Outcome of mobile ear surgery units in Thailand.

OBJECTIVES: To evaluate the outcome of mobile ear surgery, in terms of tympanic membrane perforation closure, absence of otorrhoea and hearing threshold improvement. STUDY DESIGN: Descriptive study. METHODS: The study enrolled patients with chronic ear disorders requiring surgery who presented to the mobile ear surgery unit at Sakaeo Hospital, Thailand, from 1 to 4 July 2008. The following data were recorded: pre-operative audiogram, post-operative middle-ear and mastoid infection, wound infection, graft condition, any complications, and post-operative audiogram. Patients were followed up at one week, two weeks, four weeks and 24 weeks post-operatively. RESULTS: For the 31 cases of tympanic membrane perforation, the closure rate was 90.3 per cent. For the 32 patients with otorrhoea, the rate of ear dryness was 87.5 per cent. All 35 patients had impaired hearing initially; the rate of hearing improvement was 74.3 per cent (95 per cent confidence intervals = 56.7-87.5 per cent). Patients' mean hearing improvement was 22.9 dB. CONCLUSION: The assessed ear surgery procedures had good results.

Tonsillar fossa steroid injection for reduction of the post-tonsillectomy pain.

Fifty patients (26 males and 24 females) who underwent tonsillectomy were then treated with injection of the long acting steroid (Kenacort-A) into the right tonsillar fossa after the operation. The left side was used as the control. Post-operative pain was assesed by the patients and was graded and recorded daily as mild, moderate, and severe pain on both sides of the throat for 2 weeks. A significant reduction of pain in the tested side (right side) was noted in the majority of the patients. The duration of pain was shorter in the right side than the left side. It seemed to significantly reduce the post-tonsillectomy pain. Because of its simplicity, cost effectiveness, and no complications, the technique should be used for pain-free tonsillectomy in non-contraindicated cases.

Nasolacrimal duct injury from microscopic sinus surgery: preliminary report.

Nasolacrimal duct injury is a well established complication of functional endoscopic sinus surgery. In 1992, Bolger reported an incidence of nasolacrimal duct injuries in endoscopic sinus surgery of up to 15 per cent, but there is no documentation in microscopic sinus surgery. Fluorescein instillation into the lacrimal system via the punctum was done to determine the incidence of nasolacrimal duct injuries in 16 patients who underwent 32 microscopic sinus procedures. Only one patient exhibited nasolacrimal duct injury intraoperatively on the left side (0.3%). He had complete healing of the nasolacrimal duct at 2 months and no postoperative epiphora developed.

Cytochrome P450 2E1 polymorphism and nasopharyngeal carcinoma development in Thailand: a correlative study.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare tumor in most parts of the world but occurs at relatively high frequency among people of Chinese descent. The cytochrome P450 2E1 enzyme (CYP2E1) is responsible for the metabolic activation of nitrosamines, and has been shown to be a susceptibility gene for NPC development in Taiwan [RR = 2.6; 95%CI = 1.2-5.7]. Since there has been only one report of this link, it was decided to investigate the susceptibility of CYP2E1 to NPC development in other populations. Therefore, the correlation between the RsaI polymorphism of this gene and NPC was studied in-patients including Thai and Chinese in Thailand. The present study comprised 217 cases diagnosed with NPC and 297 healthy controls. RESULTS: Similar to the result found in Taiwanese, a homozygous uncut genotype demonstrated a higher relative risk both when all cases were analyzed [RR = 2.19; 95%CI = 0.62-8.68] or individual racial groups, Thai [RR = 1.51; 95%CI = 0.08-90.06] or Chinese [RR = 1.99; 95%CI = 0.39-10.87]. The ethnicity-adjusted odds ratio is 2.39 with 95%CI, 0.72-7.89. CONCLUSIONS: Though our finding was not statistically significant due to the moderate sample size of the study, similarity to the study in Taiwan with only a slight loss in precision was demonstrated. The higher RR found for the same genotype in distinct populations confirmed that CYP2E1 is one of several NPC susceptibility genes and that the RsaI minus variant is one mutation that affects phenotype.

Upper aerodigestive tract burn: a case report of firework injury.

The case of a 46 year-old German man with upper aerodigestive burn by firework was reported. He presented with the symptoms and signs of upper airway obstruction. Tracheostomy was done and direct laryngoscopy with microscopic examination revealed swelling and denudation of the mucosa of the oral cavity and supraglottic area. Intravenous steroids and antibiotics were administrated for treatment. It is suggested that proper management needs an understanding of the mechanism and effect of the corrosive agent. Careful airway management resulted in a good outcome in this patient.

Auricular pseudocysts: a treatment with the Chulalongkorn University vacuum device.

Auricular pseudocysts are rare lesions that present as an asymptomatic cystic swelling of the anterior surface of the auricle, particularly the antihelix. Typically, the pseudocysts contain viscous straw-yellow fluid similar in appearance to olive oil; however, a clear pale yellow serous transudate may also be encountered. Various therapeutic approaches have been used with variable success. We describe a simple small vacuum device called the Chulalongkorn University vacuum device, which was developed in our center. The device can be easily made anywhere by any surgeon. We report the outcome in 17 patients treated by means of needle aspiration plus application of the Chulalongkorn University vacuum device for 5 days. A complete resolution of the lesion was obtained in 15 (88.2%) patients. Because the procedure is safe and effective and does not require an operating room setting, it may be accepted as an option in the treatment of auricular pseudocysts.

Telomerase assay and nested polymerase chain reaction from nasopharyngeal swabs for early noninvasive detection of nasopharyngeal carcinoma.

The main purpose of this study was to analyze sensitivity and specificity of combining nested polymerase chain reaction for detection of Epstein-Barr virus (EBV) genome and telomerase assay for identifying nasopharyngeal carcinoma (NPC). Eighty patients with NPC and 27 healthy control subjects were included in this study; 97. 5% and 94.9% of NPC patients were positive for EBV genome and telomerase activity, respectively. When nasopharyngeal swabs were tested, 95.7% presented the EBV genome and 85.5% were positive for telomerase expression. The sensitivity for counting either positive result of these two techniques was 100%. Among the 27 control subjects, only 6 and 5 cases were positive for EBV DNA and telomerase activity, respectively. This indicated a specificity of 92.6% when both positive results were included. At present, early diagnosis of NPC requires multiple biopsy specimens, especially to identify subclinical cases. Because this study showed a very high sensitivity for detecting NPC from swabs when combining the telomerase assay and nested polymerase chain reaction technique, this noninvasive technique may be a good candidate for screening of subclinical NPC, especially before multiple biopsy specimens are obtained.

Salivary gland choristoma of the middle ear: case treated with KTP laser.

Salivary gland choristoma of the middle ear is rare. It consists of non-malignant, non-growing, normal salivary gland tissue in the middle ear. It is a developmental abnormality that occurs around the proximal part of the second branchial arch before the fourth month of intrauterine life. The authors found the 25th recorded case in our centre and another 24 reported cases from a review of the literature between 1961 and 1999. Intratympanic salivary gland choristoma frequently occurs during the first and second decades of life and with a female preponderance (56 per cent). Nearly all the patients (96 per cent) in our review presented with a hearing loss, that had begun since birth, in infancy, or during childhood. Tinnitus (28 per cent), and serous otitis media (24 per cent) were also commonly present. One case complained of otorrhoea. Intratympanic and extratympanic anomalies were found in 96.2 per cent and 34.6 per cent of cases respectively. Of these anomalies, ossicular chain (88.5 per cent), facial nerve (65.4 per cent), middle-ear muscles (30.8 per cent) and labyrinthine windows (23 per cent) were the four most common sites. Therefore, salivary gland choristoma may represent a manifestation of a congenital ear anomaly. Diagnosis of salivary gland choristoma is generally not documented pre-operatively, but is based on surgical biopsy and histopathological investigations. Treatment of this rare lesion depends on the size, location and extent of the mass, degree of anatomical abnormality and expertise of the surgeon. In difficult cases where the mass is attached to the dehiscent or inferiorly placed facial nerve, only biopsy is recommended. However, complete surgical removal is advocated for a mass that is easy to remove. KTP laser use via a 200 micron fibre-optic light carrier can facilitate removal especially in cases with ossicular chain involvement.

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.

Lingual osseous choristoma: report of three cases.

Osseous choristoma represents the dense, mature, bony tissue in an abnormal location. We reported three cases of lingual osseous choristoma, herein, a year after the report of eight cases in 1998. All three lesions were at or close to the foramen caecum. The lesions were smooth, round or lobulated and pedunculated in shape and stony hard in consistency. All of them were preoperatively diagnosed, based on the above unique clinical findings without any radiography. The lesions were simply excised without local recurrence.

Comparison of ofloxacin otic solution with oral amoxycillin plus chloramphenicol ear drop in treatment of chronic suppurative otitis media with acute exacerbation.

The efficacy and safety of 0.3 per cent Ofloxacin otic solution (OFLX) 6 drops twice daily was compared with those of oral Amoxycillin 500 mg three times daily plus 1 per cent Chloramphenicol ear drop at 3 drops three times daily (AMOX + CRP) in a two-week treatment of chronic suppurative otitis media (CSOM) with acute exacerbation. 80 adult patients were enrolled in a prospective, randomized, investigator-blind study at the outpatient ENT service of Chulalongkorn University Hospital. The most common pathogens isolated at the pretreatment visit were Staphylococcus aureus (30.3%) and Pseudomonas aeruginosa (24.7%). The susceptibility of all the pathogenic isolates to ofloxacin, amoxycillin and chloramphenicol were 96.4, 57.1 and 51.8 per cent respectively. The overall response expressed as an improvement or cure of otalgia, otorrhea and middle ear mucosal inflammation was recorded. It revealed that the improvement rate of the OFLX-treated patients was better than that of AMOX + CRP-treated, but was not statistically significant. However, the cure rate was significantly better in OFLX-treated than in AMOX + CRP-treated groups in terms of painless (p = 0.05) and dry (p < 0.001) ears. Ototoxicity was assessed by an elevation in bone conduction threshold (BC) and/or speech reception threshold (SRT) of greater than 5 dB or a presence of high tone hearing loss resulting from treatments. A significant decrease in BC and SRT was revealed in OFLX-treated ears (p < 0.0001; p = 0.002 respectively) but a significant elevation of BC was found in AMOX + CRP-treated ears (p = 0.007). The ototoxic rate was significantly higher in AMOX + CRP-treated than in OFLX-treated ears whether assessed by BC (p < 0.001) or SRT (p = 0.03). In conclusion, OFLX was more effective and safer than AMOX + CRP in the treatment of CSOM with acute exacerbation.

Acute otalgia: a case report of mature termite in the middle ear.

Acute otalgia during childhood is one of the most common complaints in general ENT practice. It may occur as a result of acute otitis externa, otitis media or a foreign body. Animate foreign body in the ear canal or in the middle ear usually results in otalgia and hearing loss. We present a rare case of a living mature termite in the middle ear of a 9-year-old girl complaining of intermittent attacks of otalgia associated with a loud cracking sound in the left ear. In this case, a small perforation of the tympanic membrane without a history of previous trauma, infection, or evidence of a foreign body in the external ear raises a suspicion. A careful, time-consumed microscopic examination could show the living creature in the middle ear. Immediate immobilization and removal of the living foreign body are imperative. In conclusion, tympanic membrane perforation and intermittent severe otalgia without history of otitis may lead to a suspicion of any insects in the middle ear.

A non-comparative trial of the efficacy and safety of fexofenadine for treatment of perennial allergic rhinitis.

An open-label, non-comparative study was performed in three Otolaryngology centers in Bangkok, Thailand, to assess the efficacy, safety and tolerability of fexofenadine in Thai patients with perennial allergic rhinitis. Altogether 101 perennial allergic rhinitis patients were included, 33 males and 68 females. Mean age was 33 years, average duration of symptoms was 6 years. All patients received fexofenadine hydrochloride 120 mg once daily (OD) in the morning for 2 weeks. Patients recorded their allergy symptoms daily using a 5 point rating scales in the diary card. At the end of 2 weeks, patients and investigators assessed the overall efficacy of treatment. Adverse events and onset of symptom relief were also recorded by every patient. Blood test and ECG were performed before and after treatment in one center (Siriraj Hospital). Total symptom scores and nasal scores decreased significantly from a baseline at 1 week and 2 weeks after treatment (p < 0.05). The mean onset of symptom relief was 2 hours and 12 minutes. The global assessment of the treatment by patients and investigators showed significant concordance. There was no significant change in either the vital signs, laboratory tests or ECG. The incidence of treatment related adverse events was 8% but all were mild and easily tolerated. Drowsiness was reported from only one patient. This study suggests that fexofenadine 120 mg once daily was an effective, safe and well tolerated treatment for perennial allergic rhinitis in Thai patients.

Identification of distinct regions of allelic loss on chromosome 13q in nasopharyngeal cancer from paraffin embedded tissues.

Our main purpose was to identify tumor suppressor gene loci on chromosome 13 responsible for nasopharyngeal cancer (NPC) development by analyzing loss of heterozygosity (LOH) and RB protein expression in paraffin embedded tissues. Normal and tumor DNA were extracted from microdissected samples, and their whole genomes were amplified using degenerate oligonucleotide primers. The polymerase chain reaction (PCR) products were analyzed by repeated amplification using primers derived from 16 microsatellite regions spanning the long arm of this chromosome. Among 50 informative cases, LOH was observed in 44 tumors. Thirty-one tumors displayed partial loss and provided an informative basis for detailed deletion mapping. Three minimal regions of loss were delineated; the first flanked by D13S120 and D13S219, the second by D13S126 and D13S119, and the third by D13S137 and 13qter. These 3 regions were linked to BRCA2 on 13q12, RB1 on 13q14, and 13q14.3-ter, respectively. Seven and 4 cases showed LOH either on 13q12 or 13q14, respectively. Nineteen cases showed LOH of both loci separately. One NPC displayed 13q12 and 13q14.3-ter LOH. RB protein expression was detectable in 76% of the cases. Ten out of 15 cases with the allelic losses limited to 13q14 showed RB protein expression. Contrasting that, 6 out of 7 cases devoid of RB protein expressions showed 13q14LOH. In conclusion, 13qLOH, involving 3 tumor suppressor gene loci, appears to be a frequent genetic event occurring during NPC development. However, other tumor suppressor genes besides RB1, may be responsible for the majority of 13q14LOH.

Solitary schwannoma of the tympanic membrane: a case report.

The external ear canal may be occluded by a rare tumor of the tympanic membrane. We reported herein a case of solid schwannoma arising from the tympanic membrane of a 29-year-old man. It presented as a circumscribed and encapsulated tumor of the external ear canal. The definite diagnosis was based on a careful microscopic examination and pathological findings. A precise excision of the tumor together with part of the tympanic membrane, followed by a myringoplasty was performed. To the best of our knowledge, our case should be the first reported case of this entity in the world literature.

Myringoplasty: a simple procedure for out-patients.

The standard treatment of tympanic membrane perforation is myringoplasty. We describe a new myringoplasty technique requiring only a partial removal of skin on the ear drum remnant followed by lateral placing of fascia and free skin graft. The overall cure rate in our series is 97 per cent. The hearing gains for the overall cases are 13.9 dB (p < 0.001) for the AC, 13.6 dB (p < 0.001) for the air bone gap closure, 13.1 dB (p < 0.001) for the SRT and 4.2 per cent (p = 0.005) for the SDS. Minor complications are observed in only 14 per cent. Our technique is simple, effective and can be performed on an out-patient basis.

Loss of heterozygosity on chromosome 14 in nasopharyngeal carcinoma.

The main objective of this study was to determine the precise frequency of chromosome 14q loss of heterozygosity in nasopharyngeal carcinomas and to define its minimal deletion regions. Thirty-nine tumors were selected for PCR-based deletion mapping using 19 microsatellite polymorphic markers spanning the long arm of this chromosome. Loss of heterozygosity for at least one marker was observed in 29 (74.4%) tumors, while 24 of these tumors displayed partial loss and provided an informative basis for detailed deletion mapping. Three minimal regions of loss were delineated, the first defined by markers D14S278 and D14S288, the second being between D14S51 and the telomere. These data confirmed 2 potential tumor-suppressor-gene loci at 14q12-13 and 14q32. Interestingly, the third region of loss was located at the T-cell-receptor delta-chain locus. This may reflect another tumor-suppressor-gene locus at 14q11.2, or may be the consequence of a specific genomic rearrangement of this region. In addition, these allelic losses occurred with high frequency in all tumor grades and stages and in all histological sub-types. These findings suggest that the genetic alteration of chromosome 14 is common and crucial during nasopharyngeal-carcinoma development.

Severe epistaxis from rhinosporidiosis: a case report.

Rhinosporidiosis is quite rare in Thailand, but the actual incidence may be higher than the numbers reflect. This is thought to be due to misdiagnosis by physicians who are unfamiliar with this disease entity or physicians who found a case but did not describe its presence. The authors report a case in a 17 year old male with the lesion involving both nasal cavities, nasopharynx and left maxillary sinus presenting with severe epistaxis, which was treated by complete surgical removal with electric cauterization of its base. We warn physicians who face this problem to be aware of this disease entity.

Epstein-Barr viral DNA in serum of patients with nasopharyngeal carcinoma.

This study evaluated Epstein-Barr virus (EBV) DNA in sera of 42 patients with nasopharyngeal carcinoma (NPC) and 82 healthy individuals who had been infected previously with EBV. Thirteen of 42 NPC samples were positive for EBV DNA in their sera, whereas all 82 normal controls were negative. In addition, EBV typing between primary tumors and sera showed identical results, suggesting that serum EBV DNA represented tumor DNA. To evaluate the importance of the serum NPC DNA, clinical data and tumor phenotypes including age, sex, WHO type, EBV type, stage, tumor invasion, metastasis, and apoptosis were correlated with serum EBV DNA, and only apoptosis was found statistically significant. In conclusion, EBV DNA was detectable in the serum of some patients with NPC, represented tumor DNA, and might have clinical implications in the future.