Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time.

OBJECTIVE: To evaluate the clinical value of intraoperative nerve monitoring (IONM) by comparing the procedure times for thyroidectomies performed with and without IONM. METHODS: A prospective, randomized, controlled study was conducted on 32 patients (representing 41 nerves at risk) undergoing thyroidectomies carried out by two experienced head and neck surgeons (CC & WP). Sixteen thyroidectomies were performed without IONM (the "non-IONM group"), while 16 thyroidectomies were performed with IONM (the "IONM group"). The measured datapoints were setup time, time to visual identification of the recurrent laryngeal nerve (RLN), time to confirm the RLN electrophysiologically, dissection time, and total operative time. RESULTS: With both surgeons, the IONM group had shorter visual times to RLN identification than the non-IONM group (CC: 3.7 minutes vs 5.3 minutes; WP: 3.4 minutes vs 9.7 minutes). Additionally, the electrophysiological identification time for the IONM group was shorter than the visual identification time for the non-IONM group. The setup times, dissection times, and total operative times of the 2 groups did not significantly differ (P > .05). No RLN injuries were observed. CONCLUSIONS: IONM reduces the time needed for RLN identification in thyroidectomies. Functional RLN confirmation can reassure surgeons of the operative results. Moreover, use of IONM does not significantly impact setup and total operative times. LEVEL OF EVIDENCE: 2.

The implementation of TORS for head and neck surgery in Thailand.

Transoral robotic surgery (TORS) is a novel surgical treatment of head and neck cancers, mainly for limited tumor in oropharynx and supraglottis. Despite the major advantage of favorable postoperative functional outcomes, many obstacles exist during the implementation of TORS, especially in a country where financial resources are modest. We demonstrated our experience of initiating this sophisticated technology at the largest tertiary hospital in Thailand. A retrospective review study was conducted in patients with benign or malignant lesions during 2014-2020 at Siriraj Hospital. Different periods of operation time between initial and subsequent cases were compared to evaluate learning-curve improvement. A total of 36 patients underwent TORS, with median follow-up time of 18 months. The average time of room set-up, anesthesia, and positioning was 37 ± 14, 13 ± 7, and 15 ± 7 min, respectively. Whilst, the average robotic procedure time and total time in room were 44 ± 19 and 118 ± 31 min, consecutively. There was no significant difference in any time interval, except the set-up time between initial and subsequent cases. The worthwhile utilization of TORS could be administered cost-effectively despite the complicated and daunting implementation of TORS. Whilst, meticulous planning and sufficient training prior to the initiation of TORS can favorably shorten the learning curve of operative staffs in the TORS team.

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

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

BRAF mutation in cytologically indeterminate thyroid nodules: after reclassification of a variant thyroid carcinoma.

PURPOSE: Fine-needle aspiration biopsy (FNAB) is regarded by the Bethesda system as the gold-standard investigation for stratifying the risk of malignancy of a thyroid nodule. However, some limitations affect the adequacy of the obtained materials, resulting in 30% of the cytological results remaining in the indeterminate category. We aimed to investigate the diagnostic value of the BRAF mutation in cytologically indeterminate thyroid nodules after the reclassification of a variant thyroid carcinoma. PATIENTS AND METHODS: In this prospective diagnostic study, 76 patients with FNAB findings of atypia of undetermined significance (AUS) and suspicious for malignancy (SUS) were included. The BRAF V600 mutation from FNAB was confirmed by a PCR-based method (Sanger sequencing combined with allele-specific real-time PCR techniques) and immunohistochemistry (IHC). Pathological specimens and features, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), were reviewed and compared to the FNAB results. RESULTS: Using the PCR-based method, the BRAF mutation was positive in 13/76 cases (17.1%), with the diagnostic values of 16.7% sensitivity, 100% specificity, 100% positive predictive value (PPV), and 82.8% negative predictive value (NPV) in the AUS compared to 73.3% sensitivity, 100% specificity, 100% PPV, and 20% NPV in the SUS. For the IHC technique, only 20 of the 76 cytological specimens were qualified for testing. The BRAF mutation was positive in 13/20 cases, with the diagnostic values of 100% sensitivity, 63.6% specificity, 42.9% PPV, and 100% NPV in the AUS compared to 100% sensitivity and PPV in the SUS. The BRAF mutation was not found in the pathological reports for NIFTP. CONCLUSION: The malignancy rate is high in our data, with specific and acceptable accuracy rates for the BRAF mutation from FNAB found by using the PCR-based method. NIFTP has been introduced after the pathological reclassification. Molecular diagnosis might be useful to establish the nature of the disease.

Adjustable thermoplastic oral appliance versus positive airway pressure for obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: To compare outcomes of continuous positive airway pressure (CPAP) and the adjustable thermoplastic mandibular advancement splint (AT-MAS) for obstructive sleep apnea treatment. STUDY DESIGN: Randomized crossover, noninferiority, tertiary center setting. METHODS: Fifty patients with a mean age of 49.5 ± 10.6 years were enrolled. Inclusion criteria were age ≥18 years, apnea-hypopnea index (AHI) ≥5 events/hour, and oxygen saturation ≥70%. Exclusion criteria were temporomandibular joint disorders, severe periodontitis, inadequate teeth, and unstable medical diseases. Treatment intolerance was considered a failure. Two-week periods without treatment were followed by questionnaires and randomization into two groups: CPAP/AT-MAS (25) and AT-MAS/CPAP (25). After 6 weeks of intervention, questionnaires and home WatchPAT monitoring were performed. Following each 2-week washout period, patients crossed over to the other treatment followed by similar procedures. Primary outcomes involved the scores from the Functional Outcomes of Sleep Questionnaire (FOSQ). Secondary outcomes were AHI, side effects, and treatment adherence. RESULTS: Seven patients withdrew from this study: five (AT-MAS intolerance) and two (lost follow-up). There was no significant difference among FOSQ scores, particularly on global scores, between both treatments (0.57, 95% confidential interval of difference: -0.15 to 1.29). Mean AHI decreased from pretreatment 39.2 ± 2.53 to 2.56 ± 0.49 and 12.92 ± 2.05 events/hour while using CPAP and the AT-MAS, respectively (P < .05). Most common side effects of CPAP were dry throat and inconvenience to carry, whereas those of the AT-MAS were jaw pain and excessive salivation. CONCLUSIONS: Both devices improved short-term quality of life similarly; however, the AT-MAS was not as efficacious as CPAP on resolving sleep-test parameters. The AT-MAS might be considered only a temporary treatment alternative. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:516-522, 2018.

Prevalence of HPV infection in hypopharyngeal and laryngeal squamous cell carcinoma at Thailand's largest tertiary referral center.

BACKGROUND: Following the well-established relationship between human papillomavirus (HPV) and cervical carcinoma, the carcinogenicity of this virus has also been confirmed in subsets of head and neck carcinoma (HNCA), but mainly in the oropharynx. Other subsites of HNCA with less known association to HPV have never been studied in Thailand. Accordingly, the aim of this study was to investigate the prevalence of HPV DNA in hypopharyngeal and laryngeal squamous cell carcinoma in Thai population. METHODS: This cross-sectional study included hypopharyngeal and laryngeal squamous cell carcinoma patients diagnosed and treated at the Department of Otorhinolaryngology, Siriraj Hospital during the September 2011-December 2013 study period. Presence of HPV genome was confirmed by polymerase chain reaction from pathologically-confirmed fresh specimens. Demographic data and risk factors of HPV infection were evaluated. RESULTS: Eighty patients were included, and 95% of those were male. Only one patient was noted with positive HPV-62 serotype. Most patients consumed tobacco and/or alcohol. Five patients had no risk factors for cancer development. Risk of HPV infection was evaluated by self-reporting questionnaire. The mean age of sexual debut was 20.17 years. Forty-eight patients had multiple sexual partners. Sixteen and seven patients had history of sexually transmitted disease infection and habitual oral sex contact, respectively. CONCLUSION: There was no oncogenic HPV DNA detected within pathologic specimens of laryngeal and hypopharyngeal cancers in this study. Compared to rates reported from developed countries, the prevalence of HPV-related HNCA in Thailand is very low.

Hypothyroidism after Hemithyroidectomy: The Incidence and Risk Factors.

OBJECTIVE: To evaluate the incidence of post-hemithyroidectomy hypothyroidism and identify possible risk factors that indicates whether patients require thyroid function monitoring after surgery. MATERIAL AND METHOD: A retrospective review of patients with benign non-toxic thyroid disease undergoing hemithyroidectomy between April 2004 and November 2008 in the Department of Otorhinolaryngology, Siriraj Hospital was conducted All patients were in euthyroid state preoperatively. Thyroid specimens were examined for pathological diagnosis and degree of lymphocytic infiltration in thyroid tissue, and thyroid function was evaluated again six weeks after surgery. RESULTS: One hundred patients who received hemithyroidectomy were recruited for the present study. All had normal preoperative thyroid function. Six weeks after surgery, 27% of the cases developed hypothyroidism (6% overt or symptomatic hypothyroidism and 21% subclinical hypothyroidism). The mean preoperative thyrotropin level was significantly higher in the hypothyroid group than in the euthyroid group (1.9±1.2 vs. 1.1±0.7 micro IU/ml). Fifty-eight point three percent of patients with preoperative thyroid stimulating hormone (TSH) level more than or equal 2 micro IU/ml developed hypothyroidism in comparison to only 17.1% of those with preoperative TSH <2 micro IU/ml (odds ratio 6.8). Fifteen patients had signifcant lymphocytic infiltration (grade 2-4); nine of those (60%) had post-operative hypothyroidism. In contrary, only 18 of 85 patients (21.2%) with minimal infiltrates (grade 0-1) developed hypothyroidism (odds ratio 5.6). CONCLUSION: Twenty-seven percent of the patients in the present study developed hypothyroidism after hemithyroidectomy. Preoperative TSH more than or equal 2 micro IU/ml and significant lymphocytic infiltration in thyroid tissue or thyroiditis warrant post-operative close TSH monitoring. The awareness of such risk factors for post-operative hypothyroidism would improve patients care.

Human Papillomavirus Infection in Oral Cavity and Oropharyngeal Cancers: Are They the Same Story?

Background: Nowadays, human papillomavirus (HPV) infection becomes the main risk factor for head and neck cancer development. In Thailand, the related role of this viral infection to head and neck cancer is still unknown and not well established. Objective: To identify different characteristics of oral cavity and oropharyngeal cancer, and to determine the HPV-associated prevalence of these two tumor types in Thailand, which is unlike the Western countries. Material and Method: Between 2010 and 2012, a cross-sectional study was performed in 23 oral cavity and 23 oropharyngeal cancer patients. HPV genome was studied in all of them from pathological confirmed fresh specimens. Risks of HPV infection were collected using self-reported questionnaire. Results: The prevalence of HPV-related oropharyngeal cancer was significantly noted in 26.09% (p = 0.009), while no demonstrable HPV-associated prevalence in oral cavity cancer. In addition, the routes of HPV infection were not identifiable. Conclusion: Oral cavity and oropharygeal cancers are not only anatomically distinct, but also greatly differed in their characteristics and pathophysiology. The percentage of HPV-related tumors in Thailand is considerably low when compared to the Western countries. However, the impact on treatment modification cannot yet be universally applied.

Diagnostic properties of the STOP-Bang and its modified version in screening for obstructive sleep apnea in Thai patients.

OBJECTIVE: To test the diagnostic properties of the original and a modified STOP-Bang, as well as testing the additional use of a waist-to-height ratio (WHtR) of > or = 0.55 in screening for obstructive sleep apnea (OSA) in Thai patients. MATERIAL AND METHOD: Three hundred and three patients (186 males and 117 females) who underwent anthropometric measurement and standard polysomnography were asked to complete the STOP-Bang questionnaire. Subjects were considered high-risk if their scores were > or = 3. Patients with significant co-morbidities were excluded. RESULTS: Screening for OSA involved measurements of STOP-Bang sensitivity, specificity, positive predictive value, and negative predictive value at several apnea-hypopnea index (AHI) cut-off points. At AHI 5, these values were 87.3%, 48.1%, 82.2%, and 52.2%, respectively. At AHI 15, these values were 92.6%, 36.4%, 58.5%, and 83.6%, respectively. The modified STOP-Bang (using a cut-off of BMI > 30 kg/m2) showed slightly increased sensitivities at the AHI cut-off points of 5 and 15 with values of 88.7% and 93.2%, respectively, with improved area under the curves. Furthermore, by applying the WHtR of > or = 0.55 to those patients who were classified as high-risk by the questionnaires, the specificities for predicting OSA were improved to 85.2% and 76.1% for the aforementioned cut-off points, respectively. CONCLUSION: Both STOP-Bang and its modified version were highly sensitive measures for OSA screening in medical or dental clinics. However, the modified version might be more suitable for Thais and Asians, and the additional use of WHtR > or = 0.55 might be useful for reducing the unnecessary sleep investigation or management in those who were classified as high-risk patients.

Home-based diagnosis of obstructive sleep apnea by polysomnography type 2: accuracy, reliability, and feasibility.

PURPOSE: Despite being used in large cohort studies, role of polysomnography (PSG) type 2 is still controversy. This study was aimed to determine its accuracy, reliability, and feasibility in diagnosis of obstructive sleep apnea (OSA) compared to gold standard. METHODS: Adult patients with stable medical conditions who complained of snoring or excessive sleepiness and lived around Bangkok were recruited from a sleep clinic. All were asked to fill questionnaires and have PSG done in laboratory (in-Lab PSG) and at home (Home PSG) on separate nights within 2-4 weeks interval. RESULTS: Eighty-six patients, 48 males and 38 females, were included. Mean of total sleep time, sleep efficiency, and stage R were significantly greater in Home PSG than in-Lab PSG (p<0.05). Apnea-hypopnea index (AHI) was slightly higher in Home PSG (25.7 versus 23.5, p=0.04), but with excellent reliability, intra-class correlation coefficients of 0.96 (95% CI; 0.93-0.97), and good agreements (κ=0.59-0.70) between both tests. The sensitivity, specificity, and accuracy of Home PSG at cut-off point of AHI≥5, were 0.97, 0.56, and 0.85, respectively, and at AHI≥15 were 0.95, 0.76, and 0.85, respectively. Sixty-four patients (74.4%) preferred home-PSG but four patients (4.7%) needed repeated tests due to significant data loss. CONCLUSIONS: This is the first report in Asia demonstrating that home-based diagnosis of OSA by PSG type 2 was feasible performing with good reliability, high accuracy, and a low failure rate. However, further studies focusing on its cost-effectiveness are required.

Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: outcomes and practicability.

OBJECTIVES/HYPOTHESIS: To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment. STUDY DESIGN: Prospective, nonrandomized, before-after study. METHODS: Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint (TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter. RESULTS: Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects. CONCLUSIONS: This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.

Physical predictors for moderate to severe obstructive sleep apnea in snoring patients.

PURPOSE: This study aimed to identify physical findings that may predict the presence of moderate to severe obstructive sleep apnea (OSA) in snoring patients. METHODS: A total of 283 subjects (165 males and 118 females) were recruited, including 217 OSA patients and 66 patients with apnea-hypopnea index (AHI)<5 as a control group, diagnosed by level-1 polysomnography. Baseline data of patients including age, sex, weight, height, body mass index (BMI), neck circumference (NC), waist circumference (WC), neck-to-height ratio (NHtR), and waist-to-height ratio (WHtR) were recorded. Other physical parameters such as chin length (Chin1), thyromental distance, hyomental distance, cricomental distance, cricomental space (CMS), Friedman tongue position (FTP), and tonsils size were recorded by a single investigator who was blinded to the PSG results. RESULTS: The findings that were statistically different between the control group and moderate to severe OSA (AHI ≥ 15) included sex, BMI, NC, NHtR, WC, WHtR, Chin1, CM, and CMS (p<0.05). However, logistic regression analysis showed that only male gender and WHtR ≥ 0.55 were the independent predictors for AHI ≥ 15 with adjusted odds ratios of 6.6 and 3.1, respectively. CONCLUSION: Among snoring patients seeking medical consultation, male gender and WHtR of ≥ 0.55 were good predictors for moderate to severe OSA. No single head and neck finding reliably predicted this condition. In a situation with limited facilities, these data along with medical history may be helpful for prioritizing patients in order to achieve the optimal use of sleep investigation and treatment.

Blast injury of the ears: the experience from Yala Hospital, Southern Thailand.

OBJECTIVE: To report acute and subacute consequences of blast injury to the ear from terrorists' bombings experienced from Yala Provincial Hospital, Southern Thailand STUDY DESIGN: Retrospective chart review was done on 54 patients who suffered otologic injuries from bombing attacks in Yala Province from January to May 2005. Only 33 patients who had complete otologic and audiologic examination with a 3-month follow-up were studied. MATERIAL AND METHOD: The ear symptoms, the size of tympanic membrane perforation, degree of hearing loss at first examination within 30 days after injuries were recorded. After a 3-month follow-up, the rate of spontaneous healing, rate of operation needed and long-term complications including hearing loss were analyzed. RESULTS: The two most common initial symptoms were hearing loss (72.73%) and tinnitus (66.67%). Tympanic membrane perforations were encountered in 31 ears of 22 out of 33 patients. Spontaneous healing occurred in 23 ears (74.19%) with the highest incidence in small perforations (size < 50%). All healings occurred within 8 weeks. Tympanoplasty was done on the rest, except one patient. Eight patients (24.24%) had sensorineural hearing loss without tympanic membrane perforation. They still have sensorineural hearing loss, which is rather mild and typically affects in high tone with five of this group having normal hearing in speech range. Eleven patients from the tympanic membrane perforation group still have mixed hearing loss, which were also mostly mild. CONCLUSION: Patients with aural symptoms after a blast injury need thorough otologic and audiological examination. The spontaneous healing of tympanic membrane perforation from explosive injury was relatively high (74.19%) after an 8-week follow-up, only 8/31 ears required surgical repair. At 3-months follow-up, more than two-thirds of the patients still had residual hearing loss, which was rather mild and affected mainly in high tone.

Acute epiglottitis: a report of the two different methods of airway management in adults.

The authors present two cases of acute epiglottitis with upper airway obstruction that urgently needed artificial airways. In case 1, a 55-year-old woman with DM presented with severe upper airway obstruction and sepsis. The tracheostomy was chosen for airway management, antibiotic was given, and fluid and inotropic drug (dopamine) were used for cardiovascular support. She received continuing care in the intensive care unit for several days. In case 2, a 40-year-old man presented with acute airway obstruction when he breathed forcefully. The prophylaxis tracheal intubation was done by using sevoflurane inhalation. The life-threatening situations of both patients were managed successfully by the team approach of ENT surgeons, anesthesiologists, and intensivists.

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

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

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

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