Joji Kobayashi

Two‐Dimensional Analysis of Vocal Fold Vibration in Unilaterally Atrophied Larynges

Objective Considerable inconsistencies regarding the vibratory pattern of the vocal fold among patients with unilateral vocal fold paralysis (UVFP) have been reported. These differences are derived from differences in the position, stiffness, and atrophy of the paralyzed vocal fold and other factors among patients. The purpose of this study was to assess the effects of unilateral atrophy of the vocal fold on vocal fold vibration.

Vertical velocity of vocal fold vibration correlates to mucosal traveling wave velocity

more fully delineated with this method. A series of coronalplane images comprising a vocal cycle are presented and analyzed. Conclusion: This imaging modality produces a completely novel view of the vibrating larynx. Such imaging will provide insight into the 3-dimensional impact of a Silastic implant on laryngeal vibration, with the potential to improve medialization techniques. Clinical Significance: This project represents progress in the pursuit of 3-dimensional imaging of human mucosal wave motion. In the future, the ability to perform noninvasive coronal plane imaging of the larynx may enhance the understanding of a variety of disorders, including laryngeal paralysis, and could improve patient diagnosis and treatment options. (Supported by a VA Merit Review Grant.)

A Case of Acute Mastoiditis with Associated Laryngeal Paralysis.

A 58-year-old man visited our hospital with complaints of temporal headache, hoarseness, dysphagia and left hearing loss. Palsy was noted in the left soft palate, vocal cord and sternomastoid muscle. And also hyperesthesia was noted in the first branch of the left trigeminal nerve and hypoesthesia in the other branches of the nerve. His left hearing was reduced to total deafness. Enhanced CT scan and MRI showed signs of acute mastoiditis with internal jugular vein thrombosis and inflammation around the sigmoid sinus (sinus phlebitis). The mastoiditis had resulted from infection of MRSA; methicillin resistant Staphylococcus aureus. Mastoidectomy was performed, as the antibiotic therapy with Vancomycin did not work for the mastoiditis. At the time of the operation, inflammatory mucous membrane in the mastoid cavity and the bone defect on the lateral semicircular canal were observed, but neither granulation nor abscess was observed. Two days after the operation, redness around the ear was noted, so the wound was opened. Thereafter, curettage of the granulation with irrigation in the mastoid cavity was repeated. The palsy of the left soft palate improved, and the inflammation decreased. When the MRSA turned to Pseudomonas aeruginosa, the antibiotic drug was changed to Imipenem. However, the temporal headache was not relieved and the inflammation increased again. Therefore, further mastoidectomy with tympanoplasty was performed. At the time of the second operation, a fracture on the middle base of the skull and a fistula on the lateral semicircular canal were observed. Postoperatively, the temporal headache and the inflammation improved. A month after the operation, the palsy of the left soft palate, sensation in the face and the sternomastoid muscle functions recovered. Eleven months after the operation, movement of the vocal cord has been improving gradually.