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Abstract Nontuberculous mycobacterial otomastoiditis is rare and can be easily confused with various different forms of otitis media. We describe the case of a 50-year-old woman who presented with left-sided [...]

Objectives:The primary aim was to determine the prevalence of gastrointestinal diseases in patients with chronic rhinosinusitis (CRS), utilizing the National Health Insurance Research Database (NHIRD) in Taiwan. Several studies have supported the existence of distinct immune patterns between the Asian and Western populations in CRS patients. Through the population-based case–control study, we could compare the differences between various regions and provide further treatment strategies for subsequent studies in Asian CRS patients. The secondary aim was to assess whether different types of CRS influence the correlation with specific GI diseases. Understanding how different phenotypes or endotypes of CRS may relate to distinct GI disease patterns could provide valuable insights into the underlying mechanisms and potential shared pathways between these conditions. Methods:We use the NHIRD in Taiwan. Newly diagnosed patients with CRS were selected between January 1, 2001 and December 31, 2017 as the case group, and the controls were defined as individuals without a history of CRS. Patients with CRS were divided into two groups: with nasal polyps and without nasal polyps. We also separated GI tract diseases into four groups based on their different pathophysiologies. Results:This study included 356,245 participants (CRS: 71,249 and control: 284,996). The results showed that CRS was significantly associated with some specific GI tract diseases, including acute/chronic hepatitis B, gastroesophageal reflux disease (GERD) with/without esophagitis, achalasia of cardia, peptic/gastrojejunal ulcer, Crohn’s disease, and ulcerative colitis. In addition, when CRS was subcategorized into chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP), GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. Conclusions:A significant association between CRS and premorbid GI tract diseases has been identified. Remarkably, GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. The underlying mechanisms require further investigation and may lead to new treatments for CRS. Researchers can further investigate the mechanisms by referring to our classification method to determine the implications for diagnosis and treatment.

Objectives: Subjective tinnitus is a phantom sensation experienced without any external source of sound that profoundly impacts the quality of life. Some investigations have claimed that transcranial direct current stimulation (tDCS) reduces tinnitus, but studies on tDCS have demonstrated variable results. This meta-analysis aimed to examine the effect of tDCS on patients with tinnitus.Methods: We searched for articles published through January 5, 2016, in Medline, Cochrane, EMBASE, and Google Scholar using the following keywords: tinnitus, transcranial direct current stimulation, and tDCS. The study outcomes were change in magnitude estimates of loudness (loudness), tinnitus-related distress (distress), and Tinnitus Handicap Inventory (THI).Results: Pooled results demonstrated that tDCS did not have a beneficial effect on loudness (pooled standardized difference in means = 0.674, 95% CI, –0.089 to 1.437, P= .083). Further, the pooled results demonstrated a greater reduction in distress for the tDCS group (pooled standardized difference in means = 0.634, 95% CI, 0.021-1.247, P= .043).Conclusions: We conclude that the pooled results demonstrated a greater reduction in distress for groups treated with tDCS as compared with those administered a sham treatment.

This study investigated the development of subcortical pitch processing, as reflected by the scalp-recorded frequency-following response, during early infancy. Thirteen Chinese infants who were born and raised in Mandarin-speaking households were recruited to partake in this study. Through a prospective-longitudinal study design, infants were tested twice: at 1–3 days after birth and at three months of age. A set of four contrastive Mandarin pitch contours were used to elicit frequency-following responses. Frequency Error and Pitch Strength were derived to represent the accuracy and magnitude of the elicited responses. Paired-samples ttests were conducted and demonstrated a significant decrease in Frequency Error and a significant increase in Pitch Strength at three months of age compared to 1–3 days after birth. Results indicated the developmental trajectory of subcortical pitch processing during the first three months of life.

Although scalp-recorded frequency-following response (FFR) to voice pitch has shown great potential to examine pitch processing mechanisms in human participants and animals, few reports have addressed the test-retest reliability of such a response in an animal model. The purpose of this study was to investigate the feasibility and reliability of recording such a response in an animal model and to evaluate the extent to which the response could be separated from background noise. A Chinese monosyllable with a rising pitch was used to elicit the FFR to voice pitch in four guinea pigs. Four objective measures (Root-Mean-Square, Amplitude, Tracking Accuracy, Frequency Error, and Slope Error) were computed from recorded brain waves and were used to examine the phase-locking magnitude and test-retest reliability of the response. Results demonstrated that the animal model produced FFR trends that were repeatable, reliable, and significantly different from responses to the background noise.

To date, observations of the scalp-recorded frequency-following response (FFR) to voice pitch have depended on subjective interpretation of the experimenter. The purpose of this study was to develop and evaluate an automated procedure for detecting the presence of a response. Twenty American (9 boys, 1–3 days) and 20 Chinese (10 boys, 1–3 days) neonates were recruited. A Chinese monosyllable that mimicked the English vowel /i/ with a rising pitch (117–166 Hz) was used as the stimulus. Three objective indices (Frequency Error, Tracking Accuracy, and Pitch Strength) were computed from the recorded brain waves and the test results were compared with human judgments to calculate the sensitivity and specificity values. Results demonstrated that the automated procedure produced sensitivity values between 53–90% and specificity values between 80–100%, and could be used to assess the presence of an FFR for neonates who were born in a tonal or non-tonal language environment.

Mass spectrometry biomarker discovery may assist patients diagnosis in time and realize the characteristics of new diseases. Our previous work built a preprocess method called HHTmass which is capable of removing noise, but HHTmass only a proof of principle to be peak detectable and did not tested for peak reappearance rate and used on medical data. We developed a modified version of biomarker discovery method called Enhance HHTMass (E-HHTMass) for MALDI-TOF and SELDI-TOF mass spectrometry data which improved old HHTMass method by removing the interpolation and the biomarker discovery process. E-HHTMass integrates the preprocessing and classification functions to identify significant peaks. The results show that most known biomarker can be found and high peak appearance rate achieved comparing to MSCAP and old HHTMass2. E-HHTMass is able to adapt to spectra with a small increasing interval. In addition, new peaks are detected which can be potential biomarker after further validation.

Cross-language studies, as reflected by the scalp-recorded frequency-following response (FFR) to voice pitch, have shown the influence of dominant linguistic environments on the encoding of voice pitch at the brainstem level in normal-hearing adults. Research questions that remained unanswered included the characteristics of the FFR to voice pitch in neonates during their immediate postnatal period and the relative contributions of the biological capacities present at birth versus the influence of the listener's postnatal linguistic experience. The purpose of this study was to investigate the characteristics of FFR to voice pitch in neonates during their first few days of life and to examine the relative contributions of the “biological capacity” versus “linguistic experience” influences on pitch processing in the human brainstem.

When the fundamental frequency (f0) is removed from a complex stimulus, the pitch of the f0 is still perceived by the listener. Through the use of the scalp-recorded frequency-following response, this study examined the relative contributions of the f0 and its harmonics in pitch processing by systematically manipulating the speech stimulus to remove component frequencies. 12 American and 12 Chinese adults were recruited. There were statistically significant effects of pitch strength and frequency error for the experimental-condition factor. There were significantly larger responses to the harmonics-only conditions than those obtained in the f0-only and control conditions. No statistically significant difference was observed between the two groups of participants. These findings indicate that neural responses associated with individual harmonics dominate the pitch processing in the human brainstem, irrespective of whether the listener's native language is nontonal or tonal.

ABSTRACTCampylobacter jejuniis a common cause of pediatric diarrhea worldwide. Cytolethal distending toxin, produced by Campylobacter jejuni, is a putative virulence factor that induces cell cycle arrest and apoptosis in eukaryotic cells. Cellular cholesterol, a major component of lipid rafts, has a pivotal role in regulating signaling transduction and protein trafficking as well as pathogen internalization. In this study, we demonstrated that cell intoxication by Campylobacter jejunicytolethal distending toxin is through the association of cytolethal distending toxin subunits and membrane cholesterol-rich microdomains. Cytolethal distending toxin subunits cofractionated with detergent-resistant membranes, while the distribution reduced upon the depletion of cholesterol, suggesting that cytolethal distending toxin subunits are associated with lipid rafts. The disruption of cholesterol using methyl-β-cyclodextrin not only reduced the binding activity of cytolethal distending toxin subunits on the cell membrane but also impaired their delivery and attenuated toxin-induced cell cycle arrest. Accordingly, cell intoxication by cytolethal distending toxin was restored by cholesterol replenishment. These findings suggest that membrane cholesterol plays a critical role in the Campylobacter jejunicytolethal distending toxin-induced pathogenesis of host cells.

Campylobacter jejuni is a common cause of pediatric diarrhea worldwide. Cytolethal distending toxin, produced by Campylobacter jejuni, is a putative virulence factor that induces cell cycle arrest and apoptosis in eukaryotic cells. Cellular cholesterol, a major component of lipid rafts, has a pivotal role in regulating signaling transduction and protein trafficking as well as pathogen internalization. In this study, we demonstrated that cell intoxication by Campylobacter jejuni cytolethal distending toxin is through the association of cytolethal distending toxin subunits and membrane cholesterol-rich microdomains. Cytolethal distending toxin subunits cofractionated with detergent-resistant membranes, while the distribution reduced upon the depletion of cholesterol, suggesting that cytolethal distending toxin subunits are associated with lipid rafts. The disruption of cholesterol using methyl-β-cyclodextrin not only reduced the binding activity of cytolethal distending toxin subunits on the cell membrane but also impaired their delivery and attenuated toxin-induced cell cycle arrest. Accordingly, cell intoxication by cytolethal distending toxin was restored by cholesterol replenishment. These findings suggest that membrane cholesterol plays a critical role in the Campylobacter jejuni cytolethal distending toxin-induced pathogenesis of host cells.

Neural plasticity of pitch processing mechanisms at the human brainstem, as reflected by the scalp-recorded frequency-following response (FFR) to voice pitch, has been reported for normal-hearing adults. Characteristics and maturation of such a response during the first year of life have remained unclear. The purpose of this study was to examine the characteristics of FFR to voice pitch in normal-hearing infants and to make a direct comparison with adults using the same stimulus and recording parameters. 9 infants and 9 adults were recruited. A Chinese monosyllable that mimics the English vowel /i/ with a rising pitch was used to elicit the FFR to voice pitch. The results demonstrated that infant FFRs showed slightly larger Pitch Strength but comparable Frequency Error, Slope Error, and Tracking Accuracy to those obtained from adults. Early maturation of FFRs was also observed in the infants starting from 1 to 3 mo. of age.

Perturbation of cochlear microcirculation, that is, ischemia is a major cause of hearing impairment. Earlier studies examined the short-term (≤7 days) effect of cochlear ischemia. This study characterized the long-term (4 weeks) functional and morphological changes in adult guinea pig cochleae subject to transient ischemia by clamping the labyrinthine artery for 0.25–3 h. Notably, cochlear ischemia for over 1 h caused an increase of auditory brainstem response thresholds and loss of high-frequency hearing, basal-turn hair cells, and spiral ganglions. Auditory recovery may be possible after 30-min ischemia. The extent of the functional and morphological changes depended on the ischemia period, and the changes progressed in extent from the apical to the basal turn in an orderly fashion.

Objective.To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR) Acinetobacter baumanniiin the intensive care units at China Medical University Hospital in Taiwan.Design.Prospective outbreak investigation.Setting.Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.Methods.Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive procedure, were enrolled in our study. Ninety-four A. baumanniistrains were isolated from the patients or the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006. We characterized A. baumanniiisolates by use of repetitive extragenic palindromic–polymerase chain reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical characteristics of the source patients and the environment were noted.Results.All of the clinical isolates were determined to belong to the same epidemic strain of MDR A. baumanniiby the use of antimicrobial susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had undergone an invasive procedure. The outbreak strain was also isolated from the environment and the equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units found that both the patients and the environment harbored the same outbreak strain.Conclusion.The outbreak strain of A. baumanniimight have been transmitted among medical staff and administration equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing recurrent outbreaks of nosocomial infection with MDR A. baumannii.

Detailed radiological assessment by high resolution computed tomography (HRCT) of temporal bone is demanded before any temporal bone or skull base surgery. The aim of this study was to measure the relations between the anatomical landmarks of the temporal bone and to assist the otolaryngologist in establishing accurate preoperative evaluation. We enrolled 43 patients who underwent temporal bone HRCT between February 2004 and May 2004. Contiguous axial and coronal images at 1.0 mm thickness were obtained. Some landmarks such as the superior and inferior lips of the internal acoustic canal (IAC), the malleoincus joint, and the posterior semicircular canal were labeled in the coronal and axial views. Then we measured the distance between them. Average IAC diameter in the coronal and axial views was 5.33 mm and 6.92 mm. Average IAC length in the coronal and axial views was 12.29 mm and 11.09 mm. The thickness of the retrolabyrinthine bone was 3.78 mm. The incidence of thinning bone overlying the superior semicircular canal was 2.3%. Our data could be applied to normal distribution because there were no statistical differences between the measurements of normal ears and diseased ears. Several specific measurements can be applied to the preoperative evaluation of vestibular schwannoma including the retrosigmoid approach, the translabyrinthine approach and the middle fossa approach.

Objective/Hypothesis:Nasal polyposis (NP) is a chronic inflammatory disease of the upper respiratory tract. The pathophysiology is unknown but has been shown to be multifactorial. Free radical‐mediated damage has been implicated in the pathogenesis of NP. Superoxide dismutases (SODs) are the first and the most important line of antioxidant enzyme defense against reactive oxygen species. Moreover, isozymes of the SOD family are critical for modulating the activity of nitric oxide, a gaseous free radical that is believed to play roles in the physiology and pathology of respiratory tracts. However, the expression profile of SOD isoforms in NP remains unclear. We aimed to investigate the expression profile of the SOD isoforms in nasal polyps from nonallergic patients.

Objectives/ HypothesisAn important tumor suppressor gene, p53, plays a role in the regulation of cell progression and prevention of carcinogenesis. Mutated p53 is related to cell progression and malignancy. We aimed to evaluate the association between nasopharyngeal carcinoma and p53 polymorphism.

This study examined 11,333 rigid endoscopy procedures performed in the Department of Otolaryngology, National Taiwan University Hospital, during a 27-year period from 1970 to 1996. Among these cases, 3217 were performed to remove foreign bodies from the airway (459 cases, 14.3%) and esophagus (2758 cases, 85.7%). Retrospective analysis of these data revealed that peanuts (217 cases) and animal bones (1184 cases) were the most frequent foreign bodies encountered in the airway and esophagus, respectively. The successful rate of removal of these foreign bodies was 99.9% (3213/3217). The complication rate was only 0.2% (8/3217), and the mortality rate was less than 0.1% (2/3217). On the basis of these results, we conclude that foreign bodies in the airway and esophagus can be removed safely under direct visualization through rigid endoscopy with relatively few complications. A significant finding in this study is the declining trend in the number of cases in recent years. Despite the decline in the number of procedures, endoscopic removal of foreign bodies remains as a vital skill of the aerodigestive tract surgeon.

Previous research has shown the novelty of lexical-tone chimeras (artificially constructed speech sounds created by combining normal speech sounds of a given language) to native speakers of the language from which the chimera components were drawn. However, the source of such novelty remains unclear. Our goal in this study was to separate the effects of chimeric tonal novelty in Mandarin speech from the effects of auditory signal manipulations. We recruited 20 native speakers of Mandarin and constructed two sets of lexical-tone chimeras by interchanging the envelopes and fine structures of both a falling/yi4/and a rising/yi2/Mandarin tone through 1, 2, 3, 4, 6, 8, 16, 32, and 64 auditory filter banks. We conducted pitch-perception ability tasks via a two-alternative, forced-choice paradigm to produce behavioral (versus physiological) pitch perception data. We also obtained electroencephalographic measurements through the scalp-recorded frequency-following response (FFR). Analyses of variances and post hocGreenhouse-Geisser procedures revealed that the differences observed in the participants’ reaction times and FFR measurements were attributable primarily to chimeric novelty rather than signal manipulation effects. These findings can be useful in assessing neuroplasticity and developing speech-processing strategies.

Abstract: Neurofibromatosis type 2 (NF2) is a rare genetic disease involving multiple tumors of the central and peripheral nervous systems. Most patients with NF2 have bilateral vestibular schwannomas; nonvestibular schwannomas may also develop. While the majority of patients may present with hearing impairment, tinnitus, dizziness and balance disorders, some may present with cutaneous manifestations. We describe the case of a 20-year-old man who initially presented with a solitary subcutaneous painless nodule in the left preauricular area without any other symptoms. He received excisional biopsy for the preauricular mass and the pathologic diagnosis was schwannoma. Magnetic resonance imaging of brain and neck revealed multiple mass lesions over the bilateral cerebellopontine angle cisterns, extending to the bilateral internal auditory canals, bilateral cervical neuroforamens, cervical and upper thoracic spinal canals, and left posterior neck. The patient was diagnosed with NF2 according to the clinical criteria. He underwent gamma knife stereotactic radiosurgery for bilateral vestibular schwannomas and is now under regular monitoring. Conclusion: NF2 patients may present with an isolated solitary cutaneous schwannoma with no other associated clinical findings. Further assessment is thus warranted in young patients presenting with a peripheral schwannoma despite absence of other clinical findings.

Laryngeal photographs from 165 Taiwanese subjects were taken during microlaryngoscopy. Photographs of the vocal fold during the open phase were chosen. For measuring the vocal fold length, both the photograph of a ruler and the larynx were taken under the operating microscope, thus forming a ‘new scale’. Photographs of the vocal fold and the ruler were then processed at the same power of magnification. The length of the vocal folds was measured with the ‘new scale’. In 100 patients receivingdirect laryngoscopy under neuroleptic anaesthesia, the vocal fold length was 14.6 ± 1.2 mm (n = 35) for males and 11.1 ± 1.0 mm (n = 65) for females. In 65 patients under general anaesthesia, the vocal fold length was 15.3 ± 1.6 mm (n = 23) for males and 13.5 ± 1.3 mm (n = 42) for females. Statistical analysis revealed a significant difference between both groups and both sexes. Elongation of the vocal fold under general rather than neuroleptic anaesthesia may be important when performing functional surgery of the vocal fold.