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An-Suey Shiao

Publications and source records attributed to An-Suey Shiao.

17 recordsLinked to original sources
PubMed2006

Relationship between Mandarin speech reception thresholds and pure-tone thresholds in the geriatric population.

BACKGROUND/PURPOSE: In the geriatric population, the reliability of pure-tone threshold (PTT) is sometimes poorer than that in young adults because of various reasons. This study assessed the relationship between Mandarin speech reception thresholds (SRTs) and PTTs in the aged and developed SRT as a measure for corroborating PTT. METHODS: This prospective study enrolled 46 consecutive subjects over 60 years of age. The results of SRT and PTT were collected from one ear randomly selected from each subject. Simple linear and multiple regressions were used to determine the correlation and linear regression coefficients between SRTs and PTTs at various frequencies. RESULTS: In the simple regression analysis, the correlation coefficient was highest at 1000 Hz (r = 0.949) and 500 Hz (r = 0.922), followed by 250 Hz (r = 0.850) and 2000 Hz (r = 0.792). In the multiple regression model with SRT as the dependent variable and PTTs as predictor variables, the resultant multiple correlation coefficient R was 0.967, while R2 was 0.936. In this model, PTTs at the frequencies of 500 Hz and 1000 Hz contributed significantly to the variance in SRTs with p values of 0.029 and < 0.001, respectively. These results demonstrated that the Mandarin SRT is strongly associated with PTTs at the frequencies of 500 Hz and 1000 Hz. CONCLUSION: This study established the agreement between Mandarin SRTs and PTTs in the low tone area of speech frequencies in the geriatric population. In clinical settings, SRT test can be rapidly and easily performed and is relatively inexpensive. It is a vital indicator of the accuracy of PTT measurement.

Aged↗
PubMed2006

Postoperative auricular perichondritis after an endaural approach tympanoplasty.

BACKGROUND: Postoperative auricular perichondritis is a problematic and embarrassing surgical complication after an endaural approach tympanoplasty. However, a search through the literature showed only a few papers regarding postoperative auricular perichondritis, and the reported treatment experience is scarce. This study reviews the clinical aspects of postoperative auricular perichondritis and the different treatment methods. METHODS: The medical records of 8 patients with postoperative auricular perichondritis over a 5-year period were reviewed. Five patients were treated using the wide excision method, 2 underwent tubal drainage, and 1 was placed on antibiotics alone. RESULTS: In 8 patients with postoperative auricular perichondritis after an endaural approach tympanoplasty, the time between the previous ear operation and the symptoms of infection ranged from 2 to 37 days, with a mean of 17.3 days. The wide excision method was performed after the abscess localized, an average of 8.4 days after initial antibiotic treatment. The culture results found fungus in 4 patients. Multiple excision procedures were required in 4 patients, and the mean number of surgical procedures was 2.6. The mean hospital stay of patients having wide excision was 15.2 days. Two patients had stenosis of the external auditory canal resulting from repeated excision procedures. Two patients underwent tubal drainage, and their mean hospital stay was 51 days. CONCLUSION: In postoperative auricular perichondritis after an endaural approach tympanoplasty, wide excision seems to be a better choice to treat this problem. Repeated limited excisions could result in ear deformity. Cartilage exposure during chronic ear surgery should be avoided, and early precautions after operation should be taken in order to prevent complications.

Adult↗
PubMed2005

CO2 laser myringotomy in children with otitis media with effusion.

BACKGROUND: The study aimed to evaluate the clinical application of CO2 laser myringotomy in children with otitis media with effusion (OME) under topical anaesthesia in an office setting. METHODS: Laser myringotomy was performed with the CO2 laser Otoscan (OtoLAM) in 54 children (73 ears) with OME. The procedure on the tympanic membrane was performed under topical anaesthesia using Bonain's solution or 10 per cent Xylocaine (lidocaine) solution for 30 minutes before surgery. A circular perforation was created with a power of 15 W, single pulse duration of 200 msec and a scanned area of 1.9 mm in diameter. RESULTS: The mean healing time was 2.51 weeks (range 1-5 weeks). Effusion content was not a predictive prognostic factor for perforation healing time. Perforation location over anterior inferior or posterior inferior quadrants was not a predictive factor for perforation healing time. Xylocaine was the more effective anaesthestic. The OME resolution rate was 73 per cent. CONCLUSION: Laser myringotomy provides intermediate duration middle-ear ventilation. It could be beneficial in selected children with OME.

Acoustic Impedance Tests↗
PubMed2005

A comparison assessment of videotelescopy for diagnosis of pediatric otitis media with effusion.

OBJECTIVES: A correct diagnosis of pediatric otitis media with effusion (OME) is imperative for instituting an appropriate treatment. The aim of this study was to compare the diagnostic efficacies of videotelescopy, pneumatic otoscopy, and tympanometry for detecting the presence or absence of pediatric OME, and thereby, to recommend a standardized procedure for assessing possible OME in the outpatient setting of a referral center. STUDY DESIGN: Prospective study. METHODS: Between November 1999 and May 2002, 104 children were enrolled in this comparison study of diagnostic methods for OME. Based on a presumptive diagnosis of OME or atelectasis of the eardrum, patients under 12 years of age were admitted to the ward for ventilation-tube insertion. In the 2 days prior to surgery, videotelescopy, pneumatic otoscopy, and tympanometry were performed. Myringotomies were subsequently conducted under general anesthesia to confirm the presence or absence of OME. Type B tympanograms were accepted as positive results for ears with effusion. RESULTS: : Of the 201 ears assessed in the study, middle-ear effusion was detected in 179, while the remaining 22 ears were found to be dry on myringotomy. It was demonstrated that videotelescopy had the highest sensitivity (97.8%), specificity (100%), and accuracy (98.0%), reflecting significantly better results than those for pneumatic otoscopy and tympanometry. CONCLUSIONS: In our study, videotelescopy seemed to be better than pneumatic otoscopy and tympanometry for diagnosis of pediatric OME. It may be has the potential to become the standard diagnostic and teaching procedure for pediatric OME in the outpatient setting of a referral center, and for validation of pneumatic otoscopy.

Acoustic Impedance Tests↗
PubMed2005

Pediatric external canal cholesteatoma with extensive invasion into the mastoid cavity.

Cholesteatoma in the external auditory canal (EAC) is an uncommon situation, and is especially rare in pediatric patients. We report two pediatric cases of external canal cholesteatoma with extensive invasion into mastoid cavity. Both cases had otalgia and poor hearing as the initial symptoms, and received operation according to the extent of the lesions. Since external canal cholesteatoma with extensive invasion into the mastoid cavity has the propensity to involve the vertical segment of the facial nerve, extreme care should be taken when performing any procedure in this area. Through thorough pre-operative evaluation and adequate surgical procedures, good outcomes can be achieved and hearing as well as facial nerve function can be preserved.

Child↗
PubMed2005

Ear problems in swimmers.

Acute diffuse otitis externa (swimmer's ear), otomycosis, exostoses, traumatic eardrum perforation, middle ear infection, and barotraumas of the inner ear are common problems in swimmers and people engaged in aqua activities. The most common ear problem in swimmers is acute diffuse otitis externa, with Pseudomonas aeruginosa being the most common pathogen. The symptoms are itching, otalgia, otorrhea, and conductive hearing loss. The treatment includes frequent cleansing of the ear canal, pain control, oral or topical medications, acidification of the ear canal, and control of predisposing factors. Swimming in polluted waters and ear-canal cleaning with cotton-tip applicators should be avoided. Exostoses are usually seen in people who swim in cold water and present with symptoms of accumulated debris, otorrhea and conductive hearing loss. The treatment for exostoses is transmeatal surgical removal of the tumors. Traumatic eardrum perforations may occur during water skiing or scuba diving and present with symptoms of hearing loss, otalgia, otorrhea, tinnitus and vertigo. Tympanoplasty might be needed if the perforations do not heal spontaneously. Patients with chronic otitis media with active drainage should avoid swimming, while patients who have undergone mastoidectomy and who have no cavity problems may swim. For children with ventilation tubes, surface swimming is safe in a clean, chlorinated swimming pool. Sudden sensorineural hearing loss and some degree of vertigo may occur after diving because of rupture of the round or oval window membrane.

Acute Disease↗
PubMed2004

Bacteriology of medically refractory acute otitis media in children: a 9-year retrospective study.

OBJECTIVE: To identify the causative organisms for medically refractory acute otitis media (AOM) in children, and to recommend the appropriate antibiotics for these patients. STUDY DESIGN: Retrospective chart review. METHODS: The medical records for 671 children (1258 ears) undergoing myringotomies between January 1993 and December 2001 were retrospectively reviewed. "Medically refractory" AOM is defined as AOM requiring emergency myringotomy because of toxicity persisting despite second-phase antibiotics. Of these, 18 children were enrolled in our study, with 25 of the ears affected by medically refractory AOM. Myringotomy was performed for pus drainage, bacterial culture and susceptibility studies in all cases. Clinical factors were analyzed to demonstrate possible relationships with microbiological findings. RESULTS: Bacteria were recovered in specimens taken from 12 ears. The positive culture rate was 48%. Bacteriological studies showed mostly growing gram-positive bacteria, such as coagulase negative staphylococcus, Staphylococcus aureus and Streptococcus pneumoniae (in decreasing order of incidence). The sensitivity rate to pre-myringotomy antibiotics was 85.7%. With the exception of Pseudomonas aeruginosa and two ears with intracranial complications or pneumonia, all other isolated microorganisms were susceptible to first-generation cephalosporins. No statistically significant differences were noted between culture rates and clinical factors. CONCLUSION: The distribution of organisms in our medically refractory AOM cases differed from that for simple AOM, with gram-positive bacteria having significantly higher rates of incidence. Combining intravenous aminoglycoside with first-generation cephalosporin is considered an inexpensive and effective treatment covering all potential microorganisms. Vancomycin or third-generation cephalosporins are only needed for major complications or other coincident infections extant during the initial presentation.

Acute Disease↗
PubMed2004

Chronological changes of hearing in pediatric patients with large vestibular aqueduct syndrome.

OBJECTIVES: To describe the chronologic changes of hearing in patients with large vestibular aqueduct syndrome (LVAS) and identify the prognostic factors. STUDY DESIGN: A retrospective chart-review study. METHODS: Twelve consecutive patients with LVAS were recruited at Taipei Veterans General Hospital between July 1986 and July 2000. The records of serial pure-tone audiogram and high-resolution computer tomography were collected. The chronologic figures of pure-tone average (PTA) were sketched. The investigated variables included sex, laterality and type of hearing loss (HL), size of vestibular aqueduct, and the chronologic changes and configurations of hearing. Data were analyzed statistically. RESULTS: The degree of HL in early childhood was from moderate to profound. The worst hearing could be estimated by the hearing level in early childhood. Sixteen of 24 ears were stable. Bilateral, chronologically stepwise-downhill hearing occurred in only one patient (1/12) during the follow-up period. Chronologically, high-tone hearings were worse than those of low-tone, but fluctuations of high-tone hearing were smaller than those of low-tone. The sizes of vestibular aqueduct were predictive of the density of major depression and its depth. CONCLUSIONS: LVAS, a congenital disease, is characterized by fluctuating sensorineural HL. Most hearing at PTA remained stable at least in one ear chronologically. The standard deviation of hearing at 500 Hz was the only prognostic factor for the progression of PTA. An enlarged vestibular aqueduct affects fluctuations of hearing, but the pathogenesis of HL still remains unclear and deserves further investigations.

Acoustic Impedance Tests↗
PubMed2004

Facial paralysis caused by metastasis of breast carcinoma to the temporal bone.

Metastatic tumors to the temporal bone are very rare. The most common sites of origin of temporal bone metastases are breast, lung, kidney, gastrointestinal tract, larynx, prostate gland, and thyroid gland. The pathogenesis of spread to the temporal bone is most commonly by the hematogenous route. The common otologic symptoms that manifest with facial nerve paralysis are often thought to be due to a mastoid infection. Here is a report on a case of breast carcinoma presenting with otalgia, otorrhea, and facial paralysis for 2 months. The patient was initially diagnosed as mastoiditis, and later the clinical impression was revised to metastatic breast carcinoma to temporal bone, based on the pathologic findings. Metastatic disease should be considered as a possible etiology in patients with a clinical history of malignant neoplasms presenting with common otologic or vestibular symptoms, especially with facial nerve paralysis.

Aged↗
PubMed2003

Healthy-side dominance of cortical neuromagnetic responses in sudden hearing loss.

Previous brain imaging and mapping studies have reported findings indicating functional reorganization in the central auditory pathways of patients with profound unilateral hearing loss. This study reports for the first time to our knowledge, using a whole-head neuromagnetometer with monaural stimulation of both intact and affected ears, a pattern of healthy-side dominance for cortical neuromagnetic responses in adult patients in the early stage of idiopathic sudden sensorineural hearing loss, and a pattern of contralateral dominance is verified in controls.

Adult↗
PubMed2003

Congenital ossicular anomalies.

BACKGROUND: Congenital ossicular anomalies include abnormalities of either one isolated ossicle or a combination of more than one. We report our patients with this condition and relate the findings to Cremers' classification. METHODS: Chart records of patients with congenital ossicular anomalies who received exploratory tympanotomies from 1993 to 2001 were collected. The pre-operative hearing assessment, operative findings, reconstructive types and post-operative hearing results were reviewed retrospectively. RESULTS: Seventeen cases of ears that underwent exploratory tympanotomy were included in this study. The stapes was the most frequently involved ossicle. Six patients (35.3%) had isolated stapes anomalies, 8 (47%) had incus and stapes anomalies, and all of the remaining patients had anomalies in all 3 ossicles. According to Cremers' proposed classification, the distribution of our cases was as follows: 3 in Class 1, 6 in Class 2, 5 in Class 3, and 3 in Class 4. In 13 cases, the affected ears also underwent reconstructive procedures, including 6 stapedotomies, 6 ossiculoplasties, and 1 labyrinthotomy. The post-operative hearing improvement in air conduction was 28.7 dB. CONCLUSIONS: Patients with congenital ossicular anomalies often present with associated middle and inner ear abnormalities. Some patients could benefit from ossicular reconstruction. Cremers' classification is useful in categorizing the operative findings and the reconstruction. The status of the stapes may be a reference for other associated middle ear anomalies.

Adolescent↗
PubMed2003

Managements of complicated otitic abscess.

The advent of antibiotics has significantly reduced the incidence and associated morbidity of otogenic complications. Its presentation, however, has dramatically changed and appears as a masked condition despite the presence of a potentially fatal complication. Between 1998 and 2001, 3 cases of otitic abscesses, including mastoid subperiosteal abscess, zygomatic abscess, and retropharyngeal abscess, were collected retrospectively. Their clinical presentation, results of investigations, and response to treatment were reviewed. After admission, intravenous antibiotics were prescribed and early surgeries were performed for eradication of infection source. The patients exhibited excellent postoperative recovery, without facial palsy, vertigo or other complications. To be a contemporary otologist, we should not overlook such severe complications of otologic diseases. Appropriate intravenous antibiotics and adequate surgeries, as soon as possible, are recommended. Advanced magnetic resonance imaging or computed tomographic scans of the temporal bone with wider windows are necessary.

Abscess↗
PubMed2002

Confirming pure-tone thresholds by auditory brainstem response in the geriatric population.

BACKGROUND: The aged people seeking otological consultation tend to increase for the purpose of applying for hearing disability certificate. When the subjective pure-tone thresholds (PTTs) are unreliable due to patient incooporation, the objective click auditory brainstem response (ABR) is used to confirm the hearing thresholds. In this study, we assess the accuracy of ABR thresholds in the aged and determine the "ABR confirmation criteria" for normal hearing and hearing handicap. METHODS: This is a prospective study. ABR thresholds were compared with pure-tone thresholds (PTTs) in 100 ears of 50 subjects over 60 years of age using kappa measure of agreement. Based on receiver operating characteristic (ROC) curve and positive likelihood ratio (LR), the most appropriate "ABR confirmation criteria" for normal hearing and hearing handicap were determined. RESULTS: According to kappa statistics, the agreement between ABR thresholds and PTTs is better in the 2- to 4-kHz region. For normal hearing, the agreement is best when confirming the average PTTs of 2, 3 and 4 kHz by the ABR threshold of 25 dB nHL (K = 0.53, p < 0.001). For hearing handicap, the agreement is best when confirming the PTTs of 3 kHz by the ABR threshold of 55 dB nHL (K = 0.60, p < 0.001). Based on ROC curve and positive LR, the ABR accuracy, for normal hearing, is excellent at a cutoff of 30 dB nHL compared with the average PTT of 2, 3 and 4 kHz. For hearing handicap, the ABR accuracy is best in excess of 55 dB nHL compared with the PTT at 3 kHz. CONCLUSIONS: We conclude that ABR is a useful diagnostic tool to confirm the validity of pure-tone audiogram for presbycusis.

Aged↗
PubMed2002

Auricle angioleiomyoma.

Angioleiomyomas are subcutaneous benign tumors composed of numerous blood vessels with disoriented and hyperplasic smooth muscle layers. The incidence in female is higher than in male, with a ratio of 1.7 to 1.0. They are usually located at the lower extremities and rarely located at head and neck region. The case we report is a 66-year old male patient. The chief complaint was a brownish tumor over helix of left auricle with progressive enlargement noted for three years. Physical examination revealed an elastic, non-tender nodular lesion 15 x 15 x 6 mm in size and ovoid in shape. No other similar lesion was found on his face, neck and extremities. The tumor was excised entirely with clear margins. The diagnosis was angioleiomyoma via histology.

Aged↗
PubMed2002

Hearing screening with portable screening pure-tone audiometer and distortion-product otoacoustic emissions.

BACKGROUND: Hearing loss is a prevalent chronic problem among adults of all ages. Early identification and intervention for hearing loss will reduce the magnitude of functional disability. Hearing screening is an important item of physical examination. The purpose of this study is to evaluate the validity of hearing screening by means of the portable screening pure-tone audiometer and distortion-product otoacoustic emissions (DPOAE) measurement. METHODS: This prospective study recruited 64 subjects visiting Taipei Veterans Hospital for physical examination. They underwent hearing tests performed with screening pure-tone audiometer, DPOAE and conventional pure-tone audiometer. The results of conventional pure-tone audiometry were used for "gold standards" and the normal auditory function was defined as the threshold less than or equal to 20 dB. Compared with the "gold standards," we used kappa statistic to assess the agreement of hearing results measured with screening pure-tone audiometer and DPOAE. RESULTS: For screening pure-tone audiometry, the kappa values at the 5 tested frequencies (0.5, 1, 2, 4, 8 kHz) ranged from 0.79 to 0.93 and the agreement with the gold standards was classified as "excellent." The sensitivity, specificity and test accuracy values ranged from 91.8-98.5%, 88.0-96.3% and 89.8-96.9%, respectively. For DPOAE measurement, the kappa values at the 3 tested frequencies (1, 2, 4 kHz) ranged from 0.62 to 0.78. The agreement was classified as "good" at 1, 4 kHz and "excellent" at 2 kHz. The sensitivity, specificity and test accuracy values ranged from 91.7-98.5%, 62.3-86.8% and 81.3-89.1%. CONCLUSIONS: We recommend a hearing screening measured at 0.5, 1, 2, 4, 8 kHz with screening pure-tone audiometer in a simple-type soundproof chamber and performed by a screening assistant. The DPOAE measurement may be used as an auxiliary tool to provide more information for early identification and differential diagnosis of hearing loss in clinical application.

Adult↗
PubMed2002

Diagnostic methods for otitis media with effusion in children.

BACKGROUND: Correct diagnosis of otitis media with effusion (OME) in children is imperative for instituting appropriate treatment. This study aims to establish the diagnostic value of pneumatic otoscopy, tympanometry, acoustic reflectometry and videotelescopy by comparing them with myringotomy findings. METHODS: Between November 1999 and July 2001, we conducted a prospective study on diagnosis of OME in children. The children studied were candidates for ventilation tube insertions or other ENT surgeries. All tests, including acoustic reflectometry, tympanometry, pneumatic otoscopy and videotelescopy, were performed two days before surgery. Myringotomy or tympanocentesis was then performed to confirm the presence or absence of OME. A type B tympanogram was accepted as a predictor of effusion. The curve angle of acoustic reflectometry with cut-point of 69 degrees (< or = 69 degrees) was also used to predict the presence of OME. RESULTS: Eighty-nine children (58 males and 31 females), ranging in age from 1 to 13 years, participated in the study. Of 172 ears assessed in the study, middle ear effusion was detected in 124; the remaining 47 ears were found to be dry at myringotomy or tympanocentesis. Videotelescopy gave the highest sensitivity, specificity and accuracy, followed by pneumatic otoscopy, tympanometry and acoustic reflectometry. CONCLUSIONS: Videotelescopy seems to have the potential to become the standard for diagnosis of OME in children and for validation of pneumatic otoscopy. When videotelescopy is not available, tympanometry could be an instrumental adjunct to pneumatic otoscopy. Although acoustic reflectometry gave the worst results, it is still useful for assessing and screening OME in children because of the ease and speed of its operation irrespective of crying, cerumen, an air seal in the ear, or lack of cooperation from the young children.

Acoustic Impedance Tests↗