著者

児嶋 剛 堀 龍介 岡上 雄介 藤村 真太郎 奥山 英晃 北野 正之 庄司 和彦

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.109, no.11, pp.791-795, 2016 (Released:2016-11-01)

参考文献数

20

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There have been reports of cases in which a clicking sound is produced in the neck region upon swallowing. It could occur because of elongation and thickening of the hyoid bone, resulting in its coming in contact with the cervical vertebrae during swallowing, or because of abutting of the thyroid cartilage against the hyoid bone, or even because of ossification of the space between the thyroid cartilage and the greater cornu of the hyoid bone. However, in all of these cases, the causes are different and also very rare. Herein, we report a case that we encountered in which a clicking sound was produced in the neck region because of both the thyroid bone and the hyoid bone coming in contact with the cervical vertebrae. The patient was a 57-year-old man. He visited our clinic, because one-year earlier, he had started to hear a sound when swallowing, which had progressively worsened. The abnormal sound was a click coming from the left neck region, and on CT, we observed elongation and hypertrophy of the left greater cornu of the hyoid bone. It was thought that the overgrowth of the hyoid bone was the principal cause, however, this could not be confirmed prior to the surgery. Surgery was performed under local anesthesia. First, the hypertrophic omohyoid muscle and sternohyoid muscle were cut, but the symptoms did not change. Upon cutting of the left greater cornu of the hyoid bone, which was thickened and slightly elongated, and came in contact the cervical vertebrae upon swallowing, the symptoms resolved somewhat. After cutting the superior cornu of the thyroid cartilage, which interfered with the cervical vertebrae upon swallowing, the symptoms disappeared altogether. This was an extremely rare case where the symptoms were caused by both the thyroid cartilage and the hyoid bone, however, appropriate treatment was given through surgery done under local anesthesia while the symptoms were concurrently assessed.

著者

長谷部 孝毅 堀 龍介 児嶋 剛 岡上 雄介 藤村 真太郎 鹿子島 大貴 田口 敦士 庄司 和彦

出版者

公益財団法人 天理よろづ相談所 医学研究所

雑誌

天理医学紀要 (ISSN:13441817)

巻号頁・発行日

vol.23, no.1, pp.50-51, 2020-12-25 (Released:2020-07-17)

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【目的】顔面神経麻痺疾患において,予後予測,治療効果判定のために正確な評価が必要である.誘発筋電図(electroneurography; ENoG)などの電気生理学的評価方法の他に,柳原法などに代表される顔面各部位の動きを評価し,その合計で麻痺程度を評価する主観的評価方法が簡便であり広く使われている.しかしながら,顔面表情の動きを見た目で評価する方法は複数あるものの,いずれにも共通する欠点として,あくまで主観的評価のため検者間で差異が生じる可能性がある他,各部位は3 段階評価のため,わずかな改善などを点数では評価しきれないという点が挙げられる.それらを解決する方法として,画像解析による評価方法はいくつか報告されているが,解析の手間や装置の問題などから広くは使われていない.一方で,近年米Apple 社の販売するスマートフォン(iPhone X 以降) は,その認証方式として顔認証を用いており,顔面運動を正確に捉えることが可能である.そこで我々は,顔面神経麻痺に対する客観的かつ簡便な評価方法を確立することを試みた. 【方法】iPhone XS を用いて検証した.各顔面の部位の動きを係数化し最大値を取得し,左右の比較を行うことで顔面神経麻痺を評価するアプリを作成した.それを用いて外来受診した顔面神経麻痺患者の評価を行い,主観的評価法との比較,及びENoG,積分筋電図との比較を行った. 【結果】アプリでの評価は既存の主観的評価方法と相関しており,特に頬,鼻翼,口角では強い相関が見られた.また,ENoG では相関関係が見られなかったものの,積分筋電図でも相関が見られた. 【結論】デバイスは一般に普及しているため,臨床応用に向けての素地は整っており,目的としていた客観的かつ簡便な評価アプリは開発出来た.顔面の動きの捉え方は,病態生理に基づきさらなる検証およびアップデートが必要ではあるが,非耳鼻科医,さらに言えば患者本人でも現状評価を行うことができるようになることが期待される.

著者

大森 孝一 藤村 真太郎 水野 佳世子

出版者

耳鼻咽喉科臨床学会

雑誌

耳鼻咽喉科臨床 (ISSN:00326313)

巻号頁・発行日

vol.114, no.1, pp.1-10, 2021 (Released:2021-01-01)

参考文献数

48

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Digital transformation (DX) was a term proposed by Stolterman et al., who stated that the ongoing development of information technology could be of service to better people’s lives. DX is reshaping interactions between health professionals and patients, decisions about treatment plans, and medical outcomes. Based on key trends from big data, artificial intelligence (AI) and next-generation communication, DX offers the hope for better medical care of prevention, diagnosis, treatment, and welfare for patients. Big data aggregates information about electronic medical records, insurance receipts, patients’ registries, genome/omics, and biological information from wearable devices. AI health programs enable automatic analysis of endoscopic images, CT images, MR images, and voice data to enable diseases to be diagnosed by machine learning of the inputs gathered from thousands of data sets. Next-generation 5G communication is expected to enable smooth telemedicine with little delay, such as for hearing aid fitting and cochlear implant mapping. Telerobotic surgery has also been reported. Emerging digital technologies will change the face of otolaryngological medical care.