岩田 義弘

Anterior nasal atresia is a relatively rare condition that may cause airway obstruction. An 8-week-old newborn male with bilateral anterior nasal bony atresia was treated surgically via a sublabial approach. The stenotic bony apertures were widened using a surgical drill and tracheal tubes (I. D. 3.0mm) were placed in each nasal cavity for 4 weeks.<br>Three years after the operation, no recurrence was found. Fifty cases of anterior nasal atresia, including our case, have been reported in Japan. Only one case of bony stenosis was reported in 1938, and we believe that our patient is the second reported case of anterior nasal bony atresia in Japan.

The electroglottogram (EGG) has been used to obtain details of vocal fold vibration. Applications of the EGG, however, are limited in use for voice disorders since characteristics of EGG waveforms associated with vocal fold vibrations are still poorly understood. We analysed the EGG waveform characteristics to compare them with simultaneous measurements of supra and subglottic pressure in the normal male subject sustaining the vowel /a/ at constant pitch with different intensity levels. The results are : The periodicities of the consequent frequency are completely coincident among the EGG wave, supra and subglottic pressure waveforms at different intensity levels. With regard to the amplitude variations of the EGG waveform in the vocal cycle, the increasing amplitude corresponded with a rapid increase of subglottic pressure and a decrease of supraglottic pressure which is indicative of the closing phase of the vocal folds. The gradual fall of amplitude associated with the parting of the vocal folds corresponded with an increase of supraglottic pressure from negative values and maintenance of negative subglottic pressure. The negative flatter portion of EGG wave corresponding to the opened phase exhibited higher positive supra glottal pressure and lower pressure of the subglottic even at different sound pressure levels. When increasing the intensity during constant pitch phonation, the values of the contact quotient and contact speed index decreased, and the contact closing slope became steeper.These findings reveal the tendency of increasing vocal tension following louder vocalization. Simultaneous measurement of EGG waveforms, and supraglottic and subglottic pressures might provide useful and detailed information for understanding EGG waveforms, laryngeal dysfunction and/or research for voice disorders.

A patient who developed toxic shock syndrome (TSS) following sinus surgery is described. A 22-year-old male complaining of pyrexia (39°C), general fatigue, watery diarrhea, nausea, muscle soreness and sore throat was admitted as an emargency patient to one of our infirmaries 19 days after sinus surgery had been performed at another hospital. Hypotension with a systolic blood pressure of 80 mmHg and erythroderma on his palm and sole were noted. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in pus secreted from the right nasal cavity. Appropriate hydration, antibiotics and local clearance of the infection was applied in the management of the TSS. Good prognosis ensued without γ-globulin therapy. TSS should currently be con-sidered as an important complication of nasal surgery.

In our clinic, laryngo-micro surgery under general anesthesia with endotracheal intuba- tion or neurolept analgesia without intubation (NLA) have been commonly practiced for the surgical treatment of voice disorders due to polyps or polypoid degeneration of the vocal cords. Here we report the differences in postoperative phonatory functions caused by anesthesia with/without intubation. Laryngo-micro surgery (under anesthesia with intubation: 17, NLA : 14) was performed on 31 cases (16 polypoid, 15 polyps). After operation, the maximum phonation time (sec), air flow rate (ml/sec), pitch (Hz), pitch perturbation quotient (%), amplitude perturbation quotient (%), and normalized noise energy (dB) were obtained using a phonatory device PS-77 and an acoustic analyser SH-10. No significant differences were observed between the phonatory parameters in the NLA group and those in the intubation group. However, in the phonatory parameters of the NLA group, there were more normalized mean values and smaller standard variations than in the intubation group. From these results, we conclude that laryngo-micro surgery under NLA has the advantage of producing a stable postoperative phonatory effect, since it provides a good chance to observe the vocal cords' vibrations and to make an acoustic evaluation of the voice in the course of an operation.