[Surface electromyographic study on swallowing in normal adults].

OBJECTIVE: To study the characteristics of surface electromyography (sEMG) during swallowing in normal adults. METHODS: The sEMG during swallowing was carried out in 126 normal adults. There were 66 males and 60 females with their age ranged from 18 to 65 years. The recording electrodes were placed on the skin above the superior thyroid notch and the duration and amplitude of muscle activities during every deglutition were recorded. Swallowing styles were dry swallow, 20 ml water swallow and 40 ml water swallow. RESULTS: The durations of sEMG at dry swallow, 20 ml water swallow and 40 ml water swallow were (1.133 ± 0.209)s (x¯ ± s), (1.097 ± 0.208)s, and (1.510 ± 0.432)s, while the amplitudes were (0.332 ± 0.115)mV, (0.308 ± 0.095)mV, and (0.399 ± 0.139)mV in normal male group. The durations of sEMG at dry swallow, 20 ml water swallow and 40 ml water swallow were (1.118 ± 0.170)s, (1.085 ± 0.209)s, and (1.765 ± 0.463)s, while the amplitudes were (0.292 ± 0.100)mV, (0.261 ± 0.113)mV, and (0.342 ± 0.129)mV in normal female group. The amplitudes of sEMG in male were higher than those in female (P < 0.05) and the durations had no statistically significant difference between male and female (P > 0.05) in all swallow styles except that the duration of 40 ml water swallow in female was longer than that in male (P < 0.05). In all volunteers, the durations of sEMG at 40 ml water swallow were longer than those at dry swallow and 20 ml water swallow, and there was no statistically significant difference between dry swallow and 20 ml water swallow. The amplitude of sEMG at 40 ml water swallow was higher than that at dry swallow. The amplitude of sEMG in dry swallow was higher than that at 20 ml water swallow. There was no statistically significant difference in durations and amplitudes of sEMG among four different age groups of male. In the female groups, there was no statistically significant difference in durations and amplitudes of sEMG among four different age groups except that the duration at 40 ml water swallow was longer in younger group (<30 years old) than in older groups. CONCLUSIONS: Surface EMG of swallowing is a simple and noninvasive method for evaluating the swallowing function. The sEMG data of swallowing in normal adults obtained in this study may be used to provide reference for screening swallowing function in adults in the future.

[Study on the consistency of reflux score evaluated by three different level of throat physicians].

OBJECTIVE: The consistency of reflux finding score (RFS) was studied by three different level of throat physicians. METHODS: One hundred and ten laryngeal photos were chosen to assess the RFS test-retest reliability on two separate occasions at least more than one week. RESULTS: The mean total RFS scores for doctor A were 9.05 ± 2.54, doctor B were 8.80 ± 2.20, doctor C were 8.98 ± 2.21 at the initial screening, and 9.20 ± 2.47, 9.03 ± 2.14 and 8.91 ± 2.30 respectively at the repeat evaluation. The test-retest reliability of total RFS scores of three doctors were 0.860, 0.800 and 0.837 respectively, P all <0.001. The test-retest reliability of each item scores for doctor A were from 0.662 to 1.000, doctor B were from 0.486 to 1.000 and doctor C were from 0.613 to 1.000. There were no differences in the total RFS scores comparing among each evaluation of the three doctors (χ(2) = 1.553, P = 0.907). Total RFS scores more than 7 were considered as abnormal. The interobsever consistency was as follows: A with B was 83.6% (κ = 0.617, P = 0.000), A with C was 85.5% (κ = 0.644, P = 0.000),B with C was 89.1% (κ = 0.720, P = 0.000). The intraobserver consistency was 91.8% (κ = 0.807, P = 0.000), 81.8% (κ = 0.534, P = 0.000), 90.9% (κ = 0.741, P = 0.000) respectively. CONCLUSIONS: The result of this study shows that the assessment of RFS is not influenced by different educational backgrounds and clinical experience.RFS can be applied widely in China.

[Habituation of seasickness in adult during a long voyage].

OBJECTIVE: To observe the habituation of seasickness in non marine subjects during a long voyage. METHODS: A crew of 106 staffs of the Hospital Ship Ark Peace was included in this study. There were 59 male and 47 female with an age ranged from 23 to 53 years (mean 37.2 years). They all took part in the Mission Harmony 2011 for medical service in four countries around the Caribbean Sea. Questionnaires and visual analogue scales (VAS) were used to investigate the prevalence and degree of the seasickness in different periods. RESULTS: The prevalence of seasickness was 72.64% in the initial period of voyage. The prevalence and degree of seasickness in female and in staff with motion sickness history were higher and more severe than that in male and in staff without motion sickness history(P < 0.05). After two weeks, the prevalence and degree of seasickness decreased, which meant habituation of seasickness occurred. With the voyage going longer, the prevalence and degree of seasickness were further decreased, but the severe sea condition make the prevalence and degree of seasickness worse. The rate of habituation of seasickness was 62.33%, and the habituation rate of seasickness in male (76.92%) was higher than that in female (47.37%) (χ(2) = 7.161, P = 0.007). CONCLUSIONS: The habituation of the seasickness occurred after two weeks in a long voyage. Male are easier to get habituation of seasickness than female. The severe sea condition influences the prevalence and degree of seasickness.

[Relationship between obstructive sleep apnea-hypopnea syndrome and hypertension].

OBJECTIVE: To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and hypertension. METHODS: There were 1149 middle aged patients who were suspected to have OSAHS underwent polysomnography (PSG) from Jan, 1999 to June, 2011. The age of the patients ranged from 45 to 65 years. The patients were divided into 10 groups according to sleep apnea hypopnea index (AHI), group 1: AHI < 5; group 2: 5 ≤ AHI < 15; group 3: 15 ≤ AHI < 30; group 4: 30 ≤ AHI < 40; group 5: 40 ≤ AHI < 50; group 6: 50 ≤ AHI < 60; group 7: 60 ≤ AHI < 70; group 8: 70 ≤ AHI < 80; group 9: 80 ≤ AHI < 90; group 10: AHI ≥ 90. The incidence of hypertension in each group was tested using crosstabs method. The correlation between AHI, lowest oxygen saturation (LSaO2), age, body mass index (BMI) and hypertension were analyzed. RESULTS: Among 1149 suspected OSAHS patients, 1004 were diagnosed as OSAHS by PSG. There were positive correlation between AHI and diastolic, systolic blood pressure (r were 0.239 and 0.305, respectively, P < 0.01). AHI was independent risk factor of hypertension (P < 0.001). No statistically significant difference in the incidence of hypertension was found among group 1 and group 2, 3, group 4 and group 5, group 6 to group 10 (χ(2) were 3.821, 0.005 and 1.325, P > 0.05, respectively). There was significant difference in the incidence of hypertension among group 4 and group 1, 2, 3, group 5 and group 6 (χ(2) were 2.615 and 4.300, P < 0.05, respectively). There were two cutoff points at the AHI of 30 and 50. CONCLUSION: With OSAHS exacerbations, the incidence of hypertension was significantly increased.

[Measurement of objective parameters associated with pharyngeal swallowing function in Chinese adults].

OBJECTIVE: To obtain a series of objective criteria associated with pharyngeal swallowing function using dynamic swallow study in Chinese adults. METHODS: Dynamic videofluoroscopic swallow studies were performed on 80 normal adult volunteers. There were 40 males and 40 females aged from 20 to 60 years old. Measurement software Avidemux 2.5 and Image J were used to measure the objective parameters which were closely related to the pharyngeal swallowing function in the swallowing process, such as maximum displacement of the hyoid bone (HmaxD), pharyngeal transit time (PTT), pharyngeal constriction ratio(PCR), and maximum opening of the esophageal entrance (EEmax). RESULTS: In the 80 adults, the HmaxD, PTT, PCR, and EEmax were (1.91 ± 0.48) cm (x(-) ± s), (0.82 ± 0.15) s, 94.9% ± 3.41%, and (0.91 ± 0.05) cm respectively. The HmaxD of the male (2.04 ± 0.46) cm was significantly larger than that of the female (1.78 ± 0.47) cm (t = 2.44, P = 0.017), but the PTT, PCR, and EEmax had no significant difference between different gender and age groups (P > 0.05). CONCLUSIONS: Objective parameters of the HmaxD, PTT, PCR, and EEmax during swallowing are obtained in Chinese adults. These data are important for assessment of the swallow function and these data provide a foundation for further research on assessment of swallowing function in Chinese.

[Morphology of cricopharyngeal muscle under suspension laryngeal endoscope].

OBJECTIVE: To observe the morphologic features of cricopharyngeal muscle (CPM) under suspension laryngeal endoscope. METHODS: This prospective study was conducted on a series of 100 consecutive patients who undergone endoscopic microlaryngeal surgery with intubation general anesthesia. The suspension laryngoscope was introduced down to postcricoid area approaching esophageal inlet. By lifting the larynx with the laryngoscope, the mucosa-covered cricopharyngeal muscle was easily identified as the mound of tissue just at the posterior pharyngeal wall. The image of cricopharyngeal muscle under the laryngoscope was saved. RESULTS: In 94 out of 100 patients, CPM could be visualized with laryngoscope. In the other 6 patients, both CPM and glottic could not be exposed because of cervical vertebra stiffness and obesity. According to the image of CPM under the laryngoscope, the shape of the CPM was divided into three types. It was named for flat type in which there was no mound of tissue visible at the posterior pharyngeal wall and esophageal cavity could be visible completely, semi-bar type in which there was a bar at the posterior pharyngeal wall and partial esophageal cavity could be visible and full-bar type in which the bar contact esophageal anterior wall and esophageal cavity could not be visible. There were 14(14.9%) patients as flat type, 59(62.8%) as semi-bar type and 21(22.3%) as full-bar type. No significant difference was found between adults group and the aged (≥ 65 years old) group (χ(2) = 1.224, P = 0.747) and reflux associated group and non-reflux associated group respectively (χ(2) = 5.252, P = 0.072). CONCLUSIONS: The CPM could be well exposed in most of the patients with suspension laryngeal endoscope. It provides anatomy basis for endoscopic cricopharyngeal myotomy.

[Reliability and validity of the simplified Chinese version of Epworth sleepiness scale].

OBJECTIVE: To investigate the reliability and validity of the simplified Chinese version of Epworth sleepiness scale(ESS). METHODS: Five hundred and eighty-five patients with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and 103 OSAHS patients who underwent operations were included in this study. The ESS was filled before polysomnography (PSG) monitoring under the direction of professional technicians. The patients who underwent operations did both PSG and ESS tests more than 6 months after operation. Fifty-one patients who underwent PSG at our hospital from July to August, 2010 were chosen to assess the ESS test-retest reliability on two separate occasions at least more than one week. RESULTS: The total Cronbach's Alpha of ESS was 0.814. The test-retest reliability of ESS total scores was 0.679 and for each item was from 0.473 to 0.698(P < 0.01). Split-half reliability was 0.817 (P < 0.01). In the analysis of discriminant validity with apnea hypopnea index (AHI), the ESS total scores and each item's scores had significant differences in severity in OSAHS patients and simple snoring patients (P < 0.05), and this was also true in different degrees of lowest saturation of arterial oxygen (LSaO(2)) patients and normal LSaO(2) patients (P < 0.05). The factor analysis of construct validity showed that 4 factors were extracted. The cumulative proportion was 74.270%. The loading was higher than 0.4 among every item. The correlation coefficiency of overall ESS scores and each item's scores was relatively high except the last item. The ESS had low consistency with clinical diagnosis(κ = 0.099, P < 0.01) and the predictive validity was not good (r = 0.138, P < 0.01).As for 103 patients who had operations, the initial assessment of total ESS scores were 15.0[10;20] (M[P(25); P(75)]), and improved to 4[1;6] after operation. The patients who got effective results had significant difference in the total ESS scores before and after operation (Z = -7.528, P < 0.01), so was the patients who got ineffective results (Z = -4.382, P < 0.01) . CONCLUSIONS: The simplified Chinese version of ESS had a good reliability and validity. It can be used to evaluate the chance of dozing in the daytime.

[Electronic laryngoscope for transnasal esophageal examination].

OBJECTIVE: To evaluate the value of electronic laryngoscope for transnasal esophagoscopy. METHODS: The electronic laryngoscope was used for transnasal esophagoscopy in 50 patients from June 2009 to June 2011 in our department. There were 32 males and 18 females with their age ranged from 16-88 years (mean 53.8 years). Before esophagoscopy, 1% ephedrine-dicaine mixture was sprayed into the nasal and pharyngeal cavities for topical anesthesia. The esophagoscopy was used for screening examination in the patients with reflux, globus sensation, dysphagia, head and neck cancer, suspected foreign body, and vocal cord paralysis, etc. RESULTS: The transnasal esophagoscopy with electronic laryngoscope was performed successfully in all the patients. Mild nausea and vomiting occurred in 4 patients, but no patient required to stop the examination. Of the 50 patients, 38 patients (76%) had normal findings and 12 patients (24%) had positive findings of the esophagus. Esophageal cancer was diagnosed in one patient, esophageal foreign body in 2 patients, esophageal injury in one patient, candidal esophagitis in 3 patients, esophagitis in 3 patients, and achalasia of the cardia in 2 patients. CONCLUSIONS: The electronic laryngoscope for transnasal esophagoscopy is an alternative to conventional esophagoscopy, which is useful for screening the esophagus in the patients with reflux, globus, dysphagia, head and neck cancer, and suspected foreign body, etc.

[Design of standard voice sample text for subjective auditory perceptual evaluation of voice disorders].

OBJECTIVE: To design a speech voice sample text with all phonemes in Mandarin for subjective auditory perceptual evaluation of voice disorders. METHODS: The principles for design of a speech voice sample text are: The short text should include the 21 initials and 39 finals, this may cover all the phonemes in Mandarin. Also, the short text should have some meanings. RESULTS: A short text was made out. It had 155 Chinese words, and included 21 initials and 38 finals (the final, ê, was not included because it was rarely used in Mandarin). Also, the text covered 17 light tones and one "Erhua". The constituent ratios of the initials and finals presented in this short text were statistically similar as those in Mandarin according to the method of similarity of the sample and population (r = 0.742, P < 0.001 and r = 0.844, P < 0.001, respectively). The constituent ratios of the tones presented in this short text were statistically not similar as those in Mandarin (r = 0.731, P > 0.05). CONCLUSIONS: A speech voice sample text with all phonemes in Mandarin was made out. The constituent ratios of the initials and finals presented in this short text are similar as those in Mandarin. Its value for subjective auditory perceptual evaluation of voice disorders need further study.

[Intraoperative facial nerve monitoring in parotid gland surgery].

OBJECTIVE: To re-evaluate the value and the methods of intraoperative facial nerve monitoring in parotid gland surgery. METHODS: Sixty-five cases received intraoperative facial nerve monitoring in parotidectomy (test group) since 2000 - 2008. The facial nerve was identified through central trunk method (n = 18), branch method (n = 35) and mixed method (n = 12). Most patients accepted general anesthesia by incubation. The operating duration and minimum electronic stimulation threshold values of EMG in evoked facial muscle were recorded. Facial nerve was identified though branch method (n = 44) and no intraoperative facial nerve monitoring was performed in parotidectomy (control group). RESULTS: There were four cases (6.1%) of mild temporary paralysis and no permanent post-operative paralysis of facial nerve in the test group. The average operating duration was 1.8 hour. The minimum reactive electronic stimulation threshold of EMG in evoked facial muscle was 0.08 mA. The range of suitable electronic stimulation threshold of EMG was from 0.2 mA to 1.0 mA. While there were nine cases (20.5%) of mild temporary paralysis and two cases (4.5%) of permanent post-operative paralysis of facial nerve in the control group and the average operating duration was 3.0 hours. CONCLUSION: Intraoperative facial nerve monitoring (IFNM) in parotidectomy can assist a surgeon to confirm and identify the facial nerve and exercise precautions so as to shorten operating duration and prevent potential surgical complications.

[Clinical shapes of vocal cord polyps and their pathological features].

OBJECTIVE: To observe the clinical shapes of vocal cord polyps and their pathological features. METHODS: The laryngoscopic photographs of 156 patients with vocal cord polyps were reviewed. All patients received phonomicrosurgery. Eighty eight males and 68 females were included. Their ages ranged from 14 to 76 years (median 43.0 years). The clinical courses of the diseases were 1 to 132 months (median 6.5 months). There were 57 cases with right vocal cord polyps, 61 cases with left vocal cord polyps, 38 cases with bilateral vocal cord polyps. The vocal cord polyps with pedicles were found in 27 cases, without pedicles in 129 cases. The specimens of the vocal cord polyps were fixed in formalin solution and embedded in paraffin. Sections were cut, stained with HE method, and observed under light microscope. RESULTS: The vocal cord polyps were classified into 5 types according to the clinical shapes of vocal cord polyps and their pathological features: edematous type in 70 cases (44.9%), vascular type in 49 cases (31.4%), fibrous type in 15 cases (9.6%), hemorrhagic or thrombotic type in 13 cases (8.3%), and amyloid type in 9 cases (5.8%). The clinical courses among the five types of vocal cord polyps had no statistic significance (P > 0.05). CONCLUSIONS: The classification of the vocal cord polyp according to the clinical shapes of vocal cord polyps has clinical significance for the treatment. Some vocal cord polyps of edematous type, vascular type and hemorrhagic type can be cured with voice therapy. The vocal cord polyps of fibrous type and amyloid type need treatment with phonomicrosurgery. The differentiation diagnosis between amyloid type vocal cord polyps and vocal cord carcinoma should be made.

[Value of Epworth sleepiness scale in assessment the degree of sleep disordered breathing].

OBJECTIVE: To study the value of Epworth sleepiness scale in assessment of obstructive sleep apnea hypopnea syndrome (OSAHS) severity. METHODS: The polysomnography (PSG) data of 620 suspected OSAHS patients from Jan. 2000 to Dec. 2003 were retrospectively analyzed. There were 556 males and 64 females, and their age ranged from 21 to 79 years (median 45.0 years). Of the all 620 patients, the median of the weight was 82.0 kg ( range 50 to 130 kg), median of height was 172.0 cm (range 147 to 178 cm), median of body mass index was 28.0 (range 18.5 to 42.9), median of apnea-hypopnea index (AHI) was 37.2 (range 0 to 126.1), median of lowest arterial oxygen saturation (LSAT) was 0.75 (range 0.21 to 0.93), median of ESS was 13.0 (range 0 to 24). OSAHS was diagnosed in 513 patients and simple snorer was diagnosed in 107 patients by PSG. All the patients filled in ESS questionnaire in sleep disorder centre before PSG. RESULTS: The correlation coefficients of the ESS and AHI, LSAT was -0.314 and -0.312 respectively (P <0. 05). The median of ESS in severe OSAHS group was higher than that in simple snorer, mild and moderate OSAHS groups (P < 0.001), but no difference was found among the simple snorer, mild and moderate OSAHS groups (P < 0.05). The median of ESS in severe hypoxemia group was higher than that in no, mild and moderate hypoxemia groups (P < 0.001), but no difference was found among no, mild and moderate hypoxemia groups (P > 0.05). CONCLUSIONS: The Epworth sleepiness scale has little value in assessment of OSAHS severity. A new sleepiness scale method which is suitable for Chinese should be made.

[Varices of the vocal cord: report of 21 cases].

OBJECTIVE: To study the diagnosis and treatment of varices of the vocal cord. METHODS: The clinical data of 21 cases with varix of vocal cord were analyzed. All the patients presented hoarseness. There were 15 female and 6 male cases with their ages ranged from 23 to 68 years (median 44 years old). The varix was found on the right vocal cord in 12 cases, on the left vocal cord in 9 cases. Isolated varix existed on the vocal cord in 10 cases, varix with vocal cord polyps or nodules in 10 cases, varix with vocal cord paralysis in 1 case. RESULTS: All the patients were diagnosed under the laryngovideoscopy. The lesions appeared on the superior surface of the vocal cord. Varices manifested as abnormally dilated capillary running in the anterior to posterior direction in 6 cases, as clusters of capillary in 3 cases, as a dot or small sheet or short line of capillary in 12 cases. The varices were disappeared in 2 of 8 cases with vocal cord varices and polyps after removed the polyps. The varices of others patients had no change after following up for more than 6 months, but one patient happened hemorrhage of the contralateral vocal cord. CONCLUSIONS: Varices are most commonly seen in female. Laryngovideoscopy is the key in determining the vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization.

[Clinical value of TS90% in evaluation of hypoxemia in patients with obstructive sleep apnea/hypoventilation syndrome].

OBJECTIVE: To explore the appropriate study how to properly evaluate the hypoxemia degree in patients with obstructive sleep apnea/hypoventilation syndrome (OSAHS). METHODS: polysomnography was conducted on 108 OSAHS patients and 37 simple snorers to record the minimum oxygen saturation level (MiO(2)) and the total recorded time spent below 90% oxygen saturation (TS90%). The correlation between MiO(2) and the percent of the total recorded time spent below 90% oxygen saturation (TS90%) with the AHI were calculated. RESULTS: The value of TS90% was significantly increased, and the value of MiO(2) was significantly decreased as the severity of OSAHS increased (all P < 0.001). The correlation coefficients of TS90% with AHI and with Epworth sleepiness scale (ESS) were both much higher than those of MiO(2). CONCLUSION: TS90% can express the severity of hypoxemia of the OSAHS patients more correctly than MiO(2). TS90% combined with MiO(2) can comprehensively and objectively reflect the severity of hypoxia of the OSAHS patients.