Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 13 de 13
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Heliyon ; 10(4): e25751, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38375315

RESUMO

We speculated that increased blood-plasma levels of Substance P may serve as an indicator of glottal incompetence, which is usually indicated by reduced maximum phonation time. We performed an initial study to test the plausibility of this hypothesis. Patients with dysphonia caused by glottal incompetence were asked to perform vocal exercises for six months to reduce glottal incompetence and we compared the plasma concentration of Substance P before and after the vocal exercise to detect correlation between maximum phonation time and plasma concentration of Substance P. Based on the results, we further hypothesized that patients exhibiting dysphonia with maximum phonation time less than 14 s, in particular less than 10 sec, caused by glottal incompetence may have increased plasma concentration of Substance P with the results of elevated thresholds of cough reflex associated with subclinical aspiration in airways. Further study is needed on patients with decreased Substance P levels, with low scores on Activities of Daily Living and who are hospitalized with aspiration pneumonia.

2.
Acta Med Okayama ; 72(6): 611-614, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30573918

RESUMO

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.


Assuntos
Endoscópios , Desenho de Equipamento , Orofaringe/diagnóstico por imagem , Orofaringe/patologia , Otolaringologia/instrumentação , Protocolos Clínicos , Humanos
3.
Laryngoscope ; 128(11): 2593-2599, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30079962

RESUMO

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.


Assuntos
Tratamento Conservador/métodos , Higiene/educação , Doenças da Laringe/terapia , Educação de Pacientes como Assunto/métodos , Pólipos/terapia , Avaliação de Programas e Projetos de Saúde , Feminino , Humanos , Doenças da Laringe/patologia , Laringoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pólipos/patologia , Resultado do Tratamento , Prega Vocal/patologia
4.
Kurume Med J ; 64(4): 91-95, 2018 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-29780060

RESUMO

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.


Assuntos
Endoscópios , Endoscopia/instrumentação , Orofaringe/patologia , Otolaringologia/instrumentação , Doenças Faríngeas/diagnóstico , Desenho de Equipamento , Humanos , Satisfação do Paciente , Doenças Faríngeas/patologia , Valor Preditivo dos Testes , Projetos de Pesquisa
5.
Acta Otolaryngol ; 138(5): 487-491, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29205078

RESUMO

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.


Assuntos
Endoscópios , Orofaringe/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Adulto Jovem
6.
Laryngoscope ; 127(9): E324-E329, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28271504

RESUMO

OBJECTIVE: Evaluating the prevalence of specific gene mutations associated with a certain audiometric configuration facilitates clinical assessment of patients with sensorineural hearing loss (SNHL). WFS1 is responsible for autosomal dominant nonsyndromic deafness 6/14/38 and is the most frequent genetic cause of low-frequency SNHL (LFSNHL); however, the exact prevalence of WFS1 mutations in LFSNHL is unknown. Therefore, we evaluated genetic mutations and clinical features in patients with nonsyndromic bilateral LFSNHL, focusing on the WFS1. STUDY DESIGN: Retrospective case series from 2002 to 2013 at the National Hospital Organization Tokyo Medical Center and collaborating hospitals. METHODS: WFS1, GJB2, and mitochondrial DNA mutation screening was carried out for 74 of 1,007 Japanese probands with bilateral LFSNHL. RESULTS: WFS1 and GJB2 mutations were identified in eight of 74 cases (10.8%). Four cases had heterozygous WFS1 mutations; one case had a heterozygous WFS1 mutation and a heterozygous GJB2 mutation; and three cases had biallelic GJB2 mutations. Three cases with WFS1 mutations were sporadic; two of them were confirmed to be caused by a de novo mutation based on the genetic analysis of their parents. In the case with mutations in both WFS1 and GJB2, a de novo mutation of WFS1 was confirmed in the proband's mother by genetic screening of the mother's parents. CONCLUSION: Genetic screening focusing on LFSNHL has not been conducted. The present study first revealed the prevalence of specific gene mutations. WFS1 autosomal dominant mutations were identified even in sporadic cases. Our results also suggested a mutational hotspot in WFS1. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:E324-E329, 2017.


Assuntos
Conexinas/sangue , DNA Mitocondrial/sangue , Perda Auditiva Neurossensorial/genética , Proteínas de Membrana/sangue , Mutação , Idade de Início , Povo Asiático/genética , Conexina 26 , Análise Mutacional de DNA , Feminino , Testes Genéticos , Perda Auditiva Neurossensorial/sangue , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Linhagem , Estudos Retrospectivos
7.
Clin Rehabil ; 31(8): 1049-1056, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27742752

RESUMO

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.


Assuntos
Transtornos de Deglutição/reabilitação , Exercício Físico/fisiologia , Glote/fisiopatologia , Pneumonia Aspirativa/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Humanos , Japão , Laringoscopia/métodos , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Aspirativa/etiologia , Prognóstico , Recuperação de Função Fisiológica , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Resultado do Tratamento
8.
J Laryngol Otol ; 119(3): 209-11, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15845194

RESUMO

We report here a very rare case of bilateral congenital choanal atresia untreated for the 27 years after birth. A 27-year-old Japanese man complaining of long-term nasal obstruction, snoring and daytime sleepiness visited our hospital. He exhibited the characteristic appearances of long face and bilateral hypoplastic cheeks. Examination by flexible fiberscopy and computed tomography led us to diagnose him with bilateral choanal atresia. Subsequent polysomnography revealed the number of apnoea or hypopnoea episodes per hour (apnoea-hypopnoea index, or AHI) to be over 10. On the basis of these observations, we modified the diagnosis to obstructive sleep apnoea syndrome (OSAS) secondary to congenital choanal atresia.


Assuntos
Atresia das Cóanas/complicações , Apneia Obstrutiva do Sono/etiologia , Adulto , Atresia das Cóanas/diagnóstico , Atresia das Cóanas/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
9.
Rhinology ; 43(4): 296-9, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16405275

RESUMO

OBJECTIVES: Given that criteria for nasal surgery in individuals with obstructive sleep apnea syndrome (OSAS) have not been proposed, we investigated the effectiveness of nasal surgery for CPAP failure in patients with both severe OSAS and nasal obstruction. PATIENTS AND METHODS: Conventional nasal surgery was performed in 12 patients who were refractory to treatment by CPAP. The subject group consisted of 12 males (mean age, 54.2 +/- 9.2 years; range 39-66 years). The effect of nasal surgery was evaluated with data from preoperative and postoperative polysomunography. The nasal resistance value was first deduced to determine which OSAS patients with CPAP failure should undergo nasal surgery, compared to control values. RESULTS: Nasal surgery resulted in a significant decrease in nasal resistance, as measured by rhinomanometry, from 0.57 +/- 0.31 Pa/cm3 /sec to 0.16 +/- 0.03 Pa/cm3/sec and rendered all patients tolerant to CPAP. In addition, the lowest nocturnal oxygen saturation significantly increased from 68.3 +/- 12.1% to 75.3 +/- 7.1% after surgery. Subjectively, Epworth sleepiness scale (ESS) significantly decreased from 11.7 +/- 4.1 to 3.3 +/- 1.3 after surgery, but the number of apnea and hypopnea episodes per hour did not change significantly. In five patients, for whom it was possible to perform a CPAP titration before nasal surgery, the value decreased significantly from 16.8 +/- 1.1 to 12.0 +/- 1.9 cmH2O. The bilateral nasal resistance of the 410SAS patients with CPAP therapy (control group) was 0.24 +/- 0.11 Pa/cm3/sec. The cut off value for differentiation between CPAP failure patients and control group was determined as 0.38 Pa/cm3 /sec. CONCLUSION: Increased nasal resistance is a determinant of CPAP failure, and the surgical correction of severe nasal obstruction should thus be considered to facilitate treatment of OSAS patients with CPAP.


Assuntos
Obstrução Nasal/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Adulto , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/complicações , Polissonografia , Rinomanometria , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Estatísticas não Paramétricas , Resultado do Tratamento
10.
Artigo em Inglês | MEDLINE | ID: mdl-14730180

RESUMO

The etiology of acute low-tone sensorineural hearing loss (ALHL) may be associated with deteriorated function of the endolymphatic sac. Using magnetic resonance (MR) imaging on a 1.5-tesla MR system, we evaluated the frequency of visualization and contrast enhancement of the endolymphatic sac in 25 patients (9 men and 16 women; age range 11-64 years) with ALHL and 21 control subjects. The present study demonstrated that the frequency of visualization and enhancement of the endolymphatic sac in patients with ALHL was not significantly higher than in control subjects.


Assuntos
Saco Endolinfático/patologia , Perda Auditiva Neurossensorial/patologia , Imageamento por Ressonância Magnética , Doença Aguda , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Aumento da Imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva
11.
Laryngoscope ; 112(9): 1642-6, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12352679

RESUMO

OBJECTIVES: The purpose of this study was to study systematically some relationships between the resonance frequency of the middle-ear transmission system and the volume of the endolymphatic duct and sac in patients with an enlarged vestibular aqueduct (EVA). STUDY DESIGN: Prospective study. METHODS: Thirteen patients (24 ears) with EVA, 17 subjects (29 ears) with normal hearing, and 17 patients (21 ears) with sensorineural hearing loss without EVA served as experimental subjects. Standard pure-tone audiometry, standard clinical tympanometry (using a 226-Hz probe tone), and multifrequency tympanometry were performed on each ear. Magnetic resonance imaging was used to determine the area of the cochlear modiolus and the volume of the endolymphatic duct and sac. RESULTS: The audiometric configurations for most patients sloped downward from the low to the high frequencies. A significant air-bone gap was computed at each of these test frequencies. Multifrequency tympanometry yielded resonance frequencies for the patients with EVA that was significantly lower than those measured for the control subjects. In general, for patients with EVA, the resonance frequency of the middle ear system decreased as the volume of the endolymphatic duct and sac increased. This inverse relation was significant (correlation coefficient = -0.483, P =.0157). However, there was no correlation between resonance frequency and the degree of cochlea modiolar deficiency. CONCLUSIONS: Clinically, our findings suggest that EVA probably should be included in the differential diagnosis for a patient who presents with a moderate to severe mixed hearing loss, a normal tympanogram at 226 Hz, and a resonance frequency that is abnormally low.


Assuntos
Perda Auditiva Neurossensorial/fisiopatologia , Aqueduto Vestibular/fisiopatologia , Testes de Impedância Acústica , Adolescente , Adulto , Audiometria de Tons Puros , Criança , Diagnóstico Diferencial , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Prospectivos , Estatísticas não Paramétricas
12.
Otol Neurotol ; 23(3): 296-300, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-11981384

RESUMO

OBJECTIVE: To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus. STUDY DESIGN: Prospective, randomized double-blind study. METHODS: This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined. RESULTS: No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. CONCLUSION: Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.


Assuntos
Terapia a Laser , Zumbido/radioterapia , Adulto , Idoso , Relação Dose-Resposta à Radiação , Método Duplo-Cego , Feminino , Audição , Humanos , Percepção Sonora , Masculino , Pessoa de Meia-Idade , Zumbido/fisiopatologia , Falha de Tratamento
13.
Auris Nasus Larynx ; 29(2): 141-6, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11893448

RESUMO

OBJECTIVE: To examine our hypothesis that an unusual floating or tilting sensation claimed by patients with long-standing unilateral vestibular loss might be attributed to incomplete central compensation in the otolith system. METHODS: Seven patients who were with or without symptoms for 6-101 months after intratympanic gentamicin therapy for unilateral endolymphatic hydrops were sinusoidally exposed to lateral linear acceleration, and their compensatory eye movements were compared with those of 18 normal controls, using electro-oculography (EOG). The subjects, secured firmly in the chair of a linear accelerator (sled), were oscillated at three different G-loadings of 0.1 (0.11 Hz), 0.2 (0.16 Hz) and 0.3 G (0.19 Hz), respectively. During displacement, they gazed at a real (visible) or imaginary target which was located on the wall (earth-fixed), or moved on the wall in sync with the sled (body-fixed). RESULTS: Vertical EOG (V-EOG) with a frequency two-fold that of the stimulus frequency was characteristically evoked in all patients, but in none of the normal controls. One of the doubled V-EOG was larger in amplitude than the other, when the stimulus acceleration was directed from the affected ear to the intact ear in those patients whose symptoms still remained. Such a directional difference tended to be greater with the imaginary target than with the visible target. In the horizontal EOG, there was no marked difference between the patients and normal controls. Nobody reported tilt perception but only horizontal translation during the sled displacement, except one patient who was examined twice; a roll tilt was perceived in the first examination when she still had symptoms, but no tilt sensation in the second one when she no longer had symptoms. CONCLUSION: It was suggested that incomplete compensation in the otolith system could cause unusual sensations even after long-standing unilateral vestibular loss, and that V-EOG induced by a sled might be helpful in evaluating functional recovery.


Assuntos
Movimentos Oculares , Vertigem/fisiopatologia , Adulto , Antibacterianos/efeitos adversos , Estudos de Casos e Controles , Feminino , Gentamicinas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Vestibulares/induzido quimicamente , Testes de Função Vestibular
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...