Publications by authors named "Koichi Tsunoda"

68 Publications

Natural nasal-esophageal fiberscopy in the COVID-19 pandemic-preventing sneezing without anesthesia: a case report.

Eur J Med Res 2021 Jun 9;26(1):52. Epub 2021 Jun 9.

Department of Oto-Rhino-Laryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

Background: We are laryngologists. We observe natural phonatory and swallowing functions in clinical examinations with a trans-nasal laryngeal fiberscope (TNLF). Before each observation, we use epinephrine to enlarge and smooth the common nasal meatus (bottom of nostril) and then insert a wet swab inside the nose, as in taking a swab culture in the nasopharynx. During the current COVID-19 pandemic situation, this careful technique prevents any complications, including nasal bleeding, painfulness, and induced sneezing. Here, we introduce our routine to observe esophageal movement in swallowing in a natural (sitting) position without anesthesia.

Case Presentation: The case was a 70-year-old female who complained that something was stuck in her esophagus; there was a strange sensation below the larynx and pharynx. After enlarging and smoothing the common nasal meatus, we inserted the TNLF (slim type ⌀2.9 mm fiberscope, VNL8-J10, PENTAX Medical, Tokyo, Japan.) in the normal way. We then observed the phonatory and swallowing movements of the vocal folds. As usual, to not interfere with natural movements, we used no anesthesia. We found no pathological condition in the pyriform sinus. We asked the patient to swallow the fiberscope. During the swallow, we pushed the TNLF and inserted the tip a bit deeper, which made the fiberscope easily enter the esophagus, like in the insertion of a nasogastric tube. We then asked the patient to swallow a sip of water or saliva to clear and enlarge the lumen of the esophagus. This made it possible to observe the esophagus easily without any air supply. With tone enhancement scan, the esophagus was found to be completely normal except for glycogenic acanthosis.

Conclusions: The advantage of this examination is that it is easily able to perform without anesthesia and with the patient in sitting position. It is quick and minimally invasive, enabling observation the physiologically natural swallowing. It is also possible to observe without anesthesia down to the level of the esophagogastric junction using with a thin type flexible bronchoscope. In the future, gastric fiberscopes might be thinner, even with narrow band imaging (NBI) function. Before that time, physicians should remember to just insert along the bottom of the nose.
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http://dx.doi.org/10.1186/s40001-021-00523-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188538PMC
June 2021

Kampo Medicine for Essential Voice Tremor.

Altern Ther Health Med 2021 Mar;27(2):32-33

Voice tremor is a common symptom in the elderly, as well as in patients who have had Parkinson's disease and related disorders, and other neurologic conditions. In this study, we analyzed 26 patients whose essential tremor symptoms involved phonation alone and were treated in our clinic alone as essential voice tremor. Kampo medicine yokukansan was found to be effective in the treatment of essential voice tremor compared with clonazepam. We suggest that yokukansan may be one of the best choices for first-line treatment of essential voice tremor.
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March 2021

Intranasal pain in a patient with Behçet's disease.

BMJ 2020 Mar 11;368:m525. Epub 2020 Mar 11.

National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

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http://dx.doi.org/10.1136/bmj.m525DOI Listing
March 2020

Hand posture affects brain-function measures associated with listening to speech.

Sci Rep 2020 02 25;10(1):3370. Epub 2020 Feb 25.

University of Cambridge, Department of Experimental Psychology, Cambridge, CB2 3EB, UK.

A major difficulty in studies of the brain, from the molecular to large-scale network level, is ensuring the accuracy and reliability of results, since repeatability has been a problem in studies utilizing functional magnetic resonance imaging (f-MRI) near-infrared spectroscopy (NIRS), and positron-emission tomography (PET). More generally, an effort to replicate psychological studies has shown that the original results were unambiguously reobtained only 39% of the time. It has been suggested that researchers must undertake studies to identify factors that reduce reliability and conduct more carefully controlled studies to improve reliability. In our previous work, we examined whether changes in hand/arm posture can have a confounding effect on task-related brain activity. Here we show a solution to enhance reproducibility in a NIRS study in a hearing task. The results showed that crossed posture can lead to different results than parallel posture with respect to asymmetric functional connectivity, especially during non-resting state. Even when the only task is listening to speech stimuli, participants should be asked to place their hands on a surface and feet on the floor and keep the same stable posture to increase reproducibility of results. To achieve accurate reliability and reproductively of results, stable hand posture through the experiment is important.
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http://dx.doi.org/10.1038/s41598-020-59909-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042249PMC
February 2020

Exploring the Relation between Glottal Closure and Plasma Substance P: A Study Protocol.

Tohoku J Exp Med 2019 12;249(4):237-240

Department of Artificial Organs and Medical Creations, National Hospital Organization Tokyo Medical Center.

Glottal incompetence, i.e., reduced ability to produce effective glottal closure, is a problem often associated with aging. The study protocol is presented to determine whether blood substance P (SP) serves as an indicator of glottal closure function among the elderly. SP is involved in the neuromuscular mechanisms of cough; reduced concentration of SP may be a marker for increased risk of aspiration pneumonia. The antihypertensive angiotensin-converting enzyme inhibitor, which also inhibits degradation of SP, has been found to be effective in preventing aspiration pneumonia by strengthening the cough reflex. In this study, we will employ National Hospital Organization self-controlled vocal exercise (NHOEx), which has been shown to improve glottal closure by strengthening the laryngeal adduction muscles. We hypothesize that improved glottal closure by NHOEx may lead to the increase in the plasma concentration of SP, which reflects effective cough reflex. Maximum phonation time (MPT), an indicator of glottal closure, will be measured to assess improvement of glottis-closing function. The study will include 180 patients over 65 years old with dysphonia, dysphagia, or MPT of less than 15 seconds. Based on the speculation that the improved MPT may be associated with changes in SP expression, we will measure the plasma SP before and after 6-month treatment of glottal incompetence using NHOEx. The goal is to verify the reliability of SP as an indicator for glottal closure and swallowing function. Measurement of plasma SP may be helpful for earlier detection of subjects with higher risk of aspiration pneumonia among the elderly.
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http://dx.doi.org/10.1620/tjem.249.237DOI Listing
December 2019

A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan.

Auris Nasus Larynx 2020 Feb 4;47(1):7-17. Epub 2019 Oct 4.

Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan.

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.
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http://dx.doi.org/10.1016/j.anl.2019.09.004DOI Listing
February 2020

A "balloon" inside the mouth.

Endoscopy 2020 03 27;52(3):E98-E99. Epub 2019 Sep 27.

Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

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http://dx.doi.org/10.1055/a-1011-4030DOI Listing
March 2020

A new training method for velopharyngeal dysfunction: Self-inhalation for hypernasality.

Auris Nasus Larynx 2020 Apr 14;47(2):250-253. Epub 2019 Sep 14.

Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan.

Objective: There are various methods to treat velopharyngeal dysfunction including surgery and rehabilitation therapy. Even if a rehabilitation program is effective, the evaluation of its efficacy remains subjective. In this paper, we propose a new method of rehabilitation training for velopharyngeal dysfunction focusing on the objective peak inspiratory flow (PIF) rate.

Methods: Four patients, who were diagnosed with velopharyngeal dysfunction without cleft palate at ENT clinic of the National Hospital Organization, Tokyo Medical Center, participated in this study. All patients underwent our original rehabilitation program for velopharyngeal dysfunction, a method using the In-Check Dial, Turbohaler model. As a self-training rehabilitation program, we asked them to inhale forcefully 10 times daily at home using the In-Check Dial to increase the value of PIF rate for 3 months. We measured the patients' PIF rates with the In-Check Dial at the ENT clinic at the initial visit and after the 3-month training.

Results: The PIF rates of the four patients without nasal clips were higher than the rates with nasal clips at the initial visit. After the training, PIF rate without a nasal clip of all patients increased than the rate at the initial visit, which represented significant difference (P < 0.05). Also, after 3 months, PIF rate without a nasal clip was higher or equal than the rates with a nasal clip at the initial visit except one case. Naso-pharyngo-laryngeal fiberscopy did not detect salivary pooling around larynx and mirror fogging test did not show nasal escape in the three of four patients after 3 months of training. All reported improvement in dysphagia and dysarthria.

Conclusion: This new method can be used not only to evaluate velopharyngeal function but also as an effective self-training treatment.
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http://dx.doi.org/10.1016/j.anl.2019.08.011DOI Listing
April 2020

Chronic inflammatory response in the rat lung to commonly used contrast agents for videofluoroscopy.

Laryngoscope Investig Otolaryngol 2019 Jun 7;4(3):335-340. Epub 2019 May 7.

Department of Otolaryngology The University of Tokyo Tokyo Japan.

Objectives: Contrast agents (CAs) are essential for upper gastrointestinal and videofluoroscopic swallow studies (VFSSs). Recently, we reported that small amounts of Ba aspiration caused severe acute lung inflammation in a rodent model. However, the underlying molecular biological mechanisms of chronic response to CA aspiration remain unclear. The aims of this study were to explore the underlying molecular biological mechanisms of the chronic response to three kinds of CA aspiration on the lung.

Study Design: Animal model.

Methods: Eight-week-old male Sprague Dawley rats were divided into five groups (n = 6, each group). Three groups underwent tracheal instillation of one of three CAs: barium sulfate (Ba), ionic iodinated contrast agent (ICA), and nonionic iodinated contrast agent (NICA). A sham group was instilled with air and a control group was instilled with saline. All animals were euthanized 30 days after treatment and histological and gene analyses were performed.

Results: No animal died after CA or sham/control aspiration. Ba particles remained after 30 days and caused histopathologic changes and inflammatory cell infiltration. Iodinated ICA and NICA did not result in perceptible histologic change. Expression of Tnf, an inflammatory cytokine was increased in only Ba aspirated rats ( = .0076). Other inflammatory cytokines and fibrosis-related genes did not alter between groups.

Conclusion: Aspirated Ba particles did not clear from the lung within a month and caused mild chronic pulmonary inflammation. ICA and NICA did not cause any inflammatory responses in the lungs, suggesting that ICA and NICA may be safer CAs for VFSS than Ba.

Level Of Evidence: NA.
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http://dx.doi.org/10.1002/lio2.269DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580069PMC
June 2019

Development of an Oropharyngeal Scope with an Integrated Tongue Depressor: NTOP2013 Study.

Acta Med Okayama 2018 Dec;72(6):611-614

Department of Artificial Organs Medical Device Creation, Tokyo Medical Center, Tokyo 152-8902,

The oropharynx is examined with a light source such as an electric light, a penlight, or a forehead mirror based on an acquired visual field using a tongue depressor. However, it is extremely difficult to obtain objective and reproducible images of tissue within the pharynx required in recent years with these methods, and insufficient progress in the examination tools has been made. There is an increasing need to develop a method for display during oropharyngeal examination. We conducted the present study to develop a novel oropharyngeal endoscope as an objective observation method.
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http://dx.doi.org/10.18926/AMO/56381DOI Listing
December 2018

A pilot study of the clinical evidence for the methodology for prevention of oral mucositis during cancer chemotherapy by measuring salivary excretion of 5-fluorouracil.

BDJ Open 2018 23;4:17041. Epub 2018 Nov 23.

Iwate Medical University, Reconstructive Oral and Maxillofacial Surgery, Morioka, Iwate Japan.

Objective to re-examine measures to prevent oral mucositis caused by drugs in head and neck cancer patients during cancer treatment by measuring salivary excretion of 5-fluorouracil. Saliva, blood, and urine were simultaneously collected from oral cancer patients and breast cancer patient at the point in time of before, during, and after the administration of 5-FU, then the 5-FU levels of the samples were quantitatively analysed using LC-MS/MS. In all patients, the 5-FU levels in saliva and serum peaked at 30 min to 3 h after the start of 5-FU treatment, and high levels were maintained throughout the administration of the drug. With regard to urinary 5-FU levels, they remained high from 3 to 120 h after the start of 5-FU treatment. After the completion of 5-FU treatment, even though it not appeared in the patients' serum and urine promptly, 5-FU was detected in saliva at 12 h after the completion of 5-FU treatment in one oral cancer patient and at 48 h after the completion of 5-FU treatment in the breast cancer patient. It was suggested that the level of hydration after the completion of chemotherapy may be involved in the differences in 5-FU excretion.
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http://dx.doi.org/10.1038/s41405-018-0008-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251891PMC
November 2018

Pitfall in the mouth caused by longevity.

Med Hypotheses 2018 10 23;119:22-23. Epub 2018 Jul 23.

Departmet of Neurology, National Hospital Organization Tokyo Medical Center, Tokyo Japan.

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http://dx.doi.org/10.1016/j.mehy.2018.07.017DOI Listing
October 2018

Slow, slurred speech as an initial complaint in amyotrophic lateral sclerosis.

Auris Nasus Larynx 2019 Apr 16;46(2):193-195. Epub 2018 Aug 16.

Department of Neurology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

Objective: Otorhinolaryngologic examinations at an early stage, particularly those conducted by vocal specialists, can make potentially important contributions to the diagnosis of bulbar-onset ALS patients.

Methods: We analyzed 2623 patients (2010-2017) visited the ENT Voice Clinic, National Hospital Organization Tokyo Medical Center, with the primary complaint of speech or vocal dysfunction at the initial visit. Among those, 12 patients visited the voice clinic after consultations with other physicians but before receiving a diagnosis and we initially suspected bulbar-onset ALS due to slow, slurred speech (SSS). We analyzed the detail of those suspected ALS cases.

Results: Every patient suspected ALS patients consulted an average of 2.2 physicians before visiting the voice clinic and a total of 3.2 physicians before receiving the final diagnosis. The mean speech symptom duration before visiting the vocal clinic was 7.83 months in ALS, 24 months in MSA patients. The duration until final diagnosis after we referred them to neurologists was 2.16 months and 15.3 months, respectively.

Conclusion: Otolaryngologists and primary care physicians to consider the possibility of ALS when patients present even with an only symptom of SSS. They should then refer such patients to neurologists for definitive diagnoses, leading to early detection and treatment of ALS.
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http://dx.doi.org/10.1016/j.anl.2018.07.007DOI Listing
April 2019

Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial.

Laryngoscope 2018 11 6;128(11):2593-2599. Epub 2018 Aug 6.

Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.

Objectives/hypothesis: Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost-effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost-effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene.

Study Design: Multicenter randomized controlled trial.

Methods: Patients who visited a National Hospital Organization (NHO) hospital for the surgical indication of hoarseness were included in the study. Before undergoing surgery, 200 patients with benign vocal fold lesions (vocal fold polyps/nodules) were enrolled and randomly allocated to the NHO-style vocal hygiene educational program (intervention group) or control education program (control group). Two months after enrollment, the patients in both groups underwent laryngeal fiberscopic examinations to determine whether the benign lesions had resolved or whether surgery was indicated for the vocal fold polyps/nodules.

Results: After 2 months, in the intervention group, the proportion of lesion resolution (61.3%) was significantly greater than that in the control group (26.3%) (P < .001, Fisher exact test).

Conclusions: Our results clearly indicate that the quality and features of the education program could affect the outcome of the intervention. We found that a reinforced vocal hygiene education program increased the rate of the resolution of benign vocal fold polyps and nodules in a multicenter randomized clinical trial.

Level Of Evidence: 1b Laryngoscope, 2593-2599, 2018.
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http://dx.doi.org/10.1002/lary.27415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585860PMC
November 2018

Development of Oropharyngeal Scope Type II with Integrated Tongue Depressor for Examination of the Oropharynx: NTOP2016 Study.

Kurume Med J 2018 Jul 21;64(4):91-95. Epub 2018 May 21.

Department of Pediatrics, National Hospital Organization Tokyo Medical Center.

The oropharynx is examined by focusing an electric light, penlight, or forehead mirror on a desired visual field using a tongue depressor. However, it is extremely difficult to obtain objective recorded evidence for display with these methods, and the tools for examination have remained virtually unchanged for the past century. Treatment of the pharynx/oral cavity is exceedingly difficult, particularly in elderly patients and children. Therefore, there is an increasing need to develop a method for displaying the visual field during oropharyngeal examinations which is acceptable to patients, which can easily be applied at all medical institutions, which can be displayed to third parties, and which can be used by doctors for recording data and determining treatment. We earlier developed a dedicated device for this purpose (Improved Type I) and have now made further improvements. This study aims to evaluate the utility of the improved type II oropharyngeal endoscope as a tool for objective examination.
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http://dx.doi.org/10.2739/kurumemedj.MS644003DOI Listing
July 2018

An oral pharyngeal scope for objective oropharyngeal examination: a new device for oropharyngeal study.

Acta Otolaryngol 2018 May 5;138(5):487-491. Epub 2017 Dec 5.

i Department of Otolaryngology and Head and Neck Surgery , Jichi Medical University , Shimotsuke , Tochigi , Japan.

Objective: There has been little progress in examination of the oropharynx with a light source such as electric light, a penlight, or a forehead mirror over the past 100 years. It is therefore necessary to develop methods to display and record oropharyngeal observations.

Method: Since the aim of this study was to assess the safeness to use from the perspective of physicians, medical staffs, patients, and patients' families and usefulness of pharyngeal scope, the number of devices was limited, the number of patients was not set based on hypothetical statistical tests.

Results: A total of 150 volunteers were enrolled in this study. Among them, 96 underwent examination alone and the remaining 28 underwent treatment procedures. The study was done without any complications in all 150 cases. Most (91.3%) physicians hoped to continue using the new device if available. When comparing the use of the device for observation alone and for treatment procedures, there was no significant difference for evaluation items (p > .05) except convenience factor which received a significantly different (p = .0154) evaluation from physicians for observation alone and for treatment procedures. A positive evaluation was received about examination, recording/display and explanation from the patients and patients' families.

Conclusions: Our new device received positive evaluations by who underwent examination of the oral cavity and pharynx, recording of the results, and treatment procedures.
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http://dx.doi.org/10.1080/00016489.2017.1408963DOI Listing
May 2018

Detectable voice change with the edrophonium test in laryngeal myasthenia gravis.

J Int Med Res 2017 Oct 30;45(5):1466-1469. Epub 2017 Jan 30.

2 Department of Neurology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

A case of laryngeal myasthenia gravis in a 65-year-old woman presenting with hoarseness as the sole symptom is reported. Voice spectrography was performed before and after injection of intravenous edrophonium. There was a marked improvement in the patient's voice after the administration of edrophonium, which was confirmed by the changes seen on the sound spectrogram. This was the only objective indication of a diagnosis of myasthenia gravis. No thymoma was seen on chest X-ray and the patient was negative for anti-acetylcholine receptor antibodies. Treatment for laryngeal myasthenia gravis was initiated and the patient's vocal problems resolved. This case emphasizes the need to consider systemic diseases in the differential diagnosis of hoarseness and demonstrates the need for careful follow-up in such patients.
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http://dx.doi.org/10.1177/0300060516685026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718711PMC
October 2017

Laryngeal mucus hypersecretion is exacerbated after smoking cessation and ameliorated by glucocorticoid administration.

Toxicol Lett 2017 Jan 2;265:140-146. Epub 2016 Dec 2.

Department of Otolaryngology, The University of Tokyo, Japan.

Introduction: The mechanisms underlying the effects of cigarette smoke and smoking cessation on respiratory secretion, especially in the larynx, remain unclear.

Objectives: The aims of this study were to determine the effects of cigarette smoke and smoking cessation on laryngeal mucus secretion and inflammation, and to investigate the effects of glucocorticoid administration.

Methods: We administered cigarette smoke solution (CSS) to eight-week-old male Sprague Dawley rats for four weeks, then examined laryngeal mucus secretion and inflammatory cytokine expression on days 1, 28 and 90 after smoking cessation. We also investigated the effects of the glucocorticoid triamcinolone acetonide when administered on day 1 after smoking cessation.

Results: Exposure to CSS resulted in an increase in laryngeal mucus secretion that was further excacerbated following smoking cessation. This change coincided with an increase in the expression of mRNA for the inflammatory cytokines tumor necrosis factor and interleukin-6, as well as mRNA for MUC5AC, which is involved in mucin production. Triamcinolone suppressed CSS-induced laryngeal mucus hypersecretion and pro-inflammatory cytokine production.

Conclusion: Cigarette smoke-associated inflammation may contribute to the exacerbated laryngeal mucus hypersecretion that occurs following smoking cessation. The inflammatory response represents a promising target for the treatment of cigarette smoke-associated mucus hypersecretion.
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http://dx.doi.org/10.1016/j.toxlet.2016.11.023DOI Listing
January 2017

Role of lifestyle modifications for patients with laryngeal granuloma caused by gastro-esophageal reflux: comparison between conservative treatment and the surgical approach.

Acta Otolaryngol 2017 Mar 19;137(3):306-309. Epub 2016 Oct 19.

a Department of Artificial Organs and Medical Creation, and Otolaryngology , National Hospital Organization, Tokyo Medical Center , Tokyo , Japan.

Conclusions: It is considered that a regimen combining pharmacologic management and lifestyle modifications is the most effective treatment for laryngeal granulomas caused by GER.

Objectives: This study compared the results of the combination therapy and surgery to determine the best treatment of laryngeal granuloma caused by gastro-esophageal reflux in 51 patients.

Methods: Prospective study.

Results: In the conservative treatment group, the CR rate was 89.7% and recurrence rate was 2.6%, while the lesions remained in patients (7.7%). This study compared the CR and recurrence rates between conservative treatment and surgery for granuloma. The results showed that the laryngeal granuloma recurrence rate was significantly lower with the conservative treatment regimen compared with surgery (p = .0016).
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http://dx.doi.org/10.1080/00016489.2016.1244858DOI Listing
March 2017

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial.

Clin Rehabil 2017 Aug 14;31(8):1049-1056. Epub 2016 Oct 14.

1 Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan.

Objectives: To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.

Design: Parallel-arm, individual randomized controlled trial.

Methods: Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups.

Results: Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly ( p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference ( p < 0.001).

Conclusion: The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly.

Clinical Trial: gov Identifier-UMIN000015567.
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http://dx.doi.org/10.1177/0269215516673208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524188PMC
August 2017

Longer latency of sensory response to intravenous odor injection predicts olfactory neural disorder.

Sci Rep 2016 10 13;6:35361. Epub 2016 Oct 13.

Departments of Otolaryngology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

A near loss of smell may result from conductive and/or neural olfactory disorders. However, an olfactory test to selectively detect neural disorders has not been established. We investigated whether onset latency of sensory response to intravenous odor injection can detect neural disorders in humans and mice. We showed that longer preoperative onset latency of odor recognition to intravenous odor in patients with chronic rhinosinusitis predicted worse recovery of olfactory symptoms following sinus surgery. The onset latency of the olfactory sensory neuron (OSN) response to intravenous odor using synaptopHluorin signals from OSN axon terminals was delayed in mice with reduced numbers of OSNs (neural disorder) but not with increased mucus or blocked orthonasal pathways (conductive disorders). Moreover, the increase in onset latency correlated with the decrease in mature OSN numbers. Longer onset latency to intravenous odor injection is a useful biomarker for presence and severity of olfactory disorders with neural etiology.
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http://dx.doi.org/10.1038/srep35361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062120PMC
October 2016

Dysphagia due to kyphosis-induced positional changes of the carotid artery.

Endoscopy 2016 0;48(S 01):E300. Epub 2016 Sep 26.

National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.

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http://dx.doi.org/10.1055/s-0042-116024DOI Listing
September 2016

Near-infrared-spectroscopic study on processing of sounds in the brain; a comparison between native and non-native speakers of Japanese.

Acta Otolaryngol 2016 Jun 15;136(6):568-74. Epub 2016 Feb 15.

a Department of Artificial Organs and Medical Creations , National Hospital Organization, National Institute of Sensory Organs, National Tokyo Medical Center , Tokyo , Japan.

Conclusions The result suggested that mother tongue Japanese and non- mother tongue Japanese differ in their pattern of brain dominance when listening to sounds from the natural world-in particular, insect sounds. These results reveal significant support for previous findings from Tsunoda (in 1970). Objectives This study concentrates on listeners who show clear evidence of a 'speech' brain vs a 'music' brain and determines which side is most active in the processing of insect sounds, using with near-infrared spectroscopy. Methods The present study uses 2-channel Near Infrared Spectroscopy (NIRS) to provide a more direct measure of left- and right-brain activity while participants listen to each of three types of sounds: Japanese speech, Western violin music, or insect sounds. Data were obtained from 33 participants who showed laterality on opposite sides for Japanese speech and Western music. Results Results showed that a majority (80%) of the MJ participants exhibited dominance for insect sounds on the side that was dominant for language, while a majority (62%) of the non-MJ participants exhibited dominance for insect sounds on the side that was dominant for music.
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http://dx.doi.org/10.3109/00016489.2016.1139745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898151PMC
June 2016

Effect of a nasal clip on inhaling a sufficient cortico steroid powder dose.

Ann Allergy Asthma Immunol 2015 Dec 28;115(6):525-6. Epub 2015 Sep 28.

Department of Otolaryngology, University of Tokyo, Tokyo, Japan.

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http://dx.doi.org/10.1016/j.anai.2015.08.017DOI Listing
December 2015

Patients' perceptions of vocal problems: results from a survey in the Tokyo area.

Acta Otolaryngol 2015 Jun 26;135(6):532-5. Epub 2015 Feb 26.

Department of Artificial Organs and Medical Device Creation and Otolaryngology, National Hospital Organization, National Tokyo Medical Center, National Institute of Sensory Organs , Tokyo , Japan.

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.
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http://dx.doi.org/10.3109/00016489.2014.999873DOI Listing
June 2015

Sensory deprivation disrupts homeostatic regeneration of newly generated olfactory sensory neurons after injury in adult mice.

J Neurosci 2015 Feb;35(6):2657-73

Department of Otolaryngology and.

Although it is well known that injury induces the generation of a substantial number of new olfactory sensory neurons (OSNs) in the adult olfactory epithelium (OE), it is not well understood whether olfactory sensory input influences the survival and maturation of these injury-induced OSNs in adults. Here, we investigated whether olfactory sensory deprivation affected the dynamic incorporation of newly generated OSNs 3, 7, 14, and 28 d after injury in adult mice. Mice were unilaterally deprived of olfactory sensory input by inserting a silicone tube into their nostrils. Methimazole, an olfactotoxic drug, was also injected intraperitoneally to bilaterally ablate OSNs. The OE was restored to its preinjury condition with new OSNs by day 28. No significant differences in the numbers of olfactory marker protein-positive mature OSNs or apoptotic OSNs were observed between the deprived and nondeprived sides 0-7 d after injury. However, between days 7 and 28, the sensory-deprived side showed markedly fewer OSNs and mature OSNs, but more apoptotic OSNs, than the nondeprived side. Intrinsic functional imaging of the dorsal surface of the olfactory bulb at day 28 revealed that responses to odor stimulation were weaker in the deprived side compared with those in the nondeprived side. Furthermore, prevention of cell death in new neurons 7-14 d after injury promoted the recovery of the OE. These results indicate that, in the adult OE, sensory deprivation disrupts compensatory OSN regeneration after injury and that newly generated OSNs have a critical time window for sensory-input-dependent survival 7-14 d after injury.
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http://dx.doi.org/10.1523/JNEUROSCI.2484-14.2015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605607PMC
February 2015

Patient-controlled taping for the treatment of ingrown toenails.

Ann Fam Med 2014 Nov-Dec;12(6):553-5

Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, National Tokyo Medical Center, National Hospital Organization, Tokyo, Japan

Various methods are used to treat ingrown or pincer-like toenails. We developed a novel taping method to prevent topical interruption of the circulation and resulting skin conditions and evaluated it over 14.5 years. We instructed 541 patients or their guardians in the use of the technique. Ingrown toenail symptoms and abnormal nail growth were resolved and no additional therapy was required in 276 patients. The novel taping method was significantly more effective than treatments our patients had received previously. Patient-controlled taping is the first-line treatment for every ingrown or curved toenail seen in our clinic.
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http://dx.doi.org/10.1370/afm.1712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226777PMC
July 2015

Hounsfield unit values of retropharyngeal abscess-like lesions seen in Kawasaki disease.

Acta Otolaryngol 2014 Apr 10;134(4):437-40. Epub 2014 Feb 10.

Departments of 1Otolaryngology.

Conclusions: Retropharyngeal abscess-like lesions are occasionally seen in computed tomography (CT) imaging of patients with Kawasaki disease (KD) and these patients often undergo unnecessary surgery. We could distinguish the lesions from true abscesses by measuring their Hounsfield unit values (HUs).

Objective: To distinguish the retropharyngeal abscess-like lesions from true abscesses without any surgical procedure.

Methods: We investigated six cases of KD showing such lesions on CTs, both with and without contrast enhancement (CE). We measured the HUs of those lesions and compared them with those of 10 true abscesses as controls.

Results: Abscess-like lesions of KD were well enhanced by CE, whereas abscesses showed virtually no enhancement. The mean HU in the six KD cases was 20.0 ± 4.65 (mean ± SD) on plain CTs and 35.6 ± 4.49 on contrast CTs. In abscesses, it was 30.3 ± 4.42 on plain CTs and 30.3 ± 3.57 on contrast CTs. The difference in HU values [(HU on contrast CT) - (HU on plain CT)] was defined as ΔHU. The mean ΔHU was 15.6 ± 5.36 in the six KD lesions and 0.0 ± 2.93 in abscesses, with statistical significance of p < 0.0001 by Student's t test. Thus, ΔHU value may potentially be a useful parameter for their distinction.
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http://dx.doi.org/10.3109/00016489.2013.878475DOI Listing
April 2014

Non-invasive objective evaluation of radiotherapy-induced dry mouth.

J Oral Pathol Med 2014 Feb 17;43(2):97-102. Epub 2013 Jun 17.

Department of Otolaryngology, Faculty of Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Artificial Organs and Otolaryngology, National Institute of Sensory Organs, Tokyo, Japan.

Background: Dry mouth is a common complaint in patients undergoing radiotherapy. Here, we employed the oral moisture meter Mucus III to evaluate dry mouth in head and neck tumor patients before and after they underwent radiotherapy.

Methods: We recruited 17 newly diagnosed patients with pharyngeal squamous cell carcinoma or unknown primary squamous cell carcinoma, who received head and neck radiation therapy at Tokyo University Hospital in 2008-2010. The primary sites were the epipharynx (n = 1), oropharynx (n = 6), or hypopharynx (n = 5); it was unknown in five cases. Salivary function was assessed by a dry mouth questionnaire, resting saliva test, chewing gum test, and Mucus III, before (n = 17), immediately after radiotherapy (n = 10), and at 3 (n = 9) and 12 months after radiotherapy (n = 11).

Results: The questionnaire, resting saliva test, and chewing gum test at 3 and 12 months after radiotherapy indicated a significantly decreased resting and stimulated whole saliva flow rate than prior radiotherapy (P < 0.05 and P < 0.001). In contrast, Mucus III results showed significant worsening of xerostomia at 12 months after radiotherapy (P < 0.05).

Conclusion: Mucus III has been proven to be an objective diagnostic tool for patients with serious dry mouth, such as in patients with Sjogren's syndrome. However, we did not find a perfect correlation between Mucus III and other objective (resting saliva and chewing gum) and subjective (questionnaire) measures of dry mouth. To precisely diagnose radiotherapy-induced dry mouth, further improvement to the method is needed.
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http://dx.doi.org/10.1111/jop.12099DOI Listing
February 2014
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