Factors Associated with Xerostomia in Non-Radiated Patients

Objective: To identify factors significantly associated with xerostomia in non-radiated patients. Methods: Patients who attended the outpatient otolaryngology clinic at Siriraj Hospital (Bangkok, Thailand) with complaints of dry mouth were invited to join this study. Collected data included age, gender, body mass index, smoking status, alcohol use, underlying disease, and previous medication and/or therapy. Irradiated patients were excluded. Participants were classified into either the diseased or xerostomia group by abnormal oral cavity examination and symptoms, or the no xerostomia group, which was defined as dry mouth symptoms with no presence of abnormal physical findings. Results: Two hundred and two participants with a history of dry mouth were consecutively enrolled. There were 86 patients with physical findings compatible with xerostomia, and 116 symptomatic patients without xerostomia. Multivariate analysis revealed age over 50 years (adjusted odds ratio [aOR]: 3.1, 95% confidence interval [CI]: 1.3-7.9; p=0.012), analgesic and muscle relaxant intake (aOR: 3.6, 95% CI: 1.3-9.7; p=0.012), psychotherapeutic medication (aOR: 7.8, 95% CI: 2.6-23.7; p<0.001), and radioactive iodine therapy (aOR: 3.7, 95% CI: 1.2-11.8; p=0.015) to be independent predictors of xerostomia. Conclusion: Xerostomia is a condition that can adversely affect quality of life. The results of this study revealed older age (≥50 years), analgesics and muscle relaxants, psychotherapeutic medications, and radioactive iodine therapy to be significantly associated with xerostomia. A thorough understanding of the symptoms, diagnosis, relevant risk factors, and effective management is essential for improving outcomes among patients with xerostomia.   

The Relationships among Objective Measures of Tongue Strength and Risk of Aspiration

Objective: The objective measures of tongue strength can predict the risk of aspiration. Isometric tongue pressure and endurance have been reported to be lower in patients who have premature spillage, penetration and/or aspiration on endoscopic evaluation. We aimed to study the relationships between the objective measures of tongue strength and risk of aspiration in our population. Methods: Seventy-five participants were enrolled to the study. The mean age of the participants was 58.3 ±13.6 years old. They were divided into three groups (25 participants in each group). The first group was normal participants who have had no history of swallowing problem with normal flexible endoscopic evaluation of swallowing (FEES). The second group was symptomatic patients who have had history of dysphagia and/or aspiration but normal FEES. The third group was patients who have had history of dysphagia and/or aspiration with evidence of premature spillage or laryngeal penetration or aspiration by FEES. All participants underwent objective measurements of the tongue strength including maximal isometric pressure (MIP) and endurance by Iowa Oral Performance Instrument (IOPI). The quantitative data between groups were compared using ANOVA and chi-square test was used for qualitative data. The optimal cut-off points were determined by Receiver Operating Characteristic (ROC) curve. Results: MIP and endurance were significantly lower in patients who have had premature spillage, penetration and/or aspiration on endoscopic evaluation. The appropriate cut-off points for high risk group are 35 and 25 kPa for the anterior and posterior tongue pressure respectively. Conclusion: The tongue pressure can be used to screen patients who are at risk of aspiration, which will lead to early investigation and intervention for the management of these patients

Sensorineural hearing loss after concurrent chemoradiotherapy in nasopharyngeal cancer patients

<p>Abstract</p> <p>Background</p> <p>Sensorineural hearing loss (SNHL) is one of the major long term side effects from radiation therapy (RT) in nasopharyngeal cancer (NPC) patients. This study aims to review the incidences of SNHL when treating with different radiation techniques. The additional objective is to determine the relationship of the SNHL with the radiation doses delivered to the inner ear.</p> <p>Methods</p> <p>A retrospective cohort study of 134 individual ears from 68 NPC patients, treated with conventional RT and IMRT in combination with chemotherapy from 2004-2008 was performed. Dosimetric data of the cochlea were analyzed. Significant SNHL was defined as > 15 dB increase in bone conduction threshold at 4 kHz and PTA (pure tone average of 0.5, 1, 2 kHz). Relative risk (RR) was used to determine the associated factors with the hearing threshold changes at 4 kHz and PTA.</p> <p>Results</p> <p>Median audiological follow up time was 14 months. The incidence of high frequency (4 kHz) SNHL was 44% for the whole group (48.75% in the conventional RT, 37% with IMRT). Internal auditory canal mean dose of > 50 Gy had shown a trend to increase the risk of high frequency SNHL (RR 2.02 with 95% CI 1.01-4.03, p = 0.047).</p> <p>Conclusion</p> <p>IMRT and radiation dose limitation to the inner ear appeared to decrease SNHL.</p

Association of cleft palate and craniofacial syndromic anomalies with the outcome of tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion

This research was aimed to study the association of cleft palate and craniofacial syndromic anomalies with the outcome of the tympanic membrane after tympanostomy tube insertion and time to recovery from recurrent otitis media with effusion. A retrospective cohort study was done in 85 children with cleft palate and 102 non-cleft children who had tympanostomy tube insertion for otitis media with effusion. The desired outcome was the recovery of recurrent otitis media with effusion with intact tympanic membrane. Craniofacial syndromic anomalies were found in 11.8% of the children in both groups. Intact tympanic membrane was found most commonly in noncleft children without craniofacial anomalies (63.7%). Cleft palate was the most significant risk for the non-intact tympanic membrane after adjusting for syndromic anomalies and the number of tympanostomy tube insertion (p = 0.047). Time to recovery from recurrent otitis media with effusion was shortest in the non-cleft children without craniofacial anomalies (4.9 years) with the highest probability of cure (hazard ratio and 95% CI 3.46 (1.62, 7.39)). Children with cleft palate had higher probability of cure than the children with cleft palate and craniofacial syndromic anomalies (hazard ratio and 95% CI 2.59 (1.16, 5.80)). Children with cleft palate and craniofacial syndromic anomalies had highest incidence of otorrhea (59.1%) and repeated tympanostomy tube insertion (86.4%). Craniofacial syndromic anomalies with cleft palate contributed to a longer time to recovery and higher incidence of complications from tympanostomy tube

Characteristics and Clinical Presentations of Patients at the Siriraj Snoring Clinic

Objective: To describe characteristics and clinical presentations of patients in Siriraj snoring clinic and to analyze their relationships with obstructive sleep apnea (OSA) severity. Methods: Three hundred and seventy-three patients’self-administered questionnaires regarding sleep problems recorded between January 2012 and December 2013 and 275 polysomnographic reports were reviewed. Results: Among 373 respondents, there were 247 males (66.2%) and 126 females (33.8%), with an average age of 48 years and body mass index of 28.2 kg/m2.  Their most common complaints and comorbidities were snoring ≥3 nights/week (87.9%), worrying about complications from apnea (72.4%), dyslipidemia (36.7%), hypertension (34.3%), and diabetes mellitus (12.1%), respectively. Using apnea-hypopnea index (AHI) of ≥5 and ≥30 events/hour, there were 76.7% and 38.5% of patients diagnosed as OSA and severe OSA, respectively. While using respiratory disturbance index (RDI) with similar cut-off, almost everyone (98.8%) and 60.2% of patients will be diagnosed as OSA and severe OSA, respectively.  Characteristics significantly associated with AHI ≥15 events/hour were snoring ≥3 nights/week, witnessed apneas, and nocturia (p < 0.05). The comorbidities which significantly associated with OSA group were hypertension, diabetes, and dyslipidemia.  There were only weak significant relationships between AHI (and RDI) with ESS and quality of life. Conclusion: The most common complaints in our clinic were loud snoring and worrying about OSA consequences, not excessive daytime sleepiness. Based on RDI criteria, almost everyone were diagnosed as OSA; however, it had poor relationship with patients’symptoms, comorbidities and quality of life.  Thus, for better OSA evaluation, we should use data from several aspects, not only AHI nor RDI for proper patient management