Yuki Fujiwara

Peculiar snoring in patients with multiple system atrophy : Its sound source, acoustic characteristics, and diagnostic significance

It is known that abductor paralysis (AP) of the vocal folds sometimes occurs in patients with multiple system atrophy (MSA), and some of them have sleep apnea and loud snoring during sleep. However, the site of obstruction and the sound source of the snoring are still unknown. We performed fiberscopic examinations under diazepam sedation in 8 MSA patients with AP and analyzed the snoring sound. We found that the peculiar snoring occurred with inspiratory vibration of the vocal folds, and there was no obstruction in this portion. Acoustic analysis showed that the fundamental frequency of vocal fold snoring was 260 to 330 Hz, which is different from that of ordinary soft palate snoring. Recognition of vocal fold snoring is important in the early diagnosis of MSA and sleep-related breathing disorders.

Sleep Apnea and Sleep-related Breathing Disorders in Patients with Craniofacial Synostosis

Seventeen patients with craniofacial synostosis (CFS) have been treated at the Department of Plastic and Reconstructive Surgery at Osaka Medical College during the past 10 years. Six patients were thoroughly evaluated at the Department of Otolaryngology by polysomnography (PSG), cephalometric X-ray and nasopharyngoscopy during sleep. In 4 of the patients PSG showed obstructive sleep apnea syndromes (OSAS). Heavy snoring without apnea and paradoxical respiration were noted in the other 2 patients. Thus, all of the patients had sleep-related breathing disorders (SRBD). It is assumed that the incidence of SRBD in CFS is high. Cephalometric analysis and profilogram showed maxillomandibular hypoplasia in each patient, and it was assumed that the main cause of SRBD in CFS was stenosis of the upper airway tract caused by maxillo-mandibular hypoplasia. Nasopharyngoscopy was performed during sleep in 2 patients with OSAS secondary to CFS. One patient with adenotonsillar hypertrophy had nasopharyngeal obstruction and another patient whose posterior airway space (PAS) on cephalometric radiograph was 3 mm (normal value: 11 mm) had obstruction at the tongue base.

Limitation of vocal fold abduction only during sleep in a patient with Shy-Drager syndrome

(Editorial Comment: This patient had a vocal for normal vocal fold motion while awake, however, severe narrowing during sleep was attributed to multiple systemic atrophy. This report should alert physicians to another possible ediology for snoring and sleep disorder breathing.) Vocal fold palsy in patients with multiple system atrophy (MSA) was first reported by Bannister et all in 1967. Since then, there have been several more reports of vocal fold palsy in MSA.2-12 Vocal fold palsy in MSA patients without tracheostomies has attracted special attention recently because of the risk of sudden nocturnal death. However, the mechanism of vocal fold palsy has not been elucidated. Bannister et al1 and other investigators2J0 reported that alertness to the presence of sleep respiratory disorders may be life-saving, because this occasionally fatal respiratory complication may occur with vocal fold palsy. We had one patient with Shy-Drager syndrome who had severe laryngeal dysfunction while she was asleep, but no vocal fold palsy while she was awake. We report this rare case and our experience with the evaluation of laryngeal dysfunction while the patient was awake and asleep.

Cystic Parathyroid Adenoma. A Case Report.

Cystic parathyroid adenoma is rare. This report presents a 48-year-old female with primary hyperparathyroidism caused by cystic parathyroid adenoma.She was found to have hypercalcemia on laboratory examinations performed in the Department of Internal Medicine of our hospital during a search for the cause of her vertigo. Further examinations indicated a functioning parathyroid cyst. Ultrasonography and MRI scan showed that the cystic portion was sharply demarcated from the solid portion of the lesion in a parathyroid gland. The high level of plasma PTH decreased to normal after removal of the enlarged parathyroid gland. Histological examination demonstrated a secondary pseudocyst resulting from cystic degeneration of a parathyroid adenoma. Twenty-seven cases of functioning parathyroid cysts reported in the Japanese literature are reviewed. The clinical features and histological evidence of functioning parathyroid cyst are discussed.