Siriraj Medical Journal

Assessing Dysphagia in Head and Neck Cancer Patients: Validation and Cultural Adaptation of the Thai M.D. Anderson Dysphagia Inventory (TH-MDADI)

Warut Pongsapich — 2025-04-01

Objective: The validation study of the Thai version of the M.D. Anderson Dysphagia Inventory (TH-MDADI) addresses a critical gap in head and neck cancer (HNC) care in Thailand. At leading institutions like Siriraj Hospital, patient-reported outcomes have been historically neglected, with care primarily focusing on routine medical services. This study aimed to validate the TH-MDADI to enhance dysphagia assessment and promote patient centered care.

Materials and Methods: In this longitudinal prospective study, 66 HNC patients completed the TH-MDADI and SF-36 at baseline, pre-treatment, and post-treatment at Siriraj Hospital. Psychometric properties were evaluated, including internal consistency (Cronbach’s α), test-retest reliability (intraclass correlation coefficient, ICC), convergent and discriminant validity (correlations with SF-36 domains), and responsiveness (standardized response mean, SRM).

Results: The TH-MDADI demonstrated excellent internal consistency (Cronbach’s α = 0.93) and test-retest reliability (ICC = 0.92, 95% CI: 0.88–0.96). Strong correlations with related SF-36 domains (r = 0.64-0.74, p < 0.001) established convergent validity, while weak correlations with unrelated domains confirmed discriminant validity. High responsiveness to change post-treatment was observed, particularly in the Global (SRM = 3.83) and Emotional (SRM = 3.17) subscales.

Conclusion: The TH-MDADI demonstrates robust psychometric properties, establishing its value as a reliable tool for assessing dysphagia-related quality of life in Thai HNC patients. This validation represents a significant advancement in Thai cancer care, addressing the historical neglect of patient-reported outcomes. By providing clinicians with a validated assessment instrument, this study promotes a more systematic, patient-centered approach to HNC treatment in Thailand.

Incidence of Tympanic Membrane Perforation Affected by Intratympanic Steroid Injection: A Retrospective Review

Vanthana Charoensawatsiri — 2025-04-01

Objective: This study aims to determine the incidence of persistent tympanic membrane perforation following intratympanic steroid injection and to identify potential factors associated with delayed healing. Additionally, it aims to estimate the time required for perforation closure in prolonged cases to avoid unnecessary interventions.

Materials and Methods: Data from patients who underwent intratympanic steroid injections were reviewed. The primary outcome was the incidence of tympanic membrane perforation lasting beyond four weeks post-injection. Secondary outcomes included identifying factors affecting healing duration and closure time in prolonged cases.

Results: Of 295 ears treated between March 2018 and March 2021, 3.39% (10/295) experienced persistent perforation at four weeks. Of these, 1.69% (5/295) required intervention, while the rest healed spontaneously. The median closure time was 12 weeks. All patients with persistent perforation were female. No statistically significant differences were found between groups. Hearing recovery was achieved in 29.1% (74/254) of patients with sudden sensorineural hearing loss. Younger age and non-profound hearing loss were favorable prognostic factors.

Conclusion: The incidence of perforation in this study is lower than previously reported but consistent with other literature. Intratympanic steroid injections remain beneficial, outweighing the risks of complications.

Factors Influencing Treatment Response in Patients with Malignant Otitis Externa

Pithiwat Wongwan — 2025-04-01

Objective: To identify factors affecting treatment outcomes in patients with malignant otitis externa (MOE).

Materials and Methods: A retrospective review of MOE treatment was conducted in patients aged > 18 years admitted to Siriraj Hospital from January 2007 to December 2022. Predictors of treatment response chosen included duration of hospitalization, duration of antimicrobial treatment, disease-related re-admissions, and mortality.

Results: The study included 49 patients (33 males, 16 females) with a mean age of 65±12 years. Comorbidities were present in 90% of patients, with diabetes mellitus being the most common. Pseudomonas aeruginosa was identified in 37% of cases. Bilateral symptoms/infections were reported in 18%. Facial nerve palsy and non-cranial nerve complications were 51% and 12%, respectively. Computed tomography (CT) imaging revealed bony erosion in 75%. Surgical management was performed in 73% of patients. The median duration of hospital stays and antimicrobial treatment were 34 days, and 143 days, respectively. Readmissions due to disease progression occurred in 35%, and the mortality rate was 4%. Bone erosion on CT was associated with an increased likelihood of readmission. Prolonged hospital stays were associated with bilateral symptoms and positive CT findings. Extended antimicrobial treatment was linked to multiple comorbidities, bilateral symptoms, non-cranial nerve complications, positive CT findings, and surgical cases.

Conclusion: Various factors influence treatment outcomes in MOE patients. Early diagnosis, aggressive treatment, and management of prognostic factors are essential for preventing severe complications and improving survival outcomes.

Wearable Device versus Polysomnography for the Assessment of Sleep Characteristics in Patients with Sleep Disorders

Kankanok Attawiboon — 2025-04-01

Objective: To compare sleep efficiency (SE), total sleep time (TST), and sleep stages recorded by a wearable device (WD) and polysomnography (PSG) in Thai patients with sleep disorders.

Materials and Methods: Patients aged ≥18 years scheduled for PSG were included in this cross-sectional study. All research subjects completed questionnaires and wore a WD (Fitbit Alta HR®) on the same night they underwent PSG study. The data from the WD were transferred to a mobile phone and analyzed independently of PSG results, which were scored by sleep technicians. Bland-Altman plots and intraclass correlation coefficients (ICCs) were used for the analyses.

Results: Data from 55 patients (33 males, 22 females) were analyzed, with four patients excluded due to data errors. The mean differences between WD and PSG for SE (%) and light sleep were 8.4±23.8 and 43.6±26.4, respectively, both statistically significantly (p<0.05). The ICCs for SE and light sleep were -0.03 and -0.04, indicating poor reliability. However, the mean differences for TST, deep sleep, and REM sleep between the two methods were not statistically significant (p>0.05), with ICC values of 0.17, 0.16, and 0.25, respectively, all considered poor correlations.

Conclusion: In patients with sleep disorders, sleep characteristics measured by the WD and PSG showed some differences and weak correlations. As technology advances, the accuracy of wearable devices may improve. Further studies are needed to evaluate different devices and populations.

Evaluation of Regional Taste Function in Healthy Thai Subjects Using Standard Suprathreshold Tastants

Tharatham Phonmanee — 2025-04-01

Objective: To evaluate regional taste function in normal Thai subjects using standard suprathreshold tastants.

Materials and Methods: A total of 93 healthy Thai subjects (41 males and 52 females), aged 20 to 60 years, were recruited. Regional taste function was assessed using four standard suprathreshold tastants, with both identification scores and VAS scores recorded.

Results: The mean total taste identification score was 10.7 on the right side and 10.8 on the left side, with no statistically significant differences between sides across all subgroups. The mean VAS score was highest for sweet tastants and for the posterior tongue as the tested area. No significant differences were observed between sexes or among age groups when analyzed by tastant and area.

Conclusion: The regional (spatial) taste test is a useful gustatory test. This study establishes normative values for Thai subjects, which can be used in future clinical practice for patient evaluations.