Tomoyuki Haji

Thyroplasty for Adductor Spasmodic Dysphonia: Further Experiences

Objectives Two different surgical techniques for midline lateralization thyroplasty (type 2 thyroplasty) for adductor spasmodic dysphonia (SD) have been described, one using a composite graft and the other without. Indications and results for each method among different types of SD were compared, together with the theoretical background for the surgery.

Mechanical properties of the vocal fold : stress-strain studies

The viscoelasticity of the vocal and ventricular folds was experimentally assessed by analyzing the stress-strain relationships obtained using a newly developed measuring system. The degree of stiffness of the mid-membranous portion of the vocal fold was less than that near the anterior commissure or the vocal process. The ventricular fold was much less stiff and significantly more viscous than the vocal fold. At the membranous portion of the vocal fold, the degree of stiffness was less and that of viscosity greater at 2 mm above and below the free margin than at the free margin itself.

Frequency and amplitude perturbation analysis of electroglottograph during sustained phonation

Electroglottography (EGG) was used to monitor vocal fold vibration patterns in normal subjects and patients with various laryngeal disorders. In order to evaluate the regularity of vocal fold vibration, frequency and amplitude perturbation of EGG waves during sustained phonation were measured with a laboratory computer. The data were compared to the degree of hoarseness evaluated by auditory perception and by sound spectrographic analysis. Frequency and amplitude perturbation measures showed some overlap between normal and pathological groups. However, there was a close relation between perturbation analysis of EGG waves and degree of hoarseness (Spearmans rank correlation coefficient rs = 0.73, p less than 0.0005). Amplitude perturbation was found to be a more sensitive measure of the irregularity of vocal fold vibration than frequency perturbation.

Voice analysis of the partially ablated larynx: a preliminary report

This study attempts to obtain a data base of objective information on the phonatory characteristics of the partially ablated larynx. Twenty patients who had previously undergone partial laryngectomy with glottic reconstruction underwent videolaryngoscopy. The visualizations obtained revealed that the mechanism of voice production was due in part to sphincterization and compensatory hypertrophy of glottic and supraglottic remnants. Aerodynamic and phonatory function tests together with acoustical and perceived voice quality analyses of these partially ablated larynges tend to corroborate the videotape impressions in many instances. However, data accumulated thus far only reveal trends that cannot yet be subjected to definitive interpretations. With the incorporation of other methods of evaluation, augmented by the inclusion of more patient material, it is hoped that the information obtained can be used to improve reconstructive techniques, monitor surgical results, and enhance methods of voice rehabilitation in these patients.

Role of the Tensor Tympani Muscle in Eustachian Tube Function I

In order to determine the role of the tensor tympani muscle in Eustachian tube function, pressure changes in the external and middle ear of 13 cats were measured under four experimental conditions. It was revealed that contraction of the tensor tympani muscle during swallowing did not result in any tympanic pressure rise which might assist in tubal ventilation. Acoustic stimulation was then used to measure consistent contraction of the tensor tympani muscle. Combined contraction of the tensor veli palatini and tensor tympani muscle under the condition of positive tympanic pressure failed to open the tube. It was concluded that the tensor tympani muscle might not play any part in tubal function.

Acoustic radiation force impulse imaging for reactive and malignant/metastatic cervical lymph nodes.

The aim of this study was to compare lymph node stiffness using acoustic radiation force impulse (ARFI) imaging in patients with cervical lymph node swelling. Forty-two cervical lymph nodes (reactive, n = 22; metastatic, n = 20) from 19 patients (13 men, 6 women; mean age, 63.68 ± 14.9 y; range, 23-85 y) were examined between September 2011 and March 2012. The shear wave velocity (SWV, m/s) of each lymph node was evaluated by ARFI imaging. SWV of reactive lymph nodes was 1.52 ± 0.48 m/s, and that of metastatic/malignant lymph nodes was 2.46 ± 0.75 m/s. A SWV > 1.9 m/s was very useful metastatic lymph node classification, with 95.0% specificity, 81.8% sensitivity and 88.0% overall accuracy. The area under the receiver operating characteristic curve was 0.923 (95% confidence interval, 0.842-1.000). ARFI imaging can be useful in the differentiation of reactive and malignant/metastatic cervical lymph nodes.

Facial Nerve Stimulation Through Stensen's Duct

We report on a new method of stimulating the facial nerve through Stensens duct. Electrical resistance of the skin and subcutaneous tissue is one of the major problems of neurophysiological facial nerve testing. To overcome this disadvantage, the authors show that the facial nerve can be stimulated with far less current through Stensens duct. The NET, ENoG, and antidromic facial nerve responses are recordable at less than a third of the current required for conventional percutaneous stimulation. It is our belief that nerve stimulation through Stensens duct will be a new and useful method for assessing facial nerve dysfunction in the early stage of palsy.

Eustachian tube patency detected by a photoelectric method

A method was developed to observe tubal orifice movement by fiberscope and detect patency of the eustachian tube by a photoelectric device (phototubometry). A highly sensitive photodiode in the external ear canal detected tube opening as increased luminosity in the tympanic cavity from a light source placed at the pharyngeal portion of the eustachian tube. The phototubometric record was superimposed on a TV screen to compare the opening in the pharyngeal portion of the eustachian tube to the tube opening during swallowing. The phototubometric records of 21 normal subjects examined by phototubometry showed the close relationship with the opened tubal lumen at the tensor veli palatini muscle (TVP) attached portion. This method is useful for examining tubalpatency and observing changes in the pharyngeal portion of the eustachian tube.

Functional Results of Reinke's Edema Surgery Using a Microdebrider

Objectives: We evaluated the functional results of Reinkes edema surgery using a microdebrider. Methods: In this prospective nonrandomized study from 2004 through 2008, functional surgery using a microdebrider was performed on patients with severe Reinkes edema. Comparisons were conducted for preoperative and postoperative phonatory function using both subjective grade (G), roughness (R), breathiness (B), asthenia (A), and strain (S) scoring and objective Multi-Dimensional Voice Program parameters. Statistical analysis was done by paired t-test, and a p value of less than 0.05 was considered significant. Results: Seventeen patients were enrolled in this study, with a median age of 56 years and a median observation period of 129 days. The male-to-female ratio was 1 to 2.4. No major complications were observed in the perioperative period. Significant improvement was observed in the subjective values of G, R, B, and S. Improvement was also observed in the fundamental frequency, pitch perturbation quotient, and amplitude perturbation quotient calculated by the Multi-Dimensional Voice Program. Conclusions: The microdebrider is a useful tool in functional surgery for severe Reinkes edema and gives good functional outcomes. Surgeons can swiftly complete the key steps of removing pathological submucosal tissue and preserving the normal epithelium with an excellent surgical view.

A Case Report of Aspergillosis of the Larynx

Mycosis localized in the larynx is relatively rarely observed, and only a small number of cases have been reported. We encountered a 69-year-old male with laryngeal mycosis due to Aspergillus. He visited our department due to hoarseness/abnormal laryngeal sensation. At the first consultation, electronic laryngoscopy showed a white lesion anterior to the membranous portions of the bilateral vocal folds. Based on the results of biopsy, a diagnosis of laryngeal aspergillosis was made. He was treated with the oral administration of an antifungal drug on an outpatient basis, and showed a tendency toward improvement, however, the fungus partly remained, and additional resection was performed using a laser by laryngo-microsurgery. He has since remained under follow-up observation.