Endobronchial Therapy With Gentamicin and Dexamethasone After Airway Clearance by Bronchoscopy in Exacerbation of Non-Cystic Fibrosis Bronchiectasis: A Real-World Observational Study.

Background: The exacerbation of non-cystic fibrosis bronchiectasis (NCFB) may lead to poor prognosis. The objective of this study was to retrospectively analyze the clinical efficacy and safety of endobronchial therapy with gentamicin and dexamethasone after airway clearance by bronchoscopy in the exacerbation of NCFB. Methods: We retrospectively reviewed 2,156 patients with NCFB between January 2015 and June 2016 and 367 consecutive patients with exacerbation of bronchiectasis who had complete data and underwent airway clearance (AC) by bronchoscopy. The final cohort included 181 cases of intratracheal instillation with gentamicin and dexamethasone after AC (a group with airway drugs named the drug group) and 186 cases of AC only (a group without airway drugs named the control group). The last follow-up was on June 30, 2017. Results: The total cough score and the total symptom score in the drug group were improved compared to those in the control group during 3 months after discharge (p < 0.001). Re-examination of chest HRCT within 4-6 months after discharge revealed that the improvements of peribronchial thickening, the extent of mucous plugging, and the Bhalla score were all significantly improved in the drug group. Moreover, the re-exacerbations in the drug group were significantly decreased within 1 year after discharge. Univariate analysis showed a highly significant prolongation of the time to first re-exacerbation in bronchiectasis due to treatment with airway drugs compared with that of the control group. Multivariate Cox regression analysis showed that the risk of first re-exacerbation in the drug group decreased by 29.7% compared with that of the control group. Conclusion: Endobronchial therapy with gentamicin and dexamethasone after AC by bronchoscopy is a safe and effective method for treating NCFB.

[Efficacy of semicircular canal occlusion in the treatment of fifteen pateints with Meniere's disease].

Objective:To investigate the long-term efficacy of semicircular canal occlusion in the treatment of refractory Meniere's disease. Method:Fifteen patients with Meniere's disease who underwent semicircular canal occlusion were reviewed. The preoperative and postoperative frequency of vertigo ,quality of life, hearing and tinnitus level were compared. All patients were followed for more than 24 months. Result:Postoperatively, vertigo was controlled effectively in all 15 cases, and the control rate was 100%, of which 11 cases were completely controlled（Grade A） and 4 cases were basically controlled（Grade B）. The improvement rate of quality of life was 100%. The hearing worse in 4 cases（26.7%） and stabilized in 11 cases（73.3%）. The tinnitus was relieved in 7 cases（46.7%）, unchanged in 7 cases（46.7%） and aggravated in 1 case（6.7%）. Conclusion:Semicircular canal occlusion can effectively control the vertigo symptoms of refractory Meniere's disease and improve the quality of life. The long-term efficacy of semicircular canal occlusion is definite, but there is a risk of hearing loss.

Benign paroxysmal positional vertigo secondary to laparoscopic surgery.

OBJECTIVES: Benign paroxysmal positional vertigo is a common vestibular disorder and it may be idiopathic or secondary to some conditions such as surgery, but rare following laparoscopic surgery. METHODS: We report two cases of benign paroxysmal positional vertigo secondary to laparoscopic surgery, one after laparoscopic cholecystectomy in a 51-year-old man and another following laparoscopic hysterectomy in a 60-year-old woman. RESULTS: Both patients were treated successfully with manual or device-assisted canalith repositioning maneuvers, with no recurrence on the follow-up of 6 -18 months. CONCLUSIONS: Benign paroxysmal positional vertigo is a rare but possible complication of laparoscopic surgery. Both manual and device-assisted repositioning maneuvers are effective treatments for this condition, with good efficacy and prognosis.

[Study of clinical characteristics and curative effects of sudden hearing loss patients with vertigo].

OBJECTIVE: To analyze the clinical characteristics, prognosis and therapeutic effects of sudden sensorineural hearing loss (SSHL) patients associated with vertigo, and to investigate the strategy of diagnosis and treatment. METHODS: We retrospectively analyzed the clinical characteristics of 240 patients diagnosed as SSHL with vertigo, who were treated in the Chinese PLA General Hospital from July 2008 to August 2012. Various factors affecting the therapeutic effects were analyzed, such as audiological features, vestibular function tests, genders, audiograms, lasting before seeing a doctor, courses of vertigo and vascular factors. RESULT: Among the contemporaneous SSHL patients (873 cases), the cases with vertigo accounted for 27.49% (240/873). Among the 240 patients with vertigo, the cases with different hearing impaired degree of mild, moderate, severe and profound were 30, 13, 28 and 34, respectively, primarily by the profound cases. Detailed vestibular function tests were performed in 97 patients, with 54 cases having unilateral vestibular disfunction and 43 patients having normal vestibular function, among which 23 cases were diagnosed as benign paroxymal positional vertigo (BBPV). The relationship between vestibular function and different hearing impaired degrees or various audiogram types had no statistically significant difference. 219 cases had detailed records of the onset time of cochlear and vestibular symptoms, including 122 patients with cochlear symptoms and dizziness occurring simultaneously. After standardized drug treatment, the total effective rate was 46.67%, with recovery in 17 cases, excellent in 34 cases, better in 61 cases and poor in 128 cases, respectively. Statistical analysis showed that different genders, audiogram types, vertigo courses of time, the results of vestibular function and neck vascular ultrasounds were not related to the curative effects, while, the treatment time after onset was significantly associated with treatment effects. CONCLUSIONS: SSHL with vertigo has a high incidence, primarily single side affected, with relatively severe hearing impairment, and total deafness and downslope hearing curve mainly. Vestibular function can be normal or low in SSHL patients with vertigo, with a higher incidence of BPPV. Vestibular and cochlear symptoms occur simultaneously in more than half of the patients. The detection rate of vestibular dysfunction gradually increased, as the degree of hearing loss increased, without statistical significance although. The therapeutic effects of sudden hearing loss with vertigo cases have no relationship with dizziness duration or vestibular function, while the disease course plays an important role in treatment.

Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo.

OBJECTIVE: To evaluate the short-term efficacy of computer-controlled and modified roll maneuver (CMRM) versus conventional roll maneuver (RM) for treatment of geotropic lateral canal benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Prospective case-controlled study. SETTING: Academic hospital. PATIENTS: One hundred consecutive patients diagnosed as having unilateral idiopathic geotropic lateral canal BPPV with a duration of symptoms of less than 2 weeks. INTERVENTIONS: Fifty-two patients (aged 32-80 yr; mean, 55.9 yr; 18 men and 34 women) were treated with CMRM that was composed of three sequential 360-degree rotations and 48 patients (aged 30-71 yr; mean, 52.4 yr; 20 men and 28 women) treated with RM that consisted of one 360-degree rotation. MAIN OUTCOME MEASURES: Resolution of vertigo on the supine roll test at 48 hours after initial maneuver and the number of maneuvers required for final resolution of vertigo were main outcome measures to assess the efficacy of treatment. RESULTS: On the supine roll test at 48-hour follow-up after initial maneuver, 44 (84.6%) of 52 CMRM-treated patients and 23 (54.2%) of 48 RM-treated patients had resolution of vertigo (p < 0.01). All patients obtained final resolution of vertigo with a maximum of five maneuvers in each group, but the CMRM group had less mean number of maneuvers required for final resolution of vertigo compared with the RM group (1.23 ± 0.39 versus 1.63 ± 0.68, p < 0.05). No significant adverse effects and complications occurred aside from two patients with conversion into posterior canal BPPV in each treatment. CONCLUSION: The CMRM consisting of three sequential 360-degree rotations for geotropic lateral canal BPPV has a higher initial success rate compared with the conventional RM consisting of one 360-degree rotation.

Relationship between nutritional risk and exercise capacity in severe chronic obstructive pulmonary disease in male patients.

OBJECTIVE: The nutritional status of chronic obstructive pulmonary disease (COPD) patients is associated with their exercise capacity. In the present study, we have explored the relationship between nutritional risk and exercise capacity in severe male COPD patients. METHODS: A total of 58 severe COPD male patients were enrolled in this study. The patients were assigned to no nutritional risk group (n=33) and nutritional risk group (n=25) according to the Nutritional Risk Screening (NRS, 2002) criteria. Blood gas analysis, conventional pulmonary function testing, and cardiopulmonary exercise testing were performed on all the patients. RESULTS: Results showed that the weight and BMI of the patients in the nutritional risk group were significantly lower than in the no nutritional risk group (P<0.05). The pulmonary diffusing capacity for carbon monoxide of the no nutritional risk group was significantly higher than that of the nutritional risk group (P<0.05). Besides, the peak VO2 (peak oxygen uptake), peak O2 pulse (peak oxygen pulse), and peak load of the nutritional risk group were significantly lower than those of the no nutritional risk group (P<0.05) and there were significantly negative correlations between the NRS score and peak VO2, peak O2 pulse, or peak load (r<0, P<0.05). CONCLUSION: The association between exercise capacity and nutritional risk based on NRS 2002 in severe COPD male patients is supported by these results of this study.

[Cinical and genetic characteristics of familial Meniere's disease: three families report].

OBJECTIVE: To investigate the clinical and genetic characteristics of three Chinese Meniere's disease (MD) families and decipher the mechanism of MD further. METHODS: Personal and family medical evidence of hearing loss, vestibular symptoms, and other clinical abnormalities of the participants were identified, clinical and genetic features were analyzed. Targeted 307 genes capture and high-throughput sequencing were performed on the two ascertained members of family 1007184. RESULTS: Eight patients from these three families showed post-lingual sensorineural hearing loss, six women and two men were involved. Age of onset in these affected members concentrated in the middle age, with the average age of 39.3 years old. Among them, patients from 1407278 were accompanied by migraine. All of the three probands presented as recurrent vertigo firstly, and then fluctuated hearing loss showed up, accompanying by tinnitus and ear fullness feeling. The hearing loss manifested as late-onset, low frequency-involved pattern, with subsequent gradual progression from moderate to severe level. Some of the patients progressed to severe level involving all frequencies at higher ages. In addition, most of the cases showed revitalization. Four cases received vestibular function tests, three of which had varying dysfunction of vestibular function, while the other one had normal vestibular function. Patients who had abnormal vestibular function showed much more severe hearing impairment. The three-generation family 1007193 had an autosomal recessive genetic characteristics, family 1007184 showed autosomal dominant inheritance of characteristics, family 1407278 were either autosomal dominant or X-linked dominant pattern. Through target genes capture high-throughput sequencing technology, we identified two candidate variants in the two members of family 1007184, named c. 2057G>A in EGFLAM and c. 1961C>T in ITGA8. CONCLUSION: Meniere's disease has some genetic and familial aggregation in Chinese population, but its complex genetic pathogenic mechanisms need further study.

Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo.

OBJECTIVES/HYPOTHESIS: To evaluate the short-term efficacy of the computer-controlled canalith repositioning procedure (CRP) for treatment of posterior canal benign paroxysmal positional vertigo (BPPV) compared with the current standard CRP. STUDY DESIGN: Prospective case series. METHODS: One hundred thirty-two patients diagnosed as having idiopathic posterior canal BPPV, with an age range of 28 to 86 years (mean 56 years), 47 men and 85 women, were treated with computer-controlled CRP mimicking the Epley maneuver. Resolution of vertigo and nystagmus on the Dix-Hallpike test at 1-week follow-up after treatment was the main outcome measure to assess the efficacy of treatment. RESULTS: At 1-week follow-up after treatment with computer-controlled CRP, 108 (81.8%) of 132 patients had complete resolution of vertigo and nystagmus, nine (6.8%) had resolution of vertigo but presence of nystagmus, and 15 (11.4%) had provoked vertigo and nystagmus on the Dix-Hallpike test. The 81.8% success rate was comparable to those who received current standard CRP treatment in randomized controlled trials at about 80%. No significant adverse effects or complications occurred in the patients treated with computer-controlled CRP, aside from two patients (1.5%) with conversion into lateral canal BPPV. CONCLUSIONS: Computer-controlled CRP is effective for the treatment of posterior canal BPPV, with a success rate similar to those treated with the Epley maneuver, and is safe and easy to perform on patients.

[Anatomical measurements and clinical applications through facial recess approach].

OBJECTIVE: To provide the anatomic data for the correlated otologic microsurgery by the microdissection of temporal bone through facial recess approach. METHOD: Sixteen human temporal bones of eight adult cadaveric heads were dissected under surgical microscope through facial recess approach, and the relative anatomic structures were observed and measured, such as the bony entrance of facial recess approach, facial nerve, stapes, round window, round window niche, pyramidal eminence, cochleariform process, etc. The data were analyzed statistically. RESULT: The width of the bony entrance of facial recess approach was (2.94 +/- 0.32) mm, the height was (8.83 +/- 0.84) mm, the depth was (3.51 +/- 0.17) mm. The distances from stapes to tympanic segment of facial nerve, mastoid segment of facial nerve, round window, cochleariform process and anterior ligament of malleus were (1.38 +/- 0.21) mm, (6.94 +/- 0.47) mm, (3.60 +/- 0.55)mm, (2.23 +/- 0.33)mm, (4.93 +/- 0.61) mm, respectively. The distances from pyramidal eminence to tympanic segment of facial nerve, mastoid segment of facial nerve, round window, round window niche and cochleariform process were (1.05 +/- 0.09) mm, (5.63 +/- 0.41) mm, (3.01 +/- 0.34) mm, (3.29 +/- 0.44) mm, (4.13 +/- 0.51) mm, respectively. The distances from round window to cochleariform process and tympanic segment of facial nerve were (5.11 +/- 0.61) mm and (3.97 +/- 0.61) mm. The distances from round window niche to tympanic segment of facial nerve and mastoid segment of facial nerve were (4.13 +/- 0.38) mm and (7.28 +/- 0.29) mm. CONCLUSION: The facial recess approach played an important role in modern otologic microsurgery. The position of anatomical structure was constant relatively, including short crus of incus, stapes, pyramidal eminence and cochleariform process, etc. These could be used as reference marks for otologic microsurgery.

[Clinical characteristics and surgical management of extensive cholesteatoma of external auditory canal].

OBJECTIVE: To classify the external auditory canal cholesteatoma(EACC) by high-resolution temporal bone CT scans and the clinical findings of the patients, and to discuss the clinical and imaging characteristics and the surgical management of the extensive EACC. METHOD: A retrospective study was carried out among 56 patients (58 ears) with EACC and their clinical data were carefully analyzed. We classified EACC as the extensive type and the localized type. The operation strategy depended on the extent of lesion. All cases were followed up for 1 to 6 years after surgery. RESULT: There were 31 patients with localized EACC, 2 with no bone erosion and 29 (31 ears) with bone erosion within external auditory canal, and 25 patients with extensive EACC, 16 with bone erosion of intra temporal bone and 9 with bone erosion of extra temporal bone. Among all the 25 patients with the extensive type, the most common symptoms were otorrhea, otalgia and hearing loss, with 25, 23, 22 cases, respectively. The tympanic membrane (TM) was intact in 23 patients and perforated in two. The mastoid air cells in 23 patients were involved by the lesion, as well as tympanic antrum in eight, tympanic cavity in two, sigmoid sinus bony wall in five, mastoid segment of facial canal in four, and temporomandibular joint in two patients. Twenty patients underwent modified radical mastoidectomy, only one underwent reconstruction of ossicular chain, and four underwent canaloplasty. The average time of ear dry after surgery was 29 days. The postoperative hearing was improved by an average of 15 dB. No recurrence except for one patient was found during the follow-up period. CONCLUSION: It was of important clinical significance to classify EACC as the extensive type and the localized type. The extensive EACC was misdiagnosed easily because of the complicated clinical manifestations. The classification was helpful for the diagnosis and the selection of surgery strategy of EACC.

[Clinical analysis of bilateral same-day myringoplasty for 22 cases with bilateral tympanic membrane perforation].

OBJECTIVE: To investigate the feasibility of bilateral same-day myringoplasty and the indications for myringoplasty for patients with bilateral tympanic membrane perforation, and to summarize relevant experience. METHODS: Twenty-two patients underwent bilateral same-day underlay myringoplasty, and all cases were consistent with the indications for myringoplasty. The preoperative hearing and postoperative hearing at three months were compared, and the postoperative symptoms and complications were observed. Forty patients underwent monaural myringoplasty as the control group over the same period. All cases were followed up for 1 - 3 years. RESULTS: The postoperative hearing was increased by an average of 18 dB, and the rate of closure of tympanic membrane perforation was 93.2% (41/44). There were seven patients with ear fullness after operation in the bilateral myringoplasty group and two patients in the control group (χ(2) = 4.5374, P = 0.0332). There were no differences in the postoperative hearing improvement, the rate of closure and the rates of other discomfort symptoms except for ear fullness between the two groups (P > 0.05). CONCLUSION: It was feasible and safe to perform bilateral same-day myringoplasty for bilateral tympanic membrane perforation, but the postoperative temporary discomfort of bilateral ear fullness should be informed the patients in advance.

[Functional analysis of the vertical semicircular canal using vertical plane swing test and study of its normal values].

OBJECTIVE: The purpose of this study was to set up a method to analyze the vertical semicircular canal function and study the normal values of the vertical semicircular canal function using the vertical plane swing test. METHODS: A prospective analysis of 100 normal persons (aged from 18 to 59 years), who were treated by using the vertical plane swing test with the newly developed automatic vestibular function diagnosis and therapy system (SRM-IV). These persons were rotated 180° at a sinusoidal speed (acceleration 45°/s, maximum speed 90°/s) in the vertical semicircular canal plane. Using a PC, evoked vertical nystagmus was analyzed in order to evaluate the excitability of vertical semicircular canals, including the number and the duration of nystagmus, the slow phase velocity and other parameters. Meanwhile, the all persons were divided into two groups, order and younger than 45 years respectively. In the test procedure, with the two pairs of the right anterior vertical semicircular canal and left posterior vertical semicircular canal (RALP) as well as the left anterior vertical semicircular canal and the rear right vertical semicircular canals (LARP), the average slow phase velocity of the vertical nystagmus and the canal paresis (CP) of the two pairs of vertical semicircular canals were calculated using PC and SPSS13.0 software for statistical analysis. RESULTS: There was no significant difference between the two groups (P > 0.05). The general CP of RALP was 10.2% ± 7.1%, and LARP was 10.4% ± 6.2%. The normal CP range of the vertical semicircular canal in the health group was identified (idea: ≤ 20%; normal high: 20% - 25%). CONCLUSION: The 180° vertical plane sinusoidal swing method is effective in functional analysis of the vertical semicircular canal, it is expected to be reliably used in clinical treatment.

[Operation of hypopharyngeal carcinoma with restrained vocal cord motility].

OBJECTIVE: To explore the feasibility of laryngeal function preservation in surgical treatment of hypopharyngeal carcinoma with restrained vocal cord motility. METHODS: Twenty-six cases of hypopharyngeal carcinoma treated with conservative hypopharyngectomy were retrospectively analyzed. Partial resection of pyriform sinus and partial laryngectomy were performed. Suturing the remaining hypopharyngeal mucosa was used to cove the wound of hypopharynx in 5 cases, epiglottis complex flap in 21 cases. All patients received postoperative radiotherapy. RESULTS: The overall 3- and 5-year survival rates were 61.4% and 50.8% respectively. 76.9% (20/26) patients have laryngeal functions (voice, respiration and deglutition) completely restored and 23.1% (6/26) partially restored (voice and deglutition). CONCLUSIONS: To improve the quality of life of the cases, the preservative surgery is feasible for the selected hypopharyngeal carcinoma cases with restrained vocal cord motility.

[Study of the key points and safety measures during perioperative period in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To study the safety measures during perioperative period in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), to minimize uvulopalatopharyngoplasty (UPPP) major complications. METHODS: The complications and other relative information of 1446 OSAHS patients treated with UPPP were analyzed. Complications of 1004 OSAHS patients adopted standardized management measures after 2004 and 442 OSAHS patients who performed UPPP before 2003 were compared. RESULTS: Among the 1446 cases of OSAHS surgery, there were 49 cases (3.39%) of difficult intubation; 8 cases (0.55%) intraoperative mild arrhythmia; 13 cases (0.90%) of surgery dangerous situations after extubation; 19 cases (1.31%) of intraoperative primary hemorrhage; 11 cases (0.76%) of mild arrhythmia during the postoperative observation period; 21 cases (1.45%) of uncontrolled hypertension immediately after surgery; 32 cases of secondary hemorrhage a week after surgery. All complications were cured and no death occurred. Compared with those operations before 2003, complications were significantly reduced with enforcement of standardized management of perioperative measures since 2004. The data had significant difference by chi(2) test (P < 0.05). CONCLUSIONS: There are five key points during the perioperative period of OSAHS surgery: preoperative examination, intubation, surgery, postoperative extubation, and postoperative care. Risk factors and complications could be prevented effectively in the above five important processes.

[Molecular etiology of non-syndromic hearing impairment in a Chinese family].

OBJECTIVE: To investigate the molecular etiology of non-syndromic hearing impairment in two patients in a maternal inherited deafness Chinese family. METHODS: Peripheral blood specimens were collected and DNA templates extracted. The complete mitochondrial genomes and GJB2 gene were sequenced in an ABI 3100 Avant sequencer. RESULTS: The proband (III-5) and her elder sister (III-1) were found to carry the mtDNA 12SrRNA C1494T mutation. The GJB2 gene showed no mutations. The proband had the history of using aminoglycosides before hearing loss, and exhibited severe sensorineural hearing impairment; the proband's sister had no history of using aminoglycosides, and showed moderate sensorineural hearing impairment. CONCLUSION: The molecular etiology of each individual patient in a family yaries with individual genetic background.