Effect of Kao-Ta (9-Square Step Exercise) and Kao-Ten (9-Square Dance Exercise) on Balance Rehabilitation in Patients with Balance Disorders

Objective: To study the effect of Kao-ta (9-square step exercise) and Kao-ten (9-square dance exercise) on balance improvement in patients with balance disorders. Methods: This prospective pilot study in patients with balance disorders was conducted at the outpatient clinic, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from December 2015 to December 2016. Patients diagnosed by clinical symptoms and at least one abnormal condition on posturography were taught how to perform Kao-ta and Kao-ten exercise. Participants were provided with the equipment necessary to create a nine square grid at home. They were instructed to perform 3 minutes of Kao-ta followed by 2 minutes of Kao-ten twice per day for at least 45 days in an 8-week period. Posturography and visual analogue scale (VAS) of balance symptom severity were compared between before and after exercise program.  Results: Eleven patients with balance disorders were included. The mean age was 57.2±12.9 years (range: 33-70), and all patients were women. The average composite equilibrium score at baseline was 64.4±8.1. After 8 weeks of Kao-ta and Kao-ten, the average composite equilibrium score increased to 73.8±10.2 (p<0.01). The median (P25, P75) of the abnormal equilibrium score condition decreased from 2 (1, 3) at baseline to 1 (0, 2) after 8 weeks (p=0.016). The median VAS of balance symptom severity decreased from 4 (3, 6) at baseline to 2 (0.2, 5.5) after 8 weeks (p=0.028). Conclusion: Kao-ta and Kao-ten exercise can improve symptoms in patients with balance disorders after 8 weeks of exercise

Effect of Kao-Ta (9-Square Step Exercise) and Kao-Ten (9-Square Dance Exercise) on Balance Rehabilitation in Patients with Balance Disorders

Objective: To study the effect of Kao-ta (9-square step exercise) and Kao-ten (9-square dance exercise) on balance improvement in patients with balance disorders. Methods: This prospective pilot study in patients with balance disorders was conducted at the outpatient clinic, Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from December 2015 to December 2016. Patients diagnosed by clinical symptoms and at least one abnormal condition on posturography were taught how to perform Kao-ta and Kao-ten exercise. Participants were provided with the equipment necessary to create a nine square grid at home. They were instructed to perform 3 minutes of Kao-ta followed by 2 minutes of Kao-ten twice per day for at least 45 days in an 8-week period. Posturography and visual analogue scale (VAS) of balance symptom severity were compared between before and after exercise program. Results: Eleven patients with balance disorders were included. The mean age was 57.2±12.9 years (range: 33-70), and all patients were women. The average composite equilibrium score at baseline was 64.4±8.1. After 8 weeks of Kao-ta and Kao-ten, the average composite equilibrium score increased to 73.8±10.2 (p<0.01). The median (P25, P75) of the abnormal equilibrium score condition decreased from 2 (1, 3) at baseline to 1 (0, 2) after 8 weeks (p=0.016). The median VAS of balance symptom severity decreased from 4 (3, 6) at baseline to 2 (0.2, 5.5) after 8 weeks (p=0.028). Conclusion: Kao-ta and Kao-ten exercise can improve symptoms in patients with balance disorders after 8 weeks of exercise

Prevalence of HPV infection in hypopharyngeal and laryngeal squamous cell carcinoma at Thailand's largest tertiary referral center

Abstract Background Following the well-established relationship between human papillomavirus (HPV) and cervical carcinoma, the carcinogenicity of this virus has also been confirmed in subsets of head and neck carcinoma (HNCA), but mainly in the oropharynx. Other subsites of HNCA with less known association to HPV have never been studied in Thailand. Accordingly, the aim of this study was to investigate the prevalence of HPV DNA in hypopharyngeal and laryngeal squamous cell carcinoma in Thai population. Methods This cross-sectional study included hypopharyngeal and laryngeal squamous cell carcinoma patients diagnosed and treated at the Department of Otorhinolaryngology, Siriraj Hospital during the September 2011–December 2013 study period. Presence of HPV genome was confirmed by polymerase chain reaction from pathologically-confirmed fresh specimens. Demographic data and risk factors of HPV infection were evaluated. Results Eighty patients were included, and 95% of those were male. Only one patient was noted with positive HPV-62 serotype. Most patients consumed tobacco and/or alcohol. Five patients had no risk factors for cancer development. Risk of HPV infection was evaluated by self-reporting questionnaire. The mean age of sexual debut was 20.17 years. Forty-eight patients had multiple sexual partners. Sixteen and seven patients had history of sexually transmitted disease infection and habitual oral sex contact, respectively. Conclusion There was no oncogenic HPV DNA detected within pathologic specimens of laryngeal and hypopharyngeal cancers in this study. Compared to rates reported from developed countries, the prevalence of HPV-related HNCA in Thailand is very low

Factors Affecting Unfavourable Results from a Sinonasal Inverted Papilloma Surgery

Objective: Sinonasal inverted papilloma (SNIP) is the most common nasal benign tumor, but locally invasive. The standard treatment is to identify origins of the tumor and total removal. Unfavourable results are finding postoperative residual or recurrent tumors. The aim of this study is to determine factors affecting postoperative residual or recurrent tumors and a rate of getting postoperative residual or recurrent tumors from SNIP surgeries. Methods: A retrospective study in patients with SNIPs was conducted. Relationships between demographic data, tumor sites, tumor stages by Krouse classification, surgical approaches, surgeons’ experience, using microdebrider assisted surgery, operative time, intraoperative blood loss, histopathology, Epstein Barr virus (EBV), human papillomavirus (HPV) infection, time to detect tumor after surgery and unfavourable results were evaluated. HPV and EBV were detected by in situ hybridization. Results: 73 patients were included in this study. Unfavourable results were found in 27 patients (36.99%). 50% of patients received unfavourable results after postoperative duration of 115 months. 5 years of a disease-free survival rate was 64.3% (95% CI: 51.9% to 76.7%). The patients with external surgical approaches got worse results than those with endoscopic sinus surgery (p = 0.01, a hazard ratio of 3.88, 95% CI: 1.39 to 10.87). The patients operated without using microdebrider assisted surgery got worse results than those with using the device (p < 0.001, an adjusted hazard ratio of 5.09, 95% CI: 2.08 to 12.45). The patients with abnormal pathological changes (tissue dysplasia and malignant transformation) had worse results than those without changes (p = 0.02, an adjusted hazard ratio of 3.42, 95% CI: 1.24 to 9.38).   Conclusion: Non-endoscopic nasal surgery, non-using microdebrider assisted surgery, and abnormal pathological changes may be some of the causes of unfavourable results from SNIP surgeries. Long postsurgical surveillance should be done, because of 36.99% of patients received unfavourable results from SNIP surgeries

Reinnervation of the allograft larynx in the rat laryngeal transplant model

The rat model for a vascularized laryngeal allograft is duplicated with significant technical modifications. We report the addition of unilateral host-to-allograft recurrent laryngeal nerve anastomosis to this model. Long-term survival experiments determine the feasibility of reinnervation studies of the allograft larynx with this new model. A total of 59 transplants have been performed on histocompatible Munich Wistar rats, 36 with attempted unilateral allograft reinnervation. Because of the initially high operative mortality rates, additions and modifications of the original technique resulting in reproducibly enhanced survival are detailed. Factors critical to the functional study of this model with regard to reinnervation are elucidated. Preliminary data on allograft reinnervation are reported as confirmed by videodocumentation of vocal fold mobility, evoked and spontaneous electromyography, and glycogen-depletion studies. (OTOLARYNGOL HEAD NECK SURG 1995;113:517-29.