When we speak of traditional Japanese music, we are refering to a variety of music ···from artistic music to folkloric music. Despite the variety, there are certain characteristics running through them in terms of the Japanese sensibility toward music. It is this musical sense of the Japanese that will provide an important base for the new Japanese music to develop in the future.
A sense of rhythm is determined over a long period of certain group's history by the way how they have used their physical body. A majority of the Japanese, for instance, have a “static” sense of rhythm characteristic of the rice paddy farmers. People in the mountains, on the other hand, use their limbs in a flexible way, resulting in a “supple” sense of rhythm. People who live on the islands of Okinawa and Amami, as well as people who live on coastal areas, have a “swinging” sense of rhythm in correspondence to the undulation of ocean waves.
A sense of timber is determined over a long period of time by the kind of life style and natural environment people live in. People in Japan have lived mainly by farming and fishing in a climate where the four seasons are distinct. Consequently they developed sharp sensitivity toward changes in weather, making them alert to natural sounds such as a rain and a wind. It is for this reason that the Japanese favor songs and instruments that sound close to natural sounds.
Japanese melodies and based on six pentatonic scales. Each consists of two sets of the perfect fourth called the tetrachord. These scales have much in common with the music of Asia and Africa.
The Japanese subconsciously feel, though vaguely, the presence of a god or spirit in every object. Such a tendency, or a habit of the mind, is also revealed in music and songs. This attitude, which may correspond to the idea of symbiotism, is demonstrated in the Japanese way of thinking that songs too possess spiritual power.

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Laryngeal myoclonus is a rare involuntary movement characterized by persistent, repetitive and rhythmic contraction of laryngeal muscles. It is not in itself a disease entity but is a symptom found in various diseases. Two cases of pharyngo-laryngeal myoclonus that we observed were introduced and palato-pharyngo-laryngeal myoclonus literature was reviewed. So far there have been 304 case reports from 18 months to 91 years old (avg 44.5) having a male preponderance of 59% : 41% in America and Europe, and 65 case reports (2 to 76 years old, avg 30) had a sex distribution of male 62% : female 38% in Japan. Presenting complaints were earclick, involuntary movements and abnormal sounds in the cervix and et al, and some patients had no self-evident symptom. Almost all cases of myoclonus were observed in the soft palate. One of the characteristics of myoclonus was its resistance to many influences such as medication, sleep, and even coma, while it was influenced under some conditions. MRI was useful to detect the lesions. Many pathoanatomical findings demonstrated lesions of the dantato-olivary pathway and the pseudohypertropy of the inferior olivary nucleus. The pathophysiological mechanisms are still unclear and more physiological studies are needed in order to establish treatments.

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A two-dimensional vocal cords model coupled with a one-dimensional unsteady flow model is presented for an analysis of phonation. The vocal cords model consists of distributed springs and dampers covered with a massive elastic membrane. The flow model includes energy loss of flow separation and reattachment. Using this analytical model the effect of the stiffness of the vocal cords on the sound quality of speech is examined. The numerical results show that as the stiffness increases, the fundamental frequency of the vocal cords' oscillation increases except around the stiffness at which the vocal cords start to oscillate without contact. In the case of very low stiffness, the vocal cords oscillate non-periodically.

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It is considered that the mucosal flexibility of the vocal fold is essential for good phonation.When the mucosal flexibility of the vocal fold is impaired by a stiff lesion, vocal fold vibration will be affected. Therefore, it is reasonable to observe the vocal fold during vibration and evaluate the mucosal flexibility of the vocal fold.
There is the method which can be observe the wave motion of the vocal fold induced externally by means of a vibrator even without phonation. Vocal fold vibrations induced by a vibrator are compulsorily caused in the larynx through the patient's cervical skin and cartilage under general anesthesia. When microlarygoscopy is performed under general anesthesia, this method of externally induced vibration is clinically useful for precise analysis of the biomechanical properties of the vocal fold.

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Digital subtraction X-ray stroboscopy is a combined laryngostroboscopic and digital subtraction angiographic system.
Clear vibratory images of only the vibrating portions of human vocal cords in the frontal plane obtained by digital subtraction of the image of the cervical vertebrae were first reported in this journal.
However, the previous system had two major defects, regarding the size and the quality of images acquired with digital subtraction.
The size of the acquired image of the vocal folds was too small since the image size is inversely proportionate to the diameter of the image intensifier, which in this case was large. The quality was not satisfactory because of the inclusion of black lateral-striped shadows due to the difference in the number of X-ray pulses during electrical scanning with a television camera between the contrast images.
Fundamental improvement in these areas has been achieved by newly adopting an image intensifier with a 4.5 inch diameter (half the size of the previous device) and a CCD digital television camera.

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The purpose of this study is to analyse the effect of recurrent laryngeal nerve denervation on postnatal developement of intrinsic laryngeal muscle fibers. The composition of muscle fiber types in the medial component of thyroarytenoid muscle (m-TA), the lateral component of thyroarytenoid muscle (1-TA) and the posterior cricoarytenoid muscle (PCA) has been compared between normal and denervated rats using myosin ATPase stain method.
With denervated rats, Type 1 fibers disappear rapidly after denervation. Type 2A fibers do not appear through the observed period. On the other hand, the developmental changes of Type 2B fibers are almost similar to those of normal rats. The denervation prevents the differentiation of Type 1 and 2A fibers, but almost does not change the differentiation of Type 2B fibers.
These results suggest that the recurrent laryngeal nerve has an important role at its specified course of postnatal differentiation of intrinsic laryngeal muscle fibers.

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Horizontal and vertical movements of the folds were analyzed during phonation simultaneously using Video-stroboscopy (VSS) and Laser Doppler Vibrometory (LDV). Two extracted canine larynges were used. Laser light reflected on the upper surface of the vocal fold was fed into LDV to measure vertical velocity (Vvt) of the vocal fold. VSS determined traveling wave velocity (TWV) by measuring the duration of time the traveling wave moves between two markers placed on the vocal fold with known distance. Vvt and TWV were recorded simultaneously under two conditions; before and after vocal fold elongation. Airflow was increased from 81/min to 141/min under both of the above mentioned conditions. TWV always increased as mean airflow rate was raised. When the vocal fold was elongated, both TWV and Vvt became greater. TWV and Vvt had a significantly high correlation, which suggested that Vvt as well as TWV is an useful index of mucosal traveling wave.

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The distribution of ganglion cells and motor nerve fibers in the rat posterior cricoarytenoid (PCA) muscle were investigated morphologically. Motor nerve fibers were mainly located along the ventral surface of the muscle and entered the muscle at its middle portion to form neuromuscular contacts with individual muscle fibers. Clustered ganglion cells, on the other hand, accompanied with nonmyelinated postganglionic and small myelinated preganglionic nerve fibers, were frequently found on the dorsal side of the muscle, the opposite site of the motor nerves. A few ganglion cells entered the muscle and were occasionally distributed between muscle fibers and near the bifurcation of arterioles. Ganglion cells showed acetylcholinesterase positive reactions, suggesting parasympathetic nature. These findings suggested that intramuscular ganglion cells belong to parasympathetic category and that may play an important role in the complex function of blood vessels and muscle fibers in the PCA muscle.

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Supraglottic pressure, subglottic pressure, and air flow rate were concurrently measured in normal volunteers and in patients with laryngeal disorders. Subglottic pressure was sensed with a miniaturized pressure transducer transglottally inserted. The subjects consisted of 15 normal volunteers, 20 patients with vocal polyp or nodule, 10 patients with polypoid vocal fold, 10 patients with laryngeal cancer, and 10 patients with recurrent laryngeal nerve paralysis. For phonatory examination, the vowel /a/ was used with changing pitch and loudness. Five Japanese vowels were evaluated. The variables examined included the supra-subglottic pressure difference, the air flow rate, and the glottal resistance at the attack (start of phonation), the stable part, and the end portion of phonation. The values of the supra-subglottic pressure difference, the air flow rate, and the glottal resistance were highest at the stable part of phonations. These values were followed by those at the attack, and at the end portion of phonations in this order. The supra-subglottic pressure difference and the glottal resistance were highest in patients with laryngeal cancer, while the air flow rate was highest in patients with recurrent laryngeal nerve paralysis. The value of each variable increased as loudness of voice increased. The glottal resistance increased as loudness of voice increased, though this increment was smaller in patients with laryngeal disorders than in normal volunteers. The supra-subglottic pressure difference generally showed a high value with low voices, while the air flow rate usually showed a high value with high voices. The glottal resistance was higher with low voices, but showed no change with high voice as compared with easy phonation. The amplitudes of the supra-subglottic pressure difference and the air flow rate were large in patients with vocal polyp or nodule, while these values were small in those with laryngeal cancer or recurrent laryngeal nerve paralysis. No difference in the supra-subglottic pressure difference, the air flow rate and the glottal resistance was observed among five vowels both in normal volunteers and in patients. It was suggested that our method might be useful in further studies to reveal the mechanism of phonatory regulation in patients with laryngeal disorders.

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Glottic T1 carcinoma is nowadays successfully treated and its three-year survival rate is almost 100% in any treatment modalities. However, its local control rate and larynx conservation rate are still around 90%. As for vocal function, after laser surgery it is considerably worse than after radiotherapy. Since 1991 in Kurume University Hospital, a laser debulking surgery prior to radiotherapy has been indicated in selected cases whose lesions grew exophitically, in order to get both better local control rate and better post-therapeutic vocal function. In this paper this technique is described in detail and its outcome was reported.
The lesion is first vaporized with the use of a CO₂ laser until the affected vocal fold becomes normal in shape, followed by full-dose irradiation. Care must be taken not to vaporize too much.
15 cases with T1a carcinoma and 19 cases with T1b carcinoma underwent this treatment modality between 1991 and 1997. As a result, their local control rate was superior to both that after laser surgery and that after radiotherapy. In addition, their vocal functions were a little bit worse than those after radiotherapy and considerably better than those after laser surgery.
These results suggest that this radiotherapy after a laser debulking surgery definitely improves the local control rate, conserving better vocal functions.

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The risk factors for postoperative recurrent laryngeal nerve palsy (RLNP) were analyzed in 1293 patients with thyroid cancer treated between 1991 and 1995. The survival rate was also evaluated in another set of 469 patients with papillary thyroid cancer adherent to the recurrent laryngeal nerve (RLN), treated between 1971 and 1989.
Of the 1293 patients, 150 developed RLNP (11.6%). On univariate analysis, age, size of cancer tumor, and adhesion of the tumor to the RLN were identified as significant risk factors for occurence of RLNP. The results of multivariate analysis revealed that the size of the cancer tumor.
and adhesion of the tumor to the RLN were significant. 102 of 118 patients with RLNP (86.4%) recovered the function of the RLN. The recovery rate (79.4%) of RLNP in 63 patients whose RLNP adhered by the tumor was significantly worse than that (94.5%) in 55 patients whose RLNP was free from tumor. In 469 patients with papillary thyroid cancer involving the RLN, disease-specific and recurrencefree survival rates were not significantly different between 384 patients with preserved RLN and 85 patients whose RLN was excised.
It was pointed out that cancer tumor adhered to the RLN resulted in a high risk for postoperative RLNP. The RLN should be preserved if feasible, because local recurrence rarely developed after releasing the RLN from thyroid cancer.

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Three-dimensional (3D) CT endoscopy was applied to assess thyroplasty type I for two patients with recurrent laryngeal nerve (RLN) palsy. CT endoscopic images of these patients showed atrophy and flaccid tag of the vocal fold and expansion of the ventricle on the affected side threedimensionally. Increased thickness was shown post operatively. Furthermore, coronal MPR (multiplanar reconstruction) images clearly delineated position of the implanted silicone block in relation to the vocal fold. Thus, 3D CT endoscopic images could provide useful morphological information regarding RLN palsy pre-and post-operatively. In addition to conventional endoscopic and X-ray tomographic examinations.

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Gastroesophageal reflux disease (GERD) has been associated with posterior laryngitis by studies performed in the United States and Europe. Posterior laryngitis manifests as pooling of saliva in the piriform sinus, reddening of the arytenoid, and laryngeal granuloma. Esophagoscopy was performed and symptoms such as heartburn and eructations were investigated in 24 patients who complained of abnormal laryngopharyngeal sensations and had laryngeal and hypopharyngeal findings such as those mentioned above. Damage to the esophageal mucosa (reflux esophagitis) was observed in 14 of the 24 patients (62.5%), and many symptoms suggestive of gastroesophageal reflux were present even in patients with normal esophageal findings.
Esophagitis improved, as did the abnormal laryngeal and hypopharyngeal findings, in all of these patients after treatment with the proton-pump inhibitor lansoprazole, the most effective drug for reflux esophagitis presently available.
Patients who complained of abnormal laryngopharyngeal sensations but had no esophageal mucosal damage were stratified based on the presence or absence of abnormal laryngeal and hypopharyngeal findings. This analysis revealed a significantly greater number of symptoms suggestive of GERD, such as heartburn and eructations, in the group with abnormal findings.

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A 67-year-old man, who had been treated for hypertension by Angiotensin converting enzyme (ACE) inhibitor therapy for 8 years, complained of difficulties in voice phonation for 3 years. He also complained of dry cough after the administration of ACE inhibitor therapy. Under indirect laryngoscopy, a granuloma with ulceration was observed in the right arytenoid area.
Dry cough was one of the unfavorable side effects of ACE inhibitor therapy, so we thought that the long-lasting dry cough caused the laryngeal granuloma. Then, we changed the prescription from ACE inhibitor to another anti-hypertension drug. Two days later, the dry cough had improved dramatically and the laryngeal granuloma completely disappeared after 16 weeks.

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A 60-year-old female with bridge-like subglottic granuloma, caused by long-term endotracheal intubation was reported. She successfully underwent resection of this granuloma under direct laryngoscopy with a CO₂ laser. In general, intubation granuloma occurs around the arytenoid cartilage. It was supposed that this subglottic granuloma occurred symmetrically and due to the remittent inflammation both granulomas had adhered at the midsagittal plave and achieved the bridgelike shape, causing remittent dyspnea.

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Two cases of malignant lymphoma of the larynx in a 65-year-old male and a 66-year-old male were reported with a review of the literature. Laryngoscopy of case 1 revealed a small tumor under the left vocal cord and that of case 2 revealed a tumor in the right false vocal cord. Biopsy showed non-Hodgkin malignant lymphoma (diffuse, large-sized cell type), and the clinical stage was diagnosed as stage I.
The patient of case 1 underwent radiation therapy (50 Gy). No recurrence was observed for five years after the therapy.
The patient of case 2 underwent radiation therapy (50 Gy).
He died of chronic renal failure, however no recurrence was observed for one year after the therapy.

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