Peter K. M. Ku

Nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma : A twelve-year experience

The incidence of recurrent nasopharyngeal carcinoma (NPC) after primary radiotherapy is considerable. The result of re‐irradiation to the recurrent tumor is not satisfactory.

Early Swallowing Problems in a Cohort of Patients With Nasopharyngeal Carcinoma: Symptomatology and Videofluoroscopic Findings

Objective: To study the incidence and the degree of swallowing dysfunction in patients with nasopharyngeal carcinoma (NPC) who underwent radiation therapy treatment.

Traumatic Esophageal Perforation Resulting from Endotracheal Intubation

E sophageal perforation due to a traumatic intubation is exceedingly rare. If not noticed immediately or treated promptly, however, the morbidity and mortality is significant. Most cases present within 24 h after the event. A delay in symptoms that signal esophageal perforation after a traumatic endotracheal intubation has serious clinical implications. We report a case of traumatic esophageal perforation due to endotracheal intubation for elective sinus surgery under general anesthesia with a delay in onset of symptoms and signs. The diagnosis and management of this complication are discussed.

Nasal manifestation of extranodal Rosai-Dorfman disease – diagnosis and management

Two cases of Rosai-Dorfman disease with polypoid nasal infiltration mimicking nasal tuberculosis and malignant lymphoma are reported. This rare benign disease was first described by Rosai and Dorfman in 1969 and is characterized by histiocytic proliferation. It is seldom considered in the differential diagnosis of granulomatous diseases due to its rarity and histological similarity to other diseases. Extranodal manifestations of this disease are uncommon. Although no specific treatment can guarantee a sustained remission of this disease, surgery for loco-regional lesions can result in long-term symptomatic control and restoration of function. Both patients underwent endoscopic resection of the nasal polypoid lesions and have subsequently been free of recurrence. Loco-regional infiltration of the nasal cavity by Rosai-Dorfman disease is effectively managed by endoscopic resection.

Laryngopharyngeal sensory deficits and impaired pharyngeal motor function predict aspiration in patients irradiated for nasopharyngeal carcinoma.

To assess the contribution of laryngopharyngeal sensory deficits and impaired pharyngeal motor function to aspiration in patients irradiated for nasopharyngeal carcinoma.

Preoperative topical ofloxacin solution for tympanoplasty: a randomized, controlled study.

Objective To establish the efficacy of immediate preoperative ototopical ofloxacin eardrops in eradicating middle ear pathogens and improving operative outcome. Study Design Single-blind, randomized control study. Setting Tertiary referral center, ambulatory clinic, and hospital setting. Patients Consecutive patients with chronic suppurative otitis media for Type I tympanoplasty (myringoplasty). Interventions The patients were randomly assigned to 3 groups: Group A underwent 10-minute daily treatments with eardrops for 2 weeks before surgery, Group B underwent 3-minute daily treatments for 2 weeks before surgery, and Group C underwent no treatment. Main Outcome Measures Preoperative and perioperative bacteriology and success of the surgery as defined by an intact tympanic membrane in the eighth week postsurgery. Results There were 101 patients entered in the study. The preoperative, perioperative, and postoperative observation of discharge and quantity of the discharge were compared, and no differences were found among the groups (Kruskal-Wallis test). The perioperative culture results were analyzed and 18/21 (86%) became culture negative in Group A, 23/27 (85%) became culture negative in Group B, and 3/21 (14%) became culture negative in the control group (Group C versus Group A or Group B, &khgr; 2 tests p < 0.001). The success rates of surgery as defined by an intact tympanic membrane showed no difference: 28/33 (85%), 27/33 (82%), and 31/35 (89%) in Groups A, B, and C, respectively. The preoperative positive bacteriology rate in the surgical failures was 10/15 (67%), compared with 16/76 (21%) for the successful procedures (p < 0.001). Conclusion Our study has shown that ofloxacin successfully eradicates most bacterial flora preoperatively. We cannot, however, confirm the benefits of its preoperative usage in improving the graft success rate.

Polyotia--a rare external ear anomaly.

A rare case of polyotia in a 7-year old boy associated with first arch syndrome is reported. The accessory auricle formed a well defined helix and conchal bowl located anterior to a normal auricle and an atretic external auditory meatus. Surgical resection and reconstruction resulted in a good cosmetic outcome.

Contemporary Hearing Rehabilitation Options in Patients with Aural Atresia

Congenital aural atresia is the failure of development of the external auditory canal. It usually occurs in conjunction with microtia, which is the malformation of the auricle due to a failure of development of the external ear. Aural atresia, with or without microtia, may significantly affect the hearing and social life of the patients. It is important for every medical practitioner to be aware of the possible treatment options for hearing rehabilitation in this group of patients. In the era of modern technology, new choices, including Bone-Anchored Hearing Aid (BAHA) (Cochlear Ltd. and Oticon Medical), Vibrant Soundbridge (VSB) (MED-EL, Innsbruck, Austria), and Bonebridge system (BB) (MED-EL, Innsbruck, Austria), provide high-end alternatives to traditional Bone Conduction Hearing Aid and Auditory Canal Reconstruction. All these options have advantages and disadvantages, and they are appropriate for different patients and/or at different ages. This paper aims to provide an overview of the management of hearing rehabilitation in congenital aural atresia patients and a discussion of each treatment option.

Application of holmium yttrium aluminium garnet (YAG) laser in treatment of acquired posterior choanal atresia following radiotherapy for nasopharyngeal carcinoma

AIMS To report on the use of holmium yttrium aluminium garnet (YAG) laser in the treatment of acquired posterior choanal atresia following radiotherapy in patients with nasopharyngeal carcinoma. MATERIALS AND METHODS Five patients with acquired bilateral choanal atresia and two with unilateral choanal atresia in the posterior choanae were identified following treatment of nasopharyngeal carcinoma by external radiotherapy, from July 1998 to April 1999. The mean age was 44.6 years (range, 22-65 years). Two patients had stage two and five had stage three disease according to Hos classification. All patients received 66 Gy of external irradiation delivered to the nasopharynx and a mean dose of 61 Gy (39.8-72 Gy) to the neck. Five patients received an additional external boost of 20 Gy and two received 14 Gy delivered to the parapharyngeal region. Two other patients also received intracavitatory brachytherapy of 18 Gy delivered to the nasopharynx. One patient had concurrent chemotherapy by cisplatinum during external radiotherapy. The mean onset of nasal symptoms was 17 months (range, 2-38 months) following irradiation. All patients were treated by transnasal endoscopic holmium YAG laser resection. Merocel epistaxis packing and a modified nasopharyngeal tube were used to stent the nasal airway for two weeks post-operatively. RESULTS The mean follow up was 26.8 months (range, 20-32 months) after surgery. All patients were symptom free on follow up. Five patients (71 per cent) retained full patency in the posterior choanae. Two patients (28 per cent) had bilateral mild restenosis in the postnasal space, not requiring revision surgery. The surgical fields were almost bloodless. No adverse post-operative complications occurred, except for delayed nasal septal perforation in one patient and unilateral exposure of the septal cartilage in another; no further treatment was required in either patient. CONCLUSION Acquired posterior choanal atresia is an unusual complication following radiotherapy, and it can occur early after treatment. It can be successfully treated by transnasal endoscopic holmium YAG laser resection of the scar tissue, with minimal bleeding. A two week period of Merocel nasal packing and nasopharyngeal tube stenting was sufficient to prevent severe restenosis in the posterior choanae; nasal breathing through the tube lumen was possible during this time.

SILENT ASPIRATION AND SWALLOWING PHYSIOLOGY AFTER RADIOTHERAPY IN PATIENTS WITH NASOPHARYNGEAL CARCINOMA

There is a paucity of knowledge on dysphagia in patients with nasopharyngeal carcinoma postradiotherapy (NPC post‐RT). The purpose of this study was to establish silent aspiration occurrence, safe bolus consistency, and their relationship with swallowing physiology in patients with dysphagic NPC post‐RT.