Table of Content

20 September 2020 Volume 34 Issue 5

  

Diagnosis and management of peripheral vestibular diseases

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  1-6.  doi:10.6040/j.issn.1673-3770.1.2020.074

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Vertigo is one of the most important symptom of peripheral vestibular diseases which are difficult to differentially diagnose and manage because multiple disciplines are involved. The premise of effective management is accurate diagnosis of vestibular diseases. With the development of vestibular function examination technology and the deepening of vestibular disease research, great progress has been made in the diagnosis and management of vestibular diseases. The establishment and publication of international classification of vestibular diseases, the introduction of diagnostic standards for various vestibular diseases in the world, the formulation of vestibular disease drugs, surgical specifications and the rapid development of vestibular rehabilitation technology make the diagnosis and management of vestibular diseases more and more standardized and accurate.

Effects of aging on galvanic vestibular stimulation elicited vestibular evoked myogenic potential

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  7-13.  doi:10.6040/j.issn.1673-3770.1.2020.078

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Objective To observe the effect of age on cervical vestibular-evoked myogenic potential(cVEMP)and ocular vestibular-evoked myogenic potential(oVEMP)elicited by galvanic vestibular stimulation(GVS)in healthy subjects. Methods Sixty-one healthy volunteers(122 ears)aged 22-81 years(45.0±13.8 years)were recruited as study subjects and divided into three groups according to age: 20-40(26 patients, 52 ears), 41-60(24 patients, 48 ears), and >60(11 patients, 22 ears)years. Each subject underwent both GVS-cVEMP and GVS-oVEMP. The elicit rate, threshold, p1 latency, n1 latency, amplitude, and interaural amplitude asymmetry ratio of both VEMPs were calculated and compared among the age groups. SPSS 18.0 software was used for statistical analyses. Results The elicit rates of GVS-cVEMP were 96.15%, 89.58%, and 95.45% in age groups of 20-40, 41-60, and >60 years, respectively, without any statistically significant difference among groups(P>0.05). However, the elicit rates of GVS-oVEMP were 98.07%, 91.67%, and 72.13% in age groups of 20-40, 41-60, and >60 years, respectively, showing a decreased tendency with growing age(P<0.05). In the parametric analysis, the elicit rate, threshold, p1 latency, n1 latency, amplitude, no amplitude asymmetry ratio of cVEMP were not statistically correlated with age(P>0.05). However, growing age showed decreased elicit rate, increased threshold, and decreased amplitude of oVEMP(P<0.05)but no difference in the n1 latency, p1 latency, or amplitude asymmetry ratio. Conclusion With growing age, the function of peripheral vestibular system decreased, which might affect GVS-cVEMP and GVS-oVEMP.

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

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

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

Diagnostic value of electrocochleography using external auditory canal electrode in patients with Menieres disease

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  20-26.  doi:10.6040/j.issn.1673-3770.1.2020.073

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Objectives This study was designed to evaluate the diagnostic value of extra-tympanic electrocochleography(ET-ECochG)in definite Ménières disease(MD)patients. Methods Fifty-eight definite MD patients(60 ears)underwent ET-ECochG using bronze foil electrodes. The medical history, as well as pure tone audiometry, ET-ECochG, and 3D FLAIR MRI data of each patient were collected. Meanwhile, forty healthy volunteers were enrolled as controls. The amplitudes, latencies, and durations of SP and AP, the SP/AP amplitude ratio(SP/AP), and the area ratio of SP/AP(Asp/Aap)were collected. An adjusted calculation method for Asp/Aap was proposed. The differences among the ET-ECochG results of the definite MD ears, contralateral asymptomatic ears, and normal ears were analyzed using the t-test and the Mann-Whitney U test. The associations of Asp/Aap of ET-ECochG with the clinical history, pure tone audiometry, and endolymphatic hydrops evaluated via MRI were analyzed. Results ET-ECochG was identified in 46 of 60 ears(76.67%). Using the receiver operating characteristic(ROC)curve, the optimal cutoff points of SP/AP and Asp/Aap were 0.38 and 2.42, respectively. The area under the ROC curve(AUC)of Asp/Aap(0.985)was higher than the AUC of SP/AP(0.920). The ET-ECochG results of the definite MD ears, including SP/AP, Asp/Aap, and SP duration, were significantly higher than those of the contralateral asymptomatic ears and normal ears(p<0.05). The duration and disease stages of MD were significantly associated with SP/AP. The degree of endolymphatic hydrops of the cochlea was correlated with SP/AP and Asp/Aap, whereas the degree of vestibular hydrops only correlated with Asp/Aap. Conclusion SP/AP and Asp/Aap may be indicative of the degree of endolymphatic hydrops. Thus, ET-ECochG is useful for the clinical diagnosis of MD.

Clinical value of vestibular evoked myogenic potential to predict prognosis of unilateral idiopathic sudden sensorineural hearing loss

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  27-32.  doi:10.6040/j.issn.1673-3770.1.2020.063

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Objective To analyze the clinical outcomes of patients with unilateral idiopathic sudden sensorineural hearing loss(SSNHL)and explore the relationship between vestibular function and prognosis in patients with SSNHL. Methods A retrospective analysis of 59 patients(59 ears)with SSNHL was performed. A total of 183 vestibular function tests were performed in all patients to assess the influence of vestibular functions on the clinical outcome of SSNHL. Results Treatments were less effective in patients with abnormalities in ocular vestibular evoked myogenic potential(oVEMP)or cervical vestibular evoked myogenic potential(cVEMP). Those with normal oVEMP and cVEMP had relatively better hearing recovery. The outcomes of the caloric test or video head impulse test showed no association with the efficacy of treatment or hearing recovery in patients with SSNHL. Treatment was less effective in patients with abnormalities in both oVEMP and cVEMP, who also had worse hearing recovery than those who had an abnormal finding in only one of the two tests. Conclusions Patients with abnormal oVEMP or cVEMP results had poor clinical outcomes, while those with normal oVEMP and cVEMP demonstrated better hearing recovery with treatment. Thus, oVEMP and cVEMP could be effective indices to predict the prognosis of patients with SSNHL. An abnormal vestibular function is a definite indicator of a wider and more severe pathological change in the inner ear of patients with SSNHL.

Relationship between prognosis and vestibular symptoms/function in patients with unilateral profound sudden sensorineural hearing loss: A retrospective analysis

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  33-38.  doi:10.6040/j.issn.1673-3770.1.2020.075

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Objective To analyze the relationship between vestibular symptoms and function and hearing outcomes in patients with unilateral profound sudden sensorineural hearing loss(SSNHL). Methods A retrospective analysis of 52 patients with unilateral profound SSNHL was performed. Vestibular symptoms and the results of ocular vestibular evoked myogenic potential(oVEMP), cervical vestibular evoked myogenic potential(cVEMP), video head impulse test(vHIT), and caloric test were analyzed to observe the relationship between hearing outcomes and vestibular symptoms and function. Results Of 52 patients with unilateral profound SSNHL, there was a significant difference between the patients with and without vestibular symptoms, patients with vestibular dysfunction, and those with normal vestibular function. Patients with abnormal oVEMP, cVEMP, vHIT, and caloric test results showed a lower total effective rate. In contrast, patients with normal results in all four tests had a higher hearing recovery. Conclusion Patients with unilateral profound SSNHL with abnormal vestibular dysfunction and symptoms had a poor curative effect. Conversely, those with normal oVEMP, cVEMP, vHIT, and caloric test results had better chances of hearing recovery. Abnormal vestibular function suggests more extensive and severe inner ear lesions in patients with unilateral profound SSNHL.

Location and frequency characteristics of vestibular dysfunction in patients with nonsyndromic auditory neuropathy

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  39-45.  doi:10.6040/j.issn.1673-3770.1.2020.064

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Objectives This study was aimed at determining vestibular involvement and the location and frequency of vestibular dysfunction in patients with auditory neuropathy. Methods Twenty patients with non-syndromic auditory neuropathy were enrolled. Using vestibular test battery, we calculated the ocular vestibular-evoked myogenic potential(oVEMP), cervical vestibular-evoked myogenic potential(cVEMP), video head impulse test(vHIT), suppression head impulse paradigm(SHIMP), and caloric test results. Results The oVEMP and cVEMP were calculated for all patients, and the abnormality rates were 85% and 95%, respectively, showing no significant difference. The vHIT in the lateral, anterior, and posterior semicircular canals, and SHIMP in the lateral canals were calculated for 11 patients(22 ears), and the abnormality rates were 14%, 18%, 9%, and 9%, respectively, showing no significant difference among the four tests. Nineteen patients exhibited a 74% abnormality rate for the caloric test. Of the 11 patients with the SHIMP and vHIT results, 82% showed abnormal caloric test results, which was much higher than the abnormality rate of SHIMP and vHIT. Conclusion Patients with auditory neuropathy showed vestibular involvement, and the superior and inferior vestibular components, including the vestibular peripheral receptors and nerves, had an equal probability of dysfunction. All the otolith organs and semicircular canals could be involved. The possibility of dysfunction was equal for different portions of the semicircular canal, while the functional involvement was more likely to be observed in low-frequency tests.

Therapeutic effectiveness of 75 cases of retrolabyrinthine vestibular neurectomy for intractable Menieres disease

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  46-50.  doi:10.6040/j.issn.1673-3770.1.2020.061

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Objective To determine the therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease. Methods Clinical data of 75 patients with unilateral intractable Menieres disease who underwent retrolabyrinthine vestibular neurectomy were retrospectively investigated. Therapeutic effectiveness was analyzed, and the safety and reliability of the procedure was discussed. Results The mean duration of the disease was 53.11±43.87 months. Preoperative pure tone average of 500 Hz, 1 000 Hz, 2 000 Hz, and 4 000 Hz was(63.71±16.85)dB HL. Two cases were stage Ⅱ, 34 cases were stage Ⅲ, and 39 cases were stage Ⅳ. Two stage Ⅱ patients were recurrent cases after endolymphatic sac decompression surgery. Intracranial infection in 1 case(1.3%), cerebrospinal fluid leakage in 4 cases(5.3%), temporal facial nerve palsy in 1 case(1.3%), incision infection in 2 cases(2.6%), and fat liquefaction in 3 cases(3.9%)were observed postoperatively. There was no case of intracranial hemorrhage or total deafness. Therapeutic effectiveness for relieving vertigo was level A in 73 cases and level B in 2 cases. Conclusion The therapeutic effectiveness of retrolabyrinthine vestibular neurectomy for intractable Menieres disease is definite. Surgical risk and postoperative complications are controllable, and the quality of life can be significantly improved after surgery.

Abnormality rate of vestibular evoked myogenic potentials in patients with primary and recurrent benign paroxysmal positional vertigo: a clinical observation

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  51-55.  doi:10.6040/j.issn.1673-3770.1.2020.083

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Objective This study aimed to compare the abnormality rate of vestibular evoked myogenic potentials(VEMPs)in patients with primary and recurrent benign paroxysmal positional vertigo(BPPV)and test the hypothesis that otolith dysfunction causes the recurrence of BPPV. Methods Cervical VEMP(cVEMP)and ocular VEMP(oVEMP)tests using air-conducted 500 Hz tone-burst stimuli were performed on 57 patients with unilateral primary BPPV(n=36)and recurrent BPPV(n=21)between June 2019 and May 2020. Abnormalities in cVEMP and oVEMP were compared between the primary and recurrent BPPV groups. Results (1) The differences in sex, the involved side, and canal between the primary and recurrent BPPV groups were not significant; however, the difference was statistically significant in terms of age; (2) Of the 57 BPPV patients, cVEMP or oVEMP was not elicited in 21 cases(36.84%)and 35 cases(61.40%), respectively. The abnormality rate of oVEMP was much higher(P<0.05); (3)Abnormal cVEMP was observed in 16 of 36(44.45%)and 5 of 21(23.81%)cases in the primary and recurrent BPPV groups, respectively. Abnormal oVMEP was observed in 19 of 36(52.79%)and 16 in 21(76.19%)patients in the primary and recurrent BPPV groups, respectively. Differences in the abnormality rates of cVMEP and oVMEP were not found between the primary and recurrent BPPV groups(P>0.05); (4) When the recurrent BPPV group was further divided into 2-times groups and ≥3-times group according to the recurrent frequency, there were also no statistical differences in the VEMP abnormality rate in these three groups(P>0.05). Conclusion The results showed no significant difference in the abnormality rate of cVEMP and oVEMP between the primary BPPV and recurrent BPPV groups, indicating that the possible recurrent mechanism of primary BPPV still needs to be further studied.

Study of the relationship of dizziness and vertigo sensations with the nystagmus intensity

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  56-60.  doi:10.6040/j.issn.1673-3770.1.2020.077

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Objective To explore the relationship between dizziness-vertigo and nystagmus intensity, according to the nystagmus accompanied by dizziness and/or vertigo during caloric test. Methods The relationship between dizziness and vertigo sensations and nystagmus intensity was analyzed in 399 patients with peripheral vestibular disorders,who underwent routine caloric test. The nystagmus intensity is as an index, accompanied by dizziness and/or vertigo sensations induced during caloric test. Results Warm and cold stimulation induced dizziness and vertigo and associated nystagmus overall analysis, the intensity of nystagmus was always greater than that of dizziness when vertigo occurred. The nystagmus thresholds for dizziness and vertigo induced by warm and cold air stimulation in the left ears were 4.2°/s and 5.9°/s for cold, 4.2°/s and 8°/s for warm, in the right ears were 4.6°/s and 6.2°/s for cold, 5.3°/s and 6.5°/s for warm, respectively. Three hundred ninety nine patients were subjected to alternating warm and cold stimulation in both ears for a total of 1596 times, which induced dizziness 513 times(32.14%), of which 312 times only dizziness and 201 times vertigo ten seconds after dizziness. Vertigo was induced 906 times(56.77%), of which 705 occurred directly without transitioning from dizziness to vertigo, and another 201 times vertigo occurred after ten seconds of dizziness; 378(23.68%)times did not induce dizziness and vertigo. Conclusions Vertigo corresponds to a higher nystagmus intensity threshold than dizziness, with patients showing dizziness when the nystagmus is weak and vertigo when it is stronger. Warm and cold air stimulation induced nystagmus intensity from weak to strong, and from dizziness to vertigo sensations induced at the same time, suggesting that the symptoms of dizziness and vertigo are related to the asymmetric between the two vestibular tension.

A preliminary study on the causes of poor development in three-dimensional magnetic resonance imaging via intratympanic gadolinium injection

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  61-66.  doi:10.6040/j.issn.1673-3770.1.2020.070

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Objective To analyze the possible causes of poor development of imaging in patients undergoing three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging(3D-FLAIR MRI)after intratympanic gadolinium injection in our hospital in recent years and propose possible solutions. Methods This study enrolled a total of 356 patients and 706 ears between January 2017 and June 2020. All patients underwent 3D-FLAIR MRI through intratympanic gadolinium injection. The imaging was poorly developed for a total of 55 patients(70 ears). The possible causes of poor development were analyzed. Results Poor images was obtained in 70 ears, including 16 instances in which the signal was not as strong as normal, 14 that were not filled contiguously, and 40 that showed no contrast agent in the inner ear on imaging. A total of 39 ears had simple ipsilateral otitis media as revealed by imaging; among those with chronic otitis media or occult otitis media, 11 showed poor visualization(28.2%). Imaging was poor for four(12.5%)out of 32 ears with sinusitis. Among the three ears with both otitis media and sinusitis, imaging was poor for one ear(33.3%). Among the 632 ears without otitis media/sinusitis, imaging was poor for only 54 ears(8.5%). A statistically significant difference was observed between combined and non-combined otitis media, but not between those non-combined,combined rhinosinusitis, as sell as those conbined with otitis media and nasosinusitis. Conclusion When gadolinium is injected into the inner ear through the tympanum, though excluding a recent history of otitis media, chronic or occult otitis media may still be influencing factors for poor imaging development. The present article further discusses other possible influencing factors in each link of angiography and suggests avoiding them to improve the success rate of inner ear gadolinium angiography.

Characteristics of air-conducted vestibular-evoked myogenic potential in normal children

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  67-71.  doi:10.6040/j.issn.1673-3770.1.2020.071

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Objective To study the characteristics of air-conducted ocular vestibular evoked myogenic potential(AC-oVEMP)and cervical vestibular evoked myogenic potential(AC-cVEMP)in normal Chinese children. Methods Fifty-two 4-10-year-old children with normal hearing(male 30, female11, 104 female)were recruited. Using 500-Hz air-conducted pure tone burst as a stimulus, oVEMP and cVEMP were assessed. The response rates and waveform parameters of the left and right ears were recorded and analyzed statistically using SPSS software. Results The respective findings for oVEMP and cVEMP were as follows: response rates: 92% and 96%; P1 latencies:(17.07±0.89)ms and(15.55±1.58)ms; N1 latencies:(12.39±0.91)ms and(23.10±2.29)ms; N1P1 latencies:(4.68±0.88)ms and(7.83±1.56)ms; amplitudes:(7.24±4.79)μV and(197.40±118.37)μV; interaural asymmetry ratios(AR,%):(19.03±12.50)% and(22.16±18.64)%. There were no significant differences between the latencies, N1P1 latencies, or amplitudes of the left and right ears(P>0.05). Conclusion oVEMP and cVEMP can be elicited by the stimuli of air-conducted pure tone bursts in the majority of normal children. They can be used to evaluate vestibular function, as they are feasible and compliance in children is high. The results provide the normal reference range of VEMP for children in China.

The establishment of a normal value of bone-conducted vestibular-evoked myogenic potential in normal-hearing children

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  72-77.  doi:10.6040/j.issn.1673-3770.1.2020.069

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Objective To record the bone-conducted vestibular-evoked myogenic potential(BC-VEMP)in order to provide a reference for the clinical evaluation of vestibular function in normal-hearing children. Methods Thirty-one normal-hearing children(62 ears)aged 4-12 years were selected to undergo BC-VEMP determination. These children were divided into two groups according to age. Those aged 4-5 years(11 children, 22 ears)belonged to one group while those aged 6-12 years(20 children, 40 ears)belonged to the other. A 60 dB nHL was used as the initial stimulus intensity by which the N1 latency, P1 latency, n1-p1 interval, n1-p1 amplitude, amplitude asymmetry ratio, and threshold of cervical VEMP(CVMP)and ocular VEMP(ocular VEMP)were recorded. The SPSS software was used for statistical analysis. Results There was no significant difference in P1, N1 latency, P1-N1 wave interval, P1-N1 amplitude, threshold, and amplitude asymmetry ratio of BC-oVEMP between the 4-5-year-old and the 6-12-year-old groups(P>0.05). There was no significant difference in N1, P1 latency, n1-p1 wave interval, n1-p1 amplitude, threshold, and amplitude asymmetry ratio of BC-VEMP between the two groups(P>0.05). Conclusion BC-VEMP is a feasible auxiliary examination of vestibular function. The establishment of normal values of BC-VEMP in different age groups can provide a reference for clinical evaluation of vestibular function in children.

Development and application of a vestibular rehabilitation training guidance platform

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  78-81.  doi:10.6040/j.issn.1673-3770.1.2020.076

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Vestibular rehabilitation training is important for treating vestibular diseases and improving vertigo symptoms. However, the large number of patients, the lack of venues and rehabilitation specialists, and medical expenses have limited its application at all levels in hospitals. With the development of smartphones and the mobile internet, home-based rehabilitation and remote guidance have become possible. Therefore, we developed a remote vestibular rehabilitation training guidance platform to be accessed with smartphones and the mobile internet. The platform design is based on the Browser/Server mode structure; it has IOS and Android versions and supports wireless access smartphone terminals. The platform facilitates a more convenient, smooth, and effective remote guidance for vestibular rehabilitation function exercises, curative effect evaluations, and follow-up; this improves efficiency and compliance as well as reduces the technical barriers, site restrictions, and labor costs of vestibular rehabilitation. This paper introduces the functional design, related technology realization, and the operational effect of the platform.

Update on the development and evaluation of vestibular function in newborns and Infants

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  82-88.  doi:10.6040/j.issn.1673-3770.1. 2020.068

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Newborns and infants with hearing loss often suffer from vestibular dysfunction, which may aggravate with the gradual deterioration of hearing, resulting in delayed motor development or motor dysplasia. The motor development of newborns and infants depends on the function of the vestibular organs; thus, early vestibular function evaluation has positive prognostic significance. However, newborns and infants lack the language skills to fully express their symptoms. Furthermore, a series of complex vestibular function tests may cause them discomfort, such as vertigo and nausea, and the equipment and environment often scare them, which make vestibular assessment very challenging. Additionally, the structure and function of the vestibular, visual, and proprioceptive systems gradually mature with growth and development. Therefore, the clinical data of vestibular quantitative tests in different age groups cannot be compared with the standard reference range in adults. Hence, not all types of vestibular tests are necessary or appropriate in newborns and infants and should be adjusted according to the stage of development. In this study, we performed a literature review with focus on the common vestibular function tests according to the age and developmental stage of newborns and infants.

Superior semicircular canal dehiscence syndrome

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  89-96.  doi:10.6040/j.issn.1673-3770.1.2020.080

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Superior semicircular canal dehiscence(SSCD)syndrome occurs as a result of a bony defect of the skull base involving the superior semicircular canal, particularly at the arcuate eminence. The bony labyrinthine defect creates a direct communication between the dura and the labyrinthine membranous structure and acts as a mobile third window which may result in various auditory and vestibular manifestations. Tinnitus and autophony are the most common audiological manifestations. Dizziness and disequilibrium are the most common vestibular manifestations. Audiometric findings vary based on the severity of the disease. Low-frequency conductive hearing loss is a common finding. Bone conduction thresholds may be negative. A patient with SSCD will typically have a lower Vestibular Evoked Myogenic Potentials(VEMP)threshold response in the affected ear and may also have a larger than normal VEMP amplitude. High-resolution computed tomography(CT)scan of temporal bone plays an important role in confirming the diagnosis of SSCD. Pöschl and Stenver reformatted views are often recommended. Surgical treatment is reserved for patients presenting with debilitating vestibular and auditory manifestations that substantially interfere with their quality of life. There are two main surgical approaches(middle fossa, trans-mastoid)and several techniques(plugging, capping, resurfacing and combination). Presently, there is insufficient evidence to clearly determine which surgical approach or technique is superior. Surgical repair of SSCD through either the middle cranial fossa approach or trans-mastoid approach is highly effective for auditory and vestibular symptom improvement and is associated with a low risk of complications.

The role of three-dimensional fluid attenuated inversion recovery magnetic resonance imaging in diagnosis of sudden sensorineural hearing loss caused by inner ear hemorrhage

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  97-101.  doi:10.6040/j.issn.1673-3770.1.2020.082

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Sudden sensorineural hearing loss(SSNHL)is defined as a decease in hearing ≥30 dB HL affecting at least three consecutive frequencies with no identifiable cause within 72 h. A possible cause is inner ear hemorrhage. However, detecting inner ear hemorrhage is difficult with conventional magnetic resonance imaging(MRI)sequences. Some studies showed that the 3-dimensional fluid attenuated inversion recovery(3D-FLAIR)MRI sequence could sensitively detect inner ear hemorrhage in SSNHL patients. In this article, we review the related literature about the clinical application of the 3D-FLAIR MRI sequence to evaluate SSNHL caused by inner ear hemorrhage.

The progress of otogenic bacterial labyrinthitis research

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  102-107.  doi:10.6040/j.issn.1673-3770.1.2020.067

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Labyrinthitis is an infectious disease of the inner ear. Its main clinical manifestations are paroxysmal dizziness, vertigo, and sensorineural hearing loss. This article focuses on the otogenic bacterial labyrinthitis associated with otitis media. According to the pathological manifestations of the inner ear, labyrinthitis can be divided into three types: circumscribed labyrinthitis, serous labyrinthitis, and suppurative labyrinthitis. Circumscribed labyrinthitis, also known as labyrinth fistula, is often complicated by middle ear cholesteatoma, which usually occurs in the horizontal semicircular canal. Serous labyrinthitis is a sterile inflammation in the inner ear caused by bacterial toxins, which often leads to misdiagnosis and misjudgment. Suppurative labyrinthitis is a bacterial infectious inflammation that occurs in the inner ear that often causes severe sensorineural hearing loss and dizziness. At present, otogenic labyrinthitis is no longer rare, although it has not attracted enough attention. This article reviews the different types of otogenic bacterial labyrinthitis in a combination of domestic and foreign literature to provide clinical help for early diagnosis and treatment of patients with this condition.

Research progress on the effect of sleep on benign paroxysmal positional vertigo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  108-112.  doi:10.6040/j.issn.1673-3770.1.2020.103

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Benign paroxysmal positional vertigo(BPPV), the most common peripheral vestibular disease, has a high incidence and prevalence. It mostly occurs at night or during morning awakening, suggesting that it is closely related to sleep characteristics. We reviewed and summarized the relevant literature of the two diseases in recent years. We found that sleep posture was closely related to the occurrence, development, treatment, and prognosis of BPPV, and that different types of sleep disorders also individually affected the occurrence of the disease. This article was aimed to help raise awareness regarding the correlation between the two diseases as well as provide methods and ideas for the diagnosis and treatment.

Short comments of vestibular- evoked myogenic potential test

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  113-117.  doi:10.6040/j.issn.1673-3770.1.2020.081

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Stimulation via air-conducted sound or bone-conducted vibration enables recording of vestibular-evoked myogenic potential(VEMP)from cervical muscles(called cervical VEMP, cVEMP)and extraocular muscles(termed ocular VEMP, oVEMP). These two emerging tests expand the test battery available to clinicians for exploring dynamic otolithic function, and create a potential use for the sacculo-collic reflex and utriculo-ocular reflex, respectively. Coupled with audiometry and caloric test, the inner ear test battery is designed to assess the inner ear function including the cochlea, saccule, utricle and semicircular canals. Clinically, the inner ear test battery has been widely adopted in humans and experimental animals. It is believable that comprehensive assessment of the inner ear function via an inner ear test battery may stimulate to elucidate the mechanism of peripheral and central vestibular disorders.

Relationship between adenoid size and torus tubarius type and secretory otitis media in children

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  121-126.  doi:10.6040/j.issn.1673-3770.0.2020.209

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Objective To investigate the effects of the sizes of adenoids and the types of torus tubarius on secretory otitis media in children. Methods Between March 2018 and June 2019, 120 children with secretory otitis media with complete diagnosis and treatment data in our department were allocated to the case group, and 120 normal children with corresponding physical examination data were allocated to the control group. Hearing and electronic nasopharyngoscopy were performed for the two groups of children to compare their adenoid sizes and torus tubarius types as well as analyze the association between the sizes of the adenoids and the degree of hearing loss in the case group. Results The proportions of the ⅢⅣ adenoid sizes and the ⅡⅢ torus tubarius types were 77.5% and 77.5%, respectively, in the case group, which were higher than 37.5% and 46.7%, respectively, in the control group. The risk of disease was higher for the ⅠⅡ adenoid sizes and the I torus tubarius type, and the differences were statistically significant (all P<0.05). The chisquared test was performed to analyze the trends of the adenoid sizes and the torus tubarius types of the two groups, and the differences were also statistically significant (all P<0.05). However, there were no associations between the adenoid size and the torus tubarius type and hearing loss in the case group (r1= 0.135, r2 = 0.049, all P>0.05). Conclusion Adenoid hypertrophy and the ⅡⅢ torus tubarius types are risk factors for secretory otitis media in children. Routine examination and the evaluation of adenoids and the types of torus tubarius are helpful for early diagnosis of secretory otitis media in children.

The swallowing function recovery study on tongue flap after horizontal hemilaryngectomy

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  127-131.  doi:10.6040/j.issn.1673-3770.0.2019.622

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Objective To investigate the swallowing function recovery on 23 cases of supraglottic laryngeal carcinoma postoperation. Methods From 2016 to 2019, a retrospective swallowing function analysis was performed on 23 cases of supraglottic laryngeal carcinoma. All of the patients underwent horizontal hemilaryngectomy and reconstruction with tongue flap. The M.D. Anderson Dysphasia Inventory(MDADI)was used to evaluate the swallowing function from emotional dimension, social function dimension, and physiological dimension before and after operation. Results 2 patients died during follow-up period.1 case lost follow-up. 20 patients recovered to normal diet. The overall swallowing median score was 90.00［80.00,100.00］, and the postoperative score median was 80.00［80.00,80.00］(P=0.359).The median score of emotion dimension was 91.67［77.50,93.33］, 80.00［80.00,83.33］(P=0.065)after operation. The median score of social function was 90.00［80.00,96.00］before surgery, and 84.00［80.00,92.00］(P=0.587)after surgery. Physiological function median score was 83.75［76.25,89.38］, 80.00［75.00,84.38］(P=0.018)after surgery. Conclusion Tongue flap can improve the swallowing function and the quality of patient life after the horizontal hemilaryngectomy.

Expression of cyclin E2 in hypopharyngeal cancer and its clinical significance

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  132-137.  doi:10.6040/j.issn.1673-3770.0.2020.352

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Objective This study aims to evaluate the level of expression of cyclin E2 in hypopharyngeal cancer and its relationship with clinical characteristics as well as prognosis. Methods The protein levels of cyclin E2 in tumor tissues and adjacent normal tissues were assessed by immunohistochemistry staining in 50 cases of hypopharyngeal cancer. The relationship between the expression level of cyclin E2 and clinical data was analyzed using the SPSS software. Results Protein levels of cyclin E2 in hypopharyngeal cancer were higher than protein levels of cyclin E2 in normal tissue(Z=-5.764,P=0.000). The cyclin E2 level in tumor tissue correlated with the tumor staging(Z=-1.995, P=0.046)and lymph node metastasis(Z=-2.176, P=0.030). The 5-year survival rates of patients with cyclin E2 positive and negative expression were 40.2% and 81.8%, respectively. Patients with high expression levels of cyclin E2 had a lower survival rate(χ2=6.317, P=0.012). Conclusion The abnormal expression of cyclin E2 protein in tumor tissues indicates that cyclin E2 may be involved in the development of hypopharyngeal cancer and could be a potential diagnostic and prognostic molecular marker.

Effect of light-emitting diode light of different wavelengths on the rat lens: a preliminary study

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  138-144.  doi:10.6040/j.issn.1673-3770.0.2020.247

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Objective This study was aimed at exploring the effects of light-emitting diode(LED)light of different peak wavelengths(622.791, 509.699, and 462.826 nm)on the rat lens, including damage to the morphology of the lens epithelial cells. Further, we tested the activities of the antioxidant enzymes superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)in the lens and compared the malondialdehyde(MDA)activity in the lens after irradiation by LED of different wavelengths. Methods Sprague Dawley rats were irradiated with LED light of different peak wavelengths(color temperature=4 500 K; illuminance: 500 lux)12 h a day for 5 days. Hematoxylin and eosin(HE)staining was used to observe the paraffin sections of rat lens epithelial cells. The activities of SOD, GSH-Px, and MDA in the lens were detected by the automatic biochemical analyzer. Results HE staining showed that lens epithelial cells in the control group were flat, monolayer, and uniform. In the blue-light group, lens epithelial cells were disordered, swollen, and changed from a single layer to double or even multiple layers. In the green-light group, lens epithelial cells were slightly swollen, and some areas showed a double-layer arrangement. In the red-light group, lens epithelial cells were flat, monolayer and uniform too. MDA activities in the rat lens of the control and red-, green-, and blue-light groups were approximately 0.004 3, 0.004 4, 0.015 6, and 0.017 8 U/mgprot, respectively. There were no significant differences between the red-light and control groups(P>0.05), but there were significant differences among the other groups(P<0.05). SOD activities in the lens of the control and red-, green-, and blue-light groups were 1.306 7, 7.926 7, 3.070 0, and 2.1233 U/mgprot, respectively, showing significant differences(P<0.05). GSH-Px activities in the lens of the control and red-, green-, and blue-light groups were 1.413 3, 9.793 3, 2.696 0, and 2.159 0 U/mgprot, respectively, showing significant differences(P<0.05). Conclusion The influence of LED light on rat lens epithelial cells is wavelength-dependent. Shorter wavelengths of LED light are associated with greater changes in the lens epithelial cell morphology, greater effects of SOD and GSH-Px activities in the lens, and more lipid peroxide accumulation in the lens.

Analysis of the preoperative predictive factors of Uvulopalatopharyngoplasty

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  145-151.  doi:10.6040/j.issn.1673-3770.0.2019.586

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Obstructive sleep apnea(OSA)is a common sleep-related respiratory disorder. If left untreated, it can lead to cardiovascular and nervous system damage. In addition to continuous positive airway pressure(CPAP), most OSA patients have surgical treatment based on the anatomical obstruction. Uvulopalatopharyngoplasty(UPPP)is the most common procedure performed. This paper reviews the current research on the preoperative evaluation of UPPP, summarizes possible predictors, and screens out more specific predictive factors. The aim is to construct a more efficient predictive system, specify the indications and contraindications of UPPP surgery.

Correlation between obstructive sleep apnea and tumors

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  152-156.  doi:10.6040/j.issn.1673-3770.0.2019.595

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Obstructive sleep apnea(OSA)is a chronic disease that is prevalent worldwide. The morbidity of OSA has increased year by year. The primary characteristic of OSA is repeated upper airway collapse, which causes recurrent apnea, hypopnea, and frequent decline of the oxyhemoglobin saturation. This leads to sleep fragmentation and sleep structure disorder. Patients with OSA usually suffer from daytime sleepiness and inattention. Long-term sleep fragmentation and micro-arousal state are related to many chronic diseases, such as hypertension, myocardial infarction, Type 2 diabetes and Alzheimer's disease. Moreover, OSA is also closely related to tumors. With increases in the degree of OSA and hypoxemia, the incidence and mortality of related tumors have also gone up. Such tumors include lung, breast, nasopharyngeal, prostate and central nervous system cancers. To provide a reference for OSA and tumor-related research and clinical practice and develop ideas around further treatment research that could be conducted, this article reviews the profile of OSA and the statistical evidence, moreover, the molecular mechanism and treatment of OSA related to tumors will be discussed.

Diagnosis and treatment of choroidal neovascularization in pathologic myopia

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(5):  157-162.  doi:10.6040/j.issn.1673-3770.0.2019.545

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Pathologic myopia(PM)is a major cause of vision loss worldwide, particularly in Asian countries. Choroidal neovascularization(CNV)is a severe complication of PM, which can cause macular disorders, leading to central scotoma, metamorphopsia, visual field loss, and finally blindness if not treated. The advents of optical coherence topography(OCT), OCT angiography, and fundus fluorescein angiography are helpful in diagnosing CNV due to PM, which can show the position and size of CNV, whether active or passive. For the treatment, photodynamic and anti-vascular endothelial growth factor(anti-VEGF)therapies are widely applied. In recent years, administering the intravitreal anti-VEGF injection has become the first-line treatment for CNV secondary to PM. Many clinical studies have indicated that intravitreal anti-VEGF injections affect antagonizing neovascularization and reduce macular edema, thereby contributing to visual improvements and better long-term outcomes. This article provides an overview of the current diagnosis and treatment options for myopic CNV.