Practice Patterns for Chronic Respiratory Diseases in the Asia-Pacific Region: A Cross-Sectional Observational Study.

BACKGROUND: Allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis are common and little studied in the Asia-Pacific region. OBJECTIVES: We sought to investigate real-world practice patterns for these respiratory diseases in India, Korea, Malaysia, Singapore, Taiwan, and Thailand. METHODS: This cross-sectional observational study enrolled adults (age ≥18 years) presenting to general practitioners (GP) or specialists for physician-diagnosed AR, asthma, COPD, or rhinosinusitis. Physicians and patients completed study-specific surveys at one visit, recording patient characteristics, health-related quality of life (QoL), work impairment, and healthcare resource use. Findings by country and physician category (GP or specialist) were summarized. RESULTS: Of the 13,902 patients screened, 7,243 (52%) presented with AR (18%), asthma (18%), COPD (7%), or rhinosinusitis (9%); 5,250 of the 7,243 (72%) patients were eligible for this study. Most eligible patients (70-100%) in India, Korea, Malaysia, and Singapore attended GP, while most (83-85%) in Taiwan and Thailand attended specialists. From 42% (rhinosinusitis) to 67% (AR) of new diagnoses were made by GP. On average, patients with COPD reported the worst health-related QoL, particularly to GP. Median losses of work productivity for each condition and activity impairment, except for asthma, were numerically greater for patients presenting to GP vs. specialists. GP prescribed more antibiotics for AR and asthma, and fewer intranasal corticosteroids for AR, than specialists (p < 0.001 for all comparisons). CONCLUSIONS: Our findings, albeit mostly descriptive and influenced by between-country differences, suggest that practice patterns differ between physician types, and the disease burden may be substantial for patients presenting in general practice.

Update on Intranasal Medications in Rhinosinusitis.

This review describes beneficial effects and adverse events of various intranasal medications in treating rhinosinusitis. Application of intranasal steroids has been described in treating all subtypes of adult rhinosinusitis, but reports are limited in pediatrics and mostly in acute pediatric subgroups resulted in benefits While saline irrigation is effective for patients with chronic rhinosinusitis without polyps and in pediatric acute rhinosinusitis, there is no evidence yet for saline drips and sprays. Application of intranasal antifungals and nasal irrigation with surfactant brings more harm than benefits. There is no evidence supporting the use of intranasal antibiotics. We also review influence of devices, methods, and patient head position on nasal and paranasal sinus drug delivery.

Respiratory disease in the Asia-Pacific region: Cough as a key symptom.

BACKGROUND: Respiratory diseases represent a significant impact on health care. A cross-sectional, multicountry (India, Korea, Malaysia, Singapore, Taiwan, and Thailand) observational study was conducted to investigate the proportion of adult patients who received care for a primary diagnosis of asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), or rhinosinusitis. OBJECTIVE: To determine the proportion of patients who received care for asthma, AR, COPD, and rhinosinusitis, and the frequency and main symptoms reported. METHODS: Patients ages ≥18 years, who presented to a physician with symptoms that met the diagnostic criteria for a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Patients and physicians completed a survey that contained questions related to demographics and respiratory symptoms. RESULTS: A total of 13,902 patients with a respiratory disorder were screened, of whom 7030 were eligible and 5250 enrolled. The highest percentage of patients who received care had a primary diagnosis of AR (14.0% [95% confidence interval {CI}, 13.4-14.6%]), followed by asthma (13.5% [95% CI, 12.9-14.1%]), rhinosinusitis (5.4% [95% CI, 4.6-5.3%]), and COPD (4.9% [95% CI, 5.0-5.7%]). Patients with a primary diagnosis of COPD (73%), followed by asthma (61%), rhinosinusitis (59%), and AR (47%) most frequently reported cough as a symptom. Cough was the main reason for seeking medical care among patients with a primary diagnosis of COPD (43%), asthma (33%), rhinosinusitis (13%), and AR (11%). CONCLUSION: Asthma, AR, COPD, and rhinosinusitis represent a significant proportion of respiratory disorders in patients who presented to health care professionals in the Asia-Pacific region, many with concomitant disease. Cough was a prominent symptom and the major reason for patients with respiratory diseases to seek medical care.

Configuration of the Ethmoidal Roof: A Radiologic Anatomical Study

Background: Currently endoscopic sinus surgery is the standard operation for rhinosinusitis and nasal polyps, including tumors near the anterior skull base. During the surgery, the iatrogenic penetration into the anterior skull base may be at risk. Therefore, information of the anterior skull base configuration is useful for the sinus surgeon. Objective: To determine the patterns and their prevalence of slopes of the ethmoidal roof assessed from the Computed Tomography (CTs) of paranasal sinuses. Material and Method: A descriptive study was conducted at Srinagarind Hospital, Faculty of Medicine, Thailand. CTs of paranasal sinuses from 150 patients aged 18 years and above who had attended at Srinagarind hospital between January 1, 2007 and December 31, 2011 were retrieved and reviewed. The slope patterns of the ethmoidal roof were determined by visual assessment of the scans, measuring the height between the ethmoidal roof and floor of nasal cavities in three sagittal planes: medio-sagittal, latero-sagittal, and mid-sagittal. CTs were performed by a Philips 128 slice scanner. Results: The downslope anteriorly and upslope posteriorly of the ethmoidal roof was found to be commonest in medio-sagittal and mid-sagittal planes. Its prevalence in medio-sagittal and mid-sagittal planes was 80.3% (95% CI 75.5-84.4) and 52% (95% CI 46.4-57.6). The second common pattern in medio-sagittal and mid-sagittal planes was a downslope pattern with the prevalence of 13% (95% CI 9.7-17.3) and 39.3% (95% CI 34-44). The downslope pattern was found to be the most prevalent for the latero-sagittal plane, accounting for 50.7% (95% CI 45.0-56.3), followed by downslope anteriorly and upslope posteriorly of 40% (95% CI 34.6-45.6). Conclusion: This is the first study to describe the patterns of slopes of the ethmoidal roof (anterior skull base) which demonstrates that there are different patterns depending on the plane of sagittal view. Therefore, the sagittal view of the CT paranasal sinus in each plane should be interpreted before performing the operation to avoid iatrogenic intracranial complications.

Ear, Nose, Throat and Craniofacial Diseases Community Services Initiative of Khon Kaen University.

The Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University has cooperated with the local community to establish the welfare and health education service in the local community. The first initiative was carried out in the local primary school. This paper described the missions, method and results of our first attempt to screen the students in the community.

Corticosteroids for parasitic eosinophilic meningitis.

BACKGROUND: Angiostrongylus cantonensis (A. cantonensis) is the major cause of infectious eosinophilic meningitis. Dead larvae of this parasite cause inflammation and exacerbate symptoms of meningitis. Corticosteroids are drugs used to reduce the inflammation caused by this parasite. OBJECTIVES: To assess the efficacy and safety of corticosteroids for the treatment of eosinophilic meningitis. SEARCH METHODS: We searched CENTRAL (2014, Issue 11), MEDLINE (1950 to November Week 3, 2014), EMBASE (1974 to December 2014), Scopus (1960 to December 2014), Web of Science (1955 to December 2014), LILACS (1982 to December 2014) and CINAHL (1981 to December 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) of corticosteroids versus placebo for eosinophilic meningitis. DATA COLLECTION AND ANALYSIS: Two review authors (SiT, SaT) independently collected and extracted study data. We graded the methodological quality of the RCTs. We identified and analysed outcomes and adverse effects. MAIN RESULTS: We did not identifiy any new trials for inclusion or exclusion in this 2014 update. One study involving 110 participants (55 participants in each group) met our inclusion criteria. The corticosteroid (prednisolone) showed a benefit in shortening the median time to resolution of headaches (five days in the treatment group versus 13 days in the control group, P value < 0.0001). Corticosteroids were also associated with smaller numbers of participants who still had headaches after a two-week course of treatment (9.1% versus 45.5%, P value < 0.0001). The number of patients who needed repeat lumbar puncture was also smaller in the treatment group (12.7% versus 40%, P value = 0.002). There was a reduction in the median time of analgesic use in participants receiving corticosteroids (10.5 versus 25.0, P value = 0.038). There were no reported adverse effects from prednisolone in the treatment group. AUTHORS' CONCLUSIONS: Corticosteroids significantly help relieve headache in patients with eosinophilic meningitis, who have a pain score of four or more on a visual analogue scale. However, there is only one RCT supporting this benefit and this trial did not clearly mention allocation concealment and stratification. Therefore, we agreed to grade our included study as a moderate quality trial. Future well-designed RCTs are necessary.

Baby Shampoo versus Commercial Anti-fogging Solution to Prevent Fogging during Nasal Endoscopy: A Randomized Double-Blinded, Matched-Pair, Equivalent Trial.

OBJECTIVE: To compare the minimization of the fog condensation during nasal endoscopy between a commercial anti-fogging agent and baby shampoo. MATERIAL AND METHOD: This randomized double-blinded matched pair study was conducted at the Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University during February 4, 2013 to March 14, 2013. The commercial anti-fogging solution (Ultrastop®) and baby shampoo solution (Johnson's® no more tear®) were compared. A computer generated randomization was performed to select the solution applying on the lens for nasal endoscopy of the right nasal cavity. The other solution was then used for the left one. Three passes of endoscopy were performed to examine the floor of the nose, the sphenoethmoidal recess and the middle meatus area which spent about 30 seconds for each time of endoscopy. The time to become foggy on the lens and the preferred solution assessed by the endoscopists were recorded. RESULTS: There were 71 eligible patients recruited in the study, 37 males (52.1%) and 34 females (47.9%). There was no fogging during a 30-second nasal endoscopy either by baby shampoo or commercial anti-fogging solution. However, 9.86% (95% C12.75-16.97) of endoscopists preferred commercial anti-fogging agent, 7.04% (95% CI 0.94-13.14) preferred baby shampoo and 83.10% (95% CI 74.16-92.03) had equal satisfaction. Both agents had no statistically significant difference for preventing foggy on the lens. CONCLUSION: Baby shampoo is an effective agent to prevent fogging during nasal endoscopy and comparable with the commercial anti-fogging agent.

A Surveillance Bacteriological Study of Acute Bacterial Rhinosinusitis in Thailand and the Clinical Responses to the Culture-directed Antibiotics.

OBJECTIVE: To examine: 1) types of bacteria and antimicrobial sensitivity of commonly used antibiotics for acute bacterial rhinosinusitis (ABRS) in Thailand, 2) the effectiveness of using antibiotics according to antimicrobial sensitivity, and 3) the effectiveness of using antibiotics according to the Thai clinical practice guidelines (CPG) of ABRS. MATERIAL AND METHOD: Descriptive & experimental studies were conducted in seven tertiary hospitals in Thailand. The specimens from maxillary sinuses were taken for bacterial cultures either by maxillary sinus tap or endoscopically directed middle meatus swabs in patients with clinically diagnosed ABRS. Antimicrobial sensitivity was performed and antibiotics were prescribed according to the results of antimicrobial sensitivity or the Thai CPG of ABRS. RESULTS: A total of 113 patients were enrolled between August 2006 and April 2007, 104 cases of which were performed for bacteriological study. The incidence of bacterial growth was 60.6% (95% CI 51.0-69.4%). The most common bacteria was H. influenzae (25.0%, 95% CI 16.9-35.3%), followed by S. pneumoniae (14.3%, 95% CI 8.2-23.5%) and S. aureus (9.5%, 95% CI 4.7-17.9%), respectively, whilst M. catarrhalis was found only in 2.4% (95% CI 0.5-7.3%). Eight in 12 S. pneumoniae isolates were tested for the minimal inhibitory concentration of penicillin and found to be penicillin resistant strain in five specimens. Beta-lactamase producing H. influenzae was found in eight out of 20 isolates. H. influenzae had a tendency to be sensitive to amoxicillin/clavulanate, cefuroxime, cefpodoxime, azithromycin, clarithromycin, ofloxacin, levofloxacin and gatifloxacin, whilst S. pneumoniae had a tendency to be sensitive to amoxicillin/clavulanate, cefaclor ampicillin/sulbactam, cefuroxime, ofloxacin, levofloxacin, gatifloxacin, cefpodoxime, cefixime and cefdinir. The effectiveness of antibiotics prescription according to the Thai CPG of ABRS and antimicrobial sensitivity were comparable, 88.5% (95% CI 69.8-97.6%) and 82.2% (95% CI 67.9-92%), respectively. CONCLUSION: H. influenzae is found to be the most common bacteria in Thai ABRS, followed by S. pneumoniae and S. aureus. There is a high incidence of beta-lactamase producing H. influenzae and penicillin non-susceptible S. pneumoniae.

Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media.

BACKGROUND: Acute otitis media (AOM) is a common problem in children, for which amoxicillin, with or without clavulanate, is frequently prescribed as a treatment of choice. The conventional recommendation is either three or four daily doses. However, nowadays it is frequently prescribed as once or twice daily doses. If once or twice daily amoxicillin, with or without clavulanate, is as effective for acute otitis media as three or four times a day, it may be more convenient to give the medication once or twice a day to children and hence improve compliance. OBJECTIVES: To compare the effectiveness of one or two daily doses with three or four daily doses of amoxicillin, with or without clavulanate, for the treatment of AOM in children; and to compare complication rates and adverse reactions. SEARCH METHODS: We searched CENTRAL 2013, Issue 2, MEDLINE (January 1950 to March week 1, 2013), EMBASE (1974 to March 2013) and the Science Citation Index (2001 to March 2013). SELECTION CRITERIA: We included randomised controlled trials (RCTs) of children aged 12 years or younger with AOM, diagnosed by acute ear pain (otalgia) and inflamed ear drum (confirmed by positive tympanocentesis or tympanogram of type B or C). DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data on treatment outcomes from individual trials and assessed trial quality based on selection bias, performance bias and detection bias, attrition bias, reporting bias and other biases. We defined the quality grading as low risk of bias, high risk of bias or unclear risk of bias. We summarised the results as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS: We included five studies with 1601 children in the review. Pooled analysis demonstrated that the following outcomes were comparable between the two groups: clinical cure at the end of therapy (RR 1.03, 95% CI 0.99 to 1.07); during therapy (RR 1.06, 95% CI 0.85 to 1.33) and at follow-up (RR 1.02, 95% CI 0.95 to 1.09); recurrent AOM (RR 1.21, 95% CI 0.52 to 2.81); compliance rate (RR 1.04, 95% CI 0.98 to 1.10) and overall adverse events (RR 0.92, 95% CI 0.52 to 1.63). When we performed subgroup analysis separately for trials with amoxicillin only and amoxicillin/clavulanate only, it showed that all important outcomes were comparable between once or twice daily groups and the three times daily group. The risk of bias amongst the five included studies was as follows: for random sequence generation we graded two studies as low and three unclear risk of bias; for allocation concealment all studies were at unclear risk of bias; for blinding (performance and detection bias) we graded four as high and one as unclear risk of bias; for incomplete outcome data (attrition bias) we graded two low, two high and one as unclear risk of bias; for reporting bias four were at low and one at high risk; and for 'other' bias four were at low and one at unclear risk of bias. AUTHORS' CONCLUSIONS: This review showed that the results of using once or twice daily doses of amoxicillin, with or without clavulanate, were comparable with three doses for the treatment of AOM.

Invasive fungal rhinosinusitis versus bacterial rhinosinusitis with orbital complications: a case-control study.

BACKGROUND: Invasive fungal rhinosinusitis with orbital complications (IFSwOC) is a life-threatening condition. The incidence of mortality has been reported to be up to 80 percent. This study was conducted to determine the risk factors, presentations, clinical, and imaging findings that could help to manage this condition promptly. METHODS: We conducted a case-control study of 100 patients suffering from rhinosinusitis with orbital complications. The risk factors, clinical presentations, radiological findings, medical and surgical managements, durations of hospital stay, and mortality rate data were collected. RESULTS: Sixty-five patients were diagnosed with IFSwOC, while the other thirty-five patients composed the control group. The most important risk factor for IFSwOC was diabetes mellitus. Visual loss and diplopia were the significant symptom predictors. The significant clinical predictors were nasal crust, oculomotor nerve, and optic nerve involvement. The CT findings of IFSwOC were sinus wall erosion and hyperdensity lesions. The mortality rate was 25.71 percent in the IFSwOC group and 3.17 percent in the control group. CONCLUSIONS: Invasive fungal rhinosinusitis with orbital complications is symptomatic of a high mortality rate. The awareness of a patient's risk factors, the presenting symptoms, signs of fungal invasion, and aggressive management will determine the success of any treatment procedures.

Speech, language, voice, resonance and hearing disorders in patients with cleft lip and palate.

OBJECTIVE: To estimate the prevalence of speech, language, and hearing disorders in patients with cleft palate with or without cleft lip. MATERIAL AND METHOD: All data were retrieved from 384 medical records, transferred to case record forms and analyzed. RESULTS: The oronasal fistula rate was 15.25% (95% confidence interval: CI 11.49-19.02). The overall rates of delayed language development, articulation disorders, resonance disorders, voice disorders, and hearing disorders were 16.33% (95% CI = 12.65-20.69), 88.56% (84.47-92.65), 43.26% (95% CI = 36.58-49.93), 19.13% (95% CI = 14.26-24.82), and 79.49% (95% CI = 74.28-84.70), respectively. CONCLUSION: For speech and hearing, rates of abnormality were very high compared with those reported in the previous studies. Treatment protocols should receive more attention and intervention.

Corticosteroids for parasitic eosinophilic meningitis.

BACKGROUND: Angiostrongylus cantonensis (A. cantonensis) is the major cause of infectious eosinophilic meningitis. Dead larvae of this parasite cause inflammation and exacerbate symptoms of meningitis. Corticosteroids are drugs used to reduce inflammation caused by this parasite. OBJECTIVES: To examine the effects and adverse events of corticosteroids in patients with eosinophilic meningitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to July Week 4, 2012), EMBASE (1974 to July 2012), Scopus (1960 to July 2012), Web of Science (1955 to July 2012), LILACS (1982 to July 2012), and CINAHL (1981 to July 2012). SELECTION CRITERIA: Randomised controlled trials (RCTs) of corticosteroids versus placebo for eosinophilic meningitis. DATA COLLECTION AND ANALYSIS: Two review authors (SiT, SaT) independently collected and extracted study data. We graded the methodological quality of the RCTs. We identified and analyzed outcomes and adverse effects. MAIN RESULTS: One study involving 110 participants (55 participants in each group) met our inclusion criteria. The corticosteroid (prednisolone) showed a benefit in shortening the median time to resolution of headaches (five days in the treatment group versus 13 days in the control group, P < 0.0001). Corticosteroids were also associated with smaller numbers of participants who still had headaches after a two-week course of treatment (9.1% versus 45.5%, P < 0.0001). There was a reduction in median time of analgesics use in participants receiving corticosteroids (10.5 versus 25.0, P = 0.038). There were no reported adverse effects from prednisolone in the treatment group. AUTHORS' CONCLUSIONS: Corticosteroids significantly help relieve headache in patients with eosinophilic meningitis. However, there is only one RCT supporting this benefit and this trial did not clearly mention allocation concealment and stratification. Future well-designed RCTs may be necessary.

Audiological status in patients with cleft lip and palate at Srinagarind Hospital.

OBJECTIVE: To determine the audiological status in patients with cleft lip and palate. STUDY DESIGN: A descriptive retrospective study. MATERIAL AND METHOD: Data were retrieved from hospital records of 234 patients with cleft lip and palate and cleft palate who underwent hearing assessment between June 2007 and September 2010 at Srinagarind Hospital, Khon Kaen University. Descriptive data of the audiological evaluation were presented. RESULTS: Unilateral or bilateral hearing loss at the first hearing assessment was encountered among 186 patients (79.49%). Among these, 165 (88.71%) had bilateral conductive hearing loss and 16 (8.6%) had unilateral conductive hearing loss. The degree of hearing loss was greatest to a moderate degree in 181 (50.84%) ears. Most tympanometric evaluations presented with type B (335 ears or 72.67%). The age of the patient was significantly correlated with audiological status. CONCLUSION: The current study showed that there is a high prevalence of hearing impairment among patients with cleft lip and palate and cleft palate. Therefore, routine audiological assessment should be performed as early as possible, especially among children. Further prospective investigation of the prevalence of hearing loss in children with cleft lip and palate and cleft palate should be considered, and endorsed as a national healthcare policy priority in order to raise awareness and to prevent hearing loss among these children.

Frontal sinus drainage in Thai adult skulls.

OBJECTIVE: To study the pattern of the nasofrontal drainage in relation to the neighboring anatomical structures in adult Thai cadavers. MATERIAL AND METHOD: The anterior aspect of the frontal bone of the embalmed half-head was drilled to identify the presence of the frontal sinus i.e. 40 from only one side of each cadaver were chosen. A silicone base and catalyst were combined then injected into the frontal sinus, which flowed into the nasal cavity through its natural ostium, thereby creating a cast of the nasofrontal connection(s). After allowing five minutes for the silicone to set, the total vertical lamella of the middle turbinate was removed, so the cast could be measured, the connections meticulously dissected and the surrounding structures observed RESULTS: The investigation revealed five patterns of nasofrontal drainage. The most (60%) common pathway was directly through the frontal recess, while the other pathways 12.5, 10, 10 and 7.5 percent were drained directly into the ethmoid infundibulum, through the agger nasi cell and then into the ethmoid infundibulum, into both the agger nasi cell, the ethmoid infundibulum and the suprabullar recess, respectively. The average sizes of the anteroposterior and mediolateral diameters of the frontal sinus ostium were 6.5 and 5.5 mm, respectively. The agger nasi cell was present in every cadaver with a frontal sinus and was always superior to the ventral attachment of the middle turbinate. CONCLUSION: The agger nasi cell is the key structure vis-a-vis planning and performing frontal sinus surgery. In preparation for endoscopic intranasal frontal sinus surgery, it is practical to extend the infundibulotomy superiorly into the agger nasi cell, then remove its medial, posterior and superior wall.

Landmark of ethmoid arteries in adult Thai cadavers: application for sinus surgery.

BACKGROUND: Ethmoid arteries, branches of the ophthalmic artery, are crucial structures supplying ethmoid mucosa. Its locations are important during ethmoid sinus surgery. There has been no study in Thais before. OBJECTIVE: To determine the number and locations of ethmoid arteries in relation to important surrounding structures. MATERIAL AND METHOD: A prospective, descriptive study in 42 Thai cadaveric adult half-heads was conducted at departments of Otorhinolaryngology and Anatomy, Faculty of Medicine, Khon Kaen University, Thailand. Meticulous dissections were performed to identify number of ethmoid arteries branching from ophthalmic artery and site of entrance of the arteries into ethmoid sinus. Relationships of these arteries with anterior ethmoid crest, optic foramen, bulla lamella and middle third of basal lamella of middle turbinate were studied. OUTCOMES: Types of ethmoid arteries, distances between ethmoid arteries and their relations to important surrounding structures: anterior lacrimal crest, optic foramen, superior aspects of bulla lamella, middle third of basal lamella of middle turbinate and the superior aspect of anterior wall of sphenoid sinus. RESULTS: All specimens had anterior and posterior ethmoid arteries. The prevalence of tertiary ethmoid artery was 36% (95% CI22-52%). The mean distance between the anterior ethmoid artery and anterior lacrimal crest, anterior ethmoid artery and posterior ethmoid artery and the distance between posterior ethmoid artery and optic foramen were 24.3, 13.5 and 6.4 millimeters respectively. Most of the entry of anterior ethmoid artery into the ethmoid sinus was in the posterior half of the distance between the bulla lamella and middle third of basal lamella of middle turbinate, 85.7%. CONCLUSION: This is the first study of location of ethmoid arteries in Thai adult cadavers. The information of the present study may be useful for sinus surgeon.

Two-hole trephination (Muntarbhorn) technique for a large frontal sinus osteoma: a case report.

OBJECTIVE: To present an alternative surgical option for frontal sinus osteoma. MATERIAL AND METHOD: A woman presented with a symptomatic large osteoma in right frontal sinus. Two-hole trephination was planned to remove the osteoma using nasal endoscope and a drill in each hole. RESULTS: The osteoma was drilled and removed transnasally. Two months later, two small fragments of osteoma were detected remaining in the lateral aspect of the sinus. The fragments were removed successfully with the same technique. The patient was asymptomatic six months postoperatively. CONCLUSION: Two-hole trephination technique or Muntarbhorn technique is an attractive option for frontal sinus osteoma.

The burden of head and neck cancers in Thailand.

OBJECTIVE: To determine the overall burden of disease vis-a-vis head and neck cancers in Thailand, as indicated by visits to healthcare units, admissions for treatment and expenditures at all levels of the healthcare delivery system. MATERIAL AND METHOD: A descriptive study was conducted by retrieving and analysing data for the fiscal year 2010 from the National Health Security Office (NHSO) and the Social Security Office, Thailand and from in-patient data of the Civil Servants Benefit System from the Comptroller General's Department. RESULTS: In 2010, there were 167,199 visits to outpatient departments (OPDs) and 26,012 admissions to hospital (IPD) for diagnosis and treatment of head and neck cancers. The most common diagnosis for visits to OPD and admission to IPD was oral cancer (28.2% and 25%, respectively). The mean length of hospital stay was 9 days. About half of admissions took place in the central region. The hospital charges totalled 691 million Baht (US$ 21.8 million), or an average of 26,556 Baht (USS 838) per admission. CONCLUSION: Since a relatively high volume of hospital visits was found, there is an urgent need to train sufficient numbers of specialists in the field of head and neck cancer treatments to provide efficient healthcare.

Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study.

Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9-45.3), 56.0 ± 6.1 (95%CI: 53.7-58.3), and 60.1 ± 6.2 (95%CI: 57.8-62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3-48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1-61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6-65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches ( p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

Voice quality changes after functional endoscopic sinus surgery in patients with nasal polyps.

Nasal polyps are associated with hyponasality. The effect of functional endoscopic sinus surgery (FESS) on voice quality has not been adequately investigated; therefore, this study developed objective and subjective measurements to compare nasal polyp patients pre- and postsurgery. An observational prospective study was conducted at Srinagarind Hospital, Khon Kaen University, Thailand. Bilateral nasal polyposis patients who underwent FESS between August 1, 2015 and August 1, 2017, were recruited. All participants were assessed for nasal polyp grade, nasometry, acoustic parameters, acoustic perception, and patient satisfaction before surgery and at the 1-, 3- and 6-month follow-ups. Forty-six patients, 29 males and 17 females (mean age 48.2 years ± 16.2 years), were enrolled. Mean nasometry scores were significantly improved at 1, 3 and 6 months after surgery (p < 0.05), whereas the acoustic parameters were not significantly different after surgery (p > 0.05). Overall acoustic perception, assessed with a set of words and sentences, showed significant improvement in hyponasality voice after surgery (p < 0.05), whereas GIRBAS showed no significant change after surgery in each parameter of perception (p > 0.05). Patient satisfaction with voice changes after surgery was high, with significantly increased mean scores between the 1- and 6-month follow-ups (p < 0.05). The results showed that FESS for nasal polyposis patients improved voice quality and patients' voice satisfaction ratings. Trial registration: This trial was registered at the Thai Clinical Trial Registry (TCTR20210324004).