Sinusitis in children is a common disease in pediatric otorhinolaryngology. The incidence of sinusitis has gradually increased over the last 10 years. However, there is a lack of epidemiological research that focusses on pediatric sinusitis in China. Pediatric sinusitis is often accompanied by an acute viral upper respiratory tract infection, adenoid hypertrophy, and allergic rhinitis. As symptoms overlap it can be challenging to diagnose pediatric sinusitis. Nasal endoscopy is an important diagnostic method that can be used. A computed tomography(CT)scan of the sinus can often be inconsistent. Additionally, as the radiation dose is high, it should be carefully used in children. Treatment of pediatric sinusitis is different from sinusitis in adults. Also, there is less high-quality evidence available. An intranasal steroid and nasal spray are the first-line treatment used for children with sinusitis. The role of antibiotics has become increasingly controversial over the last few years. The difficulties and challenges in diagnosing and treating pediatric sinusitis need to be addressed so that clinical consensus can be reached and countermeasures can be used.

Rhinosinusitis and asthma are common heterogeneous diseases in children and have a number of complex risk factors. It has been reported that chronic rhinosinusitis may contribute to asthma and that there is a close interaction between them. The concept of ‘united airway disease’ has been well accepted, and is supported by the coexistence of upper and lower airway inflammation as well as similar potential mechanisms involved in the pathogenesis. For patients with asthma, particularly those with severe asthma, the presence of rhinosinusitis needs to be detected, as it can influence asthma severity and clinical management. Therefore, controlling rhinosinusitis may benefit asthma. Physicians should be aware of these conditions, and an improved understanding of the underlying pathophysiological mechanisms may be useful for diagnostic and therapeutic purposes. In this article, we discuss the clinical features, pathogenesis, medical intervention, and biological treatment of rhinosinusitis and asthma in children.

Pediatric rhinosinusitis has distinctly different clinical characteristics and outcomes compared to rhinosinusitis in adults. This is due to the immature development of the paranasal sinuses and immune system. Pediatric rhinosinusitis and other airway diseases, such as allergic rhinitis, otitis media, tonsillitis, and asthma, are closely related. Additionally, patients with pediatric rhinosinusitis are at risk of developing orbital and intracranial complications. Therefore, pediatric rhinosinusitis deserves great attention. This article discusses the pathogenesis, diagnosis, and treatment of chronic rhinosinusitis in children as well as the medication and surgical treatment options.

Pediatric sinusitis is one of the most common childhood diseases. Recurrent upper respiratory infections are associated with its high incidence and relapse rates, which increases the burden on families and society. In the past, the use of antibiotics has been advised in Chinese and foreign guidelines for the treatment of sinusitis as the first-line response. However, differences between children and adults in anatomy, pathophysiology, and associated diseases have led to controversy regarding antibiotic treatment for pediatric sinusitis. Further, in recent years, there have been debates about the use of antibiotics as the first-line therapy. This paper reviews the efficacy of antibiotics in the treatment of pediatric sinusitis.

There is a high incidence rate of sinusitis in children. Adenoid hypertrophy is a common cause of sinusitis in children. Adenoid hypertrophy can affect the occurrence and development of sinusitis by hindering nasal cavity development and nasal drainage, as well as releasing pathogenic bacteria. Sinusitis can cause adenoid hypertrophy through inflammatory stimulation. Allergies can affect both sinusitis and adenoid hypertrophy and might be an important therapeutic target to be considered during treatment.There is a closed relationship between adenoid hypertrophy and pediatric sinusitis. An adenoidectomy can be used to treatrefractory sinusitis in children.

In recent years, increasing attention has been given by otolaryngology doctors to pediatric patients with chronic rhinosinusitis(CRS). Pediatric patients with CRS are often successfully managed using standard drug therapy of no less than 12 weeks. However, some pediatric patients with CRS suffer from frequent recurrences and treatmentfailure. Surgery is an option when medical management fails.However, the decision regarding surgical therapy inchildren is difficult.Balloon sinuplasty was introduced to otolaryngology in 2005 to treat nasal sinus inflammatory diseases. Evidence now strongly supports its safety and efficacy in treating chronic rhinosinusitis(CRS). As it requires no bone or tissue removal and retains most or all of the sinus mucosa, this procedure could be suitable for children.We will review the literature relating to the surgical treatment of chronic rhinosinusitis in children.

Objective To study the clinical features and therapeutic strategies for orbital complications of pediatric rhinosinusitis. Methods The clinical data of 31 children with orbital complications caused by sinusitis treated in the Department of Otorhinolaryngology Head and Neck Surgery from October 2010 onwards were retrospectively analyzed and summarized. Results The orbital complications of pediatric sinusitis have different stages, which correspond with clinical characteristics and imaging findings. All cases were cured and discharged from our hospital. No recurrence occurred during the follow-up period of 9 to 24 months. One case was left with an eyelid ectropion, and one with a saddle nose. No serious complications such as cavernous sinus suppurative inflammation or an intracranial infection occurred. The bacterial culture rate in the patients pus and nasal secretions was 55%, including 4 cases of Staphylococcus aureus and 4 of Streptococcus pneumoniae. Conclusions In children, orbital complications caused by sinusitis occur more often in winter and spring, and males. It is closely related to other upper respiratory tract infections. The primary symptoms are atypical resulting in delayed treatment. Adequate and sensitive antibiotics should be used to control any infection early. Cefoperazone sodium and sulbactam sodium are usually used for treating children with rhinogenic orbital complications. If conservative treatment is ineffective, the stage of the disease should be assessed along with any changes in clinical and imaging manifestations examined. Satisfactory results can be obtained according to surgical indications.

Acute rhinosinusitis is an acute infection of the mucous membrane in the nasal cavity and sinus that results in inflammation. The nasal sinus is adjacent to the orbit anatomically, which makes it easy for a sinus infection to break through the anatomical barrier into the orbit. Due to antibiotics being widely used, this does not commonly occur. However, in children with a weakened immune system, it can result in orbital cellulitis and an orbital abscess. However, glomerulonephritis is a very rare complication. In this case report, we report a child with acute rhinosinusitis accompanied with acute glomerulonephritis and an orbital abscess. We also discuss our diagnosis and treatment process for the case.

Objective By detecting the common deafness genes in patients with severe to extremely severe sensorineural hearing loss in Nanjing, we aimed to analyze the spectrum and prevalence of the hot-deafness gene mutations among these patients. Moreover, we aimed to clarify the genetic etiology of deafness in patients with severe to extremely severe sensorineural hearing loss in Nanjing. Methods First, we obtained patient data from deafness etiology questionnaires, physical examination, high-resolution temporal bone computed tomography(CT), and clinical audiological examination. Thereafter, 2-4 mL of peripheral venous blood was collected from 128 patients with severe to extremely severe sensorineural hearing loss and the 21 common mutation sites in GJB2, GJB3, SLC26A4, mtDNA, and 12S rRNA genes were analyzed. Results Among the 128 patients, gene mutation in the analyzed sites were detected in 39 cases(30.47%, 39/128). Two patients showed double gene locus mutations, whereas 14 of them showed homozygous mutations. Thirty(23.44%, 30/128)patients were detected with GJB2 gene mutation. Among them, 18(14.06%, 18/128)patients had homozygous or compound heterozygous GJB2 gene mutations. The rate of 235delC mutation sites was 20.31%(26/128), that of the 299-300delAT mutation site was 4.69%(6/128), and that of the 176-191del mutation site was 3.91%(5/128). Ten(7.81%, 10/128)patients were detected with SLC26A4 gene mutation. Among them, 4(3.13%,4/128)patients were detected with homozygous or compound heterozygous SLC26A4 gene mutation. The rate of IVS7-2 A>G mutation was 7.03%. Mutations of mtDNA 12S rRNA and GJB3 genes were not found in the present study. High-resolution temporal bone CT revealed enlarged vestibular aqueduct in 11 patients, and 10 of them tested positive for SLC26A4 homozygous or heterozygous mutations. The concordance rate between genetic diagnosis and temporal bone CT was 90.91%(10/11). Conclusions GJB2 gene mutation was the most commonly observed mutation in patients with severe to extremely severe sensorineural hearing loss in Nanjing, and the most common mutation site was 235delC. SLC26A4 gene mutation was the second most commonly observed mutation, and the most common mutation site was IVS7-2 A>G. SLC26A4 gene mutation is often found in patients with enlarged vestibular aqueduct syndrome, and mutation in this gene is useful to diagnose the syndrome. However, temporal bone CT can be used to reduce the rate of missed diagnosis in patients with sensorineural hearing loss.

Objective To discuss the application and effect of ear reconstruction with expanded skin flaps and fascial flaps(the two flaps method), in congenital microtia. Methods The study included 712 cases(756 ears)of congenital microtia from January 2012 to January 2018, all reconstructed with the two flaps method. Results All cases were followed-up for 1 to 6 years. Among them, 15 cases(15 ears)had steel wire exposure after the operation, which was resolved after removing the steel wire over time. Ten cases had subcutaneous hematoma of the reconstructed auricle after the operation, which disappeared after replacing the negative pressure drainage tube. Three cases had exposed cartilage scaffold due to improper protection of the reconstructed auricle, which was sutured by local skin and covered with pedicled fascia flaps. Patients were cured after timely treatment. The size, shape, and location of the reconstructed auricles were basically symmetrical with the healthy ears. The reconstructed auricle skin was normal in color, the auricle cartilage scaffold was not exposed or absorbed, and the fine concave and convex structure was clear. Conclusion The two flaps ear reconstruction is a better method for the treatment of congenital microtia because of its superior result and fewer complications.

Objective We aimed to study the correlation between the eosinophil(Eos)content in the nasal secretions and pulmonary function in patients with simple allergic rhinitis(AR)during the attack and stable period. Methods Overall, 102 adults with simple AR were included in the AR group, and 53 healthy individuals were included in the control group. We used pulmonary function tests to determine the pulmonary function indexes; nasal secretion smears were prepared, and the Eos count was determined during the attack and stable period. Result There were significant differences in the Eos count in the nasal secretions and peak expiratory flow(PEF), maximal expiratory flow at 75% of the forced vital capacity(MEF₇₅), and forced expiratory volume in one second(FEV₁)between the control group and AR group during the attack and stable period(P<0.001). The Eos count in the nasal secretions of the patients in the AR group during the attack and stable period was correlated with PEF, FEV₁, and MEF₇₅, and was significantly correlated with FEV₁( r =-0.53, P<0.001). Conclusion We showed that the Eos count in the nasal secretions of patients with AR was closely related to pulmonary function. With the aggravation of airway allergy, pulmonary function decreased significantly.

Objective To examine the effect of applying fiberoptic endoscopic evaluation of swallowing(FEES)on long-term survivors of nasopharyngeal cancer. Methods Fiberoptic endoscopic evaluation of swallowing was conducted on 107 patients with nasopharyngeal carcinoma who were previously treated by radiotherapy. The Yale pharyngeal residue severity rating and Rosenbek penetration-aspiration scale were used to evaluate pharyngeal residue, penetration, and aspiration. Results A total of 107 patients were included in survey, with a median follow-up time of 8.78±2.91 years(range: 5-14 y). Late complications noted in the participants were impairment of the glottic adduction reflex(n=22, 20.56%), nasopharyngeal reflux(n=23, 21.49%), and vocal cord(n=50, 46.72%). The detection rate of pharyngeal residue on FEES with porridge was 53.06%, while that of aspiration on FEES with liquid and porridge was 45.79% and 29.90%, respectively. Conclusion The use of FEES in long-term survivors with nasopharyngeal cancer led to serious radiotherapy-induced dysphagia, particularly in pharyngeal residue with porridge and aspiration with liquid and porridge.

Objective To investigate the feasibility of using a posterior pharyngeal wall flap to repair the defects associated with early posterior hypopharyngeal wall carcinoma. Methods Three cases of early hypopharyngeal wall carcinoma were repaired with a posterior pharyngeal wall flap. Results The posterior pharyngeal wall flap healed well, and pronunciation, swallowing, and respiratory function recovered well postoperatively. Conclusion The use of a posterior pharyngeal wall flap is a simple and effective repair method for the treatment of early hypopharyngeal wall carcinoma.

Objective To compare the expression of metastasis suppressor 1(MTSS1)protein in tongue squamous cell carcinoma(TSCC)and normal tongue mucosa. Methods The expression of MTSS1 was analyzed in TSCC and normal tongue mucosa using immunohistochemical staining. Single-factor analysis was used to study the relationship between MTSS1 expression and clinicopathological factors. Results The expression of MTSS1 was lower in TSCC than in normal tongue mucosa(20 cases each). The expression of MTSS1 was higher in cases with positive lymph node metastasis(34 cases)than those negative for lymph node metastasis(46 cases). Furthermore, the expression of MTSS1 was higher in cases with higher clinical stage(37 cases)than in those with lower clinical stage(43 cases). Conclusion The decrease of MTSS1 expression may be associated with infiltration and metastasis of TSCC. MTSS1 may inhibit the occurrence and development of TSCC and play an important role in the early development of TSCC.

Objective To investigate the effects of anxiety and/or depression and cognitive decline on nocturnal blood pressure fluctuations in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods The study group included 81 patients with anxiety and/or depression and OSAHS, who were treated in Qilu Hospital of Shandong University(Qingdao)from August 2018 to May 2019, while 73 patients with OSAHS only were selected as controls. All patients were able to complete the Hamilton depression scale, self-rating anxiety scale, and self-rating depression scale evaluations and underwent overnight polysomnography(PSG)using SOMNOmedics V6. Simultaneously, PSG monitoring data were recorded. Patients were divided into three groups-mild, moderate, and severe-according to the apnea hypopnea index. Results The highest systolic blood pressure and systolic amplitude of the study group were significantly higher than those of the control group, and the differences were statistically significant. Conclusion Adverse psychological emotional states, such as anxiety and/or depression, and cognitive decline will affect the range of fluctuation of systolic blood pressure in patients with severe OSAHS. During sleep monitoring, it is necessary to pay close attention to changes in nocturnal blood pressure in patients with anxiety and/or depression and severe OSAHS to prevent cardiovascular complications.

Objective To investigate air pollutant-induced acute laryngeal mucosa injury and its possible mechanisms in rats. Methods Twelve healthy SPF Sprague Dawley(SD)rats were randomly and equally divided into control and gas pollutant exposure groups(6 rats in each group). The rats in the control group were fed in an SPF environment, while the rats in the exposure group were exposed to HEPA membrane-filtered air obtained during the red alert period in Beijing in 2016. The rats were sacrificed after exposure to pollutants for 6 days. The pathological changes in rat laryngeal mucosa and IL-1beta, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, IL-17a, IFN-gamma, and TNF-alpha cytokine expression were then detected. Results The laryngeal mucosa epithelium of rats exposed to air pollutants showed hyperkeratosis and basal cell disorder of varying degrees. IL-1beta, IL-10, IL-13, IL-17a, and TNF-alpha expression also increased (P<0.05) and IL-12 and IFN-gamma expression decreased (P<0.05) in rats exposed to air pollutants when compared to the control group. Conclusion Gas pollutants in the air can cause laryngeal mucosa injury in rats, and its mechanism may be related to Th1/Th2 imbalance, which is a Th2 dominant response.

Objective To evaluate the feasibility of a canine model of vocal cord adhesion(VCA)and to determine the effectiveness of nitro-benzyl alcohol-modified hyaluronic acid(HA-NB)with mitomycin C(MMC)for the prevention of postoperative VCA using a canine model. Methods Sixteen male beagle dogs were divided into four groups(4 dogs in each group)and treated with saline(control group), HA-NB, MMC, or HN-MMC after VCA was induced by radiofrequency coblation using a suspension laryngoscope. At 8 weeks after surgery, the extent of VCA was determined to evaluate the preventive effects of HA-NB, MMC, and HN-MMC. All larynges were harvested and examined histologically. Results VCA induction was successful in all groups. VCA ratio was evaluated at 8 weeks after the initial surgery. The mean VCA ratio in both the HA-NB and MMC groups was not significantly different to that of the control group, but it was lower in the HN-MMC group than that in the control group. The estimated marginal means of HA-NB*MMC were lowest in the HN-MMC group and showed a significant synergistic interaction between HA-NB and MMC. The scar elevation index(SEI)in the HN-MMC group was significantly lower than that in any other groups. Conclusion The combination of HA-NB gel and MMC was more effective for the prevention of postoperative VCA formation than a single application of HA-based gel or MMC.

Objective To investigate the predictive effect of the laryngoscopy scoring system on cases of difficult glottic exposure during laryngoscopy. Methods This was a double-blind study, in which the laryngoscopy scoring system was used to preoperatively examine and score patients who were undergoing laryngoscopy. The surgeon assessed and graded the difficulty in glottis exposure during the operation, to assess whether it was relevant and could analyze the associated factors. Results When the patient had a preoperative laryngoscope score of ≤6, an acceptable laryngeal exposure was observed at an 82.8% probability, while a difficult laryngeal exposure was found at 17.2%. When the patient's preoperative laryngoscopy score exceeded 6, a 100% probability of surgery would lead to difficult laryngeal exposure. The sensitivity, specificity, misdiagnosis, and missed-diagnosis rates of the difficult laryngeal exposure prediction system(>6 points)were 100%(20/20), 82.8%(48/58), 0%(0/20), and 17.2%(10/58), respectively. Statistically significant variables included open cleavage distance, thyroid cartilage angle-underarm distance, neck extension angle, body mass index, and small jaw deformity. Conclusion Using the simple and feasible preoperative support laryngoscopy scoring system, a threshold of 6 points was used to distinguish cases with difficult laryngeal exposure from those with acceptable laryngeal exposure, with relatively high accuracy. Furthermore, this scoring system proved to be simple and easy to operate in clinical practice and could be certainly considered practicable.

Objective To investigate the types and characteristics of severe complications associated with complicated foreign bodies of the esophagus, and to summarize the clinical diagnosis and treatment. Methods From January 2015 to January 2018, 244 cases with an esophageal foreign body were hospitalized in the affiliated Hospital of Guangdong Medical University, of which 22 were accompanied by severe complications. The clinical data of 22 patients were analyzed retrospectively. This data includes patients, the time of their visit, the types of foreign bodies, the location of the Kanton, types of complications, diagnosis, and treatment. Results Apart from 4 children, all patients had tried to force the foreign body into their stomach by eating steamed bread, vegetables and swallowing. This resulted in a number of serious complications. The longest time from onset to treatment was 32 days, with an average of 5.9 days. Seventeen(77.3%)of the foreign-body cases resulted from animal bones, mainly fish and chicken bones. Ten cases were at the esophageal entrance level, 5 cases at the T1-T2 level and 3 cases at the T8-T9 level. In 6 cases(27.3%), severe complications included esophageal perforation or local inflammation emphysema in the neck and diaphragm, an abscess in 5 cases(22.7%)and an esophageal or phrenic fistula in 4 cases(18.2%). There were 3 cases(13.6%)of extraesophageal foreign bodies, 1 case of a posterior pharyngeal abscess(4.5%), 1 case of a pneumothorax(4.5%), 1 case of an tracheoesophageal fistula(4.5%)and 1 case of an esophageal aortic fistula(4.5%). Foreign bodies were removed under esophagoscopy in 14 cases, foreign bodies in 3 cases by lateral cervical incision, incision and drainage of a cervical and mediastinal abscess in 3 cases, thoracoscopic exploration of the esophagus in 1 case, and pneumonectomy in 1 case. One patient underwent a tracheoesophageal fistula repair with a bronchoscopic foreign body removal. Of the 22 patients, 21 were cured(95.5%), with an average hospital stay of 6.2 days. One patient passed away(4.5%). Conclusion Foreign body of the complex esophagus is more common in elderly patients. Patients who swallow foreign bodies by mistake generally start violently swallowing and do not seek medical treatment in enough time. This leads to the patients condition worsening. A positive correlation was observed between the type of foreign body, the admitting hospital, and the time of medical treatment with the occurrence and severity of complications. An upper gastrointestinal angiography and computed tomography(CT)examination were the most effective in diagnosing an esophageal foreign body and its potential complications. These tools can clearly show the relationship between foreign bodies and the important tissues and organs around them. Multidisciplinary assistance therapy is important in reducing the occurrence of serious complications.

Reflux diseases such as gastroesophageal reflux disease(GERD)and laryngopharyngeal reflux disease(LPRD)are caused by upward reflux of gastric contents, but differ in pathogenesis and manifestations. The clinical symptoms of GERD, especially LPRD, are non-specific; therefore, it is difficult to correctly diagnose these diseases in clinical practice. However, pH changes in the esophagus or throat can be objectively and directly monitored to circumvent diagnoses based on the non-specific subjective symptoms, and therefore can be used in the diagnosis of reflux diseases. Here, we review the developmental processes and characteristics of intraluminal pH monitoring.

With the development of phacoemulsification surgery, the calculation of intraocular lens power has been paid greater attention. Various intraocular lens power formulas have been presented to optimize the visual quality after surgery. This paper comprehensively describes the progress in the research of various intraocular lens power formulas, such as the first-generation intraocular lens formula, the second-generation formula, Hill-RBF, Barrett True-K, and so on.