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1.
Acta Otolaryngol ; : 1-4, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32186232

RESUMO

Background: Many studies have focused on the suppressive effects of cochlear implants (CIs) on loudness of tinnitus.Aims/objective: This study aimed to examine the effects of CIs and their activation on changes in loudness and tinnitus and explore other factors associated with this effect.Material and methods: We recruited 26 CI recipients according to specific criteria. Participants asked to complete tinnitus questionnaires, while the CI was kept on and at 30 min after the CI was turned off. Tinnitus improvement after CI was tested using Wilcoxon signed rank tests, and correlation was tested using Spearman's rank correlation coefficients and multiple linear regression.Results: After CI, tinnitus reduced from 62% to 46%. Total and partial reduction in tinnitus was seen in 76% subjects with pre-CI tinnitus. However, 6% of the subjects had tinnitus since birth, and none showed worsening tinnitus. The average THI score while the CI on was significantly lower than that CI off.Conclusions: Post-CI tinnitus improvement was seen in 76% of those with pre-CI tinnitus; however, the low risk of new or aggravating tinnitus should be considered, and reasonable expectations for tinnitus reduction should be built into the pre-CI assessment.

2.
Stem Cell Res ; 42: 101692, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31896484

RESUMO

Hearing loss is the most common disorder in the sensory system. Mutations in GJB2 have been reported to be very common in sensorineural hearing loss patients. In this report, we generated an induced pluripotent stem cell (iPSC) line, MMCi001-A, from the peripheral blood mononuclear cells of a 4-year-old male hearing loss patient carrying GJB2 pV37I mutation by using the Sendai virus delivery system. The generated iPSCs were demonstrated to express pluripotent markers and be differentiated into three germ layers in vitro and in vivo. This GJB2-pV37I iPSCs is valuable for studying the pathogenic mechanisms and drug discovery of hearing loss.

3.
Cell Death Dis ; 9(4): 437, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29740017

RESUMO

Degeneration or loss of inner ear hair cells (HCs) is irreversible and results in sensorineural hearing loss (SHL). Human-induced pluripotent stem cells (hiPSCs) have been employed in disease modelling and cell therapy. Here, we propose a transcription factor (TF)-driven approach using ATOH1 and regulatory factor of x-box (RFX) genes to generate HC-like cells from hiPSCs. Our results suggest that ATOH1/RFX1/RFX3 could significantly increase the differentiation capacity of iPSCs into MYO7AmCherry-positive cells, upregulate the mRNA expression levels of HC-related genes and promote the differentiation of HCs with more mature stereociliary bundles. To model the molecular and stereociliary structural changes involved in HC dysfunction in SHL, we further used ATOH1/RFX1/RFX3 to differentiate HC-like cells from the iPSCs from patients with myoclonus epilepsy associated with ragged-red fibres (MERRF) syndrome, which is caused by A8344G mutation of mitochondrial DNA (mtDNA), and characterised by myoclonus epilepsy, ataxia and SHL. Compared with isogenic iPSCs, MERRF-iPSCs possessed ~42-44% mtDNA with A8344G mutation and exhibited significantly elevated reactive oxygen species (ROS) production and CAT gene expression. Furthermore, MERRF-iPSC-differentiated HC-like cells exhibited significantly elevated ROS levels and MnSOD and CAT gene expression. These MERRF-HCs that had more single cilia with a shorter length could be observed only by using a non-TF method, but those with fewer stereociliary bundle-like protrusions than isogenic iPSCs-differentiated-HC-like cells could be further observed using ATOH1/RFX1/RFX3 TFs. We further analysed and compared the whole transcriptome of M1ctrl-HCs and M1-HCs after treatment with ATOH1 or ATOH1/RFX1/RFX3. We revealed that the HC-related gene transcripts in M1ctrl-iPSCs had a significantly higher tendency to be activated by ATOH1/RFX1/RFX3 than M1-iPSCs. The ATOH1/RFX1/RFX3 TF-driven approach for the differentiation of HC-like cells from iPSCs is an efficient and promising strategy for the disease modelling of SHL and can be employed in future therapeutic strategies to treat SHL patients.

4.
Stem Cell Res ; 25: 245-249, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29174977

RESUMO

Sensorineural hearing loss (SNHL) is a prevalent form of deafness commonly arising from damage to the cochlear sensory hair cells and degeneration of the spiral ganglion neurons. In this study, Sendai virus was used to generate an induced pluripotent stem cell (iPSC) line from a 39-year-old female patient diagnosed with severe-to-profound, non-syndromic SNHL. The patient also carries a A1555G mutation in the mitochondrial 12S ribosome RNA gene (MTRNR1). This iPSC line was verified to express pluripotent markers, possess normal karyotype, harbor the specific mutation and demonstrated the capacity to differentiate into three germ layers.


Assuntos
DNA Mitocondrial/genética , Perda Auditiva Neurossensorial/genética , Células-Tronco Pluripotentes Induzidas/citologia , Mutação Puntual , RNA Ribossômico/genética , Adulto , Linhagem Celular , Células Cultivadas , DNA Mitocondrial/metabolismo , Feminino , Perda Auditiva Neurossensorial/metabolismo , Humanos , Células-Tronco Pluripotentes Induzidas/metabolismo , Mitocôndrias/genética , Mitocôndrias/metabolismo
5.
Int J Pediatr Otorhinolaryngol ; 95: 57-62, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28576534

RESUMO

OBJECTIVE: To examine whether behavioral pure-tone audiometry (PTA) thresholds in children can be accurately estimated from the corresponding infants' click-evoked auditory brainstem response (ABR) thresholds through a retrospective review of data from a universal newborn hearing screening (UNHS) program in Taiwan. METHOD: According to medical records from Mackay Memorial Hospital, Taipei Hospital District, 45,450 newborns received hearing screening during January 1999-December 2011. Among these newborns, 104 (82, both ears; 22, one ear; total, 186 ears) received regular follow-up and were recruited as subjects. The relationship between infant click-evoked ABR thresholds and the corresponding child PTA thresholds was determined through Pearson correlation coefficient and linear regression analyses. RESULTS: The correlation coefficient between click-evoked ABR thresholds and behavioral PTA thresholds at the average of frequencies of 1-4 and 2-4 kHz was 0.76 and 0.76, respectively. Linear regression analysis showed that behavioral audiometry thresholds at the average of frequencies of 1-4 and 2-4 kHz were accurately estimated from click-evoked ABR thresholds in 57% and 58% children, respectively. CONCLUSION: Click-evoked ABR testing is a reliable tool to cautiously estimate behavioral PTA thresholds at the average of frequencies of 1-4 and 2-4 kHz. For accurately performing hearing aid fitting and auditory rehabilitation in congenitally deaf infants, a combination of frequency-specific tone-burst ABR and click-evoked ABR should be used.


Assuntos
Audiometria de Tons Puros/métodos , Limiar Auditivo/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Triagem Neonatal/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Análise de Regressão , Estudos Retrospectivos , Taiwan
6.
Eur Arch Otorhinolaryngol ; 274(5): 2327-2334, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28229293

RESUMO

Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate the relationship between ARHL and the prevalence, and 10-year incidence of dementia in the Taiwan National Health Insurance Research Database (NHIRD). We selected patients diagnosed with ARHL from the NHIRD. A comparison cohort comprising of patients without ARHL was frequency-matched by age, sex, and co-morbidities, and the occurrence of dementia was evaluated in both cohorts. The ARHL cohort consisted of 4108 patients with ARHL and the control cohort consisted of 4013 frequency-matched patients without ARHL. The incidence of dementia [hazard ratio (HR), 1.30; 95% confidence interval (CI 1.14-1.49); P = 0.002] was higher among ARHL patients. Cox models showed that being female (HR, 1.34; 95% CI 1.07-1.68), as well as having co-morbidities, including chronic liver disease and cirrhosis, rheumatoid arthritis, hypertension, diabetes mellitus, stroke, head injury, chronic kidney disease, coronary artery disease, alcohol abuse/dependence, and tobacco abuse/dependence (HR, 1.27; 95% CI 1.11-1.45), were independent risk factors for dementia in ARHL patients. We found ARHL may be one of the early characteristics of dementia, and patients with hearing loss were at a higher risk of subsequent dementia. Clinicians should be more sensitive to dementia symptoms within the first 2 years following ARHL diagnosis. Further clinical studies of the relationship between dementia and ARHL may be necessary.


Assuntos
Demência , Presbiacusia , Idoso , Estudos de Coortes , Comorbidade , Demência/diagnóstico , Demência/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Presbiacusia/diagnóstico , Presbiacusia/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Taiwan/epidemiologia
7.
J Formos Med Assoc ; 116(10): 790-797, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28012675

RESUMO

BACKGROUND/PURPOSE: To evaluate the complexity of vestibular-ocular reflex (VOR) in patients with acute unilateral vestibular loss (AUVL) via entropy analysis of head impulses. METHODS: Horizontal head impulse test (HIT) with high-velocity alternating directions was used to evaluate 12 participants with AUVL and 16 healthy volunteers. Wireless electro-oculography and electronic gyrometry were used to acquire eye positional signals and head velocity signals. The eye velocity signals were then obtained through differentiation, band-pass filtering. The approximate entropy of eye velocity to head velocity (RApEn) was used to evaluate chaos property. VOR gain, gain asymmetry ratio, and RApEn asymmetry ratio were also used to compare the groups. RESULTS: For the lesion-side HIT of the patient group, the mean VOR gain was significantly lower and the mean RApEn was significantly greater compared with both nonlesion-side HIT and healthy controls (p < 0.01, one-way analysis of variance). Both the RApEn asymmetry ratio and gain asymmetry ratio of the AUVL group were significantly greater compared with those of the control group (p < 0.05, independent sample t test). CONCLUSION: Entropy and gain analysis of HIT using wireless electro-oculography system could be used to detect the VOR dysfunctions of AUVL and may become effective methods for evaluating vestibular disorders.


Assuntos
Cabeça , Reflexo Vestíbulo-Ocular/fisiologia , Movimentos Sacádicos/fisiologia , Vestíbulo do Labirinto/fisiopatologia , Adulto , Estudos de Casos e Controles , Entropia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Curva ROC , Vertigem/etiologia
8.
PLoS One ; 11(3): e0152028, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27023324

RESUMO

OBJECTIVES: To determine whether newborn hearing screening in a well-baby nursery (WBN) and neonatal intensive care unit (NICU) nursery: 1) meet three targeted, screening, referral, and diagnostic follow-up rates; 2) compare the average age of diagnosis for infants admitted to the WIN and NICU; and 3) determine prevalence of hearing loss in neonatal population; and 4) try to find a practical newborn hearing screening time algorithm to reduce refer rate in NICU. MATERIALS AND METHODS: It examined 15,624 newborns in the WBN (13,676) and NICU (1948) screened for congenital HL using AABR. The variables analyzed in it were the screening rate, referral rate, follow-up rate, diagnostic rate and diagnostic age, prevalence rate, degrees of congenital bilateral HL. The study was approved by the hospital's institutional review board (13MMHISO23). RESULTS: The screening rates were 99.8% and 99.6% in the WBN and NICU groups, respectively, without significant difference. The referral rates were 0.7% and 2.8% in the WBN and NICU groups, with significant difference. Furthermore, the diagnostic follow-up rates were 76.7% and 89.1% in the WBN and NICU groups, without significant difference. The average initial diagnostic ages were 1.9 months and 3.8 months in the WBN and NICU groups, with significant difference. The prevalence of congenital bilateral hearing loss were 0.27% and 1.6% in the WBN and NICU groups, with significant difference. CONCLUSION: The screening, referral and follow-up rate in the WBN and NICU groups were equivalent to the quality indicators. For NICU group, screening and diagnostic follow up were performed later than those in WBN group; however the lower referral rate in our NICU group was successfully achieved in this study and can be applied clinically. The prevalence of congenital bilateral hearing loss was higher in the NICU group than in the WBN group.


Assuntos
Audição/fisiologia , Unidades de Terapia Intensiva Neonatal , Triagem Neonatal , Encaminhamento e Consulta , Humanos , Recém-Nascido , Pacientes Ambulatoriais , Alta do Paciente
9.
J Adv Nurs ; 72(7): 1592-601, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26899798

RESUMO

AIM: To identify the predictors of primary caregivers' stress in caring for in-home oxygen-dependent children by examining the association between their levels of stress, caregiver needs and social support. BACKGROUND: Increasing numbers of primary caregivers of oxygen-dependent children experience caregiving stress that warrants investigation. DESIGN: The study used a cross-sectional design with three psychometric scales - Modified-Parenting Stress Index, Caregiver Needs Scale and Social Support Index. METHODS: The data collected during 2010-2011 were from participants who were responsible for their child's care that included oxygen therapy for ≧6 hours/day; the children's ages ranged from 3 months-16 years. Descriptive statistics and multivariable linear regression were used. RESULTS: A total of 104 participants (M = 34, F = 70) were recruited, with an average age of 39·7 years. The average age of the oxygen-dependent children was 6·68 years and their daily use of oxygen averaged 11·39 hours. The caregivers' overall levels of stress were scored as high and information needs were scored as the highest. The most available support from family and friends was emotional support. Informational support was mostly received from health professionals, but both instrumental and emotional support were important. Levels of stress and caregiver needs were significantly correlated. Multivariable linear regression analyses identified three risk factors predicting stress, namely, the caregiver's poor health status, the child's male gender and the caregiver's greater financial need. CONCLUSION: To support these caregivers, health professionals can maintain their health status and provide instrumental, emotional, informational and financial support.


Assuntos
Cuidadores/psicologia , Crianças com Deficiência , Oxigenoterapia , Apoio Social , Estresse Psicológico , Adulto , Criança , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Oxigênio , Relações Pais-Filho
10.
J Neurol ; 263(1): 45-51, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26477026

RESUMO

This retrospective study was conducted to determine the relationship between variable factors and the recurrence rate of post-semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) after canalith repositioning procedure (CRP). Patients with PSC-BPPV were diagnosed by history and the presence of a positive Dix-Hallpike maneuver between 2008 and 2010. In total, 243 patients (47 males and 196 females, average age = 57.5 -years) treated with Epley's maneuver or canalith repositioning procedure (CRP) were included in the study. The demographic factors studied were age, sex, sleep disorders, inner ear diseases, head trauma history, and cardiovascular diseases. Multivariate statistics using SPSS version 15, Pearson's Chi-squared test (χ2), Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression model were used for the analysis. The success rate of vertigo control after the initial CRP was 83.1 %. Pearson's χ2 test results showed that females and participants with sleep disorders exhibited a significant difference in the recurrence of vertigo after the initial CRP. In addition, the Kaplan-Meier analysis and log-rank test survival analysis revealed that the recurrence was associated with females and participants with sleep disorders and inner ear diseases.However, Cox proportional hazards regression showed no differences in recurrences associated with old age, sex, sleep disorders, inner ear diseases, head trauma, and cardiovascular diseases. Epley's maneuver or CRP is an effective, safe, and simple treatment for BPPV. Females and participants with sleep disorders and inner ear diseases are likely associated with the recurrence of BPPV after CRP.


Assuntos
Vertigem Posicional Paroxística Benigna/reabilitação , Reabilitação Neurológica/métodos , Membrana dos Otólitos/fisiopatologia , Canais Semicirculares/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco
11.
J Chin Med Assoc ; 79(2): 88-92, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26706826

RESUMO

BACKGROUND: This study was undertaken to evaluate whether endoscopic sinus surgery (ESS) with a microdebrider had an impact on complication rates, and to facilitate the determination of factors associated with complications in patients who underwent ESS at a tertiary referral center in Taiwan. METHODS: This investigation was a retrospective study and literature review. We analyzed 997 consecutive patients who underwent ESS at Mackay Memorial Hospital in Taipei, Taiwan from January 2006 through February 2010. All data including those of patient medical information, and peri- and postoperative complications were provided by the surgeons involved in patient medical care. We analyzed the complication rates using the following 10 variables by univariate analysis and multivariate logistic regression: sex, age, Lund-Mackay score, polyp grading, previous sinonasal surgery, surgeon skill, adjunctive sinonasal surgery, mesenteric type of anterior ethmoid artery, Keros skull base type, and the use of a microdebrider. RESULTS: Of the 997 patients in our study, 78 (7.8%) had complications. Major complications occurred in five patients (0.5%): two with cerebrospinal fluid rhinorrhea, one with medial rectus muscle damage, and two with retrobulbar hematoma. Minor complications were found in 73 patients (7.3%), which included 32 patients with perioperative estimated blood loss > 15% of the total estimated blood volume, 26 with lamina papyracea damage, two with orbital cellulitis, and 13 with postoperative bleeding. Univariate analysis showed that risk factors related to complication rate were advanced Lund-Mackay scores (scores 19-24), advanced polyp grading (Grades 2 and 3), inexperienced surgeon (resident), and microdebrider usage. However, multivariate analysis revealed that complication rate was linked to advanced Lund-Mackay scores (Scores 19-24), mesenteric type of anterior ethmoid artery, and inexperienced surgeon. CONCLUSION: Overall, the results of our study showed that the ESS complication rate was 7.8%, with risk factors including advanced Lund-Mackay scores (19-24, odds ratio 10.4) and inexperienced surgeon. It was also noted that ESS with a microdebrider had no impact on complication rates, although the presence of a mesenteric type of anterior ethmoid artery proved to be a protective factor.


Assuntos
Endoscopia/efeitos adversos , Seios Paranasais/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
PLoS One ; 10(4): e0117535, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25849535

RESUMO

BACKGROUND: Although the tonsils contribute to first line immunity against foreign pathogens in the upper aero-digestive tract, the association of tonsillectomy with the risk of deep neck infection remains unclear. The aim of this study was to assess the incidence rate and risk of deep neck infection among patients who had undergone a tonsillectomy. METHODS: This retrospective cohort study evaluated all patients who had undergone tonsillectomy between 2001 and 2009 as identified from the Taiwan National Health Insurance Research Database. For each post-tonsillectomy patient, 10 age-, sex-, and index date-matched controls without a history of tonsillectomy were randomly selected. Cox Proportional hazard model and propensity score model were performed to evaluate the association between tonsillectomy and deep neck infection after adjusting for demographic and clinical data. RESULTS: There were 34 (71.6 cases per 100,000 person-years) and 174 (36.6 cases per 100,000 person-years) patients that developed deep neck infection in the tonsillectomized and comparison cohorts, respectively. After adjusting for covariates, patients who had undergone a tonsillectomy had a 1.71-fold greater risk of deep neck infection by both Cox proportional hazard model (95% confidence interval, 1.13-2.59) and propensity score model (95% confidence interval, 1.10-2.66). This association was not altered regardless of the indication for tonsillectomy (i.e. chronic/recurrent tonsillitis or sleep apnea/hypertrophy of tonsil) (p = 0.9797). CONCLUSIONS: Based on our review of a nationwide cohort study we identified that the risk of deep neck infection is significantly increased among patients who have undergone a tonsillectomy. Additional research is needed to explore the possible mechanisms behind these findings.


Assuntos
Infecções Bacterianas/microbiologia , Pescoço/microbiologia , Complicações Pós-Operatórias , Tonsilectomia/efeitos adversos , Tonsilite/cirurgia , Adolescente , Adulto , Infecções Bacterianas/epidemiologia , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Tonsilite/epidemiologia , Adulto Jovem
14.
Acta Otolaryngol ; 135(8): 786-90, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25783847

RESUMO

CONCLUSIONS: ITSI as a first-line therapy in uremia patients with SSNHL offers a valid and safe treatment compared with intravenous systemic steroid treatment. A specific pathophysiology caused by possible sodium pump paralysis may be explained for uremia patients with SSNHL. OBJECTIVE: To compare the efficacy of intratympanic steroid injection (ITSI) with that of systemic intravenous steroids as a first-line therapy in uremia patients with sudden sensorineural hearing loss (SSNHL). MATERIALS AND METHODS: A total of 23 consecutive uremia patients with SSNHL were enrolled in this study. Patients were divided into two groups: the ITSI group (n = 15) and the non-ITSI group (n = 8), in which patients received intravenous systemic steroid treatment. The two groups were homogeneous in all respects. RESULTS: The hearing improvement and relative gain were statistically significant between the two groups. The value of hearing gain (ΔPTA = PTA pre - PTA post) in the ITSI group and the non-ITSI group was 24.6 ± 16.4dB and 8.4 ± 19.3dB. The value of relative gain (ΔPTA/PTApre) in the ITIS group and the non-ITSI group was 31.1 ± 22% and 9.4 ± 20.5%. In the ITSI group, 11 patients (73.3%) exhibited hearing recovery (ΔPTA > 10 dB).


Assuntos
Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/tratamento farmacológico , Audição/fisiologia , Uremia/complicações , Idoso , Audiometria de Tons Puros , Dexametasona , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Súbita/etiologia , Perda Auditiva Súbita/fisiopatologia , Humanos , Injeção Intratimpânica , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Uremia/tratamento farmacológico
15.
PLoS One ; 9(10): e109887, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25291179

RESUMO

BACKGROUND: Studies suggest an increased risk of peritonsillar abscess (PTA) recurrence in patients with prior tonsillitis. However, this association is inconsistent and could be confounded by different treatment modalities. This study aimed to assess the risk of recurrence among PTA patients with different degrees of prior tonsillitis and treatment modalities, and the role of tonsillectomy in current practice. METHODS: All in-patients with peritonsillar abscess between January 2001 and December 2009 were identified in a nationwide, retrospective cohort study. Recurrence was defined as the first occurrence of PTA ≧30 days from the initial PTA. Factors independently associated with recurrence were analyzed using Cox proportional hazard model after adjusting for demographic and clinical data. RESULTS: There were 28,837 patients, with a 5.15% recurrence rate and 4.74 years of follow-up. The recurrence rates were significantly higher among subjects with more than five prior tonsillitis or 1-4 prior tonsillitis compared to those without prior tonsillitis (adjusted hazard ratio, 2.82 [95% confidence interval, 2.39-3.33] and 1.59 [95% CI: 1.38-1.82]). The adjusted HR in patients treated with needle aspiration was 1.08 compared to those treated with incision & drainage (95% CI: 0.85-1.38). After age stratification, the adjusted HRs of more than five prior tonsillitis increased to 2.92 and 3.50 in patients aged ≦18 and 19-29 years respectively. The adjusted HR of needle aspiration only increased in patients ≦18 years old (aHR: 1.98 [95% CI: 0.99-3.97]). The overall tonsillectomy rate was 1.48% during our study period. CONCLUSIONS: The risk of PTA recurrence increases with higher degrees of prior tonsillitis in all age groups and management by needle aspiration only in the pediatric population. Patients younger than 30 years old with PTA and more than five prior tonsillitis have the greatest risk of recurrence.


Assuntos
Paracentese , Abscesso Peritonsilar/etiologia , Tonsilectomia , Tonsilite/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Peritonsilar/patologia , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Risco , Tonsilite/patologia , Tonsilite/cirurgia
16.
Clin Interv Aging ; 9: 1463-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25214774

RESUMO

BACKGROUND: Imbalance from degeneration of vestibular end organs is a common problem in the elderly. However, the decline of vestibular function with aging was revealed in few vestibular function tests such as vestibular autorotation test (VAT). In the current VAT, there are drawbacks of poor test-retest reliability, slippage of the sensor at high-speed rotations, and limited data about the effect of aging. We developed a correlational-VAT (cVAT) system that included a small, light sensor (less than 20 g) with wireless data transmission technique to evaluate the aging of vestibular function. MATERIAL AND METHODS: We enrolled 53 healthy participants aged between 25 and 75 years and divided them into five age groups. The test conditions were vertical and horizontal head autorotations of frequencies from 0 to 3 Hz with closed eyes or open eyes. The cross-correlation coefficient (CCC) between eye velocity and head velocity was obtained for the head autorotations between 1 Hz and 3 Hz. The mean of the CCCs was used to represent the vestibular function. RESULTS: Age was significantly and negatively correlated with the mean CCC for all test conditions, including horizontal or vertical autorotations with open eyes or closed eyes (P<0.05). The mean CCC with open eyes declined significantly at 55-65 years old and the mean CCC with closed eyes declined significantly at 65-75 years old. CONCLUSION: Vestibular function evaluated using mean CCC revealed a decline with age, and the function of visual-vestibulo-ocular reflex declined 10 years earlier than the function of vestibulo-ocular reflex.


Assuntos
Envelhecimento/fisiologia , Testes de Função Vestibular/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
17.
Otol Neurotol ; 35(9): 1621-5, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25144642

RESUMO

OBJECTIVE: Horizontal benign paroxysmal positional vertigo (H-BPPV) is more difficult to successfully treat than posterior benign paroxysmal positional vertigo (P-BPPV) because of the diverse mechanisms required. We developed a simple, rapid, and effective treatment algorithm for treating all subtypes of H-BPPV in an ear, nose, and throat (ENT) outpatient department. MATERIALS AND METHODS: Four hundred ninety patients with BPPV receiving outpatient treatment at Mackay Memorial Hospital were investigated. Among the 490 patients, 86 (17.6%; 86/490) were diagnosed as having H-BPPV variants using the McClure-Pagnini test. Fifty-four patients were female, and 32 were male; they ranged in age from 18 to 92 years (mean age, 56.2 yr). RESULTS: Among the 86 H-BPPV patients, 74.4% (64/86) were hypothesized to have canalithiasis, 20.9% (18/86) were hypothesized to have cupulolithiasis-utricle type (Cup-U), and 4.7% (4/86) were hypothesized to have the cupulolithiasis-cupula type (Cup-C). The primary treatment maneuver was the forced prolonged position (FPP). For 3 patients exhibiting refractory symptoms, we introduced the Gufoni maneuver. The total average success rate of treatment was 96%. CONCLUSION: We concluded that for H-BPPV patients with initial geotropic nystagmus, the FPP alone yielded an excellent treatment-control rate, and the barbecue-rotation maneuver was unnecessary. However, observing the nystagmus transformation of apogeotropic patients was necessary before administering treatment. For cupulolithiasis patients with the apogeotropic variant who did not respond to FPP treatment alone, we determined that the Gufoni maneuver was necessary as well.


Assuntos
Algoritmos , Vertigem Posicional Paroxística Benigna/terapia , Manipulações Musculoesqueléticas/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Mol Genet Metab ; 111(4): 533-8, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24594444

RESUMO

BACKGROUND: Patients with mucopolysaccharidoses (MPS) often have hearing loss. However, the characterization of hearing loss by pure-tone audiometry (PTA) in this rare disease population and its relationship to age and treatment is limited. METHODS: PTA was performed in 39 patients with MPS (29 males and 10 females; 3 with MPS I, 21 with MPS II, 9 with MPS IVA, and 6 with MPS VI; median age, 11.9 years; age range, 4.4-34.2 years). The degree of hearing loss was classified by the age-independent World Health Organization (WHO) clinical guidelines. RESULTS: Hearing loss by PTA was present in 85% (33/39) of patients and was categorized as mild (26-40 dB) in 18%, moderate (41-60 dB) in 36%, severe (61-80 dB) in 23%, and profound (≥81dB) in 5%. Among the patients with hearing loss, 33% were classified as mixed type (conductive and sensorineural), 30% as pure conductive type, 27% as pure sensorineural type, and 9% were undefined. The means of the right and left ear hearing thresholds at 2000 and 4000 Hz by air conduction (AC) and at 500, 1000, 2000, and 4000 Hz by bone conduction (BC) were all positively correlated with age (p<0.05). In the 6 patients with MPS II or VI who underwent follow-up PTA after ventilation tube insertion and enzyme replacement therapy for 1.9 to 8.5 years, all showed improvements in AC and BC of the better ear, as well as in the air-bone gap. CONCLUSIONS: Hearing impairment is common in MPS. Early otolaryngological evaluation and intervention are recommended. These findings and the follow-up data can be used to develop quality of care strategies for patients with MPS.


Assuntos
Audiometria de Tons Puros , Perda Auditiva/complicações , Perda Auditiva/diagnóstico , Mucopolissacaridoses/complicações , Adolescente , Adulto , Distribuição por Idade , Limiar Auditivo , Criança , Pré-Escolar , Feminino , Seguimentos , Perda Auditiva/epidemiologia , Humanos , Masculino , Prevalência , Adulto Jovem
19.
Int J Pediatr Otorhinolaryngol ; 78(1): 14-8, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24300945

RESUMO

OBJECTIVE: Hearing is a critical ability for the development of a child's speech and language. Many studies in different countries have shown the universal newborn hearing screening and early intervention has greatly reduced the negative impact caused by congenital hearing loss. The first universal newborn hearing screening program in Taiwan took place in MacKay Memorial Hospital in 1998 and was subsequently endorsed by the government. The incidence of bilateral congenital hearing impairment in Taiwan is approximately 2.6 per 1000 live birth. The aim of this paper is to analyze the age of diagnosis, hearing aid fitting, and intervention of congenitally hearing impaired children with and without hearing screening after public awareness and government endorsement of newborn hearing screening. MATERIALS AND METHODS: There were 263 hearing impaired children participated in this study, receiving their auditory habilitation therapy at Children's Hearing Foundation from 2006 to 2010. 114 of those children went through newborn hearing screening and 149 without it. The age of diagnosis, hearing aid fitting, and auditory intervention were compared between these two groups. The age of diagnosis and intervention of congenitally hearing impaired children among different years were analyzed too. RESULTS: The average age of diagnosis was 8.7 months, the age of hearing aid fitting was 12.4 months and age of auditory intervention was 18.8 months for the group of hearing impaired children with newborn hearing screening. For hearing impaired children without newborn screening, their average age of diagnosis was 27.5 months; age of hearing aid fitting was 31.3 months and age of auditory intervention was 40.5 months. There were significant differences in the age of diagnosis, hearing aid fitting and auditory intervention between congenitally hearing impaired children with and without hearing screening. CONCLUSIONS: This research indicates that newborn hearing screening facilitates early identification, diagnosis and intervention of congenitally hearing impaired children in Taiwan. The age of identification, diagnosis and intervention of congenital hearing impaired children has also been reduced gradually over the years after government endorsement of newborn hearing screening in Taiwan.


Assuntos
Transtornos da Audição/diagnóstico , Testes Auditivos/métodos , Triagem Neonatal/métodos , Criança , Feminino , Promoção da Saúde , Transtornos da Audição/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Taiwan
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