Haruki Fukuo

Sensation Elicited by Mechanical Stimuli to the Oropharyngeal Mucosa

An inaccurate localization of the site of stimulus, a higher two-point threshold for touch than those at lower lip or soft palate mucosae, and reference of touch sensation to the submaxillary cervical region following mechanical stimuli to the posterior oropharyngeal wall or lateral pharyngeal band were observed in the present study on otolaryngologists, medical students and patients with abnormal sensations in the throat. These results indicated that not only the somatic but also the visceral nervous system might contribute to the elicitation of sensation from the oropharyngeal structures behind the soft palate.

Usefulness of cornell medical index health questionnaire for treatment of abnormal sensation in the throat with kampo medicine; Saiko-ka-ryukotsu-borei-to.

Diagnostic procedures in oriental medicine are quite different from those in western medicine because of the difference in basic concepts of medicine. From that oriental point of view, it is claimed that Saiko-ka-ryukotsu-borei-to (Chaff-Hu Jia-Long-Gu-Mu-Li-Tang), like other Kampo prescriptions, should be selected after a diagnostic procedure based on oriental medicine for more effective treatment of patients with abnormal sensation, such as a lump or choking in the throat. However, it is not easy for physicians trained in western medicine to learn these procedures.In this study, we used the Cornell Medical Index Health Questionnaire (CMI) as an aid for selecting patients for whom Saiko-ka-ryukotsu-borei-to is supposed to be effective, and we evaluated its actual clinical usefulness. Eighty-nine male and 50 female patients with abnormal sensation in the throat were classified as normal (Area I), almost normal (Area II), slightly neurotic (Area III) and neurotic (Area IV) by Fukamachis method, and normal (Type I), autonomic nerve dysfunctioning (Type II), neurotic (Type III) and psychosomatic (Type IV) by a modification of Abes analysis of CMI responders. In addition, we chose 13 questions (Saiko-ka-ryukotsu-borei-to Sho questions) from the CMI list which are supposed to be very important from the oriental medicine point of view for selecting Saiko-ka-ryukotsu-borei-to. According to their answers to the 13 questions, the patients were placed in 3 groups: supposedly good, supposedly moderate and supposedly poor responders.Tsumura Saiko-ka-ryukotsu-borei-to® (7.5g/day) was given orally for 2 weeks and the clinical effect was evaluated 1, 2 and 3 weeks after the start of treatment. When the abnormal sensation as evaluated subjectively by the patient was reduced by more than 50%, treatment was considered to be effective. Evaluation of the answers to the CMI and of the effectiveness of the medicine revealed the following:1) In both male and female patients, improvement increased gradually and was highest at the end of the 3rd week.2) Among the male patients, those in Area I or Type I were the best responders, while among the female patients those in Area I or Type I were the worst responders.3) As expected, good responders of both sexes had much higher effective rates at the end of each week than did poor responders.These results indicate that an analysis of the answers to the CMI questionnaire is very useful for predicting the efficacy of Saiko-ka-ryukotsu-borei-to in patients with abnormal sensation in the throat.

Effect of combined use of sulpiride and tiaramide HCl on abnormal sensation in the throat.

The majority of patients with abnormal sensation in the thoat have a history of an upper respiratory tract infection, increased apprehension, cancerphobia, depression, etc. Therapy of such patients with an anti-depressant plus an anti-inflammatory agent is expected to be effective.The authors administered Sulpiride (150mg/day) and Tiaramide HCl (300mg/day) for two weeks to 114 patients with abnormal sensation in the thoat and evaluated the results. Side effects, such as abdominal symptoms, drowziness or headache, were reported by 9 patients (8%) including 3 patients in whom the medication had to be suspended. The therapeutic effect of the medication was evaluated in the remaining 111 patients at the end of the first and second week of administration and one week after the termination of treatment. It was considered to be effective when the abnormal sensation improved subjectively by 50% or more. The combined therapy was effective in 56% of the 111 patients within one week, in 72% in two weeks and in 73% in three weeks. The therapy was more effective in patients with depressive state and/or mild inflammation in the throat.

Clinical study of abnormal sensation in the throat.

The authors treated 853 patients with abnormal sensations, exclusive of pain and difficulty in swallowing, in the throat from Aug. 1981 to May 1985. There were 363 males and 490 females (1:1.3). At the time of diagnosis, the majority of the patients were in the 3rd, 4th and 5th decades of life. The sensations, 72% of which were located in the middle of the neck, projected mostly (88%) on the level between the hyoid bone and the suprasternal fossa and were strongly felt during empty swallowing by 60% of the patients. In most of the patients, the hematological examination, chemical analysis of blood and serological test were within normal limits. When the answers of the patients to the Cornell Medical Index-Health Questionnaire were analysed by Fukamachis method, 33% of the patients were classified as normal, 33% as almost normal, 25% as slightly neurotic and 9% as neurotic. The Maudsley Personality Inventory, however, revealed that the decreased score of the lie scale correlated significantly with the increased score of the neurosis scale. No hypopharyngeal malignancies have been detected so far in the patients in this study.

Effect of Myonal on tinnitus.

Myonal® (a muscle relaxant) was used alone or in combination with other drugs in the treatment of 33 males (53.1±13.6 y. o.) and 26 females (54.8±12.5 y. o.) with tinnitus. The treatment was effective in 42.4% of the patients. A better effect was obtained in the following patients:1. Those in the 5th and 6th decades.2. When Myonal® was used in combination with other drugs.3. When treatment was continued for 8 weeks or longer.Side effects were observed in 4 patients (6.8%).

Effect of Metharmon-F in middle-aged female patients with abnormal sensation in the throat.

咽喉頭異常感を主訴として受診した中高年婦人53例をメサルモン®-F (3錠/日×14日間) を単独で用いて治療し, 以下の成績を得た.1. 副作用は5例 (9.4%) に出現し, うち4例は休薬を余儀なくされた.2. 効果判定が可能であった49例のうち, 自覚的に異常感が50%以上改善した (著効+有効) 例の占める割合は, 投薬開始後1, 2および3 (投薬終了後1) 週目で, それぞれ39%, 49%, 51%であった. それが80%以上改善した (著効) 例の占める割合は, それぞれ8%, 31%, 35%であり, 著効率が比較的高いことと十分な効果が得られるまでに日数を要したことが特徴的であった.3. 層別化してみると, 30, 60才例が40, 50才例に比し, 随伴症状を有さない例が有する例に比し, 当科受診前に治療を受けたことのない例が既治療例に比し, 肥満度の低い例が高い例に比し, 月経が順調か閉経後5年を越えた例が月経不順や閉経後5年以内例に比し, 自己を楽天的と評価した例が苦労性とした例に比し, 発症後1ヶ月以内に治療を開始した例がそれ以上を経て開始した例に比し, 心理ならびに性格検査で神経症的傾向が低い例や逆に著しく高い例が幾分神経症的傾向が窺われる例に比し, また, 外向的と考えられる例が内向的と思われる例に比し良好な治療成績を示した.内分泌異常により咽喉頭異常感が発現あるいは増悪する可能性があることを文献的に考察し, 本症例に対して体内ステロイドバランスを調整してやることを目的とした治療を施してやることは有意義であると結論した.