Hidetaka Kumagami

Investigation of Pharyngeal Swallowing Function Using High-Resolution Manometry

Objectives/Hypothesis: This study aimed to demonstrate the feasibility of a novel high‐resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.

Music recognition, music listening, and word recognition by deaf children with cochlear implants.

Objectives: To examine the ability of congenitally deaf children to recognize music from incidental exposure and the relations among age at implantation, music listening, and word recognition. Design: Seventeen child implant users who were 4 to 8 yr of age were tested on their recognition and liking of musical excerpts from their favorite television programs. They were also assessed on open-set recognition of three-syllable words. Their parents completed a questionnaire about the children’s musical activities. Results: Children identified the musical excerpts at better than chance levels, but only when they heard the original vocal/instrumental versions. Children’s initiation of music listening at home was associated with younger ages at implantation and higher word recognition scores. Conclusions: Child implant users enjoy music more than adult implant users. Moreover, younger age at implantation increases children’s engagement with music, which may enhance their progress in other auditory domains.

Measurement of angle and length of the eustachian tube on computed tomography using the multiplanar reconstruction technique

Objective: To compare the anatomic features of the eustachian tube (ET) between children with and without otitis media with effusion (OME) and with adults.

Differentiating imaging findings in primary and secondary tumors of the jugular foramen

The preoperative diagnosis of a jugular foramen tumor may be challenging, since a large variety of unusual lesions may be located in this region. These tumors may be classified as primary lesions (which are located in the jugular foramen or extend from the jugular foramen into the surrounding structures) and as secondary lesions (that extend from the surrounding structures into the jugular foramen). Primary tumors include glomus jugulare tumors, schwannomas, meningiomas and peripheral primitive neuroectodermal tumors, while secondary tumors comprise chordomas, chondrosarcomas, chondroblastomas, giant-cell tumors, cholesterol granulomas, giant cholesterol cyst, endolymphatic sac tumors, reactive myofibroblastic tumors, temporal bone carcinomas and metastases. Accurate preoperative radiological suspicion is of great value for preoperative patient counseling and has a direct impact on the surgical planning in these cases. The present study describes and discusses the main differentiating imaging features of lesions involving the jugular foramen, whose accurate preoperative radiological evaluation is essential for proper surgical planning.

Water channel proteins in the inner ear and their link to hearing impairment and deafness.

The inner ear is a fluid-filled sensory organ that transforms mechanical stimuli into the senses of hearing and balance. These neurosensory functions depend on the strict regulation of the volume of the two major extracellular fluid domains of the inner ear, the perilymph and the endolymph. Water channel proteins, or aquaporins (AQPs), are molecular candidates for the precise regulation of perilymph and endolymph volume. Eight AQP subtypes have been identified in the membranous labyrinth of the inner ear. Similar AQP subtypes are also expressed in the kidney, where they function in whole-body water regulation. In the inner ear, AQP subtypes are ubiquitously expressed in distinct cell types, suggesting that AQPs have an important physiological role in the volume regulation of perilymph and endolymph. Furthermore, disturbed AQP function may have pathophysiological relevance and may turn AQPs into therapeutic targets for the treatment of inner ear diseases. In this review, we present the currently available knowledge regarding the expression and function of AQPs in the inner ear. We give special consideration to AQP subtypes AQP2, AQP4 and AQP5, which have been studied most extensively. The potential functions of AQP2 and AQP5 in the resorption and secretion of endolymph and of AQP4 in the equilibration of cell volume are described. The pathophysiological implications of these AQP subtypes for inner ear diseases, that appear to involve impaired fluid regulation, such as Menières disease and Sjögrens syndrome, are discussed.

Effects of a tongue-holding maneuver during swallowing evaluated by high-resolution manometry.

Objective: This study aimed to investigate the effects of a tongue-holding maneuver (THM) during swallowing using a novel high-resolution manometry (HRM) system. Study Design: Case series with planned data collection. Materials and Methods: Thirty-three asymptomatic Japanese adults were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1-cm apart was positioned to record pressures from the velopharynx to the upper esophagus at rest and during swallowing. The maximum values of the dry swallowing pressures at the velopharynx, mesohypopharynx, upper esophageal sphincter (UES), and distance from the nostril to each point of maximum values with and without the THM were measured. Results: The distance from the nostril to the UES was statistically shorter when swallowing with the THM than without the THM (paired t test, P = 0.009). The maximum pressure at UES was greater when swallowing with the THM than without the THM, although there was no statistically significant difference (paired t test, P = 0.051). There was no difference in the pressures and the distance between swallowing with or without the THM at any other site. Conclusions: These findings suggest that the THM may not have a potential to facilitate compensatory swallowing power when swallowing.

Cochlear Implantation in Children With Congenital Cytomegalovirus Infection

Objective: To assess the impact of cochlear implantation (CI) on children with cytomegalovirus (CMV)-induced deafness. Study Design: Retrospective chart review. Patients: Four children with congenital CMV-related deafness (CMV group) and 17 children with congenital deafness without CMV infection as the cause of deafness (non-CMV group). The age at CI ranged from 2.0 to 3.3 years (mean, 2.6 yr) in the CMV group and from 1.8 to 3.6 years (mean, 2.6 yr) in the non-CMV group. Their follow-up period ranged from 3.0 to 4.3 years (mean, 3.3 yr) in the CMV group and from 1.6 to 4.3 years (mean, 3.3 yr) in the non-CMV group. Methods: Evaluation and comparison of preoperative and postoperative hearing levels, motor, social, and language development, Infant-Toddler Meaningful Auditory Integration Scale, and Enjoji Scale of Infant Analytical Development between the 2 groups. Results: Within 12 months after CI, the mean score of both language perception and production was poorer in the CMV group than in the non-CMV group, and the difference in the language production was statistically significant. However, 12 months after CI, the language perception and production showed good progress at levels similar to that of the non-CMV group. Conclusion: Long-term results of the language perception and production after CI was satisfactory in Japanese children with congenital CMV-related deafness compared with in subjects deafened by other causes. CMV alone, as a cause of deafness, is not likely a contraindication for CI.

Influence of head rotation on upper esophageal sphincter pressure evaluated by high-resolution manometry system

Objectives: This study aimed to quantify the effects of head rotation on upper esophageal sphincter (UES) pressure in healthy subjects using a novel high-resolution manometry (HRM) system. Study Design: Prospective study. Setting: Nagasaki University Hospital. Subjects and Methods: Eighteen asymptomatic Japanese male adult volunteers were studied. A solid-state HRM was positioned to record resting UES pressure. After endoscopically confirming on which side of the pyriform sinus the manometric sensor was positioned within the hypopharynx, we measured the maximum and mean values of the resting UES pressure and the length of the zone of the UES along the esophagus with the patients in the following positions: 1) neutral and straightforward head position (NSF), 2) turning the head in the direction of the side in which the sensor was positioned (HSS), and 3) turning the head in the opposite direction of the side with sensor (HOS). Results: The maximum and mean values of the resting UES pressure were statistically higher in HSS than in NSF (P = 0.0001 and P < 0.0001, respectively), and were statistically lower in HOS than in NSF (P < 0.0001 and P < 0.0001, respectively). The length of the zone of the UES was statistically shorter in HOS than in NSF (P < 0.0001), but there was no significant difference in resting UES pressure along the esophagus between HSS and NSF (P = 0.3024). Conclusion: The present study provided us with physiological information regarding normal UES pressure in relation to head rotation. This data will be of aid to future clinical and investigative swallowing studies. Additionally, the current study provides evidence of the safety and usefulness of the head rotation maneuver for dysphagic patients.

Influence of Effortful Swallow on Pharyngeal Pressure Evaluation Using a High-Resolution Manometry

Objective. To evaluate the effect of effortful swallow on pharyngeal pressure while swallowing saliva and water using a novel high-resolution manometry (HRM) system. Study Design. Case series with planned data collection. Setting. Nagasaki University Hospital. Subjects and Methods. Eighteen asymptomatic Japanese adult volunteers were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned from the velopharynx to the upper esophagus to record pressures while swallowing. The maximum values of the pressure while swallowing saliva (dry swallowing) and 5 mL of water were measured at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES) with and without effortful swallows. Results. The maximum values of dry swallowing pressures (mm Hg) at the velopharynx, meso-hypopharynx, and UES were significantly higher with effortful swallow (155.7 ± 59.7, 256.7 ± 78.7, and 276.5 ± 87.5, mean ± standard deviation) than without it (115.3 ± 60.8, 172.9 ± 57.0, and 195.8 ± 61.3). Those of water swallowing pressures were also statistically higher with effortful swallow (169.3 ± 69.1, 236.6 ± 77.2, and 267.3 ± 79.1) than without it (119.2 ± 59.7, 189.5 ± 70.7, and 221.3 ± 72.7). Conclusion. The present results provide quantitative evidence of effortful swallow as well as physiological information. It also is hoped to be an aid to future clinical and investigative studies.

Surgical anatomy of the sphenoid sinus on the CT using multiplanar reconstruction technique

OBJECTIVE: To clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures as are relevant to performing an endoscopic sphenoidotomy. METHODS: Various dimensions of 224 CT images of the sphenoid sinus and surrounding structures from 122 Japanese adult patients were measured using the multiplanar reconstruction technique. RESULTS: The mean distance from the nasal sill to the sphenoid ostium was nearly 66 mm, and that from the sphenoid ostium to the posterior wall of the sphenoid sinus was nearly 14 mm. The angles from the sphenoid ostium to both the carotid artery and the optic canal varied among the patients. The sphenoid ostium was located at almost the vertical midpoint of the anterior wall of the sphenoid sinus. CONCLUSION: The present study provides anatomical information about the sphenoid sinus and surrounding structures that is essential for avoiding complications in performing an endoscopic sphenoidotomy.