A clinical trial of nicergoline to prevent temporary threshold shift.

Objective: To evaluate the effectiveness of nicergoline to prevent temporary threshold shift (TTS) in military personnel. Study Design: A randomized control trial. Methods: Two hundred and twenty-four participants were enrolled. Nicergoline 30 mg twice daily intake was prescribed to the study group (n = 119) for 3 weeks. The placebo was prescribed to the control group (n = 105) for 3 weeks, as well. Audiometric thresholds were measured at baseline and within 24 h after the participants attended a 1-day weapons firing practice. During the firing practice, all participants had to wear foam earplugs. The TTS was assessed by using a variety of published significant threshold shift (STS) definitions. Additionally, the effects of the treatment group on the magnitude of pre- to postexposure threshold shifts were estimated. Tinnitus and other adverse effects of the medication were recorded. Results: The incidence of STS was 65.4% from the study group and 75% from the control group. The negative STS (thresholds improved) was 68.6% from the study group and 44.7% from the control group. The positive STS (thresholds worsened) from the study group and the control group was 31.4% and 55.3%, respectively. The effect of treatment in participants receiving nicergoline demonstrated significant coefficients (change in dB) in both ears (p = .001). The mean different threshold of participants receiving nicergoline showed negative STS in all tested frequencies without statistical significance. However, the mean different threshold of participants receiving a placebo showed positive STS with statistical significance. Additionally, there were 16 ears detecting a warning sign of permanent hearing loss. These participants from the control group presented a longer duration of tinnitus (p = .042). Moreover, the serious adverse effects of nicergoline were considerably low. Conclusion: The study results suggest that nicergoline may attenuate noise-related TTS and tinnitus, and justify further investigation on the effectiveness of this drug as an otoprotectant. Level of Evidence: 2.

Cross-Cultural Adaptation and Validation of the Voice Handicap Index into Thai.

BACKGROUND: The voice handicap index (VHI) is one of the most utilized instruments for measuring a patient's self-assessment of voice severity. The VHI has been translated into several languages, but not in Thai. OBJECTIVE: To examine the psychometric properties of a Thai translation of the voice Handicap Index (VHI) and assess the applicability in the screening diagnosis. MATERIAL AND METHOD: After receiving permission from the American Speech Language Hearing Association (ASHA), the original VHI had been translated and adapted to Thai by forward and backward standard translation. Eighty-five patients with voice disorders, divided in four groups according to the etiology of the diseases (neurogenic, structural, functional, and inflammatory), and 30 asymptomatic subjects were included in the present study. Internal consistency was analyzed through Cronbach's a coefficient. For the VHI test-retest reliability analysis, the Thai VHI was completed twice by 22 patients and assessed through the intraclass correlation coefficient. For clinical validity evaluation, the VHI scores from the pathological group were compared with the control group and compared among the four different pathological groups. The cutoff point for distinguishing the normal from the patient group was assessed by ROC analysis. Effects of age and gender on VHI scores were also evaluated. RESULTS: The Thai VHI showed a significant high internal consistency and test-retest reliability (Cronbach's α = 0.96 and r = 0.843, respectively). Mann-Whitney U test was used to compare the control group and pathological groups and revealed significant difference in total scores and its three domains scores (p < 0.001). ROC analysis demonstrated that a VHI score of 13 should be considered the threshold for revealing the impact of quality of life in voice disorder patients. Age and gender were not affect the VHI scores in both control and patient groups. CONCLUSION: The Thai VHI has high reliability and validity. The Thai version of VHI is considered to be a self-assessment tool for the severity of voice disorders in Thai patients.

Otologic manifestations from blast injuries among military personnel in Thailand.

BACKGROUND: From November 2008 to October 2010, 565 military personnel sustained blast injury in Southernmost Thailand and 99 personnel, affected by multiple injuries, were transferred to Phramongkutklao Hospital. No data on the effect of blast injury to the ears among Thai military personnel have been reported. This study aims 1) to determine the prevalence of Sensorineural Hearing Loss (SNHL) and otologic manifestations from primary blast injury among military personnel, in Pattani, Yala and Narathiwat Provinces, and 2) to evaluate the impact of explosive devices and distance from explosion on SNHL under various conditions. MATERIALS AND METHODS: A cross-sectional study was conducted among 76 military personnel injured from blast injury in Southernmost Thailand. They were divided into three groups representing the bomb blast settings; open-space referred to an area without barrier, semi-open space referred to a room open on at least one side and closed space referred to a room enclosed with four walls and ceiling. RESULTS: The otologic manifestations from 76 patients were tinnitus, tympanic membrane perforation, bleeding and open wound. The prevalence of SNHL among patients in the open-, semi-open and closed space groups was 62.77%, 67.86% and 73.33%, respectively. The most common type of explosive was Improvised Explosive Devices (IEDs) 72 (94.74%). The average IED weighed 11.42kg and mean distance from explosion was 5.66m. CONCLUSION: Correlation among all three incident areas and two factors: impact of explosive devices and distance from explosion are risk factors of SNHL without significance.

Radiation-related vocal fold palsy in patients with head and neck carcinoma.

OBJECTIVE: Recurrent laryngeal nerve damage is a rare complication after receiving conventional radiotherapy for treatment of head and neck cancers and will always be underestimated. The purpose of the present study was to focus on the prevalence of vocal cord paralysis after irradiation and the natural history in those patients. MATERIAL AND METHOD: All patients who received more than 60 Gy radiation dose of convention radiotherapy for treatment of head and neck carcinoma from Phramongkutklao Hospital and Nation Cancer Institute of Thailand were recruited in the present study duringfollow-up period between May 2006-December 2007. The subjects had to have good mobility of bilateral vocal cords with no recurrence or persistent tumor before the enrollment. Baseline characteristic and the associated symptoms of the recurrent laryngeal nerve paralysis were recorded. Laryngeal examinations were done byfiberoptic laryngoscope and in suspicious cases; stroboscope and/or laryngeal electromyography were also performed. The vocal fold paralysis was diagnosed by reviewing recorded VDO by 2 laryngologist who were not involved in the present study. RESULTS: 70 patients; 51 male and 19female were recruited. 5 patients (7.14%) were diagnosed to have vocal cord paralysis and 2 patients (2.86%) were found to have vocal cord paresis confirmed by electromyography. Most of them were the patients with nasopharyngeal cancers (6/7) with the only one had oropharyngeal cancer (1/7). All of the paralysis/paresis was unilateral lesion; 4 on the left and 3 on the right side. The duration from the patients completed radiotherapy to the time of the diagnosis of vocal cord palsy was 14-35 months. The measure of agreement or Kappa value with 95% CI was 0.818 +/- 0.245. Associated symptoms of vocal cord palsy are hoarseness (100%), dysphagia (28.6%) and aspiration (28.6%). CONCLUSION: A significant number of vocal fold palsy may occur in patients with head and neck carcinoma after receiving conventional radiotherapy. Subcutaneous fibrosis or compromised blood vessels at the skull base or the neck area may be important risk factors for development of the complications and further studies are need to solve the pathogenesis.

The study of allergic skin test in patients with globus pharyngeus: a preliminary report.

BACKGROUND: Globus pharyngeus is the lump sensation in the throat associated with various conditions including somatoform disorder and gastroesophageal reflux disease. However, many patients with unrelated causes were found to respond to anti-allergic treatment. OBJECTIVE: Determine the results of allergic skin test in globus pharyngeus patients who had unidentified causes. MATERIAL AND METHOD: Fifty-four globus pharyngeus patients were enrolled and referred for complete physical examination, screening psychological status, videostroboscopy, and reflux finding score assessment. All patients including 38 controlled subjects underwent skin prick test and/or intradermal test. The globus patients who had positive test were recommended to have anti allergic treatment. Barium swallowing study, ambulatory double-probe pH monitoring, or plain film cervical spine was done in patients with negative skin tests and in non-response to medication. RESULTS: There was statistically significant difference of positive skin test results between globus and the control group (77.8% vs. 28.6% OR = 13.12, p < 0.001). In positive skin test-globus group, globus symptom was improved in 64.3% after allergic treatment, which 85.2% had moderate and excellent improvement. In patients with negative skin test and non-response group show various conditions including gastroesophageal reflux disease (18.52%), abnormal esophageal manometry (40.74%), and myofascial pain syndrome (3.71%). CONCLUSION: Due to high prevalence of positive skin test in globus pharyngeus patients, this symptom should be considered as one of the atypical allergic manifestations.

Vocal cord dysfunction concurrent with a nutcracker esophagus and the role of gastroesophageal reflux disease.

BACKGROUND: Psychological disorders were originally thought to be the sole cause of vocal cord dysfunction (VCD). Subsequently, other organic diseases, including structural laryngeal abnormalities, have also been reported to be associated with VCD. OBJECTIVES: To describe the first patient with VCD concurrent with a nutcracker esophagus and to establish the association between VCD and gastroesophageal reflux disease (GERD) by using the Bernstein test. METHODS: Symptom assessments, neuropsychiatric evaluations, fiberoptic laryngoscopy, pulmonary function tests, allergic skin prick tests, radiographs of the chest and sinuses, esophageal manometry (including 24-hour ambulatory esophageal pH monitoring), and the Bernstein test were performed. RESULTS: A 36-year-old woman had dyspnea, hoarseness, chest pain, and wheezes without relief for a decade. Neuropsychiatric evaluations disclosed mild depression. Fiberoptic laryngoscopy showed posterior laryngitis and paradoxical vocal cord adduction with audible inspiratory stridor. Pulmonary function tests showed attenuation of the inspiratory limb with notching in both flow-volume loops and a mid-vital capacity expiratory to inspiratory flow ratio of 4. All the symptoms except chest pain were improved dramatically by speech therapy and empirical treatment for GERD. Esophageal manometry revealed a nutcracker esophagus; 24-hour ambulatory esophageal pH monitoring demonstrated multiple short reflux episodes. The Bernstein test was conducted, and all the manifestations were reproduced with 0.1 N hydrochloric acid but not with isotonic sodium chloride infusion. CONCLUSIONS: This is the first human case report confirming that GERD can trigger an acute attack of VCD and may induce chest pain as a nutcracker esophagus in patients with VCD. It strengthens this association and expands our knowledge of diverse manifestations of this clinical entity.

Prevalence and an analysis of noise--induced hearing loss in army helicopter pilots and aircraft mechanics.

BACKGROUND AND OBJECTIVE: Hearing impairment from noise exposure has been reported in fix-wing pilots, especially in civilized countries. However, there are few studies on rotary wing aviators and aircraft mechanics, especially in developing countries whose hearing conservative program is not well established. The present study, therefore, was done to evaluate the prevalence of noise induced hearing loss and the contributing factors that may effect both groups of noise-exposed population. MATERIAL AND METHOD: Report questionnaires were reviewed and physical examination combined with audiometric records of 34 pilots and 42 mechanics in the Royal Thai Army Aviation Center, Lobburi, were examined. Hearing loss was studied using four categories of significant threshold shift (STS). Amplitude of noise radiated by aircraft was also measured at different distances. RESULTS: No significant difference was found in prevalence of hearing loss in aviators (32.4%) and aircraft mechanics (47.6%), but in the aircraft mechanics group there were more damage of frequency involvement including speech frequency and high frequency and more decibels loss than aviators. The type of hearing protection and smoking index were strongly correlated with hearing loss. Age, flight time and alcohol habit had no significant effect and ninety percent of the subjects had no self awareness of hearing loss. CONCLUSION: Aircraft mechanics had more severity on hearing loss than aviators. Types of noise protector and cigarette smoking had significant association with hearing loss.