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Pa-Chun Wang

Publications and source records attributed to Pa-Chun Wang.

At least 37 records · Page 2Linked to original sources
PubMed2004

Preoperative evaluation of bone destruction using three-dimensional computed tomography in cholesteatoma.

This study investigated the usefulness of three-dimensional computed tomography (3DCT) in the evaluation of bony defects caused by cholesteatoma. Fifteen patients with chronic otitis media with cholesteatoma who showed bony destruction or suspicious destruction in two-dimensional CT were examined using 3DCT. The CT data were transferred to a workstation with a real-time image processor. We used three-dimensional reconstruction software enabling image processing. In all patients, 3DCT clearly delineated the destruction of bony structures by cholesteatoma. The 3DCT-generated images provided spatial relationships, which were not easily appreciated on two-dimensional CT. Intraoperative bony destruction findings correlated with 3DCT findings. From these results, 3DCT could be useful to evaluate the invasiveness of cholesteatoma to the cranial base. It could also be helpful in planning reconstruction during surgery.

Adult↗
PubMed2004

Scanning electron microscope and energy dispersive X-ray spectrometry studies on the material surface of extruded Polycel ossicular prostheses.

BACKGROUND: The cause of ossicular prosthesis extrusion remains an issue of interest to many otologists. This study evaluated the change in material surfaces and chemical elements of extruded total ossicular replacement prostheses (TORPs) and partial ossicular replacement prostheses (PORPs). METHODS: A total of nine extruded Polycel ossicular prostheses (four TORPs, five PORPs) from nine patients was investigated using scanning electron microscope and energy dispersive X-ray spectrometry (EDX). Three prostheses (TORPs) obtained during revision surgery for hearing restoration were used as control subjects for EDX study. RESULTS: All subjects from the study group showed loss of fibrous capsule at both platform and shaft in the extruded prostheses. In comparison with the control group, the extruded prostheses had a lower level of carbon element (Wilcoxon signed-rank test, p < 0.05). CONCLUSION: Loss of fibrous capsule and micro-degradation are probably two of the many factors that contribute to the extrusion of ossicular prostheses.

Carbon↗
PubMed2004

Nasal septal abscess as a complication of laser inferior turbinectomy.

Postoperative infections are infrequent following laser inferior turbinate surgery. We report a 52-year-old man with a Klebsiella pneumoniae nasal septal abscess as a complication of potassium-titanium-phosphate 532-nm laser turbinectomy. To our knowledge, this is the first report of such a potentially serious complication resulting from minor ambulatory intranasal surgery. The clinical presentation, pathogenesis, and management of nasal septal abscesses are discussed.

Abscess↗
PubMed2004

Influence of suction tube noise on hearing in pediatric patients who received ventilation tube insertion.

BACKGROUND: Myringotomy with ventilation tube insertion is the most frequently used surgical procedure performed on children to treat otitis media with effusion. The risk of acoustic trauma caused by the suctioning noise during the procedure has not been clearly understood. The objective of this study was to investigate whether the suctioning noise during ventilation tube placement procedure damaged children's hearing. METHODS: The study was conducted in a prospective manner. The ventilation tube placement procedures were performed on a series of 30 consecutive patients (60 ears). The electro-acoustic signals of the suctioning noises during the procedure were analyzed using a high quality digital tape recording system. The hearing threshold was measured using pure tone audiometry before and after the procedures. RESULTS: The peak intensity of the suctioning noise ranged from 4 kHz to 10 kHz in frequency. The mean intensities of the suctioning noise were 86.4 +/- 9.6 dB for serous effusion and 96.4 +/- 9.6 dB for mucoid effusion, respectively. No noise-induced sensori-neural hearing loss was observed in this cohort. CONCLUSIONS: Even though the peak intensity of the suctioning noise may reach a level of more than 90 dB, it is not likely that the suctioning noise during the ventilation tube placement procedure causes noise-induced sensori-neural hearing loss.

Adolescent↗
PubMed2003

Use of patient satisfaction data in a continuous quality improvement program for endoscopic sinus surgery.

OBJECTIVE: Continuous quality improvement (CQI) is an effort by health care providers to improve the quality of service by continuously exceeding patients' expectations. Patient satisfaction is one of the measures of the quality of care. The aims of this study were to report the patients' evaluation of endoscopic sinus surgery (ESS) and to explore the feasibility in using patient satisfaction data in the CQI program for ESS. METHODS: Eighty-three patients completed a validated patient satisfaction survey (PSS) 1 month after undergoing ESS. Logistic regression models were applied to determine the confounders of patient satisfaction. RESULTS: In general, 72% of patients were very satisfied with the services. Education level and milder disease correlated with higher overall satisfaction levels (P </= 0.01). Anesthesia, the addition of nasal septal surgery, intranasal packing, and postoperative sinuscopy had significant impacts on patient satisfaction (P < 0.05). CONCLUSION: ESS is a good technique to evaluate for implementing efforts in quality improvement. Confounding factors need to be adjusted before patient satisfaction data can be used in a CQI program.

Adolescent↗
PubMed2003

Use of 3-dimensional computed tomography scan to evaluate upper airway patency for patients undergoing sleep-disordered breathing surgery.

OBJECTIVE: Our goal was to investigate the correlation between upper airway 3-dimensional computed tomography (3-D CT) measurements and polysomnography data of patients with sleep-disordered breathing (SDB). Study design and setting The 3-D CT scan measurements of the retropalatal space (RP), lateral and anteroposterior diameters of RP, retroglossal space, uvular thickness, and volume of upper airway were taken prospectively from 194 consecutive SDB patients. These were correlated with patients' respective Respiratory Distress Index (RDI), snoring index, and lowest arterial oxygen saturation gathered from polysomnographic data. RESULTS: RP (r = -0.27, P = 0.0001) and lateral diameter (P = 0.0073) were significantly correlated with RDI. Multivariate regression model (R(2) = 0.286) demonstrates RP (P = 0.0036) and retroglossal space (P = 0.027) to be predictive of RDI. No 3-D CT parameters correlated with snoring index and lowest arterial oxygen saturation attained statistical significant. CONCLUSION: The 3-D CT scan measurements can be valuable in evaluating upper airway patency in patients with SDB. The RP was the most relevant upper airway anatomic structure identified in these patients. SIGNIFICANCE: Modification of palatal surgery to increase the lateral dimension of the RP may be a breakthrough in increasing its success rate.

Adult↗
PubMed2003

Comparisons of two intranasal corticosteroid preparations in treating allergic rhinitis.

OBJECTIVES: Intranasal corticosteroid preparations can relieve symptoms of allergic rhinitis. Different aqueous corticosteroid forms have been developed for intranasal use. The objectives of this study were to compare efficacy and safety between fluticasone propionate and budesonide in the treatment for patients with allergic rhinitis. METHODS: The study was conducted in a prospective and randomized manner; a total of 24 adult patients were enrolled. All patients received MAST allergen test at entry and again at 2 months after treatments. Fourteen patients received fluticasone propionate 200 microg once daily, and 10 patients received budesonide 200 microg twice daily. To investigate the efficacy of fluticasone propionate and budesonide, a subjective scoring system was designed to evaluate the symptom improvement of patients. Adverse events were recorded on a diary card then were analyzed. Mann-Whitney U test and Kruskal-Wallis 1-way analysis of variance were used for statistical analysis. RESULTS: Analysis on patient-based symptom scores revealed that both fluticasone propionate and budesonide were equally efficacious in improving the symptoms of nasal blockage, sneezing, nasal itching, and watery rhinorrhea. There were no significant side effects reported for both groups during this follow-up period. However, analysis showed that the fluticasone propionate group demonstrated significantly greater improvement in some MAST allergen tests (Candida, mite, house dust; P < 0.05). CONCLUSION: Clinically, fluticasone propionate 200 microg once daily was efficacious as budesonide 200 microg twice daily in the relief of allergic rhinitis symptoms. However, fluticasone propionate can achieve greater immunologic improvement. Both preparations showed no evidence of short-term side effects.

Administration, Intranasal↗
PubMed2003

Quality of life in Taiwanese adults with chronic rhino-sinusitis.

BACKGROUND AND PURPOSE: Chronic rhino-sinusitis (CRS) is a disease in prevalence. This study evaluates the impact of this disorder to Taiwanese patients' general and sinus-related health status among Taiwanese patients with CRS. METHODS: A total of 201 consecutive CRS patients (male:female: 107:94, mean age: 40.1 +/- 14.6 years) seeking otolaryngological care at a tertiary referral medical center were recruited. Quality of life was measured by a Taiwan Standard Version of the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and a Chinese version Chronic Sinusitis Survey (CCSS). Patients were administered with the SF-36 and CCSS preoperatively. RESULTS: CRS has a significant impact on patients in seven of the eight domains of SF-36: role-physical (88.9 +/- 24.7), bodily pain (70.3 +/- 22.6), general health (56.1 +/- 11.6), social functioning (79.3 +/- 21.6), vitality (56.4 +/- 19.1), role-emotional (57.7 +/- 42.1), and mental health (48.4 +/- 17.2) subscores of CRS patients are all in significant decrement (p < 0.05) as compared with the data derived from Taiwanese general population. Physical functioning is the only domain without impact. Significant decrements (p < 0.05) are also observed in symptom subscale (43.3 +/- 27.8), medication subscale (80.3 +/- 26.4), and total survey score (63 +/- 20.3) of the CCSS as compared to the healthy subjects. The severity of CRS is significantly predictive (p < 0.05, R2 = 0.34) of CCSS. CONCLUSIONS: CRS has considerable impacts on a patient's sinus-related quality of life, as well as on their general health status.

Adult↗
PubMed2003

Endoscope-assisted KTP laser sinus clear-out procedure for recurrent ethmoid polyposis.

BACKGROUND DATA AND OBJECTIVE: Surgery for recurrent sinusitis with diffuse polyposis is challenging since tortuous sinus anatomy and bleeding tendency can make revision surgery particularly difficult. We report the efficacy in using KTP laser under the assistance of endoscope to perform sinus clear-out procedure for patients with recurrent ethmoid polyposis. MATERIALS AND METHODS: Thirteen patients with recurrent ethmoid polyposis underwent this procedure between November 1996 and July 2000. All were available for follow-up. Patients all had a KTP sinus clear-out procedure (15-20 W continuous mode, spot size 0.4-0.8 mm, contact or near-contact approaches) assisted by endoscope. Sinus endoscopic findings, CAT scan data, operation records and perioperative courses were retrospectively reviewed. The mean follow-up period was 24.7 +/- 11 months. RESULTS: Surgeries all went smoothly with minimal bleeding incurred. All patients demonstrated significant improvement in their sinonasal symptoms. Two cases (15.4%) had localized recurrent polyps. CONCLUSION: With its excellent capabilities in hemostasis, great intra-nasal maneuverability, and flexible operation modes, KTP laser is an ideal alternative to manage recurrent ethmoid polyposis for selected cases.

Adult↗
PubMed2003

Validation assessment of the Chinese-version Chronic Ear Survey: a comparison between data from English and Chinese versions.

The Chronic Ear Survey (CES) is a valid, disease-specific measure for the evaluation of health status and treatment effectiveness for adults with chronic suppurative otitis media (CSOM). This study compares the validation properties of the English and Chinese versions of the CES. The CES was translated into Mandarin Chinese by means of a parallel model. The Chinese version of the CES (CCES) was administered to 103 patients in a prospective manner, then was validated according to established criteria for reliability, validity, and longitudinal sensitivity. The CCES demonstrated good test-retest reliability and internal consistency (Cronbach's a = 0.81). The CCES significantly correlated with the Mandarin Chinese (Taiwan) version of the generic 36-Item Short-Form Health Survey (TSF-36). The standardized response mean for the CCES total score was 2.1, indicating excellent sensitivity to clinical change. This validation study demonstrated that the performance characteristics of the CCES were equivalent to those of the English-version CES. The CCES is a valid tool for evaluation of adults with CSOM among the Chinese-speaking population.

Activities of Daily Living↗
PubMed2003

Pneumolabyrinth associated with perilymph fistula.

Pneumolabyrinth associated with perilymph fistula, especially with the presence of air in the cochlea, has rarely been identified using imaging study. We present a 24-year-old woman who experienced right fluctuating sensorineural hearing impairment and dis-equilibrium after sustaining an open-handed slap on the right side of her face. The diagnosis of pneumolabyrinth was established through the detection of air bubbles in the right basal turn of cochlea using high-resolution computerized tomography. Right side exploratory tympanotomy confirmed the presence of a perilymph fistula. The patient was free of symptoms after surgery. Early fistula repair was beneficial in this case.

Adult↗
PubMed2002

Validation of the snore outcomes survey for patients with sleep-disordered breathing.

OBJECTIVE: To develop and validate a self-reported outcomes measure for patients with sleep-disordered breathing-the Snore Outcomes Survey. DESIGN: Item areas of the SOS were developed by an expert panel. Consecutive patients were enrolled into the study in a prospective manner. Patients received the SOS, the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Medical Outcomes Study 36-Item Short-Form Health Survey, and standard overnight polysomnography at baseline and after 4 months of continuous positive airway pressure therapy. SETTING: A tertiary care, academic otolaryngology and sleep disorders referral center. PATIENTS: One hundred fifty-six adult patients presenting with a chief complaint of snoring or sleep-disordered breathing to the Massachusetts Eye and Ear Infirmary, Boston. MAIN OUTCOME MEASURES: Test-retest reliability, intrasurvey reliability, internal consistency, validity, and standardized response means of the SOS. RESULTS: Overall, reliability of the SOS was excellent (test-retest reliability r = 0.86; P<.001; Cronbach alpha coefficient, 0.85). The SOS index significantly correlated with the Epworth Sleepiness Scale (r = - 0.42; P<.001) and the global Pittsburgh Sleep Quality Index score (r = - 0.38; P<.001), as well as with the number of recorded arterial oxygen saturation levels below 85% (r = - 0.46; P =.02). The SOS index was sensitive to clinical changes after intervention (standardized response mean, 0.57). CONCLUSION: The SOS is a reliable and valid instrument for assessing sleep-related health status for patients with snoring and sleep-disordered breathing and for measuring change in health status following therapy.

Adult↗
PubMed2002

Validation assessment of the Chinese version of the Snore Outcomes Survey.

The aim of this study was to use a parallel model to translate the Snore Outcomes Survey (SOS) into Mandarin Chinese language by comparing performing characteristics and statistical properties of the original and Chinese versions SOS. The Chinese version SOS (CSOS) was validated in a prospective, non-randomized manner. A total of 359 patients with sleep-disordered breathing (SDB) aged 18 years and older diagnosed as having SDB participated in the study at entry. Reliability, validity, and longitudinal sensitivity data for CSOS were obtained. CSOS demonstrated good test-retest reliability (Intra-class correlation coefficient = 0.751). The Cronbach's alpha coefficient was 0.86. The item-total correlation coefficients varied from 0.30 to 0.99. The CSOS correlated well with polysomnogram (PSG) parameters including respiratory distress index (RDI), lowest arterial O2 saturation (LAST). CSOS also yielded significant correlations with vitality subscale of Chinese Taiwan version SF-36 (r = 0.4, p = 0.0011). The standard response mean (SRM) for CSOS was 1.33. The validation demonstrated only minor effects of language; the statistical properties of the CSOS were equivalent to the English version. The CSOS is a valid tool to evaluate adults with SDB among Chinese-speaking population.

Adult↗
PubMed2002

Validation of a Chinese version of the Epworth sleepiness scale.

Epworth sleepiness scale (ESS) is widely used to evaluate degree of somnolence among Chinese patients with sleep-disordered breathing. Yet no Mandarin-Chinese translation has ever reported its validation data. In this study we translated and validated the ESS into Mandarin Chinese (CESS). We found, in 31 bilingual patients' responses to the CESS and the English ESS obtained 1-2 weeks apart did not differ significantly (10.5 +/- 3.7 vs. 9.6 +/- 3.9, p = 0.32, Wilcoxon's signed rank test) and were significantly correlated (Spearman's p = 0.67, p = 0.0004). A total of 359 sleep-disordered breathing subjects were enrolled into the validation study in a prospective manner. The CESS showed acceptable internal consistency (Cronbach's alpha = 0.81). Thirty out of these patients answered CESS twice at an interval of 2-4 weeks, to yield an acceptable level of test-retest reliability (p = 0.74, p = 0.001). The respiratory disturbance indices obtained from 251 out of 359 subjects were significantly correlated with their CESS scores (p = 0.22, p < 0.001). The standard response mean of CESS was 0.86 as obtained from 94 out of 359 subjects who had initial control of their symptoms at 3 months after radio-frequency palate surgery. We conclude that the CESS is reliable in both a linguistic and a test-retest sense, and appears to be valid and sensitive to clinical change. The CESS could be used to advantage among other Mandarin-speaking subjects as a standardised screening test of sleepiness in daily life.

Adult↗
PubMed2002

Outcome predictors for endoscopic sinus surgery.

OBJECTIVE: The outcomes management of endoscopic sinus surgery (ESS) is a major effort to improve the quality of chronic sinusitis treatment. The objective of this study was to investigate the factors that may predict a variety of outcomes of ESS. STUDY DESIGN AND SETTING: Two hundred and thirty consecutive patients who underwent ESS were prospectively evaluated by computerized axial tomography scan of the sinus and a validated chronic sinusitis survey (CSS) before surgery. The effects of prognostic factors were then investigated. RESULTS: Extent of disease was a consistent predictor (P < 0.05) for bleeding, complication occurrence, medical resource utilization, subjective sinus-specific health status, and physicians' objective evaluation of surgical outcomes. The preoperative CSS total score and extent of disease significantly (P < 0.05) predicted the postoperative CSS total score. Subjective and objective outcomes were significantly correlated (r = 0.58, P = 0.0001). These findings suggested the necessity of disease severity stratification when reporting ESS outcomes. CONCLUSION: Operation-related events, medical resource utilization, physician evaluation, and sinus-specific health status of patients are all integral parts of reporting outcomes of ESS. We have concluded that computerized axial tomography scan of the sinuses and CSS are efficient ways of providing reliable baseline information before ESS.

Adult↗
PubMed2002

Translation and validation assessment of the Chinese version of the chronic sinusitis survey.

BACKGROUND: The Chronic Sinusitis Survey (CSS) is a valid, disease-specific measure for evaluating the health status and treatment effectiveness of adults with chronic rhinosinusitis (CRS). In this study, we developed a Chinese version of the CSS (CCSS) which provides the psychometric properties of the Chinese CSS. METHODS: The CSS was translated into Chinese using a parallel model. The CCSS was administered to 198 patients in a prospective manner, and was validated in order to establish its reliability and validity. RESULTS: The CCSS demonstrated good test-retest reliability (correlation coefficient = 0.6-0.89, p=0.0001) and internal consistency (Cronbach's alpha =0.76). The CCSS results were significantly correlated with bodily pain (BP), general health (GH), role-emotional (RE), and mental health (MH) subscales of the Chinese (Taiwan) version of the generic 36-item Short-Form Health Survey (TSF-36). The standardized response mean for the CCSS total score was 0.75, indicating good sensitivity to clinical change. CONCLUSIONS: This validation study demonstrates that the performance characteristics of the CCSS meet the criteria for a valid measure. The CCSS is a valid tool to evaluate adults with CRS among Mandarin-speaking populations.

Chronic Disease↗
PubMedDate not supplied

Three-dimensional computed tomography and polysomnography findings after extended uvulopalatal flap surgery for obstructive sleep apnea.

OBJECTIVES: Using both sleep physiological parameters and image data to evaluate the efficacy of extended uvulopalatal flap (EUPF) surgery in the treatment of obstructive sleep apnea (OSA). MATERIAL AND METHODS: Fifty patients with OSA underwent EUPF that consisted of bilateral tonsillectomy, dissection and removal of the submucosal adipose tissue of the soft palate and supratonsillar areas, and imbrications and repositioning of the denuded uvulopalatal flap. Polysomnography (PSG) and 3-dimensional computed tomography (3-D CT) data were obtained at baseline and 6 months postoperatively. Good response to surgery was defined as a reduction of the respiratory disturbance index (RDI) to less than 20 events/h and a greater than 50% reduction of the baseline RDI. RESULTS: Forty-two patients (84%) achieved good results. The RDI and minimal O2 saturation improved significantly (P<.0001) after EUPF. The postoperative 3-D CT evaluation showed a significant increase in the retropalatal space (P<.0001). The preoperative lateral diameter of retropalatal space was predictive of the change of RDI (R2=0.15, P=.05). The effect of increased retropalatal space (r=0.59, P=.0415) was significant in patients with baseline RDI ranged from 31 to 60 events/h. CONCLUSIONS: With special emphasis on the removal of palatal fat, EUPF appeared to be effective in the reduction of sleep apnea in selected patients. 3-D CT proved that this technique was effective in widening the upper airway by relieving the retropalatal obstruction.

Adult↗