Using the external auditory canal skin graft of the healthy side to treat unilateral congenital aural atresia: preliminary results of clinical research / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate whether the contralateral normal external auditory canal (EAC) skin graft can maintain the ear canal health after EAC reconstruction in unilateral congenital aural atresia (CAA) cases. Methods: A Zelen design randomized controlled study was used to collect unilateral CAA patients for EAC reconstruction prospectively (clinical trial registration number: ChiCTR2000032103). The patients were randomly divided into the control group and the trial group. The trial group used the contralateral normal EAC skin graft group (transplant part of the contralateral normal EAC skin to repair the atresia side for unilateral CAA patients), the control group all used scalp blade thick skin. We observed the EAC health and hearing results of the two groups after EAC reconstruction. Results: A total of 13 cases were enrolled from July 2020 to August 2021. There were eight patients in the trial group, including six males and two females, with an average age of 22.3 years (14-36 years). There were two patients with CAA on the left and six patients on the right. The average follow-up time was 8.8 months (4-14 months). There were five patients in the control group, all cases were male with an average age of 16.2 years (12-20 years). There were four patients with CAA on the left and one patient on the right. The average follow-up time was 7.0 months (2-14 months). In the trial group, eight cases of reconstructed EAC epithelium were healthy, one patient had cicatricial stenosis of EAC opening and lateralization of the tympanic membrane. The other patient had cicatricial stenosis of reconstructed EAC, this case also had scar hyperplasia of the contralateral EAC opening but recovered after soft packing and triamcinolone acetonide injection treatment. The healthy side EAC of the rest trial group had no scarring stenosis or local bone hyperplasia during long-term follow-up. In the control group, one patient was lost to follow-up and the other four patients had dry ears of reconstructed EAC, but easily to form crusts and needed to be cleaned repeatedly, one patient had lateralization of the tympanic membrane, the EAC epithelium was not healthy for long-term follow-up. The incidence of complications related to EAC reconstruction was lower than previous studies (χ²=5.55, P=0.018), and the average postoperative Air-Bone Gap increased (18.8±10.0)dB. Conclusion: By optimizing the EAC reconstruction technology, the health of the reconstructed EAC is improved compared with the previous study. After active intervention and treatment, there should be no scarring stenosis or local bone hyperplasia on the contralateral side EAC.

Correction of severe cup ears using postauricular tongue-shaped flap combined with deep fascial suspension / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the effect and satisfaction of using the postauricular tongue-shaped flap combined with deep fascia suspension in correcting severe cup ear malformation. Methods: Between August 2018 and November 2019, nine cases (10 ears) of Tanzer type Ⅲ severe cup ear malformation were treated with postauricular tongue-shaped flap combined with deep fascia suspension in this study. Results: Nine cases primary healed without hematoma, infection or skin necrosis, except one case with postoperative incision dehiscence. The cup ear deformity was significantly improved after the operation, the helix was intact, and the anti-helix was visible. The length, width, and circumference of the auricle were significantly enlarged three months following surgeries. There were no other complications except 1 patient recurrence 12 months after surgery. The patients were highly satisfied with the results of the surgery. Conclusions: Although the aesthctic of the reconstructed auricle is insufficient, this new technology makes full use of the autologous auricle tissue to correct severe cup ear malformation with good results.

Analysis of correlation between congenital auricular deformities and middle ear malformations / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the potential value of knowing the relationship between congenital auricular deformities and middle ear malformations.</p><p><b>METHODS</b>A total of 86 patients with congenital auricular deformities and middle ear malformations, including 51 males and 35 females, were admitted from January 2008 to December 2009 to the Eye Ear Nose and Throat Hospital of Fudan University. Fifty-eight patients had unilateral deformities (R:L = 34:24), while 28 were bilateral. One hundred and fourteen ears with congenital auricular deformities were included. High-resolution CT (HRCT) data was obtained from each patient. The auricular deformities were classified into three grades using the Marx H classification system. The modified Jahrsdoerfer grading system was used to score the malformations using HRCT data. The correlation between the grades of auricular deformities and scores of middle ear malformations was analyzed using Spearman rank correlation analysis.</p><p><b>RESULTS</b>The Marx H grades of congenital auricular deformities were 12 patients with grade I, 25 patients with grade II and 77 patients with grade III, while their corresponding Jahrsdoerfer scores were 7.8 ± 2.4, 6.8 ± 2.6 and 6.0 ± 2.8, respectively. The statistical analysis suggested a trend of negative correlation between the Marx H grades of auricular deformities and the Jahrsdoerfer scores of middle ear malformations (r = -0.2386, P = 0.0106).</p><p><b>CONCLUSION</b>There was a trend to a negative correlation between congenital auricular deformities and middle ear malformations.</p>

Different prognostic characteristics between profound sudden sensorineural hearing loss and total sudden hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To clarify the different prognostic characteristics between profound sudden sensorineural hearing loss (SSNHL) and total SSNHL.</p><p><b>METHODS</b>The patients with SSNHL who visited Eye Ear Nose and Throat Hospital from June 2007 to September 2008 were reviewed retrospectively. All the 204 patients, with pure tone average (PTA) threshold more than 90 dB, were enrolled and divided into two groups, including total SSNHL and profound SSNHL groups. The relationship between recovery rate and prognostic factors including the age, complications, time period between onset and therapy was analyzed.</p><p><b>RESULTS</b>There were 57 cases of total SSNHL and 147 cases of profound SSNHL in this series. Tinnitus was complained in more than 90% of the patients in both groups, which was higher than that of dizziness and ear fullness. Dizziness was present in 64.9% (37/57) patient with total SSNHL group and 45.6% (67/147) patients with profound SSNHL, which had significant difference between the two groups (χ(2) = 5.72, P = 0.017). The PTA threshold improvement in total SSNHL group and profound SSNHL group was (36.4 ± 19.3) dB and (40.2 ± 21.3) dB respectively, which was no significant difference between the two groups (t = 1.165, P = 0.245). The cured patients were all those received therapy within 1 week following the onset of SSNHL, which was of 2.6% (1/38) patients in the total SSNHL group and 14.3% (14/98) patients in the profound SSNHL group (P = 0.045). Furthermore, 3.5% (2/57) patients in total SSNHL group as well as 29.9% (44/147) patients in profound SSNHL group obtained a good result with PTA threshold ≤ 50 dB after therapy (χ(2) = 15.92, P = 0.001). In addition, the favorable prognosis was related with the onset-therapy time point(P = 0.001), but not related to the patients' age.</p><p><b>CONCLUSION</b>Profound SSNHL and total SSNHL though both with PTA threshold > 90 dB had significant differences recovery rate and need to be studied separately.</p>

Distribution of dexamethasone in cochlea after intratympanic injection in rats / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the distribution and pharmacokinetics of dexamethasone of different concentrations in the inner ears of SD rats after intratympanic injection.</p><p><b>METHODS</b>Totally 144 adult SD rats were anaesthetized and dexamethasone sodium phosphate of different concentrations (5 mg/ml, 10 mg/ml, 20 mg/ml) was injected into the tympanums. The rats were sacrificed at various postinjection survival times (5 min, 10 min, 15 min, 30 min, 1 h, 2 h, 4 h, 8 h, 12 h, 24 h, 48 h, 72 h), and every 4 rats were included into each group. Then after a series of processes the inner ear tissue was cryostat sectioned. The distribution of dexamethasone was evaluated using immunofluorescence with semiquantitative analysis. Immunofluorescence was also used in another 4 normal SD rats to detect the distribution of Glucocorticoid receptor (GR) in the inner ear.</p><p><b>RESULTS</b>Dexamethasone was observed initially 15 min after local drug administration and 30 min to its peak level. The highest concentration of dexamethasone labeling was seen in the spiral ligament, organ of Corti and spiral ganglion, which paralleled the distribution of GR. The tissue concentration of 10 mg/ml and 20 mg/ml groups was higher than 5 mg/ml every corresponding time point, and the lasting time was also prolonged from 48 hours to 72 hours.</p><p><b>CONCLUSIONS</b>Dexamethasone can enter into the cochlear tissue quickly after transtympanic injection, and its distribution accords nearly exactly with that of GR. Increase of the concentration of dexamethasone results in higher tissue distribution and longer lasting time.</p>

Preliminary study on intratympanic dexamethasone injection for management of patients with profound sudden hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of intratympanic dexamethasone injection on patients with profound sudden hearing loss.</p><p><b>METHODS</b>All patients in the present study were profound sudden hearing loss, with initial hearing loss of more than 90 dB, but no previous interventions was conducted on the 78 patients within 2 weeks onset of sudden hearing loss. Patients were assigned to 3 groups according to patients' choice, Group I (local and general dexamethasone administration, 22 cases), Group II (Intravenous dexamethasone injection, 44 cases), Group III (intratympanic dexamethasone injection, 12 cases). In addition, vessel dilation drugs, neurotrophic and hyperbaric oxygen therapy were also conducted on all patients. Intravenous dexamethasone was applied 15 mg/dx3 d, 10 mg/dx3 d and 5 mg/dx3 d, respectively. Intratympanic dexamethasone (5 mg/ml, 0.8 ml) injection was performed during 10 days (1 injection/2 days). Pure tone test was conducted on 10th, 20th, and 30th day after intervention.</p><p><b>RESULTS</b>The factors which may impact on the prognosis were matched in all three groups. The threshold improvement more than 30 dB was 81.82% in group I, 83.3% in group II and 88.64% in group III. Statistical study showed there was no significant different among 3 groups (P=0.726). On the 30th day after intervention, pure tone threshold improvement was 41.36 dB in group I (local and general dexamethasone administration), 43.08 dB in group II (intravenous dexamethasone injection) and 51.70 dB in group III (intratympanic dexamethasone injection). Furthermore, pure tone threshold improvement among the 3 groups was no statistical different (F=1.58, P=0.2133). Obvious hearing improvement was noted on the 10th day after intervention, but no further improvement showed after 20 days intervention. More hearing improvement was revealed in the low frequency, while less hearing improvement was achieved in the high frequency.</p><p><b>CONCLUSIONS</b>Comparison with intravenous dexamethasone injection, intratympanic dexamethasone injection did not provide more hearing improvement on patients with profound sudden hearing loss.</p>

Prognostic factors for patients with the idiopathic sudden sensorineural hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To assess the prognostic factors associated with the sudden idiopathic sensorineural hearing loss, to predict the prognosis of patient with idiopathic sensorineural hearing loss precisely.</p><p><b>METHODS</b>Eight hundreds and eighty two patients with idiopathic sudden sensorineural hearing loss were retrospectively reviewed during January 2006 to March 2007. Patients whose initial hearing threshold < or =40 dB were excluded. The patients with initial hearing threshold >40 dB were recruited, which was divided into six subgroups based on the patterns of audiogram: downgrade audiogram subgroup, upgrade audiogram subgroup, flat audiogram subgroup, concave audiogram subgroup, profound audiogram subgroup and total deafness subgroup.</p><p><b>RESULTS</b>Regarding to the relationship between the time point for initial intervention and the prognosis, better prognosis was obtained in patients whose initial intervention was within 3 days of the disease, good prognosis was achieved within 1 or 2 weeks of the disease, poor prognosis was noted beyond 2 weeks of this disease. Furthermore, comparison with the initial intervention within 3 week, 1 month and 1 month later, the prognosis among them was not statistical different. 97.7% hearing recovery was achieved in the concave subgroup with the initial hearing threshold >40 dB group. Comparison with the other subgroup (except total deafness subgroup), the cure rate and recovery rate was 23.8% and 57.9% respectively in the profound subgroup. Poor prognosis was demonstrated in the total deafness subgroup and inefficacy rate was 67.4% in the total deafness subgroup. Comparison with patients without companying complications, the prognosis of patients with companying complications such as diabetes or high blood pressure has negative impact in hearing recovery. The age was correlated with the prognosis, elder had poor prognosis, patients more than 50 years old present with worse hearing than that less than 50 years old (H = 7.851, P = 0.0051).</p><p><b>CONCLUSIONS</b>The initial intervention beyond 2 weeks had negative impact on the prognosis. The initial audiogram patterns and hearing threshold were both significant factors on the prognosis of idiopathic sudden sensorineural hearing loss. In addition, old patient had poor prognosis. The companying complications such as high blood pressure and diabetes had negative impact on the prognosis of idiopathic sudden hearing sensorineural loss.</p>