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ABSTRACT: A 57-year-old man presented with odynophagia for 1 week was referred for FDG PET/CT scan to rule out recurrent hypopharyngeal cancer. The FDG PET/CT showed hypermetabolic lesions in hypopharyngeal area and adjacent cervical spine with pneumorrhachis, the presence of intraspinal air, on attenuation CT images, which might indicate a life-threatening infection. An emergency MRI confirmed the presence of cervical spondylodiscitis with an epidural abscess. The patient rapidly progressed to quadriplegia and difficulty voiding on the same day as the PET/CT scan, leading to emergent operation. The patient received antibiotics treatment and discharged 4 months later without evidence of cancer recurrence.
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Neoplasias Hipofaríngeas , Pneumorraque , Masculino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fluordesoxiglucose F18 , Tomografia Computadorizada por Raios X/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodosRESUMO
The presenting symptoms of sinonasal lymphoma are usually similar to those of benign inflammatory diseases. Adequate amount of biopsy tissue is required for a definitive diagnosis because tumor coexisting with necrosis or inflammation is not uncommon. Therefore, the diagnosis of sinonasal lymphoma is a challenge for rhinologists. Thirty-two patients diagnosed as having sinonasal lymphoma from 1990 to 2010 in our hospital were included in this study. The presenting symptoms of these patients included nasal obstruction, rhinorrhea, bloody discharge/epistaxis, post nasal drip, facial swelling, neck mass, orbital symptoms, fever, and body weight loss. The average period between patients' awareness of their symptoms and their decision to seek medical help was 8.9 months. When they were referred to our hospital, the first impression of 20 patients (62.5%) was benign or malignant nasal neoplasm, and that of the other 12 patients (37.5%) was rhinitis or rhinosinusitis. These patients then received image studies and biopsy or surgical intervention. Most patients needed repeated biopsies, endoscopic sinus surgery, turbinectomy, or Caldwell-Luc operation for a definitive diagnosis. Their histopathologic classification included NK/T cell lymphoma (n = 13, 40.6%), peripheral T cell lymphoma (n = 12, 37.5%), and diffuse large B cell lymphoma (n = 7, 21.9%). Peripheral T cell lymphoma and NK/T cell lymphoma mostly occurred in the nasal cavity, whereas sinus involvement without nasal disease is common in B-cell lymphoma Our results reveal that patients with sinonasal NHL tend to ignore their symptoms until they become serious, and a definitive diagnosis usually requires repeat and deep biopsy.
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Linfoma de Células B/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma de Células T Periférico/diagnóstico , Neoplasias Nasais/diagnóstico , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Neoplasias dos Seios Paranasais/diagnóstico , Biópsia , Diagnóstico Diferencial , Endoscopia , Feminino , Seguimentos , Humanos , Células Matadoras Naturais/patologia , Linfoma de Células B/cirurgia , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma de Células T Periférico/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Colorectal cancer is the third most common cancer globally and nearly one fourth of distant metastases are found at the time of the primary diagnosis. Synchronous metastasis of colorectal cancer to the palatine tonsil is rare. To date, only 5 cases have been published in the English literature. In such cases, the prognosis is worse than in other common metastatic sites. Herein, we report a case of rectal adenocarcinoma who presented with a tonsillar mass initially.
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Adenocarcinoma , Neoplasias de Cabeça e Pescoço , Neoplasias Retais , Neoplasias do Sistema Respiratório , Neoplasias Tonsilares , Adenocarcinoma/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Tonsila Palatina/patologia , Neoplasias Retais/patologia , Neoplasias Tonsilares/diagnósticoRESUMO
OBJECTIVES: This study was performed to test the clinical applicability of a new taste test-the waterless empirical taste test (WETT). METHODS: Sixty healthy volunteers and 20 patients with oral cancer were enrolled. They all received the conventional solution-based whole-mouth suprathreshold taste test (WMTT), which contained sucrose, citric acid, sodium chloride, and caffeine solutions for tastants, along with the WETT. The WETT used plastic strips to deliver tastants. The strip was embedded with sucrose, citric acid, sodium chloride, caffeine, or monosodium glutamate taste enhancer in 4 different concentrations. Each strip was tested twice. Thirty of the healthy volunteers received the WETT again to measure a retest reliability. Case-control matching by age and gender was used to compare the scores of WMTT and WETT between 13 healthy volunteers and 13 patients with oral cancer. RESULTS: The correlation was not high between the WMTT and WETT (r < 0.7) whether in the healthy volunteers or in patients with oral cancer. In terms of retest reliability of the WETT, the mean total score was 24.9 ± 7.3 for the first test and 25.8 ± 8.4 for the second test. The intraclass correlation coefficient was 0.85 (P < .001). When case-control matching was performed, the WMTT scores were not significantly different between 13 healthy volunteers and 13 patients with oral cancer (P = .266), but the WETT scores were significantly lower in patients with oral cancer (P = .017). CONCLUSION: This study showed that the results of the WETT were not highly correlated with those of the WMTT. However, its retest reliability was high, and its results were significantly different between the healthy volunteers and the patients with oral cancer.
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Neoplasias Bucais , Paladar , Cafeína , Ácido Cítrico , Humanos , Projetos Piloto , Reprodutibilidade dos Testes , Cloreto de Sódio , Sacarose , Limiar GustativoRESUMO
Transoral robotic surgery (TORS) has been used for treating pharyngeal and laryngeal cancers for many years. However, the application of neoadjuvant chemotherapy (NACT) before TORS, the sparing rate of adjuvant irradiation after TORS, and the long-term oncologic/functional outcomes of TORS are seldom reported. From September 2014 to May 2018, 30 patients with clinical T1 to T3 cancers of oropharynx (7), larynx (3), and hypopharynx (20) were prospectively recruited for TORS in a tertiary referral medical center. Twelve (40%) patients had clinical early stage (I or II) disease, and 18 (60%) patients had late-stage (III or IV) disease. All 30 patients were suggested to receive TORS with neck dissection. Cisplatin-based NACT was given to 11 patients before the surgery, and it led to a 100% reduction in tumor size. Only 40% of patients needed adjuvant irradiation with a mean dosage of 5933 cGY after TORS. After a mean follow up of 38.9± 14.7 months, the Kaplan-Meier method estimated 5-year disease-specific survival, and organ preservation was 86.3% and 96.2%, respectively. Twenty-five patients were alive without tracheostomy and tube feeding. We found that NACT is a potential method for facilitating tumor resection and TORS effectively de-escalated adjuvant irradiation with a satisfactory 5-year survival and functional outcomes.
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The objective of this study was to treat posttraumatic anosmia with oral steroid and evaluate its effect. One-hundred sixteen posttraumatic patients whose olfactory thresholds were -1.0 by the phenyl ethyl alcohol threshold test assembled in our department. They were treated with a course of high-dose steroid, and followed up for at least 3 months. During the latter period of this study, magnetic resonance imaging was performed to measure the volumes of olfactory bulbs and to detect subfrontal lobe damage. Among them, 19 (16.4%) patients' olfactory thresholds improved after steroid treatment, but the other 97 patients' thresholds did not change. The incidences of loss of consciousness and intracranial hemorrhage after head injury, the ratios of admission and craniotomy, the intervals between head injury and steroid treatment, the volumes of olfactory bulbs, and the incidences of subfrontal lobe damage were not significantly different between patients whose thresholds improved and those whose thresholds did not improve. However, patients with olfactory improvement were significantly younger than those who remained unchanged. Our study showed that oral steroid treatment might improve olfactory acuity in some patients with posttraumatic anosmia, but the possibility of spontaneous recovery cannot be ruled out.
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Lesões Encefálicas/complicações , Glucocorticoides/administração & dosagem , Transtornos do Olfato/tratamento farmacológico , Prednisolona/administração & dosagem , Adolescente , Adulto , Idoso , Lesões Encefálicas/patologia , Lesões Encefálicas/terapia , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND/PURPOSE: Pollen allergy is believed to be less common in East Asia, Latin America, and tropical areas. The purpose of this study was to understand the role of pollen allergy in Taiwan. METHODS: Patients with clinically diagnosed allergic rhinitis were enrolled. All subjects received a 30-item skin test panel that included perennial allergens (house dust mix, Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat hairs, cockroach mix, and Candida albicans) and pollen allergens (acacia, pine mix, eucalyptus, beefwood, juniper mix, willow, mulberry mix, pepper tree, cedar, Johnson grass, Bermuda grass, ragweed mix, Timothy grass, spiny pigweed, cocklebur, sage mix, sheep sorrel, dog fennel, pigweed mix, English plantain, castor bean, alfalfa, and dandelion). RESULTS: A total of 419 patients were recruited. A total of 313 (74.7%) had a positive skin test. A total of 288 patients (68.7%) were sensitive to perennial allergens, and 11 8 patients (28.2%) were sensitive to pollen allergens. However, 93 pollen-sensitive patients were also sensitive to perennial allergens, and only 25 were sensitive to pollen allergens alone. The most common allergens were D. pteronyssinus, D. farinae, house dust mix, and cockroach, but the most common pollen allergens were spiny pigweed, Johnson grass, and sheep sorrel. All nasal symptoms tended to be more severe in patients who were sensitive to perennial allergens than in those who were sensitive to pollen allergens alone. CONCLUSION: Most patients with allergic rhinitis in Taiwan are sensitive to perennial allergens, and pollens are a less common allergen.
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Alérgenos , Pólen , Rinite Alérgica Sazonal , Adolescente , Adulto , Asma/diagnóstico , Asma/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Hipersensibilidade Respiratória/diagnóstico , Hipersensibilidade Respiratória/epidemiologia , Hipersensibilidade Respiratória/fisiopatologia , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/fisiopatologia , Rinite Alérgica Sazonal/diagnóstico , Rinite Alérgica Sazonal/epidemiologia , Rinite Alérgica Sazonal/fisiopatologia , Testes Cutâneos , Taiwan/epidemiologiaRESUMO
Unilateral vocal fold paralysis (UVFP) is a common disorder that may cause glottal closure insufficiency and then hoarseness of voice and aspiration during swallowing. We conducted a systematic review and meta-analysis to evaluate whether hyaluronic acid (HA) injection laryngoplasty (IL) is an effective treatment for patients with UVFP. Comprehensive systematic searches were undertaken using PubMed, EBSCO Medline, and Cochrane Library databases. We appraised the quality of studies according to preset inclusion and exclusion criteria. The lengths of follow-up were divided into "short-term" (3 months or shorter), "medium-term" (6 months), and "long-term" (12 months or longer). We performed random-effect meta-analysis to estimate the changes in voice-related quality of life, perceptual evaluation by grading systems, voice lab analysis of maximal phonation time, and normalized glottal gap area, before and after HA IL. Fourteen studies were eligible for the final analysis. The results showed that patients' glottal closure insufficiency could be improved; maximal phonation time could be prolonged; perceptual evaluations of the voice and quality of life were better after HA IL, but the duration of treatment effect varied among different studies. In conclusion, HA IL is an effective treatment for UVFP, which may achieve a long-term effect and therefore reduce the likelihood of requiring permanent medialization thyroplasty.
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Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/farmacologia , Injeções , Laringoplastia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/patologia , Humanos , Inquéritos e Questionários , Paralisia das Pregas Vocais/diagnóstico por imagem , Prega Vocal/diagnóstico por imagem , Prega Vocal/efeitos dos fármacosRESUMO
BACKGROUND: Long-term, low-dose macrolide treatment has been in recent use to treat chronic rhinosinusitis. In this study, we investigated the effect of long-term, low-dose erythromycin on patients who had persistent rhinosinusitis after functional endoscopic sinus surgery (FESS). METHODS: Patients with persistent rhinosinusitis for 3 months after FESS were recruited and randomly assigned to two groups. Patients in the erythromycin group took erythromycin (250 mg twice a day) for 12 weeks, while those in the intranasal steroid group were administered with mometasone furoate nasal spray for 12 weeks. Both before and after treatment, sino-nasal symptoms were assessed via questionnaires. Patients also received an endoscopic examination, acoustic rhinometry, smell test, and saccharine transit test. A bacterial culture was obtained from the middle meatus. RESULTS: Seventy-two patients completed the study, with 35 in the erythromycin group and 37 in the intranasal steroid group. Endoscopic scores decreased significantly after treatment in both groups. Erythromycin improved the smell threshold and saccharine transit time better than the intranasal steroid. In contrast, the intranasal steroid increased the second minimal cross-sectional area of the nasal cavity at a level greater than erythromycin had. CONCLUSION: Our study showed that long-term, low-dose erythromycin treatment improved the endoscopic score, smell threshold, and saccharine transit time in patients with persistent rhinosinusitis after FESS.
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Antibacterianos/uso terapêutico , Endoscopia/métodos , Eritromicina/uso terapêutico , Seios Paranasais/cirurgia , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Furoato de Mometasona/uso terapêutico , Rinite/cirurgia , Sinusite/cirurgiaRESUMO
OBJECTIVES/HYPOTHESIS: To evaluate the prediction value of saliva pepsin detection for an 8-week proton pump inhibitor (PPI) response in patients with a Reflux Symptoms Index (RSI) score ≥13, which indicates possible laryngopharyngeal reflux. STUDY DESIGN: Prospective individual single-cohort study. METHODS: Patients were recruited who had experienced chronic laryngopharyngeal symptoms (RSI score ≥13) for more than 3 months after excluding other etiologies. The patients received PPI (40 mg of esomeprazole once daily) treatment for 8 weeks. Prior to treatment, the patients submitted saliva/sputum samples that were collected during the time symptoms were observed. The samples were taken for pepsin detection, and performed using the commercially available Peptest lateral flow device. The association of the Peptest results and PPI response were statistically analyzed with the χ2 test. RESULTS: Seventy-four patients completed the study, and upon completion of PPI treatment, the mean RSI score was significantly reduced from 19.22 ± 5.18 to 8.99 ± 5.69. Forty-four (59.5%) patients exhibited a good response as defined by an RSI score reduction ≥50%. The results of the Peptest were semiquantitatively graded as 0, 1, 2, 3 (negative, weak positive, moderate positive and strong positive, respectively) based upon the visual intensity of the test sample line as compared to the control line. Twenty-four patients (32.4%) exhibited grade 3 strong positive results. The Peptest strong positive results (P < .05) were significantly associated with a good PPI response, with the positive predictive value being 79.2%. CONCLUSIONS: Analysis of strong positive results for pepsin detection in saliva/sputum samples may be a useful, noninvasive method for predicting better PPI response in patients with suspected reflux induced chronic laryngopharyngeal symptoms. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:709-714, 2019.
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Refluxo Laringofaríngeo/tratamento farmacológico , Pepsina A/análise , Inibidores da Bomba de Prótons/uso terapêutico , Saliva/química , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Refluxo Laringofaríngeo/metabolismo , Masculino , Pessoa de Meia-Idade , Pepsina A/metabolismo , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: The antibacterial effect of hypochlorous acid (HOCl) solution on nasal secretion of patients with chronic rhinosinusitis (CRS) was investigated. MATERIALS AND METHODS: Five swab specimens were collected from the middle meatus of CRS patients. The first one was placed directly in a Thanswab tube while all of the others were placed randomly into 4 glass tubes containing either HOCl solution, normal saline (NS), 75% alcohol, or povidone-iodine (PVPI) solution for one minute in the first part and for 5 minutes in the second part of the study before transfer to a Thanswab tube. RESULTS: Bacteria were cultured from 27 of 50 specimens when they were put directly in a Thanswab tube and from 26 after soaking in HOCl solution, 27 in NS, 13 in 75% alcohol, and 25 in PVPI solution for one minute. In the second part of the study, bacteria were cultured from 14 of 32 specimens when they were put directly in a Thanswab tube and from 14 after soaking in HOCl solution, 13 in NS, 3 in 75% alcohol, and 11 in PVPI solution for 5 minutes. CONCLUSIONS: This study showed that HOCL solution did not exert an antibacterial effect on nasal secretion from CRS patients within 5 minutes.
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BACKGROUND: Treatment modality of unknown primary squamous cell carcinoma of the head and neck (SCCHN) remains controversial. OBJECTIVES: To evaluate the treatment outcomes and prognostic factors of unknown primary SCCHN. MATERIALS AND METHODS: Patients with unknown primary SCCHN from April 1995 to March 2013 were recruited retrospectively. RESULTS: Sixty-nine patients were enrolled. The median time of follow-up was 55.5 months. The 2-year loco-regional control rate of all the patients was 60.4%. Multivariate Cox regression analysis revealed that N3 stage, extracapsular spread, distant metastasis, and treatment modality were significantly associated with neck recurrence. The actuarial 5-year disease-specific survival rates of neck dissection, neck dissection plus adjuvant therapy, radiotherapy alone, and combined therapy were 80.0%, 61.7%, 33.3%, and 68.8%, respectively (p = 0.046). The 5-year disease-specific survival rates of N1/N2a, N2b/N2c, and N3 stage were 83.9%, 64.3%, and 36.7%, respectively (p = 0.013). Univariate regression analysis revealed that neck recurrence, supraclavicular node involvement, distant metastasis, N3 stage, and unhealthy lifestyle habits were correlated with disease-specific mortality, especially the first three parameters. Patient's occupation and comorbidity were not significantly correlated with survival. CONCLUSIONS: Composite therapy is mandatory for advanced unknown primary SCCHN. Supraclavicular node involvement and unhealthy lifestyle habits, such as betel nut chewing, indicate a poor prognosis.
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Neoplasias de Cabeça e Pescoço/terapia , Neoplasias Primárias Desconhecidas/terapia , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Metástase Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Primárias Desconhecidas/mortalidade , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Primárias Desconhecidas/cirurgia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Transoral robotic surgery (TORS) for early glottic cancer has been reported, but the issue of anterior commissure involvement has seldom been addressed. Therefore, the purpose of this study was to preliminarily report the treatment results of TORS in this disease entity. METHODS: Eight patients with T1 and T2 glottic carcinoma with anterior commissure involvement were selected to receive TORS. The clinical parameters, including rates of adjuvant radiotherapy (RT), survivals, as well as organ and function preservation, were retrospectively analyzed. RESULTS: TORS was successfully performed in all patients without temporary tracheostomy. There were no major complications and no patient received adjuvant RT to the larynx after surgery. With a mean follow-up of 40 months, all patients survived with their larynx preserved and no local recurrence, tracheostomy, or tube feeding dependence. CONCLUSION: TORS is a feasible approach for selected patients with early T classification glottic carcinoma with anterior commissure involvement. The preliminary oncologic and functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 913-918, 2016.
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Glote/cirurgia , Neoplasias Laríngeas/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Endoscópios , Feminino , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/instrumentação , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodosRESUMO
BACKGROUND: For hypopharyngeal cancer, transoral robotic surgery (TORS) has been reported as a new organ preserving treatment but outcomes are rarely reported. METHODS: From 2010 to 2013, 10 patients with early T classification pyriform sinus cancer were selected to receive TORS and conventional neck dissection. The clinical parameters, including rates of adjuvant radiotherapy, survivals, as well as organ and function preservation, were retrospectively analyzed. RESULTS: TORS was successful in all 10 patients, and 5 patients received adjuvant radiotherapy. After mean follow-up of 26 months, 1 patient died of distant metastasis and 1 patient died of other malignancy. There was no local recurrence and larynxes were all preserved. Eight surviving patients who were followed up continuously could receive oral intake and had a serviceable voice without tracheostomy or feeding tubes. CONCLUSION: TORS is a feasible transoral approach for selected patients with early T classification hypopharyngeal cancer. The reported oncologic/functional outcomes are satisfactory. © 2015 Wiley Periodicals, Inc. Head Neck 38: 857-862, 2016.
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Neoplasias Hipofaríngeas/cirurgia , Esvaziamento Cervical , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Humanos , Neoplasias Hipofaríngeas/radioterapia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Radioterapia Adjuvante , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES/HYPOTHESIS: To confirm the value of using laryngeal electromyography (LEMG) to predict the long-term prognosis of unilateral vocal fold paralysis (UVFP), and elucidate the adequate timing of LEMG. STUDY DESIGN: Prospective cohort prognosis study. METHODS: The LEMG data of 84 patients with UVFP were prospectively collected, and 81 patients received follow-up at least 6 months after symptom onset. If the paralyzed vocal fold had <20% recruitment reduction during phonation compared to the normal vocal fold signals, and absence of fibrillation when the patient was silent, the prognosis was considered to be good (negative finding). Otherwise, the prognosis was considered to be poor (positive finding). The association between UVFP outcome and LEMG prognostic rules and the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LEMG were calculated. RESULTS: The mean duration of LEMG after symptom onset was 3.7 months, and follow-up after symptoms onset was 18.4 months. Sixty-six of 71 patients with a positive finding had persistent UVFP; four of 10 patients with a negative finding recovered vocal fold motion. LEMG results were significantly associated with the outcome of UVFP (P = .007). The overall accuracy, sensitivity, specificity, PPV, and NPV of LEMG were 86.4%, 91.7%, 44.4%, 93.0%, and 40.0%, respectively. When LEMG was done more than 2 months after symptom onset, the PPV was 97.9%. CONCLUSIONS: LEMG has a high PPV in predicting the long-term outcome of UVFP patients with poor prognosis. Permanent laryngeal framework surgery is feasible if patients have positive findings at least 2 months after symptom onset.
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Eletromiografia/métodos , Paralisia das Pregas Vocais/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Paralisia das Pregas Vocais/terapia , Adulto JovemRESUMO
IMPORTANCE: Unilateral vocal fold paralysis (UVFP) is a common voice disorder that may cause glottal closure insufficiency with hoarseness of voice. Laryngeal electromyography (LEMG)-guided hyaluronic acid vocal fold (VF) injection has been proposed as a treatment option to improve glottal closure with a satisfactory short-term effect. To our knowledge, this study reports the first long-term follow-up result of this treatment modality. OBJECTIVE: To present the long-term treatment results of LEMG-guided hyaluronic acid VF injection for UVFP. DESIGN, SETTING, AND PARTICIPANTS: Prospective study of the treatment results of 74 patients who received LEMG-guided hyaluronic acid VF injection for UVFP at a tertiary referral medical center from March 2010 to February 2013. INTERVENTIONS: In the office-based procedure, 1.0 mL of hyaluronic acid was injected via a 26-gauge monopolar injectable needle electrode into paralyzed thyroarytenoid muscles by LEMG guidance. MAIN OUTCOMES AND MEASURES: Various glottal closure evaluations such as normalized glottal gap area, maximal phonation time, phonation quotient, mean airflow rate, perceptual GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and Voice Handicap Index were compared before and after injection using the nonparametric Wilcoxon signed rank test within 1 month, at 6 months, and at the last follow-up examination. RESULTS: Sixty patients had been followed up for at least 6 months. Forty-four patients received only 1 injection, and 16 patients received repeated injections (2 injections for 13 patients and 3 for 3 patients). All the glottal closure parameters improved significantly (P < .001) within 1 month, at 6 months, and at the last follow-up examination, with a mean (SD) of 17.4 (8.9) months. At the last follow-up examination, the mean (SD) normalized glottal gap area was significantly reduced from 7.9 (5.7) to 0.6 (1.6). Mean (SD) maximal phonation time was significantly prolonged from 4.6 (3.8) seconds to 12.1 (7.4) seconds. Mean (SD) phonation quotient was significantly reduced from 647 (508) mL/s to 277 (212) mL/s. Mean (SD) airflow rate was significantly reduced from 445 (338) mL/s to 175 (145) mL/s. When all the GRBAS scale parameters improved, the mean (SD) Voice Handicap Index score was significantly reduced from 76 (22) to 38 (30) (all P < .001). CONCLUSIONS AND RELEVANCE: Of the 74 patients in this study, 44 (60%) who received a single injection and 16 (22%) who received repeated injections did not require another treatment after long-term follow-up. Laryngeal electromyography-guided hyaluronic acid VF injection is an option for treating UVFP with satisfactory results.
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Eletromiografia , Ácido Hialurônico/administração & dosagem , Viscossuplementos/administração & dosagem , Paralisia das Pregas Vocais/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Injeções Intramusculares/métodos , Músculos Laríngeos , Masculino , Pessoa de Meia-Idade , Fonação , Estudos Prospectivos , Qualidade da Voz , Adulto JovemRESUMO
The 40-item University of Pennsylvania Smell Identification Test (UPSIT) is the most widely used smell test in the world. Presently, culturally modified versions of this test are available in multiple languages. A traditional Chinese version of the UPSIT (UPSIT-TC) has been developed for administration in Taiwan. The purpose of this study was to investigate the validity and reliability of the UPSIT-TC in Taiwanese patients with chronic rhinosinusitis (CRS). The phenylethyl alcohol (PEA) odor detection threshold test, the North American version of UPSIT (UPSIT-NA), and the UPSIT-TC were administered to 40 healthy subjects and to 100 CRS patients before and after functional endoscopic sinus surgery (FESS). The UPSIT-TC showed good internal consistency (Cronbach's alpha = 0.887, 0.886, and 0.870 at three test occasions) and test-retest reliability (p < 0.001). The scores of UPSIT-TC were significantly correlated to the PEA thresholds (p < 0.001). The UPSIT-TC scores were significantly higher than those of the UPSIT-NA (p = 0.028) when analysis was performed with logistic regression with independent variables including test occasions (before or after FESS), test methods (UPSIT-NA or UPSIT-TC), status of polyp (with or without), and PEA thresholds (improved or did not improve). In addition, there were significant between-group differences in UPSIT-TC scores including healthy versus CRS, CRS with polyps versus CRS without polyps, and PEA thresholds improved versus PEA thresholds which did not improve. The UPSIT-TC is reliable and valid for measuring olfactory function in Taiwanese patients with rhinosinusitis. In addition, the UPSIT-TC clearly resulted in better performance than that of UPSIT-NA.
RESUMO
OBJECTIVE: Recurrent laryngeal nerve (RLN) injury may induce unilateral vocal fold paralysis (UVFP). During thyroidectomy, the most common cause of UVFP, the superior laryngeal nerve (SLN), is also at risk of injury. In the literature, the influence of SLN injury on glottal configuration and function in patients with UVFP remains controversial. The present study investigates SLN injury influence on glottal configuration and function in patients with UVFP after thyroidectomy. STUDY DESIGN: Prospective controlled study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: The SLN and RLN function of 34 patients with UVFP after thyroidectomy was determined by laryngeal electromyography. The subjects were dichotomized into the isolated RLN injury group (n = 26) or the concurrent SLN/RLN injury group (n = 8). We evaluated glottal angle and paralyzed vocal fold shape during inspiration, normalized glottal gap area, and glottal shape during phonation. The glottal function measurements included voice acoustic and aerodynamic analyses and the Voice Handicap Index. The aforementioned parameters of the RLN and concurrent SLN/RLN injury groups were compared. RESULTS: There were no statistical differences in glottal configuration such as glottal angle, paralyzed vocal fold shape, normalized glottal gap area, and glottal shape between the RLN and concurrent SLN/RLN injury groups. There were also no significant differences in other glottal function analyses including fundamental frequency, mean airflow rate, phonation quotient, maximal phonation time, and Voice Handicap Index. CONCLUSION: In the present study, we did not find any evidence that SLN injury could significantly influence the glottal configuration and function in patients with UVFP.
Assuntos
Traumatismos do Nervo Laríngeo Recorrente/etiologia , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia , Adulto , Fatores Etários , Eletromiografia/métodos , Feminino , Seguimentos , Humanos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Estudos Prospectivos , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Taiwan , Centros de Atenção Terciária , Tireoidectomia/métodosRESUMO
BACKGROUND: Electrolyzed acid water (EAW) has been recognized to have strong bactericidal activity, and the feasibility and safety of EAW irrigation in body cavities has been reported in the literature. This study was conducted to evaluate the effect of EAW nasal irrigation on the postoperative care of functional endoscopic sinus surgery (FESS). METHODS: Patients with chronic rhinosinusitis who received FESS for treatment were recruited and randomly assigned to three groups at 1 month postoperatively. Patients in group 1 received EAW for nasal irrigation daily for 2 months, those in group 2 received neutral normal saline (NS) daily for 2 months, and those in group 3 did not receive nasal irrigation after surgery. Before and 3 months after FESS, sinonasal symptoms were assessed by questionnaire and patients received endoscopic examination, acoustic rhinometry, smell test, saccharine transit test, and bacterial culture from middle meatus. RESULTS: There were 185 patients enrolled between May 2009 and March 2012. Among the patients who completed the study, 36 received EWA irrigation, 35 received NS irrigation, and 39 (group 3) received no irrigation. Patients with nasal irrigation had a better outcome based on questionnaire score and saccharine transit time. However, there was no difference in outcome between patients who received irrigation with EAW and NS. CONCLUSION: Our study showed that EWA irrigation did not confer a greater benefit than that of NS irrigation in post-FESS care.