Thai Journal of Otolaryngology Head and Neck Surgery

Guideline for Development of Diagnosis and Treatment of Snoring and Obstructive Sleep Apnea in Thailand for Adults 2025

2025-03-14T11:19:54+07:00

Snoring is a significant symptom of obstructive sleep apnea (OSA), a condition in which the airway becomes narrowed, causing vibrations in the surrounding tissues as air passes through.

Obstructive sleep apnea (OSA) is classified as a sleep-related breathing disorder (SRBD), characterized by the relaxation of upper airway muscles during sleep, leading to airway collapse. This results in reduced airflow (hypopnea) or a complete cessation of airflow (apnea), despite increased respiratory effort. These events cause low blood oxygen levels (hypoxemia) and excessive carbon dioxide levels (hypercapnia). When this reaches a critical point, the body triggers a protective mechanism that awakens the brain (arousal), restoring muscle tone in the upper airway and reopening the airway to resume breathing. These events occur periodically throughout sleep, causing frequent brain arousals, which can prevent normal sleep.

OSA is prevalent among both Thai and global populations. Epidemiological studies have shown that the prevalence of OSA varies depending on the definition of the disease, the study population, and the survey period, with reported rates ranging from 4% to 27% in men and 1.9% to 16% in women. In some cases, the prevalence may be even higher. In Thailand, one study reported an OSA prevalence of 15.4% in men and 6.3% in women in the general population.

If left untreated, OSA can lead to various complications, including an increased risk of accidents due to excessive daytime sleepiness, decreased quality of life, hypertension, pulmonary hypertension, atrial fibrillation, coronary artery disease, cerebrovascular disease, and many other conditions. Early diagnosis and appropriate treatment planning are therefore crucial.

Given its high prevalence and significant public health impact, OSA is an important medical issue. Continuous advancements in standardized treatments can ensure that patients receive proper and effective care, ultimately benefiting both individuals and society as a whole.

Pediatrics hearing loss journey: from universal newborn hearing screening through cochlear implantation

2024-10-08T08:52:11+07:00

Hearing impairment can be screened from birth. If diagnosed, treated, and received hearing rehabilitation, the patient should have better language and speech development, enable verbal communication, access to education in regular schools, and have a good quality of life. Currently, Thailand has made progress in providing diagnostic and treatment services for hearing loss. Hearing-loss children can access hearing rehabilitation with hearing aids and cochlear implants. However, the shortage of audiology professionals may limit access to these services. This article compiles guidelines for newborn hearing screening, diagnosis and rehabilitation of hearing loss in children, hearing rehabilitation devices, and the issuance of disability certificates for hearing impairment, to serve as a guide for health personnel involved in this field.

The evidence of comparative effectiveness for tonsillectomy between Metzenbaum with bipolar electrocautery technique and monopolar with bipolar electrocautery technique

2024-09-26T15:26:22+07:00

Abstract Tonsillectomy is a commonly performed surgery in children and adults in otolaryngology practice. Recently, there have been various surgical techniques for tonsillectomy. Every surgical technique has a unique set of outcomes and risks. The most critical complication is post-tonsillectomy hemorrhage, which increases medical expenses, and if treatment is not timely, it may cause the patient's death.

Objectives This study aims at comparing the effectiveness and complications after tonsillectomy between Metzenbaum with bipolar electrocautery technique (group A) and monopolar with bipolar electrocautery technique (group B) in children and adult patients. Additionally, investigations regarding the incidence and risk factors of post-tonsillectomy hemorrhage are also entertained.

Material and methods The study comprised adult and pediatric patients who satisfied the eligibility requirements and performed tonsillectomy between January 1, 2017, and March 31, 2024. Patient history and surgical information were entered in the case record form and the Excel program for data analysis using STATA version 15.1.

Results Surgical technique affects the time required for surgery and the hospital length of stay. Group A had a significantly shorter operation time and hospital length of stay compared to group B (18.97 vs. 26.30 min, P-value < 0.001, 2.90 vs. 3.07 days, P-value = 0.0459). In the context of post-tonsillectomy hemorrhage (PTH), of the 547 patients, 115 (21.02%) had a PTH, and 113 had secondary hemorrhage (98.26%). The results of the bivariate analysis found that patients who were older than or equal to 15 years or had a body mass index more than or equal to 25 had an effect on the incidence of PTH and secondary hemorrhage (P-value = 0.007, 0.009, and 0.015, 0.025). According to the multivariate analysis conducted using the log-binomial regression model, the surgical technique was found to have a non-significant effect (P-value = 0.159, 0.982, and 0.151) on the incidence of PTH, primary hemorrhage, and secondary hemorrhage. The main factors affecting the incidence of PTH, primary hemorrhage, and secondary hemorrhage are age >= 15 years old (P-value = 0.026, <0.0001 and 0.027) with RR values of 2.31, 805644.9 and 2.30, respectively and BMI >= 25 (P-value = = 0.027, <0.0001 และ 0.042) with RR values of 1.44, 8732261 and 1.40, respectively.

Conclusion Metzenbaum with bipolar electrocautery technique provides a number of benefits over monopolar with bipolar electrocautery technique, such as less operation time and a shorter hospital length of stay. The incidence of PTH and postoperative bleeding day between the two surgical techniques is no different. 98.26% of PTH is secondary hemorrhage, which is caused by risk factors such as age >= 15 years old or having a BMI >= 25.

Key words: Tonsillectomy, Metzenbaum, Electrocautery, Hemorrhage

Role of intraoperative imprint cytology in diagnosis of cervical lymph node metastasis

2024-10-26T14:40:32+07:00

The intraoperative sentinel lymph node biopsy is a recognized method to determine the stage of head and neck cancers. This procedure assists in the diagnosis of cancer metastasis. Cytology and pathology are crucial processes for tissue diagnosis during surgery. However, due to insufficient pathologists available to interpret frozen section pathology in all hospitals. Therefore, imprint cytology presents itself as an alternative. This study aims to assess the sensitivity and specificity of intraoperative imprint cytology diagnosis compared to pathology in detecting cancer metastasis to the lymph nodes in the neck. Result: The study found that 46 patients participated in the research, with a total of 322 lymph nodes examined. The majority of patients were female, with 26 cases (56.52%) which 23-80 years old (Mean 53.93, SD 14.43). The two most common types of head and neck were thyroid cancer (22 cases, 47.83%) and oral cancer (18 cases, 39.13%). The two most common pathological types were papillary thyroid carcinoma and squamous cell carcinoma, each found in 21 cases (45.65%). Most patients were in stage 4 of cancer (22 cases, 47.83%). Most patients underwent selective neck dissection (31 cases, 67.31%) and comprehensive neck dissection (15 cases, 32.61%). The prevalence of cervical lymph node metastasis in this study was 20.5% (95%CI 16.2-25.3). The sensitivity of imprint cytology compared to pathology was 87.9% (95%CI 77.5-94.6%), and its specificity was 94.9% (95%CI 91.5-97.3%). The positive predictive value (PPV) was 81.7% (95%CI 70.7-89.9%), and the negative predictive value (NPV) was 96.8% (95%CI 93.8-98.6%). These results indicate that imprint cytology has a high sensitivity of 87.9% and a specificity of 94.9%, resulting in a PPV of 81.7% and an NPV of 96.8%. This study's findings suggest that imprint cytology can be a reliable method for detecting cancer metastasis to the lymph nodes in the neck. Particularly, a negative result from imprint cytology is highly reliable, which can help avoid extensive neck dissection surgeries, thereby reducing the complications associated with neck lymph node removal.

The Efficacy and Safety of Prasaprohyai Remedy, a Thai traditional remedy compared to Loratadine in Allergic Rhinitis Patients

2024-10-26T14:15:00+07:00

ABSTRACT

Background: Prasaprohyai remedy (PSPR) has been used to treat common cold and fever, but there is no report of efficacy and safety. Thus, the objectives of this study are to compare the efficacy and safety of PSPR powder and Loratadine in allergic rhinitis patients.

Methods: The study design was a double-blind, randomized controlled trial. Sixty-three allergic rhinitis volunteers were divided into two random groups. One took PSPR remedy powder at a dose of 1,000 mg three times a day before meals, and the other took Loratadine at a dose of 10 mg once daily before meals and received a placebo to maintain double-blind conditions for six weeks. All volunteers were followed up in the third week and the sixth week to evaluate the efficacy and safety of the medicines.

Conclusion: PSPR increased the minimal cross section area (MCA) in the sixth week. PSPR and Loratadine were able to relieve the symptoms of sneezing, running nose, stuffy nose, itchy nose, total nasal symptoms, and to raise quality of life (p < 0.05). A side effect of PSPR is eructate (23.3%) and a side effect of Loratadine is drowsiness (13.3 %). After taking PSPR, there was no adverse effect on either renal or liver function. Then PSPR appears to be as safe and effective as Loratadine treatment and could be a potential choice for the treatment of allergic rhinitis.