Intervention strategies for residual dizziness after successful repositioning maneuvers in benign paroxysmal positional vertigo: a single center randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the effects of different intervention strategies for the management of residual dizziness following successful canalith repositioning procedure (CRP) in patients with benign paroxysmal positional vertigo (BPPV). Methods: A total of 129 BPPV patients with residual dizziness following successful CRP were recruited during January 2019 and July 2019. They were randomly assigned into three groups with 43 cases in each group: the vestibular rehabilitation group received rehabilitation training for four weeks; betahistine group was given orally 12 mg betahistine three times a day for four weeks; and the control group had no specific treatment. The primary outcomes were daily activities and social participation assessed by the Vestibular Activities and Participation measure (VAP). Secondary outcomes includedbalance function assessed by sensory organization test (SOT) and the duration of residual symptoms. Stata15.0 software was used for statistical analysis. Results: The scores of VAP in the three groups decreased over time, but a more significant decrease was found in vestibular rehabilitation group. Further paired comparison showed that the difference between the vestibular rehabilitation group and the control group was of statistical significance (B=-3.88, χ2=18.29, P<0.01), while the difference between the betahistine group and the control group was not statistically significant (B=-0.96, χ2=1.16, P=0.28). The balance function of the three groups showed a trend of recovery over time, with no significant differences between groups (χ2=1.37, df=2, P>0.05). The median duration of residual dizziness for both vestibular rehabilitation and betahistine groups was 14 days, while that of control group was 19 days, with no significant difference between three groups[Log-rank (Mantel-Cox) test; χ2=1.82, df=2, P=0.40]. Conclusion: Vestibular rehabilitation can significantly improve the daily activities and social participation function in BPPV patients with residual symptoms following successful CRP, but its effects on shortening the duration of residual symptoms and promoting the recovery of balance function remain uncertain.

Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus

OBJECTIVES: To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography. METHODS: Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months. RESULTS: Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided. CONCLUSION: Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.

Effect of sigmoid sinus plasty in sigmoid sinus original pulsatile tinnitus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and management of venous original pulsatile tinnitus associated with sigmoid sinus.</p><p><b>METHODS</b>A retrospective study was conducted on 12 patients who were diagnosed with venous original pulsatile tinnitus associated with sigmoid sinus, and treated with sigmoid sinus constriction surgery. The diagnostic evidences for venous original pulsatile tinnitus associated with sigmoid sinus were re-evaluated, the pulsatile tinnitus improvements and MRV study results before and after surgeries associated with sigmoid sinus were compared.</p><p><b>RESULTS</b>Eleven patients got relief of tinnitus within three months after the surgeries, while one patient had no relief. There were ten patients underwent MRV study, the cross-sectional area of the sigmoid sinus in the healthy side was about two times in the tinnitus side. Constriction sigmoid sinus was performed on the twelve patients. The cross-sectional area of the sigmoid sinus of relieved tinnitus patients were compressed by forty-six percent to eighty-three percent. None of the cases complained of any serious complications.</p><p><b>CONCLUSIONS</b>Sigmoid sinus constriction is an available therapy for pulsatile tinnitus at present. More cases and longer follow-up are necessary to evaluate its treatment effect accurately.</p>

Assessment of middle ear effusion and audiological characteristics in young children with adenoid hypertrophy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy. The aim of this study was to assess the middle ear effusion and audiological characteristics in children with adenoid hypertrophy and compare the various assessment methods.</p><p><b>METHODS</b>Two hundred and seven candidates who were to undergo adenoidectomy were analyzed using otoscopy, tympanometry, air-conduction auditory steady-state responses (AC-ASSR), and computerized tomography (CT) before adenoidectomy.</p><p><b>RESULTS</b>About 73.4% (304/414) of ears were confirmed to have middle ear effusion (MEE) by otoscopy; 75.4% (312/414) of ears revealed MEE by CT. CT scan correctly predicted all the myringotomy results, giving 100% accuracy on the diagnosis of MEE. Additionally, CT revealed two children with inner ear malformations. Type B tracing tympanogram provided a sensitivity of 91.7% and a specificity of 92.2%. Type C tympanogram with peak pressure < -200 daPa indicated effusion; type C tympanogram having acoustic stapedius reflex could exclude MEE. We excluded the AC-ASSR results of the 4 ears with malformation; 54.4% (223/410) of ears were confirmed of hearing loss. Furthermore, 5.2% (16/310) of the ears with MEE suffered from severe to profound hearing loss. The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5, 1, 2, and 4 kHz (P < 0.001) frequencies; 29.7% (92/310) of ears with MEE were regarded as normal hearing level. About 55.8% (173/310) of ears with MEE were classified as having slight-mild hearing loss.</p><p><b>CONCLUSIONS</b>The practitioners should pay much attention to the middle ear condition and be aware of a possible development of severe to profound hearing loss during the course of MEE in young children with adenoid hypertrophy. CT scan is good for the assessment of MEE before ventilation tube insertion.</p>

Normative data and clinical practice of sinusoidal harmonic acceleration test / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish the normative data of sinusoidal harmonic acceleration test (SHAT) and evaluate the value of clinical application.</p><p><b>METHODS</b>One hundred and twenty normal persons, 21 Meniere's disease patients, 2 bilateral vestibular peripheral lesion patients, 15 unilateral vestibular peripheral lesion patients and 10 central lesion patients were tested with SHAT.</p><p><b>RESULTS</b>The calibration time was longer in the older persons. The phase decreased with the frequency, and the gain increased with the frequency, but the reliability of the re-test of the phase was better in the lower frequency. The results of the 7 Meniere's disease patients without symptoms were normal, 14 patients post-attack revealed abnormal, 11 had phase abnormal, 3 had gain decrease, 10 revealed asymmetry and spontaneous nystagmus simultaneously, 8 patients had two parameters abnormal. The unilateral vestibular peripheral lesion patients showed 73% (11/15) phase abnormal, 67% (10/15) gain decrease and 40% (6/15) asymmetry, while 5/6 asymmetry patients had spontaneous nystagmus. The gain of the bilateral vestibular peripheral lesion patients showed severe decrease. The abnormal rate in central lesion patients were 70% (7/10) in phase, 20% (2/10) in gain and 40% (4/10) in asymmetry, but the patients with asymmetry had no spontaneous nystagmus.</p><p><b>CONCLUSIONS</b>The normal range of the phase, gain and asymmetry of SHAT is in narrow bandwidth. The phase is the most important abnormal sign.</p>

Langerhans cell histiocytosis of the temporal bone: 22 cases analysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical manifestations, diagnosis, therapy and prognosis of Langerhans cell histiocytosis (LCH) of the temporal bone.</p><p><b>METHODS</b>Twenty-two patients with LCH of the temporal bone in our hospital were retrospectively summed up from January 1994 to January 2008. Following up 1 - 15 years, their clinical manifestations, diagnosis, therapy and prognosis were studied. Survival analysis and disease free survival Log-rank test were used.</p><p><b>RESULTS</b>Among 22 patients, 1 case belonged to the multisystem high risk group, 3 cases to the multisystem low risk group, and 18 cases to the single system group. The clinical characters were primarily the ear presentations, CT of the temporal bones showed extensive osteolytic destructions. The misdiagnosis rate was 72.7%. Twenty-two cases were received different combined modality therapies. Following up 1 - 15 years, 21 cases were survival and 1 case dead (4.5%), while 5 cases showed residual of insipidus, dwarfism, epilepsy or unilateral serious hearing loss (22.7%). For disease free survival curve, there was a significant difference between the multisystem group and the single system group (chi(2) = 5.87, P < 0.05).</p><p><b>CONCLUSIONS</b>As LCH of the temporal bone, the single system cases are predominant. The ear area clinical manifestations are primary. This disease is easily misdiagnosed. The therapy selection should rely on the involved systems of the disease. The prognosis of the single system group is much better than the multisystem group.</p>

High-frequency rotation sensation function damage of the crista of the horizontal semicircular canal induced by gentamicin and its morphological basis / 生理学报

The goal of the present study was to explore high-frequency rotation sensation function damage of the crista of the horizontal semicircular canal induced by gentamicin and its morphological basis. The guinea pigs were randomly divided into four groups (group 1, 2, 3 and control group, n=20). The animals of treated groups received gentamicin subcutaneously (50 mg/kg per day) for 1 week (group 1), 2 weeks (group 2) and 3 weeks (group 3), respectively. The animals of control group were administered with equal volume of saline subcutaneously. Videonystagmography (VNG) evoked by ice water or high-frequency rotations, and vestibular evoked potential (VsEP) evoked by low- and high-frequency rotations were recorded after the administration. After VNG and VsEP were examined, the cristae of the horizontal semicircular canals were prepared for scanning and transmission electron microscopy. The results are as follows: (1) In VNG examination, after ice water stimulation, no obvious nystagmus was observed in the animals of group 3, and there was no significant difference in nystagmus frequency and duration among group 1, 2 and control group (P>0.05). After high- frequency rotations, no obvious nystagmus was yet observed in the animals of group 3. There were significant differences in the nystagmus frequency and duration of the VNG waves between the experimental group 2 and control group (P<0.01), and no difference was found between group 1 and control group (P>0.05). (2) In VsEP examination, there was no significant difference in the parameters of VsEP among group 1, 2 and control group (P>0.05), and VsEP was not observed in group 3 after low-frequency rotations. After high- frequency rotations, compared with control group, the latencies and amplitudes of P1 and P2 in group 2 significantly decreased (P<0.01), while no changes were found in group 1 (P>0.05). Group 3 had no response of VsEP to high-frequency rotations. (3) Electron microscopy was used to observe the crista hair cells of the four groups. In control group, the hair cells were normal. In group 1, almost normal appearance with slight edema of the hair cells was shown. In group 2, some hair cells in the central top of the crista necrosed, but other hair cells in the peripheral area showed normal appearance. In group 3, vestibular hair cells were entirely impaired or necrosis. These results show gentamicin selectively induces high-frequency rotation sensation function damage of the crista of the horizontal semicircular canal. The damage is concentrated on the central top area and then subsequently extended to the peripheral area of vestibular crista. It can be inferred that the hair cells in the central top area of the crista are involved in high-frequency rotation vestibular perception.