Table of Content

20 January 2021 Volume 35 Issue 1

  

Analysis of distant metastasis and prognosis of adenoid cystic carcinoma of the external auditory canal

WANG Yingying, ZHOU Han, DONG Weida, XING Guangqian, CHEN Zhibin, ZHANG Qingzhao, ZHANG Liqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  1-6.  doi:10.6040/j.issn.1673-3770.0.2020.087

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Objective This study aimed to investigate the risk factors of distant metastasis of adenoid cystic carcinoma of the external auditory canal and its influence on prognosis. Methods We performed a retrospective analysis of the clinical data and follow-up information of 22 patients who underwent radical surgeries and were diagnosed with adenoid cystic carcinoma of the external auditory canal by pathology. They were admitted to the First Affiliated Hospital of Nanjing Medical University from June 2007 to March 2019. The risk factors of distant metastasis and their influence on prognosis were analyzed by univariate and multivariate analyses. Results The rate of distant metastasis in this group was 40.9%, and the incidence of lung metastasis was the highest(66.7%). Univariate analysis showed that positive surgical margin and lymphatic metastasis during the operation were related to distant metastasis of adenoid cystic carcinoma of external auditory canal(P<0.05). Multivariate regression analysis showed that positive surgical margin and lymphatic metastasis were significantly associated with distant metastasis(P<0.05). The 5-year and 10-year overall survival rates of patients with adenoid cystic carcinoma of the external auditory canal who developed distant metastasis were 44.4% and 16.7%, respectively, while those without distant metastasis had 100% 5-year and 10-year survival rates. The difference was statistically significant(P<0.05). Conclusion Adenoid cystic carcinoma of the external auditory canal has a higher rate of distant metastasis, with predominant lung metastasis. Positive surgical margin and lymphatic metastasis were were independent risk factors for distant metastasis, which is an important indicator affecting the prognosis of patients with the tumor.

Effect of repetitive transcranial magnetic stimulation on chronic vestibular syndrome

LI Jiawei, LIU Xiaoyang, YANG Xingyu, SUN Xiaoming, LI Xidan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  7-10.  doi:10.6040/j.issn.1673-3770.0.2020.060

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Objective This study aimed to investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on chronic vestibular syndrome(CVS). Methods Sixty patients with chronic vestibular syndrome(CVS)were randomly divided into a control group and a treatment group, each with 30 patients. Patients in both groups performed eye-tracking exercises in the vertical and horizontal directions. The treatment group was treated with rTMS for 4 weeks. The dizziness evaluation scale(DHI)score and unilateral/bilateral semicircular canal response(UW)values of the two groups before and after treatment were compared and analyzed. Results There was no significant difference in DHI score between the treatment group and the control group before treatment(P=0.872)while there was no significant difference in UW value between hot and cold test(P=0.079). However, after treatment, the difference of DHI score was statistically significant between the two groups(P<0.01)and the UW value of cold and hot test decreased, and the difference was statistically significant(P=0.02), There were significant differences in DHI score and UW value between the two groups before and after treatment(P<0.01), The difference in DHI score before and after treatment in the treatment group was 39.40 points, while the difference in DHI score before and after treatment in the control group was 25.67 points, the difference in UW score before and after treatment in the treatment group was 16.03, and the difference in UW score before and after treatment in the control group was 12.03. Conclusion rTMS is effective in the treatment of CVS and is good for promoting the establishment of vestibular compensation.

Application of air sac urinary catheter in nasal packing after endoscopic nasal surgery with a resection of sinonasal tumor

GAO Tianxi, LI Na, LI Julin, ZHANG Aling, ZHU Kang, CHEN Jingguo, SUN Bin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  11-15.  doi:10.6040/j.issn.1673-3770.0.2020.075

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Objective The aim of this study was to assess the utility of an air sac urinary catheter after endoscopic nasal surgery with a resection of a sinonasal tumor. Methods The clinical data of 60 patients treated with endoscopic nasal surgery with resection of sinonasal tumors in the Department of Otorhinolaryngology-Head and Neck Surgery in our hospital from March 2016 to January 2019 were retrospectively analyzed and summarized. The clinical outcomes of 32 cases of nasal packing with an air sac urinary catheter and gelatin sponge in the observation group and 28 cases with conventional gelatin sponge in the control group were compared. Results The visual analogue scale(VAS)score was significantly lower in the observation group than in the control group for postoperative pain and nasal resistance degree after surgery(P<0.05). The incidence of nasal-cardiac reflex at the pack removal time was higher in the control group(P<0.05). There was no significant difference in blood loss between the two groups(P>0.05). Conclusion Our results indicate significant advantages in combination air sac urinary catheter with gelatin sponge in nasal packing after endoscopic nasal surgery with a resection of sinonasal tumor.

Nasal teeth in children: a report of four cases with literature review

WANG Li, YUAN Huwei, PAN Hongguang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  16-20.  doi:10.6040/j.issn.1673-3770.0.2020.091

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Objective The aim of this study was to explore the pathogenesis, diagnosis, and treatment characteristics of intranasal teeth in children in order to improve the diagnosis and treatment and to reduce misdiagnoses and mistreatment in these cases. Methods The clinical data of 4 cases of nasal teeth in children were retrospectively assessed. The features of their frequent sites, main symptoms, diagnoses, surgical methods, and follow-up results were analyzed. Results The growth sites of the nasal teeth in 4 patients were all at the bottom of the nasal cavity, 2 cases on the left, 1 case on the right, and 1 case on both sides. Common symptoms were nasal obstruction, runny nose, epistaxis, and a peculiar nasal smell. CT is useful in the diagnosis. All patients underwent nasal tooth resection under nasal endoscope. Follow-ups from 3 months to 3 years after surgery showed no recurrence, no nasal adhesion, and no cases of hard palate fistula. Conclusions Nasal teeth in children are usually unilateral; however, there are also cases of bilateral nasal teeth which are easily misdiagnosed as nasal foreign bodies. The onset age is older than that of children with nasal foreign bodies. Children over 6-years-old with nasal odor need to be considered for the possible diagnosis of nasal teeth. Endoscopic resection of nasal teeth is the primary method to treat these cases..

Effect of enhanced recovery after surgery in the perioperative period of endoscopic septoplasty

XU Jianhui, LI Xin, CUN Jingjing, YE Fei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  21-24.  doi:10.6040/j.issn.1673-3770.0.2020.111

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Objective To investigate the effect of enhanced recovery after surgery(ERAS)in the perioperative period of endoscopic septoplasty. Methods Forty patients undergoing endoscopic septoplasty from July 2017 to October 2019 were prospectively selected for the study, and were randomly divided into the routine group(20 patients)and ERAS group(20 patients). The routine group was given routine perioperative treatment measures, while the ERAS group was given the ERAS program. The visual analog score(VAS)for postoperative nasal pain, postoperative hospital stay, postoperative recovery quality-15(QoR-15), and postoperative complications were compared between the two groups. Results The VAS scores 24 and 48 hours after the operation in the ERAS group were 2(1,3)and 1(1,1.75), respectively. These were lower than those in the routine group 5(4.25,6.75)and 3(2.25,4), respectively; P<0.001. The postoperative hospitalization time in the ERAS group was 2(2,2)days, which was shorter than that in the routine group 4(4,5)days. This difference was statistically significant(Z=-5.400,P<0.001). The preoperative ERAS group and routine group QoR-15 scores were 141.6±3.5 and 141.9±3.7, respectively, which was not statistically significant(t=-0.308,P=0.760). The QOR-15 scores of the ERAS group, 24(138.8±3.8)and 48(141.8±2.9)hours after the operation were higher than those of the routine group(103.5±8.5 and 126.2±8.6, respectively). This difference was statistically significant(t=16.841,P<0.001;t=7.689,P<0.001). There was no significant difference in the incidence of postoperative complications between the two groups(χ2=0.360,P=0.548). Conclusion ERAS is safe and effective in the perioperative period of endoscopic septoplasty, it can shorten hospitalization time and improve quality of life.

The psychological status of patients with nasal skull base tumor after endoscopic surgery

WEI Wei, YANG Xiaotong, LIU Junqi, YAN Bo, WANG Zhenlin, ZHANG Qiuhang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  25-29.  doi:10.6040/j.issn.1673-3770.0.2020.118

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Objective To analyze the psychological changes in patients with nasal skull base tumor after endoscopic surgery. Methods Applying the Zung-self-rating anxiety scale(SAS), Zung-self-rating depression scale(SDS), aggression questionnaire(AQ), and empty nose syndrome 6-item questionnaire(ENS6Q), we assessed 62 patients with nasal skull base tumor before surgery, at three months, and a year after surgery. Results The preoperative SAS scores(42.29±9.24)were significantly higher than those of the national normal model, and the postoperative scores at 3 months(38.94±8.08)and a year after surgery(37.74±8.19)(P<0.05). The preoperative SDS scores(46.06±8.03)were higher than those of the national normal model and the postoperative scores at 3 months(43.63±6.72)and a year after surgery(42.94±7.42)(P<0.05). At one year after surgery, the SDS scores of patients with benign tumors(40.59±6.69)were lower than those of patients with malignant tumors(44.74±7.54)(P<0.05). The postoperative ENS6Q scores of patients who underwent turbinectomy were significantly higher than those of patients before surgery(P<0.01). The SAS, SDS, and AQ scores of patients who underwent turbinectomy were not significantly different from the scores of patients with turbinate preservation before and after surgery(P>0.05). Conclusion The patients with nasal skull base tumor obviously experienced anxiety and depression. Psychological care and interventions should be provided to them.

Expressions of E-cadherin and ZEB2 in sinonasal inverted papilloma and their clinical significance

SHI Shujing, FANG Jinglei, ZHANG Anqi, XU Li, LIU Ranran, HAN Zhenqiang, WANG Jianguo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  30-34.  doi:10.6040/j.issn.1673-3770.0.2020.127

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Objective To investigate the expressions of E-cadherin and ZEB2 mRNAs in sinonasal inverted papilloma(SNIP)and assess their clinical significance. Methods Quantitative fluorescence polymerase chain reaction was performed to detect the expressions of E-cadherin and ZEB2 mRNAs in 51 cases of SNIP and 20 cases of hyperplastic turbinate tissues and investigate the relationship and correlation between E-cadherin and ZEB2 mRNA expressions and clinicopathological parameters of SNIP patients. Results The expression of E-cadherin mRNA was lower in SNIP than in hyperplastic turbinate tissue(P=0.007)and that of ZEB2 mRNA was higher in SNIP than in hyperplastic turbinate tissue(P=0.034), both with statistically significant differences. The low expression of E-cadherin mRNA and high expression of ZEB2 mRNA were not related to the age, sex, clinical stage, or recurrence of SNIP, but were related to the pathological differentiation of SNIP. Further, the difference between the atypical hyperplasia and malignant transformation groups was statistically significant. The expressions of E-cadherin and ZEB2 mRNAs correlated negatively(r=-0.317, P=0.023). Conclusion In SNIP, the E-cadherin mRNA expression was downregulated, whereas ZEB2 mRNA expression was upregulated, showing a negative correlation. Both abnormal expressions were related to the pathologic differentiation of SNIP. The mechanism may be downregulation of the E-cadherin expression by ZEB2, promoting the occurrence and malignant transformation of SNIP.

Clinical characteristics and prognosis of sudden sensorineural hearing loss in post-irradiated nasopharyngeal carcinoma survivors: a report of 18 cases

TAN Yufang, YI Tianhua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  35-39.  doi:10.6040/j.issn.1673-3770.0.2020.133

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Objective The aim of this study is to analyze the clinical characteristics and prognosis of sudden sensorineural hearing loss(SSNHL)in post-irradiated nasopharyngeal carcinoma(NPC)survivors. Methods Medical records of 18 SSNHL patients diagnosed with NPC(NPC group)between January 2014 and May 2019 were reviewed and analyzed, including age, sex, side, treatment delay time, accompanying symptoms, hearing loss severity, audiogram pattern, interval between SSNHL and NPC, and post-treatment hearing outcome. Results Eighteen patients had unilateral hearing loss, including 10 right ears(55.56%)and 8 left ears(44.44%); the sex distribution comprised of 15 males(83.33%)and 3 females(16.67%); 11 ears(61.11%)were accompanied with tinnitus and 10 ears(55.56%)were accompanied with vertigo; 10 patients(55.56%)exhibited total deafness-type hearing loss, and 12 patients(66.67%)suffered severe or profound hearing loss. The rates of complete recovery, significant recovery, partial recovery, and no recovery after treatment, 1 month post-treatment, and 3 months post-treatment were 5.56%, 11.11%, 16.67%, 66.67%, 5.56%, 16.67%, 16.67%, 61.11%, and 5.56%, 11.11%, 22.22%, and 61.11%, respectively. No statistical difference was observed between the three groups(P>0.05). Hearing gains and contralateral hearing gains were 12.22±5.16 dB HL, 3.61±2.33 dB HL, 13.89±6.88 dB HL, 4.44±2.15 dB HL, 13.33±6.02 dB HL, and 3.89±2.58 dB HL, respectively, and hearing gains were higher than the contralateral hearing gains(P<0.05). Conclusion In this study, post-irradiated NPC survivors with SSNHL demonstrated a severe hearing loss with a high rate of accompanying vertigo, and most audiograms revealed total deafness. Although hearing recovery is poor, active treatment can still improve the hearing prognosis and can even be curative.

Agreement and association analyses of skin prick testing and serum specific IgE assay for aeroallergen detection in patients with allergic rhinitis from Jiangsu and Anhui areas

YANG Qing, LU Meiping, CHENG Lei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  40-46.  doi:10.6040/j.issn.1673-3770.0.2020.279

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Objective To assess the agreement and association between skin prick testing(SPT)and serum specific IgE(sIgE)in detecting common aeroallergens in patients with allergic rhinitis(AR). Methods The study included 101 patients(53 males and 48 females; age range: 4 to 68 years, average age: 38.5±14.8 years)from the Jiangsu and Anhui Provinces who received treatment for AR in the First Affiliated Hospital of Nanjing Medical University from November 2018 to December 2019. All the patients simultaneously underwent SPT and sIgE for the detection of 10 aeroallergens; these included 6 perennial indoor allergens(Dermatophagoides farina, Dermatophagoides pteronyssinus, cat dander, dog dander, Blattella germanica, and Alternaria alternate)and 4 seasonal pollen allergens(birch, ragweed, humulus, and Artemisia ［A. annua or A. argyi］). Meanwhile, the results of the allergen detection were analyzed by SPSS 24.0 software. Results The agreement percentages of the detections of D. farina, D. pteronyssinus, A. alternata, cat dander, dog dander, humulus, B. germanica, ragweed, Artemisia, and birch by SPT and sIgE were 75.28%, 72.09%, 39.13%, 36.84%, 11.11%, 14.29%, 12.50%, 22.22%, 13.33%, and 15.38%, respectively. Cohen's kappa statistics showed that the κ-coefficients were between 0.146 and 0.484. Among them, the κ-coefficients of A. alternata, cat dander, and D. farina were 0.484, 0.471, and 0.413, respectively, which indicated moderate agreements. The κ-coefficients of D. pteronyssinus, ragweed, and birch were 0.398, 0.330, and 0.215, respectively, which indicated lower agreements. All the κ-coefficients of the other four allergens were less than 0.20, indicating poor agreement. Spearman's rank correlation analysis showed positive correlations between the SPT and sIgE results for the detection of the 10 aeroallergens(r_s ranged from 0.174 to 0.548). The r_s values of D. farina, A. alternata, cat dander, and D. pteronyssinus were 0.548, 0.532, 0.483, and 0.440, respectively, indicating moderate correlations. The r_s values of humulus, birch, and dog dander were 0.240, 0.239, and 0.210, respectively, indicating poor correlations. The r_s values of the other three allergens were all < 0.20, indicating very poor correlation. Conclusion This study demonstrated large discrepancies in the agreement and association between the SPT and sIgE detections of common aeroallergens in patients with AR in the Jiangsu and Anhui areas. The combination of in vivo and in vitro methods for allergen testing is recommended to improve the accuracy of the clinical diagnosis of AR.

Nasonex and montelukast sodium in the treatment of adenoidal hypertrophy: a Meta-analysis

GU Tingting, LIU Yan, ZHANG Yue, YU Dan, WEN Lianji

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  47-55.  doi:10.6040/j.issn.1673-3770.0.2020.181

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Objective To evaluate the efficacy of Nasonex and montelukast sodium in the treatment of adenoidal hypertrophy. Methods We conducted a systematic literature search of Pub Med, Wangfang, and the Chinese National Knowledge VIP database 2010-2020 for Nasonex and montelukast sodium treatment in children with adenoidal hypertrophy. Standard articles were screened according to inclusion and exclusion criteria. The methodological quality of trials was evaluated with the Cochrane Handbook criteria, and the Review Manager 5.3 Revman5.1 software used for Meta-analyses. Finally, eleven articles, describing 865 patients, were selected, and included in the meta-analysis. Results The meta-analysis showed that the total effective rate of Nasonex combined with montelukast sodium(“the combination drug”)was significantly higher than that of Nasonex alone(“the single drug”)in the treatment of adenoidal hypertrophy in children(OR=4.29, 95%CI［2.72, 6.77］, P<0.000 01). The combination drug also caused a significant decrease in the A/N ratio(adeniod/nasopharynx ratio))(MD =-0.06, 95%CI［-0.10, -0.03］, P<0.000 1), and lowered clinical symptoms(MD=-1.40, 95%CI［-1.57, -1.23］). The combination drug significantly improved the quality of sleep in comparison to the single drug(MD=-1.40, 95%CI［-1.60, -1.20］, P<0.000 01). The combination group also demonstrated lower effects on the impact on daily functioning than the single drug group(MD=-1.07, 95%CI［-1.22, -0.93］, P<0.000 01). Conclusion Based on the current research and analysis, Nasonex combined with montelukast sodium has a significant clinical effect in the treatment of adenoidal hypertrophy in children. It is also a better choice to relieve various clinical symptoms and reduce the volume of adenoids than Nasonex alone. There was no literature that reported obvious adverse reactions.

Preliminary study of rhinomanometry and acoustic rhinometry for normal adults in Chongming, Shanghai

WANG Huan, ZHANG Yinjie, HUANG Qingfeng, SHI Lejuan, CHEN Xiangping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  56-60.  doi:10.6040/j.issn.1673-3770.0.2020.203

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Objective To establish the normal reference ranges of nasal rhinomanometry(RM)and acoustic rhinometry(AR)results for healthy adults in the Chongming area as an objective measurement of the nasal ventilation function and to analyze the correlation preliminarily. Methods The NR6 rhinomanometer was used to calculate the inspiratory expiratory resistances of the unilateral nasal cavity measured at the front end under the pressure difference across the nose of 150 Pa. Unilateral and bilateral total resistances were calculated using computer software. The A1 nose acoustic reflect meter was used to collect the volume(V₆, V_2-5, and V₃), minimum cross-sec6tional area(MCA), and minimum nasal cavity volume of bilateral nasal cavities, and distance from the cross-sectional area to the anterior nostril(MD). Correlation analyses was performed for two indexes. Results The nasal resistance parameters of healthy adults showed a unilateral total resistance of(0.85±0.36)Pa/cm³·s and bilateral total resistance of(0.42±0.16)Pa/cm³·s, when the nasal pressure difference at the front was 150 Pa. There was no significant difference in sex. Nasal acoustic reflex parameters were as follows: V₆,(6.14±1.70)cm³; V_2-5,(2.77±1.10)cm³; MD,(1.92±0.27)cm³; V₃,(2.19±0.51)cm³ for women and(2.06±0.39)cm³ for men; MCA,(0.34±0.19)cm³ for women and(0.31±0.14)cm³ for men. V₆, V_2-5, and MD were not statistically different between the sexes, whereas V₃ and MCA statistically differed between the sexes. There was a negative correlation between MD and unilateral total resistance(r=-0.149, P<0.05). Conclusion RM and AR are objective reference indexes to evaluate the function of nasal ventilation. The correlation between them is weak; therefore, it is more valuable to combine the two results in clinical practice.

Ten cases of chronic ethmoid sinusitis were accurately treated by electromagnetic navigation guided ethmoid sinus balloon angioplasty

WAGN Zaixing, TANG Zhiyuan, ZHAO Hailiang, LIU Zhixian, LI Dingbo, LI Sheng, MA Shibo, LU Yongtian

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  61-68.  doi:10.6040/j.issn.1673-3770.0.2020.208

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Objective Evaluation of the surgical effect of using electromagnetic navigation guidance for balloon dilatation in ethmoid sinus surgery. Methods We retrospectively analyzed the clinical data of 20 cases of chronic sinusitis surgically treated with electromagnetic navigation balloon sinuplasty(ENBS)or functional endoscopic sinus surgery(FESS). We statistically analyzed the visual analog scale(VAS)score, the 22-item Sinonasal Outcome Test(SNOT-22)result, and Lund-Mackay score(LMS)before and after surgery. Results ENBS and FESS showed significant differences in the VAS score, SNOT-22 result, and LMS score before and after surgery as well as in surgery time, blood loss volume, and postoperative epithelial healing time. Conclusion ENBS and FESS for chronic sinusitis had good curative effects and showed no significant differences in the surgical treatment effect. However, ENBS enabled a more precise positioning of the scope, shorter operation time, lesser blood loss volume and trauma, and shorter postoperative recovery time compared to FESS.

Comparative study of the Xiangju capsule and Kangfuxin liquid in the treatment of chronic rhinosinusitis with nasal polyps after functional endoscopic sinus surgery

ZHANG Jinzhuang, YIN Pu, LIU Ning, WANG Jiangyu, JIA Yunfen, DING Yuanji, WU Yao

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  69-76.  doi:10.6040/j.issn.1673-3770.0.2020.217

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Objective In order to evaluate the efficacy and safety of orally administered Xiangju Capsule and lavage with the Kangfuxin solution in patients with chronic rhinosinusitis with nasal polyps(CRSwNP)after functional endoscopic sinus surgery(FESS). Methods From January to December 2019, 90 patients with CRSwNP were randomly divided into three groups: rehabilitation (n=30), Xiangju(n=30), and control (n=30). All patients underwent FESS and the same routine postoperative management. After FESS, the control, Xiangju, and Kangfuxin groups were treated with budesonide nasal spray, Xiangju capsule, and Kangfuxin solution, respectively. The course of treatment was 12 weeks. The clinical effects, postoperative mucosal outcome, adverse reactions, and recurrence were compared among the three groups. The visual analogue scale(VAS)score of subjective symptoms and levels of high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factors, and interleukin(IL)-6 and IL-10 were measured before and after the operation. Results There was no significant difference in the total effective rate in 96.7%(29/30)of the rehabilitation group, 93.3%(28/30)of the Xiangju group, and 86.7%(26/30)of the control group(P>0.05). Compared to the Xiangju group, there was no significant difference in the recurrence rate 1 year postoperatively in the group(P>0.05). As the treatment time prolonged, the VAS scores of subjective symptoms in all three groups gradually decreased(P<0.05). Four and 12 weeks postoperatively, the subjective symptom scores were significantly lower in the rehabilitation and Xiangju groups than in the control group(P<0.05)and in the rehabilitation group compared to the Xiangju group(P< 0.05). Eight weeks postoperatively, the epithelialization rate was 65.5%(19/29)in the Kangfuxin group, which was significantly higher than that in the Xiangju or control group(40.0% ［12/30］; 26.7% ［8/30］, P<0.05). Compared to the control group, the time of Mucosal epithelization in Kangfuxin group and Xiangju group was significantly shorter (P<0.05), and the time of mucosal epithelization in the Kangfuxin group was more favorable than that in the Xiangju group(P<0.05). The Lund-Kennedy score in all three groups decreased gradually with the treatment time(P<0.05). At the same time point, the Lund-Kennedy score in the rehabilitation and Xiangju groups were significantly lower than those in the control group(P<0.05)and in the rehabilitation group compared to the Xiangju group(P<0.05). The levels of serum hs-CRP, TNF, and IL-6 were significantly lower in the Kangfuxin and Xiangju groups than in the control group(P<0.05), and the levels of serum IL-10 were significantly higher in the Kangfuxin and Xiangju groups than in the control group(P<0.05). After 3, 7, and 15 days, the improvement in serum inflammatory factors in the rehabilitation group was significantly better than that in the Xiangju group(P<0.05). There were no significant drug-related side effects in any patient. Conclusion Compared to the treatment with the oral Xiangju capsule, the overall efficacy, recurrence control, and safety of post-FESS nasal spray combined with budesonide nasal spray and Kangfuxin irrigation were similar. However, the clinical symptoms of patients with CRSwNP can be quickly alleviated using the Kangfuxin solution, which can speed up the improvement of the mucosa and further shorten the time of mucosal epithelization. The mechanism of action may be the rapid correction of the imbalance of inflammatory factors in the body. “Budesonide nasal spray plus rehabilitation fluid irrigation cavity” is expected to become a standard treatment after FESS.

Diagnosis and nasal endoscopic surgery of congenital basal meningoencephaloceles in infants

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

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  77-81.  doi:10.6040/j.issn.1673-3770.0.2020.188

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Objective The aim of this study is to investigate the diagnosis of congenital basal meningoencephalocele in infants and the safety and effectiveness of nasal endoscopic surgery. Method A retrospective analysis of the clinical data of 8 cases of congenital basal meningoencephalocele in infants admitted at the Xinhua Hospital affiliated with Shanghai Jiaotong University School of Medicine between April 2014 and December 2019 was conducted. Preoperative sinus CT and MRI examinations were performed, and all cases underwent endoscopic meningoencephalocele resection and skull base reconstruction. Results Six patients presented with transethmoidal meningoencephalocele and 2 transsphenoidal meningoencephaloceles. The operation was successful at one time without complications. There were no recurrences after 6~74 months of follow-up. Conclusion For infants with persistent nasal obstruction and nasal overflow with neoplasms in the nasal cavity or nasopharynx, the possibility of congenital basal meningoencephalocele should be considered. Sinus CT and MRI examinations have important diagnostic significance. Nasal endoscopic resection of the bulge and reconstruction of the skull base is a safe and effective operation and has a good clinical effect.

Effects of palatal arch suturing on postoperative hemorrhage after tonsillectomy

TIAN Tianjie, ZHANG Zixion, YANG Fei, ZHOU Yi

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  82-85.  doi:10.6040/j.issn.1673-3770.0.2020.114

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Objective To evaluate the effect of palatal arch suturing on reducing the risk of postoperative hemorrhage after tonsillectomy. Methods We retrospectively analyzed 234 cases of adult tonsillectomy performed by the same chief physician of our department from January 2013 to October 2019. All patients underwent low-temperature plasma tonsillectomy under general anesthesia. Among them, 125 patients received bilateral palatal arch suturing to prevent postoperative hemorrhage(observation group), while 109 patients received no palatal arch suturing(control group). The incidences of postoperative hemorrhage in both groups were recorded. Results The incidences of primary hemorrhage in the observation and control groups were 0.8% and 6.4%, respectively, with a statistically significant difference(χ2=6.11, P=0.027, P<0.05); the secondary hemorrhage rates of the observation and control groups were 14.4% and 9.2%, respectively, with no statistically significant difference(χ2=1.51, P=0.219, P>0.05); the secondary hemorrhage peaks in the observation and control groups were mainly on postoperative days 7 to 10, accounting for 77.8% and 80% of the postoperative hemorrhage, respectively, with no statistically significant difference(χ2=0.019, P>0.999, P>0.05); in the observation group, there were five cases of palatal arch tearing during intraoperative suturing and three cases of pharyngeal cavity scar healing. Conclusions Palatal arch suturing could reduce the incidence of primary postoperative hemorrhage but not necessarily that of secondary hemorrhage after tonsillectomy. In addition, palatal arch suturing could cause complications, such as palatal arch tearing and scar healing. Accordingly, we should reasonably grasp and apply this method instead of blindly magnifying its effect of reducing the risk of postoperative hemorrhage after tonsillectomy.

Relationship between serum procalcitonin level of tumor-bearing mice and medullary thyroid carcinoma

ZENG Bo, TIAN Xingde

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  86-91.  doi:10.6040/j.issn.1673-3770.0.2020.157

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Objective To study the relationship between serum procalcitonin(PCT)and calcitonin(CT)levels in medullary thyroid carcinoma(MTC). Methods We evaluated the serum PCT and CT levels, tumor weight and volume, and bodyweight using MTC mice models to ascertain the relationship between serum PCT and CT and tumors. Results Serum PCT and CT in the group A mice were significantly and positively correlated with tumor weight; serum PCT and CT were also positively correlated. Conclusions This experiment demonstrates that serum PCT may be used as a tumor marker for MTC, in addition to serum CT, which has demonstrated utility for the diagnosis of MTC.

Big bubble assisted deep lamellar keratoplasty surgery for keratoconus

ZHANG Bin, LI Wei, HE Wei

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  92-94.  doi:10.6040/j.issn.1673-3770.0.2020.095

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Objective To evaluate the clinical results and safety of big bubble assisted deep anterior lamellar keratoplasty for keratoconus. Methods A case series of 20 eyes of 18 keratoconus patients underwent big bubble assisted deep anterior lamellar keratoplasty. Analysis of surgical techniques, observation of postoperative efficacy and safety. Results All of the patients operated smoothly and recovered well. The postoperative vision was improved to varying degrees, and there were no complications such as infection and rejection. Conclusions Treatment of keratoconus with big bubble assisted deep lamellar keratoplasty has good clinical effect and safety.

Endogenous endophthalmitis associated with Klebsiella pneumoniae pyogenic liver abscess: a report of 31 cases

PU Yadi, LI Yuanbin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  95-98.  doi:10.6040/j.issn.1673-3770.0.2020.227

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Objective To analyze the clinical characteristics of endogenous endophthalmitis(EE)associated with Klebsiella pneumoniae pyogenic liver abscess(KPPLA). Methods A retrospective analysis was performed, which included 31 patients(37 eyes)with EE associated with KPPLA admitted to the Yantai Yuhuangding Hospital affiliated to Qingdao University from 2013 to 2020. These patients were treated in the department of ophthalmology, hepatopancreatobiliary surgery, endocrinology, hematopathology, or respiratory medicine. General information, ophthalmologic findings, laboratory test results, etiology, imaging findings, treatment, and prognosis were analyzed. Results Most the 31 patients were middle-aged or elderly men, and most were diagosed with diabetic mellitus. Ten of the 37 eyes had no symptoms, which were diagnosed as EE during ocular examination. Twenty-two eyes were treated with an intravitreal injection, and 12 eyes were treated with vitrectomy. Ten eyes had improved visual acuity after treatment, while six eyes were enucleated. Conclusions Early symptoms of EE associated with KPPLA were atypical. Diabetes and severe systemic infection were the risk factors. Some patients had no ocular clinical manifestations in the early stage, and endophthalmitis was found in the ophthalmologic examination. Early ophthalmologic examination is important to detect asymptomatic EE. Timely and effective treatment can help preserve the patient's useful vision and improve the prognosis.

Preoperative timing and the effect of intravitreal aflibercept injection for proliferative diabetic retinopathy patients

LIU Zhigao, WANG Shuya, HAN Xuguang, WANG Yu, LI Zhiwei, MA Aihua, ZHAO Bojun

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  99-103.  doi:10.6040/j.issn.1673-3770.0.2020.250

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Objective To investigate the changes in vitreous inflammatory and angiogenic cytokine levels after administering intravitreal aflibercept(IVA)in the eyes with proliferative diabetic retinopathy(PDR). Methods A prospective comparative study was performed of the clinical data of the PDR patients who had undergone 23-gauge vitrectomy. Patients were divided into three groups: group A(16 eyes of 16 patients), without IVA administered preoperatively; group B(18 eyes of 18 patients), with IVA 2.0 mg administered 3 days preoperatively; and group C(18 eyes of 18 patients), with IVA 2.0 mg administered 6 days preoperatively. A total of 15 patients with idiopathic epiretinal membrane or idiopathic macular hole were selected as controls(group D). The vitreous humor was collected at the beginning of vitrectomy. The vitreal factors, including the vascular endothelial growth factor(VEGF)and basic fibrosis growth factor, were measured using the cytometric bead array. Results Higher levels of VEGF(P<0.05)in groups A, B, and C were observed compared to group D. However, VEGF levels were significantly higher in group A than in groups B and C(P<0.05). Conclusions IVA is effective in reducing the level of VEGF. IVA administered 3 to 6 days preoperatively is optimal and can help reduce complications.

Treatment of 48 cases of canaliculitis with small canalicular incision combined with RS-type lacrimal drainage tube

WANG Lin, WANG Ting, SUN Kaijian, WANG Da, CHEN Linlin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  104-108.  doi:10.6040/j.issn.1673-3770.0.2020.455

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Objective To investigate the efficacy of small canalicular incision combined with RS-type lacrimal drainage tube in the treatment of 48 cases of canaliculitis. Methods Case-control study. 92 patients(92 eyes)with canaliculitis were collected. The study group of 48 patients(48 eyes)was treated with small canalicular incision combined with RS-type lacrimal drainage tube. The control group of 44 patients(44 eyes)was treated with conventional canalicular incision combined with annular silicone tube. The detection indictors were compared between two groups by statistical analysis, including the time of exposing the canaliculus, the time and patient's discomfort of placing the tube during the operation, the time of removing the tube and the clinical efficacy of half a year follow-up after the operation. Results In the study group, the time of exposing the canaliculus was(2.29±0.54)minutes, the time of placing the tube was(2.38±0.62)minutes. Nine patients(18.75%)suffered from discomfort and pain during placing the tube without nasal cavity bleeding. The time of removing the tube was(0.22±0.12 )minutes, 45 cases were cured(93.75%), 2 cases were improved(4.17%), and 1 case was invalid(2.08%)in half a year follow-up after the operation. In the control group, the time of exposing the canaliculus was(2.20±0.50)minutes, the time of placing the tube was(2.86±0.74)minutes. The patient's discomfort of placing the tube included 17 painful cases(38.64%)and 11 nasal-blooded cases(25%). The time of removing the tube was(1.42±0.62)minutes, 40 cases were cured(90.91%), 3 cases were improved(6.82%), and 1 case was invalid(2.27%)in half a year follow-up after the operation. Compared with the control group, there was no significant difference in the time of exposing the canaliculus and the clinical efficacy of half a year after operation in the study group(P=0.427 and 0.618, respectively). In the study group, the time of placing and removing the tube was short, and the discomfort of patients was slight. The difference was statistically significant(P=0.001 and 0.000, respectively). Conclusion Small canalicular incision combined with RS-type lacrimal drainage tube in the treatment of canaliculitis has less surgical damage, convenient operation and exact efficacy.

Progress in aryl hydrocarbon receptor-induced inhibition of Th17 immune response in allergic rhinitis

YANG Yanyan, YANG Yujuan,SONG Xicheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  109-113.  doi:10.6040/j.issn.1673-3770.0.2020.037

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Allergic rhinitis(AR)is an immunoglobulin E(IgE)-mediated inflammatory response on the nasal mucous membranes that usually ensues contact with allergens. Studies on a Th1/Th2 cell model alone are not sufficient for discussing the pathogenesis of AR; hence, the Th1/Th2; Thl7/Treg cell model has recently been a topic of concern. The aryl hydrocarbon receptor(AhR)is a member of the basic helix-loop-helix/PER-ARNT-SIM family, which is activated by its ligand and expresses strong immunomodulation potential by regulating the differentiation of T lymphocytes and dendritic cells. This effect may play a protective role in autoimmune and allergic diseases. This report summarizes our study on the correlation between AhR activation and Th17 immune responses in AR patients, and provides new insights for further diagnosis and treatment of AR.

Research progress of IL-36 in chronic rhinosinusitis with nasal polyps

MU Tingting, YANG Yujuan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  114-118.  doi:10.6040/j.issn.1673-3770.0.2020.146

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Interleukin-36(IL-36), a member of the IL-1 superfamily(IL-1F), is biologically active in epithelial cells and in specific immune cells. Its main functions include promoting cell activation, secreting cytokines and chemokines, and recruiting and activating different immune cells. Recent studies have found that the IL-36 family has a role in the pathogenesis of chronic rhinosinusitis with nasal polyps(CRSwNP). This article reviews the research progress and biological characteristics of IL-36 in promoting the inflammatory response, tissue remodeling, and disrupting the epithelial barrier in chronic rhinosinusitis with nasal polyps.

Research progress on differentially-expressed protein kinases and inhibitors in hypopharyngeal carcinoma

WANG Yayue,SUN Juan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  119-124.  doi:10.6040/j.issn.1673-3770.0.2020.089

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Among tumors of the head and neck, hypopharyngeal cancer is highly malignant and patients suffering from it have a poor quality of life, usually with a poor prognosis. Surgery is the main method of treatment of hypopharyngeal cancer, assisted by radiotherapy and chemotherapy. After surgery, the patient's laryngeal function is seriously impaired. Finding a treatment method that can protect the laryngeal function as much as possible is the focus of current research. Targeted therapy is of great significance to protecting the laryngeal function and improving the quality of life of patients with hypopharyngeal carcinoma. The study found that a variety of protein-kinase-mediated signaling pathways and genes are involved in the development of this pathology. Now, protein kinases PKC-β, CDK4/6, Cdc42, Rac1, and STK33, which might have an important role in this process, CK2 and PHLPP are reviewed. There is hope that protein kinase inhibitors would provide new directions for the treatment of hypopharyngeal cancer.

Research progress on the relationship between the C₂H₂ zinc finger protein family and laryngeal cancer

LI Wenjing,LIU Ming

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(1):  125-130.  doi:10.6040/j.issn.1673-3770.0.2020.102

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Laryngeal cancer is one of the most common malignancies in head and neck cancer. Although continuous progress is being made in the diagnosis and treatment of laryngeal cancer, patient survival rates have not greatly improved. Cysteine-2/histidine-2(C₂H₂)-type zinc finger proteins(ZNFs), the largest family of transcription factors in humans, are characterized by multiple tandemly arranged zinc fingers. C₂H₂-type ZNFs are involved in normal biological processes such as transcriptional regulation, organ and tissue development, and differentiation; however, they are also associated with the occurrence and development of cancer. Studies have shown that the abnormal expression of various C₂H₂-type ZNFs is closely related to the clinicopathologic features and prognosis of cancers. This paper primarily reviews the progress of research on the relationship between C₂H₂-type ZNFs and laryngeal cancer.