-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the feasibility of a one-stop assessment of patients complaining of globus sensation with transnasal esophagoscopy (TNE) and functional endoscopic evaluation of swallowing (FEES).
Prospective, nonrandomized, experimental investigation.
Tertiary referral centre.
Sixty-three consecutive patients complaining of a lump in the throat were evaluated by this combined approach.
The safety and feasibility of performing a one-stop TNE plus FEES were explored by subjective measurement of the patients' tolerance and satisfaction and comments from surgeons. The possible therapeutic effects were also assessed 2 months after the procedure.
All 63 patients completed the TNE and FEES without any complications. The average duration of the examination was 6.27 ± 2.52 (95% CI 5.63-6.91) minutes. The findings included arytenoid cyst, epiglottic cyst, vocal cord nodules, vocal cord palsy, esophageal reflux, and foveolar gland hyperplasia. Two patients (3.2%) demonstrated some degree of fluid penetration or aspiration. Nine specialists all scored highly on a visual analogue scale on the manipulation, visualization, and satisfaction of the TNE procedure (median = 8 of 10). Patients also rated a low pain score (median = 1 of 10) and a high satisfaction score (median = 9 of 10).
The combined technique of TNE and FEES can be used safely as a one-stop examination tool for patients with globus pharyngeus symptoms.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 02/2012; 41(1):46-50. · 0.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is a paucity of knowledge on dysphagia in patients with nasopharyngeal carcinoma postradiotherapy (NPC post-RT). The purpose of this study was to establish silent aspiration occurrence, safe bolus consistency, and their relationship with swallowing physiology in patients with dysphagic NPC post-RT.
Eighty-five patients with dysphagic NPC post-RT were assessed across 4 bolus consistencies. We compared penetration-aspiration scores against 4 swallowing physiology impairments.
Silent aspiration occurred in 65.9% of patients with dysphagia, with 64.7% on thin fluids, 35.3% on thick fluids, 11.8% on pureed diet, and 5.9% on soft diet. Multivariate analysis of variance (MANOVA) indicated pharyngeal contraction and swallowing response had significant effect on thick fluids (p = .002), thin fluids (p = .017), and soft diet (p = .031).
Silent aspiration of thin fluids is a common occurrence in dysphagic NPC post-RT, with least aspiration noted on soft diet. Considering the high incidence of silent aspiration, instrumental assessment in this cohort is crucial.
Head & Neck 09/2011; 33(9):1335-9. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to identify independent prognostic factors that influenced local relapse-free survival (LRFS) and overall survival (OS) of patients who underwent salvage surgery for residual or recurrent nasopharyngeal carcinoma (NPC).
Ninety-seven patients who had been treated with radiotherapy or chemoradiotherapy for NPC underwent a nasopharyngectomy for a residual or recurrent local tumor between November 1987 and June 2007. The subsequent minimum follow-up was 2 years. Univariate and multivariate analyses were performed to identify prognostic factors for LRFS and OS.
The 5-year LRFS and OS was 46.7% and 51.9%, respectively. On multivariate analysis for LRFS and OS, respectively, recurrent regional disease (hazard ratio [HR], 3.245; p = .008) and (HR, 4.990; p = .001), and positive surgical margins (HR, 5.963; p = .000), and (HR, 4.912; p = .000) were independent prognostic factors.
In patients undergoing surgical salvage nasopharyngectomy for residual or recurrent NPC, positive surgical margins have an independent negative influence on LRFS and OS.
Head & Neck 08/2011; 33(8):1126-31. · 2.40 Impact Factor
-
Alexander C. Vlantis FCS(SA)ORL,
Hing Sang Chan FRCSEd(ORL,
Michael C. F. Tong FRCSEd(ORL,
Brian K. H. Yu FRCR,
Michael K. M. Kam FRCR,
C. Andrew van Hasselt MMed(Otol,
Alexander C. Vlantis,
Hing Sang Chan, Michael C. F. Tong,
Brian K. H. Yu,
Michael K. M. Kam,
C. Andrew van Hasselt
[show abstract]
[hide abstract]
ABSTRACT: Background
The purpose of this study was to identify independent prognostic factors that influenced local relapse-free survival (LRFS) and overall survival (OS) of patients who underwent salvage surgery for residual or recurrent nasopharyngeal carcinoma (NPC).Methods
Ninety-seven patients who had been treated with radiotherapy or chemoradiotherapy for NPC underwent a nasopharyngectomy for a residual or recurrent local tumor between November 1987 and June 2007. The subsequent minimum follow-up was 2 years. Univariate and multivariate analyses were performed to identify prognostic factors for LRFS and OS.ResultsThe 5-year LRFS and OS was 46.7% and 51.9%, respectively. On multivariate analysis for LRFS and OS, respectively, recurrent regional disease (hazard ratio [HR], 3.245; p = .008) and (HR, 4.990; p = .001), and positive surgical margins (HR, 5.963; p = .000), and (HR, 4.912; p = .000) were independent prognostic factors.Conclusion
In patients undergoing surgical salvage nasopharyngectomy for residual or recurrent NPC, positive surgical margins have an independent negative influence on LRFS and OS. © 2010 Wiley Periodicals, Inc. Head Neck, 2011
Head & Neck 07/2011; 33(8):1126 - 1131. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study of human papillomavirus (HPV), Epstein-Barr virus (EBV), p21, and p53 in sinonasal inverted papilloma (IP) was to help elucidate its pathogenesis.
Seventy-three IPs, 48 nasal polyps, and 85 hypertrophied turbinates were subjected to HPV polymerase chain reaction (PCR) study. Seventy-three IPs, 30 nasal polyps, and 32 hypertrophied turbinates were subjected to EBV in situ hybridization (ISH), p21, and p53 immunohistochemical (IHC) studies.
HPV was positive in 3 of 73 IPs (4.1%). All specimens were EBV negative. In all, 99% of IPs showed strong and diffuse p21 nuclear reactivity. Most nasal polyps and hypertrophied turbinates showed weak to moderate immunoreactivity of the basal and parabasal cells. Only focal p53 immunoreactivity of the basal and parabasal cells was found in 19% of IPs and 40% of nasal polyps.
HPV prevalence of our IP is low. EBV is not present in IP. High p21 and low p53 expression in IP suggests a non-p53-dependent regulation pathway.
Head & Neck 05/2011; 34(4):520-33. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Group therapy has frequently been adopted as a service delivery model for providing voice therapy. However, currently no literature has focused on understanding the underlying processes that are unique to group therapy, which contribute to treatment success. This study aimed at investigating the role of group climate in voice group therapy.
Prospective case series.
Twelve teachers with hyperfunctional dysphonia attended eight sessions of group voice therapy. Treatment comprised both direct and indirect voice therapy. Therapy techniques were introduced and practiced in a large group and small group format. Outcome measures were taken using perceptual evaluation, videostroboscopy measures, voice-related quality-of-life (V-RQOL) measures, and vocal symptom scores. The Group Climate Questionnaire was used to measure the underlying process of group therapy. Treatment outcome was measured immediately posttreatment and at 6-months posttreatment.
Results indicated statistically significant improvement in the participants' V-RQOL measures and the vocal symptom scores. Treatment gain was noted to sustain up to 6-months posttreatment. The Group Climate Questionnaire indicated that the treatment group is considered as "engaging" rather than "conflicting," which is considered to be associated with positive treatment outcome.
Group therapy as a service delivery model possesses many advantages from the psychosocial, clinical, health resources allocation perspective. This study demonstrated that group climate plays a significant role in determining treatment success in group voice therapy.
Journal of voice: official journal of the Voice Foundation 05/2011; 26(2):e41-8. · 0.95 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objective : To determine the incidence of otitis media with effusion and the associated hearing loss, the rate of ventilation tube insertion, and complications of ventilation tube insertion in Chinese cleft palate patients. Design : Retrospective review in a tertiary care hospital in Hong Kong. Patients : A total of 104 consecutive patients with cleft lip and/or cleft palate who were born between January 1996 and January 2006. Results : The incidence of otitis media with effusion in Chinese cleft palate patients for the first 2 years after birth was 76.1%. Of these patients, 16.9% had otitis media with effusion associated with a moderate hearing loss (>40 decibels hearing level [dBHL]). Approximately half (53.2%) of our patients had ventilation tube insertion. Complications including retraction, tympanosclerosis, and perforation of the tympanic membrane were found in 15.7% of all ears with otitis media with effusion and ventilation tube insertion. Conclusions : The high incidence of otitis media with effusion in cleft palate infants found in this study is consistent with that reported in the Western literature. A small but significant proportion of otitis media with effusion was associated with moderate hearing loss that truly required surgical treatment. Cleft palate children are much more likely to develop otitis media with effusion than normal children, and they develop the condition at an earlier age. A protocol for the treatment of otitis media with effusion in cleft palate patients and further prospective studies are warranted.
The Cleft Palate-Craniofacial Journal 01/2011; 48(6):684-9. · 0.82 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In tone languages such as Cantonese, a change in tone denotes a change in lexical meaning. The present study investigates the functional benefit of hearing devices in assisting tone perception among children with profound hearing impairment.
Fifty-two children with profound hearing loss were categorized into two groups based on their primary type of hearing device - a hearing aid group and cochlear implant group.
A 75-item tone identification test covering all 15 Cantonese tone contrast pairs was administered to each subject under two conditions - unaided (hearing devices turned off) and aided (devices turned on). The proportion of correct responses was computed as the total score for all items and subtotal contrast scores for each of the 15 tone contrasts.
The results indicated no significant differences between the children wearing hearing aids and those with cochlear implants under the unaided or the aided condition (z = -0.91, p = 0.36; z = -0.40, p = 0.69, respectively). Regardless of the type of device used, the total scores under the aided condition were higher than those under the unaided condition (z = -3.55 for the hearing aid group; z = -4.87 for the cochlear implant group, both ps < 0.01).
Children wearing hearing devices generally have a satisfactory functional gain in tone perception. No major observable difference was noted between children using cochlear implants and those using hearing aids. Tone contrast pairs with dissimilar fundamental frequency at onset and dissimilar tone contour patterns were more easily identified.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 09/2010; 31(7):1079-87. · 1.44 Impact Factor
-
Otolaryngology Head and Neck Surgery 08/2010; 143(2):315-6. · 1.72 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Normal nasopharyngeal mucosa contains varying amounts of lymphoid tissue, which in adults may be minimal or absent. Nasopharyngeal mucosa with minimal lymphoid tissue has a regular follicular pattern on narrow-band imaging; pale follicles have thin, dark borders and the ratio of the pale follicle to the dark border (pale-to-dark ratio) is roughly 90%. In some patients undergoing routine nasopharyngeal endoscopy, the pale-to-dark ratio is reversed on narrow-band imaging, with dark centres surrounded by pale borders and a pale-to-dark ratio of roughly 50%. These dark follicles may represent abnormal capillary loops, as they have the same appearance as microvascular changes seen on narrow-band imaging of the oesophageal mucosa which indicate dysplasia or malignancy. While this observed change in the follicular pattern may be an early event in the evolution of nasopharyngeal carcinoma, the significance of this finding remains to be confirmed by a larger-scale study.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine 08/2010; 16(4):307-9.
-
[show abstract]
[hide abstract]
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
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated the effects of implant experience and age at implantation on the Cantonese tone production of children with cochlear implants. The study also examined whether there was a particular age at which children were more responsive to acquiring tones.
The study included 45 children who had received unilateral cochlear implants at a mean age of 65.56 months. The subjects were grouped according to their age at cochlear implantation and were assessed annually for 5 years thereafter. A picture-naming task was used to measure their tone production performance.
A simple effect of age at implantation was significant at all testing intervals except at the preoperative data point. Children who were younger than 4 years of age when they received their implants scored significantly higher than did the 2 older groups at various testing intervals. A significant simple effect of implant experience was also found. Progress was most striking in children who received their implants before the age of 4 years.
For the most effective acquisition of Cantonese lexical tones, children should undergo early cochlear implantation. For children who receive implants before the age of 4 years, benefits are noted in tone production ability in terms of a faster rate of improvement within a shorter period of time.
The Annals of otology, rhinology, and laryngology 04/2010; 119(4):258-65. · 1.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We developed an objective endoscopic score of abnormality of the nasopharynx to predict the likelihood of malignancy.
A score sheet with 44 variables was developed to objectively quantify the bilateral endoscopic assessment of the nasopharynx. Patients scheduled to undergo nasopharyngeal biopsies were recruited. The nasopharynx was assessed endoscopically, photographed, and scored on 44 variables. The scores were compared to the biopsy results, and predictors of malignancy were modeled with regression analysis. The sensitivity and specificity of the novel scoring system were examined.
Seventeen patients had carcinoma, and 60 had a benign lesion or no disease. Patients with a nasopharyngeal malignancy scored significantly higher than did patients with a benign lesion or no disease. No patient with a malignant lesion had a score of less than 12. With a receiver operating characteristic curve area of 0.917, the score demonstrated an excellent ability to discriminate between nasopharynges that were likely or unlikely to contain malignant disease. Independent predictors for both malignant disease and a score greater than 12 were modeled.
A cutoff score above 12 on the novel objective endoscopic assessment of the nasopharynx measure was highly predictive of possible malignancy.
The Annals of otology, rhinology, and laryngology 02/2010; 119(2):77-81. · 1.05 Impact Factor
-
Alexander C Vlantis,
Chun Shan Lo,
George G Chen,
Nian Ci Liang,
Vivian W Y Lui,
Kefeng Wu,
Yi Feng Deng,
Xianling Gong,
Yingnian Lu, Michael C F Tong,
C Andrew van Hasselt
[show abstract]
[hide abstract]
ABSTRACT: Ent-11-hydroxy-15-oxo-kaur-16-en-19-oic acid (5F) is known to exhibit antitumor activity, but its mechanism is not completely understood. 5F has not been tested in laryngeal cancer.
Two laryngeal cancer cell lines were treated with 5F. Cell death was analyzed by MTT [3-(4,5-dimethylthiozol-2-yl)-2,5-diphenyltetrazolium bromide] and Annexin V assay. Nuclear factor kappa beta (NF-κB)- and apoptosis-related molecules were examined.
5F induced laryngeal cancer cell death in a dose-dependent manner. The Annexin V assay and the measurement of cleavage of procaspase-3 and poly(ADP-ribose) polymerase demonstrated that the 5F-induced cell death was mainly apoptotic. 5F slightly reduced the basal level of NF-κB, but significantly suppressed the inducible NF-κB by reducing its transcriptional activity, protecting its inhibitory subunit IκBα from degradation, and suppressing its level in the nucleus. 5F also inhibited pro-proliferative and anti-apoptotic molecules but promoted pro-apoptotic Bax.
5F induces apoptosis of laryngeal cancer cells by inhibiting NF-κB activation/induction, suppressing pro-proliferative and anti-apoptotic molecules, and promoting pro-apoptotic Bax.
Head & Neck 02/2010; 32(11):1506-18. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the contribution of laryngopharyngeal sensory deficits and impaired pharyngeal motor function to aspiration in patients irradiated for nasopharyngeal carcinoma.
A retrospective study at a tertiary referral university teaching hospital.
One hundred consecutive patients who underwent radiotherapy for nasopharyngeal carcinoma referred to a dysphagia clinic underwent sensory testing of their laryngopharynx and endoscopic evaluation of their swallowing. The sensory threshold of the laryngopharynx was determined, the pharyngeal contraction assessed, and the status of the larynx and hypopharynx documented before and after swallowing. The presence of laryngeal penetration and aspiration was noted.
The average time from radiation therapy to assessment was 10.2 years, and the mean duration of swallowing symptoms was 27 months. Laryngopharyngeal sensation was deficient in 89% of patients and the pharyngeal contraction impaired in 93% patients. Laryngeal penetration and aspiration occurred in 87% and 74% of patients, respectively. Aspiration was associated with food residue in the pyriform fossae after swallowing (P < .001) and impaired pharyngeal contraction (P < .001), but not with laryngopharyngeal sensory deficiency. There was no association between a laryngopharyngeal sensory deficit and impaired pharyngeal contraction.
Impaired pharyngeal contraction and food bolus clearance from the hypopharynx during swallowing are more important than laryngopharyngeal sensory deficiency in predicting aspiration in patients who underwent radiotherapy for nasopharyngeal carcinoma.
The Laryngoscope 11/2009; 120(2):223-8. · 1.75 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated the contributions of temporal periodicity cues and the effectiveness of enhancing these cues for Cantonese tone recognition in noise. A multichannel noise-excited vocoder was used to simulate speech processing in cochlear implants. Ten normal-hearing listeners were tested. Temporal envelope and periodicity cues (TEPCs) below 500 Hz were extracted from four frequency bands: 60-500, 500-1000, 1000-2000, and 2000-4000 Hz. The test stimuli were obtained by combining TEPC-modulated noise signals from individual bands. For periodicity enhancement, temporal fluctuations in the range 20-500 Hz were replaced by a sinusoid with frequency equal to the fundamental frequency of original speech. Tone identification experiments were carried out using disyllabic word carriers. Results showed that TEPCs from the two high-frequency bands were more important for tone identification than TEPCs from the low-frequency bands. The use of periodicity-enhanced TEPCs led to consistent improvement of tone identification accuracy. The improvement was more significant at low signal-to-noise ratios, and more noticeable for female than for male voices. Analysis of error distributions showed that the enhancement method reduced tone identification errors and did not show any negative effect on the recognition of segmental structures.
The Journal of the Acoustical Society of America 08/2009; 126(1):327-37. · 1.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The surgical treatment of intractable aspiration usually requires sacrifice of the patient's natural voice to prevent food entering the airway. Biller described a tubed supraglottic laryngoplasty to control aspiration while allowing patients to phonate with their larynx. Our preliminary experience with this technique in Chinese patients has been disappointing, as tension in the mucosa on wound closure led to wound dehiscence. Our objective was to modify Biller's technique in order to achieve a better outcome.
We modified Biller's technique by trimming the epiglottic cartilage and by inserting a tibial periosteal graft to reinforce closure of the mucosa, creating an arrangement resembling a Chinese steam boat.
Three Chinese patients underwent the modified Biller's technique. No wound dehiscence occurred, the surgery controlled aspiration, and the patients were able to phonate with their own larynx. All patients resumed oral feeding, and previously placed gastrostomy tubes were removed.
The 'steam-boat' supraglottic laryngoplasty is a viable surgical alternative to total laryngectomy or tracheal diversion for controlling intractable aspiration, and preserves a phonating larynx.
The Journal of Laryngology & Otology 08/2009; 123(12):1360-3. · 0.60 Impact Factor
-
Archives of otolaryngology--head & neck surgery 04/2009; 135(3):308-10. · 1.92 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We aimed to develop a quality-of-life subscale for nasopharyngeal carcinoma (NPC) and validate the functional assessment of cancer therapy-nasopharyngeal (FACT-NP).
The FACT-NP was tested cross-sectionally in survivors of postirradiated NPC (n = 357) and was administered to newly diagnosed patients (n = 160) before, at the end of, and 3 months after radiotherapy (RT).
Each FACT-NP domain was internally consistent (Cronbach's alpha = 0.87-0.90). The test-retest reliability for each subscale was satisfactory (intraclass correlation coefficient = .73-.88). Concurrent validity was suggested by the moderate to strong correlations between the FACT-NP and the Quality of Life-Radiation Therapy Instrument-Head and Neck (QOL-RTI-H&N) subscales (Pearson r = .39-.84). The FACT-NP was responsive to clinical changes from pretreatment to 3 months after RT (effect sizes > 0.6 for clinically relevant subscales). The pooled data for multitrait scaling analysis showed satisfactory item internal consistency and item discriminant validity (100% and 90% scaling success, respectively).
The FACT-NP is a reliable and valid instrument for measuring QOL in patients with NPC.
Head & Neck 03/2009; 31(6):738-47. · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: CANDILET-N is a closed-set speech-recognition test to assess lexical tone recognition in noise for Cantonese speakers. The test consists of 60 test items in a four-alternative forced-choice test paradigm, with male and female speaker versions. Each test plate consists of two disyllabic-word lexical tone minimal pair test items and their respective phonemic distracters. Psychometric performance SNR (signal-to-noise ratio) functions from 26 normal hearing adult subjects were fitted to a logistic regression model to obtain the SNR for 50% correct score (SNR-50%) for individual test items. The mean SNR-50% of the 60 test items for the female and male test sets were -10.3 dB and -11.1 dB, respectively. The SNR-50% varies across test items and their SNR need to be adjusted to improve the homogeneity among them.
Cochlear implants international 02/2009; 10 Suppl 1:130-7.
