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ABSTRACT: Transcutaneous vocal cord injection is a popular treatment choice for patients suffering from unilateral vocal cord paralysis. Transcutaneous transcartilaginous (through the thyroid cartilage) approach abolishes any anatomical constraint to reach the vocal cord. However it is a largely blind procedure as the needle should stay submucosal. Herein we report our experience in employing ultrasound guidance to circumvent this problem.
Retrospective review of a series of 8 patients who underwent combined ultrasound/endoscopy-assisted vocal cord injection for unilateral vocal cord paralysis.
Vocal cord injections were successfully completed in all but one patient. There were no associate complications.
The use of ultrasound in aiding transcutaneous transcartilaginous vocal cord injection is safe and feasible.
• Vocal cord injection is effective in treating unilateral vocal cord paralysis • A number of transcutaneous approaches with the patient awake have been described • Transcutaneous transcartilaginous approach theoretically has minimal anatomical restraint to reach the vocal cord • Disadvantage of that approach is the difficulty to accurately position the needle • Our experience of using ultrasound to circumvent this problem is positive.
European Radiology 12/2011; 22(5):1110-3. · 3.22 Impact Factor
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ABSTRACT: Complete second branchial fistula is a rare clinical entity. The classical presentation of second branchial fistula is recurrent discharge from the external opening with or without recurrent painful neck swelling. We report an unusual case whose presenting symptom was a long-standing history of throat discomfort with recurrent blood stained saliva. Her symptoms resolved after her branchial fistula was excised.
The Laryngoscope 07/2010; 120(7):1319-21. · 1.75 Impact Factor
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ABSTRACT: To determine the reproducibility of the Brodsky grading scale and the modified 3-grade and 5-grade scales in reporting the size of the tonsils.
Retrospective review of 60 video recordings of tonsil examination by 12 independent observers with different clinical backgrounds and various levels of training. The sizes of the tonsils were graded using different grading scales.
Tertiary care university hospital.
The video recordings were chosen from an ongoing epidemiologic study of sleep-related breathing disorder in children in Hong Kong. Main Outcomes Measures The intraobserver and interobserver reproducibility of each grading scale was determined using intraclass correlation. An intraclass correlation coefficient (ICC) exceeding 0.75 was set a priori to indicate an acceptable level of reliability.
The mean intraobserver ICCs for the Brodsky grading scale and the modified 3-grade and 5-grade scales were 0.858, 0.830, and 0.865, respectively. The mean interobserver ICCs for the Brodsky grading scale and the modified 3-grade and 5-grade scales were 0.763, 0.739, and 0.783, respectively.
The Brodsky grading scale and the modified 5-grade scale achieved acceptable intraobserver and interobserver reproducibility.
Archives of otolaryngology--head & neck surgery 02/2010; 136(2):159-62. · 1.92 Impact Factor
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ABSTRACT: The natural history of mild childhood obstructive sleep apnoea (OSA) was examined and factors associated with disease progression were identified.
Subjects were recruited from an epidemiological study which examined the prevalence of OSA in Chinese children aged 6-13 years. The first 56 consecutive children identified with mild OSA (apnoea-hypopnoea index 1-5) were invited for a repeat assessment 2 years after the diagnosis.
45 children participated in the follow-up study, in 13 of whom (29%) the OSA was found to have worsened. Compared with those in whom OSA had not worsened, the worsened OSA group had a greater increase in waist circumference, a higher prevalence of large tonsils (occupying > or =50% of the airway) at both baseline and follow-up, and a higher prevalence of habitual snoring at both baseline and follow-up. The presence of large tonsils had a positive predictive value of 53% and a negative predictive value of 83% for worsening OSA over a 2-year period. Multivariate linear regression analysis showed that the change in obstructive apnoea-hypopnoea index was associated with age at baseline (beta (SE) = -0.92 (0.34), p = 0.009), gender (male = 1; female = 0) (beta (SE) = 4.69 (1.29), p<0.001), presence of large tonsils at baseline (beta (SE) = 4.36 (1.24), p = 0.001), change in waist circumference (beta (SE) = 0.30 (0.09), p = 0.002) and persistently large tonsils (beta (SE) = 5.69 (1.36), p<0.001) over the 2-year period.
Mild OSA in the majority of children does not resolve spontaneously. Subjects with tonsillar hypertrophy, especially boys, should be closely monitored to allow early detection of worsening OSA. Weight control should be stressed in the management of childhood OSA.
Thorax 09/2009; 65(1):27-31. · 6.84 Impact Factor
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ABSTRACT: Aim: To establish a transoral robotic surgery (TORS) programme for the surgical management of head and neck pathology including oropharyngeal lesions, and to carry out a TORS tonsillectomy.Methods: Training for otolaryngologists was planned and undertaken. Off-site robotic training of otolaryngologists was conducted by a robotic company trainer. Visits to established international TORS programmes were made. A suitable patient was identified with the intention of undergoing a TORS tonsillectomy and evaluating the outcome.Results: A patient successfully underwent a transoral robotic surgery tonsillectomy using a surgical robot system without intraoperative or postoperative complications or sequelae.Conclusions: A transoral robotic surgery programme, including training for otorhinolaryngologists, has been established. A tonsillectomy, a feasible procedure easily carried out, was done using a surgical robot system without complications.
Surgical Practice 01/2009; 13(1):17 - 19. · 0.15 Impact Factor
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ABSTRACT: Childhood obstructive sleep apnoea (OSA) is suggested to be associated with cardiac structural abnormalities and dysfunction but existing evidence is limited and the treatment effect on echocardiographic outcome remains controversial.
To examine the presence of subclinical cardiac abnormalities in childhood OSA and the effects of treatment on cardiac changes.
Polysomnography (PSG) and echocardiographic examinations were performed in 101 children aged between 6 and 13 years who were invited from a community based questionnaire survey. They were classified into a reference group (apnoea-hypopnoea index (AHI) <1, n = 35), mild OSA group (AHI 1-5, n = 39) and moderate to severe group (AHI >5, n = 27) based on the PSG results. Treatments, including adenotonsillectomy or nasal steroids, were offered to the mild and moderate to severe OSA groups.
The moderate to severe OSA group had greater right ventricular (RV) systolic volume index (RVSVI), lower RV ejection fraction (RVEF) and higher RV myocardial performance index (RVMPI) than the reference group. They also had more significant left ventricular (LV) diastolic dysfunction and remodelling with larger interventricular septal thickness index (IVSI) and relative wall thickness than those with lower AHI values. The moderate to severe OSA group had an increased risk of abnormal LV geometry compared with the reference group (odds ratio 4.21 (95% CI 1.35 to 13.12)). Log transformed AHI was associated with RVSVI (p = 0.0002), RVEF (p = 0.0001) and RVMPI (p<0.0001), independent of the effect of obesity. Improvement in RVMPI, IVSI and E/e' were observed in those with a significant reduction in AHI (>50%) comparing 6 month with baseline data.
OSA is an independent risk factor for subclinical RV and LV dysfunction, and improvement in AHI is associated with reversibility of these abnormalities.
Thorax 12/2008; 64(3):233-9. · 6.84 Impact Factor
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New England Journal of Medicine 09/2005; 353(6):e5. · 53.30 Impact Factor
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Otolaryngology Head and Neck Surgery 08/2003; 129(1):161-2. · 1.72 Impact Factor
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ABSTRACT: To investigate whether autologous ossicles can be safely used in ossicular reconstruction in cholesteatoma surgery after attempting cholesteatoma removal under the operating microscope.
A prospective fine-section histological study of formalin-stored ossicles, harvested from cholesteatomatous ears, to evaluate for existence of residual cholesteatoma after surface disease clearance under the operating microscope.
One hundred four ossicles were harvested from 76 patients with cholesteatoma for the study. These malleus heads and includes were categorized into three groups: group 1, ossicles with retained shape and useful bulk, treated by microscopic stripping alone; group 2, ossicles with retained shape and useful bulk, treated by microscopic stripping and drilling; and group 3, badly eroded ossicles, treated by microscopic stripping alone. These treated ossicles were then subjected to 4 microm histopathological study.
Residual disease was identified in 6 of the 104 ossicles. Residual disease was found only in badly eroded ossicles that are not suitable for reconstruction. All the usable ossicles were free of disease.
Autologous ossicles that have retained body and bulk are safe to use for reconstruction after surface stripping under the operating microscope. Additional burring probably adds a further margin of safety.
The Laryngoscope 06/2003; 113(5):843-7. · 1.75 Impact Factor
