Multicentre cohort study of cochlear implantation outcomes in Thailand

OBJECTIVES

To report the status and outcomes of cochlear implantation in Thailand.

DESIGN

Cohort study.

SETTING

Tertiary care and university hospitals.

PARTICIPANTS

Patients who underwent cochlear implant surgery in Thailand.

INTERVENTIONS

This project collected data from all government and university hospitals in Thailand where cochlear implant surgery was performed between 2016 and 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

Baseline characteristics, operation data, complications, audiological outcomes and quality of life were reported.

RESULTS

This study included 458 patients, and nearly half of the patients were children and adolescents (46.94%). The mean age of the patients was 2.96±5.83 years. At 1 year postoperatively, the mean pure tone average of the hearing threshold in the implanted ear significantly improved from unaided preoperative baseline (mean difference (MD) 64.23 dB HL; 95% CI 59.81 to 68.65; p<0.001). The mean speech recognition threshold also improved (MD 55.96 dB HL; 95% CI 49.50 to 62.42, p<0.001). The quality-of-life scores of the EQ-5D-5L, PedsQL and HUI3 questionnaires at 1 year showed improved mobility (range, 0-5; MD 0.65; 95% CI 0.05 to 1.25; p=0.037), hearing (range, 0-6; MD 0.96; 95% CI 0.30 to 1.61; p=0.006) and speech (range, 0-5; MD 0.44; 95% CI 0.04 to 0.84; p=0.031). Common complications included electrode dislodgement (2.18%), vertigo (1.23%) and meningitis (1.93%).

CONCLUSIONS

Excellent audiological outcomes and improvement in the quality of life in the mobility, hearing and speech domains were observed in patients who underwent cochlear implantation in Thailand.

Chulalongkorn vestibular balance exercise for rehabilitation in persons with various types of vestibular disorders

OBJECTIVE

To study the efficiency of Chulalongkorn vestibular balance exercise for rehabilitation in persons with various types of vestibular disorders.

MATERIAL AND METHOD

Fifty-eight patients with various types of vestibular disorder were identified by a retrospective chart review. Thirty of the 58 patients met the inclusion criteria of having dizziness and unsteadiness post vestibular diseases with complete record of neuro-otologic examination; vestibular tests and had been followed-up for at least 3 month. These patients were treated with Chulalongkorn vestibular balance exercise and were evaluated for dizziness symptoms and balance bedside test at the beginning of treatment, one month and three months after the exercise.

RESULTS

The average age of the patients was 50.34 ± 14.04 years. The average of duration of exercise program was 5.6 months. There were 6 cases of vestibular neuronitis; 5 cases of post acoustic neuroma removal; 4 cases of acute cochleovestibular loss; 3 cases of motion sickness; 2 cases of cerebellar atrophy; 3 cases of multisensory dizziness; 4 cases of post meningitis with deafness; and 3 cases of ototoxicity. After the exercise, improvement of dizziness symptoms could be found in all groups of the diseases at one month and three months. The objective of balance bedside test was improved in most cases except motion sickness, multisensory dizziness and cerebellar atrophy. The overall percentage of improvement of dizziness was statistically significant at one month and three months (p = 0.0373 and p < 0.001). However the overall balance bedside test was statistically improved at three months after the exercise (p = 0.034).

CONCLUSION

Chulalongkorn vestibular balance exercise gave significantly effective results in the treatment of dizziness and unsteadiness from various types of vestibular disorder. This study demonstrated improvement of dizziness symptom post-exercise at one month and three months with statistical significance. The balance bedside test was also statistically significant improved at three months post-exercise.

Carcinoid tumor of the middle ear

The patient was a 32 year-old man who was first seen in 2003 for 2 years hearing loss. On otoscopic examination, a whitish mass could be observed through the intact tympanic membrane. High resolution computed tomography showed a tumor like lesion in the middle ear with no evidence of bone destruction. A tympanomastoidectomy was performed. Light microscopy showed fragments of cellular tissue in which both glandular and trabecular growth pattern could be identified Immunohistochemical examinations showed positive staining of the tumor cells for cytokeratin and chromogranin. The diagnosis of carcinoid tumor should be considered in all cases of adenomatous neoplasms of the middle ear and mastoid. Conservative surgical excision is the treatment of choice, and local recurrence following complete excision is uncommon.

Carcinoma of the external auditory canal

Carcinoma of the external auditory canal is one of the most inaccessible areas of the body. It is a rare malignant neoplasm with an aggressive nature and an overall poor prognosis. In a ten year period, 16 patients were treated in King Chulalongkorn Memorial Hospital. From TNM staging proposed by the University of Pittsburgh, the authors found T1 = 1, T2 = 6, T3 = 5, T4 = 4 cases. In 14 patients who were operated on (radical mastoidectomy in 8, lateral temporal bone resection in 5, sleeve resection in 1), 7 had cured (50%), 7 were recurrence. 6 cases of recurrence developed in patients with radical mastoidectomy, 1 case with lateral temporal bone resection. The overall cure rate in stage I-II = 85.71% (6/7) but only 11.11% (1/9) in the advanced stages (III-IV). The present data suggest that in early cancer (stage I-II) the lateral temporal bone resection with postoperative radiation is better than radical mastoidectomy with postoperative radiation.

The pectoralis major myocutaneous flap: applications and complications in head and neck reconstruction

Ninety-six pectoralis major myocutaneous flaps were used in the head and neck reconstruction of 93 patients who underwent extirpation of cancer. The utilization of the pectoralis major myocutaneous flap included 50 tongue replacements, 19 hypopharynx and pharyngoesophageal closure, 11 oral mucosal closure and external skin replacement, 7 soft tissue coverage of the reconstruction plate, 3 soft tissue protection of the great vessels at the neck and 6 correction of the wound breakdown from failure of the other flap reconstruction. The major complication, which included total flap loss, partial skin paddle loss, orocutaneous fistula, dehiscence and plate exposure, was 17.7%. The overall complication rate was 54.2% and most of them were healed by conservative management. The pectoralis major myocutaneous flap is feasible and reliable for immediate reconstruction of various defects in the head and neck area. The pectoralis major myocutaneous flap should be the suitable flap for the advanced-staged cancer patient with a limited life expectancy.

Eosinophilic mucin rhinosinusitis: terminology and clinicopathological presentation

Many terms related to allergic fungal rhinosinusitis (AFRS) such as eosinophilic mucin rhinosinusitis (EMRS), eosinophilic fungal rhinosinusitis (EFRS), and AFRS-like syndrome have been proposed. The authors define EMRS as patients with rhinosinusitis who demonstrate eosinophilic mucin on histopathological examination. EMRS patients who demonstrate fungal hyphae within the mucin are diagnosed as having EFRS and those who cannot demonstrate fungal hyphae within the mucin are diagnosed as having EFRS-like syndrome. EFRS patients who demonstrate an allergic response to the fungi are diagnosed as having AFRS and those who cannot demonstrate any allergic responses to the fungi are diagnosed as having non-allergic fungal rhinosinusitis (NAFRS). In the United States, the prevalence of AFRS in chronic rhinosinusitis patients who require surgery is 5-10 per cent. However, the prevalence of AFRS in Thailand is not known because AFRS has never been reported and studied in Thailand. This study shows the clinical and pathological entities of patients with EMRS in King Chulalongkorn Memorial Hospital from July 2001 to July 2002. From a total of two hundred and fourteen rhinosinusitis patients who required surgery, six were diagnosed as having EMRS. Two of six EMRS patients were diagnosed as having EFRS (both of them were also diagnosed as having AFRS) and four patients were diagnosed as having EFRS-like syndrome. In this study, the prevalence of AFRS is much less than in the United States because of the limited understanding of this disease, the lack of commercially available antigens for dematiaceous fungi, and the lack of awareness and knowledge of pathologists to diagnose eosinophilic mucin and fungi within the mucin. The terms related to AFRS are also discussed in this study.

Canalith Repositioning for Benign Paroxysmal Positional Vertigo: A Randomized, Controlled Trial

We assessed the efficacy of the canalith repositioning maneuver by comparing it with no treatment in a population of patients with benign paroxysmal positional vertigo (BPPV). In this randomized, controlled, 6-month efficacy trial, outcomes were measured subjectively by patients’ reports of symptom status and objectively by Hallpike testing. During the first month of the study, the treated group experienced significantly better outcomes than did the control group, but this trend was not sustained at 3 and 6 months.

Canalith repositioning for benign paroxysmal positional vertigo: a randomized, controlled trial

We assessed the efficacy of the canalith repositioning maneuver by comparing it with no treatment in a population of patients with benign paroxysmal positional vertigo (BPPV). In this randomized, controlled, 6-month efficacy trial, outcomes were measured subjectively by patients' reports of symptom status and objectively by Hallpike testing. During the first month of the study, the treated group experienced significantly better outcomes than did the control group, but this trend was not sustained at 3 and 6 months.

Manual rotational testing of the vestibulo-ocular reflex

OBJECTIVES/HYPOTHESIS

Manual whole-body and head-on-body rotational testing of the vestibuloocular reflex (VOR) is comparable to conventional rotary chair methods with and without visual fixation from 0.025 to 1 Hz.

STUDY DESIGN

Summary of four previously published trials from our laboratory and a fifth prospective blinded study comparing whole-body and head-on-body rotation with rotational chair results from 0.025 to 1 Hz in 10 patients with bilateral vestibular dysfunction.

METHODS

Subjects were fitted with standard electro-oculogram (EOG) electrodes and placed in the rotary chair for testing at 0.025, 0.05, 0.1, 0.25, 0.5, and 1 Hz in the dark (VOR) and in the light with a stationary target (VVOR). They were then placed in an otolaryngology examination, chair where an adjustable headband containing the velocity sensor and an opaque visor were placed on the forehead. Whole-body rotational trials from 0.025 to 1 Hz and both passive and active head-on-body trials from 0.25 to 1 Hz were performed with and without visual fixation. Data from each frequency were analyzed cycle-by-cycle and averaged for gain, phase, and asymmetry. These values were then compared to the results obtained during rotational chair testing.

RESULTS

Throughout the five studies, no systematic differences were noted between the manual rotational methods and the rotary chair results. Specifically, no consistent effect of volition or cervico-ocular reflex (COR) enhancement was demonstrated.

CONCLUSIONS

Manual rotational testing is a reliable technique for measuring the VOR up to 1 Hz as compared with standard rotary chair methods. Advantages to this technique include portability, lower equipment costs, and potential application up to 6 Hz using head-on-body rotation.