Snoring and sleep apnea occur only during sleep, never during the waking hours. Apnea occurring during sleep has been known from old times, but attention to this phenomenon has grown in the last 10 years because it is suspected to be involved in sudden death. This paper describes the following points in relation to the clinical experience of snoring and sleep apnea in the Department of Otolaryngology of Osaka Medical College together with presentation of relevant cases. (1) Definitions of snoring and sleep apnea syndrome, (2) why snoring is a problem, (3) the change in the number of patients treated for snoring in our Department, (4) diagnosis of snoring and sleep apnea, and (5) treatment of snoring and sleep apnea.
Ten cases of obstructive sleep apnea syndrome (OSAS) seen from Aprl in 1985 to June in 1988 were studied in terms of clinical features and results of various treatments. The causes of OSAS were as follows: obesity in 9 cases, anterioinferior advancement of the hyoid bone in which cephalometry showed as much as 30°more than enlargement in angulation between the mandibule and the hyoid bone in 5 cases, and tonsil hypertrophy in 5 cases. Treatment for OSAS was done respectively to remove the causes.As a result, uvulopalatopharyngoplasty (UPPP) was used in 6 patients, although 3 of them turned out to be unsuccessful. It was thought that tongue advancement may be responsible for failure in UPPP and that cephalography was useful in diagnosis of narrowing at the hypopharynx area.
This report is dealt with rehabilitation for a patient with vertigo due to streptomycin and patients with spino-cerebellar degeneration. In our hospital a combined treatment with thyropropin releasing hormon and rehabilitation training was applied on the patients with spino-cerebellar degeneration. It improved thier ability in walking. The patient is a 45-year-old teacher of a school for the hearing impaired. He had been suffering from hearing loss due to meningitis since he was a child. He developed tubercular menigitis and had injection of streptomycin. It produced vertigo. An explanation was made about the prognosis and causes of his vertigo. The patient was also advised how to get used to his vertigo and his handicap due to vertigo in daily life. This was helpful in the first step of rehabilitation. His rehabilitation training was given in the department of physical treatment and that of athletics: some exercise on mat and ball games. The training gave him selfconfldence in his daily action and helped to get used to vertigo.
We report two cases of amputation neuroma occurring after radical external surgery of the frontal sinus. We consider that radical surgical treatment should be performed for amputation neuroma. However, there are cases in which we cannot ignore the involvement of psychological factors in the background of the patients with neuroma who complain of various unpleasant symptoms in addition to swelling. Therefore, in the treatment of such cases, a psychoneurological approach is thought to also be important.
We have employed a therapeutic flexible laryngofiberscope for phonosurgical resection of laryngeal lesions such as vocal fold polyps with monitoring system by using laryngostrobovideography. This new technique has been successfully performed and excellent results have been obtained. This new method is highly recommended based upon the followings; 1) available even for patients who can not open their mouths because of odontological problems, or patients with severe cardiovascular and pulmonary lesions and 2) available under surface anesthesia of pharynx and larynx without admission.