Clinical characteristics and treatment of external auditory canal cholesteatoma / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the characteristics,the therapeutic methods and effects of external auditory canal cholesteatoma(EACC).METHODS The clinical records of 66 cases diagnosed with EACC between January 2014 and January 2016 were retrospectively reviewed.Their ages ranged from 3 to 75 years (average 32.5± 1.68 years).There were 32 men and 34 women.According to Holt's grading criteria for EACC,there were 10 ears of phase Ⅰ,26 ears of phase Ⅱ,and 30 ears of phase Ⅲ.The phase Ⅰ ears were treated by removing cholesteatoma from the external auditory canal.Canaloplasty and/or tympanoplasty were performed in phase Ⅱ ears.The phase Ⅲ ears were managed by canaloplasty and tympanoplasty or radical mastoidectomy.The duration of follow-up ranged from 6 months to 2 years.RESULTS In the present study,hearing impairment was the most common symptoms(61 ears,92.42％),other symptoms include ear fullness(49 cases,74.24％),otalgia(45 cases,68.18％),otorrhea(44 cases,66.67％),peripheral facial paralysis(lcase,1.52％).There were 2 recurrences at 11 and 14 months postoperatively.All the other ears remained patent and dry with good skin coverage.Apart from 5 patients who underwent radical mastoidectomy,the rest of patients obtained intact tympanic membranes and impoved hearing.Facial nerve function of 1 patient with peripheral facial paralysis returned to normal6 months after operation.CONCLUSION The EACC can easily damage the bony meatus of external auditory canal and the adjacent structure.The clinical stages can help identify the primary lesions and determine the choice of the best treatment approach.

Video head impulse test in peripheral vestibular diseases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVES</b>The function of the semicircular canal receptors and the pathway of the vestibulo-ocular reflex (VOR) can be diagnosed with the clinical head impulse test. The aim of the study was to investigate the horizontal VOR by means of video head impulse test in peripheral vestibular disorders.</p><p><b>METHODS</b>Using the vHIT, we examined horizontal semicircular canal VOR in a group of 55 patients and a control group of 20 healthy subjects. The group of patients included 10 cases of vestibular neuritis (VN), 6 cases of vestibular schwannoma (VS), 12 cases of Meniere's disease (MD), and 15 cases of bilateral vestibulopathy (BV), as well as 13 cases of idiopathic sudden hearing loss with vertigo (ISHL).</p><p><b>RESULTS</b>Instantaneous gains of 40 ms, 60 ms and 80 ms of horizontal VOR were 0.88 ± 0.17, 0.94 ± 0.13 and 0.96 ± 0.13, respectively. Regression gain at 60 ms was 0.99 ± 0.11, and asymmetry was 5.6 ± 3.5. Normal range of 60 ms instantaneous gain was > 0.73, normal range of regression gain was > 0.80. Abnormal vHIT was found in VS (100%), VN (90.9%), BV (86.7%), MD (40.0%) and ISHL (38.5%). Three conditions of refixation saccades occurred in cases with abnormal VOR: isolated covert saccades (12.5%), isolated overt saccades (45.0%) and the combination of overt and covert saccades (42.5%).</p><p><b>CONCLUSIONS</b>The vHIT detects abnormal VOR changes in the combination of gain assessment and refixation saccades. Since isolated covert saccades in VOR changes can only be seen with vHIT, peripheral vestibular disorders are likely to be misdiagnosed with the HIT.</p>

Retrospective study on the hearing improvement and postoperative perforation rates in 121 myringoplasty cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Retrospectively analyzed the influences of preoperative acoustic immittance pressure balance tests and intraoperative wet ear findings in myringoplasty surgery results.</p><p><b>METHODS</b>One hundred and twenty-one chronic suppurative otitis media patients underwent myringoplasty surgeries were included and divided into functional group and non-functional group according to preoperative acoustic immittance pressure balance tests. Meanwhile, cases were divided into dry ear group and wet ear group according to intraoperative findings. Postoperative hearing improvement and perforation rate were compared between the two groups.</p><p><b>RESULTS</b>Functional group had 72 cases, including 58 dry ears and 14 wet ears. Non-functional group had 46 cases, including 19 dry ears and 27 wet ears. Postoperative hearing improvement rate in functional group was 85.5% (59/69), and 72.1% (31/43) in non-functional group (χ(2) = 2.230, P = 0.093). Perforation rate in functional group was 16.7% (12/72), significant higher when compared with 2.2% (1/46) in non-functional group (χ(2) = 4.626, P = 0.015). Postoperative hearing improvement rate in dry ear group was 85.3% (64/75), and 71.8% (28/39) in wet ear group (χ(2) = 2.213, P = 0.085) . Perforation rate in dry ear group was 12.8% (10/78), and 7.0% (3/43) in wet ear group (χ(2) = 0.472, P = 0.377).</p><p><b>CONCLUSIONS</b>Non-functional result of preoperative acoustic immittance pressure balance test had significant relationship with the intraoperative wet ear findings. It may result in lower postoperative hearing level, and lower perforation rate. Large sample studies should be carried out in future.</p>

Effects of Chronic Manganism on Hearing and Cochlear Cells in Rats / 听力学及言语疾病杂志

Objective To study the effects of chronic manganism on hearing and cochlear cells in rats by using animal model of chronic manganism .Methods Sixty adult SD rats were randomly divided into Mn - exposed and controlgroups.RatsweretreatedwithMnCl24H2O(100mg·kg -1·d-1)ordeionizedwaterbygastricperfusion, lasted for 12 weeks .The Mn concentration in peripheral blood was measured respectively at 4 weeks ,8 weeks and 12 weeks after treatment .At 12 weeks after treatment ,the auditory brainstem response was recorded ,the hair cells morphology and counting were examined by stretched preparation of basilar membrane stained with FITC -phalloi-din ,and the spiral ganglion cells morphology and counting were studied by HE staining ,the ultrastructure changes of hair cells and spiral ganglion cells were detected by transmission electron microscopy .Results The blood Mn concentration increased gradually with time after treatment .ABR thresholds at 4 ,8 ,16 ,24 and 32 kHz were sig-nificantly increased at 12 weeks after treatment ,especially in the high-frequency range .Morphological study at 12 weeks after treatment showed loss of outer hair cells ,mainly in the basal turn of the cochlea ,and decreased number of spiral ganglion cells .The ultrastructure changes of outer hair cells and spiral ganglion cells included the break -ups ,disappearance or vacuolar change of mitochondria cristas .Conclusion Our data demonstrate that chronic man-ganism can cause loss of outer hair cells and spiral ganglion cells in cochlear in rats ,leading to hearing loss .

Greater auricular nerve graft for repair of facial nerve defects / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To retrospectively analysis the clinical data of facial nerve defects repair with greater auricular nerve graft.@*METHOD@#The transmastoid approach was adopted to repair the facial nerve defects by means of nerve grafting. Preoperative and postoperative facial nerve functions were graded according to the House-Brackmann scale.@*RESULT@#The patterns of temporal bone fracture in the 8 patients were longitudinal, most lesions occurred in the region of the second genu and its surrounding, preoperatively, all patients had Grade VI function. In 3 patients of facial nerve tumors, the tumors involved multiple nerve segments, and histologic results were all schwannomas, preoperatively, 1 case had Grade III function, 2 cases had Grade V function. In 2 patients of iatrogenic trauma of the facial nerve, the primary disease was chronic otitis media with cholesteatoma, the lesions were localized at the mastoid segment and the second genu respectively. In 1 patient of molten steel burn, the lesions was localized at the tympanic segment, preoperative facial nerve function was Grade VI. In addition to 3 cases lost to follow-up, the remaining patients, 4 recovered to a Grade III, 3 to a Grade VI, 2 to a Grade V and 2 remained at Grade VI.@*CONCLUSION@#In present study, the most common cause of facial nerve transection was temporal bone fracture. Facial nerve reconstruction by means of greater auricular nerve grafting was a practical and effective method, the best postoperative recovery of facial nerve function was Grade III.

The application of multi-modal MRI in venous thrombolysis therapy for hyperacute cerebral arterial thrombosis / 中华放射学杂志

Objective To investigate the value of MRI in thmmbolytic thempy of hyperacute cerebral arterial thrombosis.Methods One hundred and sixteen patients with acute cerebral arterial thrombosis were recruited.plain CT and multi.modal MRI were performed in all patients.Thirty-three patients with hyperacute cerebral infarction were treated bv recombinant tissue plasminogen activator(rt-PA) and followed-up periodically using MRI.Results The 33 patients with thrombolysis selected by MRI demonstrated clinical improvement.90 d moclified Rankin scale scores(mRs)were less than 2 and life quality Barthal indexes(BI)were from 80 to 100.The complication included one asymptomatic parenchymal hematoma(PH1)one weeks after thrombolytic therapy and 4(12.2%)hemorrhagic infarction(HI)6 to 24 hours after thrombolytic therapy.Condusions MRI has significant clinical value for the screening and follow-up of intravenous thrombolytic therapy of hyperacute ischemic stroke.MRI-based thrombolysis is a safe and effective method for hyperacute ischemic stroke.

Retrospective analysis of 1062 cases consulted by an otolaryngology chief resident / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To describe consultation practice patterns of an otolaryngology chief resident in China.@*METHOD@#The pattern and frequency of patient encounters during the Xijing Hospital of the Fourth Military Medical University otolaryngology residency program for one chief resident were retrospectively analyzed.@*RESULT@#A total of 1062 new inpatients were consulted during a 10-month period of otolaryngology residency, including emergency consultation for 467 cases (43.97%) and routine consultation for 595 cases (56.03%). The chief resident consulted an average of 28 new patients perweek. The most common diagnosis for an emergency consultation was epistaxis (279 cases, 59.72% of emergency consultation), characterized by disturbances of blood coagulation, hypertension, renal failure or liver failure, iatrogenic factors. The second cause was laryngeal obstruction and tracheotomy (113 cases, 24.19% of emergency consultation). There were 43 cases with foreign body in bronchus . For routine consultation on general internal medicine, chronic rhinitis and sinusitis (169 cases) was the most common disorder, followed by chronic pharyngitis, acute or chronic tonsillitis. For consultation on surgery, most cases were concerned about preoperative evaluations (67 cases) of the chronic otolaryngological disorders.@*CONCLUSION@#Consultation is an inimitable clinical practice and a challenge to otolaryngology residents. The chief residents should be prepared for the consultation practice. Accumulation of related data from consultation is necessary and helpful for chief residents.

Establishment of an animal model with tympanosclerosis in guinea pigs with chronic otitis media / 中国耳鼻咽喉头颈外科

OBJECTIVE To establish the optimal animal model of tympanosclerosis.METHODS Staphylococcus were inoculated into the middle ear of guinea pigs,and the guinea pigs were sacrificed periodically.The changes of their middle ears were observed by light microscope,and the hearing threshold of the animals were measured.RESULTS All the inoculated ears showed different degree of mucosal adhesions after 7 days.The most common site of tympanosclerosis was hypotympanum,followed by the anterior epitympanum,the attic,the drum,the interossicular spaces,and the tubal orifice.CONCLUSION The pathological changes of the middle ear in guinea pigs with chronic otitis are similar to those of human being.It is a favorite animal model for researching on chronic otitis media with tympanosclerosis.

Health Study on Community Female——Investigation and Analysis on Depressive State of Married Female at Chang'an District of Xi' an / 中国医学伦理学

Depression is the general symptom of gloomy mind,which could lead to suicide.The objective of this research is to explore the relation among different psychosocial factors of depressed countryside women and the roles of economy,family and health.Methods: Use SAS,SDS,Living Affair and individual status to ask 608 women in the countryside of Shanxi.Results: 33.9% women have depressed symptom,the analysis of logistic shows that the factors which will lead to depress are anxiety,minus life events,and so on.Conclusion: There is consanguineous connection between the depression of women and their living conditions,health,economy,and so on.