[Expression of heme oxygenase-1 in nasal polyps and regulation by glucocorticoid].

OBJECTIVE: To evaluate the expression and possible modulation of heme oxygenase-1 (HO-1) in nasal polyps of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: Nasal polyps and uncinate process tissues were collected from 25 CRSwNP patients and 19 healthy controls with nasal septal deviation. HO-1 expression was examined using qRT-PCR, immunohistochemistric staining and Western blot analysis. Moreover, additional uncinate process mucosal samples of 15 healthy controls with nasal septal deviation were harvested for nasal explant culture experiments. HO-1 expression was measured in cultured nasal explant in response to specific inflammatory and glucocorticoid stimulation. SPSS 20.0 software was used to analyze the data. RESULTS: The mRNA and protein expression of HO-1 was significantly increased in polyp tissues, 1.220±0.397 in mRNA and 1.409±0.701 in protein, compared with healthy controls 0.464±0.318 in mRNA and 0.017±0.1147 in protein (U=22.00 in mRNA and U=1.00 in protein, both P< 0.05). The immunohistochemical results showed that HO-1 was mainly distributed in the epithelial layer, submucosal glands and inflammatory cells in nasal tissues. Nasal explant culture experiments demonstrated that HO-1 mRNA was upregulated by IL-17A. The HO-1 mRNA level before the stimulation was 1.000, and 17.264±4.275 after the stimulation of 1 ng/ml IL-17A (U=0, P<0.05), 19.128±4.605 after the stimulation of 10 ng/ml IL-17A (U=0, P<0.05), but was significantly suppressed after stimulation with glucocorticoids (dexamethasone, DEX). The mRNA level after the glucocorticoids stimulation was 0.370±0.101 (U=0, P<0.05) and 0.316±0.167 (U=0, P<0.05) respectively. Furthermore, the HO-1 mRNA was inhibited by TGF-ß1, the mRNA level was 0.217±0.322 (U=0, P<0.05), 0.070±0.070 (U=0, P<0.05), respectively. CONCLUSION: Increased HO-1 expression may play a role in the pathogenesis of CRSwNP, which may be considered as the therapeutic target.

[Application of computer assisted navigation system in endoscopic sinus and skull base surgery].

OBJECTIVE: To evaluate the applicative value of computer assisted navigation system in endoscopic sinus and skull base surgery. METHOD: Forty-nine endoscopic surgery procedures were performed with the help of computer assisted navigation system, among which there were 25 cases of recurrent sinusitis and nasal polyps, 9 cases of nasal and sinus tumour, 7 cases of cerebrospinal fluid rhinorrhea, 2 cases of meningoencephalocele, 4 cases of congenital choanal atresia, 1 case of pituitary tumor and 1 case of foreign body in middle cranial fossa. RESULT: The preoperative time was 5-13 minutes for preparation, 7 minutes in average. The target error was less than or equal to 1.5 mm. All the 49 cases had successful surgery without complications. CONCLUSION: Computer assisted navigation system can help the surgeon to determine the sinus, skull base and adjacent anatomic landmarks correctly, improve surgical accuracy and safety, and reduce intraoperative and postoperative complications.

[Application value of dual-source CT in the diagnosis of suspicious airway foreign bodies in children].

OBJECTIVE: To evaluate the clinical value of dual-source computer tomography in the diagnosis of suspicious airway foreign bodies in children. METHOD: Twenty-two children of suspicious airway foreign bodies were examined by DSCT. The original scanning data were reconstructed with MPR, MinP, CTVE and VR. The results were compared with surgical findings. RESULT: The position, size, shape and accompanying signs of foreign bodies were clearly demonstrated by DSCT. Twenty cases were diagnosed as foreign bodies in the airway by DSCT. Nineteen cases were confirmed as foreign bodies. Purulent discharge was found by bronchoscopy in 1 case. The rate of conformed diagnosis was 95%. CONCLUSION: DSCT can demonstrate the foreign body clearly and play an important role in the diagnosis of suspicious airway foreign body in children.

[Intratympanic dexamethasone medication for sudden sensorineural hearing loss: clinical evaluation].

OBJECTIVE: To investigate clinical efficacy of intratympanic dexamethasone injection for sudden sensorineural hearing loss. METHOD: Subjects received an course of at least 7-day dexamethasone [5 g/(L x d)] intratympanic injection. Pure-tone averages (PTA) calculated using air conduction thresholds at 4 -frequencies (500, 1000, 2000, 4000 Hz) at pre-injection and post-injection were compared. The change in PTA greater than 10 dB HL was considered to be effective. RESULT: PTA at pre-injection and post-injection were (65.65 +/- 24.73) dB HL and (50.25 +/- 25.59)dB HL respectively in 21 patients with sudden sensorineural hearing loss. There was significant improvement in PTA (P < 0.01). Improvement in hearing was found in 47.6% patients. Promising results of intratympanic dexamethasone medication were found in cases with shorter duration or/and without vertigo. No unexpected adverse events such as otitis media or perforated tympanic membrane or worsening in hearing occurred during the injection or follow-up period. CONCLUSION: Intratympanic dexamethasone medication can be beneficial in treating patient with sudden sensorineural hearing loss. Duration and vertigo are two important factors for prognosis.

[Clinical analysis of 68 patients with obstructive sleep-disordered breathing in children].

OBJECTIVE: To explore the clinical features and the diagnosis and the treatment of pediatric obstructive sleep-disordered breathing. METHOD: Sixty- disordered breathing. METHOD: Sixty eight cases with obstructive sleep-disordered breathing were reviewed including clinical features and cephalometric analysis and endoscopic examination, 46 of all them were study of polysomnography. RESULT: Forty-six cases were examined with polysomnography in preoperative. AHI 0.1 approximately 24.0 times/hour. Follow-up 3 months to 1.5 year, 68 patients were performed with adenotonsillectomy, upper airway obstruction caused by adenotonsillar hypertrophy were enlarged remarkably. Fifty-six cases main symptoms (snoring, mouth breathing and apnea) disappeared completely, nine cases were relief, 3 cases were reappear. Eleven cases (16 ears) of secretory otitis media after insert plastic tube into tympanum and 9 cases chronic sinusitis were relief. CONCLUSION: Upper airway obstruction caused by adenotonsillar hypertrophy were major reasons to lead to pediatric obstructive sleep-disordered breathing. The diagnosis and treatment must be combined clinical features with all kinds of examinations (cephalometric, endoscopic, polysomnography). Tonsillectomy and/or adenoidectomy with soft-tissue shavers were safe and effective in treatment of OSAHS children.

[Surgical management of Mondini dysplasia with cerebrospinal fluid leakage].

OBJECTIVE: To evaluate the clinical manifestation and surgical technique of Mondini dysplasia with cerebrospinal fluid (CSF) leakage. METHOD: Three Mondini dysplasia with spontaneous cerebrospinal fluid leakage were treated by the authors. A transcanal tympanotomy were used to pack the vestibular cavity with muscle. RESULT: Three children were first manifested with recurrent meningitis and spontaneous cerebrospinal fluid rhinorrhea. Further examinations found that the leakages were otogenic. One side or both sides Mondini dysplasia were confirmed by CT scanning of temporal bones. The leakages were all stopped by the primary surgical closure. CONCLUSION: Mondini dysplasia should be considered in children with spantaneous cerebrospinal fluid otorhinorrhea. A temporal bone CT scan can confirmed the diagnosis. A transtympanic closure is very effective in the management.