Simultaneous operations of vibrant soundbridge implantation and auricular reconstruction for patients with microtia and atresia / 中华整形外科杂志

Objective@#To discuss the safety and efficacy of simultaneous procedures of vibrant soundbridge implantation and auricular reconstruction with congenital external and middle ear malformation.@*Methods@#This is a retrospective study, including 6 patients, 5 boys and 1 girl, aged 7-12 years. All patients received simultaneous operations of vibrant soundbridge implantation and auricular reconstruction. The mean preoperative air conduction threshold was 64.8 dB HL at 0.5, 1, 2, and 4 kHz. The VSB was placed in the third stage of auricle reconstruction, if the soft tissue expansion was performed; otherwise, the VSB was implanted in the second stage. The satisfaction with reconstructed auricle, surgical complications, hearing improvement and speech discrimination scores were evaluated 6 months after surgery.@*Results@#All patients and their families reported satisfaction with their reconstructed auricle. There was no complications, including cartilage framework exposion, infection, hematoma, skin flap necrosis, facial paralysis, tinnitus, vertigo or others. Post-operatively, mean VSB-aided hearing threshold was 36.7 dB HL, which was reduced by 28.1 dB HL. The mean speech discrimination scores measured in a sound field with a presentation level of 65 dB SPL and 80 dB SPL were improved.@*Conclusions@#The simultaneous operations of auricle reconstruction and Vibrant Soundbridge implantation is an alternative method for patients with congenital microtia and atresia.

Congenital microtia with aural atresia or stenosis accompany with first branchial cleft anomaly: report of 5 cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize the experience of the diagnosis, treatment and effects of the cases with coexistence of first branchial cleft anomaly(FBCA) and microtia with congenital aural atresia or stenosis(external auditory canal stenosis, EACS).@*Method@#This was a retrospective study. The clinical data of 5 patients with microtia and EACS in Beijing Tongren Hospital of Capital Medical University from October 2015 to March 2018 were collected, including 3 males and 2 females, aged from 5 to 28 years. The clinical characteristics, imaging findings, treatment methods and effects of 5 patients were analyzed.@*Result@#The 5 cases were all coexistence of EACS and FBCA, three of who associated with cholesteatoma of external auditory canal. CT showed external auditory canal stenosis with soft tissue shadow, sometimes gas or bone septum found inside, filling in the external auditory canal, combined with canal bone destruction irregularly. All patients underwent surgical resection of FBCA, 3 patients accompanied by cholesteatoma resection and canalplasty. The postoperative follow-up ranged from 10 to 39 months, and no recurrence of infection was observed.@*Conclusions@#EACS and FBCA both result from maldevelopment of the first branchial cleft. These two malformations, FBCA and EACS with or without cholesteatoma, can occur simultaneously, in which situation CT shows external auditory canal stenosis with soft tissue shadow inside. These patients underwent surgical resection of FBCA combined with cholesteatoma resection with good result.

The implantation of Bonebridge in bilateral congenital malformation of external and middle ear / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the auditory efficacy of Bonebridge implantation in patients with bilateral congenital malformation of external and middle ear.@*Methods@#Eleven cases (6 males and 5 females) had unilateral Bonebridge implantation. The age ranged from 8 to 26 and the average age was 16.9. Seven to ten days after operation, the first fitting was undergone. In acoustic sound field, the average auditory thresholds were respectively measured for unaided ears and Bonebridge implanted ears by pure tone auditory (PTA, 0.25, 0.5, 1, 2 and 4 kHz). For the group over 12-year-old, MSTM was applied to evaluate speech discrimination score (SDS). For the other cases, MLNT was used as the test material. The auditory efficacy post Bonebridge implantation would be analyzed and evaluated by comparing the differences between unaided ears and Bonebridge implanted ears.@*Results@#The bone conduction audibility threshold after Bonebridge implantation was as well as the preoperative. The auditory threshold with Bonebridge aided was improved to 25-35 dB HL, when compared to that of the unaided ears in the sound field. The SDS in the group over 12-year-old was improved about 50%; the efficacy was slightly limited for the other two cases (both less than 12 years old). Statistical analysis showed that there were significant differences between unaided ears and Bonebridge implanted ears in the sound field and SDS(P<0.05).@*Conclusions@#The auditory efficacy of Bonebridge is significant and noticeable in patients with bilateral congenital malformation of external and middle ear. Bonebridge provides a new and effective way for patient with congenital malformation of external and middle ear to reconstruct hearing.

Determination of Th17-related cytokine interleukin17 in patients of chronic otitis media with effusion / 中国耳鼻咽喉头颈外科

OBJECTIVETo study the role of interleukin 17 (IL-17) in the pathogenesis of chronic otitis media with effusion (COME).METHODSThe expression of IL-17 in middle ear effusion (MEE) and blood plasma were measured in 30 patients (48 ears) by means of Cytometric Bead Array (CBA), as well as in 20 normal volunteers.RESULTSCompared with the control group, the level of IL-17 significantly increased in the peripheral blood of COME patients (P<0.05). What was more, the level of IL-17 in the MEE was higher than that in peripheral blood of COME patients (P<0.05).CONCLUSIONIL-17, as an important immunoregulatory mediator, may play an important role in chronic course of COME.

The Effects of interleukin-18 on Middle Ear Inflammation in the Rat Model of Otitis Media with Effusion / 听力学及言语疾病杂志

Objective To investigated the effects of IL -18 on middle ear allergic inflammation in rat model of OME .Methods Eighteen SD rats were randomly divided into three group :group A(control group ,n=12 ears) , group B (OME model group ,n=12 ears) ,group C (IL -18 injectiion group ,n=12 ears) .The rat model of OME was established by sensitizing with ovalbumin (OVA) and later challenging in tympanic bullae .Recombinant rat IL-18 (1 μg ,+0 .2 ml saline ,) were injected in group C at 1 ,2 ,7 ,8 ,15 ,16 day .At the same time sacle ,0 .2 ml sa-line ,instead of IL -18 ,were intraperitoneal injection in group A and B .The morphologic changes of the middle ear epithelial cells and inflammatory cells infiltration were observed under light microscope .The level of IFN -γand IL-4 in tympanic lavage fluid(TLF) were determined by ELISA .Results Pathological examination showed that middle ear mucosa inflammation and eosinophil infiltration in group C were no less severe than group B .The numbers of neutrophils in group C increased significantly compraring with group B (P0 .05) ,while significantly greater than that in group A (P0 .05) .Addtionally ,there was no significant difference in the ratio of Th1 /Th2(IFN -γ/IL -4)between group B and group C (P>0 .05) . Conclusion IL -18 acts as an immune regulatory factors ,significantly increases Th1 cytokine IFN -γ.Although to some extent alleviate the OME rat middle ear Th1 /Th2 imbalance ,there is still excessive activation of Th cells . Th1 and Th2 cells factor are excessive for the secretion disorder of the immune response status .The OME rat mid-dle ear allergic inflammation has not been fundamentally alleviated ,the underlying mechamism should be further studied .

The application of vibrant sound bridge in microtia whose reconstructive external auditory canal occurred atresia / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the effect of vibrant sound bridge implantation in microtia whose reconstructive external auditory canal occurred atresia.@*METHOD@#Three cases (2 males and 1 female) of microtia had underwent hearing reconstruction operation (Include the external ear canal reconstructive surgery and tympanoplasty). The age ranged from 15 to 18 years and the average age was 17 years. All the 3 cases suffered from conductive hearing loss with the air-bone gap ranging from 51.6 to 65.0 dB HL and the average value being 56. 3 dB HL. All the 3 cases underwent vibrant sound bridge implantation, including the floating mass transducer implanted in the head of stapes in 2 cases and in the niche of round window in 1 case.@*RESULT@#The postoperative hearing level improved from 21.6 to 52.5 dB HL with an average of 32.2 dB HL. There were no complications such as vertigo, tinnitus and facial paralysis.@*CONCLUSION@#Through vibrant sound bridge implantation, the hearing level of microtia whose reconstructive external auditory canal occurred atresia was improved effectively.

High-resolution CT findings of inner ear malformations with cerebrospinal fluid leakage / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To describe the HRCT appearances of congenital inner ear malformations with cerebrospinal fluid leakage.@*METHOD@#Conducted a retrospective case review. The subjects comprised 11 patients who were decisively confirmed by HRCT and exploratory tympanotomy. The result of temporal bone computed tomography scans (HRCT) were analyzed.@*RESULT@#Inner ear malformations were classified into 4 types according to HRCT findings. There were 4 patients with cochlear aplasia, 2 patients with common cavity anomaly, 2 patients with IP-I anomaly, and 3 patients with IP- II anomaly. Eight patients had defects in the lamina cribrosa of the internal auditory canal. The development and aeration in the mastoid of involved ears was normal. Soft tissues were seen near the oval window in all involved ears.@*CONCLUSION@#HRCT image has an important value in the diagnosis and treatment of inner ear malformations with cerebrospinal fluid leakage.

The expression and significance of NF-kappaB in the rat model of otitis media with effusion experimentally induced by ovalbumin / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the T helper cells (Th) predominant differentiation and the modulation of nuclear transcription factors kappa B (NF-kappaB) in middle ear of rat model of otitis media with effusion (OME).@*METHOD@#Sixteen SD rats were randomly divided into OME (Exp group) and control group (Con group). The expression of NF-kappaB were observed by immunohistochemistry. The level of IFN-gamma and IL-4 in tympanic lavage fluid (TLF) were determined by ELISA.@*RESULT@#As compared to the Con group , the level of IL-4 and the ratio of Th2/Th1 (IL-4/IFN-gamma) in TLF of Exp group significantly increased (P<0.05), when no significant difference in IFN-gamma levels in TLF was found. The ratio of NF-kappaB p65 positive cells to white cells in temporal bone marrow smears and middle ear mucosa of Exp group was significantly higher than that of Con group (P<0.05). The expression of NF-kappaB p65 in temporal bone marrow smears and middle ear mucosa was signficantly positively correlated with the concentration of IL-4 in TLF of Exp group (P<0.05).@*CONCLUSION@#The middle ear is capable of mounting an allergic response and subsequent formation of effusion. There is Thl/Th2 immune response imbalance, which polarizes toward Th2 response in the middle ear microenvironment of allergic OME rat model. Moreover , NF-kappaB may participate in regulating Th2 predominant reaction.

Hearing results and an analysis of related impact factors following myringoplasty / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the hearing results and the effects of the prognostic factors following myringoplasty.@*METHOD@#Retrospective cohort 165 inpatients (175 ears) with preoperative conductive hearing loss were analyzed using multiple linear regression statistical analysis. They have undergone sandwich temporalis fascia myringoplasty between January 1999 and November 2003. Patients have been followed-up for more than 2 years.@*RESULT@#The average air-bone gap improvement for all 175 myringoplasty procedures was 7.1 dBHL. Multiple linear regression statistical analysis was subsequently carried out on these prognostic factors on hearing outcomes and yielded the following relative importance of the predictive is as follows: mean preoperative air conduction threshold, duration of dry ear, duration of disease, age. There is a strong correlation between subjective audition and pure tone threshold audiometry.@*CONCLUSION@#A relatively better preoperative hearing, a relatively longer duration of dry ear, a relatively shorter duration of disease and a relatively younger age were found to be significant prognostic factors influencing the postoperative air-bone gap improvement of myringoplasty. Subjective audition improvement coupled with objective pure tone threshold audiometric improvement.

Establishment and evaluation of secretory otitis media model induced by endotoxin / 中国耳鼻咽喉头颈外科

OBJECTIVE To establish secretory otitis media(SOM) model induced by endotoxin and evaluate its reliability. METHODS Healthy 50 Sprague-Dawley rats of either sex( 250-300g)were randomly divided into experimental group(ET group) and control group(NS group),with 30 and 20 rats respectively. 35ul volume of 1mg/ml endotoxin from Pseudomonas aeruginosa and same amount of saline(NS) were transbullaly injected into the right tympanic bullas of the two groups. Six rats of ET group and four rats of NS group were killed postoperative on 6h,1d,3d,7d,14d respectively. The temporal bones were harvested for histological study. The left tympanic bullas served as control. Another four rats(each group 2 rats) were used for SEM study with the same method. One rat was killed and harvested for SEM observation of mucocilliary transporting system on the tympanic ostium of Eustachian tube. RESULTS ①LM(light microscope):The epithelial layer and subepithelial space(SES) were thicked mildly in ET group at 6 hours,and more heavily at 1 day with inflammatory cells infiltration (mostly polymorphonuclear leukocytes,PMNs). At 3 days,the same changes were observed most severely. By 14 days,the mucosal lining returned to normal. No obvious changes were observed in the NS group. ②SEM(scan electrical microscope):In ET group,the impairment of mucociliary transport system such as lodging,shedding of cilias were observed at 3 days and returned to normal at 14 days. No abnormal changes were observed in NS group. CONCLUSION Endotoxin can induce SOM with inflammatory changes peak at day 3 and return to normal by day 14.

Image-guided surgery in congenital bony aural atresia / 中国耳鼻咽喉头颈外科

OBJECTIVE Congenital aural atresia repair is difficult owing to unpredictable anatomy. Benefits may be gained from image-guided surgery(IGS) . its exact role and surgery indication were def ined. METHODS From 2001 to 2004,36 ears with bony type C(Schuknecht classification) congenital atresia were performed. In the IGS group(n=18) ,repair surgery was performed with IGS,while in the control group(Non-IGS,n=18) ,similar intervention was applied without IGS. IGS group:aged from 12-29 years,follow-up from 6 months to 1 year. Non-IGS group:aged from 10-27 years,follow-up from 6 months to 3 years. Intra-and post-operative clinical and audiometric findings were compared. RESULTS All of the patients had congenital bony aural atresia,ossicles malformation,tympanic cavity hypoplasia and facial nerve malformation. IGS revealed a malformed horizontal semicircular canal hidden in the bony atresia plate during the operation while computed tomography(CT) did not show preoperatively. IGS computed tomography images correlated well with intra-operative findings,gave the surgeon more securityand reduced operative time(2 hours and 24 minutes) by 25 minutes. The prepare time increased 20 minutes(15-30 minutes) ,but total time decreased 5 minutes in IGS group. The registration accuracy was 0.6-1.3 mm,average 0.84 mm,which was suitable for the otologic surgery. There were 1 case in IGS group and 3 cases in Non-IGS group happened local aural restenosis after operation. But there were no facial nerve paralysis and hearing injury happened in both groups,and all of the patients got the satisfactory hearing after the hearing reconstruction(the air-bone gap with an average of IGS is 31.8dB,Non-IGS is 30.5dB) . CONCLUSION In our estimation,IGS is valuable for type C congenital aural atresia repair. It serves as an educational tool and a guide both for the experienced and inexperienced surgeons in critical situations where anatomical landmarks are distorted and approach is limited. There is no statistically significant between two groups on hearing improvement after operation.

Tympanoplasty in aged people / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the effect of age on tympanoplasty. METHODS The preoperative pure tone hearing threshold was 55dB in the aged group and 39 dB in the medium aged group. All patients, includ-ing 24 with chronic suppurative otitis media, 29 with cholesteatoma otitis media and 27 with chronic silent otitis media and/or tympanosclerosis, underwent radi-cal mastoidectomy and tympanoplasty (typeⅠfor 25 ears, modified type Ⅱfor 23 ears and modified type Ⅲ for 32 ears) under general anesthesia. RESULTS The average air-conductive hearing threshold was 46dB in the aged group (healing rate was 67 %) and 33dB in the medium aged group (healing rate was 70 %). With aging, the average air-conductive hearing threshold in-creased (P

The surgical reconstruction of congenital aural atresia via tympanic antrum approach / 中国耳鼻咽喉头颈外科

Objective: To investigate the effect of surgical reconstruction of congenital aural atresia via tympanic antrum approach and the prevention for reatresia of the aural canal. Methods: From 1993 to 1998, 89 patients (94 ears) with congenital aural atresia were operated via tympanic antrum approach. All of them got aural canals reconstruction and tympanoplasty, including 80 ears of type Ⅱ, 11 ears of type Ⅲ and 3 ears for fenestration of inner ear. Kenacort\|A and dilator were used to prevent reastresia of the aural canals. Results: The tympanic antrums of 94 ears were encountered smoothly, and their hearings were reconstructed. The hearing improvement were found over 20dB in 80 ears (85.1%), over 25dB in 49 ears (52.1%). Kenacort\|A and dilator should be applied when the reastresia began to appear, and then the good effect could be made. Conclusion: It′s easy to master for surgical reconstruction of congenital aural atresia via tympanic antrum approach, and it also owns the characteristics of safety, save time and reliable effect. It should be managed as soon as the reastresia appears.