Clinical Diagnosis and Treatment of Idiopathic Subglottic Stenosis: a Report with Four Patients / 现代生物医学进展

Objective:To investigate the clinical diagnosis and treatment of idiopathic subglottic stenosis.Methods:From May 2012 to January 2014,four patients with idiopathic subglottic stenosis admitted in the Department of Otolaryngology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing,Jiangsu,China were selected for review.Results:All the four patients with idiopathic subglottic stenosis were resolved after the resection of the pathological tissues and subsequent hormone treatment.Conclusions:The confirmed diagnosis of idiopathic subglottic stenosis mainly relied on the medical history and pathological examination.Favorable treatment effects might be obtained by combining surgical resection and hormone treatment.

Clinical observation on the effect of glucocorticoid insensitivity on sudden sensorineural hearing loss patients / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the correlation between the proliferation inhibition effect of glucocorticoid (GC) on peripheral blood mononuclear cell (PBMC) and the pure tone average (PTA) improvement in SSNHL patients.@*Methods@#Sixty inpatients with SSNHL were included from July 2013 to October 2015 in Nanjing Drum Tower Hospital, Medical School of Nanjing University. Peripheral venous blood was collected before receiving treatment, then the PBMC was isolated for GC proliferation inhibition. PBMCs of each patient were cultivated into 4 groups: Group A: PBMCs+ Medium; Group B: PBMCs+ Medium+ lipopolysaccharide (LPS, 1 μmol/L); Group C: PBMCs+ Medium+ LPS+ Dexamethasone; Group D: Medium. PBMCs were maintained in a humidified 5% CO2 atmosphere at 37°C and were observed after 24 hours. 5-diphenyltetrazolium bromide (MTT) was used to measure PBMC proliferation inhibition rate. The PBMC proliferation inhibition rates were calculated according to the absorbance at 490 nm wavelength under a microtiter plate reader. Independent sample t tests of PBMC proliferation inhibition rate were performed between different groups. χ2 tests were performed between gender, affected ear side, accompanied by vertigo or not, audiometric curve, time period from onset to treatment, PBMC proliferation inhibition rate and the improvement of pure tone average (PTA). Linear correlation analyses were performed between PBMC proliferation inhibition rate, the time period from onset to treatment and the hearing improvement.@*Results@#The proliferation inhibition effect of GC on PBMC varied significantly among patients. The PBMC proliferation inhibition rate in GC insensitive group was lower than that in GC sensitive group (26.72%±21.82% vs 64.44%±25.48%, t=6.113, P<0.05). The PBMC proliferation inhibition rate in refractory group was lower than that in initial group (40.93%±28.57% vs 57.04%±31.19%, t=2.035, P=0.046). There was no statistical significance between gender, affected ear side, accompanied by vertigo or not, audiometric curve and the hearing improvement (χ2 value was 2.320, 0.031, 2.143, 0.106, respectively, all P>0.05). Both in initial group and refractory group, the linear correlation analyses showed a significant positive correlation between PBMC proliferation inhibition rate and the PTA improvement (r value was 0.615, 0.657, respectively, all P<0.05), as well as a significant negative correlation between time period from onset to treatment and the PTA improvement(r value was -0.542, 0.370, respectively, all P<0.05).@*Conclusions@#The proliferation inhibition rate of PBMC in vitro by GC is correlated with patients′ hearing improvement. The proliferation inhibition test might be used to predict the sensitivity to GC treatment and be helpful for individualized treatment of SSNHLin clinical practice.

Clinical studies of discoid meniscus injury treated by arthroscopy in the middle aged and elderly people / 中国医师进修杂志

Objective To study the characteristic and manifestations in the middle aged and elderly peoplewith discoid meniscus injury and the outcome of the arthroscopic surgery. Methods Twenty-nine patients with discoid meniscus injury were treated by the arthroscopic surgery from January 2009 to May 2013. According to the injury of discoid meniscus in operation, 6 cases (6 knees , 20.69%) underwent meniscal plasty, 16 cases (16 knees, 55.17%) underwent subtotal meniscectomy, and 7 cases (7 knees, 24.14%) underwent meniscectomy. The Ikeuchi and Lysholm evaluation system was used to assess knee joint function and compared. Results All the postoperative patients were followed up for 12-18 months, and the average was 14 months. According to Ikeuchi knee rating, 5 cases were excellent, 17 cases were good, 4 cases were fair, 4 cases were poor and the rate of excellent and good was 75.86%. Lysholm scores 3, 6 and 12 months after operation were (65.76 ± 5.35), (70.27 ± 4.73) and (77.81 ± 6.24) scores, and before operation was (55.47 ± 3.63) scores. Three, 6 and 12 months after operation, Lysholm scores were significantly higher than those before operation (P<0.05). Conclusions The middle aged and elderly people discoid meniscus injury has its own characteristics compared with adolescent patients in symptoms, signs, and treatments. Arthroscopic surgery is an effective treatment for discoid meniscus with minimal.

Riedel thyroiditis: two cases report / 临床耳鼻咽喉头颈外科杂志

Riedel thyroiditis is a benign disease, which is often self-limited. Examinations, such as CT and histologic diagnosis can distinguish it from malignant neoplasms and hashimoto's thyroiditis. Riedel thyroiditis is an uncommon form of chronic thyroiditis in which the thyroid gland is replaced by fibrous tissue. It can be cured by surgery and medicine.

Clinical evaluation of intratympanic methylprednisolone perfusion for intractable Meniere's disease / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the clinical efficacy of the intratympanic methylprednisolone perfusion for patients of intractable Meniere's disease (MD).@*METHOD@#Ten cases (10 ears), collected from Janu 2008 to Janu 2010, of intractable MD were studied retrospectively. The micro-catheter was placed into the tympanum of the affected ear, then methylprednisolone was imported into the tympanum once a day for 10 days. The average followed-up duration was (15. 4 +/- 5. 4) months after the perfusion. The treatment effect of vertigo, hearing loss and activity capacity was evaluated with Diagnostic Criteria for MD set by the Guiyang Meeting in 2006. The efficacy of tinnitus was analyzed by comparing the score of tinnitus handicap inventory (THI) before and after treatment.@*RESULT@#The vertigo was absolutely controlled in 7 patients (grade A), partially controlled in 2 patients (grade B) and no efficiency in 1 patient (grade C). The 2 patients in grade B had a vertigo again in 9 months and 11 months after intratympanic perfusion, respectively, while the frequency, severity and duration of their vertigo softened obviously. Puretone threshold average (PTA) at the affected frequencies was decreased to within the level of 20 dB in one patient and was improved more than 30 dB in another one (grade A), improved 15 dB to 30 dB in 4 patients (grade B), and improved less than 15 dB in the other 4 patients. The average score of THI was 48.80 +/- 7.25 and 41.9 +/- 7.78 before and after perfusion respectively. The ability capacity of all the 10 patients after treatment was as normal (grade A), i. e. All of them could lead an independent life. There was no irreversible tympanic perforation in the operated ear and there was no other complications left.@*CONCLUSION@#Intratympanic methylprednisolone perfusion through the micro-catheter is a safe and effective method for the intractable Meniere's disease.

A primary study of bone conduction hearing loss in adults with otitis media with effusion / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the bone conductive hearing loss in adults of otitis media with effusion (OME).@*METHOD@#Fifty adults of OME treated in our hospital, from Mar. 2009 to Feb. 2010, were enrolled for analyzing bone conduction hearing loss (BCHL) before auripuncture and after auripuncture, the difference between which were compared in 51 ears. BCT of pre auripuncture 24 subjects, BCT of post-auripuncture 22 subjects, and BCT recovered from OME 9 subjects compared with the contralateral ear respectively. High and extend high frequency (8, 10, 12, 16 kHz) air conduction threshold (ACT) after recover from OME was compared to the normal contralateral ear in 4 adults.@*RESULT@#BCT improved significantly after auripuncture at the frequencies (0.5-4.0 kHz), and the improvements in 4.0 kHz are more than that in 0.5 kHz significantly (P<0.05). In the unilateral OME subjects, BCT, of post auripuncture and recovered from OME, nearly recovered to the same level as the contralateral ear in most cases. While high and extend-high frequency (8, 10, 12, 16 kHz) ACT elevated in 3 of 4 patients recovered from OME.@*CONCLUSION@#Both effusion in middle ear and injury in inner ear could result in the elevation of BCT. Elevation of BCT at regular frequencies (0.5-4.0 kHz) is frequently associated with the effusion in middle ear, while these frequencies were insensitive in the early inner ear injury. The high and extend high frequency ACT elevation may be sensitive for the early sensorineural hearing loss. As the disease prolonged, sensorineural hearing loss of the lower frequencies (0.5-4.0 kHz) could be detected of OME patient.

Diagnosis and treatment of mycotic otitis media / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To diagnose the mycotic otitis media correctly and to explore the most adequate treatment for the disease.@*METHOD@#Thirty-six inpatients (39 ears) with mycotic otitis media in Nanjing Drum Tower Hospital from Jan. 2003 to Dec. 2007 were analyzed retrospectively. Morphous of the fungi, the methods and efficacies of the treatment were analyzed respectively.@*RESULT@#According to the fungal cultures, 27 ears were induced by mold fungus and 12 ears were induced by budding fungus. Among these 36 patients (39 ears), myringoplasty accompanied local antifungal cream were applied in one ear, mastoidectomy with canal wall down and/or tympanoplasty accompanied with oral antifungal medication were administrated in 35 ears, only oral antifungal drugs were used in 3 ears (the control ears of the bilateral mycotic otitis media, which was not treated by surgery). All of the patients were followed up for 3 to 36 months, otorrhea occurred in the patients who refused to oral antifungal medication for 3 weeks after the myringoplasty, then dry again by local antifungal cream, but otorrhea recurred 3 times within 2 years. Thirty-five patients (38 ears) acquired dry ear after surgery and/or oral antifungal drugs, but 2 of the 38 ears recurred separately at the fourth and sixth month after their surgeries, then dry again by irrigation with hydrogen peroxide and by administrating local antifungal cream for 3 weeks.@*CONCLUSION@#Otologists should elevate suspicion of mycotic otitis media when they meet patients with continuous otorrhea and patients who did not respond to the antibacterial treatment. The diagnosis based on microbiological findings, such as direct microscopy or fungal cultures should be done as soon as possible. If the otomycosis is decided, we suggest that topical treatment should be selected firstly, although most patients in present study were treated by surgery accompanied with oral antifungal medications. If there is obvious bone erosion, surgery is necessary to excise the pathological tissues, minificate the mastoid cavity and close the middle cavity in order to improve the hearing and prevent the infection from the outer ear.

Auditory neuropathy in deaf school students / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate incidents and clinical features of auditory neuropathy in Nanjing deaf school students.@*METHOD@#Three hundred and fifty-eight deaf students in the school accepted the first examination including otoscopic examination, tympanometry and transiently evoked otoacoustic emissions (TEOAE) screening. Detailed audiological and vestibular evaluations including pure-tone audiometry, immittance audiometry and acoustic reflex measures, transiently evoked otoacoustic emissions (TEOAE), distortion product otoacoustic emissions (DPOAE), auditory brain stem response (ABR), electronystagmography (ENG) and vestibular evoked myogenic potential (VEMP) were given to whom had positive TEOAE screening.@*RESULT@#Three hundred and twenty-three students entered the program of screening for auditory neuropathy. One student had positive TEOAE in single ear while the other two had positive TEOAE in both ears. In the screening stage,there were strong evidences in these three students with auditory neuropathy in the detailed audiological procedures.@*CONCLUSION@#Auditory neuropathy, which can also be found in deaf schools, is not as rare as we thought before. Early identification and intervention may help those children to avoid entering the deaf school and to return to normal society.