Tokichiro Mitoma

Evaluation of velopharyngeal closure by CT scan and endoscopy.

Computerized tomography (CT) and endoscopy were used for the objective evaluation of velopharyngeal closure. In 19 patients with cleft palates and 9 normal subjects, CT scans of the velopharynx were made both at rest and during vowel phonation with a scanning time of 3.0 seconds and slicing width of 3 mm. At the same time, endoscopic observations of the velopharynx through the nose were carried out both at rest and during phonation. CT scan during phonation clearly demonstrated the mobility of the velopharynx, i.e., elevation of the soft palate, inward movement of the lateral pharyngeal walls, and protrusion of the posterior pharyngeal wall, in a single picture. Its disadvantage is exposure to x-rays and a rather complicated procedure. However, endoscopy is simple with no exposure to x-rays, but its disadvantage is occasional incomplete visualization because of the dead angle created by the elevated soft palate. Thus the combined use of CT and endoscopy can help to determine a rational choice of treatment for cleft palates.

Effect of adenoidectomy on eustachian tube function.

Adenoid vegetation has been considered to be one of the possible causes of otitis media with effusion (OME). Judging from endoscopic findings of the nasopharynx of children with OME, mechanical compression of the adenoid against the pharyngeal orifice of the Eustachian tube appears to result in dysfunction of the tube. However, accumulated clinical experience has revealed that adenoidectomy is not always effective for OME. In this study an attempt was made to assess the effect of adenoidectomy upon the Eustachian tube and middle ear function in children with OME. First, the effect of adenoidectomy on hearing was evaluated in comparison with other combined surgical procedures such as insertion of a ventilating tube and myringotomy. Second, the influence of adenoidectomy on the ventilatory function of the Eustachian tube was examined before and immediately after adenoidectomy.

Effect of adenoidectomy on Eustachian tube function of children with otitis media with effusion.

To evaluate the effect of adenoidectomy on Eustachian tube function, opening pressure was measured before and immediately after adenoidectomy and every month for 5 months in 10 children, and the inflation-deflation test was performed every month for 6 months after the insertion of tympanostomy tubes in 42 children.The following results were obtained: 1) opening pressure decreased immedeately after adenoidectomy in about half of the children, 2) inflation-deflation test results did not improve after adenoidectomy, at least for 6 months, 3) children with adenoid hypertrophy failed to respond to the inflation-deflation test at all, while 20% of the children treated with adenoidectomy showed a positive response to the test. One can conclude that children with adenoid hypertrophy should be treated with adenoidectomy.

Effect of adenoidectomy on hearing of children with otitis media with effusion.

Adenoid vegetation has been considered to be one of the causes of otitis media with effusion (OME), but our clinical experience and studies by other researchers have revealed that adenoidectomy is not always effective in the treatment of OME. In this study, an attempt was made to assess the effect of adenoidectomy upon hearing. Forty-five children with OME (76 ears) ranging in age from 3 to 9 years were treated by adenoidectomy, insertion of tympanostomy tubes, myringotomy, or a combination of these procedures, and followed for 6 months.Children treated with adenoidectomy and insertion of tympanostomy tubes and children without adenoid hypertrophy treated with insertion of tympanostomy tubes showed marked improvement of hearing, but in children with adenoid hypertrophy treated with either insertion of tympanostomy tubes or adenoidectomy hearing was not improved. The hearing of children with adenoid hypertrophy treated with adenoidectomy and myringotomy grew worse for 2 or 3 months but then improved.This study indicates that children with OME and adenoid hypertrophy should be treated with adenoidectomy as well as insertion of tympanostomy tubes.