Eiji Yumoto, Ryosei Minoda, Masamitsu Hyodo, Takahiko Yamagata
Causes of recurrent laryngeal nerve paralysis.
Auris Nasus Larynx. 2002 Jan;29(1):41-5.
Abstract/Text
OBJECTIVE: Persistent hoarseness due to recurrent laryngeal nerve paralysis (RLNP) reduces the quality of life unless it is adequately treated. This study examined the indications for phonosurgical intervention in patients with RLNP.
MATERIALS AND METHODS: The medical records of the Ehime University Hospital, Ehime, Japan, from October 1976 until December 1997 were reviewed retrospectively to identify patients with RLNP. The data collected included age, gender, paralyzed side, and cause of paralysis.
RESULTS: Four hundred and sixty-six patients with RLNP were identified: 262 males and 204 females. Unilateral RLNP was present in 422 patients, while 44 presented with bilateral RLNP. The incidence was relatively high in the 7th and 8th decades, and was twice as high in male patients as in female patients. The 466 patients were divided into 2 groups: Group 1 included 225 patients seen before January 1987, and Group 2 included 241 patients seen after this date. The number of patients with postoperative RLNP was significantly higher in Group 2 (124 of 239 patients) than in Group 1 (65 of 227 patients) (P<0.05). Surgery for cardiovascular disease, esophageal cancer, and skull base and thyroid gland tumors contributed to this increased incidence of postoperative RLNP.
CONCLUSIONS: Patients with persistent unilateral RLNP require appropriate treatment for hoarseness, regardless of its cause. Since the incidence of RLNP related to surgery was significantly increased in Group 2, phonosurgery has become more important for improving the quality of life of these patients.
J A Sercarz, G S Berke, Y Ming, B R Gerratt, M Natividad
Videostroboscopy of human vocal fold paralysis.
Ann Otol Rhinol Laryngol. 1992 Jul;101(7):567-77.
Abstract/Text
Previous stroboscopic studies of human vocal cord paralysis have been infrequent and have lacked documentation of the site of lesion. In order to study human laryngeal paralysis, the recurrent and superior laryngeal nerves were infiltrated unilaterally with lidocaine hydrochloride in three human volunteers. Vagal paralysis was simulated by combined (superior and recurrent) infiltration in one volunteer. Additionally, 20 patients with untreated laryngeal paralysis were studied from the voice laboratory at UCLA. In addition to videostroboscopic analysis, photoglottography and electroglottography were performed and synchronized with the stroboscopic images. The most significant finding in stroboscopy of the paralyzed larynx was the asymmetry of traveling wave motion. The traveling wave on the normal vocal fold had a faster wave velocity that created a phase difference in the vibration of the two folds. The wave also traversed a greater distance along the vocal fold mucosa on the normal side. No patient or volunteer with untreated laryngeal paralysis had a symmetric traveling wave, either in superior or recurrent laryngeal nerve paralysis. Synchronization with glottography indicated that the differentiated electroglottographic waveform provides useful information about the timing of glottic opening and closure in states of asymmetric laryngeal vibration. Implications for future studies and for the diagnosis of laryngeal paralysis are discussed.
Eiji Yumoto, Koji Nakano, Yukio Oyamada
Relationship between 3D behavior of the unilaterally paralyzed larynx and aerodynamic vocal function.
Acta Otolaryngol. 2003 Jan;123(2):274-8.
Abstract/Text
OBJECTIVE: We used multi-slice helical computerized tomography (MSHCT) to evaluate the 3D characteristics of the laryngeal structures in patients with unilateral vocal fold paralysis (UVFP) during phonation, and compared the results with those obtained using an aerodynamic vocal function test.
MATERIAL AND METHODS: The subjects were 37 patients with UVFP. The region over the larynx was scanned during quiet phonation and again during inspiration using MSHCT, and 3D endoscopic and coronal reconstruction images were produced. Maximum phonation time (MPT) and mean airflow rate (MFR) during phonation were measured.
RESULTS: During phonation, the affected fold was thinner than the healthy fold in 30 subjects and located at a higher position than the healthy fold in 21 subjects. Abduction or thinning of the affected fold during phonation (paradoxical movement) was seen in seven subjects. MFR was significantly greater when the affected fold was thinner than the healthy fold during phonation, and MPT was significantly shorter when the affected fold showed paradoxical movement. Over-adduction of the healthy fold during phonation was present in 15 subjects. There were no significant differences in MPT or MFR between subjects with and without over-adduction.
CONCLUSION: The combination of MSHCT endoscopic and coronal reconstruction images enables the 3D characteristics of the unilaterally paralyzed larynx to be visualized during phonation, and some of these characteristics are significantly correlated with vocal function in patients with UVFP.
Eiji Yumoto, Yukio Oyamada, Koji Nakano, Yosiharu Nakayama, Yasuyuki Yamashita
Three-dimensional characteristics of the larynx with immobile vocal fold.
Arch Otolaryngol Head Neck Surg. 2004 Aug;130(8):967-74. doi: 10.1001/archotol.130.8.967.
Abstract/Text
OBJECTIVES: To evaluate the 3-dimensional (3-D) characteristics of the laryngeal lumen in patients with unilateral vocal fold immobility (UVFI) during phonation with the aid of multislice helical computed tomography (MSHCT).
DESIGN: A retrospective study.
SETTING: University hospital. Subjects Thirty-seven patients with UVFI.
INTERVENTIONS: Each subject was asked to sustain the vowel /a/ and then to inhale slowly. The region over the larynx was scanned using MSHCT during each maneuver for 5 seconds; 3-D endoscopic images and coronal multiplanar reconstruction images were produced and evaluated. Thirty-two subjects underwent videostroboscopy within 2 weeks of the MSHCT.
MAIN OUTCOME MEASURES: Presence of thinning and paradoxical movement of the affected vocal fold, overadduction of the healthy fold, and vertical positional difference between the vocal folds during phonation were assessed based on 3-D and multiplanar reconstruction images.
RESULTS: During phonation, the affected vocal fold was thinner in 31 subjects and was situated in a higher position in 21 subjects than the healthy fold. In 4 subjects, the affected vocal fold showed paradoxical movement and 3 other subjects had probable paradoxical movement. Overadduction of the healthy vocal fold occurred during phonation in 15 subjects. Videostroboscopy detected paradoxical movement in 2 of the 3 subjects with abduction of the affected vocal fold during phonation based on 3-D images, and overadduction in all 13 subjects examined.
CONCLUSIONS: The combination of 3-D endoscopy with coronal multiplanar reconstruction images enables description of the 3-D characteristics of the unilaterally immobile larynx and supplements videostroboscopic findings exemplified by differences in vertical position and thickness between the vocal folds.
日本耳鼻咽喉科学会 嚥下障害診療ガイドライン 発行：金原出版 2008年.
M R Amin, J A Koufman
Vagal neuropathy after upper respiratory infection: a viral etiology?
Am J Otolaryngol. 2001 Jul-Aug;22(4):251-6. doi: 10.1053/ajot.2001.24823.
Abstract/Text
PURPOSE: To describe a condition that occurs following an upper respiratory illness, which represents injury to various branches of the vagus nerve. Patients with this condition may present with breathy dysphonia, vocal fatigue, effortful phonation, odynophonia, cough, globus, and/or dysphagia, lasting long after resolution of the acute viral illness. The patterns of symptoms and findings in this condition are consistent with the hypothesis that viral infection causes or triggers vagal dysfunction. This so-called postviral vagal neuropathy (PVVN) appears to have similarities with other postviral neuropathic disorders, such as glossopharyngeal neuralgia and Bell's palsy.
MATERIALS AND METHODS: Five patients were identified with PVVN. Each patient's chart was reviewed, and elements of the history were recorded.
RESULTS: Each of the 5 patients showed different features of PVVN.
CONCLUSIONS: Respiratory infection can trigger or cause vocal fold paresis, laryngopharyngeal reflux, and neuropathic pain.
Eiji Yumoto, Tetsuji Sanuki, Yutaka Toya, Narihiro Kodama, Yoshihiko Kumai
Nerve-muscle pedicle flap implantation combined with arytenoid adduction.
Arch Otolaryngol Head Neck Surg. 2010 Oct;136(10):965-9. doi: 10.1001/archoto.2010.155.
Abstract/Text
OBJECTIVES: To describe a new technique of nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) to treat dysphonia due to unilateral vocal fold paralysis and to examine postoperative vocal function.
STUDY DESIGN: Retrospective review of clinical records.
SETTING: Tertiary academic center.
PATIENTS: Twenty-two consecutive patients underwent NMP flap implantation with AA and were followed up short term over a period of 1 to 6 months (mean, 2.9 months) and long term over a period of 7 to 36 months (mean, 21.4 months).
INTERVENTIONS: An NMP flap was made using an ansa cervicalis branch and a piece of the sternohyoid muscle. A window was opened in the thyroid ala at the level of the vocal fold. Then, AA was performed and the NMP flap was securely implanted onto the thyroarytenoid muscle through the window under microscopic guidance.
MAIN OUTCOME MEASURES: The maximum phonation time, mean airflow rate, pitch range, and acoustic parameters (jitter, shimmer, and harmonics to noise ratio) were evaluated before surgery and twice after surgery.
RESULTS: All parameters improved significantly after surgery (P < .01). The measurements for maximum phonation time, mean airflow rate, and harmonics to noise ratio were within normal ranges after surgery. Furthermore, the maximum phonation time and jitter were significantly improved after long-term follow-up compared with early postoperative measurements (P < .01 and P < .05, respectively).
CONCLUSIONS: Precise harvest of an NMP flap and its placement directly onto the thyroarytenoid muscle combined with AA provided excellent vocal function. The NMP method may have played a certain role in the improvement of postoperative vocal function, although further study with electromyographic examination is required to clarify the innervation status of the thyroarytenoid muscle.
湯本英二:耳鼻咽喉科の立場から－嚥下の仕組みとその障害、とくに誤嚥性肺炎への対処－. 日本胸部臨床 2009；68:829-839．.
湯本英二：両側声帯正中位固定症に対する声門開大術. 耳鼻咽喉科展望 2004；47:10-18．.
兵頭政光、西窪加緒里、森 敏裕:輪状咽頭筋切断術：適応とコツ. 口腔咽頭科 2006；18:319-323．.
Shun-Ichi Chitose, Kiminori Sato, Sachiyo Hamakawa, Hirohito Umeno, Tadashi Nakashima
A new paradigm of endoscopic cricopharyngeal myotomy with CO₂ laser.
Laryngoscope. 2011 Mar;121(3):567-70. doi: 10.1002/lary.21362. Epub 2011 Jan 19.
Abstract/Text
