Sudden sensorineural hearing loss associated with tension-type headache: a population-based study.

OBJECTIVES: This study explored the relationship between sudden sensorineural hearing loss (SSNHL) and prior tension-type headache (TTH) in a large nationwide population-based data set in Taiwan. METHODS: In this case-controlled study in Taiwan, participants with SSNHL (n = 4,683) were identified, and controls (n = 18,732) were randomly selected from the National Health Insurance database. Cases of TTH were identified by having been diagnosed as TTH prior to the index date of SSNHL diagnosis. A conditional logistic regression model was used to estimate the adjusted odds ratio (OR) and 95% confidence intervals (CI) for the association of sudden deafness with TTH among the sampled patients. RESULTS: Among the 23,415 patients, 2.5% (600/23,415) had TTH diagnoses prior to the index date; TTH was diagnosed in 4.5% (209/4,683) of the SSNHL group and 2.1% (391/18,732) of the control group. After adjusting for sociodemographic characteristics and comorbid medical disorders, we found that patients with SSNHL were more likely to have had a previous TTH than controls (OR, 1.86; 95% CI, 1.54-2.24; p < 0.01). CONCLUSION: Both male and female patients with SSNHL had a higher proportion of prior TTH than controls without SSNHL.

Tension-type headache associated with obstructive sleep apnea: a nationwide population-based study.

BACKGROUND: There is still controversy regarding the association between primary headaches and obstructive sleep apnea. We explored the relationship between tension-type headache (TTH) and obstructive sleep apnea (OSA) using a large nationwide population-based data set in Taiwan. METHODS: We identified 4759 patients diagnosed with OSA from the Taiwan Longitudinal Health Insurance Database, based on polysomnography, as the OSA group. We then randomly selected 19036 subjects without OSA, matched by sex and age, to serve as the non-OSA group. The multivariate Cox proportional hazards model with matching for age and sex was used to assess the possible associations between TTH and OSA among the patients. RESULTS: The prevalence of TTH was 10.2% among OSA patients and 7.7% among non-OSA patients (p < 0.001). The multivariate Cox proportional hazards model revealed patients with OSA were more likely to have TTH (hazard ratio, 1.18; 95% CI, 1.06-1.31) (p = 0.003) than patients in the non-OSA group. CONCLUSION: Patients with OSA had a higher likelihood of developing TTH than patients in the non-OSA group. Further studies of physiological patterns between OSA and TTH are needed to confirm the study findings.

Developing a Cost-Effective Surgical Scheduling System Applying Lean Thinking and Toyota's Methods for Surgery-Related Big Data for Improved Data Use in Hospitals: User-Centered Design Approach.

BACKGROUND: Surgical scheduling is pivotal in managing daily surgical sequences, impacting patient experience and hospital resources significantly. With operating rooms costing approximately US $36 per minute, efficient scheduling is vital. However, global practices in surgical scheduling vary, largely due to challenges in predicting individual surgeon times for diverse patient conditions. Inspired by the Toyota Production System's efficiency in addressing similar logistical challenges, we applied its principles as detailed in the book "Lean Thinking" by Womack and Jones, which identifies processes that do not meet customer needs as wasteful. This insight is critical in health care, where waste can compromise patient safety and medical quality. OBJECTIVE: This study aims to use lean thinking and Toyota methods to develop a more efficient surgical scheduling system that better aligns with user needs without additional financial burdens. METHODS: We implemented the 5 principles of the Toyota system: specifying value, identifying the value stream, enabling flow, establishing pull, and pursuing perfection. Value was defined in terms of meeting the customer's needs, which in this context involved developing a responsive and efficient scheduling system. Our approach included 2 subsystems: one handling presurgery patient data and another for intraoperative and postoperative data. We identified inefficiencies in the presurgery data subsystem and responded by creating a comprehensive value stream map of the surgical process. We developed 2 Excel (Microsoft Corporation) macros using Visual Basic for Applications. The first calculated average surgery times from intra- or postoperative historic data, while the second estimated surgery durations and generated concise, visually engaging scheduling reports from presurgery data. We assessed the effectiveness of the new system by comparing task completion times and user satisfaction between the old and new systems. RESULTS: The implementation of the revised scheduling system significantly reduced the overall scheduling time from 301 seconds to 261 seconds (P=.02), with significant time reductions in the revised process from 99 seconds to 62 seconds (P<.001). Despite these improvements, approximately 21% of nurses preferred the older system for its familiarity. The new system protects patient data privacy and streamlines schedule dissemination through a secure LINE group (LY Corp), ensuring seamless flow. The design of the system allows for real-time updates and has been effectively monitoring surgical durations daily for over 3 years. The "pull" principle was demonstrated when an unplanned software issue prompted immediate, user-led troubleshooting, enhancing system reliability. Continuous improvement efforts are ongoing, except for the preoperative patient confirmation step, which requires further enhancement to ensure optimal patient safety. CONCLUSIONS: Lean principles and Toyota's methods, combined with computer programming, can revitalize surgical scheduling processes. They offer effective solutions for surgical scheduling challenges and enable the creation of a novel surgical scheduling system without incurring additional costs.

Prevalence of Obstructive Sleep Apnea Using Home Sleep Test in Taiwan During the Coronavirus Disease Pandemic.

Background: Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with serious sequelae. The current gold standard diagnostic method, polysomnography, is costly and time consuming and requires patients to stay overnight at a facility. Aim: This study aimed to reveal the prevalence of OSAS in general adult population using a home sleep test (HST) during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This prospective cohort study was conducted by the Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan, between January 2020 and December 2021. A total of 1372 patients aged 30-70 years completed an HST using a Type 3 portable sleep monitor (PM). The apnea-hypopnea index (AHI) was analyzed to assess the association of OSAS with age, body mass index (BMI), sex, Epworth Sleepiness Scale (ESS) and the Sleep Apnea Risk Assessment questionnaire (STOP-Bang questionnaire) rating. Results: The mean age of the patients (782 men, 57%; 590 women, 43%) was 49.24 ± 11.04 years. OSAS was detected in 954 (69.5%) patients with 399 (29.1%) mild OSAS; 246 (17.9%) moderate OSAS; and 309 (22.5%) severe OSAS. Among these, the prevalence of moderate-to-severe OSAS was 143 (10.4%) in women and 412 (30.0%) in men. The mean age was the highest (51.29 ± 11.29) in the mild OSAS group and lowest (47.08 ± 10.87) in the healthy group. OSAS severity was greater with increasing BMI, 23.39 ± 3.44 in the healthy group and 29.29 ± 5.01 in the severe OSAS group. A positive correlation was also noted between the ESS/STOP-Bang questionnaire rating and OSAS severity. Conclusion: The prevalence of OSAS in Taiwan was 69.5% in our study. It showed strong evidence that OSAS has important public health consequences and PMs are simple, fast, feasible, and cost-effective tools for OSAS screening in the home environment, especially during the COVID-19 pandemic.

Comparison between botulinum toxin and steroid septal injection in the treatment of allergic rhinitis.

OBJECTIVE: To compare the effects of botulinum toxin and steroid septal injections in treating allergic rhinitis (AR) by evaluating improvements in the rhinitis control assessment test (RCAT), visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE) scores, and active anterior rhinomanometry (RMM) measurements. METHODS: This prospective, single-blinded cohort study was conducted at the Department of Otolaryngology, Taipei City Hospital between January 2017 and December 2018. Ninety-five patients were randomized to receive botulinum toxin, dexamethasone, or normal saline (group A, group B, and placebo, respectively). The main outcome measures were pretreatment subjective nasal symptoms (RCAT, VAS, and NOSE) and active anterior RMM measurements. All measurements were repeated during posttreatment 1, 2, and 3 months. RESULTS: No significant difference was observed in pretreatment questionnaire scores and RMM values between the study and placebo groups. The mean posttreatment RCAT, VAS, and NOSE scores after 1 and 2 months significantly improved in the treatment groups compared to placebo. The VAS and NOSE at posttreatment 2 months and RCAT, VAS, and NOSE at posttreatment 3 months were significantly different comparing group A to group B. All RMM parameters showed better values in group A than in group B at 1, 2, and 3 months posttreatment, with significant differences in four parameters in posttreatment 3 months. CONCLUSIONS: Botulinum toxin septal injection is a safe treatment option for AR and improves subjective nasal symptoms for 3 months. Botulinum toxin A injection tended to be more effective than steroid septal injection in terms of duration and degree.Level of Evidence: 2b, individual cohort study.

Reducing Medication Problems among Minority Individuals with Low Socioeconomic Status through Pharmacist Home Visits.

Introduction: In this study, pharmacists conducted home visits for individuals of medically underserved populations in Taiwan (i.e., socioeconomically disadvantaged individuals, middle-aged or older adults, and individuals living alone, with dementia, or with disabilities) to understand their medication habits. We quantified medication problems among various groups and investigated whether the pharmacist home visits helped to reduce the medication problems. Materials and Methods: From April 2016 to March 2019, pharmacists visited the homes of the aforementioned medically underserved individuals in Taipei to evaluate their drug-related problems and medication problems. Age, living alone, diagnoses of dementia or disabilities, and socioeconomic disadvantages contributed significantly to inadequate disease and medical treatment knowledge and self-care skills as well as lifestyle inappropriateness among patients. The patients who were living alone and socioeconomically disadvantaged stored their drugs in inappropriate environments. Results: After the pharmacists visited the patients' homes twice, the patients improved considerably in their disease and medical treatment knowledge, self-care skills, and lifestyles (p < 0.001). Problems related to the uninstructed reduction or discontinuation of drug use (p < 0.05) and use of expired drugs (p < 0.001) were also mitigated substantially. Discussion and conclusion: Through the home visits, the pharmacists came to fully understand the medicine (including Chinese medicine) and health food usage behaviors of the patients and their lifestyles, enabling them to provide thorough health education. After the pharmacists' home visits, the patients' drug-related problems were mitigated, and their knowledge of diseases, drug compliance, and drug storage methods and environments improved, reducing drug waste. Our findings can help policymakers address the medication problems of various medically underserved groups, thereby improving the utilization of limited medical resources.

Retropalatal Müller grade is associated with the severity of obstructive sleep apnea in non-obese Asian patients. Retropalatal Müller grade and OSA in non-obese.

PURPOSE: The aim of this study was to investigate whether physical evaluations could be used for predicting the presence and severity of obstructive sleep apnea (OSA) in non-obese snoring patients. METHODS: This is a retrospective study, and a total of 244 non-obese (body mass index, BMI, <27 kg/m(2)) snoring patients (178 men and 66 women; mean age = 43.1 ± 12.1 years) were included. Each patient underwent polysomnography and a thorough physical examination, including flexible nasopharyngoscopy and Müller maneuver. Patients were divided into four groups based on apnea-hypopnea index (AHI) scores: normal (simple snoring), AHI < 5; mild OSA, 5 ≦ AHI < 15; moderate OSA, 15 ≦ AHI < 30; severe OSA, AHI ≧ 30. Logistic regression was used to identify risk factors for OSA severity. RESULTS: Fifty-nine patients (24%) were simple snorers. The prevalence of sleep apnea (mild, moderate, or severe OSA) for our non-obese snoring patients was 76%. Univariate logistic analyses showed that higher BMI, male gender and retropalatal Müller grades were significantly associated with OSA severity. Multivariate logistic regression analysis identified male gender and retropalatal Müller grade as risk factors for OSA in non-obese snoring patients. CONCLUSIONS: Physical examination may be useful for studying the upper airway in non-obese snoring patients. Flexible nasopharyngoscopy with Müller maneuver appears to be useful for evaluating the severity of OSA in non-obese patients. Retropalatal Müller grade is highly related to both the presence and severity of OSA, particularly in males.

Atrial Fibrillation Is Not Associated With Sudden Sensorineural Hearing Loss.

OBJECTIVES: The aim of this study is to assess the association between atrial fibrillation (AF) and sudden sensorineural hearing loss (SSNHL). METHODS: This study was conducted by searching the longitudinal health insurance database of the Taiwan National Health Insurance Program for relevant information from January 1, 2000, to December 31, 2011. Patients with AF were matched with non-AF controls with a 1:1 strategy according to propensity scores. Multiple logistic regression analyses were performed to determine the risk of SSNHL. RESULTS: In total, 14 698 patients with AF were matched with the same number of non-AF patients as controls. After propensity score matching, the use of antiplatelet or anticoagulation medications and the occurrence of SSNHL were found to have a significant difference between AF and non-AF patients. The occurrence of SSNHL was found to be higher in men, those of 45 to 74 years old, and patients with hypertension in both AF and non-AF groups. Multiple logistic regression analyses revealed that male gender, age between 45 and 74 years, hyperlipidemia, and hypertension are risk factors for SSNHL. The use of aspirin was found to reduce the rate of SSNHL (odds ratio [OR]: 0.67, 95% CI: 0.49-0.94, P = .019), but AF was not found to be a risk factor for SSNHL (OR: 0.89, 95% CI: 0.64-1.23, P = .467). CONCLUSION: The association between AF and SSNHL is not significant.

Diagnostic Validity of Self-Reported Hearing Loss in Elderly Taiwanese Individuals: Diagnostic Performance of a Hearing Self-Assessment Questionnaire on Audiometry.

KEY POINTS: Question: Can the traditional Chinese version of the hearing handicap inventory for elderly screening (HHIE-S) checklist screen for age-related hearing loss (ARHL) in elderly individuals? FINDINGS: In this cross-sectional study of 1696 Taiwanese patients who underwent annual government-funded geriatric health checkups, the Chinese version of the HHIE-S had a sensitivity of 76.9% and a specificity of 79.8% with a cutoff score greater than 6 for identifying patients with disabled hearing loss (defined as a PTA > 40 dB). Meaning: The traditional Chinese version of the HHIE-S is an effective test to detect ARHL and can improve the feasibility of large-scale hearing screening among elderly individuals. PURPOSE: The traditional Chinese version of the hearing handicap inventory for elderly screening (TC-HHIE-S) was translated from English and is intended for use with people whose native language is traditional Chinese, but its effectiveness and diagnostic performance are still unclear. The purpose of this study was to evaluate the validity and reliability of the traditional Chinese version of the HHIE-S for screening for age-related hearing loss (ARHL). METHODS: A total of 1696 elderly people underwent the government's annual geriatric medical examination at community hospitals. In this cross-sectional study, we recorded average conducted pure-tone averages (PTA) (0.5 kHz, 1 kHz, 2 kHz, 4 kHz), age, sex, and HHIE-S data. Receiver operating characteristic (ROC) curve analysis was used to identify the best critical point for detecting hearing impairment, and the validity of the structure was verified by the agreement between the TC-HHIE-S and PTA results. RESULTS: The HHIE-S scores were correlated with the better-ear pure-tone threshold averages (PTAs) at 0.5-4 kHz (correlation coefficient r = 0.45). The internal consistency of the total HHIE-S score was excellent (Cronbach's alpha = 0.901), and the test-retest reliability was also excellent (Spearman's correlation coefficient = 0.60, intraclass correlation coefficient = 0.75). In detecting disabled hearing loss (i.e., PTA at 0.5-4 kHz > 40 dB), the HHIE-S cutoff score of > 6 had a sensitivity of 76.9% and a specificity of 79.8%. CONCLUSIONS: The traditional Chinese version of the HHIE-S is a valid, reliable, and efficient tool for large-scale screening for ARHL.

The prevalence and demographic features of congenital cytomegalovirus infection in an urban area of East Asia: A population-based study.

Congenital cytomegalovirus (cCMV) infection is the leading environmental cause of childhood hearing impairment. However, its significance remains largely undocumented in many regions of the world. The purpose of this study was to investigate the prevalence and clinical features of cCMV infection in East Asia. Neonates born at a municipal hospital in Taipei were prospectively recruited and underwent concurrent hearing and CMV screenings. Those who failed the hearing screening or screened positive for CMV were subjected to a focused audiological and/or virological surveillance. The characteristics of the newborns and their mothers were compared between the CMV-positive and CMV-negative groups. Of the 1,532 newborns who underwent concurrent hearing and CMV screenings, seven (0.46%) were positive for cCMV infection. All seven CMV-positive newborns were asymptomatic at birth, and none of them developed hearing or other symptoms during a follow-up period of 14.4±6.3 months. The mothers of the CMV-positive newborns demonstrated higher gravidity (2.4 ± 1.4 vs. 2.1 ± 1.2) and parity (2.0 ± 1.2 vs. 1.6 ± 0.7) than those in the CMV-negative group; however, the difference did not reach statistical significance. The prevalence of cCMV infection in Taipei newborns was 0.46%, which is slightly lower than that of other populations and that of a previous report in the Taiwanese population. The relatively low prevalence in this study might be attributed to the improved public health system and decreased fertility rate in Taiwan.

Effect of endoscopic sinus surgery on irradiation-induced rhinosinusitis in patients with nasopharyngeal carcinoma.

OBJECTIVES: We evaluated the effect of endoscopic sinus surgery on irradiation-induced rhinosinusitis of the maxillary-sinus mucosa among patients with nasopharyngeal carcinoma (NPC). DESIGN: Surgical outcomes were evaluated by changes to the ultrastructure of the antral mucosa and nasomucociliary clearance. METHODS: Twenty-one NPC patients with irradiation-induced chronic sinusitis were enrolled in the study, along with five controls. Specimens were taken from 42 maxillary sinuses during surgery and 1 year after surgery. Saccharin transit time was measured before the initial surgery and 1 year after surgery. RESULTS: In the postoperative cases, we found a decrease in the number of the submucosal gland openings (P < 0.05), the cilia in the antral mucosa regenerated (P < 0.05), and the saccharin transit time reduced (P < 0.05); the number of goblet cells did not change. CONCLUSION: Endoscopic sinus surgery is an effective treatment for irradiation-induced rhinosinusitis in NPC patients, improving ventilation and drainage of the paranasal sinuses, and facilitating regeneration of the sinus mucosa.

Effects of Meropack in the middle meatus after functional endoscopic sinus surgery in children with chronic sinusitis.

OBJECTIVES: The aim of the study was to evaluate the effects and morbidities of Meropack, an absorbable hyaluronic acid packing material, placed in the middle meatus after endoscopic sinus surgery in children with chronic sinusitis. METHODS: Sixty consecutive children with similar degrees of bilateral chronic sinusitis were enrolled in the study. Meropack was randomly inserted into one side of the middle meatus, while the opposite sinus was not packed after functional endoscopic sinus surgery. Patients were investigated 3, 8, and 12 weeks after surgery. The effects and morbidities of nasal dressings in the middle meatus were evaluated with respect to six distinct parameters: blood loss during surgery, postoperative hemorrhage, synechiae, granulation tissue, infection, and patency of the maxillary sinus ostia. RESULTS: Mean blood loss of packed and unpacked sinuses did not significantly differ (p > 0.05). Twenty-nine (15 packed, 14 unpacked) of the 120 sinuses underwent resection of the lateral wall of concha bullosa. Four of 14 unpacked sinuses had postoperative hemorrhaging, while the 15 packed sinuses did not (p < 0.05). The mean synechiae scores at the first follow-up visit for the Meropack filled and unpacked sinuses differed significantly (p < 0.05). For the 8- and 12-week follow-up visits, severity of adhesions, granulation tissue formation, infection rate, and patency of the maxillary sinus ostia did not differ significantly between the Meropack filled sinuses and the unpacked sinuses (p > 0.05 for all). CONCLUSION: Meropack dressings effectively prevented postoperative hemorrhage, but did not significantly reduced synechiae after endoscopic sinus surgery. Therefore, we recommend that Meropack packing is not necessary for routine use following pediatric functional endoscopic sinus surgery (FESS). However, it should be reserved for children who are predisposed to develop postoperative hemorrhages or adhesions, such as resection of the concha bullosa, traumatic surgery with the creation of large raw surfaces on the middle turbinate, and revision surgery with preexisting adhesions.

Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study.

OBJECTIVE: The objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years. METHODS: We investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis. RESULTS: Influenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63-0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64-0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57-2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69-1.18). CONCLUSIONS: The risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality.

Comparison of microdebrider-assisted inferior turbinoplasty and submucosal resection for children with hypertrophic inferior turbinates.

OBJECTIVES: The aim of this study was to compare the effectiveness and safety of microdebrider-assisted inferior turbinoplasty (MAIT) with submucosal resection (SR) for children with hypertrophic inferior turbinates. MATERIALS AND METHODS: One hundred and twenty children with chronic nasal obstruction due to hypertrophic inferior turbinates were enrolled. These children were randomly assigned to receive SR of the inferior turbinate (n=60) or MAIT (n=60). Ten children who did not appear to display any nasal discomfort served as normal controls. Surgical-outcome was evaluated with respect to four distinct parameters: nasal endoscopy, subjective assessment of nasal symptoms by the patient using a visual analogue scale, anterior rhinomanometry, and saccharin test. These evaluations were conducted before surgery and at 1 week, 1 and 3 months after surgery. RESULTS: In the SR group, turbinate edema was decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal secretions and crusting were increased significantly (p<0.05) in the SR group at 1 week after surgery and then decreased significantly at 1 and 3 months after surgery. In the MAIT group, turbinate edema and nasal secretions were decreased significantly at 1 and 3 months after surgery (p<0.05). Nasal crusting was not observed after surgery. Subjective complaints including nasal obstruction, sneezing, rhinorrhea and hyposmia were significantly improved in both groups from 1 month after surgery (p<0.05). Rhinomanometric assessment did not reveal significant improvement until 3 months after surgery in both groups. Saccharin transit time was significantly increased (p<0.05) compared to baseline at 1 week after surgery in the SR group but was not significantly different in the MAIT group. CONCLUSION: MAIT and SR are both effective at relieving nasal obstruction due to the presence of hypertrophic inferior turbinates. MAIT is superior to SR with regard to preserving the nasal mucosa.

Vascular endothelial growth factor and children featuring nasal polyps.

BACKGROUND: The aim of this study is to explore the expression of vascular endothelial growth factor within nasal polyps, and the implication of such expression as regards the development of nasal polyps amongst children. MATERIAL AND METHODS: Sixty children suffering from chronic rhinosinusitis were enrolled in this study. Amongst them, 30 patients featured rhinosinusitis with associated nasal polyps. A biopsy specimen was taken from the stalk or the base of the nasal polyp for nasal-polyp sufferers, and the ethmoid sinus for study participants who featured no nasal polyps. The primary lesions biopsied were immunohistochemically stained with a specific endothelial-cell marker and also stained for the presence of vascular endothelial growth factor. The specific level of vascular endothelial growth factor and the mean number of blood vessels present in a visual microscopic (biopsied-specimen) field were calculated under light microscopy (x400). RESULTS: The number of vascular endothelial growth factor-expressing cells for the nasal-polyp group and for the sinusitis group was, respectively, 20.8+/-4.0 and 11.5+/-3.4 per visual field. Correspondingly, the mean intra-polyp blood-vessel density for the nasal-polyp group and that for the control group was, respectively, 10.5+/-2.6 and 5.0+/-1.9 per visual field. The mean intra-polyp blood-vessel density and the number of vascular endothelial growth factor-expressing cells proved to be significantly greater amongst individuals from the nasal-polyp group than was the case for their analogs from the sinusitis group (P<0.01, for both). The presence of vascular endothelial growth factor was found to be distributed predominantly within the vascular endothelium and the mast cells of polyp tissue. In addition, the level of vascular endothelial growth-factor expression and the mean blood-vessel count per field correlated significantly for nasal-polyp tissue (P<0.001). Furthermore, the relative size of nasal polyps correlated significantly with the number of (intra-polyp) vascular endothelial-cell growth factor-expressing cells and the mean blood-vessel density (P<0.05, for both). CONCLUSION: The level of expression of vascular endothelial-cell growth factor (VEGF) and the mean blood-vessel density were shown to be significantly greater within nasal polyps than within corresponding sinusitis mucosa. Clinically, the expression of both of these parameters correlated well with the relative size of nasal polyps. Vascular endothelial growth factor participates in the formation of nasal polyps amongst children suffering from chronic rhinosinusitis (CRS).

Corrigendum: Obstructive Sleep Apnea and the Subsequent Risk of Chronic Rhinosinusitis: A Population-Based Study.

This corrects the article DOI: 10.1038/srep20786.

Mucosal healing and mucociliary transport change after endoscopic sinus surgery in children with chronic maxillary sinusitis.

OBJECTIVES: The aim of the study was to evaluate the effects of endoscopic sinus surgery for chronic maxillary sinusitis in children by investigating ultrastructure element changes in the sinus mucosa and nasal mucociliary clearance before and after operation. METHODS: Twenty-five children with chronic maxillary sinusitis scheduled to undergo functional endoscopic sinus surgery and another five controls were enrolled. A saccharin transit test was performed before and after the operation for each subject. Forty specimens of diseased maxillary sinus mucosa were classified into edematous and polypoid types, with 20 specimens in each type. The mucosal specimens were taken from the superolateral wall of each maxillary sinus during surgery and at post-operative follow-up when the mucosal recovery had begun and the symptoms had subsided. The specimens were examined with a scanning electron microscope. RESULTS: A significant increase in number of the submucosal gland openings (GO) was noted for the sinusitis group, of both edematous and polypoid types. In post-operative cases, the number of gland openings decreased, however, it remained higher than for the control group. The number of goblet cells (GC) decreased in the sinusitis cases, and significant difference was not demonstrated compared to postoperative and control groups. After endoscopic sinus surgery, the cilia in both types of antral mucosa were significantly regenerated compared to preoperative variants. Significant differences in postoperative saccharin transit time were demonstrated for both types of antral mucosa compared to the preoperative values. CONCLUSION: After endoscopic sinus surgery for chronic pediatric sinusitis, the antral mucosa recovered and mucociliary clearance improved for both types of antral mucosa, with improved ventilation and drainage demonstrated for our patients. Based on our specimens, the edematous mucosa appear to regenerate sooner than the polypoid variant, with close post-operative follow-up for more than 2 and 4 months for the edematous and polypoid types of antral mucosa, respectively, necessary to prevent sinusitis relapse.

Association of Sudden Sensorineural Hearing Loss With Vertebrobasilar Insufficiency.

IMPORTANCE: Little is known about the association between sudden sensorineural hearing loss (SSNHL) and vertebrobasilar insufficiency (VBI). OBJECTIVE: To explore the association between SSNHL and VBI. DESIGN, SETTING, AND PARTICIPANTS: This investigation was a population-based, case-control study. Patients from January 1, 2000, to December 31, 2011, were retrospectively identified from the Taiwan National Health Insurance Research Database, which includes claims data on a random sample of 1 million people. MAIN OUTCOMES AND MEASURES: Using propensity score matching on age and sex, patients were stratified at a 1:4 ratio into a study group comprising 5304 patients with a diagnosis of SSNHL and a control group comprising 21 216 patients. Those with a diagnosis of VBI before the index date (the date each patient was diagnosed as having SSNHL) in both groups were then identified. A conditional logistic regression model was used to estimate the adjusted odds ratios (ORs) and 95% CIs as a measure of the association between SSNHL and VBI. RESULTS: The study cohort comprised 26 520 patients. Their mean (SD) age was 51.3 (17.2) years, and 47.1% (12 500 of 26 520) were female. Vertebrobasilar insufficiency was diagnosed before the index date in 0.5% (26 of 5304) of patients with SSNHL and in 0.2% (38 of 21 216) of controls without SSNHL. After adjusting for comorbid medical disorders, patients with SSNHL were more likely than controls to have had VBI (OR, 1.76; 95% CI, 1.02-3.04). There were no significant differences in the prevalence of VBI among male patients with SSNHL vs male controls (OR, 1.72; 95% CI, 0.87-3.40) or among female patients with SSNHL vs female controls (OR, 1.86; 95% CI, 0.76-4.59). CONCLUSIONS AND RELEVANCE: Patients with VBI appear to be at increased risk of developing SSNHL. Further research is needed to investigate the association among the severity of VBI, the risk of SSNHL, and the pattern of the audiometric curve.

Obstructive Sleep Apnea and the Subsequent Risk of Chronic Rhinosinusitis: A Population-Based Study.

The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) still remains unclear. This retrospective cohort study aimed to investigate the relationship between OSA and subsequent CRS using a population-based dataset. The study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 971 patients with OSA for the study cohort and 4855 patients without OSA for the comparison cohort. Each patient was tracked for 5 years to determine those who were subsequently diagnosed with CRS. Stratified Cox proportional hazard regression analyses were performed to examine the association of OSA with subsequent CRS. The results revealed that 161 (2.76%) of the total sampled patients were subsequently diagnosed with CRS. Subsequent incidences of CRS were found in 64 (6.59%) patients with OSA and 97 (2.00%) patients without OSA. The adjusted hazard ratio (HR) of subsequent CRS for patients with OSA was 3.18 (95% confidence interval: 2.27~4.45) compared to those without OSA. Furthermore, the HR for CRS was similar for subjects with OSA for both genders (with an adjusted HR of 3.44 for males and 2.63 for females). We concluded that patients with OSA had a higher risk of subsequent CRS compared to patients without OSA regardless of sex.

A population-based study on the association between chronic periodontitis and sialolithiasis.

OBJECTIVES/HYPOTHESIS: Whereas the impression that poor oral hygiene is linked to the development of sialolithiasis may be widely accepted, very few studies provide evidence to support this. This study therefore aimed to evaluate the association between chronic periodontitis (CP) and the subsequent development of salivary gland stone based on a nationwide coverage database. STUDY DESIGN: A case-control study. METHODS: A total of 987 subjects with sialolithiasis were included as cases. In a ratio of five controls per case, 4,935 controls matched in terms of sex and age group were selected. Conditional logistic regression analysis was performed to determine the possible association of sialolithiasis with previously diagnosed CP. RESULTS: The prevalence of prior CP between cases and controls demonstrated that 1,831 (30.9%) out of the 5,922 sampled subjects had prior CP. By Chi-square test, there was a significant difference in the prevalence of prior CP between the cases and controls (36.8% vs. 29.7%, P < 0.001). By conditional logistic regression analysis, the odds ratio (OR) of prior CP for cases was 1.37 (95% confidence interval [CI], 1.19-1.56) compared to the controls after adjusting for geographic location and tobacco use. Further analyzing the relationship between sialolithiasis and prior CP according to sex, sialolithiasis was associated with prior CP regardless of sex. The adjusted OR of prior CP for the cases was 1.34 (95% CI, 1.10-1.64) and 1.41 (95% CI, 1.15-1.73) for males and females, respectively, when compared to controls. CONCLUSION: This study demonstrates an association between CP and sialolithiasis. LEVEL OF EVIDENCE: 3b.