A clinical study into the vestibular function and therapy of patients with chronic positional symptoms after acute vestibular syndrome / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the status of the vestibular function of the patients with chronic positional symptoms after peripheral acute vestibular syndrome (AVS) and the curative effect of the vestibular rehabilitation therapy (VRT). Method:Using caloric test (CT), head shaking nystagmus test (HST), cervical vestibular evoked myogenic potentials as well as ocular vestibular evoked myogenic potentials to estimate the function of semicircular canal and otolith organs. The patients with normal VEMPs are divided as Group A. Otherwise are as Group B. Both groups are treated with VRT. The curative effect is estimated by vestibular symptom index (VSI) and Berg balance scale (BBS). Result:Thirty-three of 37 patients (86.5%) had an abnormal result of CT and HST, with 23 of these patients (65.7%) had an abnormal of both test. Twenty-two patients (59.5%) were in Group A and 15 (40.5%) in Group B. Before the therapy, Group B had a higher score of the balance and dizziness symptoms of VSI (P<0.05), and Group A had a higher score of the BBS (P<0.05). After the therapy, the VSI scores of both groups dropped and scores of the BBS raised. Conclusion:Patients with chronic positional symptoms after peripheral AVS have dynamic vestibular lesions to different extents. Those with otolith organs lesions tend to have a worse function of balance. Nevertheless, patients have a better off after VRT.

Clinical research of the otolith abnormal migration during canalith repositioning procedures for posterior semicircular canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the risk factor,type and characteristic nystagmus of the otolith abnormal migration during diagnosis and treatment for posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV). The therapy and prevention is also discussed.@*METHOD@#Four hundred and seventy-nine patients with PSC-BPPV were treated by Epley's canalith repositioning procedures(CRP) from March 2009 to March 2012. We observed otolith abnormal migration complicating during diagnosis and treatment. According the type of otolith abnormal migration, the additional repositioning maneuver was performed.@*RESULT@#The rate of complication was 8. 1%(39/479), with canal conversion in 5.4%(26/479) and primarily canal reentry in 2.7%(13/479). The rate of incidence of conversion to horizontal canal conversion and anterior canal were 4. 8%(23/479)and 0. 6%(3/479) respectively. All the patient was cured in follow up. The risk factors were unappropriated head movement during or after CRP, including another Dix-Hallpike were performed immediately.@*CONCLUSION@#To prevent the complications,the pathognostic positioning sequence and angle of head rotation are commenced during CRP. Appropriate short time postural restrictions post-treatment is necessary. Careful observation of nystagrnus variation is crucial to determine the otolith abnormal migration.

Evaluation on short-term efficacy of balloon dilation in the treatment of symptomatical eustachian tube dysfunction / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo evaluate the short-term efficacy of Eustachian tube balloon dilation (ETBD) in the treatment of symptomatic Eustachian tube dysfunction (SETD) by subjective and objective analysis.METHODS Forty patients who underwent ETBD were included. Subjects’ inclusion criteria were as followed: symptoms of ETD (aural fullness predominantly, with or without otalgia, muffle hearing and tinnitus), normal tympanic membrane, type A or C tympanograms, and without a history of any middle ear diseases. Main outcomes including subjective improvement, otoscopy, pure-tone audiometry, impedance audiometry, R-value in tubomanometry (TMM) and Eustachian Tube Score (ETS) were assessed 1 week and 6 months postoperatively.RESULTSAll cases were dilated successfully. A significant effect of treatment was documented when measuring subjective improvement, impedance audiometry, R-value in TMM and ETS 1 week and 6 month postoperatively. Subjective symptoms were not relieved only in one patient. The overall success rate for all patients was 98%.CONCLUSIONETBD can provide short-term benefits to those who are diagnosed with SETD and refractory to medical management. SETD might be an optimal indication for ETBD in the treatment of ETD.

Clinical analysis of COs-laser assisted suspension laryngoscopic surgery for vocal fold cyst / 中华显微外科杂志

Objective To compare the clinical effect between CO2-1aser assisted and cold instrument assisted suspension laryngoscopic surgery for vocal fold cyst.Methods From January, 2011 to December, 2014, 72 patients with vocal fold cyst, which diagnosed by strobolaryngoscopy, were randomly divided into CO2-1aser assisted group and cold instrument group.Strobolaryngoscopy, acoustic analysis and perceptual voice analyses were performed on each patient before surgery, 1 month, and 3 months after surgery, respectively.Results All operations were successfully completed.The complete vocal fold cyst resection rate of CO2-1aser assisted group was significantly higher than cold instrument group (29/36, 80.5％ vs 21/36, 58.3％, P ＜ 0.05), especially the left vocal fold cyst (13/16, 81.3％ vs 9/19, 47.4％, P ＜ 0.05).The complete right vocal fold epidermoid cyst resection rate was significantly higher than retention cyst (17/19, 89.4％ vs 11/18, 61.1％, P ＜ 0.05).Two recurrent cases were found in cold instrument group but no recurrent cases in CO2-laser assisted group (0/36, 0％ vs 2/36, 5.6％, P ＞ 0.05).Correlation analysis showed that vocal fold cyst recurrence was related to complete resection rate and has no relation with surgical methods, histopathological types and position.Subjective and objective assessment of voice quality in preoperative, 1-month postoperative and 3-month postoperative were similer between CO2-1aser assisted group and cold instrument group (P ＞ 0.05).Conclusion The CO2-laser assisted suspension laryngoscopic surgery for vocal fold cyst, can increase the surgical precision, reduce the left hand impact, improve the complete resection rate and reduce the recurrence rate.

Eustachian tube balloon dilation in eustachian tube dysfunction related diseases / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of Eustachian tube balloon dilation (ETBD) in treatment of eustachian tube related diseases.@*METHOD@#Fifteen cases (20 ears) of otitis media with effusion and 22 cases (30 ears) of symptomatic Eustachian tube dysfunction were recruited. Technique of tubomanometry (TMM) showed obstructive Eustachian tube dysfunction in all patients. All the patients were received ETBD and followed up with VAS evaluation of ear fullness, muffled hearing, poping sound in the ear and tinnitus. And also the TMM change and middle ear effusion.@*RESULT@#Ear fullness, muffled hearing released with 1 week (ear fullness: 8.2 ± 1.4 vs. 2.0 ± 1.2, P < 0.05, muffled hearing: 6.2 ± 1.2 vs. 3.1 ± 0.8, P < 0.05). No recurrence was seemed within 6 months. The eustachian function test turned better. Symptomatic Eustachian tube dysfunction had an effective rate of 96.6% while otitis media with effusion was 95.0%.@*CONCLUSION@#ETBD have good short-term effect in obstructive eustachian tube dysfunction related middle ear dysfunction, which might provide a good way to solve the eustachian tube related diseases.

The influence of congenital malformation of external and middle ear on the psychologic status of children patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This research focuses on the psychologic status of children patients with congenital malformation of external and middle ear by Achenbach's Child Behavior Checklist (CBCL) in order to explore the degree of the influence.@*METHOD@#The 66 patients of 4-16 years old were assessed psychologic status with CBCL filled in by their parents according to their performance in half a year. Then calculated the detection rate of behav ioral disorders of these patients. Collected all patients' general information and Marx's grade of malformed ears. Then analyzed the relationship between the detection rate and these factors.@*RESULT@#The detection rate of behavioral disorders of 4-16 years old patients, 21.21%, which is higher than that of Chinese norm. The Marx's grade and parents' mental stress relate with the behavioral disorders. In Logistic regression analysis, the value of Cox & Snell coefficient of the regression model is 0. 153. The detection rate of behavioral disorders in grade III patients (36.4%) is greater than that of grade II (4.3%), P = 0.004.@*CONCLUSION@#Congenital malformation of external and middle ear has an absolute influence on the patients' psychologic status, but its effect is only about 15% parts of the multitudinous influential factors. And grade III patients carry a high-risk for behavioral disorders.

The study between temporal bone HRCT and operations in congenital abnormality of external and middle ear / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#We explore the deformity degrees of external ear, mastoid process, tympanic cavity and auditory ossicle by the HRCT features of bilateral and unilateral patients of congenital abnormality of external and middle ear for preoperative analysis and selection for surgical approaches.@*METHOD@#Twenty-nine patients were enrolled in our study, and HRCT were performed on all patients. There were 23 unilateral ears deformity (13 right and 10 left), 6 patients with bilateral ears deformity in the study group. Nineteen patients (19 ears) were treated with operations.@*RESULT@#The deformity degree of auricle was correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. We got data of shortest distance from tympanic cape to atresia board in HRCT, (0.59 +/- 0.13)cm in comparison group, (0.45 +/- 0.19)cm in unilateral deformity group, (0.32 +/- 0.12)cm in bilateral deformity group, and there were significant differences compared the two deformity groups with the comparison group. There were 1 ear with normal auditory ossicle (2.86%), 5 ears with fixation of stapes foot board (14.29%), 3 ears with no auditory ossicle (8.57%); 26 ears with malleus and incus abnormality (74.29%). Abnormality of malleus was always concomitant with that of incus. Degeneration of malleus, the joint amalgamation of malleus and incus were discovered mostly in this research.@*CONCLUSION@#The deformity degree of auricle is correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. The shortest distance from tympanic cape to atresia board in HRCT in unilateral ears deformity group are shorten 0.15 cm in that of comparison group. And that of bilateral ears deformity group are shorten 0.25 cm in that of comparison group. The main abnormality of auditory ossicle in our research present in both malleus and incus, and degeneration of malleus and the joint amalgamation of malleus and incus are main types.

Cochlear otosclerosis: 3 cases report and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical features in cochlear otosclerosis.@*METHOD@#Three cases with cochlear otosclerosis in our hospital from March 2007 to October 2008 were reported and the relevant literatures were reviewed. All the cases were confirmed the diagnose by temporal bone high-resolution CT scan (HRCT).@*RESULT@#The chief complaint when visited was recurrent episodic vertigo or equilibrium disturbance with progressing hearing loss in all cases. Two ears in 2 cases were simple sensorineural deafness and considered the pure cochlear otosclerosis. Others were mixed deafness with the descent of bone conduction in different extent. The characters in HRCT: the low density area could be seen in different areas of the otic capsule, the pericochlear lucency or double-ring effect were the typical signs.@*CONCLUSION@#The diagnosis of cochlear otosclerosis is considered in the insoluble sensorineural deafness and the mixed deafness with vestibular symptoms and chronic hearing loss history. Temporal bone HRCT plays an important role in the clinical diagnosis of cochlear otosclerosis.

Characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the characteristic of nystagmus and treatment of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV).@*METHOD@#The positioning nystagmic features in 43 patients with HSC-BPPV treated between April 2004 and October 2006 were recorded and analyzed with video nystagmography. After the subtype and the effect side were determined, the appropriate repositioning maneuvers were chosen.@*RESULT@#(1) Geotropic nystagmus was recorded in 27 cases, of whom 19 cases were treated with barbecue maneuver and/or combined forced prolonged position maneuver, while the others were treated with Asprella's maneuver. (2) Apogeotropic nystagmus was recorded in 16 cases with two types, one of which could turn into geotropic nystagmus with Gufoni's maneuver or spontaneously (in 12 cases), the other type could not (in 4 cases) transform accepted barbecue maneuver and/or combined forced prolonged position maneuver. The total improvement rate was 72.1% after 1 week and 81.4% 3 months later respectively.@*CONCLUSION@#The otolith position and the pathogenesis could be distinguished according to the nystagmic characteristics and type of HSC-BPPV. It was necessary to apply the appropriate repositioning maneuvers to treat HSC-BPPV.

Endoscope-assisted surgical resection of acoustic neuroma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the therapeutic efficacy and complications of endoscope-assisted surgical resection of acoustic neuroma.@*METHOD@#Assisted by hard-tube ear endoscope, 11 patients with acoustic neuroma were operated via labyrinthine approach and retrosigmoid approach.@*RESULT@#Total removal was achieved in 9 (81.8%) cases, while subtotal removal was achieved in 2 (18.2%) cases. Facial nerves and cochlear nerves were preserved completely during operation in all cases. After operation 9 (81.8%) cases had no facial paralysis, while the other 2 cases (18.2%) had mild peripheral facial paralysis. The same hearing level as that of preoperation in 2 patients (18.2%), hearing impairment in different degrees in 9 patients (81.8%), among which moderate sensorineural hearing loss in 1 patient, moderate to severe in 2 patients, severe in 3 patients, profound in 3 patients.@*CONCLUSION@#The application of ear endoscope in acoustic neuroma surgery can improve the total removal rate of tumors and the salvage rate of vessels and nerves. However, its disadvantages make it an assistant method for microsurgery.

Influence of childhood obstructive sleep apnea-hypopnea syndrome on hearing / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the influence of hypoxemia on the hearing of children with childhood obstructive sleep apnea-hypopnea syndrome (OSAHS).@*METHOD@#Auditory brainstem response (ABR) and distortion-product otoacoustic emission (DPOAE) was recorded in 68 ears and 60 ears respectively of children suffering from OSAHS with "A" tympanogram. Meanwhile, ABR and DPOAE was also recorded in 30 controls of children with "A" tympanogram.@*RESULT@#There was no statistical difference between the mild OSAHS group and the control group in the latency of wave I, III and V, the interval between wave I and III, III and V, I and V. There was significant difference between the moderate and severe OSAHS group and the control group in the delayed latency of wave I. There was significant difference between the mild OSAHS group and the control group in the amplitudes of DPOAE at 8 kHz. There was significant difference between the moderate and severe OSAHS group and the control group in the amplitudes of DPOAE at 6 kHz and 8 kHz.@*CONCLUSION@#Cochlear function was affected when AHI > or = 10/h. ABR and DPOAE could be used to detect the early damagement of auditory function in childhood OSAHS.

The reasons and treatments of recurrent or residual cholesteatoma in middle ears / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the reasons and treatments of recurrent or residual cholesteatoma in middle ears after operations.@*METHOD@#The clinical data of 102 cases (105 ears) with recurrent or residual cholesteatoma was retrospectively analyzed.@*RESULT@#The main reason of recurrent or residual cholesteatoma is incomplete removal of cholesteatoma in the former operations or obstructive drainage of middle ears after operations. Twenty ears healed through cleaning with otoendoscope. Eighty-five ears underwent the second operations of radical mastoidectomy including 23 tympanoplasty meanwhile. The air-conductive auditory threshold of them all decreased more than 15 dBHL.@*CONCLUSION@#For the ears with low facial ridges and non-obstructive drainage of mastoid, tympanic antrum and tympanic cavity, its possible to be cured through cleaning with otoendoscope. For those with high facial ridges and obstructive drainage , it's essential to perform the second operations of radical mastoidectomy and some of them are suitable for tympanoplasty meanwhile.

Clinical analysis on syphilis with sensorineural deafness / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical presentation, diagnosis and therapy of syphilis with sensorineural deafness.@*METHOD@#Three patients of syphilis with sensorineural deafness were analyzed including the clinical manifestation, serum and therapy response.@*RESULT@#Three patients of syphilis with sensorineural deafness: 2 cases with rapid plasma reagin (RPR) and treponema pallidum particle agglutination (TPPA) positive, 1 case with RPR negative and TPPA positive; 2 cases had been diagnosed with syphilis and treated once; 2 cases with sudden sensorineural deafness and tinnitus, 1 case with tinnitus and high-frequency hearing loss. All cases hadn't another identified cause of the hearing loss or tinnitus. Their hearing loss level weren't improved after therapy.@*CONCLUSION@#Sudden hearing loss or nervous tinnitus may be the clinical manifestations of syphilis with sensorineural deafness. It is easy to miss diagnosis in clinical work. Some lab examinations were necessary to diagnose the cases with the etiology unknown of hearing loss, tinnitus or nystagmic.

Clinical study on inlay butterfly cartilage myringoplasty / 中国医师进修杂志

Objective To evaluate the application of the inlay butterfly cartilage graft technique in myringoplasty.Methods Thirty--eight ears in 38 patients (experiment group) with dry central drum perforations were treated with inlay butterfly cartilage myringoplasty,and 46 ears in 46 patients with underlay temporalis fascia myringoplasty (control group).Results After a mean follow-up of 6 months,the healing rate did not differ between two groups (92.1% in experiment group,91.3% in control group,P＞ 0.05).Average pure-tone hearing threshold improved than 10 dB and closure of the air-bone gap (ABG) within 10 dB were not different (P ＞ 0.05).The cured patients were followed up for 12-38 months,there was no ear perforation of drum in experiment group,but 4 ears in control group.Condusion Inlay butterfly cartilage myringoplasty is the reliable and ideal method for tzeating dry central drum pedoration with high success rate.

Endoscope-assisted lateral skull base surgery / 中国医师进修杂志

Objective To explore the therapeutic efficacy and complications of endoscope-assisted lateral skull base surgery. Methods Assisted by hard-tube ear endoscope, 11 patients with acoustic neuroma were operated via labyrinthine approach and retrosigmoid approach, and 5 patients with petrous apex cholesteatoma were operated via middle cranial fossa approach and mastoid-middle cranial fessa approach. Results Among 11 patients with acoustic neuroma, total removal was achieved in 9 cases (81.8%), subtotal in 2 cases (18.2%). Facial nerves and cochlear nerves were preserved completely during operation. After operation there was no facial paralysis in 9 cases (81.8%), mild peripheral facial paralysis in 2 cases (18.2%), the same hearing level as that of preoperation in 2 patients (18.2%), hearing impairment in different degrees in 9 cases (81.8%), among which moderate sensorinural hearing loss in 1 patient (9.1%), moderate to severe in 2 patients (18.2%), severe in 3 patients (27.3%), profound in 3 patients (27.3%). Among 5 patients with petrous apex cholesteatoma, total removal was achieved in all cases. After operation, preoperative facial paralysis in 3 patients disappeared within 9 months, and moderate to severe conduction deafness appeared in 2 patients. Conclusions The application of ear endoscope in lateral skull base surgery can improve the total removal of lesions and the salvage rate of vessels and nerves. However, its disadvantages make it only be an assistant method for micresurgery.

Microsurgical treatment for tumors in jugular foramen and its around / 中华显微外科杂志

Objective To explore the micresurgical techniques and outcome of tumors in jugular foramen and its around. Methods Eleven patients with jugular foramen tumors were operated through suboccipital-retrosigmoid approach (2 cases), jugular foramen approach (2 cases), temporal fossa approach (4 cases) and mastoid-cervical combined approach (3 cases). Results Nine tumors were totally removed and 2 were subtotally removed. Of those cases, there were 4 neurinoma, 4 paragangliome, I meningioma, 1 mucochondrosarcoma, and 1 low-differentiated carcinoma. Postoperative complications included transient cerebrespinal fluid leak(1 case) and new lower cranial nerve injury (2 cases). All cases were followed up for mere than 8 months. The postoperative hearing was improved in 1 case, stable in 6 cases, deteriorated in 4 cases. Postoperative facial paralysis of grade Ⅱ- Ⅲ occurred in 3 of 9 patients without facial paralysis, which recovered in half a year. Of 2 patients with facial paralysis before surgery, facial function was improved in 1 case and stable in 1 case. Conclusion Proper surgical approaches and micrceurgical techniques, which were adopted according to the types, the location, and the expansion of tumors, the function of facial nerve and lower cranial nerves, and hearing level, are good for reducing complications, exposing and removing jugular foramen tumors.

Relationship between childhood obstructive sleep apnea-hypopnea syndrome and tympanogram / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the correlation between childhood obstructive sleep apnea-hypopnea syndrome and tympanogram.@*METHOD@#A prospective clinical study was carried out. Polysomnography and tympanogram were analyzed in 72 cases.@*RESULT@#Among the 144 ears 37 ears had type C or B tympanogram. There was no correlation between tympanogram and LSaO2. It was found correlation between tympanogram and AHI (P < 0.05).@*CONCLUSION@#Hypoxemia may affect middle-ear function. It was necessary to do the examination of acoustic impedance routinely in children with moderate and severe OSAHS.

Value of harmonic scalpel in endoscopic thyroid surgery / 中国耳鼻咽喉头颈外科

0.05).The blood loss in harmonic scalpel group was less than that in titanium clamp group or conventional group(P=0.001).CONCLUSION Harmonic scalpel is a new type of surgical instrument and is suitable for endoscopic thyroid surgery.It is worth of recommending that harmonic scalpel can not only increase safety of surgery and reduce blood loss,but also decrease the difficulty of operation and shorten the operation time.

Clinical analysis of 62 cases laryngeal papiloma in children / 临床耳鼻咽喉头颈外科杂志

To investigate the clinical features of laryngeal papilloma in children.Method:In a group of 62 patients with laryngeal papilloma in children,the tumors of 28 patients were cut under the direct laryngoscope,34 patients were treated with laryngeal micro-laser operation.Result:The post-operation followup ranged from 2 to 5 years,the cure rate of 2 years was 51.61%.Conclusion:The clinical features of this disease include rapid development,a large lesion,and it is often found in the infraglottic cavity.Furthermore,we believe that in order to eliminate the tumors more accurately and decrease recurrence,microlaser surgery and the use of interferon is very necessary.