Application of 3D posture and gait analysis system for the balance evaluation in different ages of healthy subjects / 中华老年医学杂志

Objective To investigate the patterns of gait and locomotion in three dimension space using OptiTrack motion capture system in 30 healthy people aged 20-70 years. Methods The 3D OptiTrack motion capture system was applied in young(aged 20-30 years,n=10),middle-aged(aged 40-50 years,n=10)and the elderly (aged 60-70 years,n=10)to capture the gait and the rhythmic oscillations of the trunk,head,hip and kneewhen subjects walked on the treadmill under three different conditions of normal walking,walking under visual interfering and walking under proprioceptive interfering.Several markers were placed on the subject.For each locomotor trial, the preferred walking speed,stride width,stride time,the absolute angular dispersions and the stander deviation of four segments around the roll,pitch and yaw axes,and gait instability(λ)were calculated to assess the equilibrium strategies of head,trunk,pelvis and knee under different experimental conditions. Results With increasing age, there were decreases in preferring walking speed(PWS)and increases in stride width(F=3.23,3.87;P=0.030, 0.020,respectively).The absolute angle of the segment of head in roll axis was significantly smaller in young group than in middle age and elderly group(F=4.01,3.72;P=0.035,0.028,respectively)under the condition of normal walking and proprioceptive interfering.The trunk sway in yaw was significantly decreased while significantly increased in roll plane either in normal walking or walking under proprioception interfering(F=3.19,P=0.015) .The standard deviation(SD)of movement of head,trunk and hip in yaw direction was higher in young group than in middle-age and elderly group(F=2.89,3.14,3.92;P=0.036,0.019,0.034,respectively),but was lower in young group in roll direction than in middle-age and elderly group(F= 3.90,2.56,3.28;P= 0.017,0.021,0.056, respectively),the difference existed only in hip and trunk under proprioception interfering.The SD value of movement of bilateral knee joints was increased in elderly subjects.Using mediolateral-λ(ML-λ)to predict the gait stability,the results showed a significantly increased λ value by our small circle,and the λ value was positively correlated with age(r=0.03,P<0.05). Conclusions With aging,the abnormal adjustment of body posture and the incongruity of gait may cause a high risk for falling,and gait instability begins to increase as early as age 40-50 years.This finding supports that local dynamic stability is likely to be an indicator of falling risk.OptiTrack motion capture system can be used to evaluate a balance for rehabilitation.

Clinical research of the otolith abnormal migration during canalith repositioning procedures for posterior semicircular canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the risk factor,type and characteristic nystagmus of the otolith abnormal migration during diagnosis and treatment for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV). The therapy and prevention is also discussed.@*METHOD@#Four hundred and seventy-nine patients with PSC-BPPV were treated by Epley's canalith repositioning procedures(CRP) from March 2009 to March 2012. We observed otolith abnormal migration complicating during diagnosis and treatment. According the type of otolith abnormal migration, the additional repositioning maneuver was performed.@*RESULT@#The rate of complication was 8. 1%(39/479), with canal conversion in 5.4%(26/479) and primarily canal reentry in 2.7%(13/479). The rate of incidence of conversion to horizontal canal conversion and anterior canal were 4. 8%(23/479)and 0. 6%(3/479) respectively. All the patient was cured in follow up. The risk factors were unappropriated head movement during or after CRP, including another Dix-Hallpike were performed immediately.@*CONCLUSION@#To prevent the complications,the pathognostic positioning sequence and angle of head rotation are commenced during CRP. Appropriate short time postural restrictions post-treatment is necessary. Careful observation of nystagrnus variation is crucial to determine the otolith abnormal migration.

Evaluation on short-term efficacy of balloon dilation in the treatment of symptomatical eustachian tube dysfunction / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo evaluate the short-term efficacy of Eustachian tube balloon dilation (ETBD) in the treatment of symptomatic Eustachian tube dysfunction (SETD) by subjective and objective analysis.METHODS Forty patients who underwent ETBD were included. Subjects’ inclusion criteria were as followed: symptoms of ETD (aural fullness predominantly, with or without otalgia, muffle hearing and tinnitus), normal tympanic membrane, type A or C tympanograms, and without a history of any middle ear diseases. Main outcomes including subjective improvement, otoscopy, pure-tone audiometry, impedance audiometry, R-value in tubomanometry (TMM) and Eustachian Tube Score (ETS) were assessed 1 week and 6 months postoperatively.RESULTSAll cases were dilated successfully. A significant effect of treatment was documented when measuring subjective improvement, impedance audiometry, R-value in TMM and ETS 1 week and 6 month postoperatively. Subjective symptoms were not relieved only in one patient. The overall success rate for all patients was 98%.CONCLUSIONETBD can provide short-term benefits to those who are diagnosed with SETD and refractory to medical management. SETD might be an optimal indication for ETBD in the treatment of ETD.

The influence of congenital malformation of external and middle ear on the psychologic status of children patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This research focuses on the psychologic status of children patients with congenital malformation of external and middle ear by Achenbach's Child Behavior Checklist (CBCL) in order to explore the degree of the influence.@*METHOD@#The 66 patients of 4-16 years old were assessed psychologic status with CBCL filled in by their parents according to their performance in half a year. Then calculated the detection rate of behav ioral disorders of these patients. Collected all patients' general information and Marx's grade of malformed ears. Then analyzed the relationship between the detection rate and these factors.@*RESULT@#The detection rate of behavioral disorders of 4-16 years old patients, 21.21%, which is higher than that of Chinese norm. The Marx's grade and parents' mental stress relate with the behavioral disorders. In Logistic regression analysis, the value of Cox & Snell coefficient of the regression model is 0. 153. The detection rate of behavioral disorders in grade III patients (36.4%) is greater than that of grade II (4.3%), P = 0.004.@*CONCLUSION@#Congenital malformation of external and middle ear has an absolute influence on the patients' psychologic status, but its effect is only about 15% parts of the multitudinous influential factors. And grade III patients carry a high-risk for behavioral disorders.

Analysis Of Vestibular Function in Patients with Sudden Deafness / 听力学及言语疾病杂志

Objective To study the vestibular function in patients with sudden deafness .Methods Retrospec-tive analysis of 436 cases of patients with sudden deafness ,being divided into two groups according to whether the merger of vertigo .147 cases with vertigo group ,75 cases of which were mild to moderately severe hearing loss .In-clud the rise type of 28 cases ,26 cases of flat type ,21cases of decline type .72 cases of which were severe hearing loss .In 289 cases without vertigo ,157 cases had mild moderate and severe hearing loss .Includ the rise type of 36 cases ,57 cases of flat type ,64 cases of decline type .One hundred and thirty two cases of which were severe hearing loss .Use video electronystagmogram (VNG) to test the vestibular function .Process the data with SPSS 13 .0 soft-ware .Results One hundred and twenty three(83 .7% )cases of the vertigo group suffered from vestibular function decline ,with 51 cases of mild to moderately severe hearing loss ,72 cases of severe and above .165 (57 .1% )cases of the without vertigo group suffered from vestibular function decline .There were 45 cases of mild to moderately se-vere hearing loss ,120 cases of severe and above .35 patients with vertigo patients with BPPV ,28 cases of which happened within 1 week in sudden deafness occured and 80% of which were vestibular function decline .Conclusion Patients with sudden deafness with vertigo suffered from vestibular function damage .Patients with sudden deafness without vertigo also suffered from vestibular function damage .And the more serious the hearing loss ,the higher the vestibular function decline opportunities .

Utility of Sp/Ap curve area ratio electrocochleography in diagnosis of Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Comparison of the sensitivity of Sp/Ap amplitude and area ratio in the aid of diagnosis of Meniere's disease. Meniere's disease was defined by the 1995 American Academy of Otolaryngology-Head and Neck Surgery Committee on Hearing and Equilibrium.@*METHOD@#The study sample consisted of 35 patients in our hospital, who were undergone tympanic electrocochleography (EcochG). A control group of 10 patients (20 ears) with normal Sp/Ap ratio and EcochG data were identified. Sp/Ap amplitude and area curve ratios for both group were measured.@*RESULT@#The traditional upper limit and the upper limit of normal for Sp/Ap amplitude and area curve were respectively 0.4, 46 and 1.94. Of 35 patients with Meniere's disease, had an abnormal Sp/Ap amplitude ratio,and had an abnormal Sp/Ap area curve ratio; the difference between groups was statistically significant.@*CONCLUSION@#Sp/Ap curve area curve ratio is more sensitive than conventional Sp/Ap amplitude ratios in diagnosis of Meniere's disease.

Following up with otoscopy after the middle ear surgery / 中国医师进修杂志

Objective Following up with otoscopy after the middle ear surgery in order to understand the prognosis and recurrence of the surgical cavity. Methods Four hundred and eighty-three ears after middle ear surgery were followed up with otoscopy to understand the situation of its dry ear, surgical cavity lesions as well as whether there was recurrence. Among 483 ears with middle ear surgery, 172 ears were performed with tympanoplasty, 211 ears with tympanoplasty plus modified mastoidectomy, 26 ears with up wall mastoidectomy plus tympanoplasty, 15 ears with radical mastoidectomy, 59 ears with mastoid surgical cavity repair. Results By otoscopy 12 ears were found with secondary tympanic membrane perforation, 9 ears with tympanic membrane perforation without healing, 36 ears with granulation in tympanic membrane or mastoid, 23 ears with recurrent cholesteatoma, 11 ears with middle ear effusion, 5 ears with canal stenosis, 16 ears with fungus infections in surgical cavity, 2 ears with prolapse of artificial auditory ossicles, 3 ears with necrosis of mastoid cavity flap. The time of dry ear after the surgery in open mastoidectomy was (2.1 ± 0.4) months. Conclusion Following up regularly with otoscopy after middle ear surgery is benefit to the clearance of residual disease, preventing recurrence and promoting early dry ear.

Vestibular testing abnormalities in individuals with motion sickness / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the vestibular function of motion sickness.@*METHOD@#VNG, which tests the vestibular function of horizontal semicircular canal, and CPT, which tests vestibulospinal reflex and judge proprioceptive, visual and vestibular status, were performed in 30 motion sickness patients and 20 healthy volunteers (control group). Graybiel score was recorded at the same time.@*RESULT@#Two groups' Graybiel score (12.67 +/- 11.78 vs 2.10 +/- 6.23; rank test P<0.05), caloric test labyrinth value [(19.02 +/- 8.59) degrees/s vs (13.58 +/- 5.25) degrees/s; t test P<0.05], caloric test labyrinth value of three patients in motion sickness group exceeded 75 degrees/s. In computerized posturography testing (CPT), motion sickness patients were central type (66.7%) and disperse type (23.3%); all of control group were central type. There was statistical significance in two groups' CTP area, and motion sickness group was obviously higher than control group. While stimulating vestibulum in CPT, there was abnormality (35%-50%) in motion sickness group and none in control group. Generally evaluating CPT, there was only 2 proprioceptive hypofunction, 3 visual hypofunction, and no vestibular hypofunction, but none hypofunction in control group.@*CONCLUSION@#Motion sickness patients have high vestibular susceptible, some with vestibular hyperfunction. In posturography, a large number of motion sickness patients are central type but no vestibular hypofunction, but it is hard to keep balance when stimulating vestibulum.

Cochlear otosclerosis: 3 cases report and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical features in cochlear otosclerosis.@*METHOD@#Three cases with cochlear otosclerosis in our hospital from March 2007 to October 2008 were reported and the relevant literatures were reviewed. All the cases were confirmed the diagnose by temporal bone high-resolution CT scan (HRCT).@*RESULT@#The chief complaint when visited was recurrent episodic vertigo or equilibrium disturbance with progressing hearing loss in all cases. Two ears in 2 cases were simple sensorineural deafness and considered the pure cochlear otosclerosis. Others were mixed deafness with the descent of bone conduction in different extent. The characters in HRCT: the low density area could be seen in different areas of the otic capsule, the pericochlear lucency or double-ring effect were the typical signs.@*CONCLUSION@#The diagnosis of cochlear otosclerosis is considered in the insoluble sensorineural deafness and the mixed deafness with vestibular symptoms and chronic hearing loss history. Temporal bone HRCT plays an important role in the clinical diagnosis of cochlear otosclerosis.

Vestibular testing abnormalities in individuals with motion sickness / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the vestibular function of motion sickness. Method:VNG, which tests the vestibular function of horizontal semicircular canal,and CPT, which tests vestibulospinal reflex and judge proprio-ceptive,visual and vestibular status, were performed in 30 motion sickness pations and 20 healthy volunteers(control group). Graybiel score was recorded at the same time. Result:Two groups' Graybiel score (12. 67±11. 78 vs 2. 10±6. 23;rank test P<0. 05),caloric test labyrinth value [(19. 02±8. 59)°/s vs (13. 58±5. 25)°/s ;t test P< 0. 05],caloric test labyrinth value of three patients in motion sickness group exceeded 75°/s. In computerized pos-tourgrphy testing(CPT) , motion sickness patients were central type(66. 7%) and disperse type(23.3%);all of contral group were central type. There was statistical significance in two groups' CTP area, and motion sickness group was obviously higher than control group. While stimulating vestibulum in CPT, there was abnormality (35%-50%)in motion sickness group and none in contral group. Generally evaluating CPT,there was only 2 pro-prioceptive hypofunction,3 visual hypofunction, and no vestibular hypofunction, but none hypofunction in contral group. Conclusions Motion sickness patients have high vestibular susceptible, some with vestibular hyperfunction. In posturography,a large number of motion sickness patients are central type but no vestibular hypofunction, but it is hard to keep balance when stimulating vestibulum.

Characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV).@*METHOD@#The positioning nystagmic features in 43 patients with HSC-BPPV treated between April 2004 and October 2006 were recorded and analyzed with video nystagmography. After the subtype and the effect side were determined, the appropriate repositioning maneuvers were chosen.@*RESULT@#(1) Geotropic nystagmus was recorded in 27 cases, of whom 19 cases were treated with barbecue maneuver and/or combined forced prolonged position maneuver, while the others were treated with Asprella's maneuver. (2) Apogeotropic nystagmus was recorded in 16 cases with two types, one of which could turn into geotropic nystagmus with Gufoni's maneuver or spontaneously (in 12 cases), the other type could not (in 4 cases) transform accepted barbecue maneuver and/or combined forced prolonged position maneuver. The total improvement rate was 72.1% after 1 week and 81.4% 3 months later respectively.@*CONCLUSION@#The otolith position and the pathogenesis could be distinguished according to the nystagmic characteristics and type of HSC-BPPV. It was necessary to apply the appropriate repositioning maneuvers to treat HSC-BPPV.

Endoscope-assisted surgical resection of acoustic neuroma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the therapeutic efficacy and complications of endoscope-assisted surgical resection of acoustic neuroma.@*METHOD@#Assisted by hard-tube ear endoscope, 11 patients with acoustic neuroma were operated via labyrinthine approach and retrosigmoid approach.@*RESULT@#Total removal was achieved in 9 (81.8%) cases, while subtotal removal was achieved in 2 (18.2%) cases. Facial nerves and cochlear nerves were preserved completely during operation in all cases. After operation 9 (81.8%) cases had no facial paralysis, while the other 2 cases (18.2%) had mild peripheral facial paralysis. The same hearing level as that of preoperation in 2 patients (18.2%), hearing impairment in different degrees in 9 patients (81.8%), among which moderate sensorineural hearing loss in 1 patient, moderate to severe in 2 patients, severe in 3 patients, profound in 3 patients.@*CONCLUSION@#The application of ear endoscope in acoustic neuroma surgery can improve the total removal rate of tumors and the salvage rate of vessels and nerves. However, its disadvantages make it an assistant method for microsurgery.

The reasons and treatments of recurrent or residual cholesteatoma in middle ears / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the reasons and treatments of recurrent or residual cholesteatoma in middle ears after operations.@*METHOD@#The clinical data of 102 cases (105 ears) with recurrent or residual cholesteatoma was retrospectively analyzed.@*RESULT@#The main reason of recurrent or residual cholesteatoma is incomplete removal of cholesteatoma in the former operations or obstructive drainage of middle ears after operations. Twenty ears healed through cleaning with otoendoscope. Eighty-five ears underwent the second operations of radical mastoidectomy including 23 tympanoplasty meanwhile. The air-conductive auditory threshold of them all decreased more than 15 dBHL.@*CONCLUSION@#For the ears with low facial ridges and non-obstructive drainage of mastoid, tympanic antrum and tympanic cavity, its possible to be cured through cleaning with otoendoscope. For those with high facial ridges and obstructive drainage , it's essential to perform the second operations of radical mastoidectomy and some of them are suitable for tympanoplasty meanwhile.

Clinical study on inlay butterfly cartilage myringoplasty / 中国医师进修杂志

Objective To evaluate the application of the inlay butterfly cartilage graft technique in myringoplasty.Methods Thirty--eight ears in 38 patients (experiment group) with dry central drum perforations were treated with inlay butterfly cartilage myringoplasty,and 46 ears in 46 patients with underlay temporalis fascia myringoplasty (control group).Results After a mean follow-up of 6 months,the healing rate did not differ between two groups (92.1% in experiment group,91.3% in control group,P＞ 0.05).Average pure-tone hearing threshold improved than 10 dB and closure of the air-bone gap (ABG) within 10 dB were not different (P ＞ 0.05).The cured patients were followed up for 12-38 months,there was no ear perforation of drum in experiment group,but 4 ears in control group.Condusion Inlay butterfly cartilage myringoplasty is the reliable and ideal method for tzeating dry central drum pedoration with high success rate.

Endoscope-assisted lateral skull base surgery / 中国医师进修杂志

Objective To explore the therapeutic efficacy and complications of endoscope-assisted lateral skull base surgery. Methods Assisted by hard-tube ear endoscope, 11 patients with acoustic neuroma were operated via labyrinthine approach and retrosigmoid approach, and 5 patients with petrous apex cholesteatoma were operated via middle cranial fossa approach and mastoid-middle cranial fessa approach. Results Among 11 patients with acoustic neuroma, total removal was achieved in 9 cases (81.8%), subtotal in 2 cases (18.2%). Facial nerves and cochlear nerves were preserved completely during operation. After operation there was no facial paralysis in 9 cases (81.8%), mild peripheral facial paralysis in 2 cases (18.2%), the same hearing level as that of preoperation in 2 patients (18.2%), hearing impairment in different degrees in 9 cases (81.8%), among which moderate sensorinural hearing loss in 1 patient (9.1%), moderate to severe in 2 patients (18.2%), severe in 3 patients (27.3%), profound in 3 patients (27.3%). Among 5 patients with petrous apex cholesteatoma, total removal was achieved in all cases. After operation, preoperative facial paralysis in 3 patients disappeared within 9 months, and moderate to severe conduction deafness appeared in 2 patients. Conclusions The application of ear endoscope in lateral skull base surgery can improve the total removal of lesions and the salvage rate of vessels and nerves. However, its disadvantages make it only be an assistant method for micresurgery.

Clinical analysis of otitis media with effusion in adults and children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the different and common features between adults and children with otitis media with effusion (OME) on course of disease, clinical characteristics and audiometric changes.@*METHOD@#Pure tone audiometry, tympanogram and clinical information were analyzed and compared between 34 cases of adults and 42 cases of children with OME.@*RESULT@#The course of disease was relatively short in children. The adenoid vegetation inflammation was more frequently found in children, while the OME occurred more often in adults. The air conduction and bone conduction threshold increased both in children and adults, particularly at high frequencies of 2 and 4 kHz. The bone conduction threshold at 4 kHz in adults was significantly higher than that in children (P < 0.05). In the cases with C type tympanogram, the negative pressure in adults was even lower than that in children (P < 0.05).@*CONCLUSION@#The OME in children is often relatively shorter in course of disease, which is mainly caused by adenoid vegetation. Sensorineural deafness can occur both in children and adults, especially at high frequencies. OME in children is less severe, however, it may lead to negative effects in learning and cognition, which should be diagnosed and managed in time.

Audiological Analysis in Children and Adults with Chronic Suppurative Otitis Media / 听力学及言语疾病杂志

0.05) except for 8 kHz. Air conduction thresholds were basically normal in children's simple type CSOM, whereas hearing loss during intermediate frequency and high frequency in adults with osteitis and cholesteatoma type was more severe than that in children.Conclusion Hearing-loss in children's CSOM was the same as adult patients, although course of disease was not long in children. Inner ear was not or mildly impaired in children's CSOM.

Clinical analysis of 62 cases laryngeal papiloma in children / 临床耳鼻咽喉头颈外科杂志

To investigate the clinical features of laryngeal papilloma in children.Method:In a group of 62 patients with laryngeal papilloma in children,the tumors of 28 patients were cut under the direct laryngoscope,34 patients were treated with laryngeal micro-laser operation.Result:The post-operation followup ranged from 2 to 5 years,the cure rate of 2 years was 51.61%.Conclusion:The clinical features of this disease include rapid development,a large lesion,and it is often found in the infraglottic cavity.Furthermore,we believe that in order to eliminate the tumors more accurately and decrease recurrence,microlaser surgery and the use of interferon is very necessary.