- Taipei, T'ai-pei, Taiwan
Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair... more
Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤...
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Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360°... more
Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H&P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group; n = 32) or 2D VR instructional video (2D VR video group; n = 32), including essential knowledge and competency of H&P. The demographic characteristics of the two groups were comparable fo...
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Background Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning... more
Background Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods This pilot system–design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evalu...
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Helicobacter pylori (H. pylori) infection involves the development of gastric cancer and may be associated with laryngeal cancer. However, laryngeal H. pylori infection in Taiwanese patients with newly diagnosed laryngeal cancer has not... more
Helicobacter pylori (H. pylori) infection involves the development of gastric cancer and may be associated with laryngeal cancer. However, laryngeal H. pylori infection in Taiwanese patients with newly diagnosed laryngeal cancer has not been reported. This study was aimed to investigate the possible association between laryngeal H. pylori infection and laryngeal cancer in Taiwan and perform a systematic review of previous reports in other countries. An analysis of 105 patients with laryngeal lesions found the positive rates of H. pylori DNA (determined by polymerase chain reaction) and antigen (determined by immunohistochemistry) of the laryngeal lesions were relatively low (vocal polyps: 3% and 3%; vocal fold leukoplakia: 0% and 0%; laryngeal cancers: 0% and 2%). Furthermore, H. pylori-associated laryngopharyngeal reflux and the expression of E-cadherin and CD1d (determined by immunohistochemistry) were comparable among the three subgroups. Fifteen studies were involved in the syst...
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Acute lymphoblastic leukemia (ALL) is a hemopoietic malignancy of the bone marrow that rarely invades the sinonasal area. If infiltration of paranasal sinuses occurs, it may lead to rhinosinusitis and orbital complications that need... more
Acute lymphoblastic leukemia (ALL) is a hemopoietic malignancy of the bone marrow that rarely invades the sinonasal area. If infiltration of paranasal sinuses occurs, it may lead to rhinosinusitis and orbital complications that need aggressive treatment. In this report, a 26-year-old male patient who had a history of ALL and had one relapse, suffered from rapid progression of right periorbital pain and exophthalmos, which usually presented in patients with orbital complications of sinusitis. A sinus computed tomography showed right maxillary and ethmoid sinus opacification with orbital bone destruction. Urgent endoscopic sinus surgery (ESS) was performed for orbital decompression and histopathologic diagnosis. Pathology revealed lymphoblast infiltration and inflammation of respiratory mucosa. Subsequent bone marrow aspiration cytology confirmed the diagnosis of a second relapse of ALL. Obstructive causes of sinusitis should be evaluated in patients with ALL. ESS has proven to be eff...
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We present a 14-year-old girl whose initial diagnosis was obstructive sleep apnea syndrome (OSAS) with symptoms of habitual snore, sleep breath holding, shortness of breath, and lump in throat. Lingual thyroid was diagnosed by thyroid... more
We present a 14-year-old girl whose initial diagnosis was obstructive sleep apnea syndrome (OSAS) with symptoms of habitual snore, sleep breath holding, shortness of breath, and lump in throat. Lingual thyroid was diagnosed by thyroid scan and histology, and was treated by radioactive iodine therapy and endoscopic carbon dioxide laser therapy. Her OSAS completely subsided after lingual thyroid surgery. Physicians should be aware of rare causes of OSAS in children, such as lingual thyroid and certainly if accompanied by difficulties in swallowing and speech problems.
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To investigate the efficacy of relocation pharyngoplasty as a surgical technique both to enlarge pharyngeal airspace and to decrease pharyngeal collapse in the treatment of obstructive sleep apnea (OSA). Prospective comparative study... more
To investigate the efficacy of relocation pharyngoplasty as a surgical technique both to enlarge pharyngeal airspace and to decrease pharyngeal collapse in the treatment of obstructive sleep apnea (OSA). Prospective comparative study performed in a tertiary referred sleep center. Ten adult male OSA patients (median age of 38 years, median apnea-hypopnea index [AHI] of 41.6 events/hour, and median body mass index of 25.8 kg/m(2)) with favorable oropharyngeal structure were enrolled. Principal procedures of the relocation pharyngoplasty include tonsillectomy, removal of supratonsillar mucosa and adipose tissue, splinting the lateral pharyngeal wall by suturing the placating superior pharyngeal constrictor muscle to the anterior pillar, and advancing the soft palate by suturing the posterior pillar flap cephalad laterally to the supratonsillar fossa. No patients experienced swallowing disturbance or change of voice after 3 months postoperatively. The median time for patients to return to normal nourishment was 15 days. Six months after the operation, there were statistically significant improvements in snoring (P = .005) and daytime sleepiness (P = .008). Repeated polysomnography revealed significant improvement in AHI (P = .005) and rapid eye movement period (P = .037). Furthermore, reduction in AHI following relocation pharyngoplasty was found in all patients. In selected patients, relocation pharyngoplasty by advancing the soft palate and splinting the lateral pharyngeal wall obtains significant improvement in subjective snoring and daytime sleepiness, as well as objective adverse sleep respiratory events and sleep architecture, while retaining normal pharyngeal function.
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To assess if relocation pharyngoplasty (RP) causes velopharyngeal dysfunction in patients with obstructive sleep apnea (OSA) by evaluating perioperative nasalance, nasality, voice, and articulation. Prospective, comparative study.... more
To assess if relocation pharyngoplasty (RP) causes velopharyngeal dysfunction in patients with obstructive sleep apnea (OSA) by evaluating perioperative nasalance, nasality, voice, and articulation. Prospective, comparative study. Twenty-four OSA patients selected for RP (two women and 22 men; mean age, 35 years) were enrolled for the study of velopharyngeal function in speech. The RP procedure involved removal of supratonsillar adipose tissue, preservation of all palatal muscular structure, splinting the lateral pharyngeal wall, and anterior advancing of the soft palate. Measurements of nasalance (vowel /a/, /i/, consonant /m/, oronasal, oral, and nasal texts), nasality (mirror-fogging test, degree of nasality, Gutzmann test and Bzoch hypernasality test), voice (acoustic analysis), and articulation (velar sound) were taken before RP and 3 months after the procedure and compared. Comparative analysis of clinical measures showed that no significant differences were found following RP in nasalance (except for the vowel /a/), nasality, articulation, and voice. The only difference with regard to vowel /a/ showed, instead of an increase, a significant decrease of nasalance from 17.3 + or - 10.8 to 11.3 + or - 6.7 (P = .004), which may be attributed to the advancing and lifting of the soft palate in RP, leading to relaxation of the levator veli palatine and uvular muscles, which facilitates their contraction in velopharyngeal closure during particular vowel phonation. RP for OSA does not cause velopharyngeal insufficiency in terms of voice, nasality, and articulation in spite of anterior advancement of the soft palate, but does induce a nondetrimental change in nasalance.
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This study aimed to compare the differences in vocal quality between Mandarin-speaking children with cochlear implants and normal-hearing peers and to understand which cochlear implant usage parameters may predict unfavourable voice... more
This study aimed to compare the differences in vocal quality between Mandarin-speaking children with cochlear implants and normal-hearing peers and to understand which cochlear implant usage parameters may predict unfavourable voice outcomes. A cross-sectional, case-controlled study. A tertiary medical centre. Thirty-five pre-lingually deaf children (age = 10.3 ± 1.6 years; 17 boys and 18 girls) who had used cochlear implants for >2 years and 35 age- and gender-matched controls with normal hearing. Through sustained phonation of /a/ and reading of the Hare and Tortoise passage, the subjects' voice quality was analysed with aerodynamics and acoustics. A six-point scale was used for auditory-perceptual evaluation. A Pediatric Voice-Related Quality of Life Survey was filled out by the caregivers. The implanted subjects had significantly lower mean airflow rate (P = 0.006), higher phonation threshold pressure (P < 0.001), higher fundamental frequency variations (P < 0.001) and peak-amplitude variations (P < 0.001), wider fundamental frequency range (P = 0.043), wider speaking intensity range (P = 0.015) and greater perceptual severity level of monotone (P < 0.001), resonance (P < 0.001), loudness (P < 0.001) and strain (P = 0.006) than their normal-hearing peers. Duration of postoperative rehabilitation was an independent predictor of unfavourable mean speaking fundamental frequency (odds ratio = 8.56, P = 0.008). Inadequate postoperative rehabilitation may hinder the normalisation of Mandarin-speaking implantees' voice quality. A multidimensional analysis may precisely evaluate the voice of paediatric implantees; however, the generalisability of these findings requires different forms of validation, including data from other languages and other institutions.
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The aim of this study was to document receptive and expressive language levels and reading skills achieved by Mandarin-speaking children who had received cochlear implants (CIs) and used them for 4.75–7.42 years. The effects of possible... more
The aim of this study was to document receptive and expressive language levels and reading skills achieved by Mandarin-speaking children who had received cochlear implants (CIs) and used them for 4.75–7.42 years. The effects of possible associated factors were also analyzed. Standardized Mandarin language and reading tests were administered to 39 prelingually deaf children with Nucleus 24 devices. The Mandarin Chinese version of the Peabody Picture Vocabulary Test was used to assess their receptive vocabulary knowledge and the Revised Primary School Language Assessment Test for their receptive and expressive language skills. The Graded Chinese Character Recognition Test was used to test their written word recognition ability and the Reading Comprehension Test for their reading comprehension ability. Raw scores from both language and reading measurements were compared to normative data of nor- mal-hearing children to obtain standard scores. The results showed that the mean standard s...
Research Interests: Psychology, Audiology, Character Recognition, Reading, Language Development, and 15 moreLanguage, Medicine, Humans, Child, Cochlear Implant, Primary School, Language Skills, Female, Male, Cochlear Implants, Mandarin Chinese, Clinical Sciences, Neurosciences, Cochlear Implantation, and Peabody Picture Vocabulary Test
The aim of this study was to assess the verbal and performance intelligence of young Mandarin-speaking cochlear implant users with the Wechsler Intelligence Scale for Children (WISC). We also analyzed whether related factors helped... more
The aim of this study was to assess the verbal and performance intelligence of young Mandarin-speaking cochlear implant users with the Wechsler Intelligence Scale for Children (WISC). We also analyzed whether related factors helped develop verbal and performance IQs. We studied 60 children implanted with Nucleus 24 devices; the children represented a consecutive sample of every implantee aged 6 or older from 2002 to 2006. All subjects had 1 year to 8 years and 7 months of implant experience. Five children with known neurological, developmental delay and multiple handicaps were excluded. Intellectual functions were evaluated using the Mandarin version of the WISC-III, which includes 5 subsets for verbal IQ (information, comprehension, similarities, arithmetic and vocabulary) and 5 subsets for performance IQ (picture completion, picture arrangement, block design, object assembly and coding). After conversion, we found that the mean verbal IQ was 85.1 ± 19.9 (range 56–133), and the mea...
Research Interests: Psychology, Intelligence, Audiology, Child Development, Adolescent, and 15 moreMedicine, Linear models, Multivariate Analysis, Humans, Child, Female, Male, Cochlear Implants, Clinical Sciences, Reproducibility of Results, Asian Continental Ancestry Group, Intelligence quotient, Neurosciences, Cochlear Implantation, and Predictive value of tests
BACKGROUND The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM)... more
BACKGROUND The use of mobile technology in e-learning (M-TEL) can add new levels of experience and significantly increase the attractiveness of e-learning in medical education. Whether an innovative interactive e-learning multimedia (IM) module or a conventional PowerPoint show (PPS) module using M-TEL to teach emergent otorhinolaryngology–head and neck surgery (ORL-HNS) disorders is feasible and efficient in undergraduate medical students is unknown. OBJECTIVE The aim of this study was to compare the impact of a novel IM module with a conventional PPS module using M-TEL for emergent ORL-HNS disorders with regard to learning outcomes, satisfaction, and learning experience. METHODS This pilot study was conducted at an academic teaching hospital and included 24 undergraduate medical students who were novices in ORL-HNS. The cognitive style was determined using the Group Embedded Figures Test. The participants were randomly allocated (1:1) to one of the two groups matched by age, sex, ...
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The tonsil microbiome is associated with chronic tonsillitis and obstructive sleep apnea (OSA) in children, and the gut microbiome is associated with host weight status. In this study, we hypothesized that weight status may be associated... more
The tonsil microbiome is associated with chronic tonsillitis and obstructive sleep apnea (OSA) in children, and the gut microbiome is associated with host weight status. In this study, we hypothesized that weight status may be associated with clinical profiles and the tonsil microbiome in children with OSA. We prospectively enrolled 33 non-healthy-weight (cases) and 33 healthy-weight (controls) pediatric OSA patients matched by the proportion of chronic tonsillitis. Differences in the tonsil microbiome between the non-healthy-weight and healthy-weight subgroups and relationships between the tonsil microbiome and clinical variables were investigated. Non-healthy weight was associated with significant intermittent hypoxemia (oxygen desaturation index, mean blood saturation (SpO2), and minimal SpO2) and higher systolic blood pressure percentile, but was not related to the tonsil microbiome. However, chronic tonsillitis was related to Acidobacteria in the non-healthy-weight subgroup, an...
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We compared the clinical outcomes of patients with oral cavity squamous cell carcinoma (OCSCC) with cN+pN0 versus cN0pN0 disease.
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Objective A surgical response to upper airway (UA) surgery for obstructive sleep apnea (OSA) depends on adequate correction of collapsible sites in the UA. This pilot study aimed to examine the surgical response to UA surgery directed by... more
Objective A surgical response to upper airway (UA) surgery for obstructive sleep apnea (OSA) depends on adequate correction of collapsible sites in the UA. This pilot study aimed to examine the surgical response to UA surgery directed by drug-induced sleep computed tomography (DI-SCT) for OSA. Study Design Prospective case series. Setting Tertiary referral center. Subjects and Methods This study recruited 29 OSA patients (median age, 41 years; median body mass index, 26.9 kg/m2) who underwent single-stage DI-SCT-directed UA surgery between October 2012 and September 2014. DI-SCT was performed with propofol for light sedation with a bispectral monitor before and after UA surgery. Nonresponders were defined as those with a reduction in apnea-hypopnea index <50% after 6 months following UA surgery. Results DI-SCT showed that 28 (97%) patients had collapses at multiple sites, all of whom underwent multilevel UA surgery accordingly. The apnea-hypopnea index decreased from 53.6 to 26.8...
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There is no consensus on how to quantify the abnormality of upper airway structures in patients with obstructive sleep apnea (OSA). This research aimed to use morphological indicators as clinical predictors to correlate morphological... more
There is no consensus on how to quantify the abnormality of upper airway structures in patients with obstructive sleep apnea (OSA). This research aimed to use morphological indicators as clinical predictors to correlate morphological stage and surgical results in OSA patients. One hundred and five patients with OSA received palatopharyngeal surgery, i.e. extended uvulopalatal flap (EUPF). Morphological indicators including modified Mallampati grade (MMP), tonsil size, and body mass index were used to stage OSA patients preoperatively. Change of respiratory disturbance index (RDI) was used to monitor change of sleep apnea events. Success rates were compared among patients of different morphological stages. One year after EUPF, the success rates of EUPF in stage I, II, and III patients were 100, 92.9 and 61.4%, respectively. Change of RDI was significantly correlated with MMP and tonsil size. MMP and tonsil size were predictive of the change of RDI (R(2) = 0.29). Morphological stage m...
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To investigate the level of satisfaction of patients who received surgery for obstructive sleep apnea (OSA). A patient satisfaction survey (PSS) was administered three months after surgery to 76 patients who received either a... more
To investigate the level of satisfaction of patients who received surgery for obstructive sleep apnea (OSA). A patient satisfaction survey (PSS) was administered three months after surgery to 76 patients who received either a uvulopalatopharyngoplasty (UPPP) alone, or in combination with a septomeatoplasty (SMP), or a midline laser glossectomy (MLG). Patient satisfaction determinants were also explored. In general, 93.4% of patients rated their overall satisfaction as "excellent" or "very good". High satisfaction levels (excellent + very good >/= 90%) were observed in the dimensions of "professional skill", "personal manner", and "explanation of condition". By contrast, lower satisfaction levels (excellent + very good< 90 %) were observed for "perioperative discomfort". There were no significant differences among the UPPP alone, UPPP + SMP, and UPPP +MLG groups for any dimension of satisfaction (p> 0.05). Older pat...
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Nasal spray of analgesic is a novel administration for postoperative pain control. In this study, we assessed the efficacy of transnasal butorphanol (TB) for pain relief following uvulopalatopharyngoplasty (UPPP) in obstructive sleep... more
Nasal spray of analgesic is a novel administration for postoperative pain control. In this study, we assessed the efficacy of transnasal butorphanol (TB) for pain relief following uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea (OSA) patients, and compared pain alleviation effect to oral mefenamic acid and intramuscular meperidine (M> or =&M). A prospective, randomized, open label study was conducted in a tertiary care sleep center. Twelve OSA patients with full consciousness and at least moderate oropharyngeal pain (pain visual analogue scale [VAS] > or = 4) after UPPP were recruited. They were randomized to receive TB (n = 7) and M&M (n = 5). Oropharyngeal pain was measured by a VAS and the Clinical Global Impression in Severity (CGI-S) and Improvement (CGI-I) at the 12th, 24th, and 72th hours postoperatively. Postoperative pain related morbidities (PRMs) and quality of life in bodily pain (QOL-BP) were also evaluated 72 hours postoperatively. Adverse events incu...
Research Interests: Quality of life, Medicine, Prospective studies, Humans, Obstructive sleep apnea, and 15 moreFemale, Male, Anesthesia, Visual Analogue Scale, Postoperative pain, Middle Aged, Adult, Adverse Event, Intranasal Administration, Pain Measurement, Meperidine, Butorphanol, Mefenamic Acid, Pharynx, and uvula
To report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy. Case series with planned data collection. Tertiary referral center. Fifty consecutive patients (36 boys and 14 girls; median age,... more
To report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy. Case series with planned data collection. Tertiary referral center. Fifty consecutive patients (36 boys and 14 girls; median age, 7.0 years) who underwent plasma knife-assisted total tonsillectomy and adenoidectomy for OSA between January 2010 and March 2013 were assessed with the body mass index z score, apnea-hypopnea index (AHI), systolic blood pressure (BP), and diastolic BP at baseline and at ≥6 months postoperatively. Changes in these parameters were statistically analyzed using nonparametric tests with the bootstrap approach. The median follow-up period was 9.6 months. Postoperatively, the median AHI significantly reduced from 9.8 to 1.6 (P < .001). Although the median systolic BP and diastolic BP insignificantly changed in the overall group, both were significantly reduced in children with preoperative hypertension (systolic: from 119.0 to 113.0 [P = .038]; diastol...
Research Interests: Treatment Outcome, Medicine, Humans, Child, Hypertension, and 14 moreObstructive sleep apnea, Blood Pressure, Female, Male, Follow-up studies, Adenoidectomy, Clinical Sciences, Polysomnography, Retrospective Studies, Otolaryngology - Head and Neck Surgery, Tonsillectomy, Postoperative Period, Severity of Illness Index, and Child preschool
Research Interests: Physiology, Neurology, Pulmonology, Clinical Trials, Medicine, and 15 moreMultidisciplinary, Laryngology, Biological Sciences, Anatomy, Humans, Clinical Medicine, Otorhinolaryngology, Minimally Invasive Surgery, Body Mass Index, PLoS one, Questionnaires, Invasive, Neck, minimally invasive surgical procedures, and physiological processes
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Inverted papilloma of the nose and paranasal sinuses is noted for its high rate of recurrence. The feasibility of endoscopic treatment for inverted papilloma has been shown in the literature; however, reports discussing the efficacy of... more
Inverted papilloma of the nose and paranasal sinuses is noted for its high rate of recurrence. The feasibility of endoscopic treatment for inverted papilloma has been shown in the literature; however, reports discussing the efficacy of endoscopic surgery for recurrent diseases are rare. The study determined the effectiveness of endoscopic surgery for recurrent inverted papilloma and described when endoscopic medial maxillectomy was indicated. Retrospective. Seventeen patients with recurrent inverted papilloma were treated over a 10-year period. Krouse&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s staging system was used for tumor grading. Because of the extent of the tumor in the majority (70.6%) of the patients, en bloc resection could not be regularly achieved; therefore, sequential segmental endoscopic surgery was the chosen treatment. Some diseases that extensively involved the maxillary sinus were treated by the combination of endoscopic medial maxillectomy (EMM) and sequential segmental surgery (SSES) to extirpate the whole disease. Efficacy was evaluated strictly by radiographic study. Successful treatment was accomplished in 14 (82.4%) patients. Three (17.6%) patients had residual disease; each required one revision surgery. None of the patients had recurrence at the time of writing. There were no major complications or associated malignancies encountered in the patients. Endoscopic surgery is an effective treatment for recurrent inverted papilloma. Precise determination of the sites of tumor origin and attachment during the operation is the key to the successful treatment. Recurrent inverted papilloma tends to behave more aggressively and has a higher postoperative recurrence rate than the primary lesion. Stage III disease had a higher recurrence rate (27.3%) than that of other stages (0%).
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Children with sleep-disordered breathing may experience behavioral and learning problems such as inattentiveness and hyperactivity. The aim of this study was to measure the impact of adenotonsillectomy on sleep-related adverse events and... more
Children with sleep-disordered breathing may experience behavioral and learning problems such as inattentiveness and hyperactivity. The aim of this study was to measure the impact of adenotonsillectomy on sleep-related adverse events and behavioral problems in children with sleep-disordered breathing. This prospective and interventional study enrolled 40 sleep-disordered breathing children (mean age, 8.4+/-1.6 years) with hypertrophic tonsils and adenoids. All patients completed two polysomnographies, tests of variables of attention (TOVAs), and Child Behavior Checklists, one at baseline and the other 6 months after adenotonsillectomy. The apnea-hypopnea index (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), TOVA scores (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), and 8 of 9 individual domains of the Child Behavior Checklist scores (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05) significantly improved after surgery. However, the change in the apnea-hypopnea index was not negatively correlated with TOVA score (r=-0.17, P=.38). Adenotonsillectomy could significantly improve behavior (TOVA) scores, but the improvement may not simply be attributable to changes in sleep apnea events.
Research Interests: Treatment Outcome, Medicine, Child Behavior, Prospective studies, Humans, and 15 moreChild, Obstructive sleep apnea, Female, Male, Follow-up studies, The, Risk factors, Adenoidectomy, Clinical Sciences, Polysomnography, Risk Factors, Tonsillectomy, Tonsillitis, Child preschool, and Attention deficit disorder with hyperactivity
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Objective: To evaluate the clinical factors predicting the significantly elevated high-sensitivity C-reactive protein (hs-CRP) concentrations, defined herein as hs-CRP ≥ 3 mg/L, in adult males with untreated obstructive sleep apnea... more
Objective: To evaluate the clinical factors predicting the significantly elevated high-sensitivity C-reactive protein (hs-CRP) concentrations, defined herein as hs-CRP ≥ 3 mg/L, in adult males with untreated obstructive sleep apnea syndrome (OSAS). Study Design: Cross-sectional study. Setting: Tertiary referral center. Subjects and Methods: Sixty-five consecutive male patients with newly diagnosed OSAS were enrolled to receive complete medical history review, physical examination, in-laboratory overnight polysomnography, and hs-CRP test. The patients had no current or history of cardiovascular disease. The patients had a mean age of 38.2 ± 9.9 years, body mass index (BMI) of 27.4 ± 3.5 kg/m2, and Epworth Sleepiness Scale (ESS) of 11.3 ± 4.6. The serum levels of hs-CRP were assessed using peripheral venous blood samples. Results: Twenty-three percent of the overall patients had significantly elevated serum levels of hs-CRP. The increase of hs-CRP correlated fairly with BMI, apnea-hyp...
Research Interests: Medicine, Humans, Internal Medicine, Needs Assessment, Obstructive sleep apnea, and 15 moreMale, Body Mass Index, Risk factors, Clinical Sciences, Polysomnography, Middle Aged, C reactive protein, Adult, Biological markers, Risk Factors, Cross Sectional Studies, Predictive value of tests, Cohort Studies, Obstructive Sleep Apnea Syndrome, and high sensitivity C reactive protein
OBJECTIVES: This study investigated factors that may attribute to taste disturbance (TD) following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). STUDY DESIGN: This longitudinal intervention study enrolled 108... more
OBJECTIVES: This study investigated factors that may attribute to taste disturbance (TD) following uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea (OSA). STUDY DESIGN: This longitudinal intervention study enrolled 108 patients who received UPPP for OSA. Patients who reported TD in the postoperative questionnaire were examined using the three-drop-method gustatory function test (GFT). RESULTS: The GFT revealed that 5 patients (4.6%) reporting TD lost at least one of the four basic tastes 3 months after surgery. Deficiency of sweet sense was the most common type of TD (80%). The use of electrocautery for developing the uvulopalatal flap was the only significant predictor that may attribute to TD (odds ratio: 14.1). Repeating the GFT 9 months after operation showed a restoration of tastes in 4 patients. CONCLUSIONS: Development of the uvulopalatal flap using electrocautery may increase the likelihood of postoperative TD. Patients with taste disturbance after UPPP may event...
Research Interests: Adolescent, Medicine, Prospective studies, Humans, Obstructive sleep apnea, and 15 moreFemale, Male, Body Mass Index, Clinical Sciences, Aged, Middle Aged, Questionnaires, Longitudinal Studies, Palate, Adult, Retrospective Studies, Reproducibility of Results, Electrocoagulation, Otolaryngology Head and Neck Surgery, and Pharynx
Cysts in the region of the larynx can cause unwanted symptoms when the mass grows in an unusual location. Adult patients with laryngeal cysts occasionally complain of a husky voice, difficulty in swallowing, and shortness of breath.... more
Cysts in the region of the larynx can cause unwanted symptoms when the mass grows in an unusual location. Adult patients with laryngeal cysts occasionally complain of a husky voice, difficulty in swallowing, and shortness of breath. However, a laryngeal cyst may also provoke obstructive sleep apnea (OSA). Herein, we report the case of a 47-year-old woman with a huge cyst of the supraglottis and presenting symptoms of snoring, sleep apnea, and daytime somnolence. The cyst was successfully removed by endoscopic CO2 laser surgery. A 47-year-old woman was referred to our sleep clinic because of progressive snoring, sleep apnea, and daytime somnolence for more than 12 months. Meanwhile, she also suffered from exertional dyspnea, intermittent stridor, and difficulty swallowing. Her body mass index was 29.6 kg/m. An examination revealed a huge pedunculate cyst that obstructed the supraglottis. A videostroboscopy revealed that the cyst protruded into the entrance of the esophagus during swallowing, causing dysphagia (Fig 1A and B). When the patient was placed in the supine position, the mass partially obstructed the laryngeal inlet and subsequently induced a stridorous snoring sound. The patient’s daytime sleepiness was subjectively assessed by the Epworth Sleepiness Scale (ESS), and she received a score of 14. Preoperative polysomnography revealed a mild case of OSA (respiratory disturbance index 13.2 events/h). Dynamic magnetic resonance imaging (MRI) was implemented during natural sleep in the supine position. Changes in the upper airway because of snoring or stridor caused by the obstruction were monitored. The images showed a soft-
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Objective To examine the effect of positional dependency on surgical success among patients with severe obstructive sleep apnea (OSA) following modified uvulopalatopharyngoplasty, known as relocation pharyngoplasty. Study Design Case... more
Objective To examine the effect of positional dependency on surgical success among patients with severe obstructive sleep apnea (OSA) following modified uvulopalatopharyngoplasty, known as relocation pharyngoplasty. Study Design Case series with planned data collection. Setting Tertiary referred center. Subjects and Methods Standard nocturnal polysomnography was used to compare the apnea-hypopnea index (AHI) in different sleep positions before and after relocation pharyngoplasty in 47 consecutive patients with severe OSA (AHI, 59.5 ± 18.2 events/hour; Epworth Sleepiness Scale [ESS] scores, 12.2 ± 4.4) who failed continuous positive airway pressure therapy. Positional (dependency) OSA was defined when the supine:non-supine AHI ratio was >2, otherwise it was defined as nonpositional OSA. Surgical success was defined as a ≥50% reduction in AHI and a postoperative AHI of ≤20 events/hour. Polysomnographic parameters, ESS, and surgical success following surgery were recorded. Results O...
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Myeloid sarcoma in a patient with myelodysplastic syndrome (MDS) manifesting as a non-healing tonsillar ulcer is an extremely rare occurrence. We report the case of a 57-year-old male smoker with a non-healing tonsillar ulcer who... more
Myeloid sarcoma in a patient with myelodysplastic syndrome (MDS) manifesting as a non-healing tonsillar ulcer is an extremely rare occurrence. We report the case of a 57-year-old male smoker with a non-healing tonsillar ulcer who underwent tonsillectomy to rule out tonsillar carcinoma after failed antibiotic therapy. On postoperative day 2, he presented with a temperature of 40°C and white blood cell count of 34700/μL. Antibiotic therapy was begun; however, he died 1 day later due to pulmonary infection and septic shock. Though extremely rare, tonsillar involvement of MDS should be considered in the differential diagnosis of a non-healing tonsillar lesion. When definitive diagnosis requires a tissue sample, punch biopsy may be preferable to tonsillectomy in a patient who may be immunocompromised, and appropriate prophylactic antibiotics should be administered.
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Research Interests: Medical Microbiology, Biology, Virology, Puerto Rico, Medicine, and 15 moreEmerging Infectious Diseases, Phylogeny, Humans, influenza A, Virus, Taiwan, Phylogenetic analysis, Clinical Sciences, Public health systems and services research, influenza A virus, Amino Acid Profile, Amino Acid Sequence, Open Reading Frame, Molecular Immunology of Infectious Diseases... HIV, and Molecular Sequence Data
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Older age, obesity, and obstructive sleep apnea syndrome (OSAS) are known to increase the risk of hypertension in adults. However, data for children are scarce. This study aimed to investigate the relationships between hypertension, age,... more
Older age, obesity, and obstructive sleep apnea syndrome (OSAS) are known to increase the risk of hypertension in adults. However, data for children are scarce. This study aimed to investigate the relationships between hypertension, age, weight status, and disease severity in 396 children with OSAS. The prevalence rates of hypertension, obesity, and severe OSAS (apnea-hypopnea index ≥10) were 27.0%, 28.0%, and 42.9%, respectively. Weight z-score and apnea-hypopnea index were independently correlated with systolic blood pressure z-score, and minimal blood oxygen saturation (SpO2) was independently associated with diastolic blood pressure z-score. Overall, late childhood/adolescence (odds ratio (OR) = 1.72, 95% CI = 1.05–2.81), obesity (OR, 2.58, 95% CI = 1.58–4.22), and severe OSAS (OR = 2.38, 95% CI = 1.48–3.81) were independent predictors of pediatric hypertension. Furthermore, late childhood/adolescence (OR = 2.50, 95% CI = 1.10–5.71) and abnormal SpO2 (mean SpO2 < 95%; OR = 4....