Recurrent low frequency sensorineural deafness / 临床耳鼻咽喉头颈外科杂志

Low frequency sensorineural deafness is a common subtype of idiopathic sudden deafness. Certain patients suffered recurrent attacks without vertigo, much alike Meniere's disease. Few of them developed into definite Meniere's disease during long-term follow-up in many clinical studies. Although the pathophysiology of recurrent low frequency deafness is yet unknown, the desease is considered associated with early state of endolymphatic hydrops or migraine. Otologists shall be aware of its clinical course and careful explanation is necessary at time of initial informed consent.

Multi-center study on the treatment of sudden total deafness / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the results of drug therapy in patients with severe idiopathic sudden sensorineural hearing loss (ISSHL) with total frequency hearing loss.</p><p><b>METHODS</b>A prospective randomized, single blind, multi-center clinical trial was designed. The untreated patients with ISSHL were included, who had severe hearing loss (pure tone audiometry showed patients had total frequency hearing loss, and their mean auditory threshold of 500, 1000, 2000, 4000 Hz was beyond 81 dB HL), age between 18 to 65 years old, and within 14 days of the onset . The patients were divided into one of the four drug groups [batroxobin, batroxobin + ginkgo biloba leaves extract (EGb), batroxobin + EGb + glucocorticoids, EGb + glucocorticoids] according to the random table, and receive treatment.</p><p><b>RESULTS</b>Totally 276 patients with unilateral severe ISSHL were included from 33 hospitals, from August 2007 to October 2011. Among them, male patients accounted for 135 (48.91%), female 141 (51.09%); the average age was (41.7 ± 13.3)years. Forty cases were recovered (14.49%), 78 cases had marked effective (28.26%), 76 cases were effective (27.54%), 82 cases were in-effective (29.71%), and the total effective rate was 70.29%. Among four drug groups, the separate effective rate were 73.33%, 61.43%, 78.31% and 67.95% respectively, no significant difference was found between groups (χ(2) = 9.97,P = 0.62). Among the four groups, the separate cure rate for hearing loss were 11.11%, 12.86%, 16.87% and 15.38%, the glucocorticoid groups were significantly better than those not used. Among severe sudden deafness patients, 92.39% cases accompanied with tinnitus, 44.93% with dizziness (or vertigo), 50.36% with ear stuffy. There had no significant difference between the four groups with accompanied symptoms (all P > 0.05).</p><p><b>CONCLUSIONS</b>It is value to give active treatment to sever sudden deafness patients because of an effective rate of 70%. However, the doctors and patients should be mind of a cure rate of only 14%. Steroids are recommended bacause it may play a role in the improvement rate.</p>

Detrimental effects of ouabain on cochlear spiral ganglion cells in rats / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the detrimental effects of ouabain on cochlear spiral ganglion neurons (SGCs) in vivo and in vitro.</p><p><b>METHODS</b>Seventy-five male SD rats were randomly divided into 5 groups. In addition to the normal control group, rats in other 4 groups received 0.01, 0.02, 0.05 mmol/L of Ouabain or saline through cochlear scala tympani drilling. Seven days after surgery, the hearing threshold was measured by distortion product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) in rats. In the in vitro study, SGNs were isolated from SD rats (E14) and treated with 1 × 10(-8) mmol/L of Ouabain. The damaged of SGCs were detected after ouabain treatment using immunohistochemistry, transmission electron microscope and scanning electron microscope in vitro.</p><p><b>RESULTS</b>After administration of Ouabain, DPOAE did not change significantly. No significant difference in the amplitude of DPOAE could be observed among all the groups (P > 0.05). Compared with saline and normal control, ABR threshold was significantly increased in the Ouabain treated groups (P < 0.05), which correlated with the concentration of Ouabain. Electron microscopy showed that after treated with Ouabain, SGCs presented degenerative changes, including collapse of organelle structures, the karyotheca dissolved, myelin sheath disintegrating. Ouabain could damage type I SGCs but not type II SGNs.</p><p><b>CONCLUSIONS</b>Ouabain can damage SGCs, either in the in vivo or in vitro conditions.</p>

Inhibition of gamma-aminobutyric acid receptor-gated chloride currents by noradrenaline in rat spiral ganglion neuron / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the pharmacological modulatory properties of noradrenaline in the rat spiral ganglion neuron.</p><p><b>METHODS</b>Nystatin perforated patch recording technique under voltage-clamp conditions was used to record the modulatory effect of noradrenaline on the current evoked by gamma-amino butyric acid (GABA) in the spiral ganglion neuron.</p><p><b>RESULTS</b>The reversal potential of the GABA response was about (- 0.78 +/- 0.05) mV (n = 8), which was almost identical to the theoretical Cl- equilibrium potential. At the holding potential of -50 mV, GABA evoked inward current (I(GABA)) over the concentration range of 0.3 to 1 micromol/L. The EC50 and Hill coefficient for GABA were (5.2 +/- 0.5) micromol/L and 1.03 (n = 26). The I(GABA) was suppressed by bicuculline, the selective GABA-A receptor antagonist, and the chloride currents evoked by GABA was inhibited by noradrenaline.</p><p><b>CONCLUSIONS</b>The result indicates that noradrenaline depressed GABA-A receptor-gated chloride currents, which may contribute to the modulatory effect of sympathetic system on auditory transmission.</p>

Mechanism of acupuncture anesthesia for analgesia of the operative region of thyroid gland / 中国针灸

<p><b>OBJECTIVE</b>To probe into peripheral nervous mechanisms of analgesic effect of electroacupuncture (EA) at Hegu (LI 4) and Neiguan (PC 6) on cervical region.</p><p><b>METHODS</b>Twenty cases of thyroid disease who wished to receive acupuncture anesthesia, were stimulated with electroacupuncture at bilateral Hegu (LI 4), Neiguan (PC 6) in continued wave, intensity of 6-8 V, frequency of 10-20 Hz. After stimulation for 40 min, the operation was made. Before EA stimulation, 10 min, 20 min and 30 min after EA stimulation, changes of the physiologi cal functions including latent period, conduction velocity, wave peak amplitude of great auricular nerve were monitored and changes of pain sense were detected.</p><p><b>RESULTS</b>After EA given at Hegu (LI 4) and Neiguan (PC 6) for 10 min, 20 min and 30 min, the pain sense significantly decreased (P<0.01), the latent period of great auricular nerve was shortened, and the conduction velocity was fastened and the wave peak amplitude raised with significant changes as compared with those before EA stimulation (P<0.01).</p><p><b>CONCLUSION</b>EA at Hegu (LI 4) and Neiguan (PC 6) can produce a better analgesic effect on cervical region; EA at Hegu (LI 4) and Neiguan (PC 6) induces electro-physio logic changes of the nerve innervating the cervical region, showing increase of excitability; the nerves innervating Hegu (LI 4) and Neiguan (PC 6) and the nerves of cervical region possibly are homologous nerves.</p>

Technique of rat cochlea slicing and study of rat spiral ganglion neurons by infrared visual slice patch clamp method / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establishing the cochlea slice technique and infrared visual slice patch clamp method in order to observe the electrophysiological characteristics of rat spiral ganglion neurons (SGN) METHODS: SD rats were divided into three groups according to postnatal days old (0-2 d, 3-6 d and 7-14 d). Making slice of SD rat cochlear quickly, using infrared differential interference contrast (IR-DIC) technique, together with slice patch clamp, the electrophysiological characteristics of rat spiral ganglion neurons were observed, and factors which affected the quality of cochlear slice and recording of patch clamp were analyzed.</p><p><b>RESULTS</b>The success rate of 3-6 days SD was the highest, and 2-4 pieces of slice could be made from each cochlea. Cochlea connecting with partial skull and integrity of cochlear hull were the key for making slice, and the angle of modiolus axis should be adjusted to be parallel to the knife and the preparing time should be shorter. The SGN cell of good condition could be easily found and the seal test became easier with the help of infrared visual slice patch clamp method. The rest membrane potential was (-45.6 +/- 5.3) mV (x +/- s, n=52) and the current of Na+ and K+ could be activated.</p><p><b>CONCLUSIONS</b>Cochlear slice technique can retain structural integrity, cell viability and their association in cochlea, which suggest that this technique provides carrier for electrophysiological study of rat spiral ganglion neurons, and patch clamp with infrared videomicroscopy method can be used to make direct real-time observation in electrophysiological experiments of SGN, which can provide important technique support and reference for deep study of electrophysiological characteristics of SGN and auditory neurotransmission in cochlea.</p>

Atrial natriuretic factor's effects on the reperfusion process after cochlea ischemia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of atrial natriuretic peptide (ANP) on ischemia and reperfusion cochlea in guinea pigs.</p><p><b>METHODS</b>The guinea pigs were randomly allocated into four groups: experiment groups (A1 and B1) and control groups (A2 and B2). Cochlear ischemia and reperfusion was induced by thrombus and thrombolysis method. In experiment group A1, ANP was administered 10 min before the ischemic insult. In experiment group B1, ANP was administered at the beginning of reperfusion. In control groups, instead of ANP, normal sodium was injected. The blood flow of cochlea (CoBF) was monitored continuously with laser Doppler flow meter and the threshold of auditory brainstem response (ABR) was measured.</p><p><b>RESULTS</b>Before the induction of ischemia, the CoBF of experiment group A1 was higher than that of the control group A2. From the reperfusion moment to the end of the experiment, there was no difference between the CoBF of the two groups. In B1 and B2 groups, no difference could be seen between the two groups before the induction of ischemia. After reperfusion, the blood flow of control group B2 recovered to 70% of the base level, while the CoBF of experiment group B1 restored to almost the same level of the beginning. Before ischemia, the ABR threshold of the four groups had no difference. At 30 min of ischemia, the threshold of experiment group Al was lower than that of control group A2. And there was no difference in experiment group B1 and control group B2. At 30 min and 60 min of reperfusion, the threshold of experiment group B1 was significantly lower than that of control group B2. No difference could be seen between experiment group A1 and control group A2.</p><p><b>CONCLUSIONS</b>Administration of ANP at the beginning of reperfusion protects the cochlea from ischemia and reperfusion injury. The administration can not only increase the CoBF, but lower the ABR threshold.</p>

Electroanatomical systems to guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the Ensite/NavX and CARTO system / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) treatment and is becoming more widely accepted and practiced. This study aims to evaluate the characteristics of the CARTO and the Ensite/NavX system and draw a comparison between them on the aspects of procedural parameters and clinical effectiveness.</p><p><b>METHODS</b>Seventy-five cases with paroxysmal or chronic symptomatic AF were randomly assigned to CPVA procedure guided by the Ensite/NavX system (group I, n = 40) and by the CARTO system (group II, n = 35). After successful transseptal procedure, the geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferentially ablate tissues out of pulmonary veins' (PVs') ostia. In cases with chronic AF, linear ablation was applied to modify the substrate of left atrium (LA). The endpoint of the procedure was complete PVs isolation.</p><p><b>RESULTS</b>Seventy-five cases underwent the procedure successfully. The total procedure and fluoroscopic durations in group II were significantly shorter than in group I [(150 +/- 23) min and (18 +/- 17) min versus (170 +/- 34) min and (25 +/- 16) min, P = 0.03 and 0.04, respectively]. There was no significant difference in the fluoroscopic and procedure durations for geometry creation between group I and group II [(8 +/- 4) min and (16 +/- 11) min versus (5 +/- 4) min and (14 +/- 8) min, respectively]. The fluoroscopic durations for CPVA were (15 +/- 5) min in group I versus (10 +/- 6) min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than in group I [(18 +/- 11) min versus (25 +/- 10) min, P = 0.04]. AF was terminated by radio frequency delivery in 14 cases (35%) in group I versus 5 cases (14%) in group II (P = 0.035). After CPVA complete PV isolation was attained in 26 cases (65%) in group I versus 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardium effusion and another one case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured by proper treatment. No PV stenosis was observed.</p><p><b>CONCLUSIONS</b>The CPVA procedure for atrial fibrillation is effective and safe. Although there is difference between the CARTO and the Ensite/NavX system, the CPVA procedure guided by either of them yields similar clinical results.</p>

Electroanatomical systems guided circumferential pulmonary veins ablation for atrial fibrillation: initial experience from comparison between the EnSite-NavX and CARTO system / 中华心血管病杂志

<p><b>OBJECTIVE</b>The circumferential pulmonary vein ablation (CPVA) has been proved effective for atrial fibrillation (AF) and is becoming more widely accepted. This study aims to evaluate the effectiveness of the CARTO and the EnSite-NavX system and to compare between them on procedural parameters and clinical characteristics.</p><p><b>METHODS</b>Seventy-five patients with paroxysmal or persistent symptomatic AF were randomly assigned to CPVA procedure guided by either the EnSite-NavX system (group I, n = 40) or the CARTO system (group II, n = 35). After successful transseptal procedure, a geometry of left atrium was created under the guidance of the two systems. Radiofrequency energy was applied to circumferential tissues out of pulmonary veins (PVs) ostia. In cases with persistent AF, linear ablation was applied to modify the substrate of LA. The endpoint of the procedure was complete PVs isolation.</p><p><b>RESULTS</b>Seventy-four cases underwent a successful procedure. The total procedure and fluoroscopic time in group II was significantly shorter than those in group I (150 min +/- 23 min and 18 min +/- 17 min vs 170 min +/- 34 min and 25 min +/- 16 min, P = 0.03 and 0.04, respectively). There was no significant difference in the fluoroscopic and procedure durations for geometry creation between the groups I and II (8 min +/- 4 min and 16 min +/- 11 min vs 5 min +/- 4 min and 14 min +/- 8 min, respectively). The fluoroscopic time for CPVA was 15 min +/- 5 min in group I vs 10 min +/- 6 min in group II (P = 0.05), and the CPVA procedural durations were significantly shorter in group II than those in group (86 min +/- 11 min vs 110 min +/- 15 min, P = 0.04). AF was terminated by RF delivery in 14 cases (35%) in group Ivs 5 cases (14%) in group II (P = 0.04). Complete PV isolation was obtained in 26 cases (65%) in group Ivs 11 cases (31%) in group II (P = 0.004). During a mean follow-up of 7 months, 32 (80%) cases in group I and 24 (69%) cases in group II were arrhythmia-free (P = 0.06). One case developed pericardial tamponade and 1 case was found to have intestinal artery thrombosis in group II. One case had moderate hemothorax in group I. All the complications were cured and no PV stenosis was observed.</p><p><b>CONCLUSIONS</b>The CPVA procedure for atrial fibrillation is effective and safe. Although there is a difference between the CARTO and the EnSite-NavX system, the CPVA procedure guided by either of them yields similar clinical results.</p>