Temporal bone contains cochlea and vestibule, with numerous vessels and nerves. Auricular complications commonly occur when the temporal bone is fractured. Auricular complications must be identified when dealing with craniocerebral trauma, especially with temporal bone fractures. The principles to use for auricular complications with a temporal bone fracture depend on the position and severity of the injury. Individualized treatment can improve the patient's prognosis and quality of life.
The clinical characteristics and prognosis of post traumatic hearing loss were retrospectively evaluated to aid further diagnosis, medical evaluation, early identification, and effective treatment.
We recruited 84 patients (96 ears) and obtained their clinical examination findings, hearing test results, and audiograms from a single-institution otolaryngology service with comparative data generated from their first and follow-up visits.
Among all the recruited patients, 34 ears (35.4%) had normal hearing, while 62 ears (64.6%) had hearing loss after trauma, at their first visit. Among 62 ears with hearing loss, 33 ears (53.2%) had conductive hearing loss, 25 ears (40.3%) had sensorineural hearing loss, and four ears (6.5%) had a mixture of conductive and sensorineural hearing loss. At the follow-up visit, the air conduction threshold of ears with conductive hearing loss had significantly decreased from 45.77±4.28 dB HL to 34.48±4.53 dB HL (t=2.906, P < 0.05), while the bone conduction threshold decreased from 23.45±2.31 dB HL to 19.63±2.20 dB HL (t=2.906, P < 0.05). However, no significant differences between the first and follow-up visits were observed in ears with sensorineural hearing loss or ears with mixed hearing loss. Of all the 96 ears, 39 (40.6%) had intact tympanic membrane, while 57 (59.4%) had traumatic tympanic membrane perforation. At follow-up, 40 ears (70.2%) with traumatic tympanic membrane perforation had healed spontaneously, while 12 ears (21.1%) had healed after tympanoplasty. However, five ears (8.8%) did not heal. Among the ears that spontaneously healed, 83.0% had grade Ⅰ and 16.7% had grade Ⅱ tympanic membrane perforation. Ears with grade Ⅲ and grade Ⅳ tympanic membrane perforations did not heal spontaneously.
Hearing impairment is a common clinical presentation in patients with traumatic injury. In most patients, this manifests as conductive hearing loss, while severely affected patients may have sensorineural or mixed hearing loss. Patients with conductive hearing loss have a favorable prognosis, while patients with sensorineural or mixed hearing loss have a poor prognosis. Trauma could cause different degrees of tympanic membrane perforation. With gradually aggravated tympanic membrane perforation, the spontaneous healing rate decreases. Therefore, for patients with large tympanic membrane perforations, which rarely heal spontaneously, tympanoplasty is warranted.
To discuss the efficacy of surgical facial nerve (FN) reconstruction in the parotid area under various circumstances.
We considered 46 cases of surgical facial nerve reconstruction with nerve involvement in the parotid area. Among these cases, 3 required facial nerve relaxation (facial nerve intact), 7 required facial nerve suturing, 22 required sural nerve grafting (long distance nerve defects), and 14 required additional masseteric-facial nerve anastomosis due to sural nerve grafting.
All patients in the study received postoperative follow-up at 6 to 12 months. Using the House-Brackmann grading system at follow-up, 2 of the 3 facial nerve relaxation cases received grade Ⅲ, while the third received grade Ⅱ; all 7 facial nerve suturing cases received grades Ⅲ-Ⅳ. The 22 sural nerve grafting cases received grades Ⅲ-Ⅳ, however in one of these cases severe synkinesis was observed; 3 cases presented obvious synkinesis, and tight synkinesis was observed in the other 7 cases. The 14 sural nerve grafting and masseteric-facial nerve anastomosis cases received grades Ⅲ-Ⅴ with no obvious synkinesis observed in any of these cases.
Immediate, individualized surgical facial nerve reconstruction could lead to satisfactory results for various circumstances of facial nerve damage. Nerve suturing was preferred for achieving tension-free anastomosis, and masseteric-facial nerve anastomosis was preferred as a means to avoid synkinesis.
To evaluate the surgical treatment of iatrogenic facial paralysis and discuss its cause, treatment and therapeutic effect.
A retrospective study of 21 iatrogenic facial paralysis cases who underwent ear surgery in the ear, nose, and throat (ENT) Department between 2015 and 2017.
Of those that underwent middle ear surgery, 10 iatrogenic facial nerve injuries cases were observed in the following segments: the horizontal segment in 7 cases, the pyramidal segment in 2 cases, and the vertical segment in 1 case. After evaluating the degree of damage, decompression was performed in 7 cases, and facial nerve-great auricular nerve transplantation in 3 cases. The other 11 cases with facial paralysis after acoustic neuroma surgery underwent hypoglossal-facial anastomosis. Sixteen cases (about 76%) achieved HB Ⅰ-Ⅲ one year after surgery.
Although scientific and technological developments have reduced the probability of facial nerve injuries, iatrogenic facial paralysis cannot be entirely avoided. Clinical doctors need to have excellent anatomical knowledge and correct operation technique to prevent iatrogenic facial paralysis. Once iatrogenic facial paralysis occurs, early diagnosis and treatment are required to achieve ideal outcomes of patients' facial nerve function.
To explore the clinical effects of geniculate ganglion decompression of the facial nerve using the transmastoid-epitympanum approach in patients with traumatic facial nerve paralysis.
A retrospective analysis of 30 traumatic facial nerve paralysis cases was conducted. Facial nerve function and hearing levels were compared.
All patients had improved facial function after surgery, of which 26 cases recovered to HB Ⅰ or Ⅱ level. The adverse effects on their auditory function were less than 10 dB in most cases.
The transmastoid-epitympanum approach to the decompression of the geniculate ganglion is simple, minimally invasive, safe, and effective, which results in little postoperative hearing change.
This study aimed to analyze the clinical characteristics of temporal bonetrauma complicated with cerebrospinal fluid (CSF) leakage and to discuss its diagnosis and appropriate management.
Eighteen patients with temporal bone trauma complicated with CSF were analyzed retrospectively.
During follow-up, no CSF recurred after the operation except for in one patient. In this, the CSF recurred, a second operation was performed, and the CSF leakage ceased. No postoperative infection occurred in any patient.
Surgical exploration and repair is the most effective method for those who have poor outcomes with conservative treatment of the temporal bone trauma. Medical history, clinical manifestations, laboratory examination and imaging analyses are all essential for diagnosing CSF leakage, locating the CSF, and selecting an appropriate surgical method. Perioperative antibiotics to prevent infection and appropriate drugs to control cranial pressure can improve postoperative recovery.
With the complex anatomy of the human ear, we need to better understand the physiological and pathological characteristics of the “noise reduction system” of the ear, the most critical part being the middle ear muscle (MEM). MEMs play an important protective role by constantly monitoring acoustic input and dynamically adjusting hearing sensitivity, to enhance external sounds and to reduce transmission of loud sound through the middle ear. If the MEMs lose the ability to regulate cramps, spasms, or dystonia in the ear, the resulting abnormal pressure can have a significant impact on internal cellular pressure, which can cause some otologic disorders including tinnitus, Meniere’s disease, and sensorineural hearing loss. This literature review aims to explain the physiological structure and function of MEMs and discuss several otological disorders associated with MEM dysfunction.
Abstract: Vertigo is a common symptom seen in a range of conditions. It can be treated with a multi-disciplinary approach. Contemporary Chinese medicine practitioners who have a deep understanding of vertigo have previously proposed the concept of “ear vertigo”. In this paper, we cover the process of recognizing this condition in traditional Chinese medicine. We examine the name, “ear vertigo”, and its connotations, as well as discuss the etiology, pathological mechanism, and internal and external combination therapy for this condition.
The occurrence and proportion of benign paroxysmal positional vertigo (BPPV) in patients presenting with vertigo and dizziness were analyzed.
A retrospective analysis of medical records, including patients’ complaints, symptom characteristics, medical history and related test results, preliminary diagnosis, etc. of 4 227 patients was conducted from June 2017 to May 2018 at the otolaryngology, head and neck surgery and vertigo clinic at our hospital. Based on the collected data, the patients were divided into two groups, a dizziness group and a vertigo group. We performed a statistical analysis of the above data and calculated the proportion of BPPV patients in the total number of cases, and in cases of vertigo or dizziness.
Among the 4 227 patients in the analysis, 3 188 (approximately 74.54%) were patients with vertigo and 1 039 (approximately 24.59%) were patients with dizziness. Among all patients, there were 450 cases (approximately 10.65%) of BPPV of which 437 (approximately 13.66% of the total cases) BPPV patients belonged to the vertigo group, and the remaining 13 patients with BPPV (approximately 1.26% of the total) belonged to the dizziness group.
The proportion of BPPV cases in the vertigo and dizziness groups were 13.66% and 1.26%, respectively; middle-aged and older women accounted for the majority of the cases.
To investigate the etiology and risk factors of benign paroxysmal positional vertigo (BPPV).
We retrospectively analyzed and statistically compared the incidence, etiology, and possible risk factors in 450 cases of BPPV in the Department of Otolaryngology Head and Neck Surgery at our hospital from 2017.
The average age of BPPV patients was 55.52±13.89 years, and the ratio of males to females was 1∶2.21. Of these cases, 159 patients (35.33%) did not have any comorbidities, while 291 patients (64.67%) presented with associated comorbidities. Among them, 78 (17.33%) patients presented with a clear cause such as idiopathic sudden hearing loss, head trauma, vestibular neuritis, or vestibular migraine. A total of 253 (56.22%) patients had associated risk factors such as hypertension, diabetes mellitus, cervical spondylosis, and coronary heart disease. Hypertension and diabetes were the most common comorbidities present in the group, accounting for 32.44% and 11.56%, respectively. However, using binary logistic analysis, only cervical spondylosis appeared to have a significant correlation with the occurrence of BPPV.
About 64.67% of patients presenting with BPPV in this study also had a comorbidity. The majority of patients with BPPV had idiopathic BPPV. After otolith reduction, pathological injury still existed. Treatment of comorbidities should be considered carefully so as to prevent the occurrence and recurrence of BPPV.
To summarize the clinical characteristics of patients with venous pulsatile tinnitus and provide reference data for clinical diagnosis and treatment of this disease.
Clinical data of 25 patients with venous pulsatile tinnitus were analyzed. During surgery, a small incision was made in the posterior auricular region under local anesthesia, and mastoid exploration plus sigmoid sinus constriction or sigmoid sinus retraction were performed. The tinnitus evaluation questionnaire (TEQ) was used to quantify improvement in tinnitus after the operation (1st, 3rd, and 6th months). The preoperative hearing test results were compared with those obtained in the 1st month postoperatively to determine whether the surgery had adverse effects on hearing.
As reported by the patients, pulsatile tinnitus had disappeared during the follow-up period in 21 patients. Four patients had mild pulsatile tinnitus in the 6th month postoperatively; however, this conscious tinnitus did not affect the patients’daily lives. The preoperative TEQ score of the patients was 10.44±3.08. The postoperative TEQ scores in the 1st, 3rd, and 6th months were 3.68±1.75, 2.76±1.23, and 2.72±1.17, respectively, which were significantly lower than the preoperative TEQ score. The postoperative TEQ scores in the 3rd and 6th months were lower than that in the 1st month postoperatively, but there was no statistical difference between the TEQ scores in the 3rd and 6th months postoperatively. It was observed that the improvement in postoperative tinnitus stabilized gradually. There was no significant difference between the preoperative and postoperative hearing test results.
Venous pulsatile tinnitus can be diagnosed by careful medical history taking, physical examination, and imaging. Surgery under local anesthesia is convenient for the surgeon to observe real-time improvement in tinnitus, which aids in accurate evaluation of the shape of the sigmoid sinus and reducing the incidence of complications. Therefore, its clinical application is recommended.
Allergic rhinitis (AR) is an allergic respiratory inflammation. T helper type 2 (Th2) cell activation plays an important role in the mediation of the disease. AR involves the innate and adaptive immune systems. Type 2 innate lymphoid cells (ILC2s) are considered the innate counterparts of Th2 cells based on the cytokines they express. Accumulating evidence has demonstrated that innate immune cells function as homeostatic regulators in the body. ILC2s contribute to the pathology of allergic inflammatory diseases. Here, we review the characteristics of ILC2s and progress of research on the mechanism of AR.
Pollinosis refers to a series of clinical symptoms, such as allergic conjunctivitis, rhinitis, and asthma, that are mediated by specific immunoglobulin E (sIgE) after inhalation of allergic pollens by atopic individuals. The clinical symptoms of pollinosis depend on the season, region, and climate. Common pollens causing pollinosis come from trees, grass, and weeds. In northern China, the quality of life for patients with pollinosis is significantly worse than that for the patients with dust mite allergy. The weed pollen is more likely to induce asthma than the tree pollen. The diagnostic steps for pollinosis include anamnesis, allergen-specific diagnostic tests (skin test and serum sIgE test), and result assessment. Clinical management includes allergen avoidance, allergen-specific immunotherapy, and anti-inflammatory medicines (such as glucocorticoids, H1 antihistamines, and leukotriene receptor antagonists). Clinical data showed that the pollen extracts from the PUMCH Allergen Products Manufacturing and Research Center are particularly useful in the diagnosis of pollinosis. They have good efficacy and safety, and can prevent allergic rhinitis from developing into asthma and inhibit the emergence of reactions to new allergens effectively. Treatment efficacy can be maintained even after stopping active administration.
Chronic cough is a common disease in children. The etiology composition of chronic cough varies across children of different ages. Understanding the etiology of chronic cough in children at different ages has great significance for the diagnosis and effective treatment of chronic cough in children.
The prevalence of childhood asthma varies from 8%-28% worldwide. Pediatric epidemiological studies in China have found that nearly one-third of the children with asthma have not received appropriate management. More attentions need to be paid to early interventions, treatments, and long-term outcomes of childhood asthma.
In the past 20 years, the prevalence of childhood asthma has been increasing in China; its prevalence differs greatly between urban and rural populations. The proportion of asthma attack-related emergency room visits and hospitalization in children is still very high; the early diagnosis rate of childhood asthma is low and related treatment and management is not ideal. With complete understanding of the guidelines, correct applications in clinical practice, and appropriate laboratory examinations, pediatricians can improve early diagnosis of asthma and provide appropriate treatment plans and individualized preventive suggestions to children with asthma at an early stage; this can comprehensively improve asthma prevention and control and therefore, improve its prognosis.
In recent years, the prevalence of allergic rhinitis(AR)and allergic asthma has increased significantly. Because of a deeper understanding of specific immunotherapy(SIT), it is currently believed that SIT may be the only treatment that changes the natural course of allergic diseases by regulating the immune mechanisms and can maintain long-term effects after treatment has been discontinued. This article reviews the simultaneous control and long-term efficacy of SIT for AR and asthma. A literature review and analysis of domestic and international studies indicates that SIT plays an important and positive role in the treatment of AR and asthma and can prevent AR from progressing to asthma. However, SIT is also associated with some problems that merit further discussion.
Chronic rhinosinusitis (CRS) is a heterogeneous disease, and patients with asthma account for 10%-40% of the CRS cases and this number is increasing worldwide. In addition, the incidence of CRS is higher in patients with asthma than in the general population. At present, most of the studies suggest that endoscopic surgery combined with drug therapy can significantly improve the nasal symptoms of patients with CRS accompanied by asthma, and is conducive to long-term management of asthma. However, such patients are prone to recurrence after surgery and the risk for perioperative surgery is also high. This article focuses on the preoperative evaluation and perioperative management of patients with CRS accompanied by asthma, choice of surgical methods, and impact of endoscopic surgery on asthma.
The prevalence of allergic disease is increasing in China with the progress of urbanization and the environmental and lifestyle changes. The pathogenesis of allergic rhinitis and asthma is currently believed to be mainly caused by the interaction of genetic and environmental factors, but the specific mechanisms are not fully understood yet. Chronic airway inflammation and airway hyperresponsiveness are typical pathophysiological features of allergic rhinitis and asthma. Natural exposure to allergens in the environment can induce exacerbation of the symptoms, cause increases in airway and systemic inflammation, and lead to increased airway hyperresponsiveness. Stimulation by inhalation of allergens in patients with allergic rhinitis and asthma can induce the onset of symptoms induced by natural allergen exposure, which can be used as a model for studying the pathogenesis of allergic rhinitis and asthma and to evaluate the efficacy of treatment drugs for both conditions. As they occur in the same airway and as a single disease, allergic rhinitis and asthma impact each other. The relationship between the upper and lower airways can be examined by stimulating one end and observing the reaction of the other end of the airways. House dust mites are one of the most common allergens and well related to the severity of allergic rhinitis and asthma in China, especially in the southern areas. In this review, we summarized the application of allergen nasal and bronchial provocation in the research of allergic rhinitis and asthma.
Chronic rhinosinusitis with nasal polyp (CRSwNP) and asthma are representative chronic inflammatory diseases, which often coexist in the upper and lower airways. It is difficult to perform an effective therapy for patients with CRSwNP accompanied by asthma because interaction mechanisms and therapeutic effects after medical treatment and endoscopic sinus surgery remain unclear. The European position paper on rhinosinusitis and nasal polyps 2012 (EPOS 2012) presents detailed guidelines on the therapy of CRSwNP with or without asthma, including intranasal corticosteroids, nasal irrigation with saline, and so on. In addition, comprehensive follow-up treatments need to be performed according to the feature and severity of symptoms of CRSwNP. Research shows that it is beneficial for improving the prognosis of patients with CRSwNP accompanied by asthma by combining sinus surgery with medical treatment, but further randomized clinical trials are needed to better understand the management of asthma accompanied by CRSwNP.
Bronchial asthma is a common chronic airway inflammatory disease of the respiratory system. Inhaled corticosteroids are the primary treatment strategy. Studies have shown that the clinical response to inhaled corticosteroids varies due to different types of airway inflammation. A variety of biological agents aimed at inflammatory mediators in airway inflammation have been developed. Randomized controlled trials of these agents have shown that patients with severe eosinophilic asthma benefit from therapy, but controversy remains regarding some aspects of their clinical effects. Their efficacy and safety in children, as well as their long-term effects on disease course and progression need further study and confirmation.
Allergic diseases are autoimmune diseases that involve multi-organ systems producing a variety of clinical manifestations; concurrently, there is an intrinsic and inseparable link between multiple systems and clinical manifestations, producing a variety of manifestations among different age-groups and populations. Focusing on allergic diseases that are associated with the respiratory airway in children is relatively complicated due to the dynamic changes observed with respect to their body structures and immune systems. Allergic rhinitis, allergic asthma, and otitis media with effusion are three examples of allergic respiratory diseases in children that affect the same airway at different anatomical regions, and the correlation between them is receiving greater attention. Whether the upper, lower, and lateral airways could ever truly be in concurrence with each other is worth an in-depth discussion, and thus, we put forward some minor thoughts and suggestions based on the available clinical research and literature.