Multimode and comprehensive treatment for relieving discomfort after uvulopalatopharyngoplasty / 中国耳鼻咽喉头颈外科

OBJECTIVE To observe the effect of multimode comprehensive treatments on relieving discomfort during postoperative 7 days in patients after uvulopalatopharyngoplasty (UPPP).METHODS A total of 60 patients who underwent UPPP were randomly divided into experimental group and control group.Multimode comprehensive therapy was applied in experimental group(n=30) during postoperative consecutive 7 days,which included gastrogavage,whole pharynx cavity cleaning care with aspirator,intravenous flubiprofen axetil injection 100 mg two times a day,nebulization of budesonide suspension liquid 2 mg two times a day.The treatment methods in control group(n=30) included liquid or soft diets,routine oral cavity care.Visual analogue scale (VAS) was applied to evaluate the discomfort degree including pharyngeal pain,globus and pharyngeal mucus accumulation.The incision healing degree was also recorded.RESULTS VAS scores were highest(6-7.5) in the first two days after UPPP in control group.Compared with control group,the scores of pharyngeal pain,globus and pharyngeal mucus accumulation were lower and the rate of incision complete heal was higher(53.3％) in experimental group(P＜0.05).CONCLUSION The period of most severe pharyngeal discomfort after UPPP is within 48 hours after operation.Multimode comprehensive treatment can relieve pain,improve subjective globus feeling and mucus accumulation,and promote incision healing.

Confounding Effect in Clinical Research of Otolaryngology and Its Control / 中国医学科学杂志(英文版)

Confounding effect is a critical issue in clinical research of otolaryngology because it can distort the research's conclusion. In this review, we introduce the definition of confounding effect, the methods of verifying and controlling the effect. Confounding effect can be prevented by research's design, and adjusted by data analysis. Clinicians would be aware and cautious about confounding effect in their research. They would be able to set up a research's design in which appropriate methods have been applied to prevent this effect.They would know how to adjust confounding effect after data collection. It is important to remember that sometimes it is impossible to eliminate confounding effect completely, and statistical method is not a master key. Solid research knowledge and critical thinking of our brain are the most important in controlling confounding effect.

Genetic Effects on Sensorineural Hearing Loss and Evidence-based Treatment for Sensorineural Hearing Loss / 中国医学科学杂志(英文版)

In this article, the mechanism of inheritance behind inherited hearing loss and genetic susceptibility in noise-induced hearing loss are reviewed. Conventional treatments for sensorineural hearing loss (SNHL), i.e. hearing aid and cochlear implant, are effective for some cases, but not without limitations. For example, they provide little benefit for patients of profound SNHL or neural hearing loss, especially when the hearing loss is in poor dynamic range and with low frequency resolution. We emphasize the most recent evidence-based treatment in this field, which includes gene therapy and allotransplantation of stem cells. Their promising results have shown that they might be options of treatment for profound SNHL and neural hearing loss. Although some treatments are still at the experimental stage, it is helpful to be aware of the novel therapies and endeavour to explore the feasibility of their clinical application.

Pathologic changes of the palatopharyngeal muscles in patients with obstructive sleep apnea hypopnea syndrome of different degrees / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the pathologic changes of the palatopharyngeal muscles with transmission electronmicroscopy (TEM) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), the role of the above muscle in OSAHS pathogenesis was discussed.</p><p><b>METHODS</b>Thirty-eight palatopharyngeal muscle from OSAHS patients receiving uvulopalatopharyngoplasty (UPPP) were collected in in-patient department of Chinese Medical University and five palatal tumor patients receiving resection without snoring were chosen as the control. The palatopharyngeal muscle fiber and the feature of changes in mitochondrial morphology were observed by TEM.</p><p><b>RESULTS</b>The pathological changes were not observed in the normal control group. The muscle fibers were regularly arranged, and the mitochondrial between muscles were normal. The palatopharyngeal myofibrillar in mild OSAHS group was regularly arranged. The Z lines were straight, and most mitochondria structure were normal. In the moderate group, the myofibrillar was disorganized, and the Z lines were shortened or distorted. The myofibrillar in severe group was disorganized, similar to point-like or flake, and the Z lines and the structures of sarcomeres were disappeared. And organelle were disintegrated and mitochondria were disappeared similar to flocculent. There existed obvious fatty infiltration in the palatopharyngeal muscle. In the control, mild, moderate and severe group, pharyngeal muscle fiber disarrangement of the occurrence rate was 0, 2/10, 8/13, 14/15, the occurrence rate of mitochondrial degeneration was 0, 2/10, 8/13, 14/15, increased with the severity of the ultrastructural changes in the trend of increasing incidence.</p><p><b>CONCLUSIONS</b>The degree of OSAHS is correlated with the pathological changes of palatopharyngeal muscles. Incidence of myopathy is an important part of OSAHS secondary to chronic intermittent hypoxia in OSAHS and other pathological lesions, but also an important reason for increasing pharyngeal collapse.</p>

Effective evaluation of multiple level surgery in obstructive sleep apnea-hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effects of multiple level surgery in treating obstructive sleep apnea-hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>One hundred ninety two patients with OSAHS diagnosed by polysomnography were treated through uvulopalatopharyngoplasty (UPPP). Thirty patients were combined with sub-mucous resection of the nasal septum. Forty four patients received sub-mucous resection of the nasal septum and partial inferior turbinectomy. Two patients received sub-mucous resection of the nasal septum and partial resection of the tongue base. Two patients received genioglossus advancement and partial resection of the tongue base. Three patients received partial resection of the tongue base. In addition, the patients with the nasal disease and/or the lingual fat, AHI > 40 times/h, LSaO(2) < 0.64 and/or BMI > 30 kg/m(2) received tracheotomy before general anaesthesia.</p><p><b>RESULTS</b>One hundred ninety two patients were treated through UPPP. One hundred ninety one patients were successful, one patient died of pneumothorax and cardiac arrest during the incision of the trachea. All patients were followed-up for 6-37 months, among them, 132 patients showed therapeutic effect, with the effective rate as 68.7%. Fifty five patients were cured (AHI < 5 times/h); 39 patients had significant effect (AHI < 20 times/h and decreased > or = 50%); 38 patients were effective (AHI decreased > or = 50%). However, 60 patients did not have any therapeutic effect, with the ineffective rate as 31.3%. Fifty four patients had palatopharyngeal and nasal cavity emphasis, 24 patients had palatopharyngeal and oropharyngeal emphasis, 96 patients had palatopharyngeal and nasal cavity and oropharyngeal emphasis. Some patients were treated with UPPP, which made effective rate as 15 (68.2%), 12 (63.2%), 29 (55.8%). The others were treated with multiple level operations, which made effective rate as 25 (78.1%), 5 (5/5), 33 (75.0%). The effective rate was 60.2% (56/93) by simple UPPP and it was 77.8% (63/81) by multiple level treatment in patients with multiple level obstruction. There was statistical significance between them (chi(2) = 6.2, P = 0.01).</p><p><b>CONCLUSIONS</b>The effective rate was improved through multiple level operations in OSAHS patients. The serious complications could be prevented through tracheotomy before general anaesthesia in patients with severe OSAHS who needed multiple level surgery.</p>

Contralateral cervical lymph node metastasis in piriform sinus carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate relative factors affecting contralateral cervical lymph node metastasis in piriform sinus carcinoma.</p><p><b>METHODS</b>Ninety-six cases of piriform sinus carcinoma with no preoperative treatments were selected. The contralateral cervical lymph node metastasis and relative factors were analyzed during operation or postoperative follow-up. The contralateral cervical metastasis was defined as followed: 1 contralateral cervical metastasis was confirmed pathologically after bilateral neck dissection (pN2c) or 2 contralateral cervical metastasis was found firstly during postoperative follow-up and the recurrence of primary lesion was excluded.</p><p><b>RESULTS</b>The incidence of contralateral cervical metastasis was 32% (31/96). According to the T stage, the incidence of contralateral cervical metastasis was T1: 0% ,T2: 18%, T3: 37%, T4: 32% and to the N stage N0: 12%, N1: 13%, N2a: 17%, N2b: 39%, N2c: 100%, and N3: 75%. For primary lesions beyond midline the incidence of contralateral cervical metastasis was 52% but for those remaining on ipsilateral side it was 18%.</p><p><b>CONCLUSIONS</b>Contralateral cervical lymph node showed higher metastatic incidence with higher T and N stage. When the primary lesions invaded beyond midline, the contralateral cervical metastasis increased greatly and neck dissection should be selected positively.</p>