Yoshio Hirade

Acoustic Analysis of Pathological Voice: Some Results of Clinical Application

Tape-recorded voices of 30 patients were acoustically analysed: 10 had glottic Tla carcinoma, 10 unilateral vocal fold polyp and 10 unilateral recurrent laryngeal nerve paralysis. The carcinoma cases were treated with laser surgery with/without radiotherapy, the polyp cases with endolaryngeal microsurgery and the paralysis cases with intrafold silicone injection. The acoustic analysis was conducted before and after the treatment for each patient. Three acoustic parameters, viz. pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and normalized noise energy (NNE), were employed. The results were as follows: (1) PPQ and APQ were greater in paralysis cases than in carcinoma and polyp cases; (2) none of the parameters was useful in differentiating the three disease groups investigated; (3) all three parameters proved to be useful in monitoring the effects of treatments; (4) all three parameters were positively correlated to the grade of hoarseness, rough and breathy quality of hoarseness, mean airflow rate and regularity of vocal fold vibration viewed under stroboscopy; (5) PPQ, APQ and NNE were positively related to each other.

CO2 Laser for Treating Glottic Carcinoma

Fifty cases of glottic carcinomas treated with CO2 laser were reviewed. The recurrence rate was fairly high (19/50), especially in T1b and T2 cases. The recurrences were successfully treated in all but 1 case who refused treatment. The 3-year crude survival rate was 92% and the 3-year determinate survival rate was 98%. The ultimate voice conservation rate was 100% for T1a, 76% for T1b and 71% for T2 cases. The results led us to the following conclusion: (1) glottic T1a carcinomas can be eradicated with laser excision biopsy preserving good vocal function; (2) for glottic T1b and selected cases of T2, laser debulking followed by radiotherapy is one of the best choices of treatment.

Improved Surgical Technique for Epidermoid Cysts of the Vocal Fold

An improved surgical technique for epidermoid cysts of the vocal fold is presented. This technique employs a specially designed double-bladed elevator. Following betamethasone injection around the cyst, an incision is made posterior to the cyst at its mediolateral midpoint. The incision is extended anteriorly over the cyst with the use of a double-bladed elevator. The cyst then is elevated carefully from the surrounding tissue and removed. A single incision line on the upper aspect of the vocal fold should be the result. Eight patients were operated on with the present technique. The voice was improved postoperatively in all patients. The voice improvement was reflected objectively in stroboscopic findings, maximum phonation time, airflow rate, fundamental frequency and intensity of phonation, and results of acoustic analyses of voice.

Epithelial Hyperplasia of the Larynx. A 10-Year Review of 88 Patients

A retrospective review of 88 patients with epithelial hyperplasia of the larynx seen at the Department of Otolaryngology Kurume University during the 10-year period from 1971 to 1980 was completed. The results are summarized as follows: 1) The incidence was much higher in males (78 patients) than in females (10 patients). 2) The average age was 56.8 years. 3) The lesion was located on the vocal fold in 84 cases, the ventricular fold in 3, and both vocal and ventricular folds in 1. 4) Fifty-three patients underwent surgical treatments in our hospital. Three of them developed recurrence and 6 developed carcinoma. 5) On histological re-examination, the lesions were classified into three types: simple hyperplasia (Type I), dysplasia (Type II) and carcinoma (Type III). No relationship was found between the macroscopic appearance and the histological type.

A REVIEW OF CO2 LASER SURGERY FOR CARCINOMA OF THE LARYNX

During the period from 1978 to August, 1984, 66 patients with carcinoma of the larynx were treated with the use of CO2 laser at Kurume University Hospital. Results are summarized as follows: 1)Thirty patients who had no previous treatments were treated with laser alone. Of the 30, 3 were Tis cases, 18 were Tla, 7 were Tlb, 2 were T2. Nine patients developed recurrence. 8 patients received second treatments and they are alive with no evidence of disease. The other rejected to have further treatment and died of an intercurrent disease. 2)Thirty-two patients who had no previous treatments were treated with laser and radiotherapy. Of the 32, 10 were T1a cases, 14 were T1b cases, 8 were T2 cases. Seven patients developed recurrence. They were further treated with varying modalities and are alive without any evidence of disease. 3)Four patients were radiation failure. Three of them were rT1a and 1 was rT1b. They were treated with laser alone. Three are alive and the other died of an intercurrent disease. None of the 4 developed local recurrence.