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    Improving the standard treatments for thyroid nodules and malignant tumors
    PAN Xinliang
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 1-12.   DOI: 10.6040/j.issn.1673-3770.1.2020.037
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    A review of autofluorescence imaging of the parathyroid gland
    SONG Xicheng, ZHENG Haitao
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 19-25.   DOI: 10.6040/j.issn.1673-3770.1.2020.025
    Abstract81)      PDF(pc) (3552KB)(28)       Save
    The temporary and permanent dysfunction caused by parathyroid injury are inevitable. The parathyroid contains a special fluorescent substance, although its mechanism is not clear. At present, two kinds of autofluorescence detection equipment(FLUOBEAM ® imaging system, PTeye fiber probe contact system)can be used for real-time localization of the parathyroid gland for intraoperative localization and protection. The major advantage of this technique is that is allows detection of the parathyroid in excised specimens. The ratios of autofluorescence intensities of the parathyroid and thyroid are 1.23 and 7.71, respectively. The proportion of autofluorescence parathyroid identification sensitivity was 76.3-98.0% and the accuracy was 90.5-99.0%. The parathyroid gland autofluorescence technique is non-invasive, less time-consuming, provides accurate real-time information, and does not use dye as a contrast agent.
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    Advances in molecular mechanisms of anaplastic thyroid cancer
    QING Xiaoyan, XU YiquanOverview, LI ChaoGuidance
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 26-31.   DOI: 10.6040/j.issn.1673-3770.1.2020.029
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    Anaplastic thyroid cancer(ATC)is a rare invasive thyroid tumor associated with rapid progression and poor prognosis. Currently, there is no effective treatment or early diagnosis. Some scholars have shown that the poor prognosis of ATC is due to the early mutation and invasive growth of the tumor; consequently, new directions in research involve the driving mutation of the pathogenesis of ATC and targeted drug therapies. Different molecular pathways related to tumor progression are involved in ATC. Some scholars have explored the implementation of new therapies that act on these molecular pathways to improve patients' quality of life. The research results on the molecular structural characteristics of ATC bring hope for new targeted therapies. The new molecular mechanisms will help us discover more potential therapeutic targets. We have reviewed the recent research on the molecular mechanisms of ATC.
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    A radiomics nomogram based on computed tomography for predicting benign and malignant thyroid nodules
    WU Xinxin, LI Jingjing, MAO Ning, ZHENG Guibin, ZHENG Haitao, CUI Jingjing, JIA Chuanliang, CHU Tongpeng, MOU Yakui, SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 32-39.   DOI: 10.6040/j.issn.1673-3770.1.2020.028
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    Prediction of cervical lymph node metastasis in papillary thyroid cancer based on XGBoost artificial intelligence and enhanced computed tomography
    CHEN Haibing, WEI Ya'nan, XU Xiaoquan, CHEN Xi
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 40-45.   DOI: 10.6040/j.issn.1673-3770.1.2020.031
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    Objective Incorporating eXtreme Gradient Boosting(XGBoost)artificial intelligence, we aimed to build a predictive model using pre-operative enhanced computed tomography(CT)of cervical lymph node metastasis in patients with thyroid cancer, to provide a reference for pre-operative planning. Methods The clinical data of 38 patients with thyroid papillary carcinoma from October 2017 to May 2019 were retrospectively analyzed. A total of 135 lymph nodes were included. Using XGBoost artificial intelligence, the lymph node metastasis prediction model was established, and the accuracy of the prediction model was tested. Results The average accuracy of the XGBoost model was 87.41%, which was higher than that of the SVM model(79.2%). Important CT characteristics that are indicative of lymph node metastasis include degree and distribution of enhancement, location, and capsule invasion. Conclusion The predictive model of cervical lymph node metastasis in patients with thyroid cancer exhibits high accuracy and could help in the pre-operative evaluation of cervical lymph node metastasis, tumor staging, and surgical procedures.
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    Clinical analysis of malignant thyroid tumors with laryngotracheal invasion
    XIA Tongliang, WEI Dongmin, QIAN Ye, LI Wenming, JI Wei, PAN Xinliang, LEI Dapeng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 46-51.   DOI: 10.6040/j.issn.1673-3770.1.2020.033
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    Objective To explore the clinical treatment outcomes in thyroid papillary carcinoma patients with laryngotracheal invasion. Methods The study involved 87 patients with papillary thyroid carcinomas involving the larynx and trachea who reported to the Department of Otolaryngology at the Qilu Hospital of Shandong University between January 2010 and December 2019. Their basic demographic data, tumor resection procedures, tracheal repair procedures, postoperative extubation rate, and 3-year and 5-year survival rates were retrospectively analyzed. Results All the 87 patients were treated surgically. Tumor resection procedures included sharp shaving of the tracheal wall tumor(60 cases), tracheal wall wedge resection(15 cases), tracheal sleeve resection(3 cases), partial laryngectomy(1 case), total laryngectomy(4 cases), and palliative resection(4 cases). Airway reconstruction procedures included, suturing(5 cases), pectoralis major muscle flap repair(1 case), sternocleidomastoid clavicle periosteum flap repair(1 case), end-to-end anastomosis(3 cases), laryngoplasty(1 case), and tracheostomy(12 cases). Seventy-nine patients were followed for 4–122 months, of which 15 patients underwent tracheotomy, with an extubation rate of 66.7%(10 out of 15 patients). The 3-year and 5-year survival rates were 100% and 93.0%, respectively. Conclusion Accurate preoperative evaluation and reasonable surgical treatment may significantly improve the quality of life and facilitate the satisfactory survival of patients with thyroid papillary carcinoma involving the larynx and trachea.
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    Two-stage reconstructive strategy using a flap for non-circumferential tracheal defects
    DENG Di, LIU Jun, LI Linke, WANG Ji, LIU Jifeng, LV Dan, WANG Haiyang, GAN Weigang, WANG Jun, LI Bo, CHEN Fei
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 52-57.   DOI: 10.6040/j.issn.1673-3770.1.2020.032
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    Objective This study aimed to investigate the clinical value of two-stage reconstructive strategy using a flap for the treatment of non-circumferential tracheal defects. Methods Patients who underwent tracheal reconstructions with a two-stage reconstructive strategy using a flap between March 2013 and December 2018 were retrospectively evaluated. Results Thirty-seven patients, with a tracheal defect length of 6-14 tracheal rings and circumferential ratio of 1/2 to 3/4, underwent stage I surgery. Twenty-two free flaps and 15 pedicled flaps were used in the stage I surgery, and the sizes of the flap ranged from 6×4 cm to 12×9 cm. Thirty-three patients underwent stage II surgery, and the postoperative respiratory, deglutition, and articulation functions recovered satisfactorily. Conclusion The two-stage reconstructive strategy using a flap is safe and effective for the treatment of non-circumferential tracheal defects.
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    The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer
    ZHENG Guibin, ZHANG Guojun, MA Chi, WEI Shujian, SUN Haiqing, WU Guochang, GUO Yawen, ZHENG Haitao, SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 58-63.   DOI: 10.6040/j.issn.1673-3770.1.2020.021
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    Objective To explore the safety and efficiency of transoral endoscopic thyroidectomy vestibular approach(TOETVA)in papillary thyroid cancer(PTC). Methods This study retrospectively reviewed 146 patients who underwent TOETVA between June 2017 and January 2020 at the Affiliated Yantai Yuhuangding Hospital of Qingdao University. Of those, 139 patients with pathologically confirmed PTC were enrolled in this study. Analyses were performed of the workflow experience, visual pain score on the first postoperative day, length of hospital stay, number of central neck lymph nodes removed, complications, and results of follow-ups. Results A total of 135 cases required hemithyroidectomy plus isthmectomy and central neck dissection(CND)with a mean operation time of 132±34.9 min; 4 cases required total thyroidectomy and CND with a mean operation time of 168±38.5 min. The mean number of central neck lymph nodes removed was 7.1±4.6 and the metastasis rate was 47.5%(66/139). Postoperative hospital stay was 1.9±0.7 days. Regarding postoperative complications, the incidence of transient recurrent laryngeal nerve injury(RLN)and transient hypoparathyroidism was 1.4%(2/139)and 0.7%(1/139), respectively. No permanent RLN injury and hypoparathyroidism occurred. Mental nerve injury occurred in 5.0%(7/139). Transient abnormal motor function of the lower lip and marginal mandibular branches of the facial nerve was observed in nine cases and two cases, respectively. Conclusion TOETVA can be performed by standard workflow with the principle of enhanced recovery after surgery(ERAS). TOETVA is feasible in selected PTC patients for its cosmetical results and oncological safety.
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    Combined treatment of chylous leakage after lymph node dissection for thyroid cancer
    FANG Zhongju, ZHANG Yongxia, ZHAO Jiandong, ZONG Liang, ZHAI Xingyou, LI Xinjian, PENG Xin, REN Nan, CHEN Liwei, LIU Mingbo
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 64-68.   DOI: 10.6040/j.issn.1673-3770.1.2020.040
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    Objective To explore the causes and treatment of chyle leakage after lymph node dissection(LND)for thyroid carcinoma. Methods A retrospective analysis was conducted in 647 patients who underwent LND for thyroid carcinoma. For the 11 patients who developed chyle leakage, measures such as intravenous nutrition, low-fat diet, local compression and negative pressure drainage were taken. Results Chylous leakage occurred on day 0.5 to 3 after surgery, and the incidence was 1.7%. The peak drainage of chylous leakage was 120 to 1100 mL/d. Unilateral lobectomy + isthmectomy was performed in 449 cases, total thyroidectomy in 152 cases, and unilateral lobectomy + isthmectomy + contralateral subtotal thyroidectomy in 46 cases. Simple central lymph node dissection was performed in 395 cases, 5 of whom developed chyle leakage, and the incidence was 1.26%(5/395). Lateral neck+central lymphatic dissection was performed in 83 cases, 4 of whom developed chyle leakage, and the incidence was 4.8%(4/83). Upper mediastinal dissection with endoscope was performed in 6 cases, 2 of whom developed chyle leakage, and the incidence was 33.3%(2/6). The ratio of left to right chylous leakage was 7:4. Three patients had relapse dissection(rRLN). When the daily drainage volume was less than 20 mL/d, the drainage tube was removed. The closing time of chylous leakage was 6 to 23 days, median 11 days. No second operation was performed. Conclusion When lymph node dissection for thyroid carcinoma is performed, the procedures should be standardized to prevent chylous leakage. In case chylous leakage occurs, measures such as diet adjustment and negative pressure drainage can help the cure. Surgery must be performed when the conservative treatment is ineffective.
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    Lateral neck lymph node mapping in thyroid cancer surgery
    HUANG Naisi, MA Ben, GUAN Qing, WANG Yunjun, WEI Wenjun, LU Zhongwu, YANG Shuwen, XU Weibo, XIANG Jun, JI Qinghai, WANG Yu
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 69-74.   DOI: 10.6040/j.issn.1673-3770.1.2020.042
    Abstract61)      PDF(pc) (983KB)(12)       Save
    Objective Despite the high incidence of lateral neck lymph node metastasis in papillary thyroid carcinoma(PTC), its management has remained controversial. The accuracy of ultrasound and computed tomography(CT)in lateral neck evaluation for PTC is unsatisfactory. An unnecessary neck dissection may lead to increased complications, while undetected lymph node metastasis may facilitate recurrences and necessitate resurgery. We aimed to map the draining lymph nodes in the lateral neck using carbon nanoparticles and explore its potential in neck assessment. Methods We conducted a multicenter, prospective study from August 2016 to April 2019 in PTC patients who had unpalpable lateral lymph nodes that appeared suspicious on ultrasound and/or CT. Carbon nanoparticles were injected peritumorally into the thyroid gland, and modified lateral neck dissection(compartment Ⅱ-Ⅴ)was performed. The lateral lymph nodes were classified into dyed and undyed and sent for pathological analysis. Thyroidectomy and central neck compartment dissection were performed. Results A total of 125 neck dissections were performed in 122 patients. Of the dissections, 117 were for lateral neck metastases, 7 were for central metastases, and metastasis was absent in the remaining 1. A total of 4302 lateral lymph nodes were removed, 952 of them were dyed. The median number of dyed nodes was 6 per case(range: 1-33). The distribution of dyed nodes in the neck compartments was Ⅳ> Ⅲ> Ⅱ> Ⅴ, independent of tumor size, location, or extra-thyroidal extension. The percentages of dyed lymph node metastasis in Ⅱ-Ⅴ compartments were 33.3%, 60.0%, 68.8%, and 40.0%, respectively, on a per-case basis and 10.2%, 31.4%, 27.5%, and 20.8%, respectively, on a per-node basis. Compared to undyed nodes, the risk of metastasis in dyed nodes was significantly higher in all neck compartments(compartment Ⅱ: 19.9% vs. 5.6%, P<0.001; compartment Ⅲ 35.0% vs. 18.3%, P<0.001; compartment Ⅳ: 37.1% vs. 15.2%, P<0.001; compartment Ⅴ: 14.8% vs 3.7%, P<0.05). A lateral sentinel lymph node biopsy was performed in 51 patients. The sensitivity of the lateral neck sentinel lymph node biopsy was 89.5%, the false-negative rate was 26.7%, and the overall accuracy rate was 91.8%. Conclusion Using carbon nanoparticles, we successively mapped the lateral neck lymph nodes. We found that dyed nodes had a significantly higher risk of metastasis than that of undyed nodes. This method may be useful for lateral neck sentinel lymph node biopsies in PTC.
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    Giant cyst formation from lymph node metastasis in papillary thyroid cancer: a case study
    WANG Jiashuo, GUO Xing, YAN Aihui
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 111-113.   DOI: 10.6040/j.issn.1673-3770.1.2020.020
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    Benign cystic tumors of the neck are relatively common. However, malignant manifestations, such as thyroid cancer, are rare. Accurate identification of cervical cystic masses in these patients is important in preventing incorrect diagnosis and misdiagnosis. We report a case of giant cystic formation by cervical lymph node metastasis in papillary thyroid carcinoma. Processes and their potential influence in diagnosis and treatment are briefly described.
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    Efficacy of different transplantation schemes for parathyroid gland resection in patients with secondary hyperparathyroidism
    WANG Maolin, LI Julan, XIAN Kunlun
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (3): 114-119.   DOI: 10.6040/j.issn.1673-3770.1.2020.041
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    Objective Retrospectively summarize the efficacy of different transplantation schemes for parathyroid gland resection in patients with secondary hyperparathyroidism. Methods A total of 86 patients who had undergone total parathyroid gland transplantation in our hospital between March 2013 to March 2018 were divided into three groups according to the three different transplantation schemes. The preoperative, postoperative, and follow-up PTH results, hospital stay, postoperative calcium supplementation days, postoperative complications, and recurrence were collected to determine the efficacy. Results The short-term treatment efficacy(1 day after surgery-1 month after surgery)was different among the three groups, while the long-term treatment effect was not different. The short-term treatment effect of group A was the worst. The short-term treatment effect of group B and group C were similar, but overall, group C was better than group B. Conclusion The particle size of the transplanted parathyroid and the blood supply of the transplanted bed are closely related to the survival and growth of the transplanted parathyroid. Refractory secondary hyperparathyroidism can be efficaciously treated by the transplantation of small particles of parathyroid tissue into the sternocleidomastoid muscle sac.
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    Value the diagnosis and treatment of ear trauma
    Haijin YI,Shiming YANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 1-3.   DOI: 10.6040/j.issn.1673-3770.1.2019.045
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    Standardized treatment of auricular complications with temporal bone fractures
    Jia XU,Haijin YI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 4-8.   DOI: 10.6040/j.issn.1673-3770.1.2019.048
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    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.

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    Analysis of clinical characteristics and prognosis of post traumatic hearing loss
    Yujing DING,Lan LAN,Qiuju WANG,Fei JI,Fen XIONG,Linyi XIE,Haina DING,Yin XIA,Hui ZHAO
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 9-14.   DOI: 10.6040/j.issn.1673-3770.1.2019.063
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    Objective

    The clinical characteristics and prognosis of post traumatic hearing loss were retrospectively evaluated to aid further diagnosis, medical evaluation, early identification, and effective treatment.

    Methods

    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.

    Results

    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.

    Conclusions

    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.

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    Facial nerve reconstruction in the parotid area under a variety of circumstances
    Zhili WANG,Zhe CHEN,Fangyu LIN,Yongchuan CHAI,Zhaoyan WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 15-19.   DOI: 10.6040/j.issn.1673-3770.1.2019.064
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    Objective

    To discuss the efficacy of surgical facial nerve (FN) reconstruction in the parotid area under various circumstances.

    Method

    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.

    Results

    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.

    Conclusion

    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.

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    Surgical treatment of iatrogenic facial paralysis
    Yuxin TIAN,Jingjing WANG,Hui WANG,Yaqin WU,Haibo SHI,Zhengnong CHEN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 20-24.   DOI: 10.6040/j.issn.1673-3770.1.2019.054
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    Objective

    To evaluate the surgical treatment of iatrogenic facial paralysis and discuss its cause, treatment and therapeutic effect.

    Methods

    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.

    Results

    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.

    Conclusions

    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.

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    Transmastoid facial nerve decompression for treating traumatic facial paralysis involving the geniculate ganglia
    Jia XU,Xin LI,Wenjing CHEN,Juanjuan GAO,Haijin YI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 25-27.   DOI: 10.6040/j.issn.1673-3770.1.2019.052
    Abstract140)   HTML0)    PDF(pc) (1947KB)(34)       Save
    Objective

    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.

    Methods

    A retrospective analysis of 30 traumatic facial nerve paralysis cases was conducted. Facial nerve function and hearing levels were compared.

    Results

    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.

    Conclusion

    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.

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    Temporal bone trauma complicated with cerebrospinal fluid leakage: a case series and literature review
    Juanjuan GAO,Xin LI,Jia XU,Wenjing CHEN,Sichao LIANG,Zhenping GUO,Manlin LU,Haijin YI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2020, 34 (1): 28-32.   DOI: 10.6040/j.issn.1673-3770.1.2019.051
    Abstract117)   HTML3)    PDF(pc) (4154KB)(46)       Save
    Objective

    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.

    Methods

    Eighteen patients with temporal bone trauma complicated with CSF were analyzed retrospectively.

    Results

    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.

    Conclusion

    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.

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    The difficulties, challenges, and strategy for diagnosing and treating pediatric sinusitis
    LI Yong
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 1-7.   DOI: 10.6040/j.issn.1673-3770.1.2019.055
    Abstract375)      PDF(pc) (676KB)(323)       Save
    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.
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    CT scans should not be routinely used for diagnosing chronic sinusitis in children
    XU Geng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 8-9.   DOI: 10.6040/j.issn.1673-3770.1.2019.059
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    Rhinosinusitis and asthma in children: united airway disease
    YANG Yifan, CHENG Lei
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 10-15.   DOI: 10.6040/j.issn.1673-3770.1.2019.061
    Abstract274)      PDF(pc) (744KB)(88)       Save
    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.
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    Diagnosis and treatment of pediatric rhinosinusitis
    LI Huabin, CAO Yujie
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 16-19.   DOI: 10.6040/j.issn.1673-3770.0.2019.057
    Abstract196)      PDF(pc) (543KB)(80)       Save
    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.
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    The role of antibiotics for pediatric sinusitis
    LI Yong
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 20-24.   DOI: 10.6040/j.issn.1673-3770.1.2019.056
    Abstract155)      PDF(pc) (606KB)(79)       Save
    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.
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    Relationship between sinusitis and adenoid hypertrophy in children
    ZHANG Liqiang
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 25-28.   DOI: 10.6040/j.issn.1673-3770.1.2019.058
    Abstract349)      PDF(pc) (529KB)(83)       Save
    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.
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    Advances in the surgical treatment of pediatric patients with chronic rhinosinusitis
    LIU Jia, FU Yong
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 29-33.   DOI: 10.6040/j.issn.1673-3770.1.2019.060
    Abstract201)      PDF(pc) (595KB)(54)       Save
    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.
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    Clinical diagnosis and treatment of orbital complications following pediatric acute rhinosinusitis
    ZHANG Chanyuan, SUN Yulin, WANG Lin, ZHANG Li, CHEN Min, YI Longgang, LI Na, CUI Xin, JIANG Yan
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 34-40.   DOI: 10.6040/j.issn.1673-3770.1.2019.062
    Abstract163)      PDF(pc) (5143KB)(71)       Save
    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.
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    A child with acute rhinosinusitis, acute glomerulonephritis and an orbital abscess: case report
    ZHU Luping, CHEN Juan, ZHU Lei, CHEN Renjie
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (6): 41-44.   DOI: 10.6040/j.issn.1673-3770.0.2019.505
    Abstract217)      PDF(pc) (3650KB)(64)       Save
    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.
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    Thoughts on benign paroxysmal positional vertigo and its diagnosis and treatment
    Taisheng CHEN, Wei WANG, Kaixu XU, Peng LIN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (5): 1-5.   DOI: 10.6040/j.issn.1673-3770.1.2019.053
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    Physiology and pathology review of the middle ear muscles
    Zhao HAN, Juan DING
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (5): 6-10.   DOI: 10.6040/j.issn.1673-3770.1.2019.038
    Abstract345)   HTML8)    PDF(pc) (1036KB)(78)       Save

    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.

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    Understanding vertigo from a Chinese medicine perspective
    Hui XIE
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (5): 11-17.   DOI: 10.6040/j.issn.1673-3770.1.2019.044
    Abstract334)   HTML21)    PDF(pc) (625KB)(58)       Save

    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.

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    Analysis of the proportion of benign paroxysmal positional vertigo in patients with vertigo and dizziness
    Yueqi ZHANG, Qiaomei DENG, Wei WANG, Kaixu XU, Chao WEN, Qiang LIU, Taisheng CHEN, Peng LIN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (5): 18-21.   DOI: 10.6040/j.issn.1673-3770.1.2019.040
    Abstract187)   HTML7)    PDF(pc) (468KB)(93)       Save
    Objective

    The occurrence and proportion of benign paroxysmal positional vertigo (BPPV) in patients presenting with vertigo and dizziness were analyzed.

    Methods

    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.

    Results

    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.

    Conclusion

    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.

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    Correlation analysis between benign paroxysmal positional vertigo and associated comorbidities
    Qiaomei DENG, Yueqi ZHANG, Wei WANG, Kaixu XU, Chao WEN, Qiang LIU, Taisheng CHEN, Peng LIN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (5): 22-25.   DOI: 10.6040/j.issn.1673-3770.1.2019.041
    Abstract164)   HTML3)    PDF(pc) (468KB)(43)       Save
    Objective

    To investigate the etiology and risk factors of benign paroxysmal positional vertigo (BPPV).

    Methods

    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.

    Results

    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.

    Conclusion

    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.

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    Effects of surgery in patients with venous pulsatile tinnitus
    Yongbo ZHENG, Yu ZHAO, Lin LOU, Yao SONG, Yijun DONG, Jianjun REN, Jing WANG, Yang XU, Lei LEI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (5): 26-31.   DOI: 10.6040/j.issn.1673-3770.1.2019.049
    Abstract229)   HTML1)    PDF(pc) (1794KB)(46)       Save
    Objective

    To summarize the clinical characteristics of patients with venous pulsatile tinnitus and provide reference data for clinical diagnosis and treatment of this disease.

    Methods

    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.

    Results

    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.

    Conclusion

    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.

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    One airway, one disease: clinical application of sublingual immunotherapy
    Lei CHENG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 1-3.   DOI: 10.6040/j.issn.1673-3770.1.2018.048
    Abstract374)   HTML158)    PDF(pc) (1188KB)(187)       Save
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    Progress and challenges in the management of asthma in China
    Jiangtao LIN
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 4-8.   DOI: 10.6040/j.issn.1673-3770.1.2018.015
    Abstract324)   HTML191)    PDF(pc) (1238KB)(70)       Save
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    Research progress of group Ⅱ innate lymphoid cells in the allergic rhinitis
    Yinshi GUO,Hui LU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 9-12.   DOI: 10.6040/j.issn.1673-3770.1.2018.019
    Abstract266)   HTML213)    PDF(pc) (1193KB)(74)       Save

    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.

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    Overall diagnosis and treatment strategy for allergic diseases related to hay fever
    Kai GUAN,Lianglu WANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 13-19.   DOI: 10.6040/j.issn.1673-3770.1.2018.041
    Abstract345)   HTML133)    PDF(pc) (1183KB)(95)       Save

    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.

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    Recognizing the etiology of chronic cough in children of different ages
    Chuangli HAO,Wenjing GU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 20-24.   DOI: 10.6040/j.issn.1673-3770.1.2018.021
    Abstract407)   HTML230)    PDF(pc) (1102KB)(99)       Save

    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.

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    Problems associated with allergic asthma in children
    Jie SHAO
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 25-27.   DOI: 10.6040/j.issn.1673-3770.1.2018.036
    Abstract290)   HTML116)    PDF(pc) (971KB)(77)       Save

    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.

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    The prevalence, diagnosis and management of asthma in children in China
    Chuanhe LIU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 28-32.   DOI: 10.6040/j.issn.1673-3770.1.2018.037
    Abstract498)   HTML372)    PDF(pc) (1188KB)(135)       Save

    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.

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    Synchronous control and long-term efficacy of specific immunotherapy for allergic rhinitis and asthma
    Qianhui QIU,Junxiao GAO
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 33-37.   DOI: 10.6040/j.issn.1673-3770.1.2018.017
    Abstract257)   HTML185)    PDF(pc) (1236KB)(69)       Save

    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.

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    Endoscopic sinus surgery for chronic sinusitis with asthma
    Hongmeng YU,Zhuofu LIU,Qi DAI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 38-41.   DOI: 10.6040/j.issn.1673-3770.1.2018.018
    Abstract153)   HTML108)    PDF(pc) (1216KB)(55)       Save

    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.

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    Allergen inhalation challenge in the research of allergic rhinitis and asthma
    Zheng ZHU,Wanjun WANG,Qiurong HU,Jing LI
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 42-48.   DOI: 10.6040/j.issn.1673-3770.1.2018.016
    Abstract231)   HTML165)    PDF(pc) (1214KB)(90)       Save

    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.

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    Advances in interaction mechanisms and treatment strategy between chronic rhinosinusitis with nasal polyp and asthma
    Yu ZHANG,Xicheng SONG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 49-52.   DOI: 10.6040/j.issn.1673-3770.1.2018.033
    Abstract214)   HTML124)    PDF(pc) (1146KB)(64)       Save

    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.

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    Research progress in the treatment of bronchial asthma with biological agents
    Li SHA,Chuanhe LIU
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 53-58.   DOI: 10.6040/j.issn.1673-3770.1.2018.040
    Abstract152)   HTML154)    PDF(pc) (1137KB)(62)       Save

    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.

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    Paying attention to the 'lateral airway' allergic diseases in children
    Qintai YANG
    Journal of Otolaryngology and Ophthalmology of Shandong University    2019, 33 (1): 59-62.   DOI: 10.6040/j.issn.1673-3770.1.2018.042
    Abstract180)   HTML157)    PDF(pc) (1510KB)(45)       Save

    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.

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    Application value of enhanced recovery after surgery in head and neck cancer surgery
    SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2018, 32 (5): 1-4.   DOI: 10.6040/j.issn.1673-3770.1.2018.010
    Abstract445)      PDF(pc) (605KB)(276)       Save
    Enhanced recovery after surgery(ERAS)involves a series of perioperative evidence-based interventions, which intends to attenuate surgical stress and accelerate postoperative functional recovery. ERAS protocols are made for individualized plans by multi-disciplinary collaboration, which has been widely used in many fields of surgery, but is still rarely used in head and neck surgery. ERAS plays an important role in improving survival rate and quality of life in head and neck cancer patients. In this article, we will discuss application value of ERAS in head and neck surgery in brief.
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    Perioperative quality of life in patients with chronic rhinosinusitis with nasal polyps under enhanced recovery after surgery using QoR-15
    WU Xifu, KONG Weifeng, WANG Weihao, XU Huiqing, QI Min, YANG Qintai
    Journal of Otolaryngology and Ophthalmology of Shandong University    2018, 32 (5): 5-8.   DOI: 10.6040/j.issn.1673-3770.0.2018.308
    Abstract517)      PDF(pc) (406KB)(232)       Save
    Objective To evaluate the perioperative quality of life in chronic rhinosinusitis with nasal polyps(CRSwNP)patients under enhanced recovery after surgery using the quality of recovery-15 scale(QoR-15). Methods Seventy-four patients with CRSwNP were randomly divided into an ERAS group and a control group. The ERAS group performed the ERAS protocols during the perioperative period, while the control group followed the traditional plan. Outcomes of QoR-15 were compared preoperatively and postoperatively, at 24 hours and 48 hours. Results Scores of Lund-Mackay between ERAS group and control group were(9.13±1.88)and(9.60±1.86), while Lund-Kennedy scores between ERAS group and control group were(2.69±0.78)and(2.57±0.72),(P>0.05). The operating time and bleeding volume between ERAS group and control group were(1.69±0.60)and(1.77±0.65)h, and(191.67±60.35)and(202.63±60.34)mL, respectively(P>0.05). The rate of Nausea/Emesis between ERAS group and control group was 11.11%(4/36)and 7.89%(3/38), respectively(P>0.05). Preoperative scores of QoR-15 were(139.19±4.21)and(140.07±5.96)in the ERAS group and control group(P>0.05). However, the postoperative scores were [(102.75±10.83)vs(83.14±5.43), P<0.05] [(115.31±10.14)vs(109.65±9.52), P>0.05] in ERAS group and control group, at 24 hours and 48 hours. Conclusion Thus, this study shows that the QoR-15 can be used for ERAS evaluation of perioperative quality of life in CRSwNP patients.
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    Enhanced recovery after surgery for the treatment of chronic rhinosinusitis with nasal polyps
    SONG Xiaoyu, ZHANG Yu, LI Chenglin, SONG Xicheng
    Journal of Otolaryngology and Ophthalmology of Shandong University    2018, 32 (5): 9-12.   DOI: 10.6040/j.issn.1673-3770.1.2018.012
    Abstract366)      PDF(pc) (418KB)(184)       Save
    Objective To explore the perioperative application value of enhanced recovery after surgery(ERAS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP). Methods A total of 136 patients with CRSwNP were randomly divided into the ERAS group(n=70)and control group(n=66). Both groups underwent endoscopic nasal polypectomy and open sinus surgery. Patients in the ERAS group underwent preoperative education and perioperative airway assessment intervention and a series of optimization measures such as shortening fasting time, intraoperative controlled hypotension, and on-time analgesia, whereas those in the control group were treated with traditional perioperative treatment. The preoperative dysfunction of lung function, postoperative pain score, amount of nasal bleeding after 24 h, postoperative hospital stay, and total hospital stay between the two groups were compared. Results The preoperative tolerance rates of patients with preoperative pulmonary dysfunction in the ERAS and control groups were 93.3% and 75.0%, respectively(χ2=1.924, P=0.165). The VAS scores of nasal congestion, headache, eye pain, tearing, ear nausea, and sleep difficulties in the ERAS group were lower than those in the control group(P<0.001). The ERAS group had a blood loss of 5.7(3.0, 10.3)mL within 24 h postoperatively, whereas the control group had a blood loss of 7.2(5.0, 13.2)mL; there was no statistically significant difference in blood loss between the two groups (U=-0.913, P=0.361). The average hospitalization days in the ERAS and control groups were 4.6±0.8 and 7.5±1.1, respectively, with statistically significant difference(t=17.79, P<0.001). The postoperative hospitalization day of the ERAS and control groups were 2.1±0.5 and 3.8±0.3, respectively, with statistically significant difference(t=23.94, P<0.001). Conclusion The use of ERAS throughout the perioperative period in patients with CRSwNP can effectively reduce the psychological and physiological trauma stress response and shorten the hospitalization time.
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