Analysis of whole-mouth taste function test results in 584 healthy adults / 中华耳鼻咽喉头颈外科杂志

Objective: To assess the taste function of healthy Chinese adults with the reliable whole-mouth taste test, and to analyze the correlation of taste function with age and gender. Methods: The clinical data of 584 participants reporting the normal sense of smell and taste from March 2019 to January 2020 in the Physical Examination Center of Beijing Anzhen Hospital were analyzed in the study, including 297 males and 287 females, aging (46.9±16.6) years. The subjects were divided into youth group (19-35 years old), middle aged group (36-50 years old), middle-elderly aged group (51-65 years old) and elderly group (66-80 years old). The taste test involved 5 tastants (sour, sweet, salty, umami and bitter) and 7 concentrations. The perception and recognition scores of five tastes were obtained through the whole-mouth taste test. SPSS 22.0 software was used for statistical analysis. Results: The intra-class correlation coefficients of the whole-mouth taste test were 0.751 to 0.828, which showed high test-retest reliability. The total score of perception and recognition of five tastes showed the significant negative correlation with age (r value was -0.49 and -0.44, respectively, both P<0.001). Compared with the other two groups, taste function of middle-elderly aged and elderly group decreased significantly (all P<0.001). There was no significant difference in total perception scores and total recognition scores between youth and middle aged group (all P>0.05). The perception scores and recognition scores of sour, salty, umami, bitter and total scores in females were higher than those in males (all P<0.05), but there was no significant difference in perception scores and recognition scores for sweet between them (P value was 0.584 and 0.223, respectively). Conclusions: The taste function is significantly negatively correlated with age. Except the sweet, females are more sensitive to the sour, salty, umami and bitter tastes than males.

Evaluation of chemosensory function in patients with upper respiratory tract post-viral olfactory dysfunction / 中华耳鼻咽喉头颈外科杂志

Objective: To observe the changes of olfactory function, intranasal trigeminal nerve function and taste function in patients with upper respiratory tract post-viral olfactory dysfunction (PVOD), and to explore the correlation of chemosensory function. Methods: The clinical data of 42 patients with PVOD who visited to the Olfactory and Taste Center of Otorhinolaryngology Head and Neck Surgery Department of Beijing Anzhen Hospital from January to December of 2019 were analyzed retrospectively, including 20 males and 22 females, aging (48.86±11.47) years (x¯). Twenty subjects in normal control group were selected according to the sex ratio of PVOD patients. Sniffin' Sticks olfactory tests were performed on the subjects, including threshold test (T), discrimination test (D) and identification test (I), and the sum of the above three test scores was the TDI value. At the same time, olfactory event-related potentials (oERPs), trigeminal event-related potentials (tERPs) and taste function test were performed. According to the taste function test, the patients were divided into normal gustation (NG) group and gustatory dysfunction (GD) group. The results of olfaction, taste and intranasal trigeminal nerve function tests were compared among different groups, and the correlation analysis was carried out. SPSS statistical software was used for statistical analysis. Results: GD was present in 14 (33.3%) of 42 PVOD patients with a course of PVOD of 5 (3, 6) months (M (Q1, Q3)). The gustatory function of patients with PVOD was related to gender (r=0.565, P<0.001), smoking status (r=-0.512, P=0.001), duration (r=-0.357, P=0.020) and olfactory function (all P<0.05). The olfactory function of GD group was worse than that of NG group, and the differences of TDI value and T value between the two groups were statistically significant (10.25±4.58 vs 13.35±3.61, 1.54±0.66 vs 2.10±0.88, t value was 2.40 and 2.10 respectively, both P<0.05). The amplitudes of oERPs and tERPs were significantly lower in GD group than those in NG group (all P<0.05). Conclusion: In patients with PVOD, the subjective and objective olfactory function, intranasal trigeminal nerve function and taste function were decreased, and there was a correlation, suggesting that there was a synergistic effect between the chemosensory functions of PVOD patients.

Study on the clinical characteristics of isolated congenital anosmia / 中华耳鼻咽喉头颈外科杂志

Objective: To retrospectively analysely the electrophysiological and imaging features of isolated congenital anosmia (ICA) and to assess the clinical phenotypic characteristics and classification of ICA. Methods: Clinical data of 30 ICA patients in Beijing Anzhen Hospital from 2012 to 2019 was retrospectively reviewed, including 13 males and 17 females, aged (35±19) years. The control group consisted of 30 healthy people from medical examination center, including 13 males and 17 females, aged (39±14) years. The clinical characteristics of ICA were analyzed using Sniffin' Sticks test, olfactory event-related potentials (oERPs), trigeminal event-related potentials (tERP) and olfactory pathway MRI. SPSS 17.0 software was used to compare the difference of olfactory function between the two groups. The correlation between olfactory bulb, olfactory sulcus structure and age was observed, and the clinical phenotype characteristics of ICA patients were analyzed. Results: The subjective olfactory function was completely lost in ICA patients. oERP was absent in all of the ICA patients, but showed normal N1 and P2 waves in controls. tERP could be evoked in 63.3% (19/30) of ICA patients, and signals in these patients showed higher amplitude in the N1 ((-10.33±6.93) μV vs (-5.11±2.71) μV, t=-10.113, P<0.01) and P2 ((+17.25±8.51) μV vs (+7.31±3.46) μV, t=5.443, P<0.01) waves than that of the controls. Olfactory bulbs were aplastic in 80.0% (24/30) of patients and hypoplastic in 20.0% (6/30) of patients. Fifty-six point seven percent (17/30) of patients had bilateral olfactory sulcus deletion while 43.3% (13/30) had dysplasia, and all of the patients exhibited a depth of olfactory sulcus less than 8 mm. Both the structure of olfactory bulbs and olfactory sulcus were not associated with age for ICA patients (r value was -0.174 and 0.325, respectively, all P>0.05). Conclusions: ICA patients show neurophysiologic deficits and some anatomic differences compared with healthy controls. The absence of oERP combining with a depth of olfactory sulcus less than 8 mm is the important indicator for clinical diagnosis of ICA. The structure of olfactory bulb may be a critical factor for clinical classification of ICA.

Association between brain glucose metabolism and cardiac dysfunction in patients with ischemic heart disease undergoing (18)F-FDG PET/CT imaging / 中华心血管病杂志

Objective: To evaluate the relationship between the brain glucose metabolism and left ventricular function parameters, and to explore the cerebral glucose metabolism reduction regions in patients with ischemic heart disease (IHD). Methods: A total of 110 consecutive IHD patients who underwent gated (99)Tc(m)-sestamibi (MIBI) SPECT/CT myocardial perfusion imaging, gated (18)F-fluorodeoxyglucose (FDG) PET/CT myocardial and brain glucose metabolic imaging within three days in Beijing Anzhen Hospital from April 2016 to October 2017, were enrolled in this study. Left ventricular functional parameters of SPECT/CT and PET/CT including end-diastolic volume (EDV), end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) were analyzed by QGS software. Viable myocardium and myocardial infarction region were determined by 17-segment and 5 score system, and the ratio of viable myocardium and scar myocardium was calculated. According to the range of viable myocardium, the patients were divided into viable myocardium<10% group (n=44), viable myocardium 10%-<20% group (n=36) and viable myocardium≥20% group (n=30). Pearson correlation analysis was used to analyze the correlation between the range of viable myocardium and scar myocardium and the level of cerebral glucose metabolism. Brain glucose metabolism determined by the mean of standardized uptake value (SUV(mean)) was analyzed by SPM. The ratio of SUV(mean) in whole brain and SUV(mean) in cerebellum were calculated, namely taget/background ratio (TBR). Differences in cerebral glucose metabolism among various groups were analyzed by SPM. Results: There were 101 males, and age was (57±10) years in this cohort. The extent of viable myocardium and the extent of scar, LVEF evaluated by SPECT/CT and PET/CT were significantly correlated with TBR (r=0.280, r=-0.329, r=0.188, r=0.215 respectively,all P<0.05). TBR value was significantly lower in viable myocardium<10% group, compared with viable myocardium 10%-<20% group (1.25±0.97 vs. 1.32±0.17, P<0.05) and viable myocardium≥20% group (1.25±0.97 vs. 1.34±0.16, P<0.05). Furthermore, in comparison with viable myocardium≥20% group, the hypo-metabolic regions of viable myocardium<10% group were located in the precuneus, frontal lobe, postcentral gyrus, parietal lobe, temporal lobe, and so on. Conclusions: There is a correlation between impaired left ventricular function and brain glucose metabolism in IHD patients. In IHD patients with low myocardial viability, the level of glucose metabolism in the whole brain is decreased, especially in the brain functional areas related to cognitive function.

Preliminary study of DTI on cerebral white matter micro-structure of patients with idiopathic olfactory loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the cerebral white matter micro-structure in patients with idiopathic olfactory loss using diffusion tensor imaging (DTI).@*METHODS@#Sixteen patients with idiopathic olfactory loss and sixteen normal subjects matched by age and sex were recruited in this study. Sniffin'Stick olfactory test was performed to evaluate the olfactory function of all subjects. We acquired diffusion tensor images with an echo planar imaging (EPI) sequence from all subject on a 3T scanner. The fractional anisotropy (FA) images were performed using DTI-studio, and bilateral Piriform cortex, Orbitofrontal cortex, Hippocampus and Insula cortex adjacent white matter and Capsula interna were delineated as the region of interesting (ROI), the FA for each ROI was calculated. Independent sample t test analysis was used to compare the FA value of all ROIs between the controls and patients. In addition, correlation analysis between FA value and MMSE score in patients were conducted.@*RESULTS@#Compared with the controls, patients showed significantly decreased FA value in the adjacent white matter of bilateral Piriform cortex, Orbitofrontal cortex, Hippocampus and Insula cortex (0.05).@*CONCLUSIONS@#The patients with idiopathic olfactory loss show the damage of white matter micro-structure in the olfactory center, which could be important for the pathogenesis study and early intervention of idiopathic olfactory loss.

Effects of ginkgo biloba extract combined with glucocorticoid on olfactory function and inflammatory cytokines in mice with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

To determine whether ginkgo biloba extract(GBE)combined with dexamethasone(DEX)plays a role in the treatment of allergic rhinitis-related olfactory dysfunction using an animal model.Six week old BALB/C mice were sensitized and challenged with ovalbumin.30 sensitized mice were divided into three groups:Group 1 was given high-dose GBE and DEX(n=10);Group 2 was given low dose GBE and DEX(n=10);Group 3 was given DEX alone(n=10).We assessed the histology of the olfactory mucosa and serum IL-4,IFN-γ,and caspase 1.A significant higher fraction of mice in group 1 could find the food pellet within300 scompared to group 3(<0.05).Caspase-1 levels improved during the second week compared with the first week in each group.IFN-γlevels were significantly lower during the second week compared with the first week(<0.05,all).IL-4 levels also were significantly lower during the second week compared with the first week in all groups except those receiving DEX alone.IFN-γ/IL-4 levels in each group were significantly lower during the second week compared with the first week(<0.05,all).In this animal model of allergic rhinitis-related olfactory dysfunction,the addition of ginkgo biloba extract to dexamethasone have a better anti-inflammatory effect,which can partly improve the therapeutic effect on olfactory dysfunction caused by allergic rhinitis.

Obstructive Sleep Apnea Hypopnea Syndrome as a Reason for Active Management of Pulmonary Embolism / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea hypopnea syndrome (OSAHS) constitutes an independent factor for high warfarin dose for patients with pulmonary embolism (PE). The aim of this study was to investigate whether the 6-month anticoagulation treatment by warfarin is enough for patients with PE complicated by OSAHS.</p><p><b>METHODS</b>We investigated 97 PE patients, 32 of them had OSAHS and 65 non-OSAHS. Warfarin was administered for 6-month if no abnormal circumstances occurred. All patients were followed up for 18 months. Adverse events (AE) included death, major bleeding, hospitalization due to heart failure or pulmonary hypertension, and recurrence or aggravation of PE (including deep vein thrombosis). Recurrence rate of PE after warfarin cessation was compared between the two groups.</p><p><b>RESULTS</b>OSAHS patients required a significantly higher dose of warfarin than their non-OSAHS counterparts (4.73 mg vs. 3.61 mg, P < 0.001). During warfarin treatment, no major bleeding and aggravation of PE occurred among OSAHS patients, and the rates of various AE were not significantly different between the OSAHS and non-OSAHS groups. PE recurrence was higher in OSAHS than non-OSAHS groups after withdrawal of warfarin (21.43% vs. 6.78%, P = 0.047). Compared with non-OSAHS patients, OSAHS group had lower international normalized ratio (INR) value but higher plasminogen on baseline and INR resumed to a relatively low level after warfarin discontinuation.</p><p><b>CONCLUSIONS</b>OSAHS patients may present with hypercoagulation and relatively high-risk of recurrence of PE after cessation of 6-month warfarin treatment.</p>

Clinical application of Sniffin' Sticks olfactory psychophysical measurements / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVES</b>To establish the normal value of Sniffin' Sticks test in Chinese population and to explore it's clinical application in China.</p><p><b>METHODS</b>One hundred and five healthy volunteers were choosen from the department of physical examination of Beijing Tongren Hospital between 2007 and 2013. Another 165 patients complained of abnormal olfactory function were obtained from the outpatient clinic of the department of otorhinolaryngology head and neck surgery in the same period and were divided into two groups: 92 in hyposmia and 73 in functional anosmia group. The 270 subjects were divided into 3 subgroups:younger group ( <35 years of age), middle-age group (35-55 years of age) and older group ( > 55 years of age). The olfactory functions were examined with Sniffin' Sticks test and T & T test, respectively. All analyses were performed using SPSS 12.0 software.</p><p><b>RESULTS</b>For the normal value of Sniffin' Sticks test, TDI score was > 30.12 for younger group, > 27.37 for middle-age group and > 20.43 for older group; the mean TDI score was 32.12 ± 3.95 for healthy group, 17.52 ± 10.37 for hyposmia and 3.56 ± 3.49 for functional anosmia group; the differences in TDI score, olfactory threshold, discrimination threshold and identification threshold between healthy group and olfactory dysfunction group with different ages had statistical significance (Younger group: FTDI = 125.136, P = 0.000; FT = 49.454, P = 0.000;FD = 89.037, P = 0.000; FI = 39.888, P = 0.000; Middle-age group: FTDI = 190.240, P = 0.000; FT = 128.374, P = 0.000;FD = 174.122, P = 0.000;FI = 178.945, P = 0.000;Older group: FTDI = 72.992, P = 0.000; FT = 26.599, P = 0.000; FD = 77.119, P = 0.000; FI = 88.107, P = 0.000, respectively) . The mean T & T value was -1.00 ± 0.98 for healthy group, 2.27 ± 2.01 for hyposmia and 5.89 ± 0.14 for functional anosmia group. T & T score between healthy group and olfactory dysfunction group with different ages had statistical significance (Fyounger = 158.144, P = 0.000; Fmiddle-age = 247.695, P = 0.000; Folder = 70.579, P = 0.000, respectively). TDI score of the Sniffin' Sticks test result was correlated with T & T value (r = -0.927, P < 0.01); T & T threshold was correlated with the olfactory threshold, discrimination threshold and identification threshold of Sniffin' Sticks test (rT = -0.846, P < 0.01, rD = -0.908 P < 0.01, rI = -0.864, P < 0.01, respectively).</p><p><b>CONCLUSIONS</b>Sniffin' Sticks test and T & T olfactometry are able to differentiate normosmia from hyposmia and anosmia with high reliability and consistency in test results.Sniffin' Sticks test can assess subject's olfactory function status more thoroughly and is suitable for application in Chinese population.</p>

Clinical observation of isolated congenital anosmia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce 8 patients with isolated congenital anosmia and to discuss the clinical manifestations, imaging characteristics and family characteristics of this rarely seen disorder.</p><p><b>METHODS</b>Eight patients with isolated congenital anosmia treated between April 2007 and April 2012 were reviewed retrospectively. There were 4 males and 4 females. A detailed medical history collection, physical examination, nasal endoscopy, T&T and Sniffin'Sticks subjective olfactory function tests, olfactory event-related potentials sinonasal computed tomography scan and sex hormones level monitoring were performed in all patients. Seven cases underwent magnetic resonance image of olfactory pathway examination.</p><p><b>RESULTS</b>All patients were anosmia without evidence of other defects. ENT physical examination, nasal endoscopy and computed tomography scan were normal except 4 cases with obvious nasal septum deviation, 2 cases with concha bullosa. Subjective olfactory test indicated all of them were anosmia. Olfactory event-related potentials were obtained in only 1 patient. Magnetic resonance imaging revealed the smaller or atrophy olfactory bulb and olfactory tract in five cases, the absence of olfactory bulbs and tracts in two case. A female patient did not have MRI examination because of wearing IUDs. Detection of 8 patients of sex hormones were normal. Family characteristics: 3 patients showed family inheritance pattern.</p><p><b>CONCLUSIONS</b>The diagnosis of isolated congenital anosmia should be based on chief complaint, medical history, physical examination, olfactory test, nasal endoscopy, olfactory testing, olfactory imaging and olfactory event-related potentials. Magnetic resonance image of olfactory pathway and olfactory event-related potentials have important value for the diagnosis. More attention should be paid to the genetic susceptibility of the family.</p>

Functional magnetic resonance imaging of brain activation in early period after olfactory adaptation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the brain activation before and in early period after olfactory adaptation using functional magnetic resonance imaging, and discuss the mechanisms of olfactory adaptation.</p><p><b>METHODS</b>Ten right-handed, normosmic subjects underwent 2 times of olfactory stimulation tasks with the interval of 20 minutes. The odorant used was isovaleric acid. The fMRI data was processed by the SPM5 software. Rating odor intensity and valence using visual analogue scale (VAS), and the results of 2 tasks were statistically analyzed.</p><p><b>RESULTS</b>There was no significant difference between 2 tasks on both intensity and hedonicity scores. In task 1, the brain activation in bilateral cerebellum, frontal (including orbitofrontal gyrus), insula, thalamus, cingulate gyrus, putamen, amygdala, piriform cortex, the left inferior parietal lobule, precentral gyrus, right hippocampus, pallidum, middle temporal gyrus, supramarginal gyrus. In task 2, only the right middle frontal gyrus activated, and the voxels decreased significantly. Paired t-test results showed that: (task1-task2) activated regions in left precentral gyrus, frontal lobe (including the orbitofrontal gyrus), insula, right superior temporal gyrus, cerebellum; (task2-task1) activation in the left inferior parietal lobule and right lingual gyrus.</p><p><b>CONCLUSIONS</b>The sensitivity of brain activation is still at a low level, when subjects had recovered from adaptation in subjective olfactory perception. Underwent repeated olfactory stimulation, second olfactory cortex plays less role on olfactory perception and advanced processing.</p>

Juvenile nasopharyngeal angiofibroma: endoscopic surgery and follow-up results / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas (JNA) and the follow-up results.</p><p><b>METHODS</b>The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups: Group A (Radkowski I a-II b) and Group B (Radkowsik II c-III b). The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded.</p><p><b>RESULTS</b>There were 7 patients with stage I a, 3 patients with stage I b, 5 patients with stage II a, 6 patients with stage II b, 4 patients with stage II c, 23 patients with stage III a, 11 patients with stage III b. The average age at diagnosis in Group A (21 cases) was 23.9 years old. The average operating time was (106.0 +/- 43.7) min. The follow-up ranged from 3 months to 74 months (median 36 months) except for 3 missing cases. The average age at diagnosis in Group B (38 cases) was 16.2 years old and the average operating time was (152.9 +/- 58.0) min. The follow-up ranged from 3 months to 87 months (median 25 months) except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant (t = -3.232, P = 0.002). The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant (P = 0.03).</p><p><b>CONCLUSIONS</b>The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base (RadkowskiIa-II b) have a low morbidity. JNA at Radkowski stage IIc and above have residual and recurrent risk.</p>

Expression of odorant receptor genes on the olfactory epithelium following olfactory nerve disconnection / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To constitute the animal model of unilateral olfactory nerve transection and observe the expression level and distribution of odorant receptors.</p><p><b>METHODS</b>Thirty-two rats were divided into two groups: the olfactory nerve transection group (20) and the control group (12). The former group received the operation to transect the left olfactory nerve following the left olfactory bulb was exposed under microscope and the latter group did not give any disposal. At every stage of five days, two weeks, four weeks and six weeks after the operation, five rats from the nerve transection group and three from the control group were anaesthetized simultaneously, and olfactory epithelium were taken out after transcardial perfusion, then paraffin imbedding. Coronal sections were sliced for HE staining to observe the thickness changes of the olfactory epithelium, and for in situ hybridization (ISHs) to investigate the expression of olfactory receptor genes (Olr287, Olr226, Olr1493 and Olr1654) in the epithelium, also to evaluate the changes of the expression level and location of the selected receptors during the regeneration of olfactory epithelium.</p><p><b>RESULTS</b>HE staining showed that 5 days after the operation cell quantity and thickness of the olfactory epithelium decreased obviously, which increased gradually 2 or 4 weeks after operation. After 6 weeks' recovery, the thickness of the epithelium could reach the control level. The pattern of cell staining by ISH showed a specific spatial distribution along the anteroposterior (AP) and dorsoventral (DV) axis. Evidence suggested that odorant receptors were distributed in continuous and multiple overlapping bands in the normal or nerve transected-recovered epithelium rather than in the conventionally accepted three or four zones. The data also demonstrated that the distribution of sensory neuron types, as identified and defined by odorant receptor expression, was restored to normal or nearly so by 6 weeks after operation. Likewise, the numbers of probe-labeled neurons in the nerve transected-recovered had an obvious decrease 5 days after olfactory nerve transection. Reactive cells (x(-) +/- s) of Olr1493 in the operated side was (53.9 +/- 19.9), compared with (419.0 +/- 21.2) in the unoperated side, there was statistic significance between them (t = 63.960, P < 0.01). Reactive cells increased gradually according to the regeneration of the epithelium, and were nearly equivalent to the normal side 6 weeks later without significant differentiation (t = 2.600, P > 0.05), according to the absolute positive cells in the operated and unoperated side of (417.8 +/- 32.4) and (445.3 +/- 10.0) respectively.</p><p><b>CONCLUSION</b>The regeneration of the sensory neurons and receptors, both the number and the distribution, can recover to normal after olfactory nerve transection.</p>

Endoscopic management of the inverted papilloma involving frontal sinus and its drainage pathway / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The endoscopic management of inverted papilloma has gained increasing popularity over the last 15 years. However, the appropriate management of lesions involving the frontal sinus and its drainage pathway still has to be determined.</p><p><b>METHODS</b>We performed a retrospective review of the results of the patients with inverted papilloma in the Otolaryngology Head and Neck Surgery department, Beijing Tongren Hospital from 2004 to 2007 to identify the patients with lesions involving frontal sinus and its drainage pathway. By its appearance on nasal endoscopic examination and CT scanning, the tumors were defined using Krouse staging system. Sinus endoscopy was used to screen for disease after endoscopic resection. And their clinical outcomes were analyzed.</p><p><b>RESULTS</b>A total of nine patients (8 males and one female) with inverted papilloma who had frontal sinus and its drainage pathway involvement were identified. All tumors were defined as T3 lesions. Preoperative and postoperative pathologic examinations revealed inverted papilloma as the diagnosis. Four cases with lateral wall of frontal recess attachment underwent endoscopic Draf II A frontal sinusotomy. Three cases with either lateral and posterior walls of frontal recess and frontal infundibulum attachment or medial and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf II B procedure. Two cases with either posterior wall of frontal recess and frontal infundibulum attachment or medial, lateral and posterior walls of frontal recess and frontal infundibulum attachment underwent Draf III procedure. All patients remain disease free with an average follow-up of 13 months.</p><p><b>CONCLUSIONS</b>Extensive inverted papilloma (Krouse T3 lesions) can be treated successfully with an endoscopic approach.</p>

Management of nasal skull-base neoplasms with endoscopic minimally invasive technique: a report of 36 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the indication, efficacy and safety of endoscopic minimally invasive surgery technique in the management of nasal skull-base neoplasms.</p><p><b>METHODS</b>Thirty-six patients with nasal skull base neoplasms were treated from January 2000 to Jun 2004 under nasal endoscopy, including 16 nasopharyngeal fibroangioma, 8 sinus osteofibroma, 8 pituitary adenoma, 4 olfactory neuroblastoma. Pathology lab procedures were performed pre or post-operatively. The feeding artery of nasopharyngeal fibroangioma was selectively embolized with gelatin sponge before operation. All olfactory neuroblastoma and 2 pituitary adenoma received radiotherapy after operation.</p><p><b>RESULTS</b>Total or most of nasopharyngeal fibroangioma, sinus osteofibroma, olfactory neuroblastoma and pituitary adenoma were excised. Three cases presented complications of cerebrospinal fluid leakage, 2 cases were successfully mended with middle turbinate and muscle tissue respectively, another one gained self-healing after reducing the intracranial pressure and anti-inflammation. Followed up 4 to 8 years without recurrence for all patients. Seldom serious complications accrued.</p><p><b>CONCLUSIONS</b>When the indications are selected appropriately, nasal skull-base neoplasms, including benign and malignant, can be well treated with nasal endoscopic minimally invasive surgery.</p>

Endoscopic nasal lateral wall dissection approach to maxillary sinus / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report a new approach to maxillary sinus without ablation of nasolacrimal duct and inferior turbinate by endoscopic nasal lateral wall dissection (ENLWD). The preliminary clinical application results, the operative technique and indications were discussed.</p><p><b>METHODS</b>Twelve hospitalized patients, aged from 42 years to 68 years, were enrolled in this paper, 9 patients were male and 3 were female. Among the 12 patients, 8 were inverted papilloma (IP), 2 were nasal polyps, 1 was Kubo's postoperative cyst of maxillary sinus (MS) and 1 was recurrent bone cyst of maxilla. Two IP patients were excluded from this group for the follow-up time was less than 12 months. Preoperative nasal endoscopy and CT scan were done in all patients, 6 patients with tumor also received MRI examination. The operation began with a mucosal incision in front of inferior turbinate (IT) and then the lacrimal duct (LD) was dissected, thus a IT-LD flap was formed. The MS lesion was removed under endoscope when the flap was replaced medially. The inferior antrostomy was performed when the flap was repositioned.</p><p><b>RESULTS</b>All 10 patients were unilateral lesion. Six MS IP patients were T3 Krouse stage. The tumor was found originating from the every part of the MS wall in the operation, especially from the anterior and medial wall. The same situation was seen in 2 patients with nasal polyps. The follow-up ranged from 7 months to 60 months (average 22 months). The shape of IT was good, and well-epithelized operative cavities were observed. Only 1 patients of IP had a local recurrence in its inferior antrostomy 6 months after operation and no recurrence was seen after local debridement. All of them had no epiphora and other complications.</p><p><b>CONCLUSIONS</b>ENLWD is a new and minimally invasive approach not only to MS, in which the lesion can be thoroughly removed, but also to orbital floor and pterygopalatine fossa without ablation of lacrimal duct and IT.</p>

Effect of Betamethasone on the cAMP of olfactory receptor neurons in rat / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the effects of Betamethasone on the cyclic adenosine monophosphate (cAMP) in olfactory receptor neurons (ORNs) and explore the possible mechanisms of the recovery of olfactory disorders by steroid treatment</p><p><b>METHODS</b>ORNs membrane was extracted and incubated with 0.1 mg/ml and 1.0 mg/ml Betamethasone. The concentrations of cAMP were measured by enzyme-linked immunosorbent assay at different times.</p><p><b>RESULTS</b>Compared with the control group, all Betamethasone groups showed differences, indicating 0.1 mg/ml (P < 0.05) and 1.0 mg/ml (P < 0.01) Betamethasone could rise the concentration of cAMP. The Betamethasone had obvious effects on cAMP production in rat ORNs and there was a dose-dependent effect. There was no difference between 5 minutes groups and 30 minutes groups.</p><p><b>CONCLUSIONS</b>Steroid hormone could enhance the production of cAMP of ORNs. Steroid hormone may thus contribute to the recovery of olfactory disorders partially, at least, through the effect on AC-cAMP in olfactory transduction.</p>

Endoscopic transpterygoid intervention of meningoencephalocele within lateral recess of sphenoid / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To report the results of endoscopic transpterygoid intervention of nine patients with meningoencephalocele and cerebrospinal fluid (CSF) leaks within lateral recess of sphenoid sinus (LRSS). The diagnosis, operative techniques and their related problems were discussed.</p><p><b>METHODS</b>Nine hospitalized patients with meningoencephalocele and CSF leaks within lateral recess of sphenoid sinus (LRSS) were included in this paper. Six were male and 3 were female, aged from 27 to 56 years old. Two patients had the histories of endoscopic repair. The preoperative orientation of CSF leaks and meningoencephalocele depended on CT scan and MR cisternography. Endoscopic transpterygoid intervention and the repair of skull base defects were undertaken under general anesthesia.</p><p><b>RESULTS</b>All the operations were successful. One patient had a postoperative intracranial hypertension and Hydrocephalus. Two patients had postoperative ipsilateral facial, upper lip and palatal hypesthesia. One of them had a xerophthalmia. All the symptoms above mentioned relieved gradually 6 months after operation. No recurrence was found during follow -up for 6 to 58 months (mean 25. 6 months).</p><p><b>CONCLUSIONS</b>Endoscopic transpterygoid intervention for meningoencephalocele and CSF leaks within LRSS is a minimally invasive technique and a straightforward approach.</p>

Clinical features of primary ciliary dyskinesia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features, diagnosis and treatment of primary ciliary dyskinesia (PCD).</p><p><b>METHODS</b>Three cases of PCD received endoscopic sinus surgery and were followed up for life quality and recovery. Among these 3 cases, two were twin brothers and the other girl was twin born with a healthy brother. The mucosa of inferior turbinate was extracted prior to the operation without narcotic and decongestant. The ultrastructure of mucosal cilia was detected with electron microscope. Nine exons of gene DNAH5 and chromosome in one case and her fraternal twin were evaluated.</p><p><b>RESULTS</b>Nasal and sinus CT imaging of the 3 cases showed chronic pansinusitis (1 case accompanied with situs inversus according with the diagnosis of Kartagener syndrome). The nasal polyp was resected, and the sinuses were opened. The twin brothers received the adenoidectomy. All patients felt nasal ventilation improved while the surgical field still covered with thick discharges during follow-up for 2 - 4 years. Ciliary ultrastructures of the three cases showed lateral dynein absent, the sequence of 9 exons of DNAH5 and chromosome presented no change in the fraternal twins.</p><p><b>CONCLUSIONS</b>Surgery could improve the symptoms of sinusitis in PCD. Change of ciliary ultrastructure was an important indication of its pathological changes and molecular biology evaluation needs further study.</p>

Impact of olfactory nerve transection on the apoptosis of mice olfactory receptor neurons / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the impact of olfactory nerve transection on the apoptosis of mice olfactory receptor neurons (ORN), and discuss the reliability of this experimental model.</p><p><b>METHODS</b>After olfactory nerve transection of mice, anterograde horseradish peroxidase (HRP) tracing was performed to confirm the completion of nerve transection. On 8 h, 2 d, 3 d and 5 d after surgery, TdT mediated deoxyuridine triphosphate-biotin nick end labelling (TUNEL) was used to observe the apoptosis of ORN, while relative semi-quantitative RT-PCR and immunohistochemistry were used to reflect the expression of olfactory marker protein (OMP, special marker of mature ORN) in olfactory epithelium.</p><p><b>RESULTS</b>No HRP label was observed in olfactory bulb after olfactory nerve transaction. Both TUNEL-positive and OMP-positive cells were ORN. After the surgery, TUNEL-positive cells increased remarkably and peaked on 2 d after the surgery. Meanwhile OMP mRNA in olfactory epithelium began to decrease markedly till 5 d after the surgery, and the olfactory epithelium got thinner accordingly.</p><p><b>CONCLUSIONS</b>This experimental model can be used reliably to sever mice olfactory nerve and manipulate simultaneous apoptosis of mice ORN.</p>