Effect of electrode array type and insertion technique on the insertion force: in vitro cochlear model study / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the effect of insertion technique and electrode array type on the insertion force of electrode array, and to provide a basis for further optimizing electrode design and facilitating mini-invasive electrode insertion. Methods: Three types of electrode array from Nurotron (Standard Electrode, Slim-medium Electrode, Slim-long Electrode) were studied. from July 2019 to December 2019. These electrode arrays were inserted into the phantom models of the cochlea, manually or robot-assisted(medium speed and low speed). The real-time force during electrode array insertion was recorded by ATI Nano 17 Ti sensors and was analyzed by accessory software. Origin 2020b software was used for statistical processing. Results: The insertion force of all electrode arrays progressively increased with the insertion depth. With the manual technique, the peak force of slim-medium electrode insertion was significantly smaller than that of the standard electrode insertion((71.0±16.6) mN vs (140.9±52.7) mN, Z=3.683, P<0.01), and the peak force of the slim-long electrode insertion was between the peak force of standard electrode and slim-medium electrode(P>0.05). No difference was found in the force variation of insertion among the three electrodes(P>0.05). With medium-speed and low-speed robotic assistance, the peak force characteristics of three electrodes were similar to those with the manual technique, but the force variation of standard electrode insertion ((83.9±9.7) mN/s) at medium speed was significantly larger than that of the slim-long electrode insertion ((69.2±4.0)mN/s), and the force variation of the standard electrode insertion at low speed was significantly greater than the other two electrodes. For the same electrode, robot-assisted insertion presented significantly lower peak force and force variation than manual insertion for each type of electrode array. But there was no difference in the peak force and force variation between two-speed levels of robot assistance (P>0.05). Conclusions: The insertion force of the electrode array will be lower when a slim electrode array or robot technique is applied. Long electrode array might make manual insertion difficult or less precise. Robot assistance has advantage on force control during electrode array insertion.

Management of Laryngopharyngeal Reflux in Asia

Objectives@#. This study was conducted to investigate the current practices of Asian otolaryngologists for laryngopharyngeal reflux (LPR). @*Methods@#. An online survey about LPR was sent to 2,000 members of Asian otolaryngological societies, and a subgroup analysis was performed between Western and Eastern Asian otolaryngologists. The survey was conducted by the Laryngopharyngeal Reflux Study Group of Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies. @*Results@#. Among approximately 1,600 Asian otolaryngologists, 146 completed the survey (62 from Western Asian countries, 84 from Eastern Asian countries). A substantial majority (73.3%) of the otolaryngologists considered LPR and gastroesophageal reflux disease to be different diseases. The symptoms thought to be closely related to LPR were coughing after lying down, throat clearing, and globus sensation. The findings thought to be closely related to LPR were posterior commissure granulations and hypertrophy, arytenoids, and laryngeal erythema. The respondents indicated that they mostly diagnosed LPR (70%) after an empirical therapeutic trial of proton pump inhibitors (PPIs). Although multichannel intraluminal impedance-pH (MII-pH) monitoring is a useful tool for diagnosing nonacid or mixed LPR, 78% of Asian otolaryngologists never or very rarely used MII-pH. Eastern Asian otolaryngologists more frequently used once-daily PPIs (64.3% vs. 45.2%, P=0.021), whereas Western Asian otolaryngologists preferred to use twice-daily PPIs (58.1% vs. 39.3%, P=0.025). The poor dietary habits of patients were considered to be the main reason for therapeutic failure by Asian otolaryngologists (53.8%). Only 48.6% of Asian otolaryngologists considered themselves to be adequately knowledgeable and skilled regarding LPR. @*Conclusion@#. Significant differences exist between Western and Eastern Asian otolaryngologists in the diagnosis and treatment of LPR. Future consensus statements are needed to establish diagnostic criteria and therapeutic regimens.

The progress of topical drug delivery to the inner ear for the inhibition of inflammation and fibrosis following cochlear implantation / 中华耳鼻咽喉头颈外科杂志

Nowadays, more than 300 000 deaf people around the world benefit from cochlea implantation. With the extension of cochlear implantation indications, it has become a research focus for how to apply the anti-inflammatory and anti-fibrotic drugs safely and effectively to better retain residual hearing, as well as to protect hair cells and the spiral ganglion cells from apoptosis. Due to the blood-labyrinth barrier, perioperative systemic steroids are often unable to achieve satisfactory drug concentration in the inner ear. Also, given that higher doses of steroids will cause more serious side effects and sometimes steroids are strictly limited to apply on some patients with certain diseases, the attention has been attracted on topical drug delivery to the inner ear. In this review, the methods of topical drug delivery to the inner ear are divided into four categories: transtympanic injection of liquid solutions, tympanic implantation of drug delivery systems, intracochlear injection and modified implant electrode. The results in each category and up to date progress are reviewed.

Effect of compatibility of Aconitum carmichaelii and Cornus officinalis on chronic heart failure rats / 中草药

Objective To study the efficacy enhancing and toxicity reducing effects of compatibility of Aconitum carmichaeli and Cornus officinalis on chronic heart failure (CHF) rats. Methods The CHF rats was established by ip injection of adriamycin (ADM), the CHF rats were administrated tested drugs for three weeks by means of ig administration, the tested drugs included extracts of A. carmichaeli, C. officinalis, and Compound. The serum brain natriuretic peptide (BNP) level, activity of Ca2+-ATP and Na+, K+-ATP enzymes in cardiac myocytes, and cardiac histopathology were measured. Results After three weeks of modeling, the CHF rats showed signs of ascites, loss of weight, loose stool, hogback, etc. The left ventricular ejection fraction (EF) and fraction shortening (FS) decreased significantly, and the level of BNP in serum was significantly improved; Pathological changes of ventricular tissue included rupture of myocardial fibers, degeneration and necrosis of cardiomyocytes, etc. After three weeks of gavage compatibility of A. carmichaeli and C. officinalis, the general state and cardiac histopathology of the animal was obviously improved, the level of BNP in serum was reduced significantly, the activity of Na+, K+-ATP enzymes was increased significantly. No notable improvement in the above indexes was obtained after administration of A. carmichaeli and C. officinalis alone. Conclusion The compatibility of A. carmichaeli and C. officinalis can increase the activity of Na+, K+-ATP enzyme in cardiac myocytes, and improve the energy metabolism and activity of cardiac myocytes in chronic heart failure. The compatibility of A. carmichaeli and C. officinalis play the key role of enhancing efficacy and reducing toxicity.

Progressive diaphyseal dysplasia with right transverse sinus stenosis: a case report / 中华神经科杂志

Progressive diaphyseal dysplasia , also called Camurati-Engelmann disease (CED), is a kind of autosomal dominant disease mainly involved in long diaphysis , characterized as progressive and symmetric cortical thickening as well as low prevalence.The pathogenic gene of the disease is TGFB 1 located in 19q13, resulting in abnormal bone metabolism.We report a young woman suffering from CED , mainly presented as decreased visual acuity , chronic high intracranial pressure and skull damages by cerebral angiography.The digital subtraction angiography revealed the right transverse sinus stenosis .We first revealed a CED patient with chronic high intracranial pressure caused by sinus stenosis , and selected intravascular therapy for the sinus stenosis.

Relationship between clinical characters of acoustic neuroma and cellular immunity / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the relationship between the clinical characteristics of acoustic neuroma and the number ofT lymphocytes in tumor tissues.METHODS Clinical data of 65 patients diagnosed with VS were retrospectively collected.Peripheral blood samples of the patients were collected and the number of T lymphocytes were counted by flow cytometry.Immunohistochemistry was carried out with the fresh tumor samples compared with 8 normal cranial nerve controls.The expression level of each immune protein was analyzed its correlation with clinical characters was explored.RESULTS The CD3+,CD4+ and CD8+ T lymphocytes in the peripheral blood are not significantly correlated with clinical data.In the tumor tissues,the number of CD4+ and CD8+ T lymphocytes are much larger than those in normal cranial nerves,and negatively correlated with preoperative hearing.The number of CD8+ T lymphocytes has a negative relationship with postoperative facial nerve function.In addition,CD4 and CD8 expression levels in the tumor samples from patients younger than 40 are much higher than those in elder patients.Foxp3 is not detected in the normal cranial nerves.The number of Foxp3+ T lymphocytes is negatively correlated with preoperative hearing.CONCLUSION The CD4+ and CD8+ T lymphocytes mediated cellular immunity play an important role in the development of acoustic neuroma,as well as the reservation and restoration of nerve function.

Retrolabyrinthine approach for cerebellopontine angle region surgeries / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the application ofretrolabyrinthine approach in cerebellopontine angel(CPA) region surgeries.METHODS A total of 42 patients underwent microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach were reviewed.They were hospitalized from January 1st 2011 to January 1st 2016 in our institution.The microscopic-endoscopic technique was applied in all surgeries.RESULTS Complete removal was obtained in all tumor resections and satisfactory symptom-relief was achieved in all microvascular decompressions and neurectomies.In cases with acoustic neuroma and cholesteatoma,useful hearing (AAO-HNS classes A,B and C) was obtained in 66.7％(6/9) patients.No facial paralysis and postoperative complications such as cerebrospinal fluid leakage occurred during follow-up.In cranial nerve rhizopathies cases,complete relief was achieved in all patients.No facial paralysis and other lower cranial nerve dysfunction occurred.CONCLUSION With the preservation of labyrinthine structures,the microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach could increase the hearing preservation level without facial nerve injury.Retrolabyrinthine approach is a good option for cranial nerve rhizopathies and tumors smaller than 15 mm in diameter without involvement of the fundus of internal auditory canal in the CPA region.

A combination use of endoscope and microscope in cerebral pontine angle surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle (CPA) surgery.@*Methods@#A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively. The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas, 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma. Twenty cases of vestibular swannnomas, 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach, while other cases undergone the surgery via retrolabyrinthine approach. Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion. The surgical results were evaluated according to subjective and objective criteria, and all patients were followed up for 15 years.@*Results@#The symptoms was disappeared in the cranial neuropathy patients, without facial paralysis, complication of other nerves or hearing loss. Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma, which gained completely surgical removal; useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up.@*Conclusions@#A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques. It can provide better exposure with minimal invasion in CPA surgery, and is especially applicable in surgery for cranial neuropathy, vestibular schwannoma and CPA cholesteatoma, which should be performed through retrosigmoid approach and retrolabyrinthine approach.

Role of endoplasmic reticulum-plasma membrane junctions in intracellular calcium homeostasis and cardiovascular disease / 生理学报

Calcium overload is one of the important mechanisms of cardiovascular disease. Endoplasmic reticulum is an important organelle which regulates intracellular calcium homeostasis by uptake, storage and mobilization of calcium. So it plays a critical role in regulation of intracellular calcium homeostasis. Endoplasmic reticulum, which is widely distributed in cytoplasm, has a large number of membrane junction sites. Recent studies have reported that these junction sites are distributed on plasma membrane and organelle membranes (mitochondria, lysosomes, Golgi apparatus, etc.), separately. They could form complexes to regulate calcium transport. In this review, we briefly outlined the recent research progresses of endoplasmic reticulum-plasma membrane junctions in intracellular calcium homeostasis and cardiovascular disease, which may offer a new strategy for prevention and treatment of cardiovascular disease.

Efficacy of intratympanic steroid injection as supplementary or initial treatment for sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the efficacy of intratympanic steroid injection as supplementary or initial treatment for sudden sensorineural hearing loss (SSNHL).@*METHOD@#A total of 68 patients diagnosed with SSNHL were randomized into group A (45 cases including systemic steroid for 33 cases and systemic steroid + intratympanic steroid as supplementary treatment for 12 cases) and group B (23 cases, initial intratympanic steroid). Then observe the therapeutic effect in two groups.@*RESULT@#The total effective rate was 55.6% in group A and 56.5% in group B. No statistical difference was detected between these two groups (P > 0.05). There was statistical difference after therapy of intratympanic steroid as supplementary treatment for 12 patients due to poor hearing improvement after systemic steroid in group A (P < 0.05).@*CONCLUSION@#Both systemic and intratympanic steroid injection for SSNHL are effective. The efficiency of intratympanic steroid injection as supplementary or initial treatment for SSNHL is similar to that of systemic steroid. The intratympanic steroid injection for SSNHL as initial protocol or as supplementary treatment when poor hearing improvement after systemic steroid is recommended.

Missed diagnosis in 1 case of esophageal foreign body of button battery in infant: a case report and review of the literature / 临床耳鼻咽喉头颈外科杂志

To be on the alert on infants with esophageal foreign body, and to pay more attention to the button battery esophageal foreign body, the clinical data of a 12-month-old infant with button battery esophageal foreign body, which was missed diagnosis for up to 4 months, is analyzed. And the related literature is reviewed. An esophagoscopy was carried out to remove the foreign body. A favorable outcome was achieved. When the infants have unexplained gastrointestinal symptoms, we should consider the possibility of an esophageal foreign body. We should pay attention to the button battery due to its highly corrosive to the esophagus. Timely diagnosis, reasonable operation are the keys to cure.

Observation on the change of electrode impedance and THR/MCL values in 20 cases with Med-EL Combi 40+ cochlear implant / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the changes of electrode impedance, THR/MCL values, and dynamic range (DR) in Combi 40+ cochlear implant after implantation.@*METHOD@#A respective study was carried out collecting 20 consecutively implanted children's electrode impedances, THR/MCL values, and DR at seven time point during the first three years after implantation. Their variation and correlations were analyzed.@*RESULT@#Overall, electrode impedances were lowest during the operation, and significantly rise to the highest at the first stimulation, then followed by a gradual decrease. After three months, electrode impedance of apical and medial cochlear segment were basically stable, while that of the basal segment was gradually increased. Dynamic range (DR) of apical and medial group electrode increased early after the operation and showed a stabilization from the second year, whereas that of basal group have a downward trend since the first year. However, the electric charge of each group increased significantly after three months, and then become stable after first year. Otherwise, a stronger negative rectilinear correlation was found between impedance changes with DR than with THR/MCL level.@*CONCLUSION@#The electrode impedances vary clue to different electrode position. Measuring the electrode impedance can effectively evaluate the working status of Combi C40+ cochlear implant. The dynamic range of the electrode was negatively correlated with the impedances, which made it possible to predict the width of the dynamic range by measuring the impedance 3 or 6 months after operation.

Application of Autogeneic Cartilage in Hearing Reconstruction Surgery / 听力学及言语疾病杂志

Objective To study the applications and outcomes of using autogeneic cartilage in hearing recon-struction surgery in patients with chronic otitis media or cholesteatoma .Methods A total of 165 patients (173 ears) in whom autogeneic cartilage was used were analyzed retrospectively .Forty -three patients (48 ears) had simple tympanic membrane perforations ,61 patients (61 ears) had cholesteatomas including 12 retraction pockets ,23 pa-tients (23 ears) had tympanoscleroses and 38 patients (41 ears) had otitis media with granulations .The cartilage grafts were used for tympanic perforation reparing in 133 patients (139 ears) ,for ossiculoplasty in 102 patients (104 ears) ,for attic reconstruction in 31 patients (31 ears) and for canal wall reconstruction of external auditory canal in 3 patients (3 ears) .The auditory outcome (0 .5 ,1 ,2 ,and 4 kHz pure tone average hearing threshold ,the average air-bone gap) and local architecture status were followed up for 1 year after surgery .Results In 133 patients (139 ears) with tympanic perforation ,the rate of successful repair of a tympanic membrame perforation in one -stage was 97 .84% with perforation repair in 136 ears and postoperative perforation in 3 ears .In 102 patients (104 ears) of os-siculoplasty ,there was no ossicular prostheses prolapse .In 31 patients (31 ears) of attic reconstruction ,no local graft shift or collapse was found .In 3 patients (3 ears) of external auditory canal repair ,no canal wall collapse occurred . In myringoplasty group (43 patients ,48 ears) ,preoperative and postoperative air -bone gap (ABG) was 23 .8 ± 3 .1 dB and 11 .6 ± 8 .7 dB ,respectively .In cholesteatoma group (61 patients ,61 ears ) ,preoperative and postoperative ABG were 39 .2 ± 24 .7 dB and 19 .0 ± 12 .1 dB ,respectively .In tympanosclerosis group (23 patients ,23 ears) ,pre-operative and postoperative ABG were 31 .2 ± 12 .4 dB and 19 .8 ± 11 .2 dB ,respectively .In otitis media with granu-lation group (38 patients ,41 ears) ,preoperative and postoperative ABG were 41 .6 ± 9 .9 dB and 15 .3 ± 13 .4 dB ,re-spectively .Conclusion Autogeneic cartilage is very valuable in hearing reconstruction surgery ,especially in compli-cated tympanic perforation ,combination with ossiculoplasty prostheses ,or reconstruction of mastoid cavity or exter-nal call wall defect .

Effect of naoxintong capsule on the vascular endothelial function and the infarct size of patients with acute myocardial infarction / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Naoxintong Capsule (NC) on the vascular endothelial function and the infarct size of patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>One hundred and four patients with AMI were randomly assigned to the NC group (Group A, 36 cases), the Tongguan Capsule group (Group B, 32 cases), and the conventional Western medicine group (Group C, 36 cases). The conventional Western medicine was given to the three groups. NC was additionally given to Group A, and Tongguan Capsule was additionally given to Group B. The therapeutic course for all was 4 weeks. The plasma nitric oxide (NO), endothelin (ET), von Willebrand factor (vWF) were detected in the 3 groups before and after treatment. The inner diameter of brachial artery was examined by ultrasonograph. The flow-mediated dilation (FMD) and the nitroglycerin-mediated dilation (NMD) were calculated. The ECG QRS integral and the infarct size were assessed.</p><p><b>RESULTS</b>There was no significant difference in the vascular endothelial function, ECG QRS integral, or the infarct size among the three groups before treatment (P > 0.05). Compared with before treatment, NO and NMD obviously increased after treatment in Group A and Group B, while the vWF and the infarct size obviously decreased in Group A, all showing statistical difference (P < 0.05). Compared with those in Group C, the NO, FMD, NMD significantly increased and ET obviously decreased in Group A and B after treatment (P < 0.05). The ECG QRS integral and the infarct size also decreased, with statistically significant differences in Group A (P < 0.05). Better effects on improving NO, NMD, and vWF were obtained in Group A than in Group B (P < 0.05).</p><p><b>CONCLUSION</b>NC could reduce the infarct size of AMI patients possibly through improving the vascular endothelial function.</p>

A comparison between anatomical landmark registration and surface registration for computer-assisted endoscopic sinus surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the clinical advantage and disadvantage of anatomical landmark registration (ALR) and surface registration (SR) in computer-assisted endoscopic sinus surgery (CAESS).@*METHOD@#Twenty-six patients were selected for the CAESS, the preparatory times and mean target registration errors (TRE) were recorded in order to compare the difference between them two, their convenience and their value were also analyzed.@*RESULT@#CAESSs were successfully used in 26 cases without complications. The average preparation time of SR was (8.5 +/- 1.9) minutes, that of ALR was (6.5 +/- 1.7) minutes. In the SR group, the TRE of naso-labial angle was (1. 43 +/- 0.26) mm, that of front end of middle turbinate was (1.92 +/- 0.47) mm, that of front end of inferior turbinate was (1.82 +/- 0.49) mm, and that of back end of inferior turbinate was (2.03 +/- 0.42) mm. Them in ALR group were (1.58 +/- 0.35) mm, (2.05 +/- 0.37) mm, (1.92 +/- 0.31) mm and (2.48 +/- 0.64) mm, respectively. 24 cases (92. 2%) were not affected or were slightly affected by the navigation system. The value of navigation was affirmative in 22 cases (84. 6%), and its value was mainly related to TRE.@*CONCLUSION@#The accuracy of surface registration was superior to that of anatomical landmark registration, but the anatomical landmark registration was more convenient and need less preparation time. The value of navigation system is its accuracy, convenience and no disturbance to surgery. The navigation system is more valuable in the complex cases than that in the general case.

A comparison between anatomical landmark registration and surface registration for computer-assisted endoscopic sinus surgery / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the clinical advantage and disadvantage of anatomical landmark registration(ALR) and surface registration(SR) in computer-assisted endoscopic sinus surgery(CAESS).Method:Twenty-six patients were selected for the CAESS, the preparatory times and mean target registration errors (TRE) were recorded in order to compare the difference between them two, their convenience and their value were also analyzed.Result:CAESSs were successfully used in 26 cases without complications. The average preparation time of SR was(8.5±1.9)minutes, that of ALR was(6.5±1.7)minutes. In the SR group, the TRE of naso-labial angle was(1.43±0.26)mm, that of front end of middle turbinate was(1.92±0.47)mm, that of front end of inferior turbinate was (1.82±0.49)mm, and that of back end of inferior turbinate was (2.03±0.42)mm. Them in ALR group were (1.58±0.35)mm,(2.05±0.37)mm,(1.92±0.31)mm and (2.48±0.64)mm ,respectively.24 cases (92.2%) were not affected or were slightly affected by the navigation system. The value of navigation was affirmative in 22 cases (84.6%), and its value was mainly related to TRE.Conclusion:The accuracy of surface registration was superior to that of anatomical landmark registration, but the anatomical landmark registration was more convenient and need less preparation time. The value of navigation system is its accuracy, convenience and no disturbance to surgery. The navigation system is more valuable in the complex cases than that in the general case.

Study of postoperative facial nerve function influenced by sterical position between facial nerve and vestibular schwannoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the postoperative facial nerve function influenced by sterical position between facial nerve (FN) and vestibular schwannoma (VS).@*METHOD@#A retrospective review was performed of 101 patients with unilateral VS, who underwent tumor total removal via enlarged translabyrinthine approach between 2003 and 2006. Data concerning tumor stage based on tumor size, intra-operative sterical position between FN and VS which was classed on 4 types (type I: FN anterior to VS; type 2: anterior and superior to VS; type 3: superior to VS and type 4: posterior to VS), postoperative facial nerve function according to the House and Brackmann classification at days 7, 30, 90 and 180.@*RESULT@#The facial nerve was preserved anatomically in 98%. The intra-operative sterical position between FN and VS was found in 43% for type 1, 33% for type 2 and 24% for type 3, but none for type 4. Good facial function at days 180 was present in 73% and decreased along with the augmentation of tumor size. Statistically, there had a significant correlation between the sterical position and postoperative FN function. Good facial function in type 1 was better than that of type 3.@*CONCLUSION@#The rate of anatomic preservation of FN does not parallel that of good postoperative facial function. The prognostic factor of latter includes not only tumor size, but also sterical position between FN and VS.

The selection of surgical technique for cholesteatoma in pediatric patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the surgical treatments and results for cholesteatoma in pediatric patients.@*METHOD@#A retrospective analysis of 25 cases of cholesteatoma in pediatric patients. Out of all 25 patients, 18 underwent the tympanoplasty with open technique, 1 underwent the tympanoplasty with close technique, and 6 underwent the radial mastoidectomy.@*RESULT@#During the follow-up, 24 patients were cured in first-stage surgery, no recurrent cholesteatoma was observed, no observed complications occurred after surgery. Compared with the hearing thresholds of 7 patients were improved, 7 patients' hearing thresholds had no change, and 11 patients' were decreased.@*CONCLUSION@#The cholesteatoma in children are more widespread and erosive. The surgery should completely remove the diseased tissues and then preserve the hearing. The surgery should clear away all the lesions thoroughly, and then to conserve hearing ability maximally. Surgical techniques should be chosen depending on the lesions' extension, generally the tympanoplasty with open technique was more suitable. The postoperative hearing decrease based on the diseased tissue and disease extension.

Defect reconstruction after removal of tumor in lateral skull base / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the methods of reconstruction for the defects of lateral skull base after removal of tumor.@*METHOD@#One hundred and thirty two patients who underwent removal of tumor in the lateral skull base and reconstruction of defects after surgery were summarized retrospectively. They suffered from acoustic neuroma (92 cases), the tumor in the jugular foramen (21 cases), neoplasms in the infratemporal fossa (6 cases), recurrent nasopharyngeal carcinoma after radiotherapy (4 cases), cancer of middle ear (3 cases), meningioma (2 cases), arachnoid cyst in the cerebellopontine angle (2 cases), and squamous cell carcinoma of the temporal bone (2 cases). The defects of dura mater membrane, basion, arcus jugalis, base of skull and infratemporal fossa were repaired with the abdominal wall fat (113 cases), temporal muscle and temporal musculofascial flap (29 cases), sternocleidomastoideus muscle flap (19 cases), major pectoral myocutaneous flap (2 cases), the artificial mater (1 case), titanium board (1 case).@*RESULT@#All muscle or myocutaneous flaps survived in these patients, and fat tissues survival rate was 98.2% (111/113). Leakage of cerebrospinal fluid occurred in two patients after repairing with fat tissues. The intracranial infection was not found in these patients.@*CONCLUSION@#According to the position of tumor in the lateral skull and different type of defect, different reconstructing methods and materials were used. The reconstruction in the lateral skull base and infratemporal fossa defect plays an important role to eliminate dead space, and avoid leakage of cerebrospinal fluid and intracranial infection, which is one of key points in the lateral base surgery.

Diagnosis and treatment of lateral skull base tumors in pediatric / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the diagnosis and treatment of lateral skull base tumors in children.@*METHOD@#The clinical data of 8 patients with lateral skull base tumors were reviewed in a retrospective study. One had schwannoma of the trigeminal nerve, one had malignant melanoma, one had fibroma in temporal bone, one had chordoma, two had rhabdomyosarcoma, two had esthesioneuroblastoma. Of 8 patients, one case was treated with chemotherapy. The other 7 cases of benign or malignant tumors underwent surgery in different approaches. Four patients had pre-and postoperative chemotherapy. Three patients received postoperative chemotherapy.@*RESULT@#The group patients had been followed up for 1-1.5 years and it was shown that there was no recurrence in 4 cases, while there was recurrence in 4 cases. One patient of chordoma died 5 months after surgery, the other 7 patients were alive at the time of analysis. Cerebrospinal fluid leak occurred in two patients who healed with management. Hearing loss occurred in one patient in the operated ear. One patient developed hoarseness. Two patients developed swallowing obstruction and healed 3-4 months after surgery.@*CONCLUSION@#Tumors in lateral skull base in children were rare, of which malignant tumors were more common compared to benign lesions. CT and MRI are helpful in evaluating extent of disease and preoperative planning. Surgery is the first choice of the treatment for lateral skull base tumors. Radiation therapy and chemotherapy could be used for malignant tumors preoperatively and postoperatively. Combined approach of temporal and infratemporal fossa is suitable for the surgery of those tumors involved temporal bone and middle or posterior cranial fossa as well as infratemporal fossa.