Application of objective structured clinical examination on phase examinations for otolaryngology residents / 中华医学教育探索杂志

Objective structured clinical examination (OSCE) is an important assessment method for examining clinical thinking and clinical skills of medical students. OSCE has been applied in the quarterly phase examination in our department. According to the characteristics of otolaryngology, three stations of common items and five stations for personalized tests were set in the assessment. According to the different training that residents received during their stay in the previous department, different contents were assessed in the station for personalized examination. During the OSCE, residents took turns entering into each examine station and teachers gave scores according to the marking criteria of different station. After the examinations, two-way assessment and feedback were conducted between students and teachers. Through the practice in standardized training of residents in recent years, we found that OSCE was more comprehensive and flexible than others, which gained good application effects.

Advances in the development of otologic surgery robots / 中华耳鼻咽喉头颈外科杂志

In recent decades, surgical robots have made great progress and are widely used in many clinical departments.It can eliminate the doctor′s hands tremor, reducing postoperative complications and shortening the operation time due to the many advantages of robot such as stability, high precision and intelligence. Based on the huge economic benefits and good performance, the surgical robots have become a hot spot in the field of medicine and industry. Although no otologic robot has been approved for clinical use, many breakthroughs have been raised. This article reviewed the development of otologic robots in the past years and provided some ideas for future research.

Application of objective structured clinical examination on phase examinations for otolaryngology residents / 中华医学教育探索杂志

Objective structured clinical examination (OSCE) is an important assessment method for examining clinical thinking and clinical skills of medical students. OSCE has been applied in the quarterly phase examination in our department. According to the characteristics of otolaryngology, three stations of common items and five stations for personalized tests were set in the assessment. According to the different training that residents received during their stay in the previous department , different contents were assessed in the station for personalized examination. During the OSCE, residents took turns entering into each examine station and teachers gave scores according to the marking criteria of different station. After the examinations, two-way assessment and feedback were conducted between students and teachers. Through the practice in standardized training of residents in recent years, we found that OSCE was more comprehensive and flexible than others, which gained good application effects.

Effects of salicylate on dopamine levels in rat nucleus accumbens / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate dopamine level changes in the Nucleus Accumbens (NAc) of the limbic system by salicylate and the role of dopamine in the mechanisms of tinnitus.METHODS We recorded the change of dopamine before and after sodium salicylate injection in rats by microdialysis combined with electrochemical methodologies in the nucleus accumbens (NAc).RESULTS Salicylate produced significant increase in dopamine level in the NAc, to a maximum of (321±97)% of baseline and then remain stable. In contrast, saline only produced slight increase.CONCLUSION The increase of dopamine in the NAc may be related to the generation of tinnitus. The data in vivo provide direct evidence of the important role that the dopaminergic system plays in the generation of tinnitus.

The pilot study of type Ⅰ allergic reaction in Meniere′s disease patients / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the correlation between type Ⅰ allergic reaction and pathogenesis of Meniere′s disease.@*Methods@#A total of 35 (10 male vs. 25 female) patients aged between 21-66 years diagnosed with Meniere′s disease were recruited to this study, mean age of them was (47.3±13.6) years. The control group consisted of 15 inpatients (5 male vs. 10 female) with pharyngolaryngeal diseases but without otologic and rhinologic abnormity, mean age was 45.4±12.8 years. Allergic prevalence, serous total immunoglobulin E( tIgE ) levels, serous specific immunoglobulin E( sIgE ) levels and subtypes of T lymphocytes were measured and compared in patients with Meniere′s disease and the control group. Severity of vertigo, tinnitus and sensation of fullness were compared between Meniere′s disease patients with or without allergy.@*Results@#Allergic prevalence were significantly different (Pearson chi-square 5.832, P<0.05) between patients with Meniere′s disease and the control group(57.1% vs. 20.0%). Patients with Meniere′s disease report higher level of serous tIgE compared with controls, the difference is statistically significant (Z=168.000, P<0.05). However, positive rates of sIgE of food allergens and inhalant allergens were not significantly different between patients with Meniere′s disease and the control group. Scores of vertiginous severity, dizziness handicap inventory (DHI) and tinnitus handicap inventory (THI) were significantly different between Meniere′s disease patients with or without allergy (P<0.05). Treg and Treg/Th17 levels (Z=26.000) were much higher in Meniere′s disease patients with allergy than in the controls(P<0.05).@*Conclusions@#Patients with Meniere′s disease report higher rate of allergy than the control group. Type Ⅰ allergic reaction is thought to be one of the possible reasons that may induce endolymphatic hydrops and lead to Meniere′s disease.

Progress of Surgical Treatment for Vocal Cord Movement Disorders / 中国微创外科杂志

[Summary] Vocal cord movement disorders may lead to hoarseness,dysphonia or even dyspnea.They reduce the quality of speech,destroy social communications,or even are life-threatening.For patients with vocal cord movement disorders which are not sensitive to the treatment of phonation training or medication,surgical procedures can improve the quality of phonation.At present, with operation methods for vocal fold movement disorders developing rapidly,types of the operations are exploring,while at the same time the situations of confusion or repetition of operation methods and terminologies increase.On this condition,we summarized different types of surgeries for vocal cord movement disorders by reviewing relevant literatures.

Clinical profile analysis of laryngeal nonsquamous cell malignancies / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe clinical characteristics of 15 cases of laryngeal nonsquamous malignancies.@*METHOD@#The clinical data of 15 patients with laryngeal nonsquamous malignancies were collected. Details about pathology, CT, treatment and follow-up results were carefully taken into account.@*RESULT@#There were more male patients than females while the sex ratio was 4:1. Supraglottic malignancies accounting for 53.33% seemed to be the most common type. In all the 15 patients, 1 patient gave up other treatment except tracheotomy to relieve laryngeal obstruction. Three patients took radiotherapy and chemotherapy. The rest patients underwent surgical procedure after strict endoscopic, radiologic staging. Radiotherapy and (or) chemotherapy were chosen after operation. The follow-up results show that 1 year survival rate was 79.4% and the 3 year survival rate was 57.8%, 5 year survival rate was 27.5% which was not optimistic.@*CONCLUSION@#Being a kind of rare type laryngeal nonsquamous malignancies have difference clinical characteristics with laryngeal squamous cell carcinoma. Laryngeal nonsquamous cell carcinoma have much lower 5 year survival rate and are easier to suffer recurrence and metastasis compared with laryngeal squamous cell carcinoma.

Advances in minimally invasive cochlear implantation / 临床耳鼻咽喉头颈外科杂志

Cochlear implantation has gradually been accepted as an effective treatment for many patients with severe to pround sensorineural hearing loss. The traditional cochlear implantation does not exist up to expectations in some respects. With the soft surgery technique brought forward, the idea of minimally invasive cochlear implantation is deely rooted among the people. Now many institutions are carring out a series of clinical researches and practices to improve the results of cochlear implantation surgery and reduce the complications around the world. It includes minimally invasive approach, cochleostomy and electrode insertion techniques, especially the latter two affect the preservation of residual hearing. This article is a review of the advances in minimally invasive cochlear implantation from the above three aspects.

Clinical analysis of tympanosclerosis: characteristics and treatment / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical characteristics, diagnosis and surgical management of tympanosclerosis.@*METHOD@#The data of 73 patients who underwent surgery for tympanosclerosis were retrospectively analyzed with respects to the clinical characteristics, diagnosis and management.@*RESULT@#Seventy-three patients with tympanosclerosis (involving 73 ears) , including 17 patients with sclerosis of tympanic membrane (type I), 23 patients with fixed Malleus-incus complex (type II), 8 (type III) with fixed stapes, and 25 (type IV) with extensive typannosclerosis. Sclerosis was seen most frequently in the malleus, incus and attic, followed by the tympanic membrane, incudomalleolar joint and other regions. Audiometry was performed for all the patients 1 weeks before and 1 year( the least) after operation, which were (51.70 ± 14.93)dB HL and (36.24 ± 11.58) dB HL respectively, with success rate 83% (61/73).@*CONCLUSION@#Most of the patients suffer from conductive hearing loss. Teatment of the sclerosis around stapes is a key point. Acording to the sites of lesion and hearing level, hearing structures should be reconstructed by the rules of tympanoplasty and stapes surgery.

39 cases of malignant tumors originated from external and middle ear / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To describe our experience in the clinical manifestation and treatment of malignant tumors of the external and middle ear.@*METHOD@#The study reviewed 39 patients between 1994-2011 in our hospital, including 15 pinna tumors, 18 external canal tumors and 6 middle ear tumors. 23 males and 16 females were enrolled in this study. The mean age of patients at the time of surgery was 59. Radiotherapy or radiotherapy and chemotherapy were the only possible treatment in 6 cases. Thirty-three patients were treated surgically, and 9 patients also received radiotherapy after surgery.@*RESULT@#All of the patients had been followed up over 3 years, except for 1 case of external canal and 1 case of middle ear tumor. The 3-year survival of pinna, external canal and middle ear tumors were 86.7%, 82.4% and 60.0% respectively. At the last follow up, the pinna tumors showed that the survival rate was 100% in T1, T2 and Tx stage, and 0% in T4 stage; the external canal tumors showed that the survival rate was 90% in T1 stage, and 66.7% in T2, T3 stage; the middle ear tumors showed that the survival rate was 100% in T1 and T2 stage, 0% in T3 stage.@*CONCLUSION@#The T staging system is for an important prognostic factor, and it is important for an early diagnosis and radical surgery to achieve a better therapeutical result.

Voice characteristics and changes before and after treatment of laryngopharyngeal reflux patients diagnosed by two diagnostic methods / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo diagnose laryngopharyngeal reflux (LPR) by using two methods: 24h pH monitoring and RSI combined with RFS scales. To research the voice characteristics of patients with LPR and changes of voice parameters before and after PPIs therapy, and to use voice parameters to help diagnosing and evaluating treatment effect of LPR.METHODSThe patients visited department of Otolaryngology head & neck surgery of Peking University Third Hospital from August 2012 to August 2013 were included in this study. There were 26 LPR patients diagnosed by 24 hr pH-MII monitoring (pH group) and 26 LPR patients diagnosed by RSI combined with RFS (questionnaire group). Another 52 subjects without laryngeal or pharyngeal symptoms were as control group. All subjects underwent MDVP examination. The patients from pH group and questionnaire group took esomeprazole 20 mg bid for one month, afterwards MDVP was examined again. The voice related parameters were compared before and after medication therapy.RESULTSComparing data between LPR patients and normal subjects, Jitter, Shimmer, NHR had significant difference (P0.05) before treatment. After PPIs therapy there was no significant difference between each group (P>0.05).CONCLUSIONAbnormal voice parameters were existed in LPR patients. After PPIs treatment, voice related parameters improved apparently.

Translation and Application of Tinnitus Handicap Questionnaire / 听力学及言语疾病杂志

Objective To evaluate Chinese tinnitus handicap questionnaire (T HQ ) reliability and validity through clinical use and analysis .Methods A total of 230 tinnitus patients who were seen at our ENT clinic with tinnitus lasting longer than 3 months were administered with the THQ ,THI ,tinnitus questionnaire ,pure tone au‐diogram and tinnitus matching .Assessed THQ’s reliability and validity ,the relationship between THQ and its re‐lated factors .Results In the 206 tinnitus patients ,the Cronbach’sαwas 0 .93 ,split -half reliability was 0 .91 ,test-retest reliability was 0 .96 .In the 171 tinnitus patients ,the THI correlation coefficient was 0 .745 .The THQ scores were highly correlated with the hearing loss level of the worse ear .The age ,sex ,side ,complications ,dura‐tion and tinnitus matching were not correlated with THQ scores .Conclusion THQ Chinese version has good relia‐bility and validity .It is worthy of clinical application .

Development and Application of Canal Wall up Mastoid-tympanoplasty / 中国微创外科杂志

[Summary] Chronic suppurative otitis media affects patients ’ quality of life, and is life-threatening in patients with cholesteatoma which causes intracranial or extracranial complications .The purpose of surgery is to clear up all the lesions and to reconstruct hearing function .Tympanoplasty is the main surgical method , which includes basically canal wall down ( CWD) and canal wall up (CWU) styles.CWD provides lager surgical field but impairs normal auditory canal structure ; CWU preserves the posterior wall of external auditory canal and provides better quality of life although it has higher possibility of recurrence of cholesteatoma .We reviewed the surgical methods , surgical effects , recurrence rates , and surgical indications of canal wall up mastoid-tympanoplasty , hoping to provide meaningful reference for clinical application .

Evaluation of the diagnostic accuracy of modified Berlin questionnaire on predicting obstructive sleep apnea-hypopnea syndrome in adults / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the diagnostic value of modified Berlin questionnaire on predicting obstructive sleep apnea-hypopnea syndrome (OSAHS)in Chinese adults.@*METHOD@#Differ from the original version, BMI cut-off point was adjusted to 25.0 in modified Berlin questionnaire according to the Asia -Pacific obesity definition. A total number of 244 samples who experienced polysomnography (PSG) were included. After well informed, each patient finished questionnaire by an interview. The results of the original and modified questionnaires and polysomnography reports were compared with polysomnography reports to evaluate the diagnostic accuracy of the modified Berlin questionnaire.@*RESULT@#In male population, the sensitivity and specificity of original Berlin questionnaire were 74.03% and 65.71%, respectively. The percentage of diagnostic consistency was 72.49%, and Kappa coefficient was 0.304 (P 0.01). When comes to the modified Berlin questionnaire, the sensitivity and specificity were 76.47% and 47.62% in female subjects, and the percentage of consistency agreement was 65.45%, with a Kappa coefficient 0.248 (P > 0.01).@*CONCLUSION@#Compared to the original version, the modified Berlin questionnaire has a better diagnostic consistency with a considerable sensitivity and specificity in male population. However, in female subjects group, the consistency of the modified Berlin questionnaire was still not significant remains unsatisfactory, although P value has been improved. Modified Berlin questionnaire could be. used as a primary screening tool for male OSAHS patients. However, but the screening questionnaire for female should still be need to be further explored.

Diagnosis and treatment of nonsquamous cell neoplasms located in subglottis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study clinical characteristics, diagnosis, pathological types and therapy methods of nonsquamous cell neoplasm in subglottis, in order to improve comprehension of this rare disease.@*METHOD@#To analysis 3 patients' clinical data with noosquamous cell neoplasm in subglottis by reviewing related literature, and to generalize the symptoms, differentiation and treatment experience of nonsquamous cell neoplasm in subglottis.@*RESULT@#Among the 3 patients, one's main complain was hoarseness and the other two's main symptom was inspiratory dyspnea. As diagnosis was definite and acute obstruction of airway was relieved, the neoplasms were removed totally. Two patients were undergone operation through oral cavity by using suspended laryngoscope, and one patient was done surgery by neck approach. Paraffin wax result showed that one patient suffered epithelial-myoepithelial carcinoma, who received radiotherapy after surgery. There is no recurrence in all patients by following up more than 1 year.@*CONCLUSION@#The occurrence of nonsquamous cell neoplasm in subglottis is relatively low, and the subglottis should be inspected carefully to avoid missed diagnosis. Operation is the preferred method to treat this kind of disease. To choose a suitable operational manner according to size, location of the neoplasm is crucial.

CT analysis of classification of external nasal fracture and the influence of fractured position to nasal septum / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the classification and distribution of external nasal fracture, and its influence to the nasal septum.@*METHOD@#We randomly chose 60 patients who received nasal CT scan because of nasal trauma and diagnosed as external nasal fracture. We reviewed their CT data in PACS system with computer.@*RESULT@#Of the 60 cases of nasal trauma, 90 sides got external nasal fracture, among which 58 sides (64.4%) had only nasal bone fracture, 16 sides (17.8%) had only maxillary frontal process fracture, and 16 sides (17.8%) had both. Half of these 60 patients got unilateral external nasal fracture, among whom 14 patients (46.7%) had traumatic nasal septum deviation meanwhile. The other 30 patients suffered from bilateral external nasal fracture, among whom 26 patients (86.7%) had traumatic nasal septum deviation. The difference between these two groups was statistically significant (P < 0.01). Moreover, 24 patients got fracture of either nasal bone or maxillary frontal process, 11 of whom (45.8%) got traumatic nasal septum deviation at the same time. The other 36 patients suffered fracture of both these two bones, 29 of whom (80.6%) had traumatic nasal septum deviation. The difference between these two groups was statistically significant (P < 0.01). We classified the nasal bone fracture as below: 16 patients with only unilateral external nasal fracture belonged to Type I, of whom 15 patients (25.0%) were type Ia with nasal bone or maxillary frontal process fracture and 1 patient (1.7%) fell into type Ib with fracture occurred on both of these two bones at the same side. Four patients suffered bilateral external nasal fracture belonged to type II, among whom 2 patients (3.3%) belonged to type IIa with nasal bone or maxillary frontal process fracture and 2 patients fell into type IIb with fracture of both of these two bones at different sides. The other 40 patients (66.7%) belonged to Tpye III, who suffered external nasal fracture accompanied with traumatic nasal septum deviation.@*CONCLUSION@#Traumatic nasal septum deviation was extremely concomitant in patients with external nasal fracture. It will be better to perform external nasal reconstructive surgery and plasty of nasal septum deviation by using the endoscope within 1 month for the patients whose symptom were serious or who cared a lot about the appearance.

A Preliminary Study of Laryngeal Electromyography for Evaluating Swallowing Function of Patients with Amyotrophic Lateral Sclerosis / 听力学及言语疾病杂志

Objective To investigate the clinical values of laryngeal electromyography (LEMG) for evaluating the amyotrophic lateral sclerosis(ALS) patients with swallowing disorder .Methods A total of 25 ALS patients with or without complaining of swallowing disorder were recruited for the study .Their right cricothyroid muscles were taken unilaterally with concentric needle electrodes by anterior cervical approach .Each patient was tested with Kub-ota drinking test too .Results Of all the 25 patients ,11 were found abnormal in the right cricothyroid muscle which presented with typical degeneration patterns ,15 cases were found abnormal by Kubota drinking test .The coinci-dence rate of the two methods was 60% ,the poisitive coincidence rate was 32% .The McNemar test showed there was some consistency between the drinking water test and LEMG (P=0 .344) ,and the Kappa coefficient was 0 .219 . Conclusion The cricothyroid muscle electromyography may also be a potential method to evaluate ALS patients since it seemed to offer an evidence of dysphagia related with abnormal sensory function of laryngeal mucosa .But there may be some limitations .

Single stage and staged cochlear implant for chronic suppurative otitis media suffers / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore and summarize the operation method and operation stage for cochlear implant with chronic suppurative otitis media, to provide the clinical reference for cochlear implant with chronic suppurative otitis media.@*METHOD@#The clinical data of 6 cases of cochlear implant with chronic suppurative otitis media from Jun 2006 to Mar 2009 in our hospital was analyzed retrospectively. The operation stage. surgical skill, possible risk and prognosis was analyzed and summarized.@*RESULT@#3 of 6 cases received single stage subtotal petrosectomy and cochlear implant. 3 of 6 cases received subtotal petrosectomy, they received staged cochlear implant 1 to 6 months later. No complications occurred, all of the cochlear implanted had good open set speech perception.@*CONCLUSION@#Staged operation was the first choice for cochlear implant with chronic suppurative otitis media. Single stage operation took potential risks, it should be done cautiously. The key points for the operation was the clearance of the pathological tissue totally, this required good surgical skill and operation instrument.

Current situation and development in treatment of laryngopharyngeal reflux / 临床耳鼻咽喉头颈外科杂志

The mainstay of treatment of laryngopharyngeal reflux focuses on a concoction involving proton-pump inhibitor and modified beneficial behaviors, sometimes referring to medications like H2-R blocker etc. Therapeutic effect seems to be promising although may at times be challenged by conflict researches. Voice therapy and voice parameters emerge to provide a grand new perspective in treatment and evaluation of this disease.

Electrophysiological characteristics of EABR and its value assessment of cochlear implant / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the electrophysiological characteristics of electrically evoked auditory brainstem responses (EABR) and its application in cochlear implantation, especially in evaluating acoustic nerve survival.@*METHOD@#An auditory evoked potential instrument was used to record responses and Cochlear Nucleus 24CA implants were used to generate electrical stimulation. We measured EABR in 23 patients with cochlear implants and compared EABR with behavioral measures and neural response telemetry (NRT).@*RESULT@#EABR III-V waveforms were recognized in all of the 23 patients. The characteristics and origins of EABR waveforms were similar to those of ABR. The average EABR threshold was (172.61 +/- 14.61) CL. At 20 CL above threshold, the average latencies of Wave III, V were (2.93 +/- 0.18)ms, (4.80 +/- 0.28)ms which were 1-2 ms shorter than ABR latencies. But III-V intervals remained at (1.86 +/- 0.18)ms. EABR thresholds were strongly correlated with behavioral performance and NRT thresholds, while EABR input-output function is correlated with behavioral dynamic range (DR).@*CONCLUSION@#EABR is such an effective method to objectively evaluate the function of auditory pathway which can estimate residual spiral ganglion cell count. This is consistent with the foreign study leading to the conclusion that DR reflects spiral ganglion cell survival.