We have recently encountered numerous patients with age-related aberrations of the carotid artery [1–4]. This pathological condition is also a suspected risk factor for ischemic stroke [2–4] and has not been identified during previous physical examinations [3,4]. A 78-year-old man was referred to our otorhinolaryngology clinic because of an unusual, strange sensation in his throat with dysphagia. The sensation had continued for 1 week. He had a history of dilated cardiomyopathy and had been takingwarfarin to prevent arterial coagulation and othermedications for the treatment of hypertension and atherosclerosis. His height, which had previously been 173cm, was 168cm at the time of our examination as a result of cervical kyphosis associated with ageing. The patient’s neck had shortened because of habitual forward bending of the head, and that posture was associated with height loss. Using a new folding pharyngeal scope [5], we found an aberration of the internal carotid artery in the left posterior pharyngeal wall. The pulsing of the aberrant artery was synchronized with the patient’s heartbeat (see●\" Video 1, which was taken with the new pharyngeal scope). The unusual strange sensation around the pharynx resulted from a separation of the pharyngeal wall, which contains the mucosa, submucosa, and superior pharyngeal constrictor muscle, because of the aberration of the internal carotid artery. When he was lying in the supine position without a pillow, the patient’s bent posture disappeared and the aberration of the internal carotid artery in the posterior wall of the pharynx also resolved so that the artery was completely enclosed within the parapharyngeal space. When the patient returned to the seated position, the arterial aberration recurred. Magnetic resonance angiography had not detected any aberration of the internal carotid artery. In the treatment of previous patients with the same condition, approximately 2–3 months after the strange sensation was noted, the internal carotid arteries became rigid in their aberrant positions, even in the supine position without a pillow, although the sensation disappeared completely [3,4]. The new pharyngeal scope is an effective diagnostic tool in such cases.

/pdf/dysphagia-due-to-kyphosis-induced-positional-changes-of-the-39y0gh4fw3.pdf

Dysphagia due to kyphosis-induced positional changes of the carotid artery.

Objective: There has been little progress in examination of the oropharynx with a light source such as electric light, a penlight, or a forehead mirror over the past 100 years. It is therefore necessary to develop methods to display and record oropharyngeal observations.Method: Since the aim of this study was to assess the safeness to use from the perspective of physicians, medical staffs, patients, and patients’ families and usefulness of pharyngeal scope, the number of devices was limited, the number of patients was not set based on hypothetical statistical tests.Results: A total of 150 volunteers were enrolled in this study. Among them, 96 underwent examination alone and the remaining 28 underwent treatment procedures. The study was done without any complications in all 150 cases. Most (91.3%) physicians hoped to continue using the new device if available. When comparing the use of the device for observation alone and for treatment procedures, there was no significant difference for evaluation ...

An oral pharyngeal scope for objective oropharyngeal examination: a new device for oropharyngeal study

Pitfall in the mouth caused by longevity.

The oropharynx is examined with a light source such as an electric light, a penlight, or a forehead mirror based on an acquired visual field using a tongue depressor. However, it is extremely difficult to obtain objective and reproducible images of tissue within the pharynx required in recent years with these methods, and insufficient progress in the examination tools has been made. There is an increasing need to develop a method for display during oropharyngeal examination. We conducted the present study to develop a novel oropharyngeal endoscope as an objective observation method.

/pdf/development-of-an-oropharyngeal-scope-with-an-integrated-50uhwa6n2n.pdf

Development of an Oropharyngeal Scope with an Integrated Tongue Depressor: NTOP2013 Study.

Auditory Neuropathy Spectrum Disorders (ANSD) are new classification which was proposed in 2008 by Colorado Children’s Hospital Group and defined as normal otoacoustic emissions and absent ABRs in newborn. In our long term follow up study, hearing of ANSD are changed into three types. Type I is normal OAE and normal ABR (normal hearing), Type II is absent OAE and absent ABR (profound sensoryneural hearing loss), Type III is normal OAE and absent ABR (true auditory neuropathy). However, still complications of vestibular problems in ANSD are not known so far. Historically, in the same year of 1996, a new type of bilateral hearing disorder was reported by Kaga et al. and Starr et al. in different journals. Auditory nerve disease paper was published in the Scandinavian Audiology by Dr. Kaga and Auditory Neuropathy paper was published in Brain. At present, these different terms are considered to be identical in pathophygiology. The auditory nerve disease or auditory neuropathy is a disorder characterized by mild-to-moderate pure-tone hearing loss, poor speech discrimination, absent ABR but normal cochlear outer hair cell function revealed by normal OAE and –SP of Electrocochleography. A variety of processes and etiologies are thought to be involved in the pathophygiology. Most of the reports in the literature discuss auditory profiles and gene mutation of OTOF or OPA1 of patients only but not pathophygiology. Auditory nerve components consist of cochlear nerve, superior vestibular nerve and inferior vestibular nerve. My question is which nerve of these auditory nerve components is involved in AN? We reported our results of auditory and * Corresponding author: Laboratory of Auditory

Auditory neuropathy and auditory neuropathy spectrum disorders

Because of advances of the fields of anesthesia and surgical techniques, pessary use has gradually decreased. Current clinical indications for using a pessary include patients awaiting surgical repairs, treatment for failure of surgical repair, treatment for women with contraindication to surgery, and individuals who prefer medical management. Uterine prolapses are clinically classified into first, second, and third degrees, with increasing severity. The cube pessary is designed for management of third-degree uterine prolapse. It should be cleaned daily because it has no drainage function. If it is not, it can easily cause urinary tract infection (UTI). Acute pyelonephritis and urosepsis caused by neglected pessaries are rare conditions of urological emergency of older women, who may forget or cannot easily recall the presence of such foreign bodies in their vaginas. A neglected pessary in the vagina may cause complications including disturbance of micturition with incomplete emptying of urinary bladder, chronic cystitis, vesicovaginal fistula, unilateral or bilateral obstructive uropathy, hydronephrosis, pyelonephritis, bacteremia, and even life-threatening urosepsis. Severity of UTI should be related to the patient’s underlying immunocompromised condition, such as diabetes mellitus and debility. Enterobacteriaceae, such as E. coli, originating from the gastrointestinal tract is the most common pathogen with hematogenous spread or ascending infection in UTI. Inability to remove and cleanse pessaries routinely (a frequent problem for older and debilitated individuals) can result in severe vaginitis. In addition to various bacterial pathogens, actinomycosis is commonly noted in association with pessary complications. MDCT is helpful in diagnosis of pyelonephritis in older adults with atypical clinical manifestations and in identifying a foreign body or a pessary in the vagina. The McGeer criteria, which were developed as surveillance criteria at a consensus conference in 1991 and have been used for surveillance, diagnostic, and treatment purposes of UTI in older adults without an indwelling catheter, are presence of any three of fever of 38°C or higher; new or increased burning on urination, frequency, or urgency; new flank or suprapubic pain or tenderness; change in character of urine; and aggravation of mental or functional status or falls, but for clinical diagnosis and treatment of UTI, a urine culture should be required. An invasive UTI, such as pyelonephritis, prostatitis, epididymitis, or secondary bacteremia from a nephrogenic source, can cause systemic nonspecific geriatric manifestations, such as falls and mental status changes. Medical imaging, such as MDCT, is required for patients with atypical clinical presentations, in those who fail to respond to conventional therapy, and in diagnosis of acute pyelonephritis and its complications such as abscess formation. Clinicians should keep in mind the possible presence of a neglected pessary in an older woman with severe UTI.

Common but critical sensation in older adults.

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Common but critical sensation in older adults.