The short Thai version of functional outcomes of sleep questionnaire (FOSQ-10T): reliability and validity in patients with sleep-disordered breathing.

PURPOSE: The study is to evaluate reliability and validity of the short Thai version of Functional Outcome of Sleep Questionnaire (FOSQ-10T), in patients with sleep disordered breathing (SDB). METHODS: Inclusion criteria were Thai patients with SDB age ≥ 18 years old who had polysomnography results available. Exclusion criteria were patients unable to complete questionnaire for any reason, patients with a history of continuous antidepressant or alcohol use, and underlying disorders including unstable cardiovascular, pulmonary, or neurological conditions. All participants were asked to complete the FOSQ-10 T and Epworth sleepiness scales (ESS). Of these, 38 patients were required to retake FOSQ-10 T at 2-4 weeks later to assess test-retest reliability, and 19 OSA patients treated with CPAP were asked to do so at 4 weeks following therapy to assess questionnaire's responsiveness to treatment. RESULTS: There were 42 participants (24 men, 18 women), with a mean age of 48.3 years. The internal consistency of the FOSQ-10T was good, as indicated by Cronbach's alpha coefficient of 0.85. The test-retest reliability was good, as indicated by intraclass correlation coefficient of 0.77. The correlation between the FOSQ-10T and ESS scores (concurrent validity) was moderate (r = - 0.41). The scores of FOSQ-10T significantly increased after receiving adequate CPAP therapy, showing an excellent responsiveness to treatment. However, there was no significant association between FOSQ-10T scores and OSA severity measured by apnea-hypopnea index. CONCLUSIONS: The FOSQ-10T has good reliability and validity to use as a tool to assess QOL in Thai patients with SDB. It is convenient and potentially useful in both clinical and research settings.

Sparing Swallowing-Related Structures Reduces Post-Radiotherapy Dysphagia in Oropharyngeal Cancer.

OBJECTIVE: To identify swallowing-related structures (SRSs) predicting post-radiotherapy dysphagia in oropharyngeal carcinoma patients. MATERIAL AND METHODS: Between September 2020 and October 2022, oropharyngeal cancer patients who had completed radiotherapy at least one year before without recurrence or residuals were selected. They underwent flexible endoscopic evaluation of swallowing (FEES) assessments and dysphagia grading. The mean radiation doses delivered to their SRSs were recalculated. The correlation between radiation doses to each SRS and FEES scores was analysed. RESULTS: Twenty-nine participants, aged 51-73 years, were enrolled. Six patients had received two-dimensional radiotherapy, eight had undergone three-dimensional conformal radiotherapy, and fifteen had received intensity-modulated radiation therapy. Radiation doses to the inferior pharyngeal constrictor, cricopharyngeus and glottic larynx significantly predicted dysphagia for both semisolids (p = 0.023, 0.030 and 0.001) and liquid diets (p = 0.021, 0.013 and 0.002). The esophageal inlet significantly predicted swallowing outcomes for only the liquid diet (p = 0.007). CONCLUSIONS: This study supports that SRS-sparing during radiotherapy for oropharyngeal cancers improves swallowing outcomes.

Assessing Tongue Strength and Swallowing Function Following Hyoid Bone Resection Surgery.

PURPOSE: The tongue and hyoid bone are responsible for the oral phase of swallowing. The purpose of this study was to assess tongue strength and endurance, and to evaluate swallowing functions in patients who underwent hyoid bone resection surgery. MATERIAL AND METHODS: This was an experimental, non-randomized trial. It included participants who underwent hyoid bone resection surgery, divided into 2 groups; post-Sistrunk procedure and post-total laryngectomy. Swallowing problem history was recorded, and tongue strength and endurance were measured using the Iowa Oral Performance Instrument (IOPI). Post-Sistrunk procedure participants also underwent flexible endoscopic evaluation of swallowing (FEES) to assess objective swallowing function. Descriptive and bivariate statistics were used to analyze the association between the tongue strength and endurance, and the type of surgeries. RESULTS: The study involved 26 participants, including 16 males and 10 females, with a mean age of 58.4 ± 12.8 years. A total of 10 subjects underwent the Sistrunk procedure and 16 underwent total laryngectomy surgery. The average tongue strength of all participants was 40.8 ± 11.7 kPa and the average tongue endurance was 30.6 ± 13.2 s. The difference in average tongue strength between the post-Sistrunk procedure group and post-total laryngectomy group was not significantly different (37.5 ± 11.6 kPa vs. 44.1 ± 11.3kPa, P = .153). However, there was a statistically significant difference in average tongue strength between male and female participants (46.3 ± 10.0 kPa vs. 32.0 ± 8.5 kPa, P = .001). FEES did not reveal any evidence of objective swallowing abnormalities in the post-Sistrunk group. CONCLUSION: The resection of the hyoid bone, whether partial or total, did not significantly affect tongue strength and swallowing functions.

Association between hypoxic burden and common cardiometabolic diseases in patients with severe obstructive sleep apnea.

PURPOSE: To determine the possible associations between total sleep time spent with arterial oxygen saturation < 90% (T90) and comorbid cardiometabolic diseases (CMDs) in patients with severe obstructive sleep apnea (OSA). METHODS: A retrospective review of the chart was conducted in patients with severe OSA diagnosed by in-lab polysomnography (PSG) between January 2018 and December 2019 at Siriraj Hospital. The patients were divided into two groups: hypoxic (T90 ≥ 10%) and nonhypoxic (T90 < 10%). The association between common CMDs including hypertension (HT), type 2 diabetes mellitus (T2DM), and impaired fasting glucose (IFG) was investigated and compared between the two groups. RESULTS: Data were collected from 450 patients with severe OSA, 289 males/161 females with a mean age of 53.5 ± 14.2 years and an apnea-hypopnea index (AHI) of 49.6 events/h. Among these, 114 patients (25.3%) were defined as the hypoxic group (T90 ≥ 10%). When compared between the hypoxic and nonhypoxic groups, the patients in the hypoxic group were significantly younger and more obese, and had a higher proportion of male patients. The majority of patients (80%) had at least one CMD; however, the most common comorbidities significantly associated with hypoxic OSA (T90 ≥ 10%) were HT and IFG. CONCLUSION: Hypoxic burden is significantly associated with an increased prevalence of HT and IFG in patients with severe OSA. T90 may be potentially useful for predicting CMDs in these patients. However, prospective studies are still required.

Nasal Cavity Length or Analyzed Nasal Segment of Acoustic Rhinometry in Thai Adults.

Background: Nasal cavity length (NCL) is important for determining analyzed nasal segment (ANS) of acoustic rhinometry (AR). AR is a technique for nasal airway assessment which nasal cross-sectional areas and nasal volume (NV) are obtained. NCL or ANS is the important parameter to determine NV measured by AR. The ANS used to calculate NV in previous literatures vary from 4 to 8 cm. However, there has not been any study regarding NCL of Asians which is probably different from that of Western countries. Objectives: To measure NCL in Thai adults using nasal telescope and compared NCL between left and right sides as well as male and female as well as among age groups. Design: Prospective study. Methods: This study was performed on patients, aged 18-95 years, who underwent nasal telescopy under local anesthesia at the Department of Otorhinolaryngology, Siriraj Hospital. Baseline characteristics (sex and age) of patients were collected. NCL (from anterior nasal spine to posterior edge of nasal septum) of both nasal cavities was measured using rigid nasal telescope of 0 degree. Mean NCL length of both nasal cavities was calculated. Results: There were 1277 patients, with 498 (39%) male and 779 (61%) female. The mean ± standard deviation (SD) of NCL of male was 6 ± 0.6 cm whereas that of female was 5.7 ± 0.5 cm. There were no significant differences in NCL between left and right sides as well as among age groups in each gender (p > 0.05 all). However, male had significantly longer NCL compared with that of female (p < 0.001). The mean ± SD of NCL of total population was 5.9 ± 0.6 cm. Conclusion: The NCL of Thais was approximately 6 cm. These data are useful to determine ANS used to calculate NV when AR is performed. Plain Language Summaries: The length of nasal cavity (LNC) is important variable for acoustic rhinometry (AR) which is the instrument to measure nasal volume (NV). We use AR in clinical researches to diagnose and monitor the results of treatment of nose and sinus diseasesThe LNC used to calculate NV in previous studies vary from 4 to 8 cm. However, there has not been any study of LNC of Asians which is probably different from that of Western countriesWe measured LNC in 1277 Thai adults, aged 18-95 years, with 498 (39%) male and 779 (61%) female using nasal rigid endoscope and compared LNC between male and female.The average of LNC was 5.9 cm. Male had longer LNC compared with that female. The LNC of Thais was approximately 6 cm. These data are useful for AR to calculate NV.

Association between REM-related mild obstructive sleep apnea and common cardiometabolic diseases.

PURPOSE: To explore the association between rapid eye movement-related obstructive sleep apnea (REM-OSA) and common cardiometabolic diseases (CMDs) in patients with mild OSA. METHODS: This retrospective study was conducted by reviewing the medical records and polysomnograms (PSGs) of patients at Siriraj Hospital. The PSGs of patients diagnosed with mild OSA who had ≥ 15 min of REM sleep were included. REM-OSA was defined if the apnea-hypopnea index (AHI) in REM was ≥ 2 times that of non-REM. Common CMDs included coronary artery disease, stroke, heart failure, diabetes mellitus, and hypertension. RESULTS: The data of 518 patients with a mean age of 48.3 years, 198 males, and mean AHI of 9.8 events/h were analyzed in this study. When compared with the control group, the REM-OSA group (308 patients) were predominantly female (72%), overweight (62%), and had more severe oxygen desaturation, p-value < 0.001. CMDs were significantly more common in the REM-OSA group than in the controls [odds ratio (OR) 1.52, 95% confidence interval 1.04-2.21, p-value = 0.029]. Patients with a REM AHI of ≥ 20 events/h were significantly associated with hypertension compared to those with a REM AHI of < 20 events/h, p-value = 0.001. However, these associations were found not to be statistically significant after controlling for age, sex, BMI, and prevalent coexisting CMD (OR = 1.13, 95% CI: 0.72-1.76, p-value = 0.605). CONCLUSION: Common CMDs, particularly HT, tend to show an association with REM-OSA in patients with mild OSA, but this association did not reach statistically significant levels.

Physical Properties of Meals that are Suitable for Patients after Surgery to Treat Oral Cavity Cancers.

OBJECTIVES: To determine proper characteristics of food which would be safe and satisfactory for swallowing in oral cavity cancer patients undergoing surgery and to create a recipe that provides adequate nutrients, energy, good taste, and can be easily made at home. MATERIALS AND METHODS: Patients who were enrolled in this study underwent oral cancer surgery in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital from September 2017 to July 2018. This experimental research was conducted postoperatively before receiving chemoradiation. Each type of food was prepared by the researchers to have a combination of two physical properties, which were 3 different consistencies (liquid, nectar-like, and honey-like) and 2 different temperatures (room temperature (25ºC) and cold temperature (4ºC)). Each patient had to swallow six different types of prepared food by random sequences. Flexible endoscopic evaluation of swallowing (FEES) was used to evaluate objective swallowing function by 3 parameters, including premature oropharyngeal spillage, laryngeal penetration or aspiration, and post-swallow retaining residues. Satisfaction measurement was evaluated with visual analog scale (VAS). RESULTS: There were 42 postoperative oral cavity cancer patients enrolled in this study. Subjects consisted of 23 males (54.8%) and 19 females (45.2%) with the mean age of 62 ± 13 years.  Most patients had oral tongue carcinoma (64.3 %). FEES revealed nectar at room temperature was the safest with score of 0.83 ± 0.82 (possible score of 0-3, with 0 was best). However, patients significantly preferred liquid at room temperature more than other kinds of food (VAS taste = 8.26 ± 1.52 and VAS easy swallowing = 8.05 ± 1.74). When evaluating specifically in patients with oral tongue cancer, FEES scores, VAS taste, and VAS easy swallowing showed similar results the liquid at room temperature was the best. CONCLUSIONS: We suggested that the nectar-like thickened food at room temperature was determined to be the most proper food characteristic for oral cancer patients undergoing surgery in order to prevent aspiration. However, patients' satisfaction analysis suggested that they preferred other type of food. The physician should advise patients of the proper kind of food for safe swallowing and avoidance of serious complication especially aspiration pneumonia.

Outcome of the Management of Salivary Gland Diseases by Sialendoscopy: A University Hospital's Experience.

PURPOSE: Sialendoscopy is a minimally invasive procedure for the treatment of salivary gland diseases. The purpose of this study was to review a series of the patients undergoing sialendoscopy and to present our experience regarding the management and outcome of obstructive sialadenitis treated by this procedure. METHODS: This study was a case series. We collected data on patients who underwent sialendoscopy in our institute between January 2016 and July 2019. The data included patients' demographics, involved salivary glands, diagnostic investigation, types of anesthesia, endoscopic findings, materials used, complications, adjunctive treatment, duration of follow-up, and therapeutic outcome. Descriptive statistics were used to analyze the surgical findings and outcome. RESULTS: There were 61 patients involving 76 glands (48 submandibular and 29 parotid glands). There were 43 females and 18 males with the median age 45 years at the time of sialendoscopy. The median duration of follow-up was 6 months. The most dominant symptom was pain with swelling (59.20%). The 2 most common sialendoscopic findings were ductal stenosis and sialolithiasis. We observed a success rate in achieving a complete relief of 77.6% at the first procedure and 96.7% at the last follow-up. We did not have any cases with postoperative complication or recurrence. CONCLUSION: Our study supports sialendoscopy as a safe and successful procedure that plays a dual role in diagnostics and in relieving symptoms of patients with obstructive sialadenitis with or without sialolithiasis. It should be advised for patients with non-neoplastic salivary duct obstruction either for diagnosis or therapeutic intervention.

Obstructive Sleep Apnea and Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

OBJECTIVES: To evaluate the associations between obstructive sleep apnea (OSA) and sensorineural hearing loss (SNHL) and the effects of continuous positive airway pressure (CPAP) therapy on SNHL. DATA SOURCES: Ovid Medline, Embase, and Scopus databases. REVIEW METHODS: A systematic search was done for studies investigating relationships between OSA and SNHL in adults, with manual searches for additional references. The final update was done on December 22, 2021. The Risk of Bias Assessment Tool for Nonrandomized Studies was applied for quality assessments. RESULTS: The 20 included studies had a total of 34,442 participants (66% male; mean age, 46.6 years). The OSA group had a significantly worse mean hearing threshold level (HTL) than the control group for midfrequency ranges (500, 1000, 2000 Hz; mean difference, 4.00 dB; 95% CI, 2.40-5.61) and high-frequency ranges (4000, 8000 Hz; mean difference, 6.24 dB; 95% CI, 2.99-9.49). An association between OSA and SNHL was found. When compared with controls, patients with OSA had an odds ratio of 1.52 (95% CI, 1.12-2.06) for midfrequency hearing impairment and 1.19 (95% CI, 1.05-1.34) for high-frequency hearing impairment. However, we did not find significant improvements in midfrequency HTL after CPAP therapy. CONCLUSIONS: HTL was significantly poorer among participants with OSA (especially in severe cases) than non-OSA controls. Studies on patients with OSA with SNHL treated with CPAP did not show significant improvements in midfrequency HTL. Further studies are warranted on these issues.

Randomized crossover study of tongue-retaining device and positive airway pressure for obstructive sleep apnea.

PURPOSE: To compare the efficacy of tongue-retaining device (TRD) versus continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnea (OSA). STUDY DESIGN: Randomized crossover study. SUBJECTS AND METHODS: Thirty-six patients with a mean age of 52.7 ± 10.6 years were enrolled. Inclusion criteria were age ≥ 18 years, apnea-hypopnea index (AHI) ≥ 5 events/h, and minimum oxygen saturation (SO2) ≥ 70% from polysomnography (PSG). Exclusion criteria were severe periodontal disease, unstable cardiopulmonary or neurological diseases, and/or total sleep time < 2 h. A 1-week wash-in period was followed by questionnaires and randomization into two groups: TRD/CPAP and CPAP/TRD (18 patients each). After 3 weeks of intervention, questionnaires were re-administered and WatchPAT was performed. After a 1-week wash-out period, patients were switched to the other treatment. Primary outcome was AHI. Secondary outcomes were SO2, Functional Outcomes of Sleep Questionnaire (FOSQ), and Epworth Sleepiness Scale (ESS) scores, treatment side effects, and adherence. RESULTS: Nine patients withdrew, so 27 patients were included in the final analysis. Mean AHI decreased from 38.7 ± 24.0 to 2.5 ± 0.5 and 12.7 ± 2.6 events/h for CPAP and TRD, respectively (95% confidence interval of mean differences 4.65-15.62; p < 0.001). There was no significant difference in ESS and FOSQ scores between treatments. Common adverse effects were drooling, tongue numbness, and pain for TRD; and nasal blockage, mask compression, and difficult portability for CPAP. CONCLUSIONS: CPAP was superior to TRD for resolving PSG parameters; however, both similarly improved QOL and daytime sleepiness. TRD might be considered a short-term alternative treatment for OSA. TRIAL REGISTRATION: NCT02788487.

Expression levels of miR-34-family microRNAs are associated with TP53 mutation status in head and neck squamous cell carcinoma.

PURPOSE: The majority of head and neck squamous cell carcinoma (HNSCC) cases in developing countries are associated with cigarette smoking and TP53 mutations. p53 is a transcription factor that activates downstream genes, including the hsa-miR-34a and hsa-miR-34b/c loci, to achieve cell-cycle arrest, senescence, and/or apoptosis. This study examined the differences in expression levels of miR-34 in HNSCC with or without TP53 mutations. METHODS: We examined surgically resected tumor samples and normal adjacent tissues from HNSCC in oral cavity, larynx, and hypopharynx for TP53 mutations (exons 5-8) and miR-34 expression levels. RESULTS: miR-34a, miR-34b, miR-34b*, and miR-34c are significantly up-regulated in tumors with wild-type TP53 genes (n = 23); while such up-regulation is not observed in tumors with mutant TP53 (n = 19). Although expression levels of miR-34-family miRNAs do not correlate with gender, age, or tumor staging, interestingly they are correlated with smoking status and tumor sites. miR-34b/b*/c are up-regulated in tumors from those who ever smoked or recently smoked (quit smoking less than 15 years ago); but such up-regulation was not seen in those who never smoked or quit smoking for at least 15 years. HNSCC of the oral cavity also up-regulated miR-34b/b*/c while no such overexpression was observed in HNSCC of the larynx and hypopharynx. CONCLUSIONS: Surgically resected HNSCC samples with no TP53 mutations have elevated levels of miR-34a and miR-34b/b*/c, while those with TP53 mutations show no such up-regulation. miR-34b/b*/c expression is also correlated with smoking status and tumor sites.

A case of dysphagia following botulinum toxin injection for neck rejuvenation.

Botulinum toxin type A (BTX-A) is now extensively employed for cosmetic concerns. Upper face rejuvenation, including glabella frown lines and crow's feet lines, received FDA approval for cosmetic uses. However, other off-label uses for lower face conditions have been employed for texture and contouring purposes, including masseter hypertrophy and vertical banding of the neck. BTX-A for rejuvenation of the aging neck is an effective and popular treatment with high patient satisfaction rates. Alleviating the aging appearance of the neck by BTX-A is the result of denervation of hyperkinetic platysma. Concerning an extensive area of treatment and the relationship of treated muscles with other nearby muscles, dermatologists should be aware of potential adverse effects of the BTX-A injection. We herein present a case of dysphagia following botulinum toxin injection for the treatment of platysma bands.

Carotid body tumor: a 25-year experience.

Carotid body tumor is an uncommon hypervascular benign tumor in the head and neck region. It usually presents as a slow growing mass at the carotid bifurcation. Because of the high rate of neurovascular complications, resection of this tumor is considered challenging for otolaryngologists. Between 1988 and 2013, 40 carotid body tumors from 38 patients were diagnosed and underwent resection at Siriraj Hospital (25 female and 13 male patients). Their age ranged from 15 to 59 years. Seven patients had bilateral tumors simultaneously whereas six cases had familial history of carotid body tumor. Carotid angiography was performed in 29 cases; other additional diagnostic studies included CT scan, MRI, and MRA to detect the widening of carotid bifurcation, its extension, and multifocal tumors. All diagnosed tumors were successfully removed. However, internal carotid artery and carotid bifurcation were injured in 11 cases (27.5 %). Shamblin class III and previous biopsy history were considered risk factors for vascular injury. Postoperative cranial nerves deficit was found in 20 % of the cases and CNS complication occurred in two patients (5 %). There was no surgical mortality. Additionally, upon the mean follow-up period of 36 months, no recurrence or malignant transformation was detected in this study. Multidisciplinary approach, early tumor detection, meticulous preoperative evaluation, and modern vascular surgical technique are the key success factors for tumor removal.

Leiomyosarcoma: a rare tumor of the thyroid.

Primary leiomyosarcoma of the thyroid gland is uncommon. To date, 20 cases have been reported in English in the literature. The tumors usually present in elderly patients with female predilection and are associated with poor clinical outcome. Herein, we report an additional case of primary thyroid leiomyosarcoma in a 64-year-old woman. She underwent total thyroidectomy and later was discovered to have multiple lung and liver metastases. The patient died 3 months after surgery. The major differential diagnoses including undifferentiated (anaplastic) carcinoma of the thyroid, spindle cell variant of medullary thyroid carcinoma, spindle cell tumor with thymus-like differentiation, uncommon primary tumor of the thyroid and metastatic tumors with predominant spindle cells are discussed.

Sensorineural hearing loss after concurrent chemoradiotherapy in nasopharyngeal cancer patients.

BACKGROUND: Sensorineural hearing loss (SNHL) is one of the major long term side effects from radiation therapy (RT) in nasopharyngeal cancer (NPC) patients. This study aims to review the incidences of SNHL when treating with different radiation techniques. The additional objective is to determine the relationship of the SNHL with the radiation doses delivered to the inner ear. METHODS: A retrospective cohort study of 134 individual ears from 68 NPC patients, treated with conventional RT and IMRT in combination with chemotherapy from 2004-2008 was performed. Dosimetric data of the cochlea were analyzed. Significant SNHL was defined as >15 dB increase in bone conduction threshold at 4 kHz and PTA (pure tone average of 0.5, 1, 2 kHz). Relative risk (RR) was used to determine the associated factors with the hearing threshold changes at 4 kHz and PTA. RESULTS: Median audiological follow up time was 14 months. The incidence of high frequency (4 kHz) SNHL was 44% for the whole group (48.75% in the conventional RT, 37% with IMRT). Internal auditory canal mean dose of >50 Gy had shown a trend to increase the risk of high frequency SNHL (RR 2.02 with 95% CI 1.01-4.03, p=0.047). CONCLUSION: IMRT and radiation dose limitation to the inner ear appeared to decrease SNHL.

Ear diseases and hearing in the Thai elderly population. Part I. A comparative study of the accuracy of diagnosis and treatment by general practitioners vs ENT specialists.

The prevalence of ear disease and hearing disability in elderly Thais in 14 urban communities around Siriraj Hospital was studied. The accuracy of diagnosis and treatment of common ear diseases and of screening for hearing loss in the elderly between general practitioners (GP) and Ear, Nose and Throat (ENT) specialists was also compared. Elderly people aged 60 years or more who had registered with the health care program had their ear and hearing check-up performed by GPs and ENT specialists from mobile team. Altogether, 980 subjects were included, 332 were males, 648 were females, (male:female ratio 1:2). Their ages ranged from 60-96 years with an average age of 68.5 years. The prevalence of ear disease diagnosed by ENT specialists was 16.3 per cent (95% CI = 14.0-18.6), 12.5 per cent was external ear disease and 2.7 per cent middle ear disease. The most common ear problem was impacted ear wax (8%), the second most common problem was otitis externa (4.3%). Compared with an ENT specialist, the ability of a GP to diagnose ear diseases had a sensitivity of 46.5 per cent and a specificity of 80.3 per cent, the positive predictive value of their diagnoses was 31.5 per cent. The efficacy of the treatment of ear diseases in 51 elderly people by GPs and in 63 elderly people by ENT specialists was statistically significantly different (p = 0.02). Hearing screening by the GP using whisper or the watch test performed in 650 elderly people revealed abnormal findings (could not hear) in 70 cases or 10.8 per cent. Hearing screening using pure tone audiometry in 980 elderly people showed abnormal hearing level in 508 cases (52.4%). 9.5 per cent of them had a bilateral moderate to severe degree of hearing impairment. There was no difference in the level of hearing impairment between males and females or between right and left ears. The prevalence of hearing loss increases with increasing age. Tympanometry performed by an acoustic impedance machine in 980 of the elderly showed a conductive hearing loss in 85 cases (9.1%). The authors conclude that the prevalence of ear disease in elderly people living in the urban community around Siriraj Hospital is quite high. Although the ear diseases commonly encountered were not serious, if left untreated they may lead to complication and decreased hearing. Therefore, the proficiency of GPs in the management of common ear diseases in every community should be regularly maintained. Hearing impairment is very prevalent and increases with age. Thus, screening for hearing loss using an audiometer and/or acoustic impedance is recommended for all senior citizens in their community at least once a year. Early detection of elderly persons who could benefit from a properly fitted hearing aid will certainly improve the quality of life and may prevent psychiatric and functional impairment of the Thai elderly population.

Ear diseases and hearing in the Thai elderly population. part II. A one year follow-up study.

The ear and hearing survey of the Thai elderly in 14 urban communities around Siriraj Hospital was repeated one year after the first survey in order to detect any changes. Altogether 556 elderly people came for follow-up examination, 191 were males, 365 were females, the average age was 68.2 years (60-88 years). Ear disease was diagnosed by ENT specialists in 80 cases which implied that the prevalence of ear disease was 14.4 per cent. This was not statistically significantly different from the prevalence of ear disease in the survey conducted in the previous year and although the elderly who had ear diseases in the first survey had already been treated, the prevalence did not decrease. Some elderly people only had ear diseases in this survey. Hearing evaluation by pure tone audiometry was performed in 549 elders. There were 12.4 per cent who had bilateral, moderate to severe hearing loss which was 2.9 per cent higher than in the previous survey. The hearing level had also deteriorated in 14.3 per cent of the elderly people. Tympanometry was performed in 556 cases and showed that 10.5 per cent had a conductive hearing loss. When audiometry and tympanometry of the same elderly people were evaluated together, 49.2 per cent of them had a sensorineural hearing loss, 3 per cent had a conductive hearing loss and 6.5 per cent had a conductive or mixed type hearing loss. When the results of audiometry were compared with the self identification/perception of their hearing reported by the elderly in the questionnaires, they were not reliable. In conclusion, a one-year follow-up study of the prevalence of ear disease and hearing impairment in the elderly showed that the prevalence of ear disease was still high and had not changed significantly. Concerning hearing impairment, not only had the prevalence increased, but also the severity of hearing loss. Therefore, the authors stress the need to implement the "Ear and Hearing Care" program for the elderly both in rural and urban communities at least once a year in order to improve quality of life of the elderly Thai people and to prevent complications of ear disease.