Validation of the Korean version of the Reflective Practice Questionnaire in clinical clerkship of Korean medical students / 한국의학교육

Purpose@#This study aims to verify whether the Reflective Practice Questionnaire (RPQ) developed by Priddis and Rogers is valid in the Korean context to identify the level of reflection of medical students in clinical practice. @*Methods@#A total of 202 third- and fourth-year medical students from seven universities participated in the study. After receiving approval for use from the authors, a survey was conducted on the students through an adaptation process. The original scale consists of 10 factors with 40 items. The Self-efficacy in Clinical Performance Scale (SECP), Korean Self-reflection and Insight Scale (K-SRIS), and Reflection-in-Learning Scale (RinLS) were used to validate the scale. Exploratory factor, confirmatory factor, correlation, and reliability analyses were used for data analysis. @*Results@#As a result of exploratory factor analysis, 10 subfactors were extracted (Kaiser-Meyer-Olkin=0.856, Bartlett’s test: χ 2 =5,044.337, degrees of freedom=780, p<0.001). Among the 40 items, one that showed a high overlapping load for other factors was excluded. As a result of confirmatory factor analysis, the 10-factor structure model was found suitable (χ 2 =1.980, comparative fit index=0.859, Tucker-Lewis index=0.841, root mean square error of approximation=0.070). As a result of the criterion validity test, most of the subfactors of the Korean version of the RPQ (K-RPQ) showed a positive correlation with K-SRIS, RinLS, and SECP. The reliability of 10 subfactors was satisfactory, ranging from 0.666 to 0.919. @*Conclusion@#The K-RPQ was confirmed to be a reliable and valid tool to evaluate the level of reflection among Korean medical students in clinical clerkship. This scale can be used as a tool to provide feedback on each student’s level of reflection in clinical clerkship.

A Case of Langerhans Cell Histiocytosis involving the External Auditory Canal / 대한두경부종양학회지

Langerhans cell histiocytosis (LCH) is commonly characterized by abnormal function and differentiation or proliferation of monocytes. In LCH, granulomatous lesions, including langerine-positive histocytes and inflammatory infiltrates, can occur to all tissues, particularly well in the bones, skin, lungs, and pituitary gland. In case of external auditory canal LCH, conductive hearing loss may occur, and the most common symptom is otorrhea. Here we present a case that 49-year-old male with external auditory canal mass. Since no invasive findings were seen in radiologic study, endoscopic transcanal excision was performed and LCH was proven by pathologic report. We present this case of external auditory canal LCH with the review of literature.

Shoe-Type Wearable Sensors Measure Gait Parameters in Vestibular Neuritis: A Preliminary Study / 대한평형의학회지

OBJECTIVES: Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. To demonstrate gait variability in acute unilateral peripheral vestibular deficit, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and healthy subjects by the use of shoe-type inertial measurement unit (IMU) with sensors mounted. METHODS: Between April 2017 and January 2019, 30 patients diagnosed with unilateral peripheral vestibular deficit presumed to be caused by VN were enrolled in this study. The shoe-type IMU was used to analysis subjects. We assessed gait speed, cadence, stride length, stance phase, normalized stride length, normalized step length, phase coordination index and gait asymmetry of data from shoe-type IMU sensors with the walking protocol. We tested 30 healthy volunteers as control group. RESULTS: We identified spatiotemporal parameters of human gait. The gait speed of patients with VN was decreased to 3.82±0.8 compared to 4.93±1.08 in control group. In addition, there were differences in normalized stride length, normalized gait speed and related gait parameters, when comparing VN group and control group. CONCLUSION: Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with VN. Gait performance tests can examine gait variability quantitatively. It will be taken into consideration as a vestibular function test for patients with vertigo.

Comparison of the Results between the First Steroid Treatment Group and the Retreatment Group with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Sudden sensoryneural hearing loss (SSNHL) is an otological emergency disease of a non-specific cause. If there is no improvement or if the degree of hearing loss is severe, patients are often referred to other medical institution. Many papers have reported regarding the treatment results of SSNHL, however, most of them failed to mention the fact that patients were referred from other clinics after steroid treatment. This paper would like to compare the treatment results between patient groups who had been referred following steroid treatment and those who received steroid treatment for the first time.SUBJECTS AND METHOD: We retrospectively analyzed 127 patients from January 2015 to August 2017. Patients who received steroid treatment for the first time were classified as group 1; those who had received steroid treatment at another hospital and those who were re-treated were classified as group 2. The treatment results of each group were evaluated.@*RESULTS@#According to the results of this study, the recovery rates for group 1 and 2 were 66.7% and 31.4%, respectively.@*CONCLUSION@#Most of the previous studies on the treatment results of sudden hearing loss were performed in tertiary medical institutions. It is likely that the treatment results of patients who recovered after treatment in the primary and secondary medical institutions were missed, which means that the results of steroid therapy may be better than those reported previously.

Comparison of the Short-Term Effect of Steroid Dosage Regimens in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For idiopathic sudden sensorineural hearing loss (ISSHL) patients, steroids are one of the most important therapies which are used to reduce inflammation in the inner ear. However, dosage regimens of oral steroid therapy have not been well established. This study aims to investigate the progression in recovery from ISSHL, and the optimal dosage regimen with steroids. SUBJECTS AND METHOD: We undertook a retrospective study of 149 patients diagnosed with ISSHL at our institution. We compared various clinical parameters such as age, gender, vertigo, tinnitus, the interval between disease onset and initial treatment, and severity of hearing loss. The 149 patients were divided based on their steroid regimens into two groups: group 1 (which received 40 mg of prednisolone in the morning and 20 mg at night) and group 2 (which received 20 mg of prednisolone three times daily). We then compared the results of group 1 with that of group 2. RESULTS: Recovery rates in group 1 (58/90, 64.4%) were significantly higher in ISSHL than those in group 2 (27/59, 45.8%). In particular, the complete recovery rates of Siegel's criteria in group 1 (35/90, 38.9%) were higher than those in group 2 (12/59, 20.3%). Therapeutic results were affected by the presence of tinnitus. Of the patients with tinnitus, 64.3% in group 1, and 43.9% in group 2 recovered. CONCLUSION: In the group treated with twice-daily regimens, greater hearing improvements were observed compared with the group treated with three times-daily regimens. These findings suggest that higher dose for a single administration may be an important prognostic factor.

Comparison of the Effect of Intratympanic Steroid Injection Medications in Patients with Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study is aimed to investigate the efficacy of dexamethasone and methylprednisolone when used for Intratympanic steroid injection (ITSI) concurrent with systemic steroid as primary therapy. SUBJECTS AND METHOD: We undertook a retrospective study of 106 patients diagnosed with Idiopathic Sudden Sensorineural Hearing Loss at our institution. These patients were divided into the following groups based on their intratympanic steroid medications: Group 1 (which received dexamethasone for ITSI) and Group 2 (which received methylprednisolone for ITSI). The severity of pain after ITSI was also compared using Visual Analogue Scale. RESULTS: The therapeutic results of both groups showed no significant difference. The improvement of pure tone audiometry average threshold were 18.3±19.5 dB for Group 1 and 22.4±25.8 dB for Group 2, with no significant differences (p=0.402). The recovery rate according to Siegel's criteria were 34/70 (48.6%) and 18/36 (50.0%) respectively, with no significant differences (p=0.889). The degree of pain after ITSI were 1.51±1.06 and 3.92±1.63 for Group 1 and 2, respectively, showing significant differences (p<0.001). Again, there were no significant differences even when accompanying symptoms or severity of initial hearing loss were considered. CONCLUSION: There was no significant difference between efficacy of dexamethasone and methylprednisolone when used as primary therapy. Methylprednisolne caused more severe pain after ITSI, suggesting the choice of dexamethasone. Further studies are needed about the concentration of injected steroid.

Role of Innate Immunity in Otitis Media / 대한이비인후과학회지

Otitis media (OM) is the most prevalent disease of childhood and a public health problem in developed and developing countries. Despite appropriate treatment, acute OM can progress to chronic suppurative OM, characterized by effusion and discharge. Moreover, OM lead to conductive hearing loss during critical periods of language acquisition and risking permanent damage to the middle ear and inner ear in severe cases. The reasons for the chronicity of middle ear disease in 10 to 20% children are not clear. However, although many factors can contribute to OM, bacterial infection is considered to be a predominant etiology, producting inflammation characterized by mucosal hyperplasia, effusion, and leukocytic infiltration of middle ear. In this review, we review the role of innate immunity as it applies to OM and deal with recent progresses in understanding the role of innate immune cell in the middle ear epithelium.

A Case of Cerebellar Metastasis Mimicking Vestibular Neuritis / 대한평형의학회지

Vestibular neuritis is characterized by rapid onset of vertigo, nausea and vomiting without neurological symptoms or signs, but central vestibular lesions can cause similar symptoms and signs. A 66-year-old woman previously diagnosed with ovarian cancer initially presented with vertigo. The patient had typical symptoms and signs of vestibular neuritis. As time proceeded, the patient presented with bilateral catch-up saccade and the symptoms and signs of cerebellar dysfunction. Magnetic resonance image and computed tomography scan showed brain metastasis surrounded by edematous lesion. We report an ovarian cancer patient with metastasis mimicking vestibular neuritis with a review of related literature.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Clinical Usefulness of Otoacoustic Emission Sum in Sudden Sensorineural Hearing Loss Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden hearing loss remain a controversial issue with respect to its prognostic indicators. In a recent study, the change in distortion product otoacoustic emission (DPOAE) has been shown to provide useful information about its prognosis. The purpose of this study is to evaluate the relationship between the changes of DPOAE and hearing improvement in sudden deafness patients. SUBJECTS AND METHOD: Sixty-one patients underwent pure tone audiometry (PTA) and DPOAE on their first hospital day; among them 35 patients underwent DPOAE after 2 weeks. These patients were divided into mild ( or =71 dB) group according to their initial hearing thresholds. RESULTS: Of the 22 patients in the moderate to severe group, 11 patients showed a DPOAE response and 5 patients (45%) showed hearing improved. In 11 non-DPOAE response patients, 4 patients (36.4%) had improved. We compared PTA and OAE sum gap results by analyzing 35 patient's initial thresholds with those measured 2 weeks after the therapy. The correlation coefficient between the two group was 0.547 (p<0.05). CONCLUSION: The results show that OAE sum is an efficient and non-invasive objective method and that it can be used to monitor the effects of treatment in sudden hearing loss patients.

A Case of Ramsay Hunt Syndrome Complicated with Multiple Cranial Nerve Palsy Followed by a Brain Stem Lesion / 대한이비인후과학회지

Ramsay Hunt syndrome, associated with herpes zoster virus infection, typically involves facial nerve with vesicular lesions on the ear unilaterally. Frequently, the disease involves the VIII cranial nerve but rarely the III, IV, V, VI, IX, X, XI and XII cranial nerve, causing extraocular movement limitation, facial hypoesthesia, hoarseness, dysphagia, tongue movement limitation and neck weakness. Cranial neuropathies might be secondary to vasculopathy of arteries supplying the cranial nerves. Here, we report a case of Ramsay Hunt syndrome with multiple cranial nerve palsies and a brain stem lesion.

An Acoustic Study on Voice Change after Tonsillectomy / 고신대학교의과대학학술지

OBJECTIVES: Many people have been concerned about voice change after tonsillectomy. The purpose of this study is to analyze changes in the voice and to think about changes in the vocal tract after surgery by using CSL-MDVP. METHODS: Data of 27 patients who underwent tonsillectomy were prospectively evaluated. Acoustic analysis was performed before, after 1 week, after 1 month from the surgery. Nasometer was also conducted. RESULTS: In acoustic analysis, there were no significant changes in F0, jitter, shimmer, NHR, VTI, SPI. But vAM was statistically increased. Vowels and nasal consonants formant frequency analysis results in patients showed no statistically correlation in 1months after tonsillectomy. Although the statistically increased in the nasal consonants. CONCLUSIONS: Although the temporary increase or decrease in the acoustic factor or formant in the vowels and nasal consonants after tonsillectomy, but most factors are make no difference. The voice change that come postoperatively could be considered as no concern, but surgeons need to aware of various facts, which can affect voice changes before the surgery.

A Case of Large Septochoanal Polyp with Calcification / 대한이비인후과학회지

Septochoanal polyp is a rare entity that originates in the nasal septum and extends into the choana. Based on nasal endoscopy, a 43-year-old woman, presenting with nasal obstruction, was suspected of having a nasopharyngeal tumor. A CT scan revealed a large choanal polyp pedicle with calcification in the central area. Because a simple polypectomy carries a high risk of recurrence, the treatment of the septochoanal polyp should involve a resection of the septal mucosa and complete surgical removal by either endonasal or transoral approach.

Hearing Results after Tympanoplasty Type I with Cartilage-Perichondrium Composite Island Graft / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many materials such as fascia, perichondrium and cartilage are used for reconstruction of the tympanic membrane in middle ear surgery. Because of its stiffness, cartilage is resistant to resorption and retraction. However, cartilage grafts result in increased acoustic impedance, so its use has caused controversies as to the acoustic transfer aspect. The aim of this study is to assess hearing results after cartilage tympanoplasty and after fascia tympanoplasty. SUBJECTS AND METHOD: This study included 74 patients who had received tympanoplasty type I between 2007 and 2009, of whom 44 received cartilage and 30 fascia. The middle ear risk index was used to statistically compare the preoperative state of the two groups. Preoperative and six months- postoperative air-bone gaps at the frequency 0.5, 1, 2 and 3 kHz were assessed. RESULTS: Both groups were statistically similar with respect to the severity of middle ear pathology and the preoperative hearing levels. Overall postoperative hearing results showed air-bone gaps (ABG) < or =20 dB in 73% for the fascia group and 71% for the cartilage group. The mean postoperative gains in ABG were 8.97 dB for the fascia group and 10.84 dB for the cartilage group. There were no statistically significant differences in the postoperative frequency specific gains in ABG between the two groups. CONCLUSION: These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after fascia tympanoplasty. Although cartilage is the ideal grafting material in problem cases, a more liberal application might be suggested in such cases as in tympanoplasty type I without fear of impairing hearing.

Transoral CO2 Laser Surgery of Supraglottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic supraglottic laryngectomy by CO2 laser for selected T1-T3 supraglottic cancer results in improved postoperative function and decreased morbidity, with comparable survival to open surgery. The aim of this study was to retrospectively evaluate oncologic and functional outcomes after transoral CO2 laser surgery for supraglottic cancers. SUBJECTS AND METHOD: Nineteen patients (Fresh group:13 patients, Radiotherapy failure group:6 patients) who were diagnosed as supraglottic cancer and treated with CO2 laser surgery between December, 1999 and September, 2006 were evaluated. All the patients were followed-up more than 12 months. Eleven patients in the Fresh group underwent neck dissection. RESULTS: Ultimate local control rate was 100% for both Fresh group and RT failure group. Survival rates of 3-year and 5-year for the Fresh group and the RT failure group were 100% and 68.6%, and 75% and 50%, respectively. There were no significant postoperative complications. CONCLUSION: Although our experience with supraglottic cancers treated by transoral CO2 laser surgery is still too limited to confirm the definite oncologic and functional results, transoral CO2 laser surgery seems to be a safe and reasonable tool, and a time and cost-effective alternative to the traditional surgery for selected supraglottic cancers.

Endoscopic Screening of Esophagus with Lugol's Solution in Patients with Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Second primary esophageal cancer has been reported to comprise 6-9% of head and neck cancer cases, which are frequently detected in the advanced stage. Thus, detecting esophageal cancer in the early stage is important in the prognosis of head and neck cancer. However, it is difficult to detect early lesions using the conventional endoscopy. In the current study, the feasibility of endoscopic screening using Lugol's solution was assessing for detecting early esophageal cancer in patients of head and neck cancer. SUBJECTS AND METHOD : Sixty-two patients (Group I-synchronous cancer study group) diagnosed with head and neck cancer between November, 2003 and November, 2004 were prospectively studied. Fortysix patients (Group II-metachronous cancer study group) under the follow-up care with head and neck cancer during the same period were also evaluated. The esophagus was initially observed under direct endoscopic view and then Lugol dye was sprayed at the esophagus. Any unstained area was biopsied. RESULTS : Of 34 patients (54.8%) with unstained lesions in Group I, 10 (16.1%) showed dysplasia and 4 (6.4%) had cancer. Of 21 patients (45.6%) with unstained lesions in Group II, 2 (4.3%) showed dysplasia and 5 (10.8%) had cancer. Among 9 (8.3%) second primary esophageal cancer, 6 were detected with superficial esophageal cancer while the other 3 were found to be in the advanced stage of cancer. This superficial cancer revealed nonspecific mucosal findings in the direct endoscopic view and was difficult to be visualized as a pathologic lesion; however, it revealed unstained areas when Lugol's solution was sprayed, thus could be diagnosed as cancer through biopsy of the area. CONCLUSION : Endoscopy of esophagus with Lugol's solution could be highly effective as a screening method to detect second primary esophageal cancer in patients with head and neck cancer.

Transoral CO2 Laser Resection of Laryngeal Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Early stages of laryngeal carcinoma are usually treated with three different therapeutic options: partial or total laryngectomy, radiotherapy and transoral endoscopic CO2 laser partial laryngectomy. Combined use of CO2 laser and operating microscope, initially described by Strong and Jako in 1972, has been developed to a variety of procedures by many surgeons. The aim of this study was to define when laser resection of early stage laryngeal carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options. MATERIALS AND METHOD: A retrospective study of 50 patients (glottic carcinoma 41 cases, supraglottic carcinoma 9 cases) treated between May, 1997 and March, 2003 at Department of Otolaryngology, Head and Neck Surgery of Kosin Medical College Hospital, was performed. Glottic cancers were treated with cordectomy type I to V, according to the classification proposed by the European Laryngological Society in 2000. Supraglottic cancer was treated with partial epiglottectomy, epiglottectomy, supraglottic partial laryngectomy, supraglottic laryngectomy, and extended supraglottic laryngectomy. RESULTS: The overall survival rate at 3 years was 100% for the glottic cancer (Tis, 3; T1a, 27; T1b, 5; T2, 2; rT1a, 3; rT2, 1) and local recurrence was identified in 1 patient, thus local control rate was 97.6%. Overall survival rate at 3 years was 100 % for the supraglottic cancer (T1, 3; T2, 2; T3, 1; rT2, 2; rT3, 1) and local control rate was 100%. CONCLUSION: Our results suggest that transoral endoscopic laser resection is a cost-effective procedure with good oncologic results and has acceptable functional results in early laryngeal carcinoma.

Menin Mutational Analysis in a MEN I Family / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: MEN I is an autosomal dominant disorder characterized by multiple tumors occurring in the parathyroid, pituitary, and pancreas. There is a variety of mutations in MEN I that are scattered throughout the coding region, thus MEN I family has its unique type of mutations. The aim of this study is to investigate the significance of genetic screening via analyzing the MEN I gene in the MEN I family. SUBJECTS AND METHOD: Three family members related to MEN I were involved for studying the MEN I gene mutation by using single strand conformational polymorphism and DNA sequence analysis of the coding region and the exon-intron boundaries of the MEN I gene. RESULTS: A specific germline mutation of 1023 a to g transition at the splice acceptor site of exon 7 was identified in all three members of the family in the direct sequence analysis of MEN I gene. CONCLUSION: Genetic analysis for mutations in the MEN I family allows identification of individuals predisposed to the disease and enables an early diagnosis and more complete management. Also, this new diagnostic approach is helpful not only in genetic counselling of clinical management of the MEN I families but also in reducing health care expenses and psychological burden of the diseases.

Significance of MAGE A1-6 mRNA Expression in Sputa of the Head and Neck Cancer Patients: A Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We have reported that the expression of MAGE gene is specific to the mRNA level or protein level in head and neck cancer tissues. In this study, we investigated the applicability of MAGE gene to molecular diagnosis of head and neck cancer by detecting MAGE mRNA with common MAGE primers in sputa of patients. MATERIALS AND METHOD: Nested RT-PCR with MAGE common primers were designed by authors and were performed to detect MAGE 1, 2, 3, 4a, 4b, 5a, 5b, and 6 (MAGE A1-6) genes in sputa obtained from 22 cancer patients (17 squamous cell carcinoma of laryngopharynx, 2 lung metastsis after surgery for tongue and hypopharyngeal cancer, 2 neck metastasis from primary lung cancer, and 1 case of sarcoma of hypopharynx) and 40 normal persons. RESULTS: Of 17 sputa from squamous cell carcinoma patients, expression of MAGE mRNA was positive in 13 (76.5%) cases. MAGE was detected in 72.7% (8/11) of laryngeal cancer, 50% (1/2) of base of tongue cancer, and 100% in hypopharyngeal (2/2) and tonsillar cancer. According to T stage, T1, T2, T3, T4 was positive in 50% (2/4), 100% (5/5), 66.6% (2/3), and 80% (4/5) respectively. In case of primary lung cancer, metastatic lung cancer, and hypopharyngeal sarcoma, all expressed MAGE mRNA. Among 22 cancer patients, 81.8% (18/22) were positive. MAGE expression was detected in 5% (2/40) of the normal control. CONCLUSION: Nested RT-PCR with common MAGE primers was helpful for assessing the presence of cancer cell in the sputa of the respiratory tract. This examination can be used as a tumor marker for the screening of laryngopharyngeal cancers and early detection of recurrent cancers or lung metastasis after treatment.

A Comparison of Ho's, Fourth-edition, and Fifth-edition American Joint Committee Staging Systems for Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of nasopharyngeal carcinoma (NPC) is reported to be high in South China and Hong-Kong. For that reason, the Ho's staging system has been used in the Hong-Kong area, while the American Joint Committee on Cancer (AJCC) staging system has been commonly used in western countries. The fifth-edition staging system defines new rules for classifying NPC. The purpose of this study was to find out whether the fifth-edition of the AJCC staging system is better than Ho's and the fourth-edition AJCC staging system in predicting the prognosis of NPC. MATERIALS AND METHOD: Fifty NPC patients of World Health Organization type II and type III were restaged according to the Ho's staging system, the fourth-edition AJCC and the fifth-edition AJCC staging systems. The disease specific survival rate was calculated by T category, N category and stage grouping for each staging system. RESULTS: The fifth-edition of AJCC showed good distribution compared with other systems in stage classification and also showed statistical significance in the disease specific survival rate between early carcinoma (stage I-II) and advanced carcinoma (stage III-IV). On the survival curve of T and N categories, the fifth-edition of AJCC showed statistical significance in the disease specific survival rate between T1-2 and T3-4 group, and also between N0-1 and N2-3 group. But Ho's staging system showed similar statistical results to the fifth-edition of AJCC, except for higher concentration of patients at stage III. The fourth-edition of AJCC didn't show any statistical significance among categories of T, N and the stage groups. CONCLUSION: In considering the poorer survival rates resulting from the cranial nerve or intracranial invasion and bilateral, or lower neck lymph node metastasis, the extensive invasion to adjacent regions and lymph node metastasis may have an influence on the prognosis. As far as prognostic categories are concerned, the fifth-edition of AJCC appears to be an improvement over other system. So, we concluded that the fifth-edition of AJCC staging system is better than the fourth-edition of AJCC and Ho's staging system to predict the prognosis of NPC.