Predictive value of ventilatory steability in determining positive airway pressure efficacy in patients with obstructive sleep apnea / 中国耳鼻咽喉头颈外科

OBJECTIVE We hypothesized that unstable ventilatory control(high loop gain, LG) could predict the short-term efficacy of positive airway pressure therapy in patients with obstructive sleep apnea(OSA). METHODS 42 adult patients with OSA, M/F=39/3, were studied. The stability of the ventilatory control system(LG) was quantified by fitting a simplified mathematical model to the spontaneous ventilatory pattern obtained via polysomnography. LG, pulmonary function test results, and other PSG parameters were analyzed in patients who had post-treatment AHI≥10 events/hr(non-responders) using auto-positive airway pressure therapy. RESULTS The subjects aged(40±8) years, apnea-hypopnea index(AHI) were 68.2[42.9,81.0]events/hr). Nine patients(34.6％) were non-responders. Twenty pat ients(47.6％) had residual AHI＜5 events/hr. Loop gain and pre-treatment mixed apnea index were higher in the non-responders versus responders(0.74 [0.62, 0.82] vs 0.49[0.37, 0.77], P =0.035) and(11.0[4.3, 22.9] vs 2.0[0.2, 5.3], P =0.004). In the 26 patients with LG＞0.6, nine(34.9％) had posttreatment 5 events/hr≤AHI＜10 events/hr. And all of the non-responders had LG(n=9, 34.9％). The difference was signif icant between the LG＞0.6 a nd LG＜0.6 group(P =0.007). CONCLUSION Loop gain and mixed apnea index was higher in patients with residual AHI＞10 events/hr after short-term auto-PAP therapy. Ventilatory control stability evaluation might have predictive value for PAP treatment efficacy in OSA patients.

The impact of arousal on sleep-related deglutition in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the sleep-related deglutition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its correlation with sleep stage and cortical arousals. @*Methods@#From December 2015 to September 2017, simultaneous polysomnography and pharyngeal pressure monitoring were performed in 23 adult patients with OSAHS, Mann-Whitney U test were employed to analyze the following parameters: (1) the relationship between arousal and deglutition; (2) the effect of sleep stage on deglutition; (3) The relationship between the frequency of deglutition and the severity of OSAHS. @*Results@#The subjects in this study aged (43±12) years, and the mean apnea-hypopnea index (AHI) was (49.2±27.7) times/hour. A total of 1 382 deglutition were recorded during sleep, with a median of 9.2[5.8, 13.8]times/person. There was a positive correlation between deglutition frequency and AHI(r=0.570, P=0.005) and negatively correlated with oxygen saturation (r=-0.639, P=0.001). The majority of the deglutition (73.7%) occurred after the respiratory event and in association with respiratory arousal. Deglutition occurred more in Non-rapid eye movement sleep stage 1 (N1) than N2, N3 and REM sleep (Z=-3.680, P<0.001; Z=-2.746, P=0.006; Z=- 3.490, P<0.001). @*Conclusions@#The occurrence of deglutition in patients with OSAHS is associated with cortical arousals. Deglutition frequency increased with the severity of apnea and affected by sleep staging.

The implantation of Bonebridge in bilateral congenital malformation of external and middle ear / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the auditory efficacy of Bonebridge implantation in patients with bilateral congenital malformation of external and middle ear.@*Methods@#Eleven cases (6 males and 5 females) had unilateral Bonebridge implantation. The age ranged from 8 to 26 and the average age was 16.9. Seven to ten days after operation, the first fitting was undergone. In acoustic sound field, the average auditory thresholds were respectively measured for unaided ears and Bonebridge implanted ears by pure tone auditory (PTA, 0.25, 0.5, 1, 2 and 4 kHz). For the group over 12-year-old, MSTM was applied to evaluate speech discrimination score (SDS). For the other cases, MLNT was used as the test material. The auditory efficacy post Bonebridge implantation would be analyzed and evaluated by comparing the differences between unaided ears and Bonebridge implanted ears.@*Results@#The bone conduction audibility threshold after Bonebridge implantation was as well as the preoperative. The auditory threshold with Bonebridge aided was improved to 25-35 dB HL, when compared to that of the unaided ears in the sound field. The SDS in the group over 12-year-old was improved about 50%; the efficacy was slightly limited for the other two cases (both less than 12 years old). Statistical analysis showed that there were significant differences between unaided ears and Bonebridge implanted ears in the sound field and SDS(P<0.05).@*Conclusions@#The auditory efficacy of Bonebridge is significant and noticeable in patients with bilateral congenital malformation of external and middle ear. Bonebridge provides a new and effective way for patient with congenital malformation of external and middle ear to reconstruct hearing.

Value of Epworth sleepiness scale combined with home-based portable monitoring in the diagnosis of obstructive sleep apnea syndrome in adult patients / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the value of Epworth sleepiness scale(ESS) combined with home-based portable monitoring(PM) in the diagnosis of patients with obstructive sleep apnea syndrome(OSAS). METHODS Adult OSAS patients who visited Beijing Tongren Hospital and complained of snoring were included in this study. The overnight polysomnography(PSG) and the ESS were completed at the sleep center and the portable multi-channel monitoring was completed within one week. Subjects were divided into two groups according to their apnea hypopnea index(AHI) of PSG: simple snoring or mild OSAS group(AHI<15/h) and moderate-severe group(AHI≥15/h). The ESS score, respiratory disturbance index(RDI) of PM and other parameters were compared and the correlation of AHI with ESS scores, RDI were analyzed. The sensitivity and specificity of ESS score≥9 points, RDI≥15/h in the diagnosis of moderate-severe OSAS were calculated. RESULTS A total of 51 subjects were included in this study with 42 males(82.4％) and 9 females(17.6％). Mean age was(43.8±10.8) years, and the mean body mass index was(27.9±4.5)kg/m2; ESS scored 1-24 points and mean(8.6±5.0) points, 18 cases with ESS score ≥9 points; AHI ranged between 2.5 and 99.8/h with a mean of(37.4±29.8)/h. There were 19(37.3％) and 32(62.7％) patients in snoring-mild group and moderate-severe group, respectively. There was significant difference for ESS scores between the two groups(9.9±5.1 vs 6.6±4.2 points, P<0.05),RDI in moderate-severe OSAS group was significantly higher than that in snoring-mild group[(49.4±23.1)/h vs (6.8±4.5)/h, P<0.001)]. There was a positive correlation between the ESS score and PSG derived AHI(r =0.435, P =0.002); the PM derived RDI were significantly correlated with PSG derived AHI in snoring-mild group(r =0.706, P=0.001), moderate-severe group(r =0.873, P=0.000) and patients with ESS score ≥9 points(r =0.967, P=0.000). At a PSG threshold AHI=15/h, the sensitivity and specificity for ESS score ≥9 points were 45.2％ and 78.9％; the PM derived RDI≥15/h had a sensitivity and specificity of 84.4％ and 84.2％, respectively; the sensitivity and specificity for each individual screening tool along with the combination of ESS and PM were 100.0％ and 100.0％. CONCLUSION ESS combined with PM diagnostic method is a valuable measure for the diagnosis of moderate and severe OSAS patients.

Cytocompatibility of a novel nasal packing material made of polyethylene glycol diacrylate composite hydrogel / 中国组织工程研究

BACKGROUND: Previous studies have shown that the complex of polyethylene glycol diacrylate and chitosan is biodegradable, has the anti-inflammation effect and can promote wound healing, with good biocompatibility.However, the composite material is brittle, and thus, it is necessary to develop a mechanical support material due to the anatomy of the nasal cavity.OBJECTIVE: To study the cytocompatibility of a novel degradable absorbable nasal packing material made of polyethylene glycol diacrylate composite hydrogel.METHODS: In our experiment, the composite hydrogel was formed by the combination of different ratios of polyethyleneglycol diacrylate, chitosan and polyvinyl alcohol using photo-crosslinking method. According to the international standard of medical devices, we used direct and indirect international standard experimental methods to evaluate the cytotoxicity of the materials. (1) Direct contact method: the polyethylene glycol acrylate composite hydrogel and mouse fibroblasts L929 were co-cultured for 24 hours to observe the morphological changes of cells. (2) Indirect extraction: mouse fibroblasts L929 were cultured in polyethylene glycol diacrylate composite hydrogel extracts (100, 50 μL) and RPMI1640 medium (100 μL), respectively, for 3 days to observe the proliferation and cytotoxicity by cell counting kit-8 assay.RESULTS AND CONCLUSION: (1) Direct contact method: the cells around the material formed a flat structure with fusiform or stellated protrudes. The material was confirmed to have good biocompatibility depending upon the presence of adherent cell growth, full and strong refraction, and the overall growth trend. (2) Indirect extraction method: with the increase of time, the number of cells in the hydrogel extract group increased, the relative proliferation rate of cells increased gradually, and the cytotoxicity was 0 to 1. To conclude, these experimental findings indicate that the polyethylene glycol acrylate composite hydrogel material has good cytocompatibility.

Artificial trachea with pedicle rib cartilage and cilia endothelial wall / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo explore the method on reconstruction of long and special tracheal defects which can mostly match with natural airway: pedicle rib cartilage with cilia endothelial wall.METHODS8 experimental model of rabbits were trained with cervical double belt blood supply fascia embedding and autologous costal cartilage and nasal septum mucos in the first period, then followed by transplantation in the second period. After the operation, we would assess the physiology, breathing and histopathology index of the rabbits, etc. After the animal experiment, we tried to apply the method to an appropriate clinical case.RESULTS8 cases of experimental rabbits dead after the second period operation with the average survival time of 21.9 days and caused by asphyxia. Histopathological results: rib cartilage and trachea ring up of cartilage cells and fibers have high similarity in histology; cartilage of all cases under the cultivation of the pedicle fascial package has not been absorbed; all cases' nasal septum mucosa in the body and blood supply to differentiation under fascia nutrition. Then we applied the method on a clinical case.CONCLUSIONTrachea ring rib cartilage had a higher similarity to the tracheal cartilage on the histology and biological characteristics that can be used as the preparation of artificial trachea shaping material or cell culture to tissue engineering materials. Package of rib cartilage pedicle fascial can provide adequate blood supply to make up for a free training rib cartilage defect to its absorption. Nasal septum mucosa of pressure in the body and blood supply of the fascia nutrition can simulate the trachea ciliated epithelium, which can play its biological characteristics similar to the inner wall of the trachea.

Study on the correlation between the ostia diameter changes and airflow characteristics in maxillary sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship between the maxillary sinus flow field, temperature field and the maxillary sinus ostium size, and to provide a reference for endoscopic surgery according to the maxillary sinus scope.</p><p><b>METHODS</b>One case of adult female CT image data was obtained, and used to build a three-dimensional model of nasal cavity and maxillary sinus. Computational fluid dynamics method was used to study the airflow and temperature of the maxillary sinus, as well as the physiological function of the maxillary sinus. Simulation surgery by means of different maxillary sinus diameters (normal, 8 mm, 10 mm, 12 mm and 15 mm) was used to describe the maxillary sinus airflow and temperature change.</p><p><b>RESULTS</b>It was found that by numerical simulation the airflow of maxillary sinus and nasal cavity showed lower speed (average speed 0.062 m/s) than that in the middle nasal meatus (average speed of 3.260 m/s), and the average temperature in the normal maxillary sinus was 34°C, which was higher than that in the middle nasal meatus (temperature 28.7°C). With the increase of the diameter of the maxillary sinus, the air temperature change was not obvious.</p><p><b>CONCLUSIONS</b>The physiological function of the maxillary sinus can be studied through the numerical simulation. With the increase of the ostia diameter of maxillary sinus, the sinus temperature and ventilation is not affected. It provides a reference for quantification of clinical endoscopic maxillary sinus surgery.</p>

Analyses of clinical features and efficacy of sudden deafness with vertigo and dizziness / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and the effect of drug treatment for sudden hearing loss with vertigo or dizziness.</p><p><b>METHODS</b>In a prospective, randomized, single blinded randomized multicenter clinical study, patients with sudden deafness, ranging in age from 18 to 65 years old, with a duration less than 2 weeks, and with no any medical treatments were collected. In accordance with the hearing curve, those patients were divided into four types, i.e., low and intermediate frequency descent type; high frequency descent type; fall flat type; and total deafness type. Each type was treated by four different treatment options, according to the unified design of the random table, and randomly selected one of the options for treatment. The efficacy of the patients with sudden deafness with vertigo and dizziness was analyzed statistically after the follow-up for 4 weeks. SPSS 13.0 software was used to analyze the data.</p><p><b>RESULTS</b>In August 2007 to October 2011, 33 hospitals in the country included 1 024 patients with sudden deafness in line with the inclusion criteria, of whom 296 (28.91%) were accompanied by vertigo/dizziness symptoms, 126 were males and 170 were females, with an average age of (41.2 ± 13.5) years old. types of the different audiometric curves of sudden deafness, the occurrence of complete deafness with vertigo/dizziness was the highest (44.93%), followed by flat down type (25.87%), high frequency descent type (21.28%) and low intermediate frequency descent type (18.54%). After the standard treatment, the vertigo and dizziness symptoms of the sudden deafness patients could disappear, and the hearing in each group was obviously improved. The hearing curative effect on patients accompanied by vertigo/dizziness of low frequency and intermediate frequency descent type was the best, and the total efficiency can reach up to 94.74%, with the cure rate of 68.42%; followed by flat type, in which the total effective rate was 80.76%, with the recovery rate of 22.12%; and the effects on patients in high frequency descent type and total deafness type effect were relatively poor, in which the total effective rates were 70.00% (recovery rate of 10.00%) and 65.32% (recovery rate of 5.65%), respectively. The total effective rate of patients with sudden deafness associated with halo had no statistical significance (P > 0.05), in comparison to that of patients without halo; but, the cure rate of patients with no vertigo/dizziness of total deafness and the high frequency decreased patients with sudden deafness was significantly higher than that of vertigo/dizziness patients, with a statistical difference (P < 0.05).</p><p><b>CONCLUSIONS</b>The patients with sudden deafness in each type have a certain proportion of vertigo/dizziness, especially the deaf type. The possibility of hearing complete recovery in patients with vertigo/dizziness was significantly lower than that without vertigo/dizziness.</p>

Effects of nasal symptoms on the psychological statuses of adults with moderate-to-severe persistent allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the psychological statuses of Chinese adults with moderate-to-severe persistent allergic rhinitis, and evaluate the effects of nasal symptoms on their psychological statuseses.@*METHOD@#The Symptom Checklist-90 (SCL-90) or self-reporting Inventory was employed to analyze the psychological statuses of 539 adults with moderate-to-severe persistent allergic rhinitis.@*RESULT@#The SCL-90 scores of the adults with moderate-to-severe persistent allergic rhinitis were statistically higher than those of non-allergic adults in terms of somatization, depression, anxiety and hostility. No statistical discrepancies existed in gender or age. The course of disease contributed to somatization and compulsion. The effects of nasal symptoms included two aspects: nasal obstruction had a conspicuous impact on somatization, compulsion, interpersonal sensitivity, depression, anxiety and psychosis, while nasal itching contributed to somatization, depression and anxiety.@*CONCLUSION@#The psychological statuses of adults with moderate-to-severe persistent allergic rhinitis is evidently worse than that of non-allergic adults. Symptoms such as nasal obstruction and itching had an obvious impact on outpatients' psychological statuses.

Characteristics of nasal sinus lfow in patients with chronic sinusitis before and after endoscopic sinus surgery / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo evaluate the curative effect of endoscopic sinus surgery from the viewpoint of biomechanics analysis.METHODSWe select one case undergoing nasal endoscopic surgery for chronic sinusitis patients, after half year follow-up and collect preoperative and postoperative spiral CT data to build a numerical model of nasal cavity and paranasal sinuses with computer numerical simulation (CFD) research methods, to explore nasal airflow distribution and flow field characteristics of value changes before and after the operation. Patients undergo subjective assessments: nasal obstruction of VAS score, olfactory VAS score, SNOT-20, objective assessment: Lund Kennedy score, Lund Mackay score, saccharin test time and acquisition clinical efficacy data to verify the credibility of the analysis method is feasible and the results. RESULTSThe nasal resistance after endoscopic sinus surgery in nasal cavity and paranasal sinuses numerical simulation decreased, middle meatus of nose and nasal air flow velocity decreased, the pressure change slightly;nasal threshold region, middle turbinate head end section in maxillary sinus ostium section, after nearly sieve horizontal cross-section average velocity decreased, nasal airflow for the mucosa of the shear stress reduced. The volume of the nasal cavity and the area of the mucosa was increased, the volume ratio was decreased, the subjective and subjective assessment of the patients was improved, and the objective assessment was lighten.CONCLUSIONAerodynamic rules are presented through the calculation of numerical simulation of fluid mechanics which is invisible before. Better understanding of changes in the nasal airflow distribution and the changes of flow field characteristics can be useful to establish nasal endoscopic surgery in numerical analysis of offshore platform,which provides a new research tool for the understanding of the pathophysiology of chronic sinusitis by endoscopic sinus surgery.

Effects of nasal cavity ventilation expansion techniques on airlfow patterns of the upper airway / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo compare the aerodynamic differences before and after nasal cavity ventilation expansion techniques in patients with OSAHS. METHODSA total of 30 adult patients with OSAHS were included in this study. Pre-operative upper airway CT of each subject was acquired. Each subject underwent surgery. Postoperative upper airway CT was obtained at least 3 months later. By means of CFD simulation method, numerical simulation was performed to calculate the airflow dynamic indexes of the upper airway. The pre-and post-operative aerodynamic characteristics were compared. RESULTSAfter operation, post-operative negative pressure nephogram of the nasal cavity indicated more smooth variation of pressure gradient, post-operative velocity nephogram of nasal cavity indicated slower airflow velocity. Proper values of flow field indicated the volume of nasal cavity increased significantly (t=4.025,P<0.01), the total nasal airway resistance decreased significantly (t=-2.065,P<0.01). The total negative pressure of the upper airway decreased significantly (t=-2.659,P<0.01) after operation. However, the proper values of flow field increased in 5 patients. CONCLUSIONNasal cavity ventilation expansion effectively increase the volumes of nasal cavity, improve the nasal ventilation, and reduce the air flow velocity of both nasal cavity and pharynx in OSAHS patients, those reduce the pharyngeal negative pressure and the pharyngeal collapse. However, for patients with its narrowest segment at the velopharyngeal level, operation cannot do anything or even aggravate the pharyngeal collapse. Operation should be performed individually.

Pharyngeal aerodynamics characteristics in obstructive sleep apnea hypopnea syndrome patients / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo compare the differences of aerodynamic characteristics of pharyngeal cavity between normal subjects and OSAHS patients, and to study the nasal obstruction in the pathogenesis of the OSAHS.METHODSA total of 60 normal subjects and 60 OSAHS patients were enrolled in this study. Numerical simulation was performed to calculate the airflow dynamic indexes of three sections of pharyngeal cavity. Correlation analysis of the nasal resistance and negative pressure were studied.RESULTSThe average pharyngeal negative pressure and airflow velocity in OSAHS patients were significantly increased than that in normal subjects. The total nasal airway resistance significantly correlated with the average negative pressure of pharyngeal cavity. CONCLUSIONAirflow dynamic indexes of OSAHS patients had significant different pharyngeal aerodynamic characteristics from normal subjects. The increased average negative pressure in pharynx might contribute to the severity of pharyngeal collapse for OSAHS patients. Higher total nasal resistance might play a role in the pathophysiological mechanisms of OSAHS.

Feasibility and value of quantitative dynamic contrast enhancement MR imaging in the evaluation of sinonasal tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Quantitative dynamic contrast enhancement MR imaging (DCE-MRI), used to measure properties of tissue microvasculature and tumor angiogenesis, is a promising method for distinguishing benign and malignant tumors and characterizing tumor response to antiangiogenic treatment. The aim of this study was to assess the feasibility of quantitative parameters derived from clinically used DCE-MRI for distinguishing benign from malignant tumors in the sinonasal area, which may be potentially useful for prediction and monitoring of treatment response to chemoradiotherapy of sinonasal tumors.</p><p><b>METHODS</b>One hundred and forty-three patients with sinonasal tumors, including 78 malignant tumors and 65 benign tumors and tumor-like lesions, underwent clinically used DCE-MRI. Parametric maps were obtained for quantitative parameters including K(trans), kep and ve. Two radiologists reviewed these maps and measured K(trans), kep and ve in the tumor tissue. Data were analyzed using independent T-test or Mann-Whitney U test analysis and receiver operating characteristic curves.</p><p><b>RESULTS</b>K(trans), kep and ve showed significant differences between benign and malignant tumors in the sinonasal area (P = 0.000 1). The accuracy of K(trans), kep and ve in differentiation between benign and malignant sinonasal tumors were 72.0%, 76.2% and 67.1%, respectively. There were significant differences in kep and ve between malignant epithelial sinonasal tumors and lymphomas (P < 0.05). Using a ve value of 0.213 as the threshold value differentiated malignant epithelial tumors from lymphomas with an accuracy of 78.3%, sensitivity of 88.2%, specificity of 68.0%, positive predictive value of 66.7%, and negative predictive value of 90.9%. However, no significant difference in K(trans) and kep was found between malignant epithelial and non-epithelial tumors in the sinonasal area (P > 0.05).</p><p><b>CONCLUSIONS</b>It is feasible that quantitative parameters of tumors can be derived from clinically used DCE-MRI in the sinonasal region. Preliminary findings suggest an increased value for quantitative DCE-MRI in the evaluation of sinonasal tumors in clinical practice.</p>

Minimal incision access for pediatric and adult cochlear implantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cochlear implant surgery is widely practiced. Minimal incision cochlear implant surgery has been developed with the aims of reducing the impact of surgery on the patient and improving cosmesis while maintaining the low morbidity of conventional wider access approaches. This study aimed to assess the surgical technique and complication rate of minimal incision cochlear implantation (MICI) for children and adults.</p><p><b>METHODS</b>Data for this study were obtained via a retrospective analysis. Totally 378 patients were included in the study. All patients received minimal incision cochlear implantation, using the skin protector during the process of the operation. The surgical complications of MICI were recorded in a spreadsheet format. The incidence of major and minor complication were analyzed, and appropriate treatment was provided.</p><p><b>RESULTS</b>A total of 40 (10.5%) complications were noted in the study. There were 0 life-threatening, 9 major, and 31 minor complications. Of the nine major complications, five were device failures, one developed infection and extrusion, and three required receiver-stimulator repositioning.</p><p><b>CONCLUSIONS</b>MICI is as safe as standard cochlear implantation (SCI) and affords with it other benefits. Eliminating the scalp flap avoids devascularization and minimizes the opportunity of flap infection or necrosis. Complications not related to the flap are similar to SCI.</p>

Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anterior glottic web is one type of laryngeal stenosis. Previous surgical methods had some drawbacks, such as large surgical trauma, long postoperative recovery time, and multiple-stage surgery. This study aimed to explore better treatment to repair anterior glottis web.</p><p><b>METHODS</b>We performed vocal cord mucosal flap procedure on 32 patients with anterior laryngeal webs. All subjects received vocal cord scar releasing and vocal cord mucosal flap repair and suture under general anesthesia with selfretaining laryngoscope.</p><p><b>RESULTS</b>All 32 patients completed surgery in one stage, without postoperative laryngeal edema, difficulty in breathing, or other complications. After the surgery, the anterior commissure of vocal cords recovered to a decent triangle shape in 28 patients; however, in four patients there were 2 to 3 mm adhesion residuals on the anterior ends of the vocal cords, accompanied by scar appearance of bilateral vocal cords. The GRB score, voice handicap index scores, and maximum phonation time score significantly improved in all patients after the surgery. There was no evidence of recurrent laryngeal webbing in the 6-month follow-up.</p><p><b>CONCLUSION</b>Vocal cords mucosal flap repair surgery has the advantages of less trauma, quick recovery, and significant improvement of the voice in the treatment of laryngeal webs.</p>

Development of Mandarin tonal identification in noise test materials / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The aim of this study was to develop comprehensive test material for Mandarin tone identification in noise (M-TINT) based on the linguistic characteristics in Chinese.</p><p><b>METHODS</b>In keeping with both the reliability and efficiency in clinical practice, a primary list consisted of 320 words(80 syllables in four tones each) was designed according to the following principles: shortness of the lists, word familiarity and with a meaning in all four tones. The digital sound file was recorded by a male speaker and a female speaker (both of them are radio broadcaster).</p><p><b>RESULTS</b>The tonal identification material database, which included 288 items (72 loudness-balanced syllables in all 4 Mandarin tones) was established by digital filler and balanced for equal loudness. The complete material was recorded in two CDs in a male version and a female version. The speaker-specific masking noises were generated by filtering Gaussian white noise to the speaker's long-term average speech spectrum (LTASS) and by scaling the masking noises to the same RMS amplitudes, as those of the speech, in order to acquire the effective sound masking. The speaker-specific masking noises could be able or disable during the word presentation. The sound pressure level could be selected concerning on the test setting.</p><p><b>CONCLUSIONS</b>The mandarin tonal identification materials were designed by both the tonal acoustic properties and the psychophysics characteristic of adults. It is an useful speech test in clinical work and research, and can potentially be used as the basic list for other tonal language identification test in the future.</p>

Study on influential factors of clinical research projects of the hospital / 中华医院管理杂志

Objective To identify major factors which affect the completion quality of projects and build predictive models,and to propose strategies and suggestions for total process quality management of clinical research projects of the hospital.Methods Collect relevant literatures from home and abroad;consult completion reports of various research projects completed from 2003 to 2010 and sum up problems found in such projects.Carry out in-depth interviews with principal investigators,supervisors of scientific research of the hospital as well as administrators of sponsor institutions.A questionnaire survey was made on completed clinical research projects undertaken from 2003 to 2010.Results Six key factors affecting implementation of such projects were derived from factor analysis,which are research technology and external environment,project teamwork,research subject availability,project organization,manpower input,and research design.A multiple logistic regression analysis found project internal management and manpower input as two leading predictive factors for project completion outcomes,while the former has a greater impact than the latter.Conclusion Project management should focus on the 6 key factors affecting project quality.The two main predictive factors should attract greater attention and resources in both supervision and management.

H1-antihistamines / 临床耳鼻咽喉头颈外科杂志

While histamine plays an important role in the pathogenesis of allergic diseases, such as allergic rhinitis, H1-antihistamines, which have been using in the treatment of allergic diseases for more than 70 years, are considered as the cornerstone of the medication of allergic diseases. In this review, we discuss the history of histamine studies and anti-histamine discovery, the histamine receptors, as well as the mechanisms and the safety of H1-antihistamines.

Cochlear implant performance evaluation with cortical auditory evoked potential in a group of post-lingually deaf adults / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the law of auditory remodeling by studying the Cortical Auditory Evoked Potential in a group of post-lingually deaf adults in the early stage of the cochlear implant use.@*METHOD@#Ten post-lingually deaf adults implanted with PULSAR ci 100 of Medel device ranged from 19 to 52 years old with duration of deafness from 3 months to 23 years.were involved. Their P1-N1-P2 responses to /ba/ at around 60-70 dB SPi and open-set speech recognition scores of mono-syllabic words were recorded at 1. 3 and 6 months after the switch-on of cochlear implants.@*RESULT@#Six out of 10 typical waveforms of Pl-N1-P2 were obtained. The other I were with atypical waveforms. The group with atypical waveform was characterized by long duration and early onset of deafness. There was no significant difference regarding either the amplitude or the latency of each peak at the 3 data collection time points. There was significant difference among the 3 data collection time points about the speech recognition scores with the highest score at the 6th month of switch on. There was no significant correlation between the peak of the CAEP and speech recognition score.@*CONCLUSION@#In the first 6 months of cochlear implant use in the post-lingually deaf adults, the duration and the onset age of deafness played important role in respect of the presence and waveform morphology of the CAEPs. It needs at least 6 months for the central auditory system to make use of the audio input from the cochlear implant.

The application of vibrant sound bridge in microtia whose reconstructive external auditory canal occurred atresia / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of vibrant sound bridge implantation in microtia whose reconstructive external auditory canal occurred atresia.@*METHOD@#Three cases (2 males and 1 female) of microtia had underwent hearing reconstruction operation (Include the external ear canal reconstructive surgery and tympanoplasty). The age ranged from 15 to 18 years and the average age was 17 years. All the 3 cases suffered from conductive hearing loss with the air-bone gap ranging from 51.6 to 65.0 dB HL and the average value being 56. 3 dB HL. All the 3 cases underwent vibrant sound bridge implantation, including the floating mass transducer implanted in the head of stapes in 2 cases and in the niche of round window in 1 case.@*RESULT@#The postoperative hearing level improved from 21.6 to 52.5 dB HL with an average of 32.2 dB HL. There were no complications such as vertigo, tinnitus and facial paralysis.@*CONCLUSION@#Through vibrant sound bridge implantation, the hearing level of microtia whose reconstructive external auditory canal occurred atresia was improved effectively.