[The effect of different degrees of Eustachian tube dysfunction on hearing threshold in patients with acquired primary middle ear cholesteatoma after balloon eustachian tuboplasty].

Objective:To investigate the changes in hearing threshold of the acquired primary cholesteatoma of the middle ear with different degrees of eustachian tube dysfunction after balloon eustachian tuboplasty. Methods:This retrospective study included forty cases with middle ear cholesteatoma and eustachian tube dysfunction who underwent open mastoidectomy + tympanoplasty + balloon eustachian tuboplasty were enrolled. All patients were admitted from November 2020 to April 2022. The preoperative eustachian tube score of 0-2 were defined as the lower group, and the scores of 3-5 were defined as the higher group. Pure tone audiometry was measured preoperatively and 1, 3, 6 and 12 months postoperatively. The average value of bone conduction threshold and air conduction threshold of 250-4 000 Hz were calculated, and the air-bone gap was calculated simultaneously. SPSS 25.0 was used for statistical analysis. P<0.05 was considered statistically significant. Results:In the lower group, the air conduction threshold and air-bone gap at 3 months postoperatively were significantly decreased in comparison with those preoperatively（P<0.05），as was the air-bone gap at 6 months postoperatively（P<0.05）. In the higher group, the air conduction threshold and air-bone gap were significantly decreased at 3, 6 and 12 months postoperatively（P<0.05）. Conclusion:The air conduction threshold and air-bone gap of patients with the acquired primary cholesteatoma of the middle ear and eustachian tube dysfunction were significantly decreased after eustachian tube balloon dilatation. Hearing improvement lasted longer in patients with slight eustachian tube dysfunction.

[Dynamic visual acuity screening test results analysis of 25 patients with peripheral vertigo].

Objective:To observe the results of dynamic visual acuity screening tests in patients with peripheral vertigo and explore its clinical significance. Methods:The number of 48 healthy volunteers were enrolled as control group and 25 peripheral vertigo patients as experimental group. In the experimental group, there are 12 patients with vestibular neuritis, 1 patient with Hunt syndrome, 5 patients with sudden deafness with vertigo and 7 patients with bilateral vestibular dysfunction. Horizontal and vertical dynamic visual acuity screening tests were performed on them. The number of lost rows of horizontal and vertical dynamic visual acuity was compared between the control group and the experimental group to figure out if there is a statistical difference. The number of lost rows of horizontal and vertical dynamic visual acuity was compared within the experimental group to figure out if there is a statistical difference. The two groups of 18 cases of unilateral vestibular function decline and 7 cases of bilateral vestibular function decline in the experimental group were compared with the control group, and figure out if there is a statistical difference. Results:The median number of lost rows of horizontal dynamic visual acuity in 48 healthy volunteers was 1.5 and median number of lost rows of vertical dynamic visual acuity was 1.0 in the control group. The median number of lost rows of horizontal dynamic visual acuity of 26 healthy volunteers was 6 and median number of lost rows of vertical dynamic visual acuity was 5 in the experimental group. Compared to the experimental group, the number of lost rows both have statistical significance in horizontal and vertical dynamic visual acuity（P<0.01）. The comparison of horizontal and vertical lost rows within the test group also have statistical significance（P<0.01）. Twenty five patients with exceptional vestibular disease in the experimental group were divided into unilateral vestibular function reduction group（n=18） and bilateral vestibular function reduction group（n=7）. Compared with the control group, there was significant differences in the number of horizontal and vertical lost rows（P<0.01） within the three groups. After pairwise comparison, the number of lost rows of horizontal and vertical in the control group was significantly lower than that in the unilateral vestibular function reduction group and the bilateral vestibular function reduction group（P<0.01）. There was a highly significant correlation between the number of horizontally lost rows of DVA and the mean vHIT values of bilateral horizontal semicircular canals in 25 patients（P<0.01）; and a highly significant correlation between the number of vertically lost rows of DVA and the mean vHIT values of vertical semicircular canals in 4 groups bilaterally（P<0.01）. Conclusion:The Dynamic Visual Acuity Screening Test is a useful addition to existing tests of peripheral vestibular function, particularly the vHIT test, and provides a rapid assessment of the extent of 2 Hz VOR impairment in patients with reduced vestibular function.

[A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis].

Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential（VEMP） and video head impulse testing（vHIT） in patients with vestibular neuritis（VN）, thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMP（oVEMP）, cervical VEMP（cVEMP） and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%（24/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%（26/26）. Examination results of cVEMP showed that 36%（9/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%（10/25）, and 60%（15/25） patients had normal waveforms of both ears. Examination results of vHIT showed that 100%（25/25） patients had semicircular canal gain decline of one side, 92%（23/25） had anterior Semicircular canal decline of one side, and 36%（9/25） had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%（15/25） VN patients had superior vestibular nerve damage, and 40%（10/25） had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%（16/25） VN patients had superior vestibular nerve damage, and 36%（9/25） had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHIT（χ²=0.085, P>0.05）. The matching ratio of VEMP and vHIT results was 80%（20/25）, and the non-matching ratio was 20%（5/25）. Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.

Diagnosis, differential diagnosis, and treatment for sudden sensorineural hearing loss: Current otolaryngology practices in China.

Introduction: Although sudden sensorineural hearing loss (SSNHL) has been attempted to be understood for 70 years, diagnosis and treatment strategies still have strong heterogeneity worldwide, which are reflected in the guidelines issued by countries and the clinical practice of otolaryngologists. Methods: Questionnaires were sent to registered otolaryngologists nationwide via an online questionnaire system. We investigated the current views and clinical practices of otolaryngologists in mainland China about the diagnosis, examination, and treatment strategies of SSNHL. Results: Most otolaryngologists supported diagnostic classification via audiograms. Regional economic situation and hospital grade affected application strategies for differential diagnosis. Regarding corticosteroid therapy, 54.9% of respondents opted to discontinue the drug 5 days after systemic administration. Both intratympanic therapy and post-auricular injections were selected by more than half of the respondents as initial and salvage treatments. Discussion: Chinese otolaryngologists exhibit heterogeneity in clinical practices for SSNHL, including distinct approaches to combination therapy and local application of steroids. This study pointed out Chinese doctors' similarities, differences, and unique strategies in diagnosing and treating SSNHL and analyzed the possible reasons to help the world understand the current otolaryngology practices in China.

[Clinical observation of chronic recurrent secretory otitis media in adults treated by balloon dilatation of Eustachian tube combined with myringotomy and catheterization].

Objective:To explore the clinical effect of balloon dilatation of the Eustachian tube combined with myringotomy and catheterization in treating chronic recurrent secretory otitis media in adults. Methods:100 cases（135 ears） of chronic recurrent secretory otitis media in our hospital from January 2018 to May 2020 were selected as the research objects, and were divided into two groups according to the random number table method, 50 cases（68 ears） in the control group and 50 cases（67ears） in the observation group. The control group received tympanostomy and catheterization, while the observation group received tympanostomy with catheterization and balloon dilatation of the Eustachian tube. The total effective rates, Eustachian tube dysfunction scores, Eustachian tube pressure R scores, pure tone thresholds, complication rates, scores of life quality and recurrence rates 1 year after operation were compared between the two groups. Results:The total effective rate was higher in the observation group than the control group（P<0.05）. Compared with pre-operation, the score of Eustachian tube dysfunction, the pure tone listening threshold of each frequency were lower and the Eustachian tube pressure R scores were higher in the two groups at 3 months, 6 months and 12 months after operation（P<0.05）; 3 months, 6 months and 12 months after operation, the scores of Eustachian tube dysfunction, the pure tone listening threshold of each frequency in the observation group were lower than those in the control group（P<0.05）, and Eustachian tube pressure R scores were higher than those in the control group（P<0.05）. Compared with the control group, the incidence of complications and recurrence rate 1 year after operation were lower in the observation group（P<0.05）. Compared with before operation, the scores of life quality in the two groups were higher at 3 months, 6 months and 12 months after operation（P<0.05）; 3 months, 6 months and 12 months after operation, the scores of life quality were higher in the observation group than the control group（P<0.05）. Conclusion:Tympanotomy combined with balloon dilatation of Eustachian tube can effectively improve the Eustachian tube function of adult patients with chronic recurrent secretory otitis media, it has impressiveclinical effects. On the one hand,it can be better to promote the recovery of patients' hearing and improve the clinical cure rate of patients; On the other hand, it reduce the occurrence of complications and disease recurrence greatly, so the quality of the patients' life were improved significantly.

[Analysis of high frequency semicircular canal function test in patients with unilateral vestibular neuronitis in the acute phase].

Objective:To analyze results obtained from high frequency semicircular canal function test in patients with unilateral vestibular neuronitis in the acute phase, aiming to provide references for clinical vestibular rehabilitation. Methods:A total of 49 patients with unilateral vestibular neuronitis in the acute phase were enrolled in this study. They were subjected to video head impulse test（vHIT） and vestibular autorotation test（VAT）. Test results were analyzed in detail. Results:vHIT results showed that 100% of patients presented a lower lateral horizontal semicircular canal gain than normal control, 93.88% presented a lower anterior semicircular canal gain, and 22.45% presented a lower posterior semicircular canal gain. VAT results showed: ①81.63%（40/49） of patients had a decline of horizonal VAT gain,83.67% （41/49） had an abnormal horizonal phase shift, and 63.27%（31/49） had an abnormal horizontal symmetry. ②32.65% （16/49） of patients had a decline of vertical VAT gain, and 16.33%（8/49） had abnormal vertical phase shift. Comparison results between vHIT and VAT data showed: ①There is a statistical difference between the rate of abnormal decline of vHIT horizonal semicircular canal gain and that of abnormal decline of VAT gain（P<0.01）. There is a statistical difference between the rate of abnormal decline of vHIT anterior semicircular canal gain and that of abnormal decline of vertical VAT gain（P<0.01）. No significant difference was found between the rate of abnormal decline of vHIT posterior semicircular canal gain and that of abnormal decline of vertical VAT gain（P>0.05）. ②100% of patients presented a lower vHIT lateral horizontal semicircular canal gain than normal one, and 63.27% of patients had an abnormal VAT horizontal symmetry, which was statistically significant（P<0.01）. ③The rate of abnormal decline of vertical VAT gain was 63.64% in patients with all declines of vHIT lateral horizontal, anterior and posterior semicircular canal gain, which was 23.68% in patients with declines of vHIT lateral horizontal and anterior semicircular canal gain. The difference was statistically significant（P<0.05）. Conclusion:vHIT is superior to VAT in the high-frequency semicircular canal function test of unilateral vestibular neuronitis patients in the acute phase. VAT can be used as an important supplement, and the combination of vHIT and VAT can more accurately guide the vestibular rehabilitation.

[Observation on nystagmus characteristics and curative effect of patients with light cupulopathy].

Objective:To describe the characteristics of nystagmus in patients with Light Cupulopathy and to investigate its therapeutic effect. Method:The Supine roll test in our hospital's otology clinic showed persistent DCPN in 26 patients, who received Supine roll test, null-point position test, and prone-supine test. All patients were treated with barbecue maneuver. The immediate, short-term and long-term effects of treatment were investigated. Result:Null-point position on one side was present in 26 patients. The angles ranged from 15-45°, with an average of （26.34±8.78）°. Spontaneous nystagmus was observed in 30.8% （ 8/26 ） patients. The nystagmus was directed to the affected side in prone position and to the healthy side in supine position. Seventy-three percent of the patients had strong nystagmus and 26.9% had weak nystagmus in the Supine roll test. All patients received Barbecue maneuver, and the recovery rates were 0, 42.3% and 88.5% immediately, 1 week and 1 month after treatment respectively. There was a statistical difference in the recovery rate among immediate, one week and one month later （P<0.01）. Conclusion:The nystagmus performance of patients with persistent DCPN conforms to the light cupula hypothesis. The lesion side can be determined according to the null-point position and prone-supine test. The lesion side cannot be determined by the intensity of nystagmus in the Supine roll test in some cases. Repositioning maneuver is ineffective in treating light cupulopathy, but the disease is self-limited.

[Efficacy of cochlear implantation for bilateral severe Ménière's disease].

OBJECTIVE: To investigate the effecacy of cochlear implantation (CI) improving hearing of Lermoyez's syndrome, we retrospectively analyzed a case of Lermoyez's syndrome whose left ear was extremely severe sensorineural deafness and right ear was severe sensorineural deafness. METHOD: The patient had completed preoperative audiological examination , vestibular function and imaging examination, then was carried out bilateral endolymphatic sac decompression and left side CI. Follow up after the surgery. RESULT: The vertigo could be controlled very well after the bilateral endolymphatic sac decompression surgery, but the hearing loss couldn't be control, so CI was carried out to improve hearing and speech recognition rate. The contralateral hearing also improved significantly after the operation. CONCLUSION: Endolymphatic sac decompression can effectively control. Ménière's disease in patients with vertigo attacks. CI can improve patients' hearing, and speech recognition rate and, also could improve the quality of life. CI was the first choice for the patient of 4 stage Ménière's disease.

[Study of intratympanic methylprednisolone injections in diabetics with a sudden sensorineural hearing loss].

OBJECTIVE: To evaluate the effects of intratympanic methylprednisolone injection by microcatheter in diabetics with a sudden hearing loss. METHODS: From July 2005 to November 2009, 113 diabetics with a sudden hearing loss within an onset of 10 days at our department were recruited. But they received no previous intervention and were assigned to treatment and control groups. Treatment group were made by microcatheter connected with an insulin bump. Microcatheter was placed in a round window niche and methylprednisolone (62.5 mg/ml) infused at a rate of 10 microl/h for 14 days. Then the microcatheter was extracted. Simultaneously vasodilation, neurotrophic, thrombolysis and insulin hypoglycemia were administered in all patients. Pure tone test was conducted at Days 10 and 20 after intervention. RESULTS: The outcome was as follows: cure (n = 6), efficacy (n = 19), effect (n = 12) and no effect (n = 11) respectively. The overall effective rate of 77.08% in the treatment group was superior to that in the control group. And there was statistical difference (P < 0.05). Pure tone average (PTA) of two groups showed no statistical difference. After 10 days, the PTA values were (66 ± 21) versus (76 ± 14) dB in the treatment and control groups respectively. At Day 20, the values were (50 ± 16) and (59 ± 12) dB respectively. The improvement of pure tone threshold at Days 10 and 20 had significant statistical difference (P < 0.05). Neither group had hypoglycemia or diabetic complications during treatment. And the prognosis had no obvious correlation with the severity of diabetes. CONCLUSION: The therapy of intratympanic methylprednisolone injection by microcatheter connected with micropump is both effective and feasible in diabetics with a sudden hearing loss.