CHIJIWA Keiichi Kurume University, Department of Otolaryngology, Lecturer, 医学部, 助手 (20227317)
MORI Kazunori Kurume University, Department of Otolaryngology, Assistant Professor, 医学部, 講師 (30230064)
|Budget Amount *help
¥2,100,000 (Direct Cost : ¥2,100,000)
Fiscal Year 1998 : ¥100,000 (Direct Cost : ¥100,000)
Fiscal Year 1997 : ¥1,000,000 (Direct Cost : ¥1,000,000)
Fiscal Year 1996 : ¥1,000,000 (Direct Cost : ¥1,000,000)
In order to decide an indication of voice therapy, we examined the efficacy of the pushing method (PM) with the use of laryngoscopy in 15 patients with unilateral recurrent laryngeal nerve paralysis. The PM was effective for 6 patients (one male and five females), while it was not effective for nine patients (eight males and one female).
The efficacy was objectively evaluated by the following six findings ;
(1) adduction pattern of the false cord,
(2)absence/presence of the distance shortening between the anterior comissure and the arytenoid cartilage,
(3)elongation or shortening of length of the paralyzed vocal fold,
(4)absence/presence of the narrowing of the gap between the bilateral vocal processes,
(5)absence/presence of the falling of the epiglotis, and
(6)position change of the interarytenoid area.
When the voice was deterioreted by PM, the excessive closure of the larynx such as an over adduction of the normal vocal cord, shortening of the distance between the anterior comissure and th
e arytcnoid, and falling of the epiglotis, was observed during PM.On the other hand, when the voice was improved, the followings were observed ; elongation of the vocal folds, deviation of the laryngeal axis and so on.
The changes in the laryngeal movement before and after the PM could be classified into 5 types ;
type 1 : elongation of the length of the vocal folds, that is, extension of the vocal folds,
type 2 : shortening in the length of the paralyzed vocal fold, that is, widening of the vocal fold,
type 3 : compensation of the contralateral vocal fold,
type 4 : a change in the laryngeal form except for the vocal cords,
and type 5 : no change in the laryngeal form. In patients with type 1,2, or 3, their voice was improved by narrowing of the gap between the bilateral vocal folds, while in those with type 4 or 5, their voice was not improved. From these findings we speculate that the laryngeal muscles relate to the PM might be different in each type.
The electromyography (EMG) of the thyroarytenoid muscle during rest and phonation was examined in 13 patients with unilateral laryngeal nerve paralysis before and after PM.In 4 patients (2 males and 2 females) who showed voice improvement by the PM, an increase in intensity of EMG discharges during the rest and phonation was observed in the paralyzed and contralateral vocal folds after the PM compared with those before the PM.In 9 patients (9 males) whose voice was not improved by the PM, no change in the EMG during the rest and phonation was observed before and after the PM. Less