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A 14-year-old boy presented recalcitrant mutational dysphonia with excessive tension of the muscles of his speech organs. The patient did not respond to any facilitating technique of voice therapy such as coughing, humming or hard glottal attack in producing low-pitched voice. Five sessions of voice therapy, including use of the "Kayser-Gutzmann" method in which the larynx is manually pulled downward before phonation, and tongue relaxation were necessary in order to obtain a normal low-pitched voice. After twelve sessions (four months) of voice therapy, stabilization of the low-pitched voice was accomplished. The fundamental frequency of the voice was lowered from 350 Hz before to 120 Hz after the treatment. At 2-years' follow-up, the normal low-pitched voice was successfully maintained but the patient used a falsetto voice at home.Most cases of mutational dysphonia respond well to voice therapy alone, and can easily achieve a complete and permanent low-pitched voice within several sessions of voice therapy. In some patients with recalcitrant mutational dysphonia, however, relatively long-term (4 to 東北文化学園大学医療福祉学部リハビリテーション学科 1）

We describe a patient who presented with a frontal sinus osteoma accompanied by a pneumocephalus causing aphasia. A -year old woman with a chief complaint of headache was referred to our outpatient ear, nose, and throat ENT clinic. A CT scan showed a large frontal sinus osteoma and pneumocephalus. Based on the standard language test for aphasia, she presented with aphasia including verbal paraphasia, and difficulty in word finding, reading, and auditory comprehension. She had no agrammatism, or apraxia of speech, and had no difficulties in word fluency or repetition. Kohs block-design test demonstrated that her IQ score was relatively low. After an endoscopic biopsy of her frontal sinus, a craniotomy with resection of the osteoma was performed. Her postoperative CT scan showed a remarkable reduction in the size of the pneumocephalus, and her linguistic and intelligence evaluation showed complete recovery. Her frontal sinus osteoma and linguistic and intelligent function have remained in the normal range for the last years. It is possible that transient aphasia due to pressure and ischemia might have occurred in the center of the orbital pars of the left inferior frontal gyrus, and in the networks between the cortical regions of language function. This is the first case report describing a frontal sinus osteoma accompanied by a pneumocephalus resulting in aphasia without other neurological symptoms.