Otolaryngology - Research Publications
Now showing items 1-12 of 95
A rotation and translation invariant method for 3D organ image classification using deep convolutional neural networks
(PEERJ INC, 2019-03-04)
Three-dimensional (3D) medical image classification is useful in applications such as disease diagnosis and content-based medical image retrieval. It is a challenging task due to several reasons. First, image intensity values are vastly different depending on the image modality. Second, intensity values within the same image modality may vary depending on the imaging machine and artifacts may also be introduced in the imaging process. Third, processing 3D data requires high computational power. In recent years, significant research has been conducted in the field of 3D medical image classification. However, most of these make assumptions about patient orientation and imaging direction to simplify the problem and/or work with the full 3D images. As such, they perform poorly when these assumptions are not met. In this paper, we propose a method of classification for 3D organ images that is rotation and translation invariant. To this end, we extract a representative two-dimensional (2D) slice along the plane of best symmetry from the 3D image. We then use this slice to represent the 3D image and use a 20-layer deep convolutional neural network (DCNN) to perform the classification task. We show experimentally, using multi-modal data, that our method is comparable to existing methods when the assumptions of patient orientation and viewing direction are met. Notably, it shows similarly high accuracy even when these assumptions are violated, where other methods fail. We also explore how this method can be used with other DCNN models as well as conventional classification approaches.
Increased susceptibility to acoustic trauma in a mouse model of non-syndromic sensorineural deafness, DFNB91
Inactivating mutations of SERPINB6 in humans result in progressive hearing loss starting in early adulthood (DFNB91). We have previously shown that C57BL/6J mice lacking the orthologous gene, Serpinb6a, exhibit progressive hearing loss, which is associated with progressive loss of distinct cell types in the organ of Corti beginning with outer hair cells (OHCs). However, deafness in these animals occurs much earlier than expected, possibly because C57BL/6J mice also carry an age-related hearing loss mutation in the cadherin 23 gene (Cdh23ahl ) that causes late onset hearing loss. The CBA/CaH strain of mice does not carry Cdh23ah/ahl and may represent a better model of the human DFNB91 patients. Here, we show that transfer of the mutant Serpinb6a allele onto the Cdh23 normal CBA/CaH background markedly delays onset of hearing loss, more closely phenocopying DFNB91, without altering the pattern of cellular loss. Young, pre-symptomatic mice of this genotype exposed to acoustic trauma exhibit permanent hearing loss, compared to controls, associated with the disappearance of OHCs. We conclude that Serpinb6 helps to maintain hearing by protecting hair cells from stress.
The Melbourne Mastoidectomy Scale: Validation of an end-product dissection scale for cortical mastoidectomy
Introduction Cortical mastoidectomy is a common otolaryngology procedure and represents a compulsory part of otolaryngology training. As such, a specific validated assessment score is needed for the progression of competency‐based training in this procedure. Although multiple temporal bone dissection scales have been developed, they have all been validated for advanced temporal bone dissection including posterior tympanotomy, rather than the task of cortical mastoidectomy. Methods The Melbourne Mastoidectomy Scale, a 20‐item end‐product dissection scale to assess cortical mastoidectomy, was developed. The scale was validated using dissections by 30 participants (10 novice, 10 intermediate and 10 expert) on a virtual reality temporal bone simulator. All dissections were assessed independently by three blinded graders. Additionally, all procedures were graded with an abbreviated Welling Scale by one grader. Results There was high inter‐rater reliability between the three graders (r = .9210, P < .0001). There was a significant difference in scores between the three groups (P < .0001). Additionally, there was a large effect size between all three groups: the differences between the novice group and both the intermediate group (P = .0119, η2 = 0.2482) and expert group (P < .001, η2 = 0.6356) were significant. The difference between the intermediate group and expert group again had a large effect size (η2 = 0.3217), but was not significant. The Melbourne Mastoidectomy Scale correlated well with an abbreviated Welling Scale (r = .8485, P < .0001). Conclusion The Melbourne Mastoidectomy Scale offers a validated score for use in the assessment of cortical mastoidectomy.
Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery
BACKGROUND: Trans-oral endoscopic thyroidectomy allows obviating scar of the neck that expects to gain quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore, this study compared the QOL outcomes, including cosmetic outcomes, between thyroidectomy by trans-oral endoscopy and conventional open surgery. METHODS: A study was conducted from January 30, 2017 to November 10, 2018. Thirty-two and 38 patients underwent trans-oral endoscopic thyroid surgery and conventional open surgery, respectively. Their quality of life was evaluated at 2, 6, and 12 weeks postoperatively using a thyroid surgery-specific questionnaire and a 36-item short-form questionnaire. RESULTS: Trans-oral endoscopic group, patients were younger and presented with smaller thyroid nodules (p < 0.05). Regarding surgical outcomes, there were no statistically significant differences between the two groups. Mean operative time was significantly longer in the trans-oral endoscopic group (p < 0.05). The quality of life parameters in the trans-oral endoscopic group was significantly better than in the conventional surgery group (p < 0.05). These parameters included reduction of physical activity, psychosocial impairment, the role of physic, and emotion at 2 weeks after surgery; swallowing impairment, psychosocial impairment, the role of physic, social function and mental health 6 weeks after surgery; tingling and feeling of vitality at 12 weeks after surgery. Cosmetic outcomes and overall satisfaction were significantly better in the trans-oral endoscopic group than in the conventional surgery group at all of our follow up times (p < 0.05). CONCLUSIONS: The trans-oral endoscopic approach allows real scarless on the skin with better cosmetic and QOL outcomes. TRIAL REGISTRATION: This trial was retrospectively registered at the ClinicalTrial.gov (NCT03048539), registered on 4 March 2017.
Otitis media guidelines for Australian Aboriginal and Torres Strait Islander children: summary of recommendations
INTRODUCTION: The 2001 Recommendations for clinical care guidelines on the management of otitis media in Aboriginal and Torres Islander populations were revised in 2010. This 2020 update by the Centre of Research Excellence in Ear and Hearing Health of Aboriginal and Torres Strait Islander Children used for the first time the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. MAIN RECOMMENDATIONS: We performed systematic reviews of evidence across prevention, diagnosis, prognosis and management. We report ten algorithms to guide diagnosis and clinical management of all forms of otitis media. The guidelines include 14 prevention and 37 treatment strategies addressing 191 questions. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: A GRADE approach is used. Targeted recommendations for both high and low risk children. New tympanostomy tube otorrhoea section. New Priority 5 for health services: annual and catch-up ear health checks for at-risk children. Antibiotics are strongly recommended for persistent otitis media with effusion in high risk children. Azithromycin is strongly recommended for acute otitis media where adherence is difficult or there is no access to refrigeration. Concurrent audiology and surgical referrals are recommended where delays are likely. Surgical referral is recommended for chronic suppurative otitis media at the time of diagnosis. The use of autoinflation devices is recommended for some children with persistent otitis media with effusion. Definitions for mild (21-30 dB) and moderate (> 30 dB) hearing impairment have been updated. New "OMapp" enables free fast access to the guidelines, plus images, animations, and multiple Aboriginal and Torres Strait Islander language audio translations to aid communication with families.
A deep learning based framework for the registration of three dimensional multi-modal medical images of the head
(NATURE RESEARCH, 2021-01-21)
Image registration is a fundamental task in image analysis in which the transform that moves the coordinate system of one image to another is calculated. Registration of multi-modal medical images has important implications for clinical diagnosis, treatment planning, and image-guided surgery as it provides the means of bringing together complimentary information obtained from different image modalities. However, since different image modalities have different properties due to their different acquisition methods, it remains a challenging task to find a fast and accurate match between multi-modal images. Furthermore, due to reasons such as ethical issues and need for human expert intervention, it is difficult to collect a large database of labelled multi-modal medical images. In addition, manual input is required to determine the fixed and moving images as input to registration algorithms. In this paper, we address these issues and introduce a registration framework that (1) creates synthetic data to augment existing datasets, (2) generates ground truth data to be used in the training and testing of algorithms, (3) registers (using a combination of deep learning and conventional machine learning methods) multi-modal images in an accurate and fast manner, and (4) automatically classifies the image modality so that the process of registration can be fully automated. We validate the performance of the proposed framework on CT and MRI images of the head obtained from a publicly available registration database.
The minimum effective dose of abobotulinum toxin A injection for allergic rhinitis: A dose-escalation randomized controlled trial
Objective: To find the lowest effective injection dose of abobotulinum toxin A (Dysport) for allergic rhinitis. Study Design: Dose-escalation randomized controlled trial. Methods: We included all patients aged 18 years or older who had persistent allergic rhinitis and positive allergy skin prick test. The patients were randomly allocated to receive 40, 30, or 20 U of abobotulinum toxin A by injection at the inferior turbinate. We followed up on patients for 12 weeks to evaluate nasal symptoms, ocular symptoms, minimum nasal cross-sectional area as measured using acoustic rhinometry, and complications. Results: Seventeen patients were included in this study, with 7 receiving 20 U of abobotulinum toxin A and 5 each receiving 30 U and 40 U. Abobotulinum toxin A significantly improved nasal congestion, rhinorrhea, sneezing, and loss of smell at 40 U (P < .05) and nasal congestion, sneezing, and loss of smell at 30 U (P < .05). However, at a dose of 20 U, only nasal congestion and loss of smell improved (P < .05). Nasal patency had also significantly improved two weeks after treatment at doses of 40 and 30 U (P < .05). Complications included epistaxis (11.8%) and nasal dryness (23.5%). Conclusion: Abobotulinum toxin A at a dose of at least 30 U effectively reduced most nasal symptoms. Level of Evidence: 2. Trial registration: Clinicaltrials.in.th/ TCTR20200526014.
A multicenter survey on the effectiveness of nasal irrigation devices in rhinosinusitis patients
Background: Nasal irrigation is widely used as an adjunctive treatment for rhinosinusitis. However, there is little information available regarding the efficacy of the devices used in this procedure. The objective of this study was thus to evaluate the effectiveness of nasal irrigation devices based on the experiences of patients with rhinosinusitis. Methods: We conducted a multicenter survey study between November 2017 and December 2019. The questionnaire was developed based on the available literature and expert opinion and submitted to the otolaryngology residents and staff of each center as well as those in their networks. Results: Four hundred eighteen patients were enrolled in this study: 76 with acute viral rhinosinusitis (18%), 53 with acute bacterial rhinosinusitis (13%), 156 with chronic rhinosinusitis without nasal polyps (37%), and 133 with chronic rhinosinusitis with nasal polyps (32%). We found that high-volume devices were most effective in helping to clear secretion in patients with acute viral rhinosinusitis, chronic rhinosinusitis without nasal polyps, and acute bacterial rhinosinusitis (P = .017, .009, .002, respectively) and in reducing post-nasal drip in those with acute bacterial rhinosinusitis (P = .040). There were no statistically significant differences among devices in patients with chronic rhinosinusitis with nasal polyps. Conclusions: Nasal irrigation with high-volume devices was an effective treatment for rhinosinusitis and was more effective at clearing nasal secretion and reducing post-nasal drip than that with other types of devices. Level of Evidence: 2C.
Is the routine pressure dressing after thyroidectomy necessary? A prospective randomized controlled study.
(Springer Science and Business Media LLC, 2008-03-20)
BACKGROUND: An acute complication of thyroidectomy is fatal hematoma, which can produce an upper airway obstruction needing immediate intubation or tracheostomy. After neck surgery, we usually apply a pressure dressing with a non-woven, adhesive fabric to reduce bleeding and fluid collection at the operative bed. We conducted a prospective, randomized, controlled study to evaluate a pressure vs. a non-pressure dressing after thyroid surgery by monitoring blood and serum in the operative bed. METHODS: We studied 108 patients who underwent 116 thyroid surgeries at Srinagarind Hospital, Khon Kaen University, between December 2006 and September 2007. The patients were randomized to either the pressure dressing or non-pressure dressing group. Ultrasound of the neck was performed 24 +/- 3 hours after surgery. The volume of fluid collection in the operative bed was calculated. All patients were observed for any post-operative respiratory distress, wound complications, tingling sensation or tetany. RESULTS: The distributions of age, sex, surgical indications and approaches were similar between the two groups. There was no statistically significant difference in the volume of fluid collection in the operative bed (p = 0.150) and the collected drained content (p = 0.798). The average time a drain was retained was 3 days. One patient in the pressure dressing group suffered cutaneous bruising while one patient in the non-pressure dressing group developed immediate hemorrhage after the skin sutures. CONCLUSION: Pressure dressing after thyroidectomy does not have any significant impact on decreasing fluid collection at the operative bed. The use of pressure dressing after thyroidectomy may not therefore be justified. TRIAL REGISTRATION: NCT00400465, ISRCTN52660978.
Fractured metallic tracheostomy tube in a child: a case report and review of the literature.
(Springer Science and Business Media LLC, 2010-08-02)
INTRODUCTION: Tracheostomy is a common airway procedure for life support. The fracture of the tracheostomy tube is a rare complication. We report a case of a 14-year-old boy whose fractured stainless steel tracheostomy tube dislodged into the tracheobronchial tree. We include a literature review and proposed recommendations for tracheostomy care. CASE PRESENTATION: A 14-year-old Thai boy who had a stainless steel tracheostomy tube presented with a complaint of intermittent cough for 2 months. During tracheostomy tube cleaning, his parents found that the inner tube was missing. A chest X-ray revealed a metallic density foreign body in his right main bronchus. He underwent bronchoscopic removal of the inner tracheostomy tube and was discharged without further complications. CONCLUSION: A fractured tracheostomy tube is a rare complication. Appropriate cleaning and scheduled replacement of the tracheostomy tube may prevent this complication.
A child presenting with a bullet in the middle ear: case report.
(SAGE Publications, 2012)
INTRODUCTION: Foreign bodies in the external auditory canal are common in both adults and children. Removal of the foreign body requires skill, but is usually successfully performed in the emergency department. We report a case of a child with a bullet in ear canal which was pushed into the middle ear during an attempt to remove it. CASE PRESENTATION: A 6-year-old Thai boy went to the community hospital with his parents, who reported that their child had pushed a bullet into his ear. Otoscopic examination revealed a metallic foreign body in his external auditory canal. The first attempt to remove the foreign body failed and the child was referred to an otolaryngologist. We found that the tympanic membrane was ruptured, with granulation tissue in the middle ear and the bullet was located in the hypotympanum. The foreign body was removed via a post-auricular approach. CONCLUSION: Removal of a foreign body from external auditory canal is an essential skill for physicians. Careful removal can prevent further trauma and complications. When the first attempt fails, referral to an otolaryngologist is recommended.