Wen-Hung Wang

Narrowband Imaging for Early Detection of Malignant Tumors and Radiation Effect After Treatment of Head and Neck Cancer

OBJECTIVESnTo determine the value of narrowband imaging (NBI) screening for the early detection of head and neck squamous cell carcinoma (HNSCC) in patients who have received treatment and to assess the impact of radiotherapy on detection rates.nnnDESIGNnCross-sectional study.nnnSETTINGnTertiary referral center.nnnPATIENTSnFrom July 1, 2007, through February 28, 2008, a total of 206 patients with HNSCC underwent rhinolarynx videoendoscopic screening performed using conventional white-light and NBI systems during their routine postoperative sessions.nnnMAIN OUTCOME MEASUREnThe rate of detecting malignant tumors, depending on the anatomical site and stage of cancer and the history of radiotherapy after primary treatment.nnnRESULTSnWe identified 68 lesions by endoscopy in conventional white-light and/or NBI mode. Of these, 62 were histopathologically confirmed to be cancerous. The rates of detecting cancerous lesions by white-light and NBI modes were 100% and 97% for oral lesions, 69% and 100% for oropharyngeal lesions (P = .02), and 39% and 100% for hypopharyngeal lesions (P = .001), respectively. No difference was found between the 2 modes with regard to the detection of visible T1 to T4 tumors. However, NBI mode was significantly better than white-light mode for the detection of carcinoma in situ (P < .001).nnnCONCLUSIONnWe found that NBI-assisted endoscopy is highly useful for the detection of precancerous lesions in the oropharyngeal and hypopharyngeal mucosa and is not affected by a history of radiotherapy in patients with HNSCC.

Minimally invasive inlay and underlay tympanoplasty

PURPOSEnThe objective of this study is to understand the outcome of minimally invasive topical anesthetized transcanal inlay and underlay tympanoplasty, and to compare these 2 procedures in hearing result, take rate, perioperative pain, and operation time.nnnMATERIALS AND METHODSnThis is a retrospective study conducted from September 2003 to December 2006. Forty-eight tympanoplasty in 46 patients, 28 inlay and 20 underlay procedures, with small- to medium-sized tympanic membrane perforations without middle ear lesion, were studied in a tertiary referral center. Interventions included otologic examination, perioperative hearing evaluation, local anesthetized transcanal inlay, or underlay tympanoplasty. The outcome measurements were the following: the take rate and audiometric result at the last follow-up visit, perioperative pain, and duration of surgery. The statistical methods used were t test, Mann-Whitney U test, chi(2) test, and Fisher exact test.nnnRESULTSnThe take rate were 82.1% in the inlay group and 85% in the underlay group, without significant difference (P = .79) at the last follow-up visit. Air-bone gap closure was 6.3 +/- 2.5 dB in the inlay group and 9.3 +/- 3.2 dB in the underlay (P = .07). Linear analogue scale of perioperative pain was lower in the inlay group with significance (1.7 +/- 1.2 in the inlay and 4.6 +/- 1.9 in the underlay group, P < .001). The duration of the surgery was significantly shorter in the inlay group (31.8 +/- 13.9 minutes for the inlay group and 75.9 +/- 14.6 minutes for the underlay group, P < .001).nnnCONCLUSIONSnMinimally invasive topically anesthetized transcanal tympanoplasty provides satisfactory surgical and audiometric outcome both in inlay and underlay procedures. The take rate and extent of hearing recovery are similar in both groups. However, inlay tympanoplasty is superior to transcanal tympanoplasty because of less discomfort and shorter operation time.

Prospective variants screening of connexin genes in children with hearing impairment: genotype/phenotype correlation.

The crucial role of gap junctions, which are composed of connexin (CX) protein, in auditory functions has been confirmed by numerous studies. In this study, we investigate the prevalence and phenotype/genotype correlation of connexin (CX) gene family variants in a cohort of children with nonsyndromic hearing loss (HL). A total of 253 unrelated children with nonsyndromic HL were screened for the presence of variants in 6 genes of the CX gene family. The prevalence of CX gene variants in 253 patients was 19.7% (50/253). We found the frequency of a sloping audiometric configuration was significantly higher for children with GJB2 and GJB3 variants than for those with GJB4 and GJC3 variants (Adjusted ORxa0=xa04.89, pxa0<xa00.001). Conversely, the frequency of a flat audiometric configuration was significantly higher for children with GJB4 and GJC3 variants than for those with GJB2 and GJB3 variants (adjusted ORxa0=xa07.76, pxa0<xa00.001). The relative frequencies of multiplex families was significantly higher for children with GJB3 variants than for those with GJB2, GJB4, and GJC3 variants (Adjusted ORxa0=xa011.33, pxa0=xa00.003). Our results suggest the variants of GJC3, GJB4, and GJB3 may be the common genetic risk factor, after variants of GJB2, for the development of nonsyndromic HL in Taiwan. These data can be effectively applied to direct the clinical evaluation of children with CX gene variants.

Predictors of surgical and hearing long-term results for inlay cartilage tympanoplasty.

OBJECTIVEnTo determine the prognostic factors that affect surgical and audiologic outcomes in inlay tympanoplasty after long-term follow-up.nnnDESIGNnCase series study.nnnSETTINGnTertiary referral center.nnnPATIENTSnSixty-two patients who underwent 71 procedures were enrolled in the study. Patient ages ranged from 31 to 87 years (mean [SD] age, 61.2 [12.9] years). Mean (SD) follow-up was 635.7 (284.7) days. The inclusion criteria were (1) inlay cartilage tympanoplasty performed using local anesthesia via a transcanal route, (2) chronic otitis media with stable perforation, and (3) dry ear without middle ear disease.nnnMAIN OUTCOME MEASURESnThe success rate and hearing change at the last follow-up visit.nnnRESULTSnThe overall success rate was 87.3% at the last visit. Using multivariate analysis, sex, age, size of perforation, side of perforation, and the presence of diabetes mellitus and external auditory canal otomycosis did not affect the success. Smoking was the only independent factor for the prognosis of surgical outcome (odds ratio [OR], 8.16; 95% confidence interval [CI], 1.74-36.89; P < .006). On the other hand, age (OR, 6.62; 95% CI, 1.13-38.47; P = .03) and perforation size (OR, 0.11; 95% CI, 0.10-0.79; P = .03) were independent factors for the prognosis of audiologic outcomes.nnnCONCLUSIONSnThe frequency of failure was significantly higher for smokers than for nonsmokers. To quit smoking is highly recommended preoperatively for individuals scheduled for chronic otitis media inlay tympanoplasty intervention. Younger patients and those with larger perforations (>50%) were more likely to benefit from this operation.

Reconstruction of Pharyngeal Defects with a Submental Island Flap after Hypopharyngeal Carcinoma Ablation

Purpose: This study aimed to evaluate the oncologic and functional results of pharyngeal defect reconstruction using a submental island flap in hypopharyngeal cancer patients. Methods: Functional and oncologic results were assessed in 14 patients based on a retrospective chart review. Speech function grading was as follows: 1 = excellent (>70% intelligibility); 2 = good (40–70% intelligibility), and 3 = poor (<40% intelligibility). Swallowing function score was stratified as 1 = full diet (excellent), 2 = soft diet (excellent-good), 3 = liquid diet (good), 4 = combined oral and gastric tube (good-poor), and 5 = gastric tube-dependent (poor). Results: All flaps survived well. Salivary fistula with infection was found in 1 patient and treated conservatively. The mean length of hospitalization, and speech and swallowing scores according to laryngeal invasion in 11 patients after partial pharyngectomy were 21.63 ± 4.31 versus 11 ± 2.00 (p = 0.003), 2.38 ± 0.5 versus 1.67 ± 1.16 (p = 0.18) and 3.88 ± 0.84 versus 3.33 ± 1.53 (p = 0.46), respectively. Speech and swallowing returned to good-excellent in 63.6% and good in 45.5% of patients after surgery. Conclusions: The submental island flap is reliable for reconstructing laryngopharyngeal defects after ablation of hypopharyngeal cancer. Speech and swallowing are restored to good function in half of the patients. Laryngeal involvement of the cancer is predictive of longer hospitalization.

Identification of Novel Variants in the Cx29 Gene of Nonsyndromic Hearing Loss Patients Using Buccal Cells and Restriction Fragment Length Polymorphism Method

The crucial role of gap junctions, which are composed of connexin (Cx) protein, in auditory functions has been confirmed by numerous studies. Cx29 is a relatively new member of the Cx protein family. In this article, we report variants of the Cx29 gene in 253 unrelated Taiwanese patients with nonsyndromic hearing loss. Thirteen (5.14%) of the 253 patients had variants of Cx29. Five sequence changes (c.43C→G, c.230G→C, c.525T→G, c.781 + 62G→A and c.*2T→G) in the Cx29 gene were detected in the study, of which 3 (c.43C→G, c.230G→C and c.525T→G) were novel variants. One novel compound heterozygote missense variant, c.[43C→G(+) 230G→C], was identified in the Cx29 gene carried by 1 patient, and this variant appears to have been inherited from the mother’s chromosome. In addition, for diagnostic purposes, we developed a restriction fragment length polymorphism method using NaeI and StyI to identify c.43C→G and c.525T→G specific variants of the Cx29 gene, respectively. On the basis of the above results, we suggest that the c.[43C→G(+)230G→C] compound heterozygous variant of Cx29 may be a risk factor for the development of hearing loss in Taiwanese and that the restriction fragment length polymorphism method developed will be clinically useful in identifying variants of the Cx29 gene in patients with hearing loss.

Perforator flap from proximal lateral leg for head and neck reconstruction.

INTRODUCTIONnPerforator flap transfer has the benefits of minimal donor site morbidity and customization in design. This study reports on the proximal lateral leg perforator (PLLP) flap transfer for head and neck reconstruction.nnnMATERIALS AND METHODSnFrom January 2000 through December 2009, 18 patients underwent head and neck reconstruction with the PLLP flap, including 16 males and 2 females ranging in age between 32 and 80 years old. The mean follow-up time was 9.8 months.nnnRESULTSnMother vessels of PLLP flaps can arise 77.8% (14/18) from the peroneal system, 11.1% (2/18) from the posterior tibial system, or 11.1% (2/18) from the common popliteal system. The skin dimension ranges from 4 cm × 7 cm to 6.5 cm × 18 cm. The mean of the perforator size is 1.96 mm (1.5 mm to 2.3 mm). The mean of the pedicle length is 6.96 cm (4.5 cm to 10 cm). All flaps survived completely except one flap that had partial necrosis.nnnCONCLUSIONSnThe PLLP flap for head and neck reconstruction offers versatility in design, diverse tissues for composition, a two-team approach, and negligible donor site morbidity, and it spares major vessels. The unpredictable pedicle length and the feasibility for microvascular anastomosis in the perforator level can be adapted with further experience and refining techniques.

Novel expression patterns of connexin 30.3 in adult rat cochlea

Mutations of the GJB4 gene, encoding connexin 30.3 (CX30.3), are associated with skin disorders. Recently, this gene was also detected in deaf individuals without skin disorders. However, the functional roles of CX30.3 in the cochlea remain unclear. A primary step toward understanding the role of CX30.3 in hearing and its dysfunction is the documentation of its cellular and sub-cellular locations within the cochlea. In the present study, we located and determined the cellular expression of Cx30.3 within the rat cochlea by using a polyclonal anti-Cx30.3 antibody. Expression of the Cx30.3 protein was detected in the spiral limbus, spiral ligament, spiral ganglion, and stria vascularis by immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) analyses. Our results indicate the presence and localization of Cx30.3 in the rat cochlea. Knowledge of the spatial distribution of Cx30.3 will provide important insights into its role in the cochleae and normal auditory function.

Detection of superior semicircular canal dehiscence by virtual endoscopy: a pilot study.

Objective To examine the threshold of virtual endoscopy in the confirmation of superior semicircular canal dehiscence (SSCD). Study Design Retrospective case series. Subjects Three definite SSCD subjects, two possible SSCD subjects, and five control subjects. Methods High-resolution temporal bone computed tomography and virtual endoscopy were performed in all subjects. Main outcome measures were to evaluate both intrajudge and interjudge reliability and to compare the closed threshold of diseased side with the contralateral side, both ears of patients with those of the control group. Results The interjudge reliability between two observers was 0.934 and 0.926 (P < 0.001). The intrajudge reliability for two reviews were 0.916 and 0.902 (P < 0.001). The affected ear thresholds significantly differed from those of both unaffected ears and normal controls (P < 0.001 for both comparisons). Thresholds of unaffected ears and normal controls did not differ (P > 0.05). Conclusion Virtual endoscopy with critical evaluation of the consistent closed threshold provides an additional role in SSCD diagnosis.

Longitudinal Hearing Outcomes between Inlay Butterfly Cartilage and Underlay Fascia Tympanoplasty

BACKGROUND: Few studies in the literature have addressed comparing longitudinal hearing results between inlay cartilage and underlay tympanoplasty.METHODS: A total of 60 ears of 54 patients were enrolled. The mean follow-up time of short term and long term hearing examination was 182.64 and 565.67 days.RESULTS: 0.25K, 0.5K and 4K significantly improved in short-term and long-term results (p ＜ 0.05) for inlay group and 0.25 K, 0.5 K and 1 K in short-term and long-term results (p ＜ 0.05) for underlay group. The postoperative ABGs significantly improved at 0.5 K, 1 K and 4 K in short-term and long-term hearing tests for inlay group and only in long-term for underlay group.CONCLUSIONS: The acceptable hearing results were achieved in short-term period and improved ABG closure ratios continued to increase over time for both groups. Frequency-specific hearing improved at 0.25 K, 0.5 K, and ABG closure increased at 0.5K, 1 K and 4 K in long-term result for both groups.