Kwanchanok Yimtae

A randomized trial of the canalith repositioning procedure

Objective To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo.

Positive modulation of cognition and mood in the healthy elderly volunteer following the administration of Centella asiatica.

AIMS OF THIS STUDY Centella asiatica has a reputation to restore decline cognitive function in traditional medicine and in animal model. However, little evidence regarding the efficacy of Centella asiatica from systematized trials is available. Therefore, the present randomized, placebo-controlled, double-blind study investigated the effect of Centella asiatica on cognitive function of healthy elderly volunteer. MATERIALS AND METHODS Twenty-eight healthy elderly participants received the plant extract at various doses ranging 250, 500 and 750 mg once daily for 2 months. Cognitive performance was assessed using the computerized test battery and event-related potential whereas mood was assessed using Bond-Lader visual analogue scales prior to the trial and after single, 1 and 2 months after treatment. RESULTS The results showed that the high dose of the plant extract enhanced working memory and increased N100 component amplitude of event-related potential. Improvements of self-rated mood were also found following the Centella asiatica treatment. CONCLUSION Therefore, the present findings suggest the potential of Centella asiatica to attenuate the age-related decline in cognitive function and mood disorder in the healthy elderly. However, the precise mechanism(s) underlying these effects still require further investigation.

Otosyphilis: A review of 85 cases

OBJECTIVE: To review the clinical manifestations and the follow-up hearing results of the treatment modalities in the patients with otosyphilis. STUDY DESIGN AND SETTINGS: A retrospective review between 1984 and 2000 at a university hospital. Patients who presented with cochleovestibular symptoms and were confirmed seropositive for specific treponemal tests were included. Excluded were patients older than 70, or who had other identified causes of cochleovestibular symptoms. RESULTS: Subjects included 56 males and 29 females with an average age of 59.5 years (range, 40 to 70). Common presenting symptoms included hearing loss (90.6%), tinnitus (72.9%), and vertigo (52.9%). The cerebrospinal fluid analysis was positive in 5.4%. The overall respective hearing results in the short- and long-term follow-up were improved or stable in 93.4% and 83.3% of patients. Even though adding steroids and neurosyphilis regimens tended to improve and stabilize hearing, the results were not statistically significant among treatment modalities. CONCLUSION: Further study about hearing outcomes among treatment modalities is suggested.

Connection between the inner ear and the lymphatic system.

Objective The aim of this study was to identify the lymphatic drainage of the inner ear in guinea pigs.

Nasopharyngeal Tuberculosis: Manifestations between 1991 and 2000

OBJECTIVES/HYPOTHESIS: To present the clinical manifestation of nasopharyngeal tuberculosis. STUDY DESIGN: Clinical analysis of 23 patients with pathologically confirmed nasopharyngeal tuberculosis was carried out retrospectively. SETTING: Srinagarind Hospital, Khon Kaen University. Thailand. RESULTS: The most common presenting symptom was cervical lymphadenopathy (91.3%). The common locations of nodes were the superior and middle cervical. The abnormalities of the nasopharynx were found in 16 patients. The pathological findings were caseous granuloma with positive acid-fast bacilli (AFB) in 15 cases, caseous granuloma with negative AFB in 3 cases, and chronic granulomatous inflammation with negative AFB in 5 cases. Pulmonary tuberculosis was found in 8 of 18 patients. Sixteen patients who received complete treatment responded well. CONCLUSION: Nasopharyngeal tuberculosis commonly presents with cervical lymphadenopathy. The differential diagnosis of tuberculosis from nasopharyngeal carcinoma is difficult. In the patients who have cervical lymphadenopathy and no other identified causes, biopsy of nasopharynx would give an additive information for diagnosis.

Centella asiatica Improves Physical Performance and Health-Related Quality of Life in Healthy Elderly Volunteer

Recently, oxidative stress has been reported to contribute an important role in the decline of physical function as age advances. Numerous antioxidants can improve both physical and psychological performances resulting in the increase of health-related quality of life (HQOL). Therefore, we hypothesized that Centella asiatica, a medicinal plant reputed for nerve tonic, strength improvement and antioxidant activity, could improve the physical performance and HQOL especially in the physical satisfaction aspect, of the healthy elderly volunteer. To test this hypothesis, a double-blind, placebo-controlled, randomized trial was performed. Eighty healthy elderly were randomly assigned to receive placebo or standardized extract of C. asiatica at doses of 250, 500 and 750 mg once daily for 90 days. The subjects were evaluated to establish baseline data of physical performance using 30-s chair stand test, hand grip test and 6-min walk test. The health-related quality of life was assessed using SF-36. These assessments were repeated every month throughout the 3-month experimental period using the aforementioned parameters. Moreover, 1 month after the cessation of C. asiatica treatment, all subjects were also evaluated using these parameters again. The results showed that after 2 months of treatment, C. asiatica at doses of 500 and 750 mg per day increased lower extremity strength assessed via the 30-s chair stand test. In addition, the higher doses of C. asiatica could improve the life satisfaction subscale within the physical function subscale. Therefore, the results from this study appear to support the traditional reputation of C. asiatica on strength improvement, especially in the lower extremities of the elderly. C. asiatica also possesses the potential to be a natural resource for vigor and strength increase, in healthy elderly persons. However, further research is essential.

Tuberculosis in the upper aerodigestive tract and human immunodeficiency virus coinfections.

OBJECTIVE To describe the clinical manifestations of tuberculosis in the upper aerodigestive tract. DESIGN Retrospective chart analysis. SETTING Srinagarind Hospital, Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. METHODS A review of medical records of patients diagnosed with mycobacterial infection of the upper aerodigestive tract between January 1991 and December 2000. MAIN OUTCOME MEASURES Presenting symptoms, clinical findings, pathologic findings, pulmonary involvement, and outcome of treatment. RESULTS Forty-five patients presented with upper aerodigestive tract tuberculosis. The nasopharynx was involved in 23 patients, the larynx in 16, the tonsils in 6, and the soft palate in 1. One patient had tuberculous infections in both the nasopharynx and tonsils. The mean duration of symptoms before diagnosis was 2.1 months. The pathologic findings included caseous granuloma and/or positive acid-fast bacilli (AFB) in 39 cases and chronic granulomatous inflammation with negative AFB in 6 cases. Pulmonary tuberculosis was found in 19 of the 36 patients who underwent radiography. A positive serologic test for human immunodeficiency virus (HIV) infection was found in 4 of 26 patients. These 26 patients, who received a full course of treatment, responded well. CONCLUSION The most common site of tuberculosis in the head and neck involved the cervical lymph nodes and nasopharynx. Upper aerodigestive tract tuberculosis is difficult to differentiate from carcinoma; thus, tissue biopsy is necessary for a definite diagnosis. Chest radiography and screening for HIV infection are recommended in all patients with upper aerodigestive tract tuberculosis.

Doxycycline treatment of otosyphilis with hearing loss

Objectives The recommended treatment of otosyphilis is intravenous penicillin therapy. The response rate varied between 23% and 31%. This treatment needs hospitalisation and is costly, inconvenient and time consuming. Oral doxycycline was tested for its efficacy in otosyphilis. Method The authors reviewed 19 patients diagnosed as having otosyphilis with hearing loss at the outpatient unit between 2004 and 2008 by oral doxycycline 400 mg/day for 21 days. Results Of those enrolled patients, 12 patients were male and the mean age is 69.4 years. The hearing was improved in nine patients (47.3%) and the audiogram of seven patients (36.8%) showed improvement. There was no serious side effect of doxycycline. Conclusion The data suggest that doxycycline may be an effective alternate regimen for otosyphilis.

Angiostrongylus eosinophilic meningitis associated with sensorineural hearing loss.

A 59-year-old woman who presented with chronic headache, neck stiffness and left-sided hearing loss is reported. The diagnosis of angiostrongylus eosinophilic menigitis was made. The patient improved after treatment with prednisolone, including hearing. Angiostrongylus eosinophilic meningitis associated with sensorineural hearing loss has not previously been reported.

Validation of the Thai Five-Minute Hearing Test to Screen Hearing Loss in the Community

Background: Hearing impairment affects communication, social interactions, and quality of life. Audiometry is the gold standard method for hearing assessment. However, it is impractical in a country with limited resources. This study aimed to validate the Thai version of the Five-Minute Hearing Test (Thai-FMHT) to screen hearing loss in the community. Methods: This prospective cohort study was conducted in Phu Wieng district, Khon Kaen Province, Thailand during July to September 2011. Subjects who were older than 18 years, could read or understand the Thai language, and wanted to participate were enrolled. Those who had aphasia, severe mental disability, or other conditions that precluded audiometry were excluded. The Thai-FMHT was first administered, followed by standard audiometry performed by audiologists who were blinded to the result of Thai-FMHT, and finally an ear examination was performed. This trial was registered with ClinicalTrial.gov as No. NCT01408992. Results: The 558 subjects, including 176 males (32%) and 382 females (68%), completed all of the procedures. The optimal cutoff point for hearing loss in this screen was 8. The sensitivity, specificity, and positive likelihood ratio of the Thai-FMHT to screen mild hearing loss (PTA0.5-2 kHz >25 dB) were 64.7% (95% CI, 56.1-72.7%), 60.0% (95% CI, 55.1-64.7%), and 1.62 (95% CI, 1.36-1.92), respectively. Regarding screening moderate hearing loss (PTA0.5-2 kHz >40 dB), the sensitivity, specificity, and positive likelihood ratio of the Thai-FMHT were 93.1% (95% CI, 77.2-99.2%), 56.5% (95% CI, 55.1-64.7%), and 2.1 (95% CI, 1.9-2.5), respectively. Conclusion: The Thai-FMHT has a lower cutoff point than does the original one. This test is suitable for use as a screening tool for hearing loss in the community.