Eiji Yumoto

Kumamoto University, Kumamoto, Kumamoto, Japan

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Publications (291)220.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Adductor spasmodic dysphonia is a rare voice disorder characterized by strained and strangled voice quality with intermittent phonatory breaks and adductory vocal fold spasms. Type II thyroplasty differs from previous treatments in that this surgery does not involve any surgical intervention into the laryngeal muscle, nerve or vocal folds. Type II thyroplasty intervenes in the thyroid cartilage, which is unrelated to the lesion. This procedure, conducted with the aim of achieving lateralization of the vocal folds, requires utmost surgical caution due to the extreme delicacy of the surgical site, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages at a correct position. During surgery, the correct separation of the incised cartilage edges with voice monitoring is the most important factor determining surgical success and patient satisfaction. Methods: We designed new surgical instruments: a thyroid cartilage elevator for undermining the thyroid cartilage, and spacer devices to gauge width while performing voice monitoring. These devices were designed to prevent surgical complications, and to aid in selecting the optimal size of titanium bridges while temporally maintaining a separation during voice monitoring. Results: We designed new surgical instruments, including a thyroid cartilage elevator and spacer devices. Precise surgical procedures and performing voice tuning during surgery with the optimal separation width of the thyroid cartilage are key points for surgical success. Conclusion: We introduce the technique of voice tuning using these surgical tools in order to achieve a better outcome with minimal surgical complications.
    No preview · Article · Jan 2016 · Auris, nasus, larynx
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    ABSTRACT: The objective of this study was to compare time-dependent improvements in phonatory function and stroboscopic findings following two different procedures for immediate reconstruction of the recurrent laryngeal nerve (RLN) during neck tumor extirpation. Seventeen patients with neck tumors, consisting of advanced thyroid cancer (n = 15), metastatic neck lymph nodes from other malignant lesions (n = 2), underwent resection of the primary lesion and involved RLN. Immediate RLN reconstruction by either: (1) ansa cervicalis nerve (ACN) to RLN anastomosis (n = 8); or (2) placement of the great auricular nerve (GAN) between the cut ends of the RLN (n = 9) was performed from 2000 to 2011. Phonatory function [maximum phonation time, mean airflow rate (MFR), jitter, and shimmer) and stroboscopic findings (regularity, amplitude, and glottal gap) were examined at 1, 6, and 12 months postoperatively. Stroboscopic findings were assessed by two otolaryngologists and one speech pathologist. There were no significant differences in any parameter for either phonatory function or stroboscopic findings between ACN and GAN with the exception of jitter and shimmer, in which ACN was superior to GAN at 1 month postoperatively. All parameters improved significantly between 1 and 12 months postoperatively for both phonatory function and stroboscopic findings (P < 0.05). Either method of immediate RLN reconstruction at the time of neck tumor extirpation (i.e., ACN or GAN) provided both excellent long-term postoperative phonatory function and stroboscopic findings, and there was little difference in vocal outcome between the two procedures.
    No preview · Article · Dec 2015 · Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde
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    ABSTRACT: The objective of this study is to construct a propagation curve and determine propagation velocities in young healthy adults examined using a 2.64-mm-diameter high-resolution manometry catheter with 36 circumferential sensors; to explore data reproducibility; and to determine whether the swallowing pressure (SP) propagation velocity correlated with bolus volume. Repeated measures with subjects serving as their own controls. Thirty healthy subjects (average age 25.3 years) swallowed saliva and 2, 5, and 10 mL of cold water to determine the maximum SP from the soft palate to the cervical esophagus. The SP propagation curve was obtained by plotting the duration to reach each SP peak. The SP propagation velocity was calculated for each region. These parameters were examined according to bolus size and gender. The intra-class correlation coefficient for estimating the SP propagation curves was >0.61 (i.e., highly consistent). The propagation velocity was maximal at the meso-hypopharynx and minimal at the UES and cervical esophagus. The SP propagation curve was very reproducible within any subject. Neither the water volume (with the exception of 2 and 5 mL) nor gender exerted any apparent effect on velocity in any region. However, the velocity was quite variable at the cervical esophagus.
    No preview · Article · Aug 2015 · Dysphagia
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    ABSTRACT: Objectives/HypothesisTo determine the effects of three different chin-down maneuvers on swallowing pressure (SP) in healthy young adults using high-resolution manometry (HRM).Study DesignRepeated measures with subjects serving as their own controls.Methods Twenty-six healthy subjects (average age 26.4 [range 21–35] years) swallowed 5 mL of cold water to examine the maximum swallowing pressure (MSP) at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES), and to determine the duration of lowered SP at the UES using HRM. The subjects swallowed in the neutral position as a control and in the following three chin-down positions: 1) head flexion (HF); 2) neck flexion (NF); and 3) combined head and neck flexion (HFNF).ResultsThe MSP at the velopharynx and meso-hypopharynx did not significantly differ among the three chin-down positions. Upon swallowing in the NF posture, the MSP was significantly lower (P < 0.0001) at the UES, and the duration of the lowered SP at the UES was significantly prolonged (P = 0.0010) compared to the neutral position. In comparison, the duration of lowered SP at the UES was significantly (P = 0.0001) shorter in the HF position than in the neutral position. Moreover, the HFNF position significantly (P = 0.0276) lowered the MSP at the UES compared to the control position.Conclusion In young healthy adults, NF maneuver resulted in significantly lower MSP and longer duration of the lowered swallowing pressure at the UES, which might assist bolus passage through the UES.Level of Evidence3b. Laryngoscope, 2015
    No preview · Article · Aug 2015 · The Laryngoscope
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    ABSTRACT: To examine modulation of M-cadherin, a marker for satellite cells (SCs); and MyoD, which may indicate the myogenic activity following recurrent laryngeal nerve (RLN) denervation and immediate reinnervation; and to elucidate the correlation between their modulations and establishment of neuromuscular junctions (NMJs) in the reinnervated rat thyroarytenoid (TA) muscle. Quantitative real-time polymerase chain reaction qPCR and histologic assessment of the TA muscle following RLN transection and anastomosis. Rats were divided into three groups: 1) denervation alone (DNV) (n = 60), 2) denervation with anastomosis (ANS) (n = 60), and 3) sham-operated controls (n = 12). Animals were sacrificed at 3 days and 1, 3, and 5 weeks after treatment. TA muscles harvested from 40 animals from each DNV and ANS group; all of sham group were subjected to qPCR for assessment of the modulation of M-cadherin and MyoD; and the remaining larynges of DNV and ANS group were used for histologic analysis. The expression levels of messenger RNAs (mRNAs) encoding M-cadherin and MyoD in the TA muscle of the DNV group were significantly higher (P < 0.05) than in the control throughout the study period. These mRNA levels in the ANS group were significantly higher (P < 0.05) at ≤ 1 week than in the controls but fell to control levels at ≥ 3 weeks. In the ANS group, recovery of muscle area and NMJs structure occurred by 3 weeks. These data suggested that NMJ formation following reinnervation might prompt recovery of M-cadherin and MyoD mRNA expression to the quiescent level of SCs. N/A. Laryngoscope, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
    No preview · Article · Mar 2015 · The Laryngoscope
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    ABSTRACT: To evaluate the long-term efficacy of laryngeal reinnervation via refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction to treat unilateral vocal fold paralysis (UVFP), employing laryngeal electromyography (LEMG), coronal imaging, and phonatory function assessment. Case series with chart review. University hospital. We retrospectively reviewed 12 UVFP patients who underwent refined NMP implantation with arytenoid adduction. Videostroboscopy, phonatory functional analysis, LEMG, and coronal imaging were performed before and 2 years after surgery. In LEMG analysis, a 4-point scale was employed to grade motor unit (MU) recruitment: 4+ reflected no recruitment, 3+ greatly decreased recruitment, 2+ moderately decreased recruitment, and 1+ mildly decreased activity, associated with less than the full interference pattern. Coronal images were assessed in terms of differences in thickness and the vertical positions of the vocal folds. Phonatory function improved significantly after operation in all patients. In terms of LEMG findings, the preoperative MU recruitment scores were 1+ in no patients, 2+ in 4 patients, 3+ in 1 patient, and 4+ in 7 patients. Postoperative MU recruitment results were 1+ in 6 patients, 2+ in 5 patients, 3+ in 1 patient, and 4+ in no patients. Thinning of the affected fold during phonation was evident preoperatively in 9 of 10 patients. The affected and healthy folds were equal in volume in 4 of 9 patients postoperatively. The LEMG findings and coronal imaging suggest that NMP implantation may have enabled successful reinnervation of the laryngeal muscles of UVFP patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
    No preview · Article · Feb 2015 · Otolaryngology Head and Neck Surgery
  • E. Yumoto
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    ABSTRACT: All laryngologists, especially general ENT doctors who see patients with paralytic dysphonia, as well as speech pathologists, will benefit from this book's coverage of many basic and clinical aspects of reinnervation in retrieving patients' normal voices. Phonosurgical treatment for paralytic dysphonia was first established in the late 1970s in the form of arytenoid adduction and medialization laryngoplasty. It made possible the improvement of patients' post-op voices, but it was difficult to regain patients' own pre-paralysis voices. It has recently been established that immediate reconstruction of the recurrent laryngeal nerve during tumor extirpation is effective in recovery of their original voices in patients with unilateral vocal fold paralysis (VFP). The activity of the thyroarytenoid muscle is needed to recover normal voices. Nerve-muscle pedicle (NMP) flap implantation with a refined technique to the thyroarytenoid muscle is a novel method for that purpose. NMP flap implantation combined with arytenoid adduction was applied by the author to patients suffering from dysphonia and most patients did recover their nearly normal voices after surgery. This book provides readers with (1) what the currently prevalent surgical procedures are, (2) unsatisfactory results of these conventional procedures, (3) results of immediate recurrent laryngeal nerve reconstruction during tumor extirpation, (4) the outcome of delayed reinnervation combined with arytenoid adduction in patients with VFP and further, (5) the scientific basis that explains the reasons why the author's method is effective in the recovery of patients' own pre-paralysis, normal voices.
    No preview · Article · Jan 2015
  • Hiroki Takeda · Masako Masuda · Eiji Yumoto
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    ABSTRACT: Fish bone foreign bodies in the pharynx are common and can usually be removed on an outpatient basis. However, fish bones in the larynx or the extraluminal digestive tract are rare. We treated four cases in which a fish bone foreign body was found in the larynx or the extraluminal digestive tract. In the first case, a fish bone was found at the larynx (subglottis) in a 2-year-old boy. The second case was a fish bone in the retropharyngeal region which had migrated into the submucosal layer in a 74-year-old man. The third case was a 74-year-old woman with a fish bone puncturing the thyroid gland, resulting in a chronically progressing neck abscess. The forth case was a 61-year-old woman with a fish bone completely lodged in the thyroid gland. The post-operative course was uneventful in all cases. Computed tomography (CT) images were effective for making the diagnoses.
    No preview · Article · Jan 2015 · Practica Otologica
  • Y. Kumai · Y. Samejima · K. Matsubara · E. Yumoto

    No preview · Article · Jan 2015 · Nihon Kikan Shokudoka Gakkai Kaiho
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    ABSTRACT: The objective of this study is to evaluate long-term efficacy of refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) for treatment of unilateral vocal fold paralysis (UVFP). The authors retrospectively reviewed 33 patients with UVFP who received refined NMP flap implantation with AA and were followed up over a 1-year period. Evaluation of vocal fold vibration (regularity, amplitude, and glottal gap), aerodynamic analysis (maximum phonation time [MPT] and mean airflow rate [MFR]), and perceptual evaluation (Grade and Breathiness) were performed preoperatively and at five different time points (1, 3, 6, 12, and 24 months) postoperatively. All voice parameters improved significantly postoperatively. All parameters except MFR also continued to improve over the course of 24 months. In the videostroboscopic analysis, the parameter for regularity 24 months after surgery was significantly improved compared with that at 1, 3, and 6 months after surgery. There were also significant improvements in amplitude and the glottal gap 24 months after surgery in comparison with values at 3 and 6 months after surgery and 3 months after surgery, respectively. Significant improvement in aerodynamic and perceptual measurements during the follow-up period together with near-normal vocal fold vibration was achieved by delayed reinnervation with refined NMP flap implantation and AA. The combined surgical technique is effective in the treatment of severe breathy dysphonia due to UVFP. Level of evidence 4.
    No preview · Article · Dec 2014 · Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde
  • Yasuhiro Samejima · Daizo Murakami · Eiji Yumoto
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    ABSTRACT: Purpose: To prevent dysphagia after surgery for head and neck cancer, the effects of preoperative videofluoroscopic evaluations, preoperative rehabilitation, laryngeal suspending technique and velopharyngoplasty were evaluated.
    No preview · Article · Oct 2014 · Japanese Journal of Head and Neck Cancer
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    ABSTRACT: The molecular mechanisms controlling the proliferation and differentiation of spiral ganglion cells (SGCs) in the inner ear are still largely unknown. TIS21 is a transcriptional cofactor that shows antiproliferative, antiapoptotic, and prodifferentiative effects on neural progenitor cells. To investigate the function of TIS21 during SGC development, we analyzed SGC neurogenesis from embryonic day 13.5 (E13.5) to postnatal day 4 (P4) in Tis21-GFP knock-in mice, in which the protein-encoding exon of the Tis21 gene was replaced by EGFP. Through E13.5 to P4, we found fewer SGCs in homozygous Tis21-GFP knock-in mice than in wild-type mice. Our results suggest that TIS21 is required for development of SGCs. Deleting Tis21 may affect progenitor cells or neuroblasts at the beginning of cochlear-vestibular ganglion formation and would consequently lead to a decrease in the number of SGCs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Oct 2014 · Neuroscience Letters
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    Kohei Nishimoto · Yoshihiko Kumai · Eiji Yumoto
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    ABSTRACT: Objective: To establish a rat model with paradoxical vocal fold movement to understand the detailed etiology and physiology of laryngeal synkinesis by evaluating vocal fold movement and by electromyography. Methods: Adult Wistar rats were used. The recurrent laryngeal nerve was transected, anastomosed, and the anastomotic portion was placed in a silicone tube. At 2, 4, and 10 weeks after the treatment (n = 30), we performed laryngoscopy and electromyography. The vocal fold movement was recorded, the hemiglottal area was measured, and the Δarea was calculated by subtracting the area during expiration from that during inhalation. We evaluated the ratio of the Δarea on the treated side to that of the normal side. After laryngoscopy, electromyography of the thyroarytenoid and posterior cricoarytenoid muscles was performed. Results: The mean Δareas were 1.5 ± 3.4%, 2.3 ± 21.5%, and 0.7 ± 31.8% at 2, 4, and 10 weeks after anastomosis, respectively. Eighteen of 18 rats indicated synkinetic reinnervation at 4 and 10 weeks. Regarding vocal fold mobility, 8 of 18 animals showed paradoxical movement, and 5 of 18 exhibited impaired mobility. Conclusion: We have established an animal model of paradoxical movement following recurrent laryngeal nerve injury. This model may be useful in studying laryngeal synkinesis.
    Full-text · Article · Oct 2014 · Acta Oto-Laryngologica
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    ABSTRACT: Speech perception in noise is still difficult for cochlear implant (CI) users even with many years of CI use. This study aimed to investigate neurophysiological and behavioral foundations for CI-dependent speech perception in noise. Seventeen post-lingual CI users and twelve age-matched normal hearing adults participated in two experiments. In Experiment 1, CI users' auditory-only word perception in noise (white noise, two-talker babble; at 10 dB SNR) degraded by about 15 %, compared to that in quiet (48 % accuracy). CI users’ auditory-visual word perception was generally better than auditory-only perception. Auditory-visual word perception was degraded under information masking by the two-talker noise (69 % accuracy), compared to that in quiet (77 %). Such degradation was not observed for white noise (77 %), suggesting that the overcoming of information masking is an important issue for CI users’ speech perception improvement. In Experiment 2, event-related cortical potentials were recorded in an auditory oddball task in quiet and noise (white noise only). Similarly to the normal hearing participants, the CI users showed the mismatch negative response (MNR) to deviant speech in quiet, indicating automatic speech detection. In noise, the MNR disappeared in the CI users, and only the good CI performers (above 66 % accuracy) showed P300 (P3) like the normal hearing participants. P3 amplitude in the CI users was positively correlated with speech perception scores. These results suggest that CI users’ difficulty in speech perception in noise is associated with the lack of automatic speech detection indicated by the MNR. Successful performance in noise may begin with attended auditory processing indicated by P3.
    Full-text · Article · Oct 2014 · Hearing Research
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    ABSTRACT: Objectives: Evaluate the long-term efficacy of laryngeal reinnervation with refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction for unilateral vocal fold paralysis (UVFP) using laryngeal electromyography (LEMG), coronal images, and assessment of phonatory function.
    Preview · Article · Sep 2014 · Otolaryngology Head and Neck Surgery

  • No preview · Article · Sep 2014 · International journal of radiation oncology, biology, physics
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    ABSTRACT: Optimal glottal closure as well as symmetrical vocal fold masses and tensions are essential prerequisites for normal voice production. Successful phonosurgery depends on restoring these prerequisites to achieve long-term improvement.
    No preview · Article · Aug 2014 · JAMA Otolaryngology - Head and Neck Surgery
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    ABSTRACT: Conclusions: Over-adduction of the unaffected vocal fold may not compensate vocal function in unilateral vocal fold paralysis (UVFP). Objective: To determine whether over-adduction of the unaffected vocal fold has any impact on vocal function in patients with UVFP. Methods: A total of 101 patients with UVFP who underwent three-dimensional computed tomographic (CT) examination of the larynx served as subjects. Three-dimensional endoscopic images together with coronal images during phonation were produced to evaluate over-adduction of the unaffected fold, posterior glottal gap, and differences in the vertical position and thickness between the vocal folds. Maximum phonation time (MPT) and mean airflow rate (MFR) were measured. Results: In all, 47 patients showed over-adduction. Their MPT and MFR were 4.9 ± 2.9 s and 653 ± 504 ml/s, respectively. The remaining 54 did not show over-adduction. Their MPT and MFR were 4.7 ± 2.7 s and 574 ± 384 ml/s, respectively. There were no significant differences in MPT or MFR between the two groups. Of the 47 patients with over-adduction, 9 showed no posterior glottal gap. However, their vocal function was not significantly different from that of 38 patients with posterior glottal gap or from that of 43 patients without over-adduction and having a posterior glottal gap.
    No preview · Article · May 2014 · Acta Oto-Laryngologica
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    ABSTRACT: To measure the swallowing pressure (SP) of normal subjects using a 2.64-mm-diameter high-resolution manometry (HRM) catheter with 36 circumferential sensors. Repeated measures with subjects serving as controls. Thirty healthy subjects swallowed water at different temperatures and volumes to examine the maximum SP at the velopharynx, meso-hypopharynx, upper esophageal sphincter (UES), and cervical esophagus, and the duration of lowered pressure at the UES. The maximum SP at any location was unaffected by the volume of water, whereas the maximum SP at the UES and cervical esophagus was affected by the temperature. The duration of lowered SP at the UES was significantly prolonged with 10 versus 2 mL of cold water. The pressure curve in males had two peaks (at the velopharynx and UES), whereas that of females had a single peak at the UES. Our data obtained with 2.64-mm HRM demonstrated that as the bolus volume is increased, the duration of lowered SP at the UES is prolonged. The higher maximum SP at the velopharynx in males versus females suggests that there may be a gender difference in pressure at the velopharynx that has not been described previously. This implies that it is necessary to take gender differences into consideration when evaluating the etiology of swallowing dysfunction by examining the SP and SP curve. Moreover, the thinner catheter is less invasive and may contribute to obtaining more physiological measurements. 4 Laryngoscope, 2013.
    No preview · Article · Mar 2014 · The Laryngoscope
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    ABSTRACT: To assess laryngeal muscle activity in unilateral vocal fold paralysis (UVFP) patients using laryngeal electromyography (LEMG) and coronal images. Case series with chart review. University hospital. Twenty-one patients diagnosed with UVFP of at least 6 months in duration with paralytic dysphonia, underwent LEMG, phonatory function tests, and coronal imaging. A 4-point scale was used to grade motor unit (MU) recruitment: absent = 4+, greatly decreased = 3+, moderately decreased = 2+, and mildly decreased = 1+. Maximum phonation time (MPT) and mean flow rate (MFR) were employed. Coronal images were assessed for differences in thickness and vertical position of the vocal folds during phonation and inhalation. MU recruitment in thyroarytenoid/lateral cricoarytenoid (TA/LCA) muscle complex results were 1+ for 4 patients, 2+ for 5, 3+ for 6, and 4+ for 6. MPT was positively correlated with MU recruitment. Thinning of the affected fold was evident during phonation in 19 of the 21 subjects. The affected fold was at an equal level with the healthy fold in all 9 subjects with MU recruitment of 1+ and 2+. Eleven of 12 subjects with MU recruitments of 3+ and 4+ showed the affected fold at a higher level than the healthy fold. There was a significant difference between MU recruitment and the vertical position of the affected fold. Synkinetic reinnervation may occur in some cases with UVFP. MU recruitments of TA/LCA muscle complex in UVFP patients may be related to phonatory function and the vertical position of the affected fold.
    No preview · Article · Feb 2014 · Otolaryngology Head and Neck Surgery

Publication Stats

1k Citations
220.31 Total Impact Points


  • 1999-2016
    • Kumamoto University
      • • Department of Otolaryngology-Head and Neck Surgery
      • • Graduate School of Medical Sciences
      • • School of Medicine
      Kumamoto, Kumamoto, Japan
  • 2001
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 1979-1999
    • Ehime University
      • • Department of Oral and Maxillofacial Surgery
      • • Department of Otolaryngology
      • • School of Medicine
      Matuyama, Ehime, Japan
  • 1995
    • Ehime Prefectural Central Hospital
      Matuyama, Ehime, Japan