Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2020, Vol. 34 ›› Issue (5): 14-19.doi: 10.6040/j.issn.1673-3770.1.2020.062

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A new grade of vestibular function abnormality in Menieres disease: a pilot study

  

  • Received:2020-07-07 Published:2020-11-17

Abstract: Objective To establish a new grade of vestibular function abnormality in patients with Menieres disease(MD)and to preliminarily investigate its clinical significance and correlation with the hearing stage. Methods Clinical data of patients with unilateral intractable MD hospitalized from January 2015 to December 2019 were retrospectively reviewed. All patients underwent pure-tone audiometry, cervical vestibular-evoked myogenic potential(cVEMP)testing, ocular VEMP(oVEMP)testing, the video head impulse test(vHIT), and the caloric test. Abnormal semicircular canal function was defined as an abnormal vHIT or caloric test result. Abnormal saccule function was defined as an abnormal cVEMP. Abnormal utricle function was defined as an abnormal oVEMP. Vestibular function grade Ⅰ was defined when the utricle, saccule, and semicircular canal were normal. Vestibular function grade Ⅱ was defined when the utricle, saccule, or semicircular canal was abnormal. Vestibular function grade Ⅲ was defined when two structures among the utricle, saccule, and semicircular canal were abnormal. Finally, vestibular function grade Ⅳ was defined when the utricle, saccule, and semicircular canal were all abnormal. Results We enrolled 95 cases of MD, including 13, 13, 52, and 17 cases in stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The pure-tone average(PTA)hearing at 500 Hz, 1 kHz, and 2 kHz was 51.86±21.70 dB HL in the ears with MD. The abnormal rates of cVEMP, oVEMP, vHIT, and caloric test results were 63.2%, 74.7%, 33.7%, and 52.6%, respectively. According to the grade of vestibular function abnormality, 9, 28, 39, and 19 cases were in grades Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. The vestibular function stage significantly correlated with the PTA(P<0.01, r=0.35), MD stage(P< 0.01, r=0.35), and disease duration(P=0.02, r=0.24). The vestibular function stage did not significantly correlate with patient age(P=0.084). Conclusion The rates of abnormal otolith and semicircular canal functions increase with the development of MD. Therefore, patients with MD can be accurately assessed with precise testing of the utricle, saccule, and semicircular canals. The status of the development of MD is reflected in the hearing and vestibular function stages. The combined assessment of hearing and vestibular functions can provide a useful reference for the treatment and prognosis of patients with MD.

Key words: Meniere's disease, Vertigo, Clinical stage, Otolith, Semicircular canal, Vestibular function, Grading

CLC Number: 

  • R764.33
[1] Oberman BS, Patel VA, Cureoglu S, et al. The aetiopathologies of Ménières disease: a contemporary review[J]. Acta Otorhinolaryngol Ital, 2017, 37(4):250-263. doi: 10.14639/0392-100X-793.
[2] Committee on Hearing and Equilibrium. Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Menieres disease[J]. Otolaryngol Head Neck Surg, 1995, 113(3):181-185. doi:10.1016/s0194-5998(95)70102-8.
[3] 中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会. 梅尼埃病诊断和治疗指南(2017)[J]. 中华耳鼻咽喉头颈外科杂志,2017,52(3):167-172. doi:10.3760/cma.j.issn.1673-0860.2017.03.002. Editorial Board of Chinese Journal of Otorhinolary,Society of Otorhinolaryngology Head and Neck Surge. Guideline of diagnosis and treatment of Meniere disease(2017)[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(3):167-172. doi:10.3760/cma.j.issn.1673-0860.2017.03.002.
[4] Sandhu JS, Low R, Rea PA, et al. Altered frequency dynamics of cervical and ocular vestibular evoked myogenic potentials in patients with ménières disease[J]. Otol Neurotol, 2012, 33(3):444-449. doi:10.1097/mao.0b013e3182488046.
[5] Sobhy OA, Elmoazen DM, Abd-Elbaky FA. Towards a new staging of Ménières disease: a vestibular approach[J]. Acta Otorhinolaryngol Ital, 2019, 39(6):419-428. doi:10.14639/0392-100x-2461.
[6] Okumura T, Imai T, Takimoto Y, et al. Assessment of endolymphatic Hydrops and otolith function in patients with Ménières disease[J]. Eur Arch Otorhinolaryngol, 2017, 274(3):1413-1421. doi:10.1007/s00405-016-4418-2.
[7] Fukushima M, Oya R, Nozaki K, et al. Vertical head impulse and caloric are complementary but react opposite to Menieres disease Hydrops[J]. Laryngoscope, 2019, 129(7):1660-1666. doi:10.1002/lary.27580.
[8] 许珉, 陈耔辰, 魏馨雨, 等. 前庭诱发肌源性电位、冷热试验和耳蜗电图在梅尼埃病诊断中的评估价值[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(8):704-708. doi:10.13201/j.issn.1001-1781.2019.08.006. XU Min, CHEN Zichen, WEI Xinyu, et al. Evaluation of vestibular evoked myogenic potential, caloric test and cochlear electrogram in the diagnosis of Menieres disease[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(8):704-708. doi:10.13201/j.issn.1001-1781.2019.08.006.
[9] Schuknecht HF, Gulya AJ. Endolymphatic hydrops: an overview and classification[J]. Ann Otol Rhinol Laryngol, 1983, 92(5_suppl):1-20. doi:10.1177/00034894830920s501.
[10] Agrawal Y, Minor LB. Physiologic effects on the vestibular system in Menieres disease[J]. Otolaryngol Clin North Am, 2010, 43(5):985-993. doi:10.1016/j.otc.2010.05.002.
[11] Colebatch JG, Halmagyi GM. Vestibular evoked potentials in human neck muscles before and after unilateral vestibular deafferentation[J]. Neurology, 1992, 42(8):1635-1636. doi:10.1212/wnl.42.8.1635.
[12] Gilchrist DP, Curthoys IS, Burgess AM, et al. Semicircular canal occlusion causes permanent VOR changes[J]. NeuroReport, 2000, 11(11):2527-2531. doi:10.1097/00001756-200008030-00036.
[13] 李斐, 庄建华, 陈瑛, 等. 梅尼埃病不同听力分期中颈肌前庭诱发肌源性电位的差异[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(1):9-12. doi:10.13201/j.issn.1001-1781.2016.01.003. LI Fei, ZHUANG Jianhua, CHEN Ying, et al. Difference of cervical vestibular evoked myogenic potentials in different audition stage of Ménière disease[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(1):9-12. doi:10.13201/j.issn.1001-1781.2016.01.003.
[14] 牛晓蓉, 韩鹏, 陈耔辰, 等. 前庭耳石器通路功能评价在梅尼埃病分期中的初步研究[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(3):195-199. doi:10.3760/cma.j.issn.1673-0860.2017.03.006. NIU Xiaorong, HAN Peng, CHEN Zichen, et al. Pilot study on the functional evaluation of vestibular otolith-organ pathway in the stage of patients with Meniere disease[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2017, 52(3):195-199. doi:10.3760/cma.j.issn.1673-0860.2017.03.006.
[15] 范文君, 罗彬, 管锐瑞, 等. 不同分期梅尼埃病患者眼肌前庭诱发肌源性电位及冷热试验检测分析[J]. 听力学及言语疾病杂志, 2017, 25(5):488-491. doi:10.3969/j.issn.1006-7299.2017.05.012. FAN Wenjun, LUO Bin, GUAN Ruirui, et al. Application of ocular vestibular evoked myogenic potential and caloric test to different stages of meniere disease[J]. Journal of Audiology and Speech Pathology, 2017, 25(5):488-491. doi:10.3969/j.issn.1006-7299.2017.05.012.
[16] Gürkov R, Flatz W, Louza J, et al. In vivo visualized endolymphatic Hydrops and inner ear functions in patients with electrocochleographically confirmed ménières disease[J]. Otol Neurotol, 2012: 1. doi:10.1097/mao.0b013e31825d9a95.
[17] Liu YP, Jia H, Shi J, et al. Endolymphatic Hydrops detected by 3-dimensional fluid-attenuated inversion recovery MRI following intratympanic injection of gadolinium in the asymptomatic contralateral ears of patients with unilateral ménières disease[J]. Med Sci Monit, 2015, 21:701-707. doi:10.12659/msm.892383.
[1] XU Jia, LI Xin, CHEN Wenjing, GAO Juanjuan, LU Xingxing, YI Haijin. Short-term and long-term outcomes of endolymphatic sac decompression with instillation of local steroids for intractable Meniere's disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 17-21.
[2] HAN Shuhui, FAN Xintai, WANG Na, WANG Zhe, HOU Lingxiao, XU Anting. A study on the relationship between mastoid pneumatization degree and endolymphatic sac development based on a propensity score matching analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 22-26.
[3] YANG Yang, WANG Xiaoxu, ZHANG Jie. Progress on diagnosis and treatment of middle ear cholesteatoma in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 1-6.
[4] ZHANG Yaoyao,WANG Haitao. The application of MRI technology with intratympanic gadolinium injection in the diagnosis and treatment of Meniere's disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 101-107.
[5] JIANG Lina, YU Qianru, YU Jie, GUAN Benling, LU Yu, YU Shudong. Anxiety and depression in patients with common types of vertigo [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 1-5.
[6] . Diagnosis and management of peripheral vestibular diseases [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 1-6.
[7] To analyze the clinical outcomes of patients with unilateral idiopathic sudden sensorineural hearing loss(SSNHL)and explore the relationship between vestibular function and prognosis in patients with SSNHL. MethodsA retrospective analysis of patients( ears)with SSNHL was performed. A total of vestibular function tests were performed in all patients to assess the influence of vestibular functions on the clinical outcome of SSNHL. ResultsTreatments were less effective in patients with abnormalities in ocular vestibular evoked myogenic potential(oVEMP)or cervical vestibular evoked myogenic potential(cVEMP). Those with normal oVEMP and cVEMP had relatively better hearing recovery. The outcomes of the caloric test or video head impulse test showed no association with the efficacy of treatment or hearing recovery in patients with SSNHL. Treatment was less effective in patients with abnormalities in both oVEMP and cVEMP, who also had worse hearing recovery than those who had an abnormal finding in only one of the two tests. ConclusionsPatients with abnormal oVEMP or cVEMP results had poor clinical outcomes, while those with normal oVEMP and cVEMP demonstrated better hearing recovery with treatment. Thus, oVEMP and cVEMP could be effective indices to predict the prognosis of patients with SSNHL. An abnormal vestibular function is a definite indicator of a wider and more severe pathological change in the inner ear of patients with SSNHL.. Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 27-32.
[8] To analyze the relationship between vestibular symptoms and function and hearing outcomes in patients with unilateral profound sudden sensorineural hearing loss(SSNHL). MethodsA retrospective analysis of patients with unilateral profound SSNHL was performed. Vestibular symptoms and the results of ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP), video head impulse test(vHIT), and caloric test were analyzed to observe the relationship between hearing outcomes and vestibular symptoms and function. ResultsOf patients with unilateral profound SSNHL, there was a significant difference between the patients with and without vestibular symptoms, patients with vestibular dysfunction, and those with normal vestibular function. Patients with abnormal oVEMP, cVEMP, vHIT, and caloric test results showed a lower total effective rate. In contrast, patients with normal results in all four tests had a higher hearing recovery. ConclusionPatients with unilateral profound SSNHL with abnormal vestibular dysfunction and symptoms had a poor curative effect. Conversely, those with normal oVEMP, cVEMP, vHIT, and caloric test results had better chances of hearing recovery. Abnormal vestibular function suggests more extensive and severe inner ear lesions in patients with unilateral profound SSNHL.. Relationship between prognosis and vestibular symptoms/function in patients with unilateral profound sudden sensorineural hearing loss: A retrospective analysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 33-38.
[9] This study was aimed at determining vestibular involvement and the location and frequency of vestibular dysfunction in patients with auditory neuropathy. MethodsTwenty patients with non-syndromic auditory neuropathy were enrolled. Using vestibular test battery, we calculated the ocular vestibular-evoked myogenic potential(oVEMP), cervical vestibular-evoked myogenic potential(cVEMP), video head impulse test(vHIT), suppression head impulse paradigm(SHIMP), and caloric test results. ResultsThe oVEMP and cVEMP were calculated for all patients, and the abnormality rates were % and %, respectively, showing no significant difference. The vHIT in the lateral, anterior, and posterior semicircular canals, and SHIMP in the lateral canals were calculated for patients( ears), and the abnormality rates were %, %, %, and %, respectively, showing no significant difference among the four tests. Nineteen patients exhibited a % abnormality rate for the caloric test. Of the patients with the SHIMP and vHIT results, % showed abnormal caloric test results, which was much higher than the abnormality rate of SHIMP and vHIT. ConclusionPatients with auditory neuropathy showed vestibular involvement, and the superior and inferior vestibular components, including the vestibular peripheral receptors and nerves, had an equal probability of dysfunction. All the otolith organs and semicircular canals could be involved. The possibility of dysfunction was equal for different portions of the semicircular canal, while the functional involvement was more likely to be observed in low-frequency tests.. Location and frequency characteristics of vestibular dysfunction in patients with nonsyndromic auditory neuropathy [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 39-45.
[10] To determine the therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease.MethodsClinical data of patients with unilateral intractable Menieres disease who underwent retrolabyrinthine vestibular neurectomy were retrospectively investigated. Therapeutic effectiveness was analyzed, and the safety and reliability of the procedure was discussed. ResultsThe mean duration of the disease was .±. months. Preoperative pure tone average of Hz, Hz, Hz, and Hz was(.±.)dB HL. Two cases were stage Ⅱ, cases were stage Ⅲ, and cases were stage Ⅳ. Two stage Ⅱ patients were recurrent cases after endolymphatic sac decompression surgery. Intracranial infection in case(.%), cerebrospinal fluid leakage in cases(.%), temporal facial nerve palsy in case(.%), incision infection in cases(.%), and fat liquefaction in cases(.%)were observed postoperatively. There was no case of intracranial hemorrhage or total deafness. Therapeutic effectiveness for relieving vertigo was level A in cases and level B in cases. ConclusionThe therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease is definite. Surgical risk and postoperative complications are controllable, and the quality of life can be significantly improved after surgery.. Therapeutic effectiveness of 75 cases of retrolabyrinthine vestibular neurectomy for intractable Menieres disease [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 46-50.
[11] This study aimed to compare the abnormality rate of vestibular evoked myogenic potentials(VEMPs)in patients with primary and recurrent benign paroxysmal positional vertigo(BPPV)and test the hypothesis that otolith dysfunction causes the recurrence of BPPV. MethodsCervical VEMP(cVEMP)and ocular VEMP(oVEMP)tests using air-conducted 500 Hz tone-burst stimuli were performed on 57 patients with unilateral primary BPPV(n=36)and recurrent BPPV(n=21)between June 2019 and May 2020. Abnormalities in cVEMP and oVEMP were compared between the primary and recurrent BPPV groups. Results(1) The differences in sex, the involved side, and canal between the primary and recurrent BPPV groups were not significant; however, the difference was statistically significant in terms of age; (2) Of the 57 BPPV patients, cVEMP or oVEMP was not elicited in 21 cases(36.84%)and 35 cases(61.40%), respectively. The abnormality rate of oVEMP was much higher(P<0.05); (3)Abnormal cVEMP was observed in 16 of 36(44.45%)and 5 of 21(23.81%)cases in the primary and recurrent BPPV groups, respectively. Abnormal oVMEP was observed in 19 of 36(52.79%)and 16 in 21(76.19%)patients in the primary and recurrent BPPV groups, respectively. Differences in the abnormality rates of cVMEP and oVMEP were not found between the primary and recurrent BPPV groups(P>0.05); (4) When the recurrent BPPV group was further divided into 2-times groups and ≥3-times group according to the recurrent frequency, there were also no statistical differences in the VEMP abnormality rate in these three groups(P>0.05). ConclusionThe results showed no significant difference in the abnormality rate of cVEMP and oVEMP between the primary BPPV and recurrent BPPV groups, indicating that the possible recurrent mechanism of primary BPPV still needs to be further studied.. Abnormality rate of vestibular evoked myogenic potentials in patients with primary and recurrent benign paroxysmal positional vertigo: a clinical observation [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 51-55.
[12] To explore the relationship between dizziness-vertigo and nystagmus intensity, according to the nystagmus accompanied by dizziness and/or vertigo during caloric test. MethodsThe relationship between dizziness and vertigo sensations and nystagmus intensity was analyzed in 399 patients with peripheral vestibular disorders,who underwent routine caloric test. The nystagmus intensity is as an index, accompanied by dizziness and/or vertigo sensations induced during caloric test. ResultsWarm and cold stimulation induced dizziness and vertigo and associated nystagmus overall analysis, the intensity of nystagmus was always greater than that of dizziness when vertigo occurred. The nystagmus thresholds for dizziness and vertigo induced by warm and cold air stimulation in the left ears were 4.2°/s and 5.9°/s for cold, 4.2°/s and 8°/s for warm, in the right ears were 4.6°/s and 6.2°/s for cold, 5.3°/s and 6.5°/s for warm, respectively. Three hundred ninety nine patients were subjected to alternating warm and cold stimulation in both ears for a total of 1596 times, which induced dizziness 513 times(32.14%), of which 312 times only dizziness and 201 times vertigo ten seconds after dizziness. Vertigo was induced 906 times(56.77%), of which 705 occurred directly without transitioning from dizziness to vertigo, and another 201 times vertigo occurred after ten seconds of dizziness; 378(23.68%)times did not induce dizziness and vertigo. ConclusionsVertigo corresponds to a higher nystagmus intensity threshold than dizziness, with patients showing dizziness when the nystagmus is weak and vertigo when it is stronger. Warm and cold air stimulation induced nystagmus intensity from weak to strong, and from dizziness to vertigo sensations induced at the same time, suggesting that the symptoms of dizziness and vertigo are related to the asymmetric between the two vestibular tension.. Study of the relationship of dizziness and vertigo sensations with the nystagmus intensity [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 56-60.
[13] To study the characteristics of air-conducted ocular vestibular evoked myogenic potential(AC-oVEMP)and cervical vestibular evoked myogenic potential(AC-cVEMP)in normal Chinese children. MethodsFifty-two 4-10-year-old children with normal hearing(male 30, female11, 104 female)were recruited. Using 500-Hz air-conducted pure tone burst as a stimulus, oVEMP and cVEMP were assessed. The response rates and waveform parameters of the left and right ears were recorded and analyzed statistically using SPSS software. ResultsThe respective findings for oVEMP and cVEMP were as follows: response rates: 92% and 96%; P1 latencies:(17.07±0.89)ms and(15.55±1.58)ms; N1 latencies:(12.39±0.91)ms and(23.10±2.29)ms; N1P1 latencies:(4.68±0.88)ms and(7.83±1.56)ms; amplitudes:(7.24±4.79)μV and(197.40±118.37)μV; interaural asymmetry ratios(AR,%):(19.03±12.50)% and(22.16±18.64)%. There were no significant differences between the latencies, N1P1 latencies, or amplitudes of the left and right ears(P>0.05). ConclusionoVEMP and cVEMP can be elicited by the stimuli of air-conducted pure tone bursts in the majority of normal children. They can be used to evaluate vestibular function, as they are feasible and compliance in children is high. The results provide the normal reference range of VEMP for children in China.. Characteristics of air-conducted vestibular-evoked myogenic potential in normal children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 67-71.
[14] Vestibular rehabilitation training is important for treating vestibular diseases and improving vertigo symptoms. However, the large number of patients, the lack of venues and rehabilitation specialists, and medical expenses have limited its application at all levels in hospitals. With the development of smartphones and the mobile internet, home-based rehabilitation and remote guidance have become possible. Therefore, we developed a remote vestibular rehabilitation training guidance platform to be accessed with smartphones and the mobile internet. The platform design is based on the Browser/Server mode structure; it has IOS and Android versions and supports wireless access smartphone terminals. The platform facilitates a more convenient, smooth, and effective remote guidance for vestibular rehabilitation function exercises, curative effect evaluations, and follow-up; this improves efficiency and compliance as well as reduces the technical barriers, site restrictions, and labor costs of vestibular rehabilitation. This paper introduces the functional design, related technology realization, and the operational effect of the platform.. Development and application of a vestibular rehabilitation training guidance platform [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 78-81.
[15] Newborns and infants with hearing loss often suffer from vestibular dysfunction, which may aggravate with the gradual deterioration of hearing, resulting in delayed motor development or motor dysplasia. The motor development of newborns and infants depends on the function of the vestibular organs; thus, early vestibular function evaluation has positive prognostic significance. However, newborns and infants lack the language skills to fully express their symptoms. Furthermore, a series of complex vestibular function tests may cause them discomfort, such as vertigo and nausea, and the equipment and environment often scare them, which make vestibular assessment very challenging. Additionally, the structure and function of the vestibular, visual, and proprioceptive systems gradually mature with growth and development. Therefore, the clinical data of vestibular quantitative tests in different age groups cannot be compared with the standard reference range in adults. Hence, not all types of vestibular tests are necessary or appropriate in newborns and infants and should be adjusted according to the stage of development. In this study, we performed a literature review with focus on the common vestibular function tests according to the age and developmental stage of newborns and infants.. Update on the development and evaluation of vestibular function in newborns and Infants [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(5): 82-88.
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[1] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(2): 116 -118 .
[2] ZHOU Zi-ning,JIN Guo-wei . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(5): 462 -465 .
[3] ZHOU Bin,LI Bin . Endoscopic sinus surgery for 75 patients with chronic sinusitis and nasal polyps[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 24 -26 .
[4] XU Sainan,YANG Lei . Apoptosis of epithelial cells in nasal polyps promoted by erythromycin[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 27 -29 .
[5] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(1): 94 -95 .
[6] LIU Lian-he . Treatment of deep neck abscess in 37 cases[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(2): 180 -181 .
[7] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 200 -203 .
[8] QIAO Yi,NI Guan-sen,CHEN Wen-wen . Effect of H-UPPP and nasal operations on obstructive sleep apnea syndrome in 38 cases
[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 206 -208 .
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[10] FAN Qi-jun,HUANG Zhi-wu,MEI Ling,XIAO Bo-kui . Expression of the heat shock protein 27 in rat cochlea induced by sodium salicylate injection by the FQ-PCR technique[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(3): 212 -214 .