M.C.F. Tong

Preliminary results of photodynamic therapy for recurrent nasopharyngeal carcinoma

Photodynamic therapy (PDT) is a promising new modality in the treatment of cancer. In Hong Kong where nasopharyngeal carcinoma (NPC) is endemic, radiotherapy has been the primary treatment of choice. For recurrent disease after radiotherapy, there is no effective treatment. This latter report summarizes our initial experience in using PDT for these patients. Twelve patients (three females and nine males) with ages ranging from 33 to 65 years were treated with an infusion of hematoporphyrin derivative (5 mg/kg) 48–72 h before exposure to 200 J/cm2 light (wavelength, 630 nm) delivered from a gold vapor laser. All 12 patients showed a dramatic response as judged by computed tomography or magnetic resonance imaging at 6 months post-PDT. Of the eight patients in whom cure was aimed for, three remained disease-free at 9–12 months after a single treatment. Three of the remaining four patients achieved useful palliation. Skin hypersensitivity occurred in two patients and was the only significant complication encountered. This experience indicates that PDT can be an encouraging palliative or definitive management for recurrent superficial NPC.

Flexible nasopharyngoscopy for fish bone removal from the pharynx.

The use of flexible nasopharyngoscopy with biopsy forceps for the removal of fish bones found in the oropharynx and hypopharynx is described. One hundred and sixty-eight patients with ingested fish bones in the upper aero-digestive tract were studied over a 12-month period. Of these, 73 per cent were removed per-orally, or by indirect laryngoscopy. Fifteen per cent were removed using the fibreoptic nasopharyngoscope. Twelve per cent required a general anaesthetic and rigid oesophagoscopy for removal of fish bones at or below the level of the cricopharyngeus muscle. The technique has proven to be quick, well tolerated and low in morbidity. It is invaluable in patients in whom indirect laryngoscopy is unsatisfactory.

Psychometric properties of the Chinese (Cantonese) Tinnitus Handicap Inventory

Objectives:  To establish the reliablity and validity of the Chinese (Cantonese) version of the Tinnitus Handicap Inventory to measure the self‐perceived handicapping effect and severity of the condition in patients with chronic tinnitus.

Clinical evaluation of a fully implantable hearing device in six patients with mixed and sensorineural hearing loss: Our experience

Speech Lang. Hear. Res. 40, 1352–1357 8 Georgalas C., Sandhu G., Trosh A. et al. (2005) Cophenylcaine spray vs. placebo in flexible nasendoscopy: a prospective double-blind randomised controlled trial. Int. J. Clin. Pract. 59, 130–133 9 Cain A.J., Murray D.P. & Mc Clymont L.G. (2002) The use of topical nasal anaesthesia before flexible nasendoscopy: a doubleblind, randomized controlled trial comparing cophenylcaine with placebo. Clin. Otolaryngol. Allied Sci. 27, 485–488 10 Machin D., Campbell M.J., Fayers P.M. et al. (1997) Sample Size Tables for Clinical Studies, 2nd Edn. Blackwell Sci., Oxford, p. 7

Long‐term Outcome of the Hong Kong Vascularized, Pedicled Temporalis Fascia Flap in Reconstruction of Mastoid Cavity

Objectives: The vascularized, pedicled temporalis fascia flap (Hong Kong flap) is an established procedure in the reconstruction of the mastoid cavity. The long‐term outcome and complications have not been studied. We set out to appraise this procedure in our study.

Vibrant Soundbridge system: application of the stapes coupling technique.

INTRODUCTION The use of the stapes coupling technique, employed in the Vibrant Soundbridge system, is technically less demanding than the vibroplasty technique, and is more likely to generate a positive outcome without significantly changing residual hearing or resulting in medical or surgical complication. METHOD We report a patient with repeated left ossiculoplasty failure, who was successfully implanted with a Vibrant Soundbridge. CONCLUSION We believe that the stapes coupling technique can provide natural stimulation to the inner ear, resulting in a better perceived sound quality.

Tuberculous tracheobronchial strictures: clinicopathological features and management with the bronchoscopic carbon dioxide laser

SummaryTuberculous tracheobronchial stricture is a rare disease entity at the present time. We report our experiences with carbon dioxide laser treatment for four patients with tuberculous strictures that were resistant to conventional management. All patients were relatively young but were debilitated by the disease. The lesions differed from other forms of benign tracheal strictures as they tended to involve the trachea and right side of the lung and were often multiple. The reasons for this are related to the organism per se and the anatomical arrangement of the tracheobronchial airway. The pathophysiology of tuberculous strictures in the tracheobronchial airway and the technique of bronchoscopic laser resection are outlined.

A simple method for re-dilatation of an acute tracheostoma stenosis.

Tracheostomy or laryngectomy stomas may sometimes re-stenose, resulting in respiratory distress for the patient unless the stoma is rapidly re-dilated and an adequate airway re-established. This article describes a simple and effective method for the acute re-dilatation of a tracheostoma stenosis, using an aural speculum, prior to the insertion of a patent airway tube. This technique has been successfully used in our department since 1995 and, in our experience, causes significantly less distress to our patients when compared with other means employed previously.

Student telecast teaching in otorhinolaryngology.

Appropriate props were provided for verisimilitude. Evaluation of results and impact A total of 209 students (100% response rate) provided evaluation data. Their responses were overwhelmingly positive: 40 (19.1%) rated the module as excellent; 131 (62.7%) rated it as good; 37 (17.7%) as satisfactory, and 1 (0.5%) as unsatisfactory. A total of 43 (20.6%) students considered the content was easy and 21 (10.0%) thought it was difficult, with the remainder regarding it as of average difficulty. Students viewed the range of practical scenarios, opportunities for examiners’ critiques and hands-on clinical experience, and facilitators’ enthusiasm as contributing towards a major positive learning experience. This core skills module is unique as there are very few published descriptions of similar practical courses in the literature.