1
|
Cotaoco C, Ueha R, Koyama M, Sato T, Goto T, Kondo K. Swallowing improvement surgeries. Eur Arch Otorhinolaryngol 2024; 281:2807-2817. [PMID: 38265461 PMCID: PMC11065918 DOI: 10.1007/s00405-024-08452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE To discuss the different swallowing improvement surgeries that address one or more dysfunctional pharyngolaryngeal structures causing dysphagia. These surgeries reduce the risk of aspiration without sacrificing vocal function. METHODS We searched the PubMed database and used Google Scholar search engine to find studies discussing the different swallowing improvement surgeries. A manual search of references in selected articles and reviews was done as well. No chronologic limitation was set for the studies; however, only articles written in English and Japanese were considered. Due to the nature of this article, no particular inclusion or exclusion criteria were set when searching for studies to be used as references; however, all relevant studies were reviewed and agreed upon by the authors for inclusion in this review article. RESULTS/DISCUSSION Surgeries to improve swallowing function can be categorized into those that reinforce nasopharyngeal closure or pharyngeal contraction, improve laryngeal elevation or pharyngoesophageal segment opening, and those that improve vocal fold closure to protect the airway during swallowing. They are an effective alternative treatment that may significantly improve these patients' quality of life. Swallowing rehabilitation with the altered pharyngolaryngeal structures is required post-operatively to significantly improve patients' dysphagia. CONCLUSIONS Surgeries to improve swallowing function address specific dysfunctional sites involved in the swallowing mechanism. Choosing the most appropriate surgery for each patient requires knowledge of the pathophysiology for their dysphagia and detailed pre-operative work-up.
Collapse
Affiliation(s)
- Carmel Cotaoco
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
- Ear Nose Throat Head and Neck Surgery Institute, The Medical City, Pasig, Philippines
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan.
- Swallowing Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
2
|
Ueha R, Miura C, Matsumoto N, Sato T, Goto T, Kondo K. Vocal Fold Motion Impairment in Neurodegenerative Diseases. J Clin Med 2024; 13:2507. [PMID: 38731036 DOI: 10.3390/jcm13092507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Vocal fold motion impairment (VFMI) is the inappropriate movement of the vocal folds during respiration, leading to vocal fold adduction and/or abduction problems and causing respiratory and vocal impairments. Neurodegenerative diseases (NDDs) are a wide range of disorders characterized by progressive loss of neurons and deposition of altered proteins in the brain and peripheral organs. VFMI may be unrecognized in patients with NDDs. VFMI in NDDs is caused by the following: laryngeal muscle weakness due to muscular atrophy, caused by brainstem and motor neuron degeneration in amyotrophic lateral sclerosis; hyperactivity of laryngeal adductors in Parkinson's disease; and varying degrees of laryngeal adductor hypertonia and abductor paralysis in multiple system atrophy. Management of VFMI depends on whether there is a presence of glottic insufficiency or insufficient glottic opening with/without severe dysphagia. VFMI treatment options for glottic insufficiency range from surgical interventions, including injection laryngoplasty and medialization thyroplasty, to behavioral therapies; for insufficient glottic opening, various options are available based on the severity and underlying cause of the condition, including continuous positive airway pressure therapy, botulinum toxin injection, tracheostomy, vocal fold surgery, or a combination of interventions. In this review, we outline the mechanisms, clinical features, and management of VFMI in NDDs and provide a guide for physicians who may encounter these clinical features in their patients. NDDs are always progressive; hence, timely evaluation, proper diagnosis, and appropriate management of the patient will greatly affect their vocal, respiratory, and swallowing functions as well as their quality of life.
Collapse
Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Cathrine Miura
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Naoyuki Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| |
Collapse
|
3
|
Okubo A, Tsujimura T, Ueha R, Suzuki T, Tsutsui Y, Nakajima Y, Saka N, Sasa A, Takei E, Magara J, Inoue M. Chewing Well Modulates Pharyngeal Bolus Transit During Swallowing in Healthy Participants. Dysphagia 2024:10.1007/s00455-024-10689-z. [PMID: 38512436 DOI: 10.1007/s00455-024-10689-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
Mastication is controlled by central pattern generator in the brainstem and can be modulated by volition. The aim of this study was to investigate the effect of chewing well on swallowing. Twenty-six healthy participants were instructed to eat 8, 12, and/or 16 g of steamed rice with barium sulphate under the following two conditions: chewing freely task (CF; chewing naturally in their usual manner) and chewing well task (CW; chewing the food with a request to "chew well"). We evaluated bolus transport and swallowing movement using videofluoroscopy and electromyography of the masseter, suprahyoid and thyrohyoid muscles. The chewing time and pharyngeal transit time (PTT) at the first swallow showed high reproducibility in both CF and CW. PTT for CW was significantly shorter and longer than CF in 12 and 16 g, respectively. In 12 g, CW increased the pharyngeal bolus velocity and decreased thyrohyoid EMG activity during swallowing compared with CF. In 16 g, the difference between CW and CF in the estimated swallowed bolus volume was positively correlated with that in upper esophageal sphincter transit duration. We speculate that CW modulates PTT during swallowing depending on the mouthful volume.
Collapse
Affiliation(s)
- Akira Okubo
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan.
| | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo, 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Taku Suzuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Yuhei Tsutsui
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Yuta Nakajima
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Nobuaki Saka
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Anna Sasa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Eri Takei
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-Ku, Niigata, 951-8514, Japan
| |
Collapse
|
4
|
Katsuno T, Ueha R, Fujisaki A, Unno T, Cotaoco C, Kaneoka A, Koyama M, Sato T, Goto T, Kondo K. Differences in residual volume above different tracheostomy tube cuffs depending on tube structure, tube tilt angle, and liquid viscosity. Eur Arch Otorhinolaryngol 2024; 281:311-317. [PMID: 37843617 PMCID: PMC10764502 DOI: 10.1007/s00405-023-08281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Proper management of aspirated material above the tracheostomy tube cuff is crucial to prevent complications, such as aspiration pneumonia. This study aimed to thoroughly examine the effects of aspirated liquid viscosity, suction port positioning, and tube tilt angle on residual volume above the cuff (RVAC). METHODS Five types of tracheostomy tubes (approximately 9 mm outer diameter) were placed through a transparent cylinder with an inner diameter of 18 mm. The cuff was inflated to completely seal the interior of the cylinder. Four liquids with different viscosities were poured onto the cuff, and the liquid above the cuff was suctioned from the side port. The cylinder was angled at 90° and 20°, and each test was performed thrice to determine the average RVAC. RESULTS After side-port suctioning, some liquid residue was observed on the cuff of all tracheostomy tubes. The RVAC increased with higher liquid viscosity. The tubes with a longer distance from the suction port opening to the cuff top exhibited more RVAC. Moreover, the RVAC was almost the same regardless of the cylinder angle for tubes with a suction port on the lateral side. However, tubes with backside ports showed a decreased RVAC with cylinder tilt. CONCLUSIONS This study underscores the persistence of residual material on cuffed tracheostomy tubes even with regular subglottic secretion drainage. This emphasizes the need for specialized tracheostomy tube development aimed at reducing post-suction RVAC. Improved designs can potentially minimize complications associated with residue accumulation.
Collapse
Affiliation(s)
- Takahiro Katsuno
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan.
- Swallowing Center, The University of Tokyo Hospital, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Aiko Fujisaki
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Takeshi Unno
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Carmel Cotaoco
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
- Ear Nose Throat Head and Neck Surgery Institute, The Medical City, Pasig, Philippines
| | - Asako Kaneoka
- Swallowing Center, The University of Tokyo Hospital, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
- Rehabilitation Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
5
|
Ueha R, Cotaoco C, Kondo K, Yamasoba T. Management and Treatment for Dysphagia in Neurodegenerative Disorders. J Clin Med 2023; 13:156. [PMID: 38202163 PMCID: PMC10779554 DOI: 10.3390/jcm13010156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or in the entire process. This review outlines the approach to dysphagia in the setting of NDDs. Distinguishing the etiology of dysphagia can be difficult, and it is important to always look out for signs pointing to NDD as the cause. Thorough diagnostic work-up is essential, and it includes a comprehensive history and physical examination, alongside swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, and high-resolution manometry. Management requires a multidisciplinary approach with a treatment plan tailored to each patient. This involves dietary guidance, swallowing rehabilitation, and surgery in cases in which improvement with rehabilitation is inadequate. Surgery may involve altering certain pharyngolaryngeal structures to facilitate swallowing and reduce the risk of aspiration (swallowing improvement surgery) or separating the airway and digestive tract while sacrificing laryngeal function, with the main goal of preventing aspiration (aspiration prevention surgery). Proper management stems from recognizing the impact of these disorders on swallowing and consistently finding ways to improve the quality of life of patients.
Collapse
Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
| | - Carmel Cotaoco
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
- Ear Nose Throat Head and Neck Surgery Institute, The Medical City, Metro Manila 1600, Philippines
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
- Tokyo Teishin Hospital, Tokyo 102-0071, Japan
| |
Collapse
|
6
|
Kaneoka A, Inokuchi H, Ueha R, Sato T, Goto T, Yamauchi A, Seto Y, Haga N. Longitudinal Analysis of Dysphagia and Factors Related to Postoperative Pneumonia in Patients Undergoing Esophagectomy for Esophageal Cancer. Dysphagia 2023:10.1007/s00455-023-10618-6. [PMID: 37934250 DOI: 10.1007/s00455-023-10618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/15/2023] [Indexed: 11/08/2023]
Abstract
Few studies have quantified longitudinal changes in swallowing in patients undergoing esophagectomy for esophageal cancer. This study longitudinally analyzed the changes in the Modified Barium Swallow Study Impairment Profile (MBSImP™) scores, swallowing kinematic measurements, and swallowing-related symptoms in patients undergoing esophagectomy. We also examined the association between identified swallowing impairment and aspiration pneumonia after surgery. We included consecutive patients who underwent esophagectomy and completed laryngoscopy and videofluoroscopy before, two weeks, and three months after surgery. We analyzed physiological impairments using the MBSImP. We also assessed the swallowing kinematics on a 5 mL thickened liquid bolus at three time points. Vocal fold mobility was assessed using a laryngoscope. Repeated measures were statistically examined for longitudinal changes in swallowing function. The association between the significant changes identified after esophagectomy and aspiration pneumonia was tested. Twenty-nine patients were included in this study. Preoperative swallowing function was intact in all participants. The timing of swallowing initiation and opening of the pharyngoesophageal segment remained unchanged after surgery. Tongue base retraction and pharyngeal constriction ratio worsened two weeks after surgery but returned to baseline levels three months after surgery. Three months after surgery, hyoid displacement and vocal fold immobility did not fully recover. Aspiration pneumonia occurred in nine patients after surgery and was associated with postoperative MBSImP pharyngeal residue scores. Decreased hyoid displacement and vocal fold immobility were observed postoperatively and persisted for a long time. The postoperative pharyngeal residue was associated with pneumonia and thus should be appropriately managed after surgery.
Collapse
Affiliation(s)
- Asako Kaneoka
- The University of Tokyo Hospital Rehabilitation Center, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan.
- The University of Tokyo Hospital Swallowing Center, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Haruhi Inokuchi
- The University of Tokyo Hospital Rehabilitation Center, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
- The University of Tokyo Hospital Swallowing Center, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Rumi Ueha
- The University of Tokyo Hospital Swallowing Center, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
- Department of Otorhinolaryngology and Head and Neck Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Taku Sato
- Department of Otorhinolaryngology and Head and Neck Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takao Goto
- Department of Otorhinolaryngology and Head and Neck Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Akihito Yamauchi
- Department of Otorhinolaryngology and Head and Neck Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Nobuhiko Haga
- Rehabilitation Services Bureau, The National Rehabilitation Center for Persons With Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan
| |
Collapse
|
7
|
Goto T, Ueha R, Sato T, Yamasoba T. Effects of early local administration of high-dose bFGF on a recurrent laryngeal nerve injury model. J Otolaryngol Head Neck Surg 2023; 52:47. [PMID: 37488610 PMCID: PMC10367270 DOI: 10.1186/s40463-023-00647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/29/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Research on regenerative medicine using basic fibroblast growth factor (bFGF) has recently advanced in the field of laryngology. We previously reported that local administration of bFGF 1 month after recurrent laryngeal nerve (RLN) paralysis compensated for atrophy of the thyroarytenoid muscle. The objective of this study was to elucidate the effects of early bFGF administration on the thyroarytenoid muscle after RLN transection and to investigate the underlying mechanisms. METHODS A rat model of RLN paralysis was established in this study. One day after RLN transection, low- (200 ng) or high-dose (2000 ng) bFGF or saline (control) was administered to the thyroarytenoid muscle. The larynges were excised for histological and immunohistochemical examinations at 1, 7, 14, 28, and 56 days after administration. RESULTS The cross-sectional thyroarytenoid muscle area was significantly larger in the high-dose group than in the saline and low-dose groups on days 28 and 56. Immunohistochemistry indicated that bFGF significantly increased the number of satellite cells in the thyroarytenoid muscle up to day 14 and that of neuromuscular junctions on days 28 and 56. CONCLUSIONS A single, early local administration of high-dose bFGF prevented atrophic changes in the thyroarytenoid muscles by activating satellite cell proliferation and reforming neuromuscular junctions. As increased neuromuscular junctions are expected to maintain myofiber volume, bFGF administration may prevent thyroarytenoid muscle atrophy in the mid to long term.
Collapse
Affiliation(s)
- Takao Goto
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Rumi Ueha
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- The University of Tokyo Hospital Swallowing Center, Tokyo, Japan
| | - Taku Sato
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Tokyo Teishin Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Hara M, Ueha R, Sato T, Goto T, Yoshizaki A, Sumida H, Sato S, Yamasoba T. Clinical Risk Factors for Dysphagia and Esophageal Dysmotility in Systemic Sclerosis. J Clin Med 2023; 12:jcm12103448. [PMID: 37240553 DOI: 10.3390/jcm12103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/07/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Systemic sclerosis (SSc) is often associated with dysphagia and esophageal dysmotility; however, only a few clinical studies on this topic have been conducted. Patients with SSc who underwent swallowing examinations and esophagography at our institution between 2010 and 2022 were included. A retrospective evaluation of the patients' backgrounds, autoantibody positivity, swallowing function, and esophageal motility was performed using medical charts. The association between dysphagia and esophageal dysmotility in patients with SSc and respective risk factors was investigated. Data were collected from 50 patients. Anti-topoisomerase I antibodies (ATA) and anti-centromere antibodies (ACA) were detected in 21 (42%) and 11 (22%) patients, respectively. Dysphagia was present in 13 patients (26%), and esophageal dysmotility in 34 patients (68%). ATA-positive patients had a higher risk for dysphagia (p = 0.027); ACA-positive patients had a significantly lower risk (p = 0.046). Older age and laryngeal sensory deficits were identified as risk factors for dysphagia; however, no risk factors for esophageal dysmotility were identified. No correlation was found between dysphagia and esophageal dysmotility. Esophageal dysmotility is more common in patients with SSc than in those with dysphagia. Autoantibodies can be predictors of dysphagia, and dysphagia must be carefully considered in ATA-positive and elderly patients with SSc.
Collapse
Affiliation(s)
- Mariko Hara
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Ayumi Yoshizaki
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hayakazu Sumida
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
- Scleroderma Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| |
Collapse
|
9
|
Ueha R, Magdayao RB, Koyama M, Sato T, Goto T, Yamasoba T. Correction: Aspiration prevention surgeries: a review. Respir Res 2023; 24:123. [PMID: 37138284 PMCID: PMC10158002 DOI: 10.1186/s12931-023-02398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Redentor B Magdayao
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Otorhinolaryngology-Head and Neck Surgery, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
10
|
Koyama M, Ueha R, Sato T, Goto T, Yamauchi A, Kaneoka A, Suzuki S, Nito T, Yamasoba T. Aspiration Prevention Surgery: Clinical Factors Associated With Improvements in Oral Status Intake and Suction Frequency. Otolaryngol Head Neck Surg 2023; 168:1146-1155. [PMID: 36939382 DOI: 10.1002/ohn.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE In recent years, the use of aspiration prevention surgery (APS) for the treatment of severe dysphagia has been on the rise. However, relevant clinical studies have included small samples, and the frequency of, and risk factors for postoperative complications have not been clarified. We investigated the clinical features of patients undergoing APS and whether oral-intake status and suction frequency could be reduced. STUDY DESIGN A case series. SETTING Single-institution academic center. METHODS We retrospectively evaluated medical charts generated from 2010 to 2021. The clinical characteristics of patients undergoing APS, changes in the oral-intake status (Functional Oral Intake Scale, FOIS), suction frequency before and after surgery, risk factors for postoperative complications, and factors contributing to improvements in postoperative oral-intake status were retrieved. RESULTS We included the data of 100 patients (median age: 65 years, 72 men). Amyotrophic lateral sclerosis was the most common primary disease (28%), and glottis closure was the most common APS (69%). Postoperatively, 78% of patients showed improvements in the FOIS score, and suction frequency decreased in 85% of cases. Postoperative complications were observed in 10 patients (10%), wound infection in 6, and bleeding in 4; all improved. Higher preoperative FOIS scores were significantly associated with postoperative complications (p = 0.02). CONCLUSION APS contributed to improving the FOIS score and helped reduce the suction frequency in most cases. APS can be performed safely with proper perioperative management, even in patients with poor preoperative general conditions and nutritional status.
Collapse
Affiliation(s)
- Misaki Koyama
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asako Kaneoka
- Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan.,Rehabilitation Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Sayaka Suzuki
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
11
|
Abstract
BACKGROUND Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration. MAIN BODY Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50-80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency. CONCLUSIONS In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.
Collapse
Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan. .,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Redentor B. Magdayao
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan ,Department of Otorhinolaryngology-Head and Neck Surgery, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Misaki Koyama
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- grid.26999.3d0000 0001 2151 536XDepartment of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
12
|
Kaneoka A, Ueha R, Nagatomo M, Matsunaga, A, Umezaki S, Inokuchi H, Ogata, T. Esophageal Speech for a Patient with Amyotrophic Lateral Sclerosis Who Underwent a Central-part Laryngectomy to Prevent Aspiration: A Case Report. Prog Rehabil Med 2022; 7:20220064. [PMID: 36591556 PMCID: PMC9772933 DOI: 10.2490/prm.20220064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background To prevent aspiration, patients with irreversible dysphagia may undergo surgeries that separate the esophagus and trachea. Such interventions result in loss of vocal function and require alternative communication methods. We report a patient with amyotrophic lateral sclerosis (ALS) who used esophageal speech after receiving a central-part laryngectomy (CPL) to prevent aspiration. Case A 64-year-old woman with ALS was admitted to our hospital. The patient maintained good cognitive and oral function and presented with mild dysarthria and dysphagia. Faced with rapidly worsening respiratory distress, saliva aspiration, and excessive sputum, she underwent a tracheostomy on the premise of invasive ventilation. Subsequently, the patient began using a voice-generating application for communication. Given the patient's sincere hope to prevent aspiration and aspiration pneumonia, achieve safe oral intake, and decrease caregiver burden for frequent suctioning, the patient underwent a CPL. Following surgery, belching was observed during meals, and the patient could phonate when she belched. This finding led to four speech therapy sessions to practice esophageal speech, allowing the patient to use the pseudo-speech technique for short conversations. Removal of the entire cricoid cartilage in the CPL decreases the upper esophageal sphincter (UES) pressure, thereby allowing air to easily pass through the UES. Therefore, the patient could use the air as a sound source for esophageal speech without extensive training. Discussion Esophageal speech may be an alternative to oral communication in patients undergoing CPL. Further research is warranted to generalize these findings to patients undergoing CPL.
Collapse
Affiliation(s)
- Asako Kaneoka
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan, University of Tokyo Hospital Swallowing Center, Tokyo,
Japan
| | - Rumi Ueha
- University of Tokyo Hospital Swallowing Center, Tokyo,
Japan, Department of Otolaryngology and Head and Neck Surgery,
Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Miki Nagatomo
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| | - Akiko Matsunaga,
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| | - Shigeko Umezaki
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| | - Haruhi Inokuchi
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan, University of Tokyo Hospital Swallowing Center, Tokyo,
Japan
| | - Toru Ogata,
- University of Tokyo Hospital Rehabilitation Center, Tokyo,
Japan
| |
Collapse
|
13
|
Koyama S, Mori E, Ueha R. Insight into the mechanisms of olfactory dysfunction by COVID-19. Auris Nasus Larynx 2022:S0385-8146(22)00230-9. [PMID: 36529610 PMCID: PMC9731926 DOI: 10.1016/j.anl.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
One of the unique symptoms of COVID-19 is chemosensory dysfunction. Almost three years since the beginning of the pandemic of COVID-19, there have been many studies on the symptoms, progress, and possible causes, and also studies on methods that may facilitate recovery of the senses. Studies have shown that some people recover their senses even within a couple of weeks whereas there are other patients that fail to recover chemosensory functions fully for several months and some never fully recover. Here we summarize the symptoms and the progress, and then review the papers on the causation as well as the treatments that may help facilitate the recovery of the symptoms. Depending on the differences in the levels of severity and the locations where the main pathological venues are, what is most effective in facilitating recovery can vary largely across patients and thus may require individualized strategies for each patient. The goal of this paper is to provide some thoughts on these choices depending on the differences in the causes and severity.
Collapse
Affiliation(s)
- Sachiko Koyama
- Indiana University, School of Medicine, Department of Medicine, United States,Correspondence author at: Indiana University, Richard L. Roudebush VA Medical Center, 1481 W Tenth St., Indianapolis, IN, 46202, United States
| | - Eri Mori
- Department of Otorhinolaryngology, Jikei University, School of Medicine, Japan
| | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Japan,Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Japan
| |
Collapse
|
14
|
Ueha R, Ito T, Ueha S, Furukawa R, Kitabatake M, Ouji-Sageshima N, Uranaka T, Tanaka H, Nishijima H, Kondo K, Yamasoba T. Evidence for the spread of SARS-CoV-2 and olfactory cell lineage impairment in close-contact infection Syrian hamster models. Front Cell Infect Microbiol 2022; 12:1019723. [PMCID: PMC9634532 DOI: 10.3389/fcimb.2022.1019723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Close contact with patients with COVID-19 is speculated to be the most common cause of viral transmission, but the pathogenesis of COVID-19 by close contact remains to be elucidated. In addition, despite olfactory impairment being a unique complication of COVID-19, the impact of SARS-CoV-2 on the olfactory cell lineage has not been fully validated. This study aimed to elucidate close-contact viral transmission to the nose and lungs and to investigate the temporal damage in the olfactory receptor neuron (ORN) lineage caused by SARS-CoV-2. Methods Syrian hamsters were orally administered SARS-CoV-2 nonvariant nCoV-19/JPN/TY/WK521/2020 as direct-infection models. On day 3 after inoculation, infected and uninfected hamsters were housed in the same cage for 30 minutes. These uninfected hamsters were subsequently assigned to a close-contact group. First, viral presence in the nose and lungs was verified in the infection and close-contact groups at several time points. Next, the impacts on the olfactory epithelium, including olfactory progenitors, immature ORNs, and mature ORNs were examined histologically. Then, the viral transmission status and chronological changes in tissue damage were compared between the direct-infection and close-contact groups. Results In the close-contact group, viral presence could not be detected in both the nose and lungs on day 3, and the virus was identified in both tissues on day 7. In the direct-infection group, the viral load was highest in the nose and lungs on day 3, decreased on day 7, and was no longer detectable on day 14. Histologically, in the direct-infection group, mature ORNs were most depleted on day 3 (p <0.001) and showed a recovery trend on day 14, with similar trends for olfactory progenitors and immature ORNs. In the close-contact group, there was no obvious tissue damage on day 3, but on day 7, the number of all ORN lineage cells significantly decreased (p <0.001). Conclusion SARS-CoV-2 was transmitted even after brief contact and subsequent olfactory epithelium and lung damage occurred more than 3 days after the trigger of infection. The present study also indicated that SARS-CoV-2 damages all ORN lineage cells, but this damage can begin to recover approximately 14 days post infection.
Collapse
Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- *Correspondence: Rumi Ueha, ;
| | - Toshihiro Ito
- Department of Immunology, Nara Medical University, Nara, Japan
| | - Satoshi Ueha
- Division of Molecular Regulation of Inflammatory and Immune Diseases, Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | | | | | | | - Tsukasa Uranaka
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirotaka Tanaka
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hironobu Nishijima
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
15
|
Sugito R, Yamauchi A, Sato T, Goto T, Ueha R, Nito T, Yamasoba T. Sex-and Age-Based Etiological Analysis of 2901 Patients With Dysphonia in a Japanese Tertiary Medical Institute. J Voice 2022:S0892-1997(22)00236-3. [PMID: 36085095 DOI: 10.1016/j.jvoice.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Societal aging is a grave concern in Japan, and its impact on voice clinics has not been investigated. This study aimed to clarify recent demographic features of geriatric dysphonia at a tertiary medical institute in Japan. STUDY DESIGN Retrospective study. METHODS The medical records of 2901 patients newly referred to the Voice Outpatient Clinic of the University of Tokyo Hospital between 2003 and 2020 were analyzed for age, sex, and etiology. RESULTS The mean ± standard deviation age of all patients was 53.2 ± 20.7 (median, 58; range, 0-95) years. The aging rate (ratio of patients aged ≥65 years) increased continuously during the study period, and the recent aging rate was the highest in the world (43%). However, its rate of increase has slowed over the past 10 years. The etiologies of dysphonia associated with the largest number of older patients were vocal fold immobility (32%), vocal fold atrophy (23%), and benign vocal fold lesions (11%). The highest aging rate was detected in patients with laryngeal cancer/leukoplakia, vocal tremor, vocal fold atrophy, sulcus vocalis, and vocal fold immobility. CONCLUSIONS Societal aging substantially increased the aging rate of patients with dysphonia in a Japanese voice clinic. The incidence of vocal fold immobility and atrophy is expected to continue to increase, whereas that of benign vocal fold lesions is expected to decrease.
Collapse
Affiliation(s)
- Ryosuke Sugito
- Department of Otolaryngology, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Kawagoe-shi, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
16
|
Ueha R, Ito T, Furukawa R, Kitabatake M, Ouji-Sageshima N, Ueha S, Koyama M, Uranaka T, Kondo K, Yamasoba T. Oral SARS-CoV-2 Inoculation Causes Nasal Viral Infection Leading to Olfactory Bulb Infection: An Experimental Study. Front Cell Infect Microbiol 2022; 12:924725. [PMID: 35770069 PMCID: PMC9234459 DOI: 10.3389/fcimb.2022.924725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 12/26/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can cause long-lasting anosmia, but the impact of SARS-CoV-2 infection, which can spread to the nasal cavity via the oral route, on the olfactory receptor neuron (ORN) lineage and olfactory bulb (OB) remains undetermined. Using Syrian hamsters, we explored whether oral SARS-CoV-2 inoculation can lead to nasal viral infection, examined how SARS-CoV-2 affects the ORN lineage by site, and investigated whether SARS-CoV-2 infection can spread to the OB and induce inflammation. On post-inoculation day 7, SARS-CoV-2 presence was confirmed in the lateral area (OCAM-positive) but not the nasal septum of NQO1-positive and OCAM-positive areas. The virus was observed partially infiltrating the olfactory epithelium, and ORN progenitor cells, immature ORNs, and mature ORNs were fewer than in controls. The virus was found in the olfactory nerve bundles to the OB, suggesting the nasal cavity as a route for SARS-CoV-2 brain infection. We demonstrated that transoral SARS-CoV-2 infection can spread from the nasal cavity to the central nervous system and the possibility of central olfactory dysfunction due to SARS-CoV-2 infection. The virus was localized at the infection site and could damage all ORN-lineage cells.
Collapse
Affiliation(s)
- Rumi Ueha
- Swallowing Center, the University of Tokyo Hospital, Tokyo, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
- *Correspondence: Rumi Ueha, ;
| | - Toshihiro Ito
- Department of Immunology, Nara Medical University, Nara, Japan
| | | | | | | | - Satoshi Ueha
- Division of Molecular Regulation of Inflammatory and Immune Diseases, Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tsukasa Uranaka
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
17
|
Suto A, Ueha R, Ogura T, Maeda E, Tatebayashi M, Shimada D, Koyama M, Sato T, Goto T, Yamauchi A, Yamasoba T. Swallowing computed tomography and virtual reality as novel imaging modalities for the diagnosis of clicking larynx: Two case reports. Auris Nasus Larynx 2022; 50:468-472. [PMID: 35341625 DOI: 10.1016/j.anl.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/08/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
Globus sensation and pain causes are difficult to identify by conventional examination methods. With technology advances, new imaging methods including swallowing computed tomography (CT) and virtual reality (VR) have emerged and are contributing to definite diagnoses. We report two cases of cervical discomfort diagnosed as clicking larynx using swallowing CT/VR . Case 1 is a 55-year-old man. There were no findings on laryngoscopy or swallowing examinations, but swallowing CT/VR showed that the thyroid cartilage collided with the hyoid bone during swallowing, leading to the diagnosis of a clicking larynx. The patient was obese and is under observation hoping that weight loss will improve symptoms. Case 2 is a 32-year-old transgender man. He is receiving male hormones for gender identity disorder. He was diagnosed with a clicking larynx using swallowing CT/VR. Hormonal therapy may have increased the size of the thyroid cartilage, likely causing the symptoms. As they didn't choose surgical treatment, no symptomatic relief was achieved, but identifiying the cause contributed to improved patient satisfaction. Swallowing CT/VR is useful not only for evaluating the swallowing function, but also the underlying etiology of globus sensation and pain upon swallowing. Further clinical applications of this technique are expected for motion induced cervical symptoms.
Collapse
Affiliation(s)
- Aina Suto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan; Swallowing Center, the University of Tokyo Hospital, Tokyo, Japan.
| | - Takafumi Ogura
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan; Faculty of Engineering Systems Innovation, the University of Tokyo, Tokyo, Japan
| | - Eriko Maeda
- Department of Computational Diagnostic Radiology and Preventive Medicine, the University of Tokyo Hospital, Tokyo, Japan
| | | | | | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
18
|
Takeuchi M, Ahn J, Lee K, Takaki K, Ifukube T, Yabu KI, Takamichi S, Ueha R, Sekino M. Hands-Free Wearable Electrolarynx using Linear Predictive Coding Residual Waves and Listening Evaluation. ABE 2022. [DOI: 10.14326/abe.11.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Jaesol Ahn
- Faculty of Information and Communication Engineering, The University of Tokyo
| | - Kunhak Lee
- Faculty of Mechanical Engineering, The University of Tokyo
| | - Ken Takaki
- Graduate School of Engineering, The University of Tokyo
| | - Tohru Ifukube
- Research Center for Advanced Science and Technology, The University of Tokyo
| | - Ken-ichiro Yabu
- Research Center for Advanced Science and Technology, The University of Tokyo
| | | | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, The University of Tokyo
| | - Masaki Sekino
- Department of Bioengineering, The University of Tokyo
| |
Collapse
|
19
|
Ueha R, Sato T, Goto T, Koyama M, Yamauchi A, Mizukami A, Yamasoba T. Effects of Aspiration Prevention Surgery on the Dynamics of the Pharynx and Upper Esophageal Sphincter. OTO Open 2021; 5:2473974X211048505. [PMID: 34708180 PMCID: PMC8543729 DOI: 10.1177/2473974x211048505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Oral intake after aspiration prevention surgery (APS) is influenced by postoperative pharyngeal pressure and the dynamics of the upper esophageal sphincter (UES). We examined the effects of less invasive APS combined with UES relaxation techniques (laryngeal closure with cricopharyngeal myotomy [LC-CPM] and central-part laryngectomy [CPL]) on pharyngeal pressure and UES dynamics. Study Design Retrospective, observational study. Setting Single center. Methods We assessed the high-resolution pharyngeal manometric parameters of patients who underwent APS from 2018 to 2020. Then, we compared the effects of bilateral cricopharyngeal myotomy (combined with LC: LC-CPM group) and total cricoidectomy (CPL group) on both pharyngeal pressure and UES dynamics pre- and postoperatively. Results Eighteen patients (median age, 68 years; 17 men [94%]) were enrolled. Primary diseases associated with severe aspiration were neuromuscular disorders in 13, stroke in 3, and others in 2 patients. Pharyngeal swallowing pressure did not significantly change before and after APS. UES resting pressure and UES relaxation duration were significantly reduced (P < .001) and prolonged (P < .001), respectively, after APS. Only the CPL group (8 patients: median 62 years, all men) showed an increase in the velopharyngeal closure integral after APS (P < .05). More prolonged UES relaxation duration was recognized postoperatively in the CPL group (P < .01) than in the LC-CPM group. Conclusion Less invasive APS minimally affects pharyngeal swallowing pressure, decreases UES resting pressure, and prolongs UES relaxation duration. CPL may be more effective for postoperative UES relaxation in patients with a short UES relaxation time.
Collapse
Affiliation(s)
- Rumi Ueha
- Swallowing Center, University of Tokyo Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Aiko Mizukami
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
20
|
Masuda H, Ueha R, Sato T, Goto T, Koyama M, Yamauchi A, Kaneoka A, Suzuki S, Yamasoba T. Risk Factors for Aspiration Pneumonia After Receiving Liquid-Thickening Recommendations. Otolaryngol Head Neck Surg 2021; 167:125-132. [PMID: 34582292 PMCID: PMC9251747 DOI: 10.1177/01945998211049114] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective We examined the influence of liquid thickness levels on the frequency of
liquid penetration-aspiration in patients with dysphagia and evaluated the
clinical risk factors for penetration-aspiration and aspiration pneumonia
development. Study Design A case series. Setting Single-institution academic center. Methods We reviewed medical charts from 2018 to 2019. First, we evaluated whether
liquid thickness levels influence the frequency of liquid
penetration-aspiration in patients with dysphagia. Penetration-aspiration
occurrence in a videofluoroscopic swallowing study was defined as
Penetration-Aspiration Scale (PAS) scores ≥3. Second, the association
between liquid thickness level and penetration-aspiration was analyzed, and
clinical risk factors were identified. Moreover, clinical risk factors for
aspiration pneumonia development within 6 months were investigated. Results Of 483 patients, 159 showed penetration-aspiration. The thickening of liquids
significantly decreased the incidence of penetration-aspiration
(P < .001). Clinical risk factors for
penetration-aspiration were vocal fold paralysis (odds ratio [OR], 1.99),
impaired laryngeal sensation (OR, 5.01), and a history of pneumonia (OR,
2.90). Twenty-three patients developed aspiration pneumonia while
undertaking advised dietary changes, including liquid thickening.
Significant risk factors for aspiration pneumonia development were poor
performance status (OR, 1.85), PAS score ≥3 (OR, 4.03), and a history of
aspiration pneumonia (OR, 7.00). Conclusion Thickening of liquids can reduce the incidence of penetration-aspiration.
Vocal fold paralysis, impaired laryngeal sensation, and history of
aspiration pneumonia are significant risk factors of penetration-aspiration.
Poor performance status, PAS score ≥3, and history of aspiration pneumonia
are significantly associated with aspiration pneumonia development following
recommendations on thickening liquids. Level of Evidence 3.
Collapse
Affiliation(s)
- Hiroaki Masuda
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.,Swallowing Center, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Misaki Koyama
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Asako Kaneoka
- The University of Tokyo Hospital, Rehabilitation Center, Tokyo, Japan
| | - Sayaka Suzuki
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
21
|
Sugaya T, Ueha R, Sato T, Goto T, Yamauchi A, Yamasoba T. Safety of surgical tracheostomy under continued antithrombotic therapy: A retrospective cohort study. Clin Otolaryngol 2021; 47:88-93. [PMID: 34529345 DOI: 10.1111/coa.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/27/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although various guidelines have been established for the management of antithrombotic therapy during surgical treatments, surgical tracheostomy (ST) under continued antithrombotic therapy (CAT) remains challenging. Here, we investigated the risk factors for complications after ST by focusing on the application of CAT during ST. DESIGN A retrospective cohort study with medical records from 2009 to 2020. SETTING A single-center study. PARTICIPANTS This study included patients who had undergone ST at the Department of Otolaryngology of our hospital MAIN OUTCOME MEASURES: The primary outcomes were the incidence of complications and blood test results. Secondary outcomes were risk factors for postoperative complications. RESULTS We identified 288 patients (median age: 64 years; 184 men [64%]), among whom 40 (median age: 67 years; 29 men [73%]) underwent CAT. Although the patients undergoing CAT had significantly longer activated partial thromboplastin time (p=0.002) and a higher prothrombin time-international normalized ratio (p=0.006) compared to antithrombotic naïve patients, no statistically significant intergroup differences were observed for the risk of bleeding, infection, or subcutaneous emphysema. Instead, ST under local anesthesia (p=0.01) and ST for airway emergency (p=0.02) significantly increased the risk of early postoperative complications. CONCLUSION These results suggest that ST under CAT can be safely performed without any increased risk of postoperative complications. Nevertheless, surgeons should be extra cautious about early complications after ST under local anesthesia without intubation or ST for airway emergencies.
Collapse
Affiliation(s)
- Takayuki Sugaya
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.,Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
22
|
Koyama S, Kondo K, Ueha R, Kashiwadani H, Heinbockel T. Possible Use of Phytochemicals for Recovery from COVID-19-Induced Anosmia and Ageusia. Int J Mol Sci 2021; 22:8912. [PMID: 34445619 PMCID: PMC8396277 DOI: 10.3390/ijms22168912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022] Open
Abstract
The year 2020 became the year of the outbreak of coronavirus, SARS-CoV-2, which escalated into a worldwide pandemic and continued into 2021. One of the unique symptoms of the SARS-CoV-2 disease, COVID-19, is the loss of chemical senses, i.e., smell and taste. Smell training is one of the methods used in facilitating recovery of the olfactory sense, and it uses essential oils of lemon, rose, clove, and eucalyptus. These essential oils were not selected based on their chemical constituents. Although scientific studies have shown that they improve recovery, there may be better combinations for facilitating recovery. Many phytochemicals have bioactive properties with anti-inflammatory and anti-viral effects. In this review, we describe the chemical compounds with anti- inflammatory and anti-viral effects, and we list the plants that contain these chemical compounds. We expand the review from terpenes to the less volatile flavonoids in order to propose a combination of essential oils and diets that can be used to develop a new taste training method, as there has been no taste training so far. Finally, we discuss the possible use of these in clinical settings.
Collapse
Affiliation(s)
- Sachiko Koyama
- Department of Chemistry, Indiana University, Bloomington, IN 47405, USA
| | - Kenji Kondo
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Rumi Ueha
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hideki Kashiwadani
- Department of Physiology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Thomas Heinbockel
- Department of Anatomy, College of Medicine, Howard University, Washington, DC 20059, USA
| |
Collapse
|
23
|
Affiliation(s)
| | | | - Rumi Ueha
- Department of Otolaryngology, University of Tokyo, Tokyo, Japan.,Swallowing Center, University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
24
|
Mori E, Ueha R, Kondo K, Funada S, Shimmura H, Kanemoto K, Tanaka H, Nishijima H, Otori N, Yamasoba T, Kojima H. Squamous and Respiratory Metaplasia After Olfactory Mucosal Resection. Front Neurosci 2021; 15:695653. [PMID: 34354563 PMCID: PMC8329582 DOI: 10.3389/fnins.2021.695653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Resection of the olfactory mucosa (OM) is sometimes unavoidable during surgery; however, it is not known whether the OM can completely recover thereafter. The aim of this study was to uncover whether the OM fully recovers after mucosal resection and describe the process of OM regeneration. 8-week-old male Sprague–Dawley rats (n = 18) were subjected to OM resection at the nasal septum; six rats were euthanized for histological examination 0, 30, and 90 days after surgery. Immunohistochemistry was performed to identify olfactory receptor neuron (ORN) lineage cells [mature and immature ORNs and ORN progenitors, and olfactory ensheathing cells (OECs)], as well as dividing and apoptotic cells. Squamous and respiratory metaplasia and inflammatory cell infiltration were also assessed. On day 30 after resection, the mucosa had regenerated, and mainly contained thin nerve bundles, basal cells, and immature ORNs, with a few mature ORNs and OECs. On day 90, the repaired nasal mucosa had degenerated into stratified squamous or ciliated pseudostratified columnar epithelia, with reducing ORNs. The lamina propria contained numerous macrophages. Partial regeneration was observed within 1 month after OM resection, whereas subsequent degeneration into squamous and respiratory epithelia occurred within 3 months. Given the poor persistence of ORNs and OECs, OM resection is likely to result in olfactory impairment. Overall, surgeons should be cautious not to injure the OM during surgery.
Collapse
Affiliation(s)
- Eri Mori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shotaro Funada
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hajime Shimmura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kai Kanemoto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hirotaka Tanaka
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hironobu Nishijima
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
25
|
Koyama S, Ueha R, Kondo K. Loss of Smell and Taste in Patients With Suspected COVID-19: Analyses of Patients' Reports on Social Media. J Med Internet Res 2021; 23:e26459. [PMID: 33788699 PMCID: PMC8064705 DOI: 10.2196/26459] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The year 2020 was the year of the global COVID-19 pandemic. The severity of the situation has become so substantial that many or even most of the patients with mild to moderate symptoms had to self-isolate without specific medical treatments or even without being tested for COVID-19. Many patients joined internet membership groups to exchange information and support each other. OBJECTIVE Our goal is to determine the benefits and limits of using social media to understand the symptoms of patients with suspected COVID-19 with mild to moderate symptoms and, in particular, their symptoms of anosmia (loss of the sense of smell) and ageusia (loss of the sense of taste). The voluntary reports on an internet website of a membership group will be the platform of the analyses. METHODS Posts and comments of members of an internet group known as COVID-19 Smell and Taste Loss, founded on March 24, 2020, to support patients with suspected COVID-19 were collected and analyzed daily. Demographic data were collected using the software mechanism called Group Insights on the membership group website. RESULTS Membership groups on social media have become rare sources of support for patients with suspected COVID-19 with mild to moderate symptoms. These groups provided mental support to their members and became resources for information on COVID-19 tests and medicines or supplements. However, the membership was voluntary, and often the members leave without notification. It is hard to be precise from the free voluntary reports. The number of women in the group (6995/9227, 75.38% as of October 12, 2020) was about three times more than men (2272/9227, 24.62% as of October 12, 2020), and the peak age of members was between 20-40 years in both men and women. Patients who were asymptomatic other than the senses comprised 14.93% (53/355) of the total patients. Recovery of the senses was higher in the patients who were asymptomatic besides having anosmia and ageusia. Most (112/123, 91.06%) patients experienced other symptoms first and then lost their senses, on average, 4.2 days later. Patients without other symptoms tended to recover earlier (P=.02). Patients with anosmia and ageusia occasionally reported distorted smell and taste (parosmia and dysgeusia) as well as experiencing or perceiving the smell and taste without the sources of the smell or taste (phantosmia and phantogeusia). CONCLUSIONS Our analysis of the social media database of suspected COVID-19 patients' voices demonstrated that, although accurate diagnosis of patients is not always obtained with social media-based analyses, it may be a useful tool to collect a large amount of data on symptoms and the clinical course of worldwide rapidly growing infectious diseases.
Collapse
Affiliation(s)
- Sachiko Koyama
- Department of Chemistry, Indiana University, Bloomington, IN, United States
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
26
|
Ueha R, Kondo K, Kagoya R, Shichino S, Shichino S, Yamasoba T. ACE2, TMPRSS2, and Furin expression in the nose and olfactory bulb in mice and humans. Rhinology 2021; 59:105-109. [PMID: 33249429 DOI: 10.4193/rhin20.324] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
No abstract available.
Collapse
Affiliation(s)
- R Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - K Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - R Kagoya
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - S Shichino
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| | - S Shichino
- Division of Molecular Regulation of Inflammatory and Immune Diseases, Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - T Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
27
|
Uranaka T, Kashio A, Ueha R, Sato T, Bing H, Ying G, Kinoshita M, Kondo K, Yamasoba T. Expression of ACE2, TMPRSS2, and Furin in Mouse Ear Tissue, and the Implications for SARS-CoV-2 Infection. Laryngoscope 2020; 131:E2013-E2017. [PMID: 33296096 DOI: 10.1002/lary.29324] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Intracellular entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on the interaction between its spike protein with the cellular receptor angiotensin-converting enzyme 2 (ACE2) and depends on Furin-mediated spike protein cleavage and spike protein priming by host cell proteases, including transmembrane protease serine 2 (TMPRSS2). As the expression of ACE2, TMPRSS2, and Furin in the middle and inner ear remain unclear, we analyzed the expression of these proteins in mouse ear tissues. STUDY DESIGN Animal Research. METHODS We performed immunohistochemical analysis to examine the distribution of ACE2, TMPRSS2, and Furin in the Eustachian tube, middle ear spaces, and cochlea of mice. RESULTS ACE2 was present in the nucleus of the epithelium of the middle ear and Eustachian tube, as well as in some nuclei of the hair cells in the organ of Corti, in the stria vascularis, and the spiral ganglion cells. ACE2 was also expressed in the cytoplasm of the stria vascularis. TMPRSS2 was expressed in both the nucleus and cytoplasm in the middle spaces, with the expression being stronger in the nucleus in the mucosal epithelium of the middle ear spaces and Eustachian tube. TMPRSS2 was present in the cytoplasm in the organ of Corti and stria vascularis and in the nucleus and cytoplasm in the spiral ganglion. Furin was expressed in the cytoplasm in the middle ear spaces, Eustachian tube, and cochlea. CONCLUSIONS ACE2, TMPRSS2, and Furin are diffusely present in the Eustachian tube, middle ear spaces, and cochlea, suggesting that these tissues are susceptible to SARS-CoV-2 infection. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2013-E2017, 2021.
Collapse
Affiliation(s)
- Tsukasa Uranaka
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Kashio
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Han Bing
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Gao Ying
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
28
|
Sekiguchi Koyama M, Ueha R, Goto T, Sato T, Tachibana A, Mizumoto Y, Nito T, Yamasoba T. Aspiration Prevention Surgery under Local Anesthesia for Palliative Care in Patients with Head and Neck Cancer: A Report of Two Cases. ORL J Otorhinolaryngol Relat Spec 2020; 83:52-58. [PMID: 33075797 DOI: 10.1159/000510800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
Aspiration prevention (AP) surgery may improve the quality of life (QOL) of patients with severe dysphagia. However, not all patients can endure this type of surgery under general anesthesia because of their poor status. Herein, we describe the cases of 2 patients with head and neck cancer (HNC) who underwent AP surgery for palliative care. Although both patients had tracheostomy due to severe dysphagia and respiratory impairment and frequently needed suction, they were successfully managed with AP surgery under local anesthesia. A tracheostoma was reshaped to be sufficiently large for an airway to be secured without a cannula. Their respiratory failure gradually improved, and suction frequency markedly decreased after surgery; thus, they could receive medical treatment at home. When patients with HNC under palliative care have a tracheal cannula and cannot vocalize, AP surgery under local anesthesia is an option to improve their QOL.
Collapse
Affiliation(s)
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan,
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Akane Tachibana
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Yui Mizumoto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| |
Collapse
|
29
|
Sato T, Ueha R, Goto T, Yamauchi A, Kondo K, Yamasoba T. Expression of ACE2 and TMPRSS2 Proteins in the Upper and Lower Aerodigestive Tracts of Rats: Implications on COVID 19 Infections. Laryngoscope 2020; 131:E932-E939. [PMID: 32940922 DOI: 10.1002/lary.29132] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Patients with coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exhibit not only respiratory symptoms but also symptoms of chemo-sensitive disorders. Cellular entry of SARS-CoV-2 depends on the binding of its spike protein to a cellular receptor named angiotensin-converting enzyme 2 (ACE2), and the subsequent spike protein-priming by host cell proteases, including transmembrane protease serine 2 (TMPRSS2). Thus, high expression of ACE2 and TMPRSS2 is considered to enhance the invading capacity of SARS-CoV-2. METHODS To elucidate the underlying histological mechanisms of the aerodigestive disorders caused by SARS-CoV-2, we investigated the expression of ACE2 and TMPRSS2 proteins using immunohistochemistry, in the aerodigestive tracts of the tongue, hard palate with partial nasal tissue, larynx with hypopharynx, trachea, esophagus, and lung of rats. RESULTS Co-expression of ACE2 and TMPRSS2 proteins was observed in the taste buds of the tongue, nasal epithelium, trachea, bronchioles, and alveoli with varying degrees of expression. Remarkably, TMPRSS2 expression was more distinct in the peripheral alveoli than in the central alveoli. These results coincide with the reported clinical symptoms of COVID-19, such as the loss of taste, loss of olfaction, and respiratory dysfunction. CONCLUSIONS A wide range of organs have been speculated to be affected by SARS-CoV-2 depending on the expression levels of ACE2 and TMPRSS2. Differential distribution of TMPRSS2 in the lung indicated the COVID-19 symptoms to possibly be exacerbated by TMPRSS2 expression. This study might provide potential clues for further investigation of the pathogenesis of COVID-19. LEVEL OF EVIDENCE NA Laryngoscope, 131:E932-E939, 2021.
Collapse
Affiliation(s)
- Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
30
|
Nativ-Zeltzer N, Ueha R, Nachalon Y, Ma B, Pastenkos G, Swackhamer C, Bornhorst GM, Lefton-Greif MA, Anderson JD, Belafsky PC. Inflammatory Effects of Thickened Water on the Lungs in a Murine Model of Recurrent Aspiration. Laryngoscope 2020; 131:1223-1228. [PMID: 32770795 DOI: 10.1002/lary.28948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Liquid thickeners are commonly recommended in individuals with dysphagia and recurrent aspiration as a strategy for pneumonia prevention. The goal of this study was to examine the effects of small amounts of aspirated liquid thickener on the lungs. STUDY DESIGN Animal model. Prospective small animal clinical trial. METHODS Adult Sprague Dawley rats (n = 19) were divided into two groups and underwent three intratracheal instillations of either xanthan gum-based nectar-thick water (0.1-0.25 mL/kg) or water-only control over the course of 8 days. Blood was collected from a peripheral vein on days 1 and 8 and submitted for complete blood count (CBC) analysis. Rats were euthanized 10 days after the last instillation, and the lungs were harvested. Histopathology was conducted on lung specimens by a blinded licensed veterinary pathologist and scored for evidence of lung injury and pneumonia. RESULTS Fifteen animals (8 nectar-thickener group, 7 control group) survived until the endpoint of the study (day 18). Serum CBC did not show abnormalities at any timepoint in either group. Histological evidence of lung inflammation and edema were significantly greater in the nectar-thick group compared to controls (P < .05). Signs of inflammation included aggregates of foamy macrophages, expansion of bronchiolar lymphoid tissue, and large numbers of eosinophilic intraalveolar crystals. Histiocytic and neutrophilic pneumonia was noted in one animal that received thickened liquids. CONCLUSION Recurrent aspiration of small amounts of thickened water resulted in significant pulmonary inflammation in a murine model of aspiration. Results of this study support the need for further investigation of liquid thickener safety and its efficacy in reducing the pulmonary complications of swallowing disorders. LEVEL OF EVIDENCE NA Laryngoscope, 131:1223-1228, 2021.
Collapse
Affiliation(s)
- Nogah Nativ-Zeltzer
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, California, U.S.A
| | - Rumi Ueha
- Department of Otorhinolaryngology, Head and Neck Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuval Nachalon
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, California, U.S.A
| | - Betty Ma
- Office of Research: Campus Veterinary Services, University of California, Davis, California, U.S.A
| | - Gabrielle Pastenkos
- Comparative Pathology Laboratory, University of California, Davis School of Veterinary Medicine, Davis, California, U.S.A
| | - Clay Swackhamer
- Department of Biological and Agricultural Engineering, University of California Davis, Davis, California, U.S.A
| | - Gail M Bornhorst
- Department of Biological and Agricultural Engineering, University of California Davis, Davis, California, U.S.A
| | - Maureen A Lefton-Greif
- Department of Pediatrics, Otolaryngology, Head & Neck Surgery, and Physical Medicine & Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Johnathon D Anderson
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, California, U.S.A
| | - Peter C Belafsky
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, California, U.S.A
| |
Collapse
|
31
|
Kimura Y, Ueha R, Furukawa T, Oshima F, Fujitani J, Nakajima J, Kaneoka A, Aoyama H, Fujimoto Y, Umezaki T. Society of swallowing and dysphagia of Japan: Position statement on dysphagia management during the COVID-19 outbreak. Auris Nasus Larynx 2020; 47:715-726. [PMID: 32736887 PMCID: PMC7377736 DOI: 10.1016/j.anl.2020.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning. Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases. This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including “terminology”, “clinical swallowing assessment and examination“, “swallowing therapy”, “oral care”, “surgical procedure for dysphagia”, “tracheotomy care”, and “nursing care”. In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures. The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Yurika Kimura
- Department of Otolaryngology, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
| | - Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Fumiko Oshima
- Department of Rehabilitation, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
| | - Junko Fujitani
- Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Nakajima
- Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, Japan
| | - Asako Kaneoka
- The University of Tokyo Hospital, Rehabilitation Center, Tokyo, Japan
| | | | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
| | - Toshiro Umezaki
- Department of Otolaryngology, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan; Department of Speech and Hearing Sciences, International University of Health and Welfare, and the Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| |
Collapse
|
32
|
Kondo K, Kikuta S, Ueha R, Suzukawa K, Yamasoba T. Age-Related Olfactory Dysfunction: Epidemiology, Pathophysiology, and Clinical Management. Front Aging Neurosci 2020; 12:208. [PMID: 32733233 PMCID: PMC7358644 DOI: 10.3389/fnagi.2020.00208] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022] Open
Abstract
Like other sensory systems, olfactory function deteriorates with age. Epidemiological studies have revealed that the incidence of olfactory dysfunction increases at the age of 60 and older and males are more affected than females. Moreover, smoking, heavy alcohol use, sinonasal diseases, and Down’s syndrome are associated with an increased incidence of olfactory dysfunction. Although the pathophysiology of olfactory dysfunction in humans remains largely unknown, studies in laboratory animals have demonstrated that both the peripheral and central olfactory nervous systems are affected by aging. Aged olfactory neuroepithelium in the nasal cavity shows the loss of mature olfactory neurons, replacement of olfactory neuroepithelium by respiratory epithelium, and a decrease in basal cell proliferation both in the normal state and after injury. In the central olfactory pathway, a decrease in the turnover of interneurons in the olfactory bulb (OB) and reduced activity in the olfactory cortex under olfactory stimulation is observed. Recently, the association between olfactory impairment and neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), has gained attention. Evidence-based pharmacotherapy to suppress or improve age-related olfactory dysfunction has not yet been established, but preliminary results suggest that olfactory training using odorants may be useful to improve some aspects of age-related olfactory impairment.
Collapse
Affiliation(s)
- Kenji Kondo
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keigo Suzukawa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
33
|
Ueha R, Sato T, Goto T, Yamauchi A, Nativ-Zeltzer N, Mitsui J, Belafsky PC, Yamasoba T. Esophageal Dysmotility is Common in Patients With Multiple System Atrophy. Laryngoscope 2020; 131:832-838. [PMID: 32621533 DOI: 10.1002/lary.28852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/28/2020] [Accepted: 05/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Esophageal dysmotility (ED) in patients with multiple system atrophy (MSA) are poorly understood. This study aimed to investigate the prevalence of ED in patients with MSA and to assess the relationship of esophageal abnormalities with other clinical findings and characteristics in these patients. METHODS A retrospective chart review was conducted to identify patients with MSA and to compare them to the elderly controls without MSA (65+ years) who underwent a videofluorographic esophagram from 2014 to 2019. Disease type, disease severity, vocal fold mobility impairment, abnormal deglutitive proximal esophageal contraction (ADPEC), and intra-esophageal stasis (IES) were reviewed and compared between groups. RESULTS Thirty-seven patients with MSA were identified. The median age was 63 and 26 (70%) were male. These patients were matched to 22 elderly adults with presbylarynx but not MSA (median age 77, 68% male). In MSA patients, cerebellar variant type was predominant (59%), and ADPEC was recognized in 18 patients (49%). Disease severity level (P = 0.028) and existence of IES (P = 0.046) were associated with higher risks of developing ADPEC. The prevalence of IES was significantly higher in patients with MSA (95%) compared to controls without MSA (46%) (P < 0.001). Disease severity level and the existence of IES were significantly associated with the presence of ADPEC (p < 0.05). CONCLUSION ADPEC and IES were significantly more common in MSA than in elderly subjects without MSA. MSA severity is associated with the development of ADPEC. The data suggest that esophageal motility is predominantly affected in MSA. LEVEL OF EVIDENCE 3 Laryngoscope, 131:832-838, 2021.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology, The University of California, Davis, California, U.S.A
| | - Jun Mitsui
- Department of Neurology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Peter C Belafsky
- Department of Otolaryngology, The University of California, Davis, California, U.S.A
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
34
|
Ueha R, Maeda E, Ino K, Shimizu T, Sato T, Goto T, Yamasoba T. Sleep-Induced Glottis Closure in Multiple System Atrophy Evaluated by Four-Dimensional Computed Tomography. Front Med (Lausanne) 2020; 7:132. [PMID: 32363195 PMCID: PMC7180743 DOI: 10.3389/fmed.2020.00132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/26/2020] [Indexed: 12/20/2022] Open
Abstract
Multiple system atrophy (MSA) is a progressive neurodegenerative disorder. Since patients with MSA often have sleep-related respiratory disorders including upper-airway obstruction and/or central sleep disturbance, appropriate evaluation of the upper airway especially during sleep may be indispensable. Fiberoptic laryngoscopy during diazepam-induced sleep has been reported for upper-airway obstruction verification. However, some patients cannot endure the uncomfortable sensation of the fiberscope. To address these issues, we devised a protocol of four four-dimensional computed tomography (4D-CT) for upper-airway evaluation during sleep. Here, we report the case of patient with MSA who was evaluated for upper-airway obstruction during sleep using 4D-CT. A 46-year-old man (height 1.60 m, weight 79 kg) was admitted to our neurological department for tracheal intubation because of a sudden onset of respiratory failure occurring at night. At the age of 45 years, he was diagnosed as MSA with predominant parkinsonism. As pulmonary disease had been excluded and his swallowing was normal, our differential diagnoses were central sleep apnea or obstructive sleep apnea related to his MSA or obstructive sleep apnea (SA) related to his obesity. A tracheostomy was done to maintain the airway after extubation. Polysomnography showed obstructive SA and not central SA. Awake fiberoptic laryngoscopy showed no upper airway obstruction but bilateral vocal abduction impairment (BVAI) during inspiration. To assess the spatial and temporal conditions of the upper respiratory tract—the patient could not tolerate sleep laryngoscopy—we carried out a 4D-CT. Reconstructed 4D-CT images of respiration during sleep showed clear abnormalities: glottis closure at the terminal stage of inspiration and subsequent velopharyngeal closure. As glottis closure does not occur normally in obesity patients, the cause of the respiratory failure in this patient was considered MSA-related sleep-induced airway obstruction. We decided to keep the tracheostoma, because BVAI in patients with MSA may be getting worse, although central apnea after tracheostomy may cause sudden central origin-related death; 4 months postoperatively, the patient had experienced no further airway-related complications. This report indicates that 4D-CT sequential upper-airway assessment during sleep is useful for determining the abnormalities causing obstructive SA in patients with MSA.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Eriko Maeda
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Ino
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Imaging Center, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Taku Sato
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
35
|
Ueha R, Ueha S, Kondo K, Nishijima H, Yamasoba T. Effects of Cigarette Smoke on the Nasal Respiratory and Olfactory Mucosa in Allergic Rhinitis Mice. Front Neurosci 2020; 14:126. [PMID: 32132898 PMCID: PMC7040099 DOI: 10.3389/fnins.2020.00126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/31/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Cigarette smoke (CS) exposure reportedly enhances allergic airway inflammation. However, some studies have shown an association between current cigarette smoke exposure and a low risk for allergic rhinitis. Thus, the impact of CS exposure on allergic rhinitis remains poorly understood. The purpose of this study was to investigate the effects of CS on the respiratory mucosa (RM) and the olfactory epithelium (OE) of mice with allergic rhinitis, as the effects may differ depending on the nasal histological compartments. Methods Eight-week-old male BALB/c mice were used for this study. We developed a mouse model of smoking by intranasally administering 10 doses of a CS solution (CSS), and a mouse model of allergic rhinitis by sensitization with intraperitoneal ovalbumin (OVA) injection and intranasal challenge with OVA. We examined the effects of CS on the nasal RM and OE in mice with or without allergic rhinitis using histological, serum, and genetic analyses. First, we examine whether CSS exposure induces allergic responses and then, examined allergic responses in the OVA-sensitized allergic rhinitis mice with or without CSS exposure. Results Short-term CSS administration intensified allergic responses including increased infiltration of eosinophils and inflammatory cells and upregulation of interleukin-5 expression in the nasal RM of OVA-immunized mice, although only CSS induced neither allergic responses nor impairment of the RM and OE. Notably, repetitive OVA-immunization partially impaired the OE in the upper-lateral area, but CSS administration did not reinforce this impairment in OVA-induced allergic mice. Conclusion Short-term CSS exposure strengthened allergic responses in the nasal RM and did not change the structure of the OE. These results suggest that patients with allergic rhinitis could experience exacerbation of allergic symptoms after CS exposure.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ueha
- Division of Molecular Regulation of Inflammatory and Immune Diseases, Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | | | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
36
|
Tsuchiya K, Ueha R, Suzuki S, Goto T, Sato T, Nito T, Yamasoba T. Heightened risk of early vocal fold motion impairment onset and dysphagia in the parkinsonian variant of multiple system atrophy: a comparative study. Clin Park Relat Disord 2020; 3:100037. [PMID: 34316623 PMCID: PMC8298771 DOI: 10.1016/j.prdoa.2020.100037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/07/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Abstract
Objective We compared differences in frequency and timing of onset of the following clinical events between the cerebellar and parkinsonian variants of multiple system atrophy (MSA-C and MSA-P, respectively): type of operation including tracheostomy and/or aspiration prevention surgery, vocal fold motion impairment (VFMI), sleep apnea (SA), introduction of mechanical ventilation (MV), and dysphagia. The risks of these events cooccurring with either MSA-C or MSA-P were compared. Methods We retrospectively assessed clinical outcomes only of patients with MSA who presented at the Department of Otolaryngology of the University of Tokyo Hospital between 2008 and 2018. The proportion and timing of onset events between MSA-C and MSA-P and risks of onset were compared using chi-square tests and Cox proportional hazard models adjusted for age, sex, and disease severity, respectively. Results We identified 113 patients (median age: 60 years, 72 men [64%]). The frequency and timing of VFMI, SA, MV, dysphagia, and surgeries were 55 patients (49%) and 76 (95% CI 61–91) months after MSA onset, 85 (75%) and 41 (32–50), 36 (32%) and 100 (73–127), 77 (68%) and 43 (36–50), and 25 (22%) and 102 (84–120), respectively. Twenty-seven patients (24%) had MSA-P and higher risk of VFMI (p < .001), SA (p = .030), and dysphagia (p = .017) than did patients with MSA-C. Conclusion While MSA-P is less common, it may involve heightened risk of VFMI and dysphagia early onset. Thus, careful follow-up for VFMI, SA, and dysphagia may be needed for these patients. Criteria for Rating Diagnostic Accuracy Studies Class II. The onset of vocal fold motion impairment varies in multiple system atrophy types The sleep-apnea onset is relatively early in parkinsonian multiple system atrophy The onset of dysphagia is relatively early in parkinsonian multiple system atrophy Respiratory clinical events are more common in parkinsonian multiple system atrophy
Collapse
Affiliation(s)
- Kaoru Tsuchiya
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan.,Department of Otolaryngology, Kameda Medical Center, Chiba, Japan
| | - Rumi Ueha
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| | - Sayaka Suzuki
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
37
|
Katoh M, Ueha R, Sato T, Sugasawa S, Goto T, Yamauchi A, Yamasoba T. Choice of Aspiration Prevention Surgery for Patients With Neuromuscular Disorders: Report of Three Cases. Front Surg 2019; 6:66. [PMID: 31824959 PMCID: PMC6881234 DOI: 10.3389/fsurg.2019.00066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Dysphagia, one of the major complications of neuromuscular diseases such as Parkinson's disease and amyotrophic lateral sclerosis (ALS), decreases quality of life and may lead to malnutrition or aspiration pneumonia. Although recent reports have suggested that surgical aspiration prevention improves quality of life and enables oral intake, the selection of appropriate aspiration prevention techniques has rarely been discussed. In this report, we present the cases of three patients with neuromuscular diseases who underwent surgical aspiration prevention; we selected the surgical techniques based on analysis of the dysphagia mechanisms, disease progression, and general condition in each case. Case 1 was a 55-year-old man with multiple system atrophy (MSA) and presented with dysphagia associated with insufficient upper esophageal sphincter (UES) relaxation. We performed central-part laryngectomy, which was able to improve UES relaxation. Case 2 was a 79-year-old man with progressive supranuclear palsy who presented with respiratory disorder and dysphagia. Glottic closure under local anesthesia was selected because he also had acute hepatobiliary dysfunction and methicillin-resistant Staphylococcus aureus pneumonia with pleural effusion. Case 3 was a 75-year-old man with ALS and presented with respiratory disorder and mild dysphagia. Subglottic closure with total cricoidectomy was selected because his dysphagia was expected to worsen due to tracheostomy and disease progression. We also summarize the characteristics of the aspiration prevention surgical techniques based on our cases and on literature review. The causes of dysphagia, including insufficient UES opening during swallowing, weak pharyngeal constriction, velopharyngeal insufficiency, and inadequate laryngeal elevation, should be assessed by detailed examination before surgery, and the type of aspiration prevention surgery should be selected based on patient swallowing function and general condition.
Collapse
Affiliation(s)
- Mitsuhiko Katoh
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | | | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Akihito Yamauchi
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
38
|
Kobayashi R, Tsunoda K, Takazawa M, Ueha R, Hosoya M, Fujimaki Y, Nito T, Yamasoba T. A new training method for velopharyngeal dysfunction: Self-inhalation for hypernasality. Auris Nasus Larynx 2019; 47:250-253. [PMID: 31530426 DOI: 10.1016/j.anl.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There are various methods to treat velopharyngeal dysfunction including surgery and rehabilitation therapy. Even if a rehabilitation program is effective, the evaluation of its efficacy remains subjective. In this paper, we propose a new method of rehabilitation training for velopharyngeal dysfunction focusing on the objective peak inspiratory flow (PIF) rate. METHODS Four patients, who were diagnosed with velopharyngeal dysfunction without cleft palate at ENT clinic of the National Hospital Organization, Tokyo Medical Center, participated in this study. All patients underwent our original rehabilitation program for velopharyngeal dysfunction, a method using the In-Check Dial, Turbohaler model. As a self-training rehabilitation program, we asked them to inhale forcefully 10 times daily at home using the In-Check Dial to increase the value of PIF rate for 3 months. We measured the patients' PIF rates with the In-Check Dial at the ENT clinic at the initial visit and after the 3-month training. RESULTS The PIF rates of the four patients without nasal clips were higher than the rates with nasal clips at the initial visit. After the training, PIF rate without a nasal clip of all patients increased than the rate at the initial visit, which represented significant difference (P < 0.05). Also, after 3 months, PIF rate without a nasal clip was higher or equal than the rates with a nasal clip at the initial visit except one case. Naso-pharyngo-laryngeal fiberscopy did not detect salivary pooling around larynx and mirror fogging test did not show nasal escape in the three of four patients after 3 months of training. All reported improvement in dysphagia and dysarthria. CONCLUSION This new method can be used not only to evaluate velopharyngeal function but also as an effective self-training treatment.
Collapse
Affiliation(s)
- Rika Kobayashi
- Department of Artificial Organs and Medical Creation, and Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan.
| | - Koichi Tsunoda
- Department of Artificial Organs and Medical Creation, and Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan; Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| | - Mihiro Takazawa
- Department of Artificial Organs and Medical Creation, and Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan
| | - Rumi Ueha
- Department of Artificial Organs and Medical Creation, and Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| | - Makoto Hosoya
- Department of Artificial Organs and Medical Creation, and Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan; Department of Otolaryngology, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoko Fujimaki
- Department of Artificial Organs and Medical Creation, and Otolaryngology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan; Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| | - Takaharu Nito
- Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8654, Japan
| |
Collapse
|
39
|
Sato T, Nito T, Ueha R, Goto T, Yamasoba T. Investigation of the Safety of Injection Laryngoplasty under Antithrombotic Therapy. ORL J Otorhinolaryngol Relat Spec 2019; 81:215-223. [PMID: 31352442 DOI: 10.1159/000500991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/15/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Glottic insufficiency negatively affects phonation and swallowing function. Injection laryngoplasty is a convenient and minimally invasive treatment for glottic insufficiency. This study assessed whether injection laryngoplasty is safe under continued administration of antithrombotic drugs, and aimed to establish measurable laboratory values under which such a procedure can be safely performed. METHOD This retrospective medical record review covered the period from November 2012 to June 2018. We examined 17 patients who underwent injection laryngoplasty (47 injections) under continued administration of antithrombotic drugs at the University of Tokyo Hospital. We analyzed clinical and demographic profiles, complications, and blood test values. Statistical analyses were performed regarding the risks of complications due to injection side, route of administration, and number of antithrombotic drugs. RESULTS No patients exhibited airway narrowing or dyspnea; however, bleeding after injection laryngoplasty was observed in 3 patients. All patients exhibited values within the optimal treatment range. There were no significant differences regarding the risks of complications due to injection side, route of administration, or number of antithrombotic drugs. CONCLUSIONS When the platelet count, prothrombin time-international normalized ratio, and activated partial thromboplastin time were within the optimal range prior to treatment, injection laryngoplasty could safely be performed, regardless of the administration of antithrombotic drugs.
Collapse
Affiliation(s)
- Taku Sato
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan,
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
40
|
Ueha R, Nativ-Zeltzer N, Sato T, Goto T, Nito T, Tsunoda K, Belafsky PC, Yamasoba T. Chronic inflammatory response in the rat lung to commonly used contrast agents for videofluoroscopy. Laryngoscope Investig Otolaryngol 2019; 4:335-340. [PMID: 31236468 PMCID: PMC6580069 DOI: 10.1002/lio2.269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives Contrast agents (CAs) are essential for upper gastrointestinal and videofluoroscopic swallow studies (VFSSs). Recently, we reported that small amounts of Ba aspiration caused severe acute lung inflammation in a rodent model. However, the underlying molecular biological mechanisms of chronic response to CA aspiration remain unclear. The aims of this study were to explore the underlying molecular biological mechanisms of the chronic response to three kinds of CA aspiration on the lung. Study Design Animal model. Methods Eight‐week‐old male Sprague Dawley rats were divided into five groups (n = 6, each group). Three groups underwent tracheal instillation of one of three CAs: barium sulfate (Ba), ionic iodinated contrast agent (ICA), and nonionic iodinated contrast agent (NICA). A sham group was instilled with air and a control group was instilled with saline. All animals were euthanized 30 days after treatment and histological and gene analyses were performed. Results No animal died after CA or sham/control aspiration. Ba particles remained after 30 days and caused histopathologic changes and inflammatory cell infiltration. Iodinated ICA and NICA did not result in perceptible histologic change. Expression of Tnf, an inflammatory cytokine was increased in only Ba aspirated rats (P = .0076). Other inflammatory cytokines and fibrosis‐related genes did not alter between groups. Conclusion Aspirated Ba particles did not clear from the lung within a month and caused mild chronic pulmonary inflammation. ICA and NICA did not cause any inflammatory responses in the lungs, suggesting that ICA and NICA may be safer CAs for VFSS than Ba. Level of Evidence NA
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology The University of Tokyo Tokyo Japan
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology The University of California Davis California U.S.A
| | - Taku Sato
- Department of Otolaryngology The University of Tokyo Tokyo Japan
| | - Takao Goto
- Department of Otolaryngology The University of Tokyo Tokyo Japan
| | - Takaharu Nito
- Department of Otolaryngology The University of Tokyo Tokyo Japan
| | - Koichi Tsunoda
- Department of Artificial Organs and Otolaryngology National Institute of Sensory Organs Tokyo Japan
| | - Peter C Belafsky
- Department of Otolaryngology The University of California Davis California U.S.A
| | - Tatsuya Yamasoba
- Department of Otolaryngology The University of Tokyo Tokyo Japan
| |
Collapse
|
41
|
Tsujimura T, Ueha R, Yoshihara M, Takei E, Nagoya K, Shiraishi N, Magara J, Inoue M. Involvement of the epithelial sodium channel in initiation of mechanically evoked swallows in anaesthetized rats. J Physiol 2019; 597:2949-2963. [PMID: 31032906 DOI: 10.1113/jp277895] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/25/2019] [Indexed: 12/17/2022] Open
Abstract
KEY POINTS Afferents carried by the superior laryngeal nerve play a primary role in the initiation of laryngeal mechanically evoked swallows in anaesthetized rats. Amiloride and its analogues inhibit swallowing evoked by mechanical stimulation, but not swallowing evoked by chemical and electrical stimulation. The epithelial sodium channel is probably involved in the initiation of laryngeal mechanically evoked swallows. ABSTRACT The swallowing reflex plays a critical role in airway protection. Because impaired laryngeal mechanosensation is associated with food bolus aspiration, it is important to know how the laryngeal sensory system regulates swallowing initiation. This study was performed to clarify the neuronal mechanism of mechanically evoked swallows. Urethane-anaesthetized Sprague-Dawley male rats were used. A swallow was identified by activation of the suprahyoid and thyrohyoid muscles on electromyography. The swallowing threshold was measured by von Frey filament and electrical stimulation of the larynx. The number of swallows induced by upper airway distension and capsaicin application (0.03 nmol, 3 μl) to the vocal folds was counted. The effects of topical application (0.3-30 nmol, 3 μl) of the epithelial sodium channel (ENaC) blocker amiloride and its analogues (benzamil and dimethylamiloride), acid-sensing ion channel (ASIC) inhibitors (mambalgine-1 and diminazene) and gadolinium to the laryngeal mucosa on swallowing initiation were evaluated. A nerve transection study indicated that afferents carried by the superior laryngeal nerve play a primary role in the initiation of laryngeal mechanically evoked swallows. The mechanical threshold of swallowing was increased in a dose-dependent manner by amiloride and its analogues and gadolinium, but not by ASIC inhibitors. The number of swallows by upper airway distension was significantly decreased by benzamil application. However, the initiation of swallows evoked by capsaicin and electrical stimulation was not affected by benzamil application. We speculate that the ENaC is involved in the initiation of laryngeal mechanically evoked swallows.
Collapse
Affiliation(s)
- Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Rumi Ueha
- Department of Otolaryngology, University of Tokyo, Tokyo, 113-8655, Japan
| | - Midori Yoshihara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Eri Takei
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Kouta Nagoya
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Naru Shiraishi
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-dori, Chuo-ku, Niigata, 951-8514, Japan
| |
Collapse
|
42
|
Goto T, Ueha R, Sato T, Fujimaki Y, Nito T, Yamasoba T. Single, high-dose local injection of bFGF improves thyroarytenoid muscle atrophy after paralysis. Laryngoscope 2019; 130:159-165. [PMID: 30810241 DOI: 10.1002/lary.27887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Unilateral vocal fold paralysis (UVFP) induces hoarseness due to progressive atrophy of the denervated thyroarytenoid (TA) muscle. Therefore, treatments aimed at regenerating the atrophied TA muscle are required. Basic fibroblast growth factor (bFGF) is involved in muscle development and regeneration. This study aimed to elucidate the effects of bFGF injection on atrophied TA muscle. STUDY DESIGN Animal research. METHODS A recurrent laryngeal nerve-paralysis rat model was established, and low- (200 ng) or high-dose (2,000 ng) bFGF or saline (control) was injected into the TA muscle 28 days later. The larynges were excised on day 1, 3, 7, 14, and 28 after treatment. The cross-sectional area of the TA muscle in normal and paralyzed sides was compared, and the Ki67-positive (Ki67+ ) dividing cells, paired box 7-positive (Pax7+ ) satellite cells (SCs), and myogenic differentiation-positive (MyoD+ ) myoblasts were counted. RESULTS The TA muscle area of animals administered high-dose bFGF increased with time and was significantly larger than that of the saline-injected controls 28 days after treatment (P < .05). The counts of Ki67+ and Pax7+ cells were the highest on day 1, whereas the MyoD+ myoblast count was highest on day 7. These results suggest that bFGF administration into the denervated TA muscles compensated for the atrophied TA muscles by inducing proliferation of SCs and their differentiation to myoblasts. CONCLUSIONS A single injection of high-dose bFGF augmented regeneration and differentiation of the atrophied TA muscle by enhancing proliferation and differentiation of muscle SCs, suggesting its possible clinical application in humans with UVFP. LEVEL OF EVIDENCE NA Laryngoscope, 130:159-165, 2020.
Collapse
Affiliation(s)
- Takao Goto
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Rumi Ueha
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| |
Collapse
|
43
|
Ueha R, Nativ-Zeltzer N, Sato T, Goto T, Nito T, Belafsky PC, Yamasoba T. Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung. Laryngoscope 2018; 129:1533-1538. [PMID: 30467858 PMCID: PMC6618150 DOI: 10.1002/lary.27663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/12/2018] [Indexed: 11/29/2022]
Abstract
Objectives/Hypothesis Contrast agent (CA) aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological mechanisms of acute response to CA aspiration in the respiratory organs remain unclear. The aims of this study were to elucidate the histological and biological influences of three kinds of CAs on the lung and to clarify the differences in acute responses. Study Design Animal model. Methods Eight‐week‐old male Sprague Dawley rats were divided into five groups (n = 6 in each group). Three groups underwent tracheal instillation of one of three different CAs: barium (Ba) sulfate, nonionic contrast agents (NICAs), and ionic contrast agents (ICAs). A control group was instilled with saline and a sham group was instilled with air. All animals were euthanized on day 2 after treatment and histological and gene analysis was performed. Results No animal died after CA or control/sham aspiration. Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs compared with the two other iodinated contrast agents. Increases in expressions of inflammatory cytokines (tumor necrosis factor [Tnf], interleukin‐1β [Il1b], and interferon‐γ [Ifng]) were observed in Ba aspiration rats, and upregulation of Il1b was seen in ICA aspiration rats. NICA did not cause obvious histologic changes or expressions of inflammatory cytokines and fibrosis‐related genes in the lungs. Conclusions Ba caused significantly more acute lung inflammation in a rodent model than did ioinic and nonionic iodinated CAs. Nonionic contrast did not cause any discernible inflammatory response in the lungs, suggesting that it may be the safest contrast for videofluoroscopic swallow studies. Level of Evidence NA Laryngoscope, 129:1533–1538, 2019
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, University of Tokyo, Tokyo, Japan
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology, University of California Davis, Sacramento, California, U.S.A
| | - Taku Sato
- Department of Otolaryngology, University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, University of Tokyo, Tokyo, Japan
| | - Peter C Belafsky
- Department of Otolaryngology, University of California Davis, Sacramento, California, U.S.A
| | | |
Collapse
|
44
|
Ueha R, Kondo K, Ueha S, Yamasoba T. Dose-Dependent Effects of Insulin-Like Growth Factor 1 in the Aged Olfactory Epithelium. Front Aging Neurosci 2018; 10:385. [PMID: 30515092 PMCID: PMC6256067 DOI: 10.3389/fnagi.2018.00385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Olfaction is known to be impaired by aging. We hypothesized that insulin-like growth factor-1 (IGF-1) administered at an appropriate dose could prevent age-induced negative effects on olfactory receptor neurons (ORNs). We explored the effects of low- and high-dose administration of IGF-1 on the ORN cell system in aged mice and investigated the involvement of the cellular mechanisms of IGF-1 in the regeneration of ORNs in aged mice. Methods: We subcutaneously administered recombinant human IGF-1 (rhIGF-1) to 16-month-old male mice over 56 days, and then examined the histological effects of rhGF-1 on cellular composition, cell proliferation, and cell death in the aged olfactory epithelium (OE), by comparing among saline-treated and low- and high-dose rhIGF-1-treated mice. Results: Low-dose rhIGF-1 administration increased the numbers of olfactory progenitors, immature ORNs, and mature ORNs in the OE, despite an increase in Cas3+ apoptotic cells. Notably, high-dose rhIGF-1 administration increased the numbers of only immature ORNs, not olfactory progenitors and mature ORNs, with a concurrent increase in apoptotic cells. Conclusion: Our data suggest that in aged mice, IGF-1 administered at an appropriate dose could increase the number of mature ORNs and further human studies may contribute to the development of treatments for aging-related olfactory impairment.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ueha
- Division of Molecular Regulation of Inflammatory and Immune Diseases Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
45
|
Ueha R, Goto T, Sato T, Nativ-Zeltzer N, Shen SC, Nito T, Belafsky PC, Yamasoba T. High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality. Front Med (Lausanne) 2018; 5:286. [PMID: 30345277 PMCID: PMC6182049 DOI: 10.3389/fmed.2018.00286] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction: Multiple system atrophy (MSA) has detrimental effects on swallowing function. The swallowing function of patients with MSA has not been systematically characterized and the underlying pathophysiological mechanisms of dysphagia remain poorly understood. Objectives: To investigate the characteristics of swallow function in MSA using high-resolution manofluorography (HRMF). Methods: We conducted a retrospective review of twenty-five MSA patients who underwent HRMF from 2016 to 2017. HRMF was utilized on patients with only oral diet (Functional Oral Intake Scale (FOIS) >3). Pharyngoesophageal and proximal esophageal pressure profiles were evaluated and compared to established normative data. The frequency and characteristics of upper esophageal sphincter (UES) and proximal esophageal abnormalities during rest and swallow were calculated. Results: The ages of patient cohort in our study ranged from 48–81 years (median 65 years) with male predominance (68%). We observed a distinct abnormal deglutitive proximal esophageal contraction (ADPEC) in 14 (56% of patients), which appears to reflect a discoordinated response of the striated muscle esophagus. Deficient UES relaxation duration, impaired UES relaxation, hypertensive resting UES pressure and hypotensive resting UES pressure were detected in 8 patients (32%), 3 patients (12%), 1 patient (4%), and 11 patients (44%) respectively. Conclusions: In patients with MSA, abnormal UES resting pressure is common. A discoordinated proximal esophageal pressure response was identified and may be a pathognomonic manometry finding for MSA. These findings may serve as indications of early stage swallowing dysfunction in patients with MSA.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology, The University of California, Davis, Davis, CA, United States
| | - Shih Chieh Shen
- Department of Otolaryngology, The University of California, Davis, Davis, CA, United States
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Peter C Belafsky
- Department of Otolaryngology, The University of California, Davis, Davis, CA, United States
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
46
|
Sato T, Nito T, Ueha R, Goto T, Yamasoba T. Laryngeal fractures treated with titanium mesh fixation. Auris Nasus Larynx 2018; 46:474-478. [PMID: 30145027 DOI: 10.1016/j.anl.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 11/26/2022]
Abstract
The larynx plays a vital role in respiration, swallowing, and vocal function. Thus, laryngeal fractures that are not appropriately managed may lead to permanent dyspnea, dysphagia, and voice disorders. In cases of laryngeal fractures, surgical repair by internal fixation has been performed with materials such as thread, steel wire, and titanium miniplates. However, thyroid and cricoid cartilage have a complicated morphology, and ossification at each site in the cartilage is not uniform; thus, in some cases it is difficult to perform internal fixation with conventional methods. In this case report, we describe two patients who underwent successful fixation of fractures in their laryngeal cartilage after trauma by using titanium mesh with thread and screws. Since optimal reduction and fixation of fractured laryngeal cartilage cannot be performed with conventional methods in patients with unossified cartilage, titanium mesh may be considered a safe and reliable alternative.
Collapse
Affiliation(s)
- Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Japan.
| | - Takaharu Nito
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Japan
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Japan
| |
Collapse
|
47
|
Hosoya M, Kobayashi R, Ishii T, Senarita M, Kuroda H, Misawa H, Tanaka F, Takiguchi T, Tashiro M, Masuda S, Hashimoto S, Goto F, Minami S, Yamamoto N, Nagai R, Sayama A, Wakabayashi T, Toshikuni K, Ueha R, Fujimaki Y, Takazawa M, Sekimoto S, Itoh K, Nito T, Kada A, Tsunoda K. Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial. Laryngoscope 2018; 128:2593-2599. [PMID: 30079962 PMCID: PMC6585860 DOI: 10.1002/lary.27415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/22/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
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
Collapse
Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Rika Kobayashi
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.,Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Toyota Ishii
- Department of Otolaryngology, National Hospital Organization, Sagamihara Hospital Organization, Sagamihara, Japan
| | - Masamitsu Senarita
- Department of Otolaryngology, National Hospital Organization, Mito Medical Center, Mito, Japan
| | - Hiroyuki Kuroda
- Department of Otolaryngology, National Hospital Organization, Kobe Medical Center, Kobe, Japan
| | - Hayato Misawa
- Department of Otolaryngology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Fujinobu Tanaka
- Department of Otolaryngology, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Tetsuya Takiguchi
- Department of Otolaryngology, National Hospital Organization, Kanazawa Medical Center, Kanazawa, Japan
| | - Masatsugu Tashiro
- Department of Otolaryngology, National Hospital Organization, Tochigi Medical Center, Tochigi, Japan
| | - Sawako Masuda
- Department of Otolaryngology, Mie National Hospital, Tsu, Japan
| | - Sho Hashimoto
- Department of Otolaryngology, National Hospital Organization, Sendai Medical Center, Sendai, Japan
| | - Fumiyuki Goto
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Shujiro Minami
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Nobuko Yamamoto
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Ryoto Nagai
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Akiko Sayama
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Keitaro Toshikuni
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Rumi Ueha
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Yoko Fujimaki
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Mihiro Takazawa
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Sotaro Sekimoto
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Kenji Itoh
- Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Koichi Tsunoda
- Department of Otolaryngology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Clinical Research Center, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.,Department of Artificial Organs and Medical Creation, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.,Department of Otolaryngology, University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
48
|
Kaneoka A, Yang S, Inokuchi H, Ueha R, Yamashita H, Nito T, Seto Y, Haga N. Presentation of oropharyngeal dysphagia and rehabilitative intervention following esophagectomy: a systematic review. Dis Esophagus 2018; 31:5000038. [PMID: 29788321 PMCID: PMC6127108 DOI: 10.1093/dote/doy050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
No study has systematically reviewed the evidence on presentation of oropharyngeal dysphagia and swallowing rehabilitation following esophagectomy. The purposes of this systematic review are to 1) qualitatively synthesize the current findings on oropharyngeal swallowing abnormalities identified by instrumental swallowing evaluations, 2) describe the reported health-related outcomes in relation to swallowing abnormality following esophagectomy, and 3) examine the efficacy of reported rehabilitative interventions for oropharyngeal dysphagia in patients who underwent esophagectomy. Publications were searched using five electronic databases. No language or publication date restrictions were imposed. Two authors performed a blind review for published or unpublished studies that reported swallowing biomechanics and dysphagic symptoms using instrumental evaluation of swallowing, specifically the videofluoroscopic swallowing study and fiberoptic endoscopic evaluation of swallowing, and/or health-related outcomes in relation to swallowing abnormalities, and/or therapeutic interventions for oropharyngeal dysphagia following esophagectomy. Twelve studies out of 2,193 studies including 458 patients met the inclusion criteria. Reported abnormal swallowing biomechanics included vocal fold immobility, delayed onset of swallowing, reduced hyolaryngeal elevation, and reduced opening of the upper esophageal sphincter. Aspiration (0-81%) and pharyngeal residue (22-100%) were prevalent. Those abnormal swallowing biomechanics and swallowing symptoms were commonly reported following both transhiatal and transthoracic esophagectomy. Pneumonia presented in 5-25% of the study patients. One quasi-experimental study examined the effectiveness of swallowing exercises for postoperative oropharyngeal dysphagia; three case series reported a benefit of the chin-tuck maneuver in reducing aspiration and residue. This review revealed distinct swallowing impairments and increased pneumonia risks following esophagectomy. This review also found that evidence on the efficacy of therapeutic interventions was limited. Future studies are warranted to develop effective rehabilitative interventions for postesophagectomy patients with oropharyngeal dysphagia.
Collapse
Affiliation(s)
- A Kaneoka
- Rehabilitation Center, The University of Tokyo Hospital
| | - S Yang
- Department of Otolaryngology Head and Neck Surgery, The University of California, San Francisco, California, USA
| | - H Inokuchi
- Rehabilitation Center, The University of Tokyo Hospital
| | - R Ueha
- Department of Otorhinolaryngology and Head and Neck Surgery
| | - H Yamashita
- Department of Gastrointestinal Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - T Nito
- Department of Otorhinolaryngology and Head and Neck Surgery
| | - Y Seto
- Department of Gastrointestinal Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - N Haga
- Rehabilitation Center, The University of Tokyo Hospital
| |
Collapse
|
49
|
Ueha R, Ueha S, Kondo K, Kikuta S, Yamasoba T. Cigarette Smoke-Induced Cell Death Causes Persistent Olfactory Dysfunction in Aged Mice. Front Aging Neurosci 2018; 10:183. [PMID: 29950987 PMCID: PMC6008309 DOI: 10.3389/fnagi.2018.00183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/30/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Exposure to cigarette smoke is a cause of olfactory dysfunction. We previously reported that in young mice, cigarette smoke damaged olfactory progenitors and decreased mature olfactory receptor neurons (ORNs), then, mature ORNs gradually recovered after smoking cessation. However, in aged populations, the target cells in ORNs by cigarette smoke, the underlying molecular mechanisms by which cigarette smoke impairs the regenerative ORNs, and the degree of ORN regeneration after smoking cessation remain unclear. Objectives: To explore the effects of cigarette smoke on the ORN cell system using an aged mouse model of smoking, and to investigate the extent to which smoke-induced damage to ORNs recovers following cessation of exposure to cigarette smoke in aged mice. Methods: We intranasally administered a cigarette smoke solution (CSS) to 16-month-old male mice over 24 days, then examined ORN existence, cell survival, changes of inflammatory cytokines in the olfactory epithelium (OE), and olfaction using histological analyses, gene analyses and olfactory habituation/dishabituation tests. Results: CSS administration reduced the number of mature ORNs in the OE and induced olfactory dysfunction. These changes coincided with an increase in the number of apoptotic cells and Tumor necrosis factor (TNF) expression and a decrease in Il6 expression. Notably, the reduction in mature ORNs did not recover even on day 28 after cessation of treatment with CSS, resulting in persistent olfactory dysfunction. Conclusion: In aged mice, by increasing ORN death, CSS exposure could eventually overwhelm the regenerative capacity of the OE, resulting in continued reduction in the number of mature ORNs and olfactory dysfunction.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ueha
- Division of Molecular Regulation of Inflammatory and Immune Diseases Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
50
|
Ueha R, Shichino S, Ueha S, Kondo K, Kikuta S, Nishijima H, Matsushima K, Yamasoba T. Reduction of Proliferating Olfactory Cells and Low Expression of Extracellular Matrix Genes Are Hallmarks of the Aged Olfactory Mucosa. Front Aging Neurosci 2018; 10:86. [PMID: 29636678 PMCID: PMC5880952 DOI: 10.3389/fnagi.2018.00086] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The incidence of olfactory impairment increases with age; however, the detailed molecular and cellular mechanisms underlying this increase are yet to be determined. Methods: We examined the influence of aging on olfactory receptor neurons (ORNs), which are maintained by a unique stem cell system, from olfactory progenitor cells to mature ORNs, by histological comparisons of the physiological status of the olfactory epithelium between young adult and aged mice. Furthermore, we clarified the expression of genes encoding inflammatory cytokines, neurotrophins, growth factors, and extracellular matrix proteins to reveal the molecular mechanisms underlying olfactory impairment caused by aging. Results: The numbers of mature and immature ORNs, but not olfactory progenitors, decreased in the aged olfactory epithelium, with a concurrent reduction in Ki-67-positive proliferating cells. Transcriptome analyses revealed an increase in Il6, encoding a component of senescence-associated secretary phenotypes (SASP), and a decrease in Igf1, encoding a growth factor for ORNs, in the aged nasal mucosa. Interestingly, expression levels of several extracellular matrix genes, including Col1a2, decreased in the aged nasal mucosa. Consistent with the transcriptional changes, the number of Col1a2-GFP-positive cells decreased in the aged lamina propria. Conclusions: Our data suggest that reduction in ORN number and cell proliferation, reduced extracellular matrix gene expression, and increased SASP contribute to olfactory impairment during aging.
Collapse
Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Shichino
- Department of Molecular Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ueha
- Department of Molecular Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Shu Kikuta
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | | | - Kouji Matsushima
- Department of Molecular Preventive Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| |
Collapse
|