Study on the difference of A-scan and IOL Master in measuring intraocular lens power / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the difference of A-scan and lOL Master in intraocular lens power measurement. ●METHODS:Two hundred and twenty-six patients (230 eyes) with age-related cataract were included in the study. Before surgery, axial length was measured by A-scan and lOL Master respectively and corneal curvature was measured by auto refractometer. lntraocular lens power was calculated according to the SRK-T formula. Corneal curvature was measured by auto refractometer and the refractive outcome was performed by phoropter three months after cataract surgery. ●RESULTS:The mean axial length was (23. 48 ± 1. 94) mm measured by A-scan and (23. 75±1. 96) mm measured by lOL Master. There was significant difference between them ( P 0. 05). And the results were (44. 10 ± 1. 57 ) D and ( 44. 11 ± 1. 58 ) D in lOL Master group. There was no significant difference between them (P>0. 05); The mean absolute refractive error (MAE) in A-scan group was ( 0. 47 ± 0. 27 ) D and in lOL Master group (0. 41±0. 19) D. The difference was significant (P ●CONCLUSION: lOL Master is proved to be slightly more accurate than A-scan for lOL power calculation.

Esophageal Functional Changes in Obstructive Sleep Apnea/Hypopnea Syndrome and Their Impact on Laryngopharyngeal Reflux Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea/hypopnea syndrome (OSAHS) and laryngopharyngeal reflux (LPR) disease have a high comorbidity rate, but the potential causal relation between the two diseases remains unclear. Our objectives were to investigate the esophageal functional changes in OSAHS patients and determine whether OSAHS affects LPR by affecting esophageal functions.</p><p><b>METHODS</b>Thirty-six OSAHS patients and 10 healthy controls underwent 24-h double-probed combined esophageal multichannel intraluminal impedance and pH monitoring simultaneously with polysomnography. High-resolution impedance manometry was applied to obtain a detailed evaluation of pharyngeal and esophageal motility.</p><p><b>RESULTS</b>There were 13 OSAHS patients (36.1%) without LPR (OSAHS group) and 23 (63.9%) with both OSAHS and LPR (OSAHS and LPR group). Significant differences were found in the onset velocity of liquid swallows (OVL, P = 0.029) and the percent relaxation of the lower esophageal sphincter (LES) during viscous swallows (P = 0.049) between the OSAHS and control groups. The percent relaxation of LES during viscous swallows was found to be negatively correlated with upright distal acid percent time (P = 0.016, R = -0.507), and OVL was found to be negatively correlated with recumbent distal acid percent time (P = 0.006, R = -0.557) in the OSAHS and LPR group.</p><p><b>CONCLUSIONS</b>OSAHS patients experience esophageal functional changes, and linear correlations were found between the changed esophageal functional parameters and reflux indicators, which might be the reason that LPR showed a high comorbidity with OSAHS and why the severity of the two diseases is correlated.</p>

Effects of Altered Intra-abdominal Pressure on the Upper Airway Collapsibility in a Porcine Model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males. Previous studies have demonstrated that intra-abdominal pressure (IAP) is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility. This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway (UA) collapsibility via IAP-related caudal tracheal traction.</p><p><b>METHODS</b>An abdominal wall lifting (AWL) system and graded CO2pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement (TD) and airflow dynamics of UA were studied. Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed. Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student's t-test or analysis of variance.</p><p><b>RESULTS</b>Application of AWL resulted in decreased IAP and significant caudal TD. The average displacement amplitude was 0.44 mm (P < 0.001). There were three subjects showed increased tidal volume (TV) (P < 0.01) and peak inspiratory airflow (P < 0.01); however, the change of flow limitation inspiratory UA resistance (Rua) was not significant. Experimental increased IAP by pneumoperitoneum resulted in significant cranial TD. The average displacement amplitude was 1.07 mm (P < 0.001) when IAP was 25 cmH2O compared to baseline. There were three subjects showed reduced Rua while the TV increased (P < 0.01). There was one subject had decreased TV and elevated Rua (P < 0.001).</p><p><b>CONCLUSIONS</b>Decreased IAP significantly increased caudal TD, and elevated IAP significantly increased cranial TD. However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect. TV plays an independent role in the mechanism of UA collapsibility.</p>

Application of pressure of end-tidal carbon dioxide concentration in polysomnography / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of this study was to investigate the end-tidal carbon dioxide concentration (PETCO2) monitoring coupling in polysomnography for patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during sleep.</p><p><b>METHODS</b>PETCO2 was sampled through a Oral-Nasal Cannula and measured using micro-stream capnometer. Capnometer was calibrated according to the manufacturer instructions and integrated into the standard polysomnographic recordings. Thirty-eight consecutive patients underwent overnight polysomnography (PSG) were synchronously monitored PETCO2. All variables were recorded continuously and transferred to a computer for analysis.</p><p><b>RESULTS</b>PETCO2 numeric values and waveform were displayed in real time on the PSG epoch. The mean PETCO2 of wake, non-rapid eye movement, rapid eye movement and TST(?) were negatively correlated with apnea-hypopnea index and arousal index (r were -0.458 ∼ -0.688, P < 0.01), were positively correlated with mean arterial oxygen saturation (SaO2) and lowest SaO2, (r were 0.604 ∼ 0.674, P < 0.01).</p><p><b>CONCLUSIONS</b>The study provides preliminary data showing that PETCO2 potentially can be used in continuous monitoring of OSAHS patients. And PETCO2 can indicate the severity of OSAHS.</p>

Upper airway changes in obstructive sleep apnea suffers after H-uvulopalatopharyngoplasty and H-uvulopalatopharyngoplasty combined with transpalatal advancement pharyngoplasty / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the different postoperative changes of the pharynx in obstructive sleep apnea hypopnea syndrome (OSAHS) patients treated with H-uvulopalatopharyngoplasty (H-UPPP) combined with transpalatal advancement pharyngoplasty (PA) surgery or H-UPPP alone.</p><p><b>METHODS</b>The upper airway in 43 patients with OSAHS were scanned during the end of normal respiration before and after treatment. There were 17 patients undergoing H-UPPP alone, 26 patients undergoing H-UPPP combined with PA, with PSG before and after treatment. To compare the efficacy of H-UPPP with PA surgery or H-UPPP alone, upper airway characteristics were measured following each procedure in 43 patients using a quantitative 3-D CT. The 3-D CT measurement were made in lateral and anterior-posterior diameters, cross-section areas and volumes of retropalatal and retroglossal region. The changes in the structure of OSAHS patients treated with H-UPPP combined with PA surgery and H-UPPP alone were compared preoperatively and postoperatively, and the correction features that were presented in AHI and structural changes were analysed.</p><p><b>RESULTS</b>The difference between H-UPPP combined with PA (n = 26) and H-UPPP (n = 17) in the changes in apnea hypopnea index (AHI) were (67.5 ± 18.9, 38.7 ± 42.0, t = 2.84, P < 0.05), hard palate lengths were (4.50 ± 3.72) mm and (0.06 ± 0.22) mm (t = 5.55, P < 0.01); anteroposterior diameters of the hard palate level were (3.5 ± 4.3) mm and (-1.7 ± 4.4) mm (t = 3.90, P < 0.01); the minimum anteroposterior diameters of retropalatal were (1.2 ± 2.2) mm and (-1.2 ± 2.3) mm (t = -3.49, P < 0.01); the minimum lateral diameters of retroglossal area were (4.9 ± 9.6) mm and (13.1 ± 9.1) mm (t = 2.80, P < 0.01) preoperatively and postoperatively. The changes in the hard palate lengths were positively correlated to the change in AHI (r = 0.407, P < 0.01), also the change in anteroposterior diameter of the hard palate level (r = 0.351, P < 0.05), the minimum anteroposterior diameter of retropalatal area (r = 0.381, P < 0.01), and the minimum cross-section area of retropalatal (r = 0.312, P < 0.05).</p><p><b>CONCLUSIONS</b>H-UPPP combined with PA offers benefit over H-UPPP alone in OSAHS patients, which may be achieved by increased retropalatal airway size. Both the anteroposterior dimensions and the cross-area size are related with the efficacy of surgery.</p>

Correlation between lung volume and the severity of obstructive sleep apnea hypopnea syndrome in obese patients / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To examine the relationship between the severity of obstructive sleep apnea hypopnea syndrome (OSAHS), lung volume and obesity.</p><p><b>METHODS</b>The study included 60 adult male obese patients with OSAHS determined by overnight polysomnogram (PSG) using American Academy of Sleep Medicine-defined criteria. Lung volume measurements were made in maximum vital capacity (VCmax), forced vital capacity (FVC), maximum voluntary ventilation (MVV), functional residual capacity (FRC) and total lung capacity (TLC).</p><p><b>RESULTS</b>The aponea hypopnea index (AHI) were negatively correlated with FVC, MVV, VCmax (r were -0.533, -0.276 and -0.575, P < 0.01 or P < 0.05). But the lowest arterial oxygen saturation (LSaO2) and the mean arterial oxygen saturation (MSaO2) were positively correlated with FVC, MVV and VCmax (r were 0.299, 0.435, 0.412, and 0.344, 0.474, 0.457, P < 0.01 or P < 0.05). The body mass index (BMI) were positively correlated with AHI (r = 0.728, r(2) = 0.530, P < 0.01). The FVC, MVV, VCmax, LSaO2 and MSaO2 varied inversely with BMI. FRC and TLC had no relation with AHI, LSaO2, MSaO2 and BMI.</p><p><b>CONCLUSIONS</b>There are significant correlations among obesity, dynamic lung volume and OSAHS severity. This result suggests that changes in dynamic lung volume may play an important role in the pathogenesis of OSAHS in obese patients.</p>

Evaluation of neuromuscular activity in patients with obstructive sleep apnea using chin surface electromyography of polysomnography / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is believed that defects in upper airway neuromuscular control play a role in sleep apnea pathogenesis. Currently, there is no simple and non-invasive method for evaluating neuromuscular activity for the purpose of screening in patients with obstructive sleep apnea. This study was designed to assess the validity of chin surface electromyography of routine polysomnography in evaluating the neuromuscular activity of obstructive sleep apnea subjects and probe the neuromuscular contribution in the pathogenesis of the condition.</p><p><b>METHODS</b>The chin surface electromyography of routine polysomnography during normal breathing and obstructive apnea were quantified in 36 male patients with obstructive sleep apnea. The change of chin surface electromyography from normal breathing to obstructive apnea was expressed as the percent compensated electromyography value, where the percent compensated electromyography value = (normal breath surface electromyography - apnea surface electromyography)/normal breath surface electromyography, and the percent compensated electromyography values among subjects were compared. The relationship between sleep apnea related parameters and the percent compensated electromyography value was examined.</p><p><b>RESULTS</b>The percent compensated electromyography value of the subjects varied from 1% to 90% and had a significant positive correlation with apnea hypopnea index (R(2) = 0.382, P < 0.001).</p><p><b>CONCLUSIONS</b>Recording and analyzing chin surface electromyography by routine polysomnography is a valid way of screening the neuromuscular activity in patients with obstructive sleep apnea. The neuromuscular contribution is different among subjects with obstructive sleep apnea.</p>

Clinical classification and treatment of leukokeratosis of the vocal cords / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Leukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords.</p><p><b>METHODS</b>We conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features.</p><p><b>RESULTS</b>All cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows: 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% (308/339), with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339). All cancerous transformations occurred in type IV patients.</p><p><b>CONCLUSION</b>Choosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.</p>

Clinical classification and management of squamous intraepithelial lesions of the vocal cord / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures.</p><p><b>METHODS</b>Three hundred and forty-three patients with the SILs of vocal cord were enrolled. Based on the history of the diseases, macroscopic appearance by video rhino aryngoscopic, stroboscopic and microlaryngoscopic examination, and pathological findings, the correlation of clinical features, treatment modalities and treatment effect of the vocal cord SILs were discussed.</p><p><b>RESULTS</b>According to the morphological characteristics, 343 patients were divided into four types. TypeI, leukoplakia combined with inflammation (n = 19); type II, leukoplakia combined with polyps by friction (n = 72); type III, leukoplakia combined with sulcus vocalis (n = 64); type IV, keratosis (n = 188). Patients with type I lesions were treated by medications. The vocal cord configuration and the voice of the patients in type I returned to normal after treatment. Patients with type II, III, IV lesions were treated by CO(2) laser. Type II were treated by subepithelial cordectomy, type III by mucosa slicing with dredging, type IV by sub ligament cordectomy or trans muscular cordectomy. The cure rate of patients with type II, III, IV lesions was 90.7% (294/324) after single surgery, the recurrent rate was 9.3% (30/324). Twenty-one patients (11.2%), all in type IV, developed carcinogenesis. Eight cases were diagnosed in the first surgery and 13 cases in the second. Among the 13 cases diagnosed in the second surgery, 2 cases had partial laryngectomy for the third surgery.</p><p><b>CONCLUSIONS</b>Since the squamous intraepithelial lesions of vocal cord manifested differently, conservative treatment or CO(2) laser surgery should be used. In this way, a less invasive procedure, better recovery of the voice and less complication could be expected.</p>

Risk factors of juvenile onset recurrent respiratory papillomatosis in the lower respiratory tract / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Juvenile onset recurrent respiratory papillomatosis (JORRP) is a relatively rare disease. It affects the larynx in most cases. Because reports on JORRP to the lower respiratory tract (LRT) are few, we investigated clinical features of patients with a history of JORRP to analyze the risk factors of this disease.</p><p><b>METHODS</b>Data from 208 JORRP patients admitted to Beijing Tongren Hospital from January 2008 to December 2010 were reviewed. Gender, age at onset of symptoms, age at first surgery, duration of symptoms before the first surgical procedure, the number of surgical procedures, mean interval between surgical interventions, and the number of tracheotomies in patients with and without LRT spread of JORRP were analyzed. The data from patients with and without tracheotomy were recorded and compared. Two cases of primary tracheal papillomatosis were reviewed.</p><p><b>RESULTS</b>Papillomas extension down to the LRT was observed in 46 children (22.1%). Patients with LRT papillomatosis had a shorter time from the onset of the symptoms until the first surgery, required significantly more surgical procedures, and had a shorter mean surgical interval. Tracheotomy was performed in 13/162 (8.0%) children with laryngeal papillomatosis vs. 36/46 (78.3%) children with LRT papillomatosis. After tracheotomy, 36/49 (73.5%) children developed LRT papillomatosis and 10/157 (6.4%) children who did not have a tracheotomy developed LRT papillomatosis. Patients with tracheotomy required a significantly higher number of surgical procedures. The younger the patient had a tracheotomy, the longer the duration of cannulation was.</p><p><b>CONCLUSIONS</b>JORRP patients with LRT spread are prone to develop more aggressive disease. Tracheotomy resulted in a significant increase of LRT involvement.</p>

Evaluation of Watch PAT as a diagnosing test for patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study aimed to test the accuracy of the watch peripheral arterial tone (Watch PAT) in diagnosing the obstructive sleep apnea hypopnea syndrome (OSAHS) and its influencing factors.</p><p><b>METHODS</b>Thirty five outpatients who had a chief complaining of sleep snoring were recruited to receive Watch PAT test and polysomnography (PSG) simultaneously. The results of PSG were manually analyzed by an experienced technician, while the results of Watch PAT were automatically analyzed by software.</p><p><b>RESULTS</b>There was a trend that the apnea hypopnea index (AHI) of PSG was significantly higher than that of Watch PAT (P = 0.06) in the 35 patients studied, however, these two variables were significantly correlated (P < 0.001), and the correlation coefficient was as high as 0.955. A linear regression analysis which used the AHI of Watch PAT to predict the AHI of PSG also concluded same result and the equation was AHI (PSG) = 0.944 + 1.030AHI (Watch PAT), P < 0.001. The analysis which used ROC curve to test the diagnostic efficiency of Watch PAT concluded that the area under the curve could reach to 0.953 (P < 0.001), and if an AHI (Watch PAT) threshold of ≥ 8.65 was used as the cut-off point in this study, the sensitivity and specificity could reach to 92.3% and 100.0%. The absolute values of the differences (AVD) between the AHI of Watch PAT and the AHI of PSG were also calculated as a criterion for grouping the 35 patients studied, then it could be found that there was a trend that the BMI of patients who had an AVD ≥ 5 were higher than that of patients who had an AVD < 5 (P = 0.077).</p><p><b>CONCLUSIONS</b>The Watch PAT is highly sensitive in the diagnosis of OSAHS, it can be used as a simple and reliable method for screening people with suspicious OSAHS. However, the accuracy of diagnosis may be relatively low in patients who have a great BMI.</p>

Correlation between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the occurrence correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and gastroesophageal reflux disease (GERD).</p><p><b>METHODS</b>Forty-three patients suspected of laryngopharyngeal reflux disease underwent combined multichannel intraluminal impedance and esophageal manometry (MII-EM), twenty-four-hour esophageal and pharyngeal pH and impedance monitoring and PSG. Subjects were grouped according to the detections. The difference of the measurement between groups were Compared. The possible relationship between the two diseases was analyzed.</p><p><b>RESULTS</b>Fourteen of all the subjects can be diagnosed to have GERD (32.6%). Twenty-six can be diagnosed to have OSAHS (60.5%). There were 10 patients had OSAHS and GERD simultaneously, which took over 38.5% of the OSAHS group, and 71.4% of the GERD group. BMI (P = 0.000) and lower esophageal sphincter (LES) residual pressure (P = 0.021) were significantly different among the four groups OSAHS, GERD, OSAHS and GERD, and control (non-OSAHS and non-GERD), but no linear relationship between LES residual pressure and prevalence or severity of the two diseases was found. In OSAHS group, AHI were positively correlated with the following indictors: the DeMeester score (r = 0.45), acid exposure of the distal esophagus (r = 0.491). There seems to be no Linear correlation among reflux indicators, sleep indicators, and esophageal functional indicators in GERD group. Linear correlation was not found among reflux indicators, sleep indicators, and esophageal functional indicators in OSAHS and GERD group (P > 0.05).</p><p><b>CONCLUSIONS</b>The incidence and the severity of GERD and OSAHS were related to each other. Reflux events may aggravate OSAHS. The two diseases may have some relationship on the esophageal function, especially on the regulation of the LES pressure.</p>

Overnight hemoglobin-oxygen saturation monitoring the first day following revised uvulopalatopharyngoplasty in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of overnight arterial oxygen saturation (SaO2) the first day after upper airway reconstruction surgery in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>One hundred and thirteen subjects with OSAHS underwent revised uvulopalatopharyngoplasty (H-UPPP), among them, 46 subjects underwent same phase transpalatal pharyngoplasty under general anesthesia. After transferred to general ward from intensive care unit the first day after operation they received an overnight hemoglobin-oxygen saturation monitoring.</p><p><b>RESULTS</b>Twelve subjects (10.2%) had lower lowest SaO2 than preoperative value. ≥ 0.03 oxygen desaturation index (ODI3) decreased in an median of 36.9 [16.9; 52.2] events/hour compared with preoperative values (Z = -9.221, P < 0.001). One subjects (0.8%) had increased ODI3. No hemorrhages, cardiovascular complications or airway obstruction occurred. The subjects with any two of the following conditions (n = 51) had lower average SaO2, lowest SaO2 and higher ODI3 than the others (n = 62, Z were -3.084, -4.083 and -4.593, P < 0.001). The three subjects were: (1) BMI ≥ 27.0 kg/m(2); (2) Lowest SaO2 < 0.600; (3) AHI ≥ 60.0 events/h.</p><p><b>CONCLUSIONS</b>Some OSAHS patients had a decreased LSaO2 than preoperative values the first day after operation. As part of a patient safety initiative, SaO2 monitoring for those who have high risk for hypoxemia is necessary.</p>

Fibrovascular polyp of the hypopharynx and esophagus / 中华医学杂志(英文版)

Fibrovascular polyp of the hypopharynx and esophagus, a rare, benign, intraluminal and submucosal tumor, is most commonly originated from the proximal esophagus. We discussed four cases with regurgitation, respiratory symptom or the feeling of a mass in the throat. All the patients were examined with laryngoscope under general anesthesia. A transverse cervical incision was performed in one patient and the polyps were excised under laryngoscope with CO2 laser in the other three patients. All the lesions were removed successfully. Diagnostic and therapeutic principles involved in these cases are presented and discussed. The recognition of fibrovascular polyp of the hypopharynx and esophagus as a potential cause of regurgitation is paramount. Surgical excision is recommended because of the satisfactory outcome.

Correlation between upper airway soft tissue 3-D measurement and the severity of obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the correlation between upper airway CT measurement value and severity of patients with obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>The upper airway of 82 patients with OSAHS were scanned by CT during normal respiration. The 3-D CT measurement were made in lateral and anterior-posterior diameters, cross-section areas and volumes of retropalatal and retroglossal region.</p><p><b>RESULTS</b>The lateral diameters and cross-section areas of every research plane were negatively correlated with apnea and hypopnea index (AHI), in particular the minimal lateral diameter of the whole airway (r = -0.558, P < 0.01). For volumes, AHI decreased with larger volume of nasal cavity, nasopharyngeal cavity and velopharyngeal cavity (P < 0.05 or P < 0.01). The negative correlation between AHI and proportion of cavity volume to the bone frame of velopharyngeal area and whole upper airway were significant (P < 0.05 or P < 0.01). But the correlation between AHI and volume of velopharyngeal soft tissue, the proportion of soft tissue to the bone frame volume of velopharyngeal area, the proportion of soft tissue to the bone frame volume of whole upper airway was significant positive, as well as the correlation between AHI and the proportion of soft tissue to the cavity volume of velopharyngeal area and whole upper airway (P < 0.05 or P < 0.01).</p><p><b>CONCLUSIONS</b>To evaluate the severity of OSAHS with upper airway CT measurement, there is no difference between 3-D parameters and 2-D parameters. In terms of the whole airway, the lateral diameters, the cross-section area, the cavity volume, the soft tissue of the upper airway, are meaningful to evaluate the severity of disease, in particular the measurement of velopharyngeal area.</p>

Strategy of surgical management of juvenile on-set recurrent respiratory papillomatosis with trachea or bronchia involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the strategy of surgical management of juvenile on-set recurrent respiratory papillomatosis (JORRP) with trachea/bronchia involvement so as to decrease the complications of the surgery.</p><p><b>METHODS</b>Twenty four JORRP patients undergone surgery in Beijing Tongren Hospital were studied between January 2006 and February 2009. All of them had JORRP with trachea/bronchia involvement. Suspension laryngoscopic surgeries were performed using rigid bronchoscope and micro-debrider. High frequency jet ventilator was used to maintain the ventilation in general anesthesia. Excision of tumors, suction of the blood and ventilation were preformed alternately. A total of 149 times of surgeries were analyzed.</p><p><b>RESULTS</b>The age of the patients was from 3 to 16 years old (median 6 years old). The age at diagnosis was from eight months to 10 years old (median 1.5 years old). Twenty of them had undergone tracheostomy and the age at tracheostomy was from 1 to 4 years old (median 2 years old). Twenty two of them had been graded as two-degree dyspnea preoperatively, one graded as three-degree dyspnea and one four-degree dyspnea. All subjects underwent more than one surgery. Two cases were intubated and sent to intensive care unit because of postoperative hypercapnia. One was sent to intensive care unit postoperatively because of preoperative phypoxemia and hypercapnia. All subjects were discharged without dyspnea. No death and complications occurred.</p><p><b>CONCLUSIONS</b>Suspension laryngoscopic surgery using rigid bronchoscope and micro-debrider was a safe and effective strategy for the treatment of JORRP with trachea/bronchia involvement.</p>

Evaluation of retropalatal mechanical loads in patients with obstructive sleep apnea / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the mechanical load of retropalatal airway in obstructive sleep apnea patients, and to investigate the contributions of pharyngeal anatomy to upper airway collapsibility.</p><p><b>METHODS</b>Static mechanical load of transpalatal pharynx was determined by opening pressure (Popen) of the segment during general anesthesia in 30 patients and 14 controls. Size of pharynx was measured while intraluminal pressure was controlled at 3-20 cm H2O (1 cm H2O = 0.09806 kPa) and the minimal intraluminal pressure that needed to compensate for the mechanical load of a retropalatal segment was determined.</p><p><b>RESULTS</b>Pharyngeal cavity collapse at the level of the hard palate was observed in only one of the 30 subjects (3.3%), and in none of the 14 controls. At tongue base level, 23 subjects had a Popen > 0 cm H2O (76.7%) while in 7 of the controls (50.0%) had a Popen > 0 cm H2O. And at the level of the uvual and soft palate, pharyngeal collapses was observed in all subjects except in 9 of the controls (64.3%). The median of Popen was 8.3 [5.9;11.5] cm H2O in the patients group and was 2.7 [-3.9;6.0] cm H2O in the control group. Differences of Popen were significant between patients and controls (U = 58.500, P = 0.000). The correlation between Popen and AHI was also significant at 0.05 level (r = 0.377, P = 0.044).</p><p><b>CONCLUSIONS</b>Patients with sleep apnea have more collapsible passive upper airway than controls. Retropalatal and retroglossal airway are the most collapsible segments and positive pressures are needed to compensate for the mechanical loads.</p>

Self-assessment characteristics of voice handicap index for voice disorders and its influencing factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the self-assessment characteristics of Voice Handicap Index (VHI) for voice disorders and its influencing factors.</p><p><b>METHODS</b>One thousand seven hundred and sixty six dysphonic patients and 120 control subjects were included in this study. Two hundred twenty seven patients were treated with phonosurgery or Botulinumtoxin injection. VHI was used for self-assessment.</p><p><b>RESULTS</b>Dysphonic patients had worse VHI scores than control (z from 8.039 to 17.043, P = 0.000). There was a significant difference among the VHI scores of different diseases. VHI scores were descending in order among spasmodic dysphonia, vocal fold paralysis, functional dysphonia, sulcus vocalis, benign and malignant tumor of vocal fold, vocal fold cyst, Reinke's edema, vocal fold polyp, vocal fold keratosis and chronic laryngitis, vocal nodule. The emotional scores were the highest in spasmodic dysphonia, and followed by functional dysphonia. In another group, the physical scores were higher than functional scores and emotional scores. Treatment resulted in statistical improvement in VHI scores (P < 0.05). The total scores were different significantly between different educational background and age groups (F from 8.701 to 27.371, P = 0.000). The higher the educational degree, the higher the VHI scores. As to age groups, the juvenile group's scores were the lowest, while the youth's group the highest, then the scores declined when ages increased.</p><p><b>CONCLUSION</b>As a useful supplementary instrument to measure the voice disorder severity and the treatment's effect, VHI can comprehensively assess the voice handicap's affect to the life quality and the difference after the treatment, especially in physical, functional and emotional aspects, but it is somehow subject to the educational degree and age.</p>

Value of pulse transit time in detecting respiratory drive / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the accuracy of pulse transit time (PTT) in classification of apnea events, and collect data for clinical application reference.</p><p><b>METHODS</b>Thirty-two obstructive sleep apnea-hypopnea syndrome (OSAHS) patients included in the research had Polysomnography (PSG), and 10 305 apnea events were recorded. All the events were analyzed by PTT and esophageal pressure (Pes) respectively. The results were analyzed to assess the accuracy of PTT and compare the accuracy of pulse transit time between REM stage and NREM stage, and analyze the correlation between age, body mass index (BMI), apnea hypopnea index (AHI) and concordance rate in every patient.</p><p><b>RESULTS</b>The total concordance rate between PTT and Pes in classification of apnea was 96.7% (9970/10305). The sensitivities of PTT in detecting central, mixed and obstructive apnea were 88.0%, 91.3% and 97.8% respectively and the specificities were 99.8%, 97.8% and 92.8% respectively. The false determinations of apnea events mainly concentrated on the false determinations between the obstructive and mixed apnea. There was no statistical significant between the accuracy of PTT in different sleep stages. There was a negative relationship between the age, BMI, Lowest SaO2, AHI and the concordance rate.</p><p><b>CONCLUSIONS</b>There was good concordance between PTT and Pes in classification of apnea. PTT had very high sensitivity and specificity in detecting all kinds of apnea. This study showed that PTT can detect respiratory drive noninvasively with high accuracy.</p>

Research on the relationship between obstructive sleep apnea hypopnea syndrome and nocturnal laryngopharyngeal reflux / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and nocturnal laryngopharyngeal reflux (LPR), and discuss the possible mechanism.</p><p><b>METHODS</b>Nineteen OSAHS patients had PSG, nocturnal pH and intraesophageal pressure monitoring simultaneously. The sleep stage, body position and pressure change were recorded during every reflux event The relationship between obstructive sleep apnea (OSA) and LPR was analyzed.</p><p><b>RESULTS</b>Among 19 OSAHS patients, 6 cases were found to have LPR, and 63 reflux events were recorded. There was a negative relationship between the severity of OSAHS and nocturnal mean laryngopharyngeal pH value, but relationship between OSA and reflux events is not statistically significant. The intraesophageal pressure (t = 3.211, P = 0. 007) and upper esophageal sphincter (UES) pressure (t = 2.234, P = 0.046) were statistically different between the patients with and without LPR. There was a positive relationship between the mean value of intraesophageal pressure and the whole night mean laryngopharyngeal pH value (r = 0.592, P = 0.033).</p><p><b>CONCLUSIONS</b>There was significant relationship between severity of OSAHS and nocturnal laryngopharyngeal pH value. OSAHS patients are more likely to have esophageal reflux which could increase LPR, Compared with OSAHS patients without LPR, UES pressure during the night decreased significantly in those cases with LPR, it suggested this could be another mechanism of LPR.</p>