients (32 with odontogenic infections and 15 with tonsillitis) were included in the study.

We compared patient background (age, sex, body mass index, smoking history, presence of diabetes mellitus, and number of days taken from onset of illness to medical examination), blood examination date (neutrophil count, CRP, albumin, platelet/lymphocyte ratio), and Contrast-enhanced CT evaluation (whether the abscess extended below the hyoid bone or not, extension into the parapharyngeal or visceral space, abscess volume), bacterial culture with and without laryngeal edema. Patients with odontogenic infections were more likely to have abscesses extending into the parapharyngeal or visceral space and had significantly higher CRP levels. Patients with tonsillitis tend to have a history of diabetes mellitus. These results indicate that the risk factors for laryngeal edema of deep neck abscesses differ between odontogenic infection and tonsillitis. Understanding these risk factors will be useful in clinical practice.

One of the characteristics of the pediatric larynx is a short aryepiglottic fold; however, there is no definition of the length of the short aryepiglottic fold. Usually, we judge the length to be shorter or longer than that of something. We reported the length of the vocal folds as judged by measurements of the aryepiglottic fold. We herein examined the relationship between the length of the aryepiglottic fold and vocal folds.

A total of 310 children (157 boys and 125 girls) under 12 years of age who visited our department between May 2017 and December 2022were enrolled.

We retrospectively evaluated the laryngeal findings of pediatric patients. First, we classified the children into 2 groups: children who the first author judged to have short aryepiglottic folds were classified into group I, and those without short aryepiglottic folds were classified into group Ⅱ. Second, we calculated the ratio between the length between anterior end of arytenoid and posterior end of epiglottis and the length of the vocal folds, and analyzed them using the Mann-Whitney U test, an m×n contingency table, and a Cochran-Armitage trend test.

According to the length of the aryepiglottic folds, 169 patients were classified into group I and 141 were classified into group Ⅱ. The mean age was 7.1 months group I and 36.6 months in group Ⅱ. The number of patients in the newborn/infancy/preschool/school age categories was 50/95/22/2 in group I, and 19/46/42/34 in group Ⅱ. The mean ratio between the length between anterior end of arytenoid and posterior end of epiglottis and the length of the vocal folds was 0.62±0.25 in group I and 1.46±0.49 in group Ⅱ. Aryepiglottic folds were judged to be short when the ratio to the length of the vocal folds was <1.0.

Large numbers of neonates and infants were classified into group I ; however, the number of patients classified into group Ⅱ increased in pre-school and school-age children. The age category is associated with the length of the aryepiglottic folds, and the number of children in group I decreased with age.

Recently, the older adult population has increased; thus, there are more opportunities for the treatment of older patients. We reviewed the treatment outcomes of patients with laryngeal cancer and analyzed the characteristics and problems experienced by older patients.

This study included 91 patients with laryngeal cancer who were treated at our department between April 2014 and April 2022. Specifically, a comparative analysis of patients based on stage, treatment, and disease-specific survival of patients of ≥75 years of age and those <75 years of age was conducted.

No significant differences in staging or treatment choices were found between patients of ≥75 years of age and those of <75 years of age. Best supportive care was chosen significantly more often by patients of ≥75 years of age than by those of <75 years of age. No differences were observed in disease-specific survival.

When treating cancer in older patients, the general condition of the patient needs to be considered, the administered treatment has to be case-specific, and the health variable of quality of life also needs to be considered. Overall, it is of utmost importance to continue striving for the earlier detection of this disease.

During curative surgery for hypopharyngeal cancer that invades the cervical esophagus, preserving the larynx is challenging despite the fact that it does not infiltrate the larynx itself. A surgical technique was utilized in 5 cases to prevent a lack of vocalization. The ELPS method was used to determine and cut off the excision line on the oral side, followed by open surgery. The larynx and its function were preserved, allowing all patients to maintain their voice and continue food intake without the need for tube feeding. A pathological analysis showed that the hypopharyngeal tumors were fully removed and there was no evidence of local recurrence.