Jiro Udaka

Air-bone gap estimated with multiple auditory steady-state response in young children with otitis media with effusion

OBJECTIVE Multiple auditory steady-state responses (ASSRs) to air- and bone-conduction stimuli were recorded in young children with otitis media with effusion (OME). After treatment for OME, differences between pre-treatment bone-conduction ASSR levels and post-treatment conditioned orientation reflex (COR) or air-conduction ASSR levels were examined, and compared with ASSR-estimated air-bone gap (ABG) before treatment. METHODS Navigator Pro with Master was used to assess the threshold of air- and bone-conduction ASSR in both ears at 500Hz, 1000Hz, 2000Hz and 4000Hz. For bone-conduction ASSR, RadioEar B-71 bone-vibrator placed on the mastoid was used with white-noise masking on the contralateral ear. RESULTS After ventilation tube placement, the thresholds of COR got closer to those of pre-treatment bone-conduction ASSR in young children with OME. Moreover, post-treatment air-conduction ASSR thresholds also got closer to those of pre-treatment bone-conduction ASSR. The differences between pre-treatment bone-conduction ASSR thresholds and post-treatment COR or air-conduction ASSR thresholds became much smaller than ASSR-estimated ABG before treatment. CONCLUSION These findings suggest that bone-conduction ASSR can assess the normal or near normal cochlear sensitivity in young children with conductive hearing loss. It is also suggested that ASSR-estimated ABG can be used clinically to predict their accurate ABG.

The Importance of Language Disorder Screening in School Medical Examinations

??????????????????231???????????????, ??????????????????????????????????????????????????????????????????????????????????????????????????????????????????, ?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????. ?????????????????????????????????????????????????????????????????????????????????????????????, 31???????????????. ??????, ?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????47????????????, ??????????????????????????????????????????????????????, ???????????????????????????????????????????????????????????????. ???????????????????????????14????????????, ????????????????????????????????????1??????????????????, ??????13???????????????????????????????????????. ???????????????????????????????????????????????????????????????????????????????????????????????????, ??????????????????????????????????????????????????????????????????????????????, ????????????????????????????????????????????????, ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????.

A Study on Cricothyroid Muscle Activities During Carbon Dioxide Inhalation

Hirofumi Kihara, Shin-ya Ohtsu, Yoshizumi Wada, Jiro Udaka, Tatsuya Ishida and Yasuo Koike Several studies of the activity of human cricothyroid muscles during sleep have been reported. Eight adults in good health aged 36 to 61 years were subjected in this study. The activity of the cricothyroid muscle was investigated during sleep and the influence of carbon dioxide inhalation upon the cricothyroid activity was electromyographically determined. During sleep, a slight degree of cricothyroid activity was observed for inspiration. Carbon dioxide inhalation caused an increase in the cricothyroid activity during inspiratory phases.

The Efficacy of Hemitonsillectomy and Adenotomy in Treatment of Upper Airway Obstruction in Children

Adenotonsillectomy is frequently performed on children with upper airway obstruction, since the most common cause is adenotonsillar hypertrophy. Removal of a minimal amount of tonsil tissue may be immunologically better, however, removal of a wider area may be necessary to enlarge the airway sufficiently. Based on the foregoing, removal of the palatine tonsil on only one side and adenotomy (hemitonsillectomy and adenotomy: HTA) was performed in 6 cases of upper airway obstruction in patients under 5 years old. Five of these cases underwent nocternal polygraphic recordings before and one week after HTA. Airflow, thoracic movement, mesopharyngeal pressure and oxygen saturation were simultaneously monitored and the following results were obtained: the maximum amplitude of mesopharyngeal pressure remarkably decreased, and the minimum oxygen saturation increased to a normal range postoperatively. Although all cases had good long term courses, two, both 5 years old, complained of snoring and sleep apnea again 30 or 37 months after HTA. On physical examination, the remaining palatine tonsils had hypertrophied while pharyngeal lymph follicles had not hypertrophied. Funnel chest, which had been observed in one of the 2 cases before HTA, had already completely disappeared. On polysomnographic examination, recurrence of upper airway obstruction was demonstrated. The remaining palatine tonsils were removed and thereafter the 2 cases improved both clinically and on the polygraphic test. The remaining 4 cases were investigated by questionnaires, which showed that they had no recurrence 5 to 39 months postoperatively. Pigeon chest, which had been observed in one of the 4 cases before HTA, had slightly improved. These results suggest that HTA is valuable for preservation of immunological function,

Some Problems Associated with Current Methods for Examining Laryngeal Function

This paper presents a critique of clinical methods currently used for assessment of laryngeal function. Acoustic, aerodynamic and perceptual analysis are discussed. It is suggested that acoustic analysis is limited relative to establishing a specific diagnosis but may have application in screening for laryngeal malignancy. The problems identified with aerodynamic assessment are those associated with the warm-wire anemometer. Criticisms of the perceptual scales widely adopted in Japan focus on the fact that parameters selected are arbitrary and other measures may be more precise in describing vocal hoarseness. Crossing all measures of vocal function is the need for standard calibration procedures. The authors conclude that considerable study is needed before laryngeal function tests can he considered a true clinical examination of the vocal system.

A Review of the Literature Related to the Measurement of Pharyngeal Air Pressure Associated with Articulation

Intraoral or pharyngeal air pressure data obtained during production of normal consonants would be useful in reassessing the role of intraoral or pharyngeal air pressure in articulation problems of speakers with velopharyngeal incompetence. The literature related to the examination of intraoral or pharyngeal air pressure is reviewed.

SPEECH AUDIOMETRIC TRIAL USING SYNTHETIC VOWELS PRODUCED WITH DECTALK

A speech audiometric trial is described for testing the degree of hearing loss and its pathogenesis. Test vowels and distorted speech sounds were synthesized with DECtalk for use in speech audiometric tests. Results showed that 100% articulation can be obtained with undistorted synthesized vowels, while reasonable articulation scores can be obtained with distorted synthetic speech signals. This method could solve some of the problems inherent in use of recorded natural Japanese speech sounds as acoustic stimuli during otological examinations.

Sleep apnea in the field of otolaryngology.

The literature related to sleep apnea was reviewed, and the definition, etiology, clinical features, means of examination and management procedures were discussed.1) The definition suggested by Guilleminault seems to be most useful for otolaryngologists.2) If unrecognized and untreated, obstructive sleep apnea may lead to serious complications, e. g. cor pulmonale or pectus excavatum.3) The status of the upper airway tract should be investigated in detail, and the obstructions should be discovered and relieved at an early stage of development.4) Adenotonsillectomy may improve upper airway obstruction, and is thought to be very effective treatment for some patients with sleep apnea.

A case of solitary neurofibroma of the pharynx.

A 16-year-old female patient who complained of snoring was found to have a tumor occupying the pharyngeal space. It was totally removed intraorally. The histological examination revealed a neurofibroma. There were no other tumors or skin findings such as “cafe au lait spots”.The literature related to nerve sheath tumors was reviewed. It was pointed out that solitary neurofibroma is extremely rare in the pharynx.Five Japanese vowels, /a/, /i/, /u/, /e/ and /o/ were examined pre-and postoperatively with a sound-spectrogram. The results showed an apparent difference due to the change of the vocal tract. It was concluded that a vocal change can occur in cases of tumor of the pharynx.