Table of Content

20 September 2024 Volume 38 Issue 5

  

Original Article

Formation mechanism and cyst fluid composition analysis of nasal mucosal cysts after functional endoscopy sinus surgery

HOU Jing, FANG Gaoli, ZHOU Bing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  1-5.  doi:10.6040/j.issn.1673-3770.0.2023.045

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Objective The objective of this study was to investigate the formatting factors and histological characteristics of nasal mucosal vesicles that commonly occurred in the nasal cavity after functional endoscopy sinus surgery(FESS). Methods We collected 10 cases of nasal mucosal vesicles from the nasal cavity of the patients with chronic rhinosinusitis after FESS. Vesicle tissues were assayed by histomorphological analysis and scanning electron microscope. The consistency of the liquid in the vesicles was examined by biochemistry analysis. Results Compared to normal mucosa, there were statistically significant differences in the proliferation of the epithelial layer(P=0.023)and the degree of infiltration of inflammatory cells(P=0.029)in the vesicles. At the same time, there was no statistically significant difference in the number of mucosal glands(P=0.631). The levels of lactate dehydrogenase(P<0.001)and alanine transaminase(P<0.001)in the vesicular fluid were significantly higher than their levels in the blood. As for aspartate transaminase(P<0.001)and total protein(P=0.001), there were statistically significant decreases. Conclusion Nasal mucosal cysts occurring after FESS are composed of edematous mucosa, local infiltration of inflammatory cells, and exudate. A large amount of LDH and the increased AST level in the vesicle fluid suggested that the vesicles were related to surgical trauma. The vesicles that do not obstruct the ventilation and drainage of the surgical cavity do not need to be treated. The postoperative comprehensive treatment should be strengthened.

Preparation of a Der p2 B cell epitope RNA vaccine and its specific IgE inhibition in mice with allergic rhinitis

YANG Gui, HU Tianyong, HE Haipeng, MA Li, WEI Haifeng, HUANG Jiamin, LIU Zhiqiang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  6-12.  doi:10.6040/j.issn.1673-3770.0.2024.170

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Objective This study aimed to construct a house dust mite allergen Der p 2 B cell epitope RNA vaccine and evaluate its inhibitory potency against antigen-specific IgE in allergic rhinitis mice. Methods Epitope prediction software was utilized to predict potential B-cell epitope peptides on the Der p2 protein sequence, followed by synthesis of these peptides and analysis of their IgE reactivity in vitro. The B-cell epitope peptide was then linked with a carrier protein to construct the B-cell epitope RNA vaccine, which was administered to allergic rhinitis mice via subcutaneous injection. Levels of specific IgE, IgG4, Treg, and Th17 cells in the peripheral blood of the mice were subsequently tested. Results Compared with the recombinant Der p2 positive control group, the predicted four B cell epitope peptides exhibited significantly lower IgE reactivity(P<0.001). Furthermore, treatment with the Der p2 B cell epitope RNA vaccine led to a significant decrease in serum levels of specific IgE and an increase in IgG4 compared to mice in the allergic rhinitis group(P<0.05). Additionally, there was an increase in Treg ratio and a reduction in Th17 ratio after treatment(P<0.05). Conclusion The construction of the Der p2 B cell epitope RNA vaccine has been successfully achieved and it effectively reduces specific IgE levels while increasing neutralizing antibody levels and Treg ratios in peripheral blood of allergic rhinitis mice.

Analysis of sensitization characteristics of Artemisia pollen in autumn allergic rhinitis in the Changchun area of China

LIU Chang, FANG Hongyan, LIU Xiao, FU Dongna, WANG He, WANG Jing, YANG Jingpu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  13-19.  doi:10.6040/j.issn.1673-3770.0.2023.362

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Objective To analyze the relationship between Artemisia pollen concentrations in autumn and the number of visits for allergic rhinitis, and the sensitization characteristics of Artemisia pollen in the Changchun area(Jilin, China). Methods From August 1 to October 31, 2022, the concentration of airborne Artemisia pollen was determined, in addition to the number of outpatient visits to the Department of Otorhinolaryngology, Head and Neck Surgery of the Second Hospital of Jilin University, and the number of patients diagnosed with allergic rhinitis. A total of 1,945 patients from the Changchun area underwent allergen testing in the autumn(August 1 to October 31)of 2019 to 2022, and 1,506 were positive for ≥ 1 allergens by serology-specific immunoglobulin E(IgE)testing. The relationship between Artemisia pollen concentration and the number of consultations for allergic rhinitis and the main sensitizing characteristics of Artemisia pollen in this area were analyzed. Furthermore, sensitization to Artemisia pollen was compared between different age groups, sexes, and mono-sensitization and multiple-sensitization. Results The concentration of Artemisia pollen increased from August to September, and was positively correlated with the number of visits for allergic rhinitis(r_s=0.751, P<0.01). Serological-specific IgE testing revealed that Artemisia pollen positivity reached 44.6%. The positivity rate for Artemisia pollen differed among various age groups(χ2=4.377, P<0.05). Artemisia pollen sensitization was more prone to multiple sensitization, and mainly associated with ragweed(58.8%). Conclusion The concentration of Artemisia pollen in autumn was consistent with the peak for visits for allergic rhinitis in the Changchun area. Artemisia pollen was the primary allergen in autumn among patients with allergic rhinitis, and tended to be multiple allergens.

The relationship between miR-34a expression in nasal mucosa tissue and postoperative recurrence in patients with chronic sinusitis

LI Ting, ZHAO Chong, WU Xian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  20-25.  doi:10.6040/j.issn.1673-3770.0.2023.160

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Objective This study investigated the relationship between microRNA(miR)-34a expression in nasal mucosal tissue and postoperative recurrence in patients with chronic sinusitis(CRS). Methods A total of 116 patients with CRS with nasal polyps who underwent endoscopic sinus surgery were included in this study. The patients were followed up for two years after surgery and were divided into the recurrence group(n=34)and non-recurrence group(n=82). The expression levels of miR-34a in the mucosal tissue of the inferior nasal concha were detected using quantitative PCR. The relationship between miR-34a and postoperative recurrence was analyzed. The factors affecting the recurrence of CRS, including age, CRS classification, asthma, allergic rhinitis, operation time, and SAS score, were evaluated. Results The relative expression level of miR-34a in the nasal mucosa tissue of the recurrence group was significantly lower than that in the non-recurrence group(t=13.010,P<0.001). The relative expression level of miR-34a in the nasal mucosa tissue of CRS patients of age ≥45 years with combined asthma, combined allergic rhinitis, eosinophilia type, operation time ≥2 h, and SAS scores ≥50 were also significantly lower than that in CRS patients of age <45 years with no combined asthma, no combined allergic rhinitis, non-eosinophilia type, operation time <2 h, and SAS score <50(P values were 0.003, 0.006, 0.007, <0.001, <0.001, 0.004, respectively). The area under the receiver operating characteristic(ROC)curve of the expression level of miR-34a used to predict the recurrence of CRS after surgery was 0.938. The best cutoff value was 0.55, with a sensitivity of 85.29% and a specificity of 92.09%. Conclusions The decreased expression of miR-34a in the nasal mucosa tissue of patients with CRS is related to postoperative recurrence and recurrence-influencing factors. MiR-34a can serve as a marker for evaluating postoperative recurrences of CRS.

Application of plasma pointlike excitation technology in children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy combined with perioperative enhanced recovery after surgery program

LUO Lu, ZHOU En, XIAO Xuping, LIN Zhiqiang, FANG Zhijie, LYU Xiaohong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  26-30.  doi:10.6040/j.issn.1673-3770.0.2023.394

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Objective To explore the application efficacy of plasma pointlike excitation technology in children with obstructive sleep apnea(OSA)undergoing tonsillectomy and adenoidectomy combined with perioperative enhanced recovery after surgery(ERAS)program. Methods For this study, 160 children with OSA were included. All the children underwent plasma tonsillectomy and adenoid ablation, and then adopted the method of the enhanced recovery during the perioperative period. They were randomly divided into the observation group(receiving plasma pointlike excitation)and the control group(undergoing conventional plasma surgery)according to their admission numbers(odd and even), 80 cases in each group. Perioperative indicators were assessed for the two groups. Results The postoperative pain, mild in all the children, gradually decreased as time went by, and almost disappeared in most of the children on the 7th day after surgery. At the same time point, the pain was lower in the observation group than in the control group(P<0.01 for all). The observation group exhibited significant decreases in terms of surgical duration(26.850±2.536)min and intraoperative blood loss(1.738±0.896)mL when compared to the control group(29.188±2.960)min and(4.838±2.923)mL, and the differences between the two groups were statistically significant(P<0.01 for all). The compliance rate of postoperative oral energy intake was higher in the observation group than in the control group(χ2=12.172, P<0.01). One child in the control group had transient oropharyngeal bleeding for 7 days after the surgery, which was improved after symptomatic treatment. There was no recurrence of postoperative bleeding in the observation group. No statistically significant differences existed in either postoperative low fever or the recurrence of bleeding between the two groups(P>0.05). Conclusion The application of plasma pointlike excitation technology in tonsillectomy and adenoidectomy for OSA children can optimize the enhanced recovery after the operation, reduce intraoperative bleeding, shorten operative duration, and lower postoperative pain, so this technology is worthy of clinical application and promotion.

Effect of high flow respiratory humidification therapy apparatus in patients with artificial airway without mechanical ventilation after laryngeal cancer surgery

LIU Ping, GU Zijun, CHU Ting, CHEN Xi, CHENG Lei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  31-36.  doi:10.6040/j.issn.1673-3770.0.2023.113

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Objective To explore the application effect of high flow respiratory humidification therapy instrument in patients with artificial airway after laryngeal cancer surgery without mechanical ventilation. Methods Objective sampling method was used to randomly select patients who underwent laryngeal cancer surgery and underwent artificial airway with non-mechanical ventilation after surgery as study objects. The control group underwent airway humidification using Venturi's humidifying oxygen therapy device. The experimental group was treated with high flow respiratory humidification therapy apparatus with high flow temperature humidification, and the intervention effect of the two groups was compared. Results A total of 95 patients were included, including 53 patients in the control group and 42 patients in the observation group. There were statistically significant differences in the total number of days in hospital, postoperative hospital stay, number of sputum aspiration per day, average sleep time per day, number of breath-holding per day, total score of humidification comfort and pain between the two groups after intervention(all P<0.05). Conclusion For patients with artificial airway after laryngeal cancer surgery without mechanical ventilation, the use of high flow respiratory humidification therapy apparatus with high flow temperature humidification can improve the comfort of airway humidification, promote sputum discharge, shorten the total length of hospital stay and improve the prognosis of patients with laryngeal cancer.

Analysis of body image cognition status and influencing factors of patients with thyroid papillary carcinoma after open neck surgery

HAN Jingjing, WEN Xiaowen, WANG Yali, GUO Yujie, LI Na, SUN Lan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  37-42.  doi:10.6040/j.issn.1673-3770.0.2023.144

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Objective To study the status of body image cognition in patients with thyroid papillary carcinoma after open neck surgery and analyze its influencing factors. Methods A total of 200 patients with thyroid papillary carcinoma after open neck surgery in two Grade 3A hospitals in Shandong Province participated in questionnaires pertaining to general demographic data and body image self-evaluation. Univariate analysis and multiple linear regression were used to analyze the influencing factors and degree of body image cognition of patients with thyroid papillary carcinoma after open neck surgery. Results The 200 patients' average score of body image cognition was(12.86±5.56). The results of multiple linear regression analysis showed that the scar physique(P=0.006), family per capita monthly income(P=0.042), sex(P=0.003), age(P=0.004), educational background(P=0.037), and postoperative time(P=0.036)were closely related to the body image cognition of these patients and the difference was statistically significant(P<0.05). Conclusion The body image cognition of patients after open neck surgery for papillary thyroid cancer is moderately unsatisfactory. Medical staff should pay attention to the body image cognition of patients after surgery and implement individualized intervention measures according to the differences in the patient's gender, age, physical scars, postoperative time, per capita monthly family income, and educational background to maintain the utmost integrity of the patient's body image. This will improve the body-image cognition of patients. There were some limitations in this survey; only the general demographic data were included, and it is suggested that future research should include more sociological variables(such as social support).

Ophthalmotonic consensual reaction in the fellow eye following unilateral trabectome

YANG Zhen, MENG Sukun, ZHANG Chun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  43-51.  doi:10.6040/j.issn.1673-3770.0.2023.141

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Objective To observe the intraocular pressure(IOP)fluctuations and the phenomenon of ophthalmotonic consensual reaction(OCR)in the fellow eye following trabectome in one eye and to investigate its correlative influencing factors in patients with open-angle glaucoma(OAG). Methods In this single-center retrospective observational study, the eyes of 97 individuals with OAG undergoing unilateral trabectome from January 2016 to September 2022 were evaluated. Data were collected on demographics, past ocular disease and surgical history, the kind and number of preoperative anti-glaucoma medications, ophthalmic examination data, including baseline IOP in both eyes, and the IOP of both eyes at one day, one week, one month, three months, and six months postoperatively. An IOP change(ΔIOP)≥ 4 mm Hg or a 20% increase from the baseline values was defined as OCR in the fellow eye. Paired rank sum test was used to compare the difference between baseline IOP values and IOP at different time points postoperatively, and the influencing factors of OCR phenomenon in the fellow eye on postoperative day 1 were investigated using rank sum test, Fisher’s exact test, and logistic regression, while the influencing factors of the magnitude of ΔIOP in the fellow eye at postoperative day 1 were investigated using rank sum test and Spearman correlation analysis. Results The baseline IOP of all fellow eyes was 17.3±6.5 mm Hg, significantly increasing to 18.1±7.8 mm Hg at postoperative day 1(P=0.008), while IOP in the fellow at other postoperative time points did not significantly change from the baseline level(P>0.05). The incidence of OCR in fellow eyes at postoperative day 1 was 34.0%, which was higher than those of other postoperative time points. Healthy fellow eye was an independent risk factor of OCR in the fellow eye following trabectome in the surgical eye at postoperative day 1. At postoperative day 1, ΔIOP in fellow eyes was positively correlated with the magnitude of IOP reduction and the baseline IOP level in surgical eyes. Conclusion A consensual IOP rise in fellow eyes was observed after trabectome in one eye in the early postoperative period. These findings highlight the explicit need to monitor IOP in fellow eyes carefully.

Clinical effect of 650-nm low-level red light in conjunction with orthokeratology in myopia control

ZHANG Liyuan, GUO Yingzhuo, CHEN Jiao, WANG Hua, ZHONG Dingjuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  52-57.  doi:10.6040/j.issn.1673-3770.0.2023.147

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Objective To assess the clinical effectiveness and safety of utilizing a 650-nm low-level red light in combination with orthokeratology for correcting and retarding myopia. Methods A total of 71 patients with myopia aged ≥7 years were carefully selected and categorized into four distinct groups based on their individual condition: patients wearing single-vision spectacles(control group), patients receiving 650-nm low-level red light treatment and wearing single-vision spectacles(red-light group), patients wearing orthokeratology lenses(OK group), and patients receiving 650-nm low-level red light treatment and wearing with orthokeratology lenses(combination group). Follow-up examinations were carried out at 1-, 3-, and 6-month intervals following enrollment to assess various parameters, including axial length, spherical equivalent, choroid thickness, best-corrected visual acuity and intraocular pressure. The safety of the procedure was evaluated using optical coherence tomography to observe retinal structures within a 6-mm range of the macular fovea. Two-factor analysis of variance, χ2 test, and repeated-measures analysis of variance were used to analyze the data. Results At 6 months, the change of axial length relative to the baseline period value difference in the control group, OK group, red-light group and combination group were significant［(0.181±0.104)mm、(0.069±0.108)mm、(-0.130±0.141)mm、(-0.164±0.118)mm, P<0.001］. The combination group exhibited the most effective control over the axial length. Additionally, red-light group and control group in the change of equivalent spherical refractive error relative to the baseline period value difference was significant ［(0.028±0.274)D、(-0.309±0.193)D, P<0.001］. The change in choroidal thickness relative to the baseline period value difference in the red-light, OK, and combination groups at 1, 3, and 6 months were also significant(all P<0.001). Only the combination group showed a continuous growth trend for 6 months. The retinal structures of both the red-light and combination groups displayed clarity within a 6-mm range of the macular fovea, and no abnormalities were detected. Conclusion The application of 650-nm low-level red-light in combination with an orthokeratology lens can regulate the progression of myopia. Furthermore, the efficacy of the combination of these two methods surpasses that of either red light or the orthokeratology lens used individually, and did not affect the structure of retina and best corrected visual acuity.

Effect of sodium hyaluronate and balanced salt solution on ocular surface protection during minimally invasive vitreorentinal surgery

XIN Meng, JI Fang, DAI Chunhua, ZHANG Jing, LIU Shu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  58-65.  doi:10.6040/j.issn.1673-3770.0.2023.383

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Objective To evaluate the protective effect of the ocular surface of medical sodium hyaluronate(HA)and balanced salt solution(BSS)in patients with proliferative diabetic retinopathy(PDR)performing minimally invasive vitreorentinal surgery(MIVS). Methods A retrospective case-controlled study was designed. Forty patients(40 eyes)with PDR performed with anti-vascular endothelial growth factor-assisted MIVS surgery were enrolled in this study, randomly divided into the HA group ［20 cases(20 eyes)］ and the BSS group ［20 cases(20 eyes)］. During surgery, HA and BSS were applied to keep the ocular surface moist according to grouping. Ocular surface disease index(OSDI), Schirmer Ⅰ test(SⅠt), non-invasive tear film break-up time(NITBUT), corneal fluorescein staining(CFS)and corneal transparency during the surgery were performed preoperatively and at 1, 7 and 30 days postoperatively. Results The OSDI of the HA group was superior to that of the BSS group at all postoperative time points(P_{1 d}=0.001、P_{7 d}<0.001、P_{30 d}=0.001). Intragroup comparison showed that the HA group was more damaged 1 day after surgery than preoperative(P_HA1d<0.001), and 30 days after surgery was better than preoperative(P_HA30d=0.002), and the BSS group was more damaged 1 day and 7 days after surgery than preoperative(P_BSS1d<0.001, P_BSS7d<0.001). Intragroup comparison in the SⅠt 2 group showed that the damage in the HA group and the BSS group was worse than preoperative(P_HA1d<0.001, P_HA7d<0.001, P_BSS1d<0.001, P_BSS7d<0.001), and damage in the HA group was better than preoperative(P_HA30d<0.001). Compared to the NITBUT group, the 7 d HA group was better than the BSS group(P_{7 d}<0.001). Intragroup comparison showed that the damage to the HA group and the BSS group was greater at 7 and 30 days postoperatively than preoperatively(P_HA7d<0.001, P_HA30d=0.027, P_BSS7d<0.001, P_BSS30d=<0.001). Among the CFS groups, the HA group was better than the BSS group on 1d postoperatively(P_{1 d}<0.001). Intragroup comparison showed that the damage in the HA group and the BSS group was greater than before the operation(P_HA1d<0.001, P_HA7d<0.001, P_BSS1d<0.001, P_BSS7d<0.001), and the damage in the BSS group was still greater than before the operation and 30 days after the operation(P_BSS30d=0.024). Intraoperative corneal transparency in the HA group was better than that in the BSS group(P=0.038). Conclusion Compared to BSS, HA has better protection of the ocular surface during MIVS in patients with PDR, remains the corneal transparency during surgery and shortens the repair time of the ocular surface tissue after surgery.

Assessment of reporting quality of randomized controlled trials on acupuncture preventing and controlling with myopia in children and adolescents based on CONSORT and STRICTA

WANG Dongfang, ZHANG Qingyu, SONG Jike, BI Hongsheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  66-79.  doi:10.6040/j.issn.1673-3770.0.2024.174

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Objective To assess the reporting quality of randomized controlled trials(RCTs)on acupuncture for myopia in children and adolescents and provide suggestions to improve the quality of reporting clinical trials of acupuncture. Methods The databases CNKI, WanFang Data, SinoMed、VIP、PubMed、Embase and The Cochrane Library were searched for Chinese and English RCTs on acupuncture for myopia in children and adolescents from January 2001 to December 2023. The Expand Statement of Consolidated Standards of Reporting Trials 2010(CONSORT 2010)and Standards for Reporting Interventions in Clinical Trials of Acupuncture(STRICTA)were used to evaluate the reporting quality of the included studies. Results Totally, 1136 literatures were searched. After screening, 59 Chinese RCTs and 7 English RCTs were included. According to the CONSORT statement, the average reporting rate of the Chinese and English literature was 43.8% and 62.9%, respectively. The main missing items of Chinese RCTs focused on‘methodology’,‘results’,and ‘other information’. The reporting rates for the Chinese and English literatures of the STRICTA checklist were 63.2% and 74.1%. Only the item ‘Names of points used’was completely reported in the Chinese literature, while there were 8 items in English. The report rates for ‘The Extent to which the treatment was varied’、‘Practitioner background’、‘Setting and context of treatment’were less than 15%. Conclusion At present, the reporting quality of RCTs on prevention and control of acupuncture for myopia in children and adolescents in the Chinese literature is relatively low. In the future, researchers should follow the standards of CONSORT 2010 statements and STRICTA checklists to improve the quality of their studies.

Adult orbital xanthogranulomatous disease with clinicopathological analysis report and literature review

LI Gui, YANG Yanli, LI Donghai, YAN Xiuying

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  80-85.  doi:10.6040/j.issn.1673-3770.0.2024.008

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Objective To investigate the clinicopathological features, diagnosis, differential diagnosis and prognosis of adult orbital xanthogranulomatous disease. Methods The clinical and pathology data of one 56 year old male patient with Adult orbital xanthogranulomatous disease(AOXGD)were retrospectively analyzed, along with a review and summarize of the relevant literatures. Results The patient was male, 56 year old. Both eyelid masses were found for 7 years, with gradual enlargement. Giant examination: a upper eyelid mass of the left eye, size 1.0 cm×0.8 cm×0.3 cm, section surface gryxanthin tough, left eye eyelid mass, size 3.0 cm×2.0 cm×0.9 cm section gryxanthin. Microscopy: The lesion is located in the subcutaneous tissue with multiple histiocytic infiltration, Partly acidophilic and biased, the majority of histiocytes were foamy, Background with unequal amounts of lymphocytes, plasma cells, multinucleated giant cells(Duton cells), and foamy id histiocytic infiltration in local skeletal muscle. Immunophenotype: histiocytes were positive for CD68 and CD163, TREM-1 negative for CD1a, S-100 and Lahrin-, about 5% Ki67. BRAF V600E gene detection without mutation. Conclusion AOXGD is relatively rare in clinical practice, with multiple pathological subtypes, making diagnosis and treatment difficult and prone to misdiagnosis and mistreatment. Among them, AOX subtype with simple surgical resection has a good prognosis, while ECD subtype has the worst prognosis. Patients with BRAF V600E mutation can be treated with targeted drug Verofinib. TREM-1 may participate in the formation of foam like tissue cells and be related to the occurrence of AOXGD. It is expected to become a new target for AOXGD treatment or a new indicator for monitoring the recurrence and progress of AOXGD.

Intractable nosebleed due to haemophilia A: a case report and literature review

ZHENG Lu, CHENG Jie, OUYANG Hong, CHI Huaming, DU Jingdong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  86-90.  doi:10.6040/j.issn.1673-3770.0.2023.251

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Objective This study aims to examine the clinical features and methods of laboratory examination for the diagnosis of a rare hemophilia refractory epistaxis. Methods We reviewed and analyzed the patient's case data, summarized the characteristics of the case, and noted the deficiencies in the treatment process. Local and international literatures on hemophiliac rhinorrhea were also reviewed in the domestic and overseas. Results The patient presented with epistaxis without apparent cause as the first symptom, and have no space occupying lesions of the nasal cavity and nasopharynx. Initially, the patient underwent electrocoagulation treatment in the outpatient department, but the symptoms worsened immediately. After admission, the symptoms were still not relieved after undergoing anterior and posterior nasal tamponade and transfusion of coagulation factors. Only a few hours after the operation, the condition worsened again. After nasal plasma electrocoagulation under general anesthesia, the bleeding was successfully stopped and has not recurred thus far. Conclusion Hemophilia is a type of congenital hemorrhagic disease with X-linked recessive inheritance, and a nosebleed is one of its main symptoms. The possibility of hemophilia should be taken into account in patients who have nosebleeds that do not have an obvious cause and persist after treatment. After hemophilia develops into refractory nosebleed, it is necessary to supplement the coagulation factors in time due before they are depleted. During interventional therapy, such patients may have received nasal tamponade or other treatments before surgery. Although the success rate of hemostasis after interventional surgery is relatively high, nasal endoscopy should be performed again after postoperative hemostasis. The suspected bleeding site is cauterized to stop the bleeding and avoid postoperative secondary bleeding. At the same time, a multidisciplinary team must be formed to identify the cause of bleeding and improve the clinical efficacy when the specialized treatment fails.

Mucocele of inferior turbinate: a case report and literature review

LI Meichen, CHEN Hailing, LI Yang, MA Dengdian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  91-94.  doi:10.6040/j.issn.1673-3770.0.2023.261

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Objective To investigate the clinical manifestations and diagnostic methods of inferior turbinate mucocele. Methods The medical records of a 37-year-old female patient who complained of nasal congestion, runny nose, and tears for more than 20 days were reviewed. CT and MRI examinations of the paranasal sinuses indicated the following diagnoses: bilateral maxillary sinus inflammation with a cyst; right inferior turbinate cyst; deviation of the nasal septum. The patient underwent the resection of a cyst in the right inferior turbinate and multiple sinus fenestrations, all performed under nasal endoscopy. Results The function of the nasal mucosa recovered well following routine postoperative nasal endoscopy. Postoperative pathology revealed that the cyst wall in the right nasal cavity consisted of fibrous connective tissue(lined with ciliated columnar epithelium)and was accompanied by acute and chronic inflammatory cell infiltration and bone tissue hyperplasia. Conclusion This case of unconfirmed inferior turbinate mucocele is extremely rare because its etiology has not yet been clarified. Moreover, the pathogenesis remains unclear. Imaging studies aid in confirming the diagnosis, and surgical treatment is the preferred method for inferior turbinate mucocele, with a low recurrence rate and favorable prognosis.

Corneal perforation caused by microsporidia infection: a case report and literature review

WANG Ling, LI Ming, YING Fangwei, WANG Yu, WEN Wen, YAO Xiaoming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  95-99.  doi:10.6040/j.issn.1673-3770.0.2023.258

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Objective To investigate the diagnosis, treatment, clinical features, diagnostic principles, and research progress of corneal perforations caused by Microsporidia infection. Methods We retrospectively analyzed the clinical data of a patient with corneal perforation caused by Microsporidia infection and reviewed relevant literature. Results Microsporidial infection of corneal ulcer perforation is a rare infectious ocular disease. The transmission route is unclear but could be related to unclean hand hygiene. The diagnosis can be confirmed through corneal tissue examination, fluorescent whitening agent staining, and metagenomic detection. Early metagenomic detection during the disease course is crucial for the early identification of pathogen types and timely medication prescriptions. Conclusion In recent years, increased cases of Microsporidium keratoconjunctivitis have occurred in healthy individuals. Clinicians should consider Microsporidium keratoconjunctivitis in diagnosing conjunctivitis-related atypical punctate epithelial keratitis to avoid corneal perforation, which seriously endangers vision.

Hyperbaric oxygen therapy for optic neuritis after COVID-19: a case report and literature analysis

WANG Lei, WANG Xueyi, TIAN Yanjuan, KUANG Aihua, DUAN Xiaoni, ZHAO Yin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  100-104.  doi:10.6040/j.issn.1673-3770.0.2023.277

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Objective This study aims to provide a new clinical treatment method and strategy for early vision rescue of optic neuritis after COVID-19 infection. Methods The clinical data of three patients with optic neuritis after COVID-19 infection were retrospectively analyzed, and the related literature was reviewed. Results COVID-19 infection affects the retina and optic nerve of patients in the acute and subsequent recovery stages. In this study, three patients demonstrated poor vision recovery after conventional drug treatment. Among them, one patient received combined hyperbaric oxygen therapy, the vision recovery was significantly faster, and the short- and long-term vision recovery was complete. Conclusion Optic neuritis after COVID-19 infection is common. Enhancing early vision rescue with hyperbaric oxygen intervention in the treatment of optic neuritis after COVID-19 infection is an effective and better approach. Immediate vision restoration and prevention of irreversible vision loss in these patients, carry immense clinical significance and merit promotion.

Orbital apex syndrome secondary to nasal-orbital-skull base malignant tumor: a case report and literature review

PENG Yuting, LI Jianhao, WANG Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  105-111.  doi:10.6040/j.issn.1673-3770.0.2023.458

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Objective To investigate the etiology and early diagnosis of orbital apex syndrome as the initial symptom caused by sinus disease. Methods The medical records of a 74-year-old female patient were reported. She presented with "bilateral upper eyelid ptosis with visual disturbance for more than 4 months, the left eye being more severe", and the patient underwent surgical correction of the left upper eyelid ptosis, which was successful. Two weeks later, the patient presented with decreased vision in the left eye, accompanied by eye pain and headache, and was readmitted for further evaluation. Results The left eye was fixed anteriorly with limited ocular movement in all directions. The left eye was papillary hyperemic and oedematous, with scattered haemorrhages and cotton wool spots at the posterior pole. Orbital and cranial MRI and paranasal sinus CT showed nasal involvement of the orbit and skull base. Nasal biopsy specimens were obtained and sent for pathology, and the final diagnosis was olfactory neuroblastoma secondary to left orbital apex syndrome. The patient died six months after stopping treatment. Conclusion Olfactory neuroblastoma can be found with ocular symptoms as initial symptom. Nasal space occupying lesions should be considered in orbital apex syndrome. Orbital, cranial and paranasal sinus CT or MRI and pathological examination are helpful in the early etiological diagnosis of orbital apex syndrome.

Review

Research progress on mTOR signaling pathway in cochlea

LI Yu, LIU Hao, WANG Min, FU Xiaolong, LI Wen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  112-118.  doi:10.6040/j.issn.1673-3770.0.2023.448

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Deafness, a growing clinical challenge exacerbated by societal aging, increasingly affects patients' quality of life and adds to the social burden. Identifying effective intervention targets is crucial for the prevention and treatment of deafness. mTOR (target protein of rapamycin) is central to the processes of cell growth, metabolism, proliferation, and survival. Recent studies suggest that the mTOR pathway is essential for the proliferation, differentiation, maintenance, aging, and survival of cochlear inner ear hair cells and spiral neurons, which are essential for hearing. This paper reviews current research on the mTOR pathway in the cochlea, summarizes its regulatory mechanisms, and discusses unresolved issues and potential future research directions, highlighting the promise of mTOR as a novel therapeutic target for deafness.

Advancements in olfactory testing for early diagnosis of mild cognitive impairment in patients

ZHOU Chunyi, HU Hui, ZHANG Ailin, WANG Yuncui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  119-125.  doi:10.6040/j.issn.1673-3770.0.2023.134

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Mild cognitive impairment(MCI)serves as a transitional state between the typical ageing process and the onset of Alzheimer's disease. Emerging research indicates that MCI patients exhibit pathological alterations such as olfactory bulb atrophy and neuronal loss. Moreover, the severity of these pathological changes correlates with the degree of cognitive impairment. Hence, olfactory testing holds potential as a supplementary tool for MCI screening. Despite being in its nascent stages in China, research on early MCI diagnosis through olfactory tests is gaining momentum. In this study, we conduct a comprehensive review of pertinent literature, encompassing olfactory function, test content, characteristics, and current applications. Our aim is to furnish healthcare practitioners with insights into selecting suitable olfactory test instruments to enhance the early detection rate of MCI.

Current status of anatomical research on nasal orbital ethmoid and concurrent zygomatic bone fracture complications

MA Li, GAO Zhan, LI Pengqi, NI Qianwei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  126-130.  doi:10.6040/j.issn.1673-3770.0.2023.461

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The naso-orbito-ethmoid(NOE)is located at the intersection of multiple bones in the middle of the face. Its structure is complex and the probability of its fracture alone is very low. It often co-occurs with other facial fractures, most commonly zygomatic bone fractures. The cause of NOE concurrent with zygomatic bone fractures is often high-energy blunt trauma, so it often accompany various other facial injuries. Since the NOE area and the zygomatic bone are adjacent to the orbit, a large number of ocular complications can occur when NOE co-occurs with zygomatic bone fractures. The incidence of mild complications is relatively high, while the incidence of severe complications is low. The complications of concurrent fractures that involve mainly the NOE area are mainly tissue injuries close to the medial side, such as an excessive medial canthal distance. The complications of concurrent fractures mainly involving zygomatic bone are mainly tissue injuries close to the lateral side, such as limited eye movement. Concurrent fractures in both the NOE area and the zygomatic bone are often accompanied by serious complications such as blindness and cranial injury. The main mechanism of NOE concurrent with zygomatic bone fractures is that the energy from the impact point spreads along the vertical and horizontal pillars of the middle part of the face to the surrounding areas of the middle pillar, and the energy gradually attenuates with increasing propagation distance. During the energy propagation process, the sinuses can absorb some energy through deformation and fracture, thus providing a certain protective effect on the skull and eyeball.

Research progress on the mechanism, prevention and treatment of xerostomia after tonsillectomy

ZHU Huitao, CHEN Liqian, TAO Yanli

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  131-135.  doi:10.6040/j.issn.1673-3770.0.2023.087

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Postoperative xerostomia is a common complication that can cause adverse emotional reactions in patients and even interfere with speech, swallowing, and breathing functions, ultimately reducing the postoperative quality of life and satisfaction of patients. Therefore, postoperative xerostomia deserves attention. However, the underlying mechanism of postoperative xerostomia after tonsillectomy remains unclear, and current treatment alternatives are not efficient. This article focuses on summarizing the pathophysiology and prevention strategies of postoperative xerostomia after tonsillectomy to reduce its incidence by strengthening the knowledge on the intraoperative protection of mucous membranes, glands, and nerves around the tonsil and provides reference for the prevention and management of this condition in clinical practice.

Treatment options and management strategies for patients with acute laryngotracheobronchitis

WANG Zhenxiao, SHI Guanggang, HE Mingqiang, SHI Lei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  136-144.  doi:10.6040/j.issn.1673-3770.0.2023.163

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Croup, also known as laryngotracheitis, is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. It typically occurs in children between the ages of six months and three years, and is chiefly caused by the parainfluenza virus. Most children with croup present with a mild self-limited illness that can be managed as outpatients. The clinician must be able to determine which patients can be managed at home, which require evaluation and treatment in the hospital setting. There is currently no established definitive antiviral for croup. Pharmacologic therapy aims to reduce airway edema, and supportive care focuses on providing respiratory support and maintaining adequate hydration. The mainstays of treatment are glucocorticoids and nebulized epinephrine. The approach to the management of croup will be discussed in this report. The clinical features, evaluation, and diagnosis of croup are discussed separately.

Research progress of Copper complexes for antitumor therapy

YANG Yuyun, HUANG Yanli, LI Junzhen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  145-152.  doi:10.6040/j.issn.1673-3770.0.2023.117

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Copper is one of the essential elements required by the human body, being widely involved in various activities. Copper homeostasis is strictly regulated in prolcaryotic and eukaryotic cells to ensure sufficient copper availability for protein biosynthesis and the inhibition of oxidative stress and resulting toxicity. Copper is a limiting factor in the development and progression of cancer, including growth, angiogenesis and metastasis; Therefore, regulating tumor occurrence and development by varying the copper content in the human body has become a popular research topic in tumor treatment. The method adopted for this can be divided into those that increase the copper concentration in tumor cells by administering copper compounds or copper ionophores and those that reduce the copper concentration to physiological levele using copper complexing agents, thereby achieving antitumor therapy. In this paper, the current status and progress of copper complexes in tumor therapy are briefly reviewed, including the known mechanism of action and molecular targets, Furthermore, the related clinical trials are discussed, and the prospects for copper complexes in this field are outlined.

The application of artificial intelligence in screening, diagnosis and prognosis of diabetic macular edema

SHEN Jiaqi, LI Xiaosa, BI Yanlong, ZHANG Jingfa

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  153-159.  doi:10.6040/j.issn.1673-3770.0.2024.084

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Artificial intelligence(AI)has shown promising applications in the early screening, diagnosis, assessment, and treatment decision-making of clinical diseases. Diabetic macular edema(DME)is a significant cause of visual impairment among the working-age population. Given the complexity of DME imaging data, high rate of blindness, and treatment challenges associated with the disease, exploration of AI in the diagnosis and treatment of DME is of great importance. This review summarizes the advancements of AI technology in the early screening, accurate diagnosis, and prognosis prediction of DME, analyzes the challenges faced by AI solutions in practical DME applications, and offers insights into future directions, with the aim of providing valuable guidance for achieving personalized and precise diagnosis and treatment of DME.

Research progress on the role of M receptor signaling pathway in the occurrence and development of myopia

ZHANG Jinmu, GUO Bin, JIANG Wenjun, LIU Dongmei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2024, 38(5):  160-164.  doi:10.6040/j.issn.1673-3770.0.2023.153

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M receptors participate in regulating numerous physiological activities in eye tissues. Studies have shown that M receptors can regulate ciliary muscle contraction, regulate the expression of myopia-related neurotransmitters(such as dopamine)and growth factors(such as transforming growth factor β2)in the retina and choroid, and affect scleral fibroblast proliferation and matrix metalloproteinase-2 expression, which in turn affects scleral remodeling and axial growth, ultimately affecting the occurrence and development of myopia. In recent years, a large number of animal experiments and clinical studies have confirmed that M receptor antagonists effectively delay the progression of myopia.This article provides a brief review of the role of the M receptor signaling pathway in the occurrence and development of myopia in different eye tissues(ciliary muscle, retina, choroid, and sclera), to provide ideas for the studing of myopia-related mechanisms and clinical treatment.