Development of an Odor Identification Test Kit for Thai Children

Objective: To develop and validate an odor identification test kit for Thai children that can be adapted for use in Southeast Asian countries. Materials and Methods: The test kit was developed in three phases, using local fresh substances. Phase 1 involved designing the test kit and selecting odorants from a pool of 17. Phase 2 focused on test validation in normal subjects, assignment of smell scores, and assessment of test-retest reliability. Phase 3 validated the test in children with subjective olfactory dysfunction and children with repaired cleft palate. Cut-off scores were determined using receiver operating curve analysis. Results: The participants were children aged 5-12 years. Sample sizes in Phases 1, 2, and 3 were 53, 31, and 36, respectively. Seven odorants that met the selection criteria were chosen. The average score for normal subjects was 6.7 (SD 0.7), with a significant difference between age groups (p = 0.036). Children with olfactory dysfunction had an average score of 3.8 (SD 1.6), significantly lower than normal children (p < 0.001). Children with repaired cleft palate showed no significant difference in smell scores compared to normal subjects. A cut-off score of 5.5 points was used to distinguish between normal and abnormal olfactory function, with an area under the curve of 0.928. Conclusion: Children aged 5-12 years were able to complete the 7-item odor identification test developed from local fresh substances. The test kit demonstrated good reliability and effectively distinguished between children with and without smell loss, using a cut-off score of 5.5

Peak Nasal Inspiratory Flow: Reference Values for Thais

Objective: Nasal obstruction can be measured objectively by rhinomanometry and acoustic rhinometry, both complex techniques. Peak nasal inspiratory flow (PNIF) is also a tool for evaluating nasal obstruction. This study aimed to establish normal PNIF ranges for an Asian population accounting for sex, age, weight, and height. Methods: Using a portable Youlten peak flowmeter, PNIF was measured in 180 healthy Thais (ages 15-70 years). Normal ranges for male and female subjects, adjusted for weight and height, were determined using multiple regression analysis. Results: Body mass index values (mean ± S.D.) of the 82 male and 98 female subjects were 24.9 ± 4.5 and 21.7 ± 4.3 kg/m2 , respectively. PNIF was significantly higher in males than in females (139 ± 37.6 vs. 97.1 ± 27.1 l/ min, p<0.001). After adjusting for weight and height, PNIF reference ranges (lower and upper limits with 95% confidence intervals, respectively) were 126.8 (124.5 to 129.1) and 151.2 (148.9 to 153.5) l/min for males and 82.5 (80.0 to 85.0) and 111.7 (109.2 to 114.3) l/min for females. Conclusion: Sex, height, and weight affected the PNIF rate. This study has provided normal PNIF ranges for healthy male and female Thai population that account for weight and height

Endotyping of Chronic Rhinosinusitis With and Without Polyp Using Transcription Factor Analysis

Inflammation of the nose and paranasal sinus or rhinosinusitis (RS) is a significant global health problem that is both very common and very costly to treat. Previous reports reveal variability in histology and mechanism of inflammation in patients with chronic rhinosinusitis with and without polyp (CRScNP and CRSsNP, respectively). There are various methods and hypothesis that try to explain this variability. Accordingly, the aim of this study was to investigate the incidence of each type of sinonasal inflammation among patients diagnosed with CRScNP or CRSsNP using transcription factor analysis (TFA). This study included mucosa specimens from nose/paranasal sinuses from patients with chronic rhinitis (CR), CRSsNP, or CRScNP that were obtained at the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during the June 2009 to May 2012 study period. TFA was employed to measure the following transcription factors: T-box transcription factor (T-bet) for Th1, GATA binding protein 3 (GATA-3) for Th2, retinoic acid-related orphan receptor C (RORC) for Th17, and forkhead box P3 (FOXP3) for Treg. Forty-one subjects (22 males, 19 females) were enrolled, with a mean age of 45.93 ± 13 years. Twenty-six patients were diagnosed with CRScNP, 7 with CRSsNP, and 8 with CR (controls). The majority of CRScNP specimens (76.9%) had eosinophil count greater than 100 cells/high-power field (HPF). Mean eosinophil count was 930.08 ± 1,399 cells/HPF (range: 17–5,570). Th2 transcription factor (GATA-3) was statistically significantly higher in the CRScNP group than in the CRS and control groups (p &lt; 0.001); whereas, Treg transcription factor (FOXP3) was statistically significantly lower in the CRScNP group than in the CRSsNP and control groups (p &lt; 0.001). The transcription factors for Th1 and Th17 (T-bet and RORC, respectively) were not significantly different among the three groups. The result of transcription factor analysis revealed hyperfunction of Th2 in patients with CRScNP, which might result in hypereosinophilic infliltration in the polyps. One explanation for this finding is the decreased activity of Treg. Although environment-host interaction is the most probable hypothesis, the etiology of aberrant adaptive immunity needs to be elucidated

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

Chronic cough management: Practical guidelines and PICO-based evidence for treatment

This part reviews the management of chronic cough and proposes a management algorithm. Despite proven improvements in quality of life following chronic cough treatment, a clear understanding of the disease and the evidence for the efficacy of some treatments remain vague. Eight key questions regarding the treatment in the uncertain areas were systematically addressed based on the PICO framework and applying the GRADE system for evidence synthesis to provide the strength of recommendation and quality of evidence for key questions, with narrative components for the description of other chronic cough treatment including non-pharmacological therapy. Practical diagrams were developed to facilitate clinical decision-making on treatment. Our guideline introduces the concept of the cough management process for guiding practitioners to assess chronic cough using a holistic approach