Chin-lung Kuo

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David de Lorenzo

Pompeu Fabra University

Jack Meng-Tat Chia 謝明達

National University of Singapore

Marwa M fawzi

Taibah University

Viacheslav Kuleshov

Stockholm University

Milad Bastami

Tabriz University Of Medical Sciences

Hsiao-chun Hung 洪曉純

The Australian National University

María Del Carmen Garcia

Instituto Universitario Hospital Italiano

Ann Saada

Hadassah-Hebrew University Medical Center

Oded Meyuhas

The Hebrew University of Jerusalem

Walter L Hurley

University of Illinois at Urbana-Champaign

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Papers by Chin-lung Kuo

Laryngopharyngeal Reflux: An Update

Archives of Otorhinolaryngology-Head & Neck Surgery, 2019

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The effect of N-doping on the electronic structure property and the li and Na storage capacity of graphene nanomaterials: A first-principles study

Electrochimica Acta, 2021

Minimally traumatic stapes surgery for otosclerosis: Risk reduction of post-operative vertigo

Journal of the Chinese Medical Association, 2018

Background: The author (Dr. Shiao) modified traditional stapes surgery (TSS) specifically for pat... more Background: The author (Dr. Shiao) modified traditional stapes surgery (TSS) specifically for patients with otosclerosis. The proposed technique, referred to as minimally traumatic stapes surgery (MTSS), reduces the risk of subjective discomfort (i.e. vertigo and tinnitus) following surgery. This paper compares the effectiveness of MTSS with that of TSS. Methods: The medical records of patients with otosclerosis after stapes surgery (TSS or MTSS) were analyzed. Outcome variables included postoperative vertigo, tinnitus, and hearing success. Multivariate logistic regression analysis was used to determine the correlation between surgical technique and outcome variables. Results: TSS was performed in 23 otosclerosis ears and MTSS was performed in 33 otosclerosis ears. The risk of post-operative vertigo was significantly lower among patients that underwent MTSS (27%) than among those that underwent TSS (83%, p < 0.001). No differences in the incidence of tinnitus were observed between the two groups. Post-operative audiometric outcomes were also equivalent between the two groups. However, multivariate logistic regression analysis revealed a correlation between post-operative vertigo and surgical technique (p < 0.001). Conclusion: MTSS involves a lower risk of vertigo than does TSS. MTSS helps to prevent damage to the footplate, thereby reducing the risk of footplate floating. Therefore, MTSS provides a means to overcome some of the limitations associated with the narrow surgical field in Asian patients.

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Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data

Auris, nasus, larynx, Jan 3, 2015

This article presents a points-based prognostic prediction model for pediatric acquired cholestea... more This article presents a points-based prognostic prediction model for pediatric acquired cholesteatoma, incorporating the multidimensional factors that contribute to surgical failure. This study included 132 ears with acquired cholesteatoma from 128 children (≤18 years) identified between 1982 and 2012. Each case was scored for the extent of the cholesteatoma, history of grommet insertion, age of the patient, ossicular destruction, and otorrhea. The patients were classified as stage I, II, or III. We compared differences between stages regarding the cumulative rates of recidivism and linear trends in these rates. Among stage I cases, the rate of cumulative recidivism was 0%; however, among stage 2 cases, this increased with time, eventually leveling off at 15.7% after 18 years of follow-up. The same was observed among stage III cases, which leveled off at 34.1% after 17 years of follow-up. In the second half of the cohort and the entire cohort, differences in the cumulative recidivis...

Second Ear Surgery for Patients with Bilateral Otosclerosis: Recommended or not?

Journal of International Advanced Otology

Full-text (PDF): http://www.advancedotology.org/sayilar/80/buyuk/303-312.pdf Objective: To evalua... more Full-text (PDF): http://www.advancedotology.org/sayilar/80/buyuk/303-312.pdf Objective: To evaluate the benefits of second side stapes surgery. Materials and Methods: From 1996 to 2012, a cohort study was conducted on patients with otosclerosis after stapes surgery at a tertiary referral center in Taiwan. Only patients with bilateral otosclerosis were included. Hearing outcomes after the first and second ear surgeries were analysed. Logistic regression analysis was used to control confounding factors of hearing outcomes. We correlated the post-operative AC averages of first- and second-operated ears in patients undergoing bilateral surgeries. Results: Sixty-four operations were included (48 first and 16 second ear surgeries). There were no differences between first and second ear surgeries regarding the percentages of ears with post-operative ABG ≤10 dB and AC ≤30 dB (P > 0.05). For patients undergoing bilateral surgeries, the probability of symmetric hearing (interaural differen...

Updates and Knowledge Gaps in Cholesteatoma Research

BioMed Research International, 2015

The existence of acquired cholesteatoma has been recognized for more than three centuries; howeve... more The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related t...

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Otitis media with effusion in children with cleft lip and palate: A narrative review

International Journal of Pediatric Otorhinolaryngology, 2013

Repair surgery of cleft lip and palate (CLP) can produce satisfactory cosmetic results but the pr... more Repair surgery of cleft lip and palate (CLP) can produce satisfactory cosmetic results but the problem of recurrent otitis media with effusion (OME) secondary to CLP may persist. This can cause longterm hearing loss and affect linguistic, academic, and personal development. The aim of this review is to provide the most recent information regarding OME in children with CLP. Methods: All papers referring to children with CLP and OME were identified from searches in Medline, PubMed, Cochrane Library, and Web of Science. Abstracts were read and relevant papers were obtained. Additional studies were obtained from the references of the selected articles. Results: Both current and previous research on OME in children with CLP focused on the controversy over treatment strategies. Evidence on the optimal treatment for OME in CLP children was lacking. Ventilation tube surgery using the same anesthetic as lip or palate procedures was not well-supported. After summarizing the literature review, a flowchart of management guidance for such patients is also recommended. Updated reviews such as this will provide clinicians and patients/parents with a valuable reference. Conclusions: The lack of evidence on the optimal treatment for OME in children with CLP should prompt a relatively conservative approach. However, only a consensus between patients/parents and surgeons regarding the most suitable treatment strategy for OME can ensure the greatest benefit to individual patients.

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A Critical Appraisal of Ventilation Tube Insertion in Children With Cleft Palate—Reply

JAMA Otolaryngology–Head & Neck Surgery, 2015

Controversial issues of optimal surgical timing and patient selection in the treatment planning of otosclerosis

European Archives of Oto-Rhino-Laryngology, 2013

The aim of this study was to analyze the impact of clinical factors on the outcomes of otoscleros... more The aim of this study was to analyze the impact of clinical factors on the outcomes of otosclerosis surgery and support patients' access to evidence-based information in pre-operative counseling to optimize their choices. A total of 109 ears in 93 patients undergoing stapes surgery in a tertiary referral center were included. Variables with a potential impact on hearing outcomes were recorded, with an emphasis on factors that were readily available preoperatively. Hearing success was defined as a post-operative air-bone gap B10 dB. Logistic regression analysis was used to determine the factors independently contributing to the prediction of hearing success. The mean follow-up period was 18.0 months. Univariate and multivariate analyses indicated that none of the pre-operative factors (piston type, age, sex, affected side, tinnitus, vertigo, and pre-operative hearing thresholds) affected hearing success significantly (all p [ 0.05). In conclusion, selfcrimping Nitinol piston provides comparable hearing outcomes with conventional manual-crimping prostheses. However, Nitinol piston offers a technical simplification of a surgical procedure and an easier surgical choice for patients. In addition, age is not a detriment to hearing gain and instead might result in better use of hearing aids in older adults, thus facilitating social hearing recovery. Finally, hearing success does not depend on the extent of pre-operative hearing loss. Hence, patients with poor cochlear function should not be considered poor candidates for surgery. The predictive model has established recommendations for otologists for better case selection, and factors that are readily available pre-operatively may inform patients more explicitly about expected post-operative audiometric results.

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Critical reassessment of the probability of receiving additional ventilation tube insertion for recurrent otitis media with effusion in children with cleft palate

Acta Oto-laryngologica, 2014

Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Dep... more Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Institute of Brain Science, National Yang-Ming University, Taipei and Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, ROC

Peer Review for Academic Research

Archives of Otorhinolaryngology-Head & Neck Surgery, 2022

The peer review process is used to evaluate research papers and journal articles submitted for pu... more The peer review process is used to evaluate research papers and journal articles submitted for publication, providing a filter that helps to ensure the quality, credibility, and validity of published research. Reviews are generally conducted by peers who have a deep understanding of the knowledge domain and possess expertise in the methodologies and instruments involved in the research. Academics are honored to be invited to review a paper, and they undertake to fulfill their scientific obligations as well as to uphold the academic integrity of the organization. The primary goal of a peer reviewer is to determine whether a work falls within the scope of the journal. In addition, reviewers should ensure that the study has been conducted according to established methodologies. Reviewers also look at the ethical aspects of a study, evaluate the presentation and readability of the work, and apply tenets of logic to assess the integrity of its arguments and conclusions. According to statistics, the average reviewer works on approximately eight reports each year. However, there is a dearth of information regarding the effectiveness of the peer review process. This article summarizes aspects of peer review in an attempt to elucidate the state of academic publishing.

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Blockchain Technology and Healthcare Applications

Archives of Otorhinolaryngology-Head & Neck Surgery, 2020

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Acid Reflux Increases Susceptibility to Laryngopharyngeal and Oropharyngeal Cancers

Archives of Otorhinolaryngology-Head & Neck Surgery, 2020

N owadays, people's daily routines are becoming increasingly irregular, particularly when it come... more N owadays, people's daily routines are becoming increasingly irregular, particularly when it comes to eating and drinking. For example, people need to cope with pressures at work and rely on coffee to get them through the day. Some people even drink coffee as they would water, which could lead to heartburn in the long term. As the esophagus is unable withstand gastric acid like the stomach wall can, persistent exposure to gastric acid may corrode the esophagus. Previous studies have found that longterm corrosion of the esophagus by gastric acid could result in esophageal cancer [1]. Refluxing, though, does not stop at the esophagus (Figure 1); the gastric acid continues upwards to the pharynx, larynx, oral cavity, and nasal cavity, which can cause certain discomfort, such as a foreign body sensation in the throat, difficulties swallowing, and hoarseness after awakening. The author has had several patients who have come to the clinic complaining about an inability to cough out phlegm in their throat, no matter what they do. For some relief, they constantly clear their throat, but this relief is only temporary. An otolaryngoscopic examination would show that their laryngeal mucosa has become extremely swollen due to gastric acid burn. Other patients have complained about coughing for months. Yet, chest X-rays and visits to pulmonologists would show nothing remarkable. When the author tells patients that the cause of their discomfort may be acid reflux, 6 out of 10 patients would say, "But I don't have acid reflux!" or "Doctor, you must be wrong! I just had a gastroscopy last month and the gastroenterologist said I was fine!" Indeed, otolaryngologists and gastroenterologists may differ in the management of the acid reflux related disorders [2,3]. The fact is that the patients may have laryngopharyngeal reflux (LPR) rather than gastroesophageal reflux disease (GERD). In GERD, the reflux of gastric contents is limited to the esophagus. In LPR, the reflux of gastric content affects the larynx and pharynx. Despite occasional cross-diagnoses of GERD and LPR, there are essential differences. GERD is accompanied by acidity and heartburn (retrosternal burning), which is rarely encountered in LPR patients. In GERD, reflux and acidity typically occur during the night (nocturnal refluxers). In LPR, reflux typically occurs during the day (daytime refluxers). LPR symptoms occur when patients are in an upright position during periods of physical exertion (e.g., bending over, Valsalva, and exercise), whereas GERD reflux occurs while patients are lying down [4].

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Rounded Insertion": A Useful Cochlear Implantation Technique for Patients with Cochlear Hypoplasia Type I

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2016

A hearing screening revealed bilateral severe to profound sensorineural hearing loss in a newborn... more A hearing screening revealed bilateral severe to profound sensorineural hearing loss in a newborn boy. Magnetic resonance imaging showed cochlear hypoplasia type I with a rudimentary cochlear bud on the right side and cochlear aplasia on the left side. The diameter of the bud was \\6 mm without internal architecture. Otherwise, bilateral cochlear nerves were normal. The family of the newborn agreed to have a surgeon perform CI in the right ear when he reached the age of 1 year 4 months. At the time of the surgery, the vertical segment of the patient’s facial nerve showed anterior displacement with a narrow facial recess; therefore, a retrofacial approach was used to locate the round window. When the round window membrane was opened, a cerebrospinal fluid gusher occurred but gradually subsided thereafter. A ‘‘rounded insertion’’ technique was then used to implant a SONATAti with compressed electrodes (MED-EL, Innsbruck, Austria). For this, we first used a drill to extend the round window to 1.4 mm. We curved the distal tip of the electrode, fixed the first electrode of the array at the opening of the round window with a microinstrument, and used an insertion claw to push the rest of the array into the cochlea. The pushed-in electrode array was rounded in the wall of the cochlea (Figure 1). In total, 9 of 12 electrodes were inserted. A piece of thick fascia was then packed around the electrode array to seal the round window, and fibrin glue was applied over the round window to stop the cerebrospinal fluid gusher. Electrically evoked compound action potential was measured intraoperatively. A postoperative x-ray confirmed that the electrode array had been successfully rounded in the cochlea (Figure 2). There were no complications. The device was activated 3 weeks after implantation, and none of the 9 intracochlear electrodes resulted in facial twitching. The patient later received speech training and aural rehabilitation. One year postsurgery, the threshold of hearing in the patient’s right ear was 30 to 40 dB HL in the frequency range of 250 to 4000 Hz.

Depression and cholesteatoma: Preliminary findings from a nationwide population-based retrospective cohort study

Journal of affective disorders, Jan 20, 2016

To estimate the risk of developing depressive disorder (DD) following diagnosis with cholesteatom... more To estimate the risk of developing depressive disorder (DD) following diagnosis with cholesteatoma. In the study, we analyzed data from the Longitudinal Health Insurance Database of Taiwan. A total of 599 patients newly diagnosed with cholesteatoma between 1997 and 2007 were included with a comparison cohort of 2995 matched non-cholesteatoma enrollees. Each patient was followed for 3 years to identify the subsequent development of DD. Cox proportional hazard regression analysis was performed to compute adjusted 3-year hazard ratios. The incidence of DD per thousand person-years was approximately twice as high among patients with cholesteatoma (11.32) as among those without cholesteatoma (5.85). After adjusting for potential confounders, patients with cholesteatoma were 1.99 times (95% CI=1.18-3.34, P=0.010) more likely to suffer from DD within 3 years compared to those without cholesteatoma. This is the first study to demonstrate a link between cholesteatoma and subsequent DD within...

In response to A New Theory on the Pathogenesis of Acquired Cholesteatoma: Mucosal Traction

The Laryngoscope, Jan 12, 2015

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Etiopathogenesis of acquired cholesteatoma: prominent theories and recent advances in biomolecular research

The Laryngoscope, 2015

To review recent biomolecular advances in etiopathogenesis of acquired cholesteatoma. MEDLINE via... more To review recent biomolecular advances in etiopathogenesis of acquired cholesteatoma. MEDLINE via OVID (to March 2014) and PubMed (to March 2014). All articles referring to etiopathogenesis of acquired cholesteatoma were identified in the above databases, from which 89 articles were included in this review. The mechanisms underlying the etiopathogenesis of acquired cholesteatoma remain a subject of competing hypotheses. Four theories dominate the debate, including theories of invagination, immigration, squamous metaplasia, and basal cell hyperplasia. However, no single theory has been able to explain the clinical characteristics of all cholesteatoma types: uncoordinated hyperproliferation, invasion, migration, altered differentiation, aggressiveness, and recidivism. Modern technologies have prompted a number of researchers to seek explanations at the molecular level. First, cholesteatomas could be considered an example of uncontrolled cell growth, capable of altering the balance tow...

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Investigation of prognostic factors for post-traumatic olfactory dysfunction

Journal of the Chinese Medical Association : JCMA, Jan 20, 2015

Post-traumatic olfactory dysfunction is common but has a poor prognosis. The purpose of this stud... more Post-traumatic olfactory dysfunction is common but has a poor prognosis. The purpose of this study was to analyze the effect of clinical features on improvements in post-traumatic olfactory dysfunction. From 2007 to 2013, patients with post-traumatic olfactory dysfunction were enrolled. Olfactory function was assessed using the Sniffin' Sticks test at the first and final visits. Olfactory improvement was defined as a change in olfactory state to an improved level. Variables with a potential effect on improvements in olfactory dysfunction, including age, sex, time from trauma to first visit, initial olfactory function, observation time, and olfactory bulb integrity, were entered into logistic regression analysis. In total, 107 patients were included, with a mean age of 40 years. The mean follow-up period was 9.4 months. Eighteen patients (16.8%) had improvements with regard to olfactory function. No clinical factors were found to influence olfactory recovery in univariate and mul...

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A review of current progress in acquired cholesteatoma management

European Archives of Oto-Rhino-Laryngology, 2014

The aim of this study was to review recent advances in the management of acquired cholesteatoma. ... more The aim of this study was to review recent advances in the management of acquired cholesteatoma. All papers referring to acquired cholesteatoma management were identified in Medline via OVID (1948 to December 2013), PubMed (to December 2013), and Cochrane Library (to December 2013). A total of 86 papers were included in the review. Cholesteatoma surgery can be approached using either a canal wall up (CWU) or canal wall down (CWD) mastoidectomy with or without reconstruction of the middle ear cleft. In recent decades, a variety of surgical modifications have been developed including various ''synthesis'' techniques that combine the merits of CWU and CWD. The application of transcanal endoscopy has also recently gained popularity; however, difficulties associated with this approach remain, such as the need for one-handed surgery, the inability to provide continuous irrigation/suction, and limitations regarding endoscopic accessibility to the mastoid cavity. Additionally, several recent studies have reported successes in the application of laser-assisted cholesteatoma surgery, which overcomes the conflicting goals of eradicating disease and the preservation of hearing. Nevertheless, the risk of residual disease remains a challenge. Each of the techniques examined in this study presents pros and cons regarding final outcomes, such that any pronouncements regarding the superiority of one technique over another cannot yet be made. Flexibility in the selection of surgical methods according to the context of individual cases is essential in optimizing the outcomes.

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Recent Advances in Understanding the Pathogenesis of Acquired Cholesteatoma

Recent Advances in Otolaryngology—Head and Neck Surgery (Volume 5), 2016

Laryngopharyngeal Reflux: An Update

Archives of Otorhinolaryngology-Head & Neck Surgery, 2019

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The effect of N-doping on the electronic structure property and the li and Na storage capacity of graphene nanomaterials: A first-principles study

Electrochimica Acta, 2021

Minimally traumatic stapes surgery for otosclerosis: Risk reduction of post-operative vertigo

Journal of the Chinese Medical Association, 2018

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Multidimensional staging system for pediatric acquired cholesteatoma: A 30-year verification data