声帯麻痺の臨床的研究 (京都大学医学部耳鼻咽喉科学教室6年間の歩み(1977-1982年)--檜学教授還暦によせて)
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Clinical investigation of unilateral vocal cord paralysis was performed on 56 patients for the level difference on the paralysed cord and evaluation of the usefulness of various audiological examinations.On tomographic studies of the vocal cord, the paralysed vocal cord was higher than or at the same level as the intact cord and there was no case in which the paralysed cord was lower than the intact one. Inclination of the thyroid cartilage was also noted in more than half of the cases with vocal cord level difference. In 71.4% of the cases, marked enlargement of the ventricle was evident on the paralysed side, particularly during phonation. In addition to this level difference of the cord and inclination of the thyroid cartilage, deviation of the vocal cord on laryngoscopy suggests paralysis of the cricothyroid muscle. This is considered to be the rationale for the approximation between the cricoid muscle and thyroid muscle for surgical repair of hoarseness.Functional evaluation of the paralysed vocal cord was made using various methods including measurements of respiratory flow rate during phonation, vibration of the vocal cord by stroboscopy and analysis of hoarseness by audition and with a computer. The respiratory flow rates in higher levels of paralysed vocal cords were higher than those with no level difference in cords. Stroboscopic observation revealed that undulatory movements of the vocal cord mucosa on phonation did not correlate with the level difference, but with the position of the paralysed vocal cord. Auditory evaluation of the hoarseness demonstrated higher values on all factors in those with level difference of the vocal cord than those without level difference. Computer analysis of the pitch perturbation showed higher values in those with level difference and the values increased as the fixed position of the vocal cord shifted laterally.Thus, tomography of the larynx in combination with various other tests is useful in the diagnosis of unilateral vocal cord paralysis and determination of adequate treatment.