Immunotherapy of mite allergic rhinitis in children / 中华实用儿科临床杂志

Objective:To study the effect of sublingual immunotherapy on children with mite allergic rhinitis.Methods:Four hundred and ninety patients with mite allergic rhinitis have been recruited by Beijing Children′s Hospital from March 2014 to September 2019 and divided into 4 groups of young children group, different treatment duration group, individualized dose adjustment group and multiple allergy evaluation group, the clinical scores of total nasal symptoms score (TNSS), visual analogue scale scores (VAS) and total medication score were recorded at the first visit, 12 months, 24 months and 36 months after treatment, and the combined symptom and medication score(CSMS) score was calculated.Results:A total of 374 patients (76.32%) completed this study.Among them, the CSMS(2.20±1.61, 2.50±1.78), TNSS(2.80±2.32, 3.60±2.71) and VAS(3.50±1.16, 3.90±1.43) in ≤3-year-old group and children over 3-year-old group of young children set after use of 12 months were significantly lower than the score at the first time of diagnosis (respectively CSMS: 4.50±1.44, 5.30±1.32; TNSS: 6.20±1.89, 7.50±2.19; VAS: 5.40±2.33, 5.90±1.61). In addition, in the duration and efficacy set, the patients who completed the immunotherapy for 36 months can only be observed in the 3-year group, the scores were TNSS(0.90±0.97), VAS (1.30±1.19), CSMS (1.70±1.28); the scores of patients who completed the immunotherapy for 24 months in 2-year group and 3-year group were TNSS (2.10±0.95, 2.00±0.97), VAS (3.00±1.56, 3.10±1.68) and CSMS (3.10±1.15, 2.90±1.19) and the patients who completed 12-month immunotherapy were scored in 1-year group, 2-year group and 3-year group with TNSS(3.20±1.27, 3.10±1.41, 3.20±1.41), VAS(4.50±2.11, 4.70± 2.19, 4.50±2.17) and CSMS(4.20±1.39, 3.70±1.32, 4.10±1.39) respectively; patients with poor efficacy in sublingual immunotherapy achieved a score similar to the control group after 6 months of dose adjustment (equals to 12 months after treatment), that were CSMS(2.90±1.56, 2.90±1.88, 2.40±1.69), TNSS(4.70±2.98, 3.90±2.77, 3.80±2.45) and VAS(4.20±1.29, 4.50±1.65, 4.20±1.14) of 4 drops group, 5 drops group and control group; sublingual immunotherapy for patients with multiple allergens for 2 years finally achieved similar efficacy to patients with single allergen, with CSMS (2.30±0.50, 2.10±1.01, 1.90±1.01), TNSS (3.50±2.62, 3.70±2.62, 3.20±2.82) and VAS (4.50±1.00, 4.10±1.57, 3.80±1.54) in single allergen group, combined with 1-2 allergens group and combined with 3+ allergens group.Conclusions:Sublingual immunotherapy plays a corresponding role in the treatment of low-age children, multiple allergy children, and some children get better after dose adjustment.

Endothelial dysfunction in children with obstructive sleep apnea syndrome / 中华儿科杂志

Objective@#To evaluate the endothelial function in obstructive sleep apnea syndrome(OSAS) children and to identify related factors of endothelial dysfunction.@*Methods@#This was a cross-sectional study. Children with habitual snoring (snoring ≥3 nights per week) admitted to the ward of otolaryngology, head and neck surgery, Beijing Children′s Hospital were recruited to this study between 1st June 2015 and 1st March 2016. All children aged 3 to 11 years and of them 245 were boys and 110 were girls. All subjects underwent an overnight polysomnography (PSG), as well as endothelial function testing. All subjects were grouped into primary snoring (PS) and OSAS group according to the obstructive apnea hypopnea index (OAHI). T test or Wilcoxon test were used to compare the differences in PSG results between the two groups, and univariate and multivariate correlation analyses were used to explore the relevant factors affecting the endothelial function.@*Results@#A total of 355 subjects were enrolled and 248 had OSAS, and 107 had PS. There were no significant differences in age, gender and body mass index (BMI) Z-score between the two groups (all P>0.05). OSAS group had higher OAHI, oxgen desaturation index and respiratory related arousal index (5.2 (2.2, 13.2) vs. 0.4 (0.1, 0.7), 4.1 (2.0, 13.1) vs. 0.5 (0.1, 1.0), 2.5 (1.0, 4.8) vs. 0.4 (0.1, 0.9), Z=-14.957, -11.790, -10.378, all P<0.01), and lower minimum oxygen saturation and reactive hyperemia index (RHI) than those of PS (0.89 (0.85, 0.92) vs. 0.94 (0.91, 0.95), 1.2±0.2 vs. 1.1±0.1, Z=-9.337, t=5.354, P<0.01). Univariate regression analysis showed that RHI was linearly correlated with age (parameter estimate=0.017, P<0.01), gender (parameter estimate=0.065, P<0.01), OAHI (parameter estimate=-0.023, P<0.01), oxygen desaturation index (parameter estimate=-0.019, P<0.01), respiratory related arousal index (parameter estimate=-0.031, P<0.01), and oxygen saturation nadir (parameter estimate=0.067, P=0.045). The relationship between BMI Z-score and RHI was quadratic. Multivariate regression analysis showed that age (parameter estimate=0.015, P<0.01), BMI Z-score (parameter estimate=0.040, P<0.01), BMI Z-score quadratic form (parameter estimate=-0.010, P<0.01), respiratory related arousal index (parameter estimate=-0.020, P<0.01) were independently correlated with RHI.@*Conclusions@#Children with OSAS have significant endothelial dysfunction compared with PS. Frequent arousals due to obstructive respiratory events during sleep may be a candidate risk factor for endothelial dysfunction in children with OSAS.

Current situation of rectal drip therapy for children in 947 medical institutions and consideration / 中华实用儿科临床杂志

Objective:To understand the application status of rectal drip therapy, so as to make recommendations for its rational application.Methods:In order to analyze the actual situation of rectal drip therapy and the cognition status of the safety, absorption degree and convenience of rectal drip therapy, a questionnaire survey was conducted from 947 different medical institutions in 22 provinces, 4 direct-controlled municipalities and 4 autonomous regions from July 4 to July 15, 2019.Results:(1) A total of 1 505 valid questionnaires were collected from 947 medical institutions in China, 95 medical institutions indicated that 156 drugs were administered by rectal drip, including 35 drugs in tertiary medical institutions, 50 drugs in secondary medical institutions, 67 drugs in primary medical institutions, and 4 drugs in profit medical institutions.(2) The proportion of oral preparations that was used in rectal drip, and in tertiary and secondary medical institutions were 68.57%(24 cases) and 62.00%(31 cases), respectively, both of which was higher than that proportion in primary medical institutions (13 cases, 19.40%). The proportion of injections in primary medical institutions was 80.60%(54 cases) that was higher than that of tertiary medical institutions (11 cases, 31.43%) and secon-dary medical institutions (19 cases, 38.00%), and the differences were statistically significant (all P<0.001). (3) The proportion of digestive system medication rectal dripping in tertiary medical institutions (13 cases, 37.14%) and secondary medical institutions (20 cases, 38.46%) was higher than that in primary medical institutions (3 cases, 4.41%), and the difference was statistically significant ( P<0.001). The proportion of rectal dripping of Traditional Chinese Medicine (TCM) injections in primary medical institutions (47 cases, 69.12%) was higher than that in tertiary medical institutions (1 cases, 2.86%) and secondary medical institutions (0, 0), and the difference was statistically significant ( P<0.001). (4) Among the results of 1 505 questionnaires, 18.61%(280 questionnaire) of doctors thought that rectal drip therapy was safe, 39.34%(592 questionnaire) agreed it was easy to absorb, and 37.34%(562 questionnaire) hold the view that it was convenient.(5) The number of questionnaires in the two groups of used (group A) and not used (group B) was 100 and 1 405, respectively.The cognitive differences in the safety, absorption degree and convenience of rectal drip therapy between the two groups were statistically significant (all P<0.001). Conclusion:There are various drugs used in rectal drip therapy, so it should be strengthened in the management and standardized in pediatrics.

Analysis of sleep quality and related factors among children in Beijing / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the sleep quality of children in Beijing and to analyze the related factors.@*Methods@#The data were collected from the survey of 3-14 years old children in 7 urban districts of Beijing in 2015. By using multi-stage stratified cluster random sampling method, 26 kindergartens and primary and secondary schools in 7 districts and counties, including Xicheng, Chaoyang, Changping, Shunyi, Fangshan, Huairou and Mentougou, were randomly selected, with a total of 11 420 children. Children′s sleep status was investigated with Children′s Sleep Questionnaire (PSQ), and the proportion of children with sleep quality problems when the PSQ score was greater than 7. Various sleep related factors were investigated with self-made questionnaire. A multilevel model was used to analyze the relationship between PSQ score and related factors.@*Results@#The average PSQ score of the children was 3.60±2.69. The proportion of children with sleep quality problems was 8.87%(816/9 198). Multilevel model analysis showed that the younger the children, the higher the PSQ score (<6 years old vs. 6~12 years old vs. >12 years old: 3.94±2.58 vs. 3.58±2.66 vs. 3.30±2.84, F=33.015, P<0.001); male PSQ score higher than female (3.89±2.75 vs. 3.30±2.60, t=10.560, P<0.001); and snoring, obesity, father/mother snoring, playing games before bed, surfing the internet, eating and other factors were statistically related to PSQ.@*Conclusions@#Sleep quality of children in Beijing should not be neglected, especially preschool children with high PSQ scores. Parents should pay attention to children′s snoring problems and try to reduce some pre-sleep behaviors that may affect sleep quality.

Diagnosis and treatment of congenital basal encephaloceles in infants / 中国耳鼻咽喉头颈外科

OBJECTIVE To discuss the diagnosis and endoscopic treatment of congenital basal encephaloceles in infants.METHODS We retrospectively reviewed the clinical data of 6 infants with congenital basal encephaloceles in Beijing Children's Hospital between January 2014 to September 2016. CT and MRI were performed routinely. All patients underwent endoscopic resection of encephaloceles and repair of skull base defects. RESULTS Five patients presented with transethmoidal encephaloceles and one transsphenoidal encephaloceles. All patients underwent endoscopic procedure successfully. There were no complications except for one 7-month old girl who got purulent meningitis. All patients had favorable clinical outcomes during a follow-up of 3 to 29 months.CONCLUSION For infants with persistent nasal obstruction and nasal neoplasms, congenital basal encephaloceles should be considered. Nasal coronary CT and sagital MRI are of paramount importance in the diagnosis of congenital basal encephaloceles in infants. The endoscopic procedure is the safe and effective method for the management of congenital basal encephaloceles in infants.

Short-term clinical efficacy of sublingual immunotherapy in children with allergic rhinitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the short-term clinical efficacy of sublingual immunotherapy in children with allergic rhinitis. METHODS Forty-four patients, from 3-14 years of age, with mite-sensitive allergic rhinitis were treated sublingually with standardized dermatophagoidesfarinae extract. After treatment of 3 or 6 months using the dermatophagoidesfarinae extract, the total nasal symptoms score(including nasal congestion, nasal itching, rhinorrhea and sneezing scores), total rhinitis medicine scores, visual analog scale scores and the percentage of blood eosinophilic granulocyte(Eos%) before and after treatment were evaluated. SPSS 20.0 software was used to analyze the data. RESULTS After 3 or 6 months' treatment,thenasal symptoms score(including nasal congestion, nasal itching, rhinorrhea and sneezing scores), total rhinitis medicine scores and visual analog scale scoreshad significantly reduced,comparing with that before treatment(all P0.05), while nasal itching scores had significantly reduced(Z=-4.185, P<0.05). After 6 months' treatment, the percentage of Eos% had significantly reduced compared with that before treatment(Z=-4.544, P<0.05). CONCLUSION SLIT could be an effective treatment in patients with allergic rhinitis sensitive to house dust mite. It would have effect after3 months treatment and Eos%reduced significantly after 6 months treatment.

Establishment of a Template for the Assessment of Hearing Aids Outcomes / 听力学及言语疾病杂志

Objective The objective of the present study was to establish a template for the self assessment of hearing aids outcomes according to the evaluation of a large group of hearing aid users .Methods In total ,1 724 subjects participated in the study .The Chinese version of International Outcome Inventory for Hearing Aids (IOI-HA) was used as the evaluation tool .IOI -HA is a seven -item questionnaire ,each item is designed to assess a specific outcome domain .Each item was designed with a five -point rating scale ,a higher rating indicates better outcome .According to the subjects'self reported hearing difficulty when they were not wearing hearing aids (unaid-ed) ,the subjects were divided into two groups :self reported hearing difficulty to be no ,mild ,moderate group ,and self reported hearing difficulty to be moderately severe or severe group ,respectively .Templates for each group were established according to the analysis of the item ratings .Results One thousand two hundred and forty -seven sub-jects accept the investigation ,with a response rate of 72 .3% ,and 1203 completed responses were included in the fi-nal analysis .The Chinese version of IOI-HA scores showed a skewed distribution ,with a mean score ranging from 3 .52 to 4 .19 .The total IOI-HA scores ranged from 9 to 35 ,and the mean total score was 26 .30 .Results showed that for the self reported hearing difficulty (unaided) to be none ,mild or moderate group ,the mean scores for the i-tem of daily use ,benefit ,residual activity limitation ,satisfaction ,residual participation restrictions ,impact on others ,and quality of life were 4 .14 ,3 .67 ,3 .76 ,3 .58 ,3 .56 ,3 .93 and 3 .69 ,respectively .The corresponding mean scores for the self reported hearing difficulty (unaided) to be moderately severe or severe group were 4 .19 ,3 .63 ,3 .64 ,3 . 65 ,3 .52 ,3 .89 ,and 3 .79 ,respectively .A template for the Chinese IOI -HA was established according to the above data .Conclusion The template for the Chinese version of IOI -HA could be served as an effective tool to measure the general effectiveness of the hearing aid outcomes and hearing aid fitting in China ,which would also facilitate the international outcome comparison cross culture .

Transnasal endoscopic choanal plasty for repairing congenital choanal atresia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the effect of transnasal endoscopic choanal plasty for repairing congenital choanal atresia.</p><p><b>METHOD</b>A retrospective analysis of 15 patients with choanal atresia in Beijing Children's Hospital from January 2006 to September 2012 was made. All the 15 patients accepted electronic nasopharyngoscope examination and CT scanning of the paranasl sinus. The age was between 4 years old and 6 years old. Seven of them were male and 8 were female. Six cases were unilateral atresia, 9 were bilateral atresia. Ten cases (16 sides) were membranous atresia, 2 cases (4 sides) were mixed type atresia and 3 cases (4 sides) were bony atresia. All the patients accepted transnasal endoscopic choanal plasty. A tube was placed in order to support the enlarged nostrils. The nasal tube should be retained for 3 months and kept patency by routine care. Three months after operation, the tube could be removed. The patients were told to do physiological saline nasal irrigation and receive regular review by transnasal endoscopy.</p><p><b>RESULT</b>The patients were followed up for 1 year postoperatively by electronic nasopharyngoscope examination. There was no failure case in all the 15 patients. The total effective rate was 100%.</p><p><b>CONCLUSION</b>Transnasal endoscopic choanal plasty had better efficacy and safety in the treatment of congenital choanal atresia.</p>

The high risk factors of allergen sensitization among 518 children with allergic rhinitis symptoms / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the high risk factors of allergen sensitization among 1-16 years old children with allergic rhinitis (AR) symptoms.</p><p><b>METHODS</b>Medical history was collected from 518 children with AR symptoms aged 1 to 16 years old between April 2011 and November 2012, including five aspects:basic information, disease characteristics, associated with other allergic diseases, growth and development history and genetic history and so on. The allergens were determined by UniCAP 100 system. The high risk factors of allergen sensitization (sIgE ≥ grade III) among 1-16 years old children with AR symptoms were analyzed. The data processing and statistical analysis were conducted by SPSS 17.0 software.</p><p><b>RESULTS</b>Three hundred and thirty of 518 patients (63.7%) could be diagnosed as AR. The primary allergen was mixed fungal (52.4%). The highest percentage of allergen sIgE ≥ grade III accounted for the corresponding allergen positive cases was 71.1% (mixed fungal). Single factor analysis of clinical characteristics in the groups of AR and non AR showed that the history of months(χ(2) = -3.591), concomitant allergic conjunctivitis (χ(2) = 12.325) and cats or dogs at home (χ(2) = 5.615) were statistically significant between the two groups (all P < 0.05).In children with AR, single factor analysis of clinical characteristics in the groups of whether positive allergen level ≥ grade III showed that the concomitant asthma(χ(2) = 4.097), breastfeeding(χ(2) = 4.186), the housing situation (χ(2) = 4.360) and the bedroom toward (χ(2) = 4.656) were statistically significant between the two groups (all P < 0.05). In children with AR, single factor analysis of clinical characteristics in different age groups showed that the history of months(χ(2) = 64.999), concomitant eczema (χ(2) = 24.056), concomitant insect bite dermatitis (χ(2) = 9.148), cats or dogs at home (χ(2) = 8.529) and mother suffered from AR (χ(2) = 9.565) were statistically significant in different age groups (all P < 0.05).</p><p><b>CONCLUSION</b>The study revealed that the longer of history, concomitant allergic conjunctivitis and cats or dogs at home are risk factors for AR;In children with AR, not breastfeeding and the bedroom toward back are risk factors for inhalation allergen sIgE ≥ gradeIII.</p>

Endoscopic transnasal approach for repairing anterior skull base cerebrospinal fluid rhinorrhea and meningoencephalocele: preliminary experience of using fat bath-plug technique / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To summary the preliminary experience of fat bath-plug technique in endoscopic transnasal approach for repairing anterior skull base cerebrospinal fluid rhinorrhea (CSF) and meningoencephalocele.@*METHOD@#Using fat bath-plug technique repair 1 case meningoencephalocele (traumatic) and 5 cases cerebrospinal fluid rhinorrhea (1 traumatic, 4 spontaneous). The analysis index included: preoperative localization, intraoperative position, surgical procedures, perioperative symptoms, follow-up. etc.@*RESULT@#CT and MRI techniques were used for location of the fistula preoperative. The location of the fistulas were exploration during the operation and were consist with the imaging studies. All 6 fistulas were repaired during the first operation. No fever and no intracranial infection occurred postoperatively. All the patients discharged 7 days postoperatively with an iodoform nasal packing. Three to 4 weeks later the patients were reviewed to clean up the nasal cavity. All patients were recovered well with good epithelial mucosa in the 3 and 6 months endoscopic follow-ups. No CSF leak and intracranial infection happened in the 3-year telephone follow-up.@*CONCLUSION@#The fat bath-plug technique in endoscopic transnasal approach for repairing anterior skull base small fistula, especially in cribriform ethmoid roof, is effective, safe and simple.

Evaluation of imaging navigation system during endoscopic sinus surgury / 中国耳鼻咽喉头颈外科

OBJECTIVE Evaluation of imaging navigation system during endoscopic sinus surgury and compared endoscopic sinus surgery with and without image guidance, analyzing a number of parameters that can impact on efficacy. METHODS Retrospective review of 76 imaging-navigated endoscopic sinus surgery with image-guidance systems at our department between Jan 2000 and May 2003, including 20 consecutive pituitary adenoma patients and 10 nasal-sinus ossifying fibroma. The control group consisted of 10 nasal-sinus ossifying fibroma patients between Jan 1997 and May 2003 and 20 consecutive pituitary adenoma patients between Jan 1999 and May 2003 who underwent ESS without image guidance. The main outcomes measured were analysis of the using times of different diseases, the user's satisfication in different diseases, and compared pituitary adenoma/ossifying fibroma ESS with and without image guidance. RESULTS The using times of different diseases are different, the user feel satisfication in all cases but the degree is different with diseases. The patient's characterisitics of the two groups of pituitary adenoma/ossifying fibroma were similar in age and gendle. There are no statistically significant differences in estimated blood loss, operative time, anesthesia time. CONCLUSION Imaging navigation systems in different nasal-sinus diseases are all useful. Our experience illustrates the importance of the learning curve, we believe that the problems we had with those systems were largely operator-dependent and that these can be overcome with proper experience and training. For small group patients, it's no evidence to show in ESS can make more complete resection of nasal-sinus ossifying fibroma, but has evidence to show no more cost.

The distributional characteristics of frontal recess cells during image navigation assisted endoscopic sinus surgery / 中国耳鼻咽喉头颈外科

OBJECTIVE To recognize the frontal recess cells and analyze their distributional characteristics during image navigation assisted endoscopic sinus surgery. METHODS 20 cases(39 sides)of chronic sinusitis with nasal polyps were observed in this study. The fontal recess cells and frontal sinus were opened under the endoscope and the distributional characteristics were observed and recorded, and then confirmed by the image navigation system. RESULTS Centred on frontal sinus ostium, frontal recess cells were divided into three areas: the agger nasi cell(ANC)and frontal cells(FC)are located in front of frontal sinus ostium(FS); frontal septum cells(IFSSC)and terminal cells(RT)are located at the same plane of FS; supra-ethmoidal bulla recess(SBR), frontal bulla cell(FBC)and super-obital cells(SOEC)are in the posterior area. The coincidence of identification for ANC, FCI and II, SBR, FBC and IFSSC under endoscope and image navigation is 100%, the coincidence of identification for FS is 89.7%, SOEC 80%, RT 71.4% and FC III and IV 60%. CONCLUSION The distribution of the frontal recess cells around the frontal ostium showed a fixed pattern.It would well benefit the orientation of frontal ostium and the opening of frontal sinus. Furthermore, it is significant for the orientation and opening of the frontal recess cells.

Advantages of using an image-guided system for transnasal endoscopic surgery / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the advantages of image-guided system in transnasal endoscopic surgery.</p><p><b>METHODS</b>Transnasal endoscopic surgery was performed with the aid of an image-guided system in 28 patients, supported with histopathologic diagnoses of chronic sinusitis with/without nasal polyps (10 cases), juvenile nasopharyngeal angiofibroma (4 cases), pituitary adenoma (6 cases), ethmoidal ossifying fibroma (3 cases), nasopharyngeal mixed tumor (2 cases), nasal leiomyoma (1 case), fungal sinusitis (1 case) and inverted nasal papilloma (1 case).</p><p><b>RESULTS</b>For all the patients, the time periods from initialization to surgery ranged from 15 to 30 minutes (a mean of 26 minutes). The calibration coefficient ranged from 1.3 to 2.0. Accuracy of localization fell within 1 mm. Compared with traditional endoscopic surgery, operation times were not noticeably different. No complications occurred.</p><p><b>CONCLUSIONS</b>The image-guided system was able to identify borders and critical anatomical structures in real-time, especially of those with distorted anatomical markers. It provided a powerful means for a safer and less invasive endoscopic sinus surgery.</p>