ABSTRACT: The pathology of chronic otitis media (COM) could delay and reduce the energy transfer of sound to the inner ear. The significant improvement of postoperative vestibular evoked myogenic potential (VEMP) response rate and p13 latencies in the group of patients with no or negative postoperative ABG gain provided evidence that the sound energy inducing a VEMP might be different from the energy producing the auditory perception.
To evaluate the VEMP in patients with COM before and after surgery.
Twenty-four subjects with unilateral COM were enrolled. A pure tone audiogram and VEMP using 500 Hz unilateral short tone-burst stimulations were recorded before and 3 months after surgery. The postoperative VEMP responses were compared with the responses before surgery and the healthy controls.
After surgery, the 500 Hz air-bone gap (ABG) decreased significantly and the VEMP response rate increased significantly from 41.7% to 66.7% (p<0.05, bi-test). However, both the preoperative and postoperative p13 latencies were significantly longer than those of the healthy controls (p<0.05, Wilcoxon rank-sum test). In the 18 patients whose 500 Hz ABG did not improve with surgery, the p13 latencies were significantly shorter postoperatively (p<0.05, sign test), and the response rate also improved significantly from 44.4% (8/18) to 77.8% (14/18) (p<0.05, bi-test).
Acta oto-laryngologica 11/2009; 129(11):1206-11. · 0.98 Impact Factor
ABSTRACT: Otosclerosis is rare in Asians, and the clinical role of imaging remains controversial. We sought to clarify the tomographic findings of otosclerosis in Taiwanese patients and determine the value and necessity of high-resolution computed tomography (HRCT) of the temporal bone in diagnosing the disease in Taiwan.
This retrospective study enrolled 22 patients (24 ears) with clinically, surgically and pathologically confirmed otosclerosis. All subjects underwent HRCT of the temporal bone; the images were then reviewed at workstations. The control group consisted of 15 patients.
HRCT was positive in 46% of the clinically, surgically and pathologically confirmed otosclerotic ears. Patients with a positive imaging study had a smaller preoperative air-bone gap and a significantly shorter duration of the disease. The duration of the disease also tended to be greater in patients with a larger preoperative air-bone gap.
HRCT has high specificity (100%) but low sensitivity (46%) for the diagnosis of otosclerosis in Taiwanese patients despite progress in radiology. The low image positive rate we found, compared with that in Western literature, may stem from a greater percentage of inactive otosclerosis.
Journal of the Chinese Medical Association 10/2009; 72(10):527-32. · 0.79 Impact Factor
ABSTRACT: To determine the time for us to train a well-trained surgeon to perform septomeatoplasty.
From July 1, 2003 to June 30, 2007, we included 75 patients with nasal septal deviation and chronic hypertrophic rhinitis received septomeatoplasty into this study. All the procedures were performed by four surgeons trained in the same tertiary referral center. We stratified the patients into groups according to the surgeon level at the time of the operations performed. We analyzed the operation time, surgical complications and hospital stay length of these patients.
We stratified the patients according to surgeon years, from year two to year five. The surgical or operation time of the 3rd, the 4th and the 5th year surgeons was statistically shorter than that of the 2nd year surgeons. The operation time of the 4th and 5th year surgeons was statistically shorter than that of the 3rd year surgeons and the operation time of the 5th was also statistically shorter than that of the 4th year surgeons. The hospital stay length of the 4th and the 5th year surgeons was significantly shorter than that of the 3rd year surgeons. No significant difference was noted between that of the 4th and the 5th surgeons. There was no difference on surgical complication among all year group.
Surgeon's years of experience could make the difference on the speed of operation and may also shorten hospital stay length. We conclude that it takes at least five years for us to train a well-trained surgeon for septomeatoplasty.
Auris, nasus, larynx 06/2009; 36(6):661-4. · 0.58 Impact Factor
ABSTRACT: A teaching hospital would incur more operation room costs on training surgical residents.
To evaluate the increased operation time and the increased operation room costs of operations performed by surgical residents. As a model we used a very common surgical otology procedure -- tympanoplasty type I.
From January 1, 2004 to December 31, 2004, we included in this study 100 patients who received tympanoplasty type I in Taipei Veterans General Hospital. Fifty-six procedures were performed by a single board-certified surgeon and 44 procedures were performed by residents. We analyzed the operation time and surgical outcomes in these two groups of patients. The operation room cost per minute was obtained by dividing the total operation room expenses by total operation time in the year 2004.
The average operation time of residents was 116.47 min, which was significantly longer (p<0.0001) than that of the board-certified surgeon (average 81.07 min). It cost USD $40.36 more for each operation performed by residents in terms of operation room costs. The surgical success rate of residents was 81.82%, which was significantly lower (p=0.016) than that of the board-certified surgeon (96.43%).
Acta oto-laryngologica 09/2008; 129(5):512-4. · 0.98 Impact Factor
ABSTRACT: To determine the time required to train a surgeon to skillfully perform tympanoplasty type I.
From July 1, 2001 to December 31, 2006, 75 patients who underwent tympanoplasty type I were enrolled in this study. All of the procedures were performed by two surgeons trained in the same tertiary referral center. We stratified the patients into groups according to the surgeon level at the time of their surgery. We analyzed the operation time and surgical outcomes of these patients.
The average operation time of resident physicians was 116.36 min, which was significantly longer (p<0.0001) than that of the attending physicians (average 83.11 min). There was no statistical difference in surgical success rate and post-operative complication between the resident year and attending year groups. We stratified the patients according to surgeon years, from year 3 to year 7. The operation time of the 4th and the 5th year surgeons was not statistically different from that of 3rd year surgeons. However, the operation time of the 6th and 7th year surgeons was statistically shorter than that of 3rd year surgeons. There was no difference on surgical success rate and complications among all year groups.
A surgeon's years of experience could make the difference in terms of speed of operation. It takes 5 years for surgeons to reach a plateau in learning curve on the speed of performing tympanoplasty type I. We therefore conclude that it takes 5 years to train a surgeon for tympanoplasty type I.
Auris, nasus, larynx 05/2008; 36(1):26-9. · 0.58 Impact Factor