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A new method of dynamic reconstruction by suturing the cricothyroid (anticus) and the lateral cricoarytenoid (lateralis) muscles was devised for the treatment of unilateral recurrent laryngeal nerve paralysis. Eighteen adult dogs underwent this surgical procedure after sectioning a recurrent laryngeal nerve. Immediate postoperative observations revealed a marked increase in tension of the paralyzed vocal cords and remobilization to the median line of 17 of 18 dogs. More than 4 months later, fiberscopic examination revealed a satisfactory adduction of the cords. Electrophysiologic and histologic examination showed reinnervation of the affected lateralis muscle by the external branch of the superior laryngeal nerve. The clinical applications of this surgery may serve as a dynamic reconstruction for unilateral recurrent laryngeal nerve paralysis.

We have devised a new surgical method that sutures the cricothyroid (anticus) muscle to the paralyzed lateral cricoarytenoid (lateralis) muscle for the dynamic reconstruction of the larynx. Because this method achieved remobilization of the paralyzed vocal cord in dogs, we applied it to seven patients with unilateral recurrent laryngeal nerve paralysis (four patients had postsurgical paralysis and three patients had idiopathic paralysis). We obtained the following satisfactory results: (1) vocal cord tension and voice quality improved in all patients, and (2) in four patients, remobilization of the paralyzed vocal cord was obtained. We believe that this surgical method could serve as a new dynamic method of reconstruction for the treatment of unilateral recurrent laryngeal nerve paralysis.

The speech comprehension ability of patients with a cochlear implant is fairly good even when information from the implant device is insufficient. It is presumed that the higher brain system has important roles in discriminating speech. The purpose of the present study was to investigate the function of the auditory cortices of a patient with a cochlear implant before and after sound signal inputs. In this study, we used positron emission computed tomography, which can detect brain activity by providing quantitative measurements of the metabolic rates of oxygen and glucose. Without sound signals, the auditory cortices of the patient showed remarkably low metabolic rates. However, with the cochlear implant device, the activity returned to near normal levels. These findings suggest that the activation of the speech comprehension mechanism of the higher brain system can be initiated by sound signals from the implant device.

Using a fine, rigid endoscope (Olympus, SES-1711K), we examined the middle ear, including the tympanic orifice of the eustachian tube, of children with otitis media with effusion (OME) in its active stage (26 ears), in the convalescent stage (13 ears), and during treatment with ventilation tubes for 10 days to 6 months (five ears) through myringotomy with the patients under general anesthesia. Several color photographs of representative ears are shown. In the active stage of OME, edema (73.1%) and hyperemia (23.1%) were characteristic features of the middle ear mucosa, and normal mucosa was seen in only one ear (3.1%). The tympanic orifice of the eustachian tube, which could be examined in 12 ears, were stenosed with edema in four ears (33.3%) or plugged with effusion in three ears (25.0%) in this group. In the convalescent stage of OME, dilated vessels were most often seen (69.2%), but the rest of the patients had normal mucosa (30.8%) in the middle ear, and none of them had edema nor hyperemia. The tympanic orifice of the eustachian tube, which could be examined in five ears, was clearly patent in all the patients in this group. One ear that was treated with a ventilation tube for 1 month showed dilated vessels and less severe inflammation than did ears that were in the active stage of OME, and three ears that were treated for more than 3 months showed almost normal middle ear mucosa.

In an attempt to remobilize a unilaterally paralyzed vocal cord, experiments were made in five adult dogs. Adduction of the paralyzed vocal cord for phonation in synchrony with the intact cord was achieved by electrical stimulation of the adductor muscles that was triggered by the signals from the cricothyroid muscle. The difference in the level of action potentials of the cricothyroid muscle between during phonation and during respiration was used for setting the threshold so as to differentiate phonation from respiration. Nearly synchronous movement of the two vocal cords thereby attained during phonation greatly improved the voice quality that was hoarse without the paced stimulation.

Autonomic innervation of the mucosa in the pharynx was investigated by the horseradish peroxidase retrograde tracer method. The pharynx was divided into three regions, the epipharynx, mesopharynx, and hypopharynx. The epipharynx was sympathetically innervated by the fibers originating in the ipsilateral superior cervical ganglion and parasympathetically innervated by the fibers originating in the bilateral pterygopalatine ganglia. The mesopharynx and hypopharynx were sympathetically innervated by the fibers originating in the superior cervical, middle cervical, and stellate ganglia but not innervated by the pterygopalatine ganglion. The sympathetic innervation of the mesopharynx and hypopharynx was considered bilateral and predominant in the ipsilateral side. Comparing these two regions, the hypopharynx showed a tendency to be more innervated by the middle cervical and stellate ganglia.

Magnetic resonance (MR) imaging of the eustachian tube (auditory tube) was performed in normal subjects and in a patient with nasopharyngeal carcinoma. The MR images obtained in an anteriorly tilted transaxial plane parallel to the eustachian tubes were compared with serial slices of a cadaver specimen. The eustachian tube cartilage, mucous lining of the eustachian tube, the lateral pharyngeal recess, the tensor veli palatini muscle, and the levator veli palatini muscle were identified in MR images using anatomical relationships. A patient with nasopharyngeal carcinoma is described to demonstrate an example of topographical morbid changes appearing around the eustachian tube.

To determine the reason for the high incidence of nasal sinusitis in patients with cleft palate, the type of cleft, degree of nasal septal deviation, velopharyngeal function, and presence of pharyngeal flap were investigated in relation to nasal sinusitis. We also examined the relationship between the side of sinusitis and the cleft side in patients with unilateral cleft palate. Development of maxillary sinus, nasal mucociliary transport, and ciliary beating frequency of ciliated cells were also examined. The saccharin test indicated that nasal mucociliary transport was impaired. This impairment is believed to be one of the reasons for the high incidence of sinusitis in patients with cleft palate.

The effects of transtympanic iontophoresis of corticosteroids and antibiotics on otitis media with effusion (OME) were investigated. An experimental study using guinea pigs revealed that transtympanic passage of dexamethasone sodium phosphate and fosfomycin sodium by iontophoresis had sufficient anti-inflammatory and antimicrobial effects. Twenty children with OME (33 ears) who were treated by iontophoresis were compared with 28 untreated children with OME (35 ears) with respect to improvement assessed by tympanoaudiometry. After one month, tympanoaudiometry revealed improvement in 21 (63.6%) of the treated ears but in only 13 (37.1%) of the untreated ears, indicating the efficacy of this treatment for OME.

A study was performed to detect primary and secondary deficits in eustachian tube (ET) function in children with otitis media with effusion (OME). We examined ET function in the active and convalescent stages of OME in a total of 103 children (141 ears) and compared the results with those obtained in a control group of 34 ears. There were 27 children (33 ears) with OME in the convalescent stage and 76 children (108 ears) in the group with active OME. The test of ET function included the inflation-deflation test and dye clearance test. No cases of abnormally high tubal opening pressure were found in the convalescent OME group, and only 11% of ETs in the active OME group had high pressure. Negative middle ear pressure equalizing function, which was impaired in 97.2% of ETs in the active OME group, was still found to be impaired in 93.9% of ETs in the convalescent OME group. Eustachian tube clearance was impaired in 64.0% of ears with OME in the active stage; this percentage decreased considerably to 36.0% in ears in the convalescent stage of OME. We conclude that poor ability to equalize negative pressure is a fundamental deficit of ET function in OME; impaired clearance function of ET in the active stage of OME is not considered to be a primary cause of OME; there is almost no organic obstruction or stenosis of the ET in patients with OME.

In 35 patients with nasopharyngeal carcinoma that occupied the fossa of Rosenmüller, the relationship of the tumor, assessed by computed tomographic scans, to otitis media with effusion and ventilatory function of the eustachian tube was examined. Incidence of otitis media with effusion was low when the tumor was limited to the fossa of Rosenmüller (stage I), and high when the tumor extended from the fossa to the parapharyngeal space (stage II). Passive opening of the eustachian tube remained normal until the tumor occupied the parapharyngeal space (stage III). However, active tubal opening was impaired in stage I and the impairment increased with the tumor stage. These results indicate that tumor extension from the fossa of Rosenmüller to the parapharyngeal space and resultant poor active tubal opening cause the development of otitis media with effusion in patients with nasopharyngeal carcinoma.