Cheng-Chien Yang

Congenital pyriform aperture stenosis: Surgery and evaluation with three-dimensional computed tomography

Objective We described the surgical efficacy of congenital pyriform aperture stenosis by measuring the width of the nasal pyriform aperture with three‐dimensional computed tomography.

Laryngeal neurofibroma: case report of a child

Neurofibromatosis is characterized by multiple café-au-lait spots and cutaneous neurofibromas. Laryngeal involvement in neurofibromatosis is rare and is usually manifested by obstructive airway symptoms. We encountered a 1 year 8-month-old girl who was a victim of neurofibromatosis with the presentation of stridor. Fiberoptic laryngoscopy revealed a round smooth mass over the right aryepiglottic fold which prolapsed into the larynx during inspiration. Carbon dioxide laser excision was performed and histopathologic examination revealed a plexiform neurofibroma. The patient had regular follow up for almost 4 years. Even though there seemed to be a recurrence, she remained symptom free.

Effect of identification and intervention age on language development for Mandarin-speaking deaf children with high family involvement.

OBJECTIVE The purpose of this study is to assess the language ability between early-intervention and later-intervention Mandarin-speaking deaf children, who have normal cognition and high family involvement. MATERIALS AND METHODS There are 29 subjects enrolled. 11 born deaf children received early intervention (7 HA and 4 CI) before 6 months old as study group. Another 18 born deaf children received later intervention (11 HA and 7 CI) between 7 and 35 months old as reference group. They were all regarded as with normal cognition and high family involvement. Their mean assessment age was 50 months old in early group and 51 months old in later group. We used several tools to test their perceptive vocabulary size, to evaluate perceptive language syntax and to compare perceptive and expressive language scores. RESULTS Our study revealed there are significant difference between these two groups in the ability of vocabulary size, perceptive language syntax and perceptive language scores. The results showed there is no significant difference between these two groups in their expressive language scores, although their achievement score is higher in the early group. CONCLUSIONS It clearly showed the ability of perceptive language in early-intervention deaf children was better than that of later-intervention. The ability of their expressive language showed no difference between them.

The effectiveness of the promotion of newborn hearing screening in Taiwan

OBJECTIVE Hearing is a critical ability for the development of a childs speech and language. Many studies in different countries have shown the universal newborn hearing screening and early intervention has greatly reduced the negative impact caused by congenital hearing loss. The first universal newborn hearing screening program in Taiwan took place in MacKay Memorial Hospital in 1998 and was subsequently endorsed by the government. The incidence of bilateral congenital hearing impairment in Taiwan is approximately 2.6 per 1000 live birth. The aim of this paper is to analyze the age of diagnosis, hearing aid fitting, and intervention of congenitally hearing impaired children with and without hearing screening after public awareness and government endorsement of newborn hearing screening. MATERIALS AND METHODS There were 263 hearing impaired children participated in this study, receiving their auditory habilitation therapy at Childrens Hearing Foundation from 2006 to 2010. 114 of those children went through newborn hearing screening and 149 without it. The age of diagnosis, hearing aid fitting, and auditory intervention were compared between these two groups. The age of diagnosis and intervention of congenitally hearing impaired children among different years were analyzed too. RESULTS The average age of diagnosis was 8.7 months, the age of hearing aid fitting was 12.4 months and age of auditory intervention was 18.8 months for the group of hearing impaired children with newborn hearing screening. For hearing impaired children without newborn screening, their average age of diagnosis was 27.5 months; age of hearing aid fitting was 31.3 months and age of auditory intervention was 40.5 months. There were significant differences in the age of diagnosis, hearing aid fitting and auditory intervention between congenitally hearing impaired children with and without hearing screening. CONCLUSIONS This research indicates that newborn hearing screening facilitates early identification, diagnosis and intervention of congenitally hearing impaired children in Taiwan. The age of identification, diagnosis and intervention of congenital hearing impaired children has also been reduced gradually over the years after government endorsement of newborn hearing screening in Taiwan.

The outcomes of infantile vallecular cyst post CO2 laser treatment

OBJECTIVES Vallecular cyst is not a common disease of neonate and infant. However, it may cause severe airway obstruction and even death. Its clinical symptoms are similar to laryngomalacia, including stridor, suprasternal retraction, substernal retraction, feeding difficulties, vomiting, failure to thrive, feeding choking and desaturation. This study is aimed to evaluate the surgical outcomes of infantile vallecular cyst post CO₂ laser treatment and to explore the appropriate time point of surgery for infantile vallecular cyst. METHODS In a retrospective review, thirty three patients diagnosed as vellecular cyst were enrolled in this study. All the patients received awake fiberoptic videobronchoscopic examination in order to prove the diagnosis. Pre-operative and post-operative eight symptom items were both recorded for comparison of the surgical outcomes. The age of diagnosis, gender, operation, body weight at surgery, co-morbidities, dates of postoperative endotracheal intubation, ICU stays and admission days were all recorded for analysis. RESULTS Total 33 cases of vallecular cyst were diagnosed by fiberoptic videobrochoscopy at our department. Most infants were diagnosed at 2-3 months-old. Stridor was the most common pre-operative symptom (100%). Additionally, feeding choking was the most common post-operative one (29.41%). Two patients (6.06%) with newly onset postoperative feeding choking recovered spontaneously within 2 weeks. Failure to thrive got worse as age increased before the operation. Eighty-eight percent of patients had good or excellent improvement of symptoms after surgery. There was neither recurrence nor surgical complication in our study. CONCLUSION Vallecular cyst often combined with laryngomalacia. Different from laryngomalacia, it had excellent outcomes after CO₂ laser treatment. Failure to thrive got worse if delay diagnosis. Therefore, if definite diagnosis is made, early laser excision of cyst is a good method and the surgical outcomes are excellent.

Congenital Nasal Pyriform Aperture Stenosis and Single Central Maxillary Incisor: Preoperative Evaluation with Three-Dimensional Computed Tomography

BACKGROUND AND PURPOSE Congenital nasal pyriform aperture stenosis (CNPAS) is an uncommon cause of nasal airway obstruction in neonates and infants. It is frequently associated with a single central maxillary incisor (SCMI). The purpose of this study was to assess whether 3-dimensional spiral computed tomography (3D spiral CT) could be used for the diagnosis of CNPAS and for detecting SCMI in CNPAS patients before tooth eruption. METHODS From January 1996 to December 2001, 16 patients (mean age, 2 +/- 3 months) with clinically suspected CNPAS and 13 normal control subjects (mean age, 28 +/- 32 months) were studied prospectively by 3D spiral CT. On the 3D CT image of each subject, the middle pyriform aperture width (MPAW), upper 1/4 PA width (UPAW), and middle internasal process width (MINPW) were measured. In addition, the ratios of MINPW to MPAW and of MINPW to UPAW were calculated. SCMI was identified as a bigger tooth with singular convexity. RESULTS SCMI was diagnosed in 11 of the 16 CNPAS patients. In the CNPAS patient group, the mean MINPW (5 +/- 1 mm) was significantly shorter than the mean MPAW (9 +/- 1 mm) and the mean UPAW (8 +/- 1 mm) [p < 0.001]. However, in the normal control group, the mean UPAW (13 +/- 2 mm) was significantly shorter than the mean MPAW (16 +/- 3 mm) and the mean MINPW (16 +/- 3 mm) [p < 0.01]. In the CNPAS patients, the mean ratios of both MINPW to MPAW (0.5 +/- 0.1) and of MINPW to UPAW (0.6 +/- 0.1) were significantly lower than the corresponding mean ratios in the normal control subjects (1.0 +/- 0.1 and 1.3 +/- 0.2, respectively; both p < 0.001). CONCLUSION Our results indicate that CNPAS is frequently associated with a SCMI and CNPAS patients have a significant reduction in the MINPW and in the ratios of MINPW to MPAW and of MINPW to UPAW. We conclude that 3D spiral CT can be used for diagnosis of CNPAS and for detecting SCMI in CNPAS patients before tooth eruption.

A simple algorithm for treating horizontal benign paroxysmal positional vertigo.

Objective Horizontal benign paroxysmal positional vertigo (H-BPPV) is more difficult to successfully treat than posterior benign paroxysmal positional vertigo (P-BPPV) because of the diverse mechanisms required. We developed a simple, rapid, and effective treatment algorithm for treating all subtypes of H-BPPV in an ear, nose, and throat (ENT) outpatient department. Materials and Methods Four hundred ninety patients with BPPV receiving outpatient treatment at Mackay Memorial Hospital were investigated. Among the 490 patients, 86 (17.6%; 86/490) were diagnosed as having H-BPPV variants using the McClure–Pagnini test. Fifty-four patients were female, and 32 were male; they ranged in age from 18 to 92 years (mean age, 56.2 yr). Results Among the 86 H-BPPV patients, 74.4% (64/86) were hypothesized to have canalithiasis, 20.9% (18/86) were hypothesized to have cupulolithiasis-utricle type (Cup-U), and 4.7% (4/86) were hypothesized to have the cupulolithiasis-cupula type (Cup-C). The primary treatment maneuver was the forced prolonged position (FPP). For 3 patients exhibiting refractory symptoms, we introduced the Gufoni maneuver. The total average success rate of treatment was 96%. Conclusion We concluded that for H-BPPV patients with initial geotropic nystagmus, the FPP alone yielded an excellent treatment-control rate, and the barbecue-rotation maneuver was unnecessary. However, observing the nystagmus transformation of apogeotropic patients was necessary before administering treatment. For cupulolithiasis patients with the apogeotropic variant who did not respond to FPP treatment alone, we determined that the Gufoni maneuver was necessary as well.

A fabricated forearm free flap with accompanying phonation tube for simultaneous reconstruction of a pharyngolaryngeal circumferential defect and voice loss: new surgical modification with functional phonation outcome.

Total pharyngolaryngectomy is potentially ablative surgery, resulting in compromise of some most basic functions of life, including speech and swallowing. Tracheoesophageal puncture is the gold standard for voice restoration. But it still has prosthesis‐related problems.

Comparative Analysis of Treatment Result in Advanced Hypopharyngeal Cancer: Chemoradiotherapy Alone or Surgery Followed by Chemoradiotherapy

Background: Concomitant chemotherapy and radiotherapy (CCRT) is an alternative, organ preserving way to perform surgery in patients with advanced hypopharyngeal carcinoma. The purpose of this retrospective study was to compare the results of advanced hypopharyngeal carcinoma according to different treatment modalities. Materials and Methods: Twenty-eight patients with advanced stage as stage III, IVA, IVB of hypopharyngeal carcinoma who were treated by the head and neck team of the cancer center at Mackay Memorial Hospital between January 2002 and June 2005 were retrospectively analyzed. Sixteen patients were treated with concomitant chemotherapy and radiotherapy alone (CCRT group), and 12 patients were treated with surgery and postoperative concomitant chemotherapy and radiotherapy (OP+CCRT group). Median follow-up period was 21 months. Results: The overall 2-year survival rates were 43.8% for the CCRT group and 49.4% for the OP+CCRT group. The 2-year disease-free survival rates were 37.5% for the CCRT group and 50.0% for the OP+CCRT group. No significant differences were found in overall and disease-free survival rates between the CCRT and OP+CCRT groups (p=.82, p=.57). Conclusions: Concomitant chemoradiotherapy is an effective strategy to achieve organ preservation without compromising the survival of patients with advanced hypopharyngeal carcinoma. However, this is only a 2-year result; long-term follow-up is needed.