It has been well known, since the first laryngectomy was performed by Billroth in 1873, that air communication between the trachea and the gullet could produce phonation following total laryngectomy. In this article, following a brief historical review regarding postlaryngectomy voice rehabilitation mainly by surgical methods and its classification, the author's tracheo-esophageal shunt operation for postlaryngectomy speech and its results are described. The essential part of the author's technique consists of the construction of a tracheo-esophageal shunt using the posterior wall of the trachea which is exposed at the time of the laryngectomy. Fifty-four out of ninty laryngectomies were operated by using this technique during the past four years. Forty out of fifty-four patients could use the shunt for daily conversation. Fourteen out of fifty-four patients failed in speaking with the shunt. The most frequent and significant cause of failure was obstruction of the esophageal orifice of the shunt. Irradiation before and after the operation seemed to be not contraindicated for performing the procedure. Slight leakage of fluid from the esophagus into the trachea was recognized in sixteen (40%) out of forty patients, which was effectively blocked by slight digital pressure. This technique could not be applied to thirty-six out of ninety laryngectomy cases. Ths causes were analysed and discussed.
A total of 212 cases of foreign bodies in the esophagus and 25 cases in the tracheobronchial tree were treated at our department during the past 10 years from 1970 to 1979. Male to female ratio was about 1. 2 to 1. Sex difference in incidence was not so remarkable as was indicated in other papers. About a third of the patients were infants from 0 to 3 years old. Many foreign bodies in the esophagus in adults were fish bones and in children were coins. The number of cases of foreign bodies of chicken bone and PTP has increased recently. Most fobeign bodies were located at the first physiological constriction of the esophagus. Fourteen cases of foreign bodies in the tracheobronchial tree were in infants under 1 year old and most of them were peanuts. Interestingly, the left bronchus was more frequently involved than the right in the group of children under 1 year old, in other age groups however, the right bronchus was more frequently affected than the left. Comparison of the data with previous reports are also made.
The authors report the results of a statistical study of 1919 cases with nasal allergy treated at the Wakayama University Hospital during the 10 years from 1969 to 1968. Combined cases of nasal allergy and bronchitis were seen in 23. 8%, nasal allergy and skin lesions in 6. 0% and the remaining 72. 7% were nasal allergy without associated diseases. Forty-five point seven percent of nasal allergy cases were found to have developed before 15 years of age and 75. 8% of the cases which were associated with asthma were also found before 15 years of age. Eosinophilia was seen in 34. 5%, eosinophilic cells in the nasal smear in 71%, both of which showed a high incidence among young patients. The incidence of positive skin test for house dusts and alternalia were greater among young patients, while that of pollinosis was high in the thirties.
The author devised a new method of fascia grafting technique in which he employed a frame of a catgut ring that helped fitting a meatal skin graft onto the drum remnant, particularly at the anterior annular rim. By this technique, it was easier to secure a graft even in cases with a large perforation. It has been used in 48 ears with uniformly good results.