Satoshi Yoshioka

Movement of the Eustachian tube during sniffing in patients with patulous Eustachian tube: evaluation using a 320-row area detector CT scanner.

Objective The Eustachian tube is difficult to evaluate because it is located deep in the head. However, the introduction of 320-row area detector CT has made it possible to evaluate this region. In the present study, movement of the Eustachian tube during sniffing was visualized using area detector CT in patients with patulous Eustachian tube. Methods Four patients with patulous Eustachian tube were examined using an area detector CT scanner (Aquilion ONE, Toshiba). This scanner supports 320-row scanning of 0.5-mm slices at up to 0.275 s/rot., eliminating temporal mismatch between various parts of the acquired images and permitting 4-dimensional CT (4DCT) images to be obtained by continuous scanning. The scan conditions were 120 kV, 120 to 150 mA, 0.5 mm × 280 to 320 slices, and 0.35 seconds per rotation × 9 rotations. The patient was seated on a reclining chair tilted to 45 degrees and was instructed to sniff during continuous scanning. Images of the Eustachian tube were generated at 0.1-second intervals. Conclusion At the start of sniffing, the cartilaginous portion of the Eustachian tube closed from the isthmus toward the pharynx. The starting point differed from patient to patient. In patients with patulous Eustachian tube, sniffing (an unconscious habit that helps to relieve ear discomfort) is an important factor in the development of middle ear diseases. We have successfully depicted this event for the first time, demonstrating various patterns of Eustachian tube closure during sniffing in patients with patulous Eustachian tube. This method may be useful for evaluating Eustachian tube dysfunction.

High-Speed Camera Observations of Vocal Nodules

Objective: We compared the vocal fold vibration pattern among normal subjects and vocal nodules. Observation of the movement to the vocal cord mucosa using a high speed camera, examining a mechanism of abnormal vibration by observing the motion of the vocal process was intended to clarify the cause of vocal nodules. Method: Five normal speech and 8 patients with vocal nodules were compared. High-speed cameras recorded the vocal cord vibration. Easy phonation, 3000 fps or 3333 fps. We are in the position of the vocal process 3 consecutive images of the period, direction, investigated the symmetry of left and right. Results: In normal vocal cords vocal process was symmetrical. (5/5 case) Swings from side to side width and vocal process was about the same for both sides. The direction of extension of the vocal process was assembled in the center of the vocal cords membranes. (5/5 case) The midline of the laryngeal vocal nodules vocal process was in a different position on the left and right (7/8 case). Swings were different width of the vocal process (6/8 case). The direction of extension of the right and left vocal process was different. Conclusion: In the normal group, parallel to the vocal cords vibrate in contact throughout the mucosa. Vocal nodule group was lateralized position of the vocal process. We thought to focus on one part of the mucous membrane contact between vocal cords. It was considered one of the pathogenesis of vocal nodules.