Toshiyuki Kusuyama

Resolution of Vocal Fold Polyps With Conservative Treatment

OBJECTIVES Vocal fold polyp is generally thought to require surgical removal. However, a certain proportion of polyps resolve with conservative treatment. This study was performed to clarify the frequency of spontaneous resolution of vocal fold polyp and identify features associated with polyps that are likely to resolve without surgery. STUDY DESIGN Retrospective study. METHODS A review of the medical records of patients diagnosed with vocal fold polyps in Tokyo Voice Center from January 2001 to December 2008. RESULTS Of 644 patients with the diagnosis of vocal fold polyp, 132 received conservative treatment, 433 were treated surgically, and 79 dropped out without attending for further consultation after the initial visit. Of those treated conservatively, 55 experienced complete resolution after a mean of 5.1 months of follow-up from the outset, and 29 showed lesion shrinkage after a mean of 4.1 months of follow-up. Polyps that resolved with conservative therapy were more likely than those that remained unchanged or enlarged to occur in women, be smaller, and have a shorter duration of symptoms. We could not determine the superiority of voice therapy. CONCLUSIONS At least 9.7% of vocal fold polyps might resolve without surgery. Conservative treatment should be considered as an option for selected patients with smaller and more recent-onset polyps.

Primary Small Cell Carcinoma of the Larynx

Small cell carcinoma is a rare tumor of the larynx. We present such a case in a 78-year-old female. The histopathological diagnosis at the time of laryngomicroscopic biopsy was squamous cell carcinoma, upon which basis we initially chose surgical treatment. The surgical specimen, however, revealed small cell carcinoma. Despite the administration of radiotherapy and chemotherapy, the patient died 9 months after initial presentation. We believe that this case illustrates the need for a sufficiently large biopsy specimen in order to arrive at the correct histopathological diagnosis when small cell carcinoma of the larynx is present, and that immunohistochemistry and electron microscopy should be performed to aid the diagnosis.

Analysis of vocal fold vibration by x-ray stroboscopy with multiple markers.

OBJECTIVE: To derive a more precise description of vocal fold vibration, experimental phonation of excised canine larynxes was studied. STUDY DESIGN AND SETTING: Multiple X-ray-positive markers were inserted, and their vibratory movement was observed with x-ray stroboscopy with change of pitch and intensity. A histologic study was also carried out. RESULT: Regular waves were observed just above the lowest point of the lamina propria of the mucous membrane, which shifted upward at high pitch, but downward in high intensity. CONCLUSIONS: The starting point of the mucosal wave was confirmed on the lower surface of the vocal fold, histologically just above the lowest point of the lamina propria of the mucous membrane and shifted upward at high pitch, but downward in high intensity. SIGNIFICANCE: This is the first study investigating the starting point of mucosal wave in vocal fold vibration in a frontal plane using x-ray stroboscopy, providing the evidence for the body-cover theory.

Isolated vagus nerve paralysis associated with internal carotid artery dissection.

Dysphagia and hoarseness caused by laryngopharyngeal paralysis associated with internal carotid artery (ICA) dissection is rare. We reported a case which recovered spontaneously. A 57-year old man visited our hospital complaining of dysphagia and hoarseness lasting for two weeks. Paralysis of right vocal fold and rotational movement of the posterior pharyngeal wall toward the left side during swallowing were observed. Magnetic resonance imaging was performed under diagnosis of isolated right vagus nerve paralysis, and dissection of the right ICA was revealed. He was treated conservatively, and both of laryngopharyngeal movement and the ICA dissection were improved completely. There is a possibility that laryngeal paralysis caused by ICA dissection has been misdiagnosed as an idiopathic paralysis.

Newly Designed Specula for Laryngomicroscopy

We produced specula for laryngomicroscopy to observe blind spots in the operating field. Use of these specula has facilitated detailed observation of the lower surface of the false vocal folds, laryngeal ventricle, and subglottis, which were previously in blind spots. The specula are useful in the following ways: 1) clarifying blind spots for improved diagnosis and providing more accurate surgical margins; 2) observing the lower lips of the vocal folds in phonosurgery; and 3) Vaporizing with laser reflection. The specula are cheap and easy to use and are well worth considering for application to laryngomicroscopy.