Study on the concordance of objective multi-parameters analysis and perceptual evaluation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Through exploring the concordance of objective multi-parameters analysis and perceptual evaluation, to establish an objective multi-parameters evaluation protocol of voice disorder and to make the evaluation of voice objectification and quantification.</p><p><b>METHODS</b>Voice samples from 271 patients (124 female and 147 male)with dysphonia and 69 control subjects with normal voice (37 female and 32 male)were recorded and assessed by a jury composed of 5 experts in phoniatrics from different hospitals. The jury was instructed to classify voice samples according to the G (grade) component of the GRBAS scale on a visual analogue scale secondarily transformed in a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. The voice samples were unified sentences and ordered randomly 3 times, the mean of 3 evaluation scores were the final results. The objective parameters, including fundamental frequency (F0), jitter, shimmer, fundamental frequency standard deviation (F0SD), normalized noise energy (NNE), harmonic-to-noise ratio (HNR) and maximal phonatory time (MPT), were measured on a 2-second sustained vowel/a/including its initial segment, using the software Dr. Speech for Windows. The data were analyzed using SPSS11.0.</p><p><b>RESULTS</b>All objective parameters except for F0 had high correlation with G and the variance tendency of these parameters values was coherent with the extent of voice disorder. And there were statistical differences between adjacent voice disorder groups. Male and female objective multi-parameters protocols were established respectively consisting of jitter, shimmer, F0SD, NNE, HNR and MPT using discriminant analysis (P < 0.05). The concordance between perceptual evaluation and objective multi-parameters evaluation was 81.6% in male and 83.2% in female. The concordance of evaluation of normal voice and severe voice disorder groups were better than that of mild and moderate voice disorder groups. All mis-grading voices were judged in the adjacent voice group.</p><p><b>CONCLUSIONS</b>The objective parameters of voice are able to reflect the characteristic of its perceptual evaluation and the concordance between perceptual evaluation and objective multi-parameters evaluation is good. The objective multi-parameters evaluation protocol we established could provide an objective and quantitative evaluation method for voice disorders.</p>

Three cases of primary squamous cell carcinoma in the frontal sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Three cases of primary squamous cell carcinoma in the frontal sinus were reported, and the experience obtained from diagnosis, treatment of this rarely seen tumor was presented.</p><p><b>METHODS</b>Between August 2006 and January 2010, 3 cases of primary squamous cell carcinoma in the frontal sinus were diagnosed and treated including one case of basaloid squamous carcinoma, one moderately differentiated squamous cell carcinoma and one papillary squamous cell carcinoma. All 3 cases were treated with a combined approach using the endoscope and a frontal craniotomy, followed by radiotherapy and chemotherapy.</p><p><b>RESULTS</b>Case one developed multiple metastatic carcinoma lesions along the coronal incision inside the hairline. She received radiotherapy and chemotherapy, but died 16 months after surgery. Case 2 was found to have tumor recurrence in the left frontal sinus and orbit 40 days after surgery during his course of radiotherapy. Salvage surgery (orbital exoneration and tumor resection) was performed and radiotherapy and chemotherapy continued. Three months later, he was found to have bone metastasis and died 10 months after the first surgery. The third case developed orbital apex syndrome and loss of vision on the right side immediately after surgery. Fourteen months after surgery and radiotherapy, she was found to have tumor recurrence in the frontal sinus with intracranial invasion. She refused a second surgical procedure and is still alive with tumor 21 months after her operation.</p><p><b>CONCLUSIONS</b>The prognosis for patients with frontal sinus carcinoma remains extremely poor. Early detection and extended surgical resection combined with radiotherapy and chemotherapy are needed to improve the survival rates of patients with frontal sinus carcinoma.</p>

Endoscopic surgery for advanced malignant nasal and sinus tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of endoscopic surgery for advanced malignant tumors in the nasal cavity and paranasal sinuses.</p><p><b>METHODS</b>A retrospective data analysis was performed on 49 patients with advanced sinonasal tumors undergoing either an exclusive endoscopic approach or with a complemental approach from January 2004 to October 2010. Forty-nine patients were considered eligible for the present analysis, among them, T3:T4a:T4b were 12:13:24 (T stage was assessed with the sixth editions of the UICC staging systems). The histotypes encountered were squamous cell carcinoma 20 cases, adenocarcinoma 12 cases, mucosal melanoma 8 cases, olfactory neuroblastoma 6 cases, others 3 cases. These patients were operated on either by an exclusive endoscopic endonasal approach or with a complementary external approach; 36 patients received adjuvant radiotherapy or/and chemotherapy. The data were analyzed by Kaplan-Meier method and Log-rank test.</p><p><b>RESULTS</b>The hemorrhage varied from 200 to 5000 ml during the operation, with an average of 600 ml. The post-operative complications were rare, 1 patient lost her sight after operation, and no patient got infected at the site of operation (nor intracranial infection). After full amount of radiotherapy, no cerebrospinal fluid rhinorrhea was found. Four patients (8.2%) lost to follow-up. Sixteen patients died during the follow-up period, only three of them were without craniocerebral or orbital invasion. Four in 9 patients in the other pathological group (with the pathology of olfactory neuroblastoma or glioma etc), which had a poor prognosis, died during the follow-up period, of them, 3 had definitive evidence of intracranial metastasis, and none of the nine patients had been followed-up beyond 25 months. The 2 and 3 year disease-free rates were 34.2% and 21.4%, and overall survival rates were 62.5% and 58.4% respectively. The T stage, margin status, and whether accepted post operative adjuvant therapy were significant factors in predicting disease recurrence (χ² were 7.7, 4.9, 6.8 respectively and P < 0.05).</p><p><b>CONCLUSIONS</b>Now the endoscopic techniques with or without complementary approaches is an effective way for complete tumor removal. With postoperative complementary therapy, it provides a satisfactory survival rate with few side effects and better quality of life.</p>

Investigation of surgical managements of olfactory neuroblastoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of transnasal endoscopic resection and craniofacial resection through an external approach for olfactory neuroblastoma (ONB).</p><p><b>METHODS</b>Thirty two patients with ONB treated between 1987 and 2006 were retrospectively reviewed.</p><p><b>RESULTS</b>The patients were followed up for 8-135 months, the median follow-up time was 20 months. The longest follow-up time of patients treated by endoscope was 79 months, and patients treated by combined endoscope and transcranial surgery was 87 months. At Kadish stage B the 3-year survival rate of patients with transnasal endoscopic resection was 78.8% and at Kadish stage C it was 50.0%. At Kadish stage B the 3-year survival rate of patients with craniofacial resection through an external approach was 60.0% and at Kadish stage C it was 44.4%. The bleeding amounts in above two approaches were 140 ml and 450 ml. The average length of stay in hospital in transnasal endoscopic resection approach was markedly reduced (P < 0. 01).</p><p><b>CONCLUSIONS</b>Olfactory neuroblastoma can be safely and effectively excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. The time of stay in hospital can be reduced and the surgical trauma can be diminished.</p>

Management of inverted papilloma in frontal sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce the experience of management of inverted papilloma in frontal sinus in hospital.</p><p><b>METHODS</b>Six patients with inverted papilloma in frontal sinus treated between 1999 and 2006 were reported, with special emphasis on the clinical symptoms, surgical technique and prognosis.</p><p><b>RESULTS</b>Among 6 patients with frontal sinus involvement, there were 5 males and 1 female, aged between 24 and 66 years. All 6 patients were managed with endoscopic resection and additional open approach (glabellar nasal keyhole approach). Follow-up ranged from 2 -8 years. Five patients treated with this protocol remained disease free, and 1 patient died of tumor recurrence and malignant degeneration 16 years after the first surgical management of sinonasal inverted papilloma.</p><p><b>CONCLUSIONS</b>The appropriate management of inverted papilloma involving the frontal sinus is combined open/endoscopic approach. The tumor extended into the lateral, far superior, and anterior aspects of the frontal sinus is truly at the limits of current endoscopic instrumentation. In order to avoid recurrence, the tumor must be resected completely during the operation. Postoperative radiotherapy is not absolutely necessary.</p>

Endoscopic surgery in occupation lesions of the skull base / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the application of endoscopic endonasal approach in surgery for occupation lesions of the skull base.</p><p><b>METHODS</b>Forty-two cases of skull base lesions treated by endoscopic endonasal surgery were analyzed retrospectively. There were 13 malignant tumors in anterior or middle cranial fossa, 8 chordoma, 5 invasive pituitary adenoma, 4 fibrous dysplasia of the sphenoid bone, 3 neurofibroma, 3 fibroangioma, 3 ossifying fibroma and 3 other lesions.</p><p><b>RESULTS</b>Lesions were removed completely in 36 patients, 2 of them were performed in two stages because of sever bleeding, and subtotally in 6 patients. The complications included 1 acroisa of right eye and 1 cerebrospinal fluid otorrhea. Follow-up ranged 6 to 81 months after the surgery. Five patents were lost of follow-up. Eight patients recurred and 6 patients died.</p><p><b>CONCLUSIONS</b>The endoscopic transnasal surgery is a safe, effective and minimally invasive approach to resect skull base lesions in condition of indications, surgeon's experience and the facilities.</p>

Diagnosis and treatment of olfactory cleft diseases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of the diseases originated in the olfactory cleft.</p><p><b>METHODS</b>Eight consecutive patients with the diagnosis of olfactory cleft diseases, encountered between December, 2003 and May, 2006, were included in this retrospective study. On the basis of case reports, the related anatomy, diagnosis and treatment of olfactory cleft diseases were discussed.</p><p><b>RESULTS</b>For the 8 patients with olfactory cleft diseases, the clinical and pathological diagnosis were as follows: adenocarcinoma, squamous cell carcinoma, inverted papilloma, glioma with cerebrospinal fluid (CSF) rhinorrhea, pyocyst of the superior turbinate, angiofibrosteoma, neurofibroma and hemangioma. All patients were treated by endoscopic surgery. Postoperative radiotherapy was given to two patients with malignant tumour.</p><p><b>CONCLUSIONS</b>The diseases in the olfactory cleft are not uncommon, which are often overlooked. In order to avoid misdiagnosis, (1) it is important to pay attention to this specific anatomic area; (2) the particularity of olfactory cleft diseases should be emphasized, especially in the cases of huge tumors. In that cases, the primary sites of olfactory cleft tumors can not be correctly judged preoperatively by CT scans, which can only be found during endoscopic surgery. For the treatment of olfactory cleft diseases, surgery under endoscope is the treatment of choice. If the tumor is malignant, postoperative radiotherapy should be added.</p>

Mizolastine improves the quality of life in patients with perennial allergic rhinitis: a randomized, double blind, controlled study / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the effect of Mizolastine on quality of life (QOL) in patients with perennial allergic rhinitis.</p><p><b>METHODS</b>A randomized, double-blind, placebo-controlled study was carried out with Mizolastine in sixty patients with perennial allergic rhinitis. QOL was measured by using the Medical Outcome Study Short-Form Health Survey (SF-36) questionnaire (Chinese version). Mizolastine (10 mg once daily, 26 patients), Cetirizine (10 mg once daily, 22 patients) or placebo (12 patients) was given for 3 weeks. The SF-36 questionnaire was administered at the start of treatment and after 1 and 3 weeks of treatment. Symptom-medication scores were measured daily during the study.</p><p><b>RESULTS</b>After the run-in period (baseline), there were no significant differences among the Mezolastine, Cetirizine and placebo groups in terms of symptoms or QOL scores. After 1 and 3 weeks of treatment, symptoms scores were significantly decreased and QOL scores significantly improved in the Mezolastine group and Cetirizine group in comparison with the placebo group ( both P < 0.001, chi2 test). All of the eight QOL dimensions were significantly improved (from P = 0.001 to P < 0.0001, F test) after 1 and 3 weeks of Mizolastine treatment compared with placebo. There was no improvement in the placebo group.</p><p><b>CONCLUSIONS</b>Mizolastine can not only decrease symptoms scores but also improve the QOL in patients with perennial allergic rhinitis. Placebo can relieve the symptoms but can not improve the QOL.</p>

Transseptal endoscopic excision of nasal dermoid sinus cyst / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Surgery is the curative treatment for nasal dermoid cysts. Many different surgical incisions have been advocated. All approaches described have the advantage of either improved accessibility or improved patients'cosmetic satisfaction, but none is optimal. We designed a new transseptal endoscopic approach for the treatment of nasal dermoid sinus cyst and reported the result of a special case.</p><p><b>METHODS</b>The diagnostic studies, the operative technique, and the result of 18 month follow-up were presented.</p><p><b>RESULTS</b>The patient, a 16 years old girl, remains free of disease 18 months after surgical treatment, most importantly without facial scar.</p><p><b>CONCLUSIONS</b>Transseptal endoscopic approach is an alternative surgical technique for selected nasal dermoid cysts. So far as we know, the operative method presented in the current report is the first surgical approach reported in the world literature.</p>