Hayato Misawa

Clinicoepidemiologic Features of Sudden Deafness Diagnosed and Treated at University Hospitals in Japan

Nationwide epidemiologic surveys were done 3 times by the Research Committee of the Ministry of Health and Welfare in Japan to investigate the number of patients and clinical manifestations of idiopathic sudden sensorineural hearing loss (sudden deafness). The first, second, and third surveys were carried out during the 1970s, 1980s, and 1990s, respectively. For each patient, we have compiled data regarding age, sex, onset day, presence or absence of vertigo, and hearing ability, including initial and final audiograms, in a computer in the Nagoya University Computer Center. Regarding patients who visited university hospitals, complete data were collected for 421 subjects (age: 40.2 ± 15.4 years, female: 203, male: 218) between July 1973 and June 1974, for 813 subjects (age: 45.1 ± 15.4 years, female: 407, male: 406) in 1987, and for 1112 subjects (age: 49.1 ± 16.0 years, female: 591, male: 521) in 1993. The number of patients with sudden deafness treated in university hospitals in Japan has increased, especially in the elderly population. This increase is associated with population increase and age-adjusted incidence rates per 100,000 in the elderly population. The initial and final hearing levels in the first survey were worse than those in the second and third surveys; there was no significant difference in hearing between the second and third surveys. The hearing levels were worse in children and elderly patients than in the other age groups.

Tympanometric Findings in Patients With Enlarged Vestibular Aqueducts

Objectives The purpose of this study was to study systematically some relationships between the resonance frequency of the middle‐ear transmission system and the volume of the endolymphatic duct and sac in patients with an enlarged vestibular aqueduct (EVA).

Transmeatal low-power laser irradiation for tinnitus.

Objective To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus. Study Design Prospective, randomized double-blind study. Methods This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined. Results No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. Conclusion Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.

Magnetic Resonance Imaging of Endolymphatic Sac in Acute Low-Tone Sensorineural Hearing Loss without Vertigo

The etiology of acute low-tone sensorineural hearing loss (ALHL) may be associated with deteriorated function of the endolymphatic sac. Using magnetic resonance (MR) imaging on a 1.5-tesla MR system, we evaluated the frequency of visualization and contrast enhancement of the endolymphatic sac in 25 patients (9 men and 16 women; age range 11–64 years) with ALHL and 21 control subjects. The present study demonstrated that the frequency of visualization and enhancement of the endolymphatic sac in patients with ALHL was not significantly higher than in control subjects.

WFS1 and GJB2 mutations in patients with bilateral low-frequency sensorineural hearing loss

Evaluating the prevalence of specific gene mutations associated with a certain audiometric configuration facilitates clinical assessment of patients with sensorineural hearing loss (SNHL). WFS1 is responsible for autosomal dominant nonsyndromic deafness 6/14/38 and is the most frequent genetic cause of low‐frequency SNHL (LFSNHL); however, the exact prevalence of WFS1 mutations in LFSNHL is unknown. Therefore, we evaluated genetic mutations and clinical features in patients with nonsyndromic bilateral LFSNHL, focusing on the WFS1.

Obstructive sleep apnoea associated with congenital choanal atresia.

We report here a very rare case of bilateral congenital choanal atresia untreated for the 27 years after birth. A 27-year-old Japanese man complaining of long-term nasal obstruction, snoring and daytime sleepiness visited our hospital. He exhibited the characteristic appearances of long face and bilateral hypoplastic cheeks. Examination by flexible fiberscopy and computed tomography led us to diagnose him with bilateral choanal atresia. Subsequent polysomnography revealed the number of apnoea or hypopnoea episodes per hour (apnoea-hypopnoea index, or AHI) to be over 10. On the basis of these observations, we modified the diagnosis to obstructive sleep apnoea syndrome (OSAS) secondary to congenital choanal atresia.

Results of tonsillectomy for obstructive sleep apnea syndrome in adults with tonsillar hypertrophy

Abstract High surgical success rates for adenotonsillectomy in children with obstructive sleep apnea (OSAS) have been described in various studies. The purpose of this study was to evaluate the efficiency of bilateral tonsillectomy. Data from a retrospective study with eight adults (six males, two females; average age 29.0 years old; average body mass index, 27.3±5.3 kg/m2) who underwent tonsillectomy for OSAS were evaluated based on the severity level of the preoperative apnea–hypopnea index (AHI). Within 1.0 year, eight patients with a substantial tonsillar hypertrophy underwent attended polysomunography. Tonsillectomy was performed, and postoperative complications and polysomunographic findings were reviewed. The severity of OSAS was rated mild with an AHI of 10–29, moderate with an AHI of 30–49, and severe with an AHI of equal to or greater than 50. Four of eight patients exhibited severe OSAS, three patients had moderate OSAS, and one patient was of mild OSAS. The surgical response rates (defined as decrease in the postoperative AHI ≧50%) were 75% in severe apneics and 100% in moderate or mild apneics. No serious complications occurred. In the carefully selected patient, a tonsillectomy should be considered an effective and safe surgical option for the treatment of OSAS.

Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial: Effect of Reinforced Vocal Hygiene Education

Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost‐effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost‐effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene.

An oral pharyngeal scope for objective oropharyngeal examination: a new device for oropharyngeal study

Abstract Objective: There has been little progress in examination of the oropharynx with a light source such as electric light, a penlight, or a forehead mirror over the past 100 years. It is therefore necessary to develop methods to display and record oropharyngeal observations. Method: Since the aim of this study was to assess the safeness to use from the perspective of physicians, medical staffs, patients, and patients’ families and usefulness of pharyngeal scope, the number of devices was limited, the number of patients was not set based on hypothetical statistical tests. Results: A total of 150 volunteers were enrolled in this study. Among them, 96 underwent examination alone and the remaining 28 underwent treatment procedures. The study was done without any complications in all 150 cases. Most (91.3%) physicians hoped to continue using the new device if available. When comparing the use of the device for observation alone and for treatment procedures, there was no significant difference for evaluation items (p > .05) except convenience factor which received a significantly different (p = .0154) evaluation from physicians for observation alone and for treatment procedures. A positive evaluation was received about examination, recording/display and explanation from the patients and patients’ families. Conclusions: Our new device received positive evaluations by who underwent examination of the oral cavity and pharynx, recording of the results, and treatment procedures.

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial:

Objectives: To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency. Design: Parallel-arm, individual randomized controlled trial. Methods: Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups. Results: Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001). Conclusion: The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly. Clinical Trial.gov Identifier-UMIN000015567