Table of Content

20 January 2020 Volume 34 Issue 1

  

Editorial

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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Invited Review

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.

Clinical Report

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

We recruited 84 patients (96 ears) and obtained their clinical examination findings, hearing test results, and audiograms from a single-institution otolaryngology service with comparative data generated from their first and follow-up visits.

Among all the recruited patients, 34 ears (35.4%) had normal hearing, while 62 ears (64.6%) had hearing loss after trauma, at their first visit. Among 62 ears with hearing loss, 33 ears (53.2%) had conductive hearing loss, 25 ears (40.3%) had sensorineural hearing loss, and four ears (6.5%) had a mixture of conductive and sensorineural hearing loss. At the follow-up visit, the air conduction threshold of ears with conductive hearing loss had significantly decreased from 45.77±4.28 dB HL to 34.48±4.53 dB HL (t=2.906, P < 0.05), while the bone conduction threshold decreased from 23.45±2.31 dB HL to 19.63±2.20 dB HL (t=2.906, P < 0.05). However, no significant differences between the first and follow-up visits were observed in ears with sensorineural hearing loss or ears with mixed hearing loss. Of all the 96 ears, 39 (40.6%) had intact tympanic membrane, while 57 (59.4%) had traumatic tympanic membrane perforation. At follow-up, 40 ears (70.2%) with traumatic tympanic membrane perforation had healed spontaneously, while 12 ears (21.1%) had healed after tympanoplasty. However, five ears (8.8%) did not heal. Among the ears that spontaneously healed, 83.0% had grade Ⅰ and 16.7% had grade Ⅱ tympanic membrane perforation. Ears with grade Ⅲ and grade Ⅳ tympanic membrane perforations did not heal spontaneously.

Hearing impairment is a common clinical presentation in patients with traumatic injury. In most patients, this manifests as conductive hearing loss, while severely affected patients may have sensorineural or mixed hearing loss. Patients with conductive hearing loss have a favorable prognosis, while patients with sensorineural or mixed hearing loss have a poor prognosis. Trauma could cause different degrees of tympanic membrane perforation. With gradually aggravated tympanic membrane perforation, the spontaneous healing rate decreases. Therefore, for patients with large tympanic membrane perforations, which rarely heal spontaneously, tympanoplasty is warranted.

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

We considered 46 cases of surgical facial nerve reconstruction with nerve involvement in the parotid area. Among these cases, 3 required facial nerve relaxation (facial nerve intact), 7 required facial nerve suturing, 22 required sural nerve grafting (long distance nerve defects), and 14 required additional masseteric-facial nerve anastomosis due to sural nerve grafting.

All patients in the study received postoperative follow-up at 6 to 12 months. Using the House-Brackmann grading system at follow-up, 2 of the 3 facial nerve relaxation cases received grade Ⅲ, while the third received grade Ⅱ; all 7 facial nerve suturing cases received grades Ⅲ-Ⅳ. The 22 sural nerve grafting cases received grades Ⅲ-Ⅳ, however in one of these cases severe synkinesis was observed; 3 cases presented obvious synkinesis, and tight synkinesis was observed in the other 7 cases. The 14 sural nerve grafting and masseteric-facial nerve anastomosis cases received grades Ⅲ-Ⅴ with no obvious synkinesis observed in any of these cases.

Immediate, individualized surgical facial nerve reconstruction could lead to satisfactory results for various circumstances of facial nerve damage. Nerve suturing was preferred for achieving tension-free anastomosis, and masseteric-facial nerve anastomosis was preferred as a means to avoid synkinesis.

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

A retrospective study of 21 iatrogenic facial paralysis cases who underwent ear surgery in the ear, nose, and throat (ENT) Department between 2015 and 2017.

Of those that underwent middle ear surgery, 10 iatrogenic facial nerve injuries cases were observed in the following segments: the horizontal segment in 7 cases, the pyramidal segment in 2 cases, and the vertical segment in 1 case. After evaluating the degree of damage, decompression was performed in 7 cases, and facial nerve-great auricular nerve transplantation in 3 cases. The other 11 cases with facial paralysis after acoustic neuroma surgery underwent hypoglossal-facial anastomosis. Sixteen cases (about 76%) achieved HB Ⅰ-Ⅲ one year after surgery.

Although scientific and technological developments have reduced the probability of facial nerve injuries, iatrogenic facial paralysis cannot be entirely avoided. Clinical doctors need to have excellent anatomical knowledge and correct operation technique to prevent iatrogenic facial paralysis. Once iatrogenic facial paralysis occurs, early diagnosis and treatment are required to achieve ideal outcomes of patients' facial nerve function.

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

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To explore the clinical effects of geniculate ganglion decompression of the facial nerve using the transmastoid-epitympanum approach in patients with traumatic facial nerve paralysis.

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

All patients had improved facial function after surgery, of which 26 cases recovered to HB Ⅰ or Ⅱ level. The adverse effects on their auditory function were less than 10 dB in most cases.

The transmastoid-epitympanum approach to the decompression of the geniculate ganglion is simple, minimally invasive, safe, and effective, which results in little postoperative hearing change.

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

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This study aimed to analyze the clinical characteristics of temporal bonetrauma complicated with cerebrospinal fluid (CSF) leakage and to discuss its diagnosis and appropriate management.

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

During follow-up, no CSF recurred after the operation except for in one patient. In this, the CSF recurred, a second operation was performed, and the CSF leakage ceased. No postoperative infection occurred in any patient.

Surgical exploration and repair is the most effective method for those who have poor outcomes with conservative treatment of the temporal bone trauma. Medical history, clinical manifestations, laboratory examination and imaging analyses are all essential for diagnosing CSF leakage, locating the CSF, and selecting an appropriate surgical method. Perioperative antibiotics to prevent infection and appropriate drugs to control cranial pressure can improve postoperative recovery.

Analysis of the factors affecting the prognosis of low-frequency descending sudden hearing loss without vertigo

ZONG Xiaofang, HU Guohua, ZHONG Shixun, LEI Yan, JIANG Lizhu, KANG Houyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  33-37.  doi:10.6040/j.issn.1673-3770.0.2019.510

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Objective To analyze the effect of related factors on the prognosis of low-frequency descending sudden hearing loss without vertigo. Methods A total of 106 cases of low-frequency descending sudden hearing loss meeting the inclusion criteria were collected. The correlation between gender, age, side, course of the disease, concomitant symptoms, degree of hearing loss and therapeutic effect were analyzed. Results The total effective rate of low-frequency descending sudden hearing loss was 79%. The total effective rate was higher in patients aged ≤30 years old(91%, 31/34), compared to patients between 31 and 45 years old(80%, 37/46)and between 46 and 68 years old(61%, 16/26). The difference was statistically significant(p<0.05). Patients with a course ≤7 days(95%, 52/55)had a better prognosis than those with a course > 7 days(63%, 32/51), with this having a statistically significant difference(p<0.001). The therapeutic effect of patients with ear fullness(88%, 53/60)was better than those without ear fullness(37%, 31/46), and this difference was statistically significant(p<0.05).There was no statistically significant difference in the total effective rate between genders, incidence sides, whether they had tinnitus, or mild or moderate hearing loss(p>0.05). Conclusion The prognosis of low-frequency descending sudden hearing loss without vertigo is related to age, course of the disease, ear fullness, and initial hearing levels. Young age, a short course of the disease and ear fullness are positive factors for a good prognosis of low-frequency descending sudden hearing loss without vertigo.

A preliminary study on the energy absorbance of wideband acoustic immittance in young adults with normal hearing

XING Yuxuan, JIANG Wen, TONG Yue, WU Yang, LIU Wen, QIAO Yuehua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  38-41.  doi:10.6040/j.issn.1673-3770.0.2019.528

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Objective To explore characteristics of energy absorbance(EA)of wideband acoustic immittance(WAI)in young adults with normal hearing, and to compare the inter-ear and inter-sex differences in EA. Methods Sixty normal hearing young adults(120 ears)were selected and subjected to pure tone audiometry, acoustic impedance, and wideband acoustic immittance tests. The results were statistically analyzed. Results EA demonstrated an irregularly inverted “W” type of trend. Differences in EA were statistically significant at the frequency of 2 000 Hz, while there were no significant differences with regard to the residual frequency. The EA between 250 Hz and 630 Hz in women were slightly lower than that in men. The EA between 630 Hz and 3 150 Hz in women were slightly higher than that in men; however, the difference was not statistically significant. Conclusion The EA of young adults with normal hearing was particularly low at lower frequencies, and subsequently increase rapidly; furthermore, the EA for mid-high frequencies were relatively higher. WAI did not demonstrate significant differences between ears and both sexes. Comparing the differences in EA could be used to increase the specificity and sensitivity of the diagnosis of middle ear diseases in clinical settings.

Treatment of 32 cases pseudocyst of auricle with modified anterior capsulectomy and suture

ZHANG Shengjun, YIN Chengjiang, SONG Li, WANG Rencai, WANG Qirong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  42-45.  doi:10.6040/j.issn.1673-3770.0.2019.560

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Objective To explore the effect and experience of anterior capsulotomy combined with suturing on pseudocyst of auricle. Methods 62 patients with pseudocyst of auricle were analyzed retrospectively. They were randomly divided into two groups: the treatment group(32 cases)and the control group(30 cases). The treatment group received the anterior capsule wall resection of pseudocyst of auricle plus the method of puncture and drainage of pseudocyst of auricle and the method of pressure bandaging. The clinical effects of the two groups were compared. Results The total effective rate of the treatment group was 93.8%, and that of the control group was 76.7%. The effect of the treatment group was significantly better than that of the control group, and the difference between the groups was statistically significant(P<0.05). The incidence of total complications was 15.6% in the treatment group and 50.0% in the control group(P<0.05). The overall satisfaction rate was 87.5% in the treatment group and 66.6% in the control group(P < 0.05). Conclusion The effect of modified anterior capsulotomy combined with suture is better than that of traditional incision and drainage, puncture and drainage, pressure bandaging, freezing, injection of sclerosing agent, etc. it is worth popularizing.

CT changes in upper airway compliance in patients with obstructive sleep apnea-hypopnea ayndromeusing CPAP

L(¨overU)Dan, SUN Minghong, YU Xueying, ZHANG Yanqing, MEI Xubin, LIU Wenjun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  46-49.  doi:10.6040/j.issn.1673-3770.0.2018.294

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Objective To assess changes using computed tomography(CT)in obstructive sleep apnea-hypopnea syndrome(OSAHS)patients upper airways before and after noninvasive positive pressure ventilation was conducted. To investigate the effect of noninvasive positive pressure ventilation on the compliance of the minimum cross-sectional area of each block. Methods The subjects were 95 people(58 males and 37 females)that had been diagnosed withOSAHS. The minimum cross-sectional area of the nasopharyngeal cavity, palatopharyngeal cavity, glossopharyngeal cavity, and throat cavity was measured using CT scanning of the airway. The Muller test, small breaths and closed nasal inhalation, was used both before continuous positive airway pressure(CPAP)treatment and after 6 months. The compliance of the minimum cross-section area of each block was measured and calculated. The minimum cross-section area compliance of each block was compared. Results Before and after CPAP treatment, the minimum cross-sectional areas of the obstruction compliance weredifferent. This includedthe velopharyngeal, pharyngeal, laryngeal compliance.The difference, P<0.01 was statistically significant. Following6 months of CPAP treatment, patients with a nasopharyngeal cavity and pharyngeal cavity or a pharynx cavity and hypopharyngeal cavity hadlower compliance than before treatment. Thet values were 6.743, 69.601, 36.724, 12.242.Thedifference was statistically significant, P<0.01. Conclusion Before and after CPAP treatment, the conformance was different, and both the palatopharyngealand laryngopharyngeal cavity were more compliant. Following6 months of CPAP treatment, the compliance of all obstructive cavities reduced.The compliance of the velopharyngeal and glossopharyngeal areas displayed the most significant changes.

The prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in intensity modulated radiation therapy for nasopharyngeal carcinoma

CHEN Xuesong, FU Weiwei, LIU Jiangtao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  50-53.  doi:10.6040/j.issn.1673-3770.0.2019.357

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Objective To evaluate the role of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in the prognosis of nasopharyngeal carcinoma(NPC). Methods A total of 120 patients with NPC undergoing intensity modulated radiation therapy(IMRT)from June 2012 to January 2014 were retrospectively included and their clinical information was obtained. The relationship between NLR, PLR, and overall survival(OS), progression-free survival(PFS), distant metastasis-free survival(DMFS), and local recurrence-free survival(LRF)was explored by correlation analysis, survival analysis, and multivariate regression analysis. Results The overall 5-year estimated OS, PFS, LRFS and DFS were 86.8%, 78.3%, 94.2%, and 85.3%, respectively. There was a significant association between NLR and T-stage, N-stage and tumor stage. PLR was also significantly associated with T-stage and tumor stage. NLR was shown to be an independent prognostic indicator for OS, PFS, DMFS. Conclusion NLR is an independent prognostic factor in nasopharyngeal carcinoma patients treated with IMRT.

Value of NLR, LMR, and PLR in predicting chronic sinusitis recurrence after endoscopic sinus surgery

XIE Shuhua, YANG Zhumei, LIU Huiru, DONG Jing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  54-57.  doi:10.6040/j.issn.1673-3770.0.2019.478

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Objective To explore the value of the neutrophil to lymphocyte ratio(NLR), lymphocyte to monocyte ratio(LMR), and platelet to lymphocyte ratio(PLR)in predicting the recurrence of chronic sinusitis after endoscopic sinus surgery. Methods Sixty patients with chronic sinusitis treated by endoscopy from March 2016 to March 2018 were selected. All patients were followed up for 6 months and were divided into the postoperative recurrence group(n=21)and non-postoperative recurrence group(n=39)according to whether sinusitis recurred or not. In the same period, 87 people who underwent a health examination at our hospital were selected as the control group(n=87). The NLR, LMR and PLR of all patients were collected and analyzed. The receiver operating characteristic curve(ROC)of the above indicators was drawn. Results The NLR and PLR levels in the chronic rhinosinusitis(CRS)group were higher than those in the control group(p<0.05). The level of LMR in the CRS group was lower than that in the control group (p<0.01). There was no significant difference in NLR, LMR and PLR between the non-postoperative recurrence group and the control group (p>0.05). The levels of NLR and PLR in the postoperative recurrence group were higher than those in the non-postoperative recurrence group (p<0.05). The level of LMR in the postoperative recurrence group was lower than that in the non-postoperative recurrence group (p<0.01). The sensitivity and specificity of NLR were 63.33%(19/30)and 93.33%(28/30), respectively. The sensitivity and specificity of LMR were 72.00%(18/25)and 91.43%(32/35), respectively. The sensitivity and specificity of PLR were 67.86%(19/28)and 93.75%(30/32), respectively. The ROC curves showed that the areas under NLR, LMR and PLR curves were 0.719(0.587-0.851), 0.922(0.853-0.991), and 0.830(0.587-0.851), respectively. Conclusion NLR, LMR and PLR can help to predict chronic sinusitis recurrence after endoscopic sinus surgery.

Application of the hemi-tongue root flap for the repair of lateral defects in the pharyngeal cavity

YUE Jianlin, LIN Yun, JIANG Zhen, LI Xuexin, SUN Ruijie, PAN Xinliang, LIU Dayu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  63-66.  doi:10.6040/j.issn.1673-3770.0.2019.502

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Objective To investigate the effect of repairing lateral defects of the pharyngeal cavity caused after resection of hypopharyngeal carcinoma by using the hemi-tongue flap. Methods A retrospective analysis was performed to evaluate 36 cases of hypopharyngeal carcinoma who had undergone complete tumor resection and were simultaneously treated for hypopharyngeal wall defects in the Qilu Hospital of Shandong University(Qingdao)from October 2014 to April 2016. The cohort included 29 cases of cancer of the piriform fossa and 7 cases of cancer of the posterior pharyngeal wall. The lateral pharyngeal wall was entirely invaded by the tumor. On performing a clinical staging, 3 cases were of stage Ⅱ, 7 of stage Ⅲ, 25 of stage ⅣA, and 1 of stage ⅣB. Three-year survival rate, postoperative complication rate, recovery of throat function, and retention of laryngeal function were analyzed. Results All cases had negative pathologic incisions, and all patients retained laryngeal function, with good swallowing and swallowing protective functions(the nasogastric feeding tube was removed 10 to 14 days after surgery, and oral feeding was smooth). Tracheal cannula was successfully removed in 34 patients, with a removal rate of 94.4%. Postoperative pharyngeal fistula occurred in 1 case, which was healed after short-term dressing, so the incidence of pharyngeal fistula was 2.8%. The above 36 patients had a 3-year survival rate of 69.4%. Conclusion The hemi-tongue root flap is close to the site of pathology, easy to maneuver, and leads to a lesser incidence of pharyngeal fistula. It fulfils the requirements of anatomical and functional reconstruction in the repair of lateral pharyngeal defects.

Evaluation the efficacy of a CO₂ laser and traditional exfoliation in the treatment of vocal cord leukoplakia by using objective voice analysis

SHEN Min, QU Jining, JIANG Yidao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  67-70.  doi:10.6040/j.issn.1673-3770.0.2019.349

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Objective To evaluate the efficacy of a CO₂ laser and traditional exfoliation in the treatment of vocal cord leukoplakia by using objective voice analysis and to explore the value of objective voice analysis and the effects of the two treatment methods. Methods Medical records of patients with leukoplakia diagnosed in our department from January to February 2018 in 2017 were screened for CO₂ and traditional exfoliation and retrospectively analyzed. The CO₂ treatment group and the traditional exfoliation treatment group were denoted to be the observation and control groups, respectively; the postoperative effective rate was compared between these two groups. The Voice Disorder Index(VHI)was analyzed at 2 weeks, 1 month, and 3 months after surgery. XION DiVAS audio analysis software was used to detect preoperative and surgery 2 Weekly, January, March fundamental frequency perturbation(Jitter), amplitude perturbation(Shimmer), lowest sound intensity(SPLmin),(highest fundamental frequency)F0max, fundamental frequency(F0), longest sound duration(MPT), Voice Disorder Index(DSI). Results Compared to the control group, the observation group had a higher effective rate and a better curative effect. The VHI index in the two groups was lower than that of the preoperative group in the first and third months after operation, and the observation group The VHI index was lower than that of the control group, and the difference was statistically significant. In both groups, postoperative fundamental frequency perturbation, amplitude perturbation, and lowest sound intensity were lower than those before treatment, while fundamental frequency, longest sound duration, and snoring index was higher than those before treatment; a significant difference was noted between the observation group and the control group. The highest fundamental frequency after treatment was not significantly different from that before treatment. Conclusion For objective voice analysis, use of a CO₂ laser for treatment of vocal cord leukoplakia is more effective than the use of traditional exfoliation and can significantly improve the patient's voice.

Amyloidosis of the head and neck: a clinicopathological study of 23 cases

LIU Yaqin, ZHANG Liqing, ZHANG Jiacheng, DONG Weida, ZHOU Han

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  72-77.  doi:10.6040/j.issn.1673-3770.0.2019.464

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Objective The objective of this study was to investigate the clinical features,diagnosis, treatment, and prognosisofamyloidosis of the head and neck region. Methods The clinical data of 23 patients who were pathologically diagnosed with amyloidosis and admitted to our hospital from the April of 2007 to October 2018 were collected and analyzed. Results The study included 16 patients with primary localized amyloidosis and 7 patients with secondary localized amyloidosis. All the patients received surgical treatment. Postoperative follow-up ranged from 5 months to 11 years. Recurrence was observed in 2 patients who presented with multiple-localized amyloidosis, hoarseness, and foreign body sensation. Conclusion Clinical manifestations of amyloidosis of the head and neck region are variable. This disease develops slowly and tends to recur. The laryngoscopic characteristics are diverse and necessitate distinction from other tumors.However, it can be diagnosed by staining with Congo red in pathological sections. Treatment of amyloidosis is mostly surgical and based on long-term follow-up.

Expression of the alternative splice forms of Col2a1 in mice eyes, ears and cartilage at various development stages

HAO Peixia, LIU Xiuzheng, ZHANG Xiaolin, FAN Yiyan, DONG Hongliang, REN Jizhen, YIN Jingjing, MA Xiufang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  78-84.  doi:10.6040/j.issn.1673-3770.0.2019.555

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Objective To study the expression of the alternative splice forms of Col2a1 in mice eyes, ears and cartilage at various development stages and lay a foundation for further understanding the role of Col2a1 in the development and function of these tissues and organs. Methods Obtained eye, ear and cartilage tissues of mice embryos E12.5, E16.5 and postnatal D0, D7, D14, D21, D28, then analyzed the mRNA expression level of the splice forms: IIA, IIB,IIC and IID of Col2a1 through real-time PCR. Results Four splice forms of Col2a1 were detected in three tissues; expression levels of IIA and IIB were higher than IIC and IID, and IIC was the lowest. All splice forms were highiy expressed in eyes and ears at embryonic stages, then decreased at postnatal to adult stages, and splice forms except IIB presented the same trends in cartilage. Expression of IIB was low in the three tissues at the embryonic stage, then its expression increased with development. The ratio of IIA to IIB varied dramatically in cartilage, it was no more than 2 at E12.5, and decreased to 0.004 at D28; while the ratio in eyes and ears also appeared to decline from embryo to adult stages, but was still above 1 at the adult stage. Conclusion Expression of the four splice forms of Col2a1 in eye, ear and cartilage tissue were all regulated by development stages with IIA and IIB being the main forms. IIA expressed actively in all three tissues at embryonic stages, and was replaced by IIB in adult cartilage, while IIA remained higher than IIB in adult eyes and ears.

Clinical characteristics and spectral-domain optical coherence tomography findings of 15 focal choroidal excavation cases

ZHAO Juan, ZHOU Li, SI Yanfang, BI Xiaoda, ZHANG Lin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  85-88.  doi:10.6040/j.issn.1673-3770.0.2019.154

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Objective To observe the clinical characteristics and spectral-domain optical coherence tomography(SD-OCT)findings of focal choroidal excavation(FCE). Methods A retrospective observation case series were examined. The medical records of 18 eyes from 15 patients with FCE who had undergone SD-OCT were reviewed. All patients had their best-corrected visual acuity(BCVA)reviewed, a slit-lamp biomicroscopy, direct ophthalmoscopy, and an SD-OCT. Additionally, color photography, a fundus fluorescein angiography(FFA)and indocyanine green angiography(ICGA)were performed in some cases. Results The 15 patients included 9 males and 6 females with an average age of 36.93±8.43 years old. Patients refraction ranged from(-1.54±1.83)D, with a BCVA of 0.78±0.23.3 pations(6 eyes)and bilateral involvement. Twelve pations in 12 eyes were affected unilaterally. Varying, average degrees of foveal pigmentary alterations were generally seen during clinical examinations and color photography. The SD-OCTs showed that the retinal pigment epithelium(RPE)layer, the outer photoreceptor segment, the pigment junction layer, the photoreceptor inner segment, and outer segment junction layer, as well as the external limiting membrane, were involved in the excavation. The photoreceptor inner and outer segment junction layer and the RPE layer were accompanied by differing degrees of reflection attenuation. Their position was under and beside the macular fovea. The FCE can be classified as compact in which there is no separation between the photoreceptors and the RPE in the depression or detached in which there is separation between the photoreceptors and the RPE in the depression. Sixteen cases were classified as compact, and 2 cases as detached. The SD-OCTs showed that the FCE was located in the subfoveal of 12 eyes. In the other 6 eyes the FCE was seen to be eccentric. The FCE was complicated with central serous chorioretinopathy in 2 cases and idiopathic choroidal neovascularization in 1 case. Conclusion The FCE was generally classified as conforming with mild and moderate myopia found in a single eye. The FCE was complicated with maculopathy. The SD-OCT reveals the morphological and histological changes of the FCE. From these results, focal choroidal excavation using SD-OCT can be widely recommended.

Effects of intraocular lens implantation and postoperative intraocular pressure fluctuations on the fundus macular and optic disc vascular density

LI Rui, LI Yong, XIE Hongtao, YUE ZhangXian, LIU Zhaochen, YUAN huimin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  89-92.  doi:10.6040/j.issn.1673-3770.0.2019.280

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Objective To analyze the effect of intraocular pressure fluctuations on vascular density in patients who undergo cataract surgery. Methods One hundred patients(100 eyes)who underwent phacoemulsification and intraocular lens implantation at our hospital between January 2016 and January 2019 were enrolled. The patients were divided into 4 groups according to their intraocular pressure levels as follows: 38 patients were in the <21 mmHg group, 15 patients the 21-30 mmHg group, 19 patients in the 31-40 mmHg group, and 28 patients were in the >40 mmHg group. The patients underwent an intraocular pressure and macular spot test before and after surgery, as well as 60 minutes, 8 hours, and 24 hours after the operation. Optic disc vascular density and perfusion density were also determined. Results Immediately after the surgery and 1-hour following, the macular and optic disc perfusion density were lower than before the operation. In the >40 mmHg group, the intraocular pressure was lower than the preoperative blood density 8 hours after surgery. The macular density and optic disc perfusion density were lower than before the operation after 24 hours in the >40 mmHg group. The macular perfusion density of patients in the 31-40 mmHg and >40 mmHg groups was lower than before the operation. Conclusion Intraoperative perfusion pressure in cataract surgery can cause optic disc macular perfusion density and vascular density to decrease. Vascular density can be restored to a normal level 60 minutes after the operation. The fundus blood flow density will be affected by intraocular pressure fluctuations.

Advances in research on the trifoliate factor family in the middle ear respiratory mucosal epithelium

XU LingReview,SUN YanGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  93-98.  doi:10.6040/j.issn.1673-3770.0.2019.534

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Trefoil factor family(TFF)is a protein polypeptide with one or more three-leaf factor domains, which is evolutionarily highly conserved. Three members of TFF(TFF1, TFF2, and TFF3)have been identified in mammals and are mainly synthesized in mucosal tissues, such as gastrointestinal and respiratory mucosa. They are expressed in goblet cells, ciliated epithelial cells, and submucosal glands in the respiratory tract, and match the expression pattern of mucin in the airway mucosa. The tympanic cavity of the middle ear is covered by a continuous upper layer of mucous membrane. The middle ear mucosa of the eustachian tube and the anterior and lower tympanum comprises respiratory epithelial cells. Therefore, TFF can be expressed in middle ear mucosal epithelial cells. TFF may play an important role in promoting the repair of injured middle ear mucosa, completing the protection of middle ear mucosa, as well as in the migration of middle ear mucosal epithelial cells and inflammatory responses. This review focuses on the current status of research on TFF, primarily in the context of respiratory mucosal epithelium in the middle ear, thus exploring new avenues for the study of occurrence and development of otitis media.

Recent advances regarding extracellular vesicles in head and neck cancers

BIAN Xiaomin, HAN GuanghongReview,YU DanGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  99-104.  doi:10.6040/j.issn.1673-3770.0.2019.370

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Proliferation and metastasis of tumors are mediated by “mutual dialogue” between cells in the tumor microenvironment(TME). Extracellular vesicles(EVs), vesicle-like bodies secreted by cells, are involved in intercellular communication and are secreted from almost all cell types. They are the key signal mediators between cancer cells and the TME. They play an important role in transporting molecules between cells in the TME. Tumor cell-derived EVs participate in the proliferation and migration of cancer cells through the activation of various signaling pathways in target cells in the TME. The molecular mechanisms and clinical applications of EVs in head and neck cancers are still largely unknown and need further study. In this review, we discuss the TME of head and neck cancers with emphasis on EV-mediated mechanisms in tumor proliferation, invasion, metastasis, angiogenesis, and drug resistance.

Advances in the diagnosis and treatment of carotid artery injuries

REN YuReview,XIAO XupingGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  105-109.  doi:10.6040/j.issn.1673-3770.0.2019.358

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Carotid artery injuries can cause bleeding, traumatic arteriovenous fistula, and pseudoaneurysm and can directly affect the blood supply or reflux to the brain. There are two types of carotid injury, penetrating carotid artery injury and blunt carotid artery injury, which are managed by different treatment options. Prompt treatment is imperative for carotid injuries. This paper summarizes the recent advances in the diagnosis and treatment of carotid artery injuries.

Molecular level detection of umbilical cord blood cells and pathogenesis of allergic diseases

RUI XiaoqingReview,LI YoujinGuidance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  110-114.  doi:10.6040/j.issn.1673-3770.0.2019.454

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Changes in immune status may be an early sign of subsequent allergic diseases in infants. Umbilical cord blood, as a reflection of early immune status, has become a hot research topic in the pathogenesis of allergic diseases. This article reviews the application value of umbilical cord blood at cellular and molecular level in the pathogenesis of allergic diseases.

Mantle cell lymphoma involving the Waldeyer's ring: a case series and literature review

WEN Feng, WANG Bingjie, HU Xihao, ZHAO Enmin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  115-120.  doi:10.6040/j.issn.1673-3770.0.2019.490

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Objective To analyze the clinical characteristics of mantle cell lymphoma(MCL)of the Waldeyer's ring. Methods A retrospective study of 4 patients with MCL in the Waldeyer's ring, treated in the department of otolaryngology, head and neck surgery of Peking University First Hospital between 2016 and 2019 were used in this review. Their clinical manifestations, histopathology, immunohistochemistry, cytogenetics, the treatment used, and prognosis were summarized and analyzed in combination with a literature review. Results MCL involving the Waldeyer's ring is extremely rare. The palatine tonsil is the most frequently involved site, followed by the nasopharynx and tongue base. They generally present with asymptomatic soft tissue swelling and typically lack the systemic B symptoms. When the tumor is large, there are corresponding obstruction symptoms. For MCL in the nasopharynx, the symptoms are a unilateral or bilateral nasal obstruction with or without ear fullness. For MCL in the palatine tonsil or tongue base, the most common symptoms were a sensation of fullness of the throat, difficulty swallowing, and not having clear speech because of the tumor in the oral cavity. Examination revealed soft tissue swelling of the nasopharynx, palatine tonsil or tongue base. MCL was diagnosed by examining the affected tissue obtained from a biopsy of the lymph node, tissue, bone marrow, or blood phenotype. MCLs have distinct immunophenotype expressing pan B-cell markers(CD 19, 20, and 22). Generally, the T-cell marker CD5 is also expressed, giving this tumor a characteristic profile. The most sensitive and specific marker for MCL is CyclinD1, of which almost all cases are moderately to strongly positive. MCL is characterized by a genetic profile of t(11;14)(q13;q32)in nearly all cases that can be evaluated by conventional cytogenetics and fluorescencein situ hybridization. MCL patients frequently present at an advanced disease stage with extranodal involvement, resulting in poor clinical outcomes due to frequent relapse and the aggressive course. Treatment options for MCL vary widely, with poor prognosis. Conclusions MCL may rarely occur in the Waldeyer's ring. It may be diagnostically challenging to differentiate from other lymphomas that may occur in this area. However, it exhibits some distinctive histological and immunohistochemistry traits which can help distinguish it. Due to the poor overall prognosis, early identification would be important in providing individualized treatment. Rituximab combined with chemotherapy and the use of new drugs such as ibrutinib can improve the prognosis of patients.

Nasal septum-nasal deformity surgery for correction of severe traumatic nasal deformity: a case report

CHEN Kai, WANG Jun, TANG Yuedi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(1):  121-124.  doi:10.6040/j.issn.1673-3770.0.2019.381

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