Chung-feng Hwang - Academia.edu (original) (raw)

Papers by Chung-feng Hwang

Research paper thumbnail of Clinical Significance of the Neural Response Telemetric Thresholds in Mandarin-speaking Cochlear Implant Patients

Journal of the Chinese Medical Association

Research paper thumbnail of Expression of circadian clock genes in leukocytes of patients with Meniere's disease

Laryngoscope Investigative Otolaryngology

Research paper thumbnail of Data for: Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial

This study enrolled patients who visited our ENT out-patient department with the primary complain... more This study enrolled patients who visited our ENT out-patient department with the primary complaint of tinnitus more than 6 months. A full medical history assessment was performed, and each patient underwent an otoscopic examination, a basic audiologic evaluation. A full medical history assessment was performed, and each patient completed the NIHL questionnaire (Supplementary S1), audiogram, tympanogram, speech discrimination test, distortion product otoacoustic emissions (DPOAE) testing, pitch and loudness match of the tinnitus, Tinnitus Handicap Inventory (THI) and serum zinc level analyses. All tests were repeated after 2 months of treatment with zinc gluconate (Zinga 78 mg, 10 mg elemental zinc), two tablets twice per day (40 mg per day).

Research paper thumbnail of Hearing Features and Cochlear Implantation Outcomes in Patients With Pathogenic MYO15A Variants

Ear & Hearing

OBJECTIVES Recessive variants in the MYO15A gene constitute an important cause of sensorineural h... more OBJECTIVES Recessive variants in the MYO15A gene constitute an important cause of sensorineural hearing impairment (SNHI). However, the clinical features of MYO15A-related SNHI have not been systemically investigated. This study aimed to delineate the hearing features and outcomes in patients with pathogenic MYO15A variants. DESIGN This study recruited 40 patients with biallelic MYO15A variants from 31 unrelated families. The patients were grouped based on the presence of N-terminal domain variants (N variants). The longitudinal audiological data and for those undergoing cochlear implantation, the auditory and speech performance with cochlear implants, were ascertained and compared between patients with different genotypes. RESULTS At the first audiometric examination, 32 patients (80.0%) presented with severe to profound SNHI. Patients with at least one allele of the N variant exhibited significantly better hearing levels than those with biallelic non-N variants (78.2 ± 23.9 dBHL and 94.7 ± 22.8 dBHL, respectively) (p = 0.033). Progressive SNHI was observed in 82.4% of patients with non-profound SNHI, in whom the average progression rate of hearing loss was 6.3 ± 4.8 dBHL/year irrespective of the genotypes. Most of the 25 patients who underwent cochlear implantation exhibited favorable auditory and speech performances post-implantation. CONCLUSIONS The hearing features of patients with biallelic pathogenic MYO15A variants are characterized by severe to profound SNHI, rapid hearing progression, and favorable outcomes with cochlear implants. Periodic auditory monitoring is warranted for these patients to enable early intervention.

Research paper thumbnail of Extraosseous ewing sarcoma of the tonsil

Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2012

Research paper thumbnail of The comparison of Mandarin speech identification and tone identification between ACE and CIS speech processing strategy

Research paper thumbnail of Data for pressure ulcers and skin infections after cochlear implantation

Data in Brief

This article contains data concerning the research article entitled "Pressure ulcers and skin inf... more This article contains data concerning the research article entitled "Pressure ulcers and skin infections after cochlear implantation: A delayed yet serious issue" (Hui-Shan Hsieh, Chee-Yee Lee, Hung-Pin Wu, Ming-Ying Zhuo, and Chung-Feng Hwang) [1]. This data article reports the causes of skin flap pressure ulcer over the antenna site and protocol for the clinical managements. The patients with cochlear implant (n = 315) were enrolled. We used the National Pressure Ulcer Advisory Panel (NPUAP) pressure injury staging system to grade injury severity in all patients. The data included in this article are as follows: the clinical characteristics of patients, baselines variables between groups with and without pressure ulcer, the severity of skin flap reactions based on the NPUAP pressure injury system and corresponding interventions, related clinical details of patients with pressure ulcer, This article will be valuable for routine clinical practice as serving as a paradigm.

Research paper thumbnail of Constant Light Dysregulates Cochlear Circadian Clock and Exacerbates Noise-Induced Hearing Loss

International Journal of Molecular Sciences

Noise-induced hearing loss is one of the major causes of acquired sensorineural hearing loss in m... more Noise-induced hearing loss is one of the major causes of acquired sensorineural hearing loss in modern society. While people with excessive exposure to noise are frequently the population with a lifestyle of irregular circadian rhythms, the effects of circadian dysregulation on the auditory system are still little known. Here, we disturbed the circadian clock in the cochlea of male CBA/CaJ mice by constant light (LL) or constant dark. LL significantly repressed circadian rhythmicity of circadian clock genes Per1, Per2, Rev-erbα, Bmal1, and Clock in the cochlea, whereas the auditory brainstem response thresholds were unaffected. After exposure to low-intensity (92 dB) noise, mice under LL condition initially showed similar temporary threshold shifts to mice under normal light–dark cycle, and mice under both conditions returned to normal thresholds after 3 weeks. However, LL augmented high-intensity (106 dB) noise-induced permanent threshold shifts, particularly at 32 kHz. The loss of...

Research paper thumbnail of Prognostic Factors for Hearing Outcomes in Children with Cleft Lip and Palate

Plastic and Reconstructive Surgery

Background: This study was performed to investigate the prognostic factors that influence hearing... more Background: This study was performed to investigate the prognostic factors that influence hearing outcomes of children with cleft lip and palate after ventilation tube insertion. Methods: The authors retrospectively reviewed the hearing thresholds of 90 children with cleft lip and palate and performed univariate and multivariate analyses of five prognostic factors for hearing outcomes: age at palatoplasty, age at first ventilation tube insertion, timing of ventilation tube insertion, frequency of ventilation tube insertion, and type of cleft palate. Results: On univariate analysis, the authors found that older age at palatoplasty (p = 0.002), older age at first ventilation tube insertion (p = 0.025), and increased frequency of ventilation tube insertion (p = 0.048) were significant prognostic factors for poorer hearing outcomes in children with cleft lip and palate. Multiple logistic regression analysis showed that late palatoplasty (age older than 1 year) was the most influential factor for poor hearing outcome (OR, 2.83), followed by two or more ventilation tube insertions (OR, 1.94). Conclusion: The age at palatoplasty and frequency of ventilation tube insertion were found to be significant prognostic factors influencing hearing outcomes in children with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Research paper thumbnail of ELF-1 expression in nasopharyngeal carcinoma facilitates proliferation and metastasis of cancer cells via modulation of CCL2/CCR2 signaling

Cancer Management and Research

Background: Nasopharyngeal carcinoma (NPC) is a prevalent malignant tumor in Southeast Asia. The ... more Background: Nasopharyngeal carcinoma (NPC) is a prevalent malignant tumor in Southeast Asia. The management of NPC has remained a challenge until now. ELF-1 is a member of the ETS family of transcription factors that regulate genes involved in cellular growth. ELF-1 expression has been reported in various cancers and is required for tumor growth and angiogenesis; however, its function in NPC remains unclear. In the present study, we characterized the role and underlying mechanism of ELF-1 in NPC. Methods: The biological functions of ELF-1 in NPC cells such as proliferation, migration, invasion, and drug resistance were investigated using MTT, BrdU incorporation, and Transwell assays. To gain more insight into the mechanism of ELF-1 in NPC, we analyzed CCL2/CCR2 signaling by Western blotting, ELISA, siRNAs, and CCR2 antagonist. Results: Gain-of-function of ELF-1 in TW01 and TW04 cells promoted NPC cell proliferation, BrdU incorporation, migration, invasion and cisplatin resistance. By contrast, knockdown of ELF-1 produced opposite results. Overexpression of ELF-1 enhanced the expression of CCL2 via binding to its promoter region and increased the level of the extracellular matrix protein CCL2 in cell culture medium. ELF-1 expression also modulated the downstream targets of CCL2/CCR2 signaling. Most importantly, ELF-1-induced NPC malignant phenotypes were abrogated by a CCR2 inhibitor, implying that the CCL2/CCR2 signaling axis was involved in ELF-1-mediated regulation in NPC. Conclusion: Our data suggest that ELF-1 plays an oncogenic role in NPC development associated with the CCL2/CCR2 signaling pathway and may therefore be a potential target for NPC therapy.

Research paper thumbnail of Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial

Biomedical Journal

Background: Zinc plays a vital antioxidant role in human metabolism. Recent studies have demonstr... more Background: Zinc plays a vital antioxidant role in human metabolism. Recent studies have demonstrated a correlation between noise-induced hearing loss (NIHL) and oxidative injury; however, no investigation has focused specifically on the subgroup of NIHL associated tinnitus patients. We aimed to evaluate the effectiveness of zinc supplementation in treating NIHL associated tinnitus. Methods: Twenty patients with tinnitus and a typical NIHL audiogram (38 ears) were included in this study. Another 20 healthy subjects were used as the control group. A full medical history assessment was performed, and each subject underwent an otoscopic examination, basic audiologic evaluation, distortion product otoacoustic emissions (DPOAEs), tinnitus-match testing, Tinnitus Handicap Inventory (THI) and serum zinc level analyses. After 2 months of treatment with zinc, all tests were repeated. Results: There was a significant difference between pretreatment and post-treatment within the tinnitus group (73.6 vs. 84.6 mg/dl). The pre-and post-treatment difference in serum zinc was significantly higher in the young group (&50 years) compared to the old group (19.4 ± 11.4 vs. 2.6 ± 9.2 mg/dl, respectively; p ¼ 0.002). There were no statistically significant differences in hearing thresholds, speech reception thresholds, or tinnitus frequency and loudness results before and after treatment. In addition, 17 patients (85%) showed statistically significant improvement of THI-total scores post-treatment, from 38.3 to 30 (p ¼ 0.024). Conclusions: Zinc oral supplementation elevated serum zinc levels, especially in younger patients. THI scores improved significantly following zinc treatment in patients with NIHL associated tinnitus. However, no improvements in objective hearing parameters were observed.

Research paper thumbnail of Intratympanic Dexamethasone and HBO for Sudden Hearing Loss

Otolaryngology–Head and Neck Surgery

Otolaryngology-Head and Neck Surgery 147(2S) ORAL PRESENTATIONS Results: Eighteen patients (75%) ... more Otolaryngology-Head and Neck Surgery 147(2S) ORAL PRESENTATIONS Results: Eighteen patients (75%) were male with mean age of 40 ± 14.4 years. In the frequencies of 4000 and 8000 Hz before (9.38 ± 1.0 and 10.7 ± 1.2, respectively) and after (17.9 ± 2.6 and 17.6 ± 2.6, respectively) 1 month (but not 1 week) of treatment, a significant difference (P = .001) was detected. A progressive decrease in amplitude of the OAE during TEOAE measurement in 1, 2, and 4 frequencies among 41.66%, 18.75%, and 43.75% were observed, respectively. Interestingly, all of the hearing impaired patients were males. Hearing impairment was statistically more common among older patients (51.6 ± 16 vs 33.1 ± 14; P = .002). Conclusion: INFα may cause some ototoxic effects. Baseline audiogram, close observation, and TEOAE monitoring during therapy are recommended.

Research paper thumbnail of Endoscopic Laser Anterior Commissurotomy for Anterior Glottic Web: One-Stage Procedure

Annals of Otology, Rhinology & Laryngology

Objectives The conventional method for preventing web formation after anterior glottic web surger... more Objectives The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation. Methods Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break “alley” between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice...

Research paper thumbnail of Hypermobile Pulsatile Eardrum Attributable to Temporal Bone Metastasis

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2017

I nstitutional review board approval of the Chang Gung Medical Foundation was obtained. A 73-year... more I nstitutional review board approval of the Chang Gung Medical Foundation was obtained. A 73-year-old woman with a history of breast cancer treated with surgery and chemoradiotherapy 11 years prior complained of right-sided hearing loss and pulsatile tinnitus of 5 months in duration. She had previously undergone unsuccessful myringotomy to treat middle ear effusion at a local hospital. Otoscopy revealed a severely atrophic right eardrum accompanied by middle ear effusion (Figure 1). The atrophic segment of the tympanic membrane was grossly mobile, exhibiting pulsation in synchrony with the heartbeat (see Video 1 in the online version of the article). High-resolution computed tomography of the temporal bone revealed osteolytic change over the right temporoparieto-occipital bone and right lateral orbital wall, suggestive of bony metastasis. Additionally, leptomeningeal involvement was apparent in the right temporal region. Cerebrospinal fluid leakage into the middle ear was evident on brain magnetic resonance imaging (see online supplemental materials). We discussed the situation with the patient, indicating that surgery would give only temporary relief from the symptoms. Tympanocentesis was suggested to reduce the risk of cerebrospinal fluid leakage or meningitis. She underwent aspiration without grommet insertion and experienced partial resolution of her symptoms. Otoscopy revealed an air-fluid level in the pulsatile eardrum (see Video 2 in the online version of the article). Temporal bone metastases may present with mild ear symptoms mimicking the familiar symptoms of hearing loss and pulsatile tinnitus. A hypermobile pulsatile eardrum with middle ear effusion should raise clinical suspicion of cerebrospinal fluid leakage and temporal bone metastasis, especially in a patient with a history of a malignant neoplasm.

Research paper thumbnail of Comparisons of Auditory Performance and Speech Intelligibility after Cochlear Implant Reimplantation in Mandarin-Speaking Users

BioMed Research International, 2016

Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear im... more Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear implant reimplantation in Mandarin-speaking users.Methods. In total, 589 patients who underwent cochlear implantation in our medical center between 1999 and 2014 were reviewed retrospectively. Data related to demographics, etiologies, implant-related information, complications, and hearing and speech performance were collected.Results. In total, 22 (3.74%) cases were found to have major complications. Infection (n=12) and hard failure of the device (n=8) were the most common major complications. Among them, 13 were reimplanted in our hospital. The mean scores of the Categorical Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) obtained before and after reimplantation were 5.5 versus 5.8 and 3.7 versus 4.3, respectively. The SIR score after reimplantation was significantly better than preoperation.Conclusions. Cochlear implantation is a safe procedure with low rates of ...

Research paper thumbnail of Intraoperative Facial Nerve Monitoring During Cochlear Implant Surgery

Medicine, 2015

Iatrogenic facial nerve injury is one of the most severe complications of cochlear implantation (... more Iatrogenic facial nerve injury is one of the most severe complications of cochlear implantation (CI) surgery. Intraoperative facial nerve monitoring (IFNM) is used as an adjunctive modality in a variety of neurotologic surgeries. The purpose of this retrospective study was to assess whether the use of IFNM is associated with postoperative facial nerve injury during CI surgery. The medical charts of 645 patients who underwent CI from 1999 to 2014 were reviewed to identify postoperative facial nerve palsy between those who did and did not receive IFNM. Four patients (3 children and 1 adult) were found to have delayed onset facial nerve weakness. IFNM was used in 273 patients, of whom 2 had postoperative facial nerve weakness (incidence of 0.73%). The incidence of facial nerve weakness was 0.54% (2/372) in the patients who did not receive IFNM. IFNM had no significant effect on postoperative delayed facial palsy (P ¼ 1.000). All patients completely recovered within 3 months after surgery. Interestingly, all 4 cases of facial palsy received right CI, which may be because all of the surgeons in this study used their right hand to hold the drill. When right CI surgery is performed by a right-handed surgeon, the shaft of the drill is closer to the inferior angle of the facial recess, and it is easier to place the drilling shaft against the medial boundary (facial nerve) when the facial recess is small. The facial nerve sheaths of another 3 patients were unexpectedly dissected by a diamond burr during the surgery, and the monitor sounded an alarm. None of these 3 patients developed facial palsy postoperatively. This suggests that IFNM could be used as an alarm system for mechanical compression even without current stimulation. Although there appeared to be no relationship between the use of monitoring and delayed facial nerve palsy, IFNM is of great value in the early identification of a dehiscent facial nerve and assisting in the maintenance of its integrity. IFNM can still be used as an additional technique to optimize surgical success.

Research paper thumbnail of Hearing Assessment after Treatment of Nasopharyngeal Carcinoma with CRT and IMRT Techniques

BioMed Research International, 2015

Objectives. This study analyzed the long-term hearing loss after treatment of primary nasopharyng... more Objectives. This study analyzed the long-term hearing loss after treatment of primary nasopharyngeal carcinoma to elucidate its causal factors.Methods. Ninety-two nasopharyngeal carcinoma patients were treated with radiotherapy or chemoradiotherapy. Pure tone audiometry was performed before the therapy and annually up to 9 years after completing treatment. The hearing thresholds were corrected for age-related deterioration and compared to the results without adjusting for age.Results. The mean air and bone conduction threshold with and without correction for age-related deterioration differed significantly 2–9 years after completing radiotherapyp<0.05. The audiometry results with age correction showed a flattened configuration compared to the results without age correction. The total radiation dose and radiation modality showed a causal relationship with a greater incidence of hearing loss after therapyp<0.05. There was more deterioration in the air and bone hearing thresholds...

Research paper thumbnail of Sleep Disturbance and Altered Expression of Circadian Clock Genes in Patients With Sudden Sensorineural Hearing Loss

Medicine, 2015

The cause of sudden sensorineural hearing loss (SSNHL) remains unclear and therefore it is often ... more The cause of sudden sensorineural hearing loss (SSNHL) remains unclear and therefore it is often considered as idiopathic. Sleep disturbance has been linked to SSNHL and circadian rhythm disruption, but the link between circadian rhythm disruption and SSNHL has never been investigated.In this study, we surveyed the sleep quality of 38 patients with SSNHL using a simple insomnia sleep questionnaire. The expression of circadian clock genes in peripheral blood (PB) leukocytes from 38 patients with SSNHL and 71 healthy subjects was accessed using real-time quantitative reverse transcriptase-polymerase chain reaction and validated using immunocytochemical staining.We found that 61.8% of patients with SSNHL suffered from insomnia before the insult of hearing loss. Besides, significantly decreased expression of PER1, CRY1, CRY2, CLOCK, BMAL1, and CKlε was found in PB leukocytes of patients with SSNHL when compared with healthy subjects. SSNHL patients with vertigo had significantly lower e...

Research paper thumbnail of Cochlear Implant and Its Related Science

BioMed Research International, 2015

Research paper thumbnail of Ethanolic Extracts of Pluchea indica Induce Apoptosis and Antiproliferation Effects in Human Nasopharyngeal Carcinoma Cells

Molecules (Basel, Switzerland), Jan 22, 2015

Pluchea indica is used in traditional medicine for the treatment of lumbago, ulcer, tuberculosis ... more Pluchea indica is used in traditional medicine for the treatment of lumbago, ulcer, tuberculosis and inflammation. The anti-cancer activities and the underlying molecular mechanisms of the ethanolic extracts of P. indica root (PIRE) were characterized in the present study. PIRE strongly inhibited the viability of the human nasopharyngeal carcinoma cells (NPC-TW 01 and NPC-TW 04) in a time- and dose-dependent manner. Migration of cancer cells was also suppressed by PIRE. In addition, PIRE significantly increased the occurrence of the cells in sub-G1 phase and the extent of DNA fragmentation in a dose-dependent manner, which indicates that PIRE significantly increased apoptosis in NPC cells. The apoptotic process triggered by PIRE involved up-regulation of pro-apoptotic Bax protein and down-regulation of anti-apoptotic Bcl-2 protein, consequently increasing the ratios of Bax/Bcl-2 protein levels. Moreover, the p53 protein was up-regulated by PIRE in a concentration-dependent manner. T...

Research paper thumbnail of Clinical Significance of the Neural Response Telemetric Thresholds in Mandarin-speaking Cochlear Implant Patients

Journal of the Chinese Medical Association

Research paper thumbnail of Expression of circadian clock genes in leukocytes of patients with Meniere's disease

Laryngoscope Investigative Otolaryngology

Research paper thumbnail of Data for: Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial

This study enrolled patients who visited our ENT out-patient department with the primary complain... more This study enrolled patients who visited our ENT out-patient department with the primary complaint of tinnitus more than 6 months. A full medical history assessment was performed, and each patient underwent an otoscopic examination, a basic audiologic evaluation. A full medical history assessment was performed, and each patient completed the NIHL questionnaire (Supplementary S1), audiogram, tympanogram, speech discrimination test, distortion product otoacoustic emissions (DPOAE) testing, pitch and loudness match of the tinnitus, Tinnitus Handicap Inventory (THI) and serum zinc level analyses. All tests were repeated after 2 months of treatment with zinc gluconate (Zinga 78 mg, 10 mg elemental zinc), two tablets twice per day (40 mg per day).

Research paper thumbnail of Hearing Features and Cochlear Implantation Outcomes in Patients With Pathogenic MYO15A Variants

Ear & Hearing

OBJECTIVES Recessive variants in the MYO15A gene constitute an important cause of sensorineural h... more OBJECTIVES Recessive variants in the MYO15A gene constitute an important cause of sensorineural hearing impairment (SNHI). However, the clinical features of MYO15A-related SNHI have not been systemically investigated. This study aimed to delineate the hearing features and outcomes in patients with pathogenic MYO15A variants. DESIGN This study recruited 40 patients with biallelic MYO15A variants from 31 unrelated families. The patients were grouped based on the presence of N-terminal domain variants (N variants). The longitudinal audiological data and for those undergoing cochlear implantation, the auditory and speech performance with cochlear implants, were ascertained and compared between patients with different genotypes. RESULTS At the first audiometric examination, 32 patients (80.0%) presented with severe to profound SNHI. Patients with at least one allele of the N variant exhibited significantly better hearing levels than those with biallelic non-N variants (78.2 ± 23.9 dBHL and 94.7 ± 22.8 dBHL, respectively) (p = 0.033). Progressive SNHI was observed in 82.4% of patients with non-profound SNHI, in whom the average progression rate of hearing loss was 6.3 ± 4.8 dBHL/year irrespective of the genotypes. Most of the 25 patients who underwent cochlear implantation exhibited favorable auditory and speech performances post-implantation. CONCLUSIONS The hearing features of patients with biallelic pathogenic MYO15A variants are characterized by severe to profound SNHI, rapid hearing progression, and favorable outcomes with cochlear implants. Periodic auditory monitoring is warranted for these patients to enable early intervention.

Research paper thumbnail of Extraosseous ewing sarcoma of the tonsil

Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2012

Research paper thumbnail of The comparison of Mandarin speech identification and tone identification between ACE and CIS speech processing strategy

Research paper thumbnail of Data for pressure ulcers and skin infections after cochlear implantation

Data in Brief

This article contains data concerning the research article entitled "Pressure ulcers and skin inf... more This article contains data concerning the research article entitled "Pressure ulcers and skin infections after cochlear implantation: A delayed yet serious issue" (Hui-Shan Hsieh, Chee-Yee Lee, Hung-Pin Wu, Ming-Ying Zhuo, and Chung-Feng Hwang) [1]. This data article reports the causes of skin flap pressure ulcer over the antenna site and protocol for the clinical managements. The patients with cochlear implant (n = 315) were enrolled. We used the National Pressure Ulcer Advisory Panel (NPUAP) pressure injury staging system to grade injury severity in all patients. The data included in this article are as follows: the clinical characteristics of patients, baselines variables between groups with and without pressure ulcer, the severity of skin flap reactions based on the NPUAP pressure injury system and corresponding interventions, related clinical details of patients with pressure ulcer, This article will be valuable for routine clinical practice as serving as a paradigm.

Research paper thumbnail of Constant Light Dysregulates Cochlear Circadian Clock and Exacerbates Noise-Induced Hearing Loss

International Journal of Molecular Sciences

Noise-induced hearing loss is one of the major causes of acquired sensorineural hearing loss in m... more Noise-induced hearing loss is one of the major causes of acquired sensorineural hearing loss in modern society. While people with excessive exposure to noise are frequently the population with a lifestyle of irregular circadian rhythms, the effects of circadian dysregulation on the auditory system are still little known. Here, we disturbed the circadian clock in the cochlea of male CBA/CaJ mice by constant light (LL) or constant dark. LL significantly repressed circadian rhythmicity of circadian clock genes Per1, Per2, Rev-erbα, Bmal1, and Clock in the cochlea, whereas the auditory brainstem response thresholds were unaffected. After exposure to low-intensity (92 dB) noise, mice under LL condition initially showed similar temporary threshold shifts to mice under normal light–dark cycle, and mice under both conditions returned to normal thresholds after 3 weeks. However, LL augmented high-intensity (106 dB) noise-induced permanent threshold shifts, particularly at 32 kHz. The loss of...

Research paper thumbnail of Prognostic Factors for Hearing Outcomes in Children with Cleft Lip and Palate

Plastic and Reconstructive Surgery

Background: This study was performed to investigate the prognostic factors that influence hearing... more Background: This study was performed to investigate the prognostic factors that influence hearing outcomes of children with cleft lip and palate after ventilation tube insertion. Methods: The authors retrospectively reviewed the hearing thresholds of 90 children with cleft lip and palate and performed univariate and multivariate analyses of five prognostic factors for hearing outcomes: age at palatoplasty, age at first ventilation tube insertion, timing of ventilation tube insertion, frequency of ventilation tube insertion, and type of cleft palate. Results: On univariate analysis, the authors found that older age at palatoplasty (p = 0.002), older age at first ventilation tube insertion (p = 0.025), and increased frequency of ventilation tube insertion (p = 0.048) were significant prognostic factors for poorer hearing outcomes in children with cleft lip and palate. Multiple logistic regression analysis showed that late palatoplasty (age older than 1 year) was the most influential factor for poor hearing outcome (OR, 2.83), followed by two or more ventilation tube insertions (OR, 1.94). Conclusion: The age at palatoplasty and frequency of ventilation tube insertion were found to be significant prognostic factors influencing hearing outcomes in children with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Research paper thumbnail of ELF-1 expression in nasopharyngeal carcinoma facilitates proliferation and metastasis of cancer cells via modulation of CCL2/CCR2 signaling

Cancer Management and Research

Background: Nasopharyngeal carcinoma (NPC) is a prevalent malignant tumor in Southeast Asia. The ... more Background: Nasopharyngeal carcinoma (NPC) is a prevalent malignant tumor in Southeast Asia. The management of NPC has remained a challenge until now. ELF-1 is a member of the ETS family of transcription factors that regulate genes involved in cellular growth. ELF-1 expression has been reported in various cancers and is required for tumor growth and angiogenesis; however, its function in NPC remains unclear. In the present study, we characterized the role and underlying mechanism of ELF-1 in NPC. Methods: The biological functions of ELF-1 in NPC cells such as proliferation, migration, invasion, and drug resistance were investigated using MTT, BrdU incorporation, and Transwell assays. To gain more insight into the mechanism of ELF-1 in NPC, we analyzed CCL2/CCR2 signaling by Western blotting, ELISA, siRNAs, and CCR2 antagonist. Results: Gain-of-function of ELF-1 in TW01 and TW04 cells promoted NPC cell proliferation, BrdU incorporation, migration, invasion and cisplatin resistance. By contrast, knockdown of ELF-1 produced opposite results. Overexpression of ELF-1 enhanced the expression of CCL2 via binding to its promoter region and increased the level of the extracellular matrix protein CCL2 in cell culture medium. ELF-1 expression also modulated the downstream targets of CCL2/CCR2 signaling. Most importantly, ELF-1-induced NPC malignant phenotypes were abrogated by a CCR2 inhibitor, implying that the CCL2/CCR2 signaling axis was involved in ELF-1-mediated regulation in NPC. Conclusion: Our data suggest that ELF-1 plays an oncogenic role in NPC development associated with the CCL2/CCR2 signaling pathway and may therefore be a potential target for NPC therapy.

Research paper thumbnail of Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: A clinical trial

Biomedical Journal

Background: Zinc plays a vital antioxidant role in human metabolism. Recent studies have demonstr... more Background: Zinc plays a vital antioxidant role in human metabolism. Recent studies have demonstrated a correlation between noise-induced hearing loss (NIHL) and oxidative injury; however, no investigation has focused specifically on the subgroup of NIHL associated tinnitus patients. We aimed to evaluate the effectiveness of zinc supplementation in treating NIHL associated tinnitus. Methods: Twenty patients with tinnitus and a typical NIHL audiogram (38 ears) were included in this study. Another 20 healthy subjects were used as the control group. A full medical history assessment was performed, and each subject underwent an otoscopic examination, basic audiologic evaluation, distortion product otoacoustic emissions (DPOAEs), tinnitus-match testing, Tinnitus Handicap Inventory (THI) and serum zinc level analyses. After 2 months of treatment with zinc, all tests were repeated. Results: There was a significant difference between pretreatment and post-treatment within the tinnitus group (73.6 vs. 84.6 mg/dl). The pre-and post-treatment difference in serum zinc was significantly higher in the young group (&50 years) compared to the old group (19.4 ± 11.4 vs. 2.6 ± 9.2 mg/dl, respectively; p ¼ 0.002). There were no statistically significant differences in hearing thresholds, speech reception thresholds, or tinnitus frequency and loudness results before and after treatment. In addition, 17 patients (85%) showed statistically significant improvement of THI-total scores post-treatment, from 38.3 to 30 (p ¼ 0.024). Conclusions: Zinc oral supplementation elevated serum zinc levels, especially in younger patients. THI scores improved significantly following zinc treatment in patients with NIHL associated tinnitus. However, no improvements in objective hearing parameters were observed.

Research paper thumbnail of Intratympanic Dexamethasone and HBO for Sudden Hearing Loss

Otolaryngology–Head and Neck Surgery

Otolaryngology-Head and Neck Surgery 147(2S) ORAL PRESENTATIONS Results: Eighteen patients (75%) ... more Otolaryngology-Head and Neck Surgery 147(2S) ORAL PRESENTATIONS Results: Eighteen patients (75%) were male with mean age of 40 ± 14.4 years. In the frequencies of 4000 and 8000 Hz before (9.38 ± 1.0 and 10.7 ± 1.2, respectively) and after (17.9 ± 2.6 and 17.6 ± 2.6, respectively) 1 month (but not 1 week) of treatment, a significant difference (P = .001) was detected. A progressive decrease in amplitude of the OAE during TEOAE measurement in 1, 2, and 4 frequencies among 41.66%, 18.75%, and 43.75% were observed, respectively. Interestingly, all of the hearing impaired patients were males. Hearing impairment was statistically more common among older patients (51.6 ± 16 vs 33.1 ± 14; P = .002). Conclusion: INFα may cause some ototoxic effects. Baseline audiogram, close observation, and TEOAE monitoring during therapy are recommended.

Research paper thumbnail of Endoscopic Laser Anterior Commissurotomy for Anterior Glottic Web: One-Stage Procedure

Annals of Otology, Rhinology & Laryngology

Objectives The conventional method for preventing web formation after anterior glottic web surger... more Objectives The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation. Methods Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break “alley” between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice...

Research paper thumbnail of Hypermobile Pulsatile Eardrum Attributable to Temporal Bone Metastasis

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2017

I nstitutional review board approval of the Chang Gung Medical Foundation was obtained. A 73-year... more I nstitutional review board approval of the Chang Gung Medical Foundation was obtained. A 73-year-old woman with a history of breast cancer treated with surgery and chemoradiotherapy 11 years prior complained of right-sided hearing loss and pulsatile tinnitus of 5 months in duration. She had previously undergone unsuccessful myringotomy to treat middle ear effusion at a local hospital. Otoscopy revealed a severely atrophic right eardrum accompanied by middle ear effusion (Figure 1). The atrophic segment of the tympanic membrane was grossly mobile, exhibiting pulsation in synchrony with the heartbeat (see Video 1 in the online version of the article). High-resolution computed tomography of the temporal bone revealed osteolytic change over the right temporoparieto-occipital bone and right lateral orbital wall, suggestive of bony metastasis. Additionally, leptomeningeal involvement was apparent in the right temporal region. Cerebrospinal fluid leakage into the middle ear was evident on brain magnetic resonance imaging (see online supplemental materials). We discussed the situation with the patient, indicating that surgery would give only temporary relief from the symptoms. Tympanocentesis was suggested to reduce the risk of cerebrospinal fluid leakage or meningitis. She underwent aspiration without grommet insertion and experienced partial resolution of her symptoms. Otoscopy revealed an air-fluid level in the pulsatile eardrum (see Video 2 in the online version of the article). Temporal bone metastases may present with mild ear symptoms mimicking the familiar symptoms of hearing loss and pulsatile tinnitus. A hypermobile pulsatile eardrum with middle ear effusion should raise clinical suspicion of cerebrospinal fluid leakage and temporal bone metastasis, especially in a patient with a history of a malignant neoplasm.

Research paper thumbnail of Comparisons of Auditory Performance and Speech Intelligibility after Cochlear Implant Reimplantation in Mandarin-Speaking Users

BioMed Research International, 2016

Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear im... more Objectives. We evaluated the causes, hearing, and speech performance before and after cochlear implant reimplantation in Mandarin-speaking users.Methods. In total, 589 patients who underwent cochlear implantation in our medical center between 1999 and 2014 were reviewed retrospectively. Data related to demographics, etiologies, implant-related information, complications, and hearing and speech performance were collected.Results. In total, 22 (3.74%) cases were found to have major complications. Infection (n=12) and hard failure of the device (n=8) were the most common major complications. Among them, 13 were reimplanted in our hospital. The mean scores of the Categorical Auditory Performance (CAP) and the Speech Intelligibility Rating (SIR) obtained before and after reimplantation were 5.5 versus 5.8 and 3.7 versus 4.3, respectively. The SIR score after reimplantation was significantly better than preoperation.Conclusions. Cochlear implantation is a safe procedure with low rates of ...

Research paper thumbnail of Intraoperative Facial Nerve Monitoring During Cochlear Implant Surgery

Medicine, 2015

Iatrogenic facial nerve injury is one of the most severe complications of cochlear implantation (... more Iatrogenic facial nerve injury is one of the most severe complications of cochlear implantation (CI) surgery. Intraoperative facial nerve monitoring (IFNM) is used as an adjunctive modality in a variety of neurotologic surgeries. The purpose of this retrospective study was to assess whether the use of IFNM is associated with postoperative facial nerve injury during CI surgery. The medical charts of 645 patients who underwent CI from 1999 to 2014 were reviewed to identify postoperative facial nerve palsy between those who did and did not receive IFNM. Four patients (3 children and 1 adult) were found to have delayed onset facial nerve weakness. IFNM was used in 273 patients, of whom 2 had postoperative facial nerve weakness (incidence of 0.73%). The incidence of facial nerve weakness was 0.54% (2/372) in the patients who did not receive IFNM. IFNM had no significant effect on postoperative delayed facial palsy (P ¼ 1.000). All patients completely recovered within 3 months after surgery. Interestingly, all 4 cases of facial palsy received right CI, which may be because all of the surgeons in this study used their right hand to hold the drill. When right CI surgery is performed by a right-handed surgeon, the shaft of the drill is closer to the inferior angle of the facial recess, and it is easier to place the drilling shaft against the medial boundary (facial nerve) when the facial recess is small. The facial nerve sheaths of another 3 patients were unexpectedly dissected by a diamond burr during the surgery, and the monitor sounded an alarm. None of these 3 patients developed facial palsy postoperatively. This suggests that IFNM could be used as an alarm system for mechanical compression even without current stimulation. Although there appeared to be no relationship between the use of monitoring and delayed facial nerve palsy, IFNM is of great value in the early identification of a dehiscent facial nerve and assisting in the maintenance of its integrity. IFNM can still be used as an additional technique to optimize surgical success.

Research paper thumbnail of Hearing Assessment after Treatment of Nasopharyngeal Carcinoma with CRT and IMRT Techniques

BioMed Research International, 2015

Objectives. This study analyzed the long-term hearing loss after treatment of primary nasopharyng... more Objectives. This study analyzed the long-term hearing loss after treatment of primary nasopharyngeal carcinoma to elucidate its causal factors.Methods. Ninety-two nasopharyngeal carcinoma patients were treated with radiotherapy or chemoradiotherapy. Pure tone audiometry was performed before the therapy and annually up to 9 years after completing treatment. The hearing thresholds were corrected for age-related deterioration and compared to the results without adjusting for age.Results. The mean air and bone conduction threshold with and without correction for age-related deterioration differed significantly 2–9 years after completing radiotherapyp<0.05. The audiometry results with age correction showed a flattened configuration compared to the results without age correction. The total radiation dose and radiation modality showed a causal relationship with a greater incidence of hearing loss after therapyp<0.05. There was more deterioration in the air and bone hearing thresholds...

Research paper thumbnail of Sleep Disturbance and Altered Expression of Circadian Clock Genes in Patients With Sudden Sensorineural Hearing Loss

Medicine, 2015

The cause of sudden sensorineural hearing loss (SSNHL) remains unclear and therefore it is often ... more The cause of sudden sensorineural hearing loss (SSNHL) remains unclear and therefore it is often considered as idiopathic. Sleep disturbance has been linked to SSNHL and circadian rhythm disruption, but the link between circadian rhythm disruption and SSNHL has never been investigated.In this study, we surveyed the sleep quality of 38 patients with SSNHL using a simple insomnia sleep questionnaire. The expression of circadian clock genes in peripheral blood (PB) leukocytes from 38 patients with SSNHL and 71 healthy subjects was accessed using real-time quantitative reverse transcriptase-polymerase chain reaction and validated using immunocytochemical staining.We found that 61.8% of patients with SSNHL suffered from insomnia before the insult of hearing loss. Besides, significantly decreased expression of PER1, CRY1, CRY2, CLOCK, BMAL1, and CKlε was found in PB leukocytes of patients with SSNHL when compared with healthy subjects. SSNHL patients with vertigo had significantly lower e...

Research paper thumbnail of Cochlear Implant and Its Related Science

BioMed Research International, 2015

Research paper thumbnail of Ethanolic Extracts of Pluchea indica Induce Apoptosis and Antiproliferation Effects in Human Nasopharyngeal Carcinoma Cells

Molecules (Basel, Switzerland), Jan 22, 2015

Pluchea indica is used in traditional medicine for the treatment of lumbago, ulcer, tuberculosis ... more Pluchea indica is used in traditional medicine for the treatment of lumbago, ulcer, tuberculosis and inflammation. The anti-cancer activities and the underlying molecular mechanisms of the ethanolic extracts of P. indica root (PIRE) were characterized in the present study. PIRE strongly inhibited the viability of the human nasopharyngeal carcinoma cells (NPC-TW 01 and NPC-TW 04) in a time- and dose-dependent manner. Migration of cancer cells was also suppressed by PIRE. In addition, PIRE significantly increased the occurrence of the cells in sub-G1 phase and the extent of DNA fragmentation in a dose-dependent manner, which indicates that PIRE significantly increased apoptosis in NPC cells. The apoptotic process triggered by PIRE involved up-regulation of pro-apoptotic Bax protein and down-regulation of anti-apoptotic Bcl-2 protein, consequently increasing the ratios of Bax/Bcl-2 protein levels. Moreover, the p53 protein was up-regulated by PIRE in a concentration-dependent manner. T...