The Rehabilitation Effects of the Cochlear Implantation on Prelingually Deaf Children with Alba Abnormality / 听力学及言语疾病杂志

Objective To study the rehabilitation effects of the cochlear implants on prelingually deaf children with alba abnormality.Methods A retrospective analysis of the effects of CIs was conducted in the prelingually deaf children of 11 cases of the children with abnormal alba(the research group) and 18 cases of the children who had normal alba(the control group) at the First Affiliated Hospital of Fujian medical university.All the operations were completed by the same doctor.There were no obvious complications during and after the operation.The cochlear implants were turned on after one month and the prelingually deaf children with extremely severe bilateral sensorineural deafness were trained for speech at the rehabilitation centre.The assessment criteria of the categories of auditory performance(CAP) and speech intelligibility rate(SIR) were used.After six months and twelve months of the operation, the family members were followed who have direct contacts with the children.The evaluation of data between the research and the control groups was administered.Results In the research group, the average level of CAP after six months'' post-operation was 2.41±0.47.But in the control group, the average level was 3.28±0.45.In the research group, the average level of SIR after six months'' post-operation was 1.27±0.44.There were 3 children in the research group at level 2, but in the control group, the average level was 1.89±0.31.Two children in the control group were level 1 while the others were level 2.In the research group, the average level of CAP after twelve months'' post-operation was 4.00±0.43 while only one child at level 3.There was one child at level 5 in the research group, the rest were level 4.There was a statistically significant difference in the average level of the CAP after six months'' post-operation(t=4.983, P0.05) and in the average level of the SIR after twelve months'' post-operation(t=0.434, P>0.05).Conclusion There is no significant difference of the rehabilitation effects of post-operation between the prelingually deaf children with alba abnormality and those with normal alba.

Analysis of clinical risk factors of the deep space neck absces / 中国耳鼻咽喉头颈外科

OBJECTIVE To identify the clinical risk factors related to the increasing likelihood of surgical drainage and the medical therapy failure in deep space neck abscess. METHODS The clinical data of 111 consecutive patients from January 2009 to June 2016 with deep space neck abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors by stepwise forward regression. RESULTS All patients had successful resolution of their infections by medical therapy and(or) surgical drainage. At the level of α=0.05, dyspnea was the risk factor of increasing likelihood of surgical drainage (β=3.001, OR=20.099); the maximum dimension of abscess>2.0 cm was not only the risk factor of increasing likelihood of surgical drainage(β=2.396, OR=10.979), but also that of medical therapy failure(β =4.618, OR=101.313). Age, sex, white blood cell count at presentation, fever, diabetes, neck swelling, and multiple space abscess of neck did not increase the risk of surgical treatment (P>0.05, respectively). CONCLUSION Active preoperative preparation and surgical intervention should be used with those who have dyspnea and the maximum dimension of abscess >2.0 cm as soon as possible. However, those who without dyspnea and abscess size less than or equal to 2.0 cm may be recovered without incision and drainage of operation by only sufficient and effective intravenous antibiotics treatment under close guarded surveillance.

The significance of keratinocyte in hyperproliferation of middle ear cholesteatoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#In order to investigate the interaction between the cytokines and keratinocyte and determine the role of cytokines in hyperproliferative of chronic otitis media with cholesteatoma, we observe the expression of matrix metalloproteinase 9 (MMP9), vascular endothelial growth factor (VEGF), keratinocyte growth factor (KGF) and its receptor (KGFR) in middle ear cholesteatoma.@*METHOD@#We examined the expression of MMP9, VEGF, KGF, KGFR and Ki-67 by immunohistochemistry in 50 specimens from chronic otitis media with cholesteatoma and 15 specimens from the normal skin of external auditory meatus. Ki-67 as an evaluation of cholesteatoma proliferation markers were used to detect the keratinocyte proliferative activity.@*RESULT@#(1) The expression of VEGF and MMP9 in cholesteatoma specimens was higher than normal skin, and the difference was statistically significant (t = 4.914, P < 0.01; t = 3.284, P < 0.01). (2) The expression of KGF and KGFR in middle ear tissues was higher than normal skin, and the difference was statistically significant (t = 4.814, P < 0.01; t = 3.104, P < 0.01); The expression of KGF and KGFR increased, and the expression of Ki-67 also correspondly increased in the cholesteatoma. (3) In the tissue MMP9 and VEGF were positive. Mean optical density increased as well. KGF expression also increased accordingly.@*CONCLUSION@#MMP9, VEGF, KGF and KGFR proteins played an important role in hyperproliferation of cholesteatoma tissues. VEGF, MMP9 and KGF had a synergistic effect in hyperproliferation of cholesteatoma tissues.

Clinical features of sudden sensorineural hearing loss accompanied with inner ear hemorrhage / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, diagnosis and prognosis of sudden sensorineural hearing loss accompanied with inner ear hemorrhage.</p><p><b>METHODS</b>Eleven cases of sudden sensorineural hearing loss accompanied with inner ear hemorrhage were retrospectively analyzed, including clinical manifestation, hematological and audiological examinations, as well as characteristics of inner ear three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).</p><p><b>RESULTS</b>Eleven cases of sudden hearing loss with inner ear hemorrhage were accompanied by varying degrees of vertigo, lasting from several minutes to several hours, nine of whom had persistent tinnitus. The audiometry curves of the 11 cases included total deafness or flat descending type. The inner ear 3D-FLAIR MRI studies revealed abnormal high signals at different positions of the inner ear, one case with endolymphatic hydrops. After the treatment, seven cases were invalid, two cases had notable effect, and two cases were effective.</p><p><b>CONCLUSIONS</b>Abnormal high signals in the inner ear were sensitively detected by 3D-FLAIR MRI sequence, which was applied for the diagnosis of the sudden hearing loss accompanied with inner ear hemorrhage. The effect of conventional treatment was not good and the appropriate treatments for this type of sudden hearing loss need further investigation.</p>

Imaging and audiology analysis of the congenital inner ear malformations / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate imaging and audiology features of temporal bone and analyze the classification and prevalence of inner ear abnormalities in children with sensorineural hearing loss.@*METHOD@#Children who were diagnosed with sensorineural hearing loss were examined by high resolution CT and the inner ear fluid of MRI. And each chart was retrospectively reviewed to determine the imaging and audiology features.@*RESULT@#There were 125 patients(232 ears) found with inner ear malformation in 590 children with SNHL. About 21.71% of the inner ear malformation occurred in severe and profound hearing loss ears, and 12.85% occurred in r moderate hearing loss ears. The inner ear malformation rate in normal hearing ears were 13.59%.@*CONCLUSION@#CT and MRI examinations of temporal bone are important diagnostic tools to indentify inner ear malformations. Inner ear malformations are almost bilateral and hearing loss are profoud. Cochleo-vestibular malformations and large vestibular aqueduct are the 2 most frequent deformities. Among the children with SNHL, deformity rate in the severe and profound hearing loss ears is higher than that in moderate hearing loss ear. Inner ear malformations can exist in people with normal hearing.

Research in grounded theory of postoperative pain management among the surgical nurses / 中国实用护理杂志

Objective To find out the nurse's cognitive level of the postoperative pain management and its relevant elements,and influence of intervention measures on their postoperative pain management,so that can provide a theoretic basis for a more effective postoperative pain management.Methods The grounded theory research method taken from qualitative research Was mainly used,and triangulation was applied in collecting the information,such as observational method,interviewing method among nurses and collecting questionnaire among nurses and patients.In addition,the information was analyzed by using the constant tomparative method,generalized the relative elements influencing the postoperative pain managemen,summarized the intervention measure.In the end.analyzed comparatively the change of the nurses'knowledge and behavior of the postoperative pain management before and after intervention.Results Surgical nurses'knowledge and behavior of the postoperative pain management was improved in various degrees.The difference of the data has statistical significance.Satisfaction degree of patients improved and the theoretical model included conceptual structure,contributory factors and results.Conclusions The advance of the surgical nurse's self-awareness can improve the level of the postoperative pain management.

The expression of receptor activator nuclear factor-kappaB ligand and osteoprotegerin in cholesteatoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the expression of receptor activator nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) in cholesteatoma and to determine their roles in the destruction of bone. To observe the role of osteoclasts in bone destruction.@*METHOD@#Immunohistochemical technique and computer image analysis were used to examine the expression of RANKL and OPG in 27 cholesteatoma and 11 normal tissue respectively.@*RESULT@#RANKL was expressed mainly in promatrix cells, including fibroblasts and foam cells. OPG was expressed both in epithelium and promatrix cells. The results of the computer image quantitative analysis showed that the mean optical density of RANKL and the ratio of RANKL/OPG in cholesteatoma were higher than that in normal skin epithelial tissue (P0.05).@*CONCLUSION@#The overexpression of RANKL and the increased ratio of RANKL/OPG in cholesteatoma are associated with the destruction of bone. Osteoclasts is possible mediator of osteolysis.

Early diagnosis and treatment of the tympanic isthmus obstruction / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the treatment and diagnosis of early tympanic isthmus obstruction and dysfunction of eustachian tube.@*METHOD@#Three hundred patients (338ears) suffering from early tympanic isthmus obstruction were examinated and observed from 1991 to 2004, and were injected triamcinolone into tympanic cavity at the position of hypokinesis or blockaded the external acoustic meatus according to different state of the illness.@*RESULT@#Two hundred and sixty of three hundred case were cured, thirty cases were improved, ten cases were inefficacy.@*CONCLUSION@#Tympanic isthmus obstruction is a pathognostic type of secretory otitis media. There is significant difference between tympanic isthmus obstruction and secretory otitis media caused by dysfunction of eustachian tube. Prolonged tympanic isthmus obstruction is a reason of primary cholesteatoma of epitympanum's pathogeny. It is important to diagnose and treat of the tympanic isthmus obstruction early.

The morphological study of eroded auditory ossicles by cholesteatoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the morphology of eroded auditory ossicles obtained in middle ear surgery for cholesteatoma and to investigate the mechanism of bone erosion in cholesteatoma.@*METHOD@#The morphology of eroded auditory ossicles in 8 cholesteatoma cases and 2 normal cases were observed with light microscopy. The ultrastructure of eroded auditory ossicles in 5 cholesteatoma cases and the ultrastructure of control bones in external ear canal of 2 cases were observed and compared with transmission electron microscopy.@*RESULT@#Osteomyelitis and multinucleate osteoclasts with ruffled borders were observed in the eroded auditory ossicles of cholesteatoma. Intramembranous and endochondral ossification were both observed. The obvious bone destruction and remodeling were observed consistently.@*CONCLUSION@#Osteoclasts and Osteomyelitis are both responsible for bone destruction in cholesteatoma. Intramembranous and endochondral ossification may co-participate in bone remodeling. Osteogenesis is also a basic pathologic phenomena in cholesteatoma. The obvious bone destruction and remodeling can coexist in cholesteatoma cases.