Kuen-Yao Ho

Different impact from betel quid, alcohol and cigarette: risk factors for pharyngeal and laryngeal cancer.

The risks of betel quid chewing with or without tobacco, alcohol drinking and cigarette smoking have been well explored in the oral cavity but not in the pharynx and larynx. We conducted a case‐control study to investigate the association of these three risk factors to cancers of the pharynx and larynx in Taiwan. A total cases of 148 pharyngeal cancer, 128 laryngeal cancer and 255 hospital controls, all men, were recruited. Betel quid chewing was a significant independent risk factor (adjusted odds ratio [aOR] = 7.7; 95% confidence interval [CI] = 4.1–15.0) similar to that of alcohol drinking (aOR = 6.6; 95% CI = 3.5–13.0) for pharyngeal cancer, but not for laryngeal cancer (aOR = 1.3; 95% CI = 0.7–2.5) on which cigarette smoking (aOR = 7.1) exerts a stronger significant independent risk than alcohol drinking (aOR = 3.8). For pharyngeal cancers, chewers who consumed >20 quid/day, chewed with inflorescence in the quid or swallowed the betel quid juice were at higher risks; significant dose‐response effects were found in daily quantity of drinking and chewing, and cumulative quantity of drinking. Synergistic effects from the 3 risk factors existed both on the pharynx (aOR = 96.9) and the larynx (aOR = 40.3), and attributed for 93.1% and 92.9% respectively. Our study is the first evidence to show that betel quid chewing without tobacco has different impact on the pharynx (digestive tract) and the larynx (airway), and supports the concept that exposure quantity and direct mucosal contact with the betel quid juice may contribute to carcinogenesis. Our results show an important insight into the impact of betel quid chewing on other sites of the digestive tract other than the oral cavity.

Audiometric Patterns and Prognosis in Sudden Sensorineural Hearing Loss in Southern Taiwan

OBJECTIVES: To investigate factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL). STUDY DESIGN AND SETTING: This is a retrospective study of patients with SSNHL hospitalized at an academic medical center. All patients in this study were treated with prednisolone and dextran. We compared a new 7-pattern classification for audiometric pattern and prognosis analysis with Sheehy classification. RESULTS: We analyzed 148 affected ears in 146 patients. Occurrence of SSNHL was associated with changes in season. The best prognosis was with the midtone pattern of the 7-pattern classification and with the low-tone pattern of Sheehy classification. The older patients, those with vertigo, or those treated after 6 days had a poor prognosis. There was no significant association between ESR level and prognosis. CONCLUSIONS: SSNHL patients with midtone loss have the best prognosis. This study of the audiometric patterns and prognostic factors of SSNHL allow us to better predict its outcome. EBM RATING: B-2

A long-term study on hearing status in patients with nasopharyngeal carcinoma after radiotherapy.

Objective: To study the long-term sensorineural hearing status after radiotherapy in patients suffering from nasopharyngeal carcinoma. Study Design: A prospective study of 220 patients (395 ears) with a median follow-up of 36 months. Setting: A university hospital. Patients: Four criteria were needed. The patient had to have had at least 12 months of audiologic follow-up, no concurrent chronic ear disease, no direct tumor invasion of ear, and no significant sensorineural hearing loss before radiotherapy. Intervention: Pure-tone audiography and impedance audiometry—which were performed before and at the third month after completion of radiotherapy and at a yearly interval thereafter—formed the basis of the study. Main Outcome Measures: The significance level in this study was defined as a bone conduction threshold increase of more than 10 dB between the initial audiogram and those obtained after the completion of radiotherapy. An increase of more than 30 dB was defined as severe loss. Results: Paired t test indicated that the mean bone conduction threshold before and after radiotherapy were significantly different (paired t test, p < 0.05). Logistic regression showed that patient age was related to the significant loss at speech frequency but not to the loss at 4 kHz. The presence of postradiation otitis media with effusion, preirradiation hearing status, and addition of chemotherapy were found to be not influential on hearing change. Conclusion: Hearing deterioration may begin as early as 3 months after the completion of radiotherapy. Early change may be transient, but the effect of radiation on hearing tended to be chronic and progressive.

Hyperlipidemia in noise-induced hearing loss.

Objectives To assess the influence of hyperlipidemia on the development of noise-induced hearing loss (NIHL). Study Design This case-control study analyzed data from the Department of Preventive Medicine at one academic medical center in southern Taiwan. Subjects and Methods We collected the laboratory data from routine health examinations administered to workers who were exposed to noise greater than 85 dBA over a one-year period. We analyzed the relationships of cholesterol and triglyceride levels with NIHL. Results A total of 4071 cases were analyzed. After adjusting for age and gender, hypertriglyceridemia was found to be related to NIHL (aOR = 1.281; 95% CI, 1.088–1.507), but hypercholesterolemia was not (aOR = 0.951; 95% CI, 0.795–1.138). Conclusions This study, one of the largest to date to study the relationship between hyperlipidemia and NIHL, found that individuals with hypertriglyceridemia are at greater risk of NIHL. On the basis of this finding, workers exposed to high noise levels should be educated on control of triglyceride levels to help reduce their risk of NIHL.

Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery

Vagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection.

Incidence of dehiscence of the facial nerve at surgery for middle ear cholesteatoma.

OBJECTIVE: To identify the incidence of dehiscence of the facial nerve in patients undergoing surgery for cholesteatoma and to describe its relevance with iatrogenic facial nerve injury. STUDY DESIGN AND SETTING: This was a retrospective study including 117 tympanoplasties with or without mastoidectomy performed in 49 men and 66 women. RESULTS: The presences of FND after exenteration of disease are 33.3% of total surgical procedures, 33% of the initial procedures, and 37.5% of the revision procedures. The locations of facial nerve dehiscence were 87.2% in only the tympanic segment, 7.7% in only the vertical segment, and 5.1% in both the tympanic and vertical segments. CONCLUSIONS AND SIGNIFICANCE: The incidence of facial nerve dehiscence is high (33.3%) in our study. The surgeon should keep in mind that the location of facial nerve dehiscence with cholesteatoma is comparable with the most common area of iatrogenic facial nerve injury during otologic surgery.

Rupture of radiation-induced internal carotid artery pseudoaneurysm in a patient with nasopharyngeal carcinoma - spontaneous occlusion of carotid artery due to long-term embolizing performance

Rupture of internal carotid artery (ICA) pseudoaneurysm is a lethal complication in patients with nasopharyngeal carcinoma (NPC). Angiography is the best diagnostic and treatment method. The aim of embolization is to block the pseudoaneurysm; but sometimes, total occlusion of great vessels is ineludible. We describe a case of NPC post‐radiation therapy and with ruptured pseudoaneurysm treated by angio‐embolization.

Association of Polymorphisms of Heat Shock Protein 70 with Susceptibility to Noise-Induced Hearing Loss in the Taiwanese Population

Noise-induced hearing loss (NIHL) is the major cause of adult sensorineural hearing loss. It is a complex disease caused by the interaction of environmental and genetic factors. Previous studies found that heat shock proteins (HSPs) were associated with the development of NIHL. Specifically, polymorphisms in the heat shock protein 70 (HSP70) gene family are associated with a susceptibility to NIHL. In this study, three single nucleotide polymorphisms (SNPs) of the HSP70 family (SNP1: rs2075800; SNP2: rs1043618; SNP3: rs2763979) were genotyped in 349 noise-exposed Taiwanese workers. The subjects were categorized into noise-susceptible (NS; n = 27) and general susceptibility (GS; n = 322) groups by the change of a 4K-weighted audiometric average in an interval of 5 years. The G/C genotype of SNP2 was found to be associated with NIHL susceptibility (adjusted OR = 2.634; 95% CI = 1.096–6.328). No significant association was found for SNP1 and SNP3 with NIHL susceptibility. Analysis of haplotypes composed of these three SNPs revealed a significant association between NIHL susceptibility and haplotype CCC (OR = 2.197; 95% CI = 1.110–4.370). In conclusion, the genetic polymorphisms in the HSP70 genes seem to be associated with the individual’s susceptibility to NIHL in the Taiwanese population. These findings could be used as a reference in the understanding and prevention of NIHL.

Effect of manganese-superoxide dismutase genetic polymorphisms IVS3-23T/G on noise susceptibility in Taiwan

PURPOSE The aim of the study is to investigate the distribution of manganese-superoxide dismutase (SOD2) genetic polymorphisms IVS3-23T/G and their influence on noise susceptibility in Asians. MATERIALS AND METHODS Questionnaires about history of noise exposure were administered to factory workers, and audiometric data and blood specimens were obtained during their routine annual health examinations. The SOD2 typing was extended with polymerase chain reaction and screened with single-strand conformation polymorphism. The associations of genetic polymorphisms with noise-induced hearing loss (NIHL) were analyzed. RESULTS The allele frequencies of T and G in the population of this study were 0.868 and 0.132, respectively. In 200 screened participants, individuals with T/G genotype were significantly more vulnerable to noise (adjusted odds ratio, 6.222; 95% confidence interval, 1.498-25.855) than the wild type (ie, T/T) by logistic regressions. CONCLUSIONS The distributions of SOD2 genetic polymorphisms for Asians are different from those reported on Europeans. Individuals with T/G genotype were more vulnerable to noise. This single nucleotide polymorphism is worthy of more studies for the application to NIHL monitoring.

Clinical analysis of intratympanic tympanosclerosis: etiology, ossicular chain findings, and hearing results of surgery

CONCLUSION The success rate (57.5%) in this study is not high for surgical treatment of tympanosclerosis, and therefore lends further evidence that intratympanic tympanosclerosis has been considered intractable for reconstructive surgery. OBJECTIVE To investigate the clinical findings and surgical results of intratympanic tympanosclerosis. METHODS From January 1989 to December 2006, a total of 1523 tympanoplasties were performed. Of these, 84 tailored tympanomastoidectomies were performed for tympanosclerosis in 80 patients. RESULTS The incidence of intratympanic tympanosclerosis with chronic ear disease was 5.5%. Chronic otitis media was the most common etiologic factor for the tympanosclerosis (79 ears, 94.1%). Tympanosclerosis in the middle ear cavity was most often found around the malleus handle (67 ears, 79.8%), and more than half of the cases of tympanosclerosis (43 ears, 51.2%) had multiple areas affected by the sclerotic tissue. Tympanosclerotic fixation of the stapes was found in 31 ears (36.9%), and an intact ossicular chain was seen in 57 ears (67.9%). There was a postoperative improvement in hearing in 42 ears (57.5%).