Diagnostic Accuracy of Ocular Vestibular Evoked Myogenic Potentials for Superior Canal Dehiscence Syndrome in a Large Cohort of Dizzy Patients.

OBJECTIVES: To determine the diagnostic accuracy of ocular vestibular evoked myogenic potentials (oVEMPs) for superior canal dehiscence syndrome (SCDS) in a large cohort of unselected dizzy patients. Most SCDS patients are dizzy (90%); however, only 30% demonstrate archetypical SCDS clinical proxies (Tullio or Hennebert findings). Several case-control studies have addressed specific SCDS markers using VEMP testing, but the diagnostic value of VEMP for SCDS has not been demonstrated in a target population of dizzy patients. The aim of this study was to confirm the diagnostic properties of oVEMP for SCDS in an unselected cohort of dizzy patients. DESIGN: This diagnostic accuracy study was performed in a tertiary referral center and included a consecutive sample of dizzy patients referred for vestibular function testing. One hundred fifty subjects were collected prospectively; five were excluded due to middle ear disorders, 10 had the target condition (SCDS group), and 135 had an alternative condition (non-SCDS group), based on diagnostic criteria for SCDS used in our department as reference standard. The non-SCDS group was subdivided into diagnostic categories including an "undefined dizziness" group. The index test applied to the total sample (missing data: 1%) consisted of oVEMP recording using three different stimulation modalities, that is, air-conducted (AC) sound stimulation and midsagittal bone-conducted (BC) vibration at both forehead (Fz) and vertex (Cz). Data analysis was conducted on four oVEMP parameters: amplitude, latency, amplitude asymmetry ratio, and interaural latency difference. Between-group analysis was conducted with nonparametric tests. The oVEMP diagnostic accuracy for SCDS was determined with uni/multiparametric receiver operating characteristic analysis. Best cutoff points were computed for those parameters or parameter combinations that showed an accuracy level appropriate for clinical use (area under the curve [AUC] > 0.8). RESULTS: Different oVEMP parameters, in particular, the amplitude to AC stimulation (SCDS: 53, inter quartile range [IQR]: 27.6-68.3 µV; non-SCDS: 4.4, IQR: 2.0-8.1 µV; p < 0.001), were able to separate SCDS from non-SCDS conditions with statistical significance. AC oVEMP amplitude had the highest diagnostic accuracy (area under the curve = 0.96) for SCDS, with optimal sensitivity (100%) and high specificity (89%) at a specific cutoff point (16.7 µV); as an SCDS index, it could distinguish these patients not only from those with other vestibular diagnoses but also from patients with undefined dizziness (sensitivity 100%; specificity 81%). CONCLUSIONS: oVEMP was able to identify all subjects affected by SCDS, according to our diagnostic criteria, in a large cohort of unselected dizzy patients. The AC oVEMP amplitude parameter showed optimal sensitivity and high specificity for SCDS and may represent an ideal screening test for SCDS among dizzy patients. This is noteworthy when considering that not all SCDS patients express the clinical key features of vestibular hypersensitivity to sound or pressure change, even though most complain of dizziness.

Primary nasopharyngeal tuberculosis presenting as durative aural fullness: one case report and literature review / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical features, diagnosis and treatments of primary nasopharyngeal tuberculosis.@*METHOD@#A case report was presented, and meanwhile etiopathogenesis and differential diagnosis were also reviewed.@*RESULT@#A biopsy was taken and the histopathological examination showed tuberculosis granuloma with caseous necrosis. After anti-tuberculosis therapy, the symptoms disappeared.@*CONCLUSION@#Not only otologic disorders but also nasopharyngeal diseases need to be considered when aural fullness exists. More importantly, primary nasopharyngeal tuberculosis should be taken as one of the differential diagnosis.

Clinical analysis on 15 cases with cystic lymphangiomas located in head and neck in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the diagnosis and effective treatment of cystic lymphangiomas located in head and neck in children.@*METHOD@#Fifteen cystic lymphangiomas,diagnosed with pathological evidence, located in head and neck in children were retrospectively analyzed including clinical characteristics, diagnosis, treatment and follow-up data.@*RESULT@#CT and ultrasonography were used to evaluate the size, shape and extent of lymphangiomas in all patients. All patients were treated with surgery. Complete resection was performed in 14 cases, and subtotal resection in one case. Two post-operative complications were found,one was paralyses of mandibular branch of facial nerve, another was Horners syndrome. Tracheotomy operation was done in one case,and the tracheal cannula was taken away before discharged from hospital. Fourteen patients were followed up. There was no recurrence during the follow-up from 6 months to 8 years, while one case who suffered from Horner's syndrome after operation was not cured.@*CONCLUSION@#CT and ultrasonography are effective to diagnose cystic lymphangiomas and evaluate the security of clinical treatment. Total or subtotal resection is effective to treat cystic lymphangiomas.

Analysis of clinical characteristics and treatment outcome of bilateral and unilateral sudden sensorineural hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical characteristics and treatment of bilateral and unilateral sudden sensorineural hearing loss (SSHL) and figure out the differences between bi-and unilateral sudden sensorineural hearing loss, and further improve the diagnosis and treatment of SSHL.@*METHOD@#The retrospective study was based on 334 patients with SSHL (315 with uni-SSHL versus 18 with bi-SSHL) and all of the patients were in-patients.@*RESULT@#The incidence of bi-SSHL was 5.4% of patients with SSHL. There was no significant difference on the clinical features such as age, gender, interval from onset of symptoms to seeing doctors and associated symptoms between bi-and unilateral SSHL. 27.8% of the patients with bi-SSHL had preexisting diabetes mellitus, which was significantly higher than the rate of the uni-SSHL (9.8%, P<0.05). Hearing loss was more profound in the uni-SSHL ones, however, the hearing improvements were better than their counterparts. The overall effective rate of the two groups was 58.4% and 13.9% respectively. Earlier diagnosis and treatment with steroids would have a good prognosis.@*CONCLUSION@#Unilateral SSHL is more common than bilateral SSHL. Bilateral SSHL occurs more common with preexisting diabetes mellitus and has worse prognosis compared to unilateral SSHL. The earlier steroid treatment the better prognosis.

Applied anatomy of operation through posterior tympanum approach / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To provide the anatomic data for operation on the middle ear through the observation and measurement of related anatomic structure.@*METHOD@#Forty human temporal bones of 20 voluntary bone donors were dissected, relative anatomical data of operation were observed and measured under operating microscope through posterior tympanum approach entering posterior tympanum.@*RESULT@#The average distances from suprameatal spine to short crus of incus, pyramid segment of facial canal were 19.14 mm, 16.30 mm, respectively. The average distances from pyramid segment of facial canal to the surface of mastoid, crotch of chorda tympani nerve, posterior wall of auditory meatus were 20.84 mm, 11.28 mm, 4.40 mm, respectively. The average length of facial nerve in the horizontal segment, the perpendicular paragraph was about 11.60 mm, 15.30 mm, respectively. The average distance from pyramidal eminence to the anterior lip of round window niche, from oval window to round window niche, from incudostapedial joint to round window niche was 4.46 mm, 3.74 mm, 3.80 mm, respectively. The included angle of facial nerve in the horizontal segment and chorda tympani nerve with facial nerve in the perpendicular paragraph was 110.4 degrees, 24.8 degrees, respectively. Horizontal semicircular canal and facial nerve in the level paragraph was 17.5 degrees, long process of incus and incus buttress was 46.0 degrees.@*CONCLUSION@#The position of anatomic structure in middle ear was constant and the relationship including distance and angle between anatomic structures changed in limited region. The anatomical parameters provide a reference value for avoiding the injury during the operation.