The cause and evaluation of unilateral vocal cord paralysis.

BACKGROUND: Unilateral vocal cord paralysis (UVCP) is a common finding in the practice of otolaryngology. It usually presents with hoarseness, although more severe symptoms may include aspiration, choking or pneumonia. OBJECTIVE: To evaluate the etiology, outcomes and sensitivity of diagnostic tests. PATIENTS: Patients with UVCP. SETTING: Department of Otolaryngology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. DESIGN: Descriptive study. RESULT: Ninety patients with UVCP were encountered between 1994 and 1998. The left vocal cord was involved in 73 per cent of cases and the right vocal cord in 27 per cent. The causes were neoplasm (29%), postoperative (24%), inflammation (21%), trauma from endotracheal intubation and external laryngeal trauma (8%), central (5%) and idiopathic causes (13%). Among the 13 post-thyroid surgical cases, three had a complete recovery, seven had compensation and three had no recovery and no compensation. Two trauma cases were caused by intubation, both had a complete recovery. Follow-up of these were over periods of one and three months, respectively. CONCLUSION: Thirty nine per cent of chest X-rays were positive. This was the only useful diagnostic test.

Idiopathic sudden sensorineural hearing loss.

BACKGROUND: Sudden sensorineural hearing loss is one of the most controversial unsolved mysteries in Otolaryngology. Lack of a universally accepted definition of sudden sensorineural hearing loss, insufficient knowledge of pathogenesis, lack of a standard method for evaluating the patients, in addition to a high spontaneous recovery rate, all complicate the study of sensorineural hearing loss and the investigation of different treatment modalities. OBJECTIVE: To study the clinical manifestation and prognostic factors, which influence the recovery of hearing in sudden sensorineural hearing loss. PATIENTS AND METHOD: Patients with idiopathic sudden sensorineural hearing loss who were admitted to Srinagarind Hospital from January 1994 to December 1998 were included. The clinical manifestations, audiograms and investigations of these patients were analysed. RESULTS: Of the fifty-six patients, who met the criterion, 34 were females and 22 males. The average age of onset was 43.7 years (SD = 13.46, range = 13-66 years). The onset of hearing loss was sudden in 50 per cent of cases, whereas, 46.4 per cent of cases were noted on awakening in the morning and the remainder had rapidly progressive hearing loss. The hearing loss was unilateral in 92.9 per cent of cases. 96.4 per cent of the patients had tinnitus and 66.1 per cent of the patients had vertigo. 64.3 per cent of the patients had some degree of recovery (complete recovery in 28.6% and partial recovery in 35.7%). The severity of hearing loss significantly influenced the outcome of the patients. CONCLUSION: Approximately two-thirds of the patients with idiopathic sudden hearing loss had some degree of recovery. Among contributing factors, only the severity of hearing loss significantly influenced the prognosis.

Dislodge of T-tube into the bronchus, an unusual complication of the Montgomery T-tube: a case report.

Laryngotracheal stenosis is a sequel of laryngeal trauma. Many surgical techniques have been developed to correct this problem. Sometimes it requires a tracheal T-tube after the surgical correction. Here the authors report an unusual complication of tracheal T-tube and suggest a method for the management of this complication.

Treatment of benign paroxysmal positional vertigo by canalith repositioning procedure: experience from Srinagarind Hospital.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. The diagnosis is confirmed by observing a classical response during the Dix-Hallpike maneuver. The cause of BPPV is usually idiopathic. There are two popular hypotheses described regarding the pathogenesis of BPPV. The first one is the "cupulolithiasis" hypothesis, and the second hypothesis, the so-called "canalithiasis" hypothesis. The clinical course of BPPV is spontaneous recovery in weeks or months. Treatments for BPPV have ranged from no intervention to surgical treatment. The new treatment, "Canalith-repositioning procedure (CRP)" which was introduced by Epley in 1992 produces a very high rate of success. This treatment has caused interest and has been modified and studied worldwide in recent years. OBJECTIVE: To study the efficacy of the canalith-repositioning procedure that we modified from Epley's maneuver in the treatment of BPPV patients. DESIGN: A descriptive study. The BPPV patients, who came to the neurotologic clinic at Srinagarind Hospital from January 1997 to December 1998, were treated with our technique that was modified from Epley's maneuver. We neither used pre-medication, a mastoid oscillator, nor post-treatment instruction. RESULTS: The total number of patients included in this study was 19. The efficacy of this procedure for curing nystagmus and vertigo was 89.5 per cent. One patient did not follow-up and one patient did not respond to the CRP. Complication such as vago-vagal reflex, lateral canalithiasis, occurred in 5.3 per cent of the patients. The recurrence of BPPV in our study was 26.3 per cent. However, CRP was also effective in treatment of both patients with recurrence as well as those without recurrence. CONCLUSION: The canalith-repositioning procedure that is modified from Epley is effective in the treatment of BPPV.