PING-HUNG SHEN - Academia.edu (original) (raw)

Papers by PING-HUNG SHEN

International Forum of Allergy & Rhinology, 2019

Background: The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory... more Background: The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis a er failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal gra s and pedicled flaps on the opening of the newly formed frontal ostium. Methods: Fi y patients with refractory frontal sinusitis or mucoceles a er ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal gra s and pedicled flap reconstruction of the neo-ostium. The frontal neo-ostium was measured with Lindholm distending forceps, and anteroposterior (A-P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. Results: The initial intraoperative mean lateral and A-P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time-points postoperatively. The mucosal gra s and pedicled flaps had greater lateral and A-P dimensions, and a greater percentage of intraoperative frontal neo-ostium area at all time-points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT (p = 0.027), but not the smell VAS score (p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups (p = 0.92 and p = 0.85, respectively). Conclusion: The use of mucosal gra s and pedicled flaps reduces stenosis of the frontal neo-ostium postsurgery and should be considered a er EMLP.

Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology)

This is a 65 year-old female who had olfactory disorder for more than 20 years. In addition, she ... more This is a 65 year-old female who had olfactory disorder for more than 20 years. In addition, she had Parkinson's disease for 15 years, which is known to lead to olfactory disorder. At the clinic, sinus

Seizures occurring after skull base surgery using endoscopic surgical procedures (endoscopic skul... more Seizures occurring after skull base surgery using endoscopic surgical procedures (endoscopic skull base surgery, ESBS) are rare. Here is an investigation of two particular cases of seizures following ESBS. Case one, involved an enlarged pituitary prolactinoma with decompression intent. Whereas, the other case involved a traumatic meningocele with a CSF leak, which underwent meningocele excision and skull base reconstruction. The investigations of these two cases, presented here include the time course of postsurgical seizures; can help, better, understand the possible causes and their treatment methods.

Allergy & Rhinology, 2021

Background The Taiwan Smell Identification Test (TWSIT) was developed and successfully administer... more Background The Taiwan Smell Identification Test (TWSIT) was developed and successfully administered in Taiwanese population since 2015. However, for sanitation reason, the original liquid-jar form of this test is not appropriate. The commercialized TWSIT was then re-designed as “scratch-and-sniff” version: the TIBSIT (Top International Biotech, Taipei, Taiwan). This project aims to investigate the normative value of TIBSIT in different age groups and genders. Methods Volunteers aged 20 to 80 with no subjective smell loss were recruited in a rhinology clinic. The participants were given full instructions on using the TIBSIT. Results Two hundred and nine healthy subjects (female: male =107: 102) were enrolled into this study. The median TIBSIT score in female and male subjects is 47 and 46, respectively. Subjects were further divided into three age groups: (A) 20∼34 years (n = 77), (B) 35∼54 years (n = 77), and (C) 55∼80 years (n = 55). The TIBSIT scores at the tenth percentile value ...

Chinese medical journal, 2014

BACKGROUND Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate af... more BACKGROUND Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes. METHODS A retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications. RESULTS Nine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of rec...

The long pentraxin 3 (PTX3) is a prototypic molecule for recognizing pathogens. Liver X receptors... more The long pentraxin 3 (PTX3) is a prototypic molecule for recognizing pathogens. Liver X receptors (LXRs), belonging to nuclear receptors (NRs) for cholesterol metabolism through heterodimerizing with other NRs, were recently reported to participate in inflammation. However, their roles in chronic rhinosinusitis without nasal polyps (CRSsNP) are unclear. Therefore, this study was sought to explore roles of LXRs in chronic rhinosinusitis (CRS) sinonasal tissues and derived fibroblasts. Immunohistochemistry indicated that LXRα and β expression and lipid/fat deposition were differentially expressed in the control and CRSsNP nasal mucosa. GW7647 (a peroxisome proliferator activated receptor α (PPARα) agonist) and GW3965 (a dual agonist for LXRα and β) significantly caused PTX3 induction in the fibroblast cells. GW3965 induced PTX3 mRNA and protein expression, and the induction substantially led to PTX3 secretion. Meanwhile, an endogenous agonist-cholesterol had a similar enhancing effect...

This is a case of pediatric Burkitt's lymphoma in a 6-year-old boy who presented with acute m... more This is a case of pediatric Burkitt's lymphoma in a 6-year-old boy who presented with acute mastoiditis and rhinosinusitis. He also developed multiple cranial neuropathies and was initially misdiagnosed as ＂Miller Fisher syndrome＂. The final diagnosis was made by endoscopic biopsy of the periorbital tissue after attempting decompression of painful orbital swelling.

American Journal of Rhinology & Allergy

Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of ... more Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct and its use have been reported in the treatment of many maxillary sinus and lateral skull base diseases. Objective To retrospectively assess the effectiveness of a 10-year multicenter follow-up for the resection of inverted papilloma of the maxillary sinus (IPMS) via a PLRA. Methods A total of 71 patients were admitted and underwent IPMS excision via an intranasal endoscopic PLRA from 2003 to 2013. All patients underwent high-resolution computed tomography scanning of the nasal sinus, and some also underwent magnetic resonance imaging examination. Results Based on the Krouse staging system, all 71 patients belong to T3 staging. The PLRA was employed to remove IPMS in 71 patients. The postoperative pathological examination of the excised tissue revealed inverted papilloma, and cancerization was identified in...

International Forum of Allergy & Rhinology

A 42-year-old male was found a right-side middle turbinate tumor incidentally during a routine si... more A 42-year-old male was found a right-side middle turbinate tumor incidentally during a routine sino-nasal surgery for hypertrophic rhinitis. Pathologist confirmed extranasopharyngeal angiofibroma. Due to its rarity of pathology and presentation, we report this case to remind otolaryngologists to be more careful about these highly vascular intranasal tumors, and this tumor can be excised under endoscope and without preoperative embolization.

Journal of neurosurgery, Jan 4, 2015

OBJECT This study was undertaken to analyze the results of a novel surgical method-the endoscopic... more OBJECT This study was undertaken to analyze the results of a novel surgical method-the endoscopic prelacrimal recess approach (PLRA)-in patients with tumors involving the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). The surgical technique and indications for this approach are also discussed. METHODS The authors analyzed data from 7 cases involving patients who underwent resection of PPF and ITF tumors by means of the endoscopic PLRA from 2004 to 2013. Preoperative and postoperative imaging studies were available in all cases and were reviewed. The surgical specimens were all confirmed to be schwannomas. RESULTS All tumors were completely resected via endoscopic PLRA. There were no recurrences noted over a 28-month follow-up period. In 4 cases, the patients experienced postoperative facial numbness during the first two weeks after surgery, which gradually lessened thereafter. One patient continued to have mild facial numbness at most recent follow-up. The numbness had f...

American journal of rhinology & allergy, 2015

Objective smell tests not only identify levels of smelling ability but also provide information o... more Objective smell tests not only identify levels of smelling ability but also provide information on changes in olfaction after treatment. Odor identification is strongly socially and culturally dependent; therefore, the odorants used in a smell identification test should be familiar to the test population. We developed this smell test for Taiwanese populations with two aims: the test odors should be familiar to Taiwanese and the test should be easily and quickly administered in a busy clinic. Additives that are familiar to Taiwanese people were selected for this smell identification test. Subsequently, the test was validated with the traditional Chinese version of the University of Pennsylvania Smell Identification Test (TC-UPSIT). Finally, this Taiwan Smell Identification Test (TWSIT) was implemented in daily clinical use, and cut-off points of "normosmia," "hyposmia," and "anosmia" were established. A total of 1000 subjects were included in the market ...

Journal of the Chinese Medical Association : JCMA, 2015

Retrosigmoid vestibular neurectomy is considered to be the most effective and safe procedure to c... more Retrosigmoid vestibular neurectomy is considered to be the most effective and safe procedure to control intractable vertigo associated with Ménière's disease while preserving hearing. The surgical procedure of retrosigmoid vestibular neurectomy at the cerebellopontine angle has been well established. Here, we provide for otologic surgeons additional details about the procedure, with special attention to the anatomic features to emphasize our technique, which enables an adequate sectioning of the vestibular fibers on the cochlear nerve close to the overlapping zone containing large-caliber vestibular fibers and small-caliber cochlear fibers. We used the lateral decubitus position to enter the cerebellopontine angle. The cerebellum was gently retracted to expose the cerebellomedullary cistern, which was then opened to drain the cerebrospinal fluid for slacking of the cerebellum. The underlying lower cranial nerves IX, X, and XI were identified. The retractor was then moved upward ...

Chinese medical journal, 2014

Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary... more Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes. A retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications. Nine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of recurrence tumors (rT1), rT2, ...

International Forum of Allergy & Rhinology, 2011

Background: Outcomes for revision endoscopic sinus surgery (RESS) are rarely reported in relation... more Background: Outcomes for revision endoscopic sinus surgery (RESS) are rarely reported in relation to technique. Our goal was to document the outcome of full-house functional endoscopic sinus surgery (FESS) (FHF) (complete sphenoethmoidectomy with Draf IIA frontal sinusotomy) for treatment of this recalcitrant group. Methods: Twenty-one patients with chronic sinusitis having had at least 1 previous sinus surgery (mean, 2.14) underwent FHF, followed by postoperative nasal douching and oral antibiotics for 12 weeks. A er a minimum 6 months of follow-up, patients were asked to complete a 5-item Patient Response Score (PRS) (graded on a 6-point scale from 1 = completely improved to 6 = much worse). Objective measures collected included computed tomography (CT) Lund MacKay score (L-M score, LMS), and endoscopic findings: mucosal swelling (MS) and mucopus (MP) (graded on a 4-point scale from 0 = none to 3 = severe). Results: Patients were divided into 3 subgroups based on months of follow up from surgery: 6-12, 12-18, and 18-24. There was no statistical difference in any outcome based on length of follow up. Mean symptom outcome was reported as much improved (PRS = 1.9 ± 0.1). Both mucosal swelling and mucopus improved dramatically (2.48 vs 0.29, p < 0.001; 2.52 vs 0.29, p < 0.001, respectively). LMS also improved dramatically (11.52 vs 2.1, p < 0.001). Presence of nasal polyps did not affect any subjective or objective outcome. Conclusion: Marked improvements in symptoms and mucosal findings were consistently obtained with FHF between 6 and 24 months postoperatively. C 2011 ARS-AAOA, LLC.

American Journal of Rhinology and Allergy, 2013

Background Patients who suffer from hyposmia and anosmia report a negative effect on their overal... more Background Patients who suffer from hyposmia and anosmia report a negative effect on their overall quality of life. Smell disturbance of patients with chronic rhinosinusitis (CRS) can improve after endoscopic sinus surgery (ESS). Although several studies have shown that 50–83% of patients may notice an improvement in olfactory function after ESS, the olfactory improvement after revision ESS (RESS), especially by objective measurements, is still lacking. Methods Olfactory function was assessed by the traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC) preoperatively and postoperatively, recorded as smell identification test (SIT) score. Olfactory outcomes from anosmia to hyposmia/normosmia, or from hyposmia to normosmia, were considered as “improvement.” Postoperative assessments were divided into two periods: period 1 (P1) is defined as >6 but <12 months postoperatively; period 2 (P2) is defined as >12 but <24 months postope...

American Journal of Rhinology and Allergy, 2011

There is increasing evidence to support the use of anesthetics to affect operative fields during ... more There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.

Journal of the Chinese Medical Association

Vidian neurectomy has been used to manage intractable vasomotor rhinitis for decades. After the i... more Vidian neurectomy has been used to manage intractable vasomotor rhinitis for decades. After the introduction of endoscopic sinus surgery in the 1980s, transnasal endoscopic vidian neurectomy (EVN) was subsequently reported. The most common problem in performing EVN was excessive bleeding from the pterygopalatine fossa. The complexity and vascularity of the pterygopalatine fossa can cause bloody surgical fields and prevent complete neurectomy. In response to this surgical problem, a procedure was developed to use powered instrumentation and coblation during EVN. There were eight cases of EVNs (16 neurectomies) assisted by power instrumentation and coblation from December 2011 to May 2012. The average blood loss of these cases was 37.5 mL (range, 25e50 mL). The average surgical time of each neurectomy was 27.4 minutes (range, 20e35 minutes). No complications occurred in any of the eight cases. Very limited bleeding and less thermal damage were noted while achieving a complete neurectomy.

International Forum of Allergy & Rhinology, 2019

Background: The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory... more Background: The endoscopic modified Lothrop procedure (EMLP) is used to manage ongoing refractory frontal sinusitis a er failed previous endoscopic sinus surgery (ESS), but this approach has a significant restenosis rate. We evaluated the potential benefits of mucosal gra s and pedicled flaps on the opening of the newly formed frontal ostium. Methods: Fi y patients with refractory frontal sinusitis or mucoceles a er ESS were randomized to undergo EMLP, either with (n = 27) or without (n = 23) mucosal gra s and pedicled flap reconstruction of the neo-ostium. The frontal neo-ostium was measured with Lindholm distending forceps, and anteroposterior (A-P) and lateral dimensions were measured intraoperatively, and then again at 6 weeks, 6 months, and 12 months postoperatively. Olfaction outcomes were assessed using the Taiwan Smell Identification Test (TWSIT) and a smell visual analog scale (VAS) score preoperatively and at 6 months postsurgery. Results: The initial intraoperative mean lateral and A-P dimensions were 23.2 ± 2.7 mm and 14.8 ± 2.3 mm and were significantly decreased at all time-points postoperatively. The mucosal gra s and pedicled flaps had greater lateral and A-P dimensions, and a greater percentage of intraoperative frontal neo-ostium area at all time-points postoperatively (all p < 0.05). At 6 months postoperatively, TWSIT (p = 0.027), but not the smell VAS score (p = 0.063), was significantly improved compared with baseline. TWSIT and smell VAS score changes did not differ between groups (p = 0.92 and p = 0.85, respectively). Conclusion: The use of mucosal gra s and pedicled flaps reduces stenosis of the frontal neo-ostium postsurgery and should be considered a er EMLP.

Nihon Bika Gakkai Kaishi (Japanese Journal of Rhinology)

This is a 65 year-old female who had olfactory disorder for more than 20 years. In addition, she ... more This is a 65 year-old female who had olfactory disorder for more than 20 years. In addition, she had Parkinson's disease for 15 years, which is known to lead to olfactory disorder. At the clinic, sinus

Seizures occurring after skull base surgery using endoscopic surgical procedures (endoscopic skul... more Seizures occurring after skull base surgery using endoscopic surgical procedures (endoscopic skull base surgery, ESBS) are rare. Here is an investigation of two particular cases of seizures following ESBS. Case one, involved an enlarged pituitary prolactinoma with decompression intent. Whereas, the other case involved a traumatic meningocele with a CSF leak, which underwent meningocele excision and skull base reconstruction. The investigations of these two cases, presented here include the time course of postsurgical seizures; can help, better, understand the possible causes and their treatment methods.

Allergy & Rhinology, 2021

Background The Taiwan Smell Identification Test (TWSIT) was developed and successfully administer... more Background The Taiwan Smell Identification Test (TWSIT) was developed and successfully administered in Taiwanese population since 2015. However, for sanitation reason, the original liquid-jar form of this test is not appropriate. The commercialized TWSIT was then re-designed as “scratch-and-sniff” version: the TIBSIT (Top International Biotech, Taipei, Taiwan). This project aims to investigate the normative value of TIBSIT in different age groups and genders. Methods Volunteers aged 20 to 80 with no subjective smell loss were recruited in a rhinology clinic. The participants were given full instructions on using the TIBSIT. Results Two hundred and nine healthy subjects (female: male =107: 102) were enrolled into this study. The median TIBSIT score in female and male subjects is 47 and 46, respectively. Subjects were further divided into three age groups: (A) 20∼34 years (n = 77), (B) 35∼54 years (n = 77), and (C) 55∼80 years (n = 55). The TIBSIT scores at the tenth percentile value ...

Chinese medical journal, 2014

BACKGROUND Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate af... more BACKGROUND Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes. METHODS A retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications. RESULTS Nine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of rec...

The long pentraxin 3 (PTX3) is a prototypic molecule for recognizing pathogens. Liver X receptors... more The long pentraxin 3 (PTX3) is a prototypic molecule for recognizing pathogens. Liver X receptors (LXRs), belonging to nuclear receptors (NRs) for cholesterol metabolism through heterodimerizing with other NRs, were recently reported to participate in inflammation. However, their roles in chronic rhinosinusitis without nasal polyps (CRSsNP) are unclear. Therefore, this study was sought to explore roles of LXRs in chronic rhinosinusitis (CRS) sinonasal tissues and derived fibroblasts. Immunohistochemistry indicated that LXRα and β expression and lipid/fat deposition were differentially expressed in the control and CRSsNP nasal mucosa. GW7647 (a peroxisome proliferator activated receptor α (PPARα) agonist) and GW3965 (a dual agonist for LXRα and β) significantly caused PTX3 induction in the fibroblast cells. GW3965 induced PTX3 mRNA and protein expression, and the induction substantially led to PTX3 secretion. Meanwhile, an endogenous agonist-cholesterol had a similar enhancing effect...

This is a case of pediatric Burkitt's lymphoma in a 6-year-old boy who presented with acute m... more This is a case of pediatric Burkitt's lymphoma in a 6-year-old boy who presented with acute mastoiditis and rhinosinusitis. He also developed multiple cranial neuropathies and was initially misdiagnosed as ＂Miller Fisher syndrome＂. The final diagnosis was made by endoscopic biopsy of the periorbital tissue after attempting decompression of painful orbital swelling.

American Journal of Rhinology & Allergy

Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of ... more Background The intranasal endoscopic prelacrimal recess approach (PLRA) access to all aspects of the maxillary sinus while preserving the inferior turbinate and nasolacrimal duct and its use have been reported in the treatment of many maxillary sinus and lateral skull base diseases. Objective To retrospectively assess the effectiveness of a 10-year multicenter follow-up for the resection of inverted papilloma of the maxillary sinus (IPMS) via a PLRA. Methods A total of 71 patients were admitted and underwent IPMS excision via an intranasal endoscopic PLRA from 2003 to 2013. All patients underwent high-resolution computed tomography scanning of the nasal sinus, and some also underwent magnetic resonance imaging examination. Results Based on the Krouse staging system, all 71 patients belong to T3 staging. The PLRA was employed to remove IPMS in 71 patients. The postoperative pathological examination of the excised tissue revealed inverted papilloma, and cancerization was identified in...

International Forum of Allergy & Rhinology

A 42-year-old male was found a right-side middle turbinate tumor incidentally during a routine si... more A 42-year-old male was found a right-side middle turbinate tumor incidentally during a routine sino-nasal surgery for hypertrophic rhinitis. Pathologist confirmed extranasopharyngeal angiofibroma. Due to its rarity of pathology and presentation, we report this case to remind otolaryngologists to be more careful about these highly vascular intranasal tumors, and this tumor can be excised under endoscope and without preoperative embolization.

Journal of neurosurgery, Jan 4, 2015

OBJECT This study was undertaken to analyze the results of a novel surgical method-the endoscopic... more OBJECT This study was undertaken to analyze the results of a novel surgical method-the endoscopic prelacrimal recess approach (PLRA)-in patients with tumors involving the pterygopalatine fossa (PPF) and infratemporal fossa (ITF). The surgical technique and indications for this approach are also discussed. METHODS The authors analyzed data from 7 cases involving patients who underwent resection of PPF and ITF tumors by means of the endoscopic PLRA from 2004 to 2013. Preoperative and postoperative imaging studies were available in all cases and were reviewed. The surgical specimens were all confirmed to be schwannomas. RESULTS All tumors were completely resected via endoscopic PLRA. There were no recurrences noted over a 28-month follow-up period. In 4 cases, the patients experienced postoperative facial numbness during the first two weeks after surgery, which gradually lessened thereafter. One patient continued to have mild facial numbness at most recent follow-up. The numbness had f...

American journal of rhinology & allergy, 2015

Objective smell tests not only identify levels of smelling ability but also provide information o... more Objective smell tests not only identify levels of smelling ability but also provide information on changes in olfaction after treatment. Odor identification is strongly socially and culturally dependent; therefore, the odorants used in a smell identification test should be familiar to the test population. We developed this smell test for Taiwanese populations with two aims: the test odors should be familiar to Taiwanese and the test should be easily and quickly administered in a busy clinic. Additives that are familiar to Taiwanese people were selected for this smell identification test. Subsequently, the test was validated with the traditional Chinese version of the University of Pennsylvania Smell Identification Test (TC-UPSIT). Finally, this Taiwan Smell Identification Test (TWSIT) was implemented in daily clinical use, and cut-off points of "normosmia," "hyposmia," and "anosmia" were established. A total of 1000 subjects were included in the market ...

Journal of the Chinese Medical Association : JCMA, 2015

Retrosigmoid vestibular neurectomy is considered to be the most effective and safe procedure to c... more Retrosigmoid vestibular neurectomy is considered to be the most effective and safe procedure to control intractable vertigo associated with Ménière's disease while preserving hearing. The surgical procedure of retrosigmoid vestibular neurectomy at the cerebellopontine angle has been well established. Here, we provide for otologic surgeons additional details about the procedure, with special attention to the anatomic features to emphasize our technique, which enables an adequate sectioning of the vestibular fibers on the cochlear nerve close to the overlapping zone containing large-caliber vestibular fibers and small-caliber cochlear fibers. We used the lateral decubitus position to enter the cerebellopontine angle. The cerebellum was gently retracted to expose the cerebellomedullary cistern, which was then opened to drain the cerebrospinal fluid for slacking of the cerebellum. The underlying lower cranial nerves IX, X, and XI were identified. The retractor was then moved upward ...

Chinese medical journal, 2014

Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary... more Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes. A retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications. Nine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of recurrence tumors (rT1), rT2, ...

International Forum of Allergy & Rhinology, 2011

Background: Outcomes for revision endoscopic sinus surgery (RESS) are rarely reported in relation... more Background: Outcomes for revision endoscopic sinus surgery (RESS) are rarely reported in relation to technique. Our goal was to document the outcome of full-house functional endoscopic sinus surgery (FESS) (FHF) (complete sphenoethmoidectomy with Draf IIA frontal sinusotomy) for treatment of this recalcitrant group. Methods: Twenty-one patients with chronic sinusitis having had at least 1 previous sinus surgery (mean, 2.14) underwent FHF, followed by postoperative nasal douching and oral antibiotics for 12 weeks. A er a minimum 6 months of follow-up, patients were asked to complete a 5-item Patient Response Score (PRS) (graded on a 6-point scale from 1 = completely improved to 6 = much worse). Objective measures collected included computed tomography (CT) Lund MacKay score (L-M score, LMS), and endoscopic findings: mucosal swelling (MS) and mucopus (MP) (graded on a 4-point scale from 0 = none to 3 = severe). Results: Patients were divided into 3 subgroups based on months of follow up from surgery: 6-12, 12-18, and 18-24. There was no statistical difference in any outcome based on length of follow up. Mean symptom outcome was reported as much improved (PRS = 1.9 ± 0.1). Both mucosal swelling and mucopus improved dramatically (2.48 vs 0.29, p < 0.001; 2.52 vs 0.29, p < 0.001, respectively). LMS also improved dramatically (11.52 vs 2.1, p < 0.001). Presence of nasal polyps did not affect any subjective or objective outcome. Conclusion: Marked improvements in symptoms and mucosal findings were consistently obtained with FHF between 6 and 24 months postoperatively. C 2011 ARS-AAOA, LLC.

American Journal of Rhinology and Allergy, 2013

Background Patients who suffer from hyposmia and anosmia report a negative effect on their overal... more Background Patients who suffer from hyposmia and anosmia report a negative effect on their overall quality of life. Smell disturbance of patients with chronic rhinosinusitis (CRS) can improve after endoscopic sinus surgery (ESS). Although several studies have shown that 50–83% of patients may notice an improvement in olfactory function after ESS, the olfactory improvement after revision ESS (RESS), especially by objective measurements, is still lacking. Methods Olfactory function was assessed by the traditional Chinese version of the University of Pennsylvania Smell Identification Test (UPSIT-TC) preoperatively and postoperatively, recorded as smell identification test (SIT) score. Olfactory outcomes from anosmia to hyposmia/normosmia, or from hyposmia to normosmia, were considered as “improvement.” Postoperative assessments were divided into two periods: period 1 (P1) is defined as >6 but <12 months postoperatively; period 2 (P2) is defined as >12 but <24 months postope...

American Journal of Rhinology and Allergy, 2011

There is increasing evidence to support the use of anesthetics to affect operative fields during ... more There is increasing evidence to support the use of anesthetics to affect operative fields during endoscopic sinus surgery and thus the speed, thoroughness, and safety of the surgery itself. Previous research has suggested preoperative beta-blockers improve surgical fields (SFs); our study is novel in showing the impact of a beta-blocker infusion on SFs during sinus surgery. A prospective, randomized, double-blind, placebo-controlled trial was conducted in 40 patients. Patients undergoing endoscopic sinus surgery for chronic rhinosinusitis received a constant infusion of i.v. esmolol or saline in addition to a standard inhaled anesthetic protocol. At regular 15-minutes intervals, the quality of SF, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed. Total blood loss was also recorded. Average vital sign parameters (HR/SBP/DBP) were significantly lower in the esmolol group (69.1/90.2/55.1 versus 77.2/99.5/63.5; p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). The esmolol infusion improved SFs relative to control (2.3 versus 2.6; p = 0.045). Esmolol infusion resulted in good SFs (grades 1 and 2) more often than poor fields (grades 3 and 4); on the contrary, the control group showed more poor than good SFs (chi-square; p = 0.04). A correlation between increasing HR and worsening SFs was identified (r = 0.259; p = 0.002). The control group had significantly higher average blood loss (1.3 versus 0.8 mL/min; p = 0.037). Esmolol-induced relative hypotension and bradycardia during endoscopic sinus surgery achieves significantly improved SFs relative to saline control.

Journal of the Chinese Medical Association

Vidian neurectomy has been used to manage intractable vasomotor rhinitis for decades. After the i... more Vidian neurectomy has been used to manage intractable vasomotor rhinitis for decades. After the introduction of endoscopic sinus surgery in the 1980s, transnasal endoscopic vidian neurectomy (EVN) was subsequently reported. The most common problem in performing EVN was excessive bleeding from the pterygopalatine fossa. The complexity and vascularity of the pterygopalatine fossa can cause bloody surgical fields and prevent complete neurectomy. In response to this surgical problem, a procedure was developed to use powered instrumentation and coblation during EVN. There were eight cases of EVNs (16 neurectomies) assisted by power instrumentation and coblation from December 2011 to May 2012. The average blood loss of these cases was 37.5 mL (range, 25e50 mL). The average surgical time of each neurectomy was 27.4 minutes (range, 20e35 minutes). No complications occurred in any of the eight cases. Very limited bleeding and less thermal damage were noted while achieving a complete neurectomy.