Endolymphatic sac tumor with intralabyrinthine hemorrhage: a case report / 临床耳鼻咽喉头颈外科杂志

A 27-year-old female patient suffering endolymphatic sac tumor with intralabyrinthine hemorrhage was reported. The patient had hearing loss in the left ear with continuous tinnitus, and MRI showed the soft tissue shadow of endolymphatic sac. Considering that the tumor involved semicircular canal and vestibule,endolymphatic cyst tumor resection was performed by labyrinth route. After surgery, there was no cerebrospinal fluid leakage and facial nerve function was normal. More importantly, enhanced MRI of temporal bone showed no tumor recurrence 1 year after surgery.

Study on the factors impacting on early cochlear implantation between the eastern and western region of China / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To describe tne regional different factors which impact on early cochlear implantation in prelingual deaf children between eastern and western regions of China.@*METHOD@#The charts of 113 children who received the cochlear implantation after 24 months old were reviewed and analyzed. Forty-five of them came from the eastern region (Jiangsu, Zhejiang or Shanghai) while 68 of them came from the western region (Ningxia or Guizhou). Parental interviews were conducted to collect information regarding the factors that impact on early cochlear implantation. Result:Based on the univariate logistic regression analysis, the odds ratio (OR) value of universal newborn hearing screening (UNHS) was 5. 481, which indicated the correlation of UNHS with early cochlear implantation is significant. There was statistical difference between the 2 groups (P0. 05). The multivariate analysis indicated that the UNHS and financial burden are statistically different between the eastern and western regions (P=0. 00 and 0. 040 respectively).@*CONCLUSION@#The UNHS and financial burden are statistically different between the eastern reinforced in the western region. In addition, the government and society should provide powerful policy and more financial support in the western region of China. The innovation of management system is also helpful to the early cochlear implantation.

The AppIication of EndoIymphatic Space Imaging in the Diagnosis of DeIayed EndoIymphatic Hydrops / 听力学及言语疾病杂志

Objective To investigate the pathological mechanism of delayed endolymphatic hydrops(DEH) , and clarify the clinical value of endolymphatic space imaging after intratympanic injection of gadolinium in the diag_nosis of delayed endolymphatic hydrops .Methods Twenty -four hours after bilateral intratympanic injection of gadolinium ,the locations and severity of endolymphatic hydrops of all patients were evaluated by using three dimen_sional fluid-attenuated inversion recovery (3D -FLAIR) and three dimensional real inversionrecovery (3D -real IR) .ResuIts All patients had unilateral or bilateral endolymphatic hydrops .Among 9 ipsilateral DEH patients , only 1 (11 .1% ) patient was identified as mild endolymphatic hydrops and the rest (88 .9% ) examined had signifi_cant endolymphatic hydrops in vestibule of their affected ears ;Endolymphatic hydrops appeared in cochlea of the af_fected ear in 8 (88 .9% ) patients ,except for 1 patient .Endolymphatic hydrops were not observed in the contralater_al ears of 9 ipsilateral DEH patients .Mild endolymphatic hydrops in bilateral vestibule ,severe in right cochlear and none in left cochlea of contralateral DEH patient were identified .ConcIusion Endolymphatic hydrops is the primary pathological factors of DEH .Endolymphatic space imaging after intratympanic injection of gadolinium can intuitively reflect the locations and severity of endolymphatic hydrops in DEH patients .

The EvaIuation of Auditory and VerbaI AbiIity in 107 Pre-LinguaIIy Deaf ChiIdren with CochIear ImpIantation / 听力学及言语疾病杂志

Objective To evaluate the auditory and verbal abilities of cochlear implantees using question_naires ,to explore basic rules of the development of auditory and verbal abilities ,and to analyze their relationships with some influencing factors .Methods A retrospective analysis of 107 cases of pre-lingually deaf children with cochlear implantation was conducted with Infant-Toddler Meaningful Auditory Integration Scale/Meaningful Audi_tory Integration Scale (IT -MAIS/MAIS) ,categories of auditory performance (CAP) and speech intelligibility rat_ing (SIR) for the evaluation of auditory and verbal abilities .An analysis was performed to assess influencing fac_tors ,such as postoperative time ,age at implantation ,physical age at follow -up ,time with hearing aids before im_plantation .SAS 9 .1 .3 was used in statistical analysis .ResuIts A total of 107 pre-lingually deaf children (48 males and 59 females) participated in this study .The postoperative time ranged from 0 to 49 months ,with an average of 9 .0 ± 10 .9 months .The results showed the postoperative time and age at implantation had significant influences on the scores of IT -MAIS/MAIS ,and postoperative time and physical age at follow -up had significant influences on the scores of CAP/SIR (P0 .05) .ConcIusion The ages at implantation ,postoperative time and physical age had significant influences on the auditory and verbal abilities of pre-lingually deaf children with cochlear implanta_tion .Further studies are needed to explore their relationships with hearing aids usage before implantation .

The management of facial nerve tumors involving the internal auditory canal / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#10 summarize tne clinical features of the facial nerve tumors involving the internal auditory canal and promote the management of facial nerve tumor.@*METHOD@#We retrospectively reviewed the clinical manifestations, the experiences of diagnosis and treatment of the facial nerve tumor involving the internal auditory canal. All these 5 cases were enrolled during January 2013 to Apr 2015.@*RESULT@#Among the 5 cases, 3 cases were facial neurilemmoma and the others were facial neurofibroma. The main symptoms of facial nerve tumors involving the internal auditory canal most commonly were facial paralysis companied with hearing loss. All the patients accepted the surgical treatment with various approaches, 3 cases of translabyrinthine approach, 1 case of middle fossa approach, and 1 case of combination of translabyrinthine and transotic approach. Total tumor resection were achieved in all 5 cases. Facial-hypoglossal nerve anastomosis was performed in one case, another case was undergone great auricular nerve graft.@*CONCLUSION@#Surgical intervention for patients with facial neuroma involving internal auditory canal should be considered when facial weakness has deteriorated to grade 4. The management should be based on the patient's hearing, facial nerve function, tumor size and invasive extension to select the appropriate surgical procedures.

Study of categories of auditory performance and speech intelligibility rating of post-lingual cochlear implantes / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the verbal communication skills of post-lingual cochlear implantees with categories of auditory performance (CAP) and speech intelligibility rating(SIR), and to explore their relationships with the duration of hearing loss, the postoperative time and preoperative hearing aid usage.@*METHOD@#A retrospective analysis was conducted on 23 cases of post-lingual patients with cochlear implantation. CAP and SIR were applied in the evaluation of verbal communication skills. IBM SPSS Statistics 19 was used in statistical analysis.@*RESULT@#The average score of CAP was 6.13, and statistical analysis showed CAP score was not significantly correlated with the duration of hearing loss, the postoperative time or the time of wearing a hearing aid preoperatively. The average SIR score of all these post-lingual patients was 4.91.@*CONCLUSION@#It showed that CAP score was not significantly correlated with these three factors. This may due to the low accuracy of CAP or the small sample size in the present study. SIR was not suitable for the evaluation of post-lingual cochlear implantees.

The management of facial nerve tumor manifested as facial paralysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To heighten the awareness of the facial nerve tumors.@*METHOD@#The clinical data of twenty-three patients complaining of facial paralysis who were diagnosed postoperatively as facial nerve tumors were analyzed. The hearing assessment of all patients was based on pure tone audiometry at the frequency of 0. 5, 1, 2, 4 kHz. Temporal bone high resolution CT scan and temporal bone MRI with gadolinium enhancement were conducted on all patients. Facial nerve function was assessed with the House-Brackmann (HB) grading system. Facial electroneurography (ENoG) was conducted on 20 patients to quantify the degree of nerve degeneration preoperatively. The pathological types of tumor were determined by postoperative pathological reports.@*RESULT@#Nineteen out of 23 cases presented hearing loss (82.6%), 10 cases suffered from tinnitus (43.5%), otalgia (17.4%) affected 4 cases, 3 cases manifested otorrhea (13.0%), and 2 cases presented vertigo (8.7%). Geniculate ganglion was the most commonly involved site (20 cases, 87.0%), followed by tympanic segments (18 cases, 78.3%), pyramid segment (16 cases, 69.6%), mastoid segment (10 cases, 43.5%), labyrinthine segment (9 cases, 39.1%), internal auditory canal segment and parotid gland segment (5 cases, 21.7%, respectively). Twenty-one cases (91.3%) of schwannomas, 1 case (4.3%) of neurofibroma and 1 case (4.3%) of hemangiomas were identified with histopathology postoperatively. The tumors were all completely excised, and the facial nerve function could recovered to HB III at the best after facial nerve repairment.@*CONCLUSION@#Facial nerve tumor is a rare and often misdiagnosed disease which was commonly manifested as facial nerve paralysis. Temporal bone CT and MRI can help to clarify the diagnosis preoperatively. Pure tone audiometry and electroneurography also plays a some certain roles in the diagnosis of facial nerve tumors. The tumors should be completely resected and the surgical approaches were determined based on tumor size, facial nerve function and preoperative auditory function.

Quantitative analysis of psychiatric disorders in patients with intractable Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the correlation between psychological disorder and vestibular dysfunction in patients suffering from peripheral vertigo.@*METHOD@#Retrospective review of 17 peripheral vertiginous patients with intractable Meniere's disease recruited from the EENT hospital whom underwent intratympanic gentamicin injection. Hospital anxiety and depression scale, self-rating anxiety scale, self-rating depression scale, symptom checklist-90 were used in this study. Pre- and postoperative scores where compared.@*RESULT@#The vertigo control rate of 17 patients reached 88%, with hearing impairment noted only in 17.6% of the patients. 33.3% of the preoperative tinnitus patients and 76.9% of the preoperative aural fullness patients had their symptoms relieved respectively. The outcomes of hospital anxiety and depression scale, self-rating anxiety scale, self-rating depression scale, symptom checklist-90 are significantly greater in vertiginous group than that in normal controls (P 0.05).@*CONCLUSION@#Significant differences were noted between peripheral vertiginous patients and normal controls in psychiatric questionnaires, suggesting that psychological dysfunction may contribute to the vertigo attack.

Clinical experience in facial nerve tumors: a review of 27 cases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location.@*METHOD@#Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively.@*RESULT@#Twenty (74.1%) schwannomas, 4 (14.8%) neurofibromas ,and 3 (11.1%) hemangiomas were identified with histopathology postoperatively. During the course of the disease, 23 patients (85.2%) suffered facial paralysis, both hearing loss and tinnitus affected 11 (40.7%) cases, 5 (18.5%) manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitches. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve. Intra-operative findings showed that 24 (88.9%) cases involved no less than 2 segments of the facial nerve, of these 24 cases 87.5% (21/24) involved the mastoid portion, 70.8% (17/24) involved the tympanic portion, 62.5% (15/24) involved the geniculate ganglion, only 4.2% (1/24) involved the internal acoustic canal (IAC), and 3 cases (11.1%) had only one segments involved. In all of these 27 cases, the tumors were completely excised, of which 13 were resected followed by an immediate facial nerve reconstruction, including 11 sural nerve cable graft, 1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis. Tumors were removed with preservation of facial nerve continuity in 2 cases.@*CONCLUSION@#Facial nerve tumor is a rare and benign lesion, and has numerous clinical manifestations. CT and MRI can help surgeons to make a right diagnosis preoperatively. When and how to give the patients an operation depends on the patients individually.

Diagnosis and management of pulsatile tinnitus of venous origin / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the diagnosis and management of pulsatile tinnitus of venous origin.@*METHOD@#A retrospective study was conducted on 12 patients who were diagnosed with pulsatile tinnitus of venous origin and treated with ligation of internal jugular veins. We reevaluated the evidences of identifying pulsatile tinnitus of venous origin and reviewed the short-term and long-term postoperative effects and complications. We also reviewed associated articles in this report.@*RESULT@#Seven patients got relief of tinnitus in less than one week after the surgery, while the other 5 patients had no relief. Seven patients were inquired in this study and the other five lost to follow-up. According to the long review (from one to five years postoperatively), two patients who acquired immediate effect got relief of tinnitus, four including complained of no relief and the seventh aggravated into roaring. Three patients who got no immediate relief got no improvement at all. No one in our review complained of any complications.@*CONCLUSION@#It's assumed that a history of pulsatile tinnitus, alleviation of tinnitus when pressing jugular veins, tinnitus changing with head position or posture and no occupying lesion in temporal CT scan or cranial MRI are inadequate in diagnosing pulsatile tinnitus of venous origin. Vascular imaging is also necessary to exclude other pathological changes like dura arteriovenous fistula, sigmoid diverticulum and so on. CT arteriography and venography are recommended preferentially. Ligation of internal jugular veins is controversial in patients who have no absence of transverse and sigmoid sinus and identified as pulsatile tinnitus of venous origin.

Clinical experience in facial nerve tumors:A review of 27 cases / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location.Method:Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively.Result:Twenty(74.1%) schwannomas,4 (14.8%)neuofibromas ,and 3(11.1%)hemangiomas were identified with histopathology postoperatively.During the course of the disease,23 patients(85.2%)suffered facial paralysis,both hearing loss and tinnitus affected 11 (40.7%)cases,5(18.5%)manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitched. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve.Intra-operative findings showed that 24(88.9%)cases involved no less than 2 segments of the facial nerve,of these 24 cases 87.5%(21/24)involved the mastoid protion,70.8%(17/24)involved the tympanic protion, 62.5%(15/24)involved the geniculate ganglion, only 4.2%(1/24)involved the internal acoustic canal(IAC),and 3 cases (11.1%)had only one segments involved. In all of these 27 cases ,the tumors were completely excised,of which 13 were resected followed by an immediate facial nerve reconstruction,including 11 sural nerve cable graft,1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis.Tumors were removed with preservation of facial nerve continuity in 2 cases.Conclusion:Facial nerve tumor is a rare and benign lesion,and has numerous clinical manifestations.CT and MRI can help surgeons to make a right diagnosis preoperatively.When and how to give the patients an operation depends on the patients individually.

The character of superior semicircular canal dehiscence syndrome on multi-slice CT / 中华放射学杂志

Objective To better understand the MSCT characteristic of superior semicircular canal dehiscence syndrome (SSCDS). Methods A retrospective study was conducted on 8 patients who were diagnosed with SSCD syndrome in the otology and skull base surgery group of fudan university. All the patients CT features, the conventional axial and coronal images base on high-resolution MSCT and the images displayed the whole superior semicircular canal, which were reconstructed by using the technology of MPR, were reviewed. Results All the images that displayed the whole superior semicircular canal exhibited the dehiscence. Six patients' dehiscences occur in the middle of the roof over the superior semicircular (4 of 6 dehiscences also occur in the front of the roof), 2 patients dehiscences occur in the back of the roof over the superior semicircular. The range of the maximal diameter of the dehiscence was 0.8-4.2 mm, (median value: 2.4 mm). Conclusion The technology of MPR based on the high-resolution MSCT scan is very useful in diagnosis of the SSCDS.

The study on the en bloc resection of the external auditory canal to treat external auditory canal carcinoma in the early stage / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To introduce the en bloc resection of the external auditory canal. To improve early diagnosis and the effective surgical management of external auditory canal carcinoma.@*METHOD@#Twelve cases of the early stage external auditory canal carcinoma were reviewed retrospectively. All cases were undergone surgical treatment by en bloc external auditory canal resection plus lateral temporal bone resection and superficial parotidectomy. All the patients were followed up from 1 to 3 years.@*RESULT@#There were 7 males and 5 females, age ranged from 28 to 75 years. According to T stage, there were 4 T1, 8 T2. Eight cases complaint of otalgia or ear pain and 6 cases present with otorrhea. Among 6 otorrhea cases, 3 cases had bloody secretions. Mass with variable sizes in the external auditory canal could be identified by physical examination. Six cases were diagnosed by biopsy preoperatively, another 6 cases were diagnosed by mass resection pathologically. Postoperative pathological diagnosis revealed that 6 cases with adenoid cystic carcinomas, 5 cases of squamous cell carcinomas, 1 case of cerumenal adenocarcinoma. No lesion involved in parotid gland and lymphoid of parotid surface. Safety lateral incision margin was obtained and no lesion penetrated tympanic membrane in all cases. Five cases of squamous cell carcinomas, 1 case of cerumenal adenocarcinoma and 3 cases of adenoid cystic carcinomas received radiotherapy postoperatively. All patients were alive free of carcinoma during the follow-up. Operation side in 6 cases present with incomplete facial paralysis immediately postoperatively and graded III to IV by House-Brackmann Facial Nerve Grading System, which all fully recovered within 1-3 months. All cases showed conductive hearing loss after surgery. The preoperative average hearing threshold was 38dB (500, 1000, 2000 Hz) while postoperative average hearing threshold of all cases was 65 dB (500, 1000, 2000 Hz). One patient had parotid fistula after surgery and recovered by pressure pocketing.@*CONCLUSION@#Timely and accurate biopsy is the key point to diagnose the early stage external auditory canal carcinoma. The complete resection with safety margin of external auditory canal carcinoma can improve the effect of surgery.

Misdiagnosis of facial never tumor / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the misdiagnosis of facial nerve tumor and better understand facial nerve tumor.</p><p><b>METHODS</b>Twenty-eight patients with facial nerve tumor were undergone surgical treatment during January 1993 to September 2006. Eleven patients had been misdiagnosed. All patients were undergone pure tone audiometry, CT scan or MRI. Facial nerve function was evaluated with House-Brackmann grading system.</p><p><b>RESULTS</b>Eleven cases were misdiagnosed. Two cases were misdiagnosed as parotid tumor preoperatively. They were identified as facial never tumor because the masses originated from facial nerve during the surgery and confirmed by pathological examination. Four cases with unilateral facial nerve paralysis lasting from one year to eight years had been misdiagnosed as Bell palsy. Two cases with recurrent facial nerve palsy were misdiagnosed as Bell palsy. Finally MRI and CT demonstrated a mass at the genicular segment of facial nerve. One case with hearing loss and mass in external acoustic meatus was misdiagnoses as external acoustic meatus neoplasm. It was verified as facial schwannomas by biopsy and CT scan. One case with ear discharge, tympanic membrane perforation, soft tissue mass at epitympanum was misdiagnosed as chronic suppurative otitis media, lump was found close to the horizontal segment of facial nerve intraoperatively, and then it was confirmed as facial schwannomas by pathology. One case with soft tissue mass at mastoid and facial paralysis lasting about one and a half years was misdiagnosed as congenital cholesteatoma preoperatively. After admission, MRI study revealed the mass was involved in the facial nerve and parotid gland, and facial nerve tumor was suspected. All the 11 cases were undergone surgery, and the diagnosis was confirmed pathologically.</p><p><b>CONCLUSIONS</b>Facial nerve tumor was rare and unfamiliar with most of Otologists. The present study showed that the three symptoms or signs should be alert: patient presents with facial paralysis does not partially recovered within six months or patient presents with recurrent facial paralysis, CT scan and MRI should be ordered for these patients to rule out space-occupation along facial nerve. Soft tissue mass associates with the horizontal or vertical segment of facial nerve should be distinguished with Cholesteatoma and otitis media while patient complains of facial paralysis. Parotid neoplasm close to facial nerve should be considered it originates from facial nerve.</p>

The effects of small dose of intratympanic gentamicin injection on intractable Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the efficacy of small dose of intratympanic gentamicin injection on intractable Meniere's disease.@*METHOD@#Retrospectively study the efficacy of gentamicin intratympanic injection on intractable Meniere's disease. The end-point of treatment was determined based on bedside tests (Spontaneous Nystagmus test, Head shaking test and Head Thrust test), hearing tests, or the improvement of patients symptoms.@*RESULT@#Nineteen patients with Meniere's disease were treated with intratympanic gentamicin injection. Vertigo control was achieved in 17 patients (89%). Of them, vertigo of 5 patients was successfully controlled after single injection. Eight patients need double injections and 4 patients need the third injections to control the vertigo. Endolymphatic sac shunt was performed to 1 patient because he could not tolerate the fullness of ear due to injection. The remainder 2 patients with double injections showed no improvement of vertigo and rejected further treatment. Hearing was improved in two patients after gentamicin injection. Three patients complained of hearing loss after intratympanic gentamicin injection. The hearing of the other patients did not change.@*CONCLUSION@#Three weeks after using small dose of gentamicin intratympanic injection to treat intractable Meniere's disease, it was determined whether more injections is required. The results showed that by using this approach, the vertigo could be effectively controlled and the risk of hearing loss following intratympanic gentamicin injection could be reduced.

Effects of blood transfusion on cellular immuno-function in patients with laryngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the influence of blood transfusion on cellular immunofunction in patient with laryngeal carcinoma.Method:EPICS-XL flow cytometry was used to measure T cell subgroup,NK cell and CD28 in 36 patients with laryngeal carcinoma pre-operation and 2 weeks post-operation.Patients were divided into allotransfusion group and non-transfusion group.Comparison was conducted between the 2 groups.Result:①Comparsion with normal population,decreasing of CD3,CD4,NK cell and CD28 in the 36 patients pre-operation was statistically significant (P＜0.01).②Decreasing of CD3,CD4,NK cell and CD28 was statistically signficant post-operation(P＜0.05).③In the non-transfusion group change of CD3,CD4,CD8,NK cell and CD28 post-operation was statistically insignificant (P＞0.05).Conclusion:While cellular immunofunction is generally low in patients with laryngeal carcinoma,allotransfusion will reduce further.It makes contribution to spreading and metastasis of carcinoma easier.

Imaging of glomus tympanicum tumors / 中华放射学杂志

Objective To evaluate the imaging diagnosis value of glomus tympanicum tumors.Methods Images of 10 patients with surgically and pathologically confirmed glomus tympanicum tumors were reviewed.The image characteristics and diagnostic value were summarized.Results In 8 patients with high resolution CT scan and 2 patients with routine CT scan,soft tissue nodules within the tympanic cavity were identified on axial or coronal images in 7 of them.And in 3 patients with chronic tympanitis,glomus tympanicum tumors were not differentiated on CT images.Eight patients had undergone MR examination,on T2WI the tumors were moderate hyperintense(n=6)and hyperintense(n=2),and the tumors were enhanced obviously after contrast.In 3 patients with chronic tympanitis,moderate high signal of the tumor can be differentiated with the high signal of tympanitis on T2WI.On contrast MRI,the signal of enhanced tumor or unenhanced tympanitis was identified clearly.Conclusion On diagnosis of glomus tympanicum tumors,MRI is prior to CT,especially in patient with glomus tympanicum and tympanitis.