A comparative study of venlafaxine vs. paroxetine in treatment of peripheral vertigo patients with anxiety and depression / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the efficacyof venlafaxine vs. paroxetine in treatment of peripheral vertigo patients with anxiety and depression. METHODS 180 peripheral vertigo patients with anxiety and depressionwere randomly divided into venlafaxine group(90cases) and paroxetine group(90cases), and were treated respectively for 6 weeks. The patients were assessed by Dizziness Handicap Inventory(DHI), Hamilton Depression Scale24(HAMD) and Hamilton Anxiety Scale(HAMA) before and after the treatment at the 2nd, 4th and 6th week respectively. The clinical efficacy of the two drugs was evaluated according to the reduction rate before and after the treatment. RESULTS Atthe 2ndweek, the scores of HAMA in venlafaxine group was lower than paroxetine groupstatistically(P0.05). The scores of DHI were decreased in both groups(P<0.05), and index p in venlafaxine group was lower than paroxetine group(P<0.05). CONCLUSION Both of them can reduce the physical symptoms and dysfunction, are effective on anxiety and depression, but venlafaxine is faster to take effect than paroxetine, and has a better patient compliance.

Study of clinical characteristics and curative effects of sudden hearing loss patients with vertigo / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics, prognosis and therapeutic effects of sudden sensorineural hearing loss (SSHL) patients associated with vertigo, and to investigate the strategy of diagnosis and treatment.</p><p><b>METHODS</b>We retrospectively analyzed the clinical characteristics of 240 patients diagnosed as SSHL with vertigo, who were treated in the Chinese PLA General Hospital from July 2008 to August 2012. Various factors affecting the therapeutic effects were analyzed, such as audiological features, vestibular function tests, genders, audiograms, lasting before seeing a doctor, courses of vertigo and vascular factors.</p><p><b>RESULT</b>Among the contemporaneous SSHL patients (873 cases), the cases with vertigo accounted for 27.49% (240/873). Among the 240 patients with vertigo, the cases with different hearing impaired degree of mild, moderate, severe and profound were 30, 13, 28 and 34, respectively, primarily by the profound cases. Detailed vestibular function tests were performed in 97 patients, with 54 cases having unilateral vestibular disfunction and 43 patients having normal vestibular function, among which 23 cases were diagnosed as benign paroxymal positional vertigo (BBPV). The relationship between vestibular function and different hearing impaired degrees or various audiogram types had no statistically significant difference. 219 cases had detailed records of the onset time of cochlear and vestibular symptoms, including 122 patients with cochlear symptoms and dizziness occurring simultaneously. After standardized drug treatment, the total effective rate was 46.67%, with recovery in 17 cases, excellent in 34 cases, better in 61 cases and poor in 128 cases, respectively. Statistical analysis showed that different genders, audiogram types, vertigo courses of time, the results of vestibular function and neck vascular ultrasounds were not related to the curative effects, while, the treatment time after onset was significantly associated with treatment effects.</p><p><b>CONCLUSIONS</b>SSHL with vertigo has a high incidence, primarily single side affected, with relatively severe hearing impairment, and total deafness and downslope hearing curve mainly. Vestibular function can be normal or low in SSHL patients with vertigo, with a higher incidence of BPPV. Vestibular and cochlear symptoms occur simultaneously in more than half of the patients. The detection rate of vestibular dysfunction gradually increased, as the degree of hearing loss increased, without statistical significance although. The therapeutic effects of sudden hearing loss with vertigo cases have no relationship with dizziness duration or vestibular function, while the disease course plays an important role in treatment.</p>

Cinical and genetic characteristics of familial Meniere's disease: three families report / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical and genetic characteristics of three Chinese Meniere's disease (MD) families and decipher the mechanism of MD further.</p><p><b>METHODS</b>Personal and family medical evidence of hearing loss, vestibular symptoms, and other clinical abnormalities of the participants were identified, clinical and genetic features were analyzed. Targeted 307 genes capture and high-throughput sequencing were performed on the two ascertained members of family 1007184.</p><p><b>RESULTS</b>Eight patients from these three families showed post-lingual sensorineural hearing loss, six women and two men were involved. Age of onset in these affected members concentrated in the middle age, with the average age of 39.3 years old. Among them, patients from 1407278 were accompanied by migraine. All of the three probands presented as recurrent vertigo firstly, and then fluctuated hearing loss showed up, accompanying by tinnitus and ear fullness feeling. The hearing loss manifested as late-onset, low frequency-involved pattern, with subsequent gradual progression from moderate to severe level. Some of the patients progressed to severe level involving all frequencies at higher ages. In addition, most of the cases showed revitalization. Four cases received vestibular function tests, three of which had varying dysfunction of vestibular function, while the other one had normal vestibular function. Patients who had abnormal vestibular function showed much more severe hearing impairment. The three-generation family 1007193 had an autosomal recessive genetic characteristics, family 1007184 showed autosomal dominant inheritance of characteristics, family 1407278 were either autosomal dominant or X-linked dominant pattern. Through target genes capture high-throughput sequencing technology, we identified two candidate variants in the two members of family 1007184, named c. 2057G>A in EGFLAM and c. 1961C>T in ITGA8.</p><p><b>CONCLUSION</b>Meniere's disease has some genetic and familial aggregation in Chinese population, but its complex genetic pathogenic mechanisms need further study.</p>

Clinical characteristics and surgical management of extensive cholesteatoma of external auditory canal / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To classify the external auditory canal cholesteatoma(EACC) by high-resolution temporal bone CT scans and the clinical findings of the patients, and to discuss the clinical and imaging characteristics and the surgical management of the extensive EACC.@*METHOD@#A retrospective study was carried out among 56 patients (58 ears) with EACC and their clinical data were carefully analyzed. We classified EACC as the extensive type and the localized type. The operation strategy depended on the extent of lesion. All cases were followed up for 1 to 6 years after surgery.@*RESULT@#There were 31 patients with localized EACC, 2 with no bone erosion and 29 (31 ears) with bone erosion within external auditory canal, and 25 patients with extensive EACC, 16 with bone erosion of intra temporal bone and 9 with bone erosion of extra temporal bone. Among all the 25 patients with the extensive type, the most common symptoms were otorrhea, otalgia and hearing loss, with 25, 23, 22 cases, respectively. The tympanic membrane (TM) was intact in 23 patients and perforated in two. The mastoid air cells in 23 patients were involved by the lesion, as well as tympanic antrum in eight, tympanic cavity in two, sigmoid sinus bony wall in five, mastoid segment of facial canal in four, and temporomandibular joint in two patients. Twenty patients underwent modified radical mastoidectomy, only one underwent reconstruction of ossicular chain, and four underwent canaloplasty. The average time of ear dry after surgery was 29 days. The postoperative hearing was improved by an average of 15 dB. No recurrence except for one patient was found during the follow-up period.@*CONCLUSION@#It was of important clinical significance to classify EACC as the extensive type and the localized type. The extensive EACC was misdiagnosed easily because of the complicated clinical manifestations. The classification was helpful for the diagnosis and the selection of surgery strategy of EACC.

Anatomical measurements and clinical applications through facial recess approach / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To provide the anatomic data for the correlated otologic microsurgery by the microdissection of temporal bone through facial recess approach.@*METHOD@#Sixteen human temporal bones of eight adult cadaveric heads were dissected under surgical microscope through facial recess approach, and the relative anatomic structures were observed and measured, such as the bony entrance of facial recess approach, facial nerve, stapes, round window, round window niche, pyramidal eminence, cochleariform process, etc. The data were analyzed statistically.@*RESULT@#The width of the bony entrance of facial recess approach was (2.94 +/- 0.32) mm, the height was (8.83 +/- 0.84) mm, the depth was (3.51 +/- 0.17) mm. The distances from stapes to tympanic segment of facial nerve, mastoid segment of facial nerve, round window, cochleariform process and anterior ligament of malleus were (1.38 +/- 0.21) mm, (6.94 +/- 0.47) mm, (3.60 +/- 0.55)mm, (2.23 +/- 0.33)mm, (4.93 +/- 0.61) mm, respectively. The distances from pyramidal eminence to tympanic segment of facial nerve, mastoid segment of facial nerve, round window, round window niche and cochleariform process were (1.05 +/- 0.09) mm, (5.63 +/- 0.41) mm, (3.01 +/- 0.34) mm, (3.29 +/- 0.44) mm, (4.13 +/- 0.51) mm, respectively. The distances from round window to cochleariform process and tympanic segment of facial nerve were (5.11 +/- 0.61) mm and (3.97 +/- 0.61) mm. The distances from round window niche to tympanic segment of facial nerve and mastoid segment of facial nerve were (4.13 +/- 0.38) mm and (7.28 +/- 0.29) mm.@*CONCLUSION@#The facial recess approach played an important role in modern otologic microsurgery. The position of anatomical structure was constant relatively, including short crus of incus, stapes, pyramidal eminence and cochleariform process, etc. These could be used as reference marks for otologic microsurgery.

Law of spatial direction changes in the view of endoscope simulated by SketchUp software / 中国组织工程研究

The endosopic imaging was simulated using SketchUp software, and the preliminary definitions of the visual relative quantity space (VRQS), visual absolute quantity space (VAQS), and visual space scale unit (length) VSSU (VSUL) were made to discuss characters of them; With the elevation angle or the distance of the endoscope entering the nasal cavity changed, the law and the cause of the spatial directions in the visual field of the endoscope were analyzed by the theory of VRQS, VAQS, and VSSU (VSUL). The perspective law in the 0° VRQS is: With the distance to the visual point nearer, the length of the VSSU in the view of the endoscope is longer. If the distance of the endoscope entering the model is increased only, the position of the spatial direction in the view of the endoscope shows the repeatable and substituted characteristics. If the elevation angle of the endoscope is changed only, the spatial directions in the view are changed. The change of the spatial directions in the view could be explained by the theory of VRQS, VAQS, and VSSU (VSUL). The change of the elevation angle of the endoscope can caused the change of the spatial directions in the view. The spatial directions in the view of the endoscope have the repeatable and substituted characteristics; the theory of VRQS, VAQS, and VSSU (VSUL) can completely explained the changes of the spatial directions, which provides a good basis for the operations and the further research.

Repeatable characteristics of the spatial directions in the view of the endoscope / 中国耳鼻咽喉头颈外科

OBJECTIVE To know the principles of the transformations of the spatial directions in the view of the 0~ sinus endoscope and to simulate the space in endoscope using SkechUp software. METHODS The ideal model of the nasal cavity was designed and observed by the 0?rod-lens telescope. The space of the model in the endoscope was simulated using SkechUp.The principles of the transformations of the spatial directions were observed,which consisted of the lateral horizontal line (Lhn,n=0-6),the lateral vertical line (Lvn,n=0-9),the top horizontal line (Thn, n=0-9) and the lateral angle line (LAL).The location of the horizon was observed.RESULTS If the elevation angle (between the endoscope and bottom of nasal cavity) of the endoscope entering the model was unchanged and the distance of the endoscope entering the model was increased gradually,the positions of Lhn,Lvn and Thn in the visual field of the endoscope were replaced by Lh (n+1),Lv (n+1) and Th (n+1) respectively.The positions of Lhn,Lvn and Thn had repeatable characteristics.One horizontal plane in the space can become a horizon in the view and the location of the horizon in the view was invariable.If the distance of the endoscope entering the model was unchanged,the endoscope was moved to produce15?,30?,45?,60?elevation angle gradually,the positions of LAL (15?,30?,45?,60?) had the symmetry and repetition and the position of the horizon in the view was variable.CONCLUSION The directions of Lh and Lv and the locations of the horizon in the view of the 0?endoscope are correlative with the elevation angle of the endoscope,not pertinent to the distance of the endoscope coming into the nasal cavity.The directions of the space in the visual field of the endoscope have the symmetry and repeatable characteristics.Simulating the space in the visual field of the endoscope using SkechUp software provides the bases for the operation.

Pilot study of applying digital visible models for endoscopic nasal surgery / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the benefits of applying digital visible models for endoscopic nasal surgery.METHODS CT data sets of 16 patients were segmented to create digital visible models by using AutoCAD(computer aided design),MOI (Moment of Inspiration) and SketchUp software package.Standard digital available data sets for clinical tasks such as surgical simulation and surgical planning.The digital visible models and the intra-and postoperative corresponding visions were compared. RESULTS The 3D structure model of nasal cavity, sinuses and their adjacent structures for endoscopic nasal surgery were successfully reconstructed.The models allowed the user to interact with the data and manipulate them(in the view of X-ray,looking around inside the model).The model can be observed during operation,provided accurate morphological data for surgery guidance plan.CONCLUSION The method creating digital visible models using AutoCAD,MOI and SketchUp software package is simple and feasible.The digital visible models are suitable for clinical use as well as for education of endoscopic nasal surgery.The benefit of this technology was confirmed by clinicians.

The characteristics of spatial vertical direction in the nasal endoscope view / 解放军医学杂志

Objective To observe the characteristics of the spatial vertical direction in the view of 0? endoscope with the elevation angle(between the endoscope and nasal bottom)unchanged,and to provide the basis for operations.Methods The ideal model of nasal cavity was designed and observed with the 0? rod-lens telescope.Space of the model in the visual field of endoscope with 30? or 45? elevation angle produced was simulated by SketchUp software.Then ten lines(perpendicular to the horizontal planes,distributed in different plane and in the same side of the visual vertical line)were drawn randomly and named as Ln(n=1-10)respectively.A point was randomly selected and a vertical line was drawn and assigned as b line.The position of b line in the visual view of endoscope with a 30? elevation angle was named as A1B1.The relationship of positions of Ln with A1B1 were observed when the distances of endoscope entering the model were changed and the endoscope was moved parallelly.When the point A1 was on the b line in visual view of endoscope with 45? elevation angle,the position of b line was named for A1B2.The relationship of positions of Ln with A1B2 were observed when the distances of endoscope entering the model were changed and the endoscope was moved parallelly.The position of A1B1 was compared with A1B2.Results When the distances of endoscope entering the model were changed and the endoscope was moved parallelly,the superposition of Ln with A1B1 and A1B2 could be observed in visual view with 30? and 45? endoscopic elevation angle.The positions of A1B1 and A1B2 were not in superimposition.Conclusion The spatial vertical directions in the view of the endoscope are correlated with the elevation angle but not correlated with the distance of endoscope entering the model and parallel movements of the endoscope.This finding may be helpful for the endoscopic operations.