Yueng-Hsiang Chu

Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases: Sudden sensorineural hearing loss and hyperbaric oxygen therapy

Clin. Otolaryngol. 2011, 36, 121–128

Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases.

Clin. Otolaryngol. 2011, 36, 121–128 n n n nObjective:u2002 To investigate the necessity of routine application of hyperbaric oxygen therapy for sudden sensorineural hearing loss. n n n nDesign/setting and participants:u2002 A retrospective chart review looked at 465 patients, with 353 of them receiving pharmacologic treatments alone. Among these patients, 76 underwent systemic steroid treatment only (steroid group) and 277 received systemic steroids and dextran (steroid–dextran group). The remaining 112 patients were treated with hyperbaric oxygen in addition to pharmacologic agents (steroid–dextran–hyperbaric oxygen group). n n n nMain outcome measures:u2002 The outcome was determined by comparing the difference of pure-tone thresholds and absolute hearing gains after treatment calculated at each audiometric octave frequency or grouped frequencies of audiograms. On the basis of the severity of initial hearing loss, patients were classified at three scales of hearing impairments measured in decibels hearing level (dBHL): ≦70 dBHL, less severe; 71–90xa0dBHL, severe; and ≧91xa0dBHL, profound. The outcomes of their hearing recovery were classified into three recovery grades: good, fair and poor. n n n nResults:u2002 In those patients with initial hearing loss >90xa0dBHL, the addition of hyperbaric oxygen to steroid–dextran gave a significant hearing gain difference (Pxa0=xa00.030) by showing a greater hearing gain of 24.5xa0±xa02.7xa0dB compared with steroid only (12.9xa0±xa03.7xa0dB) or steroid–dextran (15.6xa0±xa02.7xa0dB). This outcome was confirmed when we compared the outcome using the recovery grading; steroid–dextran–hyperbaric oxygen group showed that more patients with initial profound (≧91xa0dBHL) hearing loss responded to hyperbaric oxygen treatment by exhibiting good and fair recoveries (2% and 70%) as compared with steroid only (0% and 42%) or steroid–dextran (8% and 46%) groups (Pxa0=xa00.043), while the patients with initial severe (71–90xa0dBHL) and less severe (≦70xa0dBHL) hearing loss responded to the addition of hyperbaric oxygen treatment with less favourable recoveries. Furthermore, the addition of dextran in steroid–dextran group showed no significant benefit compared with the steroid group (Pxa0=0.435). n n n nConclusions:u2002 When applied as an adjuvant to pharmacologic agents, hyperbaric oxygen benefits patients with initial profound sudden sensorineural hearing loss. Therefore, we recommend the routine application of hyperbaric oxygen in conjunction with pharmacologic agents for those patients. The addition of dextran to steroid has no benefit and cannot be recommended.

Reconstruction of hypopharyngeal defects with submental flap after laryngopharyngectomy.

The submental flap has rekindled interest in using cervical flaps for reconstruction of head and neck defects. In this article, the authors present their experience of using this flap for hypopharyngeal defects after laryngopharyngectomy. This is a retrospective study of six patients who underwent hypopharyngeal defect reconstruction with submental flap from 2008 to 2011, operated upon by a single surgeon (JC Lee). The flap was used primarily to reconstruct defects after tumor extirpation. The maximum flap size was 12xa0×xa07xa0cm and the minimum size was 9xa0×xa04xa0cm (average, 10.5xa0 ×xa05.3xa0cm). No flap failures were observed. All the donor site defects were closed primarily. Two patients developed a small pharyngocutaneous fistula that resolved spontaneously. No other complications were observed. After speech reeducation, all achieved a good-quality, understandable artificial voice. All patients were able to eat by mouth without the need for tube feeding. The submental flap is an excellent alternative in the reconstruction of hypopharyngeal defects because of its reliability, versatility, pliability, and relative ease of application. Our initial reports confirm that this kind of reconstruction is feasible and time-saving, and restored a good quality of life.

Multiple-Parameter Evaluation Demonstrates Low Donor-Site Morbidity After Submental Flap Harvesting

PURPOSEnThe objective of this study was to implement a scoring system to analyze the authors experience of donor-site morbidity after harvesting a submental flap for the reconstruction of surgical defects at the head and neck region after oncologic resection.nnnMATERIALS AND METHODSnA retrospective case series study was conducted of patients who underwent reconstruction with a submental flap at the Tri-Service General Hospital (Taipei, Taiwan) from 2008 through 2012. Five parameters representing donor-site morbidity (whistling, smiling, neck extension, beard change, and esthetic outcome) were evaluated with a scoring system developed by a blinded panel of 2 clinicians and the patients. Scores were analyzed and compared between patient subgroups.nnnRESULTSnTwenty-two patients (20 men and 2 women; mean age, 56 yr) underwent reconstruction with a submental flap after head and neck tumor ablation. Primary lesion sites included the oral cavity (13 patients), pharynx (6 patients), larynx (1 patient), neck (1 patient), and sinus (1 patient). The means of all 5 parameters evaluated were higher than 8 on a scale of 0 to 9 (whistling, 8.7; smiling, 8.7; beard change, 8.9; neck extension, 8.2; esthetic outcome, 8.2), showing that submental flap harvesting led to low donor-site morbidity.nnnCONCLUSIONSnDonor-site morbidity after submental flap harvesting was evaluated with a scoring system measuring 5 parameters, namely whistling, smiling, beard change, neck extension, and esthetic outcome. In general, donor-site morbidity was very low. This implemented system and these findings will be helpful in future reconstructive surgical planning and management.

Regulation of tumor progression via the Snail-RKIP signaling pathway by nicotine exposure in head and neck squamous cell carcinoma.

Recent studies suggest that long‐term exposure of the carcinogen 4‐methylnitrosamino‐1–3‐pyridyl‐1‐butanone (NNK) found in tobacco smoke is involved in the progression of head and neck squamous cell carcinoma (HNSCC). The underlying nicotine‐mediated mechanism remains unclear.

Granular cell tumor of the hypopharynx.

A 29-year-old female had a lump sensation in her throat for several months. There was no history of endotracheal intubation or laryngeal surgery. Videolaryngoscopy (Fig 1) revealed a gray, sessile tumor in the postcricoid region of the hypopharynx associated with free movement of bilateral vocal folds. The patient underwent laryngomicrosurgery, and the neoplasm was excised in total with a carbon dioxide laser. Grossly, the tumor was well circumscribed, with a dimension of approximately 0.6 0.4 0.3 cm. Microscopically, it was characterized by tumor cells containing numerous fine cytoplasmic granules and scattered large eosinophilic globules (Fig 2). Histochemical staining was positive for S-100 protein and periodic acidSchiff. The postoperative course was uneventful, and there was no recurrence 14 months after the operation.

The use of adjunctive traditional Chinese medicine therapy and survival outcome in patients with head and neck cancer: a nationwide population-based cohort study.

BACKGROUNDnTraditional Chinese medicine (TCM) is widely used in the treatment of patients with several types of cancer. However, no large-scale clinical studies have evaluated whether TCM is associated with better survival in patients with head and neck cancer (HNC).nnnMETHODSnThe Taiwan National Health Insurance Research Database was used to conduct a retrospective cohort study of patients with HNC between 2001 and 2011. The patients with HNC were separated into TCM users and non-users, and Cox regression models were applied to determine the association between the use of TCM and survival outcome.nnnRESULTSnThe TCM and comparison cohorts comprised data for 2966 and 2670 patients, respectively. The mean age was 51.3 years in the TCM cohort and 51.7 years in the comparison cohort. Multivariate analysis demonstrated that the use of TCM was significantly associated with lower risk of all-cause mortality by 32% (adjusted hazard ratio, 0.68; 95% confidence interval, 0.62-0.75). Patients with longer TCM use had a lower mortality rate (P for trendu2009<u20090.001).nnnCONCLUSIONSnOur study showed that adjunctive therapy with TCM is associated with higher survival outcome. However, some limitations exist, such as the lack of information of cancer stage. In addition, causality cannot be assessed with this retrospective study. A randomized controlled trial to test the effect of adjunctive TCM therapy in HNC patients is needed.

Management of different kinds of head and neck defects with the submental flap for reconstruction

Head and neck surgeries often accompany with moderate-sized defects that require time-consuming reconstructions by free flaps. The submental flap is a versatile and time-effective option for reconstruction of orofacial defects providing acceptable cosmetic and functional results without requiring microsurgical techniques. A retrospective case series study of patients who underwent reconstruction with the submental flap between 2009 and 2013 was conducted. There were 36 patients (33 men and 3 women), with a mean age of 56.4 years, enrolled in this study. The primary lesion sites included oral cavity (24 patients), pharynx (8 patients), larynx (2 patients), neck (1 patient) as well as maxillary sinus (1 patient). All flaps were harvested as the myocutaneous flaps. All donor sites were closed primarily without the need of additional surgery. No complete loss of the flap was encountered and two cases developed marginal necrosis of the flap. The submental flap had a reliable pedicle and had minimal donor-site morbidity. It is an excellent flap option for patients with small- to medium-sized defects in head and neck region.

The correlation between lipoprotein ratios and hearing outcome in idiopathic sudden sensorineural hearing loss patients

Recent reports have identified hypercholesterolaemia as a significant risk factor for idiopathic sudden sensorineural hearing loss (ISSNHL). Therefore, we investigated whether lipid profiles and lipoprotein ratios are correlated with the prognosis of hearing recovery in ISSNHL patients.

Automatic recognizing of vocal fold disorders from glottis images

The laryngeal video stroboscope is an important instrument to test glottal diseases and read vocal fold images and voice quality for physician clinical diagnosis. This study is aimed to develop a medical system with functionality of automatic intelligent recognition of dynamic images. The static images of glottis opening to the largest extent and closing to the smallest extent were screened automatically using color space transformation and image preprocessing. The glottal area was also quantized. As the tongue base movements affected the position of laryngoscope and saliva would result in unclear images, this study used the gray scale adaptive entropy value to set the threshold in order to establish an elimination system. The proposed system can improve the effect of automatically captured images of glottis and achieve an accuracy rate of 96%. In addition, the glottal area and area segmentation threshold were calculated effectively. The glottis area segmentation was corrected, and the glottal area waveform pattern was drawn automatically to assist in vocal fold diagnosis. When developing the intelligent recognition system for vocal fold disorders, this study analyzed the characteristic values of four vocal fold patterns, namely, normal vocal fold, vocal fold paralysis, vocal fold polyp, and vocal fold cyst. It also used the support vector machine classifier to identify vocal fold disorders and achieved an identification accuracy rate of 98.75%. The results can serve as a very valuable reference for diagnosis.