A case report of nasopharyngeal inflammatory myofibroblastoma in infant / 临床耳鼻咽喉头颈外科杂志

Inflammatory myofibroblastic tumor （IMT） is a rare mesenchymal soft tissue tumor characterized by borderline or low-grade malignancy. It is rare childhood tumor with an average age of onset of 10 years old. It is even rarer in infants and toddlers, and the etiology and pathogenesis of this tumor are still unclear. The clinical presentation of IMT is non-specific and are related to the location of the tumor. When the tumor compresses adjacent organs, it can cause pain and functional impairment. According to the current literature, IMT is most commonly found in the digestive and respiratory systems, but also occasionally occur in the genitourinary system, head and neck, and limbs. At present, there have been no reports of nasopharyngeal IMT involving nasal cavity of infants and toddlers at home and abroad.This article reports a case of a massive inflammatory myofibroblastic tumor involving the nasal cavity and nasopharynx in an infant. Plasma-assisted minimally invasive surgery was performed through multiple surgical approaches and achieved satisfactory therapeutic results. This case report may provide valuable reference for the treatment of similar diseases.

Two children with late-onset congenital central hypoventilation syndrome / 临床耳鼻咽喉头颈外科杂志

Two children with late-onset congenital central hypoventilation syndrome were reported, one of whom was male and had no abnormal manifestations after birth, respiratory failure occurs at the age of 1 year and 6 months. After being hospitalized, he was treated with oxygen inhalation and non-invasive ventilation, but carbon dioxide retention could not be corrected. After one month of tracheal intubation, he was failure to wean from ventilator, so tracheostomy was performed. He needs a ventilator to help breath while sleeping, and can breath autonomously during the day without ventilator. The other case was a female, with no abnormalities after birth. At the age of 11 months, she developed respiratory failure. During sleep, the child needs non-invasive assisted ventilation through a nasal mask, and during the day, she breathed autonomously.Two patients were followed up forever 2 years and their growth and development were normal.

Preliminary analysis of the effect of individualized voice therapy on pediatric voice disorders / 临床耳鼻咽喉头颈外科杂志

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.

Mechanism of Der f 1/IGF-1 nanoparticle promoting the production of regulatory T cell / 临床耳鼻咽喉头颈外科杂志

Objective:To prepare PLGA nanoparticles loaded with Der f 1/IGF-1（Der f 1/IGF-1 NPs） and investigate their role in promoting the formation of Treg cells. Methods:NPs coated with Der f 1/IGF-1 were prepared by double emulsion method and their physicochemical properties and cumulative release rate in vitro were analyzed. After pretreatment, BMDC was divided into Saline group, Blank NPs group, Der f 1/IGF-1 group and Der f 1/IGF-1 NPs group. Determination of the expression of IL-10 and TGF-β in BMDC by ELISA. The number of Treg cells was detected by flow cytometry. Results:The results showed that Der f 1/IGF-1 NPs were spherical structures, with good dispersion, particle size less than 200 nm, negative charge and stable slow-release effect of Zeta potential. After BMDC pretreatment, the expression levels of TGF-β and IL-10 in BMDC cells in the Der f 1/IGF-1 NPs group were significantly increased compared with the Blank NPs group, and the difference was statistically significant（P<0.001）. After co-culture with CD4+ T cells, the proportion of Treg cells produced in the Der f 1/IGF-1 NPs group was significantly increased, and the difference was statistically significant（P<0.001）. Conclusion:Der f 1/IGF-1 NPs can induce Treg cell generation in vitro. This study provides a new and more effective method for the reconstruction of immune tolerance dysfunction.

Interpretation of French Society of ENT guidelines on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

Summary@#The French Society of ENT and Head Neck Surgery（SFORL）present the guidelines on the roles of the various treatment options in childhood obstructive sleep apnea in May 2018，this paper is the interpretation of the guidelines.

Interpretation of French Society of ENT guidelines on the roles of the various treatment options in childhood obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

The French Society of ENT and Head Neck Surgery（SFORL）present the guidelines on the roles of the various treatment options in childhood obstructive sleep apnea in May 2018，this paper is the interpretation of the guidelines.

Rigid bronchoscope combined with fiber bronchoscope application in 176 children with airway obstruction / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the value of rigid bronchoscope combined with fiber bronchoscope application in children with airway obstruction.METHODS Retrospective analysis of 176 cases children with airway obstruction from January 1, 2006 to January1, 2016, all patients were diagnosised and treated in our hospital. RESULTS All children were acceptted rigid bronchoscopy combined with fiber bronchoscope under general anesthesia, then received the different thrapy according to the different causes. 104 patients with airway foreign body were all obtained satisfactory effect, 2 cases of children with bronchial foreign body(cap) inspection, failed to remove and contact thoracic surgery doctors to remove the foreign body by thoracotomy. 10 plastic bronchitis patients improved after treatment or cured. 7 cases of bronchial tuberculosis were cured after treatment. 4 patients with airway tumor after minimally invasive surgery, obtained good effect, 2 cases were turned to the other cancer hospital. 2 cases of patients with tracheal stenosis, the symptom is reduced after expansion. Bronchial granulation, tracheomalacia, bronchial softening, bronchial atresia patients improved after treatment. This group of all patients with pneumonia were cured after symptomatic treatment.CONCLUSION Rigid bronchoscopy and fiber bronchoscope are both useful for diagnosis and treatment of children with airway obstruction, both have its advantages and disadvantages, combined application can improve the accuracy of disease diagnosis and timely intervention on the patients.

Bacteriology of adenoids and tonsils in children with sleep-disordered breathing / 中国耳鼻咽喉头颈外科

OBJECTIVE This study was conducted to analyze the underlying bacterial pathogens of the tonsils and adenoids in children with sleep-disordered breathing(SDB).METHODS The core tissue from the tonsils and/or adenoids of 163 SDB children was cultured aerobically. Of the 163 cases, 120 children underwent adenoidectomy and tonsillectomy simultaneously(A+T), 39 children underwent adenoidectomy(A) and 4 tonsillectom(T) only. 124 children who underwent tonsillectomy were subdivided into two groups based on history(with or without a history of recurrent tonsillitis). 71 children with the history were enrolled in the 'recurrent tonsillitis group' and 53 children without the history were enrolled in 'non- recurrent tonsillitis group'.RESULTS Of the total 120 cases who underwent A+T, 114(95.00%) cases had same distribution of bacteria detected in both sides in the same patient. Besides this, 17 cases in whom mixed organisms were identified in both sites shared common pathogen. No significant difference in the detection rates of staphylococcus aureus and haemophilus influenzae were found when we compared seasons(Tonsil:χ2=8.538,P=0.201; Adenoid:χ2=5.427, P=0.490). No significant difference in the type and detection rate of essential bacteria was found when we compared between recurrent tonsillitis group and 'non-recurrent tonsillitis group' (χ2=3.028,P=0.387).CONCLUSION The bacterial isolates from the tonsils and adenoids are virtually identical in type and detection rate in the same SDB patient. The bacterial distribution of the tonsillar and adenoidal core is unaffected by the seasonal variation and history of recurrent tonsillitis.

Increased Expression of miR-146a in Children With Allergic Rhinitis After Allergen-Specific Immunotherapy

PURPOSE: MicroRNAs (miRs) were recently recognized to be important for immune cell differentiation and immune regulation. However, whether miRs were involved in allergen-specific immunotherapy (SIT) remains largely unknown. This study sought to examine changes in miR-146a and T regulatory cells in children with persistent allergic rhinitis (AR) after 3 months of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). METHODS: Twenty-four HDM-sensitized children with persistent AR were enrolled and treated with SCIT (n=13) or SLIT (n=11) for 3 months. Relative miR-146a and Foxp3 mRNA expression, the TRAF6 protein level, and the ratio of post-treatment to baseline IL-10+CD4+ T cells between the SCIT and SLIT groups were examined in the peripheral blood mononuclear cells (PBMCs) of AR patients using quantitative reverse transcription polymerase chain reaction (qRT-PCR), flow cytometry, and Western blot analysis, respectively. Serum levels of IL-5 and IL-10 were determined using ELISA. RESULTS: After 3 months of SIT, both the TNSS and INSS scores were significantly decreased compared to the baseline value (P<0.01). The relative expression of miR-146a and Foxp3 mRNA was significantly increased after both SCIT and SLIT (P<0.01). The ratio of post-treatment to baseline IL-10+CD4+ T cells and the serum IL-10 level were significantly increased in both the SCIT and SLIT groups (P<0.01), whereas the TRAF6 protein level and serum IL-5 level were significantly decreased (P<0.01). No significant differences in these biomarkers were observed between the SCIT and SLIT groups. CONCLUSIONS: Our findings suggest that miR-146a and its related biomarkers may be comparably modulated after both SCIT and SLIT, highlighting miR-146a as a potential therapeutic target for the improved management of AR.

Preliminary study on the application of upper-airway model construction with 3DMIA in children with OSAHS / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the applicability of 3DMIA software to upper airway modeling in children with obstructive sleep apnea hypopnea syndrome (OSAHS). METHODS A total of 30 children diagnosed with OSAHS by polysomnography were included in this study. Data regarding upper airway structure were collected via spiral CT while sleeping and awake, from which a three-dimensional model of the upper respiratory tract from the nasopharynx to the supraglottic region using 3DMIA software was constructed. The upper airway volume and airway minimum cross-sectional area were measured employing software algorithms. RESULTS The upper airway volume and airway minimum cross-sectional area of the 30 children during sleep were significantly less than those while awake (P<0.01). CONCLUSION 3DMIA software modeling and software algorithm measurement are more objective than traditional radiology (e.g. Fujioka) with respect to evaluation of the extent of the upper airway narrowing in OSAHS children, and has good applicability to study upper airway morphology and function in children with OSAHS.

Study on the relationship between tone burst ABR and CE-Chirp ASSR in infants with profound sensorineural hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyse the correlation between tone burst auditory brainstem response (tone burst auditory brainstem response, tb-ABR) and CE-Chirp voice evoked auditory steady-state response (auditory steady-state response, CE-Chirp ASSR) in infants with profound sensorineural hearing loss.</p><p><b>METHODS</b>A total of 45 infants with profound sensorineural hearing loss underwent threshold tone burst ABR and CE-Chirp ASSR of the frequency response test, response thresholds were recorded in 0.5, 1.0, 2.0 and 4.0 kHz. Whether there was correlation or not existed between two methods were analyzed, SPSS 11.0 statistics software was used.</p><p><b>RESULTS</b>Tone burst ABR and CE-Chirp ASSR could lead to different degrees of threshold in each frequency. Response e elicited threshold percentage mainly concentrated in the 91-100 dBnHL, correlation coefficient between 500-4 000 Hz response threshold elicited rate were: 0.837, 0.913, 0.909, and 0.919, respectively (P < 0.001). The difference of the frequency response threshold test between CE-Chirp ASSR and tone burst ABR were not significant (P > 0.05, Chi square).</p><p><b>CONCLUSIONS</b>The tone burst ABR and CE-Chirp ASSR each frequency have different levels of residual hearing in infants with profound sensorineural hearing loss diagnosed by Click ABR, good correlation exists between tone burst ABR and CE-Chirp ASSR.</p>

New therapeutic strategies of obstructive sleep apnea-hypopnea syndrome in children / 中华实用儿科临床杂志

A good sleep is conducive to pediatric physical recovery,which can promote intellectual development and growth for children in growing period.Children with obstructive sleep apnea-hypopnea syndrome (OSAHS) frequently occur partial or complete upper airway obstruction during sleep,hypoxia,arousal and sleep fragmentation are likely to cause more serious consequences than adults.At the same time,for the children with high risk factors,a new family of non-invasive positive pressure ventilation is very important mean of treatment beyond surgery.For children with OSAHS,early diagnosis,early treatment,lifting of upper airway obstruction,prevention and treatment of complications are particularly important.

Epstein-Barr virus-encoded RNAs as a survival predictor in nasopharyngeal carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Epstein-Barr virus (EBV) infection is one of the most important factors of nasopharyngeal carcinoma (NPC) endemic areas. Transcription of EBV-encoded non-polyadenylated RNAs (EBERs) are presented in most of NPC tumors. Exploring EBERs as a prognostic marker for NPC might further be informative about the biology and the progression of the disease. The aim of this study was to analyze the role of EBV latency in the clinical management of nasopharyngeal carcinoma (NPC), by detecting EBERs.</p><p><b>METHODS</b>RNA in situ hybridization (ISH) for detecting EBERs was carried out on 908 NPC tumor tissues. Overall survival (OS) curves were analyzed with the Kaplan-Meier method and the Cox proportional-hazards regression models.</p><p><b>RESULTS</b>The median follow-up time was 70 months (1-120 months). Eight hundred and sixteen (89.9%) from a total of 908 consecutive NPC cases were found to be EBV-EBER positive. EBER-ISH staining revealed nuclear localization in NPC cells. In the Kaplan-Meier analysis for OS, high EBER expression levels in NPC patients were statistically significant positive prognostic factors for survival (log-rank, P = 0.022), especially in adults aged 17-40 years (P = 0.023) and in those with advanced stage disease (log-rank, P = 0.002). Cox proportional-hazards regression model analysis showed that the EBER expression level was an independent risk factor for OS (hazard ratio 0.724, P = 0.005).</p><p><b>CONCLUSIONS</b>EBERs were frequently detected in NPC tumor tissues, and high-level EBER expression correlated with good prognosis in NPC patients, especially in adult patients and in those with advanced stage disease. EBER may serve as a potential prognostic predictor in NPC.</p>

The clinical application of coblation-assisted adenotonsillectomy for treatment of the infant with sleep-disordered breathing / 实用医学杂志

Objective To investigate the clinical application of the coblation in the treatment of the infant with sleep-disordered breathing. Methods The clinical data were reviewed from 161 infants, who had the cobtilaon tonsillectomy and/or adenoidectomy sugeries in our hospital from January , 2008 to June, 2012. Among the 161 SDB cases, there were 85 obstructive sleep apnea hypopnea syndrom cases and 76 primary snoring cases. After 12 months, the follow-up visit is cut off in January, 2013. Successful follow-ups had been done to 161 infant with SDB. And the clinical efficacy and the occurrence of the complications were investigated. Results the intra-operative blood loss was 10 mL or less. 2(1.24%) were delayed hemorrhage with less pain afteroperation. One year after the surgery, there were 141 cured (87.6%), 15 with apparent effects (9.3%), 3 with effective results (1.9%), 2 with no effect(1.2%)and the total effective rate is 98.8%. Conclusion It is minimally invasive, safe and effective to use coblation to remove tonsil and adenoid in the treatment of infants with sleep-disordered breathing.

Clinical efficacy of combined treatment with montelukast and intranasal steroid for chronic adenoid hypertrophy in children / 临床儿科杂志

Objectives To observe the clinical efficacy of combined treatment with montelukast and intranasal steroid for chronic adenoid hypertrophy in children. Methods 47 children with chronic adenoid hypertrophy were selected and ran-domly divided into drug combination group (n=23) treated with montelukast combined with intranasal steroids for two months and control group (n=24) treated with intranasal steroids only for two months. Clinical efficacy was compared between two groups by clinical score and the result of fibronasopharyngoscopy. Results The clinical scores were 0 (0, 1.0) and 0(0, 0) at 2 weeks and 2 months after treatment in combination group, and 1.0 (1.0, 1.0) and 0 (0, 1.0) in control group. There were sig-nificant differences between two groups (Z=2.404, P<0.05;Z=2.069, P<0.05). Conclusions The clinical efficacy of combined treatment with Montelukast and intranasal steroid is better than that of treatment with intranasal steroid only in children with chronic adenoid hypertrophy.

Clinical study of post-operative pain following coblation tonsillectomy and/or adenoidectomy in children with sleep-disordered breathing / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the characteristics of post-operative pain following coblation tonsillectomy and/or adenoidectomy in children with sleep-disordered breathing (SDB) and explore the correlation between the first day post-operative pain scores and age and operating time.@*METHOD@#1) A total of 113 SDB children scheduled to undergo coblation tonsillectomy and/or adenoidectomy were recruited. 113 children were divided into two groups according to the method of operation, children who underwent coblation tonsillectomy and adenoidectomy were enrolled in study group one and children who underwent coblation adenoidectomy only were in study group two. Be sides, children of study group one with a history of chronic tonsillitis were in chronic tonsillitis group, children without a history of chronic tonsillitis were in non-chronic tonsillitis group. 2) The parents scored pain in their children on a VAS (anchored by "no pain" at 0 and "worst pain" at 10) in the morning, before using any analgesics and having breakfast, over the first 3 and the seventh post-operative days. 3) Post-operative pain scores were compared between both the study group one and two and chronic tonsillitis group and non-chronic tonsillitis group. Futhermore, the correlation between the first day post-operative pain scores and age and operating time were also analysed.@*RESULT@#1) The difference of post-operative pain scores over the first 3 and the seventh post-operative days were significant between the study group one and group two (P0.05). 3) The first day post-operative pain scores was correlated with age (r=0.273, P<0.01) and operating time (r=0.423, P<0.01).@*CONCLUSION@#The first day post-operative pain scores was correlated with age and operating time. Children with a history of chronic tonsillitis were more painful than children without the history.

Low-temperature coblation-assisted versus conventional dissection tonsillectomy in surgeries for children / 临床耳鼻咽喉头颈外科杂志

Objective:To compare low temperature coblation assisted tonsillectomy with conventional dissec-tion tonsillectomy intraoperation and afteroperation. Method:Ninty-two pedia-patients were randomly divided into coblation-assisted tonsillectomy group and the control group. Arthrocare EVac 70 T&.A Wand was used for cobla-tion-assisted tonsillectomy, and the energy set was 7. Conventional dissection tonsillectomy was operated in control group. The operating time,bleeding,tonsillar fossae healing and return to normal diet and activities, intraoperative complications were recorded seperately. Postoperative pain of the pedia-patients was recorded daily using Wong Baker FACES pain scale for 10 days of afteroperation. Result: Coblation assisted group had a shorter operative time than the control group (10. 2min vs. 36. 5min, P<0. 001). The average amount of intraoperative bleeding of Coblation assisted group was(6. 83±3. 36) ml, while the control group was(30. 07±7. 04)ml. Pedia-patients of Coblation group had a better pain score on 1, 2, 3 days after operation than in control group, and there was no statistically significant difference on 4 to 10 days between the two groups. Coblation group ones returned to normal diet earlier than the control group, but both group required similar time returned to normal activities. There was one patient in control group, who required suturing to stop bleeding for active oropharyngeal bleeding on the 6th day after operation. Conclusion: Comparing with traditional dissection, Coblation assisted tonsillectomy is easy to perform with less intraoperative bleeding,shorter operation time,earlier return to normal diet, less pain on 1st to 3th day postoperatively.

Low-temperature coblation-assisted versus conventional dissection tonsillectomy in surgeries for children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare low temperature coblation assisted tonsillectomy with conventional dissection tonsillectomy intra-operation and after-operation.@*METHOD@#Ninety-two pedia-patients were randomly divided into coblation-assisted tonsillectomy group and the control group. Arthrocine EVac 70 T&A Wand was used for coblation-assisted tonsillectomy, and the energy set was 7. Conventional dissection tonsillectomy was operated in control group. The operating time,bleeding,tonsillar fossae healing and return to normal diet and activities, intraoperative complications were recorded separately. Postoperative pain of the pedia-patients was recorded daily using Wong Baker FACES pain scale for 10 days of after-operation.@*RESULT@#Coblation assisted group had a shorter operative time than the control group (10.2 min vs. 36.5 min, P<0.001). The average amount of intraoperative bleeding of Coblation assisted group was (6.83+/-3.36) ml, while the control group was (30.07+/-7.04) ml. Pedia-patients of Coblation group had a better pain score on 1, 2, 3 days after operation than in control group, and there was no statistically significant difference on 4 to 10 days between the two groups. Coblation group ones returned to normal diet earlier than the control group, but both group required similar time returned to normal activities. There was one patient in control group,who required suturing to stop bleeding for active oropharyngeal bleeding on the 6th day after operation.@*CONCLUSION@#Comparing with traditional dissection, Coblation assisted tonsillectomy is easy to perform with less intraoperative bleeding, shorter operation time, earlier return to normal diet, less pain on 1st to 3rd day postoperatively.

Analysis of clinical manifestations and misdiagnosis of congenital vallecular cyst / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical manifestations and the cause of misdiagnosis of congenital vallecular cyst.@*METHOD@#Nineteen cases of congenital vallecular cysts were collected and reviewed retrospectively. Their clinical manifestations and diagnosis were analyzed.@*RESULT@#Their clinical manifestations included inspiratory stridor, respiratory distress, inspiratory dyspnea, feeding difficulty etc. Among 19 cases, 15 cases were misdiagnosed as neonate pneumonia (9 cases), bronchial pneumonia (5 cases), and laryngitis (1 case), respectively. All cases were diagnosed as congenital vallecular cysts by fibrolaryngoscope. The diagnosis was confirmed by pathological examination.@*CONCLUSION@#Congenital vallecular cyst is fairly uncommon. To cure these patients on time, early examination of upper airway is recommended for patients with inspiratory stridor and inspiratory dyspnea. Fibrolaryngoscope would be useful for diagnosis and timely treatment.

Analysis of characteristics of heart rate and heart rhythm in children with obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the characteristics of heart rate (HR) and heart rhythm in children with obstructive sleep apnea-hypopnea syndrome (OSAHS).@*METHOD@#Ninety-five patients underwent overnight PSG for clinically suspected OSAHS. According to the apnea index (AI), the patients were assigned to control group (AI 92%, n = 27) or OSAHS group (AI > 1/h, SaO2 < 92%, n = 68). The HR and heart rhythm were monitored and compared between the two groups.@*RESULT@#The maximum HR during sleep was significantly higher in OSAHS group while the minimum HR was significantly lower during sleep. Bradycardia and tachycardia is a common feature of pediatric OSAHS. There was a significantly higher incidence of tachycardia in OSAHS groups than in the control group.@*CONCLUSION@#These findings suggest that pediatric OSAHS might influence HR and heart rhythm.