Thai Journal of Otolaryngology Head and Neck Surgery

Prevalence of Chronic Rhinosinusitis in Rajavithi Hospital Workers, Bangkok, Thailand

Fri, 02 Feb 2024 00:00:00 +0700

ABSTRACT

Background: The prevalence of chronic rhinosinusitis (CRS) has been reported to range from 5% to
12% in different parts of the world. However, the prevalence of CRS in Thailand has not been
investigated. Our objective was to determine the prevalence of CRS among hospital workers and
identify any potential problems encountered during the survey.

Methods: Adult workers (>18 years) of Rajavithi Hospital, a tertiary hospital in Bangkok, Thailand,
were recruited. This cross-sectional survey was conducted from September 2021 to September 2022.
The participants were given a link to online questionnaires asking if they had nasal obstruction,
discharge, decreased smell sensation, or facial pain and their respective duration. Phone numbers
and email were asked for contact when needed. The participants who fulfilled the symptom and
duration according to the European position paper on rhinosinusitis and nasal polyp 2020 were
counted as symptom-based CRS patients. These patients were then contacted for nasal endoscopy. The
endoscopic-based diagnosis of CRS was made after positive endoscopy findings.

Result: A total of 1,025 participants (mean age of 33.7 years) were recruited. Of total, there were
34 (3.3%) and 6 (0.58%) participants fulfilled symptom- and endoscopy-based diagnoses,
respectively. Fourteen participants did not respond to calls or emails. Five patients refused to
visit the clinic due to inconveniences. One patient refused nasal endoscopy because of the
expenses.

Conclusion: The overall prevalence of chronic rhinosinusitis in workers of Rajavithi Hospital, was
3.3% and 0.58% by symptom- and endoscopy-based criteria, respectively. Difficulty reaching the
participants for nasal endoscopy was the leading survey problem.

Keywords: Prevalence, Chronic rhinosinusitis, nasal endoscopy, Rajavithi hospital, Bangkok;

Clinical Practice Guidelines on Biologics for Chronic Rhinosinusitis

สมาคมแพทย์โรคจมูก (ไทย) — Fri, 02 Feb 2024 00:00:00 +0700

บทคัดย่อ (Abstract)
โรคไซนัสอักเสบเรื้อรังเป็นโรคที่พบบ่อย และรบกวนต่อคุณภาพชีวิตของผู้ป่วย การรักษาประกอบด้วย
การรักษาด้วยยา และการผ่าตัด ในผู้ป่วยบางรายอาจมีภาวะไซนัสอักเสบที่ไม่ตอบสนองต่อการรักษา
(Recalcitrant sinusitis) ถึงแม้จะได้รับการรักษาที่เหมาะสมตามมาตรฐานแล้ว
จากการค้นคว้าวิจัยในปัจจุบันถึง กลไกในการก่อโรค และแนวทางการรักษา
ได้มีการรักษามุ่งเป้าด้วยยาชีววัตถุ (Biologics) ในผู้ป่วยไซนัสอักเสบ เรื้อรังประเภทที่ 2 (Type 2
Chronic rhinosinusitis) เช่น anti-IgE, anti-IL5, anti-IL5R, anti‐IL4R และ anti‐ IL13
อย่างไรก็ตามด้วยข้อจ ากัดเรื่องจ านวนของผู้ป่วยที่เป็นโรค การเข้าถึงของยา
และค่าใช้จ่ายที่เกิดขึ้นในการ รักษา ดังนั้นการศึกษาถึงข้อบ่งชี้ในการใช้ยา Biologics
และแนวทางติดตามผลการรักษาในบริบทของผู้ป่วยใน ประเทศไทยจึงเป็นสิ่งจ าเป็น สมาคมแพทย์โรคจมูก (ไทย)
ร่วมกับสมาคมโรคภูมิแพ้ โรคหืด และวิทยาภูมิคุ้มกัน แห่งประเทศไทย และราชวิทยาลัยโสต ศอ
นาสิกแพทย์แห่งประเทศไทย จึงได้จัดท าแนวทางเวชปฏิบัติการใช้ยา Biologics ในโรคไซนัสอักเสบเรื้อรัง
(ฉบับ พ.ศ. 2566) เพื่อเป็นแนวทางให้ โสต ศอ นาสิกแพทย์ กุมารแพทย์ แพทย์โรคภูมิแพ้
และแพทย์เฉพาะทางระบบทางเดินหายใจ ได้ใช้ประกอบการพิจารณาเลือกการรักษาด้วยยา
Biologics ในผู้ป่วยไซนัสอักเสบเรื้อรังได้อย่างถูกต้อง เหมาะสม และคุ้มค่า

Can Acupressure Reduce Symptom Severity and Drug Usage in Patients with Allergic Rhinitis?

Fri, 02 Feb 2024 00:00:00 +0700

Abstract
Background Patients with allergic rhinitis are increasing worldwide. Though treatment guidelines
have been provided, many patients remain with uncontrolled symptoms and search for add-on or
alternative treatments.

Objective: To explore the effect of add-on acupressure on the nasal symptoms of allergic rhinitis.

Methods: We performed pre- and post-treatment study in patients with allergic rhinitis. The
patients were instructed to apply pressure on five acupuncture points: 1 Yin tang, 2 Ying xiang, 2
He gu acupoints, as an add-on treatment. The acupressure was applied for ten seconds, followed by
massaging for ten seconds. The procedure was repeated five times for each point. The nasal symptom
scores, visual analog scale (VAS) scores, and peak nasal inspiratory flow (PNIF) were measured
before acupressure and two weeks after acupressure. At the last visit, they were asked whether
acupressure helped reduce their symptoms or drug usage.

Results: This study enrolled eight patients. The median age was 37.5 years (range: 19–74 years).
Further, seven (87.5 %) patients presented moderately severe persistent symptoms. There was a
significant improvement in the total nasal symptom scores (p-value = 0.012), VAS scores (p-value =
0.0018), and PNIF (p-value = 0.0287). At the end of the study, 75% and 25% of the patients reported
that acupressure reduced their symptoms and drug usage, respectively.

Conclusion: Through both subjective and objective assessments, two-week add-on acupressure can
reduce symptom severity in patients with allergic rhinitis.

Keywords: acupressure, complementary therapies, allergic rhinitis

Validation of using 2-item and 5-item of the Dizziness Handicap Inventory Thai version for screening Benign Paroxysmal Positional Vertigo (BPPV) in Thai population

Krittanai Teeratamtada — Fri, 02 Feb 2024 00:00:00 +0700

Abstract
Objective: To validate the use of total score, 5-item score, and 2-item score of the Thai version
of the Dizziness Handicap Inventory (DHI-TH) for screening benign paroxysmal positional vertigo
(BPPV) in Thai population.
Study Design: A retrospective electronic medical chart review
Setting: Tertiary care teaching hospital
Patients: A total of 60 electronic medical records of patients who were diagnosed with BPPV at the
vestibular clinic were identified during the period from January 2021 to May 2022. The electronic
medical records of another 60 patients with other vestibular disorders were also reviewed.

Main Outcome Measures: The total score, 2-item score, and 5-item score of the DHI-TH were obtained.
Results: The area under the receiver operating characteristic curve (AUC) of the 2-item and 5- item
score for predicting BPPV was 0.855 (95% confidence interval: 0.788-0.923) and 0.806 (95%
confidence interval: 0.728-0.884), respectively. Using a cut-off value of 6 in the 2-item score had
a good sensitivity of 73.33%, specificity of 80% in discriminating BPPV from those without BPPV.
For the 5-item score, a cut-off value of 15 had 63.33% sensitivity and 90% specificity in
separating BPPV from non-BPPV.

Conclusions: Both 5-item and 2-item scores from the DHI-TH are valid for initial BPPV screening. We
recommend using 2-item score due to its time efficiency, aligning with comparable
sensitivity and specificity observed in the 5-item score.

Keywords: Benign paroxysmal positional vertigo—Dizziness—Screening—Dizziness Handicap
Inventory

A case report: Neonatal infected congenital sublingual cyst with upper airway obstruction

Arunrat Dumkliang — Fri, 02 Feb 2024 00:00:00 +0700

Abstrast
Congenital sublingual cyst (CSC) is an exceptionally rare anomaly in newborn, with limited case
studies published to date. The occurrence of symptomatic CSC in newborn is extremely uncommon, and
this case is the first reported case of a neonate with an infected CSC leading to airway
obstruction.
A three-week-old female infant presented at the emergency room with symptoms of aspiration
pneumonia and upper airway obstruction attributed to a substantial turbid within sublingual cyst.
Emergency measures included securing her airway by Dual PAP and admitted to NICU. Immediate bedside
intervention involved needle aspiration, revealing a cystic content comprising 18 ml of pus. Over
the subsequent two weeks, the sublingual cyst gradually returned to its previous size.
Consequently, a scheduled marsupialization was performed. The postoperative outcome was favorable,
with successful reversal, extubation on the first day postoperatively, resuming normal oral
feeding, and mild sublingual bulging. The infant was discharged on the third week, and notably,
there was no recurrence of the cyst during the 18 months of follow up.
In conclusion, this reported case highlights the rare occurrence of symptomatic CSC in a newborn
necessitating definitive surgical management. The goal of surgical intervention is to restore
normal function while minimized the risk of recurrence and less of morbidity. This extraordinary
case report serves as a valuable contribution to medical knowledge, motivation the sharing of this
unique clinical experience with the broader medical community.