Analysis of Esophageal Voice: Videofluoroscopic & Acoustic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Advanced laryngeal cancer is frequently treated by total laryngectomy. This operation is effective but results in gross functional disability because of the permanent loss of voice. As an alternative using voice, esophageal speech has been employed as a natural and satisfactory means of communication for laryngectomized patients. Unfortunately, during past decades the success rate has ranged 40-60%. The purpose of this study was to determine which factors contribute to the proficiency of esophageal speech. MATERIALS AND METHOD: Videofluoroscopy and voice analysis of fourteen alaryngeal male patients who had trained esophageal speech were performed. RESULTS: Aerophagia and air ejection were impossible in poor esophageal speakers. Fluent esophageal speakers had short pseudoglottis, longer maximum phonation time, more efficient jitter, shimmer and harmonic-to-noise ratio. CONCLUSION: Aerophagia and air ejection are essential for esophageal speech. Short pseudoglottis (less than 2 cm) affords better esophageal speech. Natural repetitive movements of aerophagia and air ejection with accurate articulatory motion can improve the quality of esophageal speech.

A Case of Nonfunctioning Parathyroid Carcinoma / 대한이비인후과학회지

Parathyroid carcinoma is an uncommon endocrine tumor. Its usual clinical presentation is that of primary hyperparathyroidism with elevated serum calcium and parathyroid hormone levels. Nonfunctioning carcinoma of the parathyroid gland with normal serum calcium levels is very rare and more aggressive. Histologically, the neoplastic cells may be of variable size and shape but are usually uniform and not too dissimilar from normal parathyroid cells. There is a general agreement that a diagnosis of carcinoma based on cytologic detail is unreliable, and local invasion and metastasis constitute the only reliable criteria of malignancy. In both functional and nonfunctional carcinoma, early surgery has proven to be the only curative treatment approach whereas both chemotherapy and radiation therapy fail to produce systemic or regional benefit when used alone. En bloc excision of primary lesion with removal of any involved structures should be performed. This paper is a case report of a nonfunctioning parathyroid carcinoma and a review of the literature.

Effects of Deafferented Sensory Inputs on c-fos mRNA Expression in Medial Vestibular Nucleus of Rats Following Unilateral Labyrinthectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fos is a protein product of proto-oncogene c-fos, which is induced by various kinds of stimulations such as noxious, physiologic and electrical stimulations. In the vestibular system, there have been several evidences that c-fos was expressed in the brainstem vestibular nuclei during vestibular compensation following unilateral labyrinthectomy (ULX). In this study, the author evaluated the effect of deafferented sensory inputs on the c-fos mRNA expression in the medial vestibular nucleus of unilaterally labyrinthectomized rats. MATERIALS AND METHODS: Animals in the experimental group underwent tarsorraphy and cervical dorsal ganglionectomy to deprive them of visual and proprioceptive sensory inputs immediately after ULX, whereas the experimental group II did not receive any procedure after ULX. Expression of c-fos mRNA was demonstrated by in situ hybridization technique. All animals were sacrificed at 1, 3, 6, 9, 24, 48 hours after ULX and frozen sectioned tissues of brainstem were used in situ hybridization. RESULTS: Three hours after ULX, the expression of c- fos mRNA was increased in the dorsal portion of medial vestibular nucleus (dMVN) in both groups and after 6 hours of ULX, it was markedly reduced. In group I (deafferented), however, asymmetric expression was observed in 24 hours after the operation. In group II, the increased expression of c-fos mRNA in the ipsilateral dMVN continued until 9 hours after the operation and thereafter, the asymmetry of c-fos mRNA expressions between the ipsilateral and contralateral dMVN was decreased. CONCLUSION: These findings suggest that vision and proprioception influenced the expression of c-fos mRNA in the brainstem medial vestibular nucleus after ULX and corrected the asymmetric expression between the healthy and lesioned nuclei earlier than the deafferented group.