Table of Content

20 September 2019 Volume 33 Issue 5

  

Editorial

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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Invited Review

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

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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.

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

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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.

Clinical Report

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

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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.

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

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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.

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

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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.

Quantitative analysis of behavior pattern in vertiginous patients

Chuanshuo LI,Yongtuan LI,Hainan CAO,Menglu ZHANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  32-36.  doi:10.6040/j.issn.1673-3770.0.2019.030

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To investigate the relationship between behavior patterns and vertigo in patients experiencing vertigo, and the relationship between different behavior patterns and symptoms.

This retrospective study was conducted in 56 patients with vertigo at the Department of Otolaryngology of Eastern Qingdao Municipal Hospital from December 2017 to December 2018. Sixty people with no previous vertigo were recruited as the control group. The participants were evaluated with the Dizziness Handicap Inventory（DHI） and Type A Behavior Pattern (TABP) scale. The control group was evaluated using only TABP scale. We compared the proportion of different behavior patterns between vertigo patients and the control group, and then analyzed the influence of different behavior patterns on otogenic vertigo symptoms.

The proportion of Type A behavior and tendency to Type A behavior was 46.43% in the vertigo patients and 23.33% in the individuals without vertigo. The difference between the two groups was statistically significant ( {\chi }^{\mathrm{2}} = 6.839, Ρ <0.05). The proportion of Type A behaviors in patients with vertigo was significantly higher than that in the control group. The degree of dizziness in patients with Type A behavior was not statistically significant compared with patients with non-Type A behavior ( {\chi }^{\mathrm{2}} =0.020, Ρ >0.05).

The proportion of Type A behavior in vertigo patients with vertigo was significantly higher than that in the normal perple without vertigo attacks, suggesting that patients with vertigo are more likely to have Type A behavior. However, the symptoms of Type A behavior in patients with vertigo did not have a greater impact on their emotions and life compared with other behavioral pattern types.

Research Report

Effect of combined acoustic therapy with background sound on decompensated tinnitus with different frequencies

Xing ZHOU,Xiangrong QIAN,Li’an GU,Yafeng YU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  37-39.  doi:10.6040/j.issn.1673-3770.1.2019.047

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To explore the therapeutic effect of complex sound therapy on decompensated tinnitus with different frequencies.

One hundred and twenty-four patients with decompensated tinnitus for more than 6 months were admitted to the otolaryngology clinic. Following ear and audiology examinations, patients were randomly divided into an experimental group and a control group. The experimental group received combined acoustic therapy with background sound, while the control group received combined acoustic therapy alone for 30 days. According to the patient′s tinnitus frequency, the experimental group was further divided into low-, medium-, and high-frequency subgroups. All the patients were evaluated before and after treatment using the Tinnitus Handicap Inventory (THI) and the Self-Rating Anxiety Scale (SAS).

THI and SAS scores significantly decreased after treatment in both the groups. There was no significant difference in THI scores between the groups. However, SAS scores were significantly lower in the experimental group than in the control group. Post-treatment THI scores were significantly lower in the low-frequency subgroup than in the high-frequency subgroup.

Combined acoustic therapy with or without background sound can improve decompensated tinnitus symptoms. Combined acoustic therapy with background sound can improve decompensated tinnitus-associated anxiety symptoms and is, particularly, helpful for symptomatic relief in patients with low-frequency tinnitus.

Original Article

Preliminary study on screening cochlear proteins interacting with myosin VI

Qingxiu YAO,Hui WANG,Zhuangzhuang LI,Dongzhen YU,Shankai YIN

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  40-43.  doi:10.6040/j.issn.1673-3770.0.2019.063

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To screen for cochlear proteins that interact with myosin VI.

Cochlear proteins from SD rats were extracted for co-immunoprecipitation and mass spectrometry to screen for proteins interacting with myosin VI, which were further verified by immunofluorescence of whole mount basilar membrane and cryostat sections of cochleae.

Combined immunoprecipitation and mass spectrometry yielded more than 20 proteins interacting with myosin VI, and immunofluorescence showed that spectrin αII is primarily located at the cuticular plate and the lateral wall while myosin VI is mainly located in the cell body and cuticular plate. Both myosin VI and spectrin αII were co-localized in the cuticular plate.

More than 20 cochlear proteins could interact with myosin VI, suggesting that myosin VI may interact with a variety of proteins to maintain stereociliary stability.

Therapeutic outcome analysis of 704 cases of sudden deafness

Yiliang YE,Biaoqing LU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  44-47.  doi:10.6040/j.issn.1673-3770.0.2019.052

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To analyze the therapeutic outcome based on the hearing loss level and hearing curve in sudden deafness and to provide clinical treatment strategies.

In total, 704 patients (805 ears) with sudden deafness hospitalized in the Otorhinolaryngology Department of Zhongshan Hospital of Traditional Chinese Medicine from January 2015 to December 2018 were selected for the study. The therapeutic outcomes based on the hearing loss level and hearing curve in sudden deafness were compared and analyzed.

Among 172 cases of low frequency hearing loss, the recovery rates of cases involving mild and moderate deafness were 64.66% and 53.33%, respectively, with no significant differences (χ² = 0.122; P = 0.727), and the total effective rates were 78.66% and 73.33%, respectively, with no significant differences (χ² = 0.012; P = 0.913). Among 205 cases involving high frequency hearing loss, the recovery rates of cases involving mild, moderate, moderate-severe, and severe deafness were 5.98%, 4.34%, 0%, and 0%, respectively, with no significant differences (χ² = 0.012; P = 0.913), and the total effective rates were 22.22%, 19.56%, 38.46%, and 40.00%, respectively, with no significant differences (χ² = 5.067; P = 0.167). Among 226 cases of flat hearing loss, the recovery rates of those with mild, moderate, moderate-severe, and severe deafness were 34.14%, 4.76%, 10.44%, and 9.21%, respectively, with no significant differences (χ² = 9.325, 6.956, and 7.852, respectively; P = 0.007, 0.021, and 0.013, respectively), and the total effective rates were 57.44%, 37.09%, 50.74%, and 52.63%, respectively, with no significant differences (χ² = 4.103; P = 0.129). Among 101 cases of total deafness, the recovery rates of cases involving severe and extremely severe deafness were 12.50% and 1.07%, respectively, which was statistically significant (χ² = 4.954; P = 0.026), and the total effective rates were 62.50% and 34.40%, respectively, with no significant differences (χ² = 2.504; P = 0.114).

The degree of hearing loss is a factor influencing the therapeutic outcome in sudden deafness. Except for low frequency hearing loss, all other types showed a poor therapeutic outcome.

Clinical analysis of cochlear implants in 16 patients with large vestibular aqueduct syndrome

Kaili SUN,Xiaoyuan WU,Xu BIE,Xiuzhen SUN

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  48-51.  doi:10.6040/j.issn.1673-3770.0.2018.536

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To study the pathogenesis, audiometry, and the current preventive and treatment measures of large vestibular aqueduct syndrome (LVAS).

A retrospective analysis was performed on the clinical data of 16 cases (32 ears) from 2012 to 2017 that underwent temporal bone high-resolution computed tomography (HRCT), audiology, and cochlear implantation (CI) at Second Affiliated Hospital of Dalian Medical University for LVAS (predisposing factors, diagnosis, surgical cases, preimplantation audiological examination, and prelingual and post-language deafness).

Among the 16 patients who underwent HRCT, 11 had prelingual deafness, 2 had a family history of genetic diseases, 13 also underwent an MRI of the inner ear and brain, 9 underwent acoustic impedance tests, 6 underwent the otoacoustic emission tests, 15 underwent auditory brainstem response and audio steady-state response tests, and 6 underwent pure tone audiometry. Of the 32 ears, 1 had moderate-to-severe acoustic deafness, 1 had severe acoustic deafness, and the remaining had severe sensorineural hearing loss. The patients were treated with CI, following which 1 had dizziness, and 1 had facial paralysis.

LVAS with progressive, fluctuating hearing loss has an autosomal recessive inheritance. Early diagnosis can be made using HRCT and audiological examination. The preventive and treatment measures of LVAS currently include genetic screening for prenatal and postnatal deafness and CI.

JOS staging and clinical features of middle ear cholesteatoma in children

Yang YANG,Xiao XIAO,Min CHEN,Jinsheng HAO,Bing LIU,Wei LIU,Jie ZHANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  52-55.  doi:10.6040/j.issn.1673-3770.0.2019.376

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To summarize and analyze the clinical features and postoperative performance of children with middle ear cholesteatoma, using the Japan Otological Society (JOS) 2015 edition of the cholesteatoma staging criteria.

From January 2016 to December 2016, 19 children with middle ear cholesteatoma who underwent primary surgery were enrolled. The JOS staging criteria were used to evaluate the clinical manifestations, surgical procedures, and efficacy.

The total of 19 cases consisted of 18 boys and 1 girl. Age at the time of surgery ranged from 3 years and 1 month to 10 years and 8 months, with an average of 6 years and 7 months. All cases were unilaterally affected, including eight left ears and 11 right ears: acquired primary cholesteatoma in 2 cases (10.5%), JOS stage: I in both cases; acquired secondary cholesteatoma in 15 cases (79%), JOS stage: I in 1 case, II in 12 cases, III in 2 cases; 2 cases of congenital cholesteatoma (10.5%), JOS stage: I in 1 case, II in 1 case. The average preoperative air-conduction hearing threshold range was 10 dB HL-65 dB HL. Follow-up time was 15 to 24 months. Three patients underwent endoscopic tympanoplasty with external auditory canal; 2 underwent mastoidectomy + canal wall-down tympanoplasty; 14 underwent mastoidectomy + canal wall-up tympanoplasty, one of whom showed recurrence 8 months after surgery. No recurrence resulted after the second surgery to clear the lesion.

The proportion of children with JOS II was the highest in the study population, and the proportion of subsequent gallbladder complications was the highest. Use of the JOS middle ear cholesteatoma staging standard may help to summarize the condition of children with middle ear cholesteatoma, and to guide and optimize surgical treatment .

Secretory otitis media with sudden hearing loss: three cases′ report and a literature review

Xin CAO,Haijin YI,Xin LI,Jia XU,Juanjuan GAO

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  56-61.  doi:10.6040/j.issn.1673-3770.0.2019.147

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To analysis and evaluate the clinical features and pathological mechanisms of secretory otitis media combined with sudden hearing loss in order to improve the understanding of this disease and the correct diagnosis and treatment.

Through analyzing clinical materials of three cases with secretory otitis media combined with sudden hearing loss and reviewing the literatures about this condition to summarize the clinical characteristics, possible pathological mechanisms and the key point of treatments.

Three subjects had the characteristics of secretory otitis media and sudden hearing loss. Two of the three cases had acute respiratory infection. All subjects were cured treated with antibiotics and systemic or topical administration of corticosteroids.

Secretory otitis media combined with sudden hearing loss is a rare condition. The inner ear damage mechanisms of secretory otitis media combined with sudden hearing loss maybe associated with infection of media ear through the round membrane. Early and timely therapy may improve the treatment outcomes for patients with secretory otitis media combined with sudden hearing loss.

Applied anatomy of endoscopic resection of the petrous apex through the transcanal infracochlear approach

Feiyan LU,Yongtian LU,Junwei ZHOU,Yuan LIU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  62-68.  doi:10.6040/j.issn.1673-3770.0.2019.177

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To explore endoscopic transcanal infracochlear approach for resection of the petrous apex and observe structures of the middle ear. The study also aimed to identify anatomical landmarks for locating the infracochlear corridor as well as quantify the corridor under three-dimensional reconstruction of high-resolution CT(HRCT) of temporal bone. The purpose is to provide a constant anatomical landmark and imaging basis for surgical intervention.

1.Ten (20 sides) fresh frozen adult cadaver heads were used. Preoperative temporal bone CT was used to measure the vertical distance between the basal turn of the cochlea and angle between the internal carotid artery and jugular bulb, as well as the distance between the basal turn of the cochlea and jugular vein bulb. 2. Retrospective analysis of high-resolution CT(HRCT) of the temporal bone in 85 patients (170 sides) was performed to record and summarize the imaging characteristics between the infracochlear corridor and cells of the petrous apex.

1. CT measurements of temporal bones of 20 sides in the frozen cadavers and 170 sides in patients showed that vertical distance between the basal turn of the cochlea and angle between the internal carotid artery and jugular bulb were (6.46 ±1.02) mm and (6.83 ±1.50) mm, respectively, and that between the basal turn of the cochlea and jugular bulb were (3.67±0.58) mm and (3.82±1.29) mm, respectively. Among them, the vertical distance between the pneumatized petrous apices were (6.79 ± 0.60) mm and (7.19 ± 1.44) mm, and that between the non-pneumatized apices were (6.28 ± 1.17) mm and (6.68 ± 1.50) mm, respectively. The distances from the basal turn of the cochlea to the jugular bulb with respect to the pneumatized petrous apices were (4.06 ± 0.36) mm and (4.06 ± 1.42) mm, respectively; and that of the non-pneumatized portions were (3.45 ± 0.58) mm and (3.74 ± 1.22) mm, respectively. 2. Results of CT classification of the infracochlear corridor and petrous apex of the temporal bone were as follows: Type A, pneumatized type 31.18% (53 ears); Type B, marrow type 57.65% (98 ears), and Type C, sclerosed type 11.18% (19 ears).

High-resolution CT (HRCT) may be considered an important pre-operative reference tool for endoscopic transcanal infracochlear approach for resection of the petrous apex. From an anatomical point of view, endoscopic resection of lesions in the petrous apex is feasible using the transcanal infracochlear approach as it can avoid damage to the internal auditory canal, cochlea, and labyrinth, and preserve hearing. The technique can be considered one of the important surgical methods for treatment of minor lesions in the posterior and inferior aspects of the upper petrous apex.

Expression and biological function of long chain non-coding cytoskeleton regulator RNA in nasopharyngeal carcinoma

Lin LI,Heng ZHANG,Yufei XIAN,Xiaoli SHENG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  69-72.  doi:10.6040/j.issn.1673-3770.0.2018.425

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To investigate the expression and biological function of long non-coding cytoskeleton regulator RNA (CYTOR) in nasopharyngeal carcinoma.

Real-time PCR was used to examine CYTOR expression in nasopharyngeal carcinoma tissues (n = 32), nasopharyngeal carcinoma cell lines (CNE1 and HONE1), 28 patients with benign nasopharyngeal lesions, and human nasopharyngeal epithelial cells (NP69). Moreover, CYTOR expression in the CNE1 and HONE1 cell lines was knocked down using RNAi assay. MTT, Transwell, and wound healing assays were also used to detect the proliferation and migration of nasopharyngeal carcinoma cells from CNE1 and HONE1 after downregulating CYTOR expression.

CYTOR expression in the nasopharyngeal carcinoma tissues and nasopharyngeal carcinoma cell lines was observed to be significantly higher than that in the nasopharyngeal benign lesion mucosal tissues and NP69. After transient inhibition of CYTOR expression, the migration and proliferation abilities of the nasopharyngeal carcinoma cell lines were also observed to decrease significantly (P < 0.05).

CYTOR expression is elevated in pharyngeal cancer tissues and nasopharyngeal carcinoma cell lines and is positively correlated with the migration ability of nasopharyngeal carcinoma.

Comparison between the efficacy of nasal lavage and combination treatment in allergic rhinitis and vasomotor rhinitis

Minghong SUN,Xian GAO,Ting ZHAO,Wenjun LIU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  73-78.  doi:10.6040/j.issn.1673-3770.0.2018.620

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The aim of this study was to compare the efficacy of nasal lavage alone and nasal lavage in combination with nasal corticosteroids in allergic rhinitis (AR) and vasomotor rhinitis (VMR).

This study included 93 patients with AR and 56 patients with VMR, who were randomly divided into three groups each: A1, A2, and A3 (n = 31 in each group) and V1 (n = 19), V2 (n = 17), and V3 (n = 20), respectively. Patients in groups A1 and V1, A2 and V2, and A3 and V3 were treated with budesonide nasal spray, nasal flushing with 0.9% sodium chloride solution, and a combination of nasal lavage and budesonide nasal spray, respectively, for three months each. Nasal symptoms were assessed using the visual analog scale (VAS) before and after the intervention; the rhinoconjunctivitis quality of life questionnaire (RQLQ) was used to evaluate the quality of life, and the fractional exhaled nitric oxide (FENO) values were measured by the exhaled NO assay system..

All patients completed the experiment with good tolerance, and no serious adverse reactions occurred. The VAS, RQLQ, and FENO values in the A3 group after three months were significantly lower than the values before intervention. There was no statistically significant difference in the total VAS scores among the A1, A2 and A3 groups (F = 1.465, P = 0.174). There were statistically significant differences in the total RQLQ scores between the A3 and A1 groups (t = 2.668, P = 0.014), but not between the A2 and A3 groups (t = 1.545, P = 0.136). There were statistically significant differences in the FENO values between the A3 and A1 groups (t= 3.241, P=0.004) and between the A3 and A2 groups (t= 2.987，P = 0.008). At the end of the third month of treatment, VAS, RQLQ, and FENO values in the V3 group were significantly lower than the values before intervention. The differences in total VAS scores were statistically significant between the V3 and V1 groups (t = 2.352, P = 0.027) and between the V3 and V2 groups (t = 2.083, P = 0.043). There were statistically significant differences in RQLQ scores between the V3 and V1 groups (t = 2.581, P=0.013) and between the V3 and V2 groups (t = 2.339, P = 0.031). There was no significant difference in the FENO values among the V1, V2 and V3 groups (F=1.563, P=0.159).

Nasal lavage alone or nasal lavage in combination with glucocorticoids was more efficient in the long-term treatment of AR and VMR.

Original Article

Surgical repair of orbital floor fracture with content prolapse and inferior rectus incarceration through maxillary sinus approach

Yuzhu LIU,Yingkai GAO,Guiyun JIANG,Haoxu PEI,Xiaoxue YUE

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  79-81.  doi:10.6040/j.issn.1673-3770.0.2019.022

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To explore the effects of surgical repair of orbital floor fracture with content prolapse and inferior rectus incarceration through the maxillary sinus approach.

From January 2002 to December 2017, 7 patients with orbital floor fracture with content prolapse and inferior rectus incarceration were treated in our hospital. The patients underwent nasal endoscopic reduction of orbital floor fracture through the maxillary sinus approach, restoration of content prolapse, and lysis of inferior rectus incarceration, supporting the bottom with a Foley′s urethral balloon catheter.

The maxillary sinus balloon catheter was withdrawn 14 days after the surgery. Seven cases of double vision disappeared, and the eye position and movement returned to normal. Seven patients had no change in visual acuity compared to their preoperative values.

Surgical repair through the maxillary sinus approach of orbital floor fracture with sacral content prolapse and inferior rectus incarceration reduction is characterized by less trauma, no incision on the face, clear visual field, and wide space available for operation.

Clinical effects of different middle turbinate treatments on chronic rhinosinusitis with nasal polyps during endoscopic sinusitis

Guohui CHEN,Shouhuan HE,Qing SUN,Tianle GAO,Guangping BAI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  82-86.  doi:10.6040/j.issn.1673-3770.0.2018.447

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To explore the clinical effects of different middle turbinate treatments on on chronic rhinosinusitis with nasal polyps (CRSwNP) during endoscopic sinusitis.

115 patients with CRSwNP were selected and treated with endoscopic sinus surgery, the patients were divided into study group (n=60, Middle conchoplasty) and control group (n=55, excision) according to the treatment of middle turbinate during operation, after operation they had follow-up for 3 months, the improvement of clinical symptoms, the changes of nasal function and olfactory function before and after operation of the 2 groups were compared, and the assessment of the Lund-Mackay and SNOT-20 scales was carried out.

Compared with the preoperative group, the scores of dizziness, cough, nasal obstruction and purulent discharge in the 2 groups were lower, and the scores of dizziness, cough and purulent discharge in the study group were lower than those in the control group (t=12.979、13.298、9.216；P<0.001); 3 months after operation, the airway resistance, DCAN and olfactory function scores of the 2 groups decreased, and the nasal function indexes of the study group were lower than those of the control group (t=14.999, 3.611, 3.798;P<0.001); the nasal function indexes of the 2 groups increased, and the study group was higher than the control group (t=2.216, 11.379; P<0.001); Lund-Kennedy score and SNOT-20 score of the 2 groups decreased 3 months after operation, and that of the study group was lower than that of the control group (t=17.025,11.822; P<0.001).

The application of middle turbinate in endoscopic sinusitis. for CRSwNP patients is more effective, which can promote the recovery of nasal function and olfactory function and improve the quality of life of the patients.

Clinical analysis of 15 cases of adenoid cystic carcinoma in the paranasal sinuses and nasal cavity

Jian FENG,Han ZHOU,Shenghua SONG,Qing ZHAO,Jiacheng ZHANG,Yaqin LIU,Yujie SHEN,Weida DONG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  87-91.  doi:10.6040/j.issn.1673-3770.0.2018.545

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To explore the clinical features, diagnosis, treatment, and prognosis of adenoid cystic carcinoma of the nasal cavity and paranasal sinuses.

We performed a retrospective analysis of the clinical data of 15 patients with adenoid cystic carcinoma of the nasal cavity and paranasal sinuses admitted to the First Affiliated Hospital of Nanjing Medical University in the period from January to October 2008. The prognostic factors of the disease were statistically analyzed.

The initial diagnoses in the 15 patients included: nasal congestion in 5 cases (33%), nose bleeding in 5 cases (33%), eye pain and tearing in 3 cases (20%), local uplift in 3 cases (20%), facial numbness in 2 cases (13%), headache in 1 case (7%), and 1 case (7%) without symptoms. All 15 patients underwent surgical resection; 4 underwent endoscopic sinus surgery (26.7%), 9 underwent nasal resection and postoperative radiotherapy (60%), and 2 underwent nasal excision and postoperative radiochemotherapy (13.3%). Postoperative pathological examination revealed highly differentiated (tubular type, sieve type) adenoid cystic carcinoma in 10 cases (66.7%) and poorly differentiated (solid type) in 5 cases (33.3%). All 15 patients were followed up for a period of 6 months to 10 years. As of October 2018, 8 of the 15 patients survived (53%), and 7 had died (47%). Of the 4 patients at an early stage of the disease (I and II), one died, and among the 11 patients that were in the advanced stage of the disease (III, IV), there were 6 deaths. The overall 1-, 3-, 5-, and 10-year survival rates were 93%, 87%, 73%, and 53%, respectively. There was a positive correlation between the surgical mode and the life span (t=4.406， P=0.003), and a negative correlation between age, differentiation, and life span (t= -2.390, -6.126 P=0.048, ＜0.001, respectively). Gender, surgical procedure, clinical stage, and life span were not correlated (P=0.154, P=0.262, P=0.052, respectively).

The clinical manifestations of adenoid cystic carcinoma of the nasal cavity and paranasal sinuses are diverse and non-specific, and early diagnosis is difficult. Surgery is the main treatment for this type of carcinoma. Endoscopic surgery or endoscopic-assisted open surgery has good clinical application value. The age and degree of pathological differentiation are related to the prognosis. For patients with poorly differentiated and advanced tumors, comprehensive treatment mode should be adopted, and regular follow-up time should be shortened for increasing the lifespan.

Clinical analysis of endoscopic ligation of the sphenopalatine artery in elderly patients with intractable epistaxis

Qiang LI,Zhiyuan LIU,Han ZHOU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  92-95.  doi:10.6040/j.issn.1673-3770.0.2018.366

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To investigate the efficacy of endoscopic ligation of the sphenopalatine artery in elderly patients with intractable epistaxis.

The study included 41 elderly patients with intractable epistaxis. All patients were randomly assigned to two groups, namely, the treatment group (21 patients undergoing an endoscopic ligation of the sphenopalatine artery) and the control group (20 patients undergoing an endoscopic nasal packing). During the hospitalization and the 6-month follow-up, the epistaxis relapse rate, the postoperative pain, a satisfaction survey, the length of the hospital stay, and complications were evaluated.

A significantly higher cure rate was obtained in the treatment group compared with the control group (81.0% vs. 50%, P<0.05). The average hospitalization duration of the treatment group was significantly shorter than that of the control group (6.5 days vs. 10.7 days, P<0.05). The treatment group was remarkably superior to the control group in both the degree of postoperative pain and satisfaction (both P<0.001). No severe complications were observed in any patient.

For elderly patients with intractable epistaxis, endoscopic ligation of the sphenopalatine artery should be considered as a first-line treatment due to its advantages such as fast and effective action, short hospital stay, little postoperative pain, and few complications.

Expression of the microRNA let-7a in the serum of 42 patients with laryngeal cancer and its significance

Lu LUO,En ZHOU,Si OUYANG,Yi CHEN,Xuping XIAO,Jihua WANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  96-100.  doi:10.6040/j.issn.1673-3770.0.2019.468

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To investigate changes in the serum let-7a expression in laryngeal squamous cell carcinoma (LSCC) patients and the diagnostic value of let-7a for LSCC.

Forty-two LSCC patients and 42 healthy subjects who were hospitalized in our hospital were enrolled in this study. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to determine the expression level of let-7a in patient serum samples, the association between serum let-7a levels and clinical and pathological LSCC parameters, and the diagnostic efficacy of let-7a for LSCC.

Relative expression levels of let7a in the experimental (0.380±0.083) and normal control (0.933±0.0723) groups were significantly different . Relative let-7a expression levels in patients with laryngeal cancer before (0.380±0.0831) and after (0.488±0.1468) surgery were also significantly different. The let-7a level in tissues was associated with lymph node metastasis , but not with gender, age, smoking, alcohol consumption, tumor classification, infiltration depth, TNM stage, or degree of differentiation . ROC curve analysis showed that the best critical value for the relative expression of let-7a in 0.765 was laryngeal carcinoma with a sensitivity of 756.0%, a specificity of 76.1%, an AUC of 0.850, and a 95% confidence interval of 0.776-0.932.

Overall, we confirmed that serum let-7a expression is down-regulated in LSCC patients and is a potential molecular marker for laryngeal cancer diagnosis. Our findings also showed that the serum let-7a level is associated with lymph node metastasis, which is helpful for tumor disease judgment and postoperative tumor monitoring, but further research is needed to validate these findings.

Simultaneous Dx-pH monitoring of the oropharynx and esophagus for laryngopharyngeal reflux disease research

Lei WANG,Gang WANG,Wei WU,Hongdan LIU,Bingxin XU,Xin LI,Haolun HAN,Baowei LI,Ruiying DING,Lianyong LI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  101-106.  doi:10.6040/j.issn.1673-3770.0.2019.114

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To investigate the relationship between laryngopharyngeal reflux disease（LPRD）and gastroesophageal reflux disease (GERD) by simultaneous Dx-pH monitoring of the oropharynx and esophagus.

This was a retrospective study of 56 patients, who had presented with suspected laryngopharyngeal reflux at the Department of Otolaryngology Head and Neck Surgery, Chinese PLA 306th Hospital, from June to December 2017. All patients were evaluated using the reflux symptom index (RSI), reflux finding score (RFS), gastroesophageal reflux disease questionnaire (GerdQ), simultaneous 24 hour Dx-pH monitoring of the oropharynx and esophagus, and gastroscopy.

Synchronous pH monitoring revealed 17 cases had a positive Ryan score, implying LRPD, of which, 12 cases (70.6%, 12/17) were diagnosed with LPRD alone. Further, 20 cases were diagnosed with GERD, of which, 15 cases (75%, 15/20) were GERD alone. The number of patients with only LPRD was higher than the number diagnosed with both LPRD and GERD (29.4%, 5/17). There were no statistical differences in total percent acid exposure time or the total number of oropharyngeal pH events between the “LPRD only” and the “LPRD+GERD” groups. Additionally, there were no statistical differences in the esophageal reflux indices between the “GERD only” group and the “LPRD+GERD” group. Eleven cases (64.7%, 11/17) of LPRD were negative for GERD, determined by the GerdQ, Dx-pH esophageal probe tests, and gastroscopy.

LPRD and GERD can exist independently. Most LPRD cases are not accompanied by GERD and LPRD is not secondary to severe GERD.

Electronic nasopharyngoscopy for the diagnosis and treatment of otorhinolaryngologic diseases: A retrospective study of 27400 cases

Chengcheng LIANG,Xin WANG,Dapeng LEI

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  107-110.  doi:10.6040/j.issn.1673-3770.0.2018.579

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To evaluate the efficiency of electronic nasopharyngoscopy in the diagnosis and treatment of otorhinolaryngologic diseases.

A retrospective analysis of patients who underwent electronic nasopharyngoscopy in the department of otolaryngology from December 1, 2016, to October 1, 2018.

In total, 27400 patients underwent electronic nasopharyngoscopy for a definitive diagnosis of otorhinolaryngologic diseases. There were 16661 cases of oral or otolaryngologic lesions: 122 cases of foreign bodies in otolaryngological organs, 85 cases of wounds caused by foreign bodies, 32 cases of functional dysphonia, 122 cases of otic lesions, 598 cases of nasal lesions, 498 cases of oral and oropharyngeal lesions, 1364 cases of nasopharyngeal lesions, 13751 cases of laryngeal and hypopharyngeal lesions, 75 cases of tracheal lesions, and 14 cases of parapharyngeal lesions. Electronic nasopharyngoscopy-assisted biopsies performed on 1452 patients with suspected malignant tumors presented with a positive rate of 94.77%. Surgeries were performed on 84 patients and foreign body extractions were performed on 101 patients with the electronic nasopharyngoscopy,

Electronic nasopharyngoscopy is safe, effective, and specific in the diagnosis and treatment of otolaryngology diseases. It is helpful for the early detection and treatment of minute lesions and otolaryngological tumors.

Foreign bodies in the throat and bronchi of children: a report of 221 cases

Weihua CHEN,Kaiyang ZHANG,Xiaobin ZHENG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  111-115.  doi:10.6040/j.issn.1673-3770.0.2018.355

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To summarize the clinical characteristics, diagnosis, and treatment experience of laryngeal and tracheobronchial foreign body aspiration in children, and improve the approach to diagnosis and treatment of this condition.

Clinical data of 221 cases of laryngeal and tracheobronchial foreign body aspiration in children were retrospectively analyzed, and the pathogenesis in the patients with respect to age, main clinical symptoms and signs, and diagnostic and treatment considerations were summarized.

In total, 91.9% of the patients were under three years of age, and the proportion of patients between 13 and 24 months was as high as 61.1%. The main clinical symptom was irritant cough, and the main clinical sign was a lung respiratory murmur or double lung respiratory tone asymmetry. The diagnostic accuracy of lung CT was 100%, and the accuracy of localization was 96.4%. The positive rate of exogenous foreign body removal by rigid bronchoscopy in patients with a history of foreign body inhalation was higher than that in patients without such a history (χ²=22.886，P＜0.001). These patients presented with lower respiratory sounds in one lung or asymmetric respiratory sounds in both lungs more often than those without the manifestations enumerated above（χ²=3.905，P=0.048）.In addition to five patients who underwent surgery under the administration of anesthesia or without anesthesia, the remaining patients had the foreign bodies removed by direct laryngoscopy or rigid bronchoscopy.

Combined with a history of foreign body inhalation, typical pulmonary signs, and lung CT examination results, laryngeal and tracheobronchial foreign bodies can be accurately diagnosed. The extraction of foreign bodies by direct laryngoscopy or rigid bronchoscopy under general anesthesia is an effective method to treat laryngeal and tracheobronchial foreign body aspirations.

The correlation between sleep disorders and depression in the aging population in a rural area of Shandong province

Xiaobing JIANG,Yifeng DU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  116-120.  doi:10.6040/j.issn.1673-3770.0.2019.188

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To investigate the correlation between sleep disorders and depression among the elderly population in a rural area of Yangu county in Shandong Province.

From August 2014 to November 2014, a cross-sectional survey was conducted in elderly patients aged 65~85 years in Yanlou Town of Yanggu County in Shandong Province. The study population was assessed for sleep impairment using the Pittsburgh Sleep Quality Index Scale (PSQI) and the Hamilton Depression Rating Scale (HAMD) was used to evaluate depression.

1. A total of 145 elderly patients were found to have depression, an incidence of 20.4%. 2. Women and people with low level education were more easily depressed. 3. There was a significant difference in PSQI score between the non-depressed group and the possible or positive depression group (P<0.05). 4. Sleep disorder is a risk factor for depression among the elderly population.

Sleep disorder is a risk factor for depression among the elderly population in a rural area of Shandong Province. We should take active measures to intervene against sleep disorders.

Changes in the ocular biometric parameters before and after cycloplegia in juveniles with different degrees of myopia

Danfeng ZHANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  121-124.  doi:10.6040/j.issn.1673-3770.0.2018.529

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To analyze the changes in refraction and the ocular biometric parameters with cycloplegia in juveniles with different degrees of myopia.

Fifty-six juveniles with myopia, aged from 7 to 17 years, were enrolled from our optometry outpatient center. Before inducing cycloplegia, refraction, accommodation response, and ocular biometric parameters were measured in all subjects by optical biometry (Lenstar900). Refraction and the ocular biometric parameters were measured again after cycloplegia. The subjects were divided into two groups according to the degree of myopia: low myopia group and moderate-to-high myopia group. We analyzed the differences in the ocular biometric parameters between the two groups and the relationship of these parameters with the age. We also compared the differences in refraction and the ocular biometric parameters between before and after cycloplegia, and analyzed the relationship between those differences and the age and accommodation response.

Before cycloplegia, there was a statistically significant difference in the axial length (AL) between the two groups, and AL showed a significant positive correlation with the age. There was no statistical difference in the aqueous depth (AD), lens thickness (LT), and pupil diameter (PD) between the two groups, and none of these parameters correlated with the age. The differences in the changes in refraction, LT, AL, and PD before and after cycloplegia between the two groups were not statistically significant; however, the difference in the changes in AD was statistically significant.

The differences in the changes in refraction before and after cycloplegia between the two groups were not statistically significant; however, the changes in the AD were significant. Therefore, it is not necessary to measure refraction with cycloplegia in juveniles with myopia; accommodation should be measured instead.

The clinical application of surgical scene preconditioning for patients with phobia undergoing ocular surgery

Rui ZHANG,Chunbei GONG,Wenchun YU,Zhen WANG,Chunlian YAO

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  125-128.  doi:10.6040/j.issn.1673-3770.0.2018.543

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To investigate the clinical application of surgical scene preconditioning for patients with phobia undergoing ocular surgery.

A total of 210 patients who underwent a routine ophthalmic surgery in our hospital from September 2017 to September 2017 were randomly divided into a preconditioning group (108 cases) and a control group (102 cases). The routine care methods were used in the control group, and the patients in the preconditioning group were pre-adapted using a simulation of the ophthalmic surgical scene based on the routine care method. The intraoperative interruption rate, changes in the vital signs at 7 am on the day of surgery, preoperative and postoperative vital signs, postoperative pain level, and surgical satisfaction were recorded and compared between the two groups.

There were no significant changes in the systolic blood pressure and heart rate at 7 am on the day of surgery, preoperatively, and postoperatively in the preconditioning group. The between-group differences were not statistically significant. The control group had a higher blood pressure and faster heart rate after the surgery, and the difference between the two groups was statistically significant. The number of postoperative interruptions and postoperative pain level in the preconditioning group were significantly lower than those in the control group, and the preconditioning group was more satisfied than the control group; the difference was statistically significant.

The surgical scene preconditioning for patients with phobia undergoing ocular surgery can improve the patients’ tolerance and reduce their physiological and psychological stress response. This finding should be considered for promotion in clinical settings.

Morphological structure analysis of the macular area after anti-VEGF treatment for short-term retinal vein occlusion

Keyang HAN,Beibei YU,Bojun ZHAO

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  129-131.  doi:10.6040/j.issn.1673-3770.0.2017.515

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To observe the morphological changes in the macular area in patients with macular edema secondary to retinal vein occlusion after intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs, using optical coherence tomography (OCT).

Fifty-six patients with retinal vein occlusion complicated with macular edema were randomly selected from the clinic. An intravitreal injection with 0.05ml of an anti-VEGF drug was administered. OCT was performed before and 7 days after the intervention. The relationship between the best corrected visual acuity, neuroepithelial effusion, external membrane, ellipsoidal band, and choroidal thickness was assessed.

The best corrected visual acuity improved significantly from 0.89±0.52 to 0.56±0.46. The neuroepithelial effusion decreased from 66% to 29%; the structural integrity of the external membrane and ellipsoidal zone significantly improved from 0.88±0.79 and 0.86±0.72 to 0.30±0.54 and 0.21±0.41, respectively. The choroid thickness did not change significantly with preoperative short-term treatment (318.18±47.42) or postoperatively (320.54±45.55).

Patients with retinal vein occlusion secondary to macular edema with short-term morphological changes in the macular area showed improvement in visual acuity after the injection of anti-VEGF drugs, with no significant effect on the choroid.

Meta-analysis

Meta analysis of the nasal cavity bacterial culture in chronic rhinosinusitis

Shujing HAN,Jie LU,Ping CHU,Lixing TANG,Huiwen ZHENG,Xiaojian YANG,Wei ZHANG,Pengpeng WANG,Jie ZHANG,Yongli GUO,Wentong GE

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  132-138.  doi:10.6040/j.issn.1673-3770.0.2018.603

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To clarify the bacterial distribution in the nasal cavity of patients with chronic rhinosinusitis and provide a basis for the diagnosis and treatment of Chronic Rhinosinusitis (CRS).

PubMed, EMBASE, MEDLINE, CNKI, VIP Information and Wanfang data were searched for studies on the nasal cavity bacterial culture in CRS. Search strategy: chronic rhinosinusitis AND (microbio* OR bacteria OR virus); Chinese retrieval (rhinosinusitis) AND (microecology OR bacteria OR virus).

Totally, 2141 cases of CRS were included in 20 studies. The pooled positive rates of Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, Pseudomonas aeruginosa and Haemophilus influenzae were 0.24(95%CI: 0.17 ~ 0.31), 0.17(95%CI: 0.11 ~ 0.23), 0.06(95%CI: 0.02 ~ 0.11), 0.09(95%CI: 0.05 ~ 0.14), and 0.09(95%CI: 0.03 ~ 0.15), respectively.

S. aureus and S. epidermidis are the main pathogenic bacteria present in the nasal cavity of CRS patients, followed by S. pneumoniae, P. aeruginosa, and H. influenzae.

Review

PU.1 transcription factor and helper Th9 cells with allergic rhinitis

Xiaohan LIU,Xiaobing ZHANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  139-143.  doi:10.6040/j.issn.1673-3770.0.2018.456

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Allergic rhinitis is an IgE-mediated type I allergic disease of the nasal mucosa. Previous knowledge of AR has been extended from the imbalance of Th1/Th2 type cytokines to the Th1/Th2/Th17/Treg cell pattern. The Th9 cells discovered in recent years play an important role in the occurrence and development of allergic diseases. PU.1 is an important transcription factor in the Ets family and plays an important role in the regulation of natural immunity and acquired immunity. The activation of PU.1 directly affects the developmental differentiation and biological characteristics of Th9 cells. This article summarizes the possible roles of transcription factors PU.1 and Th9 cells in the pathogenesis of allergic rhinitis.

Advances in phonomicrosurgery for glottic webs

Meijun ZHENG,Hui YANG,Juanjuan HU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  144-147.  doi:10.6040/j.issn.1673-3770.0.2018.388

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The management of glottic webs is clinically challenging secondary to the high incidence of postoperative re-adhesions. Conventionally, T-tube placement, balloon dilation, and external techniques that need laryngofissure and tracheostomy were performed to treat this condition. However, conventional surgical procedures are invasive and may be associated with significant risks and high failure rates. Recently, phonomicrosurgery is being widely used to treat glottic webs owing to the success and efficacy of this procedure.

Can adenotonsillectomy adequately cure children with obstructive sleep apnea syndrome

Zhaokun WU,Xinhua ZHU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  148-152.  doi:10.6040/j.issn.1673-3770.0.2019.127

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The incidence of obstructive sleep apnea syndrome (OSAS) in Chinese children is 5.8 per cent in boys and 3.8 per cent in girls^{and is therefore, a common group of diseases in childhood. The occurrence and development of OSAS affects the normal growth and development of children, resulting in growth retardation, neurocognitive defects, abnormalities in intellectual development and behavior, and other problems. Therefore, early recognition, diagnosis, and initiation of appropriate treatment is crucial in OSAS. The treatment methods for OSAS in children varies, including; Conservative treatment with internal medicine, surgery, specialized otolaryngology treatment, and a multi-disciplinary combined treatment with varying therapeutic effects. However, surgery continues to be the recognized first-line treatment for pediatric OSAS with adenotonsillectomy (AT) being the mainstay treatment. However, there are differing opinions on the efficacy and postoperative complications of AT. Some scholars believe that AT results in significant improvements and that the symptoms of OSAS can be completely relieved after this procedure. Other scholars believe that the efficacy of AT is still questionable and that postoperative complications and residual disease are difficult to avoid, and therefore, AT is not enough to cure OSAS in children. After reviewing the literature exhaustively, this paper elucidates AT treatment of OSAS in children, to provide a reference for the clinical treatment of this syndrome.}

A review of corneal collagen cross-linking for the treatment of infectious corneal disease

Xin GAO,Xu WANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  153-157.  doi:10.6040/j.issn.1673-3770.0.2018.314

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Corneal collagen crosslinking (CXL) using ultraviolet light (UVA)-riboflavin photochemistry increases corneal rigidity and improves biomechanical stability of the stroma, thereby limiting the progression of corneal expansion. In recent years, CXL has also been used as a safe and effective treatment for infectious corneal diseases. In this paper, we review the basic principles, indications, and contraindication of CXL for the treatment of infectious corneal disease.

Autophagy and its research progress in glaucoma

Ruibao LIU,Ying ZHAO,Minglu GUO,Yu DUAN,Yanxia WU,Xuejing LU

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  158-161.  doi:10.6040/j.issn.1673-3770.0.2018.606

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Autophagy is a cellular metabolic process in which cells degrade and renew abnormal proteins, glycogen, damaged organelles, and other accumulations and release small molecules favorable for secondary utilization by cells to maintain intracellular homeostasis. It is a unique life phenomenon in eukaryotic cells and plays an important role in cell growth, development, and aging. Activation of abnormal autophagy is associated with various diseases, including tumor, immune disorders, and neurodegenerative diseases, in the human body. In recent years, it has been found that autophagy is involved in the physiological and pathological process of glaucoma; however, whether autophagy promotes the survival or death of retinal ganglion cells remains controversial. Therefore, an in-depth study on the occurrence and mechanism of autophagy is of great significance for a comprehensive understanding of the role of autophagy in the pathogenesis of glaucoma.

Brief Report

A retrospective study on clinic manifestation and pathological of the larynx leukoplakia in 76 cases

Yangfan LIU,Jian JIA,Baoluo WAN

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  162-165.  doi:10.6040/j.issn.1673-3770.0.2019.240

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Clinical analysis of 43 cases of nasal septum correction by a two-line method of decompression using a nasal endoscope

Haiying WANG

Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(5):  166-168.  doi:10.6040/j.issn.1673-3770.0.2019.041

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