Yasuo Koike

Restoration of voice after laryngeal surgeries

Some aspects of speech deficiency in Japanese‐speaking patients who had undergone surgeries for laryngeal malignancy were studied. Surgical procedures included reconstructive surgeries after total laryngectomy and conservation surgeries. A series of listener‐judgments and some acoustic analyses of speech were made. The recorded voices of the patients were more or less hoarse. The median speaking pitch varied greatly from patient to patient, and often assumed an unusual value. The average articulation score for five Japanese vowels was computed for each subject. The score varied from patient to patient, and was thought to be useful in quantitatively evaluating speech quality. It was shown that certain glottal consonants such as /h/ can be affected by laryngeal surgeries. It was emphasized that the larynx should be regarded not only as a generator or a vibrator, but also as an articulator which produces consonants. The listening tests also revealed that the intonation pattern of Japanese two‐syllable nouns can be influenced by laryngeal surgeries, and that distinction among certain words may become impossible as a result. This type of speech problem may require serious consideration in some language environments.

Subtotal pharyngolaryngectomy conservation surgery for carcinoma of sinus pyriformis extending toward the larynx

SummaryIn newly developed surgery for pyriform sinus tumor extending toward the larynx, the supraglottic portion of the larynx and the vertical half of the larynx on the tumor side are included in the area of resection. The arytenoid and cricoid cartilages on the tumor side and the vertical half of the hypopharyngeal wall are resected.Three out of seven patients remain cured at the end of 5 years and this ratio is the same as that for total pharyngolaryngectomy for pyriform sinus tumor.The resulting voice is somewhat hoarse, however, verbal communication is not remarkably affected.It is concluded that in surgical repair for pyriform sinus tumor extending toward the larynx, subtotal pharyngolaryngectomy is the procedure of choice to preserve the laryngeal function and anticipate reasonable prospects for a cure.

Mucosal Blood Volume and Oxygen Saturation in the Human Vocal Fold

With a newly developed spectrophotometric analyzer we were able to measure hemoglobin (Hb) concentration and its oxygen saturation in the human vocal and ventricular folds. Studies were made on 30 subjects including 18 normal controls. In laryngomicrosurgery under general anesthesia, measurements were made with a fiber probe touching the laryngeal mucosa. Results were as follows: In normal mucosa of the vocal fold, the mean value of IHb was 40 and the ISO2 was 55, while in that of the ventricular fold, the mean values were 74 and 56, respectively. Thus, in spite of the influence of general anesthesia, the mucosal blood volume was lower in the vocal fold than in the ventricular fold. The mean value of IHb was 30 in the vocal fold polyps, 122 in the vocal fold nodule, 43 in the polypoid degenerations, 17 in the vocal fold cyst, 62 in the granuloma, 6 in the sulcus vocalis and 19 in the hyperkeratoses. This method is considered useful for objective and quantitative analysis of pathological conditions in the vocal fold.

Biofeedback Rehabilitation in a Patient with Severe Bell's Palsy as Prophylactic Treatment for Synkinesis.

Synkinesis of the facial muscles are common sequelae of peripheral facial nerve palsy. However, treatment for synkinesis is limited. The case of an 18-year-old woman with right-sided Bells palsy is reported. An electroneurography (ENoG) test showed complete degeneration of the facial nerve on the right side. There was a good possibility that the patient would eventually be troubled by synkinesis. As prophylactic treatment for the prevention of synkinesis, biofeedback rehabilitation was undertaken using a mirror and electromyography. Subsequently, the patient showed no simultaneous activation of the orbicularis oculi during mouth movements, which is the most common clinical symptom of Synkinesis. It is proposed that biofeedback rehabilitation is an effective prophylactic treatment for synkinesis.

Enzyme-Histochemistry of Muscle Spindles in Human Intrinsic Laryngeal Muscles

Muscle spindles were investigated using enzyme histochemistry in serial sections of human intrinsic laryngeal muscles obtained from surgical specimens. Muscle spindles were demonstrated in the middle one third of each laryngeal muscle. Five muscle spindles were observed in the interarytenoid, three in the posterior cricoarytenoid, two in the cricothyroid and thyroarytenoid, and one in the lateral cricoarytenoid. The maximum width of the muscle spindles ranged from 35 to 150 rim. Each muscle spindle contained three to eight intrafusal fibers, and the intrafusal fibers ranged from 7.7 to 15.6 pm in diameter. On the basis of enzyme reactivity, intrafusal fibers could be classified into three kinds of muscle fiber, nuclear bags fibers, nuclear bag2 fibers and nuclear chain fibers, which is the same classification observed in other skeletal muscles.

The Role of Leukotriene in Otitis Media with Effusion in Children

Children with otitis media with effusion (OME) were divided into two groups : a group administered Oxatomide which had anti-leukotriene (LT) effects (Oxatomide-administered group) (17 cases, 17 ears) and a control group (15 cases, 16 ears), and the concentrations of LTC4, LTD4 and LTE4 in middle ear effusion were measured by radioimmunoassay. In the Oxatomide-administered group, the LTC4 concentration was 28.7 ± 15.3 picograms per milligram of total protein (pg/mgTP) and total concentration of LTD4 and LTE4 (LTD4 + LTE4 concentration) was 80.3 ± 53.8 pg/mgTP. On the other hand, in the control group, the LTC4 concentration was 50.5 ± 42.5 pg/mgTP and the LTD4 + LTE4 concentration was 288.2 ± 144.6 pg/mgTP. The LTD4 + LTE4 concentration was significantly lower (p < 0.001) in the Oxatomide-administered group than in the control group, and duration of treatment for OME showed a tendency to be shorter in the Oxatomide-administered group than in the control group. On the basis of these results, it was suggested that LTD4 and/or LTE4 might be related to the prolongation of OME.

Hearing Conservation of Noise Exposed Employees in Paper Manufactoring

Acting on a government guideline enacted in 1992, hearing examinations were performed on 492 employees working at a noise exposed manufactoring plant. Audiometry revealed 221 cases of noise-induced hearing losses (44.9%), and 54 abnormal findings (11%). In the latter cases, 29 patients with neural and 9 with conductive hearing loss were identified on additional otological tests. In the noise-induced hearing loss group, 95% of the subjects were grade I . The longer the workers were exposed to noise, the greater was the hearing loss. One hundred and fifty of the 221 cases of noise-induced hearing loss were aware of their hearing disturbance, tinnitus or both. In spite of these problems, the proportion of sound-proofing users increased only gradually. Howerer, the proportion of sound-profing users was not high (57.9%), and thus this could be improved. The noise levels of this factory were reduced to below Leq 90 dB (A), and the work environment were improved. We conclude that education on hearing health and the greater usage of sound-proofing is important in preventing hearing impairments.

Clinical Efficacy of Clarithromycin Therapy for Chronic Sinusitis and Secretory Otitis Media in Children.

The clinical efficacy of clarithromycin was investigated in 34 children with chronic sinusitis, and 36 children with secretory otitis media accompanied by chronic sinusitis.1) Rhinoscopy showed reduced nasal mucosal swelling in 74.2%, decreased nasal discharge in 78.5%, decreased postnasal drip in 89.3% and improved quality of nasal discharge in 88.6%. Follow up X-ray films showed improved opacity of maxillary sinuses in 81.6%.2) There was improvement in 71.4% in the appearance of the tympanic membrane and in 66.7% in that of the tympanogram.3) The rate of clinical efficacy was 88.6% (marked improvement, 54.3%; some improvement, 34.3%) for chronic sinusitis and 79.6% (marked improvement, 38.8%; some improvement, 40.8%) for secretory otitis media.4) No side effects were observed.On the basis of these results, clarithromycin was judged to be useful in the treatment of children with chronic sinusitis and with secretory otitis media accompanied by chronic sinusitis.

Clinical Studies on Roxithromycin Treatment of Chronic Sinusitis.

Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.

A Study on Cricothyroid Muscle Activities During Carbon Dioxide Inhalation

Hirofumi Kihara, Shin-ya Ohtsu, Yoshizumi Wada, Jiro Udaka, Tatsuya Ishida and Yasuo Koike Several studies of the activity of human cricothyroid muscles during sleep have been reported. Eight adults in good health aged 36 to 61 years were subjected in this study. The activity of the cricothyroid muscle was investigated during sleep and the influence of carbon dioxide inhalation upon the cricothyroid activity was electromyographically determined. During sleep, a slight degree of cricothyroid activity was observed for inspiration. Carbon dioxide inhalation caused an increase in the cricothyroid activity during inspiratory phases.