PURPOSE: Laryngeal framework surgery, including medialization laryngoplasty and arytenoid adduction (AA), is expected to have a lasting or permanent effect in patients with unilateral vocal fold paralysis (UVFP); however, there are few reports about the long-term outcomes of AA. This study aimed to evaluate the long-term postoperative effects of AA surgery and examine its stability and reliability. METHODS: This study collected the voice handicap index (VHI) questionnaire from patients with UVFP who underwent AA more than 2 years previously. The VHI values preoperatively and 3 months postoperatively (early postoperative evaluation) were retrospectively calculated, and VHI values more than 2 years after surgery (late postoperative evaluation) were collected by mailing a sheet to the patients and asking to fill and return it. Possible influenced subscales such as age, sex, causes of UVFP, affected side, and surgeons were also analyzed. RESULTS: A total of 77 patients with UVFP who underwent AA had significantly lower early and late postoperative evaluations than preoperative evaluations. In 38 patients with no missing values, there were no significant differences between early and late postoperative evaluations, measured at a median of approximately 5 years. There were also no significant differences between early and late postoperative evaluations in any of the subscale groups. CONCLUSION: Patients with UVFP who underwent AA surgery achieved stable voice improvement in the long term after surgery.

Cartilage conduction hearing aids (CC-HAs) are a novel type of hearing aid relying on cartilage conduction, the so-called third auditory conduction pathway. However, CC-HAs have only recently entered routine clinical use, and therefore data on their usefulness are lacking. The purpose of this study was to examine the possibility of assessing whether individual patients would show good adaptation to CC-HAs. Thirty-three subjects (41 ears in total) underwent a free trial of CC-HAs. Age, disease category, and the pure-tone threshold of air and bone conduction, unaided field sound threshold, aided field sound threshold, and functional gain (FG) at 0.25, 0.5, 1, 2, and 4 kHz were compared between patients who subsequently purchased and did not purchase the CC-HAs. Overall, 65.9% of the subjects purchased CC-HAs after the trial. In comparison to non-purchasers, those who decided to purchase CC-HAs showed better pure tone hearing thresholds at high frequencies for both air conduction (2 and 4 kHz) and bone conduction (1, 2, and 4 kHz), as well as for aided thresholds in the sound field (1, 2, and 4 kHz) when using CC-HAs. Therefore, the high-frequency hearing thresholds of subjects trialing CC-HAs might be helpful for identifying those who are likely to benefit from them.

The association between swallowing function and cough strength in patients with unilateral vocal fold paralysis (UVFP) is unknown. We evaluated the relationship between voluntary cough strength and dysphagia among patients with UVFP (UVFP group) by comparing their data with that of corresponding healthy participants (healthy control [HC] group) in a prospective observational study. From February 1st, 2018 to March 30th, 2019, we recruited patients with a voice disorder due to UVFP, who were referred to our university hospital. Patients with a history of laryngeal surgery, vagal nerve paralysis, or cardiac and respiratory failure were excluded. Descriptive and clinical data regarding swallowing, voice, and cough peak flow (CPF) were collected as a measure of cough strength. The UVFP group comprised six women and seven men (median age, 68.0 years), and the HC group comprised six women and eight men (median age 65.5 years). The groups differed significantly in the Eating Assessment Tool (EAT)-10 scores and CPF rates (P < 0.001). Among patients with UVFP, 84.6% had an abnormal EAT-10 score of ≥ 3. Additionally, 16.7% of the patients exhibited liquid aspiration with contrast medium on a videofluorographic swallowing study (VFSS). There was no correlation between the CPF values, EAT-10 scores, or the VFSS results. Therefore, patients with severe UVFP, whose condition had been fixed, had difficulties when swallowing (85% of cases), and some even presented with aspiration on VFSS (20% of cases), while receiving a regular diet.

OBJECTIVES: To compare the loudness functions (loudness ratings as a function of sound level) obtained from patients diagnosed as having functional hearing loss (FHL) with those for patients with sensorineural hearing loss (SNHL) and healthy volunteers. DESIGN: Loudness functions for a 1000 Hz tone for patients with FHL and SNHL were assessed based on the categorical loudness scaling method. The data were compared with control data obtained in our facilities. STUDY SAMPLE: 18 patients (33 ears) with FHL and 10 patients (19 ears) with SNHL. RESULTS: For patients with SNHL and healthy volunteers, loudness increased progressively with increasing sound level above the audiometric threshold, with no exceptions. However, for about 70% of the patients with FHL, a different type of loudness function was obtained; the thresholds determined from the loudness function, which were defined as the minimum sound levels at which loudness could be judged, were 10 dB or more lower than the audiometric threshold (>10 dB), and/or the loudness ratings were elevated for a sound at the audiometric threshold. CONCLUSIONS: The results support the hypothesis that patients with FHL often make threshold judgments based on a certain loudness.

PURPOSE: This study was performed to evaluate the characteristics of the Voice Handicap Index (VHI), a self-assessment measure, for patients with unilateral vocal fold paralysis (UVFP) who underwent arytenoid adduction (AA), in comparison with postoperative vocal function examinations. METHODS: A retrospective chart review was conducted for patients who underwent AA at Tohoku University Hospital during the period between 2014 and 2017. VHI was compared before and after surgery; moreover, correlations were assessed between the VHI and other voice measurements, including perceptual assessment of voice, as well as aerodynamic and acoustic measures. Factors involved in the VHI score were explored by multivariate analysis. RESULTS: Forty-three UVFP patients (28 males, age 32-81 years; 15 females, age 34-80 years) were enrolled in the study; the average age of all patients was 61.5 years (32-81 years). Among the enrolled patients, 33 (76.7%) left and 10 (23.3%) right vocal folds were impaired. After surgery, nearly all of the patients exhibited significantly improved VHI score; each of the three subscales (functional, physical, and emotional) was also improved. The postoperative VHI correlated mildly with several values of the other voice measurements, with the exception of the mean flow rate. Multivariate analysis showed that the sole variable associated with postoperative VHI score was preoperative VHI. CONCLUSIONS: The postoperative VHI likely reflects improvement in the voices of the patients with UVFP. Although there were weak correlations with other voice measures, postoperative VHI is a relatively independent measurement parameter for patients with UVFP who underwent AA.

PURPOSE: To clarify the correlations among symptoms, swallowing functions, and ingestion status and to validate a method of swallowing evaluation during chemoradiotherapy (CRT) for head and neck cancer. METHODS: Oropharyngeal and hypopharyngeal cancer patients who were to receive definitive CRT as initial treatment were included in this prospective, single-center, observational study. The Functional Oral Intake Scale (FOIS) for ingestion status and grades of symptoms (dryness, dysgeusia, mucositis, and the analgesic ladder); the Yale Pharyngeal Residue Severity Rating Scale on fiberoptic endoscopic evaluation of swallowing (FEES) and the Penetration-Aspiration Scale (PAS) on videofluoroscopic (VF) evaluation for swallowing functions; and the 10-item Eating Assessment Tool (EAT-10) questionnaire were assessed at 5 time points unless the participant refused. The FEES and VF evaluation findings at each point were also compared. RESULTS: There were 38 participants. Dysgeusia, mucositis, and pain grade, as well as the FOIS score, were the worst at 70 Gy and then improved after treatment. The improvements of pharyngeal residue and the PAS after treatment were limited. The EAT-10 and the pain ladder were highly correlated with the FOIS changes at many time points. The VF evaluation rate dropped after 40 Gy, whereas the FEES rate remained high. There were good correlations between pharyngeal residue and the PAS at 0 Gy, 70 Gy, and 3 months. CONCLUSION: The EAT-10 and pain reflected the FOIS score changes well, while two swallowing evaluations did not. To avoid aspiration, VF evaluation may not be necessary during CRT because of high correlations with pharyngeal residue on FEES.

OBJECTIVE: To examine the feasibility and possible effects of in-home auditory training using audiovisual speech stimuli on a tablet computer for patients with hearing loss using a hearing aid (HA) or a cochlear implant (CI). METHODS: In total, 11 patients with hearing loss (mean age, 60.2 ± 13.7 years) who had been using an HA or CI for more than 1 year were examined. As auditory training, the participants listened repeatedly to audiovisual speech stimuli on a tablet computer for 3 months. Speech intelligibility for trained words, untrained words, and monosyllables presented at a sound pressure level of 70 dB were assessed before and at 1, 2, and 3 months after training. RESULTS: Eight out the 11 patients completed 3 months of in-home auditory training. Three of these patients withdrew from the training before completing the protocol, mainly because of "boredom from recurring simple tasks". Significant improvements in speech intelligibility were found for the trained and untrained words after the 3-month training period (p < 0.05), but no significant differences were found for monosyllables. CONCLUSION: In-home auditory training using a tablet computer could help improve auditory quality of life in patients with hearing loss using an HA or CI. But the further comparative studies using other existing method will be necessary to establish the practical importance of the present method.

OBJECTIVE: To assess the accuracy of tubo-tympano-aerodynamic-graphy (TTAG) in the estimation of morphological severity of patulous Eustachian tube (PET), and to compare the results with that of sonotubometry in clinical cases and in model experiments. STUDY DESIGN: Retrospective chart review and model experiment. SETTING: Tertiary referral center. SUBJECTS: A retrospective survey of medical records in Sen-En Rifu Hospital identified 26 patients (12 men and 14 women subjects aged 14-78 yr, average 49.4 ± 20.9 yr), comprising of 35 ears with PET. A definite diagnosis of PET was made for all patients based on the diagnostic criteria proposed by the Japan Otological Society. MAIN OUTCOME MEASURES: Commercial equipment for sonotubometry and TTAG (JK-05A; RION Co., Ltd., Kokubunji, Tokyo, Japan) were used in the following investigations. Model Experiment: The ET model was made using two truncated syringes with silicone barrels and a narrow connecting tube (0.2, 0.4, 0.58, 0.8, 1.00, 2.00, and 3.00 mm). Clinical Investigation: Morphological evaluation of ET patency was performed by a three-dimensional (3-D) CT (3D Accuitomo; Morita MFG. Corp., Kyoto, Japan) and analyzed by software (Integrated Information System i-VIEW; Morita MFG. Corp.). RESULTS: The transmitted sound pressure level gradually increased as the tube caliber was widened up to 3 mm diameter. On the other hand, pressure transmission was suddenly elevated and reached a plateau at 0.58 mm in diameter. The cross-sectional area at the narrowest portion of the ET was significantly correlated with the sound attenuation from nostril to external auditory canal (EAC) (Spearman rank correlation test: r = -0.521, p < 0.001). In contrast, the cross-sectional area at the narrowest portion of the ET was not correlated with the pressure changes of TTAG (Spearman rank correlation test: r = 0.317, p = 0.64). CONCLUSION: Sound transmission assessed by sonotubometry could be more useful than pressure transmission assessed by TTAG to predict the morphological severity of PET.

OBJECTIVE: Some patients with a patulous Eustachian tube (PET) complain of a nasal voice. This feature is often dismissed without further investigation. As such, there are only a few reports on this important symptom and scant studies have been conducted on a sufficiently large number of cases with PET. Therefore, this study was undertaken to investigate the characteristics of patients having a nasal voice and to examine whether this symptom can be an indication of the severity of PET. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. SUBJECTS AND METHODS: A retrospective survey of medical records in Sen-En Rifu Hospital identified 85 patients (40 men and 45 women) with PET between 2013 and 2016. Diagnosis of definite PET was based on the Proposal on Diagnostic Criteria of PET announced by the Otological Society of Japan (2017). The questionnaire inquired about the presence of a nasal voice and it was distributed to each patient at the first visit to the clinic. If a patient marked "yes" for the presence of nasal voice, he/she was later asked on the telephone to exclude nasal voice ascribable to causes other than PET, such as nasal diseases. Correlation between nasal voice and patient characteristics (age, sex, affected side, and PET symptoms such as autophony of own voice, aural fullness, and autophony of breathing sounds), subjective severity of PET evaluated by patulous Eustachian tube handicap inventory-10 (PHI-10), and that with the objective severity of PET evaluated by tubo-tympano-aerodynamic-graphy (TTAG) and sonotubometry were investigated. RESULTS: Seventy-six patients (36 men and 40 women) with definite PET were evaluated in this study. Thirteen patients (17.1%) (five men and eight women) reported a nasal voice coinciding with the occurrence of PET symptoms such as voice autophony, aural fullness, and breathing autophony. Age, sex, affected side, PET symptoms (autophony of their own voice, aural fullness, and autophony of their breathing sounds), and objective findings (TTAG and sonotubometry) were not significantly different between the two groups. The average total score of the PHI-10 in the "PET associated Nasal Voice Group" was 35.8 ± 4.5, which was statistically higher than that of the "non PET associated Nasal Voice Group" 23.6 ± 10.7 (p = 0.002). Out of 76 patients, 44 were treated surgically (Kobayashi Plug). In the "PET associated Nasal Voice Group," 85% (11 out of 13) were subjected to surgical treatment, whereas 52% (33 out of 63) underwent surgical treatment in the "non PET associated Nasal Voice Group." The rate of surgical treatment was significantly higher in "PET associated Nasal Voice Group" (p = 0.047). CONCLUSION: Nasal voice due to PET symptoms was observed in 17.1% of PET patients. It was generally found in patients with severe subjective symptoms. Nasal voice can be an indication of subjective severity. However, this study failed to show objective evidence of wider Eustachian tube in such cases. Patients with a nasal voice tended to seek vigorous treatment including surgery.

PURPOSE: To identify precipitating factors responsible for enteral nutrition (EN) dependency after concomitant chemoradiotherapy (CCRT) of head and neck cancers and to examine their statistical correlations. METHODS: Factors related to feeding condition, nutritional status, disease, and treatment of 26 oropharyngeal and hypopharyngeal cancer patients who received definitive CCRT were retrospectively investigated by examining their medical records. The days of no oral intake (NOI) during hospitalization and the months using enteral nutrition after CCRT were counted as representing the feeding condition, and the changes in body weight (BW) were examined as reflecting nutritional status. The factors related to EN dependency after CCRT were analyzed. RESULTS: Long duration of total NOI (≥ 30 days) and maximum NOI ≥ 14 days were significant predictors of EN dependency. Decreased BW (≥ 7.5 kg) was the next predictor identified, but it was not significant. Multivariate analysis showed that the total duration of NOI was more correlated with EN dependency than changes in BW. CONCLUSIONS: A long duration of NOI was more strongly related to EN dependency than nutritional factors.

OBJECTIVE: To investigate the relationship between the morphological patency of the eustachian tube (ET) and sound transmission via the ET. STUDY DESIGN: Retrospective chart review and model experiment. SETTING: Tertiary referral center. SUBJECTS: A total of 56 ears of 28 patients (9 men and 19 women, aged from 12 to 82 yr, mean 40.4 ± 21.5 yr) who underwent sonotubometric measurement using postural change as well as computed tomography (CT) of the ET in the sitting position, including 26 ears with definite patulous ET, 9 ears with possible patulous ET, and 21 ears without patulous ET. METHOD: Commercial equipment for sonotubometry (JK-05A; RION Co., Ltd., Kokubunji, Tokyo, Japan) was used in the following two investigations. Retrospective survey: sound patency of 7 kHz band noise via the ET was assessed by comparison of acoustic transfer function via the ET in the sitting and forward-bending positions. Sound patency via the ET was compared with morphological patency of the ET (cross-sectional area in the narrowest portion) assessed by three-dimensional CT of the ET in the sitting position. Model experiment: effect of the ET caliber on the acoustic transfer function was examined using a simple model constructed with two truncated syringes with silicone barrels and a narrow connecting tube. RESULTS: Sound patency assessed by sonotubometry was well correlated with the cross-sectional area at the narrowest portion of the ET in the sitting position (r = 0.786, p < 0.001). Correlation between the sound patency via the narrow tube and the caliber of the tube was also confirmed by the model experiment. CONCLUSIONS: Sound patency assessed by sonotubometry using 7 kHz band noise could be useful to predict the morphological severity of patulous ET.

OBJECTIVES: During the 5-year period from 2001 to 2005, 4,075 patients with voice disorders were examined and treated at the Tokyo Voice Center. In this presentation the clinical records of these 4,075 patients were studied retrospectively. MATERIALS AND METHODS: The study involved an analysis of 4,075 patients (1,644 male, 2,400 female, 31 gender identity disorders (GID); 1 to 91 years of age; mean age, 44.1 years), mainly referred from other hospitals to the Tokyo Voice Center. In all patients, otolaryngologic, phoniatric and videostroboscopic examinations were completed. The clinical records of these patients were statistically studied with respect to distribution by age, sex, occupation, smoking, diagnosis, and relationship with vocal use as etiologic factors. RESULTS AND CONCLUSIONS: 1) Vocal fold nodules were most frequently diagnosed among organic diseases, followed by laryngitis and vocal fold polyps. Functional dysphonia was most frequently diagnosed among non-organic diseases, followed by epipharyngitis and spasmodic dysphonia. 2) Vocal fold nodules, laryngitis, vocal fold polyps, and vocal fold cysts were significantly related with vocal abuse. 3) Reinkeís edema, vocal fold leukoplakia, laryngeal cancers, vocal fold cysts, and vocal fold polyps were significantly related with smoking.

OBJECTIVES: During the past five years 108 patients with vocal fold cysts were examined and treated at the Tokyo Voice Center. In this presentation the clinical records of these 108 patients were studied statistically, especially to compare among different histological types. MATERIALS AND METHODS: The study involved analysis of 108 patients (53 males and 55 females). In all patients, otolaryngological, phoniatric and videostroboscopic examinations were completed. The clinical records of these patients were statistically studied with respect to distribution by age, sex, smoking, and professional voice usage, especially comparing among different histological types. Subsequently these statistical differences were compared with differences between vocal fold nodules and vocal fold polyps. RESULTS AND CONCLUSIONS: 49% of the cases were professional voice users and 15% were non-professional cases who had episodes of vocal abuse. There were significant differences between cases of epidermoid cyst and retention cyst with respect to distribution by age, sex, professional voice usage, and endoscopy findings, just as there were significant differences between vocal fold nodules and vocal fold polyps.