Sleep quality and sleep disturbances in Chinese pregnant women: a multicenter cross-sectional study / 中华耳鼻咽喉头颈外科杂志

Objective: This study aims to investigate the sleep quality of pregnant women in Xuhui District, Shanghai, and the related factors of sleep disturbances during pregnancy. Methods: From February 2019 to February 2021, we used online integrated sleep questionnaire (including PSQI, BQ, ESS, AIS) in Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, The International Peace Maternity and Child Health Hospitals of China Welfare Institution, and Shanghai Eighth People's Hospital, to investigate the sleep quality across pregnancy. We also collected maternal physical examination results, childbearing history, sociodemographic, and other clinical data. The prevalences and related factors of various sleep disturbances in pregnant women were analyzed, including insufficient/excessive nighttime sleep, low sleep efficiency, difficulty falling asleep, poor sleep quality, insomnia, daytime sleepiness, and high risk of sleep-disordered breathing (SDB). Results: This study includes 1 898 cases in the first trimester (T1), 3 099 cases in the second trimester (T2), and 1 539 cases in the third trimester (T3). Poor sleep quality (38.6%), daytime sleepiness (mild 41.9%, moderate 17.7%, severe 2.1%), and suspicious insomnia (32.3%) are most prevalent among women in T1 (P<0.01). In comparison, short sleep time (2.7%), long sleep time (8.6%), difficulty falling asleep (12.2%), poor sleep efficiency (35.4%), very poor sleep quality (6.7%), clinical insomnia (21.8%), and high-risk SDB (6.4%) are most prevalent among women in T3 (P<0.05). During pregnancy, late gestation (OR=1.016, 95%CI: 1.006-1.025) and multiple induced/drug abortions (OR=1.329, 95%CI: 1.043-1.692) are risk factors for poor sleep quality (PSQI>5), while multiple full-term deliveries (OR=0.800, 95%CI: 0.675-0.949) is its protective factor. Advanced maternal age (OR=0.976, 95%CI: 0.956-0.997), multiple full-term deliveries (OR=0.808, 95%CI: 0.680-0.959), late gestation (OR=0.983, 95%CI: 0.974-0.992) and hypertension (OR=0.572, 95%CI: 0.401-0.814) are protective factors for daytime sleepiness (ESS>6). The high-risk pregnancy category (OR=9.312, 95%CI: 1.156-74.978) is a risk factor for insomnia (AIS≥4), while multiple full-term deliveries (OR=0.815, 95%CI: 0.691-0.961) is its protective factor. High BMI (OR=1.334, 95%CI: 1.270-1.402) and hypertension (OR=4.427, 95%CI: 2.539-7.719) are risk factors for high-risk SDB in pregnant women. Conclusions: The prevalences of various sleep disturbances are high throughout pregnancy. Noticeably, symptoms of maternal SDB develop along with pregnancy. Different types of sleep disturbances are associated with different factors. Women of high-risk pregnancy category, in late gestation, with high BMI, hypertension, a history of induced/drug abortion, or without a history of full-term delivery can be at high risk of sleep disturbances during pregnancy.

Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

An endoscopic approach to reconstruction of skull base defects using a vascular pedicled nasoseptal mucoperiosteal flap / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce a method and the clinical effects of repairing skull base defects and dural defects using vascular pedicled nasoseptal mucoperiosteal flaps through an endoscopic endonasal approach.</p><p><b>METHODS</b>The clinical and follow-up data for 8 patients who underwent endoscopic endonasal reconstruction of skull base defects and cerebrospinal fluid rhinorrhea with a vascular pedicled nasoseptal mucoperiosteal flap between July 2008 and March 2010 were retrospectively reviewed. All patients were male. The age of these patients ranged from 28 to 60 years (average 41 years). The diagnosis for these patients included one hemangiopericytoma of the anterior skull base one olfactory neuroblastoma (type of Kadish C), one ethmoid sinus cancer, three local recurrent cancers of the nasopharynx after radiotherapy, one carcinoid of skull base and one traumatic cerebrospinal fluid rhinorrhea with recurrent intracranial infection. There were six anterior skull base defects and two middle cranial fossa defects. An endoscopic endonasal surgical approach was used for the repair. A pedicled flap using the nasal septal mucoperiosteum based on the posterior nasal artery was harvested from the ipsilateral side. The tissue flap was used to cover the dural defects. The margin was covered with gelatin sponge and fixed with fibrin glue. The nasal cavity was packed with iodoform gauze, a Foley catheter balloon and Merocel in this sequence to secure the flap in place. Nasal packing was removed 5 to 7 days postoperatively.</p><p><b>RESULTS</b>Partial septal flap necrosis was found in one case, but the flaps in the other 7 cases survived. A postoperative cerebrospinal fluid leak occurred in one case 7 days after surgery. This was re-explored and successfully repaired with abdominal fat. All cases healed well, with no delayed cerebrospinal fluid leaks or intracranial infections during the 6 to 24 months follow-up period.</p><p><b>CONCLUSION</b>The vascular pedicled nasoseptal mucoperiosteal flap is a reliable choice for endoscopic endonasal skull base reconstruction.</p>

Effect of high frequency hearing loss on the temporal processing in the low frequency regions of guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To constitute the animal model of high frequency hearing loss and observer the temporal processing abilities of low frequency regions using prepulse inhibition of auditory startle response (gap-PPI).</p><p><b>METHODS</b>Ten guinea pigs were randomly grouped into two groups: the high frequency hearing loss group with six guinea pigs and the control group with four guinea pigs. The former group was exposed to 12 kHz tone at 110 dB SPL for 30 hours to establish the high frequency hearing loss above 8 kHz and the latter group received no stimulations. Before and two, four, six and eight weeks after noise exposure, gap-PPI and auditory brainstem response (ABR) were recorded in both groups. In the gap-PPI experiment, three different background noises as 0.5 - 2 kHz, 0.5 - 4 kHz and 0.5 - 8 kHz were applied to test the temporal gap.</p><p><b>RESULTS</b>High frequency hearing loss above 8 kHz was shown two weeks after noise exposure. The averaged ABR thresholds of 16 kHz, 32 kHz and 48 kHz were elevated about 55 dB and shown statistical significance compared to those before exposure (P < 0.05). No significant difference of ABR thresholds were shown between 1 kHz, 2 kHz, 4 kHz and 8kHz before and after noise exposure (P > 0.05). In the control group, the ABR thresholds remained stable during experiment. In the gap-PPI test, two weeks after noise exposure of 8 kHz, the experiment group showed attenuated inhibition ability and recovered gradually four weeks after noise exposure. No statistical differences of inhibition ability at time points of two, four, six and eight weeks after noise exposure of 4 kHz were detected when compared with that of pre-exposure. Under the background noise of 2 kHz, the inhibition ability attenuated and reached statistical significance at 6 - 8 weeks after noise exposure.</p><p><b>CONCLUSION</b>The high frequency hearing loss might induce an impairment of the temporal processing in the low frequency region.</p>

Streptomycin-induced apoptosis of rat cochlear hair cell cultured in vitro / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate if caspase pathway was involved in streptomycin-induced cell apoptosis in cochlear hair cells.</p><p><b>METHODS</b>F344 rats at postnatal day 3 or 4 were used for the study in cochlear organotypic cultures. The cochlear basilar membrane was micro-dissected out and cultured overnight, and then treated with 1 mmol/L streptomycin for 24 hours. Before the termination, the activity of caspase-8, 9 or 6 were detected with FAM-peptide-FMK labeled caspase-8, 9 or 6, respectively. The stereocilia and cuticular plate of hair cells were stained with TRITC conjugated phalloidin, and the nuclei were stained with Topro-3 DNA probe. The specimens were observed and photographed under confocal fluorescent microscope.</p><p><b>RESULTS</b>Streptomycin with 1 mmol/L causes about 80% cochlear hair cells missing in the basal turn and 10% hair cell loss in the apex. After streptomycin treatment, the nuclear shrinkage and fragmentation were found in most cochlear hair cells, and the caspase-8, caspase-9 and caspase-6 were greatly activated.</p><p><b>CONCLUSIONS</b>Apoptosis is involved in the cochlear hair cells death induced by Streptomycin in vitro. The caspase activities in upstream and downstream are maybe the major apoptotic pathway.</p>

Maxillomandibular advancement for obstructive sleep apnea/hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore effectiveness of maxillomandibular advancement (MMA) in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>MMA was performed in 10 OSAHS patients with mandibular dysplasia diagnosed by mandibular protrusion angle (SNB) < 75 degrees and a posterior airway space (PAS) < 11 mm. Six patients had uvulopalatopharyngoplasty (UPPP) also. Six patients had over 6 months postoperative follow up.</p><p><b>RESULTS</b>The blood loss was about 250-600 ml in the operation, and the serious complications didn't happen. The patients were satisfied with the postoperative facial change. Based on success criteria of 2009, of 5 patients showed highly responsive result and 1 patient was responsive (valid). rate was 83% and the responsive rate 100%. The snoring loudness score and Epworth sleepy score were reduced from preoperative 8 (6-10) and 15 (11-24) to postoperative 2 (0-4) and 5 (1-8). AHI was reduced from preoperative 52.2 (23.7-83.8) to postoperative 12.6 (7.6-31.8), lowest mean oxygen saturation increased from 0.64 (0.57-0.83) to 0.82 (0.78-0.93). Percentage of time with oxyhemoglobin saturation below 0.90 (CT90) reduced from 21.0% (12.0%-37.2%) to 2.0% (0%-8.0%).</p><p><b>CONCLUSIONS</b>MMA is effective for the OSAHS patients with mandibular dysplasia.</p>

Correlation between reduction of distortion product otoacoustic emission and percentage of outer hair cell missing in chinchillas / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the quantitative relationship between the reduction of distortion product otoacoustic emission (DPOAE) and the percentage of outer hair cell loss.</p><p><b>METHODS</b>Coadministration of cisplatin (0.2 mg/kg) and ethacrynic acid (40 mg/kg) were used to establish a cochlear lesion model in chinchillas. DPOAE was measured before and 1 week, 2 weeks, and 3 weeks later respectively after cisplatin and ethacrynic acid treatment. Animals were terminated 3 weeks after the treatment. Cochlear surface preparations were performed, and the cochlear hair cells were counted through entire length of the cochlea. The correlation between DPOAE reduction and outer hair cell missing was analyzed using Pearson correlation analysis.</p><p><b>RESULTS</b>Cisplatin and ethacrynic acid treatment induced cochlear hair cell lesion that the outer hair cell loss in the cochlea developed in a stereotypic pattern; damage began in the base of the cochlea and progressed towards the apex. Reduction of DPOAE was relatively consistent with outer hair cells loss. On the average, 1% outer hair cells loss may result in 0.24 dB reduction in DPOAE levels. Pearson analysis showed a positive correlation between the reduction in DPOAE and missing of outer hair cells (r = 0.796, P < 0.05).</p><p><b>CONCLUSIONS</b>It may be helpful to evaluate missing percentage of outer hair cells from reduction in DPOAE levels.</p>

Ototoxic effects of streptomycin in vestibular organotypic cultures / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the ototoxic effects of streptomycin in vestibular organotypic cultures.</p><p><b>METHODS</b>F344 rats with age at postnatal day three or four were used for this study. The maculae of saccule and utricle were routinely dissected out and cultured with serum-free medium containing various dose of streptomycin for 24 hours. The ciliary turf of vestibular hair cells was stained with fluorescent phalloidin, and its nucleus was stained with to pro-3 DNA probe. The vestibular hair cells were quantitatively counted and photographed under confocal fluorescent microscope.</p><p><b>RESULTS</b>Morphological feature of vestibular hair cells were good in normal control cultures. However, the density of hair cells was decreased in evidence with increase of streptomycin sulfate concentrations. Twenty-four hours after streptomycin cultures, 0.25 mmol/L streptomycin caused a 10% hair cell missing, 50% hair cell loss from 1 mmol/L streptomycin treatment, and more than 75% hair cells gone post-3 mmol/L streptomycin cultures. After streptomycin treatment, the nuclear shrinkage and fragmentation were found in vestibular hair cells, whereas the vestibular supporting cells were normal.</p><p><b>CONCLUSION</b>Streptomycin induced-vestibular hair cells lesion was in a dose dependent manner with nuclear shrinkage and fragmentation. This may suggest that streptomycin leads vestibular hair cell die through apoptosis.</p>

Cochlear implantation with suprameatal approach in Chinese children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the technique of the suprameatal approach for cochlear implantation in Chinese profound sensory hearing loss children.</p><p><b>METHODS</b>Suprameatal approach for cochlear implantation were used in 50 cases (total 53 ears) with profound sensory hearing loss from May 2005 to January 2007. The electrode was passed through the suprameatal tunnel and went between the incus and chorda tympani into the scala tympani.</p><p><b>RESULTS</b>Electrodes were completely inserted in 51 ears. There were no postoperative complications in all cases. Although the long effect need to be observed, all cases received better hearing and speech development benefit from cochlear implantation in the follow-up period. Among the 50 cases, 26 had speech perception in the open condition; 18 patients could speak short sentences although not clearly; and 6 patients learned to speak individual words only.</p><p><b>CONCLUSIONS</b>The suprameatal approach was found to be a simple and safe technique that does not need mastoidectomy and avoid endangering the facial nerve and the chorda tympani. It enables wide exposure of middle ear and is especially suitable for cases with narrow facial recess or anteriorly located facial nerve.</p>

Effectiveness and related factors of Z-palatopharyngoplasty for treating obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and related factors of Z-palatopharyngoplasty for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>Thirty four OSAHS patients with graded 1-3 tonsil, posterior airway space (PAS) > or = mm , Friedman II and III oropharyngeal airway were included in this study, all cases had Z-palatopharyngoplasty. The follow up was at least 6 months postoperatively. Measurement parameters of responders and nonresponders were analyzed.</p><p><b>RESULTS</b>According to related criterion of China, cure rate was 35.3%, accumulative total excellence rate 64.7% and accumulative valid rate 70. 6%. The cured and excellence patients were considered as responders, the other as nonresponders. The lowest oxygen saturation (LSaO2), percentage of time with oxyhemoglobin saturation below 0.90 (CT90), mandibular plane angle (MPA), mandibular body length, position of tongue and Friedman clinical stage are statistically significant between responder and nonresponder. The best cut points of LSaO2, CT90 and MPA were 0.72, 22.80% and 29.40 degrees respectively. The logistic regression showed that Friedman stage and MPA entered into equation, which was Y = ln [P/(1-P)] = -122.85 + 31.57X1 + 1.01X2, if setting X1 as Friedman stage, and X2 as MPA.</p><p><b>CONCLUSIONS</b>Z-palatopharyngoplasty is effective surgical approach for OSAHS patients with posterior airway space (PAS) > or = 11 mm. The affective factors of Z-palatopharyngoplasty included LSaO2, CT90, MPA, mandibular body length, position of tongue and Friedman clinical stage. Among them, the mandibular plane angle and Friedman clinical stage were predominant factors.</p>

Objectively evaluating auditory temporal resolution by iso-modulation depth temporal modulation transfer function in inferior colliculus and auditory cortex of guinea pigs / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility to evaluate objectively auditory temporal resolution using the iso-modulation depth temporal modulation transfer function (TMTF) derived from the amplitude of evoked response to sinusoidally modulated signals.</p><p><b>METHODS</b>Chronic electrodes were implanted in inferior colliculus and auditory cortex of guinea pigs. We recorded the evoked response to sinusoidally modulated tones with modulation frequency being varied from 20 to 400 Hz and modulation depth fixed at 100%. The response amplitude in uV was converted into relative amplitude using the fast Fourier transform (FFT) function provided by Biosig software, and then the iso-modulation depth TMTF was plotted with the relative amplitude changed with modulation frequency. Then we recorded the evoked response to the sinusoidally modulated tones with modulation depth being varied from 100% to 10% and derived the iso-amplitude TMTF comparable to conventional modulation depth threshold TMTF. The derived iso-amplitude TMTF was compared to iso-modulation depth TMTF to determine the validity of iso-modulation depth TMTF.</p><p><b>RESULTS</b>The iso-modulation-depth TMTF and iso-amplitude TMTF in inferior colliculus and auditory cortex of guinea pigs represented respectively bandpass and lowpass characteristic. The cut-off frequency calculated from the two TMTF methods didn't differ significantly and the cut-off frequency derived from auditory cortex iso-modulation depth TMTF was consistent with behavioral results.</p><p><b>CONCLUSIONS</b>The TMTF plotted with the response amplitude to sinusoidally modulated tones with the modulation depth fixed at 100% and the modulation frequency was a valid method to evaluate objectively auditory temporal resolution.</p>

Duration-tuning of the neurons in the inferior colliculus of guinea pigs and the role of gamma-aminobutyric acid mediated inhibition / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate duration tuning in the inferior colliculus (IC) of guinea pigs and the role of GABA-mediated inhibition on this tuning.</p><p><b>METHODS</b>Totally 23 healthy albino guinea pigs of either sex were employed in this study. After anesthesia, spikes of neurons in inferior colliculus were recorded using five-barrel glass-pipettes. The characteristic frequency was determined by recording iso-intensity response curves at moderate intensity level (40-70 dB SPL) and duration tuning was measured with signals of fixed intensity and varied durations. GABA-A receptor antagonist, bicuculline, was applied to neurons by means of in vivo micro-iontophoresis through one channel in the five-barrel glass-pipettes.</p><p><b>RESULTS</b>IC neurons of guinea pigs, especially for those who showed sustained temporal response pattern, showed stronger duration tuning in their transient response peak to signal onset. Among 207 neurons recorded, totally 93 neurons were found to show clear duration selectivity. The duration selectivity was eliminated or turned to be weaker in most of the neurons in which the effect of bicuculline was observed successfully.</p><p><b>CONCLUSIONS</b>Unlike what was reported in bats, duration selectivity may be a transient process for most of IC neurons in guinea pigs. Duration selectively of IC neurons in the guinea pig was also largely dependent on the GABAergic inhibition.</p>

Significance of CT in diagnosis of chronic suppurative otitis media / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the methods of preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid.</p><p><b>METHODS</b>The temporal bone lamellar CT findings in 106 patients with chronic suppurative otitis media (including cholesteatoma) were retrospectively analyzed. The CT value of pathological tissue were measured for 183 times and were compared with the surgical findings and postoperative pathological findings to definitude the CT value range of different pathological tissue. Sixty patients taken from 106 patients at random were analyzed and made the diagnosis again by the same doctor team according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue. The diagnose accordance rate was compared with the routine diagnose report from radiology department. The predetective diagnosis was made in 10 patients with chronic suppurative otitis media according to clinical manifestation (pathological changes of tympanic membrane, nature of otorrhea, character of hearing), temporal bone lamellar CT finding (CT value of pathological tissue, surrounding histoclasia) to validate the value of this study for preoperative diagnosis and differentiation of different pathological tissue in middle ear and mastoid.</p><p><b>RESULTS</b>The CT value of cholesteatoma, granulation tissue, cholesteatoma combined with granulation tissue, effusion, calcified tissue, thickened and polypoid membrane was respectively (46.6 +/- 10.3) Hu, (26.6 +/-7.4) Hu, (42.1 +/- 11.4) Hu, (- 24.6 +/- 9.2) Hu, (223.6 +/- 63.7) Hu, (23.8 +/- 8.5) Hu. The diagnose accordance rate in 60 patients who were analyzed and made diagnosis again according to the CT value of the different pathological tissue and surrounding histoclasia resulted by pathological tissue raised from 68. 3% to 81.7% ( P < 0.05) . The predetective diagnose accordance rate reached at 90% according to clinical manifestation, temporal bone lamellar CT.</p><p><b>CONCLUSIONS</b>It was not reliable to diagnose and differentially diagnose different pathological tissue in middle ear and mastoid only by the CT value, however, the CT value could still be considered to be a very significant information. The accurate rates of diagnosis and differentiation of different pathological tissue in middle ear and mastoid obviously raised by synthetically analyzing various kinds of pathological tissues in middle ear and mastoid according to clinical manifestation, temporal bone lamellar CT finding.</p>

Effectiveness of combined surgery for treating severe obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the efficiency of a comprehensive surgical approach of genioglossus advancement and hyoid suspension (GAHM) plus uvulopalatopharyngoplasty (UPPP) for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS) and to evaluate related factors on surgery outcomes.</p><p><b>METHODS</b>Eighteen patients with severe OSAHS (apnea hypopnea index, AHI > 40/h) confirmed with polysomnography received genioglossus advancement and hyoid suspension plus uvulopalatopharyngoplasty. The obstruction in both the oropharynx and the hypopharynx were evaluated by preoperative physical examination, fiberoptic pharyngolaryngoscopy, cephalometry, and computed tomography of the upper airway. The follow up was at least 6 months postoperatively. The Wilcoxon signed rank test was used to compare the preoperative and postoperative results by SPSS 11.0 for windows. The Mann-Whitney test was used to analyze the difference between responders and nonresponders.</p><p><b>RESULTS</b>The follow up time ranges from 6 to 24 months, there were statistically significance in all but body mass index (BMI) between preoperative and postoperative measurements. Mean AHI was reduced from preoperative (x +/- s, 63.8 +/- 16.3)/h to postoperative (23.6 +/- 19.5)/h, lowest mean oxygen saturation increased from 0.72 +/- 0.07 to 0.81 +/- 0.13(x +/- s). According to criterion at home, the 6-month rate of responder is 83%, if AHI <20/h and decreased by at least 50% as success, the rate of success is 67%. The age, posterior airway space (PAS) and percentage of time with oxyhemoglobin saturation below 0.90 (CT90) were (39.1 +/- 7.4) years, (8.3 +/- 0.9) mm, (18.5 +/- 10.9)% in responder, while (52.5 +/- 9.4) years, (6.8 +/- 1.3) mm, (37.7 +/- 23.6) % in nonresponder, and there are statistically significant between responder and nonresponder.</p><p><b>CONCLUSIONS</b>GAHM plus UPPP is effective surgical approach for patients with severe OSAHS who suffer from oropharyngeal and hypopharyngeal obstruction. Age, PAS and CT90 were possible affective factors on surgical outcomes.</p>

Cochlear function after selective spiral ganglion cells degeneration induced by ouabain / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ouabain, a cardiac glycoside that specifically binds to Na/K-ATPase and inhibits its activity, was applied to gerbils to develop a method for studying auditory neuropathy.</p><p><b>METHODS</b>Ouabain was applied to the round window of the cochlea in each gerbil by using a piece of gelfoam with 3 microl or 24 microl (1 mmol/L) ouabain solution. The changes of the threshold of auditory brainstem response, cochlear function round window electrocochleography, as well as the morphological changes of the spiral ganglion cells of the cochlea were observed after application of ouabain for 24 hours or 96 hours.</p><p><b>RESULTS</b>In ouabain treated gerbils, auditory brainstem response and compound action potential thresholds showed either elevation or no response at all. However, the thresholds of cochlear microphonic and distortion product otoacoustic emissions were not affected. Degeneration and necrosis of some spiral ganglion cells in ears with applications of ouabain (24 hours, 3 microl, 1 mmol/L; 96 hours, 24 microl, 1 mmol/L ouabain). The number of spiral ganglion cells was decreased (24 hours, 3 microl, 1 mmol/L ouabain) or near to a total loss (96 hours, 24 microl, 1 mmol/L ouabain).</p><p><b>CONCLUSIONS</b>These results indicate a high degree of independence between the spiral ganglion cells and the outer hair cell systems in the cochlear transduction mechanism. The method used in this study would provide a valuable tool for studying auditory neuropathy.</p>

Metabolic profile and insulin resistance in patients with OSAS / 上海第二医科大学学报

40/h) and non-severe group(n=15,AHI 5-40/h).Anthropometric measurements,fasting plasma glucose,insulin,blood fat,and CT quantitative measurement of abdominal adipose tissue were recorded. Results Insulin resistance index(HOMA-IR) in patients with OSAS was related to hypoxia independently of obesity variables.The severe group was characterized by more serious metabolic disorders and higher prevalence of metabolic syndrome than the non-severe group.OSAS was positively associated with an increased metabolic disorders risk for the severe group versus the non-severe group(OR=8.8).Using the receiver operating characteristic(ROC) curve analysis,waist circumference had the greatest areas under the ROC curves compared with body mass index and neck circumference.The results of multiple stepwise regression of lowest pulse oxygen saturation(LSpO2)during overnight sleep indicated that neck circumference followed by epworth sleepiness score(ESS) entered the equation(P

Limited Septoplasty Under Nasal Endoscopy / 上海第二医科大学学报

Objective To compare the outcomes of powered-assisted septoplasty with CO_ 2 laser-assisted septoplasty. Methods Thitry patients with limited deviation of nasal septum were analyzed retrospectively. Among 30 patients, 18 underwent powered-assisted septoplasty and the rest underwent CO_ 2 laser-assisted septoplasty. The surgical results were assessed by the visual analogue scale (VSA) and acoustic rhinometry. Results VSA scores significantly improved in both groups after surgery (P

Anatomic and spiral computed tomographic study of the genial tubercles for genioglossus advancement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study anatomic and computed tomographic measurements of Chinese mandibular genial tubercles and to evaluate the correlations between them.</p><p><b>METHODS</b>The axial images were taken by spiral CT in 40 adult human skulls with 1 mm thick section from infraorbital margin to menton. Sagittal plane reconstruction was produced through mandibular central line. Then the height and width of superior genial tubercles, the distance between menton and inferior margin of genial tubercles, the distance between mandibular incisor apex and superior margin of superior genial tubercles, the thickness of mandible were measured respectively. Thereafter anatomic measurements were taken by the same methods as computed tomographic images. The measured value were showed as means +/- standard deviation, then paired-t test and correlation analysis was made by SPSS 10.0.</p><p><b>RESULTS</b>The genioglossus almost origins from superior genial tubercles, geniohyoideus from inferior genial tubercles. The height of superior genial tubercles which were measured by anatomy and spiral CT were (5.82 +/- 0.71) mm and (6.17 +/- 0.71) mm respectively. The width of superior genial tubercles were (6.98 +/- 1.35) mm and (7.01 +/- 1.13) mm. The distance between menton and inferior margin of superior genial tubercles were (11.08 +/- 2.05) mm and (10.41 +/- 1.55) mm. The distance between mandibular incisor apex and superior margin of superior genial tubercles for male were (15.57 +/- 1.82) mm and (14.34 +/- 2.06)mm, and for female were (9.36 +/- 2.79) mm (8.78 +/- 2.53) mm. The thickness of mandibles at genial tubercles were (11.95 +/- 1.59) mm and (12.19 +/- 1.64) mm. The distance from menton to superior margin of superior genial tubercles were (16.1 +/- 2.30) mm and (15.73 +/- 2.12) mm. The correlations between anatomic measurements and spiral CT measurements of the above mentioned parameters were significant except for height of superior genial tubercles (r = 0.59 - 0.92).</p><p><b>CONCLUSION</b>The anatomic and spiral CT measurements of genial tubercles appear to have significant correlations. Preoperative spiral CT measurements of genial tubercles could be help for the design of osteotomy in genioglossus advancement.</p>