A survey on the management of acute rhinosinusitis among Asian physicians.

BACKGROUND: Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia. METHODOLOGY: Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan. RESULTS: ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS. CONCLUSION: ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.

Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial.

OBJECTIVES: To compare the clinical effectiveness and adverse events for 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in the treatment of otomycosis. METHODS: A total of 120 otomycosis patients were randomly assigned to receive either 1 per cent clotrimazole solution (intervention group) or 3 per cent boric acid in 70 per cent alcohol (control group) at the Khon Kaen Hospital ENT out-patient department. Treatment effectiveness was determined based on the otomicroscopic absence of fungus one week after therapy, following a single application of treatment. RESULTS: After 1 week of treatment, there were data for 109 participants, 54 in the clotrimazole group and 55 in the boric acid group. The absolute difference in cure rates between 1 per cent clotrimazole solution and 3 per cent boric acid in 70 per cent alcohol was 17.9 per cent (95 per cent confidence interval, 2.3 to 33.5; p = 0.028) and the number needed to treat was 6 (95 per cent confidence interval, 3.0 to 43.4). Adverse events for the two agents were comparable. CONCLUSION: One per cent clotrimazole solution is more effective than 3 per cent boric acid in 70 per cent alcohol for otomycosis treatment.

Myasthenia gravis poses a diagnostic problem for the otolaryngologist: a closer look at symptoms may alert the possibility of myasthenia gravis.

A nine-year retrospective study of the new cases of myasthenia gravis (MG) at Ramathibodi Hospital was done to find the incidence, the symptoms, and the physical signs at initial attendance (IA) and at the time of correct diagnosis (CD). In contrast to previous studies on MG, we found an incidence of only 1.1 patient with MG/year in the department of otolaryngology, representing only 3.3% of the new cases of MG seen at Ramathibodi Hospital. Ninety percent of patients with MG had five or more symptoms at the time of IA but only 30% had positive physical signs at the time of IA. However, all the patients had five or more symptoms at the time of CD and all the patients had five or more physical signs at the time of CD. Seven out of 10 patients were diagnosed as MG late, 8-182 days after the time of IA. The presence of five or more symptoms at the time of IA should have alerted the otolaryngologist to consider MG as a possible diagnosis. This emphasis has yet to be written in the otolaryngological literature.

Surgical anatomy of lateral nasal wall in northeast Thai cadavers.

A morphometric osteological study of the lateral nasal wall of Thai cadavers proved essential for the endoscopic sinus surgery on Thai patients in order to increase effectiveness and decrease the number of intraoperative complications. The middle turbinate should be preserved during the operation because it is a useful landmark for finding the natural maxillary sinus ostium and for avoiding nasolacrimal duct injury.

Outcome of mobile ear surgery units in Thailand.

OBJECTIVES: To evaluate the outcome of mobile ear surgery, in terms of tympanic membrane perforation closure, absence of otorrhoea and hearing threshold improvement. STUDY DESIGN: Descriptive study. METHODS: The study enrolled patients with chronic ear disorders requiring surgery who presented to the mobile ear surgery unit at Sakaeo Hospital, Thailand, from 1 to 4 July 2008. The following data were recorded: pre-operative audiogram, post-operative middle-ear and mastoid infection, wound infection, graft condition, any complications, and post-operative audiogram. Patients were followed up at one week, two weeks, four weeks and 24 weeks post-operatively. RESULTS: For the 31 cases of tympanic membrane perforation, the closure rate was 90.3 per cent. For the 32 patients with otorrhoea, the rate of ear dryness was 87.5 per cent. All 35 patients had impaired hearing initially; the rate of hearing improvement was 74.3 per cent (95 per cent confidence intervals = 56.7-87.5 per cent). Patients' mean hearing improvement was 22.9 dB. CONCLUSION: The assessed ear surgery procedures had good results.