Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies.@*Methods@#Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases.@*Results@#Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web.@*Conclusions@#CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

Analyses of chronic otitis media with intact tympanic membrane concurrent with intracranial complication / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical and imaging characteristics of chronic otitis media with intact tympanic membrane.</p><p><b>METHOD</b>Ten patients were retrospective studied in the department of otorhinolaryngology of Guangdong general hospital from December 2006 to January 2015. The clinical characteristics of their manifestations, audiology and imaging examinations were analyzed.</p><p><b>RESULTS</b>All the cases could be divided into two groups: the intracranial complication group who was primarily diagnosed as intracranial complications, and the hearing loss group who primarily complained of hearing loss. Five cases belonged to the first group, which include 1 cerebellar abscess, 3 meningitis and 1 meningoencephalitis, 2 of them were profound hearing loss, 2 were mixed hearing loss, and 1 was normal hearing. The other 5 cases belonged to the hearing loss group, 3 were mixed deafness, 2 were conductive deafness. All the case showed positive high-resolution computed tomography (HRCT) features. In the first group, four cases showed the soft tissue shadow in tympanic antrum/superior tympanic pouch and 1 case showed a wide damage of skull base, in addition to intracranial complications. In the second group, five cases showed soft tissue imaging in tympanic antrum/superior tympanic pouch. Pathology showed that 2 cases were cholesterol granuloma(one was in the first group and the other was in the second group), 4 were intracranial inflammatory(the first group) and 4 were cholesteatoma(the seond group).</p><p><b>CONCLUSIONS</b>In chronic otitis media with intact tympanic membrane, intracranial complications may be the primarily diagnosis, which should be paid much attention by multidisciplinary team. HRCT and audiology were valuable for early diagnosis.</p>

The effect of binaural bi-modal fitting on speech recognition of cochlear implant recipients with low frequency electrodes incompletely implanted / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effect of binaural bi-modal fitting (one cochlear implant and a contralateral hearing aid) on speech recognition of cochlear implant recipients with low frequency electrodes incompletely implanted.@*METHOD@#A total of 15 cochlear implant(CI) users who have low residual hearing (250 Hz 45-90 dBHL, 500 Hz 75 - 100 dBHL) of their non surgery ears. We closed the top three electrodes to simulate the state of low-frequency electrodes incompletely implanted by fitting software. (1) The same tester received twice speech recognition tests in incompletely implanted state, one test used single CI model and the other used binaural bi-modal fitting model. (2)The same tester received above twice speech recognition tests again, but in completely implanted state. Then we compared the results of tests.@*RESULT@#The CI users used binaural bi-modal fitting have higher speech recognition score than the same users used unilateral cochlear implant model in low-frequency electrodes incompletely implanted state(P<0. 05). The gap between the scores of the tests by using two usage patterns in low frequency electrodes incompletely implanted state was more than that in completely implanted state (P<0. 05).@*CONCLUSION@#Binaural bi-modal fitting can help CI users to improve their speech recognition ability in low-frequency electrodes incompletely implanted state.

The correlations between varying tinnitus severity and anxiety and depression in non-acute tinnitus patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the correlation betwen varying degrees of non-acute tinnitus and anxiety and depression.@*METHOD@#Seventy-seven outpatients with non-acute tinnitus as their in chief complaint were submitted to Tinnitus Handicap Inventory(THI), Self-Rating Anxiety Scale(SAS), and Self-Rating Depression Scale (SDS).@*RESULT@#THI and its three subscales were found to have significant correlations with SAS and SDS. The group (THI ≥ 38) had more anxiety and depression than the mild (THI < 38). Significant correlations were also observed between THI, SAS and SDS in the group with THI ≥ 38, in contrast with the group of THI < 38.@*CONCLUSION@#Patients with THI ≥ 38 suffered from severe anxiety and depression than the mild. Doctors should pay more attention to these patients, especially their psychological disorders.

Application of HRCT multi-planar reconstruction for measuring cochlear morphology in cochlear implantation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the value of high-resolution temporal bone CT (HRCT) multi-planar reconstruction (MPR) technique for measuring cochlear morpholog in the preoperative evaluation of cochlear implant.@*METHOD@#We retrospectively analyzed the clinical data of 80 cochlear implant recipients. The groups were investigated in our research according to the patient's sex, age and whether the inner ear is malformed or not. Temporal bone HRCT MPR was applied to analyze the measurement parameter in the standard orientation of the cochlea image: the largest distance from the round window to the lateral wall (distance A), the perpendicular distance (B) and angle of the basal turn of the cochlea relative to the midsagittal plane (γ). Reproducibility of the measured data was evaluated and the results between the different groups were compared.@*RESULT@#Measurement of parameter values between the intraobserver and interobserver showed good reproducibility. In normal group, distance A [(8.79±0.34) mm] and perpendicular distance B [(6.58±0.28) mm] of males' cochleae were significantly larger than A [(8.53±0.47) mm] and B [(6.22±0.43) mm] of females' (P0.05). The A and B values didn't change with age (P>0.05), but the angle γ tended to decrease with increasing age (r=-0.25, P0.05).@*CONCLUSION@#HRCT MPR technique is simple and reliable in measurement of cochlear morphology. It can be used to guide the surgery and provide an objective basis for designing the personalized electrode. More clinical application of this technology is recommended.

The additional 180° roll test in the determination of affected side of horizontal semicircular canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the significance of additional 180-degree roll test (RT) in the determination of affected side in patients with horizontal semicircular canal benign paroxysmal vertigo (HSC-BPPV).@*METHOD@#One hundred and six patients with HSC-BPPV were performed the 90 degree RT. patients whose affected side cannot be determined by 90 degree RT were performed 180 degree roll test.@*RESULT@#The affected side was deter- mined by the 180 degree RT in 10 cases in which the lesion side cannot be determined by the 90-degree RT.@*CONCLUSION@#The affected side of HSC BPPV was able to be determined by 180 degree RT when it not possible to be determined by 90 degree RT. 180 degree RT is an effective and simple additional method.

Clinical characteristics of solitary plasmacytoma of temporal bone / 临床耳鼻咽喉头颈外科杂志

Patient of plasmacytoma of temporal bone often suffered from evident symptom in unilateral ear and obvious damage of bone. Clinical characteristics, imaging examination and histopathology can established an accurate diagnose. The therapy will be surgery and followed radiotherapy.

Clinical approach of trans-horizontal semicircular canal and vestibule for treatment of Mondini dysplasia with cerebrospinal fluid leakage / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the clinical manifestation of Mondini dysplasia with cerebrospinal fluid leakage and investigate the effect of the surgical repair through trans-horizontal semicircular canal and vestibule approach.@*METHOD@#Four cases which were operated by the approach of trans-horizontal semicircular canal and vestibule in our hospital were analyzed retrospectively.@*RESULT@#The leakages were all stopped by the primary surgical closure after six-month follow up.@*CONCLUSION@#Mondini dysplasia should be considered in children or teenagers with recurrent bacterial meningitis whether or not with otorhinorrhea. Pure tone audiometry and a temporal bone CT or MRI will confirm the diagnosis. A trans-horizontal semicircular canal and vestibule approach is an effective and simple way for the treatment.

The effect of reversal steps stapedotomy on the treatment of otosclerosis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine the efficacy of reversal steps stapedotomy in the treatment of otosclerosis.@*METHOD@#From January 2006 to December 2009, a total of 70 patients (81 ears) with otosclerosis who underwent stapedotomy were retrospectively evaluated. Among these 81 ears, 41 ears underwent classical stapedotomy and 40 ears underwent reversal steps stapedotomy. We compared the postoperative results of pure tone tes , the intraoperative complications of stapes and incus and the incidence rate of postoperative vertigo after surgery between the two groups.@*RESULT@#The rate of postoperative air bone gap < or = 20 dB was 70.7% in the classical stapedotomy group and was 80.0% in reversal steps stapedotomy group. There were no significant differences between the two groups (P =0.181). The reversal steps stapedotomy group seem to had less complications of stapes and incus. The incidence rate of postoperative vertigo in reversal steps stapedotomy group significantly lower than in classical stapedotomy group (P = 0.037).@*CONCLUSION@#Reversal steps stapedotomy can effectively improve the hearing of patients with otosclerosis and can reduce the complications of stapedotomy.

Measurement study of MDCT 3D reconstruction and microanatomy related to individual piston shaping on malleostapedotomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the management of basic parameters related to individual piston shaping on malleostapedotomy by MDST 3D reconstruction and microanatomy and to assess the accuracy of MDST method.@*METHOD@#Ten Chinese temporal bones without ear diseases were numbered randomly and scanned by GE Light Speed Ultra 64 rows of spiral CT. 3D structure of ossicular chain were reconstructed by MPR and VR methods in AW4. 1 workstation. Then measurements of distances between stapes head to stapes footplate (A line), and manubrium to stapes head (B line), and manubrium to stapes footplate (C line), angle between line A and line B (angle AB) are completed. After that, all samples of temporal bone were undergone canal wall down mastoidectomy under microscope and the relevant measurements were completed.@*RESULT@#The MPR and VR technique of MDCT reconstructed ossicular chain clearly, and revealed the spatial relationship between every structure stereoscopically. Respectively, lengths of A, B, C line by MDST and microanatomy are (3.42 +/- 0.86) mm and (3.60 +/- 0.94) mm, (3.42 +/- 0.80) mm and (2.96 +/- 0.42) mm, (5.86 +/- 0.60) mm and (6.22 +/- 1.10) mm, while angle AB (141.05 +/- 30.07) degrees and (144.57 +/- 41.86) degrees. There are no statistically significant differences between two groups (P>0.05).@*CONCLUSION@#The MPR and VR technique of MDCT can clearly reconstructed the 3D shapes of the temporal bone and finish the exactly managements on A, B, C lines and AB angel which is crucial for shaping a individual piston on malleus-to-oval window surgery.

Application of rhomboid flap for the repairment of postoperative defects in head and neck cutaneous tumor / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summarize the clinical repairment experience of postoperative skin defects in head and neck cutaneous tumor.@*METHOD@#From July 2002 to September 2006, 24 patients with head and neck cutaneous tumor were treated in our department. Every specimen and resection margin of all cases were monitored by intraoperative frozen section. Extents of operative skin defects were from 1.0 cm x 1.5 cm to 3.0 cm x 3.5 cm, all of which were repaired by rhomboid flap.@*RESULT@#All the cases were primarily repaired, and followed up 6 month to 3 years. The repaired skins had the normal colour, without obviously scars or secondary deformations.@*CONCLUSION@#The rhomboid flap is reasonably designed, conveniently procured and manipulated. It is a better method to immediately repair the head and neck skin defects after radical excision of tumor.

Narrow-band level set and visualization technology for cochlea segmentation / 生物医学工程学杂志

Segmentation is a precondition step for modeling and analysis of the cochlea. In this paper, an interactive segmentation approach with a combination of 3D (three-dimensional) narrow-band level set algorithm and visualization technology was adopted to separate the cochlea. The 3D narrow-band level set algorithm was used to separate the objective of interest from volume data, and the visualization technology was used to display the segmented result. Users could modify intermediate parameters based on the direct 3D visual feedback until getting satisfying result. The basic principle and characteristics of level set and narrow-band level set algorithms were described in detail. The 3D narrow-band level set algorithm was successfully used to separate the cochlea from spiral CT images of the temporal bone. The experimental results show that the interactive method combining the narrow-band level set algorithm with visualization technique is capable of segmenting the cochlea from the medical volume data. Compared with the method of segmenting object from image volume slice by slice, our method can save much time.

Malleostapedotomy in stapes surgery for otosclerosis with malleus/incus mobility disorder / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the feasibility, safety and effectiveness of malleostapedotomy based on malleus-oval window technique in otosclerosis with malleus/incus mobility disorder.@*METHOD@#Six cases with malleostapedotomy on stapes footplate fixation accompanied by malleus/incus movements disorder from March 2005 to March 2007 were analyzed retrospectively, when totally 78 cases of conventional stapes surgeries were performed on isolated otosclerosis . The surgical procedures, intraoperative findings and postoperative vertigo as well as pure tone gain were discussed.@*RESULT@#All of the 6 cases showed stapes footplate fixation. Both abnormal incudomalleolar joint and incudostapedial joint were found in 2 cases. It was suspected that previous inflammation resulted in yellowish mucosa, ossicular malformation and stiffness. The third one showed local tympanosclerosis in the attic. In another 2 cases, idiopathic malleus head fixation related to the anterior and superior mallear ligament abnormal were presented while a surgical incudomalleolar joint dislocation prior to the observation happened in the last one. Among these 6 cases, there was no 4.0 Hz notch and postoperative vertigo which needs a further care. Postoperative air-bone gap on 0.5 kHz, 1.0 kHz, 2.0 kHz, 4.0 kHz averaged less than 10 dB. All the patients had been followed up for 3 months.@*CONCLUSION@#Malleostapedotomy based on malleus-oval window technique is a safe and effective procedure available for otosclerosis with malleus/incus movement disorder from different origins.

Image date and clinicopathologic features of myoepithelial carcinoma in parapharyngeal space / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the image data and clinicopathologic features of myoepithelial carcinoma in parapharyngeal space.@*METHOD@#Based on one patient with myoepithelial carcinoma of parapharyngeal space treated in our hospital, image data and clinicopathologic findings were analyzed. The clinical characteristics of myoepithelial carcinoma in head and neck region were discussed.@*RESULT@#CT obviously showed the mass in parapharyngeal space with destruction of temporal bone. Immunohistochemical stain showed positive staining for S-100 protein, Smooth muscle actin, Cytokeratin and Vimentin. There were otalgia, bloody pus, headache and signs of cranial nerve lesion.@*CONCLUSION@#Myoepithelial carcinoma was a rare malignant epithelial neoplasm and had a poor prognosis. Myoepithelial carcinoma often occurrence in salivary gland of maxillofacial region. The clinical signs were otalgia and headache in patient with myoepithelial carcinoma in parapharyngeal space. CT image showed malignant neoplasm and surrounding tissues were destroyed. Diagnosis depends on pathology and immunohistochemistry.