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Objectives: This study aimed to identify vocal fold leukoplakia (VFL) lesions on the inferior surface as a risk factor for recurrence. Methods: This was a retrospective study with data collected from 2001 to 2018. The study comprised 37 patients with VFL, divided into the nonrecurrent and recurrent groups. We examined the clinicopathological characteristics and the surgical procedures performed in each patient. Results: Among the 37 patients, 15 (40.5%) had residual (3) or recurrent (12) VFL. Of those patients with and without recurrence, 8 of 12 (66.7%) and 6 of 22 (27.3%), respectively, had inferior surface lesions of the vocal fold at the initial operation ( P = .036). Recurrences were significantly higher in patients with inferior surface lesions. Other evaluated factors did not show significance for recurrence. Conclusion: The presence of VFL lesions on the inferior surface is a significant risk factor for recurrence.

Recurrent respiratory papillomatosis (RRP) is a disorder characterized by the frequent recurrence of benign neoplasms in the respiratory tract. Some patients with RRP develop laryngeal papilloma, while others present with extralaryngeal lesions in the nose, pharynx, and trachea. The present study aimed to determine the pharyngeal sites where RRP-related lesions develop more frequently.We retrospectively reviewed the medical records of 127 patients treated at our department between January 2015 and December 2020. We compared the human papilloma virus (HPV) infection status and differences in tumor location between 41 patients with RRP and 86 patients with pharyngeal papilloma (PP).In the RRP group, extralaryngeal papillomata were observed in 10 patients, eight (19.5%) of whom presented with lesions in the inferior wall of the nasopharynx (IWoN). On the contrary, only one patient with PP (1.1%) developed papillomata in this region. IWoN papilloma was significantly more likely to arise in the RRP group than in the PP group (p = 0.0004).In RRP, pharyngeal lesions frequently arise in the IWoN, while this region remains largely unaffected in patients with PP.

Objective To develop a summary of the first version of the Clinical Practice Guideline of Voice Disorders for Diagnosis, Management, and Treatment in Japan by the Clinical Practice Guideline Committee of the Japan Society of Logopedics and Phoniatrics and The Japan Laryngological Association. The 2018 recommendations, based on a review of the scientific literature, are intended to serve as clinical practice guidelines for the diagnosis, management, and treatment of voice disorders in Japan. Methods A summary of the original version of the Clinical Practice Guideline of Voice Disorders for Diagnosis, Management, and Treatment in Japan was described. Recommendations for the diagnosis, management, and treatment of voice disorders were prepared. Twelve clinical questions (CQs) regarding the diagnosis, management, treatment, and effectiveness of therapy for voice disorders were also prepared. Results A summary of the first version of the clinical practice guidelines for the diagnosis, management, and therapy of voice disorders was prepared and is presented. Additionally, answers to the 12 CQs on the diagnosis, management, treatment, and effectiveness of voice disorder therapy were prepared, and include evidence-based recommendations. Conclusion These guidelines present a summary of the standard approaches for the diagnosis and treatment of voice disorders and relevant CQs that consider the medical environments in Japan. We hope that the guidelines will assist physicians in clinical settings for patients with voice disorders.

Objective To examine whether human papilloma virus (HPV) vaccination in combination with surgical resection could suppress recurrence for an extended period of time in patients with recurrent respiratory papillomatosis (RRP). Methods In a prospective case series, data of patients who received combination therapy comprising surgery and quadrivalent HPV vaccination (Gardasil; Merck & Co., West Point, PA) were collected. Patients were followed up for RRP from March 2012 to July 2018 in an academic tertiary care center. The patients comprised 16 adults with RRP who were observed for >12 months after HPV vaccination, and whose HPV-DNA status was tested before and for >12 months after completion of combination therapy. The outcomes of this study were the severity score of larynx disease, tumor incidence rate, and relationship between this rate and HPV-DNA negative conversion after therapy. Results The severity score of laryngeal disease significantly decreased from before combination therapy to the time of final examination (P = 0.00045). The tumor incidence rate decreased to approximately 20% during the period from 12 to 47 months after HPV vaccination. Regarding HPV-DNA status in the final test results of each patient, 12 of 16 (75%) patients showed negative conversion; these 12 were significantly less likely to experience recurrence than patients who persistently tested positive for HPV-DNA during the period between 12 and 47 months after vaccination. Conclusion HPV vaccination prevented recurrence associated with RRP surgery for 4 years in 80% of patients. This may be an effective adjuvant therapy, and HPV-DNA negative conversion after HPV vaccination might predict prevention of recurrence. Level of evidence 2 Laryngoscope, 130:442-447, 2020.

Prevention of the recurrence of recurrent respiratory papillomatosis (RRP), a neoplasm of the respiratory tract, is a challenge. Human papillomavirus (HPV) vaccine has been expected to suppress the aggressiveness of RRP. However, there has been insufficient data to verify whether HPV vaccination can serve as an adjuvant therapy option for RRP. The aim of this study was to add our data on the efficacy of HPV vaccination for RRP to the academic discipline. Twenty-four RRP patients were treated with a combination therapy of surgery and three sessions of quadrivalent HPV vaccine. The patients' clinical courses, which were HPV infection status changes, intersurgical interval, and disease severity score (Derkay's site score), were statistically analyzed before and after combination therapy. Twelve of the 24 (52.5%) RRP patients who were HPV-DNA positive turned negative after the combination therapy. The mean of intersurgical interval was significantly extended from 6.85 ± 4.49 months to 30.5 ± 27.6 months after the therapy (P0.01). The median of Derkay's score of the participants also significantly decreased from 7.5 (interquartile range, 5-12) to 1 (interquartile range, 0-4.25) after the therapy (P0.01). Thus, combination therapy comprising of surgery and HPV vaccination can postpone the recurrence and lessen the severity of RRP.

Objective A single injection of basic fibroblast growth factor (bFGF) into the vocal folds of patients with glottal insufficiency has been shown to be effective for a few years. However, the long-term therapeutic effect of a single injection of bFGF into the vocal folds has yet to be demonstrated. In this study, the therapeutic effect of a single injection of bFGF into the vocal folds was investigated over several years by monitoring patients for 36 months following this treatment. Methods Nineteen patients with glottal insufficiency received injections of bFGF diluted to 20 μg/mL in the superficial layer of the lamina propria of the bilateral vocal folds. The following parameters were evaluated at preinjection baseline and 6, 12, 18, 24, and 36 months later, and statistical comparisons were performed. The parameters evaluated were: the Grade, Rough, Breathy, Asthenic, and Strained (GRBAS) scale score; maximum phonation time; acoustic analysis; and glottal wave analysis (GWA) and kymograph edge analysis (KEA) using high-speed digital imaging (HSDI). The amplitude perturbation quotient (APQ) and period perturbation quotient (PPQ) were measured by acoustic analysis. The mean minimum glottal area during vocalization and mean minimum distance between the vocal folds were measured by GWA. The amplitudes of the bilateral vocal folds were measured by KEA. Results Postinjection, the GRBAS scale score decreased from 6 months after injection, and maximum phonation time was prolonged. The mean minimum glottal area during vocalization and the mean minimum distance between the vocal folds calculated by GWA of HSDI decreased significantly after 6 months. These effects persisted until 36 months postinjection. APQ and PPQ derived from acoustic analysis tended to decrease, but not significantly. There was no clear change in the amplitudes of the bilateral vocal folds calculated by KEA of HSDI before and after injection. Conclusions These results suggest that the effects of a single injection of bFGF into the vocal folds persist for 36 months.

Summary Background In our first report on antibody levels in middle-aged and older men with recurrent laryngeal papillomatosis (RLP), we reported increases in human papillomavirus (HPV) antibody levels similar to those seen in adult women and young men. We posited that HPV antibodies produced in laryngeal mucus by Gardasil would prevent postoperative reinfection in patients with RLP. Study Design This is a case series study. Purpose The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence of RLP. Specifically, in this second report, whether HPV antibodies produced in laryngeal secretions by Gardasil are capable of causing negative conversion of HPV-DNA (deoxyribonucleic acid) in laryngeal mucosa was investigated. Methods A total of 11 patients for whom antibodies were measured in the first report were studied. Before vaccination and after 1 year Post-vaccination, HPV screening tests were performed on laryngeal secretions, and whether HPV-DNA negative conversion had occurred was evaluated. At the time of collection of laryngeal secretions, the presence or absence of laryngeal papillomas was examined. Results Before vaccination, all patients were HPV low-risk positive on laryngeal secretion screening tests. After vaccination, three patients were positive. Laryngeal papillomas remained in five patients. Conclusions The HPV-DNA test showed negative conversion in eight of 11 (72.7%) patients after vaccination. Residual laryngeal papillomas were found in five of 11 (45.5%) patients. The serum HPV antibody titer did not differ significantly between the group in which laryngeal secretions showed HPV negative conversion and the group in which conversion did not occur. The serum antibody titer did not differ significantly as a function of whether there were residual tumors.

Background Nasal surgery often fails to ameliorate the symptoms of obstructive sleep apnea syndrome (OSAS). We developed a compound nasal surgery (CNS) method that consists of septoplasty combined with submucosal inferior turbinectomy and posterior nasal neurectomy to ensure low nasal resistance during sleep. Objective To clarify the effect of CNS on OSAS, pre- and postoperative changes in sleep-related events were studied by using polysomnography, the Epworth sleepiness scale (ESS), the visual analog scale for snoring, and health-related quality of life (QOL). Methods Forty-five consecutive patients with OSAS and with nasal problems underwent CNS. Three months later, the postoperative effect on OSAS was assessed by using polysomnography findings, daytime sleepiness by the ESS, nasal allergy symptoms, and health-related QOL. Snoring was assessed by the family by using a visual analog scale. Results The indices of apnea, apnea-hypopnea, oxygen desaturation, and arousal; the ESS; allergic symptom score; health-related QOL; and snoring on a visual analog scale were all significantly improved. Conclusions CNS improves OSAS events without any pharyngeal surgical procedure in selected patients. If high nasal resistance associated with OSAS is present, then CNS should thus be considered.

Summary Background Patients with human papillomavirus (HPV) DNA–positive recurrent laryngeal papillomatosis commonly have repeated recurrences following surgery. The reason is suspected to be a mechanism by which latent HPV infection in the surrounding healthy mucosa reinfects the surgical site. It may be that production of HPV antibodies in the laryngeal mucosa with Gardasil injection could inhibit postoperative recurrence. Study Design This is a case series study. Purpose The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence. However, as a first report, we describe the antibody titers before and after vaccination. Methods Gardasil was injected in 12 men (aged 32–74 years; mean age 47.9 years) with HPV-positive laryngeal papillomatosis. Serum antibody titers of HPV-6, -11, -16, and -18 were measured by a competitive Luminex-based immunoassay before the vaccination and 7 months after the start of the vaccination. Results Each of the antibody titers was very low before vaccination, and they rose in all patients after the vaccination. Conclusions This finding demonstrates that antibody titers increase with Gardasil injection in post-adolescent males.

Summary Objectives Human papilloma virus (HPV) infection is involved in both juvenile and adult laryngeal papilloma. We wished to determine which types of adult laryngeal papilloma were clinically related to HPV infection. We hypothesized that multiple-site and recurrent papillomas would have a strong relationship to HPV and conducted the present study to test this hypothesis. Methods Thirteen male patients with adult laryngeal papilloma who underwent resection of papilloma between August 2006 and September 2009 were studied. We examined the relationships between whether the tumor was solitary or multiple, presence or absence of recurrence after surgery, and HPV infection. High-risk HPV types (HPV-DNA types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68) and low-risk HPV types (6, 11, 42, 43, and 44) were tested by a liquid-phase hybridization method. In addition, HPV typing was performed for patients positive for low-risk HPV types. Twenty patients with laryngeal carcinoma or laryngeal leukoplakia were enrolled as the control group. Results In the laryngeal papilloma group, all patients tested were negative for high-risk HPV and 69.2% were positive for low-risk HPV. Typing performed for seven of the patients who tested positive for low-risk HPV showed that one patient was positive for HPV-11, whereas the remaining six patients were positive for HPV-6. All patients with recurrent laryngeal papillomatosis (RLP) were positive for low-risk HPV. All patients who were positive for low-risk HPV had RLP. Tumor samples from repeat operations were positive for low-risk HPV in all patients tested. HPV was not detected in the control group. Conclusions The relationship between RLP and low-risk HPV was strong, with all cases that were positive for low-risk HPV showing recurrence. Tumor tissue resected at the time of repeat surgery was positive for low-risk HPV in all cases tested.

Many patients who complain of age-associated voice changes exhibit insufficient glottic closure during phonation owing to vocal cord atrophy. Some patients with pre-existing conditions, such as recurrent laryngeal nerve paralysis and sulcus vocalis, also experience insufficient glottic closure during speech, which progresses as the laryngeal adjustment function deteriorates in an age-dependent manner. Therapeutic methods for insufficient glottic closure during phonation include the intracordal injection of collagen. The procedure is selected or used in combination with other treatments based on detailed preoperative examinations. Thus, treatment with collagen is not necessarily always performed. It can be administered as office-based surgery under local anesthesia and is minimally invasive as long as allergy is not a concern.

This chapter summarizes how aging affects vocal function. First, the changes in voice pitch vary according to gender. Elderly men tend to speak at a higher pitch than younger men, whereas postmenopausal women speak at a lower pitch than younger women. Second, maximum phonation time is not a useful tool for assessing the healthy elderly, but it can be used for patients with age-related vocal fold atrophy. Third, aging has no impact on the mean airflow rate, but it affects airway resistance. The elderly tend to have lower airway resistance than younger people. However, no consensus exists on whether aging has an impact on expiratory pressure and sound pressure level. Finally, the elderly tend to have a weaker ability to regulate the larynx than the young.

Airborne pollen was examined in Ito City, Shizuoka for the purpose of treatment and prophylaxis pollen allergies because the patients with pollen allergy to herbaceous plants have recently increased.Setting up a Durham's sampler, we measured airborne pollen identified and classified: Poaceae, Polygonaceae, Amaranthaceae, Urticaceae, Cannabaceae, Ambrosia and Artemisia indica.We studied whether each airborne pollen count has something to do with weather condition (2004-2015).Average total airborne Poaceae pollen count and standard deviation from January to June was 19.4±5.5 cells/cm(2), average total airborne Polygonaceae pollen count and standard deviation from April to September was 11.6±13.4 cells/cm(2). Airborne Poaceae, Amaranthaceae, Cannabaceae, Uriticaceae. Ambrosia and Artamisia indica pollen count from July to Deccember in order: 34.0±15.5 cells/cm(2), 1.3±1.1 cells/cm(2), 8.7±6.4cells/cm(2), 4.9±6.4 cells/cm(2), 10.5±7.8 cells/cm(2), and 13.6±16.3 cells/cm(2).Cannabaceae admitted that its airborne pollen count has negative correlation to the rainfall.Artemisia indica admitted that its airborne pollen count has negative correlation to the average temperature.Herbaceous plants pollen doesn't cause allergies because it is much less than tree pollen in ItoCity.It is thought that the diversity of the plants keep the people from having a serious allergy to pollen with awarm weather in this area.

OK-432 is an immunomodulator that has been reported to be efficacious as an injection therapy for cervical lymphomas and ranulas. We performed OK-432 injection therapy to treat a cystadenocarcinoma of the parotid gland in a 72-year-old man. The 50 × 46-mm tumor was located in the deep lobe of the gland. The tumor had compressed the glossopharyngeal, vagus, and hypoglossal nerves, causing neurally mediated syncope, hoarseness, dysphagia, and dysarthria. A concentration of 5 KE/2 ml of OK-432 was injected. Within 2 months, the cyst had disappeared; no recurrence was apparent during 59 months of follow-up. To the best of our knowledge, no previous report has described injection of OK-432 for malignant cystic disease. We describe the injection method, injection dose, and postinjection course in the hope that this information will prove useful for future applications against malignant cystic disease.

Vascular tumors are divided histologically into vascular lesions on the surface of the body, i.e. hemangiomas, and vascular malformations which have normal endothelial cells but manifest structurally abnormal vascular proliferation. Vascular malformations are often encountered in the head and neck region. We studied patients who underwent laryngoscopic surgery in our department for vascular malformations of the larynx.Direct laryngoscopic surgery was performed under general anesthesia. The mucosa surrounding the vascular malformation was stripped and resected. The vasa vasorum were treated with an Ho:YAG laser. We reviewed five patients who had received laryngoscopic treatment in the larynx region during the past two years.Histopathologic examination of the removed tumor tissues revealed venous malformation in four cases and lymphatic malformation in one case. The postoperative course was uneventful with neither hemorrhaging nor other complications, and none of the cases showed any recurrent disease up to the present.Our experience suggests that the laryngoscopic surgery provides minimal surgical intervention and can be applied to a wide range of age.

We propose a new screening judgment on the effectiveness of multilevel staged surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS) using polysomnography without electrocephalogaphy, the Epworth sleepiness scale (ESS), and SF36v2 questionnaires on quality of life (QOL). Subjects numbered 24 with sleep-disordered breathing, including 20 with OSAHS, who underwent coblation-assisted uvulopalatopharyngoplasty (UPPP) and optional endonasal rhinoplasty consisting of bilateral submucosal inferior turbinectomy and septoplasty to reduce negative pharyngeal pressure three months before or after UPPP. Three months after each operation, the postoperative effect was evaluated using polysomnography without electroencephalography, ESS, and QOL. Apnea-hypopnea, apnea, hypopnea, ESS, and QOL indexes all improved significantly, as did snoring measured on a visual analog scale. Combined endonasal rhinoplasty and coblation-assisted UPPP mutually increased effectiveness even in moderate and severe OSAHS and sleep-disordered breathing together with snoring and/or daytime sleepiness.

発声機能検査は, 声が出にくい, 大きな声が出ない, 声を出すと疲れるなどの発声障害症状を客観的に評価する検査である. 気流阻止法による空気力学的発声機能検査では, 基本周波数, 音圧, 呼気流率に加えて呼気圧を同時測定することができる. 呼気流率に対する呼気圧の値は発声時の気道抵抗を表し, 声門抵抗と一定の関係にある. 音声改善手術を行うことで喉頭での空気力学的動態が改善し, 各パラメータ値も健常域に復帰する. 発声機能検査は, 音声障害患者の重症度判定, 経過観察, 治療効果判定などにきわめて有用な検査である. 臨床応用を目指して研究中である高速ビデオ撮影検査では, 1/2000秒の精度で声帯振動評価が可能である. 現在までに検討した画像解析法, すなわち声門面積波形解析, 声帯振幅解析, 声門開口部解析などについて紹介する.

Objective The goal was to test the hypothesis that the elderly have diminished laryngeal regulation capability, so we investigated phonatory function in the elderly and young using a sound pressure-loading test. Study Design and Setting In 36 healthy men (17 in their 20s, 19 in their 70s) and 45 healthy women (22 in their 20s, 23 in their 70s), fundamental frequency, sound pressure level, mean flow rate (MFR), and expiratory lung pressure (EP) were determined from phonatory function testing. Subjects phonated at a comfortable level and at high intensity, without changing vocal pitch. Results MFR, EP, and airway resistance increased with high-intensity phonation in the young; however, only MFR and EP increased in the elderly. Conclusions The findings supported our hypothesis: with high-intensity phonation, the elderly undergo unchanged laryngeal regulation but a greater degree of expiratory regulation. Significance The elderly are likely to become tired due to the effort required for phonation.

Patients with human papillomavirus (HPV) DNA-positive recurrent laryngeal papillomatosis commonly have repeated recurrences following surgery. The reason is suspected to be a mechanism by which latent HPV infection in the surrounding healthy mucosa reinfects the surgical site. It may be that production of HPV antibodies in the laryngeal mucosa with Gardasil injection could inhibit postoperative recurrence.This is a case series study.The purpose of this study was to examine whether Gardasil injection effectively inhibits recurrence. However, as a first report, we describe the antibody titers before and after vaccination.Gardasil was injected in 12 men (aged 32-74 years; mean age 47.9 years) with HPV-positive laryngeal papillomatosis. Serum antibody titers of HPV-6, -11, -16, and -18 were measured by a competitive Luminex-based immunoassay before the vaccination and 7 months after the start of the vaccination.Each of the antibody titers was very low before vaccination, and they rose in all patients after the vaccination.This finding demonstrates that antibody titers increase with Gardasil injection in post-adolescent males.

Summary Objective To evaluate the relationship between laryngopharyngeal reflux disease and presence of lumbar kyphosis. Study Design A cross-sectional study. Methods We included 20 patients with lumbar kyphosis and 31 control subjects. A diagnosis of laryngopharyngeal reflux disease and gastroesophageal reflux disease was made if the Reflux Symptom Index score was ≥13 and if the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease was ≥8, respectively. We compared the prevalence of the two reflux diseases, frequent reflux symptoms, and demographic factors between the two groups. Results There was no significant difference in demographic factors between the two groups. Five (25%) of 20 patients with lumbar kyphosis had a Reflux Symptom Index ≥13 compared with one (3.2%) of 31 controls. Seven (35.0%) of 20 patients had a Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease ≥8 compared with three (9.7%) of 31 controls. A comparison of the prevalence of laryngopharyngeal reflux disease and gastroesophageal reflux disease showed a significant difference between patients with kyphosis and controls ( P value = 0.029 and 0.036, respectively). In Reflux Symptom Index, heartburn, hoarseness, and a swallowing problem were significantly frequent symptoms in the kyphosis group compared with the control group. Conclusions The prevalence of laryngopharyngeal reflux disease and gastroesophageal reflux disease was significantly higher in patients with lumbar kyphosis than in controls. Therefore, otolaryngologists and orthopedic surgeons should be aware that patients with lumbar kyphosis are likely to have gastroesophageal reflux disease and also laryngopharyngeal reflux disease.

Objective In order to ascertain age-related changes in phonatory function, an aerodynamic phonatory function test based on the airway interruption method was conducted. Study design Subjects were 142 men and 144 women aged between 20 and 79 years. No subjects demonstrated abnormalities of sound quality. The test was conducted using the Nagashima PS77E phonatory function analyzer. Subjects were instructed to phonate at the most comfortable pitch and intensity, and fundamental frequency (F0), sound pressure level (SPL), mean flow rate (MFR), expiratory lung pressure (EP), and airway resistance were determined. Results F0 was lower among women aged ≥50 years. EP was lower for women aged ≥70 years than for those in other age groups. For both genders, airway resistance was lower for those aged ≥70 years when compared to other age groups. Conclusions Among women, F0 was lower aged ≥50 years. In advanced age, EP and airway pressure decreased among women and airway resistance decreased among men. EBM rating: C-4

Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician's viewpoint, not the patient's. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become 'It is only a vocal problem and does not significantly affect the patient's well-being,' knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study 'a survey for sulcus vocalis' and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.

Summary Objective The aim of our study was to clarify the human papillomavirus (HPV) infection status of various laryngeal diseases in Tokyo, Japan. Study Design This is a retrospective study. Methods A total of 144 patients who underwent surgical resection for various laryngeal lesions were enrolled in this study. These subjects were categorized into four groups based on lesion type: non-neoplastic, 44; precancerous, 29; cancer, 35; and papilloma, 36. To determine the rate of HPV infection, laryngeal secretions and resected tissue from our study participants were examined by liquid-phase hybridization (LPH) and consensus primer-directed polymerase chain reaction (PCR). Results The LPH for low-risk HPV was applied to all 144 patients, and that for high-risk HPV was additionally applied to 121 of the 144 patients. The PCR was applied to 94 of the 144 patients. The LPH detected low-risk HPV-DNA in 23 patients (1 cancer and 22 papillomas) and high-risk HPV-DNA in 3 patients (1 cancer and 2 papillomas). The PCR detected HPV-6 and HPV-11 in the papilloma group, whereas it detected HPV-31 in one patient with laryngeal cancer and one patient with precancerous lesion. Both the LPH and the PCR revealed the HPV infection rate in the non-neoplastic group to be 0%. Conclusions Although we found no significant difference in the HPV-DNA positive rates of laryngeal cancer and precancerous lesions in the non-neoplastic group, the positive rates were significantly smaller in this group than in the papilloma group. In the Tokyo area, HPV had little or no association with laryngeal cancer, precancerous lesions, and non-neoplastic lesions in the larynx.

本研究では痙攣性発声障害 (SD) の重症度を評価する目的で音声評価法を考案し, その有用性について検討した.SD患者15人を対象としたモーラ法の検討では, 聴覚的重症度が高い患者ではモーラ法のスコアーも高かった.また, 経過観察における重症度評価にも有用であった.別のSD患者15人を対象として音響学的および空気力学的評価を行った.朗読時間に対する無音区間の比率, shimmer, SNR, およびflow標準偏差値と聴覚的重症度との間に有意の関係が認められた.日常生活の各場面を想定した支障度評価用アンケートを作成し, 聴覚的重症度と比較検討した.その結果, われわれが診察中に把握することができない患者の日常の支障度を評価することが可能であった.

Hypopharynx hemangioma is a rare disease. We reported a case of a 63-year-old woman who complained of laryngeal discomfort of nine months. Fiberscopy demonstrated a tumor with dark red, regular smooth surface that was located at the left piriform sinus.The tumor was completely excised by Holmium YAG laser. Histological examination revealed that it was a cavernous hemangioma.Recurrence of the tumor has not been observed in the three months since the surgery. The authors considered the effectiveness of the Holmium YAG laser in this case.

We have developed a special purpose adaptor making it possible to use a commercially available high-speed camera to observe vocal fold vibrations during phonation. The camera can capture dynamic digital images at speeds of 600 or 1200 frames per second. The adaptor is equipped with a universal-type attachment and can be used with most endoscopes sold by various manufacturers. Satisfactory images can be obtained with a rigid laryngoscope even with the standard light source. The total weight of the adaptor and camera (including battery) is only 1010 g. The new system comprising the high-speed camera and the new adaptor can be purchased for about $3000 (US), while the least expensive stroboscope costs about 10 times that price, and a high-performance high-speed imaging system may cost 100 times as much. Therefore the system is both cost-effective and useful in the outpatient clinic or casualty setting, on house calls, and for the purpose of student or patient education.

It is conceivable that the subjects who have phonatory disorders, in comparison with normal individuals, exert a greater expiratory effort when phonating loudly. Furthermore, we presume that the extent and pattern of the changes in the expiratory effort for increasing vocal intensity may vary according to the types of laryngeal lesions. To prove these hypotheses, we investigated the changes in expiratory effort for increments of the vocal intensity by measuring the expiratory lung pressure. The subjects included 10 each of normal controls, patients with Reinke’s edema, and those with recurrent laryngeal nerve paralysis. For the normal controls, the increase in vocal intensity was achieved by slightly increasing the expiratory lung pressure. The patients with Reinke’s edema showed a greater increase in expiratory lung pressure, as compared with the normal group. The patients with recurrent laryngeal nerve paralysis exhibited greater expiratory effort with extreme increases in airflow than normal group for louder phonation. It was concluded that the subjects who have phonatory disorders, in comparison with normal individuals, require a greater expiratory effort. This phonatory function test with an increase in voice intensity made the aerodynamic pathologic condition clearer. (Otolaryngol Head Neck Surg 1998;118:723-7.)

Clinical features of acute epiglottitis were studied in 93 patients, 74 males and 19 females ranging from 19 to 78 years of age (mean age: 46.0 years), who had been admitted to our department over the last 10 years. The mean duration of illness was 2.3 days, and the mean period of hospitalization was 7.8 days. Then white blood cell count had increased to 16, 000/mm3 and their CRP to 9.8 mg/dl on average. A smoking habit was noted in 69 of the 93 patients (73.5%) . Thirteen patients (14.0%) had diabetes mellitus as an underlying disease. Forty-five patients (48.4%) had a prior history of therapy at other institutions. Airway control was required in 7 patients (7.5%) . It was suggested that acute epiglottitis develops rapidly, although it improves smoothly after appropriate therapy. It was also suggested that airway obstruction may occur in patients with associated diabetes mellitus or in those who visit a hospital within a couple of days after the onset of symptoms. Patients with acute epiglottitis often visit clinicians specializing in fields other than otolaryngology. Therefore, otolaryngologists should try to inform other clinicians about the clinical features of acute epiglottitis.

Objectives:Investigate the correlation between vocal cord vibration parameters and aerodynamic parameters.Methods:We examined 13 patients with various voice disorders. Using the phonatory function analyzer PS77E, we measured sound pressure level (SPL), mean flow rate (MFR), expiratory lung pressure (EP), and airway resistance (EP/MFR). We used a high-speed video (HSV) system to observe the vocal cord vibration. We obtained the image data at a speed of 2000 frames/sec, while each subject was vocalizing the vowel sound /a/. We analyzed the predetermined area using Kay Image Processing Software (KIPS) with regard to the following: 1) maximum or minimum area, maximum or minimum opening at the midpoint of the glottis from a montage with glottal area waveform (GAW) analysis, and 2) maximum or minimum opening of the glottis, dominant amplitude or frequency of the opening variation of the vocal fold, and ratio of time of glottal total closure to the entire time domain in the calculation using kymograph edge analy...

Objectives:The Holmium:YAG (Ho:YAG) laser can perform evaporation, incision, and coagulation simultaneously. It enables the treatment of target tissue only, making surgery less thermally damaging to surrounding tissue. It provides a different range and depth of evaporation depending on the distance between the laser fiber tip and the mucosa. Clinical cases are presented, and the potential for treatment of laryngeal diseases is discussed.Methods:We designed the following three ways of irradiation. 1) Non-contact irradiation: Evaporation occurs only at the mucosal surface. 2) Contact irradiation: When irradiated with light contact with the mucosa, the area of evaporation on the mucosal surface is smaller than in 1. 3) Shooting irradiation: When irradiated with pressing the tip of the fiber on the mucosa, only spots of evaporation are left on the mucosal surface. On the other hand, evaporation can be up to a depth of approximately 2 cm with irradiation for approximately 3 seconds.Results:Cases of hemorrhagic...