Table of Content

20 November 2020 Volume 34 Issue 6

  

Anxiety and depression in patients with common types of vertigo

JIANG Lina, YU Qianru, YU Jie, GUAN Benling, LU Yu, YU Shudong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  1-5.  doi:10.6040/j.issn.1673-3770.0.2019.444

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Objective To evaluate anxiety, depression, and disability in patients with vertigo and their underlying factors to provide a basis for clinical diagnosis and treatment of the four common types of vertigo. Methods Patients diagnosed with benign paroxysmal positional vertigo(BPPV), vestibular migraine(VM), Meniere's disease(MD), and vestibular neuritis(VN)were included in the study. Each patient's disease course, duration, relevant general information, and improvements in otological examination findings were evaluated. Anxiety, depression, and disability were also evaluated using the hospital anxiety and depression scale(HAD)and the dizziness disability scale(DHI). Results One hundred and twenty-one patients with vertigo were included; 47 had BPPV, 31 had VM, 29 had MD, and 14 had VN. The positive rates of anxiety and depression among patients with BPPV, VM, MD, and VN were 31.9%, 71.0%, 75.9%, and 42.9%, respectively. The proportions of mild, moderate, and severe cases of vertigo disability were: 58.9%, 19.8%, and 21.3%, respectively, for BPPV; 19.4%, 25.8%, and 54.8%, respectively, for VM; 6.9%, 24.1%, and 69.0% for, respectively, for MD; 38.6%, 21.4%, and 40.0%, respectively, for VN. There was a correlation between anxiety and depression scores(r=0.570, P<0.05)as well as DHI and HAD scores(r=0.804; P<0.05). Conclusion Anxiety and depression were manifested to varying degrees among the vertigo patients, but there was a correlation between them. VM and MD patients had a higher incidence of anxiety and depression, while VM, MD, and VN patients had more severe vertigo and disability than BPPV patients. Therefore, anxiety and depression should be considered during the diagnosis and treatment of vertigo, especially in patients with VM and MD, to facilitate diagnostic accuracy and effective treatment.

Treatment of sudden seafness by heart and spleen

LIN Yushan, LU Biaoqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  6-11.  doi:10.6040/j.issn.1673-3770.0.2019.584

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Objective The aim of this study was to examine the clinical effects of Guipi Decoction in the treatment of sudden deafness. Methods From January 2015 to June 2019, 108 patients with sudden deafness of Qi and blood deficiency type, who were hospitalized in the otolaryngology department of Zhongshan Hospital(affiliated with Guangzhou University of Traditional Chinese Medicine), and had complete clinical data were divided into the study group(n=78)and the control group(n=30). The control group was treated with conventional western medicine, while the study group was given Guipi Decoction along with western medicine treatment. Results The total effective rate of the study group was 79.49%, which was higher than that of the control group(60.00%). The difference between the two groups was statistically significant(P<0.05). There was no significant difference in the effective rate of sense(P>0.05). Conclusion The clinical effect of routine western medicine combined with Guipi Decoction in the treatment of sudden deafness of qi deficiency type is better than that of routine western medicine alone, which may have a clinical application.

Cholesteatoma of the external auditory canal complicated with suppurative parotitis: a case report and literature review

GUO Fang, ZHANG Dejun, FU Zeming, GUO Yingyuan, WAN Yining, GUAN Guofang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  12-15.  doi:10.6040/j.issn.1673-3770.0.2020.355

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Objective To investigate the etiology, diagnosis, and treatment of external auditory canal cholesteatoma complicated with suppurative parotitis and to review the relevant literature on external auditory canal cholesteatoma. Methods We retrospectively analyzed a case of patient with external auditory canal cholesteatoma complicated with suppurative parotitis who was admitted to our hospital. The patient presented with hearing loss in the left ear accompanied by otorrhea, as well as swelling and pain on the left side of the face. Temporal bone CT and ear canal MRI showed cholesteatoma formation in the left external auditory canal involving the mastoid process, tympanic cavity, tympanic sinus, parotid gland, and parapharyngeal space. The clinical diagnosis was external auditory canal cholesteatoma(left, Holt Ⅲ)and suppurative parotitis(left). The surgical methods used were cholesteatoma resection from the left external auditory canal, open radical mastoidectomy, tympanoplasty, artificial ossicular implantation, plasty of the cavity of auricular concha, removal of the parotid abscess, and repair of the parotid fistula. Results The cholesteatoma of the external auditory canal and middle ear and parotid abscess were completely removed, and the parotid fistula was repaired. Postoperative follow-up examinations showed that the patient recovered well without recurrence of the cholesteatoma or parotitis. Conclusion External auditory canal cholesteatoma has the potential to cause bone destruction. Cases of Holt phase Ⅲ cholesteatoma of the external auditory canal complicated by suppurative parotitis are rare and it is pivotal that the pathogenesis is understood and that individualized treatment plans are chosen according to the full lesion range.

Correlation between eosinophils and olfactory dysfunction in patients with CRSwNP after nasal operation

TAO Dandan, DONG Hongjun, CHU Yunfeng, HUANG Chao, HU Lei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  16-20.  doi:10.6040/j.issn.1673-3770.0.2019.388

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Objective To investigate the association between postoperative tissue eosinophils and olfactory dysfunction in patients with chronic rhinosinusitis and nasal polyps(CRSwNP). Methods A retrospective study of 120 patients who underwent CRSFNP endoscopic sinus surgery(ESS)between July 2016 and July 2018 was performed. The conditions of the patients were graded with the VAS and Lund-Kennedy scores; the eosinophil counts of the sinus mucosa were obtained. Olfactory function was assessed using the Sniffin' Sticks test and chemosensory event-related potential(CSERP). Spearman correlation analysis was used to determine the relationship between eosinophil count and the Sniffin' Sticks test results and CSERP parameters as well as the correlation between the VAS score and CSERP. Results The correlation analysis results after adjustment for covariates(age, gender, alcohol consumption, smoking, allergic rhinitis, asthma, postoperative time, and Lund-Kennedy score)were consistent with the results of the unadjusted covariates. The tissue eosinophil counts were associated with the threshold scores(r=-0.460, P=0.012): tissue eosinophil count and phenylethyl alcohol(N1: r=0.471, P=0.010; P2: r=-0.487, P=0.007)and ethanol(N1: r=-0.516, P=0.008; P2: r=-0.590, P=0.002). The peak latency of CSERP induced by stimulation was related to N1 and P2; however, it showed no significant correlation with the CSERP amplitude(P>0.05). There was a significant negative correlation between the threshold score generated by phenylethyl alcohol stimulation and the CSERP peak latency(N1: r=-0.560, P<0.001). There was a significant negative correlation between the CSERP latency generated by ethanol stimulation and the symptomatic VAS score(r=-0.400, P=0.005). Conclusions Postoperative tissue eosinophilia in patients with CRSwNP is significantly associated with postoperative olfactory disturbance, and the sensitivity of the trigeminal nerve may be associated with tissue eosinophilia. Inflammation of the nasal mucosa may affect the function of the olfactory and trigeminal nerves.

Curative effects of external application of traditional Chinese medicine in a hot salt bag combined with an intravenous drip of sodium aescinate in the treatment of nasal injury swelling

ZHANG Jingyi, WANG Wenyi, RONG Lingyan, ZHANG Jiakui, SONG Xicheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  21-26.  doi:10.6040/j.issn.1673-3770.0.2019.537

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Objective To study the curative effects of local external application of traditional Chinese medicine in a hot salt bag combined with a sodium aescinate intravenous drip for the treatment of nasal injury swelling. Methods Fifty-six patients with a fresh nasal soft tissue injury who were admitted to the Wendeng Osteopath Hospital between February 2018 and October 2018 were randomly divided into control and treatment groups. All patients were treated with a cold compress and a sodium aescinate intravenous drip within 48 h after the injury. Subsequently, treatment with a sodium aescinate intravenous drip combined with local external application of placebo in the control group and traditional Chinese medicine in the treatment group was performed for 6 days. The times it took for the swelling and pain to resolve were recorded. The grades and progression of swelling were also recorded. Results The time it took for the swelling to disappear was(39.07±8.64)h and(32.79±7.89)h in the control and treatment groups, respectively. The time it took for the pain to disappear was(35.39±9.55)h and(28.25±7.32)h in the control and treatment groups, respectively. The differences from pairwise comparisons were statistically significant(P<0.05). After 36 h of treatment, there were 10, 5, 3 and 10 control group cases, in contrast to 8, 2, 1, and 17 treatment group cases, of mild, moderate, severe, and resolved swelling, respectively. The differences were statistically significant(P<0.05). Conclusion The sodium aescinate intravenous drip showed better efficacy in the treatment of nasal injury swelling when combined with external application of traditional Chinese medicine, compared with placebo, in a hot salt bag.

Nasal chondromesenchymal hamartoma in infants: A report of two cases and literature review

CHEN Kun,LI Lei, MENG Guozhen, YANG Jun, HOU Dongming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  27-30.  doi:10.6040/j.issn.1673-3770.0.2019.588

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Objective This study aimed to investigate the clinical and pathological features, diagnosis, treatment, and prognosis of nasal chondromesenchymal hamartoma(NCMH)in infants. Method We performed a retrospective analysis of the clinical and pathological data of two infants with NCMH admitted to the Xinhua Hospital affiliated with the Shanghai Jiao Tong University School of Medicine between May 2016 and March 2019. The diagnosis, treatment, and prognosis of the patients were also investigated. Results The NCMHs originated from the nasal cavity or skull base and were completely resected by nasal endoscopy. There was no recurrence in long-term follow-up. Histologically, the mesenchymal cells and collagen fibers showed benign hyperplasia around cartilage structures. Conclusion The clinical manifestations of infant NCMHs are diverse and non-specific; thus, early diagnosis is difficult. Nasal endoscopic surgery is the main treatment method for NCMH and has good clinical effects.

Endoscopy surgery for maxillary cysts: A clinical analysis

WANG Lei, YUAN Ying, YU Xuemin, HAN Yu'e, WANG Ning, LI Xiao, LI Long, HOU Nini

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  31-35.  doi:10.6040/j.issn.1673-3770.0.2019.630

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Objective To explore the surgical methods and clinical efficacy of an endoscopic transnasal maxillary approach for removing maxillary bone cysts. Methods A retrospective analysis was performed, which included 21 patients with maxillary cysts who underwent endoscopic surgery in our department between March 2014 and April 2019. In all cases, the wall of the maxillary bone cyst protruded into the maxillary sinus. According to an imaging examination such as a computed tomography(CT)scan, the size, range of the cyst, and the relationship between the cyst and each wall of the maxillary sinus were determined. Two surgical approaches were performed. The first approach was through the natural opening of the maxillary sinus. The other approach was through the pre-lacrimal recess, in combination with the first approach. The cyst walls protruding into the maxillary sinus were removed as thoroughly as possible so that the cyst and maxillary sinus could be fused into a common cavity, and a drainage channel was established between the cyst-maxillary sinus and the nasal cavity. Results All patients were followed up for 6 to 24 months after the operation. The mucosae of the operative cavities were well epithelialized. Nasal and facial symptoms disappeared or were significantly relieved. The drainage of the capsule cavity and maxillary sinus was smooth. There was no recurrence in all cases. Conclusions Removal of maxillary bone cysts using a transnasal maxillary approach was reliable and established a smooth drainage channel for the cyst and the maxillary sinus. Additionally, the postoperative cavity could be easily observed. Compared with the traditional approach, it is less traumatic, and results in a quicker recovery time, and lower recurrence rate. These results are in line with other minimally invasive surgeries and show that the technique is worthy of clinical promotion.

Changes in and prognostic value of the inflammatory index before and after concurrent chemoradiotherapy for nasopharyngeal carcinoma

FAN Li, LI Yue, XU Ximing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  36-41.  doi:10.6040/j.issn.1673-3770.0.2020.053

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Objective To investigate the effect of the neutrophil-lymphocyte ratio(NLR)and platelet-lymphocyte ratio(PLR)in peripheral blood on the prognosis of nasopharyngeal carcinoma(NPC)before and after concurrent chemoradiotherapy. Methods Pre-/post-treatment and changes in neutrophil, platelet, and lymphocyte levels of 229 patients who were diagnosed with locally advanced NPC and received concurrent chemoradiotherapy in Renmin Hospital of Wuhan University were retrospectively analyzed. A receiver operating characteristic(ROC)analysis was performed to determine the optimal cutoff values of NLR, PLR, ΔNLR, and ΔPLR, and the patients were then divided into lower and higher groups according to the optimal cutoff values of ΔNLR and ΔPLR. A Kaplan-Meier analysis and Cox risk model were used to identify independent predictors of recurrence and prognosis. Results The areas under the ROC curve of PLR, NLR, ΔNLR, and ΔPLR in the diagnosis of tumor recurrence were 0.680, 0.678, 0.854, and 0.730, respectively, and the optimal cut-off values for each parameter were 2.730, 135.550, 4.982, and 122.553, respectively. Univariate analysis showed that TNM stages, clinical stages, PLR and NLR, ΔNLR, and ΔPLR were correlated with the recurrence of NPC, whereas the Cox regression model suggested that TNM stages, ΔNLR, and ΔPLR were independent risk factors for the recurrence of NPC. Kaplan-Meier analysis found that the 2-year recurrence-free survival rates of the ΔHNLR and ΔHPLR groups were lower than those of the ΔLNLR and ΔLPLR groups(ΔHNLR vs. ΔLNLR=0.488 vs. 0.993; ΔHPLR vs. ΔLPLR=0.476 vs. 0.935), and that the median recurrence-free survival time for both the ΔHNLR and ΔHPLR groups was 23 months. Conclusion Both NLR and PLR in patients with locally advanced NPC increased after concurrent chemoradiotherapy, and poorer prognosis was correlated with higher ΔNLR and ΔPLR values. Therefore, ΔNLR and ΔPLR can be used to assess risk for tumor recurrence in patients with locally advanced NPC.

Clinical analysis of the endonasal transpterygoid approach to the resection of malignant tumors involving the middle skull base of 30 cases

ZHENG Chaopan, ZENG Xiaoyan, ZHANG Bo, HAN Lin, LUO Man, MA Lingguo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  42-48.  doi:10.6040/j.issn.1673-3770.0.2020.094

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Objective To explore the endonasal transpterygoid approach to the resection of malignant tumors involving the middle skull base and its outcomes. Methods The surgery-related data of 30 cases of malignant tumors involving the middle skull base attended to at the Department of Otorhinolaryngology of the Shenzhen People's Hospital between October 2012 and June 2019 were retrospectively analyzed. The skills and experience of the surgeons and the techniques employed during the surgery were summarized. The Kaplan-Meier method was used for survival analysis. The prognoses of the tumor-involved internal carotid arteries were also explored. Results The surgeries, using the endonasal transpterygoid approach, were performed under general anesthesia; the average duration of surgery was 145 minutes, the average intraoperative blood loss was 470 mL, and intraoperative cerebrospinal fluid leakage occurred in 6 cases. The postoperative intracranial infection in 2 cases and the cerebrospinal fluid leakage in 1 case were cured. Pathologically, there were 21 cases of recurrent nasopharyngeal carcinoma, 3 cases of adenoid cystic carcinoma, 2 cases of mucoepidermoid carcinoma, 1 case of chordoma, 1 case of carcinosarcoma, 1 case of nasopharyngeal follicular dendritic cell sarcoma, and 1 case of skull base lymphocytic epithelioma-like carcinoma. The 1-year, 2-year, 3-year, and 5-year survival rates of the 30 patients with malignant tumors were 92.9%, 79.6%, 48.6%, and 36.5%, respectively. The median survival duration was 29.00(35.00, 23.00)months for recurrent nasopharyngeal carcinoma and 38.00(38.00, 38.00)months for other malignant tumors. The survival curves of recurrent nasopharyngeal carcinomas and other malignant tumors showed statistical significance(χ2=4.248; P=0.039). The median durations of survival of patients with and without internal carotid artery invasion were 16.00(23.00, 14.00)and 36.00(80.00, 31.00)months, respectively, and their survival curves were significantly different(χ2=9.421; P=0.002). Internal carotid artery involvement is a risk factor for poor prognosis, and the risk of death of patients with internal carotid artery involvement was 9.678 times that of those without involvement(HR=9.678, P=0.011). Conclusion The endoscopic transpterygoid approach is a reasonable option for the surgical treatment of tumors involving the middle skull base; however, the involvement of the internal carotid artery is an important prognostic factor that should always be considered.

Application of the improved vacuum sealing drainage device in the treatment of refractory pharyngocutaneous fistula

CUI Xiaohuan, LI Lina, ZHANG Yanping, JIANG Xingwang, BI Xinxin, RAN Taotao, WU Yingying, LIU Yali

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  49-53.  doi:10.6040/j.issn.1673-3770.0.2020.044

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Objective To explore the therapeutic effect of the improved vacuum sealing drainage(VSD)device on refractory pharyngocutaneous fistula. Method Two patients with refractory pharyngocutaneous fistula were reported in this article. A 48-year-old patient with hypopharyngeal carcinoma(postcricoid region, clinical T2N2M0)experienced refractory pharyngocutaneous fistula on the fifth day of concurrent radiotherapy and chemotherapy after tumor resection. A similar fistula occurred in another patient aged 62 with laryngeal carcinoma experiencing partial vocal fold resection by CO₂ laser 146 days after radiation therapy. The improved VSD devices was applied to assist fistula treatment in both patients, and the healing process was observed. Results After the application of the improved VSD device, the swelling of the fistula subsided on the sixth and third day in patients 1 and 2, and it was repaired when the wound area contracted obviously on days 58 and 38, respectively. Then, the pharyngocutaneous fistula healed on days 74 and 63, respectively. Conclusion The improved VSD device can be used flexibly according to the wound condition, and is helpful for treating refractory pharyngocutaneous fistula complicated with head and neck carcinoma.

Clinical analysis of 6 cases of pharyngeal actinomycosis

JING Qiancheng, GONG Wei, ZHOU Dinggang, ZHOU Fang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  54-57.  doi:10.6040/j.issn.1673-3770.0.2020.054

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Objective To summarize the clinical data of patients with pharyngeal actinomycosis and discuss the clinical characteristics, diagnosis, and treatment methods. Methods Six cases of pharyngeal actinomycosis diagnosed between September 2015 and October 2019 by a combination of video rhinolaryngoscopy, screening for specific infection, secretion culture, and biopsy were evaluated. The patients were treated with penicillin antibiotics, local cleaning, and atomization inhalation. Results All cases were diagnosed as pharyngeal actinomycosis, and all the lesions disappeared, accompanied by symptomatic relief “After treatment”. there was no recurrence during the 3 months to 1 year of follow-ups. Conclusion Pharyngeal actinomycosis is related to local chronic disease, and it is mainly confirmed by pathological examination. Comprehensive treatment with antibiotics, atomization, and local cleaning have definite outcomes.

Correlation between Preoperative neutrophil/lymphocyte ratio and lymph node metastasis in patients with laryngeal cancer

PANG Zhenwen, HUANG Yufeng, YANG Aifang, ZENG Xianjie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  58-62.  doi:10.6040/j.issn.1673-3770.0.2019.546

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Objective To investigate the relationship between preoperative neutrophil-to-lymphocyte ratio(NLR)and lymph node metastasis in patients with laryngeal cancer. Methods A total of 102 patients with laryngeal cancer admitted to the Affiliated Cancer Hospital of Guangxi Medical University from January 2008 to December 2017 were enrolled. The preoperative NLR was used as the dependent variable to analyze the clinical pathological staging and lymph node test results of laryngeal cancer. Results The patients with preoperative NLR>2.2 has higher transfer rate and metastasis than the patients with preoperative NLR≤2.2 and the difference was significant(P<0.001).The lymph node stage of patients with preoperative NLR>2.2 was significantly higher than that of the patients with preoperative NLR≤2.2, and the difference was significant(P<0.001).The mean NLR of patients with early tumor(T1,T2)was lower than that of patients with late tumor(T3,T4), the latter had higher lymph node transfer rate and metastasis, and the difference was statistically significant(P<0.001).The mean value of NLR in clinical stage IV patients with transfer rate and metastasis were significantly higher than that of stage III, and the difference was also statistically significant(P<0.05). Among patients with supraglottic and glottic carcinoma, the preoperative NLR>2.2 group had higher lymph node metastasis rate and metastasis than NLR≤2.2 group, and the difference was statistically significant(P<0.05); There was no significant difference in lymph node metastasis for subglottic patients(P>0.05), whereas the difference in lymph node metastasis was statistically significant(P<0.05). Conclusion There is a correlation between the preoperative NLR level and lymph node metastasis in patients with laryngeal cancer, which can reflect the degree of lymph node metastasis to some extent, and provide a valuable reference for clinical treatment.

The therapeutic effects of low temperature plasma radiofrequency ablation and CO₂ laser surgery on early glottic carcinoma: a Meta-analysis

TAN Fengwu, DENG Yaping, LI Kehua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  63-71.  doi:10.6040/j.issn.1673-3770.0.2019.570

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Objective To evaluate the clinical effects of low temperature plasma radiofrequency ablation(LTP-RFA)using a suspension laryngoscope and CO2 laser surgery on early glottic carcinoma by a meta-analysis. Methods Related literature was retrieved from electronic databases, including PubMed, EMbase, Medline, VIP, Wanfang, and CNKI, from inception to June 1st, 2019. At the same time, the reference lists of the enrolled articles were retrieved manually. Literature comparing the therapeutic effects of LTP-RFA using a suspension laryngoscope and CO₂ laser surgery on early glottic carcinoma was retrieved according to the inclusion and exclusion criteria. Literature screening, data extraction, and literature evaluation were carried out by two authors independently. Revman 5.3 software was adopted for meta-analysis. Results A total of 10 studies involving 1 055 patients were enrolled. Meta-analysis results suggested that, compared with CO₂ laser surgery, LTP-RFA significantly reduced the operative time ［SMD =-2.97, 95%CI(-4.05, -1.90), P<0.00 001］, shortened the postoperative mucosal recovery time ［OR=5.53, 95%CI(2.84, 10.78), P<0.00 001］and increased intraoperative blood loss ［SMD=-0.73, 95%CI(0.09, 0.71), P=0.01］. In addition, there were no statistically significant differences in recurrence rate ［OR=0.79, 95%CI(0.46, 1.36), P=0.39］, degree of postoperative pain ［SMD=-0.17, 95%CI(-0.43, 0.08), P=0.18］, and postoperative voice quality ［SMD=-0.21, 95%CI(-1.13, 0.71), P=0.65］ between the two methods. However, sensitivity analysis results revealed that this conclusion may not be robust. No obvious publication bias was detected in the funnel plot regarding the operative time and recurrence rate. Conclusion LTP-RFA has a superior effect over CO₂ laser surgery in treating early glottic carcinoma in terms of operative time and postoperative mucosal recovery, but LTP-RFA has greater intraoperative blood. There are no statistically significant differences in recurrence rate, postoperative pain degree, and postoperative voice quality between these two approaches.

Expression and clinical significance of CPS1 in laryngeal squamous cell carcinoma

FAN Yiyan, ZHANG Xiaolin, LIU Xiuzhen, YIN Jingjing, YUAN Jin, WANG Yanfei, CHEN Jun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  72-76.  doi:10.6040/j.issn.1673-3770.0.2019.618

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Objective To study the expression levels of carbamoyl phosphate synthase I(CPS1)in laryngeal squamous cell carcinoma and adjacent non-cancerous tissues and reveal its possible correlation with clinical parameters, and explore the clinical significance of CPS1 in the disease. Methods The real-time quantitative polymerase chain reaction(RT-qPCR)was used to measure the expression of CPS1 mRNA in laryngeal squamous cell carcinoma and adjacent tissues. Western blotting and immunohistochemistry were used to detect expression levels of the CPS1 protein and its distribution in laryngeal squamous cell carcinoma tissues. Results The results of RT-qPCR and western blot analysis showed that the mRNA and protein expression levels of CPS1 in laryngeal squamous cell carcinoma were significantly higher than that in adjacent tissues(P<0.01). Immunohistochemistry showed the same trend in CPS1 protein levels. The expression of CPS1 was closely related to the degree of tumor differentiation, clinical stage, and lymph node metastasis(P<0.05), but not to the patients' age, gender, smoking history, drinking history, and tumor site(P>0.05). Conclusion The expression of CPS1 in laryngeal squamous cell carcinoma is significantly higher than in the adjacent tissues, and is closely related to clinical progression. These results suggest that CPS1 may play a role in the occurrence and metastasis of laryngeal cancer, and is a diagnostic indicator for laryngeal cancer.

Improvement of the sniffing position for microlaryngoscopic surgery with a self-retaining laryngoscope

GU Xiaona, CHENG Xiangrong, ZHANG Peng, ZHU Liang, TENG Hua, WANG Yong, HU Xiaoyan,

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  77-81.  doi:10.6040/j.issn.1673-3770.0.2020.043

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Objective To explore the advantages of the sniffing position during exposure to the surgical field in microlaryngoscopic surgery with a self-retaining laryngoscope. Methods Sixty patients with voice disorders who were enrolled for microlaryngoscopic surgery with a self-retaining laryngoscope under general anesthesia were selected and randomly divided into two groups: the sniffing position group(group A)and the horizontal recumbent position group(group B). Thirty patients were in each group. The time to glottis exposure and VAS scores for postoperative laryngeal pain, tongue numbness, pharyngeal or laryngeal mucosal injury and intraoperative or postoperative tooth injury were observed and recorded in all patients. The exposure of the visual field during the surgery was evaluated. Results (1) The time to glottis exposure was significantly shorter in group A(2.42±1.04 minutes)than in group B(3.20±0.95 minutes), and the difference was statistically significant(P<0.05). (2) Surgical complications: the VAS scores for postoperative laryngeal pain was significantly lower in group A than in group B(P<0.05). The incidence of pharyngeal or laryngeal mucosal injury was significantly lower in group A(6.7%)than in group B(30.0%). Postoperative tongue numbness and intraoperative or postoperative tooth injury did not occur almost. Overall, the postoperative recovery of group A was better, and surgical complications were less compared with those in group B. Conclusion Compared with the horizontal recumbent position, the sniffing position is more conducive for glottis exposure in microlaryngoscopic surgery using a self-retaining laryngoscope, as it takes less time and causes fewer surgical complications.

Identification of differentially expressed genes and pathways for abnormal methylation in squamous cell carcinoma of the head and neck

DONG Shikun, SHEN Yujie, ZHANG Liqing, ZHOU Han, ZHANG Jiacheng, DONG Weida

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  82-91.  doi:10.6040/j.issn.1673-3770.0.2019.621

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Objective The biomarkers and pathways of head and neck squamous cell carcinoma(HNSCC)are yet to be identified. The purpose of this study is to analyze differentially expressed genes associated with abnormal methylation in HNSCC and identify key genes and potential pathways. Methods The gene expression data set, GSE107591, and methylation data set, GSE33202, were obtained from the GEO database. The abnormally methylated genes and differentially expressed genes were screened using R, and the low methylation-high expression genes(Hypo-HGs)and high methylation-low expression genes(Hyper-LGs)were identified using the intersect function. Enrichr was used for functional and enrichment analysis of the two groups of genes. The protein-protein interaction(PPI)network was constructed using STRING and visualized using Cytoscape. Finally, we used survival analysis to identify key genes. We performed immunohistochemical analysis using CMap to identify small candidate molecules that may reverse HNSCC gene expression. Results A total of 28 hypomethylated, highly expressed genes were identified and GO enrichment analysis showed that they were mainly involved in the positive regulation of T cell chemotaxis, epidermal development, and cell-basal junction components. The results of WikiPathway analysis indicate that these genes are mainly involved in typical and atypical TGF-β signaling, blood clotting cascade, α6β4 signaling pathway, complementation and coagulation cascade, and aging and autophagy in cancer. Additionally, we found 24 genes with high methylation and low expression, which are mainly involved in GO biological processes including the regulation of angiogenesis and development, negative regulation of the interferon-γ response, negative regulation of the interferon-γ-mediated signaling pathway, and epithelial development. WikiPathway analysis further showed that these genes are mainly involved in the catalytic cycle of mammalian riboflavin monooxygenases(FMOs). Specifically, HIF1A and PPARG regulate glycolysis and metabolism of benzene and aflatoxin B1. Furthermore, key genes related to the prognosis of HNSCC were identified, namely SERPINE1, PLAU, MMRN1, LAMB3, LAMC2, PDPN, and CXCL13. Conclusion In this study, we have identified differentially expressed genes and pathways of abnormal methylation in HNSCC through biological analysis, thereby providing an important molecular basis for exploring the pathogenesis of HNSCC. Key genes, including SERPINE1, PLAU, MMRN1, LAMB3, LAMC2, PDPN, and CXCL13 can be used as abnormal methylation-based biomarkers and therapeutic targets for future diagnosis and treatment of HNSCC.

Meta-analysis of the effect of surgery for obstructive sleep apnea hypopnea syndrome on blood pressure

JI Di, DENG Anchun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  92-98.  doi:10.6040/j.issn.1673-3770.0.2019.564

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Objective Assessing the efficacy of surgery for obstructive sleep apnea hypopnea syndrome(OSAHS)with or without refractory hypertension on blood pressure to provide a reference for the clinical treatment of OSAHS. Methods An electronic search was conducted in VIP, CNKI, and Pubmed databases. Studies were included according to inclusion and exclusion criteria. Literature quality was evaluated via the Methodological index for non-randomized studies(MINORS)system. Effects of surgery for obstructive sleep apnea hypopnea syndrome(OSAHS)on blood pressure were qualitatively evaluated and meta-analyzed with RevMan 5.3. Results Fifteen self-controlled trials or randomized controlled trials(RCTs)involving 989 patients were included. Selected blood pressure outcomes: ［24-hour average systolic blood pressure WMD=15.50, 95% confidence interval(CI, 11.14, 19.85), P<0.05; 24-hour average diastolic blood pressure WMD = 8.50, 95%CI(5.89, 11.11), P<0.05; average systolic blood pressure during the day WMD=13.74, 95%CI(9.10, 18.39), P<0.05; average diastolic blood pressure during the day WMD=8.42, 95%CI(6.06, 10.78), P<0.05; average systolic blood pressure during the night WMD=15.10, 95%CI(8.90, 21.30), P<0.05; average diastolic blood pressure during the night WMD=9.95, 95%CI(6.35, 13.54), P<0.05］. Selected outcomes in patients with OSAHS with refractory hypertension: ［24-hour average systolic blood pressure WMD=13.22, 95%CI(9.59, 16.84), P<0.05; 24-hour average diastolic blood pressure WMD=6.30, 95%CI(3.13, 9.46), P<0.05; average systolic blood pressure during the day WMD=13.32, 95%CI(8.25, 18.38), P<0.05; average diastolic blood pressure during the day WMD=5.62, 95%CI(3.60, 7.63), P<0.05; average systolic blood pressure during the night WMD=12.27, 95%CI(5.55, 18.98), P<0.05; average diastolic blood pressure during the night WMD=9.20, 95%CI(3.26, 15.13), P<0.05］; Selected outcomes on blood pressure after UPPP/H-UPPP: ［24-hour average systolic blood pressure WMD=13.61, 95%CI(4.21, 23.02), P<0.05; 24-hour average diastolic blood pressure, P>0.05; average systolic blood pressure during the day WMD=13.47, 95%CI(1.02, 25.91), P<0.05; average diastolic blood pressure during the day WMD=4.78, 95%CI(1.08, 8.48), P<0.05; average systolic blood pressure during the night WMD=16.81, 95%CI(3.68, 29.95), P<0.05; average diastolic blood pressure during the night WMD=13.66, 95%CI(3.07, 24.24), P<0.05; morning systolic blood pressure WMD=9.83, 95%CI(6.63, 13.02), P<0.05; morning diastolic blood pressure WMD=6.40, 95%CI(3.79, 9.00), P<0.05］; Two articles affirm that the experimental group(with UPPP+conventional treatment)has significantly better outcomes than the control group(conventional treatment only)on 24-hour SBP, 24-hour DBP, mSBP, and mDBP. Conclusion More high-quality studies are needed. It is challenging to distinguish the effect of each surgery on blood pressure because of small sample sizes in these studies. Surgery is effective in reducing the 24-hour average systolic blood pressure, 24-hour average diastolic blood pressure, average systolic blood pressure during the day, average diastolic blood pressure during the day, average systolic blood pressure during the night, and average diastolic blood pressure during the night in OSHAS patients with or without refractory hypertension. UPPP/H-UPPP additionally reduced morning systolic blood pressure and morning diastolic blood pressure but not 24-hour average diastolic blood pressure. The long-term efficacy remains to be studied.

Primary localized tonsil amyloidosis: a case report and literature review

FENG Chen, JIN Xiaoxue, HAN Yingying, ZOU Juanjuan, LI Yanzhong, WANG Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  99-103.  doi:10.6040/j.issn.1673-3770.0.2020.237

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Objective To investigate the clinical characteristics, diagnosis, treatment, and prognosis of primary localized tonsil amyloidosis, to enable its early diagnosis. Methods A patient with primary localized tonsil amyloidosis was retrospectively reviewed, along with previous cases of primary localized tonsil amyloidosis found in the literature. Results The clinical manifestations of primary localized tonsil amyloidosis lack specificity, and its early manifestations are often atypical. Besides, the disease often rapidly progresses. The clinical manifestations are mainly a pharyngeal foreign body sensation caused by the asymmetric growth or rapid enlargement of the bilateral tonsil. Other non-specific manifestations include tonsil growth, an ulcer, dry pharynx, pharynx itch, pharynx pain, and dysphagia. For patients with painless hypertrophy of the tonsil and no inflammatory symptoms, a pathological biopsy should be performed if bilateral tonsil asymmetry is apparent, there is a surface ulcer, the texture is hard, or the history is short. Conclusion The clinical and imaging manifestations of primary localized tonsil amyloidosis are non-specific. Therefore, it is imperative to carefully consider the patient's medical history, systemic examination findings, and pathological biopsy findings to diagnose primary localized tonsil amyloidosis at an early stage.

Clinical analysis of 63 cases with multiple oral, maxillofacial, and neck infections

HUANG Fang, ZHOU Xiaoping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  104-107.  doi:10.6040/j.issn.1673-3770.0.2019.559

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Objective To explore the clinical features and treatment of multiple oral, maxillofacial, and neck infections. Method The clinical data of 63 patients with multiple oral, maxillofacial, and neck infections admitted to our department between December 2013 and August 2018 were summarized and analyzed. Result The average age of the 35 males was(52.03±16.97)years and that of the 28 females was(45.67±19.18)years. There were two or more interstitial infections. Among the 63 cases, 16 were complicated with diabetes and 6 were treated with tracheotomy. Seventeen were treated for cellulitis; all of them were cured and discharged. Forty-six patients showed the formation of abscess, and they were treated with puncture and abscess incision and drainage; 43 were cured and discharged, 2 improved, and 1 left without being discharged. Conclusion Multiple oral, maxillofacial, and neck interstitial infections should be treated with broad-spectrum antibiotics as soon as possible to keep the respiratory tract unobstructed. If necessary, tracheotomy should be performed. After abscess formation, early incision and drainage should be performed. Diabetes, hypertension, heart disease, and other accompanying diseases should also be treated.

Influence of breath holding on intraocular pressure measured by non-contact tonometry

SONG Lihua, TAO Yuan,CUI Fenghua, GUO Yuanyuan, WANG Hong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  108-111.  doi:10.6040/j.issn.1673-3770.0.2019.579

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Objective To explore the effect of breath holding on intraocular pressure measured by non-contact tonometry. Methods The intraocular pressure of 60 eyes of 60 patients were measured by non-contact tonometry, in the breathing state and after breath holding for 10 and 30 s. Further, the difference and correlation of the measured intraocular pressure among different breathing states were analyzed. Results In the calm breathing state, the intraocular pressure of all 60 eyes was in the normal range. After breath holding for 10 and 30 s, the intraocular pressure of three 22 eyes exceeded the normal range, respectively. The intraocular pressure was significantly higher after breath holding for 10 s than that in the calm breathing state(P<0.05)and after breath holding for 30 s than that after breath holding for 10 s or in the calm breathing state(P<0.05). There was a correlation between the intraocular pressure measured by non-contact tonometry and the breath holding time and between changes in the intraocular pressure measured after breath holding and the breath holding time. The longer the breath holding time, the higher was the intraocular pressure. There was no correlation between changes in the intraocular pressure and the patients' age, sex, corneal thickness, or corneal curvature. Conclusion When measuring intraocular pressure by non-contact tonometry, patients should be advised to avoid breath holding and interferences. For patients with poor breath-hold performance due to stress or other factors, the intraocular pressure should be measured within 10 s of breath holding. The effect of breath-holding time of 10 s was significantly lower than that of longer breath-holding times on intraocular pressure measurements.

The position of ciliary processes in glaucoma patients and their clinical significance

ZHAO Dongdong, ZHAI Yuxi, LU Haohao, ZHANG Ruochen, GAO Jianlu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  112-117.  doi:10.6040/j.issn.1673-3770.0.2020.008

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Objective The study aimed to identify the correlation between the position of ciliary processes and other biological parameters in primary glaucoma patients and control group. These data may provide evidence for precise treatment in transscleral cyclophotocoagulation. Methods A total of thirty primary glaucoma patients and ten age matched healthy controls were enrolled in the study. Glaucoma patients were divided into 3 groups; acute primary angle closure glaucoma(APACG), chronic primary angle closure glaucoma(CPACG)and primary open angle glaucoma(POAG). All subjects underwent the A-scan and ultrasound biomicroscopy examinations. The parameters measured included angle open distance(AOD), trabecular-iris angle(TIA), trabecular-ciliary body process angle(TCA), ciliary body process height(CBTmax), the projected position of the ciliary body(a), anterior chamber depth(ACD), lens thickness(LT), axial length(AL). Results Both control group and POAG group are greater than APACG group and CPACG group in parameters of AOD、TIA and TCA, and the differences are statistically significant. However, the differences in AOD、TIA and TCA between control group and POAGand between APACG and CPACG were not statistically significant. The parameters of CBTmax in the control group was higher than that in the POAG, APACG, and CPACG groups(P<0.05), but the differences among POAG, APACG, and CPACG groups were not statistically significantly. Compared to the control group, the position of ciliary body in the APACG group was the most forward, followed by CPACG group, with statistically significant differences. However, the differences of ciliary body position between the POAG group and the control group were not statistically significantly. Furthermore, the parameters of ACD, LT, AL, and the len relative position were highly correlated with parameters of AOD, TIA, TCA, and the ciliary body projected position(P<0.001). Conclusion Compared with normal and POAG patients, the projected position of the ciliary body in PACG patients is forward. UBM can guide precise transscleral cyclophotocoagulation by positioning the ciliary process in glaucoma patients.

Elucidating the role and mechanism of Tim-3 in allergic rhinitis

XIANG Liulan, YE Yuanhang,JIANG Luyun, LIU Yang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  118-122.  doi:10.6040/j.issn.1673-3770.0.2019.582

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Allergic rhinitis(AR)is a chronic, non-specific inflammatory disease of the nasal mucosa. As a Type I hypersensitivity reaction, it leads to several diseases and labor losses and is a global health problem that burdens society. Different proteins, including Tim-3, regulate the immune cells that are involved in the pathogenesis of AR. Tim-3 has been demonstrated to be involved in immune cell expression and has a regulatory effect on several immune responses. Thus, it is also closely related to disorders of the immune system. Presently, the treatment options and medications for AR are limited, and it require more effective therapeutic interventions. While there are several studies on Tim-3's mechanism of action in AR, a review of the available literature is lacking. This article aims to enrich the body of research on the immune regulation mechanism behind AR and provide new ideas for its treatment.

Correlation between high-mobility group box-1 and allergic rhinitis

ZHU Zhengru,ZHANG Xiaobing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  123-128.  doi:10.6040/j.issn.1673-3770.0.2020.031

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Allergic rhinitis(AR)is a noninfectious inflammatory disease of the nasal mucosa mediated by IgE and characterized by the upregulation of inflammatory mediators and infiltration of inflammatory cells in the nasal mucosa. As a typical warning protein and damage-related model molecule, high-mobility group box-1(HMGB1)plays a variety of roles in mediating inflammatory response, cell migration, and tissue invasion. Currently, studies on HMGB1 and allergic diseases mainly focus on systemic lupus erythematosus, asthma, and atopic dermatitis, whereas the role of HMGB1 in AR is still controversial. This article summarizes the relevant researches on the role of HMGB1 in the pathogenesis of AR.

Progress in the research on the roles of invadopodia and metalloproteinase-14 in tumorigenesis and cancer development

PEI Xueyan,WANG Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  129-134.  doi:10.6040/j.issn.1673-3770.0.2019.604

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Malignant tumors are still enigmatic in the field of medical science. The prognosis of cancer patients largely depends on whether the primary tumor has metastasized or not. Matrix metalloproteinase-14(MMP-14)is involved in physiological functions of normal cells and in tumor-related processes, such as cell migration, inflammation, invasion, metastasis, and angiogenesis. Invadopodia are protrusions of the plasma membranes of malignant tumor cells, with the ability to degrade the extracellular matrix. Thus, MMP-14 and invadopodia have critical roles in tumorigenesis and cancer progression.

Progress in the clinical diagnosis and treatment of cervical necrotizing fasciitis

YUAN Kanglong,XIAO Xuping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2020, 34(6):  135-138.  doi:10.6040/j.issn.1673-3770.0.2020.072

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Cervical necrotizing fasciitis(CNF)is a severe soft tissue inflammation of the neck caused by mixed bacterial infections. It is characterized by necrosis of neck subcutaneous tissue with deep and shallow fasciitis. Elderly individuals and those with chronic comorbid diseases(such as diabetes)are more susceptible to CNF. The early clinical diagnosis rate is lowand the disease progresses rapidly. Life-threatening complications are such as descending necrotizing mediastinitisand septic shock are frequently observed. The mortality rate is extremely high. This article reviews the clinical diagnosis and treatment of CNF to facilitate early diagnosis and treatment.