Yau Hui

Chinese tonal language rehabilitation following cochlear implantation in children.

Cantonese language rehabilitation in 28 prelingually deaf children who underwent cochlear implantation was evaluated. All patients were implanted with multichannel devices and the operations went smoothly. They all had improved scores on audiological assessments and speech perception tests. The speech evaluation tests included the recognition of sounds, vowels, consonants and tone. Sentence recognition and story comprehension were both improved after training for 2 years. Cochlear implantation is a useful measure for the speech rehabilitation of prelingually profound deaf children when hearing aids are of no benefit. The multichannel implant device is of clinical significance in the rehabilitation of those patients using tonal language.Cantonese language rehabilitation in 28 prelingually deaf children who underwent cochlear implantation was evaluated. All patients were implanted with multichannel devices and the operations went smoothly. They all had improved scores on audiological assessments and speech perception tests. The speech evaluation tests included the recognition of sounds, vowels, consonants and tone. Sentence recognition and story comprehension were both improved after training for 2 years. Cochlear implantation is a useful measure for the speech rehabilitation of prelingually profound deaf children when hearing aids are of no benefit. The multichannel implant device is of clinical significance in the rehabilitation of those patients using tonal language.

Primary Closure of Pharyngeal Remnant After Total Laryngectomy and Partial Pharyngectomy: How Much Residual Mucosa Is Sufficient?

After total laryngectomy with or without partial pharyngectomy, the remaining pharyngeal defect can be repaired either by primary closure or with additional tissue, depending on the amount of pharyngeal tissue remnant available. The aim of this study was to determine the minimum width of the pharyngeal remnant that could be safely closed primarily without causing difficulty in swallowing.

Early changes of auditory brain stem evoked response after radiotherapy for nasopharyngeal carcinoma--a prospective study.

A prospective study of the effect of radiotherapy for nasopharyngeal carcinoma on hearing was carried out on 49 patients who had pure tone, impedance audiometry and auditory brain stem evoked response (ABR) recordings before, immediately, three, six and 12 months after radiotherapy. Fourteen patients complained of intermittent tinnitus after radiotherapy. We found that 11 initially normal ears of nine patients developed a middle ear effusion, three to six months after radiotherapy. There was mixed sensorineural and conductive hearing impairment after radiotherapy. Persistent impairment of ABR was detected immediately after completion of radiotherapy. The waves I-III and I-V interpeak latency intervals were significantly prolonged one year after radiotherapy. The study shows that radiotherapy for nasopharyngeal carcinoma impairs hearing by acting on the middle ear, the cochlea and the brain stem auditory pathway.

Otorrhea after grommet insertion for middle ear effusion in patients with nasopharyngeal carcinoma

PURPOSE To document the incidence of complications after myringotomy and grommet insertion in patients with nasopharyngeal carcinoma. The focus is on the incidence of otorrhea and perforation. The possible risk factors for these conditions and treatment response were studied. MATERIALS AND METHODS We reviewed the records on 206 ears of 163 patients who suffered from nasopharyngeal carcinoma and underwent myringotomy and grommet insertion in a 7-year period. The follow-up period ranged from 4 weeks to 78 months (median, 9 months). RESULTS The overall incidence of otorrhea in these ears was 38%. Patients with nasopharyngeal carcinoma (NPC) had a significantly high incidence of postoperative discharge (chi2 test, P<.0001) compared with other patients who underwent myringotomy and grommet insertion. The mean interval between myringotomy and otorrhea was 19.8 weeks. Forty-seven per cent of the ears with a discharge developed otorrhea within 1 month. In 42%, the otorrhea responded to treatment and the ears became dry. After extrusion of the grommet, 29% of those ears with otorrhea ended with an eardrum perforation, and 24% of the ears showed recurrent effusion. CONCLUSIONS For patients with NPC who underwent myringotomy, there was a significant risk of otorrhea (49%) and persistent perforation (29%), and these complications were difficult to manage. We conclude that myringotomy and grommet insertion should not be routinely offered to NPC patients with middle ear effusion.

Risk factors of tracheostomal recurrence after laryngectomy for laryngeal carcinoma

BACKGROUND Tracheostomal recurrence after total laryngectomy for laryngeal carcinoma has a poor prognosis. The independent risk factors of tracheostomal recurrence are, however, not well documented. METHODS This is a multivariate analysis of the risk factors of tracheostomal recurrence after total laryngectomy for 322 laryngeal squamous cell carcinomas. The factors included in the analysis were sex, age, tumor stage, sites of tumor involvement, preoperative airway obstruction, preoperative tracheostomy, extent of surgical resection, radiotherapy, and pathological resection margin. RESULTS Seventeen (5%) patients developed tracheostomal recurrence. Univariate analysis showed that preoperative airway obstruction, subglottic involvement, and postcricoid extension were significant factors associated with tracheostomal recurrence. Multivariate analysis using logistic regression method showed that both subglottic and postcricoid involvement were independent predisposing factors for tracheostomal recurrence. The tracheostomal recurrence rates were 2% in patients without the risk factor and 10% in patients with the presence of one or both risk factors. CONCLUSIONS Subglottic and postcricoid involvement were independent risk factors for tracheostomal recurrence.

Correlation of Pure Tone Audiogram Results and Hearing Benefit of Tympanoplasty for Chronic Suppurative Otitis Media

The aim of this study was to evaluate the correlation between pure tone audiogram results and the subjective sensation of hearing benefit of patients who had tympanoplasty for chronic suppurative otitis media. This is a prospective study of 115 patients who had tympanoplasty between 1992 and 1994. The outcome, including a pure tone audiogram and the subjective sensation of hearing benefit, was evaluated at 1 year after operation. There were 63 (55%) patients with subjective hearing benefit after the tympanoplasty. The subjective sensation of hearing benefit correlated with the magnitude of the air conduction (AC) threshold reduction, and increased from 39% for an AC reduction of less than or equal to 10 dB to 100% for an AC reduction of more than 30 dB. The effect of the interaural AC threshold difference on the subjective sensation of hearing was not significant; improvement was felt by 92% of patients when the operated ear became the better hearing ear, and by 73% of patients when the operated ear remained the worse hearing ear. There was considerable discrepancy between the subjective hearing benefit and the pure tone audiogram results. A combination of parameters, including the air-bone gap, the AC threshold, and the subjective hearing change, is recommended in reporting the results of tympanoplasty.

Comprehensive analysis of pharyngeal recurrence of laryngeal carcinoma after total laryngectomy

PURPOSE This study analyzes the incidence, risk factors, treatment results, and prognosis of local recurrence at the pharynx after total laryngectomy for laryngeal carcinoma. PATIENTS AND METHODS The records of 292 patients who underwent total laryngectomy for the treatment of laryngeal carcinoma between January 1978 and December 1990 were reviewed. RESULTS Of these 292 patients, there were 24 patients who developed local recurrence at the pharynx. The 5-year actuarial cumulative local recurrence rate was 10%. There were 17 cases of pharyngeal recurrence alone, five cases of pharyngeal and nodal recurrence, one case of pharyngeal and tracheostomal recurrence, and one case of pharyngeal and distant metastasis. Ten (42%) patients were salvaged surgically; the 5-year actuarial survival rate after surgical salvage was 53%. The other 14 patients were treated with palliative treatment, and all died of tumor, with the longest period of survival being 28 months. CONCLUSION Surgical salvage of pharyngeal recurrence has acceptable results. Close monitoring of patients is important to have an early diagnosis of salvageable recurrence.

Neurothekeoma of the paranasal sinuses in a 3-year-old boy

Neurothekeoma is a benign soft tissue tumor commonly located on the skin. In this report, a 3-year-old boy presented with restricted right eye movement and decrease in visual acuity. The patient was found to have a 6-cm neurothekeoma involving the maxillary and ethmoid sinuses. To our knowledge, this is the first reported case of neurothekeoma with involvement of the maxillary and ethmoid sinuses. This uncommon lesion should be considered as the differential diagnosis of pediatric soft tissue tumors in the head and neck region.

Permeatal Temporalis Fascia Graft Harvesting for Minimally Invasive Myringoplasty

INTRODUCTION Minimally invasive surgery is advocated for its minimal external wound, rapid healing, and better cosmetic results. In myringoplasty, the permeatal approach is the least invasive approach to small to medium-sized central tympanic membrane perforations. In this approach, however, a separate skin incision is necessary for harvesting an autogenous graft, usually the tragal perichondrium, the cubital vein, or the temporalis fascia. These methods all have the disadvantage of an additional skin incision and a lengthened operating time. To solve this problem, allogenous fascia grafts have been used for myringoplasty, but these are now no longer popular because of the risk of transmission of viable infectious particles such as the human immunodeficiency virus and Jakob-Creutzfeldt disease. Research into graft material alternatives is still ongoing to reduce the operating time and improve cosmetic result. Recently, the acellular dermal allogenous graft was evaluated for myringoplasty in animal models. All in all, the autogenous temporalis fascia remains the preferred graft material for its superior tissue quality, its ready availability in the operative field, and the excellent results in myringoplasty. This report describes a new technique of permeatal temporalis fascia graft harvesting, which allows a minimally invasive myringoplasty to be successfully performed.

ENT management of a child with CHARGE association.

The acronym CHARGE is used to describe specific congenital birth defects in children: colobomata, heart defect, atresia of the choanae, retarded growth or development, genital hypoplasia, and ear anomalies or deafness. CHARGE association with hearing impairment is a challenge to ENT surgeons. We report the case of a child with CHARGE association who underwent cochlear implantation using an unconventional surgical approach and review the postoperative speech perception results. The benefits of cochlear implantation in children with multiple congenital defects are discussed.