けいれん性発声障害に対する手術適応と甲状軟骨形成術II型を利用する方法

概要

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It is difficult to determine the surgical indication of type 2 thyroplasty for spasmodic dysphonia because: 1) there is a great variety of symptoms among patients, 2) there is a high rate of changeability with time, and consequently 3) it is difficult to diagnose. There seems to be no objective criteria for making a diagnosis or for deciding the indication. Based on our surgical experience of over 300 cases, our principal policy for deciding is that the indication should be limited to those with an apparent excessively tight closure of the glottis during phonation; or those with severe anguish resulting from spasmodic dysphonia. While the deprivation of easy communication in itself isn’t an indication of surgery, the strong desire of a patient to get relief from this malady is an indication. If the decision is difficult to make, one should take into account: 1) the period of time of the past suffering, 2) the objective findings such as anterior foaming at the glottis on phonation, 3) the severity of speech distortion, 4) the strong desire of the patient for the operation, and 5) voice recordings under other circumstances such as on the phone. Full information regarding the operation should be made available to the patients.