[Cochlear implantation and rehabilitation in prelingually deafened adolescents and young adults].

OBJECTIVE: To investigate the outcomes of prelingually deafened adolescents and young adults receiving cochlear implantation (CI). METHODS: Thirty-three patients with prelingual deafness aged 7-33 years at the time of CI were followed up for 4 years. The Speech Discrimination Score (SDS) was tested using disyllabic words and short sentences with close-set and open-set, respectively. RESULTS: After appropriate mapping, sound field audiometry with warble tone showed that the warble tone threshold average (WTA) of the patients reached 25-41 dBHL, with a mean threshold of 28.62∓2.37 dBHL. At 1 year after the operation, the mean value of SDS was 70.03% in close-set word list with lip-reading and 61.18% without lip-reading, and was improved to 82.12% and 72.67% at 4 years, respectively. In open-set word list, the mean value of SDS was 77.94% with lip-reading and 67.85% without lip-reading. The safety and the benefits-cost evaluation of CI for prelingually deafened school age children and adolescents had been recognized by 90.9% of the families involved. CONCLUSION: These patients can obtain appropriate speech discrimination scores with improved quality of life after CI.

[Study of three-dimensional speech chart by time-frequency analysis in Chinese Mandarin Monosyllabic word phonemes].

OBJECTIVE: To investigate the physical characteristic of Chinese Mandarin Monosyllabic word phonemes by the time-frequency analysis. METHODS: Manufactured and study the three-dimensional speech chart which was on the basic of information of the time-frequency analysis in 40 monosyllabic words with the SigmaPlot 9.0 and Matlab 7.0 software. RESULTS: The mean value of basic frequency in 40 monosyllabic words was between 220 to 320 Hz area, and the mean value of four groups has significant difference by t-test. It is indicated by time-frequency analysis that the characteristics vary according to the tone of monosyllabic words. With the change of time, the various frequencies and its intensity of tone first remain basically unchanged, the curve is horizontal type; the different frequencies of tone second gradually tend to high-frequency direction, the graph is upward-type, additionally, the intensity of some tone drops little; the divers frequencies of tone third firstly deflect to low-frequency areas, then increasingly deviate to high-frequency direction of bias after maintaining a period of time, the figure is v-type, intensity changes are concave-shaped; The various frequencies of tone fourth deviate from high-frequency to low-frequency areas, and its intensity drops sharply, the graph is decreased type. CONCLUSION: Through time-frequency analysis and three-dimensional speech chart observation, we consider that the physical characteristic of Chinese Mandarin Monosyllabic word phonemes mainly reflects the frequencies and intensity change with time.

[Therapeutic effect of ossicular reconstruction with bioceramic or porous macromolecular polyethylene partial ossicular replacement prosthesis in patients with tympanosclerosis].

OBJECTIVE: To evaluate the effect of ossicular reconstruction with partial ossicular replacement prosthesis (PORP) in patients with tympanosclerosis. METHODS: The data of 31 cases of tympanosclerosis treated between 1992 and 2009 were reviewed. Of the 31 patients, 17 (17 ears) underwent ossicular reconstruction with porous macromolecular polyethylene PORP, and 14 (14 ears) with bioceramic PORP. All the patients were followed up for 3-24 months. RESULTS: Significant improvement was found in postoperative speech frequency (500, 1000, 2000 Hz) pure tone average (PTA) and air-bone gap (ABG) (P < 0.05) after the treatments without statistically significant differences between the two groups (P > 0.05). CONCLUSION: Porous macromolecular polyethylene and bioceramic are valuable ossicular prosthesis for tympanosclerosis.

[Tumor-targeted human telomerase reverse transcriptase promoter/tk gene therapy against human nasopharyngeal carcinoma cells in vitro].

OBJECTIVE: To investigate the targeted killing effect of human telomerase reverse transcriptase promoter (hTERTp)/tk gene on human nasopharyngeal carcinoma (NPC) cells. METHODS: The recombinant plasmid hTERTp/tk/pGL3 was transfected into human NPC HNE1 cells and the expressions of TK and telomerase were investigated. The targeted killing effect induced by hTERTp/tk on HNE1 cells was assessed using RT-PCR and MTT assay. RESULTS: TK gene expression was detected in HNE1 cells transfected by hTERTp/tk/pGL3, and the cells showed reduced telomerase and hTERT expression as compared with the control cells. hTERTp/tk/pGL3 resulted in target killing of HNE1 cells but not of the normal control cells. The tumor cell-killing effect of hTERTp/tk/pGL3 was slightly milder than that of the positive control CMV/tk/pGL3 that produced nonselective cell killing. CONCLUSION: hTERTp/tk, a tumor-specific expression system, allows targeted tumor cell killing and reduces the activity of telomerase in NPC cells in vitro.

[Clinical analysis of 118 patients with tympanosclerosis].

OBJECTIVE: To study the incidence of tympanosclerosis (TS) and the major risk factors of hearing loss. METHODS: A total of 118 TS patients (137 ears) were compared with 265 patients with chronic otitis media (COM) (311 ears) for gender, age and course of disease. The disease regions and hearing loss of the TS patients were analyzed. RESULTS: TS showed higher prevalence in women of older ages. Sclerosis was seen most frequently in the tympanic membrane, followed by the malleus, incus, incudomalleolar joint, other regions, ariticulus incudostapedius and stapes. The patients with sclerosis or deterioration in the ossicular chain had worse hearing loss than the other patients. Carhart notch occurred in 45 ears (32.85%), an incidence similar to that of inverted "V"-shaped curve of air-conduction audiometry near 2 kHz (47 ears, 34.31%). The factors contributing to the hearing loss, listed in the order of their importance, included pathologies in the incus, malleus, incudomalleolar joint, ariticulus incudostapedius, stapes, other regions, tympanic membrane, and gender. CONCLUSIONS: Female patients may had increased risk of TS. The presence of Carhart notch and inverted "V"-shaped curve in air-conduction audiograph may indicate myringosclerosis or ossicular chain sclerosis. Abnormal ossicular chain is the leading factor contributing to hearing loss.

[Cochlear implant in patients with congenital malformation of the inner ear].

OBJECTIVE: To summarize the clinical experience with multi-channel cochlear implantation in patients with inner ear malformations and evaluate and the outcomes of speech rehabilitation. METHODS: A retrospective study was conducted in 295 patients receiving cochlear implantation from 1998 to 2007, including 25 patients with large vestibular aqueduct syndrome (LVAS), 9 with Modini malformation, and 5 with common cavity deformity. All the patients received the Nucleus24 cochlear implants. In LVAS cases, 4 had Nucleus 24R (ST) implants, 8 had Contuor implants, 10 had Contuor Advance, and the remaining cases used Nucleus24(M) straight-electrode implants. RESULTS: Severe gusher appeared in 3 cases of LVAS, and perilymph fluctuation were seen in other 15 cases. Four patients with Mondini malformation and 2 with common cavity malformation also experienced severe gusher, but the electrodes were inserted smoothly in all the patients without postoperative facial paralysis or cerebrospinal fluid leakage. The hearing threshold in these patients was similar to that in patients with normal cochlear structure. After speech rehabilitation for over 6 months, the abilities of speech discrimination and spoken language improved in all the cases in comparison with the preoperative lingual functions. CONCLUSION: Multi-channel cochlear implantation can be performed in patients with inner ear malformation, but should not be attempted in patients with poor cochlear and cochlear nerve development. A comprehensive pre-operative radiographic and audiological evaluation is essential.

[Cochlear implantation in patients with large vestibular aqueduct syndrome].

OBJECTIVE: To evaluate the hearing and speech recognition in patients with large vestibular aqueduct syndrome undergoing multi-channel cochlear implantation. METHODS: From 2005 to 2008, multi-channel cochlear implantation surgeries were performed in 22 patients with large vestibular aqueduct syndrome. All the patients received multi-channel cochlear implantation through transmastoid facial recess approach. The postoperative outcomes of the patients were compared with those of 22 patients with non-malformed cochlear. RESULTS: Severe gusher occurred in 3 cases during the implantation, and perilymph fluctuation was found in another 15 cases, with a rate of anomalies of 81.8%. All the electrodes were totally inserted into the cochlear, and no facial paralysis or cerebrospinal fluid leakage occurred after the operation. The hearing threshold in these patients was similar to that in patients with normal cochlear receiving the implantation. After speech rehabilitation for over 6 months, all the patients showed improved hearing and verbal ability. CONCLUSION: Multi-channel cochlear implantation can be performed in patients with large vestibular aqueduct syndrome, but preoperative hearing assessment and radiographic examinations should be performed.

[Effect of surgical reconstruction of congenital aural atresia via the mastoid antrum approach: analysis of 48 cases].

OBJECTIVE: To assess the effect of surgical reconstruction of congenital aural atresia via the mastoid antrum approach and investigate method for preventing postoperative atresia of the reconstructed aural canal. METHODS: From 2000 to 2008, aural canal reconstruction and tympanoplasty was performed via the mastoid antrum approach. In 48 patients with congenital aural atresia (54 ears, including 45 ears of type II, 9 ears of type III). All the patients were followed-up for 18 months to assess the therapeutic effect. RESULTS: The mastoid antrum was located uneventfully for all the 54 ears, all showing ossicular chain anomalies involving most frequently the malleus and the incus followed by the upper structures of the stapes. Facial nerve abnormalities were seen in 23 ears (42.6%). Hearing improvement to over 20 dB was achieved in 45 ears (83.3%) and to over 25 dB in 25 ears (46.2%) one year later. CONCLUSION: The mastoid antrum approach for surgical reconstruction of congenital aural atresia is safe and reliable. Maintenance of the width of the aural canal and prevention of lateral healing of the transplanted tympanic membrane are crucial in the treatment of congenital aural atresia.

[Therapeutic effects of small fenestra stapedotomy with semiconductor diode laser: a comparison with microdrill].

OBJECTIVE: To compare the effects of small fenestra stapedotomy with semiconductor diode laser and microdrill in patients with otosclerosis. METHODS: Twenty-six patients (29 ears) undergoing stapedotomy with semiconductor diode laser and 19 patients (21 ears) with microdrill were compared for the hearing results and complication rates. RESULTS: No statistically significant differences were found in postoperative speech frequency and high frequency pure tone average in closing the air-bone gap between the two groups. The ears treated by stapedotomy with semiconductor diode laser showed significantly better preoperative minus the postoperative air-bone gap and milder dizziness. CONCLUSION: In spite of the good hearing outcomes in both groups, small fenestra stapedotomy with semiconductor diodelaser can achieve better results and reduce the incidence of complications.

[Therapeutic effect of insulin-like growth factor-1 injection into the inner ears through scala tympani fenestration on gentamicin-induced hearing loss in guinea pigs].

OBJECTIVE: To study the therapeutic effect of insulin-like growth factor-1 (IGF-1) injection into the inner ears through a scala tympani fenestration on sensorineural deafness in a guinea pig model of gentamicin-induced hearing loss. METHODS: Twenty guinea pigs with gentamicin-induced hearing loss were randomized equally into IGF-1 group and control group. In both groups, scala tympani fenestration was performed for injection of IGF-1 (10 microl) or artificial perilymphatic fluid (10 microl). Auditory brainstem responses (ABR) test was performed before and 7 and 14 days after surgery, respectively, and the cochlea was removed by decollation of 3 guinea pigs from each group after ABR test for observing the changes in the hair cells using scanning electron microscope. RESULTS: Significant reduction in the ABR response threshold (RT) occurred in IGF-1 group 7 and 14 days after the surgery, and on day 14, ABR RT showed significant difference between IGF-1 group and the control group. Scanning electron microscopy revealed severer damages of the hair cells in the control group, and in the IGF-1 group, finger-like microvilli was detected on the surface of the damaged hair cells. CONCLUSION: IGF-1 injection in the inner ear through the scala tympani fenestration may ameliorate the damages of the auditory function and relieve sustained toxicity of gentamicin in guinea pigs possibly by protection and partial repair of the damaged cochlea hair cells as well as protection of the afferent nerves.

[Auditory brainstem response in normal guinea pigs and those with gentamicin-induced hearing loss under awake and anesthetic conditions].

OBJECTIVE: To observe the alterations of auditory brainstem response (ABR) in guinea pigs with gentamicin-induced hearing loss under awake and anesthetic conditions. METHODS: We recorded the ABR in 20 normal guinea pigs and 20 with gentamicin-induced hearing loss before and after anesthesia for statistical analysis. RESULTS: No significant difference was observed in the waveform, response threshold (RT), I and III peak latencies (PL), I-III interpeak latencies (IPL) of ABR between awake and anesthetic conditions in normal guinea pigs (P>0.05), nor did gentamicin-induced hearing loss showed obvious impact on the ABR parameters (P>0.05). CONCLUSION: No significant ABR alterations occur under awake and anesthetic conditions in either normal guinea pigs or those with hearing loss, therefore ABR test can be performed without anesthesia to ensure the success and error minimization of the experiment.

[Role of ciliary neurotrophic factor in regeneration of severed facial nerve of cats].

OBJECTIVE: To study the role of extrinsic (CNTF) in the regeneration of severed facial nerve in cats. METHOD: The facial nerve in temporal bone of adult cats were severed and the severed ends were connected with CNTF or saline applied at the connection. Electrophysiological examination and immunocytochemistry were performed with immunoelectron microscope for morphological analysis at 2, 4 and 8 weeks after the operation. RESULTS: Two weeks after operation, both CNTF and saline groups failed to exhibit muscular excitement by facial nerve stimulation, but the amount of myelinated nerve fibers had statistical difference between the two groups (P<0.05). At 4 weeks, the latency of the facial muscle excitement was 7.832+/-2.695 ms in CNTF group and 16.120+/-3.516 ms in saline group, and the average number of myelinated axons was significantly different between the two groups (1,435+/-318 vs 957+/-269, P<0.05). At the 8th weeks, the latency of facial muscle excitement was reduced to 3.125+/-0.165 ms in CNTF group and to a comparable level of 3.095+/-0.178 ms in saline group (P>0.05), and the average number of myelinated axons increased to 1,695+/-283 and 1,543+/-320 respectively in the two groups (P>0.05). Significant increase of Schwann cells was noted in both groups at this stage. CONCLUSION: Local application of CNTF may enhance facial early-stage nerve regeneration in adult cats, but its long-term effects remain unclear.

[Subcloning of human neurotrophin-3 gene and construction of its genetically engineered cell model].

OBJECTIVE: To subclone human neurotrophin-3 gene (NT3) and transfer this gene into human bone marrow mesenchymal stem cells (BM-MSCs) to construct genetically engineered cells that produce NT3 in vitro. METHODS: Human BM-MSCs were cultured in low-glucose DMEM supplemented with 10% fetal bovine serum and 10 ng/ml epidermal growth factor. Flow cytometry (FCM) was used to examine the phenotypes of the cells. The eukaryotic expression vector pcDNA3.1(+)/NT3 was constructed and transferred into human BM-MSCs in vitro via liposomes. The genetically engineered BM-MSCs were selected several times with G418 and the clones were obtained and then amplified, followed by extraction of the RNA for detection of NT3 gene expression by reverse transcriptional (RT) PCR. The biological activity of the genetically engineered cells was examined by the collecting the supernatant of the culture medium for incubation of guinea pig cochlea hair cells. RESULTS: The cultured cells expressed CD13, CD29 and CD59, but no7 CD11, CD14, CD31, CD34, CD45, CD80, CD86, CD117 or HLA-DR. The BM-MSCs genetically modified with pcDNA3.1(+)/NT3 not only expressed and produced NT3, but also promoted the survival of the guinea pig cochlea hair cells in vitro. CONCLUSION: It is possible to construct the genetically engineered BM-MSCs that excrete NT3 in vitro.

[Telomere shortening in the pathogenesis of nasopharyngeal carcinoma].

OBJECTIVE: To explore the role of telomere shortening in the pathogenesis of nasopharyngeal carcinoma (NPC). METHODS: Southern blotting was employed to determine the mean telomere length (MTL) in 42 tumor samples and 15 samples of the tissues adjacent to the tumors obtained from 42 NPC patients, along with the tissue specimens from 17 patients with chronic nasopharyngitis. RESULTS: In NPC tissues, the length of the MTL was 4.5+/-2.3 kb, obviously shorter than those of the MTL in tissues adjacent to the tumor 14.6+/-2.8 kb and in chronic nasopharyngitis 15.8+/-3.1 kb. CONCLUSION: Telomere shortening may play an important role in the pathogenesis of nasopharyngeal epithelium cell malignancies.

[Two cases of ectopic thyroid tumor].

We report our experience with 2 cases of ectopic thyroid tumor and on the basis of literature review, attempting to investigate the origin, clinical manifestations, diagnosis and treatment of this disease.

Resection of nasopharyngeal angiofibroma with extranasal and extrapharyngeal involvement.

The authors report their own experiences with the diagnosis and therapy of 7 cases of nasopharyngeal angiofibroma with extranasal and extrapharyngeal involvement, thereby attempt to formulate the surgical approach for resection of huge nasopharyngeal angiofibroma with extensive involvement. The results suggested that appropriate surgical approach was of paramount importance for eliminating the tumor and may effectively reduce traumatic injury during the operation. Elective embolization of the vessels feeding the tumor could reduce bleeding and therefore increase the safety of the operation.