Kiminori Sato, S. Chitose, Kiminobu Sato, F. Sato, T. Ono, H. Umeno
Swallowing is a vital function, and the clearance of the pharynx by deglutition, which removes matter at risk of being aspirated, and the respiratory phase patterns associated with deglutition are important for protecting the airways and lungs against aspiration. We herein review the swallowing and respiratory phase patterns associated with deglutition during sleep in the aged. During sleep, deglutition is extremely infrequent or absent for long periods of time in the aged. The deeper the sleep stage, the lower the mean deglutition frequency. Consequently, clearance of the pharynx and esophagus by deglutition is extremely reduced during sleep in the aged. Furthermore, respiratory phase patterns associated with deglutition display adverse patterns during sleep in the aged. Regarding aged individuals with obstructive sleep apnea, swallowing following and/or followed by inspiration, which is observed a great deal before CPAP (continuous positive airway pressure) therapy, is markedly reduced during CPAP therapy. However, swallowing following and/or followed by expiration is markedly increased during CPAP therapy. Respiratory phase patterns associated with sleep-related deglutition are improved under CPAP therapy. Due to the complexity of the swallowing process, many adverse health conditions can influence the swallowing functions during sleep in the aged. Sleep-related deglutition and respiratory phase patterns may adversely influence aspiration-related diseases, such as aspiration pneumonia, especially in the aged, not only in cases of primary presbyphagia but also those of secondary presbyphagia as well.
{"title":"Sleep-Related Deglutition and Respiratory Phase Patterns in the Aged and Aspiration Pneumonia","authors":"Kiminori Sato, S. Chitose, Kiminobu Sato, F. Sato, T. Ono, H. Umeno","doi":"10.5426/LARYNX.32.105","DOIUrl":"https://doi.org/10.5426/LARYNX.32.105","url":null,"abstract":"Swallowing is a vital function, and the clearance of the pharynx by deglutition, which removes matter at risk of being aspirated, and the respiratory phase patterns associated with deglutition are important for protecting the airways and lungs against aspiration. We herein review the swallowing and respiratory phase patterns associated with deglutition during sleep in the aged. During sleep, deglutition is extremely infrequent or absent for long periods of time in the aged. The deeper the sleep stage, the lower the mean deglutition frequency. Consequently, clearance of the pharynx and esophagus by deglutition is extremely reduced during sleep in the aged. Furthermore, respiratory phase patterns associated with deglutition display adverse patterns during sleep in the aged. Regarding aged individuals with obstructive sleep apnea, swallowing following and/or followed by inspiration, which is observed a great deal before CPAP (continuous positive airway pressure) therapy, is markedly reduced during CPAP therapy. However, swallowing following and/or followed by expiration is markedly increased during CPAP therapy. Respiratory phase patterns associated with sleep-related deglutition are improved under CPAP therapy. Due to the complexity of the swallowing process, many adverse health conditions can influence the swallowing functions during sleep in the aged. Sleep-related deglutition and respiratory phase patterns may adversely influence aspiration-related diseases, such as aspiration pneumonia, especially in the aged, not only in cases of primary presbyphagia but also those of secondary presbyphagia as well.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"85 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127985560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transoral robotic surgery using the da Vinci surgical system has become a viable treatment options for small primary oropharyngeal, hypopharyngeal, and supraglottic cancers. Recently, various clinical trials have been conducted around the world. In addition to its usage in the above field, transoral robotic surgery has also been applied to sleep apnea syndrome treatment and locally advanced cancer dissection with reconstructive surgery. However, despite the fact that roughly 10 years have passed since the introduction of robotic surgery support equipment in Japan, operations in the head and neck area have remained outside of insurance coverage. Last year, approval of the device for head and neck cancer treatment was finally granted, and a training program was established. The number of surgical facilities and cases treated by transoral robotic surgery is now on the rise. It is a promising treatment in Japan, and insurance coverage should be applied promptly. In addition, although the robotic equipment at present is used for laparoscopic surgery, endoscopic type robot is suita-ble for the head and neck region is expected to be developed in the future. Close attention should be paid to fu-ture device development.
{"title":"The Current State of Robotic Surgery in Japan","authors":"A. Shimizu","doi":"10.5426/LARYNX.32.147","DOIUrl":"https://doi.org/10.5426/LARYNX.32.147","url":null,"abstract":"Transoral robotic surgery using the da Vinci surgical system has become a viable treatment options for small primary oropharyngeal, hypopharyngeal, and supraglottic cancers. Recently, various clinical trials have been conducted around the world. In addition to its usage in the above field, transoral robotic surgery has also been applied to sleep apnea syndrome treatment and locally advanced cancer dissection with reconstructive surgery. However, despite the fact that roughly 10 years have passed since the introduction of robotic surgery support equipment in Japan, operations in the head and neck area have remained outside of insurance coverage. Last year, approval of the device for head and neck cancer treatment was finally granted, and a training program was established. The number of surgical facilities and cases treated by transoral robotic surgery is now on the rise. It is a promising treatment in Japan, and insurance coverage should be applied promptly. In addition, although the robotic equipment at present is used for laparoscopic surgery, endoscopic type robot is suita-ble for the head and neck region is expected to be developed in the future. Close attention should be paid to fu-ture device development.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130842662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic cough, which persists for more than eight weeks, results in a significant impairment of the quality of life. The JRS Guidelines for the Management of Cough and Sputum 2019 shows the diagnostic algorithms for chronic cough. However, some patients with chronic cough seem to have an unknown etiology, making them difficult to treat. Since the larynx plays a crucial role in protecting the lower airway from aspiration via cough-ing, the laryngopharynx is a sensitive organ. Therefore, laryngopharyngeal reflux (LPR), even when receiving proton pump inhibitor (PPI) therapy, can cause coughing. Because LPR disease (LPRD) is not easy to diag-nose, it is important to measure LPR using hypopharyngeal multichannel intraluminal impedance pH metry (HMII) for patients with chronic cough of unknown etiology. We showed that 73% of patients with chronic cough were diagnosed with LPRD, and 73% of those with chronic cough diagnosed with LPRD became asymp-tomatic after antireflux surgery. LPRD should be distinguished from chronic cough of unknown etiology.
{"title":"A Difficult-to-treat Cases of Laryngeal Disease -Chronic Cough-","authors":"Takeshi Suzuki","doi":"10.5426/LARYNX.32.155","DOIUrl":"https://doi.org/10.5426/LARYNX.32.155","url":null,"abstract":"Chronic cough, which persists for more than eight weeks, results in a significant impairment of the quality of life. The JRS Guidelines for the Management of Cough and Sputum 2019 shows the diagnostic algorithms for chronic cough. However, some patients with chronic cough seem to have an unknown etiology, making them difficult to treat. Since the larynx plays a crucial role in protecting the lower airway from aspiration via cough-ing, the laryngopharynx is a sensitive organ. Therefore, laryngopharyngeal reflux (LPR), even when receiving proton pump inhibitor (PPI) therapy, can cause coughing. Because LPR disease (LPRD) is not easy to diag-nose, it is important to measure LPR using hypopharyngeal multichannel intraluminal impedance pH metry (HMII) for patients with chronic cough of unknown etiology. We showed that 73% of patients with chronic cough were diagnosed with LPRD, and 73% of those with chronic cough diagnosed with LPRD became asymp-tomatic after antireflux surgery. LPRD should be distinguished from chronic cough of unknown etiology.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115511207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The validity of the application of the Cepstral/Spectral Index of Dysphonia (CSID) to Japanese dysphonic speech was examined by analyzing normal and breathy voice samples both produced by healthy Japanese vol-unteers with no vocal problems. Four Japanese sentences which had phonological similarities to the English test sentences were prepared for the application of the CSID. The voice samples included sustained vowel /a/ and the four sentences. The CSID was applied for analyzing both the sustained vowel and the four sentences. Established indices based on pitch synchronous analyses, such as period perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and noise to harmonic ratio (NHR) were applied to the samples of the sustained vowel. For the grade of the hoarseness and the breathiness, auditory perceptual evaluations of Japanese speech sentences and the sustained vowel were performed using a visual analog scale (VAS). GRBAS scale was used for evaluations of the sustained vowel only. Strong statistical relationships were found between the CSID and the three indices with pitch synchronous analyses. Furthermore, the CSID had strong statistical relationships with the two auditory perceptual evaluations as well, which was equal to relationships between the auditory perceptual evaluations and the indices with pitch synchronous analyses. Given that the CSID can be used to analyze speech samples whereas the indices with pitch synchronous analysis have certain technical problems to analyze speech samples, this index is consid-ered to be applicable as a useful measure for evaluating vocal dysfunction of Japanese speech and should be used actively in clinical settings.
{"title":"The Validity of the Application of the Cepstral/Spectral Index of Dysphonia（CSID）to Japanese Dysphonic Speech","authors":"T. Haji, Kanako Terada","doi":"10.5426/LARYNX.32.195","DOIUrl":"https://doi.org/10.5426/LARYNX.32.195","url":null,"abstract":"The validity of the application of the Cepstral/Spectral Index of Dysphonia (CSID) to Japanese dysphonic speech was examined by analyzing normal and breathy voice samples both produced by healthy Japanese vol-unteers with no vocal problems. Four Japanese sentences which had phonological similarities to the English test sentences were prepared for the application of the CSID. The voice samples included sustained vowel /a/ and the four sentences. The CSID was applied for analyzing both the sustained vowel and the four sentences. Established indices based on pitch synchronous analyses, such as period perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and noise to harmonic ratio (NHR) were applied to the samples of the sustained vowel. For the grade of the hoarseness and the breathiness, auditory perceptual evaluations of Japanese speech sentences and the sustained vowel were performed using a visual analog scale (VAS). GRBAS scale was used for evaluations of the sustained vowel only. Strong statistical relationships were found between the CSID and the three indices with pitch synchronous analyses. Furthermore, the CSID had strong statistical relationships with the two auditory perceptual evaluations as well, which was equal to relationships between the auditory perceptual evaluations and the indices with pitch synchronous analyses. Given that the CSID can be used to analyze speech samples whereas the indices with pitch synchronous analysis have certain technical problems to analyze speech samples, this index is consid-ered to be applicable as a useful measure for evaluating vocal dysfunction of Japanese speech and should be used actively in clinical settings.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116278634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Komazawa, Mayu Hirosaki, Tomohiro Hasegawa, Yusuke Watanabe
Although it is generally accepted that phonomicrosurgery may be indicated for vocal fold mass lesions even in professional singers, the specific indications for surgery on stroboscopic findings for microlesions of the vocal folds in professional singers are not clear. The present study included 88 patients (male, n=36; female, n=52) who presented to the AKASAKA Voice Health Center with clear complaints in singing and who underwent phonomicrosurgery to resect microlesions of the vocal folds. At three months postoperatively, 102 of the total 117 subjective complaints in singing were resolved (87%). We classified five vertical locations of lesions (determined based on surgical findings) on the medial surface of the vocal folds, and statistically analyzed the differences in verticality according to the various attributes of the cases. The results showed that lesions were significantly more prevalent in the upper part of the vocal folds when the singing or disordered voice was in a high pitch and light register, while lesions were significantly more prevalent in the lower part of the vocal folds when the voice was in a low pitch and heavy register. Considering laryngeal regulation during singing, we hypothesize that lesions in the lower part of the mucosal wave-generating area are more likely to cause a malfunction in singing. A lesion in such a location can also be identified by stroboscopy, as a prominence on the medial margin in the closing phase (lesion on lower crest: LLC). Although individualized treatment is necessary, stroboscopic findings that demonstrate the presence of an irreversible LLC in singing may be a good indication for phonomicrosurgery.
{"title":"Microlesions of the Vocal Fold in Professional Singers : An Indication for Phonomicrosurgery for Lesions in Vertical Locations","authors":"D. Komazawa, Mayu Hirosaki, Tomohiro Hasegawa, Yusuke Watanabe","doi":"10.5426/LARYNX.32.129","DOIUrl":"https://doi.org/10.5426/LARYNX.32.129","url":null,"abstract":"Although it is generally accepted that phonomicrosurgery may be indicated for vocal fold mass lesions even in professional singers, the specific indications for surgery on stroboscopic findings for microlesions of the vocal folds in professional singers are not clear. The present study included 88 patients (male, n=36; female, n=52) who presented to the AKASAKA Voice Health Center with clear complaints in singing and who underwent phonomicrosurgery to resect microlesions of the vocal folds. At three months postoperatively, 102 of the total 117 subjective complaints in singing were resolved (87%). We classified five vertical locations of lesions (determined based on surgical findings) on the medial surface of the vocal folds, and statistically analyzed the differences in verticality according to the various attributes of the cases. The results showed that lesions were significantly more prevalent in the upper part of the vocal folds when the singing or disordered voice was in a high pitch and light register, while lesions were significantly more prevalent in the lower part of the vocal folds when the voice was in a low pitch and heavy register. Considering laryngeal regulation during singing, we hypothesize that lesions in the lower part of the mucosal wave-generating area are more likely to cause a malfunction in singing. A lesion in such a location can also be identified by stroboscopy, as a prominence on the medial margin in the closing phase (lesion on lower crest: LLC). Although individualized treatment is necessary, stroboscopic findings that demonstrate the presence of an irreversible LLC in singing may be a good indication for phonomicrosurgery.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"141 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127331928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kiminori Sato, S. Chitose, F. Sato, Kiminobu Sato, T. Kurita, H. Umeno
There is growing evidence that the cells in the maculae flavae are tissue stem cells and that the maculae flavae are a stem cell niche of the human vocal fold mucosa. The stem cell system of the tissue stem cells of the human vocal fold mucosa, including their stemness, asymmetric cell division, cellular hierarchy and lineage determination, was reviewed and summarized. Regarding the stemness, the cells in the human maculae flavae have stemness and multipotency. Subcultured cells form a colony-forming unit. The cell features in the maculae flavae meet the minimal criteria defining mesenchymal stem cells. In addition, subcultured cells differentiate into ectoderm, mesoderm and en-doderm. Cell divisions in the maculae flavae reflect asymmetric self-renewal in vitro. Regarding the heterogeneity and hierarchy of cells in the maculae flavae of the human adult vocal fold mucosa, three phenotypes of cells (cobblestone-like polygonal cells, vocal fold stellate cell-like cells possessing lipid droplets in the cytoplasm and fibroblast-like spindle cells) are present in the human adult maculae flavae. The cobblestone-like polygonal cells are at the top of the cellular hierarchy in the stem cell system. The lineage determination of the tissue stem cells has not yet been elucidated. The cells in the maculae flavae of the human adult vocal fold mucosa have heterogeneity and hierarchy in the stem cell system.
{"title":"Tissue Stem Cells of the Human Vocal Fold Mucosa and Their Stem Cell System","authors":"Kiminori Sato, S. Chitose, F. Sato, Kiminobu Sato, T. Kurita, H. Umeno","doi":"10.5426/LARYNX.32.93","DOIUrl":"https://doi.org/10.5426/LARYNX.32.93","url":null,"abstract":"There is growing evidence that the cells in the maculae flavae are tissue stem cells and that the maculae flavae are a stem cell niche of the human vocal fold mucosa. The stem cell system of the tissue stem cells of the human vocal fold mucosa, including their stemness, asymmetric cell division, cellular hierarchy and lineage determination, was reviewed and summarized. Regarding the stemness, the cells in the human maculae flavae have stemness and multipotency. Subcultured cells form a colony-forming unit. The cell features in the maculae flavae meet the minimal criteria defining mesenchymal stem cells. In addition, subcultured cells differentiate into ectoderm, mesoderm and en-doderm. Cell divisions in the maculae flavae reflect asymmetric self-renewal in vitro. Regarding the heterogeneity and hierarchy of cells in the maculae flavae of the human adult vocal fold mucosa, three phenotypes of cells (cobblestone-like polygonal cells, vocal fold stellate cell-like cells possessing lipid droplets in the cytoplasm and fibroblast-like spindle cells) are present in the human adult maculae flavae. The cobblestone-like polygonal cells are at the top of the cellular hierarchy in the stem cell system. The lineage determination of the tissue stem cells has not yet been elucidated. The cells in the maculae flavae of the human adult vocal fold mucosa have heterogeneity and hierarchy in the stem cell system.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134071197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aki Taguchi, Sayuri Takeshita, Kotone Hasegawa, O. Shiromoto, T. Haji
The high-pitched blowing exercise is a technique for conducting water resistance with high-pitch voice. This exercise is one of semi-occluded vocal tracts (SOVTE). When we performed high-pitched blowing through a laryngoscope in cases where high-pitched vocalization was difficult, the interval of posterior glottis disappeared, and the voice function also improved. We conducted a detailed examination of the voice pitch for water resistance. The subjects were 40 healthy young women currently attending our school (age: 19 - 22 years old), randomly divided into 4 groups: Silent Group, Speaking Voice Group, Chest Voice Group, and Head Voice Group. The examination items were the duration of water resistance before/after training, maximum phonation time (MPT), phonatory function test, physiological voice range, acoustic analysis, and subjective evaluation. As an additional study, we also measured the open quotient (OQ) by a photoglottogram (PGG). We observed no marked changes in the Silent Group before/after training. Regarding the phonatory function test findings,were recognized improvement in the MPT, amplitude perturbation quotient, harmonics-to-noise ratio, and voice handicap index. For the PGG, 25% OQ indicated a favorable level in the Head Voice Group. These findings suggested that the high-pitched blowing exercise was more effective than ordinary water resistance for voice disorder.
{"title":"Training Effect on Water Resistance —Consideration of Voice Pitch—","authors":"Aki Taguchi, Sayuri Takeshita, Kotone Hasegawa, O. Shiromoto, T. Haji","doi":"10.5426/LARYNX.32.117","DOIUrl":"https://doi.org/10.5426/LARYNX.32.117","url":null,"abstract":"The high-pitched blowing exercise is a technique for conducting water resistance with high-pitch voice. This exercise is one of semi-occluded vocal tracts (SOVTE). When we performed high-pitched blowing through a laryngoscope in cases where high-pitched vocalization was difficult, the interval of posterior glottis disappeared, and the voice function also improved. We conducted a detailed examination of the voice pitch for water resistance. The subjects were 40 healthy young women currently attending our school (age: 19 - 22 years old), randomly divided into 4 groups: Silent Group, Speaking Voice Group, Chest Voice Group, and Head Voice Group. The examination items were the duration of water resistance before/after training, maximum phonation time (MPT), phonatory function test, physiological voice range, acoustic analysis, and subjective evaluation. As an additional study, we also measured the open quotient (OQ) by a photoglottogram (PGG). We observed no marked changes in the Silent Group before/after training. Regarding the phonatory function test findings,were recognized improvement in the MPT, amplitude perturbation quotient, harmonics-to-noise ratio, and voice handicap index. For the PGG, 25% OQ indicated a favorable level in the Head Voice Group. These findings suggested that the high-pitched blowing exercise was more effective than ordinary water resistance for voice disorder.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129856847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hiroaki Hashimoto, S. Kameda, Hitoshi Maezawa, S. Oshino, N. Tani, H. Khoo, T. Yanagisawa, T. Yoshimine, H. Kishima, M. Hirata
The present study clarified the swallowing-related neural activities using human intracranial electrodes. Eight epileptic participants fitted with intracranial electrodes on the orofacial cortex were asked to swallow a water bolus, and cortical oscillatory changes were investigated. High γ （75-150 Hz）power increases associ-ated with swallowing were observed in the subcentral area. To decode swallowing intention, ECoG signals were converted into images whose vertical axes were the electrode’s contacts and whose horizontal axis was the time in milliseconds; these findings were used as training data. Deep transfer learning was carried out using AlexNet, and the power in the high-γ band was used to create the training image set. The accuracy reached 74%, and the sensitivity reached 83%. We showed that a version of AlexNet pre-trained with visually meaningful images can be used for transfer learning of visually meaningless images made up of ECoG signals. This study demonstrated that swallowing-related high γ activities were observed in the subcentral area, and deep transfer learning using high γ activities enabled us to decode the swallowing-related neural activities.
{"title":"The Analysis and Decoding of Swallowing-related Neural Activities Using Intracranial Electrodes","authors":"Hiroaki Hashimoto, S. Kameda, Hitoshi Maezawa, S. Oshino, N. Tani, H. Khoo, T. Yanagisawa, T. Yoshimine, H. Kishima, M. Hirata","doi":"10.5426/LARYNX.32.165","DOIUrl":"https://doi.org/10.5426/LARYNX.32.165","url":null,"abstract":"The present study clarified the swallowing-related neural activities using human intracranial electrodes. Eight epileptic participants fitted with intracranial electrodes on the orofacial cortex were asked to swallow a water bolus, and cortical oscillatory changes were investigated. High γ （75-150 Hz）power increases associ-ated with swallowing were observed in the subcentral area. To decode swallowing intention, ECoG signals were converted into images whose vertical axes were the electrode’s contacts and whose horizontal axis was the time in milliseconds; these findings were used as training data. Deep transfer learning was carried out using AlexNet, and the power in the high-γ band was used to create the training image set. The accuracy reached 74%, and the sensitivity reached 83%. We showed that a version of AlexNet pre-trained with visually meaningful images can be used for transfer learning of visually meaningless images made up of ECoG signals. This study demonstrated that swallowing-related high γ activities were observed in the subcentral area, and deep transfer learning using high γ activities enabled us to decode the swallowing-related neural activities.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134020994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Previous epidemiological studies have indicated that bilateral vocal fold palsy (BVFP) is the most common cause of bilateral vocal fold immobility (BVFI), followed by posterior glottic stenosis (PGS) due to ankylosis of the cricoarytenoid joint, fixation and/or fibrosis at the posterior glottis. The differential diagnosis between BVFP and PGS is made based mainly on careful clinical history-taking, fiberscopic observation of the subglottal region through the tracheostoma, and performance of electromyography. Based on the our clinical findings of adducted-type BVFI thus far, we have suggested treatment options and a severity classification system of BVFI that focuses mainly on electromyography results for assessing dynamic restenosis and traction-mobility test results for assessing static restenosis. Both the surgical techniques of laser subtotal arytenoidectomy and laterofixation are effective and useful for widening the glottis in cases of BVFI. However, the deterioration of the voice quality in laser subtotal aryteenoidectomy is less marked than with laterofixation.
{"title":"A Difficult-to-treat Laryngeal Disease -Bilateral Vocal Fold Immobility-","authors":"K. Matsushima","doi":"10.5426/LARYNX.32.161","DOIUrl":"https://doi.org/10.5426/LARYNX.32.161","url":null,"abstract":"Previous epidemiological studies have indicated that bilateral vocal fold palsy (BVFP) is the most common cause of bilateral vocal fold immobility (BVFI), followed by posterior glottic stenosis (PGS) due to ankylosis of the cricoarytenoid joint, fixation and/or fibrosis at the posterior glottis. The differential diagnosis between BVFP and PGS is made based mainly on careful clinical history-taking, fiberscopic observation of the subglottal region through the tracheostoma, and performance of electromyography. Based on the our clinical findings of adducted-type BVFI thus far, we have suggested treatment options and a severity classification system of BVFI that focuses mainly on electromyography results for assessing dynamic restenosis and traction-mobility test results for assessing static restenosis. Both the surgical techniques of laser subtotal arytenoidectomy and laterofixation are effective and useful for widening the glottis in cases of BVFI. However, the deterioration of the voice quality in laser subtotal aryteenoidectomy is less marked than with laterofixation.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123962354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Contrast agent aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies (VFs). Barium sulfate (Ba) suspension is the most widely used contrast agent for VFs. The molecular biological mechanisms underlying acute and chronic responses to contrast agent (CA) aspiration in the respiratory organs remain unclear. We examined these mechanisms underlying the acute and chronic responses to three kinds of CA aspiration in the lung and studied the effects of different barium concentrations on the respiratory organs. Eight-week-old male Sprague Dawley rats were used for animal models of aspiration. We elucidated the mechanisms underlying these effects induced by CA aspiration, including Ba, ionic iodinated CA (ICA), and non-ionic iodinated CA (NICA). In the acute phase, Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs than the two other iodinated CAs. Increases in the expression of inflammatory cytokines were observed in the Ba and ICA aspiration rats. NICA did not cause any obvious histologic changes or the expression of inflammatory cytokines and fibrosis-related genes in the lungs. In the chronic phase, Ba particles remained after 30 days and caused histopathologic changes and inflammatory cell infiltration. Iodinated ICA and NICA did not result in any perceptible histologic changes. Furthermore, both low-Ba and high-Ba aspiration caused inflammatory cell infiltration in the lung at two days post aspiration with an increase in the expression of inflammatory cytokines. At 30 days post-aspiration, small quantities of barium particles remained in the lung of the low-Ba group without any inflammatory reaction. Chronic inflammation was recognized in the high-Ba group up to 30 days post aspiration. Ba caused significantly more acute and chronic lung inflammation in our rodent model than ICA or NICA. Aspirated Ba particles did not clear from the lung within one month and caused mild chronic pulmonary inflammation. Even with a small amount of low-concentration Ba aspiration (30% [w/v]), Ba particles can remain in the lung for over a month, causing sustained late effects. NICA did not cause any discernible inflammatory response in the lungs, suggesting it may be the safest contrast agent for VFs.
{"title":"The Effects of Barium Concentration Levels on the Pulmonary Inflammatory Response in Barium Aspiration Models","authors":"R. Ueha","doi":"10.5426/LARYNX.32.99","DOIUrl":"https://doi.org/10.5426/LARYNX.32.99","url":null,"abstract":"Contrast agent aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies (VFs). Barium sulfate (Ba) suspension is the most widely used contrast agent for VFs. The molecular biological mechanisms underlying acute and chronic responses to contrast agent (CA) aspiration in the respiratory organs remain unclear. We examined these mechanisms underlying the acute and chronic responses to three kinds of CA aspiration in the lung and studied the effects of different barium concentrations on the respiratory organs. Eight-week-old male Sprague Dawley rats were used for animal models of aspiration. We elucidated the mechanisms underlying these effects induced by CA aspiration, including Ba, ionic iodinated CA (ICA), and non-ionic iodinated CA (NICA). In the acute phase, Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs than the two other iodinated CAs. Increases in the expression of inflammatory cytokines were observed in the Ba and ICA aspiration rats. NICA did not cause any obvious histologic changes or the expression of inflammatory cytokines and fibrosis-related genes in the lungs. In the chronic phase, Ba particles remained after 30 days and caused histopathologic changes and inflammatory cell infiltration. Iodinated ICA and NICA did not result in any perceptible histologic changes. Furthermore, both low-Ba and high-Ba aspiration caused inflammatory cell infiltration in the lung at two days post aspiration with an increase in the expression of inflammatory cytokines. At 30 days post-aspiration, small quantities of barium particles remained in the lung of the low-Ba group without any inflammatory reaction. Chronic inflammation was recognized in the high-Ba group up to 30 days post aspiration. Ba caused significantly more acute and chronic lung inflammation in our rodent model than ICA or NICA. Aspirated Ba particles did not clear from the lung within one month and caused mild chronic pulmonary inflammation. Even with a small amount of low-concentration Ba aspiration (30% [w/v]), Ba particles can remain in the lung for over a month, causing sustained late effects. NICA did not cause any discernible inflammatory response in the lungs, suggesting it may be the safest contrast agent for VFs.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126427592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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