Reclassification of flat type sudden deafness / 中华耳鼻咽喉头颈外科杂志

Objective: To reclassify the flat type sudden deafness according to the types of audiogram shape, and to explore the correlation between different pattern of hearing loss and prognosis. Methods: All of 1 024 patients with unilateral sudden deafness (492 males and 532 females, aged from 19 to 65 years, with an average age of 41.2 years old) admitted to 33 hospitals nationwide from August 2007 to October 2011 were divided into four types according to Chinese Guideline of Sudden Deafness(2015): low-frequency, high-frequency, flat and total deafness. Then, 402 patients with flat type sudden deafness were further divided into ascending type, descending type and consistent type according to the audiogram shapes. First, we compared the clinical characteristics and prognosis among these three subtypes of flat deafness, then compared the clinical characteristics and prognosis between ascending flat deafness and low-frequency deafness, descending flat deafness and high-frequency deafness, consistent flat deafness and total deafness, explored the factors related to the prognosis of flat deafness. SPSS 21.0 software, ANOVA, χ2 test, t-test and Logistic regression were used to analyze the data. Results: The cure rates of flat ascending, flat descending and flat consistent sudden deafness groups were 70.7%, 17.1% and 34.0% respectively, with a statistically significant difference (χ2=33.984, P<0.001); However, there was no significant difference in age, sex and affected side (all P>0.05). The independent related factors for the recovery of flat type sudden deafness were as follows: whether there was dizziness [OR=0.459; 95% confidence interval (CI): 0.271-0.777], the type of audiogram shape (OR=0.721; 95%CI: 0.530-0.981), and days from onset to therapy (OR=0.903, 95%CI: 0.835-0.978), all of which had P values<0.05. There was no significant difference in the cure rates between ascending flat sudden deafness and low-frequency descending sudden deafness, descending flat sudden deafness and high-frequency descending sudden deafness (all P>0.05). The pure tone average(PTA) of flat consistent sudden deafness and total deafness were (69.1±18.9) and (101.7±17.7) dB HL, respectively, with a statistically significant difference (t=20.890, P<0.001), and the cure rates were 34.0% and 14.5%, respectively, with a statistically significant difference (χ2=29.012, P<0.001). Conclusion: According to the audiogram shape, the flat type sudden deafness can be further divided into ascending flat sudden deafness, descending flat sudden deafness and consistent flat sudden deafness, which can more effectively evaluate the prognosis. The cure rate of ascending flat sudden deafness is similar to that of low-frequency sudden deafness, and the prognosis is well; The cure rate of descending flat sudden deafness is similar to that of high-frequency descending sudden deafness, and the prognosis is poor. The cure rate of consistent flat sudden deafness is higher than that of total deafness. PTA plays an important role in the prognosis of consistent flat sudden deafness and total deafness. Total deafness can be regarded as a single type of sudden deafness.

Gadolinium angiography of inner ear in patients with sudden deafness and its clinical analysis / 中华耳鼻咽喉头颈外科杂志

Objective: To observe the gadolinium imaging findings of inner ear in patients with sudden deafness and to analyze its clinical features. Methods: From November 2017 to July 2020, 21 patients with sudden deafness in the People's Hospital of Dongsheng District, Ordos City were selected as the research objects, including 14 males and 7 females, aged 36-76 years, with a median age of 50 years. The course of disease was 1-19 days, with an average of 5.5 days. The patients received audiology tests, laboratory examination, and intravenous gadolinium angiography, each of whom was scanned twice by 3D-FLAIR sequence: once before intravenous gadolinium injection, and once again 4.5-6.0 h after intravenous gadolinium injection. The following corresponding clinical treatment was given. The imaging manifestations and clinical features were observed. Results: Among 21 cases of sudden deafness in acute stage, the signal intensity of 11 cases was significantly higher than that of the contralateral ear, and 2 cases had vestibular labyrinthine hydrops. In laboratory examination, only 2 cases of total deafness had increased WBC count and faster erythrocyte sedimentation rate, and the rest had no abnormality. The hearing types of 21 patients with sudden deafness were: total deafness in 8 cases, flat decline in 10 cases, low frequency decline in 1 case, high frequency decline in 2 cases. The total effective rate was 57% (12/21). The hearing types of 11 patients with abnormal gadolinium angiography were total deafness in 5 cases, flat decline in 5 cases and high frequency decline in 1 case. The total effective rate was 64% (7/11). Conclusion: Gadolinium angiography is abnormal in some patients with sudden deafness, and the permeability of blood labyrinth barrier may be increased, which is worthy of further study.

Development of the mastoid air cells and its relationship to Ménière's disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the fundamental pathological anatomy and possible pathogenetic factors of Ménière's disease(MD), we compared the types of mastoid air cells between the MD group and the control group.</p><p><b>METHODS</b>The MD group had 113 ears and the control group had 100 ears. Temoral bone CT scanning was performed in all the subjects. The types of mastoid air cells were determined by surgical findings and imaging data. All the mastoid air cells were divided into diploetic type, gasified type and sclerosis type. Analysis of the proportion of different types and the statistical analysis were performed between the two groups.</p><p><b>RESULTS</b>51.4% (57/113) in the MD group and 18.0% (18/100) in the control group were diploetic type mastoid, the difference was significant (χ(2) = 24.476, P < 0.001). The gasified type was 43.4% (49/113) in the MD group and 77.0% (77/100) in the control group, the difference was significant (χ(2) = 24.843, P < 0.001). The sclerosis type was 6.2% in the MD group and 5.0% (5/100) in the control group, and there was no statistical significance (χ(2) = 0.142,P > 0.05).</p><p><b>CONCLUSIONS</b>The mastoid air cells are dysplasia in MD patients, and it may be one of the fundamental pathological anatomy. The long-term ventilation and drainage disorder and recurrent inflammation attack may play an important role in occurrence, development and prognosis of MD.</p>

Relationship between the tinnitus frequency and the effects of medication and the prognosis in patients with chronic subjective tinnitus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the influence of tinnitus frequency on medication and prognosis in patients with chronic subjective tinnitus.</p><p><b>METHODS</b>Seventy-two patients (Ninety-three ears) diagnosed as chronic subjective tinnitus were studied from October 2010 to March 2011. All cases were divided into low frequency(twenty-three ears), medium frequency(fourteen ears) and high frequency (fifty-six ears) according to tinnitus matching test. All cases were treated with microcirculation promotion and steroid therapy (5% glucose 250 ml + ginkgo biloba extract 87.5 mg + dexamethasone 10 mg intravenous drip). Curative effect was evaluated and the factors of prognosis were analyzed after three weeks.</p><p><b>RESULTS</b>After medication, results were acquired as follows: recovery in 0 ear (0%), excellent in 0 ear (0%), effective in 18 ears (19.4%), invalid in 75 ear (80.6%). The effective percentage was 39.1%, 35.7% and 7.1%, respectively. There was significant difference between these groups, but no significant difference between low frequency and medium frequency. Logistic regression analysis showed that the difference of frequency was significant prognostic factors for medication.</p><p><b>CONCLUSIONS</b>Microcirculation promotion and steroid therapy had a poor treatment effect in patients with chronic subjective tinnitus. The prognosis of chronic low-medium frequency tinnitus was better than chronic high frequency tinnitus. The difference of frequency retained significant influence on effects and prognosis of medication.</p>

Analysis of the effectiveness in patients who were treated with a course of drugs for sudden deafness which was present for at least three weeks / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate and analyze the significance of a course of glucocorticosteroids and other drugs for the treatment of patients with sudden deafness present for at least three weeks.</p><p><b>METHODS</b>A retrospective review was done on 48 patients (58 ears) with sudden deafness present for at least three weeks or more, who were admitted to the Department of Otorhinolaryngology, Peking University People's Hospital from November 2002 to July 2010. The patients were divided into three groups by the type of hearing threshold. The different treatments were used in the three groups. The SPSS 17.0 software was used to analyze the data.</p><p><b>RESULTS</b>In patients with a low tone hearing loss (6 ears), 83.3% improved. For patients with a high tone loss (22 ears) 31.8% improved. For a flat tone hearing loss (30 ears) 36.7% improved. For patients with a hearing loss more than one year (12 ears) there was improvement in 58.3% (7 ears) of the patients. In 9 ears which had a flat tone hearing loss of 90 dB or greater before treatment, 77.8% (7 ears) improved with 33.3% (3 ears) having a significant improvement. In 21 ears which had a hearing threshold was under 90 dB, 14.3% (3 ears) improved.</p><p><b>CONCLUSIONS</b>In the treatment of patients with sudden deafness which was longer than 21 days the treatment was significant, especially for those who had a 90 dB or greater flat-tone type hearing threshold before treatment. Even though the hearing loss was more than a year in some patients there was still a benefit from treatment.</p>

Analysis of sub-typing in full-frequency sudden deafness / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the relationship between the sub-typing of full-frequency sudden deafness and its effect in treatment.</p><p><b>METHODS</b>A series of 87 cases that have full-frequency sudden deafness were studied from Aug, 2005 to Mar, 2008. All cases were treated with methylprednisolone, Batroxobin and Xueshuantong.</p><p><b>RESULTS</b>Based on the frequency of hearing loss, the objectives were divided into sudden-drop-down type and slow-drop-down type. The effective percentage and significant effective percentage in sudden-drop-down type were 84.4% (27/32) and 68.8% (22/32), respectively. The effective percentage and significant effective percentage in slow-drop-down type were 52.7% (29/55) and 32.7% (18/55), respectively. Slow-drop-down type showed a higher effective and significant effective percentage respectively (P < 0.01). According to the degree of hearing loss, objectives were divided into flat-type and profound-type. The effective percentage and significant effective percentage in flat-type were 73.3 % (44/60) and 53.3 % (32/60) respectively. The effective percentage and significant effective percentage in flat-type were 44.4% (12/27) and 29.6% (8/27) respectively. The flat-type showed a higher effective (P < 0.01) and significant effective percentage (P < 0.05) for treatment.</p><p><b>CONCLUSIONS</b>The sudden deafness needs a further classification. According to the frequency of hearing loss, it can be divided into sudden-drop-down and slow-drop-down type. According to the degree of hearing loss, it can be divided into flat-type and profound-type. It would be appropriate to using 90 dB(average hearing threshold) as a criteria for the classification of hearing loss.</p>

Non-invasive visualization of endolymphatic hydrops in patients with Meniere's disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To visualize the endolymph in Meniere's disease by applying for non-invasive intratympanic gadolinium through eustachian tube and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).</p><p><b>METHODS</b>With a 3 Tesla magnetic resonance imaging (MRI) unit, 3D-FLAIR imaging was performed 24 h after intratympanic gadolinium through eustachian tube in seven patients with Meniere's disease. Pure tone test was performed 24 h before and after administered gadolinium. Tympanometry was performed 24 h before, 24 h and 3 months after administered gadolinium.</p><p><b>RESULTS</b>In five patients, the gadolinium could appear in parts of the perilymph inside the inner ear but not in the middle ear and mastoid, moreover, the border between the perilymph and endolymph was visible so that endolymphatic space was clearly shown on 3D-FLAIR imaging. In two patients with endolymphatic hydrops, the perilymphatic space surrounding endolymph was small or disappeared. In two patients, the gadolinium could appear in parts of the middle ear and mastoid but not in the inner ear. No significant changes in pure tone test and tympanometry were noted.</p><p><b>CONCLUSIONS</b>3D-FLAIR MRI with intratympanic gadolinium through eustachian tube could clearly reveal the visualization of endolymphatic space in Meniere's disease.</p>

Expression of matrix metalloproteinase-2,9 in cholesteatoma from different positions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study various expressions and roles of MMP-2,9 in cholesteatoma from different positions.</p><p><b>METHODS</b>MMP-2 and MMP-9 were detected with immunohistochemical methods using antibody in 18 attic cholesteatoma, 16 tympanic sinus cholesteatoma, 10 auditory meatal skin in cholesteatoma (CAMS) and 10 normal auditory meatal skin (NAMS).</p><p><b>RESULTS</b>The stain in cholesteatoma was stronger than that in CAMS and NAMS (P < 0.05). Expression of MMP-2,9 was seen in all layers of the epithelium in cholesteatoma and the stain was strongest in basement membrane. Expression of MMP-2,9 in tympanic sinus cholesteatoma was stronger than that in attic cholesteatoma. The expression of MMP-2 and MMP-9 were closely related in cholesteatoma (r = 0.974, P < 0.01). The expression of MMP-2,9 in cholesteatoma was related with destruction of ossicular chain (r = 0.789, P < 0.01; r = 0.803, P < 0.01).</p><p><b>CONCLUSIONS</b>MMPs play a very important role in bone destruction in cholesteatoma. The destruction of bone in tympanic sinus cholesteatoma is more severe than that in attic cholesteatoma. Tympanic sinus cholesteatomas are more invasive in destruction surround bone matrix.</p>

A pilot study on the diagnosis of laryngopharyngeal reflux diseases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the value of the reflux symptom index (RSI) and reflux finding score (RFS) in laryngopharyngeal reflux disease (LPRD).</p><p><b>METHODS</b>Twenty-five patients with RSI scores > 13 or RFS scores > 7 and sixteen patients with RSI scores > 13 and RFS scores > 7 were suspected as LPRD. Forty one patients with the RSI scores > 13 and/or RFS scores > 7 were suspected as LPRD, 15 patients with the RSI scores <or= 13 and RFS scores <or= 7 were regarded as control group. All the patients had 24-hour dual probe pH monitoring. Twenty-five patients with positive pH monitoring hand received anti-reflux treatment with omeprazole for 3 months, and then the RSI and RFS was estimated again.</p><p><b>RESULTS</b>The RSI and RFS scoring had high consistent with the results of pH monitoring (Kappa = 0.43, u = 3.48, P < 0.01), especially if RSI scores > 13 and RFS scores > 7 (Kappa = 0.55, u = 3.06, P < 0.01). There was a significant decreasing in RSI and RFS scoring in patients after anti-acid treatment for 3 months (t(RSI) = 8.838, P(RSI) = 0.000; t(RFS) = 5.695, P(RFS) = 0.000).</p><p><b>CONCLUSIONS</b>The RSI and RFS can be used as screening tool for laryngopharyngeal reflux diseases and as a simple method for evaluating the effectiveness of treatment.</p>

Different pathogenesis of benign paroxysmal positional vertigo from the nystagmus during particle repositioning maneuver / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the nystagmus during particle repositioning maneuver for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV), and verify different pathogenesis of benign paroxysmal positional vertigo (BPPV).</p><p><b>METHODS</b>The chief complains, nystagmus during positioning test and particle repositioning maneuver (PRM) were recorded in detail from 66 PC-BPPV cases during Dec.2007 and Apr.2008, and verifying possible pathogenesis of BPPV was based on nystagmus.</p><p><b>RESULTS</b>Of all 66 PC-BPPV cases, the four positions of PRM were found in 24 cases presented upward torsional nystagmus at the second or third position, 21 cases presented negative nystagmus except the first position, 7 cases presented intensity horizontal nystagmus during PRM and 14 cases presented downward nystagmus at the second or third position during PRM. Of all 66 cases, 78.8% of them were accord with canalithiasis and cupulolithiasis while the other may be related with otolith organ or nerve disease.</p><p><b>CONCLUSIONS</b>Besides canalithiasis and cupulolithiasis, part of BPPV may be related with otolith organ or nerve disease.</p>

Suppressive effect and its frequency selection of dopamine on the cochlear auditory afferent nerve activity in guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the suppressive effect and its frequency selection of dopamine on the cochlear auditory afferent nerve activity. To offer an important step in understanding the modulation of dopamine in the inner cell synaptic complex.</p><p><b>METHODS</b>Forty guinea pigs were randomly divided into four groups and the whole intracochlear perfusions were performed: (1) perfused with artificial perilymph solutions; (2) perfused with artificial perilymph solutions containing 10 mmol/L dopamine; (3) perfused with artificial perilymph solutions containing 30 mmol/L dopamine; (4) perfused with artificial perilymph solutions containing 50 mmol/L dopamine. Compound action potential (CAP) evoked by different frequencies (250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, 8000 Hz, 16 000 Hz) and cochlear microphonics (CM) evoked by 4000 Hz tone burst were recorded from the round window of guinea pigs before perfusion and 1 hours, 2 hours after perfusions.</p><p><b>RESULTS</b>There was no significant difference in CAP threshold before and after perfusion in the artificial perilymph solutions group (P > 0.05). An increase of CAP threshold of most detecting frequencies were observed in the three dopamine-perfused groups (P < 0.05). The inhibition effect intended with the increasing of the concentration of dopamine in the perfusion solution. There was significant difference in CAP threshold shift between different frequencies, especially in the group perfused with 30 mmol/L dopamine. The maximal threshold shift was found at 4000 Hz and 8000 Hz. No significant changes of CM amplitude and non-linearity of input-output function were observed before and after perfusion with artificial perilymph solutions and dopamine.</p><p><b>CONCLUSIONS</b>Dopamine can inhibit the cochlear auditory afferent nerve, but there is no obvious influence on outer hair cell produced by dopamine. The inhibition effect has frequency selection, the suppression on high frequencies is more stronger than low frequencies.</p>

Change of extracellular ascorbic acid in the brain cortex following ice water vestibular stimulation: an on-line electrochemical detection coupled with in vivo microdialysis sampling / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ascorbic acid (AA) represents one of the most important enzyme co-factors, antioxidants and neuromodulators and plays an important role in the cerebral system. Increasing evidence has suggested that AA could treat certain kinds of vertigo diseases such as Meniere's disease. To elucidate the neurochemical functions associated with AA in vertigo, the change of extracellular AA in the brain cortex following caloric vestibular stimulation (CVS) was evaluated.</p><p><b>METHODS</b>An on-line electrochemical detection was coupled with in vivo microdialysis to continuously monitor the change of extracellular AA in the primary somatosensory (SI) area of guinea pigs following a caloric vestibular stimulation. Sixteen guinea pigs were divided into three groups, i.e., experimental group with irrigation of the ear canal with ice water (0 degrees C) (n = 8), and two control groups, one with irrigation of the ear canal with warm water (38 degrees C) (n = 4) and the other with irrigation of the auricle with ice water (n = 4).</p><p><b>RESULTS</b>In the experimental group, the ice water irrigation of the left external ear canal induced a horizontal nystagmus towards the right side lasting about 45 seconds. No nystagmus was induced by warm water irrigation of the external ear canal or by ice water irrigation of the auricle. The extracellular AA concentration significantly increased following the ice water vestibular stimulation, reaching a maximum of (130 +/- 20)% (n = 8) of the basal dialysate level (2.61 +/- 0.92) micromol/L (n = 8), lasting at least for an hour. AA level did not change distinctly after the irrigation of the left external ear canal with warm water or the irrigation of the auricle with ice water.</p><p><b>CONCLUSIONS</b>The concentration of extracellular AA in the brain cortex of the SI area increased following the ice water vestibular stimulation. This demonstration may be useful for the investigation of the neurochemical processes associated with AA in the process of vertigo.</p>

Prognosis and treatment of sudden sensorineural hearing loss with total and severe all frequency hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the treatment and prognosis of sudden sensorineural hearing loss (SSHL) with total and severe all frequency hearing loss.</p><p><b>METHODS</b>Sixty-two patients diagnosed as SSHL (0.25, 0.5, 1, 2, 4 kHz pure tone average > or = 56 dB) were studied from January 2003 to October 2006, in which 18 of them were treated with Xueshuantong (Panax notoginseng saponins) while 19 of them treated with steroid and Xueshuantong, and 25 of them treated with steroid, DF-521 and Xueshuantong.</p><p><b>RESULTS</b>The hearing improvement rate of the patients treated with Xueshuantong was 22.2% (4/18) while the patients treated with steroid and Xueshuantong was 57.9% (11/19) and the patients treated with steroid, DF-521 and Xueshuantong was 68.0% (17/25). The good improvement rate of the patients treated with Xueshuantong was 5.6% (1/18) while the patients treated with steroid and Xueshuantong was 36.8% (7/19) and the patients treated with steroid, DF-521 and Xueshuantong was 60.0% (15/25). Over hearing improvement was significantly better in patients treated with steroid, defibrinogenation and Xueshuantong than in those treated with Xueshuantong only (P < 0.05). The patients of total hearing loss had a significantly higher vertigo rate and worse therapy effect.</p><p><b>CONCLUSIONS</b>The combined therapy include high-dose corticosteroids and defibrinogenation therapy is effective for the patients with total deafness and severe all frequency hearing loss. The prognosis of patients with total hearing loss was poor.</p>

Postaurical injection of compound betamethasone to treat the intractable low-frequency sensorineural hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the treatment of compound betamethasone injection in cases with the intractable low-frequency sensorineural hearing loss (LFSNHL).</p><p><b>METHODS</b>Compound betamethasone injection 1 ml had been injected postaural only once to 23 cases with the unilateral LFSNHL, then observe the effect and follow-up at least 6 months. At the same time, the same therapy used to 4 cases with the binaural LFSNHL. The control group gave Merislon and Sibelium peroral for 2 weeks to 18 cases with the unilateral LFSNHL.</p><p><b>RESULTS</b>In unilateral LFSNHL group, twelve cases recovered, 7 cases had the hearing improved and 4 cases were ineffective in 23 cases. The efficiency was 82.6%. 2 cases (2 ears) showed hearing falling at low-frequency after 2-3 months. Others didn't recur after 6 months. 1 case showed low-grade skin atrophy at the local injection part. No other side-effects showed. In 4 binaural cases, 2 cases in effect and the others had no effect, and the former recurred after 1-2 months. In control group, 1 week after the end of therapy, 3 cases (3 ears) recovered, 1 case (1 ear) recovered 2 weeks later after the end of therapy, and the 4 cases didn't recur after 2 months. The other 14 cases were ineffective.</p><p><b>CONCLUSIONS</b>Compound betamethasone injection postaural treated intractable LFSNHL effectively, but no obvious efficiency to cases with the binaural LFSNHL. May be these cases have some relationship with autoimmune inner ear disease (AIED).</p>

Immunohistochemical discrimination of aggressivity between the cholesteatoma from different positions / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate whether the cholesteatoma from different positions have different biological characteristics.</p><p><b>METHODS</b>The expression of the Ki-67 and collagen IV in 19 specimens of cholesteatoma were stained immunohistochemically using the SP method, according to the origin of the specimens, include 7 cases from the epitympanum, 8 cases from tympanic sinus and 4 cases from the out acoustic canal. According to the severity of the inflammation in the perimatrix, the inflammation group included 7 cases, the non-inflammation group included 8 cases.</p><p><b>RESULTS</b>The average count was the same between the cholesteatoma from epitympanum and tympanic sinus. And the count of the cholesteatoma in the middle ear was also the same to the cholesteatoma from the out acoustic canal. But even from the same sample, the cholesteatoma from the positions with severe inflammation in the perimatrix count much higher, and the difference was statistically significant. Collagen IV had been found to localized in the basic membrane. In some specimens the staining of the collagen IV was not continuous.</p><p><b>CONCLUSIONS</b>The results suggested that it was the severity of inflammation in the perimatrix influenced the differences, but not the origins of the cholesteatoma.</p>