Reliability and validity of the Japanese version of the Glasgow Edinburgh Throat Scale (GETS-J): Use for a symptom scale of globus sensation.

OBJECTIVE: Globus sensation, a feeling of lump or something stuck in the throat, could be caused by structural, functional, and psychogenic diseases. Due to a possible multifactorial nature of the disease, neither diagnosing test battery nor standard treatment for globus sensation has been established. Therefore, a questionnaire to accurately identify globus patients and evaluate the severity of the disease is desired. Glasgow Edinburgh Throat Scale (GETS) is a 10-item questionnaire about the throat symptoms consisting of three subscales relating to dysphagia, globus sensation, and pain/swelling in the throat. It was reported that globus patients marked high scores specifically for the globus scale among three scales, indicating that GETS can be used as a valid symptom scale for globus sensation. Aims of this study were to translate GETS into Japanese and to test its reliability and validity. METHODS: Fifty-five patients complaining of globus sensation without abnormal endoscopic and CT findings were enrolled into the study. They were asked to answer the questions of GETS translated into Japanese (GETS-J). Reliability (internal consistency) of the questionnaire was tested using Cronbach's coefficient alpha. To test the validity, principal components analysis was used to identify the factorial structure of the questionnaire and GETS-J data were compared with those reported in the original GETS. Contribution of psychiatric comorbidities to globus sensation was also investigated by examining the correlation between Hospital Anxiety and Depression Scale (HADS) and GETS-J. RESULTS: Reliability of the questionnaire examined by the Cronbach's coefficient alpha was satisfactory and all higher than 0.75. Principal components analysis identified following three questions as the globus scale: Q1, Feeling something stuck in the throat; Q5, Throat closing off; Q9, Want to swallow all the time. Somatic distress, i.e., patients' reaction to throat symptoms, was significantly correlated with globus scale (r=0.680). Anxiety component of HADS was significantly correlated with somatic distress but not with globus scale. These results were consistent with those of the original GETS except for the replacement of Q3 (discomfort/irritation in the throat) to Q5 (throat closing off) for globus scale in GETS-J. CONCLUSION: Translation of GETS into Japanese showed high reliability and validity, suggesting that translation and cross-cultural adaptation were not problematic. High correlation of globus scale of GETS-J with somatic distress indicated that GETS-J could be a useful questionnaire to identify the globus patients and evaluate the severity of the disease. Anxiety may complicate the somatic distress in patients with globus sensation.

Middle ear gas exchange via the mucosa: estimation by hyperventilation.

CONCLUSION: It is thought that gas exchange via the mucosa occurred in relation to the partial pressure gradient, and it was impaired mainly by inflammatory changes in the mastoid mucosa. It was verified that gas exchange via the mucosa is less likely to be impaired than gas exchange via the eustachian tube. OBJECTIVES: To evaluate the capacity of middle ear gas exchange via the mucosa by examining the effect of hyperventilation on middle ear pressure. SUBJECTS AND METHODS: A total of 55 patients, 40 patients with a type A tympanogram and 15 with type C, were selected. Tympanometry was performed in one ear every 2 min while hyperventilation was forcibly continued for 44-6 min in the supine position. The middle ear pressure and the pressure of end-tidal carbon dioxide (PETCO2) was measured, and sonotubometry was performed. RESULTS: PETCO2 decreased gradually as hyperventilation continued in all cases. Although middle ear pressure decreased by hyperventilation in 49 of 55 patients, in 6 patients it hardly decreased despite the decrease in PETCO2. These six patients were treated for otitis media with effusion within 1 month before this examination.

Treatment of ranula--excision of the sublingual gland versus marsupialization.

The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.

[Head and neck malignant tumors in Niigata Prefecture. The first report: demographics in 4,053 cases].

In 1986, the Niigata Registration Committee of Head and Neck Malignant Tumors was established by otolaryngologists in Niigata Prefecture to register cases of head and neck malignancies. Between 1986 and 1999, 4,053 cases were registered and we epidemiologically analyzed them. Men accounted for 2,866 (70.7%) and women for 1,187 (29.3%). The mean age and standard deviation of the age at diagnosis were 63.4 and 12.4 in men and 59.5 and 16.0 in women. The larynx was the most common site (1,154 cases) in men, followed by the oral cavity (360 cases), hypopharynx (273 cases), mesopharynx (239 cases), and maxillary sinus (154 cases). The thyroid gland was the most common site (416 cases) in women, followed by the oral cavity (214 cases), nasal cavity and paranasal sinuses (excluding the maxillary sinus) (76 cases), salivary glands (72 cases), and mesopharynx (71 cases). The site with the highest mean age was the lip (71.3 years old) in men and the larynx (68.7 years old) in women. The thyroid gland showed the lowest mean age for both genders (men: 56.7, women: 53.6), and that markedly lowered the female mean age because the thyroid gland accounted for one third of all cases in women. Comparing our data to national statistics, the incidence of oral malignancy was almost half in our data. We concluded that, in Niigata Prefecture, the dental professions treated as many cases of oral malignancy as we did. A high gender ratio (male/female) was seen for the larynx (22.2), hypopharynx (4.3), and mesopharynx (3.4). It was more than 1 and less than 2 for the oral cavity, salivary gland, neck lymphoma, ear, and nasal cavity and paranasal sinuses (excluding the maxillary sinus). The thyroid gland showed the lowest gender ratio (0.3), which was the only female-dominant site. We concluded that many sites of malignant head and neck tumors have a lower gender ratio than previously anticipated.