Hiroshi Okamura

Static Lung Volumes in Singers

It has long been assumed that the superior vocal ability of the trained professional singer arose from a higher than average breathing capacity and consequent above-normal ventilatory efficiency. However, until now, it has not been clear whether this presumed superior pulmonary capacity and breathing efficiency arose from training, from heredity, or from other factors. To clarify the role of training (and by inference that of other factors also) upon the capacity for singing, various indices reflecting static lung volumes, as distinguished from dynamic parameters measured during the act of singing, in trained professional singers, students of voice and subjects with no vocal training, were compared. Results indicated that contrary to reports by others, there were no significant differences in the total lung capacity (TLC) of the trained professional singer and that of the other two groups when allowances were made for age and sex; but when the ability to mobilize or utilize TLC was compared, it was found that the trained singer was much better able to do this than either of the other two groups. Specifically, it was found that the ratio of the residual lung volume (RV) (the amount of air remaining in the lungs at the end of a total voluntary expiration) to TLC was lower in the trained singer than in the students of voice, and that these students, in turn, had a lower RV/TLC ratio than the untrained subjects. These findings, therefore, suggest that the increased singing ability of the trained professional singer arises in large part from the ability to increase breathing efficiency by reducing the residual lung volume and, further, that this ability tends to improve with length of vocal training.

Wound Healing of Canine Vocal Folds after Phonosurgery

To develop phonosurgical techniques, the authors investigated the healing mechanisms of wounds on the vocal folds of canine larynges, and devised a method to cover the raw surfaces of such wounds. To restore the normal physiologic properties of the vocal folds, the normal mucosa should be removed as little as possible in phonosurgery. When the mucosa of the vocal folds is extensively removed by surgical intervention and the raw surface cannot be covered with the local pedicle flap, it should be covered with a free mucosal flap. We found an activated human fibrinogen concentrate, which is a biologic tissue adhesive, to be suitable for adhering a free mucosal flap to the raw surface by a laryngomicrosurgical approach.

Radiographic Analysis of Laryngeal Movement during Phonation by Digital Fluorography

Yumi Sasaki and Hiroshi Okamura Movements of laryngeal components for different vocal attacks were investigated with the use of a digital fluorography (DF) system. In this paper, three kinds of vocal attacks (soft , hard and breathy attack) were compared through subtracted images obtained with TID mode subtraction technique. In the hard attack, the vocal folds during adduction were thicker and the false vocal folds adduction was more marked than in the soft attack . The distention of the subglottal space due to the increase in subglottal presser was larger in the hard attack than in the soft one . In the breathy attack, the vocal folds during adduction were thinner than in the soft attack , and the false vocal folds did not adduct. These findings suggested an existence of a incomplete glottal closure before phonation.

Congenital Malformations Associated with Cleft Lip and/or Palate.

The authors analyzed statistically 287 patients with cleft lip and/or cleft palate, who had visited the ENT clinic of Ehime University Hospital, from 1976 to 1990.Sixty-five patients (22.6%) had other congenital malformations. Malformations of the limbs were observed most frequently, then malformations of the ear, and third of the heart. Sixteen patients (5.6%) had congenital malformation syndromes, four of them with anomalies of chromosomes. The incidence of normal language development after palate plasty was 92.7% in patients without associated malformations and 58.3% in those with associated malformations.The authors recommend a team approach, including pediatrician, anesthesiologist and speech therapist in the treatment of cleft palate speech when other congenital malformations are present.

Abstract Surgical treatment of cystic lymphangioma in the head and neck region

Either surgical or conservative therapy is chosen for the treatment of cystic lymphangioma in the head and neck region. At the authors institution, surgery has been the choice as long as tumor is resectable without any major sequelae. They surgically treated four patients successfully since 1986. Case 1, two-month-old boy, and case 2, four-month-old girl, complained of progressive inspiratory dyspnea due to the tumor in the neck and were surgically treated. Case 3 was a girl of three years and six months. She was noticed to have right buccal swelling at her birth. She had been followed until the tumor rapidly enlarged with severe pain. The tumor, which replaced the lateral lobe of the parotid gland and adhered to the facial nerve branches, was resected without facial nerve palsy. Case 4, a 26-month-old boy, had a left submandibular swelling and was treated surgically.

Diagnosis and surgical tretment of pharyngeal dysphagia.

We introduce here our diagnostic approaches for pharyngeal dysphagia and briefly discuss the results of surgical treatments. In dysphagia, we routinely use fluorography, manometry, electromyography and endoscopy. Fluorography in conjunction with manometry particularly provides valuable information for understanding the function of pharyngeal swallowing.Fluorography is the most important diagnostic means of studying the function of swallowing. We utilize the double contrast pharyngogram using Computed Radiography as the screening method for detecting clinical and subclinical dysphagia, since barium coating or remaining on the pharyngeal mucosa is always observed in patients with organic or functional dysphagia. Moreover, we devised a new system of pharyngo-esophagography using a video tape recorder, digital fluorography and a multiformat camera, because a contrast medium rapidly passes through the pharyngeal phase of swallowing. The video signal from the fluoroscopic unit is fed into the video tape recorder, and recorded images are transferred through the digital fluorography to the multiformat camera. Sequential images of barium swallowing in one deglutition are copied on sheet film at the rate of 30 frames per second. By this method, qualitative and quantitative assessments of pharyngeal swallowing can be carried out easily.Manometric study indicates the constricting power of pharyngeal muscles for propulsion of a bolus into the esophagus and timing of relaxation of the esophageal orifice during swallowing. The relaxation of the esophageal orifice cannot be detected by fluorography. Only a manometric approach indicates the timing, duration and degree of relaxation.We also describe our experience with surgical treatment of 19 patients with pharyngeal dysphagia caused by cerebro-vascular accidents, degenerative diseases of the neuromuscular system and myositis, and we discuss briefly the use of cricopharyngeal myotomy, section of the infrahyoidal muscles and a laryngeal elevation technique in these diseases.Finally, we emphasize the importance of multidimensional diagnostic approaches to pharyngeal dysphagia, on the basis of which the most suitable method of treatment can be selected.

Otitis media with effusion in routine medical examinations of one and a half-year-old children. Follow-up studies.

During the past 4.5 years screening tests using tympanometry (TM) for otitis media with effusion (OME) were performed as part of the routine medical examination of 13, 315 children at one and a half-years of age in Matsuyama City.1) In the first screening, B or C type TM was recorded in 3, 969 of the 13, 315 children (29.8%).2) In the second screening, B or C type TM was found in 1, 475 of the 3, 969 children (11.1%).3) In the third screening, 1, 067 (1, 804 ears) of the 1, 475 children could be followed in detail at the Ehime Prefectural Rehabilitation Center for the Physically Handicapped.4) In 1, 015 of the 1, 804 ears, B or C type TM was noted at the first examination in the center.5) Examinations were performed without treatment on 534 of the 1, 015 ears (52.6%). TM and ear drum abnormalities returned normal spontaneously in 526 of the 534 ears (51.8%).6) 481 of the 1, 015 ears (47.4%) were treated in the offices of other otorhinolaryngists. The TM and ear drum findings were later restored to normal in 393 of the 481 ears (38.7%).7) In the children who were followed for longer than three years, TM and ear drum findings were restored to normal within six months in 65.0%. However, 7.6% of those children have not yet been cured.