Study of cochlear hydrops analysis masking procedure in patients with Meniere's disease and otologically normal adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The cochlear hydrops analysis masking procedure (CHAMP) is a new diagnostic technique for Meniere's disease (MD). But its value has not been well proven. This study aimed to evaluate the diagnostic value of CHAMP for MD.</p><p><b>METHODS</b>CHAMP test was taken in three populations using the Auditory Evoked Potential system delivered by Bio-logic Systems Corporation: (1) otologically normal subjects; (2) patients clinically diagnosed with definite MD; (3) patients clinically diagnosed with probable and possible MD.</p><p><b>RESULTS</b>According to the comparison between the normal and definite MD group, if the abnormal criterion of CHAMP was defined as latency delay less than 0.3 ms, then the corresponding sensitivity was only 52%. However, if the abnormal criterion was defined as latency delay between 0.6 and 3.8 ms, then a sensitivity of 93% and a specificity of 100% can be achieved. The complex amplitude ratio showed a significant overlap between normal and definite MD group. If the abnormal criterion was defined as a complex amplitude ratio less than 0.95, the corresponding specificity was only 50%. However, if the abnormal criterion was defined as less than 0.80, the corresponding sensitivity was 60%, and the specificity was 97%. If the abnormal criterion of CHAMP was defined as latency delay less than 0.6 ms or the complex amplitude ratio less than 0.80, CHAMP result can be obtained in all subjects with good sensitivity and specificity.</p><p><b>CONCLUSIONS</b>CHAMP can differentiate patients with Meniere's disease from otologically normal subjects with high sensitivity and specificity. The recommended criterion of abnormal CHAMP was a latency delay less than 0.6 ms or a complex amplitude ratio less than 0.80.</p>

Application of unilateral olfactory testing and clinical analysis of unilateral hyposmia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate whether patients presenting with self-reported olfactory disorders demonstrates significant side difference in odour recognition by measuring separately for each nostril.</p><p><b>METHODS</b>One hundred and four patients with chief complaint of hyposmia were evaluated by medical history, physical examination, T&T olfactory testing and medical imaging. Smell was tested using T&T olfactometry in each nostril separately.</p><p><b>RESULTS</b>Based on the history and results from the clinical examination, unilateral sinonasal diseases and abnormal nasal structure were excluded. In almost one eighth of all presenting patients (13.46%), a side difference was detected. Especially, six of the patients were identified with lateralized hyposmia.</p><p><b>CONCLUSIONS</b>Olfactory testing could be performed in each nostril separately. The above findings suggested that testing each nostril separately was necessary so as not to miss unilateral hyposmia as a special clinical manifestation of olfactory disorder.</p>

Comparison of tone burst evoked auditory brainstem responses with different filter settings for referral infants after hearing screening / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Auditory brainstem responses (ABR) evoked by tone burst is an important method of hearing assessment in referral infants after hearing screening. The present study was to compare the thresholds of tone burst ABR with filter settings of 30 - 1500 Hz and 30 - 3000 Hz at each frequency, figure out the characteristics of ABR thresholds with the two filter settings and the effect of the waveform judgement, so as to select a more optimal frequency specific ABR test parameter.</p><p><b>METHODS</b>Thresholds with filter settings of 30 - 1500 Hz and 30 - 3000 Hz in children aged 2 - 33 months were recorded by click, tone burst ABR. A total of 18 patients (8 male/10 female), 22 ears were included.</p><p><b>RESULTS</b>The thresholds of tone burst ABR with filter settings of 30 - 3000 Hz were higher than that with filter settings of 30 - 1500 Hz. Significant difference was detected for that at 0.5 kHz and 2.0 kHz (t values were 2.238 and 2.217, P < 0.05), no significant difference between the two filter settings was detected at the rest frequencies tone evoked ABR thresholds. The waveform of ABR with filter settings of 30 - 1500 Hz was smoother than that with filter settings of 30 - 3000 Hz at the same stimulus intensity. Response curve of the latter appeared jagged small interfering wave.</p><p><b>CONCLUSIONS</b>The filter setting of 30 - 1500 Hz may be a more optimal parameter of frequency specific ABR to improve the accuracy of frequency specificity ABR for infants' hearing assessment.</p>

Study of characteristic of the cochlear hydrops analysis masking procedure in normal adults / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the characteristic of the cochlear hydrops analysis masking procedure (CHAMP) in normal adults, and to evaluate the diagnostic values of its parameters for membranous labyrinth hydrops.</p><p><b>METHODS</b>Twenty otologically normal adults were recruited (male:female = 10:10), and their auditory brainstem responses (ABR) were obtained to six stimulus conditions using Bio-logic auditory evoked potential system: clicks presented alone (unmasked condition) and clicks presented with ipsilateral pink noise high-pass filtered at 8, 4, 2, 1, and 0.5 kHz respectively.</p><p><b>RESULTS</b>The wave V latency of ABR to the high-pass masking pink noise clicks were longer than ABR to clicks alone. The latency delays of wave V for clicks presented with ipsilateral pink noise high-pass filtered at 8, 4, 2, 1, and 0.5 kHz compared to clicks alone were (0.30 ± 0.18), (0.97 ± 0.43), (1.65 ± 0.64), (3.21 ± 0.56), (4.66 ± 0.37) ms respectively. The complex amplitude ratio between ABR to click + 0.5 kHz high-pass noise and click alone was 0.95 ± 0.11.</p><p><b>CONCLUSIONS</b>CHAMP is a promising diagnostic method for membranous labyrinth hydrops, and the latency delay of wave V might be used as the normal criterion. The specificity of the complex amplitude ratio need further evaluation in clinical work.</p>

Olfactory functional magnetic resonance imaging with modified OEP-98C olfactometer and event-related design / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the feasibility of functional magnetic resonance imaging (fMRI) in analysis of olfaction function with modified OEP-98C olfactometer and event-related design.</p><p><b>METHODS</b>Six young right-handed men underwent olfactory fMRI with event-related design. OEP-98C olfactometer was modified to accommodate MR environment. There were 2 types of tasks in the experiment. In one task, only isoamyl acetate was used as odorant. In the other task, to avoid possible decreased olfactory attention, vanillin was given before each presentation of isoamyl acetate.</p><p><b>RESULTS</b>In both tasks, uniform activation in piriform cortex and secondary olfactory cortexes was determined. The activation of piriform cortex was not significantly different between the two tasks (P > 0.01).</p><p><b>CONCLUSIONS</b>With isoamyl acetate as odorant, modified OEP-98C olfactometer, and event-related design, olfaction fMRI can depict cortex activation at primary and secondary olfactory cortex. Applying other odorant with similar quality to avoid olfactory attention decrease can not promote depiction of activation in primary olfactory cortex.</p>

Discordance between olfactory psychophysical measurements and olfactory event related potentials in five patients with olfactory dysfunction following upper respiratory infection / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Subjective olfactory tests are easy to perform and popularly applied in the clinic, but using only these, it is difficult to diagnose all disorders of the olfactory system. The olfactory event related potentials technique offers further insight into the olfactory system and is an ideal objective test. This analysis was of subjective and objective data on the olfactory function of twelve patients with loss of smell associated with an upper respiratory infection (URI).</p><p><b>METHODS</b>We tested the twelve patients with URI induced olfactory loss by medical history, physical examination of the head and neck, olfactory tests and medical imaging. Olfactory function was assessed by Toyota and Takagi olfactometry including olfactory detection and recognition thresholds and olfactory event-related potentials (OERPs) recorded with OEP-98C Olfactometer.</p><p><b>RESULTS</b>An unusual phenomenon was observed in five patients in whom the subjective detection and recognition thresholds were normal, while the expected OERPs were not detectable.</p><p><b>CONCLUSIONS</b>We suggest that the discordance between olfactory psychophysical measurements and OERPs might be the results of abnormal electrophysiology related with olfactory neuropathy caused by viral URI. In addition, the measurement of OERPs might play a significant role in evaluating olfactory dysfunction.</p>

MRI features of olfactory bulb volume in healthy middle and old-aged persons / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the differences of olfactory bulb (OB) volumes between younger and older, male and female, left-side and right-side in healthy middle and old-aged persons by MRI.</p><p><b>METHODS</b>Ninety five healthy middle and old-aged volunteers (male:female = 45:50) were divided into 2 groups, group one included persons aged from 50 to 69, group two included persons elder than 70. The left-side, right-side and both-side volumes of OB, the volumes of brain and the ratio of OB/brain were measured by MRI.</p><p><b>RESULTS</b>(1) The left-side and both-side volumes of OB (x(-) +/- s), the volumes of brain [(39.89 +/- 8.7) mm(3), (81.70 +/- 16.8) mm(3) and (1281.86 +/- 140.2) cm(3)] in 50 - 69 years old group were respectively larger than those in >/= 70 years old group [(34.45 +/- 10.4) mm(3), (72.10 +/- 19.3) mm(3) and (1165.77 +/- 165.3) cm(3)], and the differences reached statistical significance (t were respectively 2.649, 2.449, 3.516, all P < 0.05). There were no significant differences of right-side OB volumes and the ratio of OB/brain between 50 - 69 years old group and >/= 70 years old group (t were respectively 1.904, 0.616, each P > 0.05). (2) The male's OB volumes of left-side, right-side and both-side, the brain volumes and the ratio of OB/brain were respectively larger than females', and the differences reached statistical significance (t were respectively 4.461, 3.630, 4.399, 3.800, 2.400, all P < 0.05). (3) The right-side OB volumes were larger than left-side's and significant differences were found in female group, 50 - 60 years old group and >/= 70 years old group (t were respectively 2.732, 2.117, 3.516, all P < 0.05). There were no significant differences of OB volumes between left-side and right-side in female (t = 2.649, P = 0.110). The ratio of right-side OB/brain were larger than the ratio of left-side's and the differences reached statistical significance (t = 3.183, P = 0.002).</p><p><b>CONCLUSIONS</b>MRI could be used to measure the volume of OB. The older the people, the smaller the OB volumes. There was no influence of age on the ratio OB/brain. The OB volumes of right-side were larger than those of left-side. The OB volumes of male were larger than those of female.</p>

Analysis of abnormality of the middle ear in infant and young children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis of middle ear abnormality in infants and young children.</p><p><b>METHODS</b>To analyze retrospectively the data of audiology (including ABR, tympanometry) and CT scanning in 31 infants and young children who presented middle ear abnormality.</p><p><b>RESULTS</b>Wave I latencies of ABR were delayed in 38 of 62 ears and not delayed in 15 ears, but CT scanning showed high density in 6 ears of these 15 ears. Wave I could not be elicited in 9 ears. Tympanometries were tested in 16 cases and were abnormal in 17 ears. CT scanning was carried out in 15 cases who's ABR and tympanometries showed abnormal. High signal intensity was present in mastoids and middle ear cavities in both ears of 12 cases and unilateral ear of 3 cases. Wave I latency of ABR was delayed and High signal intensity was present in mastoids and middle ear cavities in CT scanning of 13 ears. Wave I latency of ABR was normal, but high signal intensity was present in mastoids and middle ear cavities in CT scanning of 4 ears, there was no any ear which Wave I latency was delayed but CT scanning was normal. And disaccord among ABR, Tympanometry and CT scanning were showed. A typical case was reported.</p><p><b>CONCLUSIONS</b>The most abnormality of the middle ear could be found used the tympanometry and I latency of ABR in infant and young children, but still there were some abnormality of the middle ear could not be showed. Some quandaries were existed and more sensitivity tests were needed in the diagnosis of abnormality in middle ears of infant and young children.</p>

Clinical analysis of otogenic intracranial complications / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features and treatment protocols of otogenic intracranial complications in Peking Union Medical College Hospital.</p><p><b>METHODS</b>Retrospective study of 14 patients (10 males and 4 females, aged between 12 - 62 years, mean age 32.1 years) hospitalized from 1982 - 2006. Twelve cases were otitis media (OM) with cholesteatoma, the other 2 cases were non-cholesteatomatous OM. All the otogenic intracranial complications located at the same sides as otologic disorders. Brain abscess was the most common type of otogenic complications and Proteus was the most common microorganism detected. Suppurative ear discharge, headache, high fever and nausea with vomiting were the most common clinical manifestations with very high incidences. All the patients received combined protocols of mastoid surgeries and antibiotics treatment.</p><p><b>RESULTS</b>All the 14 patients recovered clinically. For patients discharged before 1987, there were 4 patients followed up for 22.5 - 24.4 years with a mean time of 23.8 without recurrence, 1 patient died of cardiovascular disease 19.2 years later after discharge, 4 patients lost follow-up. For the 5 patients discharged after 1997, brain abscess recurred in one patient with pseudo-recovery after 24 days and he fully recovered after re-hospitalization and treatment. All the five patients were followed up for 1.5 years to 10.6 years with a mean time of 6.5 years without recurrence.</p><p><b>CONCLUSIONS</b>Youngsters and males seemed to be more vulnerable. Brain abscess was the most common intracranial complication and Proteus was the most common pyogenic microorganism. Combination of mastoid surgery and antibiotics were essential for effectively controlling the intracranial complications and improving the recovery. CT and MRI were essential for correct diagnosis bedtimes and MRI seemed to have a better performance.</p>

Posttraumatic anosmia: olfactory event related potentials and MRI evaluation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Using olfactory event related potentials (OERP) and magnetic resonance to evaluate olfactory function in patients with posttraumatic anosmia.</p><p><b>METHODS</b>Twenty four patients with posttraumatic anosmia were reviewed retrospectively. A thorough medical history, physical examination, nasal endoscopy, T&T olfactory testing, olfactory event-related potentials, brain computed tomography scan and magnetic resonance image of olfactory pathway were performed in all patients.</p><p><b>RESULTS</b>Subjective olfactory testing indicated 20 of 24 patients were birhinal anosmia, 2 with right nostril anosmia and left impairment, 2 with left anosmia and right normal. No OERP were obtained in 24 (20 were birhinal, 4 was monorhinal), except 4 cases with single nostril. Magnetic resonance imaging revealed the injures to the olfactory bulbs (100%), rectus gyrus (91.7%), orbital gyrus (67%), olfactory tracts (8%) and temporal lobes (8%).</p><p><b>CONCLUSIONS</b>OERP can objectively evaluate posttraumatic olfactory function, and magnetic resonance of olfactory pathway can precisely identify the location and extent of injures.</p>

Clinical analysis of primary facial nerve neuroma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical features of facial nerve neuroma about its diagnosis and management.</p><p><b>METHODS</b>Ten patients with facial nerve neuroma were analyzed retrospectively from February 1993 to August 2005. The period of follow-up varied from 1.5 years to 10 years (mean 5 years). Facial nerve function was evaluated with House-Brackmann grading system.</p><p><b>RESULTS</b>The patients complained of facial paralysis in 7 cases, otitis media in 1 case, a mass in parotid gland in 1 case and a mass on the side of the orbital on face in 1 case. Seven patients were undergone either CT scan or MRI or both. Image studies revealed mass located along the facial nerve course from the nerve endings to the intracranial parts. All the patients accepted the surgery. Intraoperative findings showed that the tumor location matched the image findings. Postoperative pathological diagnosis demonstrated 8 Schwannoma, 2 neurofibroma. There was partial tumor resection in 1 patient accepted and his nerve function was unchanged. Four patients were undergone facial nerve graft but 1 case failed while facial nerve function was improved in 3 other patients. Two patients underwent tumor resection while the continuity of facial nerve was preserved as result their facial nerve function improved respectively. No facial nerve reconstruction was done on other 2 patients.</p><p><b>CONCLUSIONS</b>Multiple origins of facial nerve neuroma were noted and the most common system was facial nerve palsy. The decision on how to treat these patients should be individualized and based on initial facial function, growth rate, surgical experience and informed patient consent. The more effective methods need being seeked for the management of facial nerve neuroma.</p>

Clinical research of patients with congenital anosmia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report on a series of patients with congenital anosmia, and to discuss its classification and clinical characteristics.</p><p><b>METHODS</b>Eight patients with congenital anosmia were reviewed retrospectively. Four of eight cases were congenital anosmia with other abnormalities, including three cases with Kallmann's syndrome, one with hypoplasia of nasal cavity and nasal sinus. Four cases were isolated congenital anosmia. A thorough medical and chemosensory history, physical examination, nasal endoscopy, T&T olfactory testing, olfactory event-related potentials and sinonasal computed tomography scan were performed in all patients. Magnetic resonance image of olfactory pathway was available in seven cases, and olfactory biopsies were done in two cases.</p><p><b>RESULTS</b>All patients reported had never been able to smell anything. ENT physical examination and nasal endoscopy were normal, except one case with hypoplasia of nasal cavity. Subjective olfactory test indicated all of them were anosmia. No olfactory event-related potentials to maximum stimulus were obtained. Magnetic resonance imaging revealed the absence of olfactory bulbs and tracts in six cases, hypoplasia of bilateral olfactory bulbs and tracts in one case. Computed tomography scan indicated normal except hypoplasia of nasal cavity and sinus in one case. Three cases with Kallmann syndrome showed poor development of both primary and secondary sexual characteristics and had decreased serum luteinizing hormone, follicle-stimulating hormone, testosterone and estradiol.</p><p><b>CONCLUSIONS</b>Diagnosis of congenital anosmia is established on chief complain, physical examination, nasal endoscopy, olfactory testing and olfactory imaging. Magnetic resonance imaging of olfactory pathway is indispensable.</p>

Upper airway morphologic changes in obstructive sleep apnea hypopnea syndrome patients before and after orthognathic surgery and distraction osteogenesis / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the morphologic changes of upper airway in obstructive sleep apnea and hypopnea syndrome (OSAHS) associated with micrognathism before and after orthognathic surgery and distraction osteogenesis, and subsequently to instruct clinical jobs effectively.</p><p><b>METHODS</b>Nine OSAHS patients associated with micrognathism (8 males, 1 female, mean age: 28.6 years) received orthognathic surgery and (or) distraction osteogenesis, and the curative effect was evaluated according to the subjective feelings and PSG. Upper airway structure before and after the treatment was measured by Somatom Sensation 16 CT scanner.</p><p><b>RESULTS</b>All 9 patients were clinically cured. The transverse length, the cross section area, and especially the sagittal length of the upper airway were obviously increased after the orthognathic surgery. The changes involved mainly in the velopharyngeal region and the laryngopharyngeal region, but not in the laryngopharyngeal region.</p><p><b>CONCLUSIONS</b>The orthognathic surgery and distraction osteogenesis can treat the OSAHS patients with microgonathism effectively by increasing their velopharyngeal and laryngopharyngeal sagittal length of upper airway.</p>

Investigation of the characters of cervical lymph node metastases of primary malignant tumor beyond head and neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the characters of cervical lymph node metastases of primary tumors beyond head and neck.</p><p><b>METHODS</b>Among 466 cases of malignant tumor with cervical lymph node metastases treated in Peking Union Medical College Hospital from January 1989 to June 2004, 77 cases of tumor which sites primarily beyond head and neck were studied. Retrospective analysis of their clinical characters was done by LEVEL system.</p><p><b>RESULTS</b>The primary sites of these 77 cases of malignant tumor consisted of lung, stomach, esophagus, galactophore, colon, mediastinum, ovary, uterus, pancreas, liver, mesentery, adrenal gland and rectum. The frequency of cervical lymph node metastases was 81.8% (63/77) in LEVEL V (50 in the left), 11.7% (9/77) in LEVEL IV, 5.2% (4/77) in LEVEL III, 1.3% (1/77) in LEVEL I separately. The proportion of the metastases of malignant tumor from primary site beyond head and neck in each region was 2.1% in LEVEL I, 3.7% in LEVEL III, 14.3% in LEVEL IV, 70.8% in LEVEL V. Among the cervical lymph node metastases of primary tumor beyond head and neck, 51.9% were low-grade adenocarcinoma, 15.6% were medial-grade adenocarcinoma, 11.7% were low-grade squamous cell carcinoma, 10.4% were medial-grade squamous carcinoma.</p><p><b>CONCLUSIONS</b>The cervical lymph node metastases of malignant tumor might be seen from many organs beyond head and neck. The metastases from primary sites beyond head and neck usually focus on LEVEL V (81.8%), especially in the left. And the primary tumors beyond head and neck metastasis in this region were more than the tumors from head and neck locally. The histological type of the primary tumors were frequently low-medial grade carcinomas.</p>

Management of nasopharyngeal stenosis following uvulopalatopharyngoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Severe nasopharyngeal stenosis (NPS) is a rare complication of uvulopalatopharyngoplasty (UPPP) and very difficult to manage. This report presents our successful treatment experience.</p><p><b>METHODS</b>From Nov 1997 to Feb 2006, 6 adults patients with NPS secondary to UPPP were treated in Peking Union Hospital. Two cases was grade II stenosis, received surgery of local pharyngeal and soft palate mucosa flap rotation to enlarge nasopharyngeal airway with stenosis; For the remaining 4 cases with more severe NPS (grade III) who had received 1-3 times unsuccessful repair procedures previously, prolonged nasopharyngeal hollow obturators were used for 6 months after stenosis repair surgery.</p><p><b>RESULTS</b>With 9-48 months follow-up, All cases results were satisfactory. Nasal obstruction symptom was eliminated, NPS corrected, no velopharyngeal insufficiency complication happened. Daytime removable nasopharyngeal hollow stent obturators with palate support device is more comfortable for patients.</p><p><b>CONCLUSIONS</b>Local flap rotation to enlarge stenosis airway and prolonged use nasopharyngeal hollow obturators are reliable methods of correction NPS following UPPP.</p>

Animal model of facial neuritis induced by herpes simplex virus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the role of herpes simplex virus type 1 ( HSV-1 ) in facial paralysis by developing an experimental animal model of viral facial paralysis.</p><p><b>METHODS</b>Both sides of posterior auricular branch of facial nerve were anatomies and incised in 66 mice. The HSV-1 was inoculated into right ear branch and fetal bovine serum was inoculated into left ear branch as control. The symmetry of mouse face was observed and scored. The temporal bones were serially sectioned and stained with hematoxylin and eosin. The extratemporal facial nerves were stained with osmium tetroxide. HSV-1 DNA in bilateral facial nerve, brain stem, trigeminal ganglion and spinal cord was detected by the polymerase chain reaction.</p><p><b>RESULTS</b>Twenty-eight (42. 42%) mice developed right facial paralysis between 2 and 5 days after inoculation. Continuing 3-6 days, the facial paralysis recovered spontaneously. Thirty-eight mice had no signs of facial paralysis. Compared with the left, nerve swelling, inflammatory cell infiltration were manifested in right temporal facial nerve of paralyzed mice. The ratio of the cross-sectional area of the facial nerve to the facial canal ( FN/FC ) was significantly higher than that on the control side (P < 0.01). Demyelinated nerve fibers were seen in the right extratemporal facial nerve. Not only in paralyzed mice, but also in non-paralyzed mice, HSV DNA was detected in some nerve tissues.</p><p><b>CONCLUSIONS</b>Inoculating HSV-1 into posterior auricular branch of facial nerve can produce an acute and transient facial paralysis in mice. The possible pathophysiologic mechanism of the facial paralysis is viral invasion and transportation from distal branch to main trunk. Then the viral facial neuritis causes facial paralysis.</p>

Diagnosis and treatment of Madelung's disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review the characteristics of Madelung's disease which is rare and unfamiliar to clinicians and to find the method of diagnosis and treatment.</p><p><b>METHODS</b>Detailed clinical data of 7 patients with Madelung's disease were reviewed and analyzed. And related literatures were discussed together.</p><p><b>RESULTS</b>All of 7 patients have excessive subcutaneous fat deposit predominantly around neck. One patients had the complication of central and peripheral neuropathy, One patients had the complication of glucose intolerance, One patients had the complication of chronic hepatopathy and hyperuricaemia. These 3 patients were associated with sleep apnea syndrome simultaneously. Another one patient was accompanied by autonomic nervous system disease only. Total neck lipectomy and abstinence from alcohol were performed on 5 patients. No recurrence was seen during a follow-up of 6 months to 5 years. One patient received partial lipectomy twice and relapsed again. All pathological results were nonencapsulated fat. One patient refused treatment. Six men patients were alcohol abusers.</p><p><b>CONCLUSIONS</b>Madelung's disease is characterized by massive accumulation of nonencapsulated subcutaneous fat mainly located symmetrically in the neck. Chronic alcoholism may be a major risk factor. It may be associated with some internal diseases. Total neck lipectomy to improve figuration and relieve pressure and abstinence from alcohol may be the main effective therapy.</p>

Three cases report of olfactory cleft disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report a new entity-olfactory cleft disease, and summarize the clinical characteristics, computerized tomography presentation, as well as the effect of trial therapy.</p><p><b>METHODS</b>Three patients with chief complaint of anosmia were evaluated by thorough ENT examination, T&T olfactory testing, sinonasal endoscopy; sinonasal computerized tomography imaging, and olfactory event-related potentials. All patients accepted trial therapy including antibiotics and corticosteroid.</p><p><b>RESULTS</b>Complete obstruction of bilateral olfactory cleft with cleft mucosal edema was seen during endoscopy in all 3 patients. Anosmia was determined in all patients by T&T olfactory testing. No olfactory event-related potentials was identified in all patients. CT revealed soft tissue image limited to bilateral olfactory cleft. No olfactory improvement was found in 2 patients after trial medical therapy. One patient had transitory olfactory improvement after corticosteroid treatment.</p><p><b>CONCLUSIONS</b>Olfactory cleft disease is a new entity, with chief complaint of anosmia. Nasal endoscopy and computed tomography scanning provides the most information for the diagnosis. Effect of medical therapy is poor.</p>

Comparison of the low and high frequency tympanometries as diagnostic tests of middle ear function in infants / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of low frequency and high frequency tympanometry in the diagnosis of middle ear function of infants.</p><p><b>METHODS</b>Tympanometries with 226 Hz, 678 Hz and 1000 Hz probe tones were obtained from infants aged 5-25 weeks with normal ABR (15 infants, 30 ears) and those with prolonged Wave I latency suggesting middle ear dysfunction (17 infants, 20 ears) using GSI Tympstar middle ear analyzer.</p><p><b>RESULTS</b>The type, peak pressure, peak compensated static acoustic admittance and gradient of 226 Hz tympanometry were of no significant differences between two groups. The pattern of 678 Hz tympanograms for admittance, susceptance and conductance included non-peaked, single-peaked, W-shaped and three-peaked type in both groups. The consistency between auditory brainstem response (ABR) and 678Hz tympanometry for admittance, susceptance and conductance were 70.0%, 58.0%, 64.0% (kappa = 0. 324,0. 234,0. 118) respectively. A single peaked tympanogram was typical in normal infants for 1000 Hz admittance, susceptance and conductance tympanograms and there were 28 ears (93.3%), 25 ears (83.3%) and 26 (86.7%) respectively. Tympanogram without any positive peak was the most characteristic for a probe frequency of 1000 Hz in infants with prolonged wave I latency and there were 15 ears (75%), 17 ears (85%) and 13 ears (65%) respectively. For admittance, susceptance and conductance, the consistency between 1000 Hz tympanometry and ABR were 90.0%, 92.0% and 86.0% and kappa were 0.783, 0.831 and 0.690, respectively.</p><p><b>CONCLUSIONS</b>1000 Hz probe tone tympanometry was accurate diagnostic tests for middle ear function in infants younger than 25 weeks of age, while 226 Hz and 678 Hz probe tone tympanometries were not.</p>

Apoptosis and apoptosis-related genes in experimental autoimmune inner ear disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the protein and mRNA expression patterns of apoptosis-related genes, together with evidence of apoptosis, in relation to experimental autoimmune inner ear disease (AIED).</p><p><b>METHODS</b>Male C57BL/6 mice at 4 weeks age (n = 80) were randomly assigned to one of the five group (n = 16). The inbred mice were given a single subcutaneous injection of diluted solution of pertussis and an emulsion containing equal parts of complete Freund adjuvant (CFA) and inner ear antigens (IEAg) extracted form guinea pig. The animals were sacrificed for inner ear examination at a defined time after the immunization (7, 14, 21 or 28 days). An autoimmune inner ear diseases model was established. Apoptosis was detected by terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (d-UTP) nick end-laying (TUNEL) method. Using immunohistochemical techniques and reverse transcriptase polymerase chain reaction to clarify the profile of Fas, FasL, and bcl-2.</p><p><b>RESULTS</b>Under normal conditions, no TUNEL-positive cell was observed in the cochlea except for a few positive cells in the supporting cells of Corti's organ and macula sacculi. Inner ear antigens administration induced TUNEL-positive reactions in a wide variety of cells such as inner hair cells, supporting cells, stria vascularis and spiral ligament fibrocytes. No positive staining was evident in outer hair cells, spiral ganglion cells and Scarpa's ganglion cells during the whole period. Fas proteins were expressed in a wide range of cells in inner ear. The levels of Fas mRNA were no significant differences between normal and AIED mice. FasL and bcl-2 proteins could be detected in spiral ganglion cells and Scarpa's ganglion cells both in normal and AIED mice. FasL positive cells increased in number in inner ear of AIED mice. bcl-2 positive cells were not detectable in inner hair cells, stria vascularis and spiral ligament both in normal and AIED mice. The mRNA of three kinds of apoptosis-related genes was detectable in the normal and AIED mice. FasL mRNA was expressed at low levels in normal, being maximal at 14 d post inoculation and decreased gradually to steady levels by 2 weeks. The levels of bcl-2 mRNA increased significantly during the period of AIED.</p><p><b>CONCLUSION</b>Apoptosis mediated by Fas/FasL signal system may play a role in the initiation and maintenance of AIED. bcl-2 has a crucial role in the regulation of the process of apoptosis in the inner ear of AIED mice.</p>