Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study.

CONCLUSION: Sudden sensorineural hearing loss (SSNHL) in pregnancy is rare. It usually occurs in the third trimester. SSNHL in pregnancy does not increase risks during delivery or subsequent stroke. OBJECTIVES: This study aimed to investigate the incidence and to determine the factors associated with SSNHL in pregnancy. METHOD: Data were retrieved from Taiwan's National Health Insurance Database (NHIRD), covering the years 2000-2009. Patients admitted for SSNHL during pregnancy were enrolled. An age-matched controlled cohort was randomly selected from pregnant women without SSNHL in the NHIRD. The clinical characteristics of both cohorts were collected for further analyses. RESULTS: Thirty-three patients with SSNHL in pregnancy were enrolled. The estimated incidence of SSNHL in pregnancy in Taiwan was 2.71 per 100,000 pregnancies. The incidence of SSNHL in pregnancy was lower than that of the general female population. The incidence of SSNHL in the third trimester was higher compared to the other two. The incidence of SSNHL occurring in the 30-39 years old age group was higher than other groups. Women with better socioeconomic status had a higher incidence of SSNHL. There were no identified systemic diseases before SSNHL. Two patients had pre-eclampsia and one patient had premature delivery. Nevertheless, SSNHL in pregnancy did not increase the risk for stroke.

The basis of preoperative vocal fold paralysis in a series of patients undergoing thyroid surgery: the preponderance of benign thyroid disease.

BACKGROUND: Preoperative vocal fold paralysis (VFP) is thought to be rare in patients with benign thyroid disease (BTD). In contrast with cases of malignancy, in which the recurrent laryngeal nerve (RLN) should be severed, in patients with BTD and VFP the RLN can be preserved without threatening patients' lives. This study investigates the clinical features that enable identification of patients who have VFP associated with BTD. METHODS: Medical records of 187 consecutive patients who underwent thyroid surgery were retrospectively reviewed. The association between preoperative VFP and pathology (benign or malignant), clinical features, and treatment results of patients with BTD and VFP were analyzed. RESULTS: Of the 187 patients, 145 patients had BTD and 8 of these cases (5.52%) had preoperative unilateral VFP. The prevalence of BTD with VFP was 4.3% (8/187). The other 42 patients had malignant thyroid disease and 4 of these cases (9.52%) had preoperative unilateral VFP. None of the aforementioned VFP was caused by previous thyroidectomy or surgery to the neck. Although the relative risk of VFP in patients with thyroid malignancy was 1.726 (9.52%/5.52%), there was no significant association between VFP and malignancy. Of the eight patients with BTD, benign fine-needle aspiration cytology or frozen sections, goiter with a diameter larger than 5 cm, cystic changes, and significant radiologic tracheo-esophageal groove compression were the common findings. During thyroidectomy, the RLN was injured but repaired in three patients. Two events occurred in patients who had severe RLN adhesion to the tumor caused by thyroidectomy performed decades ago. Two of the five patients without nerve injury recovered vocal fold function. The overall VFP recovery rate for patients with BTD and VFP was 25% (2/8). CONCLUSIONS: Preoperative unilateral VFP is not uncommon in thyroid surgery. Obtaining information on laryngeal function is of extreme importance when planning surgery, especially contralateral surgery. Goiter with preoperative VFP is not necessarily an indicator of malignancy. Benign perioperative cytopathologic findings with typical radiographic compression strongly suggest that VFP is caused by BTD. If, during thyroidectomy, the RLN is carefully preserved, recovery of vocal fold function may still be possible.

Long-term result of management of otitis media with effusion in patients with post-irradiated nasopharyngeal carcinoma.

The treatment of post-irradiated otitis media with effusion (OME) remains controversial. Hence the aim of this study was to understand the long-term result of management of post-irradiated OME. Eighty-five nasopharyngeal carcinoma patients with post-irradiated OME were prospectively enrolled. All were followed up with close observation and a hearing aid was advised for those with hearing loss. If patients were still bothered by aural fullness, tinnitus or hearing impairment and did not want to continue conservative treatment, tympanostomy plus aspiration was performed. Only those who had persistent OME and failed repeated tympanostomy for at least 3 months were suggested to undergo grommet insertion. After a mean follow-up of 842.1 ± 49.0 days from the completion of radiotherapy, OME was present in 45 patients (52.9%). Another 16 (18.8%) had chronic discharging ears with or without perforated eardrums. Grommets remained on the eardrums in eight patients. Among them, five were without otorrhea but discharge came from grommet tubes intermittently in three patients. Only 15 (17.6%) were free of OME, and one patient had a dry perforated eardrum. Our results showed current methods did not result in long-term resolution of some recalcitrant post-irradiated OME.

A preliminary study on the role of inherited prothrombotic risk factors in Taiwanese patients with sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSHL) is a disease with unknown etiology. Recently, several studies revealed that some inherited prothrombotic risk factors are associated with SSHL in western populations. The objective of this study was to investigate the roles of the two most common genetic prothrombotic factors, the factor V Leiden G1691A and prothrombin G20210A in Taiwanese patients with SSHL. Twenty-four patients diagnosed with SSHL of more than 30 dB on average pure tone audiometry (PTA) and thirty-six healthy subjects without a history of hearing loss were enrolled in this study. Genomic DNA was isolated from peripheral blood leukocytes and the single nucleotide polymorphisms (SNPs) genotyping of factor V Leiden G1691A and prothrombin G20210A were analyzed using the TaqMan genotyping assays. Neither factor V Leiden G1691A nor prothrombin G20210A was detected in SSHL patients or in the control subjects. Both the patient group and the control group exhibited wild-type V Leiden 1691GG and wild-type prothrombin 20210GG. In conclusion, the factors V Leiden G1691A and prothrombin G20210A do not seem to play any role in Taiwanese patients with SSHL. Further studies with a large series of patients are needed to identify other possible candidate genes in order to elucidate the pathogenesis of SSHL.

Using greater superficial petrosal nerve and geniculate ganglion as the only two landmarks for identifying internal auditory canal in middle fossa approach.

The middle fossa approach is a surgical technique indicated for acoustic neuroma with advantages of complete tumor removal and hearing preservation. Various methods have been developed for identifying internal auditory canal (IAC). Here, we describe a new method, which uses greater superficial petrosal nerve (GSPN) and geniculate ganglion (GG) as the only two landmarks to identify IAC. In this study, the surgical anatomy and relations between GSPN, GG, petrous ridge, and IAC were measured on 20 temporal bone specimens and 40 HRCT scans of normal inner ear structures. The temporal bone study showed that the GSPN is nearly parallel to the petrous ridge, with an average angle of about 6 degrees. The line perpendicular to the GSPN from the tip of the GG to the petrous ridge reaches at the porus acousticus, with an average distance of 12.95 mm. The temporal bone HRCT scan study revealed that the length from the tip of the GG to the midpoint of the IAC portion on the line perpendicular to the petrous ridge is about 9.9 mm. We applied this method on 20 temporal bones by drilling the point away from the tip of the GG about 9.9 mm on a line angled with the GSPN about 96 degrees. All IACs were safely identified without damaging the cochlea, the labyrinthine portion of the facial nerve, or the vestibule. In conclusion, the GSPN and GG can be the only two landmarks for safely identifying the IAC without injury to the inner ear structures in the middle fossa approach.

Steroid treatment of posttraumatic anosmia.

The objective of this study was to treat posttraumatic anosmia with oral steroid and evaluate its effect. One-hundred sixteen posttraumatic patients whose olfactory thresholds were -1.0 by the phenyl ethyl alcohol threshold test assembled in our department. They were treated with a course of high-dose steroid, and followed up for at least 3 months. During the latter period of this study, magnetic resonance imaging was performed to measure the volumes of olfactory bulbs and to detect subfrontal lobe damage. Among them, 19 (16.4%) patients' olfactory thresholds improved after steroid treatment, but the other 97 patients' thresholds did not change. The incidences of loss of consciousness and intracranial hemorrhage after head injury, the ratios of admission and craniotomy, the intervals between head injury and steroid treatment, the volumes of olfactory bulbs, and the incidences of subfrontal lobe damage were not significantly different between patients whose thresholds improved and those whose thresholds did not improve. However, patients with olfactory improvement were significantly younger than those who remained unchanged. Our study showed that oral steroid treatment might improve olfactory acuity in some patients with posttraumatic anosmia, but the possibility of spontaneous recovery cannot be ruled out.

A pilot study of a traditional Chinese version of the University of Pennsylvania Smell Identification Test for application in Taiwan.

BACKGROUND: The 40-item University of Pennsylvania Smell Identification Test (UPSIT) is the most widely used smell test in the world. Presently, culturally modified versions of this test are available in 12 languages. This study describes the first assessment of a prototype traditional Chinese version of the UPSIT (UPSIT-TC) for administration in Taiwan. The goals were to determine the efficacy of specific items for testing Taiwanese subjects and to establish normative adjustments to allow for the use of North American norms. METHODS: The American version of the UPSIT and the UPSIT-TC were administered to 40 healthy Taiwanese subjects on two test occasions separated from one another by 2 weeks. One subject was excluded because of invalid data. RESULTS: The mean UPSIT score was 28.3 (median, 28; SD, 3.8) for the first test administration and 28.5 (median, 28.0; SD, 4.4) for the second test administration. The mean UPSIT-TC score was 33.1 (median, 33.0; SD, 2.9) for the first administration and 32.8 (median, 33.0; SD, 3.6) for the second test administration. The UPSIT-TC scores were significantly higher than those of the UPSIT on both test occasions (p < 0.0001). Pearson correlations computed across the two test occasions were positive and statistically significant for both the UPSIT and the UPSIT-TC (respectively, r = 0.803 and 0.664; p < 0.0001). CONCLUSION: In accord with the modifications, the scores on the prototype UPSIT-TC were significantly higher than those on the American UPSIT when administered to a Taiwanese sample. Both versions of the UPSIT were stable across repeated test sessions.

Role of pollen allergy in Taiwanese patients with allergic rhinitis.

BACKGROUND/PURPOSE: Pollen allergy is believed to be less common in East Asia, Latin America, and tropical areas. The purpose of this study was to understand the role of pollen allergy in Taiwan. METHODS: Patients with clinically diagnosed allergic rhinitis were enrolled. All subjects received a 30-item skin test panel that included perennial allergens (house dust mix, Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat hairs, cockroach mix, and Candida albicans) and pollen allergens (acacia, pine mix, eucalyptus, beefwood, juniper mix, willow, mulberry mix, pepper tree, cedar, Johnson grass, Bermuda grass, ragweed mix, Timothy grass, spiny pigweed, cocklebur, sage mix, sheep sorrel, dog fennel, pigweed mix, English plantain, castor bean, alfalfa, and dandelion). RESULTS: A total of 419 patients were recruited. A total of 313 (74.7%) had a positive skin test. A total of 288 patients (68.7%) were sensitive to perennial allergens, and 11 8 patients (28.2%) were sensitive to pollen allergens. However, 93 pollen-sensitive patients were also sensitive to perennial allergens, and only 25 were sensitive to pollen allergens alone. The most common allergens were D. pteronyssinus, D. farinae, house dust mix, and cockroach, but the most common pollen allergens were spiny pigweed, Johnson grass, and sheep sorrel. All nasal symptoms tended to be more severe in patients who were sensitive to perennial allergens than in those who were sensitive to pollen allergens alone. CONCLUSION: Most patients with allergic rhinitis in Taiwan are sensitive to perennial allergens, and pollens are a less common allergen.

Central nervous system infection in patients with postirradiated nasopharyngeal carcinoma: a case-controlled study.

BACKGROUND: It has been assumed that postirradiated nasopharyngeal carcinoma (NPC) patients are prone to central nervous system (CNS) infection. OBJECTIVE: The purpose of this study was to better understand this clinical entity. METHODS: From September 1989 to May 2006, we conducted a retrospective study of 18 postirradiated NPC patients with CNS infection including brain abscess, cavernous sinus thrombosis, epidural abscess, and meningitis in our institute. During the same period, 18 NPC patients without CNS infection who were matched for tumor stage, age, and gender with the study group were randomly selected from the cancer registry at our hospital and enrolled as the control group. All medical records of these patients were evaluated. RESULTS: The local tumor relapse rate, nasopharyngeal radiotherapy dose, and skull base osteoradionecrosis were all significantly higher in patients with CNS infection (p = 0.003, 0.011, and 0.001, respectively). Although the incidences of otitis media and chronic rhinosinusitis were higher in patients with CNS infection, there were no significant differences between the two groups (p = 0.469 and 0.568, respectively). The in-hospital mortality was 61.1%, and the overall mortality of CNS infection was 83.3%. There was a significant difference in overall survival rate between the two groups (p = 0.001). CONCLUSIONS: Postirradiated NPC patients with skull base osteoradionecrosis are prone to have CNS infection. CNS infection is an adverse prognostic factor in postirradiated NPC patients.

Preoperative prognostic factors for olfactory change after functional endoscopic sinus surgery.

BACKGROUND: Functional endoscopic sinus surgery (FESS) has been considered to improve the olfactory function in patients with chronic rhinosinusitis. However, which factors might affect the olfactory outcome after FESS has not been well investigated. METHODS: A total of 70 patients with chronic rhinosinusitis who underwent FESS were enrolled in the study. The potential prognostic factors for improvement in olfaction after FESS were evaluated in these patients. On the day before FESS, the olfactory function was evaluated by a symptom score, a phenyl ethyl alcohol odor detection threshold test, the University of Pennsylvania Smell Identification Test, and a short-term odor memory/discrimination test, and were reevaluated by the same methods 6 months after FESS. RESULTS: The degree of nasal obstruction, the second minimal cross-sectional area measured by acoustic rhinometry, computed tomography scores before FESS, the degree of preoperative olfactory loss indicated by threshold and identification scores, and coexistence of nasal polyps or allergic rhinitis were not significantly reliable to influence the rates of olfactory improvement after FESS. CONCLUSION: Degree of nasal obstruction, extent of rhinosinusitis disease, and coexistence of nasal polyps or allergic rhinitis did not predicate the overall possibility of any olfactory improvement after FESS.

Measurements of normal inner ear on computed tomography in children with congenital sensorineural hearing loss.

The objective of this study is to use standardized measurements of the inner ear to see whether there are subtle bony malformations in children with congenital sensorineural hearing loss (SNHL) whose temporal bone computed tomography (CT) are grossly normal. The study includes 45 ears with congenital SNHL and grossly normal temporal bone CT scans and 45 ears with normal inner ear structures and normal hearing. Standardized measurements of the inner ear structures were made on axial temporal bone CT scans. Student's t test was performed to compare the measurements of the two groups. There were significant differences in the measurements of the bony island width of the superior semicircular canal, bony island width of the lateral semicircular canal and maximal height of cochlea between two groups (P < 0.05). In conclusion, standardized measurements of bony labyrinth of inner ear on temporal bone CT can identify subtle abnormalities of inner ear in patients with congenital SNHL having grossly normal radiological images.

Nasal irrigation reduces postirradiation rhinosinusitis in patients with nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Radiotherapy (RT) is the standard treatment for NPC. The newer RT technique, intensity-modulated radiotherapy (IMRT) has become popular in recent years. IMRT-induced rhinosinusitis is not uncommon in postirradiated NPC patients but the incidence and the disease course have not been reported. The purpose of this study was to determine the IMRT effect on the paranasal sinuses and evaluate the efficacy of nasal irrigation on the management of RT-induced rhinosinusitis. METHODS: NPC patients who completed IMRT from October 2004 to May 2006 were enrolled in the study and were randomly allocated to irrigation or nonirrigation groups. Patients in the irrigation group performed daily nasal irrigation until 6 months after RT. The severity of postirradiated rhinosinusitis was evaluated by nasal endoscopy, questionnaire, and computed tomography until a year after RT. RESULTS: One hundred seven postirradiated NPC patients completed the study. Among them, 44 patients performed daily nasal irrigation until 6 months after RT, and the other 63 patients did not perform nasal irrigation after RT. Patients in the irrigation group had significantly lower endoscopic and questionnaire scores than patients in the nonirrigation group (p = 0.001 and 0.0001, respectively) from pre-RT to 6 months after RT. The between-group differences were most obvious at the post-RT second and third months. CONCLUSION: Rhinosinusitis is a common acute post-RT complication in NPC patients. Our results showed that nasal irrigation was a safe and effective method for the management of this acute complication.

Developing a rabbit model of rhinogenic chronic rhinosinusitis.

OBJECTIVE: The purpose of this study was to develop a rabbit model of rhinogenic chronic rhinosinusitis (CRS). METHODS: New Zealand white rabbits were used and divided into two groups. In group A rabbits, a piece of Merocel (Medtronic-Xomed, Jacksonville, FL) was inserted into one nasal cavity and the other was left undisturbed as control. In group B rabbits, 1 microg phorbol 12-myristate 13-acetate (PMA) was injected into bilateral nasal lateral walls and then a piece of Merocel (Medtronic-Xomed) was inserted into one nasal cavity. At week 2, the Merocel (Medtronic-Xomed) was removed, and computed tomography (CT), nasoendoscopy, and cultures were performed. All examinations were repeated at week 12. Rabbits that had purulent discharge in nasal cavities and sinuses opacification shown in CT scans were diagnosed as having rhinosinusitis. Rabbits with CRS were randomly allocated to receive intravenous ceftriaxone (50 mg/kg/day) for 28 days or nothing. All rabbits with CRS received CT scans, nasoendoscopy, and cultures at week 16. RESULTS: At week 12, CRS had developed in two controlled nasal cavities, six nasal cavities inserted with Merocel (Medtronic-Xomed), six nasal cavities injected with phorbol 12-myristate 13-acetate (PMA), and seven both PMA-injected and Merocel- (Medtronic-Xomed) inserted nasal cavities. Seven of nine treated CRS sides were clear of opacification after treatment. All non-treated CRS sides had persistent diseases at week 16. There was a significant difference in the CRS incidence (P = .00043) and culture rates (P = .027) between treated and non-treated CRS nasal cavities. CONCLUSIONS: Our study developed a rabbit model of rhinogenic CRS. This model is easily performed and is reversible by treatment.

Postoperative antibiotic care after functional endoscopic sinus surgery.

BACKGROUND: Antibiotics are used routinely in the postoperative care of functional endoscopic sinus surgery (FESS), but their efficacy has not been well evaluated. METHODS: Patients with chronic rhinosinusitis who underwent FESS were enrolled in this study. They were randomly divided into two groups: a study group and a control group. In the study group, patients took amoxicillin/clavulante for 3 weeks after FESS. In the control group, no antibiotic was given after FESS. Before FESS, all patients filled out a symptom questionnaire and received nasal endoscopy. Swab specimens were taken from the middle meati for bacterial cultures. These procedures were done again 3 weeks after FESS. RESULTS: Seventy-one patients completed the study. Thirty-one patients were in the study group, and 40 patients were in the control group. The symptom scores significantly decreased after surgery in both groups, but bacteria identified before and after FESS were statistically different in both groups. There were no differences in the symptom and endoscopic scores, rates of bacterial culture, and drug sensitivity to amoxicillin/clavulante between the two groups after FESS. CONCLUSION: This study showed that postoperative care with amoxicillin/clavulante did not improve the short-term outcome of FESS on chronic rhinosinusitis or decrease bacterial growth 3weeks after FESS, although the long-term influence was not evaluated in this study.

Visual screening of oral cavity cancer: The role of otolaryngologists.

OBJECTIVES: Because most screening was done by dentists, the purpose of this prospective cohort study was to evaluate the effectiveness of oral visual screening by otolaryngologists. In addition, we wanted to determine which group of enrolled patients was at potential risk of contracting oral cancer. METHODS: All male patients age > or =18 years who visited our clinic received oral mucosal screening. Basic data, including personal habits, were also obtained. A multivariate logistic regression model was devised to determine relevant risk factors for developing oral cancer. RESULTS: A total of 5,825 patients were enrolled in this study. Positive findings were found in 226 patients (3.9%). One hundred seventy-two patients received biopsy and 131 patients were proven to have oral cancer (sensitivity rate: 76.2%). The results showed that those who smoked, consumed alcohol, and chewed betel quid on a regular basis were most likely to contract oral cancer (odds ratio = 49.81, 95% confidence interval = 29.38-84.42). CONCLUSIONS: The otolaryngologists involved in this study successfully performed the oral screening. The sensitivity and specificity rates were both satisfactory. We suggest that those who are habitual cigarette smokers, alcohol consumers, and betel quid chewers should receive oral mucosal screening regularly so that potential oral cancer can be detected as early as possible.

Hearing loss associated with enlarged vestibular aqueduct and Mondini dysplasia is caused by splice-site mutation in the PDS gene.

Recessive mutations of PDS gene are the common causes of Pendred syndrome and non-syndromic hearing loss associated with temporal bone abnormalities ranging from isolated enlargement of the vestibular aqueduct (EVA) to Mondini dysplasia. In this study we evaluate the relationship between EVA and Mondini dysplasia in 10 prelingual deaf patients and PDS gene mutation. One of three mutations, IVS7-2A-->G, IVS16-6G-->A or IVS15+5G-->A, was identified in the PDS gene in each patient. In family studies of four probands with the IVS7-2A-->G mutation, we found that this mutation was inherited from the same mutant alleles of parental origin. The effect of IVS7-2A-->G mutation on PDS gene expression was determined by reverse transcription and polymerase chain reaction (RT-PCR). Sequencing of the RT-PCR products revealed that the PDS transcripts from the allele with IVS7-2A-->G mutation lose the entire exon 8, resulting in a joining of exons 7 and 9. Deletion of the exon 8 results in frameshift and premature termination of translation. Haplotype analysis showed a significant haplotype shared among the family members carrying IVS7-2A-->G mutation, suggesting that they may be derived from a common ancestor. Our results provide evidence that hearing loss with EVA and Mondini dysplasia may be caused by splice-site mutation in the PDS gene.