Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate t... more Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate the relationship between ARHL and the prevalence, and 10-year incidence of dementia in the Taiwan National Health Insurance Research Database (NHIRD). We selected patients diagnosed with ARHL from the NHIRD. A comparison cohort comprising of patients without ARHL was frequency-matched by age, sex, and co-morbidities, and the occurrence of dementia was evaluated in both cohorts. The ARHL cohort consisted of 4108 patients with ARHL and the control cohort consisted of 4013 frequency-matched patients without ARHL. The incidence of dementia [hazard ratio (HR), 1.30; 95% confidence interval (CI 1.14-1.49); P = 0.002] was higher among ARHL patients. Cox models showed that being female (HR, 1.34; 95% CI 1.07-1.68), as well as having co-morbidities, including chronic liver disease and cirrhosis, rheumatoid arthritis, hypertension, diabetes mellitus, stroke, head injury, chronic kidney disease, coronary artery disease, alcohol abuse/dependence, and tobacco abuse/dependence (HR, 1.27; 95% CI 1.11-1.45), were independent risk factors for dementia in ARHL patients. We found ARHL may be one of the early characteristics of dementia, and patients with hearing loss were at a higher risk of subsequent dementia. Clinicians should be more sensitive to dementia symptoms within the first 2 years following ARHL diagnosis. Further clinical studies of the relationship between dementia and ARHL may be necessary.
Acquired sensory hearing loss (SHL) is suggested to be associated with depression. However, some ... more Acquired sensory hearing loss (SHL) is suggested to be associated with depression. However, some studies have reported conflicting results. Our study investigated the relationship between the prevalence of SHL and the incidence of depression over 12 years of follow-up by using data from the Taiwan National Health Insurance Research Database (NHIRD). We sought to determine the association between SHL and subsequent development of depression and discuss the pathophysiological mechanism underlying the association.Patients with SHL were identified from the NHIRD (SHL cohort). A non-SHL cohort, comprising patients without SHL frequency-matched with the SHL patients according to age group, sex, and the year of diagnosis of SHL at the ratio of 1:4, was constructed, and the incidence of depression was evaluated in both cohorts. A multivariable model was adjusted for age, sex, and comorbidity.The SHL cohort and non-SHL cohort comprised 5043 patients with SHL and 20,172 patients without SHL, respectively. The incidences density rates were 9.50 and 4.78 per 1000 person-years in the SHL cohort and non-SHL cohort, respectively. After adjustment for age, sex, and comorbidities, the risk of depression was higher in the SHL cohort than in the non-SHL cohort (hazard ratio = 1.73, 95% confidence interval = 1.49-2.00).Acquired SHL may increase the risk of subsequent depression. The results demonstrated that SHL was an independent risk factor regardless of sex, age, and comorbidities. Moreover, a strong association between hearing loss and subsequent depression among Taiwanese adults of all ages, particularly those aged ≤49 and >65 years and without using steroids for the treatment of SHL was observed. Prospective clinical and biomedical studies on the relationship between hearing loss and depression are warranted for determining the etiopathology.
The current ethical dilemmas met by healthcare professionals were never compared with those 15 ye... more The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the palliative care system is in its early stages of development.
This retrospective study was conducted to determine the relationship between variable factors and... more This retrospective study was conducted to determine the relationship between variable factors and the recurrence rate of post-semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) after canalith repositioning procedure (CRP). Patients with PSC-BPPV were diagnosed by history and the presence of a positive Dix-Hallpike maneuver between 2008 and 2010. In total, 243 patients (47 males and 196 females, average age = 57.5 years) treated with Epley's maneuver or canalith repositioning procedure (CRP) were included in the study. The demographic factors studied were age, sex, sleep disorders, inner ear diseases, head trauma history, and cardiovascular diseases. Multivariate statistics using SPSS version 15, Pearson's Chi-squared test (χ (2)), Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression model were used for the analysis. The success rate of vertigo control after the initial CRP was 83.1 %. Pearson's χ (2) test results showed that femal...
We report a case in which metastasis occurred from a left-side maxillary carcinoma to bilateral t... more We report a case in which metastasis occurred from a left-side maxillary carcinoma to bilateral temporal bones through different routes, manifested by rapidly progressing left-side mixed hearing loss, left-side vestibular dysfunction, and serous otitis media. Later the left-side hearing threshold became severely elevated, suggesting profound sensory hearing loss. Histopathology of the temporal bones revealed that the side with the lesion was severely damaged by tumor through direct and hematogenous metastasis. On the contralateral side, it showed four findings: (i) sparse and separate tumor invasion of the petrous bone, the mastoid cavity, and the facial canal (hematogenous spread); (ii) tumor involvement in the lower part of the cochlear aqueduct without invasion of the internal acoustic canal or cochlea, implying early meningeal carcinomatosis; (iii) vascular stria atrophy, spiral ganglion diminution, and well preserved hair cells; and (iv) diffuse effusion in the middle ear and mastoid cavity. Our observations revealed that tumor cells dispersed to the same side through different routes, whereas early metastasis to the contralateral side was mainly through hematogenous and subarachnoid spread.
International journal of pediatric otorhinolaryngology, 2008
To investigate the myelination progression course in language-correlated regions of children with... more To investigate the myelination progression course in language-correlated regions of children with normal brain development by quantitative magnetic resonance imaging (MRI) analysis compared with histological studies. The subjects were 241 neurologically intact neonates, infants and young children (128 boys and 113 girls) who underwent MRI between 2001 and 2007 at the University of Tokyo Hospital, ranging in age from 0 to 429 weeks corrected by postnatal age. To compare their data with adult values, 25 adolescents and adults (14 men and 11 women, aged from 14 to 83 years) were examined as controls. Axial T2-weighted images were obtained using spin-echo sequences at 1.5 T. Subjects with a history of prematurity, birth asphyxia, low Apgar score, seizures, active systemic disease, congenital anomaly, delayed development, infarcts, hemorrhages, brain lesions, or central nervous system malformation were excluded from the analysis. Seven regions of interest in language-correlated areas, na...
Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate t... more Age-related hearing loss (ARHL) is postulated to affect dementia. Our study aims to investigate the relationship between ARHL and the prevalence, and 10-year incidence of dementia in the Taiwan National Health Insurance Research Database (NHIRD). We selected patients diagnosed with ARHL from the NHIRD. A comparison cohort comprising of patients without ARHL was frequency-matched by age, sex, and co-morbidities, and the occurrence of dementia was evaluated in both cohorts. The ARHL cohort consisted of 4108 patients with ARHL and the control cohort consisted of 4013 frequency-matched patients without ARHL. The incidence of dementia [hazard ratio (HR), 1.30; 95% confidence interval (CI 1.14-1.49); P = 0.002] was higher among ARHL patients. Cox models showed that being female (HR, 1.34; 95% CI 1.07-1.68), as well as having co-morbidities, including chronic liver disease and cirrhosis, rheumatoid arthritis, hypertension, diabetes mellitus, stroke, head injury, chronic kidney disease, coronary artery disease, alcohol abuse/dependence, and tobacco abuse/dependence (HR, 1.27; 95% CI 1.11-1.45), were independent risk factors for dementia in ARHL patients. We found ARHL may be one of the early characteristics of dementia, and patients with hearing loss were at a higher risk of subsequent dementia. Clinicians should be more sensitive to dementia symptoms within the first 2 years following ARHL diagnosis. Further clinical studies of the relationship between dementia and ARHL may be necessary.
Acquired sensory hearing loss (SHL) is suggested to be associated with depression. However, some ... more Acquired sensory hearing loss (SHL) is suggested to be associated with depression. However, some studies have reported conflicting results. Our study investigated the relationship between the prevalence of SHL and the incidence of depression over 12 years of follow-up by using data from the Taiwan National Health Insurance Research Database (NHIRD). We sought to determine the association between SHL and subsequent development of depression and discuss the pathophysiological mechanism underlying the association.Patients with SHL were identified from the NHIRD (SHL cohort). A non-SHL cohort, comprising patients without SHL frequency-matched with the SHL patients according to age group, sex, and the year of diagnosis of SHL at the ratio of 1:4, was constructed, and the incidence of depression was evaluated in both cohorts. A multivariable model was adjusted for age, sex, and comorbidity.The SHL cohort and non-SHL cohort comprised 5043 patients with SHL and 20,172 patients without SHL, respectively. The incidences density rates were 9.50 and 4.78 per 1000 person-years in the SHL cohort and non-SHL cohort, respectively. After adjustment for age, sex, and comorbidities, the risk of depression was higher in the SHL cohort than in the non-SHL cohort (hazard ratio = 1.73, 95% confidence interval = 1.49-2.00).Acquired SHL may increase the risk of subsequent depression. The results demonstrated that SHL was an independent risk factor regardless of sex, age, and comorbidities. Moreover, a strong association between hearing loss and subsequent depression among Taiwanese adults of all ages, particularly those aged ≤49 and >65 years and without using steroids for the treatment of SHL was observed. Prospective clinical and biomedical studies on the relationship between hearing loss and depression are warranted for determining the etiopathology.
The current ethical dilemmas met by healthcare professionals were never compared with those 15 ye... more The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the palliative care system is in its early stages of development.
This retrospective study was conducted to determine the relationship between variable factors and... more This retrospective study was conducted to determine the relationship between variable factors and the recurrence rate of post-semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) after canalith repositioning procedure (CRP). Patients with PSC-BPPV were diagnosed by history and the presence of a positive Dix-Hallpike maneuver between 2008 and 2010. In total, 243 patients (47 males and 196 females, average age = 57.5 years) treated with Epley's maneuver or canalith repositioning procedure (CRP) were included in the study. The demographic factors studied were age, sex, sleep disorders, inner ear diseases, head trauma history, and cardiovascular diseases. Multivariate statistics using SPSS version 15, Pearson's Chi-squared test (χ (2)), Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression model were used for the analysis. The success rate of vertigo control after the initial CRP was 83.1 %. Pearson's χ (2) test results showed that femal...
We report a case in which metastasis occurred from a left-side maxillary carcinoma to bilateral t... more We report a case in which metastasis occurred from a left-side maxillary carcinoma to bilateral temporal bones through different routes, manifested by rapidly progressing left-side mixed hearing loss, left-side vestibular dysfunction, and serous otitis media. Later the left-side hearing threshold became severely elevated, suggesting profound sensory hearing loss. Histopathology of the temporal bones revealed that the side with the lesion was severely damaged by tumor through direct and hematogenous metastasis. On the contralateral side, it showed four findings: (i) sparse and separate tumor invasion of the petrous bone, the mastoid cavity, and the facial canal (hematogenous spread); (ii) tumor involvement in the lower part of the cochlear aqueduct without invasion of the internal acoustic canal or cochlea, implying early meningeal carcinomatosis; (iii) vascular stria atrophy, spiral ganglion diminution, and well preserved hair cells; and (iv) diffuse effusion in the middle ear and mastoid cavity. Our observations revealed that tumor cells dispersed to the same side through different routes, whereas early metastasis to the contralateral side was mainly through hematogenous and subarachnoid spread.
International journal of pediatric otorhinolaryngology, 2008
To investigate the myelination progression course in language-correlated regions of children with... more To investigate the myelination progression course in language-correlated regions of children with normal brain development by quantitative magnetic resonance imaging (MRI) analysis compared with histological studies. The subjects were 241 neurologically intact neonates, infants and young children (128 boys and 113 girls) who underwent MRI between 2001 and 2007 at the University of Tokyo Hospital, ranging in age from 0 to 429 weeks corrected by postnatal age. To compare their data with adult values, 25 adolescents and adults (14 men and 11 women, aged from 14 to 83 years) were examined as controls. Axial T2-weighted images were obtained using spin-echo sequences at 1.5 T. Subjects with a history of prematurity, birth asphyxia, low Apgar score, seizures, active systemic disease, congenital anomaly, delayed development, infarcts, hemorrhages, brain lesions, or central nervous system malformation were excluded from the analysis. Seven regions of interest in language-correlated areas, na...
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