Virgil Yue

Diagnosis of peritonsillar infections : a prospective study of ultrasound, computerized tomography and clinical diagnosis

Peritonsillar infections include cellulitis and abscess (quinsy). Clinical diagnosis is often supplemented by diagnostic drainage (aspiration or incision) in an effort to distinguish abscess from cellulitis. In a prospective study of 14 patients we have shown that clinical impression alone is unreliable (sensitivity 78 per cent, specificity 50 per cent). Computerized tomography (CT) (sensitivity 100 per cent, specificity 75 per cent) and intraoral ultrasound (sensitivity 89 per cent, specificity 100 per cent) are much more reliable. We propose that intraoral ultrasound could play a useful role in the clinical assessment of peritonsillar infections helping to improve accuracy in distinguishing abscesses from cellulitis.

Prevalence of otitis media with effusion in multicultural schools in Hong Kong

The prevalence of otitis media with effusion (OME) in Asia has only been studied in a limited fashion. This preliminary study forms part of a larger study aiming to establish the prevalence of OME in Hong Kong. One hundred and seventy-seven children (from multicultural schools) between the ages of five and 6.03 years were screened for OME otoscopy and tympanometry. Nine positive screens (5.1 per cent) were obtained for OME. Within this mixed ethnic group, Chinese children had a significantly lower point prevalence (1.3 per cent) than Caucasian children (9.5 per cent) (p < 0.05). Although the point prevalence from this mixed ethnic group of children was significantly higher (p < 0.05) than that of local Chinese school children (1.95 per cent) by the same group of investigators, the point prevalence in the ethnic Chinese children was comparable. The reason for the lower prevalence of OME in the Chinese population needs further research.

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.

Performance of older adult cochlear implant users in Hong Kong

Objective: To compare the speech perception performance of older adults with that of adult cochlear implant (CI) recipients in a single center in Hong Kong. Design: A retrospective study of 14 older adult CI users (age at operation, 56 to 77 yr old) and 14 adults (age at operation, 18 to 53 yr old) who received CIs and were matched for duration of profound deafness. The outcome indicator of their performance includes ratings of 0 to 7 on the speech perception category (SPC), which is based on their speech perception test scores at 6, 12, and 24 mo after implantation. Statistical analyses were used to compare SPC ratings between the two groups at the tested intervals. Results of specific speech perception tests between the two groups were also analyzed at the tested intervals, along with the rate of improvement of the specific tasks from 0 to 6 mo, 0 to 12 mo, and 0 to 24 mo postoperatively. Multiple regression analysis was used to assess which variables would independently predict the outcome performance of CIs. Results: There were no significant differences (p = 0.228 to 0.724) between the SPC ratings of the adult group and the older adult group at the tested intervals. The adult group scored significantly better in the postoperative 0- to 6-mo improvement rate (p = 0.047) in open-set sentence recognition, but the improvement decelerated so that it was comparable with that of the older adult group by 12 mo after implantation. The adult group also scored significantly better (p = 0.031) in tone identification at 24 mo after implantation compared with the older adult group. The majority of the speech perception task scores, and rates of improvement were comparable between the older adult group and the adult group at the tested time intervals. Multiple regression analysis revealed a significant relationship (p = 0.025) between the outcome indicator of everyday sentence recognition at 12 mo after implantation and the outcome predictor of duration of profound deafness. However, the goodness of fit (r2) of this model was 0.11, suggesting that only 11% of the variance in 12-mo postoperative everyday sentence recognition was explained by duration of profound deafness, leaving a large proportion of unexplained variance. Conclusion: The overall performance of the older adult CI recipients is comparable with that of the adult group. Duration of profound deafness, irrespective of age, is accountable for a small part of the outcome. Because older adults as well as younger adults can benefit from CIs, age should not be the predominant factor for declining CIs among older adults.

Age and outcome of cochlear implantation for patients with bilateral congenital deafness in a Cantonese-speaking population.

Objective: To evaluate the effect of age at implantation by assessment of speech perception in cochlear implant users with bilateral congenital deafness. Design: A retrospective cohort analysis of 60 cochlear implant users (age at implantation, 1.01 to 22.0 yr) who have at least 2 yr of experience. Their outcome performance was defined by the change in i) speech perception category (SPC) score based on postoperative assessment results and ii) the type of education attended after implantation. The association of age at implantation with SPC scores was analyzed at different ages at implantation (2, 3, 4, 5, and 6 yr old). The SPC scores for a particular age at implantation were compared at 6, 12, and 24 mo after implantation. The impact of age at implantation on choice of education was evaluated by analyzing the transition from a school for the deaf to mainstream education for the 45 children who were operated on before the age of 10, because older children are less likely to make such a change. Results: Children implanted at the ages of 2, 3, 4, 5, and 6 yr all obtained significant improvements in SPC scores 24 mo after implantation. The greatest improvement was noted at 24 mo after implantation among those operated on before age 3. For all age groups, improvement at 24 mo after implantation is greater than at 12 mo, whereas the latter is greater than the improvement noted at 6 mo after implantation. Comparison of children implanted before the age of 3 and between ages 3 and 10 showed a significant difference in the choice of education after implantation. Children who were implanted before the age of 3 were more likely to attend mainstream education after implantation. Conclusion: Results from the present study are consistent with the current belief that implantation at a younger age provides greater benefit. The proportion of children attending mainstream education was significantly higher for those implanted before age 3, which may be a potential benefit to early implantation for relieving the burden of governments in providing special education.

Cochlear implantation for post-irradiation deafness

Irradiation to the head and neck area can lead to various possible otological complications. Nasopharyngeal carcinoma (NPC), being a prevalent disease in Hong Kong and Southern China, is the commonest indication for irradiation that we have encountered leading to such complications. Conventional radiotherapy for NPC, with one anterior facial field and two lateral opposing facial fields, subject both temporal bones to significant irradiation. Occasionally, a profound degree of sensorineural hearing loss necessitates the consideration of cochlear implantation for hearing rehabilitation. This paper summarizes our experience and results of cochlear implantation for a series of patients who had developed profound deafness subsequent to radiotherapy for treatment for NPC.

Long-term results in cochlear implantation in chronic suppurative otitis media

Cochlear implantation in patients suffering from bilateral chronic suppurative otitis media (CSOM) remains a unique surgical challenge to otorhinolaryngologists as the operation is performed in a potentially septic environment that may compound the risk of implant failure as well as creating a portal of entry for sepsis into the central nervous system. And, the surgeons have to eradicate the infection and to implant a device in a previously operated site with distorted anatomy. Moreover, the patients have to be followed up in the long term to look for the recurrence of the diseases. A variety of techniques have been described to facilitate cochlear implantation in the presence of CSOM, with particular emphasis on middle-ear obliteration and blind-sac closure of the external auditory canal (EAC) (Hamzavi et al., 2001; El-Kashlan et al., 2003). This paper summarizes the long-term results in cochlear implantations in patients with bilateral CSOM in the Prince of Wales Hospital with emphasis on the use of vascularized temporalis fascial flap (Hong Kong Flap) (van Hasselt et al., 1995) in mastoid cavities without blind-sac closure of the EAC.

Teenage implantees: experience in Hong Kong Chinese

A retrospective analysis of all implantees in a single centre in Hong Kong who were between the ages of 10 and 18 at the time of implant surgery from 1995 to 2002 was performed. The results of speech perception tests were analysed and discussed. The materials used were Speech Perception Assessment for Cantonese (SPAC) (Cheung and Lee, 1996) and Hong Kong Speech Perception Test Manual (Cochlear Implant Working Group, 2000) with the tests performed in the quiet setting. The former was adopted for children and adults of age 16 and above while the latter was for children under the age of 15. The speech perception category (SPC) developed by the Melbourne group was also used to compare preand postoperative outcomes.