Jiun-Yih Shiao

Preoperative prognostic factors for olfactory change after functional endoscopic sinus surgery

Background Functional endoscopic sinus surgery (FESS) has been considered to improve the olfactory function in patients with chronic rhinosinusitis. However, which factors might affect the olfactory outcome after FESS has not been well investigated. Methods A total of 70 patients with chronic rhinosinusitis who underwent FESS were enrolled in the study. The potential prognostic factors for improvement in olfaction after FESS were evaluated in these patients. On the day before FESS, the olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test, the University of Pennsylvania Smell Identification Test, and a short-term odor memory/discrimination test, and were reevaluated by the same methods 6 months after FESS. Results The degree of nasal obstruction, the second minimal cross-sectional area measured by acoustic rhinometry, computed tomography scores before FESS, the degree of preoperative olfactory loss indicated by threshold and identification scores, and coexistence of nasal polyps or allergic rhinitis were not significantly reliable to influence the rates of olfactory improvement after FESS. Conclusion Degree of nasal obstruction, extent of rhinosinusitis disease, and coexistence of nasal polyps or allergic rhinitis did not predicate the overall possibility of any olfactory improvement after FESS.

A pilot study of a traditional Chinese version of the University of Pennsylvania Smell Identification Test for application in Taiwan.

Background The 40-item University of Pennsylvania Smell Identification Test (UPSIT) is the most widely used smell test in the world. Presently, culturally modified versions of this test are available in 12 languages. This study describes the first assessment of a prototype traditional Chinese version of the UPSIT (UPSIT-TC) for administration in Taiwan. The goals were to determine the efficacy of specific items for testing Taiwanese subjects and to establish normative adjustments to allow for the use of North American norms. Methods The American version of the UPSIT and the UPSIT-TC were administered to 40 healthy Taiwanese subjects on two test occasions separated from one another by 2 weeks. One subject was excluded because of invalid data. Results The mean UPSIT score was 28.3 (median, 28; SD, 3.8) for the first test administration and 28.5 (median, 28.0; SD, 4.4) for the second test administration. The mean UPSIT-TC score was 33.1 (median, 33.0; SD, 2.9) for the first administration and 32.8 (median, 33.0; SD, 3.6) for the second test administration. The UPSIT-TC scores were significantly higher than those of the UPSIT on both test occasions (p < 0.0001). Pearson correlations computed across the two test occasions were positive and statistically significant for both the UPSIT and the UPSIT-TC (respectively, r = 0.803 and 0.664; p < 0.0001). Conclusions In accord with the modifications, the scores on the prototype UPSIT-TC were significantly higher than those on the American UPSIT when administered to a Taiwanese sample. Both versions of the UPSIT were stable across repeated test sessions.

Developing a Rabbit Model of Rhinogenic Chronic Rhinosinusitis

Objective: The purpose of this study was to develop a rabbit model of rhinogenic chronic rhinosinusitis (CRS).

Nasal irrigation reduces postirradiation rhinosinusitis in patients with nasopharyngeal carcinoma.

Background Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Radiotherapy (RT) is the standard treatment for NPC. The newer RT technique, intensity-modulated radiotherapy (IMRT) has become popular in recent years. IMRT-induced rhinosinusitis is not uncommon in postirradiated NPC patients but the incidence and the disease course have not been reported. The purpose of this study was to determine the IMRT effect on the paranasal sinuses and evaluate the efficacy of nasal irrigation on the management of RT-induced rhinosinusitis. Methods NPC patients who completed IMRT from October 2004 to May 2006 were enrolled in the study and were randomly allocated to irrigation or nonirrigation groups. Patients in the irrigation group performed daily nasal irrigation until 6 months after RT. The severity of postirradiated rhinosinusitis was evaluated by nasal endoscopy, questionnaire, and computed tomography until a year after RT. Results One hundred seven postirradiated NPC patients completed the study. Among them, 44 patients performed daily nasal irrigation until 6 months after RT, and the other 63 patients did not perform nasal irrigation after RT. Patients in the irrigation group had significantly lower endoscopic and questionnaire scores than patients in the nonirrigation group (p = 0.001 and 0.0001, respectively) from pre-RT to 6 months after RT. The between-group differences were most obvious at the post-RT second and third months. Conclusion Rhinosinusitis is a common acute post-RT complication in NPC patients. Our results showed that nasal irrigation was a safe and effective method for the management of this acute complication.

Role of Pollen Allergy in Taiwanese Patients With Allergic Rhinitis

BACKGROUND/PURPOSE Pollen allergy is believed to be less common in East Asia, Latin America, and tropical areas. The purpose of this study was to understand the role of pollen allergy in Taiwan. METHODS Patients with clinically diagnosed allergic rhinitis were enrolled. All subjects received a 30-item skin test panel that included perennial allergens (house dust mix, Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat hairs, cockroach mix, and Candida albicans) and pollen allergens (acacia, pine mix, eucalyptus, beefwood, juniper mix, willow, mulberry mix, pepper tree, cedar, Johnson grass, Bermuda grass, ragweed mix, Timothy grass, spiny pigweed, cocklebur, sage mix, sheep sorrel, dog fennel, pigweed mix, English plantain, castor bean, alfalfa, and dandelion). RESULTS A total of 419 patients were recruited. A total of 313 (74.7%) had a positive skin test. A total of 288 patients (68.7%) were sensitive to perennial allergens, and 11 8 patients (28.2%) were sensitive to pollen allergens. However, 93 pollen-sensitive patients were also sensitive to perennial allergens, and only 25 were sensitive to pollen allergens alone. The most common allergens were D. pteronyssinus, D. farinae, house dust mix, and cockroach, but the most common pollen allergens were spiny pigweed, Johnson grass, and sheep sorrel. All nasal symptoms tended to be more severe in patients who were sensitive to perennial allergens than in those who were sensitive to pollen allergens alone. CONCLUSION Most patients with allergic rhinitis in Taiwan are sensitive to perennial allergens, and pollens are a less common allergen.

Central nervous system infection in patients with postirradiated nasopharyngeal carcinoma: a case-controlled study.

Background It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection. Objective The purpose of this study was to better understand this clinical entity. Methods From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated. Results The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001). Conclusions Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.

Visual Screening of Oral Cavity Cancer: The Role of Otolaryngologists

Objectives: Because most screening was done by dentists, the purpose of this prospective cohort study was to evaluate the effectiveness of oral visual screening by otolaryngologists. In addition, we wanted to determine which group of enrolled patients was at potential risk of contracting oral cancer.