Tomisato, Shuta



School of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery (Shinanomachi)




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  • Low―intensity cognitive behavioral therapy for stuttering in Adults

    Tomisato S., Yada Y., Shiraisi S., Wasano K.

    Journal of Otolaryngology of Japan (Journal of Otolaryngology of Japan)  123 ( 5 ) 363 - 370 2020.05

    ISSN  00306622

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    Cognitive Behavioral Therapy(CBT)is receiving attention as an approach to the control of stuttering, although few studies have examined its effect. In this report, we report cases of adult stuttering that improved with low―intensity CBT. The participants were 11 adults with stuttering(AWS, 22 to 47 years old, 2 women), who sought consultation at our clinic. In CBT, the patients were made to understand that stuttering was related to anxiety and that it can be dealt with by coping with anxiety, such as with exposure therapy. We explained to the AWS that while rehearsing their speech in the mind, they should distract their attention from “whether stuttering will occur or not.” The scores on the Liebowitz Social Anxiety Scale(LSAS―J)and Overall Assessment of the Speaker's Experience of Stuttering for Adults(OASES―A)showed statistically significant improvement after 5 sessions, although there was no significant change of the score on the Modified Erickson Scale of Communication Attitudes(S―24)or in the stuttering frequency. Although the stuttering frequency did not improve, our findings showed that CBT was still effective against stuttering by improving social anxiety disorder and difficulty suffering.

  • Online cathodal transcranial direct current stimulation to the right homologue of Broca's area improves speech fluency in people who stutter

    Yada Y., Tomisato S., Hashimoto R.i.

    Psychiatry and Clinical Neurosciences (Psychiatry and Clinical Neurosciences)  73 ( 2 ) 63 - 69 2019.02

    ISSN  13231316

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    Aim: Previous functional imaging studies demonstrate that people who stutter (PWS) exhibit over- and under-activation of Broca's and Wernicke's areas and their right hemisphere homologues when speaking. However, it is unclear whether this altered activation represents the neural cause of speech dysfluency or a secondary compensatory activation in PWS. To clarify the functional significance of the altered activation pattern in classic language areas and their right homologues, we examined whether the severity of stuttering was affected when the activation of these areas was modulated by brain stimulation. Methods: While PWS read passages aloud, we applied transcranial direct current stimulation (tDCS) using electrode montages that included an anodal or cathodal electrode placed over one of the language areas and its right hemisphere homologue, with the second electrode placed over the contralateral supraorbital region. Each participant underwent both anodal and cathodal tDCS sessions, each of which included a sham stimulation. Effects of stimulation polarity and electrode location on the frequency of stuttering were analyzed. Results: We observed a significant interaction between polarity and location on the frequency of stuttering. Follow-up analyses revealed that a tDCS montage including the cathodal electrode over right Broca's area (RB) significantly reduced the frequency of stuttering. Conclusion: The results indicated that stuttering severity was ameliorated when overactivation in RB was reduced by tDCS. This observation further suggests that speech dysfluency in PWS may be caused either by functional alteration in RB or by abnormal activation in speech motor control areas that are connected with RB.

  • Four cases of small cell carcinoma of the sinonasal cavity

    Tomisato S., Hashimoto Y., Yamamoto S., Hiraga Y., Kawasaki T., Wasano K.

    Practica Otologica, Supplement (Practica Otologica, Supplement)  152   82 - 83 2018

    ISSN  09121870

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    We report four cases of small cell carcinoma of the sinonasal cavity. The primary sites were the ethmoidal sinonasal cavity in two cases and maxillary sinonasal cavity in two cases. In three of the four cases, chemoradiotherapy was planned, because the cancers were locally advanced, with the tumor size and extent exceeding T3. One of these patients died of an adverse event during the chemoradiotherapy with cisplatin (CDDP) and irinotecan (CPT-11). In another, metastases in the liver and ileum were detected after the chemoradiotherapy with CDDP and etoposide (VP-16), and the patient died 22 months after her initial visit. In the third case, no evidence of recurrence or metastasis was detected until 20 months after completion of the chemoradiotherapy with the carboplatin (CBDCA) and VP-16. In the one case with multiple distant metastases at presentation, six courses of chemotherapy with CBDCA and VP-16 were administered, however, the patient died six months after her initial visit. Because small cell carcinoma of the sinonasal cavity is very rare, no standard treatment has been established yet. In most previously reported cases, chemoradiotherapy was selected because operation was not possible due to the tumor invasion to surrounding organs and the sensitivity to radiation was good. Patients reported here who completed chemoradiotherapy showed good local control. However, the prognosis of small cell carcinoma of the sinonasal cavity is poor and strict surveillance for recurrence and metastasis is needed after treatment.

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