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

Hearing and Balance Survey in Thai Elders

Objective: To survey hearing and balance problems of a sampling group of Thai elders in the central region of Thailand. Methods: A population study was people aged 60 and over who agreed to join the survey at the 14 elderly social associations. The questionnaires were used as a self-report for hearing and balance problems. After ears examination by ENT specialists, the participants underwent air-conduction audiometry for hearing screening. Results: 828 participants 259 (31.3%) males and 569 (68.7%) females, age ranged from 60 to 97 (median=68, mean ± SD = 69.65 ± 6.89 years), had completed screening program for hearing and balance problems using both questionnaires and examinations. There was a statistically significant correlation between self-report hearing loss and severe or profound hearing loss in both ears (P <0.05). All age groups reported dizziness and vertigo but the elderly over 75 years reported more falls with a statistical significance (P=0.021). The elderly who did not report dizziness or vertigo had a1.1-1.6 times higher fall histories than those who reported (P <0.001). The participants who had hypertension and dyslipidemia reported more falls with statistical significances (P=0.025 and 0.036 respectively). Conclusion: Our hearing and balance questionnaires may be used as a tool for screening at a primary care for the elderly > 70 years old especially in those with underlying diseases. Hearing and balance screening will provide early detection and primary intervention to minimize the negative impact in the elderly’s daily life

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

Hearing and Balance Survey in Thai Elders

Objective: To survey hearing and balance problems of a sampling group of Thai elders in the central region of Thailand. Methods: A population study was people aged 60 and over who agreed to join the survey at the 14 elderly social associations. The questionnaires were used as a self-report for hearing and balance problems. After ears examination by ENT specialists, the participants underwent air-conduction audiometry for hearing screening. Results:828 participants (259 (31.3%) males and 569 (68.7%) females, age ranged from 60 to 97 (median=68, mean ± SD = 69.65 ± 6.89 years), had completed screening program for hearing and balance problems using both questionnaires and examinations. There was a statistically significant correlation between self-report hearing loss and severe or profound hearing loss in both ears (P <0.05). All age groups reported dizziness and vertigo but the elderly over 75 years reported more falls with a statistical significance (P=0.021). The elderly who did not report dizziness or vertigo had a1.1-1.6 times higher fall histories than those who reported (P <0.001). The participants who had hypertension and dyslipidemia reported more falls with statistical significances (P=0.025 and 0.036 respectively). Conclusion: Our hearing and balance questionnaires may be used as a tool for screening at a primary care for the elderly > 70 years old especially in those with underlying diseases. Hearing and balance screening will provide early detection and primary intervention to minimize the negative impact in the elderly’s daily life

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

Hearing Gain with Tailor-made Polyethylene Strut in Total Stapedectomy

Objective: To study audiometric changes after total stapedectomy with tailor-made polyethylene strut. Methods: A retrospective analysis of preoperative and postoperative hearing results. One hundred and ninety- eight patients underwent total stapedectomy during 2009-2014. Stapedectomy was performed with tailor-made polyethylene strut prosthesis on vein or perichondrium graft over oval window. Changes of preoperative and postoperative pure tone average (PTA) were calculated from 4 frequencies after stapedectomy. Results: Ninety percent success rate in the air-bone gap closure within 10 dB after stapedectomy. Conclusion: Tailor-made polyethylene strut prosthesis is a cheap and cost-effective prosthesis, which is an alternative option for surgeons instead of the commercial prosthesis