Published papers

Objective: Pemphigus Vulgaris (PV) is a rare autoimmune disease that could cause laryngeal lesions; however, only a few studies have described the localization of the laryngeal lesions associated with this disease owing to its rarity. Therefore, this study aimed to determine the localization of laryngeal lesions in patients with PV. Methods: Fourteen patients with PV accompanied by laryngeal or pharyngeal lesions, who underwent flexible laryngeal endoscopy performed by laryngologists, were examined retrospectively. Results: The arytenoid area was the most frequently affected site in the larynx, followed by the epiglottis and aryepiglottic folds. Vocal folds and ventricular bands were the least affected. Conclusion: Lesions in the arytenoid area were observed more frequently in this study than in previous studies. This result suggests that a more careful inspection of arytenoid lesions in patients with PV is required under laryngeal fiber observation. Moreover, we proposed a novel classification system for laryngeal findings in patients with PV and a systematic observation method. This novel classification and method would be useful not only for determining the lesions but also for careful inspection in this field. Level of Evidence: 4 Laryngoscope, 134:3719–3725, 2024.

Objectives: Vocal fold medialization surgery is generally considered a phonosurgical procedure for improvement of vocal function in patients with glottic insufficiency. However, the literature describing this procedure for the management of dysphagia is limited. This study aims to assess the effects of medialization surgery on swallowing function in patients with unilateral vocal fold paralysis (UVFP). Methods: We enrolled 32 patients with UVFP undergoing vocal fold medialization surgery (medialization laryngoplasty combined with arytenoid adduction [ML + AA], 12 cases; injection laryngoplasty [IL], 20 cases). We assessed the aerodynamic vocal function including maximum phonation time and mean flow rate to evaluate glottal closure status. The Hyodo score determined by flexible endoscopic evaluation and Functional Oral Intake Scale (FOIS) were evaluated pre- and postoperatively. Results: Almost 60% of patients with UVFP had dysphagia, and one-third were at high risk for aspiration. Aerodynamic parameters effectively improved after IL and ML + AA. With regard to swallowing, both the FOIS and total Hyodo score were significantly improved postoperatively. We found a particularly significant improvement in pharyngeal clearance. However, patients with high vagal nerve paralysis and postoperative insufficient glottal closure showed poor swallowing benefits after the interventions. In patients with recurrent laryngeal nerve palsy, there were no significant differences in postoperative swallowing function between the ML + AA and IL groups. Conclusion: Vocal fold medialization surgery was effective in improving swallowing function in most cases with UVFP, except for those with high vagal paralysis and insufficient postoperative glottal closure. Both IL and ML + AA showed an equivalent effect on swallowing improvement. Level of evidence: 3b.

Recurrent respiratory papilloma (RRP) often presents multiple lesions in the respiratory tract and sometimes becomes fatal because of severe airway obstruction. We report the case of a 69-year-old woman who had juvenile-onset RRP in the trachea that was refractory to surgical treatment, and complete remission was achieved by low-dose cisplatin combined with de-escalated radiotherapy without any side effects. This case report is the first to illustrate the data on low-dose cisplatin for refractory benign RRP, and our experience reinforces the opinion that low-dose cisplatin combined with de-escalated radiotherapy can be an effective and safe treatment alternative for uncontrollable and lethal RRP. Laryngoscope, 134:2335–2337, 2024.

Introduction: Stuttering is a condition that can be severely disabling in the workplace and socially. Although many stuttering cases resolve, some adults who stutter (AWS) continue to be affected not only by dysfluent speech, but also by other social and psychological conditions that may develop as a result of stuttering. The aim of the present study was to determine the relationship between severity of stuttering, severity of social anxiety, and coping profile. Methods: We objectively assessed adults who stutter (n = 44; mean age = 27.5 years) and age-matched non-stuttering control subjects on four variables: stuttering frequency, communication attitude, social anxiety, and coping profile. Stuttering frequency was calculated as the percentage stuttered morae in the Kitsuon-kensa-ho test. All subjects were assessed on the Japanese versions of the Modified Erickson's Communication Attitude Scale (S-24-J), Liebowitz Social Anxiety Scale (LSAS-J), and the Brief Scale for Coping Profile (BSCP). Results: Compared to the non-stuttering group, the stuttering group had a higher average score on the S-24-J and LSAS-J, and tended to "avoid and suppress" instead of "seek help for resolution" on the BSCP. Comparison of individual stutterers’ S-24-J scores whose LSAS-J scores were above or below the LSAS-J cutoff score revealed that their the S-24-J scores tended to be higher. Also, BSCP participants tended to engage in "proactive resolution" and "emotional venting involving others," not "seeking help for resolution." The stuttering group (vs. the non-stuttering group) and the high social-anxiety group (vs. the low social-anxiety group) adopted non-adaptive coping strategies. Conclusions: This suggests that the coping profile of AWS may contribute to the cycle of social anxiety and stuttering to a greater or lesser extent. Thus, therapy that reduces anxiety and helps AWS to adopt more adaptive coping strategies may improve stuttering.

Background: Cluttering is a speech disorder distinct from stuttering. Despite this distinction, there is no established method to clearly differentiate the two disorders. This study aimed to use objective criteria to differentiate cluttering from stuttering in Japanese speakers. Methods: Participants were 32 consecutive native-Japanese speakers who visited the Keio University Hospital between July 2020 and January 2023 with a chief complaint of speech disfluency. One physician and two speech-language-hearing therapists concurred on a stuttering or cluttering diagnosis of the 32 patients based on recordings of the Kitsuon kensa-ho test. The frequencies of stuttering-like disfluencies (SDF) and normal disfluencies (NDF) were calculated from the Kitsuon kensa-ho, and the ratio of disfluencies (RDF) was calculated as the ratio of SDF to NDF. Differences between the cluttering and stuttering groups in the RDF and the mean articulatory rate (MAR) for oral reading and a monologue task were tested using the Mann–Whitney U test. ROC curves were used to determine the sensitivity and specificity that well-distinguished subjects with cluttering from those with stuttering; the experts’ diagnosis was the gold standard. Results: Of the 32 participants, 12 (38%) were diagnosed with cluttering and 20 (62%) with stuttering. The cluttering and stuttering groups were comparable in demographic characteristics. The RDF on monologue task had the highest sensitivity in diagnosing cluttering, and the MAR on monologue task had the highest specificity. Adopting provisional criteria of a monologue RDF greater than 1.2 and a monologue MAR greater than 7.5 produced a sensitivity of 0.92 and a specificity of 0.95. Conclusion: We conclude that combining monologue RDF and monologue MAR well-distinguished cluttering from stuttering. This method provides new objective diagnostic criteria, which can aid clinicians, therapists, and basic researchers.

Do adults who stutter have abnormally high social anxiety? Is it related to maladaptive cognition? As these are persistent, unresolved questions in stuttering research, it behooves clinicians to at least assess and attempt to identify social anxiety in patients who stutter and its basis before decisions are made about stuttering treatment. The Unhelpful Thoughts and Beliefs About Stuttering (UTBAS) scale is a self-administered questionnaire that measures the degree of non-adaptive cognition in people who stutter (PWS) due to social anxiety. The 66-item UTBAS is time-consuming to complete, prompting the development of a shorter 6-item version, the UTBAS-6, which is in English. Here, we aimed to assess some psychometric properties of the Japanese version of the UTBAS-6, the UTBAS-6-J, which has not been done to date. In 56 adult patients (mean 32.6 ± 11.1 years) who stutter, we quantified the reliability, the internal consistency, and the concurrent validity of the UTBAS-6-J. Along with the UTBAS-6-J, patients also were administered the Overall Assessment of the Speaker’s Experience of Stuttering – Japanese version (OASES-A-J), the Modified Erickson Communication Attitude Scale – Japanese version (S-24-J), and the Liebowitz Social Anxiety Scale – Japanese version (LSAS-J). Cronbach’s alpha for UTBAS-6-J total scores was 0.974, indicating excellent internal consistency. UTBAS-6-J scores were significantly correlated with scores on the OASES-A-J, the S-24-J, and the LSAS-J (all p < 0.005). Concurrent validity of the UTBAS-6-J with these three questionnaires was confirmed. The UTBAS-6-J has good internal consistency and concurrent validity, which will aid clinical decision-making about stuttering treatments.

We report four cases of small cell carcinoma of the sinonasal cavity. The primary sites were the ethmoidal sinonasal cavity in two cases and maxillary sinonasal cavity in two cases. In three of the four cases, chemoradiotherapy was planned, because the cancers were locally advanced, with the tumor size and extent exceeding T3. One of these patients died of an adverse event during the chemoradiotherapy with cisplatin (CDDP) and irinotecan (CPT-11). In another, metastases in the liver and ileum were detected after the chemoradiotherapy with CDDP and etoposide (VP-16), and the patient died 22 months after her initial visit. In the third case, no evidence of recurrence or metastasis was detected until 20 months after completion of the chemoradiotherapy with the carboplatin (CBDCA) and VP-16. In the one case with multiple distant metastases at presentation, six courses of chemotherapy with CBDCA and VP-16 were administered, however, the patient died six months after her initial visit. Because small cell carcinoma of the sinonasal cavity is very rare, no standard treatment has been established yet. In most previously reported cases, chemoradiotherapy was selected because operation was not possible due to the tumor invasion to surrounding organs and the sensitivity to radiation was good. Patients reported here who completed chemoradiotherapy showed good local control. However, the prognosis of small cell carcinoma of the sinonasal cavity is poor and strict surveillance for recurrence and metastasis is needed after treatment.

Cognitive Behavioral Therapy（CBT）is receiving attention as an approach to the control of stuttering, although few studies have examined its effect. In this report, we report cases of adult stuttering that improved with low―intensity CBT. The participants were 11 adults with stuttering（AWS, 22 to 47 years old, 2 women）, who sought consultation at our clinic. In CBT, the patients were made to understand that stuttering was related to anxiety and that it can be dealt with by coping with anxiety, such as with exposure therapy. We explained to the AWS that while rehearsing their speech in the mind, they should distract their attention from “whether stuttering will occur or not.” The scores on the Liebowitz Social Anxiety Scale（LSAS―J）and Overall Assessment of the Speaker's Experience of Stuttering for Adults（OASES―A）showed statistically significant improvement after 5 sessions, although there was no significant change of the score on the Modified Erickson Scale of Communication Attitudes（S―24）or in the stuttering frequency. Although the stuttering frequency did not improve, our findings showed that CBT was still effective against stuttering by improving social anxiety disorder and difficulty suffering.

Aim: Previous functional imaging studies demonstrate that people who stutter (PWS) exhibit over- and under-activation of Broca's and Wernicke's areas and their right hemisphere homologues when speaking. However, it is unclear whether this altered activation represents the neural cause of speech dysfluency or a secondary compensatory activation in PWS. To clarify the functional significance of the altered activation pattern in classic language areas and their right homologues, we examined whether the severity of stuttering was affected when the activation of these areas was modulated by brain stimulation. Methods: While PWS read passages aloud, we applied transcranial direct current stimulation (tDCS) using electrode montages that included an anodal or cathodal electrode placed over one of the language areas and its right hemisphere homologue, with the second electrode placed over the contralateral supraorbital region. Each participant underwent both anodal and cathodal tDCS sessions, each of which included a sham stimulation. Effects of stimulation polarity and electrode location on the frequency of stuttering were analyzed. Results: We observed a significant interaction between polarity and location on the frequency of stuttering. Follow-up analyses revealed that a tDCS montage including the cathodal electrode over right Broca's area (RB) significantly reduced the frequency of stuttering. Conclusion: The results indicated that stuttering severity was ameliorated when overactivation in RB was reduced by tDCS. This observation further suggests that speech dysfluency in PWS may be caused either by functional alteration in RB or by abnormal activation in speech motor control areas that are connected with RB.