著者

松永 敦

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.20, no.2, pp.104-106, 2008-12-01 (Released:2012-09-24)

参考文献数

3

著者

岩橋 利彦

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.28, no.2, pp.53, 2016-12-01 (Released:2017-06-13)

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【目的】大声発声および頻回の咳払いは声の衛生における問題行動とされている.その理由として,大声発声や咳払い時の声帯間の強い衝突が喉頭組織へ障害を与えることが考えられている.しかしながら,通常のビデオ画像(30frame/秒)では,急速な声帯の内転を断続的にしか捉えることができないため,実際にその衝突の速さを実測することは困難であった.今回我々は,高速度撮影装置を用いて,声の衛生上の問題行動である咳払いおよび大声発声に加えて,音声訓練に用いられるハミング発声時における声帯間角度・角速度の変化を連続的に解析し,通常発声時の変化と比較検討した.【対象と方法】健常成人20例を対象として,高速度撮影装置を接続した喉頭ファイバースコープを挿入した状態で,強弱の咳払い,持続母音/e:/の通常発声・大声発声およびハミング発声の5 つのタスクを指示し,喉頭の高速度動画(4000frame/秒)を記録した.動画解析ソフトDipp-Motion Proを用いて,高速度動画において前交連および左右の声帯突起上の計3点の定点を自動追尾させ,声帯内転時の声帯間角度・角速度の連続的変化を解析した.その後,声帯運動範囲の100–80%,80–20%,20–0%の各区間における平均角速度を算出した. 【結果】咳払いおよび大声発声時には声帯間角度の変化は多次関数曲線を描き,角速度の変化は加速し続けたが,通常発声およびハミング時には角度の変化はS字曲線を描き,角速度の変化は一旦加速した後に減速した.強い咳払いにおける平均角速度は通常発声と比較して全区間で有意に大きく,特に20–0%区間の平均角速度は2倍以上となった.ハミングにおける平均角速度は通常発声と比較して全区間で有意に小さく,特に20–0%区間の平均角速度は1/2以下であった. 【結論】高速度撮影装置の使用により声帯の内転角速度の連続的解析が可能となった.咳払い・大声発声における声帯内転速度は通常発声より速く,ハミングでは遅くなることが証明された.

著者

杉山 庸一郎

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.33, no.01, pp.16-20, 2021-06-01 (Released:2021-09-17)

参考文献数

22

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Bilateral vocal fold immobility influences not only vocal function but also the airway tract, possibly resulting in dyspnea. Pathophysiological diagnosis using electromyography of laryngeal muscles is also critical for patients with bilateral vocal fold immobility to optimize the surgical procedures. Vocal fold lateralization, transverse cordotomy, and arytenoidectomy can be utilized for bilateral vocal fold paralysis and posterior glottic stenosis depending on the severity of stenosis and mobility of cricoarytenoid joints. A unilateral approach should be recommended for the initial surgery to reduce the risks of aspiration and hoarseness. Laryngofissure with cartilage grafting and T-tube stenting may be performed for severe posterior glottic stenosis, often coinciding with subglottic stenosis. Laryngeal stenosis due to the bilateral vocal fold immobility should be carefully evaluated and treated with appropriate surgical technique, thereby keeping adequate airway space with preventing severe postoperative swallowing and phonatory dysfunction.

著者

土師 知行 寺田 香菜子

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.32, no.02, pp.195-206, 2020-12-01 (Released:2021-05-11)

参考文献数

19

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The validity of the application of the Cepstral/Spectral Index of Dysphonia (CSID) to Japanese dysphonic speech was examined by analyzing normal and breathy voice samples both produced by healthy Japanese volunteers with no vocal problems. Four Japanese sentences which had phonological similarities to the English test sentences were prepared for the application of the CSID. The voice samples included sustained vowel /a/ and the four sentences.The CSID was applied for analyzing both the sustained vowel and the four sentences. Established indices based on pitch synchronous analyses, such as period perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and noise to harmonic ratio (NHR) were applied to the samples of the sustained vowel.For the grade of the hoarseness and the breathiness, auditory perceptual evaluations of Japanese speech sentences and the sustained vowel were performed using a visual analog scale (VAS). GRBAS scale was used for evaluations of the sustained vowel only.Strong statistical relationships were found between the CSID and the three indices with pitch synchronous analyses. Furthermore, the CSID had strong statistical relationships with the two auditory perceptual evaluations as well, which was equal to relationships between the auditory perceptual evaluations and the indices with pitch synchronous analyses. Given that the CSID can be used to analyze speech samples whereas the indices with pitch synchronous analysis have certain technical problems to analyze speech samples, this index is considered to be applicable as a useful measure for evaluating vocal dysfunction of Japanese speech and should be used actively in clinical settings.

著者

木村 美和子 田山 二朗

出版者

THE JAPAN LARYNGOLOGICAL ASSOCIATION

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.25, no.2, pp.44-48, 2013-12-01 (Released:2014-07-25)

参考文献数

12

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The purpose of this study was to compare the functional biomechanical properties of some injectable phonosurgical biomaterials commonly used for vocal fold augmentation. Linear viscoelastic shear properties of cross-linked hyaluronic acid (HA; Juvederm®), micronized AlloDerm (Cymetra®), 3% bovine collagen (Atelocollagen), and calcium hydroxylapatite (CaHA; Radiesse®) were determined as functions of frequency covering the phonatory range, and compared to those of the human vocal fold cover. Measurements of elastic shear modulus (G‘) and dynamic viscosity (η‘) were made up to 250 Hz with a controlled-strain simple-shear rheometer. Linear least-squares regression was conducted to curve-fit log G‘ and log η‘ versus log frequency, and statistical analysis was performed with one-way ANOVA. There were statistically significant differences in the magnitudes of G‘ and η‘ among the phonosurgical materials and the normal human vocal fold cover (p<0.01), whereas there was no significant difference (p<0.05) in pairwise comparisons among all materials and the normal vocal fold cover. The rheometric properties of Juvederm and Atelocollagen were the closest match to those of the vocal fold cover. These findings suggest that none of the tested injectable biomaterials are ideal implants for facilitating the functional vibratory performance of the vocal fold cover. Future studies for the development of materials with optimal viscoelastic properties are warranted.

著者

井口 郁雄

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.29, no.2, pp.30-36, 2017-12-02 (Released:2018-06-08)

参考文献数

10

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Regional branches of the Japan Medical Association take the initiative to establish the comprehensive system of care which provides medical and nursing care recently. Otolaryngologists are expected to join in this system to exercise their expertise because of the burgeoning of needs for evaluation and rehabilitation of deglutition disorders. Without the system, practicing otolaryngologists who are interested in the care of deglutition disorders may be faced with difficulties of medical collaboration. Also, if the collaboration itself requires considerable effort, some medical providers would avoid the clinical practice of dysphagia. It is therefore imperative to build an easy-to-join system for otolaryngologists to exert their expertise in the regional community. Division of Hiroshima Prefecture, The Oto-Rhino-Laryngological Society of Japan has set up the committee of home care in November 2015. We describe regarding the launch of the committee, activities such as “dysphagia case conference” for the members and actions against public administration and the Japan Medical Association in this article.

著者

塩谷 彰浩 大久保 啓介 福田 宏之 小川 郁

出版者

The Japan Laryngological Association

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.14, no.2, pp.69-73, 2002

被引用文献数

1

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Juvenile laryngeal papillomatosis develops between the ages of 6 months and 4-5 years and runs a multiple and recurrent clinical course. There were 61 patients with laryngeal papillomatosis treated at Keio university hospital during the 20-year period between May 1981 and May 2001, of whom 20 patients were under the age of 15 at onset. The average number of repeated operations they received was 18.1, showing the pronounced multiple, recurrent trend of this disease. Treatment is basically laryngomicrosurgery using a CO<SUB>2</SUB> laser, and attempts should be made to conserve normal mucosa as much as is practicable as well as to improve phonation and respiratory function, in addition to targeting the total resection of the tumor. As the human papilloma virus, which is etiologically responsible for the formation of papillomas, grows in the mucosal epithelium, it is in principle, sufficient to vapolize the epithelial layer alone, avoiding a deeper intervention than is required. Tracheostomy should be avoided wherever feasible because it may cause tumor dissemination. Development of effective adjuvant therapy, besides surgery, is also generally anticipated. Efficacy of interferon-&alpha; in this disease has been demonstrated and indole 3 carbinol (I3C), a major component of cabbage, and the antiviral agent cidofovir are also currently used. Independently, we focused on Chinese medicines, prescribing this type of herbal medicines in anticipation of their effects for contraction of residual tumor and preventive effects against recurrence. It is worth noting that favorable results have been observed in 6 of the 10 patients receiving Chinese medicines whose therapeutic responses could be evaluated.

著者

塩谷 彰浩 大久保 啓介 福田 宏之 小川 郁

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.14, no.2, pp.69-73, 2002-12-01 (Released:2012-09-24)

参考文献数

16

被引用文献数

1 1

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Juvenile laryngeal papillomatosis develops between the ages of 6 months and 4-5 years and runs a multiple and recurrent clinical course. There were 61 patients with laryngeal papillomatosis treated at Keio university hospital during the 20-year period between May 1981 and May 2001, of whom 20 patients were under the age of 15 at onset. The average number of repeated operations they received was 18.1, showing the pronounced multiple, recurrent trend of this disease. Treatment is basically laryngomicrosurgery using a CO2 laser, and attempts should be made to conserve normal mucosa as much as is practicable as well as to improve phonation and respiratory function, in addition to targeting the total resection of the tumor. As the human papilloma virus, which is etiologically responsible for the formation of papillomas, grows in the mucosal epithelium, it is in principle, sufficient to vapolize the epithelial layer alone, avoiding a deeper intervention than is required. Tracheostomy should be avoided wherever feasible because it may cause tumor dissemination. Development of effective adjuvant therapy, besides surgery, is also generally anticipated. Efficacy of interferon-α in this disease has been demonstrated and indole 3 carbinol (I3C), a major component of cabbage, and the antiviral agent cidofovir are also currently used. Independently, we focused on Chinese medicines, prescribing this type of herbal medicines in anticipation of their effects for contraction of residual tumor and preventive effects against recurrence. It is worth noting that favorable results have been observed in 6 of the 10 patients receiving Chinese medicines whose therapeutic responses could be evaluated.

著者

海野 徳二 野中 聡

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.1, no.1, pp.26-30, 1989-06-01 (Released:2012-09-24)

参考文献数

12

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This paper describes an aerodynamic and electromyographic study of the sneeze. A sneeze is characterized by a deep inspiration followed by an abrupt expulsive expiration. The sneeze consists of three phases; inspiratory (preparatory), compressive (minimum flow) and expiratory. In the compressive phase the airway is temporarily obstructed while the intrathoracic pressure is elevated by contractions of the expiratory muscles. The study attempted to determine if the point of obstruction was at the level of the glottis similar to that observed in the cough. Aerodynamic studies using the body plethysmograph show that intrathoracic compression is greatest during the compressive phase, and that expiratory air, when present, is expelled only through the mouth. Electromyographic data show that the diaphragm (DIA) and posterior circoarytenoid (PCA) muscles are activated during the inspiratory phase and then the rectus abdominis (RA), thyroarytenoid (TA) and levator veli palatini (LP) muscles are activated during the compressive and expiratory phases. The interrelationship among these muscle groups appears to be extremely delicate as seen in the transition between the compressive and expiratory phase where an abrupt change in TA and PCA activity is observed while the RA and LP continue to be active. In cases where delayed activation of the PCA is observed the subglottic pressure created was not sufficiently high to perform an effective sneeze. From these aerodynamic and electromyographic data the authors conclude that in the sneeze the glottis is the occlusive point necessary for the elevation of the intrathoracic pressure.

著者

田口 亜紀 兵頭 政光 城本 修

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.20, no.2, pp.99-103, 2008-12-01 (Released:2012-09-24)

参考文献数

4

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It has become recently well known that voice therapy is an effective method to treat voice disorders conservatively. We introduced voice therapy for various kinds of voice disorders. 224 cases (73 males and 151 females) with voice disorders were treated at Ehime University Hospital 1998 and 2008. The wide range of maladies consisted of vocal nodules, laryngeal granulomas, sulcus vocalis and atrophies, vocal fold paralyses, and functional voice disorders. Methods of treatment included vocal hygiene education, laryngeal relaxation maneuvering, abdominal breathing, pitch adjustment, resonant voice therapy and the accent method. In performing a structured therapeutic program, the needs of each patient should be considered. Close cooperation between otolaryngologists and speech therapists is mandatory. Surgical management should be considered in cases where insufficient improvement has resulted from voice therapy.

著者

鹿野 真人 桑畑 直史 佐久間 仁 大谷 巌

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.11, no.2, pp.62-67, 1999-12-01 (Released:2012-09-24)

参考文献数

7

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A survey regarding post-laryngectomy olfaction was conducted on 17 patients. 12 patients expressed the ability to smell after laryngectomy. All of five patients who had esophageal voice and five of 10 patients who had electrolaryngeal voice stated that they could smell. The post-operative period before patients indicated that they could smell ranged from 0 to 5 years. These patients who claimed the ability to smell could not do so with complete function. 11 patients (65%) hoped to regain normal olfaction.In order to achieve this goal, we manufactured a tool to restore the capability of smelling. Utilization of this tool is projected to restore normal nasal airflow and to improve the olfactory threshold. This tool offers an invaluable improvement of the quality of life of patients that have undergone laryngectomy.

著者

本多 清志

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.8, no.2, pp.109-115, 1996-12-01 (Released:2012-09-24)

参考文献数

38

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Voluntary use of voice in human speech and song is supported by uniquely human mechanisms of peripheral apparatus and neural adaptation to their forms. This paper examines various mechanisms of voice fundamental frequency (F0) control by laryngeal muscles based on previous reports by the author and others. Besides the well-known function of the cricothyroid, other intrinsic muscles potentially contribute to voice control by their own unique manners. Extrinsic laryngeal muscles apply horizontal and vertical forces to the laryngeal framework to enhance F0 control. The horizontal component interacts with supra-laryngeal articulators and provides causal explanation of the intrinsic vowel F0. The vertical component produces a rotation of the cricoid cartilage by means of vertical laryngeal movement along the curvature of the carvical spine. Thus, F0 is tuned by overall force balance among a number of laryngeal muscles, and our capacity of its voluntary use reflects morphological characteristics of the human larynx.

著者

平野 滋

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.19, no.2, pp.87-92, 2007-12-01 (Released:2012-09-24)

参考文献数

17

被引用文献数

2 4

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Highpoints of laryngomicrosurgery are described in this paper as the following : 1. Align head position appropriately for ideal exposure of the glottis.The appropriate posture for direct laryngoscopy is the “Flexion-Extension” position. Suspension laryngoscopy and external counter pressure contribute to optimal exposure of the glottis.2. Selection of laryngoscope.Several types of laryngoscopes have been developed including round shaped, triangular shaped, retractable, etc. A posterior glottis laryngoscope was also developed for the management of posterior glottis lesions such as granulomas. It is important to have different types of laryngoscopes and to select the most appropriate one according to each lesion.3. Selection of instruments.There are several kinds of cold instruments as well as laser equipment. It is also important to use these instruments properly for each type of lesion.4. Surgical technique.Amputation or the micro-flap procedure should be selected for elevated lesions of the vocal fold on a case by case basis.

著者

平野 滋

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.16, no.2, pp.96-101, 2004-12-01 (Released:2012-09-24)

参考文献数

24

著者

兵頭 政光 相原 隆一 河北 誠二 湯本 英二

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.7, no.1, pp.64-70, 1995-06-01 (Released:2012-09-24)

参考文献数

14

被引用文献数

2 5

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The hypopharyngeal constrictor muscle consists of the thyropharyngeal (TP) and cricopharyngeal (CP) muscles. These two muscles cooperatively and, in a sense, competitively work at the pharyngeal swallowing stage. Contraction of the TP muscle drives bolus into the esophagus, while the CP muscle ralaxes and allows the bolus to pass through the upper esophageal sphincter which is made by a contraction of the CP muscle.We investigated histochemical properties of these two muscles. Acetylcholine esterase stain showed that the neuromuscular junctions of the CP muscle were scattered in the horizontal direction compaired to those of the TP muscle. Glycogen depletion test showed that the glycogen-negative muscle fibers were distributed uniformly througout the TP muscle, while those of the CP muscle decreased in number from the stimulated side toward the unstimulated side. These results suggested that the CP muscle fibers terminate in the belly of the muscle, and that length of the CP muscle fiber is not uniform. Actomyosin ATPase stain revealed that type 2B fiber was predominant in the TP muscle, while type 1 fiber was predominant in the CP muscle. The mean diameter of the TP muscle fibers was larger than that of the CP muscle.In conclusion, the histochemical properties of the TP and CP muscle showed a great contrast to each other. But these different properties gradually change around the border of the two muscles.

著者

千年 俊一

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.15, no.1, pp.11-18, 2003-06-01 (Released:2012-09-24)

参考文献数

15

被引用文献数

1 1

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Development of the laryngeal mucosa and its relationship to the appearance of glandular distribution was studied by examining the changes in the laryngeal structures at the level of subglottic larynx of 55 human infants. By making a transverse section at the level of cricoid cartilage, the area and diameter of each subglottic structure were examined using an image analysis system. The results were analyzed not only by their age at birth, but also based on the Total Development Score (TDS) that was estimated by adding the age at death and the gestational period. The areas of the whole structure, cricoid ring, maximum airway, subglottic mucosa and inner cavity (available airway) increased in close correlation with the TDS. In contrast to the increased diameter of the inner cavity, the thickness of the mucosa was almost the same size. The area occupied by the glands increased according to TDS. These results indicate the stability of the subglottic airway with advancing age and, also, the local defense system by glandular tissues develops constantly after birth.

著者

新谷 朋子 関 伸彦 氷見 徹夫

出版者

THE JAPAN LARYNGOLOGICAL ASSOCIATION

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.22, no.2, pp.99-104, 2010-12-01 (Released:2011-04-08)

参考文献数

21

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Gastroesophageal Reflux (GERD) and Laryngopharyngeal Reflux (LPRD) may be associated with night time reflux, snoring and sleep apnea; however, uncertainty remains whether reflux episodes are related to apneic episodes. The argument that the coincidental correlation of the severity of reflux-induced symptoms with the severity of obstructive sleep apnea is evidence against precipitation of apneic episodes by reflux episodes is unconvincing. While CPAP treatment improves the symptoms of GERD and LPRD, and treating GERD improves sleep disturbance, it is uncertain whether these treatments improve sleep apnea. It is necessary to consider additional treatments of GERD such as Proton Pump Inhibitors (PPI).

著者

藤田 真知子

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.1, no.2, pp.115-121, 1989-12-01 (Released:2012-09-24)

参考文献数

19

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The fundamental frequency (F0) and sound pressure level (SPL) of voice were measured in 1,563 dysphonia patients of varying etiologic diseases. The measured values were compared with the values obtained from normal control subjects. The results were summarized as follows : (1) In most disease groups, the highest F0 was low and the F0 range was decreased. (2) In most disease groups, the SPL for the loudest phonation was reduced and the SPL range was small. (3) The F0 level for habitual phonation was low in acute laryngitis and Reinke's edema and it was high in sulcus vocalis, carcinoma and mutational dysphonia in males, whereas, in females, the F0 level for habitual phonation was low in many disease groups. (4) Similar tendencies were noted with the lowest F0. (5) The SPL for habitual phonation was within the normal range in almost all disease groups. (6) F0 and SPL presented low but significant correlation to the degree of the lesion in the cases with polyp and carcinoma. (7) The effect of treatment was reflected on F0 and/or SPL in many disease groups.

著者

小林 武夫 石毛 美代子 一ノ瀬 篤司

出版者

THE JAPAN LARYNGOLOGICAL ASSOCIATION

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.25, no.1, pp.12-14, 2013-06-01 (Released:2013-09-27)

参考文献数

9

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Spasmodic dysphonia (SD) is a focal dystonia that affects the larynx. Abductor SD (ABSD) is less common than adductor SD (ADSD). ABSD is typified by breathy breaks in connected speech.A male professional classic baritone singer, age 46, presented with gradually increasing breathy unphonated breaks in singing over the course of three years. He visited various institutions and was said to have incomplete elevation of the soft palate of unknown origin, myasthenia gravis, etc. His symptoms were remarkable in pronouncing vowels following unphonated consonants. He had been exposed to neither vocal abuse nor heavy singing performances. Our diagnosis was ABSD. An injection of Botulinum toxin (BT) into the posterior cricoarytenoid muscles was done via lateral cervical approach. His voice improved remarkably. His daily conversation became smooth; however, he could not regain his previous brilliant singing voice. He was obliged to discontinue his professional singing performances.

著者

二藤 隆春 木村 美和子 田山 二朗

出版者

日本喉頭科学会

雑誌

喉頭 (ISSN:09156127)

巻号頁・発行日

vol.19, no.2, pp.101-105, 2007-12-01 (Released:2012-09-24)

参考文献数

11

被引用文献数

1