Table of Content

20 March 2021 Volume 35 Issue 2

  

Further standardized promotion of the application of radiofrequency coblation in otorhinolaryngology, head and neck surgery

XIAO Shuifang, ZHANG Junbo

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  1-8.  doi:10.6040/j.issn.1673-3770.1.2020.104

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Radiofrequency coblation is a relatively new electrical cutting technology. Since its first introduction in Department of Otorhinolaryngology, Head and Neck Surgery for inferior turbinate reduction more than 20 years ago, this technology has been employed in a wide range of surgeries, including tonsillectomy, adenoidectomy, some pharyngeal surgeries for treating obstructive sleep apnea syndrome, and surgeries for resecting some benign or malignant disease located in located in nasal cavity, nasal sinus, nasal skull base, and upper aerodigestive tract. On the basis of literatures and our own clinical experience, we reviewed the application status of this technology, focusing on its advantages and limitations in different surgical procedures compared with other cutting devices. The purpose is to further promote the radiofrequency coblation assisted surgery, and to provide some references for physicians who want to perform the surgeries.

Application progress of radiofrequency ablation technology in the treatment of early glottic carcinoma

ZHOU En, XIAO Yu, XIAO Xuping

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  9-15.  doi:10.6040/j.issn.1673-3770.1.2020.101

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Early glottic laryngeal cancer treatment should focus not only on controlling the primary tumor and optimizing the tumor-free survival rate, but also on the preservation of the healthy laryngeal tissue, the protection of the voice function of the larynx, and improving the patient's quality of life. With advancements in medical technology and equipment, the clinical application of endoscopically-monitored laser, robotic, and plasma radiofrequency ablation surgeries aimed at preserving laryngeal function in early laryngeal cancer have been gaining popularity. This article reviews the progress made in the application of plasma radiofrequency ablation to the surgical treatment of early glottic carcinoma.

Application and progress of coblation in children with obstructive sleep apnea

FENG Chen, GUO Ruixiang, WANG Yan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  16-21.  doi:10.6040/j.issn.1673-3770.1.2020.105

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The scientific concept of precise and minimally invasive surgery promotes the continuous progress of otolaryngology head and neck surgery. A typical example is the application and development of coblation. This article describes the advantages and disadvantages of coblation in children with obstructive sleep apnea surgery(tonsillectomy and adenoidectomy). Its operation is simple, and the operation time is short. Regarding coblation, the surgical field is clear, and the amount of bleeding is low. Moreover, the temperature is low to avoid thermal burns. The wound surface is smooth and flat, the postoperative pain is mild, and the restoration to normal diet occurs early; the albuginea is formed early after the operation, but a thin layer of denatured collagen is added on the basis of inflammatory cells and fibrous tissue; therefore, the albuginea is thicker, and delayed shedding time may delay bleeding. This article highlights the individualized treatment of tonsillectomy in children and advocates for intracapsular(partial)tonsillectomy in order to preserve the immunity of children. Coblation technology has obvious advantages, but it still needs to be continuously explored in clinical practice to widen its application prospects.

Comparison of coblation assisted tonsillectomy and tonsillotomy in children

SHEN Yao, ZHOU Chengyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  22-27.  doi:10.6040/j.issn.1673-3770.1.2020.087

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Objective To compare the efficacy of coblation assisted tonsillectomy and tonsillotomy in the treatment of children with obstructive sleep apnea-hypopnea syndrome. Methods This was a retrospective review of 4 311 children who underwent adenoidectomy and coblation assisted tonsillectomy or tonsillotomy in our hospital from January 2004 to December 2018. The patients were divided into two groups according to the operation method performed along with adenoidectomy: coblation assisted tonsillectomy was performed in 358 patients in group A, and coblation assisted tonsillotomy was performed in 3953 patients in group B. The operation time, degree of postoperative pain, number of days taken to return to normal eating, and incidence of secondary hemorrhage were compared. After 1 year follow-up, the recurrence rate and sleep snoring and suffocation scores were compared between the two groups. Results The operation time(28.42±9.51 minutes), degree of postoperative pain(2.67±0.75), number of days taken to return to normal eating(7.15±2.56 days), and incidence of secondary hemorrhage(0.15%)in group B were lower than those in group A, and the differences were statistically significant(t=9.841, P<0.01; t=30.251, P<0.01; t=31.489, P<0.01; χ2=13.224, P<0.01). There was a significant difference in sleep snoring scores before and after the operation in both the groups(group A: χ2=570.251, P<0.01; group B: χ2=6 767.566, P<0.001). There was also a significant difference in the suffocation scores before and after the operation in both the groups(group A: χ2=622.465, P<0.01; group B: χ2=6 293.219, P<0.001), but there were no significant differences in sleep snoring and suffocation scores between the two groups(F=4.643, P=0.075; F=5.335, P=0.060). Additionally, there was no significant difference in recurrence rate between the two groups(χ2=0.009, P=0.925). Conclusion The curative effect of tonsillotomy is similar to that of tonsillectomy, but it can shorten the operation time, improve the patient's postoperative comfort and reduce the incidence of secondary bleeding.

Clinical analysis of low-temperature plasma radiofrequency ablation for benign tumors in the parapharyngeal space

ZHU Huaming, GUAN Jian, MAO Song, ZHANG Weitian, YI Hongliang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  28-33.  doi:10.6040/j.issn.1673-3770.1.2020.086

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Objective To evaluate the feasibility and effect of low-temperature plasma radiofrequency ablation(LTPRA)in the operation of benign tumors in the parapharyngeal space(PPS). Methods Twenty patients with benign tumors in the PPS who underwent surgery in our hospital from January 2012 to December 2018 were analyzed. Of the 20 patients, 11(group A)were treated with LTPRA and 9(group B)without LTPRA. All the patients were thoroughly evaluated before surgery. The clinical data, pathological results, and surgical information of patients were collected. Results In this study, neurogenic tumors were the most common benign tumors in the PPS(13 cases). Six patients in group A(of 11 cases)underwent the transoral or transnasal surgical approaches. In group B, all nine patients underwent lateral approaches. Surgical complications occurred in both groups. One recurrent case was observed from group B. Conclusion Surgery for PPS tumors tends to be safe and minimally invasive. Different surgical approaches can be selected according to the location and character of the tumor. LTPRA plays an important role in the operation of PPS tumors in transoral and transnasal approaches.

A study of low-temperature plasma ablation for the treatment of benign thyroid nodules under ultrasound guidance

LI Jianzhong, ZHOU Yongrui, LI Huiying, LI Miaobian, SUN Yidi, QIU Qianhui

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  34-38.  doi:10.6040/j.issn.1673-3770.1.2020.096

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Objective To evaluate the clinical value of low temperature plasma ablation in the treatment of benign thyroid nodules under ultrasound-guidance. Methods 36 patients with benign thyroid nodules receiving the treatment of low temperature plasma ablation under ultrasound-guidance were randomly selected from October 2019 to October 2020. To study the volume(V), volume reduction rate(VRR)of thyroid nodule before operation and 1 month, 3 months and 6 months after operation, and serum free triiodothyronine(FT3), free thyroxine(FT4), thyrotropin(TSH)before operation and 1 month after operation, to evaluate the effectiveness and safety of low temperature plasma ablation in benign thyroid nodules under ultrasound-guidance. Results After related treatment, the volume of benign thyroid nodules gradually decreased and the volume reduction rate increased, the difference was statistically significant(F(1.311,45.887)=378.369;P<0.001); There was no statistic difference in TSH between the patients before the operation and the 1 month after treatment(P=0.123). Comparison of FT3 and FT4 before and 1 month after operation, FT3 and FT4 in 1 month after operation were slightly higher

Clinical analysis of 216 cases of congenital pyriform sinus fistula treated by radiofrequency ablation

DOU Qianwen, TIAN Xiufen

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  39-45.  doi:10.6040/j.issn.1673-3770.1.2020.092

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Objective Congenital pyriform sinus fistula(CPSF)is a rare parotid source disease. It is easily misdiagnosed as a simple abscess in the neck in clinical practice. In the past, neck fistulectomy was usually the treatment of choice; however, it was traumatic, and the fistula could not be eliminated completely, thus leading to recurrence. Our study aimed to investigate congenital pyriform sinus fistula and evaluate the therapeutic effect of radiofrequency ablation in the treatment of congenital pyriform sinus fistula. Methods The data of 216 patients with congenital pyriform sinus fistula treated by radiofrequency ablation between March 2013 and May 2019 were collected and analyzed retrospectively. Results Among the 216 patients, the ratio of males to females was approximately 1.18∶1, and 90.7% of the cases were left-sided, 8.3% were right-sided, and only 1.0% were bilateral. The age range of the patients was 23-66 years. Eight patients were lost to follow-up, with an average follow-up of 15 months. Among 208 patients after coblation, 17 cases(8.2%)had postoperative hoarseness, 12 cases(5.8%)had recurrence, and there was no infection, irritating cough, or esophageal injury. Conclusion Radiofrequency ablation is the first choice for the treatment of congenital pyriform sinus fistula.

Plasma radiofrequency assisted bilateral posterior partial transverse cordotomy in the treatment of 13 patients with upper airway obstruction caused by bilateral vocal cord paralysis

ZHAO Jing, LI Jinrang, GUO Hongguang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  39-45.  doi:10.6040/j.issn.1673-3770.1.2020.098

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Objective To evaluate the efficacy of the endoscopic plasma radiofrequency assisted bilateral posterior partial transverse cordotomy in patients with upper airway obstruction due to bilateral vocal cord paralysis. Methods Clinical data of 13 patients with upper airway obstruction caused by bilateral vocal cord paralysis was retrospectively analyzed, including 6 males and 7 females, aged 27-73 years. All patients underwent endoscopic plasma radiofrequency assisted bilateral posterior partial transverse cordotomy, to summarize and evaluate clinical effect of this operation. Results The follow-up period was from 1 year 1 month to 2 years 11 months, and no serious complications occurred in all the patients. A one-step successful decannulation was achieved in 84.44%(10/13), a two-step successful decannulation was achieved in 88.89%(11/13). Decannulation time was1-3 months, and the median decannulation time was 1 month.There was no recurrence of upper airway obstruction. Conclusion Endoscopic bilateral posterior partial transverse cordotomy can establish a reliable and effective airway and maximize the retention of swallowing and voice functions. At the same time, it is a safe, reliable, simple and minimally invasive treatment option.

Partial tonsillectomy for 86 cases of obstructive sleep apnea syndrome in children

LIU Shaofeng, HUANG Guiliang, HUANG Zhenyun, SUN Changzhi, LUO Renzhong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  50-54.  doi:10.6040/j.issn.1673-3770.1.2020.093

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Objective To investigate the complications of partial tonsillectomy in children with obstructive sleep apnea(OSA). Methods In this study, a total of 172 children with OSA who underwent surgery at our hospital from June 2018 to December 2018 were enrolled. The children were divided into a control group(n=86)and an observation group(n=86). The control group underwent tonsillectomy and the observation group underwent partial tonsillectomy. The effects of treatment were compared between the groups. Result There was no statistically significant difference in the occurrence of postoperative primary bleeding between the two groups(χ2=0.000, P>0.999). The proportion of secondary bleeding was higher in the control group than that in the observation group(χ2=4.317, P<0.038). The pseudomembrane shedding time in the observation group was earlier than that in the control group(t=7.393, P<0.001). The pain scores of the control group at 1 d and 3 d after operation were higher than those of the observation group(t=5.376, 8.881, P<0.001). There were no significant differences in the recurrence rate and infection rate between the two groups(χ2=0.506, 0.256, P=0.613). Conclusion Partial tonsillectomy may reduce postoperative secondary hemorrhage and postoperative pain, and promote postoperative recovery in children with OSA. It can be considered a valid alternative to conventional tonsillectomy in pediatric OSA syndrome.

Cryogenic plasma-assisted nasal resection of seventeen cases of anterior and middle skull base tumors

SUN Chuan, LIU Yaqun, HE Shuangba, ZHANG Qingxiang

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  55-59.  doi:10.6040/j.issn.1673-3770.1.2020.095

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Objective To investigate the effect of low-temperature plasma-assisted transnasal middle skull base tumor resection. Methods A retrospective analysis of the medical records of 17 patients with anterior middle skull base tumors excised using intranasal low-temperature plasma was conducted. The advantages and disadvantages of this technique were summarized, and the postoperative complications and therapeutic effects were noted. Results The intraoperative blood loss in this group was 70-800 mL, and the median blood loss was 210 mL. The duration of surgery was 50-270 min, and the median duration of surgery was 145 min. The duration of hospital stay ranged from 10 to 35 days, with an average of 21 days. All the 17 cases of nasal sinus and skull base tumors were completely resected. No cranial nerve injury and related dysfunction and complications, such as cerebrospinal fluid rhinorrhea and intracranial infection, were observed after the surgery. The patients were followed up for 54.9±29.8 months; 3 died, 1 was lost to follow-up, and the rest had no tumor recurrence. Conclusion Low-temperature plasma-assisted transnasal middle skull base tumor resection can safely and effectively reduce intraoperative hemorrhage, the duration of surgery, and postoperative complications.

Application of radiofrequency ablation with plasma spot excitation in early glottic carcinoma(T_is-T_1b)

XIAO Xuping, ZHOU En, XIAO Yu

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  60-66.  doi:10.6040/j.issn.1673-3770.1.2020.102

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Objective This study aimed to evaluate the efficacy of radiofrequency coblation(RFC)in the treatment of early glottic carcinoma(T_is-T_1b). Methods A total of 58 patients with early glottic carcinoma(T_is-T_1b)at People's Hospital were enrolled from October 2018 to April 2020. All patients were men. According to the surgical method, 31 and 27 patients were included in the RFC and CO₂ laser groups, respectively. The average patient age was 52.1±8.7 and 55.6±10.3 years in the RFC and CO₂ laser groups, respectively. In the RFC group, the tumor-node-metastasis(TNM)stage was T_is, T_1a, and T_1b in 6, 23, and 2 patients, respectively, while in the CO₂ laser surgery group, the TNM stage was T_is, T_1a, and T_1b in 3, 22, and 2 patients, respectively. All patients were followed up for 6-18 months, and the operation time, postoperative pain score, and cough score were recorded. All patients underwent reassessment at 1, 3, and 6 months after surgery using an electronic laryngoscope. Results The operation time was shorter in the RFC group than in CO₂ laser group(11.81 vs. 16.77 min, P<0.001). There were no significant differences in the length of hospital stay, blood loss, pain score, cough score, anterior conglutination rate, and granulomatous hyperplasia between the groups(P=0.676,0.390,0.483,0.483,0.094,0.788). All patients were followed up in the outpatient department. No deaths occurred during the follow-up period. Four patients developed local recurrence, including 2 patients(1 patient with T1b involving anterior commissure and 1 patient with T1a)in the RFC group and 2 patients(2 patients with T1b involving anterior commissure)in the CO₂ laser group. Both patients in the RFC group underwent repeat plasma surgery and 1 patient in the CO₂ laser group underwent CO₂ laser extended resection. In one patient with unilateral cervical lymph node metastasis, the surgery was converted to open surgery. There was no significant difference in the local recurrence rate between the groups(P=0.276). The acoustic parameters of Jitter, Shimer, and NHR recovered gradually in all patients at different time points postoperatively(P<0.05), and the acoustic parameters of the RFC group were better than those of the CO₂ laser group(P=0.000,0.001,0.000). Conclusion Radiofrequency ablation with the plasma spot excitation technique is safe and effective for the treatment of early glottic carcinoma(T_is-T_1b). It has the advantages of short operation time, small mucosal injury, and good preservation of voice function. However, the long-term tumor control rate and survival rate need to be further observed.

Thirty-seven cases of inverted papillomas in the nasal cavity and the nasal sinus treated by low-temperature plasma under nasal endoscope

WANG Shengguo, CHEN Zhitai, ZHOU Benzhong, LI Longqiao, SHI Xianping, WU Feifeng, ZHANG Zesheng

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  67-70.  doi:10.6040/j.issn.1673-3770.1.2020.090

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Objective To summarize the clinical characteristics of inverted papillomas in the nasal cavity and the nasal sinus in stage and evaluate the therapeutic feasibility of low-temperature plasma under nasal endoscopy. Methods Thirty-seven patients with inverted papillomas in the nasal cavity and the nasal sinus were treated with low-temperature plasma under nasal endoscopy. According to the staging system developed by Krouse, 8 cases were of the T1 stage, 18 cases were of the T2 stage, and 11 cases were of the T3 stage. Postoperative nasal endoscopy was performed for 4-10 years. Results The thirty-seven cases of inverted papilloma in the nasal cavity and nasal sinus were removed completely. Postoperative recurrence was observed in 3 patients, but no recurrence was observed after the second operation. Conclusion Nasal endoscopy combined with low-temperature plasma for the resection of T1-T3 inverted papillomas of the nasal cavity and sinuses is safe and minimally invasive, and it is associated with a low postoperative recurrence rate.

Application of endoscopic adenoids cryoablation combined with low-temperature plasma tympanostomy in the treatment of 55 children with adenoid hypertrophy and secretory otitis media

WU Hua, SUN Yongming, ZHENG Jianhua, CAI Xuehua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  71-75.  doi:10.6040/j.issn.1673-3770.1.2020.097

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Objective To explore the clinical efficacy of low temperature plasma adenoid ablation combined with low-temperature plasma tympanostomy for the treatment of secretory otitis media in children. Methods A total of 111 children(183 ears)with adenoid hypertrophy and secretory otitis media were randomly divided into an experimental group(55 cases, 89 ears)and a control group(56 cases, 94 ears). Both groups underwent low temperature plasma endoscopic adenoid ablation. Additionally, the control group underwent tympanoplasty while the experimental group underwent low-temperature plasma tympanoplasty under otoendoscope. The effectiveness and infection rates in the two groups were recorded after surgery, and the recurrence rate in the two groups was determined after six months of follow-up. Results There was no significant difference in the effective rates, infection rates and recurrence rates of serous secretory otitis media between the experimental group and the control group. The infection rate of mucinous secretory otitis media was not significantly different between the experimental group and the control group(P=0.191), but the effective rate of the experimental group was higher than that of the control group(P=0.006), and the postoperative recurrence rate was opposite, the difference was statistically significant(P=0.012). Conclusion Low temperature plasma adenoid ablation combined with low-temperature plasma tympanostomy has good therapeutic effect on secretory otitis media in children and may reduce the risk of postoperative recurrence.

Clinicopathological analysis of nodular fasciitis of head and neck

JI Yanping, XUE Yu, LIN Lan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  76-79.  doi:10.6040/j.issn.1673-3770.0.2020.235

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Objective To explore the clinicopathological features, immunophenotype, diagnosis, and differential diagnosis of nodular fasciitis(NF)in the head and neck. Methods The clinical manifestations of 28 patients with NF diagnosed pathologically in the head and neck at the Eye, Ear, Nose and Throat Hospital, Fudan University from 2008 to 2019 were collected, and their pathological morphology and immunohistochemical expression were analyzed using hematoxylin and eosin staining and EnVision. Finally, a retrospective analysis and literature review were performed. Results The number of men and women is analogous(male-to-female ratio: 1∶1.15). The age ranged from 4 to 77 years, and mean age was 40 years. The course of the disease was shorter, in the 25 patients aged less than 6 months. The average diameter of the mass was 1.3 cm, and boundary was relatively clear, 15 cases(53.6%)were located around the outer ear, face in six cases(21.4%), back of the nose and parotid gland both in three cases(10.7%), and neck in one case(3.6%). Macroscopic examination showed that tumors were mostly nodular. Microscopically, they were consisted of proliferating spindle-shaped or fat spindle-shaped fibroblasts and myofibroblasts. They were arranged in a swirling and braided pattern, and the mucus-like matrix and collagen fibers were observed. The microcystic cavity was fishnet-shaped, and extravasated red blood cells and multinucleated giant cells were often seen in the interstitial space. Immunohistochemistry expressed vimentin, SMA, MSA, calponin, and CD10 but not CK, desmin, CD34, S-100, WT-1, or ALK. During the postoperative follow-up period, which ranged from 2 to 125 months, no local replace occured. Conclusion NF is a benign, self-limiting fibroblastic/myofibroblastic proliferative lesion. Local surgical resection is the best treatment option. Because of its rapid progress, microscopic mitotic figures are easy to see and can invade surrounding tissues. It can easily be misdiagnosed as a malignant soft tissue tumor, and other tumorous lesions must be excluded before the diagnosis of NF. Subsequently, a pathological diagnosis should be made. Immunohistochemical expression results are helpful in the definitive and differential diagnoses of the disease. In addition, MYH9-USP6 gene fusion has been reported in NF^［1］. Therefore, FISH detection is feasible to help diagnose and differentiate the disease.

Clinical evaluation of individualized nasal cavity ventilation expansion techniques for the treatment of obstructive sleep apnea-hypopnea syndrome

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

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  80-85.  doi:10.6040/j.issn.1673-3770.0.2020.258

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Objective To investigate the efficacy of individualized nasal cavity ventilation expansion techniques for obstructive sleep apnea-hypopnea syndrome(OSAHS)patients with nasal obstruction. Methods Between January 2018 and June 2019, 42 adult OSAHS patients with nasal obstruction were selected and treated at the Qilu Hospital of Shandong University(Qingdao). Polysomnogram(PSG),nasal acoustic reflex,resistance examination, and nasal respiration volume were performed before and 3 months after surgery to record the apnea-hypopnea index(AHI), the lowest arterial oxygen saturation(LSaO₂), nasal minimal cross-sectional area(NMCA), nasal cavity volume(NCV), nasal airway resistance(NAR), and nasal total volume(V_T). The nasal obstruction symptom evaluation(NOSE)and Epworth sleepiness scale(ESS)were also administered. Continuous positive airway pressure(CPAP)was performed before surgery; the acceptance of CPAP treatment was recorded using the visual analog scale(VAS). The average effective treatment pressure was assessed using the manual pressure titration, and it was reviewed 3 months after the surgery to analyze the effect of nasal dilatation. Results Three months after the surgery, the scores of NOSE, ESS, and VAS for all the patients were significantly lower than those obtained before the surgery(4.52±1.770 vs. 12.43±2.855; 7.55±2.144 vs. 12.67±2.205; 7.42±1.02 vs. 4.92±1.38, P<0.05). Subjective nasal congestion and somnolence significantly resolved in all the patients. Among the objective indexes, NMCA, NCV, and VT increased significantly, and the average effective pressure of NAR and CPAP decreased significantly(P<0.05). AHI was lower and LSaO₂ was higher in patients with mild and moderate OSAHS after than before the surgery ［Mild: 10.76±2.74 times/h vs. 6.27±2.34 times/h, 76.44±2.63% vs 82.0±2.80%; Moderate: 25.12±5.32 times/h vs. 17.38±6.51 times/h, 70.92±3.17% vs 73.85±3.31%, P<0.05］. Conclusion Individualized nasal dilatation can effectively improve nasal ventilation and the sleep quality of OSAHS patients with nasal congestion symptoms. It is an effective surgical method for the treatment of nasal OSAHS, and it can improve compliance with CPAP treatment. Multifaceted comprehensive treatments are needed for moderate and severe OSAHS cases.

Visual analysis of domestic studies on dry eye syndrome in the past ten years using Citespace

XIAO Xili, NIE Yuxiao, CHEN Jie

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  86-97.  doi:10.6040/j.issn.1673-3770.0.2020.271

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Objective We used the CitesSpace-based knowledge mapping to evaluate the research on dry eyes and identify the hotspots and foci and their evolutionary trend. Methods We used a collection of dry eye studies spanning nearly ten years(2010-June 2020). The institute was the node for the study on network cooperation and relationship mapping. Using keywords for the node, we performed the keyword co-occurrence analysis, Burst analysis, clustering analysis, and time evolution analysis. Subsequently, the mapping results were interpreted. Results The cooperative high-yield institutions were the Departments of Ophthalmology of Sun Yat-sen University, Fudan University, and the First Affiliated Hospital of Nanchang University. The following are current research hotspots for the etiology and pathogenesis of dry eye, dry eye and meibomian gland function, ocular surface, and tear film, among others:(1)Relationship between diseases such as inflammatory conditions, diabetes, glaucoma, and cataract;(2)Dry eye symptoms and treatment methods: the clinical efficacy and mechanisms of medicinal flowers, sodium hyaluronate eye drops, traditional acupuncture, and fumigation of traditional Chinese medicine, Research using animal experiments;(3)Research on related factors and treatment of dry eye in children. Prediction of dry eye:(1)Mechanism and prevention: the relationship between dry eye and cataract, cataract surgery, and meibomian gland dysfunction;(2)Diagnosis and evaluation: the application of ocular surface comprehensive analyzer in dry eye;(3)Treatment: exploring the curative effect and corresponding mechanisms of various treatment methods of dry eye, including traditional Chinese medicine treatment methods, such as acupuncture, and modern treatment methods such as intense pulsed light(IPL)and new drugs such as rifaxute eye drops. These may continue to be research hotspots in this field. Conclusions This study ascertains the institutions that are influential in the research field of dry eye, summarizes the current research hotspots, and predicts the evolution of these hotspots to guide future research.

Mutation analysis of ZEB1 in a pedigree with keratoconus

ZHAO Lianghui, CAI Tao, DU Xianli

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  98-104.  doi:10.6040/j.issn.1673-3770.0.2020.358

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Objective To analyze the clinical phenotype of and pathogenic gene mutation in a male child with keratoconus, to identify the mutation site of the pathogenic gene, and to discuss the relationship between genotype and phenotype. Methods Clinical data of a male child with keratoconus and his parents were collected. Pentacam corneal topography, Belin/Ambrosio Enhanced Ectasia Display, and biomechanical analysis were used to improve the diagnosis of keratoconus. Peripheral blood genomic DNA of the family members was obtained, and the exome of the proband was sequenced using whole exome sequencing technology. Finally, the pathogenic mutation was found to be co-segregated within the family, and the relationship between the mutation and patient phenotype was further analyzed. Results The proband and his father were both diagnosed with keratoconus. Whole exome sequencing revealed a mutation(c.643G>C)in the zinc finger E-box-binding homeobox 1(ZEB1)gene that led to replacement of valine at 215 position in the protein encoded by ZEB1 with leucine(p.V215L). Conservative analysis showed that this mutation is highly conserved in various species. Bioinformatics predictions showed that the mutation is highly pathogenic. Mutations in the gene were also present in the paternal gene. The mother of the proband presented with normal clinical manifestations, and the mutation was not detected in the genetic tests of the mother and 100 unrelated normal controls. Conclusions The clinical phenotypes of both proband and his father were consistent with the typical keratoconus phenotype. Exon sequencing revealed a new mutation in the ZEB1 gene(c.643G>C, p.V215L). The mutation was co-segregated within the family.

Effects of optimal pulse technology combined with meibomian gland massage to treat meibomian gland dysfunction

LI Wei, ZHANG Bin

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  105-109.  doi:10.6040/j.issn.1673-3770.0.2020.341

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Objective To evaluate the clinical effect of optimal pulse technology combined with meibomian gland massage to treat meibomian gland dysfunction. Methods We performed a prospective analysis of 172 eyes of 86 patients with meibomian gland dysfunction from May to December 2019. The study population was randomly divided into observation and control groups, each including 86 eyes of 43 patients. All patients were treated with optimal pulse technology for a total of 4 times, once every 4 weeks. Patients in the observation group underwent meibomian gland massage after each treatment. The ocular surface disease index(OSDI)score, noninvasive tear break-up time(NITBUT), noninvasive tear meniscus height(NITMH), meibomian gland score(MGS), and meibomian gland yielding secretion score(MGYSS)were recorded before and after the first treatment. Results The indices recorded at each time point, except for NITMH and MGS, improved significantly(P<0.001). The OSDI score did not differ between the two groups at 4 weeks after the treatment(P=0.857)and was better in the observation group than in the control group at other time points(P_{8 weeks}=0.002, P_{12 weeks}=0.024, P_{16 weeks}<0.001). NITBUT was better in the observation group than in the control group at each time point(P<0.001; P_{4 weeks}<0.001, P_{8 weeks}=0.005, P_{12 weeks}=0.045, P_{16 weeks}=0.013). Conclusions The optimal pulse technology combined with meibomian gland massage can relieve symptoms, stabilize tear film, and reduce inflammation. The treatment effect is obvious.

Analysis of ocular biological parameters of patients with cataract in Kashgar and Jinan

LIU Shaohua, HAO Linlin, MA Guangfeng, HOU Jing, ZHANG Han

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  110-113.  doi:10.6040/j.issn.1673-3770.0.2020.450

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Latest research progress of 3D printing technology and clinical applications in otorhinolaryngology

WANG Yanjie, CHENG Fengli,ZHAO Changqing

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  114-118.  doi:10.6040/j.issn.1673-3770.0.2019.538

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With advances of computer technology, the emergence of new materials, and the decline in production costs, 3D printing technology has been widely used in various medical processes, especially surgery. In the field of otolaryngology, 3D printing is mainly used in prosthesis manufacturing and implantation, preoperative planning, model reconstruction, surgical skills training, and medical education. Operation times is shortened and the goal of reducing costs can be achieved by using personalized implants and customized surgical instruments. Furthermore, surgical side injuries are reduced through preoperative planning and model exercises. In recent years, tissue-engineered grafts and the complex printing of viable tissues and organs have been explored as another potential application of 3D printing. This article mainly discusses the application and study prospect of 3D printing within the field of Otorhinolaryngology.

Cognitive and behavioral dysfunction related to obstructive sleep apnea in children: current status, problems, and prospects

ZHANG Yitong, LIU Haiqin,REN Xiaoyong

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  119-124.  doi:10.6040/j.issn.1673-3770.0.2020.187

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In recent years, the incidence of obstructive sleep apnea(OSA)in children has been progressively increasing. As children are in their growth and development stage, sleep fragmentation and intermittent hypoxemia caused by OSA can seriously damage their neurocognitive abilities, as well as disrupt their healthy growth. OSA in children markedly differs from that in adults in terms of cause, diagnostic criteria, and related examinations. Furthermore, its influence on cognitive and behavioral functions is still controversial. Reviewing the relevant literature, the author summarizes the correlation between OSA in children and their cognitive functions, and addresses future developmental trends.

Advances in understanding the roles of monocarboxylate transporters in head and neck squamous cell carcinoma

MA Xiaoyu, BIAN Xiaomin,YU Dan

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  125-130.  doi:10.6040/j.issn.1673-3770.0.2020.196

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The family of monocarboxylate transporters(MCTs)is involved in regulating tumor metabolism. Specifically, such proteins play a role in transporting lactic acid, pyruvate, ketone bodies, and other metabolites in cells. Various MCT isoforms are highly-expressed across different tumor cells. Family members MCT1 and MCT4 in conjunction with associated chaperones basigin(CD147)and glucose transporter type 1(GLUT-1), as well as the anoxia biomarker carbonic anhydrase 9(CAIX), all play important roles in head and neck squamous cell carcinomas(HNSCCs), including nasopharyngeal, laryngeal, and oral squamous cell carcinomas. Combining MCT modulation with existing therapies has the potential to improve HNSCC treatment efficacy. This review discusses the mechanisms by which MCTs contribute to development of HNSCC and the current state of research regarding MCT therapeutic targeting.

Research progress of exosomes in thyroid cancers

ZHANG Yiyi,XUE Gang, JIN Chunting

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  131-135.  doi:10.6040/j.issn.1673-3770.0.2020.206

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The exosome are extracellular vesicle with a diameter of 50-140 nm, generated by almost all types of cell and carrying nucleic acids, proteins, lipids, and metabolites. They are found in all biological fluids such as blood,milk,urine etc.and play a key role in intercellular communication by delivering active biomolecules. This paper rviews the general situation, functions and applications of exosomes, summarize the effects of exosomal miRNAs and circRNAs in thyroid carcinoma and the potential as a new type of biomarkers.

Current progress of exosome research in allergic diseases

ZHANG Xuping, LIU Xuexia,ZHANG Hua

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  136-140.  doi:10.6040/j.issn.1673-3770.0.2020.285

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Exosomes are closed vesicles with a lipid bilayer membrane that are produced from late endosomes. They can carry and secrete cargo such as intracellular proteins and nucleic acids, and they can be transported to recipient cells. Exosomes are used for signal transduction and intercellular communication. These carriers play an important role in various physiological and pathological processes. Recent studies have found that exosomes can regulate immune responses, transmit inflammatory signals, and release cytokines, which play a key role in allergic diseases. Since exosomes exist in a variety of body fluids, they are expected to aid early disease screening, efficacy evaluation, and prognostic analysis. Therefore, this study reviews the research progress regarding exosomes in allergic diseases, hoping to provide new ideas and effective targets for the diagnosis and treatment of diseases.

Visual quality and complications after implantation of multifocal intraocular lens

WEI Peipei,LI Can

Journal of Otolaryngology and Ophthalmology of Shandong University. 2021, 35(2):  141-146.  doi:10.6040/j.issn.1673-3770.0.2020.164

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Phacoemulsification combined with intraocular lens implantation is one of the main methods of cataract surgery. Currently, there are two types of intraocular lenses: single focus intraocular lens and multifocal intraocular lens. Although the single focus intraocular lens can provide good distance visual acuity, it does not effectively improve intermediate and near visual acuities, and presbyopic glasses are still needed. Based on this limitation, the multifocal intraocular lens was introduced. Our article aims to review the visual quality and complications after the implantation of multifocal intraocular lens.