Effect of REZ-I cochlear implantation on residual hearing in adult patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of cochlear implantation with REZ-I straight electrodes on residual hearing of postlingually deafened adults, and to explore the audiologically safety and injury characteristics of cochlear implantation.</p><p><b>METHODS</b>Sixteen unilateral REZ-I (22 channels) cochlear implantation recipients from September 2009 to December 2009 were picked out. Their pre-and post-implantation audiometry data including pure-tone audiometry (PTA), auditory steady-state responses (ASSR), auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) were retrospectively analyzed, in order to compare the change between pre- and post-implantation residual hearing.</p><p><b>RESULTS</b>Among the 12 recipients who had some measurable residual hearing before implantation, 5 (41.6%) patients had conserved some measurable hearing but the other 7 (58.4%) recipients had lost all measurable hearing after implantation on the implanted side. The implanted ears had an average PTA threshold drop of 9.5 dB HL and a statistically significant difference between pre- and post-implantation (P < 0.05) PTA thresholds in the frequencies of 250 Hz, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Compared to non-implanted ears, the drop in 500 Hz and 1kHz had a statistically significant difference between pre- and post-implantation PTA thresholds (P < 0.05). The ASSR residual hearing threshold elevation were statistically significant (P < 0.05) between pre- and post-implantation ASSR at 250 Hz and 500 Hz on the implanted side, while the The ASSR residual hearing threshold elevation were statistically significant (P < 0.05) at 500 Hz when compared to non-implanted side. The difference of residual hearing between pre- and post-implantation was not statistically significant for both DPOAE and ABR.</p><p><b>CONCLUSION</b>There will be a certain degree of damage to residual hearing of the implanted side following REZ-I cochlear implantation.</p>

Improvement of immunogenicity of Streptococcus pneumoniae psaA DNA vaccine by prime and boost strategy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study on the preparation of Streptococcus pneumoniae psaA DNA vaccine and to analyse the immunogenicity by the prime-boost strategy.</p><p><b>METHODS</b>The psaA gene was amplified from the genome of Streptococcus pneumoniae by PCR, and then was inserted into plasmid pVAX1 and pET28a to construct recombinant expression vectors respectively. 293T cells were transiently transfected with pVAX1-psaA, and RT-PCR analysis of total cell RNA extracts showed successful expression of psaA. BALB/c mices (n = 5) were intramuscularly injected with 100 microg psaA DNA vaccine for three times, and then boosted with 50 microg recombinant PsaA protein. The antibody response against PsaA was measured by ELISA.</p><p><b>RESULTS</b>The psaA gene was amplified and subcloned successfully. The constructed psaA DNA vaccine was confirmed by DNA sequencing, and the recombinant PsaA protein was purified by the one-step Ni(2+) affinity chromatography. Expression of the PsaA was observed in cells transfected with pVAX1-psaA. The animal experiment results showed that the anti-PsaA level of the DNA prime-protein boosting mice was higher significantly than the other groups (t = 87.518, P < 0.05).</p><p><b>CONCLUSION</b>The psaA DNA vaccine was prepared successfully, and the immunogenicity of Streptococcus pneumoniae psaA DNA vaccine could be improved significantly by the DNA prime and protein boost strategy.</p>

A new method for REZ-1 cochlear implant electrode array insertion / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To develop a new method for REZ-1 cochlear implant electrode array insertion.</p><p><b>METHODS</b>REZ-1 cochlear implant electrode array was implanted in 22 human temporal bone specimens. Cochlear diameters were measured from spiral CT scan before implantation. Cochlear views were taken before and after pullback technique. Modiolus-electrode distances were measured and compared. The diameters of sixty normal cochleae were measured.</p><p><b>RESULTS</b>In 3 cases, 27 electrode rings were inserted into the cochlea, while in others, all 28 electrode rings were inserted into the cochlea. After pullback of the electrode array, No. 12 to No. 19 electrode rings were closer to the modiolus in 17 cases (paired t test, P<0.01). The cochlear diameters in the 17 cases were smaller than 9.50 mm, while in the other 5 cases, the cochlear diameters were at least 9.60 mm. The cochlear diameters in the 17 cases were 9.11 (0.57) mm, while the cochlear diameters in the 5 cases were 9.78 (0.28) mm (Mann-Whitney test, P<0.001). The diameters of normal cochleae were (9.04 +/- 0.45) mm, with 90% larger than 9.50 mm.</p><p><b>CONCLUSIONS</b>In cases whose cochlear diameter is smaller than 9.50 mm, pullback technique can help some electrode rings be closer to the modiolus. Measurement of the cochlear diameter can help the surgeon to have a better choice in the selection of REZ-1 cochlear implantation methods.</p>

Diagnosis of superior semicircular canal dehiscence syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To better understand superior semicircular canal dehiscence (SSCD) syndrome.</p><p><b>METHODS</b>A retrospective study was conducted on 6 patients who were diagnosed with SSCD syndrome in the Otology and Skull Base Surgery group of Fudan University. The clinical presentations including symptoms, signs, auditory tests and high resolution temporal bone computed tomography were reviewed.</p><p><b>RESULTS</b>Four patients presented with low frequency hearing loss while acoustic reflex responses were intact. Another patient was concomitance with chronic otitis media demonstrated profound sensorineural hearing loss. The sixth patient demonstrated normal hearing. Two patients also complained of autophony, but they were unable to tolerate their own voice. Five patients presented with vertigo while 2 patients were unable to tolerate the environmental noise. All patients showed slow component vertical torsional eye movement away from the effected eye which was induced by the presence of loud sound or pressure in the middle ear or valsalva maneuver. Four patients also demonstrated vertigo induced by the loud sound, 1 patient was induced head movement by 110 dB tone. All patients were revealed variable bone defect overlying on the SSC using high resolution temporal bone CT scan with SSC reformation.</p><p><b>CONCLUSIONS</b>The diagnosis of SSCD syndrome was established on both the presence of bone defect overlying superior semicircular canal which was demonstrated using high resolution temporal bone CT scan, and the presence of associated vestibular and auditory symptoms and signs.</p>

Uptake and accumulation of gentamicin by mouse hair cells from the cochlear explants in vitro / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the upstaging and accumulation of gentamicin by mouse hair cells in vitro.</p><p><b>METHODS</b>Cochlear explants were prepared from the microdissected neonatal mouse cochlea. Cochlear explants were cultured with gentamicin-Texas-red conjunction (GTTR) for different time. Laser confocal microscopy was used to observe the distribution of GTTR in the cochlear sensory cells after labeling with phalloidin-alexa-488.</p><p><b>RESULTS</b>Soon after culture, there was diffuse red staining all tissue cells in the explants. At later time the hair cells were more staining than other cells in the explants. There was no obviously accumulation of GTTR in the supporting cells. The peak level of fluorescent density was reached at 24 hours culture. The GTTR was seen in the infracuticular zone of the hair cells. There was still accumulation of GTTR in the hair cells of the explants after 7 days culturing.</p><p><b>CONCLUSIONS</b>GTTR and cochlea explants were useful methods to investigate the pharmacokinetics and mechanisms of gentamicin accumulation over time.</p>

Analysis of prognostic factors in microsurgery of intratemporal facial nerve schwannoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss prognostic factors in microsurgery of intratemporal facial nerve schwannoma.</p><p><b>METHODS</b>Clinical and follow-up materials from 13 cases of facial nerve schwannoma were analyzed retrospectively. Spearman rank-order correlation and nonparametric Mann-Whitney U test from SPSS 10.0 for Windows was used for the analysis.</p><p><b>RESULTS</b>Each of 13 cases was operated on using modern microsurgery. Eleven cases among them received facial nerve reconstruction. One of the 13 cases lost follow-up. Others had no residue or recurrence. The House-Brackmann grades of the cases received facial nerve reconstruction were II through V. Spearman rank-order correlation showed the postoperative facial nerve function was correlated with the preoperative duration of facial nerve paralysis (r = 0.925, P = 0.000) and the preoperative facial nerve function(r = 0.712, P = 0.021). Mann-Whitney U test showed that the tumor position had no effect on the postoperative facial nerve function (P = 0.889).</p><p><b>CONCLUSIONS</b>Among most of the patients who received microsurgery of facial nerve schwannoma, facial nerve functions could be restored to great extent. The longer the preoperative duration of facial nerve paralysis or the worse the preoperative facial nerve function, the worse the postoperative facial nerve function in cases who received facial nerve resection and reconstruction. Facial nerve reconstruction was helpful for the patient with facial nerve schwannoma whose facial muscles were denervated but have fibrillation potentials, as well as for the patient whose facial nerve schwannoma intruded internal acoustic canal.</p>

Cultivation, identification and ultrastructural observation of the proliferative cells from the newborn rat cochlea / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore whether there could be proliferative cells in the cochlea of the newborn rat or not and what kinds of cells should be differentiated from the proliferative cells while to study the effect of the growth factors on the proliferative cells and the ultrastructure of the proliferative cells.</p><p><b>METHODS</b>The Corti's organ were dissected from the cochlea of newborn SD rats and cultured. The proliferative condition of cells was tested by infusing the 5-bromo-2-deoxyuridine (BrdU) into the culture medium. And the variety of the spheres and differentiated cells were identified by immunohistochemistry. Corti's organ from forty-eight surface preparations was randomly divided into 4 groups: control group; epidermal growth factor (EGF) group; basic fibroblast growth factor (bFGF) group and EGF + bFGF group, with each group including 12 Corti's organ, and then the number of cell spheres of each Corti's organ was counted. The data was statistically analysed with ANOVE. Finally, the proliferative cells were observed under scanning electron microscope and transmission electron microscope.</p><p><b>RESULTS</b>(1) The cell spheres can be observed in the cell culture of the Corti's organ. In present experiment, 90.1% of cells in spheres were labeled by BrdU, while nestin of spheres, the marker of hair cells--myosin 7A, espin, and phalloidin of the differentiated cells were positive. The marker of neuron-microfilament-M was also positive, and some differentiated cells were labeled by myosin 7A and BrdU, espin and BrdU, NF-M and BrdU at the same time. (2) The average number (x +/- s) of spheres from single Corti's organ was: 45.3 +/- 23.00 in control group, 86.2 +/- 34.1 in EGF group, 96.5 +/- 33.6 in bFGF group and 131.2 +/- 47.00 in EGF + bFGF group. There were significant differences between other groups respectively (P < 0.05) but there was no significant differences between EGF group and bFGF group (P > 0.05). (3) Scanning electron microscopy and transmission electron microscopy showed that cells of the spheres were round and had the same size and many short and thin microvilli on the surface of these cells. The cytoplasm were rich of organellae such as endoplasmic reticulum, mitochondrion, and cytoskeleton such as microfilament, microtube, et al. Tight junction, desmosomes and gap junctions between two adjacent cells were seen.</p><p><b>CONCLUSIONS</b>The proliferative cells are observed in the cochlea of the newborn rats and proliferative cells could differentiated into hair cells with bundles-like structure and neuron. Both EGF and bFGF possess the promoting effects for proliferation on the proliferative cells while the proliferative cells have characters of earlier immature cells.</p>

Precise three-dimensional modeling and virtual visualization of human membranous labyrinthine / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish a precise three-dimensional model of membranous labyrinth for further morphologic investigation and physiological research.</p><p><b>METHODS</b>Complete series of serial unstained celloidin sections of a fresh human temporal bone were taken photos by high-pixel digital camera. The images were then processed with the technique of photo stitch and employed to reconstruct the three-dimensional model of the membranous labyrinth using the method of surface rendering.</p><p><b>RESULTS</b>In 3D-Doctor software, the model was displayed by different methods. The model was also exported to VRML format and their virtual visualization was realized through the software of Cortona virtual reality modeling language viewer.</p><p><b>CONCLUSIONS</b>Precise modeling of membranous labyrinth could be realized by advanced imaging technique. With the advanced virtual reality software and equipment, the virtual visualization of membranous labyrinth could be realized, which would benefit the morphologic investigation and education.</p>

Preparation of new protein carrier of vaccine against pneumococcal otitis media with genetic engineering technology / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To prepare pneumolysin as a new protein carrier of vaccine against otitis media with genetic engineering technology and establish the base of the study on pneumococcal conjugative vaccines.</p><p><b>METHODS</b>Genomic DNA was isolated from streptococcus pneumoniae. A pair of primers which included two restriction sites was designed based on the published pneumolysin gene sequence. The pneumolysin gene was amplified from pneumococcal DNA with PCR technology. The restriction enzyme digested fragment was linked into the cloning vector PET-28a and the recombinant plasmid DNA containing pneumolysin was then transfected into host cell E. coli JM109 (DE3).</p><p><b>RESULTS</b>DNA fragments were subcloned to construct the complete pneumolysin gene by a conventional coning and PCR. The inserted pneumolysin gene sequence was confirmed by DNA sequencing and the pneumolysin protein was successfully expressed. The relative molecular mass of the expressed product was 52 000. The expressed product amounted to 8% of the total host cell protein.</p><p><b>CONCLUSIONS</b>The pneumolysin gene was successfully cloned into host cell using genetic engineering technology. The recombinant pneumolysin was expressed and purified for preparation. This work laid a foundation of the preparation of pneumococcal conjugative vaccines.</p>

Distribution of gentamicin in inner ear after intratympanic gentamicin injection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate uptake and accumulation of gentamicin by cells in the guinea pig inner ear after intratympanic injection using a fluorescent probe--gentamicin-Texas-red conjunction (GTTR).</p><p><b>METHODS</b>Adult guinea pigs (n = 80) were administered a single dose of GTrR to the middle ear cavity through the intact membrane and survived for 12 h, 24 h, 48 h, 3 d, 4 d, 7 d, 14 d and 28 d. The distribution of GTTR in the cochlear and vestibular cells was observed after staining with phalloidin-alexa-488. Texas Red and DMSO were injected into the tympanum as control.</p><p><b>RESULTS</b>Diffuse staining of gentamicin in the labyrinth was observed initially after local drug administration. At later time point the outer hair cells and sensory cells of vestibular organ were staining more densely than the support cells in the inner ear. The peak level of fluorescent density was reached 3 days after local injection. The GTTR was observed in the infracuticular zone.</p><p><b>CONCLUSIONS</b>GTTR was a potential fluorescent probe to investigate the pharmacokinetics and mechanisms of gentamicin accumulation in local application.</p>

Three-dimensional morphological measurements of the utricle, saccule and stapes footplate / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the optimal drill area on the footplate with the 3D measurements of the stapes and the vestibular end organs.</p><p><b>METHODS</b>Four temporal bones were extracted from the fresh cadavers and undecalcified polymer-embedded. After serially sectioning, image processing and the 3D precisely reconstruction, a local Cartesian coordinates was established in which the tympanic surface of the footplate was supposed to be XY plane and the Z coordinate axis passed through the central point of the footplate and was vertical to the XY plane. The configurations of the utricle and saccule were delineated quantitatively, and then any distance between one point on the surface of the footplate and another point on the surface of the utricle or saccule and its orientation can be measured.</p><p><b>RESULTS</b>There was a "V" shaped cleft between the utricle and the saccule. The angle of the" V" shaped cleft was 50.31 +/- 19.90 (17.00 - 68.00) degrees. The apex of the cleft directed anterosuperiorly and approached the footplate center, while beneath the posteroinferior part of the footplate was an open and deep area. The vertical distance from the center point of the footplate to the vestibular end organs was (2.20 +/- 0.548) mm, the maximum of 3.0 mm and the minimum of 1.6 mm.</p><p><b>CONCLUSIONS</b>The posterior and inferior quadrant of the footplate may be the optimal drill area for the fenestra.</p>

Diagnosis and management of facial nerve neuromas / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To provide the experience for early diagnosis and management of facial nerve neuromas, and to discuss the clinic and imaging feature of facial nerve schwannoma and facial nerve fibroma in 22 cases.</p><p><b>METHODS</b>Twenty cases facial nerve schwannoma and two cases of facial nerve neurofibroma were diagnosed and reviewed retrospectively. Surgical removal were performed through the middle cranial fossa in 2 cases, through intratemporal approach in 8 cases, through intraparotid approach in 2 cases, and combined intra-temporal with out-temporal approaches in 10 cases. Seventeen cases underwent facial nerve graft for repairing a facial nerve defect. Great auricular nerve was used in 3 cases with intratemporal approach and 1 case with intratemporal combined intraparotid approach. Sural nerve graft was used in 5 cases with intratemporal approach and 8 cases with intra-temporal combined intraparotid approach. Two cases were employed two-stage facial muscle flap-plasty.</p><p><b>RESULTS</b>Facial nerve neuromas were totally removed in 21 cases and subtotal neuroma removed in 1 case. In these cases, 20 patients were no recurrence and 1 patient was lost follow-up. One patient with subtotal neuroma removal received Gamma Knife treatment before and after surgery, and this case was no recurrence. The CT imaging of the temporal bone showed that schwannoma was separated "white mass" with smooth margin along the region of facial nerve without intact canal. But neurofibroma locate in enlarge fallopian with intact canal. Magnetic resonance imaging had the advantage of evaluating all segments of the facial nerve and showed continuity of intratemporal and intraparotid mass with the facial nerve. Pathological results indicated that 20 cases were diagnosed as facial nerve schwannoma and 2 cases were neurofibroma.</p><p><b>CONCLUSIONS</b>Although tumors originating from the facial nerve are extremely rare, it is possible to make early diagnosis through finding clinical feature and imaging methods. Generally, systematic surgical approach for tumor removal and facial nerve reconstruction should be considered in the cases with facial neurinoma.</p>

Clinical research about the distribution of perineural vascular plexus of the facial nerve / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To objectively evaluate the usefulness and the reliability of the perineural vascular plexus as a landmark for facial nerve as well as whether it will be a landmark for identification of the facial nerve in surgery for otology and neurotology by means of investigating the location of the facial nerve for prevention of iatrogenic facial palsy.</p><p><b>METHODS</b>Prospective case series were designed. Three hundred and eleven consecutive patients were studied which required tympanoplasty for chronic otitis media or microsurgery for facial nerve decompression and congenitally malformation of the ear from July 2002 to July 2005. All the patients were operated by the first author. Perineural vascular plexus as a landmark for identification of the facial nerve in surgery were observed to assess the utility.</p><p><b>RESULTS</b>The well recognized perineural vascular plexus were seen on the horizontal mesotympanic segment of the nerve in 95.8% of patients (298 cases), and only in 4.2% of the patients (13 cases), the vessel plexus was difficult to identify. The 95% confidence interval was from 93.6% to 98.0%.</p><p><b>CONCLUSIONS</b>The vascular plexuses around or over the horizontal portion of the facial nerve provide an early and direct indicator of the location of the facial nerve. The perineural vascular plexus could be a dependable and reliable landmark for the identification the horizontal part of the facial nerve in surgery for otology and neurotology.</p>

Mutual interaction of vestibular afferent nervous system and vestibular efferent nervous system in vestibular compensation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the mutual interaction of vestibular afferent nervous system and vestibular efferent nervous system in vestibular compensation.</p><p><b>METHODS</b>Build up animal model of vestibular compensation by destroying single side vestibule of wistar rat. In the study the rats were divided into 3 groups: Group A 16 normal rats; Group B 15 rats, after 7 days of left vestibular damage; Group C 7 rats 3 months after left vestibular damage; and Group D 7 rats, after vestibular compensation. Electromyography of the rats was recorded and the expression of calcitonin gene relative peptide (CGRP), choline acetyltransferase (AChT) and Na-K-ATPase were investigated in efferent vestibular nervous system.</p><p><b>RESULTS</b>Electric potential activity of muscles of injury side decreased while that of the opposite side increased. In animals of vestibular compensation electric potential of bilateral musculus longus capitis at quiescent stage recovered symmetrically. CGRP positive cells of efferent vestibular nervous system increased bilaterally, and their activity enhanced, especially obvious at the acute stage. AChT positive cells of injury side of efferent vestibular nervous system decreased, but reaction degree of two sides enhanced. Reaction degree of the opposite side enhanced obviously at the stage of vestibular compensation. Expression of Na-K-ATPase mRNA of the same side was lower, but vestibular signal of the opposite side enhanced, clinically head and neck inclined obliquely by means of medial fasciculus of tractus vestibulospinalis. Months later, vestibular signal of the same side enhanced, and that of the opposite side enhanced also, clinical symptoms improved slightly. At the vestibular compensation stage, expression of Na-K-ATPase mRNA of the same side enhanced, and it was same as that of the opposite side or much higher, clinically it reached vestibular compensation.</p><p><b>CONCLUSION</b>Comprehensive effect of the above results maybe as follows: Efferent vestibular nervous system inhibited afferent signal of the opposite vestibule, and it modulated excitement of vestibular center of the same side, and it worked in the complicated mechanisms of vestibular compensation. CGRP may have facilitation function to the vestibular afferent signal of injury side. While Ach improved vestibule compensation by means of inhibition of vestibule excitement of the healthy side.</p>