Minoru Kinishi

Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome

OBJECTIVE Although the antiviral agent, acyclovir, is currently employed for the treatment in Ramsay Hunt syndrome, the benefit of acyclovir on facial nerve is still unknown and remains controversial. This study was designed to evaluate the effect of acyclovir in facial nerve recovery in Ramsay Hunt syndrome. METHODS To evaluate drug effect on facial nerve function, evaluation of the facial voluntary movement and nerve excitability testing were performed. We have used an infusion therapy of acyclovir in combination with a high dose of steroid (AS), which was started within 7 days of onset of facial nerve palsy in 91 patients with Ramsay Hunt syndrome. The results were compared with those of 47 patients whose therapy was steroid alone started within 7 days of onset. RESULTS Out of 91 patients treated with AS, nerve exitability was good in 68 (75%), while it was poor in 17 and absent in six. Of 47 patients treated with steroid alone, nerve exitability was good in 25 (53%), while it was poor in 11 and absent in 11. There was statistically significant difference between AS and steroid therapy in the posttreatment degree of nerve function. Complete recovery to grade I in facial voluntary movement was attained in 82 of 91 patients (90%) in the AS therapy, while out of 47 patients treated with steroid alone complete recovery to grade I was attained in only 30 (64%). A statistically significant difference in the recovery rate of facial nerve function was induced between AS and steroid therapy. CONCLUSION The AS therapy was proved to keep good degree of nerve function indicated with nerve excitability testing and improve recovery rate of facial nerve in Ramsay Hunt syndrome. Based on this study, we now believe that the AS therapy is an advisable treatment modality to improve the recovery rate of facial nerve function in Ramsay Hunt syndrome.

Significance of Retropharyngeal Node Dissection at Radical Surgery for Carcinoma of the Hypopharynx and Cervical Esophagus

Objectives To clarify the efficacy of dissection of retropharyngeal lymph nodes (RPLNs) in the surgical treatment of carcinoma of the hypopharynx and cervical esophagus.

Epithelial migration in the healing process of tympanic membrane perforations

SummaryThe healing process in 10 human tympanic membrane perforations after trauma and 20 myringotomies was observed under the microscope and was photographed. The movement of the healing process was from the central portion of the perforation to the periphery and followed the same direction as the drums epitehlial migration. At the central portion of the perforations margin, the keratin layer proceeded to the periphery and was followed by the epidermal cell layer. Only slight movement was observed at the peripheral portion of the perforation. Histopathological examination confirmed these observations. These findings demonstrate that epithelial migration on the tympanic membrane plays a great role in the healing of a perforation.

Primary tracheoesophageal shunt operation for postlaryngectomy speech with sphincter mechanism.

This paper describes a primary voice restoration technique designed to eliminate the problem of aspiration commonly encountered in rehabilitation procedures following laryngectomy. This technique, utilized in 16 patients, consists of a unique combination of tracheal flap for voice production and bilateral esophageal constrictor muscle flaps to prevent aspiration. Fourteen patients developed satisfactory tracheoesophageal speech; of them 12 had normal deglutition without problems of aspiration. On radiographic examination, the bilateral esophageal muscle flaps, in combination with the dilatation and elevation of the cervical esophagus, provide a sphincter mechanism that prevents tracheal reflux during deglutition.

Primary Tracheojejunal Shunt Operation for Voice Restoration following Pharyngolaryngoesophagectomy

A primary tracheojejunal shunt operation was performed for voice restoration following pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. A fistula was created between the membranous part of the trachea and the lower part of the transplanted jejunum. The membranous part of the trachea was tubed to construct the tracheojejunal shunt. All three patients who had the tracheojejunal shunt operation retained phonatory function. Pitch formation was seen in the voice waveform with use of the tracheojejunal shunt. No leakage was seen at all during deglutition and a swallowing function was obtained in all patients who had the tracheojejunal shunt.

Aerodynamic Studies of Laryngectomees after the Amatsu Tracheoesophageal Shunt Operation

Ten speakers with tracheoesophageal shunts were subjected to aerodynamic investigation. Measurements were made of tracheal pressure, airflow rate, and intensity and fundamental frequency of voice. Airway resistance, pulmonary power, acoustic power, and efficiency of voice were calculated from the data. It was found that intensity and airflow rate showed a tendency to augment with increased tracheal pressure, while fundamental frequency remained almost unchanged as tracheal pressure increased. Airway resistance of the tracheoesophageal speakers ranged from about 100 to 1,200 dyne s/cm5 and tracheal pressure ranged from 12 to 80 cm of water, while efficiency of voice ranged from 0.3 × 10−4 to 6.5 × 10−4. These results revealed that compared to the normal larynx, efficiency of voice was approximately the same, although airway resistance and tracheal pressure were substantially greater.

Evaluation of speech of laryngectomees after the amatsu tracheoesophageal shunt operation

Fourteen patients were evaluated by a number of tests to analyze the voice produced following the senior authors surgical technique for speech rehabilitation.

Acoustic analyses clarify voiced-voiceless distinction in tracheoesophageal speech

In order to clarify the ability of the voice to achieve voiced voiceless distinction in [ce1]tracheoesophageal (TE) speech, acoustic cues such as closure duration, onset and offset of vibration during closure period and voice onset time (VOT), in conjunction with intraoral pressure, were analyzed in 40 TE speakers. Both closure period and VOT during [p] production were longer in TE speakers with high intelligibility compared with laryngeal speakers; during [b] production these parameters were similar between the two groups. TE speakers with high intelligibility and laryngeal speakers showed significant differences between [p] and [b] production in terms of both closure duration and VOT. TE speakers with low intelligibility of [b] had higher values of VOT during [b] production compared with those with high intelligibility. TE speakers with low intelligibility of [p] had lower values of VOT during [p] production compared with those with high intelligibility. It is concluded that these characteristic acoustic cues reflect voicing ability in TE speech.In order to clarify the ability of the voice to achieve voiced-voiceless distinction in [ce1]tracheoesophageal (TE) speech, acoustic cues such as closure duration, onset and offset of vibration during closure period and voice onset time (VOT), in conjunction with intraoral pressure, were analyzed in 40 TE speakers. Both closure period and VOT during [p] production were longer in TE speakers with high intelligibility compared with laryngeal speakers; during [b] production these parameters were similar between the two groups. TE speakers with high intelligibility and laryngeal speakers showed significant differences between [p] and [b] production in terms of both closure duration and VOT. TE speakers with low intelligibility of [b] had higher values of VOT during [b] production compared with those with high intelligibility. TE speakers with low intelligibility of [p] had lower values of VOT during [p] production compared with those with high intelligibility. It is concluded that these characteristic acoustic cues reflect voicing ability in TE speech.

Neoglottic Activity in Tracheoesophageal Phonation

It has been generally accepted that the retropharyngeal wall protrudes into the lumen and forms a prominence during alaryngeal phonation. Although the prominence is thought to be responsible for the vibratory source, the relationship between the vocalization process and the dynamics of the prominence is not well known. This study is undertaken to clarify the above-described relationship during tracheoesophageal (TE) phonation, one of the most common forms of voice restoration following total laryngectomy. Electromyography (EMG) with simultaneous manometry and fiberoptic observation of the hypopharynx were done in 7 subjects who underwent TE fistulization at the time of laryngectomy. Fiberscopy revealed prephonatory closure of the hypopharyngeal lumen, and subsequently, a definite configuration of the lumen where diverted air can escape with mucosal vibration during phonation. The EMG disclosed a characteristic pattern that had two bursts of activity with an intervening quiet period. It may be concluded that TE phonation consists of two steps: The first step, associated with the first burst and regarded as the preparatory stage, consists of the hypopharyngeal closure which forms a small lumen. The second step, associated with the second burst and regarded as the phonatory stage, consists of the vibration of the neoglottis with a definite configuration which is maintained by the hypopharyngeal muscle contraction.

The clinical features and pathogenesis of myringitis granulosa

SummaryMyringitis granulosa is not a rare pathologic condition of the tympanic membrane. However, the condition can be misdiagnosed as chronic suppurative otitis media, since intermittent purulent discharge is the commonest symptom in both disorders. Although the clinical features of myringitis granulosa have been well described by several authors, its pathogenesis is still obscure. In this study, 40 cases of myringitis granulosa were examined in detail to clarify the clinical features and the pathogenesis present. No drum perforations, no hearing impairments and normal X-ray findings indicated that myringitis granulosa had no relation to chronic suppurative otitis media. The other areas of the affected tympanic membrane, except for the site of granulation, showed such pathologic conditions as atrophy, clouding and calcifications. In these pathologic tympanic membranes, epithelial migration was disturbed to a high degree. We suggest that the granulation process on the tympanic membrane should be divided into two stages: (1) injury reaching the lamina propria of the tympanic membrane; and (2) disturbed epithelization of the tympanic membrane. The disturbance of epithelial migration of the tympanic membrane occurs with both stages.