Diagnosis and treatment strategies of 56 cases of middle ear myoclonus / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the clinical characteristics and treatment of middle ear myoclonus. Methods: Fifty-six cases of middle ear myoclonus were enrolled in Shandong Provincial ENT Hospital, Shandong University from September 2019 to August 2021, including 23 males and 33 females. The age ranged from 6 to 75 years, with a median age of 35 years; Forty-seven cases were unilateral tinnitus, nine cases were bilateral tinnitus. The time of tinnitus ranged from 20 days to 8 years. The voice characteristics, inducing factors, nature (frequency) of tinnitus, tympanic membrane conditions during tinnitus, audiological related tests, including long-term acoustic tympanogram, stapedius acoustic reflex, pure tone auditory threshold, short increment sensitivity test, alternate binaural loudness balance test, loudness discomfort threshold, vestibular function examination, facial electromyography, and imaging examination were recorded. Oral carbamazepine and/or surgical treatment were used. The patients were followed up for 6-24 months and the tinnitus changes were observed. Results: Tinnitus was diverse, including stepping on snow liking sound, rhythmic drumming, white noise, and so on. The inducing factors included external sound, body position change, touching the skin around the face and ears, speaking, chewing and blinking, etc. Forty-four cases were induced by single factor and 9 cases were induced by two or more factors. There was no definite inducing factor in 1 case. One patient had tinnitus with epilepsy. One case of traumatic facial paralysis after facial nerve decompression could induce tinnitus on the affected side when the auricle moved. Tympanic membrane flutter with the same frequency as tinnitus was found in 12 cases by otoscopy, and the waveform with the same frequency as tinnitus was found by long-term tympanogram examination. There were 7 patients with no tympanic membrane activity by otoscopy, the 7 cases also with the same frequency of tinnitus by long-term tympanogram examination, but the change rate of the waveform was faster than that of the patients with tympanic membrane flutter. All patients with tinnitus had no change in hearing. One case of tinnitus complicated with epilepsy (a 6-year-old child) was treated with antiepileptic drug (topiramate) and tinnitus subsided. One case suffered from tinnitus after facial nerve decompression for traumatic facial paralysis was not given special treatment. Fifty-four cases were treated with oral drug (carbamazepine), of which 10 cases were completely controlled and 23 cases were relieved; 21 cases were invalid. Among the 21 patients with no effect of carbamazepine treatment, 8 patients were treated by surgery, 7 patients had no tinnitus after surgery, 1 patient received three times of operation, and the third operation was followed up for 6 months, no tinnitus occurred again. The other 13 cases refused the surgical treatment due to personal reasons. Conclusions: Middle ear myoclonus tinnitus and the inducing factors manifestate diversity. Oral carbamazepine and other sedative drugs are effective for some patients, and surgical treatment is feasible for those who are ineffective for medication.

Characteristics of responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency / 中华耳鼻咽喉头颈外科杂志

Objectives: This study aimed to evaluate the responsiveness of cochlear nerve to electrical stimulation in patients with cochlear nerve deficiency(CND), to compare their results with those measured in implanted children with normal-sized cochlear nerves, and to investigate the characteristics of the cochlear nerve injury of children with CND. Methods: Participants were children who underwent cochlear implantation at Shandong Provincial ENT Hospital from January 2012 to January 2020, including CND group and control group. The CND group included 51 subjects (male:20; female: 31) who were diagnosed with CND and had normal cochlea. For the CND group, four children had been bilaterally implanted, the mean implantation age was (2.7±1.5) years old. The control group included 21 subjects (male:10; femal:11) who had normal-sized cochlear nerve and normal cochlea. For the control group, all children had been unilaterally implanted except one, and the mean implantation age was (3.0±1.9)years old. Three subjects in the CND group used CI422 electrode arrays, and all the other subjects used CI24RECA/CI512 electrode arrays. The electrically evoked compound action potentials (ECAP) had been tried to record for each electrode using Custom Sound EP software (v. 4.3, Cochlear Ltd.) at least six months post first activation. Furthermore, ECAP amplitude growth functions (AGF) were measured at multiple electrode locations across the electrode array. Generalized linear mixed effect models with the subject group and electrode location as the fixed effects and subjects as the random effect were used to compare results of ECAP measurements. Results: In the control group, ECAP could been recorded at all electrodes (100%), but it could only be recorded in 71% (859/1 210) electrodes in the CND group. Additionally, the percentage of electrodes with measurable ECAP decreased from electrode 1 to electrode 22 in the CND group. Compared to the control group, the ECAP thresholds significantly increased, the ECAP amplitudes and AGF slopes significantly decreased, and the ECAP latency significantly increased in the CND group (P<0.01). GLMM showed that the stimulating site had a significant effect on the ECAP threshold, maximum amplitude, and AGF slope (P<0.01), but had no significant effect on the ECAP latency (P>0.05) in the CND group. However, the stimulating site had no significant effects on the ECAP measurements in the control group. Furthermore, the functional status of cochlear nerve varied greatly among CND group. From electrode 1 to electrode 22, the ECAP thresholds gradually increased, the ECAP maximum amplitudes and AGF slopes gradually decreased in the CND group. Conclusion: Compared with patients with normal-sized cochlear nerve, not only the number of residual spinal ganglion neurons reduce,but also the function of spinal ganglion neurons damages in CND patients. The degree of cochlea nerve deterioration varies greatly among CND patients. Generally, the deterioration of cochlear nerve tends to increase from the basal to the apical site of the cochlea.

Correlation analysis of 3D-FLAIR MRI characteristics of the inner ear and vestibular function in the patients with vestibular neuritis / 中华耳鼻咽喉头颈外科杂志

Objective: The characteristics of 3D-FLAIR MRI images of the inner ear of patients with vestibular neuritis were preliminarily studied to explore the possible pathogenesis of vestibular neuritis, and the correlation analysis was conducted in combination with vestibular function to provide a basis for accurate diagnosis of vestibular neuritis. Methods: A total of 36 patients with vestibular neuritis (VN) from December 2019 to October 2020 were collected from the Vertigo Department of Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University. There were 36 cases (18 females, 18 males) with unilateral acute vestibular neuritis, 17 cases of left ear and 19 cases of right ear. According to the results of 3D-FLAIR MRI in the inner ears, the patients were divided into the enhanced group and the non-enhanced group (the health side served as the normal control group). The results of vestibular function examination in the two groups were compared. SPSS19.0 software was used for statistical processing to analyze the relationship between the vestibular function and the characteristics of 3D-FLAIR imaging in the inner ears. Results: Abnormal enhancement of 3D-FLAIR was found in 31 cases (86.1%) of the 36 cases, including 14 cases of both vestibular nerve and vestibular terminal organ enhancement, eight cases of superior vestibular nerve enhancement alone, seven cases of vestibular terminal organ enhancement alone, and two cases of cochlear enhancement alone. Observation of abnormal reinforcement of vestibular nerve showed: twenty-one cases of superior vestibular nerve reinforcement, one case of superior and inferior vestibular nerve reinforcement. No abnormalities were found in 3D-FLAIR of inner ear in 5 cases. According to the analysis of vestibular function results, there were 19 cases (52.8%) with total vestibular involvement, sixteen cases (44.4%) with superior vestibular involvement alone, and one case (2.8%) with inferior vestibular involvement alone. Comparison of vestibular function between the five cases (non-enhancement group) and the 31 cases (enhanced group) in the 3D-FLAIR group of the inner ears showed that the CP values of caloric tests in the enhanced group were higher (60.81±3.49 vs 34.12±7.37), with statistically significant difference (t=-2.898, P<0.01). Conclusion: In patients with vestibular neuritis, 3D-FLAIR MRI scan of the inner ear provides visual imaging evidence for clinical practice, considering that the lesion site of vestibular neuritis is not only in the vestibular nerve, but also in the vestibular end organ. Patients with 3D-FLAIR enhanced in the inner ear may have more significant vestibular function damage.

The imaging characteristics and prognosis of patients with cochlear implants whose cochlear nerves are not shown on MRI / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the temporal bone CT and inner ear magnetic resonance imaging characteristics of cochlear implant patients with no cochlear nerve display in the inner auditory canal under MRI. To retrospectively analyze the long-term hearing and speech rehabilitation effects of such patients after cochlear implant. And to analyze the correlation between the results of imaging examinations and the postoperative effects of cochlear implant patients with this type of cochlear nerve deficiency. Methods: A total of 88 children with cochlear nerve deficiency, who underwent cochlear implantation in Shandong Provincial ENT Hospital from May 2014 to October 2018, were enrolled. Patients with cochlear malformations were excluded,only the patients with cochlear nerve deficiency whose cochlear structure was normal and no cochlear nerve displayed in inner auditory canal under MRI were enrolled. There were 64 patients, including 4 bilaterally implanted, 68 ears in total, with an average age of (2.8±1.7) years (range 1-6 years) at the time of implantation. The implanted product was Cochlear, including 24RECA and 512 models. All patients underwent inner ear magnetic resonance imaging and temporal bone CT scan before operation. Auditory speech function assessments were performed at 12 months, 24 months, and 36 months after surgery, including categories of auditory performance (CAP), speech intelligibility rating (SIR) and hearing aid threshold test. The imaging evaluation content included the width of the cochlear nerve canal of temporal bone CT, the width of the internal auditory canal, the width of the auditory nerve at the cerebellopontine angle of the inner ear MRI, and the ratio of the facial nerve to the width of the auditory nerve at the cerebellopontine angle. The correlations between the results of postoperative hearing aid hearing threshold, CAP, SIR and imaging results were analyzed. Results: Among the 64 cases of cochlear nerve not shown under MRI, 56 ears with CT data showed that the width of the cochlear nerve canal in temporal bone CT was (0.72±0.30) mm (mean±standard deviation, the same below), and the width of the internal auditory canal was (4.07±1.10) mm; 66 ears with MRI data showed that the diameter of the auditory nerve at the cerebellopontine angle of the inner ear MRI was (1.58±0.27) mm, the diameter of the facial nerve was (1.57±0.27) mm, and the ratio of the diameter of the facial nerve to the auditory nerve was (1.02±0.23). The average hearing thresholds at 12, 24, and 36 months after surgery were (46.8±2.5) dB HL, (40.7±0.8) dB HL, and (36.8±1.5) dB HL, respectively. The preoperative and postoperative CAP scores at 12, 24 and 36 months were (1.0±1.0), (3.8±1.4), (4.5±1.4) and (5.1±0.7) points, respectively. The preoperative and postoperative SIR scores at 12, 24, and 36 months were (1.1±0.3), (1.9±0.9), (2.5±0.9), and (2.9±0.6) points, respectively. The hearing threshold at 24 months after surgery was negatively correlated with the width of the internal auditory canal of temporal bone CT (r=-0.349, P=0.037), and the hearing threshold at 36 months after surgery was positively correlated with the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI (r=0.740, P=0.001). Conclusions: Children with cochlear implants whose cochlear nerves are not shown on MRI can benefit from cochlear implantation, and their speech and auditory functions can improve significantly after surgery. The width of the internal auditory canal in the temporal bone CT and the ratio of the diameter of the facial nerve to the auditory nerve at the cerebellopontine angle of the inner ear MRI may be related to the long-term hearing threshold after surgery.

Frequency characteristics of horizontal semicircular canals damage and the ultrastructure analysis of crista ampullaris in patients with Meniere's disease / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the frequency characteristics and the pathological characteristics of the horizontal crista ampullaris in patients with Meniere's disease,and to analyse its structural basis. Methods: Between March, 2019 and November, 2019, seventy-two patients diagnosed as Meniere's disease (27 males and 45 females, aged from 13 to 74 years, with a course of disease ranging from 4 months to 32 years)in Shandong Provincial ENT Hospital were included.Caloric test, sinusoidal harmonic acceleration test (SHA), video-head impulse test (v-HIT), Gadolinium-enhanced inner-ear 3D-FLAIR MRI and pure tone audiometry were conducted in the patients. The function of the horizontal semicircular canal in these patients were analysed as well as its relationship with the degree of endolymphatic hydrops,clinical stage and duration. Light microscopy and transmission electron microscopy were used to observe the ultrastructure of horizontal semicircular canal crista ampullaris from six patients with refractory Meniere's disease who underwent labyrinthectomy. The number of type Ⅰ and type Ⅱ vestibular hair cells, the common pathophysiological changes of horizontal semicircular canal crista ampullaris were investigated in these patients. Statistical analysis was performed using SPSS 19.0. Results: With the increase of detection frequency, the abnormal rate decreased gradually. The abnormal rate of caloric test was 69.4% (50/72), SHA 51.4% (37/72), V-HIT 36.1% (26/72), comparation of the positive rate among the three tests showed statistically significant differences(P<0.05).Neither caloric test nor SHA had correlation with the degree of hydrops(P>0.05), but v-HIT(r=0.434,P<0.01).There was correlation with clinical stage to SHA and v-HIT(r=0.338,0.462,P<0.01), except caloric test(P>0.05).No significant relation was found with caloric test, SHA, v-HIT and course of disease(P>0.05).Morphological observation found abnormal monolayer epithelialization of the horizontal semicircular canal crista ampullaris significantly decreased number of type Ⅱ hair cells compared with type Ⅰhair cells. Hair cells showed perinuclear vacuolization, cytoplasmic vacuoles, mitochondrial electron density increasement and loss of stereocilia. Conclusions: The horizontal semicircular canal damage in the patients with Meniere's disease has a frequency-dependent characteristic, mainly occurres in low frequency area. With progress of the disease, the high frequency area of ampulla will be impaired gradually, and it is related to the degree of endolymphatic hydrops and hearing level. Hair cell injury would be observed,the frequency characteristics may be more associated with the disorder of type Ⅱ hair cells.

3D-FLAIR MRI findings in idiopathic sudden sensorineural hearing loss and the correlations with clinical features and prognosis / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the correlations of different appearances of labyrinthine 3D-FLAIR MRI with clinical features and prognosis in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: Clinical data of patients with unilateral ISSNHL hospitalized from May 2017 to January 2019 were retrospectively analyzed. According to the results of 3D-FLAIR MRI, the patients were divided into three groups including hyperintense with absorption, hyperintense without absorption and normal. The differences and correlations among the three groups in clinical characteristics (gender, age, deafness side, duration, treatment days, dizziness/vertigo, basic diseases, vestibular function, deafness classification and typing) and prognosis were analyzed by SPSS 20.0 software. Results: Data were collected from 1 245 cases, including 739 (59.36%) with normal signal, 288 (23.13%) hyperintense without absorption, and 218 (17.51%) hyperintense with absorption. The side ratio, treatment days, dizziness/vertigo incidence, vestibular dysfunction, deafness classification and typing were different among the three groups (P<0.001). The incidence of right side was significantly higher in both the hyperintense with and without absorption groups than that in the normal. The vestibular dysfunction was more common in the hyperintense with absorption group than in the normal and hyperintense without absorption groups. It showed statistical differences in the dizziness/vertigo incidence, deafness classification, treatment days, and deafness typing compared between groups, which was the most significant in the hyperintense with absorption group, followed by the hyperintense without absorption group. There was no statistical difference in the total effective rate among the three groups (P=0.139), whereas a significant difference in the recovery rate (P<0.001). The prognosis was significantly correlated with duration, age, treatment days and dizziness/vertigo in the normal group (all P<0.001), correlated with duration and treatment days in the hyperintense with absorption group (both P<0.001), only correlated with the duration in the hyperintense without absorption group (P<0.001). Conclusion: 3D-FLAIR MRI manifestation is closely related to the clinical features and efficacy of ISSNHL. It is helpful to clarify the pathology of inner ear, which is expected to be a new imaging indicator for disease evaluation.

Multi-center study on the treatment for intermediate and high-frequency sudden sensorineural hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the therapeutic effect of treatment for intermediate and high-frequency sudden sensorineural hearing loss (SSNHL).</p><p><b>METHODS</b>A prospective clinical multicentre research was conducted using international standardized approach of clinical research. SSNHL Cases with intermediate and high-frequency hearing loss, that accepted no medication from onset of hearing loss within two weeks duration and ages ranged between 18 and 65, were collected. All patients were treated by one of four treatments plans chosen by unified random table.</p><p><b>RESULTS</b>141 patients with intermediate and high-frequency SSNHL were recruited in the research. Twenty subjects were treated with lidocaine, 21 cases with lidocaine and hormone, 40 cases with Ginaton, and 60 cases with Ginaton and hormone. 42 out of 141 (29.79%) patients were total recovery, 24 (17.02%)achieved excellent recovery, 27 (19.15%)achieved partial recovery, and 48 (34.04%) were ineffective. The total effective rate was 65.96%. In lidocaine group, the total effective rate was 55.00%, 66.67% in lidocaine and hormone group, 67.50% in Ginaton group, and 68.33% in Ginaton and hormone group. Considering the total effective rate, there was no statistical difference between four groups (P > 0.05). However, the recovery rate in Ginaton group was significant difference comparing with that in lidocaine group (P = 0.0496). 119 had concomitant symptom of tinnitus, and the tinnitus was improved in patients of 81.51%. With regard to total effective rate of tinnitus in four treatment groups, it was 57.89% (11/19) in lidocaine group, 100.00% (18/18) in lidocaine and hormone group, 88.57% (31/35) in Ginaton group, 78.72% (37/47) in Ginaton and hormone group. There was significant ascendancy in lidocaine and hormone group versus that in lidocaine group (P = 0.002) and Ginaton and hormone group (P = 0.029). And the difference between lidocaine and Ginaton groups was statistical significance (χ(2) = 6.705, P < 0.05). In 43 patients with muffled symptom in aural region, 90.70% was partial recovery. There was no statistical difference between each groups (χ(2) = 5.97,P = 0.74). There were 17 with dizziness or vertigo improved in all cases. Another 10 patients accompanied other complaints all improved.</p><p><b>CONCLUSIONS</b>for the treat of intermediate and high-frequency SSNHL, the therapeutic effect in hearing has no significantly different between single and combined drug therapies. Considering the recovery rate, there is an obvious advantage in Ginaton group compared with lidocaine group. Tinnitus is the major concomitant symptom in intermediate and high-frequency SSNHL, and lidocaine and hormone therapy should be used.</p>

Visualization of endolymphatic hydrops in 3D-FLAIR MRI after intratympanic Gd-DTPA administration in Meniere's disease patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the feasibility of endolymphatic visualization and the diagnosis of Meniere's disease by applying intratympanic gadolinium administration through the tympanic membrance and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI). To study the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests, such as pure tone audiometry (PTA), electrocochleography (EcoG), caloric test and vestibular evoked myogenic potential (VEMP).</p><p><b>METHODS</b>With a three Tesla magnetic resonance imaging (MRI) unit, 3D-FLAIR imaging was performed 24 hours after intratympanic gadolinium through the tympanic membrance in 32 patients with clinically diagnosed unilateral Meniere's Disease. We visualized the enhanced imaging of perilymphatic space in bilateral cochlea, vestibular and (or) canal, scoring scala tympani and scala vestibule of bilateral cochlear basal turn respectively and measuring the developing area of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem subjectively. PTA, EcoG, caloric test and VEMP were performed. The relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests were studied.</p><p><b>RESULTS</b>The gadolinium appeared in almost all parts of the perilymph in cochlea, vestibular and (or) canals in all 32 patients' inner ears, so the endolymphatic space was clearly shown on 3D-FLAIR imaging. The scala vestibuli score value between the affected side and the healthy side were statistically significant (Z = 4.309, P < 0.05) . The developing vestibular area between the affected side and the healthy side [(6.04 ± 2.89) mm(2), (8.28 ± 3.04)mm(2)] were statistically significant (t = 3.322, P < 0.05) . Abnormal vestibular evoked myogenic potentials were significantly correlated with the developing vestibular area of the affected side (F = 11.96, P < 0.05) . Abnormal electrocochleography were significantly correlated with scala vestibuli score value of cochlear basal turn in the affected side (Z = 3.17, P < 0.05) . No significant correlation was found between the scala vestibuli score value or the developing vestibular area and caloric test or PTA findings.</p><p><b>CONCLUSIONS</b>3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can discriminate the border between the perilymph and the endolymph and show endolymphatic hydrops. This method may provide radiographic reference for the diagnosis of Meniere's disease. The results of VEMP and electrocochleography might have appropriate correlation with degree of vestibular and cochlear hydrops.</p>

Short-term efficacy of semicircular canal occlusion in the treatment of intractable Meniere's disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the short-term efficacy and safety of triple semicircular canal occlusion (TSCO) in the treatment of intractable Meniere's disease (MD), so as to provide an alternative surgical procedure for treating MD.</p><p><b>METHODS</b>Seventeen patients, who had received standardized conservative treatment for at least one year with poor effect, underwent TSCO were retrospectively analyzed. Vertigo control and auditory function were evaluated. Pure tone audiometry, caloric test, and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular function. Postoperative follow-up period was 6 - 13 months, with an average of ten months.</p><p><b>RESULTS</b>According to the preoperative staging of hearing, among the 17 patients, there were 2 cases in stage II (with an average hearing threshold of 25 - 40 dBHL) and 15 in stage III (41 - 70 dBHL). No vertigo was found during the follow-up period, with 100% control rate of vertigo. During the same period, we had performed endolymphatic sac decompression operation in 25 MD patients. The control rate of vertigo was 72.0%. The vertigo control rate of TSCO was significantly higher than that of endolymphatic sac decompression operation (χ(2) = 3.87, P < 0.05). Three months after surgery, 12 patients showed no significant change in comparison to primary status, 5 patients presented with an mild increase in the average hearing threshold of less than 20 dBHL, with 29.4% of hearing loss rate. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3 days, while, balance disorders were disappeared in 10 patients within 1 - 2 weeks after surgery, and in another 7 patients within 2 months, with an average recovery time of 12.6 days. Three months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in VEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications.</p><p><b>CONCLUSIONS</b>TSCO, which can reduce vertiginous symptoms in patients with intractable MD, represents an effective and safe therapy for this disorder. TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from moderate to severe hearing loss.</p>

Clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo (BPPV).</p><p><b>METHODS</b>A total of 48 patients with BPPV of posterior semicircular canal in vertigo clinic of our hospital from May 2007 to December 2008 were retrospectively analyzed in this study. All patients underwent the inspection of caloric test, static posturography, and dynamic posturography. The vestibular tests were performed at two different time points: at onset when patients had typical nystagmus provoked by the Dix-Hallpike maneuver before treatment with the Epley maneuver (canalith repositioning maneuver, CRM), and at one week after treatment with CRM as their nystagmus disappeared. And results at theses two time points were compared. Eight patients whose dynamic balances were still abnormal after CRM accepted vestibular rehabilitation exercise using dynamic posturography, and re-examined 3 weeks later with dynamic posturography.</p><p><b>RESULTS</b>Among 48 cases of BPPV, the abnormal rates of caloric test, static posturography, and dynamic posturography before CRM were 25.0%, 33.3% and 70.8%, respectively. The abnormal rate of dynamic posturography was much higher than that of caloric test or static posturography, and the differences were statistically significant (χ² = 4.84, 7.88; P < 0.05). After CRM, the abnormal rates of caloric test, static posturography, and dynamic posturography were 14.6%, 8.3% and 16.7%, respectively. After CRM, the abnormal rate of static and dynamic posturography showed significant reduction (χ² = 24.04, 10.08; P < 0.05), however, the results of caloric test showed no significant change (χ² = 3.20, P > 0.05). Eight patients whose dynamic balances were still abnormal after CRM, accepted vestibular rehabilitation exercise lasting 3 weeks using dynamic posturography. The dynamic balances were all improved to normal after vestibular rehabilitation.</p><p><b>CONCLUSIONS</b>Dynamic posturography can quantitatively analyze postural balance, and is helpful in comprehensive evaluation of the vestibular function of BPPV patients. Impaired balance often presents in patients with BPPV. Treatment of BPPV using the canalith repositioning maneuver results in improved postural stability in static and dynamic posturography. However, not all patients have normal dynamic stability after successful CRM. The vestibular rehabilitation exercise using dynamic posturography is a helpful adjunct to the treatment for these patients.</p>

Revision surgery of the posterior fossa cranial nerves disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the clinical manifestations and the revision surgery principles of recurrent diseases of the posterior fossa nerves after primary surgery.</p><p><b>METHODS</b>Between 2000 to 2007, fourteen patients with recurrent diseases of the posterior fossa nerves in Shandong provincial hospital were recruited in this study, all of whom were subjected to revision surgery. The clinical manifestations and surgical findings were retrospectively reviewed.</p><p><b>RESULTS</b>Of the five patients with recurrent trigeminal neuralgia primarily, two underwent microvascular decompression (MVD); the remaining three firstly received the II and III branches partial sensory rhizotomy and, subsequently, the pain reoccurred in the I branch distribution area. The remnant sensor fibre was resected in the reoperation by which the sufferings were controlled completely in four of these patients during 2 to 11 years of follow-up. In five patients with hemifacial spasm underwent re-exploration, there appeared obvious fibrosis, conglutination, and the formation of new vessels around the facial nerve, with which the result of reoperation for this disorder was unsatisfied. In four glossopharyngeal neuralgia patients, reanastomosis of the glossopharyngeal nerve were found in two patients, adhesion between the glossopharyngeal nerve and the vagus nerve was found in one patient, but occurred in none of the another one. In the revision surgery, the regeneration of nerve fibre and two adjacent branches of vagus nerve fibre were resected, with no occurrence during 2 to 5 years of follow-up. The pathological changes found in revision were severe adhesion between cerebellum, meninges, terylene slim and structures around. Also, the formation of new vessels, cerebellum malacia, and bleeding could be found in the procedures.</p><p><b>CONCLUSIONS</b>The cause of recurrent of trigeminal neuralgia and hemifacial spasm are unclear. Recurrent glossopharyngeal neuralgia may attribute to the nerve fibers reanastomosis, adhesion or the communicating branches with vagus nerve. With respect to the treatment of the recurrence of trigeminal neuralgia, glossopharyngeal neuralgia after primary surgery, the effectiveness of nerve fibre resection is definite, whereas, the result of revision surgery for hemifacial spasm is poor.</p>

Surgical management of jugular foramen tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the clinical manifestations, imaging characteristics, surgical approaches, managements, and outcome of jugular foramen tumors. The detailed clinical information of this extremely rare tumor was presented, with special emphasis on certain key issues, e. g, the preoperative estimation, perioperative management, surgical skill and experience, which exerted an influence on the significance of total tumor resection and preventing complications.</p><p><b>METHODS</b>From 1985 to 2007, 42 patients with jugular foramen tumor (30 cases of jugular paragangliomas and 11 cases of tumor with particular pathological types) were enrolled in this study. Prior to surgical procedures, all patients were subjected to systematic imaging examinations on temporal bone, such as CT, HRCT, CTA, and MRI, and some patients were further examined by angiography or embolization according to the individual situations. The infratemporal type A and combined translabrinthin and/or transchecholea approaches were selected for the treatment of 30 cases of jugular paragangliomas; while, the modalities of infratemporal type A, enlarged mastoidectomy, or mastoid-neck approach were employed for the remaining 11 specific cases.</p><p><b>RESULTS</b>Forty-two patients in this report were categorized into beyond C types based on FISCH classification in which all had invaded to posterior fossa. In the 31 cases, the major initial clinical symptoms were tinnitus, hearing loss, and facial palsy; while, in the 11 specific cases, the main symptoms did not possess any unique trait for the diagnosis and 5 of which were found via CT or MRI examination by chance. Facial nerve management included permanent anterior transposition (19 cases), facial nerve bridge technology (16 cases), interposition graft (4 cases), VII-XI jump graft (2 cases), and VII-XII anastomosis (1 case).</p><p><b>CONCLUSIONS</b>The preoperative estimation of tumor in nature was of great importance in the determination of proper surgical approaches and the infratemporal type A could fully meet the requirement for resection of tumors in jugular foramen. Facial nerve anterior rerouting could provide a clear visual field during the procedure, especially for the lesions in anterior tympanic cavity. In most cases, the facial nerve bridge technology could also fulfill the needs for complete tumor resection as well as the better preservation of facial function. In case of considering the sacrifice of internal carotid artery, balloon test occlusion was indispensable for preoperative estimation. The CT or MRI characteristics of tumors with particular pathological types were different from those of jugular paragangliomas. The preoperative management, surgical skills, and experience played a pivotal role in complete tumor resection.</p>

Prevention of facial nerve paralysis induced by herpes simplex virus type 1 (HSV-1) in mouse and establishment of a relapse model induced by reactivation of latent HSV-1 / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish an animal model of Bell's palsy induced by the reactivation of latent herpes simplex virus type 1 (HSV-1), and observe the effect of interferon and IgG on the facial nerve paralysis induced by HSV-1 infection. METHODS Totally 64 four-week-old female Balb/c mice weighted 16-18 gram were selected. Using scratching the surface of bilateral auricles by a 26-gauge needle, 25 microl HSV-1 with a titer of 6.7 x 10(8) PFU/ml was inoculated into the left auricle and the same volume of PBS was placed in the right in order to develop a mouse model of latent HSV-1. In this study, interferon and IgG administration were performed before and after facial nerve paralysis and continued for 3 days. Controls were given normal sodium instead of interferon and IgG, and the incidence and duration of facial nerve paralysis were compared in the groups interferon and IgG and control. Ciclosporin was given to the mice eight weeks after recovery from facial nerve paralysis caused by inoculation with HSV-1. The HSV-1 DNA in bilateral facial nerve and bilateral trigeminal ganglion after the treatment were examined with polymerase chain reaction (PCR) analysis. RESULTS There were 10 mice of facial nerve paralysis in the first group. The incidence of facial nerve paralysis was 50% and the duration of facial nerve paralysis was (7.2 +/- 2.2) days. There were 6 mice of facial nerve paralysis in the second group. The incidence of facial nerve paralysis was 30% and the duration of facial nerve paralysis was (4.5 +/- 1.8) days. There were 16 mice of facial nerve paralysis in the control group. The incidence of facial nerve paralysis was 67% and the duration of facial nerve paralysis was (8.9 +/-2.6) days. IgG didn't reduce the incidence and duration of facial nerve paralysis by statistics analysis (P > 0.05), but interferon reduced the incidence and duration of facial nerve paralysis (P < 0.05). After administration of ciclosporin, 3/28 of mice developed facial nerve paralysis. The HSV-1 DNA was detected from facial nerve of all the mice of facial palsy. No facial palsy was observed in mice in which no HSV-1 DNA was detected from facial nerve.</p><p><b>CONCLUSIONS</b>Facial nerve paralysis might be caused by reactivation of latent HSV-1, and the reactivation might be related with immunosuppression. Administration of interferon reduces the incidence and duration of facial nerve paralysis. Administration of IgG can't reduced the incidence and duration of facial nerve paralysis.</p>

Recurrent laryngeal nerve decompression / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the result of recurrent laryngeal nerve decompression in the treatment of functional disturbance of recurrent laryngeal nerve caused by thyroid surgery or thyroid benign tumors.</p><p><b>METHODS</b>From October 2002 to June 2005, 9 cases of unilateral recurrent laryngeal nerve paralysis and 4 cases of glottic insufficiency were treated with recurrent laryngeal nerve decompression. Seven cases of the nerve paralysis were caused by the surgery of benign thyroid tumors resection which were done by general surgeons. The paralysis nerve were found ligated in 6 of the 7 cases, and nerve-scar adhesion was found in the other case. Beside nerve decompression, type I thyroplasty have been undertaken in the same time to 2 of the 7 cases with severe hoarseness. One case of thyroid adenoma and 1 case of nodular goiter with unilateral recurrent laryngeal nerve paralysis were treated with tumor resection and nerve decompression respectively. Four cases of glottic insufficiency, 3 cases of nodular goiter were treated with tumor resection and nerve decompression, and Hashimoto's thyroiditis in the other case was treated with partial lobe resection and nerve decompression. The recovery of function of recurrent laryngeal nerve were detected to the recovery of vocal cord mobility through electrolaryngoscope postoperatively.</p><p><b>RESULTS</b>For the 7 cases of recurrent laryngeal nerve paralysis after thyroid surgery, the motion of the paralysed vocal cord restored within 3 months in 6 cases with the interval of 1 week to 3 months between the two operations, no restoration was found in the other patient with an interval above 4 months between the two operations after 1 year follow-up. For the thyroid adenoma and nodular goiter with unilateral recurrent laryngeal nerve paralysis, the motion of paralysed vocal cord restored within 3 months respectively after decompression. The glottic closure recovered within 1 week after decompression in the 4 cases of the glottic insufficiency patient.</p><p><b>CONCLUSIONS</b>Exploration and decompression as soon as possible to the paralysed recurrent laryngeal nerve because of thyroid surgery are very important for the restoration of the function of the nerve. For the patient with serve hoarseness, nerve decompression and type I thyroplasty at the same time is recommended in an effort to relieve hoarseness as soon as possible. For the functional disturbance of recurrent laryngeal nerve with thyroid neoplasm patient, early exploration and decompression of the nerve is imperative.</p>

Treatment and long term follow-up of trigeminal neuralgia by retrogasserian combing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To research and appraise the method and long-term effects of trigeminal neuralgia by the operation of retrogasserian combing.</p><p><b>METHODS</b>From 1994 to 2000, fifty cases of trigeminal neuralgia were treated through posterior fossa microsurgery, 30 of which received both microvascular decompression and retrogasserian combing while 20 only by retrogasserian combing.</p><p><b>RESULTS</b>Of the 50 cases, forty of trigeminal nerves were found to be compressed by arteries, while 28 of them were the superior cerebellar artery, and 12 the anterior inferior cerebellar artery. All the cases were cured through the operations. Fifty patients were followed up for 4 to 8 years, and then 2 recurrent patients were found and other 48 patients had no recurrence. Nine out of fifty patients have facial insensitivity, others facial sense perceptions are right.</p><p><b>CONCLUSIONS</b>The effect of the operation of retrogasserian combing is sure. This operation was applicable to any case of trigeminal neuralgia, especially to the cases that no vascular compression was found in the operations.</p>

Experimental study of the facial nerve paralysis induced by herpes simplex virus type 1 infection in mice / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish an animal model of Bell palsy induced by type I herpes simplex virus (HSV-1) infection and to assess the role and site of HSV-1 in the pathogenesis of facial paralysis.</p><p><b>METHODS</b>Fifty-three female Balb/c mice four-week-old weighted 16-18 g were studied. After scratching the surface of bilateral auricles with a 26-gauge needle, 25 microL HSV-1 with a titer of 6. 7 x 10(7) PFU/ml was inoculated into the right auricle, and the same volume of PBS was placed in the left. As a control, PBS was placed on the bilateral auricles of 4 mice. The HSV-1 DNA in bilateral facial nerve, bilateral brainstem, bilateral trigeminal carrier ganglion, bilateral brain, and blood at different stage was examined with polymerase chain reaction analysis.</p><p><b>RESULTS</b>Thirty-seven animals (75.51%) appeared different degree facial paralysis among the 49 inoculated animals. Fourteen facial paralysis (37.84%) were on the right, 3 (8.11%) on the left, and 20 (54.05%) on the bilateral side. Six animals with facial palsy were recovered during 3-13 days, the average recovery time was 7.83 days.</p><p><b>CONCLUSIONS</b>The existence of HSV-1 in the brainstem and the cerebral cortex is significant for facial paralysis.</p>

Serious complications of the microvascular decompression in cerebellopontine angle / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the serious complications of microvascular decompression and (or) selective neurectomy in cerebellopontine angle.</p><p><b>METHODS</b>To review 322 cases of microvascular decompression and (or) facial nerve splitting, selective neurectomy for hemifacial spasm, trigeminal neuralgia and glossopharyngeal neuralgia respectively. Among 322 cases, hemifacial spasm 164, which 96 underwent facial nerve splitting, 68 underwent microvascular decompression and facial nerve splitting. The selective neurectomy and neurectomy were performed in 128 cases of trigeminal neuralgia and 30 cases for glossopharyngeal neuralgia respectively.</p><p><b>RESULTS</b>Of the serious complications 2 died (0.6%), The mild to severe hearing impairment occurred in 21 cases (6.5%), in which 3 cases presented total hearing loss (0. 9%); Postoperative cerebellospinal leakage in 20 (6. 2%).</p><p><b>CONCLUSIONS</b>It was demonstrated that, even though the microvascular decompression and /or neurectomy was a safe procedure for posterior neuropathy, mortal and serious complications might occur. It was essential to pay great attention to the entire decompression procedure in avoiding cerebellar injury. Using of intraoperative ABR and avoiding of impairment of the acoustic nerve might contribute to the prevention of the postoperative hearing loss.</p>