Miwako Kimura

Clinical analysis of presbylarynx—Vocal fold atrophy in elderly individuals

OBJECTIVE The proportion of elderly Japanese is increasing significantly and aging society greatly influences the medical services. The number of elderly patients who visited out Voice Outpatient Clinic has been increasing in recent years. The aim of the present study was to analyze the trend in the number of patients with aging-related vocal fold atrophy, and to assess the characteristics of senile change of vocal function. METHODS A retrospective review of the 1999-2005 medical records of patients aged > or =65 years was conducted, and patients with presbylarynx were analyzed. We evaluated age, sex, occupation, maximal phonation time (MPT), and mean airflow rate (MFR) during comfortable phonation to assess the physiological characteristics of senile change of vocal function. We compared MFR of presbylarynx with those of normal elderly person. RESULTS The number of patients aged > or =65 who visited our clinic in the 7-year study period was 361, and 72 (20%) were diagnosed with vocal fold atrophy. They included 47 (65%) men and 25 (35%) women, with a mean age of 71 years (range, 65-89). Among these patients, 27 (38%) were still employed at the time of consultation, while 17 (24%) were retired, at least 26 jobs required voice skills; and 15 patients (21%) were involved in singing and recitation of poems. MPT correlated negatively with age, while MFR correlated positively with age. CONCLUSION The number of elderly patient with vocal fold atrophy increased gradually almost every year. The male patients account for 65%. Thirty-three percent of patient of the present study with presbylarynx were still in the workforce. MFR correlated positively and significantly with age. MFR was higher in presbylarynx than normal elderly person.

Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis

OBJECTIVE It is important to assess the causes of vocal fold paralysis. Many studies have reported causes of paralysis, but few reports have shown changes in longitudinal etiology in a single institution. METHODS We investigated the medical records of 797 patients with vocal fold paralysis from 1990 to 2005 at the voice and bronchoesophageal outpatient clinics at the University of Tokyo Hospital. We evaluated the etiology of paralysis, and compared our results with a previous study by Hirose in our clinic from 1961 to 1989 to assess changes in etiology. RESULTS The postoperative group comprised 466 patients (58.5%), while the non-surgical group comprised 331 (41.5%) patients. In the postoperative group, the most common cause of paralysis was thyroid surgery (106 cases), and other common causes were surgery for aortic aneurysm (61 cases) and tracheal intubation (58 cases). In the non-surgical group, idiopathic paralysis (134 cases) was the most common cause. Other common causes were lung cancer (34 cases) and cerebrovascular disease (24 cases). In a previous study from our clinic, the rate of postoperative paralysis was 43.5%. In the current analysis, the percentage of postoperative patients has increased remarkably compared with that of the previous report while the rate of idiopathic paralysis, has decreased by half. CONCLUSION The increase in postoperative cases of paralysis may be caused by the increasing frequency of operations for many diseases, due to the progress of medical techniques in recent years. The decrease in idiopathic cases may be related to the advances of diagnostic devices such as CT and MRI.

Arytenoid Adduction for Correcting Vocal Fold Asymmetry: High-Speed Imaging

Objectives We hypothesized that high-speed digital imaging provides a quantitative method to evaluate the effect of arytenoid adduction for the correction of asymmetric and irregular vocal fold vibration in unilateral vocal fold paralysis. Methods Six subjects with unilateral vocal fold paralysis participated in the study (4 male, 2 female; mean [±SD] age, 52.5 ± 21.3 years). Videokymographic and laryngotopographic methods for image analysis were performed for highspeed recordings of vocal fold vibration for visualizing the glottal vibratory patterns, and for quantifying the frequency of vibration of each vocal fold, respectively. Comparisons of the paralyzed and the normal vocal folds were made before and after arytenoid adduction. Results Analysis of the laryngotopographs revealed 2 distinct frequencies of vibration for the paralyzed and the contralateral vocal folds for all subjects before surgery. After arytenoid adduction, the vibration frequencies became identical or nearly identical in all subjects. Conclusions Asymmetric vibration in vocal fold paralysis was exemplified by differences in vibration frequency between the vocal folds. The present data showed that after arytenoid adduction the vibration frequencies and the vibratory patterns of the contralateral vocal folds approached symmetry. This surgical procedure could improve the functional symmetry of the larynx for phonation.

Geometrical deformation of vocal fold tissues induced by formalin fixation

Objectives/Hypothesis Many existing studies of vocal fold geometry are based on anatomical measurements made on histologically fixed laryngeal tissues using formalin. However, the validity of these geometric data is questionable because of the potentially significant tissue deformation associated with formalin fixation, particularly tissue shrinkage. Previous experiments have shown that valid geometric data may be obtained on vocal fold tissue samples quickly frozen with liquid nitrogen. Based on this finding, the present study attempted to quantify the geometric deformation of formalin‐fixed vocal fold tissues with respect to quick‐frozen tissues.

Histological investigation of the supra‐glottal structures in humans for understanding abnormal phonation

Phonation is the vocal fold vibration on normal voice. But sometimes we can observe the other phonation styles like as the pressed voice or some throat singings like as ‘‘kargyraa’’ or ‘‘drone’’ in Khoomei in Mongolian music. Also, clinically, we know that some patients who have the wide glottal slit in phonation because of the recurrence nerve palsy or after partial laryngectomy, could make the ‘‘supra‐glottal phonation.’’ The ‘‘supra‐glottal phonation’’ would be made from the vibration of ‘‘supra‐glottal structures’’ such as the false vocal folds, the arytenoids and the epiglottis, etc. Endoscopic examination suggests the existence of some contractile functions in supra‐glottal space. However, these phonation systems have not been clear to explain their neuromuscular mechanism in histology. This study aimed to find the basis for making the supra‐glottal phonation from the points of view of the histological structures. We tried to investigate if there were any muscles that could contract the supra‐glotta...

Analyses of risk factors for postoperative airway compromise following arytenoid adduction.

Conclusion. This study suggests that placing no drainage tube and postoperative bleeding are risk factors for postoperative airway compromise (PAC) following arytenoid adduction (AA). Objectives. In this study, we aimed to elucidate the risk factors for PAC following AA. Patients and methods. The data for 184 consecutive patients who underwent AA were analyzed retrospectively. Univariate and forward stepwise multivariate logistic regression analyses were performed. Results. Placing no drainage tube was a significant risk factor for PAC as determined by both univariate and multivariate analyses. Postoperative bleeding was a significant risk factor for severe airway compromise requiring emergency airway treatment.

Parathyroid adenoma causing spontaneous cervical hematoma: a case report.

A case of parathyroid adenoma causing a spontaneous cervical hematoma is reported. A 55-year-old woman presented with painful swallowing, dysphagia, and dyspnea. Primary hyperparathyroidism and a parathyroid tumor on the left side of the neck had been found 2 years earlier. Fiberoptic laryngoscopy and computed tomography (CT) showed a narrowing of the airway as a result of a retropharyngeal hematoma, and tracheostomy was carried out. Parathyroidectomy was performed 5 months after the absorption of the hematoma, with no complications. A pathological diagnosis revealed a parathyroid adenoma with hemosiderin deposition and fibrosis. Serum calcium and intact parathormone levels normalized postoperatively. Although a spontaneous cervical hematoma resulting from parathyroid tumors rarely occurs, it may lead to an airway compromise. Physicians should be aware of this if such tumors are managed conservatively without surgery.

Sensorineural Hearing Loss with Intracranial Venous Malformations in Klippel-Trenaunay Syndrome

Fig 1. Pure tone audiogram revealed horizontal-type sensorineural hearing loss in left ear.°right air conduction thresholds; X left air conduction thresholds; ] left bone conduction thresholds. Pure tone averages were 10 dB hearing level (dBHL) and 65 dBHL in right and left ears, respectively. dBHl pain. The patient denied tinnitus, vertigo, or any other otologic symptoms. He had no family history of idiopathic or hereditary hearing loss. On examination of the head and neck, superficial hemangiomas were also found in the left temporal and zygomatic regions, as well as in the left part of the pharynx. Both eardrums were normal. A pure tone audiogram revealed an SNHL (pure tone average, 65 dB hearing level) in the left ear, and the hearing was normal in the right ear (Fig 1). The speech discrimination scores were 100% and 65% in the right and left ears, respectively. Both ears showed type A tympanograms. Despite the hearing loss in the left ear, the stapedial reflex was normally evoked by left-sided stimulation with intense sound stimuli (>90 dB hearing level); this findINTRODUCTION

High-speed digital imaging of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy

Objective: To determine the utility of high-speed digital imaging (HSDI) in evaluating vocal kinetics of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP). Study Design: Case series. Setting: The University of Tokyo Hospital. Subjects and Methods: High-speed digital recordings of laryngeal images were obtained from six patients after SCL-CHEP to clarify the vocal kinetics of the postoperative neoglottis. Simultaneous recording of electroglottograms (EGGs) were obtained and multiline kymograms were generated on the basis of the recorded images. The distribution of frequency, amplitude, and phase in the neoglottis were visualized by using gradients of colors superimposed onto the glottal and supraglottal areas of laryngeal images to produce laryngeal topograms. Furthermore, waveforms of estimated laryngeal sound source (ELSS) were obtained on the basis of glottal inverse filtering of the vocal signal to reflect vibratory motions in the neoglottis. The vibratory part of the neoglottis was determined as a possible sound source when the frequencies of the ELSS, EGG, and laryngeal topograms, as well as the waveforms of ELSS, EGG, and kymograms, were consistent with each other. Results: Spaces between the arytenoid(s) and epiglottis (5 patients) or pyriform sinus mucosa (1 patient) were estimated as the major source of sound during postoperative vocalization. The possible sound source could be determined by HSDI, even in the neoglottis, with more than one vibratory position. Conclusion: HSDI could be useful for evaluating the vocal kinetics of the neoglottis after SCL-CHEP.

Observation of voice registers

In singing, voice register is one of the most salient aspects of voice quality, and it has therefore generated a lot of debates, acoustically, physiologically, and pedagogically. In singing, the voice registers can be physiologically classified into four categories: vocal fry, modal, falsetto, and whistle. In this study, vocal fold vibratory patterns appeared in each register were observed using high‐speed images and simulated using the two‐mass model. In vocal fry, three different vibratory patterns (aperiodic, subharmonic, and periodic with small open quotient) were observed. In addition, the simulation showed that transitions between the three different vibratory patterns are easy. In whistle, closure of the posterior part of glottis and rapid vibration of the anterior part were observed.